An individual task meta-analysis of social cognition in euthymic bipolar disorders

Network dysfunction of sadness facial expression processing and morphometry in euthymic bipolar disorder

Facial emotion recognition (FER), including sadness, is altered in bipolar disorder (BD). However, the relationship between this impairment and the brain structure in BD is relatively unexplored. Furthermore, its association with clinical variables and with the subtypes of BD remains to be clarified. Twenty euthymic patients with BD type I (BD-I), 28 BD type II (BD-II), and 45 healthy controls completed a FER test and a 3D-T1-weighted magnetic resonance imaging. Gray matter volume (GMV) of the cortico-limbic regions implicated in emotional processing was estimated and their relationship with FER performance was investigated using network analysis. Patients with BD-I had worse total and sadness-related FER performance relative to the other groups. Total FER performance was significantly negatively associated with illness duration and positively associated with global functioning in patients with BD-I. Sadness-related FER performance was also significantly negatively associated with the number of previous manic episodes. Network analysis showed a reduced association of the GMV of the frontal-insular-occipital areas in patients with BD-I, with a greater edge strength between sadness-related FER performance and amygdala GMV relative to controls. Our results suggest that FER performance, particularly for facial sadness, may be distinctively impaired in patients with BD-I. The pattern of reduced interrelationship in the frontal-insular-occipital regions and a stronger positive relationship between facial sadness recognition and the amygdala GMV in BD may reflect altered cortical modulation of limbic structures that ultimately predisposes to emotional dysregulation. Future longitudinal studies investigating the effect of mood state on FER performance in BD are warranted.

Patients with chronic bipolar disorder show impairments in interpreting literary fiction - A preliminary explorative study with the short story task

INTRODUCTION

Theory of mind (ToM) is a crucial skill in navigating and functioning in the social world. Significant ToM impairment was consistently found in bipolar disorder; it can be both a state and trait marker of the disorder. However, most of the ToM tests are not sensitive enough to detect subtle individual differences, which would be necessary for an individualized treatment plan. The Short Story Task (SST) is a new way to sensitively assess individual differences in ToM performance. The aim of the study was to test the feasibility of SST in patients with bipolar disorder.

METHOD

31 persons (11 male, 20 female) with bipolar I disorder and 31 healthy individuals (15 males and 16 females) as a control group were recruited. SST was used to evaluate ToM performance. The SST uses a Hemingway novel, in which the patient is presented with a realistic social situation, where the motivations of the characters and the underlying relationships of events are not explicitly described.

RESULTS

In the explicit mental state reasoning questions the CG (M = 8.06) had significantly higher (p < 0.001) scores than the persons with bipolar I disorder (M = 5.03). There was no ceiling effect for explicit ToM scores in either group. Participants in CG (M = 8.03) also significantly outperformed (p = 0.006) the BG participants (M = 6.55) in the comprehension questions. The spontaneous mental state inference question was performed equally (M = 0.23) in both groups. Group assignment (t = -3.503, p < 0.001), comprehension score (t = 2.864, p = 0.006), and spontaneous mentalization (t = 2.846, p = 0.006) significantly predicted the explicit ToM performance.

CONCLUSIONS

Overall, we found that the Short Story Task is a promising tool for measuring ToM in patients with bipolar disorder without ceiling effect. Primarily explicit ToM was found to be deficient, which corresponds well with the ToM literature in bipolar disorder. Contrary to our hypothesis we could not detect impairment in spontaneous ToM and found that patients living with bipolar disorder also showed deficits in comprehension. The lack of assessment of neurocognitive skills is a significant limitation of the current study.

Discrepancy of social cognition between bipolar disorders and major depressive disorders

BACKGROUND

The research landscape examining social cognition (SC) impairment in patients with major depressive disorders (MDD) and bipolar disorders (BD) is notably scarce. Presently, assessments predominantly rely on static stimuli and self-reported measures, which may not capture the dynamic dimensions of social cognition.

OBJECTIVES

This study aimed to validate the Chinese version of Movie Assessment of Social Cognition (MASC-CH) and to investigate whether MDD and BD exhibit distinct patterns of SC impairments, shedding light on potential differences between these two mood disorders.

METHODS

The study encompassed 197 participants, aged 18-65, distributed as follows: 21 BD, 20 MDD, and 156 healthy controls (HC). We focused on examining "cognitive" and "emotional" SC scores and "undermentalizing" and "overmentalizing" error patterns, with nonsocial inference as a control. Additional assessments included the Reading Mind in the Eyes Test (RMET) and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). We also explored the association between depression severity (measured by the Hamilton Depressive Rating Scale, HDRS) and distinct SC dimensions between MDD and BD.

RESULTS

The MASC-CH exhibited strong validity and reliability for SC assessment. In group comparisons, BD participants scored significantly lower on MASC-CH, while the MDD group scores were not significantly different from HC. Specifically, BD individuals had notably lower cognitive SC scores and made more undermentalizing and absence of mentalizing errors than MDD and HC. Additionally, a negative correlation between HDRS score and overmentalizing was observed in BD, not in the MDD.

CONCLUSIONS

The findings indicate that depression severity scores in BD were inversely related to MASC-CH scores. In contrast, this relationship was not observed in the MDD group. These results underscore the importance of SC impairments as distinguishing characteristics of both BD and MDD. It provides valuable insights into the distinct social-cognitive profiles of both mood disorders.

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.

Can the Ability to Recognize Facial Emotions in Individuals With Neurodegenerative Disease be Improved? A Systematic Review and Meta-analysis

BACKGROUND

Facial emotion recognition (FER) is commonly impaired in individuals with neurodegenerative disease (NDD). This impairment has been linked to an increase in behavioral disorders and caregiver burden.

OBJECTIVE

To identify interventions targeting the improvement of FER ability in individuals with NDD and investigate the magnitude of the efficacy of the interventions. We also wanted to explore the duration of the effects of the intervention and their possible impacts on behavioral and psychological symptoms of dementia and caregiver burden.

METHOD

We included 15 studies with 604 individuals who had been diagnosed with NDD. The identified interventions were categorized into three types of approach (cognitive, neurostimulation, and pharmacological) as well as a combined approach (neurostimulation with pharmacological).

RESULTS

The three types of approaches pooled together had a significant large effect size for FER ability improvement (standard mean difference: 1.21, 95% CI = 0.11, 2.31, z = 2.15, P = 0.03). The improvement lasted post intervention, in tandem with a decrease in behavioral disorders and caregiver burden.

CONCLUSION

A combination of different approaches for FER ability improvement may be beneficial for individuals with NDD and their caregivers.

Emotional intelligence: a comparison between patients after first episode mania and those suffering from chronic bipolar disorder type I

BACKGROUND

Deficits in emotional intelligence (EI) were detected in patients with bipolar disorder (BD), but little is known about whether these deficits are already present in patients after presenting a first episode mania (FEM). We sought (i) to compare EI in patients after a FEM, chronic BD and healthy controls (HC); (ii) to examine the effect exerted on EI by socio-demographic, clinical and neurocognitive variables in FEM patients.

METHODS

The Emotional Intelligence Quotient (EIQ) was calculated with the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Performance on MSCEIT was compared among the three groups using generalized linear models. In patients after a FEM, the influence of socio-demographic, clinical and neurocognitive variables on the EIQ was examined using a linear regression model.

RESULTS

In total, 184 subjects were included (FEM n = 48, euthymic chronic BD type I n = 75, HC n = 61). BD patients performed significantly worse than HC on the EIQ [mean difference (MD) = 10.09, standard error (s.e.) = 3.14, p = 0.004] and on the understanding emotions branch (MD = 7.46, s.e. = 2.53, p = 0.010). FEM patients did not differ from HC and BD on other measures of MSCEIT. In patients after a FEM, EIQ was positively associated with female sex (β = -0.293, p = 0.034) and verbal memory performance (β = 0.374, p = 0.008). FEM patients performed worse than HC but better than BD on few neurocognitive domains.

