Associations of emotion recognition, loneliness, and social functioning in euthymic patients with bipolar disorder

Age-induced changes in affective prosody comprehension and its relationship with general cognitive ability and social support utilization among older adults

Aging can impact emotional recognition, affecting older adults' mental health and social function. This study examined how aging affects affective prosody comprehension (APC: understanding emotions through speech) across seven emotions (happiness, surprise, sadness, anger, fear, disgust, and neutrality) and its relationship with cognitive function (via the Montreal Cognitive Assessment) and social support (via the Social Support Rating Scale) in 199 cognitively normal older adults. We found that older adults had lower APC accuracy and more errors, often mistaking negative emotions for neutral or positive ones. APC accuracy was significantly associated with social support, and a partial least squares (PLS) cognitive component fully mediated the relationship between the APC component and social support utilization, explaining 61.7% of the total effect. These results suggest that declines in APC during aging are linked to social support utilization through cognitive function, offering insights for interventions to improve social and cognitive health in older adults.

Quality of life in older adults with mood states associated with bipolar disorder: A secondary analysis of the English longitudinal study of ageing data

OBJECTIVES

To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder.

METHODS

The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure.

RESULTS

The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group.

CONCLUSIONS

Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes.

Independent inheritance of cognition and bipolar disorder in a family sample

Cognitive deficits in people with bipolar disorder (BD) may be the result of the illness or its treatment, but they could also reflect genetic risk factors shared between BD and cognition. We investigated this question using empirical genetic relationships within a sample of patients with BD and their unaffected relatives. Participants with bipolar I, II, or schizoaffective disorder ("narrow" BD, n = 69), related mood disorders ("broad" BD, n = 135), and their clinically unaffected relatives (n = 227) completed five cognitive tests. General cognitive function (g) was quantified via principal components analysis (PCA). Heritability and genetic correlations were estimated with SOLAR-Eclipse. Participants with "narrow" or "broad" diagnoses showed deficits in g, although affect recognition was unimpaired. Cognitive performance was significantly heritable (h2 = 0.322 for g, p < 0.005). Coheritability between psychopathology and g was small (0.0184 for narrow and 0.0327 for broad) and healthy relatives of those with BD were cognitively unimpaired. In this family sample, cognitive deficits were present in participants with BD but were not explained by substantial overlaps in genetic determinants of mood and cognition. These findings support the view that cognitive deficits in BD are largely the result of the illness or its treatment.

Posterior cingulate and medial prefrontal excitation-inhibition balance in euthymic bipolar disorder

BACKGROUND

Persistent cognitive deficits and functional impairments are associated with bipolar disorder (BD), even during the euthymic phase. The dysfunction of default mode network (DMN) is critical for self-referential and emotional mental processes and is implicated in BD. The current study aims to explore the balance of excitatory and inhibitory neurotransmitters, i.e. glutamate and γ-aminobutyric acid (GABA), in hubs of the DMN during the euthymic patients with BD (euBD).

METHOD

Thirty-four euBD and 55 healthy controls (HC) were recruited to the study. Using proton magnetic resonance spectroscopy (1H-MRS), glutamate (with PRESS sequence) and GABA levels (with MEGAPRESS sequence) were measured in the medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and the posterior cingulate gyrus (PCC). Measured concentrations of excitatory glutamate/glutamine (Glx) and inhibitory GABA were used to calculate the excitatory/inhibitory (E/I) ratio. Executive and attentional functions were respectively assessed using the Wisconsin card-sorting test and continuous performance test.

RESULTS

euBD performed worse on attentional function than controls (p = 0.001). Compared to controls, euBD had higher E/I ratios in the PCC (p = 0.023), mainly driven by a higher Glx level in the PCC of euBD (p = 0.002). Only in the BD group, a marginally significant negative association between the mPFC E/I ratio (Glx/GABA) and executive function was observed (p = 0.068).

CONCLUSIONS

Disturbed E/I balance, particularly elevated Glx/GABA ratio in PCC is observed in euBD. The E/I balance in hubs of DMN may serve as potential biomarkers for euBD, which may also contribute to their poorer executive function.

