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Wu Y, Zhong Y, Zhang G, Wang C, Zhang N, Chen Q. Distinct functional patterns in child and adolescent bipolar and unipolar depression during emotional processing. Cereb Cortex 2024; 34:bhad461. [PMID: 38044479 DOI: 10.1093/cercor/bhad461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
Accumulating evidence from functional magnetic resonance imaging studies supported brain dysfunction during emotional processing in bipolar disorder (BD) and major depressive disorder (MDD). However, child and adolescent BD and MDD could display different activation patterns, which have not been fully understood. This study aimed to investigate common and distinct activation patterns of pediatric BD (PBD) and MDD (p-MDD) during emotion processing using meta-analytic approaches. Literature search identified 25 studies, contrasting 252 PBD patients, and 253 healthy controls (HCs) as well as 311 p-MDD patients and 263 HCs. A total of nine meta-analyses were conducted pulling PBD and p-MDD experiments together and separately. The results revealed that PBD and p-MDD showed distinct patterns during negative processing. PBD patients exhibited activity changes in bilateral precuneus, left inferior parietal gyrus, left angular gyrus, and right posterior cingulate cortex while p-MDD patients showed functional disruptions in the left rectus, left triangular part of the inferior frontal gyrus, left orbital frontal cortex, left insula, and left putamen. In conclusion, the activity changes in PBD patients were mainly in regions correlated with emotion perception while the dysfunction among p-MDD patients was in the fronto-limbic circuit and reward-related regions in charge of emotion appraisal and regulation.
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Affiliation(s)
- Yun Wu
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing, Jiangsu 210097, China
- Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
- Jiangsu International Collaborative Laboratory of Child and Adolescent Psychological Development and Crisis Intervention, Nanjing Normal University, 122 Ninghai Rd., Gulou District, Nanjing 210097, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing, Jiangsu 210097, China
- Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
- Jiangsu International Collaborative Laboratory of Child and Adolescent Psychological Development and Crisis Intervention, Nanjing Normal University, 122 Ninghai Rd., Gulou District, Nanjing 210097, China
| | - Gui Zhang
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing, Jiangsu 210097, China
- Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
- Jiangsu International Collaborative Laboratory of Child and Adolescent Psychological Development and Crisis Intervention, Nanjing Normal University, 122 Ninghai Rd., Gulou District, Nanjing 210097, China
| | - Chun Wang
- Psychiatry Department, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Gulou District, Nanjing, Jiangsu 210029, China
| | - Ning Zhang
- Psychiatry Department, Nanjing Brain Hospital Affiliated to Nanjing Medical University, 264 Guangzhou Road, Gulou District, Nanjing, Jiangsu 210029, China
| | - Qingrong Chen
- School of Psychology, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing, Jiangsu 210097, China
- Jiangsu Key Laboratory of Mental Health and Cognitive Science, Nanjing Normal University, 122 Ninghai Road, Gulou District, Nanjing 210097, China
- Jiangsu International Collaborative Laboratory of Child and Adolescent Psychological Development and Crisis Intervention, Nanjing Normal University, 122 Ninghai Rd., Gulou District, Nanjing 210097, China
- Jiangsu Collaborative Innovation Center for Language Ability, School of Linguistic Sciences And Arts, Jiangsu Normal University, 57 Heping Road, Yunlong District, Xuzhou, Jiangsu 221009, China
