Sensitivity to positive and negative feedback in euthymic patients with bipolar I disorder: the last episode makes the difference

Objectives: It is unclear whether abnormalities in cognition and motivation, such as altered feedback processing, observed during euthymia represent trait markers of bipolar I disorder (BD-I) or scars from previous episodes that also occur in major depression (MD). The present research examines how previous episodes influence sensitivity to positive and negative feedback, applying multiple hierarchical regression analysis with number of past depressive and manic episodes, residual mood symptoms, affective quality of the last episode, time in remission, medication, illness severity, and age as predictors. Methods: The study included 23 euthymic patients with BD-I, 19 remitted patients with MD, and 19 healthy persons who underwent a task which discriminates whether persons learn better from negative or positive feedback. Results: For both models, predicting sensitivity to positive [F((5,60)) = 6.50, p = 0.001, adjusted R-2 = 0.22] and negative feedback [F((5,60)) = 5.12, p = 0.001, adjusted R-2 = 0.22], the quality of the last affective episode was the only significant predictor. BD-I patients who last experienced a manic episode learned well from positive but not negative feedback, whereas BD-I patients who last experienced a depressive episode showed the opposite pattern. Conclusions: Our data identify differences in response to positive and negative consequences carrying over into the euthymic state that are qualitatively related to the polarity of the preceding episode, whereas other disease-related variables had no significant influence. This sheds new light on previous inconsistent data in euthymic BD-I patients and could also guide tailored treatment.