Differential impairment of social cognition factors in bipolar disorder with and without psychotic features and schizophrenia

Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression

The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.

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.

Are There Any Differences in Clinical and Biochemical Variables between Bipolar Patients with or without Lifetime Psychotic Symptoms?

INTRODUCTION

Psychotic symptoms occur in more than half of patients affected by Bipolar Disorder (BD) and are associated with an unfavorable course of the disorder. The objective of this study is to identify the differences in the clinical and biochemical parameters between bipolar patients with or without psychotic symptoms.

METHODS

A total of 665 inpatients were recruited. Demographic, clinical, and biochemical data related to the first day of hospitalization were obtained via a screening of the clinical charts and intranet hospital applications. The two groups identified via the lifetime presence of psychotic symptoms were compared using t tests for quantitative variables and χ2 tests for qualitative ones; binary logistic regression models were subsequently performed.

RESULTS

Patients with psychotic BD (compared to non-psychotic ones) showed a longer duration of hospitalization (p < 0.001), higher Young Mania Rating Scale scores (p < 0.001), lower Global Assessment of Functioning scores (p = 0.002), a less frequent history of lifetime suicide attempts (p = 0.019), less achievement of remission during the current hospitalization (p = 0.028), and a higher Neutrophile to Lymphocyte Ratio (NLR) (p = 0.006), but lower total cholesterol (p = 0.018) and triglycerides (p = 0.013).

CONCLUSIONS

Patients with psychotic BD have a different clinical and biochemical profile compared to their counterparts, characterized by more clinical severity, fewer metabolic alterations, and a higher grade of inflammation. Further multi-center studies have to confirm the results of this present study.

Cognition, prior aggression, and psychopathic traits in relation to impaired multimodal emotion recognition in psychotic spectrum disorders

Background

Psychopathic traits have been associated with impaired emotion recognition in criminal, clinical and community samples. A recent study however, suggested that cognitive impairment reduced the relationship between psychopathy and emotion recognition. We therefore investigated if reasoning ability and psychomotor speed were impacting emotion recognition in individuals with psychotic spectrum disorders (PSD) with and without a history of aggression, as well as in healthy individuals, more than self-rated psychopathy ratings on the Triarchic Psychopathy Measure (TriPM).

Methods

Eighty individuals with PSD (schizophrenia, schizoaffective disorder, delusional disorder, other psychoses, psychotic bipolar disorder) and documented history of aggression (PSD+Agg) were compared with 54 individuals with PSD without prior aggression (PSD-Agg) and with 86 healthy individuals on the Emotion Recognition Assessment in Multiple Modalities (ERAM test). Individuals were psychiatrically stable and in remission from possible substance use disorders. Scaled scores on matrix reasoning, averages of dominant hand psychomotor speed and self-rated TriPM scores were obtained.

Results

Associations existed between low reasoning ability, low psychomotor speed, patient status and prior aggression with total accuracy on the ERAM test. PSD groups performed worse than the healthy group. Whole group correlations between total and subscale scores of TriPM to ERAM were found, but no associations with TriPM scores within each group or in general linear models when accounting for reasoning ability, psychomotor speed, understanding of emotion words and prior aggression.

Conclusion

Self-rated psychopathy was not independently linked to emotion recognition in PSD groups when considering prior aggression, patient status, reasoning ability, psychomotor speed and emotion word understanding.

Early growth response 2 in the mPFC regulates mouse social and cooperative behaviors

Adolescent social neglect impairs social performance, but the underlying molecular mechanisms remain unclear. Here we report that isolation rearing of juvenile mice caused cooperation defects that were rescued by immediate social reintroduction. We also identified the transcription factor early growth response 2 (Egr2) in the medial prefrontal cortex (mPFC) as a major target of social isolation and resocialization. Isolation rearing increased corticosteroid production, which reduced the expression of Egr2 in the mPFC, including in oligodendrocytes. Overexpressing Egr2 ubiquitously in the mPFC, but not specifically in neurons nor in oligodendroglia, protected mice from the isolation rearing-induced cooperation defect. In addition to synapse integrity, Egr2 also regulated the development of oligodendroglia, specifically the transition from undifferentiated oligodendrocyte precursor cells to premyelinating oligodendrocytes. In conclusion, this study reveals the importance of mPFC Egr2 in the cooperative behavior that is modulated by social experience, and its unexpected role in oligodendrocyte development.

Real-time facial emotion recognition deficits across the psychosis spectrum: A B-SNIP Study

Affective and non-affective psychotic disorders are associated with variable levels of impairment in affective processing, but this domain typically has been examined via presentation of static facial images. We compared performance on a dynamic facial expression identification task across six emotions (sad, fear, surprise, disgust, anger, happy) in individuals with psychotic disorders (bipolar with psychotic features [PBD] = 113, schizoaffective [SAD] = 163, schizophrenia [SZ] = 181) and healthy controls (HC; n = 236) derived from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP). These same individuals with psychotic disorders were also grouped by B-SNIP-derived Biotype (Biotype 1 [B1] = 115, Biotype 2 [B2] = 132, Biotype 3 [B3] = 158), derived from a cluster analysis applied to a large biomarker panel that did not include the current data. Irrespective of the depicted emotion, groups differed in accuracy of emotion identification (P < 0.0001). The SZ group demonstrated lower accuracy versus HC and PBD groups; the SAD group was less accurate than the HC group (Ps < 0.02). Similar overall group differences were evident in speed of identifying emotional expressions. Controlling for general cognitive ability did not eliminate most group differences on accuracy but eliminated almost all group differences on reaction time for emotion identification. Results from the Biotype groups indicated that B1 and B2 had more severe deficits in emotion recognition than HC and B3, meanwhile B3 did not show significant deficits. In sum, this characterization of facial emotion recognition deficits adds to our emerging understanding of social/emotional deficits across the psychosis spectrum.

Higher order theory of mind in patients with bipolar disorder and schizophrenia/schizoaffective disorder

Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition (p < 0.001, [Formula: see text] = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores (R² = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance (R² = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.

