Accuracy of emotion labeling in children of parents diagnosed with bipolar disorder

Facial emotion recognition in children of parents with a mental illness

Objective

Facial emotion recognition (FER) is a fundamental social skill essential for adaptive social behaviors, emotional development, and overall well-being. FER impairments have been linked to various mental disorders, making it a critical transdiagnostic mechanism influencing the development and trajectory of mental disorders. FER has also been found to play a role in the transgenerational transmission of mental disorders, with the majority of research suggesting FER impairments in children of parents with a mental illness (COPMI). Previous research primarily concentrated on COPMI of parents with internalizing disorders, which does not cover the full spectrum of outpatient mental health service populations. Furthermore, research focuses on varying components of FER by using different assessment paradigms, making it challenging to compare study results. To address these gaps, we comprehensively investigated FER abilities in COPMI using multiple tasks varying in task characteristics.

Methods

We included 189 children, 77 COPMI and 112 children of parents without a diagnosed mental illness (COPWMI), aged 6 to 16 years. We assessed FER using three tasks with varying task demands: an emotional Go/NoGo task, a morphing task, and a task presenting short video sequences depicting different emotions. We fitted separate two-level hierarchical Bayesian models (to account for sibling pairs in our sample) for reaction times and accuracy rates for each task. Good model fit was assured by comparing models using varying priors.

Results

Contrary to our expectations, our results revealed no general FER deficit in COPMI compared to COPWMI. The Bayesian models fitted for accuracy in the morphing task and Go/NoGo task yielded small yet significant effects. However, Bayes factors fitted for the models suggested that these effects could be due to random variations or noise in the data.

Conclusions

Our study does not support FER impairments as a general feature of COPMI. Instead, individual factors, such as the type of parental disorder and the timing of its onset, may play a crucial role in influencing FER development. Future research should consider these factors, taking into account the diverse landscape of parental mental 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.

Emotion Processing Deficit in Euthymic Bipolar Disorder: A Potential Endophenotype

BACKGROUND

Emotion processing deficits have been described in patients with bipolar disorder (BD) and are considered one of the core cognitive abnormalities in BD with endophenotype potential. However, the literature on specific impairments in emotion processing cognitive strategies (directive/cortical/higher versus intuitive/limbic/lower) in euthymic adult BD patients and healthy first-degree relatives/high-risk (HR) subjects in comparison with healthy controls (HCs) is sparse.

METHODS

We examined facial emotion recognition deficits (FERD) in BD (N = 30), HR (N = 21), and HC (N = 30) matched for age (years), years of education, and sex using computer-administered face emotions-Matching And Labeling Task (eMALT).

RESULTS

The three groups were significantly different based on labeling accuracy scores for fear and anger (FA) (P < 0.001) and sad and disgust (SD) (P < 0.001). On post-hoc analysis, HR subjects exhibited a significant deficit in the labeling accuracy of FA facial emotions (P < 0.001) compared to HC. The BD group was found to have significant differences in all FA (P = 0.004) and SD (P = 0.003) emotion matching as well as FA (P = 0.001) and SD (P < 0.001) emotion labeling accuracy scores.

CONCLUSIONS

BD in remission exhibits FERD in general, whereas specific labeling deficits of fear and anger emotions, indicating impaired directive higher order aspect of emotion processing, were demonstrated in HR subjects. This appears to be a potential endophenotype. These deficits could underlie the pathogenesis in BD, with possible frontolimbic circuitry impairment. They may have potential implications in functional recovery and prognosis of BD.

Facial emotion recognition deficits in patients with bipolar disorder and their healthy parents

BACKGROUND

There is evidence on deficits in facial emotion recognition (FER) in patients with bipolar disorder (BD), and these deficits may be present in individuals with genetic risk for BD. This study investigated facial emotion identification and discrimination abilities in patients with BD, their parents, and healthy controls.

MATERIALS AND METHODS

This study included 38 patients with bipolar I disorder and 30 healthy controls for patients as well as 30 healthy mothers and 30 healthy fathers of these patients and 30 healthy controls who matched the mothers and fathers for age, gender, and education (total 188 participants). Facial Emotion Identification and Discrimination Tests were applied to all participants; the Hamilton Depression Rating Scale and Young Mania Rating Scale were applied to patients and their control group.