Peripheral inflammation is associated with impaired sadness recognition in euthymic bipolar patients

BACKGROUND

Inflammation impairs cognitive function in healthy individuals and people with psychiatric disorders, such as bipolar disorder (BD). This effect may also impact emotion recognition, a fundamental element of social cognition. Our study aimed to investigate the relationships between pro-inflammatory cytokines and emotion recognition in euthymic BD patients and healthy controls (HCs).

METHODS

We recruited forty-four euthymic BD patients and forty healthy controls (HCs) and measured their inflammatory markers, including high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and TNF-α. We applied validated cognitive tasks, the Wisconsin Card-Sorting Test (WCST) and Continuous Performance Test (CPT), and a social cognitive task for emotion recognition, Diagnostic Analyses of Nonverbal Accuracy, Taiwanese Version (DANVA-2-TW). We analyzed the relationships between cytokines and cognition and then explored possible predictive factors of sadness recognition accuracy.

RESULTS

Regarding pro-inflammatory cytokines, TNF-α was elevated in euthymic BD patients relative to HCs. In euthymic BD patients only, higher TNF-α levels were associated with lower accuracy of sadness recognition. Regression analysis revealed that TNF-α was an independent predictive factor of sadness recognition in patients with euthymic BD when neurocognition was controlled for.

CONCLUSIONS

We demonstrated that enhanced inflammation, indicated by increased TNF-α, was an independent predictive factor of impaired sadness recognition in BD patients but not in HCs. Our findings suggested a direct influence of TNF-α on sadness recognition and indicated vulnerability to depression in euthymic BD patients with chronic inflammation.

Loneliness in the Daily Lives of People With Mood and Psychotic Disorders

BACKGROUND AND HYPOTHESIS

Loneliness, the subjective experience of feeling alone, is associated with physical and psychological impairments. While there is an extensive literature linking loneliness to psychopathology, limited work has examined loneliness in daily life in those with serious mental illness. We hypothesized that trait and momentary loneliness would be transdiagnostic and relate to symptoms and measures of daily functioning.

STUDY DESIGN

The current study utilized ecological momentary assessment and passive sensing to examine loneliness in those with schizophrenia (N = 59), bipolar disorder (N = 61), unipolar depression (N = 60), remitted unipolar depression (N = 51), and nonclinical comparisons (N = 82) to examine relationships of both trait and momentary loneliness to symptoms and social functioning in daily life.

STUDY RESULTS

Findings suggest that both trait and momentary loneliness are higher in those with psychopathology (F(4,284) = 28.00, P < .001, ηp2 = 0.27), and that loneliness significantly relates to social functioning beyond negative symptoms and depression (β = -0.44, t = 6.40, P < .001). Furthermore, passive sensing measures showed that greater movement (β = -0.56, t = -3.29, P = .02) and phone calls (β = -0.22, t = 12.79, P = .04), but not text messaging, were specifically related to decreased loneliness in daily life. Individuals higher in trait loneliness show stronger relationships between momentary loneliness and social context and emotions in everyday life.

CONCLUSIONS

These findings provide further evidence pointing to the importance of loneliness transdiagnostically and its strong relation to social functioning. Furthermore, we show that passive sensing technology can be used to measure behaviors related to loneliness in daily life that may point to potential treatment implications or early detection markers of loneliness.

The relationship between peripheral insulin resistance and social cognitive deficits among euthymic patients with bipolar disorder

BACKGROUND

Despite extensive literature documenting emotion-related social-cognitive deficits in euthymic patients with bipolar disorder (BD), the factors contributing to these deficits have not been definitively established. To address this gap, the present study aimed to examine the association between peripheral insulin resistance (IR) and emotion-related social-cognitive abilities in BD patients and controls.

METHOD

Sixty-five BD patients and 38 non-psychiatric controls were recruited, and their social cognitive ability and IR were measured using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the homeostasis model assessment of insulin resistance (HOMA-IR), respectively.

RESULTS

The study found that the BD patients scored significantly lower than the non-psychiatric controls in the task of emotional management. The BD patients had a higher mean HOMA-IR value as compared with the controls but this result was not statistically significant (p = 0.051). The interaction between BD diagnosis and HOMA-IR value was significant on the MSCEIT Facilitating emotions branch and Facilitation subscale (p = 0.024, p = 0.010), and post-hoc analyses revealed that the BD patients in the higher HOMA-IR group had significantly lower scores than BD patients in the lower HOMA-IR group and the non-psychiatric controls in the higher HOMA-IR group on both the MSCEIT Facilitating emotion branch and Facilitation subscale.