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.

Aberrant activation of the mentalizing brain system during eye gaze discrimination in bipolar disorder

Bipolar disorder (BD) is associated with a range of social cognitive deficits. This study investigated the functioning of the mentalizing brain system in BD probed by an eye gaze perception task during fMRI. Compared with healthy controls (n = 21), BD participants (n = 14) showed reduced preferential activation for self-directed gaze discrimination in the medial prefrontal cortex (mPFC) and temporo-parietal junction (TPJ), which was associated with poorer cognition/social cognition. Aberrant functions of the mentalizing system should be further investigated as marker of social dysfunction and treatment targets.

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

BACKGROUND

Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences.

METHODS

120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions.

RESULTS

Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief.

LIMITATIONS

The cross-sectional design does not allow for causal inferences.

CONCLUSION

BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.

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.

Comparison of social cognition using an adapted Chinese version of the Reading the Mind in the Eyes Test in drug-naive and regularly medicated individuals with chronic schizophrenia and healthy controls in rural China

BACKGROUND

Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling.

METHODS

We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as 'successfully completed' or 'incomplete'. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China.

RESULTS

In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age ('educated-younger' v. 'undereducated-older') show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant.

CONCLUSIONS

We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully.

Social cognition in first-degree relatives of bipolar disorder: Theory of Mind and nonverbal sensitivity

Social cognition might be impaired in first degree relatives (FDR) of BD but existing research shows controversial results about social cognitive impairments in this population. The aim of this study was to assess Theory of Mind (ToM) and nonverbal sensitivity in FDR of BD and compare the results with those of two groups of persons with remitted bipolar disorder (BD), type I and II, and a control group. Social cognitive ability was examined in first degree relatives of BD, with a biological parent, offspring or sibling diagnosed with the disorder. For this study, 37 FDRs of bipolar patients, 37 BD I, 40 BD II and 40 control participants were recruited. Social cognition was explored by means of the Reading the Mind in the Eyes Test and the MiniPONS. Results showed a significant impairment in FDR of BD in the ToM task, but not in nonverbal sensitivity. Performance of FDRs in social cognition is better than that of BDs (either type I or type II) but worse when compared with that of healthy individuals without a family history of psychiatric disorders. Nevertheless, no differences were found between BD I and BD II groups. Males and older participants showed a worse performance in all groups. Group family therapy with FDRs of BD might include training in the recognition of nonverbal cues, which might increase the understanding of their familiars with BD, in order to modify communication abilities.

Social Cognition in Children With ADHD

Objective: Despite evidence of social skill deficits in children with ADHD, there is no consensus regarding a social cognitive profile and whether these skills predict behavior. Therefore, a comprehensive battery was used to investigate the relationship between social cognition and behavioral functioning. Method: Children ages 7 to 13 with ADHD (n = 25) and controls (n = 25) completed tests assessing social cognitive domains (affect recognition and theory of mind [ToM]). Parents completed measures of social cognition (pragmatic language ability and empathy), behavioral symptoms, and adaptive functioning. Results: Children with ADHD performed significantly worse on measures of cognitive ToM and affect recognition and received lower ratings of pragmatic language and cognitive empathy than typically developing peers. These domains, particularly pragmatic language, predicted parent ratings of problematic and adaptive behaviors. Conclusion: Results establish a relationship between specific social cognitive abilities and daily functioning, which has implications for treatment.

The impact of neurocognition on mentalizing in euthymic bipolar disorder versus schizophrenia

Introduction: Theory of mind (ToM) or mentalizing deficits have been found in schizophrenia (SZ) and bipolar disorder (BD), but their relationships to patients' coexistent neurocognitive deficits are still unclear. The present study aimed to explore the possible differential involvement of neurocognitive deficits in ToM impairments in SZ and euthymic BD. Methods: Fifty-three euthymic patients with BD type I, 54 clinically stable patients with SZ, and 53 healthy participants were assessed with an advanced ToM task (Faux Pas Recognition Test) which measures cognitive and affective ToM components, and a comprehensive battery of neuropsychological measures. The three groups were matched for gender, age and education. Results: Patients with BD showed significant impairment, comparable to that in SZ, only in the cognitive facet of ToM, whereas SZ patients had significantly poorer performance than both BD patients and healthy participants in overall and affective ToM. In both SZ and euthymic BD, ToM performance was related to deficits in particular cognitive functions. After controlling for coexistent neurocognitive deficits, overall and affective ToM in SZ were still impaired whereas the cognitive ToM impairment in BD and SZ did not remained statistically significant. Conclusions: Our findings suggest a different profile of ToM deficits between SZ and BD and an independence of ToM dysfunction from concurrent neurocognitive deficits in SZ but not in BD.

Distinguishing patterns of impairment on inhibitory control and general cognitive ability among bipolar with and without psychosis, schizophrenia, and schizoaffective disorder

BACKGROUND

Deficits in inhibitory control on a Stop Signal Task (SST) were previously observed to be of similar magnitude across schizophrenia, schizoaffective, and bipolar disorder with psychosis, despite variation in general cognitive ability. Understanding different patterns of performance on the SST may elucidate different pathways to the impaired inhibitory control each group displayed. Comparing nonpsychotic bipolar disorder to the psychosis groups on SST may also expand our understanding of the shared neurobiology of this illness spectrum.

METHODS

We tested schizophrenia (n = 220), schizoaffective (n = 216), bipolar disorder with (n = 192) and without psychosis (n = 67), and 280 healthy comparison participants with a SST and the Brief Assessment of Cognition in Schizophrenia (BACS), a measure of general cognitive ability.

RESULTS

All patient groups had a similar degree of impaired inhibitory control over prepotent responses. However, bipolar groups differed from schizophrenia and schizoaffective groups in showing speeded responses and inhibition errors that were not accounted for by general cognitive ability. Schizophrenia and schizoaffective groups had a broader set of deficits on inhibition and greater general cognitive deficit, which fully accounted for the inhibition deficits. No differences were found between the clinically well-matched bipolar with and without psychosis groups, including for inhibitory control or general cognitive ability.