RESULTS

Facial Emotion Identification and Discrimination Test scores of patients and their parents were reasonably lower than their matching control groups. Moreover, we found that difficulty in FER affected more emotions in mothers than in fathers and mothers performed significantly worse than patients in the identification of angry and embarrassed faces.

CONCLUSION

These findings indicate that parents of patients with BD have impairment with recognizing facial emotions and suggest that there may be an association between FER of patients with BD and that of their mothers.

A meta-analysis of neurocognition in youth with familial high risk for bipolar disorder

Objective:

Neuropsychological impairment, including deficits in social cognition is evident in subjects at genetic high-risk for psychosis. However, findings in youth at genetic risk to bipolar disorder (BP) have been suggested to be less supportive of premorbid deficits. We aimed to conduct a meta-analysis of cognitive deficits in youth with familiar risk for bipolar disorder (FHR-BD).

Methods:

A novel meta-analysis of FHR-BD (mean age 10–25), including 18 studies (786 offsprings/siblings of patients with BD and 794 healthy controls), was conducted.

Results:

Both general cognition (d = 0.29, CI = 0.15–0.44) and social cognition (d = 0.23, CI = 0–0.45) were impaired in FHR-BD. In comparison to controls, FHR-BD had significant deficits in several cognitive domains, including visual memory (d = 0.35), verbal memory (d = 0.21), processing speed (d = 0.26) and sustained attention (d = 0.36). There was no significant difference between FHR-BD and controls in planning and working memory.

Conclusions:

Cognitive deficits are evident in individuals who are at genetic high-risk for developing BD. Neurodevelopmental abnormalities are likely playing a role not only in schizophrenia but also in BD.

Neurocognition in young offspring of individuals with bipolar disorder: The role of co-existing familial and clinical high-risk for bipolar disorder

Bipolar disorder (BD) is associated with cognitive dysfunction which has also been reported in offspring of individuals with BD (BDoff). However, it remains unclear whether cognitive underperformance in BDoff is associated with the presence of history of subclinical syndromes associated with risk for BD. To address this knowledge gap we assessed executive function, visual and verbal memory, working memory, processing speed and verbal fluency in 21 offspring with clinical high risk (CHR; BDoff+CHR), 54 offspring without CHR (BDoff-non-CHR), and 50 healthy individuals without familial risk of BD. BDoff underperformed compared to controls in most cognitive tasks. There was no significant neurocognitive difference between BDoff+CHR and BDoff-non-CHR except in the fluency/central executive domain (Cohen's d = 0.60, p = 0.03). Our results suggest that cognitive dysfunction in multiple domains is associated with familial predisposition to BD regardless of CHR status. On the other hand, abnormalities in central executive processes might be more pronounced in BDoff+CHR than BDoff-non-CHR. Further longitudinal studies investigating cognitive trajectory of BDoff and its interaction with the emergence of subclinical syndromes are needed to fully characterize the relationship between cognition and mood dysregulation in BD.

Social Cognition, Language, and Social Behavior in 7-Year-Old Children at Familial High-Risk of Developing Schizophrenia or Bipolar Disorder: The Danish High Risk and Resilience Study VIA 7-A Population-Based Cohort Study

OBJECTIVE

To characterize social cognition, language, and social behavior as potentially shared vulnerability markers in children at familial high-risk of schizophrenia (FHR-SZ) and bipolar disorder (FHR-BP).

METHODS

The Danish High-Risk and Resilience Study VIA7 is a multisite population-based cohort of 522 7-year-old children extracted from the Danish registries. The population-based controls were matched to the FHR-SZ children on age, sex, and municipality. The FHR-BP group followed same inclusion criteria. Data were collected blinded to familial high-risk status. Outcomes were social cognition, language, and social behavior.

RESULTS

The analysis included 202 FHR-SZ children (girls: 46%), 120 FHR-BP children (girls: 46.7%), and 200 controls (girls: 46.5%). FHR-SZ children displayed significant deficits in language (receptive: d = -0.27, P = .006; pragmatic: d = -0.51, P < .001), social responsiveness (d = -0.54, P < .001), and adaptive social functioning (d = -0.47, P < .001) compared to controls after Bonferroni correction. Compared to FHR-BP children, FHR-SZ children performed significantly poorer on adaptive social functioning (d = -0.29, P = .007) after Bonferroni correction. FHR-BP and FHR-SZ children showed no significant social cognitive impairments compared to controls after Bonferroni correction.

