Increased salience of gains versus decreased associative learning differentiate bipolar disorder from schizophrenia during incentive decision making

P. Brambilla, C. Perlini, M. Bellani, M. Balestrieri, L. Tomelleri, A. Ferro, S. Cerruti, V. Marinelli, G. Rambaldelli, M. Tansella, T. Christodoulou, J. Jogia, D. Dima, S. Frangou

Research output: Contribution to journalArticlepeer-review


Background Abnormalities in incentive decision making, typically assessed using the Iowa Gambling Task (IGT), have been reported in both schizophrenia (SZ) and bipolar disorder (BD). We applied the Expectancy-Valence (E-V) model to determine whether motivational, cognitive and response selection component processes of IGT performance are differentially affected in SZ and BD. Method Performance on the IGT was assessed in 280 individuals comprising 70 remitted patients with SZ, 70 remitted patients with BD and 140 age-, sex-and IQ-matched healthy individuals. Based on the E-V model, we extracted three parameters, 'attention to gains or loses', 'expectancy learning' and 'response consistency', that respectively reflect motivational, cognitive and response selection influences on IGT performance. Results Both patient groups underperformed in the IGT compared to healthy individuals. However, the source of these deficits was diagnosis specific. Associative learning underlying the representation of expectancies was disrupted in SZ whereas BD was associated with increased incentive salience of gains. These findings were not attributable to non-specific effects of sex, IQ, psychopathology or medication. Conclusions Our results point to dissociable processes underlying abnormal incentive decision making in BD and SZ that could potentially be mapped to different neural circuits.
Original languageEnglish
Pages (from-to)571-580
Number of pages10
JournalPsychological Medicine
Issue number3
Early online date12 Jun 2012
Publication statusPublished - Mar 2013

Bibliographical note

Copyright © Cambridge University Press 2012


  • Bipolar disorder
  • schizophrenia
  • salience
  • reward
  • motivation
  • gambling
  • expectancy–valence
  • decision making


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