CONCLUSIONS

We conclude that 1) while impaired inhibitory control on a SST is of similar magnitude across the schizo-bipolar spectrum, including nonpsychotic bipolar, different mechanisms may underlie the impairments, and 2) history of psychosis in bipolar disorder does not differentially impact inhibitory behavioral control or general cognitive abilities.

Electrophysiological correlates of emotional scene processing in bipolar disorder

Emotional dysfunction is a core feature of bipolar I disorder (BD). Behavioral data suggest that emotional processing may differ based on history of psychosis, but physiological studies frequently disregard this differentiating feature. Face processing studies indicate that emotion-related components of event-related potentials (ERPs) are abnormal in BD, but fMRI data using emotional scenes are mixed. The current study used ERPs to examine emotional scene perception in BD with and without a history of psychosis (BDP, BDNP). 386 participants from the PARDIP consortium (HC = 181, BDP = 130, BDNP = 75) viewed neutral, pleasant, and unpleasant scenes from the International Affective Picture System (IAPS) during continuous EEG recording. The early posterior negativity (EPN) and late positive potential (LPP) were examined for group and stimulus effects. Analyses were conducted for groups on and off medications to examine associations between medication status, psychosis, and ERP response. Group differences were found between HC and BD in emotional modulation of the EPN and between HC and BDP in the LPP to pleasant images. There was a significant interaction between psychosis history and anticonvulsant status in the EPN, but no other medication associations were found. The relationship between neural/self-reported emotional responses and clinical symptoms were examined with canonical correlations, but no significant associations were found. Results from this large well characterized sample indicate mild deviations in neural reactivity related to medication, mood, and psychosis history. However, processing of emotional scenes appears mostly intact in individuals with BD regardless of symptom severity.

The relationship between performance in a theory of mind task and intrinsic functional connectivity in youth with early onset psychosis

Psychotic disorders are characterized by theory of mind (ToM) impairment. Although ToM undergoes maturational changes throughout adolescence, there is a lack of studies examining ToM performance and its brain functional correlates in individuals with an early onset of psychosis (EOP; onset prior to age 18), and its relationship with age. Twenty-seven individuals with EOP were compared with 41 healthy volunteers using the "Reading-the-Mind-in-the-Eyes" Test, as a measure of ToM performance. A resting-state functional MRI scan was also acquired, in which the default mode network was used to identify areas relevant to ToM processing employing independent component analysis. Group effects revealed worse ToM performance and less intrinsic functional connectivity in the medial prefrontal cortex in EOP relative to healthy volunteers. Group by age interaction revealed age-positive associations in ToM task performance and in intrinsic connectivity in the medial prefrontal cortex in healthy volunteers, which were not present in EOP. Differences in ToM performance were partially mediated by intrinsic functional connectivity in the medial prefrontal cortex. Poorer ToM performance in EOP, coupled with less medial prefrontal cortex connectivity, could be associated with the impact of psychosis during a critical period of development of the social brain, limiting normative age-related maturation.

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.

Theory of mind in remitted bipolar disorder: Interpersonal accuracy in recognition of dynamic nonverbal signals

A relatively unexplored aspect in bipolar disorder (BD) is the ability to accurately judge other´s nonverbal behavior. To explore this aspect of social cognition in this population is particularly meaningful, as it may have an influence in their social and interpersonal functioning. The aim of this research was to study interpersonal accuracy (IPA) in remitted BDs, that is, the specific skills that fall under the general term Theory of Mind (ToM). Study participants included 119 remitted individuals with BD (70 BD I and 49 BD II), and they were compared with a group of 39 persons diagnosed with unipolar depression (UD) and 119 control participants. The MiniPONS was used to test the whole spectrum of nonverbal cues as facial expressions, body language and voice. Results indicated a superiority of the control group with statistically significant differences both in the performance in the MiniPONS (number of right answers) and in each of the areas evaluated by this test. BD groups, in recognition of the meaning of gestures in face, body and voice intonation, performed significantly worse than controls. ANCOVA analysis controlling the effect of age shows that control group performed significantly better compared to clinical groups, and there were no differences between UD and BD groups. The results indicate a deficit in IPA and suggest that better comprehension of deficiencies in interpersonal accuracy in BD may help to develop new training programs to improve in these patients the understanding of others, which might have a positive impact in their psychosocial functionality, and thus lead to the objective of functional rehabilitation.

Lower- and Higher-Level Social Cognitive Factors Across Individuals With Schizophrenia Spectrum Disorders and Healthy Controls: Relationship With Neurocognition and Functional Outcome

BACKGROUND

Schizophrenia spectrum disorders (SSDs) often feature social cognitive deficits. However, little work has focused on the factor structure of social cognition, and results have been inconsistent in schizophrenia. This study aimed to elucidate the factor structure of social cognition across people with SSDs and healthy controls. It was hypothesized that a 2-factor model, including lower-level "simulation" and higher-level "mentalizing" factors, would demonstrate the best fit across participants.

METHODS

Participants with SSDs (N = 164) and healthy controls (N = 102) completed social cognitive tasks ranging from emotion recognition to complex mental state inference, as well as clinical and functional outcome, and neurocognitive measures. Structural equation modeling was used to test social cognitive models, models of social cognition and neurocognition, measurement invariance between cases and controls, and relationships with outcome measures.

RESULTS

A 2-factor (simulation and mentalizing) model fit the social cognitive data best across participants and showed adequate measurement invariance in both SSD and control groups. Patients showed lower simulation and mentalizing scores than controls, but only mentalizing was significantly associated with negative symptoms and functional outcome. Social cognition also mediated the relationship between neurocognition and both negative symptoms and functional outcome.

CONCLUSIONS

These results uniquely indicate that distinct lower- and higher-level aspects of social cognition exist across SSDs and healthy controls. Further, mentalizing may be particularly linked to negative symptoms and functional outcome. This informs future studies of the neural circuitry underlying social cognition and the development of targeted treatment options for improving functional outcome.