CONCLUSION

Language, social responsiveness, and adaptive social functioning deficits seem associated with FHR-SZ but not FHR-BP in this developmental phase. The pattern of results suggests adaptive social functioning impairments may not be shared between FHR-BP and FHR-SZ in this developmental phase and thus not reflective of the shared risk factors for schizophrenia and bipolar disorder.

Is aberrant affective cognition an endophenotype for affective disorders? - A monozygotic twin study

BACKGROUND

Identification of endophenotypes can improve prevention, detection and development of new treatments. We therefore investigated whether aberrant affective cognition constitutes an endophenotype for affective disorders by being present in monozygotic (MZ) twins with unipolar or bipolar disorder in partial remission (i.e. affected) and their unaffected co-twins (i.e. high-risk) relative to twins with no family history of affective disorder (i.e. low-risk).

METHODS

We conducted an assessor blind cross-sectional study from 2014 to 2017 of MZ twins using Danish population-based registers in recruitment. Twins attended one test session involving neurocognitive testing, clinical ratings and questionnaires. Main outcomes were attention to and recognition of emotional facial expressions, the memory of emotional self-referential words, emotion regulation and coping strategies.

RESULTS

Participants were 103 affected, 44 high-risk and 36 low-risk MZ twins. Groups were demographically well-balanced and showed comparable non-affective cognitive performance. We observed no aberrant affective cognition in affected and high-risk relative to low-risk twins. However, high-risk twins displayed attentional avoidance of emotional faces (ps ⩽ 0.009) and more use of task-oriented coping strategies (p = 0.01) compared with affected twins. In contrast did affected twins show more emotion-oriented coping than high- and low-risk twins (ps ⩽ 0.004).

CONCLUSIONS

Our findings provide no support of aberrant affective cognition as an endophenotype for affective disorders. High-risk twins' attentional avoidance of emotional faces and greater use of task-oriented coping strategies may reflect compensatory mechanisms.

Neuropsychological Functioning and Temperament Traits in a Czech Sample of Children and Adolescents at Familial Risk of Bipolar Disorder

Background: Although a positive family history is the strongest predictor for bipolar disorder (BD), most offspring of BD parents (BO) will not develop the disorder. Identification of vulnerability markers for BD is essential for specific individual risk estimation. Impairments in cognitive functioning and the presence of specific temperament traits are considered promising candidates. Methods: Sixty-three BO (48% female; 11.8 ± 3.3 years) and 54 control offspring (CO; 44% female; 12.3 ± 3.2 years) comparable in sex (p = 0.4) and age (p = 0.4) were enrolled. Detection of current sub/threshold mood symptoms by the Kiddie Schedule for Affective Disorders and Schizophrenia and General Behavior Inventory was applied to separate BO into ultrahigh-risk (UHR) and high-risk (HR) subgroups. Cognitive functions were tested by the Developmental Neuropsychological Assessment II test battery, d2 Test of Attention, and Amsterdam Neuropsychological Tasks. Temperament was assessed by the Temperament in Middle Childhood and Early Adolescent Temperament Questionnaires. Results: The BO sample consisted of 5 BD, 17 UHR, and 41 HR participants. We did not observe any significant differences between the BO and CO groups or between the UHR, HR, and CO subgroups (Hedges' g = 0.21-0.39) in cognitive functioning. The BO differed significantly in some temperament traits from the CO (g = 0.42-0.61), while the UHR subgroup exhibited lower effortful control and attention focusing than both HR and CO participants (g = 0.92-1.19). Limitations: The cross-sectional design and wide age range of the sample limited our findings. Conclusions: Neuropsychological impairment does not seem to be a trait marker of BD in the premorbid stage. Temperament with low effortful control and low attention focusing might be associated with the development of mood disorders in BO.

