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.

Clinical features in co-occuring obsessive-compulsive disorder and bipolar disorder: A systematic review and meta-analysis

Obsessive-compulsive disorder (OCD) frequently co-occurs with various psychiatric conditions and may impact as many as one-fifth of individuals diagnosed with bipolar disorder (BD). Despite the expanding body of literature on the coexistence of OCD and BD, there is a notable lack of comprehensive data pertaining to the distinct features of obsessive-compulsive symptoms that define this comorbidity. To bridge this knowledge gap, we conducted a systematic search of PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO until August 7th, 2023. We performed random-effects meta-analyses to compare individuals with both OCD and BD to those with OCD in terms of OCD symptomatology as well as the specific categories of obsessions and compulsions. Out of the 10,393 records initially screened, 17 studies were ultimately incorporated into the qualitative assessment, with 15 of them being included in the quantitative analysis. Individuals with OCD and BD experienced fewer lifetime contamination obsessions (OR=0.71; 95 %CI=0.53, 0.95; p = 0.021) and more sexual obsessions (OR=1.77; 95 %CI=1.03, 3.04; p = 0.04) compared to individuals with OCD without BD. No significant difference was observed for other types of obsessions or compulsions or for the severity of OCD symptoms, although BD type may play a role according to meta-regression analyses. The detection of the presence of sexual or contamination obsessions through a detailed interview may be the focus of clinical attention when assessing OCD in the context of comorbid BD. Sub-phenotyping complex clinical presentation of comorbid psychiatric disorders can aid in making more informed decisions when choosing an appropriate treatment approach.

Heightened response to positive facial cues as a potential marker of resilience following childhood adversity

Background: Childhood maltreatment profoundly influences social and emotional development, increasing psychiatric risk. Alterations in the implicit processing of threat-related cues following early abuse and neglect represent a marker of mental health vulnerability. Less is known about how early adversity influences the perception of positive social cues, despite their central role in establishing and maintaining social interactions and their association with better mental health outcomes.Methods: The sample consisted of 42 children and adolescents with substantiated childhood maltreatment experiences and 32 peers (mean age 13.3), matched on age, pubertal status, gender, socioeconomic status, ethnicity, and cognitive ability. A computerised experimental task assessed the perceived emotional intensity of positive (happy) and negative (fearful) facial expressions. Mental health symptoms were measured via self- and parental reports, and perceived social support was self-reported.Results: The experience of abuse and neglect was associated with heightened perceived intensity of positive facial cues. Cross-sectional post-hoc moderation and mediation analyses, employing a model-building approach, revealed that in maltreatment-exposed participants: (i) their increased response to positive facial cues was associated with lower symptoms; (ii) the presence of social support accounted for their heightened perceived intensity of positive facial cues; (iii) the presence of social support putatively contributed to lower symptoms by increasing the perceived intensity of positive facial cues. No group differences in perceived intensity of negative expressions were observed.Conclusions: These findings provide fresh insight into how positive faces are processed following maltreatment experience in childhood. Maltreatment experience was found to be associated with heightened perceived intensity of happy faces, which in turn was associated with better mental health and greater levels of social support. This suggests that heightened saliency of positive emotions acts protectively in children with maltreatment experience.

Differences in facial emotion recognition between bipolar disorder and other clinical populations: A systematic review and meta-analysis

Facial emotion (or expression) recognition (FER) is a domain of affective cognition impaired across various psychiatric conditions, including bipolar disorder (BD). We conducted a systematic review and meta-analysis searching for eligible articles published from inception to April 26, 2023, in PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO to examine whether and to what extent FER would differ between people with BD and those with other mental disorders. Thirty-three studies comparing 1506 BD patients with 1973 clinical controls were included in the present systematic review, and twenty-six of them were analyzed in random-effects meta-analyses exploring the discrepancies in discriminating or identifying emotional stimuli at a general and specific level. Individuals with BD were more accurate in identifying each type of emotion during a FER task compared to individuals diagnosed with schizophrenia (SCZ) (SMD = 0.27; p-value = 0.006), with specific differences in the perception of anger (SMD = 0.46; p-value = 1.19e-06), fear (SMD = 0.38; p-value = 8.2e-04), and sadness (SMD = 0.33; p-value = 0.026). In contrast, BD patients were less accurate than individuals with major depressive disorder (MDD) in identifying each type of emotion (SMD = -0.24; p-value = 0.014), but these differences were more specific for sad emotional stimuli (SMD = -0.31; p-value = 0.009). No significant differences were observed when BD was compared with children and adolescents diagnosed with attention-deficit/hyperactivity disorder. FER emerges as a potential integrative instrument for guiding diagnosis by enabling discrimination between BD and SCZ or MDD. Enhancing the standardization of adopted tasks could further enhance the accuracy of this tool, leveraging FER potential as a therapeutic target.