CONCLUSIONS

Patients after a FEM showed preserved EI, while patients in later stages of BD presented lower EIQ, suggesting that impairments in EI might result from the burden of disease and neurocognitive decline, associated with the chronicity of the illness.

A review of resting-state fMRI correlations with executive functions and social cognition in bipolar disorder

BACKGROUND

Deficits in executive functions (EF) and social cognition (SC) are often observed in bipolar disorder (BD), leading to a severe impairment in engaging a functional interaction with the others and the surrounding environment. Therefore, in recent years, resting-state functional magnetic resonance imaging (rs-fMRI) studies on BD tried to identify the neural underpinnings of these cognitive domains by exploring the association between the intrinsic functional connectivity (FC) and the scores in clinical scales evaluating these domains.

METHODS

A bibliographic search on PubMed and Scopus of studies evaluating the correlations between rs-fMRI findings and EF and/or SC in BD was conducted until March 2022. Ten studies met the inclusion criteria.

RESULTS

Overall, the results of the reviewed studies showed that BD patients had FC deficits compared to healthy controls (HC) in selective resting-state networks involved in EF and SC, which include the default mode network, especially the link between medial prefrontal cortex and posterior cingulate cortex, and the sensory-motor network. Finally, it also emerged the predominant role of alterations in prefrontal connections in explaining the cognitive deficits in BD patients.

LIMITATIONS

The heterogeneity of the reviewed studies, in terms of cognitive domains explored and neuroimaging acquisitions, limited the comparability of the findings.

CONCLUSIONS

rs-fMRI studies could help deepen the brain network alterations underlying EF and SC deficits in BD, pointing the attention on the neuronal underpinning of cognition, whose knowledge may lead to the development of new neurobiological-based approaches to improve the quality of life of these patients.

Faux-Pas Recognition Test: A Turkish adaptation study and a proposal of a standardized short version

Faux Pas Recognition Test (FPRT) is one of the most commonly used tools to assess the theory of mind (ToM) and a valid and reliable screening of this social cognitive function in both clinical and research settings is essential. We aimed to evaluate the psychometric properties of the FPRT on a healthy Turkish sample and to develop a shorter form with adequate psychometric properties to provide an easier application for the tester by shortening the test's duration of administration. Four hundred sixteen healthy individuals completed the Turkish version of the FPRT. Addenbrooke's Cognitive Evaluation-Revised form (ACE-R) was given to the participants who were over 60 years of age in order to eliminate the adverse effects of a potential cognitive decline on FPRT performance. Effects of psychological symptoms on FPRT performance were controlled with Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Both the original and short versions of the test showed good psychometric properties: for the original version internal consistency reliability was 0.94 for faux-pas (FP) stories and 0.92 for control stories; for the short version it was 0.92 for FP stories and was 0.93 for control stories. For the original version of the FPRT; inter-rater reliability was 0.88 for FP stories and was 0.96 for control stories. Split-half reliability was 0.78 for FP stories and was 0.85 for control stories. Gender and age comparisons were carried out. Results revealed that women had significantly higher total scores than men in three measures of FPRT.

The role of the cerebellum in sequencing and predicting social and non-social events in patients with bipolar disorder

Introduction

Advances in the operational mode of the cerebellum indicate a role in sequencing and predicting non-social and social events, crucial for individuals to optimize high-order functions, such as Theory of Mind (ToM). ToM deficits have been described in patients with remitted bipolar disorders (BD). The literature on BD patients' pathophysiology reports cerebellar alterations; however, sequential abilities have never been investigated and no study has previously focused on prediction abilities, which are needed to properly interpret events and to adapt to changes.

Methods

To address this gap, we compared the performance of BD patients in the euthymic phase with healthy controls using two tests that require predictive processing: a ToM test that require implicit sequential processing and a test that explicitly assesses sequential abilities in non-ToM functions. Additionally, patterns of cerebellar gray matter (GM) alterations were compared between BD patients and controls using voxel-based morphometry.

Results

Impaired ToM and sequential skills were detected in BD patients, specifically when tasks required a greater predictive load. Behavioral performances might be consistent with patterns of GM reduction in cerebellar lobules Crus I-II, which are involved in advanced human functions.

Discussion

These results highlight the importance of deepening the cerebellar role in sequential and prediction abilities in patients with BD.

Relationship between theory of mind and metabolic parameters and functioning in patients with bipolar I disorder

Purpose: We aimed to investigate the relationship theory of mind abilities with functionality and metabolic alteration in patients with bipolar disorder-1 (BD-1) during the remission period. Materials and Methods: This cross-sectional study is consisted of 68 patients with bipolar disorder-1 and 45 healthy controls. Sociodemographic form, Reading the Mind in the Eyes Test (RMET), Bipolar Disorder Functioning Questionnaire (BDFQ) were administered to the participants. Body mass index (BMI), waist circumference (WC), fasting plasma glucose (FG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG) levels were recorded. Results: There were significant differences between the patient group and healthy control group in terms of WC, BMI, HDL, LDL, TG. The results of independent samples t-test indicated a statistically significant difference in RMET score between the two groups with control group significantly higher than patient group. Conclusion: Patients with BD-1 during the remission period have lower performance on theory of mind abilities and more alteration in metabolic parameters than healthy controls. Metabolic alteration and theory of mind impairment should be potential treatment target for BD

Theory of mind profile and cerebellar alterations in remitted bipolar disorder 1 and 2: a comparison study

The literature on social cognition abilities in bipolar disorder (BD) is controversial about the occurrence of theory of mind (ToM) alterations. In addition to other cerebral structures, such as the frontal and limbic areas, the processing of socially relevant stimuli has also been attributed to the cerebellum, which has been demonstrated to be involved in the above-mentioned disorder. Nevertheless, the cerebellar contribution to ToM deficits in bipolar patients needs to be elucidated further. To this aim, two tests assessing different components of ToM were used to evaluate the ability to appreciate affective and mental states of others in 17 individuals with a diagnosis of BD type 1 (BD1) and 13 with BD type 2 (BD2), both in the euthymic phase, compared to healthy matched controls. Cerebellar gray matter (GM) volumes were extracted and compared between BD1 and controls and BD2 and controls by using voxel-based morphometry. The results showed that BD1 patients were compromised in the cognitive and advanced components of ToM, while the BD2 ToM profile resulted in a more widespread compromise, also involving affective and automatic components. Both overlapping and differing areas of cerebellar GM reduction were found. The two groups of patients presented a pattern of GM reduction in cerebellar portions that are known to be involved in the affective and social domains, such as the vermis and Crus I and Crus II. Interestingly, in both BD1 and BD2, positive correlations were detected between lower ToM scores and decreased volumes in the cerebellum. Overall, BD2 patients showed a more compromised ToM profile and greater cerebellar impairment than BD1 patients. The different patterns of structural abnormalities may account for the different ToM performances evidenced, thus leading to divergent profiles between BD1 and BD2.

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

Emotion recognition deficit is related to impaired community functioning. Loneliness is also associated with impaired social performance. However, the way in which emotion recognition and loneliness may contribute to social functioning remains unclear in euthymic patients with bipolar disorder. We aimed to examine emotion recognition ability in Han Chinese euBD patients relative to healthy controls (HCs) and to investigate the associations between emotion recognition, loneliness, and social functioning. Thirty-nine HCs and 46 euthymic BD patients completed an emotion recognition task and nonsocial cognitive measures related to executive function and attention. The UCLA loneliness scale and Social Performance Scale were administered to evaluate psychological loneliness and social functioning, respectively. We observed lower emotion recognition accuracy, higher loneliness, and poorer social functioning in the BD patients after adjustment for demographic data. Loneliness was negatively associated with global social functioning in both the BD and HC groups. Higher loneliness and lower emotion recognition accuracy were associated with poorer social functioning in euthymic BD in different subdomains. Our study confirmed a subtle impairment of emotion recognition ability in euthymic BD. Loneliness impacts globally on social functioning, while emotion recognition ability may affect specific subdomains of social functioning in euthymic BD. Alleviation of loneliness and enhancement of social cognition might improve social functioning in BD patients.