The relationship between "Eyes Reading" ability and verbal memory in bipolar disorder

In psychiatric disorders, neurocognitive impairments are prevalent and have been associated with poor outcome. Deficits in Theory of Mind (ToM, "mentalising") have also been observed in bipolar disorder (BD); however, the literature shows inconsistent data. The aim of this study was to explore ToM performance in a well-characterized sample of euthymic individuals with BD and its relationship with neurocognitive function. One hundred sixteen euthymic patients with BD between 18 and 74 years (mean age = 42.4, SD = 13.8) and 79 healthy controls (mean age = 39.8, SD = 16.5) were investigated with an extensive neurocognitive test battery (Trail Making Test A/B, d2 Test of Attention, Stroop Color-Word Test, California Verbal Learning Test, Multiple Choice Vocabulary Test). Additionally, all participants were given the Reading the Mind in the Eyes Test (RMET) to measure affective ToM, the ability to make assumptions about other people´s feelings. Overall, "Eyes Reading" performance was not impaired in individuals with BD compared with controls. However, a significant relationship between RMET and verbal memory in BD was shown, particularly in males. Data showed worse RMET performance in patients with memory deficits compared to patients without memory deficits and controls. Due to cross-sectional data, no conclusions can be made with respect to cause and effect.

Theory of mind impairment and its clinical correlates in patients with schizophrenia, major depressive disorder and bipolar disorder

BACKGROUND

Although Theory of Mind (ToM) impairment has been observed in patients with a wide range of mental disorders, the similarity and uniqueness of these deficits across diagnostic groups has not been thoroughly investigated.

METHODS

We recruited 35 participants with schizophrenia (SCZ), 35 with bipolar disorder (BD), 35 with major depressive disorder (MDD), and 35 healthy controls in this study. All participants were matched in age, gender proportion and IQ estimates. The Yoni task, capturing both the cognitive and affective components of ToM at the first- and second-order level was administered. Repeated-measure ANOVA and MANOVA were conducted to compare the group differences in ToM performance. A network was then constructed with ToM performances, psychotic and depressive symptoms, and executive function as nodes exploring the clinical correlates of ToM.

RESULTS

Overall, ToM impairments were observed in all patient groups compared with healthy controls, with patients with SCZ performing worse than those with BD. In second-order conditions, patients with SCZ and MDD showed deficits in both cognitive and affective conditions, while patients with BD performed significantly poorer in cognitive conditions. Network analysis showed that second-order affective ToM performance was associated with psychotic and depressive symptoms as well as executive dysfunction, while second-order affective ToM performance and negative symptoms showed relatively high centrality in the network.

CONCLUSIONS

Patients with SCZ, MDD and BD exhibited different types and severity of impairments in ToM sub-components. Impairment in higher-order affective ToM appears to be closely related to clinical symptoms in both psychotic and affective disorders.

What your eyes tell me: Theory of mind in bipolar disorder

The aim of this study was to assess social- perceptual Theory of Mind in bipolar disorder (BD). 112 euthymic participants with BD I or BD II (65 with BD I and 47 with BD II) were compared to a group of 112 persons with no psychiatric diagnosis and 43 with unipolar depression (UD). They completed the task of the "Reading the Mind in the Eyes" (RMET). The results show that participants with BD, I and II, as well as the group with UD performed significantly more poorly than the control group. As for the wrong answers, BDs mostly chose positive valence stimuli, while the UD group chose negative valence items. The main limitation of this research is related to the characteristics of the cross-sectional study. It cannot detect at what time of the disorder these differences in emotion processing will appear with more intensity. As for future research, we suggest interventions to improve the deficits in ToM in bipolar persons. The use of the RMET in the first stages of BD II could help to facilitate a correct diagnosis.

Toward a Two-Dimensional Model of Social Cognition in Clinical Neuropsychology: A Systematic Review of Factor Structure Studies

OBJECTIVE

Social cognition has received growing interest in many conditions in recent years. However, this construct still suffers from a considerable lack of consensus, especially regarding the dimensions to be studied and the resulting methodology of clinical assessment. Our review aims to clarify the distinctiveness of the dimensions of social cognition.

METHOD

Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, a systematic review was conducted to explore the factor structure of social cognition in the adult general and clinical populations.

RESULTS

The initial search provided 441 articles published between January 1982 and March 2017. Eleven studies were included, all conducted in psychiatric populations and/or healthy participants. Most studies were in favor of a two-factor solution. Four studies drew a distinction between low-level (e.g., facial emotion/prosody recognition) and high-level (e.g., theory of mind) information processing. Four others reported a distinction between affective (e.g., facial emotion/prosody recognition) and cognitive (e.g., false beliefs) information processing. Interestingly, attributional style was frequently reported as an additional separate factor of social cognition.

CONCLUSIONS

Results of factor analyses add further support for the relevance of models differentiating level of information processing (low- vs. high-level) from nature of processed information (affective vs. cognitive). These results add to a significant body of empirical evidence from developmental, clinical research and neuroimaging studies. We argue the relevance of integrating low- versus high-level processing with affective and cognitive processing in a two-dimensional model of social cognition that would be useful for future research and clinical practice. (JINS, 2018, 24, 391-404).

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.

Eye gaze perception in bipolar disorder: Self-referential bias but intact perceptual sensitivity

OBJECTIVES

Deficits in social cognition predict poor functional outcome in severe mental illnesses such as schizophrenia and autism. However, research findings on social cognition in bipolar disorder (BD) are sparse and inconsistent. This study aimed to characterize a critical social cognitive process-eye gaze perception-and examine its functional correlates in BD to inform psychopathological mechanisms.

METHODS

Thirty participants with BD, 37 healthy controls (HC), and 46 psychiatric controls with schizophrenia (SZ) completed an eye-contact perception task. They viewed faces with varying gaze directions, head orientations, and emotion, and made eye-contact judgments. Psychophysics methods were used to estimate perception thresholds and the slope of the perception curve, which were then compared between the groups and correlated with clinical and functional measures using Bayesian inference.