State-dependent alterations of implicit emotional dominance during binocular rivalry in subthreshold depression

Binocular rivalry, a visual perception phenomenon where two or more percepts alternate every few seconds when distinct stimuli are presented to the two eyes, has been reported as a biomarker in several psychiatric disorders. It is unclear whether abnormalities of binocular rivalry in depression could occur when emotional rivaling stimuli are used, and if so, whether an emotional binocular rivalry test could provide a trait-dependent or state-dependent biomarker. In the current study, 34 individuals with subthreshold depression and 31 non-depressed individuals performed a binocular rivalry task associated with implicit emotional processing. Participants were required to report their perceived orientations of the rival gratings in the foreground and to neglect emotional face stimuli in the background. The participants were retested after an approximately 4-month time interval. Compared to the non-depressed group, the subthreshold depression group showed significantly longer perceptual dominance durations of the grating with emotional faces as the background (i.e., implicit emotional dominance) at the initial assessment. However, the abnormality was not found at the follow-up assessment. More importantly, we found smaller changes in depressive severity at the follow-up assessment for individuals displaying longer emotional dominance at the initial assessment than for individuals with weaker emotional dominance. The current emotional binocular rivalry test may provide an objective, state-dependent biomarker for distinguishing individuals with subthreshold depression from non-depressed individuals.

Detecting depression based on facial cues elicited by emotional stimuli in video

Recently, depression research has received considerable attention and there is an urgent need for objective and validated methods to detect depression. Depression detection based on facial expressions may be a promising adjunct to depression detection due to its non-contact nature. Stimulated facial expressions may contain more information that is useful in detecting depression than natural facial expressions. To explore facial cues in healthy controls and depressed patients in response to different emotional stimuli, facial expressions of 62 subjects were collected while watching video stimuli, and a local face reorganization method for depression detection is proposed. The method extracts the local phase pattern features, facial action unit (AU) features and head motion features of a local face reconstructed according to facial proportions, and then fed into the classifier for classification. The classification accuracy was 76.25%, with a recall of 80.44% and a specificity of 83.21%. The results demonstrated that the negative video stimuli in the single-attribute stimulus analysis were more effective in eliciting changes in facial expressions in both healthy controls and depressed patients. Fusion of facial features under both neutral and negative stimuli was found to be useful in discriminating between healthy controls and depressed individuals. The Pearson correlation coefficient (PCC) showed that changes in the emotional stimulus paradigm were more strongly correlated with changes in subjects' facial AU when exposed to negative stimuli compared to stimuli of other attributes. These results demonstrate the feasibility of our proposed method and provide a framework for future work in assisting diagnosis.

Comparisons of facial emotion recognition in different social contexts among patients with schizophrenia, major depressive disorder and bipolar disorder

BACKGROUND

Previous studies have found that patients with schizophrenia (SCZ), major depressive disorder (MDD), and bipolar disorder (BD) all have facial emotion recognition deficits, but the differences and similarities of these deficits in the three groups of patients under different social interaction situations are not clear. The present study aims to compare the ability of facial emotion recognition in three different conversation situations from a cross-diagnostic perspective.

METHODS

Thirty-three participants with SCZ, 35 participants with MDD, and 30 participants with BD were recruited, along with 31 healthy controls. A computer-based task was given to assess the ability of Facial Emotion Categorization (FEC) under three different conversational situations (praise, blame, and inquiry).

RESULTS

In the "praise" situation, patients with SCZ, MDD and BD were all slower to recognize anger emotion than the healthy controls. In all three clinical groups, patients with SCZ recognized angry faces faster than those with MDD and BD on a continuum from happy faces to angry faces in the "inquiry" situation, while no significant difference was found in the latter two groups. In addition, no significant defect was found in the percentage and threshold of angry face recognition in all three patient groups.

CONCLUSIONS

Our findings indicate that patients with SCZ, MDD, and BD share both common and distinct deficits in facial emotion recognition during social interactions, which may be beneficial for early screening and precise intervention for these mental disorders.

