Mechanisms of emotional processing in bipolar disorder: Mood-state dependency, disorder specificity and vulnerability
Final Report Abstract
The present project investigated the role of abberant emotional reactivity and regulation in the development of bipolar I disorder (BD-I). In order to disentangle vulnerability markers from disease markers, we investigated not only patients with BD-I disorder but also first-degree relatives of BDI, which were not affected by the disorder as well as individuals scoring high on a personality trait associated with the development of BD-I (hypomanic personality). Further, patients unipolar depression were investigated to determine mechanisms specific to BD-I or applying more general to affective disorders. Our results revealed impaired emotion regulation in bipolar disorder patients for positive and negative stimuli that apparently leads to exacerbated neuropsychological deficits in bipolar patients, as evidenced by behavioural slowing under high emotional distraction and repective task-related hyper-activated neural networks. Interestingly, individuals with a higher risk to develop bipolar disorder equally showed abberant emotion regulation, however, in contrast to bipolar patients vulnerability to bipolar disorder does not lead to the neuropsychological deficits observed in clinical conditions. Emotion regulation deficits were not specific to BD-I. Patients with unipolar depression equally showed impaired regulation of negative emotions. However, regulation of positive emotions was preserved in patients with unipolar depression whilst impaired in BD-I patients. This specific deficit in processing positive emotions was also present when applying a different paradigm to a sample of individuals with high hypomanic personality traits that focused on the updating of beliefs aout future events. Hypomanic subjects exhibited an asymmetric belief revision for positive events and the strength of this optimistic update bias was linked to current manic symptoms. In sum, the present study did not only contribute to a better understanding of etiological mechanisms of BD-I and affective disorders in general, but also provides starting points for the development of new therapy modules focusing on the processing and regulation of positive emotions. New psychotherapeutic outpatient guidelines in Germany with the possibility of acute therapy programs in heavily ill patients, such as BD patients, offer the potential to develop such specific modules.
Publications
- (2011). How to regulate emotion? Neural networks for reappraisal and distraction. Cerebral Cortex, 21, 1379-1388
Kanske, P., Heissler, J., Schönfelder, S. & Wessa, M.
(See online at https://doi.org/10.1093/cercor/bhq216) - (2012). Neural correlates of emotion regulation deficits in remitted depression: The influence of regulation strategy, habitual regulation use, and emotional valence. Neuroimage, 61, 686-93
Kanske, P. Heissler, J. Schönfelder, S. & Wessa, M.
(See online at https://doi.org/10.1016/j.neuroimage.2012.03.089) - (2013). Goal-directed behavior under emotional distraction is preserved by enhanced task-specific activation. Social, Cognitive and Affective Neuroscience, 8, 305-12
Wessa, M., Heissler, J., Schönfelder, S. & Kanske, P.
(See online at https://doi.org/10.1093/scan/nsr098) - (2013). Neural correlates of emotional distractibility in bipolar disorder, unaffected relatives and individuals with hypomanic personality. American Journal of Psychiatry, 170, 1487-1496
Kanske, P., Heissler, J., Schönfelder, S., Forneck, J. & Wessa, M.
(See online at https://doi.org/10.1176/appi.ajp.2013.12081044) - (2014). A Multicenter Tractography Study of Deep White Matter Tracts in Bipolar I Disorder: Psychotic Features and Interhemispheric Disconnectivity. JAMA Psychiatry, 71, 388-396
Sarrazin, S., Poupon, C., Linke, J., Wessa, M., Phillips, M., et al.
(See online at https://doi.org/10.1001/jamapsychiatry.2013.4513) - (2014). Inefficiency of emotion regulation as vulnerability marker for bipolar disorder: Evidence from healthy individuals with hypomanic personality. Journal of Affective Disorders, 152-154, 83-90
Heissler, J., Kanske, P., Schönfelder, S. & Wessa, M.
(See online at https://doi.org/10.1016/j.jad.2013.05.001) - (2014). Time course of emotion-related responding during distraction and reappraisal. Social Cognitive and Affective Neuroscience, 9, 1310-1319
Schönfelder, S., Kanske, P., Heissler, J. & Wessa, M.
(See online at https://doi.org/10.1093/scan/nst116) - (2015). Impaired regulation of emotion: neural correlates of reappraisal and distraction in bipolar disorder and unaffected relatives. Translational Psychiatry, 5, 1-9
Kanske, P., Schönfelder, S., Forneck, J. & Wessa, M.
(See online at https://doi.org/10.1038/tp.2014.137) - (2016). Differential association of default mode network connectivity and rumination in healthy individuals and remitted MDD patients. Social Cognitive and Affective Neuroscience, 11, 1792-1801
Lois, G. & Wessa, M.
(See online at https://doi.org/10.1093/scan/nsw085) - (2017). Large-scale network functional interactions during distraction and reappraisal in remitted bipolar and unipolar patients. Bipolar Disorder, 19, 487-495
Lois, G., Gerchen, M. F., Kirsch, P., Kanske, P., Schönfelder, S. & Wessa, M.
(See online at https://doi.org/10.1111/bdi.12512)