LIMITATIONS

Due to the cross-sectional nature of the study, causality could not be inferred. The study did not examine potential mediators or moderators between IR and social cognition.

CONCLUSIONS

The results suggested that BD patients with IR experience additional impairment in specific domains of social cognition.

Social cognitive deficit is associated with visuomotor coordination impairment and dopamine transporter availability in euthymic bipolar disorder

BACKGROUND

Extensive evidence has suggested functional connections between co-occurring visuomotor and social cognitive deficits in neuropsychiatric disorders; however, such association has not been studied in bipolar disorder (BD). We aimed to investigate the relationship between visuomotor coordination and social cognition in the euthymic stage of BD (euBD). Given the shared neurobiological underpinnings involving the dopaminergic system and corticostriatal circuitry, we hypothesized a positive correlation between social cognition and visuomotor coordination in euBD patients.

METHODS

40 euBD patients and 59 healthy control (HC) participants underwent evaluation of social (Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW)), non-social cognitive function and visuomotor coordination. A subgroup of participants completed single-photon emission computed tomography for striatal dopamine transporter (DAT) availability assessment.

RESULTS

EuBD patients showed impaired nonverbal emotion recognition (ps ≤ 0.033) and poorer visuomotor coordination (ps < 0.003) compared to HC, with a positive correlation between these two abilities (r = 0.55, p < 0.01). However, after considering potential confounding factors, instead of visuomotor coordination, striatal DAT availability was a unique predictor of emotion recognition accuracy in euBD (beta = 0.33, p = 0.001).

CONCLUSION

Our study result supported a functional association between social cognition and visuomotor coordination in euBD, with striatal dopaminergic dysfunction emerged as a crucial contributing factor in their interrelation.

Measuring loneliness: Psychometric properties of the three-item loneliness scale among community-dwelling adults

Loneliness is a prevalent set of negative feelings associated with unsatisfactory and reduced social interactions, inadequate social support, poor satisfaction with life and health, negative emotions, and economic burden. Thus, its measurement is of foremost importance. Therefore, this study aimed (i) to devise the Portuguese version of the three-Item Loneliness Scale (T-ILS), which is ideal for epidemiological studies, and (ii) to evaluate its psychometric properties. Three hundred forty-five community-dwelling Portuguese adults with a mean age of 54.6 ± 19.5 years, 61.7% women, recruited door-to-door, were assessed with the Portuguese versions of T-ILS, Satisfaction With Life Scale-SWLS, Lubben Social Network Scale 6-items-LSNS-6, a question regarding Happiness/Unhappiness, and a sociodemographic questionnaire. The T-ILS showed good psychometric properties and correlated moderately with SWLS and LSNS-6, and happiness, and weakly with the number of people in the household. The Portuguese version of the T-ILS proved to be a valid and reliable instrument, easy and quick to administer. It proved to be a valuable tool in screening loneliness in Portugal, being potentially useful to the identification of lonelier people in need of intervention.

Loneliness and mood disorders: consequence, cause and/or unholy alliance?

PURPOSE OF REVIEW

People with persistent depressive disorders and with bipolar disorder are more likely to feel lonely than people in the general population. This evidence update focused on studies in the last 2 years, characterized by the COVID-19 pandemic and consequent social distancing directives.

RECENT FINDINGS

Longitudinal studies identified that people who feel lonely are more likely to become depressed or to experience relapse of mood disorders. There is emerging evidence that feelings of loneliness or mandatory social isolation can precede manic episodes. Hence the relationship between loneliness and mood disorders is complex and bidirectional. Interventions were developed to reduce loneliness in people with mental health problems, including depressive disorders, through cognitive modification and/or supported socialisation. No loneliness-focused interventions have been specifically tailored to people with bipolar disorder.

SUMMARY

Studies carried out before and during the COVID-19 pandemic found that feelings of loneliness can be both consequences and precursors of persistent depression and bipolar disorder. Mood symptoms and loneliness have a cumulative negative effect on physical and mental health outcomes. Conceptual overlaps and relations between loneliness and mood symptoms should be clarified in qualitative studies. Theory-driven intervention models should be developed and tested in methodologically robust studies.