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Feng Y, Song J, Lin G, Qian H, Feng L, Wang Z, Wen J, Wang C, Wang J, Li P, Gao Z, Wang X, Hu X. Can neurological soft signs and neurocognitive deficits serve as a combined endophenotype for Han Chinese with bipolar disorder? Int J Methods Psychiatr Res 2023; 32:e1970. [PMID: 37038344 DOI: 10.1002/mpr.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Bipolar disorder's (BD) potential endophenotypes include neurological soft signs (NSS) and neurocognitive disorders (ND). Few research, meanwhile, has coupled NSS and ND as combined endophenotypes of BD. OBJECT This study intends to investigate NSS and ND and compare their differences in euthymic patients with bipolar disorder (EBP), their unaffected first-degree relatives (FDR), and healthy controls (HC). Additionally, search for potential endophenotypic subprojects of NSS and ND and construct and verify a composite endophenotypic. METHODS The subjects were all Han Chinese and consisted of 86 EBP, 81 FDR, and 81HC. Cambridge Neurological Inventory and MATRICSTM Consensus Cognitive Battery tested NSS and ND independently. RESULTS All three groups displayed a trapezoidal distribution of NSS levels and cognitive abnormalities, with EBP having the most severe NSS levels and cognitive deficits, followed by FDR and HC. Among them, motor coordination in NSS and Information processing speed (IPS), Verbal learning (VL), and Working memory (WM) in neurocognitive function are consistent with the traits of the endophenotype of BD. The accuracy in differentiating EBP and HC or FDRs and HC was higher when these items were combined as predictor factors than in differentiating EBP and FDR. CONCLUSION These results provide more evidence that motor coordination, IPS, VL, and WM may be internal characteristics of bipolar disease. When these characteristics are combined into a complex endophenotype, it may be possible to distinguish BD patients and high-risk groups from normal populations.
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Affiliation(s)
- Yingying Feng
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Jia Song
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Guorong Lin
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Hong Qian
- Division of Child Healthcare, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Feng
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Zongqin Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Juan Wen
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Chengchen Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Jiayuan Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Peifu Li
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Zuohui Gao
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xiaoli Wang
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xiaohua Hu
- Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
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Lee J, Choi KH. Mother-Child Social Cognition Among Multicultural Families in South Korea. Front Psychiatry 2022; 13:883212. [PMID: 35845467 PMCID: PMC9277018 DOI: 10.3389/fpsyt.2022.883212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Despite the rapidly growing number of multicultural families in South Korea, factors influencing parenting and mother-child interactions have not been well-understood. To our knowledge, the present study is the first to have examined how maternal social-cognitive capacity is associated with children's social cognition (e.g., theory of mind and emotion recognition) among multicultural families dwelling in South Korea. Methods Forty-seven multicultural mother-child dyads were recruited. The comprehensive measures on social cognition were administered to both the mothers and children, and social functioning and emotion regulation were administered to the children. Results A series of hierarchical regressions indicated that mothers' social cognition significantly explained children's ability to recognize static and dynamic emotional expressions, accounting for 27 and 34% of the variance, respectively. Furthermore, mothers' social cognition was significantly correlated to children's social functioning and emotion regulation. However, mothers' social cognition and children's theory of mind were non-significantly related. Discussion The current study examined the effects of social cognition of immigrant mothers on their children's socio-emotional development. As the findings indicated an important role of maternal factors (i.e., social cognition) for children's social cognition and their functions, psycho-social approaches (e.g., social cognition parenting education and training) should be incorporated in services for multicultural families.
