Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
Biol Psychiatry. 2009 Nov 1;66(9):840-6. doi: 10.1016/j.biopsych.2009.05.011. Epub 2009 Jul 17.
Bipolar disorder (BD) is associated with high-risk behaviors, such as gambling and impulsivity. However, little is known about the psychological factors that influence these behaviors or their significance for the development of the disorder. In this study, we investigated the effects of highlighting rewards versus highlighting punishments in the risky decision-making of euthymic individuals with bipolar disorder.
Twenty euthymic, medication-free men and women with previously undiagnosed bipolar II or bipolar disorder not otherwise specified and 20 age- and IQ-matched healthy men and women completed a computerized risky decision-making task in which mathematically equivalent dilemmas were presented in terms of opportunities to gain rewards ("positively-framed") or to avoid suffering losses ("negatively-framed"). The dependent measures were the proportion of risk-seeking choices (and deliberation times) when making decisions in positively versus negatively framed dilemmas.
As expected, healthy control participants made more risky-seeking choices in response to the negatively framed dilemmas compared with the positively framed dilemmas. However, this effect was significantly attenuated in BD participants who also took significantly longer to make risk-averse responses to the positively framed dilemmas. The BD participants overestimated the number of bad outcomes arising out of positively framed dilemmas.
These data demonstrate that risky choice in BD is associated with reduced sensitivity to emotional contexts that highlight rewards or punishments, possibly reflecting altered valuations of prospective gains and losses associated with behavioral options.
双相情感障碍（BD）与高风险行为有关，例如赌博和冲动。然而，对于影响这些行为的心理因素及其对疾病发展的意义知之甚少。在这项研究中，我们研究了在心境稳定的双相情感障碍患者的风险决策中突出奖励与突出惩罚的影响。
20 名心境稳定、未服用药物的双相 II 型或未特定的双相情感障碍男性和女性患者以及 20 名年龄和智商匹配的健康男性和女性参与者完成了一项计算机化的风险决策任务，其中以获得奖励的机会（“正面框架”）或避免遭受损失的机会（“负面框架”）呈现数学上等价的困境。因变量是在正面框架和负面框架下做出决策时冒险选择的比例（和思考时间）。
正如预期的那样，与正面框架相比，健康对照组参与者在面对负面框架时做出了更多的冒险选择。然而，这种影响在 BD 参与者中明显减弱，他们在面对正面框架时也需要更长的时间来做出避险反应。BD 参与者高估了正面框架下出现的不良结果的数量。
这些数据表明，BD 中的风险选择与对突出奖励或惩罚的情绪背景的敏感性降低有关，这可能反映了与行为选择相关的未来收益和损失的评估发生了变化。