RESULTS

Compared with HC, patients with BD over-perceived eye contact when gaze direction was ambiguous, and this self-referential bias was similar to that in SZ. Patients with BD had lower thresholds (i.e., needed weaker eye-contact signal to start perceiving gaze as self-directed) but a similar slope compared with HC. Regression analyses showed that steeper slope predicted better socio-emotional functioning in HC and SZ, but not in BD.

CONCLUSIONS

The psychopathology of social dysfunction was fundamentally different between BD and SZ in this modest sample. Eye gaze perception in BD was characterized by a self-referential bias but preserved perceptual sensitivity, the latter of which distinguished BD from SZ. The relationship between gaze perception and broader socio-emotional functioning in SZ and HC was absent in BD.

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.

Social cognition in neuropsychiatric populations: a comparison of theory of mind in schizophrenia and mesial temporal lobe epilepsy

Social cognition deficits are observed both in patients with schizophrenia (SCZ) and in patients with mesial temporal lobe epilepsy (MTLE). This may be due to dysfunction of the amygdala network, which is a common feature of both diseases. In this study, SCZ (n = 48) or MTLE (n = 31) and healthy controls (HC, n = 47) completed assessments of mentalising (Reading Mind in the Eyes Test, RMET) and basic cognitive processing, e.g., working memory, executive functions and psychomotor speed (Trail-Making Test B and Digit Symbol). SCZ were also assessed with the Positive And Negative Syndrome Scale (PANSS). We found that the RMET scores of the two clinical groups were similar (p > 0.05) and lower than in the HCs (SCZ: p < 0.05; MTLE: p < 0.001). In the next step, SCZ were split into two groups with respect to the level of symptoms. Analysis of the RMET scores revealed no differences between the HC (M = 25.7 ± 4.1) and POS-LO (M = 25.3 ± 4.8); both groups outperformed the POS-HI group (M = 21.3 ± 5.2) and the MTLE group (M = 20.8 ± 4.6). No differences were found for the median-split with regard to negative symptoms. In SCZ, the mind-reading deficit appears to be associated with the level of positive symptoms. Both POS-HI and MTLE patients present significant mentalising deficits compared to healthy controls.

Theory of mind and executive functions in schizophrenia and bipolar disorder: A cross-diagnostic latent class analysis for identification of neuropsychological subtypes

OBJECTIVE

Executive dysfunction is a common feature of schizophrenia and bipolar disorder (BP). While deficits in social cognitive abilities, including theory of mind (ToM), have been suggested to be specific to schizophrenia, available evidence suggests that there is also a significant overlap in social cognitive performances of both disorders. However, there is significant heterogeneity of executive dysfunction and ToM deficits in BP and schizophrenia. Cross-diagnostic data-driven methods can reveal potential neurocognitive subtypes characterized by relatively selective deficits in social cognition.

METHODS

Neurocognitive subgroups were investigated using latent class analysis, based on executive functions and ToM, in a mixed sample of 97 clinically stable patients with schizophrenia or BP and 27 healthy controls.

RESULTS

Four neurocognitive subgroups, including a "neuropsychologically normal" cluster, a severe global impairment cluster and two clusters of mixed cognitive profiles were found. Severe impairment cluster was characterized by particularly severe ToM deficits and predominantly included patients with schizophrenia. Schizophrenia patients in this cluster had severe negative symptoms. In contrast, individuals with BP compared to schizophrenia patients were more likely to be included in the "neuropsychologically normal" cluster.

CONCLUSION

Identification of distinctive neurobiological subtypes of patients based on social and non-social cognitive profiles can improve classification of major psychoses. Neurocognitive subgroupings of patients might be also beneficial for intervention strategies including cognitive rehabilitation.

The effects of cigarette smoking behavior and psychosis history on general and social cognition in bipolar disorder

OBJECTIVES

Several studies have documented the prevalence and effects of cigarette smoking on cognition in psychotic disorders; fewer have focused on bipolar disorder (BD). Cognitive and social dysfunction are common in BD, and the severity of these deficits may be related both to illness features (e.g., current symptoms, psychosis history) and health-related behaviors (e.g., smoking, alcohol use). The current study assessed the influence of cigarette smoking on general and social cognition in a BD cohort, accounting for illness features with a focus on psychosis history.

METHODS

We assessed smoking status in 105 euthymic patients with BD, who completed a comprehensive battery including social (facial affect recognition, emotional problem-solving, and theory of mind) and general (the MATRICS Consensus Cognitive Battery and executive functioning) cognitive measures. We compared smokers vs nonsmokers on cognitive performance and tested for the effects of psychosis history, premorbid intellectual functioning, substance use, and current affective symptoms.

RESULTS

Within the nonpsychotic subgroup with BD (n=45), smokers generally outperformed nonsmokers; by contrast, for subjects with BD with a history of psychosis (n=41), nonsmokers outperformed smokers. This pattern was noted more globally using a general composite cognitive score and on social/affective measures assessing patients' ability to identify emotions of facial stimuli and solve emotional problems.

CONCLUSIONS

Cigarette smoking differentially affects performance on both general and social cognition in patients with BD as a function of psychosis history. These results suggest that there may be at least partially divergent underlying neurobiological causes for cognitive dysfunction in patients with BD with and without psychosis.

Social cognition in schizophrenia in comparison to bipolar disorder: A meta-analysis

OBJECTIVE

Cognitive dysfunction is a common characteristic of both schizophrenia and bipolar disorder (BP). While these deficits are more severe in schizophrenia, there is a significant overlap between conditions. However, it was hypothesized that social cognitive deficits might be more specific to schizophrenia.

METHODS

We conducted a meta-analysis of studies comparing facial emotion recognition and theory of mind (ToM) abilities in schizophrenia and BP. 26 studies comparing 1301 patients with schizophrenia and 1075 with BP were included.

RESULTS

Schizophrenia patients significantly underperformed compared with BP patients in both facial emotion recognition (d=0.39) and ToM (d=0.57). Neurocognitive deficits significantly contributed to schizophrenia-BP group differences for ToM. However, between-group differences for social cognition were not statistically more severe than neurocognition.