Deficits of social cognition in bipolar disorder: Systematic review and meta-analysis

BACKGROUND

The association between impaired social cognition and bipolar disorder (BD) is well established. However, to our knowledge, there has not been a recent systematic review that characterizes disparate dimensions of social cognition in BD. Herein, this systematic review and meta-analysis aimed to synthesize the literature on core aspects of social cognition (i.e., Theory of Mind, emotion recognition, and social judgment) to identify potential areas of impairment.

METHODS

Online databases (i.e., PubMed, Cochrane Libraries, PsycINFO) and Google Scholar were searched from inception to May 2021. Studies with populations ages ≥16 with DSM-IV or DSM-5 defined BD (I or II) either in a euthymic or symptomatic state were included. The risk of bias was measured using the ROBINS-1 tool, and the quality of the sources was evaluated using GRADE criteria. The results of the studies were quantitatively measured by synthesizing Hedge's g effect sizes through a random effects meta-analytic approach.

RESULTS

A total of 29 studies were included in the final review (i.e., 12 studies on the Theory of Mind, 11 on emotion recognition, and 6 on social judgment). Overall, results demonstrated social cognition to be moderately impaired in individuals with BD (d = 0.59). The individual domains ranged in effect size (0.38 < d < 0.70), providing evidence for variation in impairment within social cognition.

DISCUSSION

Individuals with BD exhibit clinically significant deficits in social cognition during euthymic and symptomatic states. Social cognition impairments in individuals with BD are an important therapeutic target for treatment discovery and development.

Identifying social cognition subgroups in euthymic patients with bipolar disorder: a cluster analytical approach

BACKGROUND

Bipolar disorder (BD) is associated with social cognition (SC) impairments even during remission periods although a large heterogeneity has been described. Our aim was to explore the existence of different profiles on SC in euthymic patients with BD, and further explore the potential impact of distinct variables on SC.

METHODS

Hierarchical cluster analysis was conducted using three SC domains [Theory of Mind (ToM), Emotional Intelligence (EI) and Attributional Bias (AB)]. The sample comprised of 131 individuals, 71 patients with BD and 60 healthy control subjects who were compared in terms of SC performance, demographic, clinical, and neurocognitive variables. A logistic regression model was used to estimate the effect of SC-associated risk factors.

RESULTS

A two-cluster solution was identified with an adjusted-performance group (N = 48, 67.6%) and a low-performance group (N = 23, 32.4%) with mild deficits in ToM and AB domains and with moderate difficulties in EI. Patients with low SC performance were mostly males, showed lower estimated IQ, higher subthreshold depressive symptoms, longer illness duration, and poorer visual memory and attention. Low estimated IQ (OR 0.920, 95% CI 0.863-0.981), male gender (OR 5.661, 95% CI 1.473-21.762), and longer illness duration (OR 1.085, 95% CI 1.006-1.171) contributed the most to the patients clustering. The model explained up to 35% of the variance in SC performance.

CONCLUSIONS

Our results confirmed the existence of two discrete profiles of SC among BD. Nearly two-thirds of patients exhibited adjusted social cognitive abilities. Longer illness duration, male gender, and lower estimated IQ were associated with low SC performance.

Social cue recognition and attributional bias in remitted bipolar disorder: Impact on social functioning

The role of social cue recognition and attributional bias on social functioning has been sparsely studied in remitted bipolar disorder (BD). In view of this, we evaluated thirty subjects with BD (without a history of psychotic symptoms) who were in remission and thirty age and, gender-matched healthy controls for social cue recognition [using SoCueReTI (Social Cue Recognition Test- Indian Setting)], and attributional bias (using an Attributional style questionnaire). Social functioning was assessed in subjects with BD using the Functional assessment short test (FAST) - Interpersonal relationships. Subjects with BD had significant deficits in recognizing social cues in low-intensity and high-intensity vignettes when compared to healthy controls. Deficits in recognizing social cues in low-intensity vignettes were significantly correlated with the FAST scores, even after controlling for the number of episodes and duration of illness. Further replication studies are needed to ascertain the association between social cue recognition deficits and social functioning in BD.

Characterization of facial emotion recognition in bipolar disorder: Focus on emotion mislabelling and neutral expressions

Increasing evidence suggests that facial emotion recognition is impaired in bipolar disorder (BD). However, patient-control differences are small owing to ceiling effects on the tasks used to assess them. The extant literature is also limited by a relative absence of attention towards identifying patterns of emotion misattribution or understanding whether neutral faces are mislabelled in the same way as ones displaying emotion. We addressed these limitations by comparing facial emotion recognition performance in BD patients and healthy controls on a novel and challenging task. Thirty-four outpatients with BD I and 32 demographically matched healthy controls completed a facial emotion recognition task requiring the labelling of neutral and emotive faces displayed at low emotional intensities. Results indicated that BD patients were significantly less accurate at labelling faces than healthy controls, particularly if they displayed fear or neutral expressions. There were no between-group differences in response times or patterns of emotion mislabelling, with both groups confusing sad and neutral faces, although BD patients also mislabelled sad faces as angry. Task performance did not significantly correlate with mood symptom severity in the BD group. These findings suggest that facial emotion recognition impairments in BD extend to neutral face recognition. Emotion misattribution occurs in a similar, albeit exaggerated manner in patients with BD compared to healthy controls. Future behavioural and neuroimaging research should reconsider the use of neutral faces as baseline stimuli in their task designs.

Facial emotion recognition and its association with quality of life and socio-occupational functioning in patients with bipolar disorder and their first-degree relatives

INTRODUCTION

Facial emotion recognition deficits (FERD) are common even in the remitted phase of bipolar disorder (BD). Research regarding FERD in first-degree relatives is inconclusive. This study aimed to assess the facial emotion recognition in remitted patients of bipolar disorder and first-degree relatives(FDR) in comparison with healthy controls. Correlation between FERD and quality of life and socio-occupational functioning was also assessed.

METHODS

It was an observational, cross-sectional study done at a tertiary hospital in India. Study population (n = 75) included remitted patients of bipolar disorder (n = 27), first-degree relatives of BD patients (FDR) (n = 20) and healthy controls (HC) (n = 28). Facial emotion recognition, social and occupational functioning, and quality of life (QoL) was measured using Tool for Recognition of Emotions in Neuropsychiatric Disorders, Social & Occupational Functioning Assessment Scale and World Health Organization Quality of Life-Bref, respectively, in all the participants.

RESULTS

The BD group did significantly worse in facial emotion recognition in comparison to FDR and HC groups (p < 0.001). Emotion recognition of fear, anger, surprise, and happy were most affected. FDR did not vary significantly from HC in facial emotion recognition. Lower scores on facial emotion recognition were associated with lower QoL in the social domain(p = 0.006) and poorer socio- occupational functioning scores (p = 0.01), but it was not significant within the BD group.

CONCLUSION

FERD is seen in remitted patients of bipolar disorder but not in the first -degree relatives. FERD affects social quality of life and functioning. Poorer social functioning in remitted patients of bipolar disorder might be multifactorial and cannot be attributed solely to FERD.

Latent classes of maladaptive personality traits exhibit differences in social processing

OBJECTIVE

Social processing (SP) deficits manifest across numerous mental disorders. However, this research has been plagued by heterogeneity and a piecemeal approach whereby skills are examined in isolation rather than as part of an integrated cognitive system. Here, we combined two dimensional frameworks of psychopathology to address these limitations.

METHOD

We utilized the Alternative Model for Personality Disorders (AMPD) to distill trait-related heterogeneity within a community sample (n = 200), and the Research Domain Criteria (RDoC) 'Systems for Social Processes' to comprehensively assess SP. We first applied latent class analyses (LCA) to derive AMPD-based groups and subsequently contrasted the performance of these groups on a SP test battery that we developed to align with the RDoC SP constructs.

