Background: Individuals with bipolar I disorder (BD) have difficulty inhibiting context-inappropriate responses. However, neural mechanisms of impaired cognitive control over impulsive behaviors, especially in response to emotion, are unclear. Theta-band neural oscillatory activity over midfrontal areas is thought to reflect cognitive control. The current study examined behavioral performance and theta-band activity during inhibition to affective stimuli in BD, relative to healthy control participants (HC). Methods: Sixty-seven participants with BD and 48 HC completed a Go/No-Go task with emotional face stimuli during electroencephalography (EEG) recording. Behavior was measured with reaction time and signal detection metrics (perceptual sensitivity, response bias). Time-frequency decomposition of EEG data was used to extract event-related theta-band (3-7 Hz) neural oscillatory power and inter-trial phase consistency over midline fronto-central areas. Behavior and theta-band activity measures were compared between groups, while covarying for age. Results: Participants with BD exhibited slower reaction times when executing correct responses and reduced behavioral discrimination of emotional vs. neutral faces, compared to HC. Theta-band power and inter-trial phase consistency were reduced in BD relative to HC and reduced on Go trials relative to No-Go trials. The magnitude of differences in theta-band activity between Go/No-Go trial types did not differ between groups. Higher theta-band power and inter-trial phase consistency were both associated with quicker reaction times on Go trials, and higher power was associated with a stronger response tendency. Conclusions: Attenuated midline fronto-central theta-band power and inter-trial phase consistency may contribute to reduced cognitive control and maladaptive behavioral responding to emotional cues in individuals with BD.
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