Data augmentation for depression detection using skeleton-based gait information

In recent years, the incidence of depression is rising rapidly worldwide, but large-scale depression screening is still challenging. Gait analysis provides a non-contact, low-cost, and efficient early screening method for depression. However, the early screening of depression based on gait analysis lacks sufficient effective sample data. In this paper, we propose a skeleton data augmentation method for assessing the risk of depression. First, we propose five techniques to augment skeleton data and apply them to depression and emotion datasets. Then, we divide augmentation methods into two types (non-noise augmentation and noise augmentation) based on the mutual information and the classification accuracy. Finally, we explore which augmentation strategies can capture the characteristics of human skeleton data more effectively. Experimental results show that the augmented training dataset that retains more of the raw skeleton data properties determines the performance of the detection model. Specifically, rotation augmentation and channel mask augmentation make the depression detection accuracy reach 92.15% and 91.34%, respectively.

Euthymic patients with predominantly manic polarity avoid happy faces in a dot probe task

Background

Some studies suggest a mood-congruent attentional bias in bipolar patients. However, for euthymic patients, especially in dependence on the predominant polarity, there is little and inconsistent data. A clearer understanding of emotion-related attentional biases and their relationship to dysfunctional emotion regulation could help improving the diagnostics and treatment of bipolar disorder (BD). Twenty bipolar patients in a depressive state (BP-acute-D), 32 euthymic patients with manic (BP-euth-M) or depressive (BP-euth-D) predominant polarity, and 20 healthy control participants (HC) performed a dot-probe task (DPT) with happy and sad faces presented for 250 ms or 1250 ms in two different runs. Emotion regulation strategies were assessed with two questionnaires.

Results

In the short presentation condition of the DPT, BP-euth-M showed less attention for happy faces than HC (p = .03, r = − 0.48). BP-acute-D scored lower in cognitive reappraisal and putting into perspective and higher in suppression, catastrophizing, and rumination than HC. BP-euth-M scored higher in rumination and BP-euth-D lower in putting into perspective and higher in catastrophizing than HC. In BP-euth-D and HC, bias scores for sad faces in the longer presentation condition and reappraisal scores correlated positively.

Conclusions

Results of the DPT suggest an avoidance of happy faces for BP-euth-M which we interpret as a protection mechanism for triggers of mania. That individuals who apply more reappraisal show more selective attention to sad faces could on the one hand reflect a mental effort in reevaluating the sad emotional input and on the other hand a greater tolerance for it.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

Pavlovian occasion setting in human fear and appetitive conditioning: Effects of trait anxiety and trait depression

Contexts and discrete stimuli often hierarchically influence the association between a stimulus and outcome. This phenomenon, called occasion setting, is central to modulation-based Pavlovian learning. We conducted two experiments with humans in fear and appetitive conditioning paradigms, training stimuli in differential conditioning, feature-positive discriminations, and feature-negative discriminations. We also investigated the effects of trait anxiety and trait depression on these forms of learning. Results from both experiments showed that participants were able to successfully learn which stimuli predicted the electric shock and monetary reward outcomes. Additionally, as hypothesized, the stimuli trained as occasion setters had little-to-no effect on simple reinforced or non-reinforced stimuli, suggesting the former were indeed occasion setters. Lastly, in fear conditioning, trait anxiety was associated with increases in fear of occasion setter/conditional stimulus compounds; in appetitive conditioning, trait depression was associated with lower expectations of monetary reward for the trained negative occasion setting compound and transfer of the negative occasion setter to the simple reinforced stimulus. These results suggest that clinically anxious individuals may have enhanced fear of occasion setting compounds, and clinically depressed individuals may expect less reward with compounds involving the negative occasion setter.

Facial emotion recognition and mood symptom course in young adults with childhood-onset bipolar disorder