RESULTS

Our LCA yielded four distinct subgroups. The recognizable trait profiles and psychopathological symptoms of these classes suggested they were clinically meaningful. The subgroups differed in their SP profiles: one displayed deficits regarding the self, a second displayed deficits in understanding others, a third displayed more severe deficits including affiliation problems, whilst the fourth showed normal performance.

CONCLUSIONS

Our results support the link between clusters of maladaptive personality traits and distinctive profiles of SP deficits, which may inform research on disorders involving SP dysfunctions.

Differences in Facial Expression Recognition Between Unipolar and Bipolar Depression

PURPOSE

To explore the differences in facial emotion recognition among patients with unipolar depression (UD), bipolar depression (BD), and normal controls.

METHODS

Thirty patients with UD and 30 patients with BD, respectively, were recruited in Zhumadian Second People's Hospital from July 2018 to August 2019. Fifteen groups of facial expressions including happiness, sadness, anger, surprise, fear, and disgust were identified.

RESULTS

A single-factor ANOVA was used to analyze the facial expression recognition results of the three groups, and the differences were found in the happy-sad (P = 0.009), happy-angry (P = 0.001), happy-surprised (P = 0.034), and disgust-surprised (P = 0.038) facial expression groups. The independent sample T-test analysis showed that compared with the normal control group, there were differences in the happy-sad (P = 0.009) and happy-angry (P = 0.009) groups in patients with BD, and the accuracy of facial expression recognition was lower than the normal control group. Compared with patients with UD, there were differences between the happy-sad (P = 0.005) and happy-angry (P = 0.002) groups, and the identification accuracy of patients with UD was higher than that of patients with BD. The time of facial expression recognition in the normal control group was shorter than that in the patient group. Using happiness-sadness to distinguish unipolar and BDs, the area under the ROC curve (AUC) is 0.933, the specificity is 0.889, and the sensitivity is 0.667. Using happiness-anger to distinguish unipolar and BD, the AUC was 0.733, the specificity was 0.778, and the sensitivity was 0.600.

CONCLUSION

Patients with UD had lower performance in recognizing negative expressions and had longer recognition times. Those with BD had lower accuracy in recognizing positive expressions and longer recognition times. Rapid facial expression recognition performance may be as a potential endophenotype for early identification of unipolar and BD.

Characterization and interrelationships of theory of mind, socially competitive emotions and affective empathy in bipolar disorder

OBJECTIVE

Evidence shows impaired theory of mind (ToM) in patients with bipolar disorder (BD), yet research examining its cognitive and affective components simultaneously is sparse. Moreover, recognition of socially competitive 'fortune of others' emotions (e.g. envy/gloat) may be related to ToM, but has not been assessed in BD. Finally, if and how ToM and 'fortune of others' emotions relate to affective empathy in BD is currently unclear. This study aimed to address these points.

METHODS

64 BD patients and 34 healthy controls completed the Yoni task, a visual task assessing first- and second-order cognitive and affective ToM as well as 'fortune of others' emotions. The Toronto Empathy Questionnaire was used to assess self-reported affective empathy.

RESULTS

Patients with BD showed no deficits in cognitive and affective ToM or recognition of 'fortune of others' emotions. The ability to infer 'fortune of others' emotions correlated with several ToM measures, indicating that these functions are part of the same system. Patients with BD reported similar levels of affective empathy to healthy controls, and this was not related to ToM or 'fortune of others' emotions, suggesting that affective empathy represents a separate social domain.

CONCLUSIONS

These findings highlight areas of spared social functioning in BD, which may be utilized in therapeutic strategies.

PRACTITIONER POINTS

Our results suggest theory of mind and empathy may represent areas of potentially spared cognitive functioning in BD. As many BD patients have experienced adversity during developmental periods in which theory of mind and empathy develop, our findings suggest that these abilities may be markers of resilience in the disorder. Our findings are important for the formulation of therapeutic interventions for BD, which may include considering practical ways that a patients' knowledge of intact ToM and empathy could be utilized to reduce self-stigma and promote self-efficacy, improved well-being and functioning.

Manic morbidity and executive function impairment as determinants of long-term psychosocial dysfunction in bipolar disorder

OBJECTIVE

In this study, we aimed to evaluate the role of cognitive performance and measures of clinical course-including both syndromal and subsyndromal symptomatology-as determinants of the functional outcome of patients with Bipolar Disorder (BD) during a mean follow-up period of more than 4 years.

METHODS

Seventy patients with euthymic BD completed a neurocognitive battery at study entry. Clinical course was assessed prospectively for a period longer than 48 months by two measures: time spent ill (documented using a modified life charting technique) and density of affective episodes (defined as the number of depressive and hypo/manic episodes per year of follow-up). Psychosocial functioning was assessed during euthymia using the Functioning Assessment Short Test (FAST) total score at the end of follow-up period.

RESULTS

Baseline deficits in phonological fluency, a measure of executive functions (β = -2.49; 95% CI = -3.98, -0.99), and density of hypo/manic episodes during follow-up (β = 6.54; 95% CI = 0.43, 12.65) were independently associated with FAST total score at the end of study.

CONCLUSIONS

Although interrelated, manic morbidity and executive function impairments independently contribute to long-term psychosocial dysfunction in BD and could be potential targets of intervention.

Impaired theory of mind and emotion recognition in pediatric bipolar disorder: A systematic review and meta-analysis

BACKGROUND

Social cognition is impaired in patients with severe mental disorders. We aimed to investigate impairments in social cognition in youth with pediatric bipolar disorder (PBD) through a systematic review of the literature and the meta-analysis.

METHOD

Following the PRISMA guidelines, we searched in PubMed, Scopus, and Cochrane CENTRAL for studies reporting on the theory of mind (ToM) and emotion recognition (ER) abilities of patients with PBD compared to healthy controls (HC). We conducted a random-effects model meta-analysis for the contrast between PBD and HC. Subgroup and meta-regression analyses were conducted for demographic and clinical variables as appropriate.

RESULTS

A total of thirteen studies involving 429 patients with PBD and 394 HC were included. Patients with PBD had significantly poorer social cognitive abilities (Hedges' g for ER, g = -0.74, CI = -0.91, -0.57; and for ToM, g = -0.98, CI = -1.41 to -0.55). Subgroup analysis also revealed significant impairment in ER for patients in a euthymic state (g = -0.75). Age, gender, sample size, the severity of mood symptoms, estimated IQ, the frequencies of bipolar-I disorder, attention-deficit hyperactivity disorder, medications, study quality and euthymia did not moderate the difference in meta-regression. Heterogeneity was low in all analyses and there was no evidence for publication bias.

CONCLUSION

The results of this meta-analysis supported the notion that PBD is associated with a deficit in social cognitive abilities at a medium to a large level. Impairments in social cognition could be an illness-related trait of PBD. Meta-regression results did not find a moderator of the deficits in social cognition.

Theory of Mind Deficits and Their Influence on Functional Impairment in Remitted Phase of Bipolar Disorder

BACKGROUND

Functional impairment has been convincingly established in the euthymic/ remitted phase of bipolar disorder (BD). Though deficits in social cognition, especially theory of mind (ToM), predict functional impairment, the association has not been consistently proven.

METHODS

Thirty remitted subjects with BD (as per DSM 5) and 30 age- and gender-matched healthy controls were screened for eligibility and the sociodemographic details and ToM scores, that is, first-order ToM, second-order ToM, and Faux pas, were collected. In subjects with BD, functioning was assessed using Functioning Assessment Short Test (FAST) and illness variables were collected.

RESULTS

No significant difference was found in occupation or education between the groups. Remitted subjects with BD had statistically significant deficits in all domains of ToM, that is, first-order ToM (r = 0.65), second-order ToM (r = 0.69), and Faux pas (r = 0.75). Significant correlations existed between first-order ToM and FAST total score, as well as second-order ToM and FAST total score, but the correlations dropped after controlling for duration of illness and number of depressive episodes. Quantile regression analysis showed that the only factors which predicted global functional impairment was a higher number of episodes (βτ= -0.45, SE = 3.51, t = 0.13, P = 0.04), while all other illness variables and ToM failed to predict the global functioning.