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Affiliation(s)
| | - Kee-Hong Choi
- School of Psychology, Korea University, Seoul, South Korea
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Zhou R, Chen J, Zhao G, Wang Z, Peng D, Xia W, Mao R, Xu J, Wang F, Zhang C, Wang Y, Yuan C, Su Y, Huang J, Yang T, Wang C, Cui L, Wang J, Palaniyappan L, Fang Y. Neural biomarker of functional disability in major depressive disorder: A structural neuroimaging study. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110337. [PMID: 33905754 DOI: 10.1016/j.pnpbp.2021.110337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most patients with the major depressive disorder (MDD) have varying degrees of impaired social functioning, and functional improvement often lags behind symptomatic improvement. However, it is still unclear if certain neurobiological factors underlie the deficits of social function in MDD. The aim of this study was to investigate the biomarkers of social function in MDD using structural magnetic resonance imaging (MRI). METHODS 3T anatomical MRI was obtained from 272 subjects including 46 high-functioning (high-SF, Sheehan Disability Scale (SDS) rating < 18) and 63 low-functioning (low-SF, SDS score ≥ 18) patients with MDD and 163 healthy controls (HC). Voxel-based morphometry (VBM) was employed to locate brain regions with grey matter (GM) volume differences in relation to social function in MDD. Regions showing GM differences in relation to social function at baseline were followed up longitudinally in a subset of 38 patients scanned after 12-week treatment. RESULTS Volume of right parahippocampal gyrus (rPHG) was significantly reduced in low-SF patients with MDD when compared to high-SF ones (FDR-corrected p < 0.05). Over 12 weeks of follow-up, though SF improved overall, the high and low-SF subgroups continued to differ in their SF, but had no progressive changes in PHG volume. LIMITATIONS Limited functional assessment, high drop-out rate and median-based grouping method. CONCLUSIONS Greater GM volume (GMV) of the rPHG may mark better social function in patients with MDD.
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Affiliation(s)
- Rubai Zhou
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of EEG & Neuroimaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Robarts Research Institute& The Brain and Mind Institute, Western University, London, ON, Canada
| | - Jun Chen
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic disorders, Shanghai 201108, China
| | - Guoqing Zhao
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Psychology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, China
| | - Zuowei Wang
- Hongkou District Mental Health Center of Shanghai, Shanghai 200080, China
| | - Daihui Peng
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Weiping Xia
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Department of Medical Psychology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Ruizhi Mao
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jingjing Xu
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Fan Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chen Zhang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yong Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chengmei Yuan
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yousong Su
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jia Huang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Tao Yang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Chenglei Wang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Lvchun Cui
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic disorders, Shanghai 201108, China; Department of EEG & Neuroimaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Ministry of Education, Shanghai 200030, China; Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Lena Palaniyappan
- Robarts Research Institute& The Brain and Mind Institute, Western University, London, ON, Canada; Department of Psychiatry, Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.
| | - Yiru Fang
- Clinical Research Center and Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China; CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai 200031, China; Shanghai Key Laboratory of Psychotic disorders, Shanghai 201108, China.
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5
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Lemvigh CK, Karantonis JA, Furlong LS, Carruthers SP, Pantelis C, Rossell SL, Van Rheenen TE. Characterization and interrelationships of theory of mind, socially competitive emotions and affective empathy in bipolar disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:76-92. [PMID: 34232514 DOI: 10.1111/bjc.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evidence shows impaired theory of mind (ToM) in patients with bipolar disorder (BD), yet research examining its cognitive and affective components simultaneously is sparse. Moreover, recognition of socially competitive 'fortune of others' emotions (e.g. envy/gloat) may be related to ToM, but has not been assessed in BD. Finally, if and how ToM and 'fortune of others' emotions relate to affective empathy in BD is currently unclear. This study aimed to address these points. METHODS 64 BD patients and 34 healthy controls completed the Yoni task, a visual task assessing first- and second-order cognitive and affective ToM as well as 'fortune of others' emotions. The Toronto Empathy Questionnaire was used to assess self-reported affective empathy. RESULTS Patients with BD showed no deficits in cognitive and affective ToM or recognition of 'fortune of others' emotions. The ability to infer 'fortune of others' emotions correlated with several ToM measures, indicating that these functions are part of the same system. Patients with BD reported similar levels of affective empathy to healthy controls, and this was not related to ToM or 'fortune of others' emotions, suggesting that affective empathy represents a separate social domain. CONCLUSIONS These findings highlight areas of spared social functioning in BD, which may be utilized in therapeutic strategies. PRACTITIONER POINTS Our results suggest theory of mind and empathy may represent areas of potentially spared cognitive functioning in BD. As many BD patients have experienced adversity during developmental periods in which theory of mind and empathy develop, our findings suggest that these abilities may be markers of resilience in the disorder. Our findings are important for the formulation of therapeutic interventions for BD, which may include considering practical ways that a patients' knowledge of intact ToM and empathy could be utilized to reduce self-stigma and promote self-efficacy, improved well-being and functioning.