Facial emotion recognition deficits are common in bipolar disorder (BD) and associated with impairment. However, the relationship between facial emotion recognition and mood course is not well understood. This study examined facial emotion recognition and subsequent mood symptoms in young adults with childhood-onset BD versus typically developing controls (TDCs). The sample included 116 young adults (ages 18-30, 58% male, 78% White) with prospectively verified childhood-onset BD (n = 52) and TDCs (n = 64). At baseline, participants completed a facial emotion recognition task (Diagnostic Analysis of Non-Verbal Accuracy-2) and clinical measures. Then, participants with BD completed mood symptom assessments every 6 months (M = 8.7 ± 5.2 months) over two years. Analyses included independent-samples t tests and mixed-effects regression models. Participants with BD made significantly more recognition errors for child expressions than TDCs. There were no significant between-group differences for recognition errors for adult expressions, or errors for specific child or adult emotional expressions. Participants had moderate baseline mood symptoms. Significant time-by-facial emotion recognition interactions revealed more recognition errors for child emotional expressions predicted lower baseline mania and stable/consistent trajectory; fewer recognition errors for child expressions predicted higher baseline mania and decreasing trajectory. In addition, more recognition errors for adult sad expressions predicted stable/consistent depression trajectory and decreasing mania; fewer recognition errors for adult sad expressions predicted decreasing depression trajectory and stable/consistent mania. Effects remained when controlling for baseline demographics and clinical variables. Facial emotion recognition may be an important brain/behavior mechanism, prognostic indicator, and intervention target for childhood-onset BD, which endures into young adulthood and is associated with mood trajectory.

Judgmental perception of co-speech gestures in MDD

Cognitive bias in depression may increase sensitivity to judgmental appraisal of communicative cues. Nonverbal communication encompassing co-speech gestures is crucial for social functioning and is perceived differentially by men and women, however, little is known about the effect of depression on the perception of appraisal. We investigate if a cognitive bias influences the perception of appraisal and judgement of nonverbal communication in major depressive disorder (MDD). During watching videos of speakers retelling a story and gesticulating, 22 patients with MDD and 22 matched healthy controls pressed a button when they perceived the speaker as appraising in a positive or negative way. The speakers were presented in four different conditions (with and without speech and with natural speaker or as stick-figures) to evaluate context effects. Inter-subject covariance (ISC) of the button-press time series measured consistency across the groups of the response pattern depending on the factors diagnosis and gender. Significant effects emerged for the factors diagnosis (p = .002), gender (p = .007), and their interaction (p < .001). The female healthy controls perceived the gestures more consistently appraising than male controls, the female patients, and male patients whereas the latter three groups did not differ. Further, the ISC measure for consistency correlated negatively with depression severity. The natural speaker video without audio speech yielded the highest responses consistency. Indeed co-speech gestures may drive these ISC effects because number of gestures but not facial shrugs correlated with ISC amplitude. During co-speech gestures, a cognitive bias led to disturbed perception of appraisal in MDD for females. Social communication is critical for functional outcomes in mental disorders; thus perception of gestural communication is important in rehabilitation.

The Relationship Between Facial Expression and Cognitive Function in Patients With Depression

Objective: Considerable evidence has shown that facial expression recognition ability and cognitive function are impaired in patients with depression. We aimed to investigate the relationship between facial expression recognition and cognitive function in patients with depression.

Methods: A total of 51 participants (i.e., 31 patients with depression and 20 healthy control subjects) underwent facial expression recognition tests, measuring anger, fear, disgust, sadness, happiness, and surprise. The Chinese version of the MATRICS Consensus Cognitive Battery (MCCB), which assesses seven cognitive domains, was used.

Results: When compared with a control group, there were differences in the recognition of the expressions of sadness (p = 0.036), happiness (p = 0.041), and disgust (p = 0.030) in a depression group. In terms of cognitive function, the scores of patients with depression in the Trail Making Test (TMT; p < 0.001), symbol coding (p < 0.001), spatial span (p < 0.001), mazes (p = 0.007), the Brief Visuospatial Memory Test (BVMT; p = 0.001), category fluency (p = 0.029), and continuous performance test (p = 0.001) were lower than those of the control group, and the difference was statistically significant. The accuracy of sadness and disgust expression recognition in patients with depression was significantly positively correlated with cognitive function scores. The deficits in sadness expression recognition were significantly correlated with the TMT (p = 0.001, r = 0.561), symbol coding (p = 0.001, r = 0.596), maze (p = 0.015, r = 0.439), and the BVMT (p = 0.044, r = 0.370). The deficits in disgust expression recognition were significantly correlated with impairments in the TMT (p = 0.005, r = 0.501) and symbol coding (p = 0.001, r = 0.560).

Conclusion: Since cognitive function is impaired in patients with depression, the ability to recognize negative facial expressions declines, which is mainly reflected in processing speed, reasoning, problem-solving, and memory.

