ArticleEuropean archives of psychiatry and clinical neuroscience2026
Reinforcement learning impairment in individuals with euthymic bipolar I disorder with a history of psychosis.
Article in European archives of psychiatry and clinical neuroscience, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Reinforcement learning deficits in at-risk mental state for psychosis: the role of primary negative symptoms.European archives of psychiatry and clinical neuroscience · 2026Article
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12 authors.
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Abstract
Reinforcement-learning (RL) impairment is an important determinant of functional outcome in bipolar-disorder (BD). This study examined RL in 38 euthymic bipolar-I-disorder (BD-I) individuals aged 16-40 years who were treated within three years from first-episode mania with psychosis and 40 demographically-matched healthy-controls using a computerized RL-paradigm, which investigated rapid and gradual learning, and reward-driven and punishment-driven learning. Symptom severity and cognitive functions were assessed. Our results showed that BD-I individuals displayed lower lose-shift scores than controls (p = 0.03). There were no group differences in other rapid RL measures. Regarding overall RL, a repeated-measures ANOVA revealed main effect of group (F1,76 = 6.5, p = 0.03; controls performed better than patients), block (F2.87,218.45 = 43.7, p < 0.001; performance improving over time) and probability (F1,76 = 15.6, p < 0.001; better performance in 90% than in 80% condition). Post-hoc analysis revealed that controls performed better than BD-I individuals on loss-avoidance stimuli (p = 0.02). Better performance of controls relative to BD-I individuals on gain stimuli approached statistical significance (p = 0.06). No correlations of RL measures with symptoms, cognition or antipsychotic dose were observed. In conclusion, this study is among the few to examine RL impairment in euthymic BD-I with history of psychosis at a relatively early illness stage, and indicates that BD-I individuals displayed punishment-driven learning (i.e., negative RL) deficits compared with controls. Diminished punishment-sensitivity may indicate vulnerability to maladaptive behaviors, particularly in response to negative events or stress, and poorer functional impairment. Further research is required to clarify longitudinal trajectory of punishment-insensitivity and its relationship with psychosis and functional outcomes in the early-stage of BD.
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