Bipolar disorder patients avoid rewarding activities

People with bipolar I disorder tend to be aware of the potential for goal achievement to trigger mania and as a result dampen their emotions and avoid reward, preliminary research suggests.

However, such steps may be associated with lower quality of life, say Sheri Johnson (University of California, Berkeley, USA) and team. "Thus, clinicians who consider advising patients about behavioural strategies for mania prevention should consider whether their intervention might affect quality of life," they note.

"Psychoeducation about the relations among goal pursuit, positive emotions, and mania should be accompanied by a careful consideration of the delicate balance to be struck."

For the study, published in the Journal of Affective Disorders, 90 patients with bipolar I disorder and 72 mentally healthy individuals completed the Responses to Positive Affect (RPA) measure and the Brief Quality of Life in Bipolar Disorder scale.

Almost all of the bipolar disorder patients reported experiencing their mania being triggered by one of the events on the Reward-Triggered Mania subscale, with 57 out of the 60 participants who completed it responding "somewhat true" or "very true" to at least one event, while 47 responded "very true" to at least one event. Such events include falling in love, having a child, getting married, and getting a promotion.

Most of the bipolar disorder patients also reported engaging in at least one of the reward-limiting mania prevention strategies on the Reward Avoidance subscale, with 46 responding "somewhat true" or "very true" to at least one strategy, while 28 responded "very true" to at least one strategy, such as limiting social life, love life or work life so it is not too exciting.

The findings for dampening of positive feelings on the RPA showed that this was more common among bipolar disorder patients than mentally healthy individuals. (M=16.3 vs 12.5) and that it significantly correlated with a poorer quality of life.

The researchers note, however, that this association was no longer significant after taking into account neuroticism.

"It is likely that other personality variables, lifetime experiences related to the disorder, and broader social and individual factors shape these responses," they comment.

Given the predicament faced by patients with bipolar disorder in pursuing positive experiences and achievements, the team says that "clinicians and researchers should be careful to ensure that due attention to preventing mania does not interfere with ongoing engagement in key domains of life and affective experience."

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