Decision-making cognition in mania and depression

Background. Despite markedly different clinical presentations, few studies have reported differences in neuropsychological functioning between mania a nd depression. Recent work has suggested that differences may emerge on cog nitive tasks requiring affective processing, such as decision-making. The p resent study sought to compare decision-making cognition in mania and depre ssion in order to clarify the current profiles of impairment for these diso rders and to contribute to our more general understanding of the relationsh ip between mood and cognition. Methods. Medicated manic patients, depressed patients, and normal healthy c ontrols completed a computerized decision-making task. All subjects were as ked to win as many points as possible by choosing outcomes based on variabl y-weighted probabilities and by placing 'bets' on each decision. Results. Both patient groups were impaired on this task, as evidenced by sl ower deliberation times, a failure to accumulate as many points as controls and suboptimal betting strategies. Manic, but not depressed, patients made suboptimal decisions - an impairment that correlated with the severity of their illness. Conclusions. These findings are consistent with a growing consensus that ma nic and depressed patients are characterized by significant impairments in cognitive and particularly executive, functioning. Furthermore, the distinc t patterns of observed impairment in manic and depressed patients suggests that the nature and extent of cognitive impairment differ between these two groups. Viewed in the context of other recent studies, these findings are consistent with a role for the ventromedial prefrontal cortex in mediating mood-cognition relationships.