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Impulsivity, decision-making and risk-taking behaviour in bipolar disorder: a systematic review and meta-analysis

Published online by Cambridge University Press:  03 September 2020

Almudena Ramírez-Martín ,
Javier Ramos-Martín Open the ORCID record for Javier Ramos-Martín [Opens in a new window] ,
Fermin Mayoral-Cleries ,
Berta Moreno-Küstner  and
Jose Guzman-Parra
Almudena Ramírez-Martín
Affiliation:
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Malaga, Spain
Javier Ramos-Martín
Affiliation:
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Malaga, Spain
Fermin Mayoral-Cleries
Affiliation:
Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
Berta Moreno-Küstner
Affiliation:
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Malaga, Spain
Jose Guzman-Parra*
Affiliation:
Department of Mental Health, University General Hospital of Malaga. Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
*
Author for correspondence: Jose Guzman-Parra, E-mail: joseguzman@uma.es
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Abstract

Despite the robust body of work on cognitive aspects of bipolar disorder (BD), a clear profile of associated impairments in impulsivity, decision-making and risk-taking from studies that use behavioural measures has yet to be established. A systematic review, across four electronic databases (PsycINFO, MEDLINE/PubMed, ScienceDirect and Scopus), of literature published between January 1999 and December 2018 was carried out in accordance with the PRISMA statement. The protocol was registered on PROSPERO (CRD42018114684). A fixed-effect and random-effects meta-analysis using the Hedges' g (ES) estimate was performed. The analysis revealed significant impairment in BD individuals with medium effect sizes in various aspects of impulsivity – response inhibition (ES = 0.49; p < 0.0001), delay of gratification (ES = 0.54; p < 0.0001) and inattention (ES = 0.49; p < 0.0001) – and in decision-making (ES = 0.61, p = 0.0002), but no significant impairment in risk-taking behaviour (ES = 0.41; p = 0.0598). Furthermore, we found significant heterogeneity between studies for decision-making and risk-taking behaviour but not for impulsivity. Impaired risk-taking behaviour was significant in a subgroup of BD-I and euthymic individuals (ES = 0.92; p < 0.0001) with no significant heterogeneity. A stratification analysis revealed comparable results in euthymic and non-euthymic individuals for impulsivity. Our findings suggest that behaviour impulsivity is elevated in all phases of BD, representing a core and clinically relevant feature that persists beyond mood symptoms. More studies about decision-making and risk-taking are necessary to establish if they are impaired in BD and to analyze the role of mood state.

Keywords

Bipolar disorderdecision-makingimpulsivitymeta-analysisrisk-taking behavioursystematic review
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 13 , October 2020 , pp. 2141 - 2153
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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