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Affiliation(s)
- Cecilie K Lemvigh
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Glostrup, Denmark.,Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia
| | - James A Karantonis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.,Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Lisa S Furlong
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia
| | - Sean P Carruthers
- Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Center Glostrup, Glostrup, Denmark.,Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Susan L Rossell
- Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.,Faculty of Health, Arts and Design, Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
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Kjærstad HL, Eikeseth FF, Vinberg M, Kessing LV, Miskowiak K. Neurocognitive heterogeneity in patients with bipolar disorder and their unaffected relatives: associations with emotional cognition. Psychol Med 2021; 51:668-679. [PMID: 31875793 DOI: 10.1017/s0033291719003738] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Recent evidence suggests that neurocognitive impairments in remitted patients with bipolar disorder (BD) are heterogeneous. Our study aims to replicate recent findings of neurocognitive subgroups, and further explore whether these are related to impairments in affective cognition, in a large sample of remitted patients recently diagnosed with BD and their unaffected relatives compared to healthy controls (HCs). METHODS Hierarchal cluster analysis was conducted using neurocognitive data from remitted patients with BD (n = 158). Relatives of patients with BD (n = 52) were categorised into groups consistent with their affected relative's cluster assignment. The neurocognitive clusters of patients with BD and relatives, respectively, were compared with HCs (n = 110) in neurocognition and affective cognition (i.e. emotion processing and regulation). RESULTS Three discrete neurocognitive clusters were identified in patients with BD: a globally impaired (23.4%), a selectively impaired (31.0%) and a cognitively intact cluster (45.6%). The neurocognitive subgroups differed in affective cognition, with patients categorised as globally impaired exhibited most impairments in facial expression recognition and emotion regulation in social scenarios. First-degree relatives of cognitively impaired patients displayed impaired facial expression recognition but no impairments in non-emotional cognition. CONCLUSIONS In a clinical sample of remitted patients recently diagnosed with BD 54.4% had either global or selective cognitive impairment, replicating results of previous studies in patients with longer illness duration. The results suggest that patterns of neurocognition are associated with differential impairments in affective cognition. Aberrant affective cognition in relatives of patients categorised as neurocognitively impaired indicates an inherited risk for BD.
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Affiliation(s)
- Hanne Lie Kjærstad
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Maj Vinberg
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kamilla Miskowiak
- Copenhagen Affective Disorder research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Cotrena C, Branco LD, Shansis FM, Fonseca RP. Predictors of quality of life in bipolar disorder: A path analytical study. Psychiatry Res 2020; 285:112846. [PMID: 32066003 DOI: 10.1016/j.psychres.2020.112846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/18/2019] [Accepted: 02/03/2020] [Indexed: 02/07/2023]
Abstract
Quality of life (QoL) is an important outcome in psychiatric illnesses like bipolar disorder (BD). However, little is known about the variables that affect it, and therefore contribute to prognosis and treatment outcomes in these populations. This study aimed to explore QoL in BD and investigate its relationship with modifiable (cognitive reserve, cognitive ability, mood symptoms) and non-modifiable factors (diagnosis, previous suicide attempts, substance misuse, age). The WHOQOL-bref was administered to 121 control participants and 109 patients with BD, who also underwent clinical and neuropsychological assessments. Factor analysis was used to identify latent constructs underlying WHOQOL-bref domains, and structural equation models were used to examine predictors of each latent construct. Two latent constructs were identified in the WHOQOL-bref, and labeled 'Personal' and 'Social' QoL. Both were directly predicted by depression symptoms and a diagnosis of BD, and indirectly predicted by (hypo)manic symptoms. Cognitive reserve was a stronger predictor of social QoL than a diagnosis of BD. Our findings suggest that the management of depression symptoms and fostering of cognitive reserve may improve QoL in BD. A diagnosis of BD and/or substance use disorders were risk factors for poor QoL, and may signal the need for preventive interventions to promote well-being.
