Scholl J, Panchal P, Nelissen N, Atkinson LZ, Kolling N, Saunders KE, Geddes J, Rushworth MF, Nobre AC, Harrison PJ, and Harmer CJ
Cognitive and neural mechanisms underlying bipolar disorder (BD) and its treatment are still poorly understood. Here we examined the role of adaptations in risk-taking using a reward-guided decision-making task. We recruited volunteers with high (n = 40) scores on the Mood Disorder Questionnaire, MDQ, suspected of high risk for bipolar disorder and those with low-risk scores (n = 37). We also recruited patients diagnosed with BD who were assigned (randomized, double-blind) to six weeks of lithium (n = 19) or placebo (n = 16) after a two-week baseline period (n = 22 for FMRI). Participants completed mood ratings daily over 50 (MDQ study) or 42 (BD study) days, as well as a risky decision-making task and functional magnetic resonance imaging. The task measured adaptation of risk taking to past outcomes (increased risk aversion after a previous win vs. loss, 'outcome history'). While the low MDQ group was risk averse after a win, this was less evident in the high MDQ group and least so in the patients with BD. During fMRI, 'outcome history' was linked to medial frontal pole activation at the time of the decision and this activation was reduced in the high risk MDQ vs. the low risk MDQ group. While lithium did not reverse the pattern of BD in the task, nor changed clinical symptoms of mania or depression, it changed reward processing in the dorsolateral prefrontal cortex. Participants' modulation of risk-taking in response to reward outcomes was reduced as a function of risk for BD and diagnosed BD. These results provide a model for how reward may prime escalation of risk-related behaviours in bipolar disorder and how mood stabilising treatments may work., Competing Interests: Competing interests: The study was funded by a Wellcome Trust Strategic Award (CONBRIO: Collaborative Oxford Network for Bipolar Research to Improve Outcomes, reference No. 102,616/Z). JRG, CJH, PJH and KEAS are supported by the Oxford Health NIHR Biomedical Research Centre. MFSR is funded by the Wellcome Trust (221794/Z/20/Z). The Wellcome Centre for Integrative Neuroimaging is supported by core funding from the Wellcome Trust (203139/Z/16/Z). JS has been funded by the Institut National de la Santé et de la Recherche Médicale, the Biotechnology and Biological Sciences Research Council (BB/V004999/1, Discovery Fellowship) and Medical Research Council (MR/N014448/1, Skills Development Fellowship). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. JS, PP, NN, LZA, NK, JG, MFSR report no biomedical financial interests or potential conflicts of interest. CJH has received consultancy payments from P1vital, Lundbeck, Compass Pathways, IESO, Zogenix (now UCB). PJH reports receiving an honorarium for editorial work for Biological Psychiatry and Biological Psychiatry Global Open Science. ACN was non-executive director at the Oxford Health Foundation Trust during a period overlapping with the study. KEAS has received consultancy payment from Yale University., (© 2025. The Author(s).)