Machine learning-based ability to classify psychosis and early stages of disease through parenting and attachment-related variables is associated with social cognition

Background

Recent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, specifically for individuals diagnosed with psychosis (PSY). Furthermore, evidence highlighted a tight relationship between attachment style and social cognition abilities, a key PSY behavioral phenotype. The aim of this study is to generate a machine learning algorithm based on the perceived quality of parenting and attachment style-related features to discriminate between PSY and healthy controls (HC) and to investigate its ability to track PSY early stages and risk conditions, as well as its association with social cognition performance.

Methods

Perceived maternal and paternal parenting, as well as attachment anxiety and avoidance scores, were trained to separate 71 HC from 34 PSY (20 individuals diagnosed with schizophrenia + 14 diagnosed with bipolar disorder with psychotic manifestations) using support vector classification and repeated nested cross-validation. We then validated this model on independent datasets including individuals at the early stages of disease (ESD, i.e. first episode of psychosis or depression, or at-risk mental state for psychosis) and with familial high risk for PSY (FHR, i.e. having a first-degree relative suffering from psychosis). Then, we performed factorial analyses to test the group x classification rate interaction on emotion perception, social inference and managing of emotions abilities.

Results

The perceived parenting and attachment-based machine learning model discriminated PSY from HC with a Balanced Accuracy (BAC) of 72.2%. Slightly lower classification performance was measured in the ESD sample (HC-ESD BAC = 63.5%), while the model could not discriminate between FHR and HC (BAC = 44.2%). We observed a significant group x classification interaction in PSY and HC from the discovery sample on emotion perception and on the ability to manage emotions (both p = 0.02). The interaction on managing of emotion abilities was replicated in the ESD and HC validation sample (p = 0.03).

Conclusion

Our results suggest that parenting and attachment-related variables bear significant classification power when applied to both PSY and its early stages and are associated with variability in emotion processing. These variables could therefore be useful in psychosis early recognition programs aimed at softening the psychosis-associated disability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00552-3.

Development of an Emotion-Sensitive mHealth Approach for Mood-State Recognition in Bipolar Disorder

Internet- and mobile-based approaches have become increasingly significant to psychological research in the field of bipolar disorders. While research suggests that emotional aspects of bipolar disorders are substantially related to the social and global functioning or the suicidality of patients, these aspects have so far not sufficiently been considered within the context of mobile-based disease management approaches. As a multiprofessional research team, we have developed a new and emotion-sensitive assistance system, which we have adapted to the needs of patients with bipolar disorder. Next to the analysis of self-assessments, third-party assessments, and sensor data, the new assistance system analyzes audio and video data of these patients regarding their emotional content or the presence of emotional cues. In this viewpoint, we describe the theoretical and technological basis of our emotion-sensitive approach and do not present empirical data or a proof of concept. To our knowledge, the new assistance system incorporates the first mobile-based approach to analyze emotional expressions of patients with bipolar disorder. As a next step, the validity and feasibility of our emotion-sensitive approach must be evaluated. In the future, it might benefit diagnostic, prognostic, or even therapeutic purposes and complement existing systems with the help of new and intuitive interaction models.

Affective cognition in bipolar disorder: A systematic review by the ISBD targeting cognition task force

BACKGROUND

Impairments in affective cognition are part of the neurocognitive profile and possible treatment targets in bipolar disorder (BD), but the findings are heterogeneous. The International Society of Bipolar Disorder (ISBD) Targeting Cognition Task Force conducted a systematic review to (i) identify the most consistent findings in affective cognition in BD, and (ii) provide suggestions for affective cognitive domains for future study and meta-analyses.

METHODS

The review included original studies reporting behavioral measures of affective cognition in BD patients vs controls following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Searches were conducted on PubMed/MEDLINE, EMBASE, and PsychInfo from inception until November 2018.

RESULTS

A total of 106 articles were included (of which nine included data for several affective domains); 41 studies assessed emotional face processing; 23 studies investigated reactivity to emotional words and images; 3 investigated explicit emotion regulation; 17 assessed implicit emotion regulation; 31 assessed reward processing and affective decision making. In general, findings were inconsistent. The most consistent findings were trait-related difficulties in facial emotion recognition and implicit emotion regulation, and impairments in reward processing and affective decision making during mood episodes. Studies using eye-tracking and facial emotion analysis revealed subtle trait-related abnormalities in emotional reactivity.

CONCLUSION

The ISBD Task Force recommends facial expression recognition, implicit emotion regulation, and reward processing as domains for future research and meta-analyses. An important step to aid comparability between studies in the field would be to reach consensus on an affective cognition test battery for BD.