Summary: A new study identifies a neurobehavioral signature that predicts increased risk for future mania and hypomania in people on the bipolar spectrum. Researchers combined measures of reward sensitivity, impulsivity, brain reward circuitry activity, and sleep–circadian behavior to define three distinct risk profiles—healthy, moderate risk, and high risk—and found that the moderate- and high-risk groups showed greater mania symptoms over a 12-month follow-up.
The findings provide a potential route for earlier detection of mania vulnerability and offer measurable targets for preventive interventions in bipolar spectrum disorders (BSD).
Key Facts:
- Researchers identified three neurobehavioral profiles—healthy, moderate risk, and high risk—based on reward sensitivity, impulsivity, and sleep–circadian measures.
- Individuals in the high-risk group had higher baseline mania/hypomania symptoms and, along with the moderate-risk group, experienced greater mania symptoms across 12 months than the healthy group.
- The study demonstrates the value of integrating behavioral, clinical, and neuroimaging measures to detect individuals at heightened risk for mania and to guide early intervention strategies.
Source: Elsevier
Background: Mania—an abnormally elevated mood and energy state lasting at least one week—and hypomania—less severe elevations lasting at least four days—are central and often disruptive features of bipolar spectrum disorders. Predicting which individuals will go on to develop mania or hypomania has been difficult, yet earlier identification could allow clinicians to offer targeted prevention and monitoring before severe episodes occur.
Building on previous work linking heightened reward motivation and sleep–circadian disruption to mania onset, the research team led by Adriane M. Soehner, PhD (University of Pittsburgh), also incorporated neuroimaging evidence pointing to altered reward-related activity in left ventrolateral prefrontal cortex—a region involved in reward processing and salience detection.
The investigators hypothesized that a combined neurobehavioral signature—elevated reward sensitivity and impulsivity together with disrupted sleep–circadian patterns and related neural activation—would identify individuals at greater risk for developing mania or hypomania.
Young adults without a formal BSD diagnosis completed comprehensive assessments and underwent functional magnetic resonance imaging (fMRI). Follow-up symptom assessments were completed at six and 12 months for roughly half the sample, enabling the team to evaluate whether baseline profiles predicted symptom trajectories over time.
Three distinct profiles emerged from the mixture-model analysis of baseline measures: a healthy profile with minimal reward or sleep–circadian disruption; a moderate-risk profile with intermediate elevations in reward sensitivity and sleep–circadian irregularities; and a high-risk profile characterized by pronounced impulsivity, heightened reward-related neural activity, and marked sleep–circadian disruption. Participants in the high-risk group already exhibited higher mania/hypomania scores at baseline compared with the other groups.
Across the 12-month follow-up, both the high-risk and moderate-risk groups showed greater mania/hypomania symptoms than the healthy group. Depression symptom patterns differed: the healthy group’s depression scores increased at a faster rate over follow-up compared with moderate- and high-risk groups, suggesting a degree of specificity of the identified profiles to mania/hypomania vulnerability rather than general mood disturbance.
Dr. Soehner noted that combining behavioral, clinical, and neurobiological measures—reward sensitivity, impulsivity, neural reward activation, and sleep–circadian indicators—yields a practical signature for identifying elevated mania risk and offers actionable targets for early interventions and monitoring.
Cameron Carter, MD, Editor of the publishing journal, emphasized that these results illustrate growing capacity to merge neurobiological and clinical information to single out people at highest risk for serious mood episodes, making timely identification and intervention more feasible. He also cautioned that future research must demonstrate whether applying this approach in clinical practice reduces suffering and improves long-term outcomes.
About this bipolar disorder research news
Author: Eileen Leahy
Source: Elsevier
Contact: Eileen Leahy – Elsevier
Image: Image credited to Neuroscience News
Original Research: Open access. “Neurobehavioral Reward and Sleep-Circadian Profiles Predict Present and Next-Year Mania/Hypomania Symptoms” by Ashley Tentrock et al., published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.
Abstract
Neurobehavioral Reward and Sleep-Circadian Profiles Predict Present and Next-Year Mania/Hypomania Symptoms
Background
Heightened reward sensitivity and impulsivity, related patterns of neural activity, and sleep–circadian disruption are established risk factors for bipolar spectrum disorders, whose hallmark symptoms are mania and hypomania. This study aimed to derive neurobehavioral profiles based on reward and sleep–circadian features and to test whether those profiles specifically predict mania/hypomania vulnerability compared with depression risk.
Methods
At baseline, a transdiagnostic cohort of 324 adults (ages 18–25) completed trait assessments of reward sensitivity (Behavioral Activation Scale), impulsivity (UPPS-P Negative Urgency), and an fMRI card-guessing reward task from which left ventrolateral prefrontal activity to reward expectancy was extracted as a neural correlate of reward motivation and impulsivity. Symptom measures including lifetime predisposition to subthreshold mania/hypomania, depression, and sleep–circadian disturbances were gathered at baseline, 6 months, and 12 months. Mixture modeling identified baseline profiles from reward, impulsivity, and sleep–circadian variables.
Results
Three profiles were identified: healthy (n = 162) with minimal reward or sleep–circadian disruption; moderate-risk (n = 109) showing moderate reward and sleep–circadian disruption; and high-risk (n = 53) marked by high impulsivity and sleep–circadian disturbance alongside elevated reward-related neural activation. At baseline, the high-risk group had significantly higher mania/hypomania scores than other groups, while depression scores did not differ between high- and moderate-risk groups. Over follow-up, both moderate- and high-risk groups exhibited elevated mania/hypomania symptoms compared with the healthy group; depression symptoms increased more rapidly in the healthy group over the same period.
Conclusions
A combined profile of heightened reward sensitivity and impulsivity, associated reward-circuit activity, and sleep–circadian disruptions corresponds to current and next-year predisposition to mania and hypomania. These convergent measures can serve to detect individuals at elevated risk and identify targets for early, targeted interventions and monitoring in bipolar spectrum conditions.