An fMRI Study on Temporal Discounting in Bipolar Disorder
| Status: | Completed |
|---|---|
| Conditions: | Depression, Psychiatric, Bipolar Disorder |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 65 |
| Updated: | 2/10/2017 |
| Start Date: | July 14, 2014 |
| End Date: | August 29, 2016 |
Reconceptualizing Suicide as Impaired Temporal Discounting: an fMRI Study in Bipolar Disorder
The investigators propose to explore the link between bipolar disorder, anxiety, and suicide
by investigating intertemporal discounting in depressed, suicidal patients with bipolar I
and II disorder who have various levels of anxiety. The investigators will determine the
effect of anxiety on their intertemporal discounting (small rewards now compared to larger
rewards later) in a decision-making paradigm and investigate the associated functional
neuroanatomy using functional magnetic resonance imaging (fMRI).
by investigating intertemporal discounting in depressed, suicidal patients with bipolar I
and II disorder who have various levels of anxiety. The investigators will determine the
effect of anxiety on their intertemporal discounting (small rewards now compared to larger
rewards later) in a decision-making paradigm and investigate the associated functional
neuroanatomy using functional magnetic resonance imaging (fMRI).
Among the various psychological properties of the decision making process is temporal
discounting, which is a decrease in the subjective value of a good as a function of the
amount of and delay to reward. The ability to decide between immediate versus future rewards
depends on self-control and consideration of the future. We can reconceptualize suicide as
intertemporal discounting with an interaction between cognition and mood. Someone
contemplating suicide weighs the time value of costs and benefits with shifting negative and
positive valence systems. To the best of our knowledge, no one has assessed the interaction
between mood symptoms, anxiety, and their impact on the temporal discounting paradigm in
bipolar patients. If we better understood the difference between anxious, suicidal and
non-anxious, suicidal bipolar patients, we could design more effective interventions to
prevent this tragic outcome. We propose a novel paradigm to explore the link between bipolar
disorder, anxiety, and suicide. If we conceptualize suicidal behavior and death by suicide
as decisions, then it makes sense to examine key aspects of decision making in these
patients. In particular, we can examine how mood, anxiety, and suicidal ideation and
behaviors arise from patterns of decision making, along with neural correlates of
decision-making, as assessed with fMRI.
discounting, which is a decrease in the subjective value of a good as a function of the
amount of and delay to reward. The ability to decide between immediate versus future rewards
depends on self-control and consideration of the future. We can reconceptualize suicide as
intertemporal discounting with an interaction between cognition and mood. Someone
contemplating suicide weighs the time value of costs and benefits with shifting negative and
positive valence systems. To the best of our knowledge, no one has assessed the interaction
between mood symptoms, anxiety, and their impact on the temporal discounting paradigm in
bipolar patients. If we better understood the difference between anxious, suicidal and
non-anxious, suicidal bipolar patients, we could design more effective interventions to
prevent this tragic outcome. We propose a novel paradigm to explore the link between bipolar
disorder, anxiety, and suicide. If we conceptualize suicidal behavior and death by suicide
as decisions, then it makes sense to examine key aspects of decision making in these
patients. In particular, we can examine how mood, anxiety, and suicidal ideation and
behaviors arise from patterns of decision making, along with neural correlates of
decision-making, as assessed with fMRI.
Inclusion Criteria:
1. Meets DSM-IV criteria for BD I and II current depressive episode
2. Able to give written informed consent
3. Age > to 18 years and < 65 years
4. Currently suicidal as defined by a MADRS suicide item score of > 3 or previous
history of serious suicidal ideation that required hospitalization.
5. All subjects need to have normal hearing and normal/corrected-to-normal vision.
Exclusion Criteria:
1. Medical illness or non-psychiatric medical treatment that would likely interfere with
study participation
2. Neurologic disorder, previous ECT, or history of head trauma (i.e. known structural
brain lesion potentially confounding MRI results)
3. Substance abuse within the past 3 months or current substance dependence (confirmed
by MINI)
4. Left-handedness
5. Contraindications to MRI (metallic implants, claustrophobia, etc.)
6. Subjects who need urgent psychiatric care requiring hospitalization (evaluated by
clinicians).
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