Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Mannheim, Germany.
Bipolar Disord. 2011 Nov-Dec;13(7-8):638-50. doi: 10.1111/j.1399-5618.2011.00956.x.
It is unclear whether abnormalities in cognition and motivation, such as altered feedback processing, observed during euthymia represent trait markers of bipolar I disorder (BD-I) or scars from previous episodes that also occur in major depression (MD). The present research examines how previous episodes influence sensitivity to positive and negative feedback, applying multiple hierarchical regression analysis with number of past depressive and manic episodes, residual mood symptoms, affective quality of the last episode, time in remission, medication, illness severity, and age as predictors.
The study included 23 euthymic patients with BD-I, 19 remitted patients with MD, and 19 healthy persons who underwent a task which discriminates whether persons learn better from negative or positive feedback.
For both models, predicting sensitivity to positive [F((5,60)) = 6.50, p = 0.001, adjusted R(2) = 0.22] and negative feedback [F((5,60)) = 5.12, p = 0.001, adjusted R(2) = 0.22], the quality of the last affective episode was the only significant predictor. BD-I patients who last experienced a manic episode learned well from positive but not negative feedback, whereas BD-I patients who last experienced a depressive episode showed the opposite pattern.
Our data identify differences in response to positive and negative consequences carrying over into the euthymic state that are qualitatively related to the polarity of the preceding episode, whereas other disease-related variables had no significant influence. This sheds new light on previous inconsistent data in euthymic BD-I patients and could also guide tailored treatment.
在病情稳定期观察到的认知和动机异常，如反馈处理改变，是否代表双相 I 型障碍（BD-I）的特征标志物，还是也发生在重度抑郁症（MD）中的先前发作的痕迹，目前尚不清楚。本研究通过多项分层回归分析，以过去的抑郁和躁狂发作次数、残留的情绪症状、最后一次发作的情绪质量、缓解时间、药物治疗、疾病严重程度和年龄作为预测因子，来检验先前发作如何影响对正性和负性反馈的敏感性。
该研究纳入了 23 名病情稳定的 BD-I 患者、19 名缓解期 MD 患者和 19 名健康对照者，他们接受了一项任务，该任务可以区分个体是否从负性或正性反馈中更好地学习。
对于两个模型，预测对正性反馈的敏感性[F((5,60)) = 6.50, p = 0.001, adjusted R(2) = 0.22]和负性反馈的敏感性[F((5,60)) = 5.12, p = 0.001, adjusted R(2) = 0.22]，上一次情感发作的质量是唯一显著的预测因子。最后经历躁狂发作的 BD-I 患者从正性反馈中学习良好，但从负性反馈中学习不佳，而最后经历抑郁发作的 BD-I 患者则表现出相反的模式。
我们的数据表明，对正性和负性后果的反应在进入病情稳定期时存在差异，这种差异与先前发作的极性具有定性关系，而其他与疾病相关的变量则没有显著影响。这为病情稳定期 BD-I 患者中先前不一致的数据提供了新的视角，并可能为个体化治疗提供指导。