CONCLUSION

Social cognitive impairment is more severe in schizophrenia in comparison to BP. However, between-group differences are modest and are comparable to other neurocognitive differences between schizophrenia and BP. There is significant overlap in social cognitive performance deficits observed in both schizophrenia and BP.

Evidence for social cooperation in rodents by automated maze

Social cooperation is defined as a joint action for mutual benefit that depends on the individual and the counterparts’ behaviors. To gain valid evidence for social cooperation behavior we conducted a series of experiments in our suggested fully automated non-conditioned maze and depicted three major findings: (i) During 18 days of training the rats showed a progressive social learning curve as well as latent social learning; (ii) Examining the perceptual communication between the cooperating partners, we found a correlation between the available perceptual modalities and the social cooperation performance; and (iii) Investigating contextual learning as a competing process to the social cooperation, we found that additional contextual cues impaired the social cooperation performance. In conclusion, our suggested automated cooperation maze is designed to further our understanding of social cooperation under normal conditions, such as decision-making, and to examine the neural basis of social cooperation. A variety of neuropsychiatric disorders are characterized by disruptions in social behavior and social cognition, including depression, autism spectrum disorders, obsessive-compulsive disorder, and schizophrenia. Thus, on the pathological end, our maze for social cooperation evaluation can contribute significantly to the investigation of a wide range of social cooperation impairments in a rodent model.

Biological aspects and candidate biomarkers for psychotic bipolar disorder: A systematic review

AIM

We carried out a systematic review of the available literature about potential biomarkers of psychotic bipolar disorder (BD-P), a specific subset presenting worse outcome and greater risk of relapse than non-psychotic bipolar disorder (BD-NP).

METHODS

We searched the main psychiatric databases (PubMed, ISI Web of Knowledge, PsychInfo). Only original articles with the main topic of BD-P compared to schizophrenia/BD-NP/healthy controls (HC) written in English from 1994 to 2015 were included.

RESULTS

BD-P patients presented higher kynurenic acid levels in the cerebrospinal fluid, elevated anti- S accharomyces cerevisiae antibodies levels, and lower serum levels of dehydroepiandrosterone sulfate and progesterone than BD-NP/HC. Event-related potentials abnormalities have been identified in BD-P with respect to BD-NP. BD-P patients also presented bigger ventricles but similar hippocampal volumes compared to BD-NP/HC. Although the results are contrasting, some cognitive deficits seemed to be related to the psychotic dimension of bipolar affective disorder, such as impairment in verbal/logical memory, working memory, verbal and semantic fluency and executive functioning. Finally, polymorphisms of genes, such as NRG1, 5HTTLPR (s), COMT, DAOA and some chromosome regions (16p12 and 13q), were positively associated with BD-P.

CONCLUSION

Data about the identification of specific biomarkers for BD-P are promising, but most of them have not yet been replicated. They could lead the clinicians to an early diagnosis and proper treatment, thus ameliorating outcome of BD-P and reducing the biological changes associated with a long duration of illness. Further studies with bigger samples are needed to detect more specific biological markers of the psychotic dimension of bipolar affective disorder.

The manic phase of Bipolar disorder significantly impairs theory of mind decoding

Bipolar disorder is associated with significant deficits in the decoding of others' mental states in comparison to healthy participants. However, differences in theory of mind decoding ability among patients in manic, depressed, and euthymic phases of bipolar disorder is currently unknown. Fifty-nine patients with bipolar I or II disorder (13 manic, 25 depressed, 20 euthymic) completed the "Reading the Mind in the Eyes" Task (Eyes task) and the Animals Task developed to control for non-mentalistic response demands of the Eyes Task. Patients also completed self-report and clinician-rated measures of depression, mania, and anxiety symptoms. Patients in the manic phase were significantly less accurate than those in the depressed and euthymic phases at decoding mental states in the Eyes task, and this effect was strongest for eyes of a positive or neutral valence. Further Eyes task performance was negatively correlated with the symptoms of language/thought disorder, pressured speech, and disorganized thoughts and appearance. These effects held when controlling for accuracy on the Animals task, response times, and relevant demographic and clinical covariates. Results suggest that the state of mania, and particularly psychotic symptoms that may overlap with the schizophrenia spectrum, are most strongly related to social cognitive deficits in bipolar disorder.

Meta-analysis of Theory of Mind (ToM) impairment in bipolar disorder

BACKGROUND

Theory of mind (ToM) dysfunction is prominent in a number of psychiatric disorders, in particular, autism and schizophrenia, and can play a significant role in poor functioning. There is now emerging evidence suggesting that ToM abilities are also impaired in bipolar disorder (BP); however, the relationship between ToM deficits and mood state is not clear.

METHOD

We conducted a meta-analysis of ToM studies in BP. Thirty-four studies comparing 1214 patients with BP and 1097 healthy controls were included. BP groups included remitted (18 samples, 545 BP patients), subsyndromal (12 samples, 510 BP patients), and acute (manic and/or depressed) (10 samples, 159 BP patients) patients.

RESULTS

ToM performance was significantly impaired in BP compared to controls. This impairment was evident across different types of ToM tasks (including affective/cognitive and verbal/visual) and was also evident in strictly euthymic patients with BP (d = 0.50). There were no significant differences between remitted and subsyndromal samples. However, ToM deficit was significantly more severe during acute episodes (d = 1.23). ToM impairment was significantly associated with neurocognitive and particularly with manic symptoms.

CONCLUSION

Significant but modest sized ToM dysfunction is evident in remitted and subsyndromal BP. Acute episodes are associated with more robust ToM deficits. Exacerbation of ToM deficits may contribute to the more significant interpersonal problems observed in patients with acute or subsyndromal manic symptoms. There is a need for longitudinal studies comparing the developmental trajectory of ToM deficits across the course of the illness.

