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Shared and dissociable features of apathy and reward system dysfunction in bipolar I disorder and schizophrenia

Published online by Cambridge University Press:  17 April 2019

Matthias Kirschner Open the ORCID record for Matthias Kirschner [Opens in a new window] ,
Flurin Cathomas ,
Andrei Manoliu ,
Benedikt Habermeyer ,
Joe J. Simon ,
Erich Seifritz ,
Philippe N. Tobler  and
Stefan Kaiser
Matthias Kirschner*
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
Flurin Cathomas
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland
Andrei Manoliu
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom
Benedikt Habermeyer
Affiliation:
Psychiatric Services Aargau, 5201Brugg, Switzerland
Joe J. Simon
Affiliation:
Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, Heidelberg, Germany Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, Dusseldorf, Germany
Erich Seifritz
Affiliation:
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, 8032Zurich, Switzerland Neuroscience Center Zurich, University of Zurich, 8057Zurich, Switzerland Zurich Center for Integrative Human Physiology, University of Zurich, 8057Zurich, Switzerland
Philippe N. Tobler
Affiliation:
Neuroscience Center Zurich, University of Zurich, 8057Zurich, Switzerland Zurich Center for Integrative Human Physiology, University of Zurich, 8057Zurich, Switzerland Department of Economics, Laboratory for Social and Neural Systems Research, University of Zurich, 8006Zurich, Switzerland
Stefan Kaiser
Affiliation:
Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Chemin du Petit-Bel-Air, 1225 Chêne-Bourg, Switzerland
*
Author for correspondence: Matthias Kirschner, E-mail: Matthias.Kirschner@puk.zh.ch; matthiaskirschner@gmail.com
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Abstract

Background

Bipolar disorder I (BD-I) is defined by episodes of mania, depression and euthymic states. These episodes are among other symptoms characterized by altered reward processing and negative symptoms (NS), in particular apathy. However, the neural correlates of these deficits are not well understood.

Methods

We first assessed the severity of NS in 25 euthymic BD-I patients compared with 25 healthy controls (HC) and 27 patients with schizophrenia (SZ). Then, we investigated ventral (VS) and dorsal striatal (DS) activation during reward anticipation in a Monetary Incentive Delayed Task and its association with NS.

Results

In BD-I patients NS were clearly present and the severity of apathy was comparable to SZ patients. Apathy scores in the BD-I group but not in the SZ group correlated with sub-syndromal depression scores. At the neural level, we found significant VS and DS activation in BD-I patients and no group differences with HC or SZ patients. In contrast to patients with SZ, apathy did not correlate with striatal activation during reward anticipation. Explorative whole-brain analyses revealed reduced extra-striatal activation in BD-I patients compared with HC and an association between reduced activation of the inferior frontal gyrus and apathy.

Conclusion

This study found that in BD-I patients apathy is present to an extent comparable to SZ, but is more strongly related to sub-syndromal depressive symptoms. The findings support the view of different pathophysiological mechanisms underlying apathy in the two disorders and suggest that extra-striatal dysfunction may contribute to impaired reward processing and apathy in BD-I.

Keywords

Apathybipolar disorderdiminished expressioneuthymicfMRIMonetary Incentive Delay Tasknegative symptomsreward anticipationstriatumtransdiagnostic
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 936 - 947
Copyright
Copyright © Cambridge University Press 2019

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Footnotes

*

MK and FC contributed equally to this work.

†

Contact Info: Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland; tel: +41 44 384 36 14; fax: +41 44 384 25 06; e-mail: matthias.kirschner@puk.zh.ch

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