Neurocognitive correlates of emotion-based urgency in DSM-5 bipolar disorder: the moderating role of diagnosis status and positive affect in a functional near-infrared spectroscopy (fNIRS) experimental study

• Published in: Journal of affective disorders Vol. 387; p. 119534
• Main Authors: Teh, Wen Lin, Lee, Steve Yin Lam, Chandwani, Nisha, Johnson, Sheri L., Subramaniam, Mythily, Ho, Roger Chun Man
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.10.2025
• Subjects: Adult; Affect - physiology; Bipolar; Bipolar Disorder - diagnosis; Bipolar Disorder - physiopathology; Bipolar Disorder - psychology; Brain - physiopathology; Cognitive control; Diagnostic and Statistical Manual of Mental Disorders; Emotions - physiology; Executive function; Executive Function - physiology; Female; Fnirs; Functional Neuroimaging; Humans; Impulsive Behavior - physiology; Male; Memory, Short-Term - physiology; Middle Aged; Neuropsychological Tests; Psychiatric/Mental Health; Single-Blind Method; Spectroscopy, Near-Infrared; UPPS; Urgency; Working memory; Young Adult; Bipolar; Executive function; UPPS; Working memory; Urgency; Fnirs; Cognitive control
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2025.119534

A key goal of clinical neuroscience is to uncover reliable neurobiological targets for treatment. Urgency (negative or positive urgency subdomains, or N.urg/P.urg respectively), or affect-based impulsivity, is clinically relevant in bipolar disorder (BD). However, the neurocognitive correlates of positive and negative urgency have been mixed, with few considering the moderating effects of BD diagnosis and positive emotional context. We conducted a 2 (group: BD vs. gender-matched healthy controls, or HC) by 2 (condition: positive vs. neutral affect) by 2 (task difficulty; within subjects) mixed, single-blind study. We examined neurocognitive correlates of urgency using EF performance and neuroimaging data from 74 participants (60 % females, Mage = 36). Between-group differences (HC > BD) in EF performance ranged from negligible to large (ηp2: 0 to 0.18). At the p < .05 threshold, positive urgency was correlated with lower cognitive control and working memory efficiency (r ranging from 0.25 to 0.34, p < .05). N.urg was correlated with reduced activity in the ventrolateral PFC (vlPFC) during cognitive control (r = −0.26 to −0.29, p < .05). Multivariate Analysis of Variance (MANOVA) and subsequent simple slopes analyses revealed significant moderation by emotional context and BD diagnosis. High N.urg predicted hypoactivity in the left orbitofrontal cortex in BD only, whereas high P.urg predicted hyperactivity in the right vlPFC in positive emotion context condition only. No correlations/MANOVA findings remained significant after p-value correction. Notwithstanding the study's limitations, the nature of the relationship between urgency and neurocognitive factors may be person- and context dependent. •Negative urgency was correlated with bilateral ventrolateral PFC activity.•Negative urgency predicted l. OFC hypoactivity (Stroop) in Bipolar group.•Positive urgency predicted r. vlPFC hypoactivity (positive context; N-back).•Bipolar diagnosis and positive affect condition were important moderators.