CONCLUSION

Though there seems to be an association between ToM and functioning, only illness variables predicted functional impairment in subjects with BD. We need prospective studies to delineate the contributors to functional impairment.

Impairment in Emotional Intelligence May Be Mood-Dependent in Bipolar I and Bipolar II Disorders

Background: An emotional intelligence (EI) deficit has been noticed in euthymic bipolar spectrum disorder (BD) patients. However, whether this deficit is affected by mood or subtype is unclear. Objectives:The aim of this study was to investigate whether an EI deficit is mood-dependent, and which mood symptoms have more impact on EI in BD. Methods: Two hundred and thirty participants aged between 18 and 65 years old were recruited [130 BD patients (51 bipolar I disorder (BDI) and 79 bipolar II disorder (BDII): 39.2% males; 91 healthy controls (HCs): 48.4% males)]. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), which contains experiential and strategic EI ratings, was used to assess social cognition. The Hamilton Depression Rating Scale (HDRS) and the Young's Mania Rating Scale (YMRS) were used for evaluating the severity [HAMD and YMRS scores ≦7 were euthymic (BDeut) and HAMD YMRS sores ≧8 were episodic (BDepi)]. Analyses of covariance (ANCOVA) were performed, with adjustment for background information between the BD patients and HCs. Results: The results showed that, compared to the HCs, the BDeut patients showed no difference in any MSCEIT measures, while the BDepi patients showed lower scores in all MSCEIT measures, except for perceiving emotions. In addition, a main effect of mood state instead of BD subtype was found for the managing emotions branch (p < 0.0007). Regression analyses showed that the duration of illness and HDRS scores were correlated with the scores in the strategic area of the MSCEIT, while age and YMRS scores were more relevant to the scores in the experiential area of the MSCEIT. Conclusion: The results confirm that an EI deficit is mood-dependent in BD patients. In addition, a depressive mood is more related to the strategic EI area, while a manic mood is correlated with the experiential EI area. Understanding the different domains of EI deficits in BD patients may be helpful for developing interventions for BD.

The activity and connectivity of the facial emotion processing neural circuitry in bipolar disorder: a systematic review

BACKGROUND

Facial emotion processing abnormalities may be a trait feature of bipolar disorder (BD). These social cognitive impairments may be due to alterations in the neural processing of facial affective information in visual ("core"), and limbic and prefrontal ("extended") networks, however, the precise neurobiological mechanism(s) underlying these symptoms are unclear.

METHODS

We conducted a systematic review to appraise the literature on the activity and connectivity of the facial emotion processing neural circuitry in BD. Two reviewers undertook a search of the electronic databases PubMed, Scopus and PsycINFO, to identify relevant literature published since inception up until September 2019. Study eligibility criteria included; BD participants, neuroimaging, and facial emotion processing tasks.

RESULTS

Out of an initial yield of 6121 articles, 66 were eligible for inclusion in this review. We identified differences in neural activity and connectivity within and between occipitotemporal, limbic, and prefrontal regions, in response to facial affective stimuli, in BD compared to healthy controls.

LIMITATIONS

The methodologies used across studies varied considerably.

CONCLUSIONS

The findings from this review suggest abnormalities in both the activity and connectivity of facial emotion processing neural circuitry in BD. It is recommended that future research aims to further define the connectivity and spatiotemporal course of neural events within and between occipitotemporal, limbic, and prefrontal regions.

Deficiencies in Theory of Mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: A systematic review of secondary literature

Deficiencies in Theory of Mind (ToM) are consistently found in individuals with schizophrenia (SZ), major depressive disorder (MDD), and bipolar disorder (BD). However, the character of these deficits and their role in the pathogenesis of mental illness remains poorly understood. This systematic review synthesizes the available secondary literature pertaining to ToM functioning in individuals with MDD, BD, or SZ, and their respective spectrum disorders in order to delineate disorder or symptom specific patterns of ToM impairment. Literature suggests that ToM deficits increase in severity along the affective-psychotic spectrum, with mild deficits in patients with MDD, and severe deficits in patients with mania or psychosis. Furthermore, ToM deficits appear to be part of a broader developmental phenotype associated with SZ and BD, as suggested by findings of attenuated impairments in ToM in remitted patients with SZ or BD, unaffected first-degree relatives of patients, and clinical high-risk groups. Future psychiatric research on ToM should aim to disentangle relationships between ToM deficits and specific symptom dimensions transdiagnostically, and employ standardized, construct-specific ToM tasks.

The social cognitive ability in Han Chinese euthymic patients with bipolar I and bipolar II disorder

BACKGROUND/PURPOSE

Although social cognitive deficits were found in euthymic patients of bipolar disorder (BD), the characteristics of social cognition in Han Chinese euthymic BD patients remain obscure. This study aimed to examine social cognition in Han Chinese euthymic BD patients relative to healthy controls (HC). Moreover, we explore the differences in social cognition between euthymic BD I and BD II patients.

METHODS

43 Han Chinese BD patients (BD-I:25, BD-II:18) and 28 HC were recruited. All patients were euthymic (Young Mania Rating Scale (YMRS) ≤ 7 and Hamilton Depression Rating Scale (HDRS) ≤ 7). Social cognitive ability was measured using Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), including 4 branches: perceiving emotions, facilitating emotions, understanding emotions, and managing emotions. Continuous performance Test (CPT) and Wisconsin Card Sorting Test (WCST) were used to examine attention and executive function.

RESULTS

Significant difference in understanding emotions branch of MSCEIT was found between BD patients and HCs (Mann-Whitney U test, p = 0.005). Besides, BD patients had significantly worse performance in WCST and CPT. However, the differences in WCST, CPT, MSCEIT total scores and its subscales were not significant between BD I and BD II patients.

CONCLUSION

Euthymic Han Chinese BD patients exhibit significant social cognitive deficits in understanding emotion and cognitive dysfunction in attention and executive function. Furthermore, Han Chinese BD I patients showed similar social cognitive and general cognitive ability as compared with BD II patients. Social cognitive rehabilitation on both euthymic BD I and II patients should be considered.

Cognitive theory of mind in bipolar disorder: Comparisons with healthy controls and associations with function

Cognitive forms of Theory of Mind (ToM) have been linked to social function in Bipolar Disorder (BD). To explore this social functioning was assessed with the GAF and cognitive ToM was assessed with the Hinting Task and the Picture Sequencing Task (PST) in 45 patients with BP and 45 healthy controls. As predicted, the BD group took longer to complete the PST. The BD group did not offer more incorrect responses to either cognitive ToM task. Greater latency on the PST predicted poorer social function after controlling for symptoms, partially supporting a relationship between ToM and social function in BD.

Aberrant cognition in newly diagnosed patients with bipolar disorder and their unaffected relatives

BACKGROUND

Patients with bipolar disorder (BD) experience persistent impairments in both affective and non-affective cognitive function, which is associated with a worse course of illness and poor functional outcomes. Nevertheless, the temporal progression of cognitive dysfunction in BD remains unclear and the identification of objective endophenotypes can inform the aetiology of BD.

METHODS

The present study is a cross-sectional investigation of cognitive baseline data from the longitudinal Bipolar Illness Onset-study. One hundred seventy-two remitted patients newly diagnosed with BD, 52 of their unaffected relatives (UR), and 110 healthy controls (HC) were compared on a large battery of behavioural cognitive tasks tapping into non-affective (i.e. neurocognitive) and affective (i.e. emotion processing and regulation) cognition.

RESULTS

Relative to HCs, patients with BD exhibited global neurocognitive deficits (ps < 0.001), as well as aberrant emotion processing and regulation (ps ⩽ 0.011); including decreased emotional reactivity to positive social scenarios, impaired ability to down-regulate positive emotion, as well as a specific deficit in the ability to recognise surprised facial expressions. Their URs also showed a trend towards difficulties identifying surprised faces (p = 0.075). No other differences in cognitive function were found for URs compared to HCs.