Cortical abnormalities in bipolar disorder: an MRI analysis of 6503 individuals from the ENIGMA Bipolar Disorder Working Group

Despite decades of research, the pathophysiology of bipolar disorder (BD) is still not well understood. Structural brain differences have been associated with BD, but results from neuroimaging studies have been inconsistent. To address this, we performed the largest study to date of cortical gray matter thickness and surface area measures from brain magnetic resonance imaging scans of 6503 individuals including 1837 unrelated adults with BD and 2582 unrelated healthy controls for group differences while also examining the effects of commonly prescribed medications, age of illness onset, history of psychosis, mood state, age and sex differences on cortical regions. In BD, cortical gray matter was thinner in frontal, temporal and parietal regions of both brain hemispheres. BD had the strongest effects on left pars opercularis (Cohen's d=-0.293; P=1.71 × 10^-21), left fusiform gyrus (d=-0.288; P=8.25 × 10^-21) and left rostral middle frontal cortex (d=-0.276; P=2.99 × 10^-19). Longer duration of illness (after accounting for age at the time of scanning) was associated with reduced cortical thickness in frontal, medial parietal and occipital regions. We found that several commonly prescribed medications, including lithium, antiepileptic and antipsychotic treatment showed significant associations with cortical thickness and surface area, even after accounting for patients who received multiple medications. We found evidence of reduced cortical surface area associated with a history of psychosis but no associations with mood state at the time of scanning. Our analysis revealed previously undetected associations and provides an extensive analysis of potential confounding variables in neuroimaging studies of 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.

Facial emotion labeling in unaffected offspring of adults with bipolar I disorder

BACKGROUND

Young people 'at risk' for developing Bipolar Disorder have been shown to have deficits in facial emotion labeling across emotions with some studies reporting deficits for one or more particular emotions. However, these have included a heterogeneous group of young people (siblings of adolescents and offspring of adults with bipolar disorder), who have themselves diagnosed psychopathology (mood disorders and neurodevelopmental disorders including ADHD).

METHODS

24 offspring of adults with bipolar I disorder and 34 offspring of healthy controls were administered the Diagnostic Analysis of Non Verbal Accuracy 2 (DANVA 2) to investigate the ability of participants to correctly label 4 emotions: happy, sad, fear and anger using both child and adult faces as stimuli at low and high intensity.

RESULTS

Mixed effects modelling revealed that the offspring of adults with bipolar I disorder made more errors in both the overall recognition of facial emotions and the specific recognition of fear compared with the offspring of healthy controls. Further more errors were made by offspring that were male, younger in age and also in recognition of emotions using 'child' stimuli.

LIMITATIONS

The sample size, lack of blinding of the study team and the absence of any stimuli that assess subjects' response to a neutral emotional stimulus are limitations of the study.

CONCLUSIONS

Offspring (with no history of current or past psychopathology or psychotropic medication) of adults with bipolar I disorder displayed facial emotion labeling deficits (particularly fear) suggesting facial emotion labeling may be an endophenotype for bipolar disorder.

Neurobiology of Risk for Bipolar Disorder

Bipolar disorder (BD) is a chronic mental illness which follows a relapsing and remitting course and requires lifetime treatment. The lack of biological markers for BD is a major difficulty in clinical practice. Exploring multiple endophenotypes to fit in multivariate genetic models for BD is an important element in the process of finding tools to facilitate early diagnosis, early intervention, prevention of new episodes, and follow-up of treatment response in BD. Reviewing of studies on neuroimaging, neurocognition, and biochemical parameters in populations with high genetic risk for the illness can yield an integrative perspective on the neurobiology of risk for BD. The most up-to-date data reveals consistent deficits in executive function, response inhibition, verbal memory/learning, verbal fluency, and processing speed in risk groups for BD. Functional magnetic resonance imaging (fMRI) studies report alterations in the activity of the inferior frontal gyrus, medial prefrontal cortex, and limbic areas, particularly in the amygdala in unaffected first-degree relatives (FDR) of BD compared to healthy controls. Risk groups for BD also present altered immune and neurochemical modulation. Despite inconsistencies, accumulating data reveals cognitive and imaging markers for risk and to a less extent resilience of BD. Findings on neural modulation markers are preliminary and require further studies. Although the knowledge on the neurobiology of risk for BD has been inadequate to provide benefits for clinical practice, further studies on structural and functional changes in the brain, neurocognitive functioning, and neurochemical modulation have a potential to reveal biomarkers for risk and resilience for BD. Multimodal, multicenter, population-based studies with large sample size allowing for homogeneous subgroup analyses will immensely contribute to the elucidation of biological markers for risk for BD in an integrative model.