Auditory processing deficits in bipolar disorder with and without a history of psychotic features

OBJECTIVES

Auditory perception deficits have been identified in schizophrenia (SZ) and linked to dysfunction in the auditory cortex. Given that psychotic symptoms, including auditory hallucinations, are also seen in bipolar disorder (BD), it may be that individuals with BD who also exhibit psychotic symptoms demonstrate a similar impairment in auditory perception.

METHODS

Fifty individuals with SZ, 30 individuals with bipolar I disorder with a history of psychosis (BD+), 28 individuals with bipolar I disorder with no history of psychotic features (BD-), and 29 normal controls (NC) were administered a tone discrimination task and an emotion recognition task.

RESULTS

Mixed-model analyses of covariance with planned comparisons indicated that individuals with BD+ performed at a level that was intermediate between those with BD- and those with SZ on the more difficult condition of the tone discrimination task and on the auditory condition of the emotion recognition task. There were no differences between the BD+ and BD- groups on the visual or auditory-visual affect recognition conditions. Regression analyses indicated that performance on the tone discrimination task predicted performance on all conditions of the emotion recognition task. Auditory hallucinations in BD+ were not related to performance on either task.

CONCLUSIONS

Our findings suggested that, although deficits in frequency discrimination and emotion recognition are more severe in SZ, these impairments extend to BD+. Although our results did not support the idea that auditory hallucinations may be related to these deficits, they indicated that basic auditory deficits may be a marker for psychosis, regardless of SZ or BD diagnosis.

Predictors of functional outcome after a manic episode

BACKGROUND

The identification of functional outcome predictors after acute episodes of bipolar disorders (BD) may allow designing appropriate treatment aiming at restoring psychosocial functioning. Our objective was to identify the best functional outcome predictors at a 6-month follow-up after an index manic episode.

METHODS

We conducted a naturalistic trial (MANACOR) focusing on the global burden of BD, with special emphasis on manic episode-associated costs. We observed patients with BD seen in services of four hospitals in Catalonia (Spain).The total sample included 169 patients with chronic DSM-IV-TR BD I suffering from an acute manic episode who were followed-up for 6 months. In this subanalysis we report the results of a stepwise multiple regression conducted by entering in the model those clinical and sociodemographic variables that were identified through preliminary bivariate Pearson correlations and using total scores on the Functioning Assessment Short Test (FAST) at the 6-month follow-up as the dependent variable.

RESULTS

Number of previous depressive episodes (Beta=3.25; t=3.23; p=0.002), presence of psychotic symptoms during the manic index episode (Beta=7.007; t=2.2; p=0.031) and the Body Mass Index (BMI) at baseline (Beta=0.62; t=2.09; p=0.041) were best predictors of functional outcome after a manic episode.

LIMITATIONS

The main limitations of this study include the retrospective assessment of the episodes, which can be a source of bias, and the 6-month follow-up might have been too short for assessing the course of a chronic illness.

CONCLUSIONS

Psychotic symptoms at index episode, number of past depressive episodes, and BMI predict worse outcome after 6 months follow-up after a manic episode, and may constitute the target of specific treatment strategies.

Brain activation during self- and other-reflection in bipolar disorder with a history of psychosis: Comparison to schizophrenia

Objectives

Reflecting on the self and on others activates specific brain areas and contributes to metacognition and social cognition. The aim of the current study is to investigate brain activation during self- and other-reflection in patients with bipolar disorder (BD). In addition, we examined whether potential abnormal brain activation in BD patients could distinguish BD from patients with schizophrenia (SZ).

Methods

During functional magnetic resonance imaging (fMRI), 17 BD patients, 17 SZ patients and 21 healthy controls (HCs) performed a self-reflection task. The task consisted of sentences divided into three conditions: self-reflection, other-reflection and semantic control.

Results

BD patients showed less activation in the posterior cingulate cortex (PCC) extending to the precuneus during other-reflection compared to HCs (p = 0.028 FWE corrected on cluster-level within the regions of interest). In SZ patients, the level of activation in this area was in between BD patients and HCs, with no significant differences between patients with SZ and BD. There were no group differences in brain activation during self-reflection. Moreover, there was a positive correlation between the PCC/precuneus activation during other-reflection and cognitive insight in SZ patients, but not in BD patients.

Conclusions

BD patients showed less activation in the PCC/precuneus during other-reflection. This may support an account of impaired integration of emotion and memory (evaluation of past and current other-related information) in BD patients. Correlation differences of the PCC/precuneus activation with the cognitive insight in patients with BD and SZ might reflect an important difference between these disorders, which may help to further explore potentially distinguishing markers.

•

We investigated self-reflection and other-reflection in bipolar disorder.

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Bipolar had less PCC/precuneus activation during other-reflection than controls.

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PCC/precuneus activation was unrelated to cognitive insight in bipolar patients.

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

OBJECTIVE

Social cognition has been shown to be affected in bipolar disorders, even during euthymia. However, the social cognitive profile of this group of disorders remains to be ascertained, given that such a broad neuropsychological construct has not been systematically examined in bipolar subjects across different tasks. The aim of this study was to quantify the magnitude of patient-control differences for distinct social cognition assessment instruments: the Hinting Task, the Eyes Test, Faux Pas, the Mayer-Salovey-Caruso Emotional Intelligence Test, and emotional labeling using visual stimuli.

METHOD

Effect sizes were extracted from studies chosen according to more stringent criteria than previously used in systematic reviews on the topic and pooled by means of meta-analytical procedures.

RESULTS

No significant patient-control differences were found for the recognition of three basic emotions (happiness, sadness, and anger). Small but significant effect sizes favoring healthy controls (Hedges׳ g<0.5) were noted for emotional intelligence, the Hinting Task, the Eyes Test, and the recognition of fear, disgust, and surprise. A medium effect size (Hedges' g=0.58) was noted for the Faux Pas Test.

LIMITATIONS

The possible effects of other neurocognitive impairments on social cognitive performance could not be explored.

CONCLUSION

On average, small-to-moderate differences may exist between euthymic bipolar disorder subjects and healthy controls regarding social cognitive performance, with mental state decoding being more preserved than mental state reasoning. The influence of clinical and neurocognitive variables, which may play an important role in the social cognitive outcomes of these patients, deserves further clarification.

