Bipolar Disorder Psychosis Risk Predicts Cue Discrimination on the AX-Continuous Performance Task Paradigm

Bipolar Disorder (BD)-characterized by mania, affective lability, and elevated psychosis risk-is associated with sustained attention deficits. However, evidence regarding performance on the AX-Continuous Performance test task (AX-CPT), a task reliably impaired in schizophrenia-spectrum psychosis, is mixed. This study examined whether individual differences in mania/affective lability risk and psychosis risk, across cohorts of BD and BD-at-risk individuals, were associated with altered AX-CPT performance.

The standard measures d'context and A-cue bias quantified AX-CPT performance. Factors from the Mood Spectrum Self Report (MOODS-SR-L) indexed lifetime mania/affective lability risk (psychomotor activation, suicidality, and mixed instability) and lifetime psychosis risk. Linear regressions were performed for dimensional continuous aims (Aims 1-2) for both d'context and A-cue bias. Tests between BD with low and high-risk groups (Aims 3-4) were completed with ANCOVAs for both AX-CPT output measures.

In the final sample of euthymic BD (n = 27) and at-risk individuals (n = 121), higher levels of psychosis and mania/affective lability risk were associated with reduced target discrimination (d'context; absolute t's > 2.015, p's < 0.047), but not with altered A-cue bias. Group comparisons showed no significant differences for either AX-CPT measure. Associations with d'context from Aims 1-2 remained after covarying for current depressive symptoms but were removed when covarying for current mania severity (absolute t's < 1.26, all p's > 0.203).

Target discrimination deficits were associated dimensionally with psychosis and mania/affective lability risk but not categorically with BD diagnosis. This suggests scope for dimensional risk models for understanding sustained attention deficits in BD and at-risk individuals and highlights contributions of mania/affective lability and psychosis risk.