CONCLUSIONS

Neurocognitive deficits and impairments within emotion processing and regulation may be illness-related deficits of BD that present after illness-onset, whereas processing of emotional faces may represent an early risk marker of BD. However, longitudinal studies are needed to examine the association between cognitive impairments and illness progression in BD.

Emotional intelligence in bipolar-I-disorder: A comparison between patients, unaffected siblings, and control subjects

BACKGROUND

Impairments in social and nonsocial cognition have been demonstrated in both patients suffering from bipolar disorder (BD) and their unaffected relatives and might therefore represent a heritable marker of risk. This study investigated the relevance of emotional intelligence (EI) as part of the emotion processing domain of social cognition in this regard.

METHODS

A total of 54 outpatients suffering from BD, 54 unaffected siblings, and 80 control subjects were investigated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) and the Brief Assessment of Cognition in Schizophrenia (BACS). Analyses of covariance (ANCOVAs) were performed with adjustment for the BACS composite score. The three groups were compared by one-way analysis of variance or chi-square test, depending on the variable type. As the three groups differed significantly in their level of education, additional ANCOVAs with adjustment for education were performed.

RESULTS

Patients achieved significantly lower levels of overall EI and overall nonsocial cognitive functioning compared to unaffected siblings and controls, whereas performance of the latter two groups was comparable in both domains.

CONCLUSIONS

Due to comparable levels of EI in unaffected siblings of patients suffering from BD and control subjects, EI assessed by means of the MSCEIT does not represent an endophenotype for BD.

Emotional processing subtypes in bipolar disorder: A cluster analysis

BACKGROUND

Evidence regarding the performance of Bipolar Disorder patients (BD) on Emotional Processing (EP) is conflicting, suggesting that heterogeneity within this population may exist. It is not completely understood if this impacts on clinical presentation and functional outcomes.

METHODS

A total of 212 BD patients were recruited. Patients underwent MATRICS Consensus Cognitive Battery as well as a clinical evaluation to detect premorbid traits, comorbidities and clinical features. Performance on each basic emotion on the Emotional Recognition Task (ERT) and Reading the Mind in the Eyes Test were entered into hierarchical cluster analyses in order to determine the number of clusters and to assign subjects to specific clusters. We then compared subgroups on clinical factors and real-world community functioning.

RESULTS

No differences between BD patients as a group and controls were found in EP performance. Two clusters of BD patients were found, one with "intact" performance (71.2%) that performed as healthy controls (HC) and other with "impaired" performance (28.8%) performing worse than HC and schizophrenic patients on basic emotion recognition. Patients in the "impaired group" presented higher rates of childhood trauma, schizotypal traits, lower premorbid IQ and education, poor psychosocial functioning and cognitive performance.

LIMITATIONS

Cross-sectional data which limits our ability to infer directionality of our findings.

CONCLUSION

These results suggest the presence of two subgroups regarding EP performance with unique clinical and neurodevelopmental profiles associated. Next steps will include using these data to identify a homogeneous group of patients to target these disabling symptoms with treatment.

Cerebellar-Cortical Connectivity Is Linked to Social Cognition Trans-Diagnostically

Background: Psychotic disorders are characterized by impairment in social cognitive processing, which is associated with poorer community functioning. However, the neural mechanisms of social impairment in psychosis remain unclear. Social impairment is a hallmark of other psychiatric illnesses as well, including autism spectrum disorders (ASD), and the nature and degree of social cognitive impairments across psychotic disorders and ASD are similar, suggesting that mechanisms that are known to underpin social impairments in ASD may also play a role in the impairments seen in psychosis. Specifically, in both humans and animal models of ASD, a cerebellar-parietal network has been identified that is directly related to social cognition and social functioning. In this study we examined social cognition and resting-state brain connectivity in people with psychosis and in neurotypical adults. We hypothesized that social cognition would be most strongly associated with cerebellar-parietal connectivity, even when using a whole-brain data driven approach. Methods: We examined associations between brain connectivity and social cognition in a trans-diagnostic sample of people with psychosis (n = 81) and neurotypical controls (n = 45). Social cognition was assessed using the social cognition domain score of the MATRICS Consensus Cognitive Battery. We used a multivariate pattern analysis to correlate social cognition with resting-state functional connectivity at the individual voxel level. Results: This approach identified a circuit between right cerebellar Crus I, II and left parietal cortex as the strongest correlate of social cognitive performance. This connectivity-cognition result was observed in both people with psychotic disorders and in neurotypical adults. Conclusions: Using a data-driven whole brain approach we identified a cerebellar-parietal circuit that was robustly associated with social cognitive ability, consistent with findings from people with ASD and animal models. These findings suggest that this circuit may be marker of social cognitive impairment trans-diagnostically and support cerebellar-parietal connectivity as a potential therapeutic target for enhancing social cognition.

Understanding cognitive impairment in mood disorders: mediation analyses in the UK Biobank cohort

BACKGROUND

Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear.

AIMS

To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors.

METHOD

Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation.

RESULTS

Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range -0.23 to -0.17 (95% CI -0.39 to -0.03) across different estimation methods, and for the major depression group they were approximately -0.07 (95% CI -0.10 to -0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (-0.05; 95% CI -0.09 to -0.01). No evidence was found for mediation via cardiometabolic disease.

CONCLUSIONS

In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow.

DECLARATION OF INTEREST

I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.

Theory of mind in schizophrenia and bipolar disorder: psychometric properties of the Norwegian version of the Hinting Task

ABSTRACTIntroduction: The quality of measures used to assess theory of mind (ToM) in severe mental illness has not been sufficiently investigated. This study evaluated the psychometric properties of the Norwegian version of the Hinting Task in schizophrenia, bipolar I and II disorder and healthy controls.Methods: The study included 90 patients and 183 healthy controls. Internal consistency, ceiling effects, discriminatory power and concurrent and construct validity were investigated.Results: The Hinting Task displayed adequate levels of internal consistency for schizophrenia and bipolar I disorder. Ceiling effects emerged in all groups except the schizophrenia group. Schizophrenia patients scored significantly lower than all other groups, but no other significant group differences were detected. In the schizophrenia group, the Hinting Task's concurrent validity was substantiated by significant correlations with measures of neurocognition, symptoms and functional capacity. In the bipolar disorder groups, however, only a few significant relationships were found. Correlations between the Hinting Task and a measure of emotion recognition indicated that construct validity was higher for schizophrenia than bipolar disorder.Conclusions: The results suggest that the Norwegian Hinting Task is suited for use in schizophrenia research and assessment, but caution is warranted when using the test for other populations.

What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations

Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.

Social cognition in bipolar disorder: the role of sociodemographic, clinical, and neurocognitive variables in emotional intelligence

OBJECTIVE

The main aims of this study were to examine the differences in the Emotional Intelligence (EI), the emotional domain of social cognition (SC), between euthymic patients with bipolar disorder (BD) and healthy controls (HC) and to evaluate the contribution of sociodemographic, clinical, and neuropsychological variables to EI.

METHODS

We recruited 202 patients with BD and 50 HC. EI was evaluated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). The sociodemographic, clinical, and neurocognitive variables that showed a significant association with EI were entered into hierarchical multiple regression analysis.

RESULTS

BD patients obtained significantly lower scores compared to HC in the Emotional Intelligence Quotient (EIQ) and in the Understanding Emotions branch score. The best fitting model for the variables associated with EI in the patients group was a linear combination of gender, estimated IQ, family history of affective diagnosis, and executive function. The model, including these previous variables, explained up to 27.6% of the observed variance (R²  = 0.276, F = 16.406, P < 0.001).

CONCLUSIONS

The identification of variables associated with deficit in EI, such as male gender, lower estimated IQ, family history of affective diagnosis. and lower executive function performance, may help in selecting treatment targets to improve SC, and especially EI, in patients with BD.

