Risk taking in bipolar disorder

Part 1 Background: People with a diagnosis of bipolar disorder can make suboptimal decisions during manic and depressive episodes which can have negative long-term consequences. This review aims to explore individual factors, including mood state and personality traits, which could affect decision making processes of individuals with bipolar disorder. Methods: A systematic search of three databases, plus hand searching relevant reference sections, identified twenty five relevant studies, nineteen of which met the inclusion criteria for the review. Results: Mania and severe depression are associated with poorer performance on computerised tasks designed to measure risk decision making. There is tentative evidence for altered decision making processes even during euthymic and remitted phases of bipolar disorder, but little difference in overall decision making outcomes. Limitations: The evidence base is small and centred around a few computerised tasks, which may have limited ecological validity in the assessment of decision making. Complex decision making tasks are difficult to interpret in terms of underlying processes. Conclusions: Both mood episode and trait factors, such as impulsivity, may have some predictive value of decision making in people with a diagnosis of bipolar disorder, although trait factors are largely unexplored in this population. Further research is needed to develop a psychological model for understanding the relative impact of individual factors, plus social and environmental factors which can influence the decision making process. Part 2 "Excessive" risk taking behaviour is a clinical characteristic of a manic episode, which can lead to harmful consequences for the individual with bipolar disorder. This study investigated the hypothesis that risk taking behaviour may be more sensitive to change following mood induction in people with bipolar disorder than in controls. Participants were 26 people with bipolar I disorder who were out of an acute episode and 28 healthy controls. Risk taking was measured using the Balloon Analogue Risk Task (BART; Lejuez et al, 2002), a computerised task that has been found to correlate with real world risky behaviours. After baseline measures, participants were randomly assigned positive or negative mood induction and completed two sets of BART trials, before and after mood induction. Trait sensitivity to reward was also measured, as a potential factor underlying BART performance. The primary hypothesis was not supported by the findings, nor could the variance in risk taking before or after mood induction be explained by trait sensitivity to the behavioural activation system. The bipolar group demonstrated less risk taking at baseline than controls. The results suggest excessive risk taking behaviour may be specifically associated with manic symptoms other than positive affect. However people with bipolar disorder may make poorer quality risk decisions out of an acute episode than controls