Social cognition in patients with schizophrenia spectrum and bipolar disorders with and without psychotic features

Background

Social cognition may be critical to the impoverished social functioning seen in serious mental illness. However, although social-cognitive deficits are consistently demonstrated in schizophrenia spectrum disorders (SSD), studies in bipolar disorder (BD) have produced inconsistent results. This inconsistency may relate to symptom profiles of patients studied, particularly the presence or absence of psychotic features. Thus, we examined social cognition in bipolar disorder with psychotic features (BD +) versus without psychotic features (BD −) relative to SSD and controls.

Methods

A sample of 537 SSD patients, 85 BD + patients, 37 BD − patients, and 309 controls were administered the MATRICS Consensus Cognitive Battery, including a social cognition measure, the managing emotions branch of the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). Analyses of covariance compared MSCEIT performance between diagnostic groups while controlling for race, psychotropic medication status, and neurocognition.

Results

SSD but not BD − or BD + patients showed significant MSCEIT deficits relative to controls.

Conclusions

MSCEIT deficits were found in SSD but not BD − or BD +, suggesting that social cognition may represent an underlying difference between SSD and BD. However, variance in MSCEIT performance among BD patients may also suggest latent BD subgroups characterized by social-cognitive deficits. Findings can help inform future investigations into how social cognition and social brain development differ between SSD and BD.

Theory of Mind in Bipolar Disorder, with Comparison to the Impairments Observed in Schizophrenia

Our ability to make sense of information on the potential intentions and dispositions of others is of paramount importance for understanding their communicative intent, and for judging what an appropriate reaction might be. Thus, anything that impinges on this ability has the potential to cause significant social impairment, and compromise an individual's level of functioning. Both bipolar disorder and schizophrenia are known to feature theory of mind impairment. We conducted a theoretical review to determine the extent and types of theory of mind impairment in bipolar disorder, and evaluate their relationship to medication and symptoms. We also considered possible mediatory mechanisms, and set out to discover what else could be learnt about the impairment in bipolar disorder by comparison to the profile of impairment in schizophrenia. The literature established that in bipolar disorder (i) some form of theory of mind impairment has been observed in all mood states, including euthymia, (ii) the form of theory of mind assessed and task used to make the assessment influence the impairment observed, and (iii) there might be some relationship to cognitive impairment, although a relationship to standard clinical variables was harder to establish. What also became clear in the literature on bipolar disorder itself was the possible relationship of theory of mind impairment to history of psychotic symptoms. Direct comparative studies, including patients with schizophrenia, were thus examined, and provided several important directions for future research on the bases of impairment in bipolar disorder. Particularly prominent was the issue of whether theory of mind impairment could be considered a candidate endophenotype for the psychoses, although current evidence suggests that this may be premature. The differences in impairment across schizophrenia and bipolar disorder may, however, have genuine differential effects on social functioning and the likely success of remediation.

Social cognition and functional capacity in bipolar disorder and schizophrenia

Social cognition is a functionally relevant predictor of capacity in schizophrenia (SZ), though research concerning its value for bipolar disorder (BD) is limited. The current investigation examined the relationship between two social cognitive factors and functional capacity in bipolar disorder. This study included 48 individuals with bipolar disorder (24 with psychotic features) and 30 patients with schizophrenia. Multiple regression controlling for estimated IQ scores was used to assess the predictive value of social cognitive factors on the UCSD Performance-Based Functional Skills Assessment (UPSA). Results found that for the bipolar with psychosis and schizophrenia groups, the social/emotion processing factor predicted the UPSA. The theory of mind factor only predicted the UPSA for the schizophrenia group.. Findings support the clinical utility of evaluating emotion processing in individuals with a history of psychosis. For BD, theory of mind may be better explained by a generalized cognitive deficit. In contrast, social/emotion processing may be linked to distinct neurobiological processes associated with psychosis.

Facial emotion identification in early-onset psychosis

Facial emotion identification (FEI) deficits are common in patients with chronic schizophrenia and are strongly related to impaired functioning. The objectives of this study were to determine whether FEI deficits are present and emotion specific in people experiencing early-onset psychosis (EOP), and related to current clinical symptoms and functioning. Patients with EOP (n=34, mean age=14.11, 53% female) and healthy controls (HC, n=42, mean age 13.80, 51% female) completed a task of FEI that measured accuracy, error pattern and response time. Relative to HC, patients with EOP (i) had lower accuracy for identifying facial expressions of emotions, especially fear, anger and disgust, (ii) were more likely to misattribute other emotional expressions as fear or disgust, and (iii) were slower at accurately identifying all facial expressions. FEI accuracy was not related to clinical symptoms or current functioning. Deficits in FEI (especially for fear, anger and disgust) are evident in EOP. Our findings suggest that while emotion identification deficits may reflect a trait susceptibility marker, functional deficits may represent a sequelae of illness.

Metacognition in psychosis: comparison of schizophrenia with bipolar disorder

While deficits in metacognition have been observed in schizophrenia (SZ), it is less clear whether these are specific to the disorder. Accordingly, this study compared metacognitive abilities of patients with schizophrenia and bipolar disorder (BD) and examined the degree to which neurocognition contributed to metacognitive deficits in both groups. Participants were 30 patients with SZ and 30 with BD. Metacognitive capacity was measured using the Metacognition Assessment Scale Abbreviated (MAS-A). This scale comprises four domains: self-reflectivity, understanding others' minds, decentration and mastery. Verbal memory, executive functioning and symptoms were concurrently assessed. Group comparisons revealed that SZ patients had greater deficits in metacognitive self-reflectivity, which correctly classified 85.2% of patients with SZ in a logistic regression. Self-reflectivity and understanding others'minds were related to verbal memory and executive functioning in the SZ group, but not in the BD group. Furthermore, greater positive and general psychotic symptoms were associated with poorer metacognition in SZ. Results suggest SZ involves unique deficits in the ability to self-reflect and that these deficits may be uniquely linked with neurocognition.