Social cognition in first episode bipolar disorder patients

The aim of this study was to describe theory of mind (ToM) and emotional processing (EP) functioning in recently diagnosed bipolar disorder (BD). We evaluated 26 first episode BD (mean age 22.9 ± 7.4) and 26 controls matched on age, gender, education, and premorbid intelligence. A significant poorer performance on the capacity of patients to infer other's intentions (cognitive ToM) that was partially independent from neurocognitive deficits (p < 0.01) as well as a lower recognition of fear was observed among patients. No significant association between any of these deficits and psychosocial functioning emerged in multivariate regression analyses.

Facial emotion recognition, socio-occupational functioning and expressed emotions in schizophrenia versus bipolar disorder

Facial emotion recognition deficits have been consistently demonstrated in patients with severe mental disorders. Expressed emotion is found to be an important predictor of relapse. However, the relationship between facial emotion recognition abilities and expressed emotions and its influence on socio-occupational functioning in schizophrenia versus bipolar disorder has not been studied. In this study we examined 91 patients with schizophrenia and 71 with bipolar disorder for psychopathology, socio occupational functioning and emotion recognition abilities. Primary caregivers of 62 patients with schizophrenia and 49 with bipolar disorder were assessed on Family Attitude Questionnaire to assess their expressed emotions. Patients of schizophrenia and bipolar disorder performed similarly on the emotion recognition task. Patients with schizophrenia group experienced higher critical comments and had a poorer socio-occupational functioning as compared to patients with bipolar disorder. Poorer socio-occupational functioning in patients with schizophrenia was significantly associated with greater dissatisfaction in their caregivers. In patients with bipolar disorder, poorer emotion recognition scores significantly correlated with poorer adaptive living skills and greater hostility and dissatisfaction in their caregivers. The findings of our study suggest that emotion recognition abilities in patients with bipolar disorder are associated with negative expressed emotions leading to problems in adaptive living skills.

Translation and cross-cultural adaptation of the Brazilian Portuguese version of the Emotional Memory Scale

Background Emotional memory is an important type of memory that is triggered by positive and negative emotions. It is characterized by an enhanced memory for emotional stimuli which is usually coupled with a decrease in memory of neutral preceding events. Emotional memory is strongly associated with amygdala function and therefore could be disrupted in neuropsychiatric disorders. To our knowledge, there is no translated and culturally adapted instrument for the Brazilian Portuguese speaking population to assess emotional memory. Objective To report the translation and cross-cultural adaptation of a Brazilian Portuguese version of the Emotional Memory Scale, originally published by Strange et al. in 2003. Methods The author of the original scale provided 36 lists with 16 words each. Translation was performed by three independent bilingual translators. Healthy subjects assessed how semantically related each word was within the list (0 to 10) and what the emotional valence of each word was (-6 to +6). Lists without negative words were excluded (negative selection), most positive and most unrelated words were excluded (positive and semantic selection, respectively), and lists with low semantic relationship were excluded (semantic assessment). Results Five lists were excluded during negative selection, four words from each list were excluded in positive and semantic selection, and 11 lists were excluded during semantic assessment. Finally, we reached 20 lists of semantically related words; each list had one negative word and 11 neutral words. Conclusion A scale is now available to evaluate emotional memory in the Brazilian population and requires further validation on its psychometrics properties.

Reliability of two social cognition tests: The combined stories test and the social knowledge test

Deficits in social cognition are common in psychiatric disorders. Validated social cognition measures with good psychometric properties are necessary to assess and target social cognitive deficits. Two recent social cognition tests, the Combined Stories Test (COST) and the Social Knowledge Test (SKT), respectively assess theory of mind and social knowledge. Previous studies have shown good psychometric properties for these tests, but the test-retest reliability has never been documented. The aim of this study was to evaluate the test-retest reliability and the inter-rater reliability of the COST and the SKT. The COST and the SKT were administered twice to a group of forty-two healthy adults, with a delay of approximately four weeks between the assessments. Excellent test-retest reliability was observed for the COST, and a good test-retest reliability was observed for the SKT. There was no evidence of practice effect. Furthermore, an excellent inter-rater reliability was observed for both tests. This study shows a good reliability of the COST and the SKT that adds to the good validity previously reported for these two tests. These good psychometrics properties thus support that the COST and the SKT are adequate measures for the assessment of social cognition.

Neurocognitive features in clinical subgroups of bipolar disorder: A meta-analysis

OBJECTIVE

There is a significant cognitive heterogeneity in bipolar disorder (BD). The aim of this systematic review was to examine the potential distinctive neuropsychological of features of clinical subgroups of BD. A literature search investigating cognitive differences between potential subtypes of BD was conducted.

METHODS

It was possible to conduct a meta-analysis of studies investigating the relationship between cognitive deficits and subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)), subgroups based on history of psychosis (PBD and NPBD). The cognitive domains investigated in this meta-analysis included verbal memory, visual memory, processing speed, executive functions speed (EF-speed), EF-accuracy, attention, working memory, social cognition. Current meta-analysis included 48 reports and compared cognitive performances of 1211 BD-I and 836 BD-II patients. It also compared cognitive functioning in 1017 PBD and 744 NPBD patients.

RESULTS

Both history of psychosis (d = 0.19) and BD-I (d = 0.17) diagnosis were associated with modestly more pronounced global cognitive impairment. In specific domains, BD-I significantly underperformed BD-II in verbal memory, processing speed, EF-speed, EF-accuracy (d = 0.15-0.26). PBD was associated with significantly impaired cognition compared to NPBD in verbal memory, processing speed, EF-speed, EF-accuracy, working memory and social cognition (d = 0.12-0.28).

CONCLUSION

In BD, history of psychosis and full-manic episode are modestly associated with increased cognitive deficits. Neurocognitive differences between clinical subtypes of BD are quite subtle and are not distinctive. Furthermore, other factors reflecting differences in illness severity can explain observed between-group differences. Most of the cognitive heterogeneity in BD cannot be explained by proposed subtypes of BD.

Mentalization deficit in bipolar patients during an acute depressive and manic episode: association with cognitive functions

Background

A number of studies in bipolar patients have shown a deficit in mentalization (theory of mind), one of the main aspects of social cognition. The aim of current study was to assess both cognitive and affective mentalization in well-defined groups of depressed and manic bipolar patients, compared to healthy control subjects, using a battery of tests measuring mentalization processes. The second aim was to investigate a possible relationship between cognitive and affective mentalization and cognitive functions in bipolar patients during a depressive and manic episode.

Methods

The study involved 25 bipolar disorder type I patients (10 male, 15 female) during a depressive episode (mean 24 ± 2 points in the 17-item Hamilton Depression Rating Scale) and 25 patients (10 male, 15 female) during a manic episode (mean 27 ± 4 points in the Young Mania Rating Scale). The control group consisted of 25 healthy subjects (10 male, 15 female) without psychiatric disorders. To measure mentalization, a revised version of the Reading the Mind in the Eyes (R-MET), the Strange Stories (SS), the Faux Pas Recognition (FPR), and the Moving Shapes Paradigm (MSP) tests were used. Assessment of cognitive functioning was made using the Digit Span, Trail Making, and Wisconsin Card Sorting Tests.

Results

In bipolar patients significant deficits in both cognitive and affective mentalization were demonstrated during both acute depressive and manic episodes. The impairment in FPR in manic patients was more severe than that in the depressive ones. On the other hand, in MSP, manic patients showed significantly increased intentionality for non-mentalization animations, compared with depressive patients and for “cause and effect” animations compared with control subjects. A significant relationship was found between the decrease in cognitive and affective mentalization and deficits of cognitive functions during both the depressive and manic episodes.

Conclusions

The results obtained confirm the deficits of mentalization in bipolar I patients, during both acute depressive and manic episodes. We found that in such patients mentalization deficits significantly correlated with cognitive dysfunctions more so during depressive episodes.

Metacognitive profiles in schizophrenia and bipolar disorder: Comparisons with healthy controls and correlations with negative symptoms

While deficits in metacognition, or the ability to notice and reflect upon mental states has been observed in schizophrenia and linked with poorer concurrent and future function, it is unknown whether these deficits are unique to schizophrenia. Accordingly, this study assessed metacognition using the Metacognitive Assessment Scale-Abbreviated (MAS-A) and the Metacognitions Questionnaire- 30 (MCQ-30) among 26 adults with schizophrenia, 23 with bipolar disorder and 23 healthy controls. Symptom levels of the psychiatric groups were assessed with the Brief Psychiatric Rating Scale. ANCOVA controlling for age and education revealed that the schizophrenia group had lower scores on the MAS-A total and its subscales compared to the bipolar group and healthy controls. The bipolar disorder group also had lower MAS-A scores than the healthy control group. No group differences were found for the MCQ-30. Examination of symptom correlates revealed MAS-A scores were most commonly related to negative symptoms in both clinical groups. The total score and need for control subscale of MCQ-30 was related to total symptomatology and positive symptoms in patients with bipolar disorder. Correlations between the two measures of metacognition revealed that higher MAS-A scores were significantly related to lower scores on the Need to Control Thoughts MCQ-30 subscale.

Social cognition in bipolar disorder: Focus on emotional intelligence

BACKGROUND

The present study aims to characterize emotional intelligence (EI) variability in a sample of euthymic bipolar disorder (BD) patients through the Mayer- Salovey-Caruso Emotional Intelligence Test (MSCEIT).

METHOD

A total of 134 euthymic BD outpatients were recruited and divided into three groups according to the total Emotional Intelligence Quotient (EIQ) score of the MSCEIT, following a statistical criterion of scores 1.5SDs above/below the normative group mean, as follows: a low performance (LP) group (EIQ <85), a normal performance (NP) group (85≤EIQ≤115), and a high performance (HP) group (EIQ >115). Afterwards, main sociodemographic, clinical, functional and neurocognitive variables were compared between the groups.

RESULTS

Three groups were identified: 1) LP group (n=16, 12%), 2) NP group (n=93, 69%) and 3) HP group (n=25, 19%). There were significant differences between the groups in premorbid intelligence quotient (IQ) (p=0.010), axis II comorbidity (p=0.008), subthreshold depressive symptoms (p=0.027), general functioning (p=0.013) and in four specific functional domains: autonomy, occupation, interpersonal relations and leisure time. Significant differences in neurocognitive performance were found between groups with the LP group showing the lowest attainments.

LIMITATIONS

The cross-sectional design of the study.

CONCLUSION

Our results suggest that EI variability among BD patients, assessed through MSCEIT, is lower than expected. EI could be associated with premorbid IQ, subthreshold depressive symptoms, neurocognitive performance and general functioning. The identification of different profiles of SC may help guide specific interventions for distinct patient subgroups aimed at improving social cognition, neurocognitive performance and psychosocial functioning.

Cognitive Impairment in Bipolar Disorder: Treatment and Prevention Strategies

Over the last decade, there has been a growing appreciation of the importance of identifying and treating cognitive impairment associated with bipolar disorder, since it persists in remission periods. Evidence indicates that neurocognitive dysfunction may significantly influence patients' psychosocial outcomes. An ever-increasing body of research seeks to achieve a better understanding of potential moderators contributing to cognitive impairment in bipolar disorder in order to develop prevention strategies and effective treatments. This review provides an overview of the available data from studies examining treatments for cognitive dysfunction in bipolar disorder as well as potential novel treatments, from both pharmacological and psychological perspectives. All these data encourage the development of further studies to find effective strategies to prevent and treat cognitive impairment associated with bipolar disorder. These efforts may ultimately lead to an improvement of psychosocial functioning in these patients.

Disentangling Working Memory Functioning in Mood States of Bipolar Disorder: A Systematic Review

Working memory (WM) deficits are often reported in patients with Bipolar Disorder (BD). However, it is not clear about the nature of these WM deficits (update or serial order processes) and their association with each BD states (euthymic, mania, and depressive). This review investigated the association between BD patient's states and the functioning of WM components. For this purpose, we carried out a systematic review fulfilling a search in the databases Medline, Scopus, SciELO, and Web of Science using specific terms in the abstracts of the articles that generated 212 outcomes in the restricted period from 2005 to 2016. Twenty-three papers were selected, completely read, and analyzed using PICOS strategy. The mood episodes predicted deficits in different components of WM in BD patients (the phonological loop or visuospatial sketchpad) and were associated with different WM processes (updating and serial recall). Lower cognitive scores persist even in remission of symptoms. This result suggests that WM deficit apparently is stage-independent in BD patients. Furthermore, findings suggest that the neutral point on Hedonic Detector component of WM could be maladjusted by BD.

Social cognition in first-degree relatives of patients with bipolar disorder: A meta-analysis

Cognitive impairment is evident euthymic patients with bipolar disorder (BP) and in their first-degree relatives (BP-Rel). Increasing evidence suggests that BP is also associated with social cognitive impairment. It is important to establish whether social cognitive impairment is also evident in BP-Rel. A novel meta-analysis of theory of mind (ToM) and facial emotion recognition in BP-Rel including 16 studies (728 first-degree relatives of patients with BP and 865 healthy controls) was conducted. ToM (d=0.34, CI=0.16-0.52) was significantly impaired in BP-Rel. The effect size for the difference between BP-Rel and healthy controls was smaller for facial emotion recognition (d=0.17, CI=0.16-0.29) and could be nonsignificant after the effect of publication bias was taken into account. First-degree relatives of patients with BP underperform healthy subjects in social cognitive abilities, particularly in ToM. However, the effect size for between-group difference is small. ToM impairment might be a vulnerability marker of BP.

Emotion processing and psychosocial functioning in euthymic bipolar disorder

OBJECTIVE

To examine emotion processing in euthymic bipolar patients (EBP) compared to healthy controls. In addition, to determine whether or not there is an association between emotion processing and psychosocial functioning.

MATERIAL AND METHODS

A sample of 60 EBP and 60 healthy controls matched for age, gender, education level, and premorbid intelligence were studied. All subjects were assessed using the MATRICS Consensus Cognitive Battery (MCCB) and two additional executive function measures: the Trail Making Test-Part B and the Stroop Test. Emotion processing was examined using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Psychosocial functioning was assessed using the Functional Assessment Short Test (FAST).

RESULTS

Euthymic bipolar patients obtained lower scores than controls in all MSCEIT measures except for the using emotions branch. Likewise, EBP obtained a worse performance than healthy controls in all neurocognitive domains. Correlation between MSCEIT strategic area measures and FAST total score was found (r = -0.311; P < 0.016). Regression analysis showed that residual depressive symptomatology explains a 9.1% of the variance in functional outcome. MSCEIT strategic area score explained an additional 8.6%. Neurocognition did not increase the percentage of the variance explained by emotion processing.

CONCLUSIONS

Euthymic bipolar patients exhibit deficits in emotion processing. Emotion processing is associated with social functioning in these patients.

The effects of medication and current mood upon facial emotion recognition: findings from a large bipolar disorder cohort study

OBJECTIVES

Emotional processing abnormalities have been implicated in bipolar disorder (BD) but studies are typically small and uncontrolled. Here, facial expression recognition was explored in a large and naturalistically recruited cohort of BD patients.

METHODS

271 patients with BD completed the facial expression recognition task. The effects of current medication together with the influence of current mood state and diagnostic subtype were assessed whilst controlling for the effects of demographic variables.

RESULTS

Patients who were currently receiving treatment with lithium demonstrated significantly poorer accuracy in recognising angry faces, an effect that held in a monotherapy sub-analysis comparing those participants on lithium only and those who were medication-free. Accuracy in recognising angry faces was also lower amongst participants currently taking dopamine antagonists (antipsychotics). Higher levels of current depressive symptoms were linked to poorer accuracy at identifying happy faces.

CONCLUSION

Use of lithium and possibly dopamine antagonists may be associated with reduced processing of anger cues in BD. Findings support the existence of mood-congruent negative biases associated with depressive symptoms in BD. Observational cohort studies provide opportunities to explore the substantial effects of demographic, psychometric and clinical variables on cognitive performance and emotional processing.