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Affiliation(s)
- Charles Cotrena
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, building 11, rm 940, Porto Alegre 90619-900, RS, Brazil.
| | - Laura Damiani Branco
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, building 11, rm 940, Porto Alegre 90619-900, RS, Brazil.
| | - Flávio Milman Shansis
- Medical Sciences Pos Graduate Program, University of Vale do Taquari (Univates), Lajeado, RS, Brazil
| | - Rochele Paz Fonseca
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6681, building 11, rm 940, Porto Alegre 90619-900, RS, Brazil
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8
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Poormirzaei M, Bagheri M. The mediating role of child's cognitive emotion regulation in the relationship between parental mindfulness and child's mind reading ability. Cogn Process 2020; 21:403-410. [PMID: 31960225 DOI: 10.1007/s10339-020-00951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
The present research aimed at investigating the relationship between parental mindfulness and the child's mind reading ability based on his cognitive emotion regulation as playing a mediating role in the cultural context of Iran. The final participants included 278 primary school children and their parents from Kerman city in 2017. Mindfulness was measured by the interpersonal mindfulness in parenting scale, cognitive emotion regulation by cognitive emotion regulation questionnaire of kids, and mind reading by reading the mind in the eyes test for children. Based on the findings, the model was significant only for mothers and effects of awareness and present-centered attention and non-reactivity, as facets of parental mindfulness, on the child's mind reading ability were mediated partly and completely by the child's positive cognitive emotion regulation, respectively. The relationship pattern of variables was equal for boys and girls. Planning applied interventions based on the results of this study are recommended.
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Affiliation(s)
| | - Masoud Bagheri
- Department of Psychology, Shahid Bahonar University, Kerman, Iran.
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Miskowiak KW, Seeberg I, Kjaerstad HL, Burdick KE, Martinez-Aran A, Del Mar Bonnin C, Bowie CR, Carvalho AF, Gallagher P, Hasler G, Lafer B, López-Jaramillo C, Sumiyoshi T, McIntyre RS, Schaffer A, Porter RJ, Purdon S, Torres IJ, Yatham LN, Young AH, Kessing LV, Van Rheenen TE, Vieta E. Affective cognition in bipolar disorder: A systematic review by the ISBD targeting cognition task force. Bipolar Disord 2019; 21:686-719. [PMID: 31491048 DOI: 10.1111/bdi.12834] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
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.
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Affiliation(s)
- Kamilla W Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Ida Seeberg
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Hanne L Kjaerstad
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Katherine E Burdick
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Anabel Martinez-Aran
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Caterina Del Mar Bonnin
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | | | - Andre F Carvalho
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Peter Gallagher
- Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK
| | - Gregor Hasler
- Psychiatry Research Unit, University of Fribourg, Fribourg, Switzerland
| | - Beny Lafer
- Bipolar Disorder Research Program, Departamento de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Carlos López-Jaramillo
- Research Group in Psychiatry, Department of Psychiatry, Universidad de Antioquia, Medellín, Colombia
| | - Tomiki Sumiyoshi
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit Brain and Cognition Discovery Foundation, University of Toronto, Toronto, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Scot Purdon
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Ivan J Torres
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Lakshmi N Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lars V Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Carlton, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University, Australia
| | - Eduard Vieta
- Clinical Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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10
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Peckham AD, Johnson SL, Swerdlow BA. Working memory interacts with emotion regulation to predict symptoms of mania. Psychiatry Res 2019; 281:112551. [PMID: 31525674 PMCID: PMC6988851 DOI: 10.1016/j.psychres.2019.112551] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 08/06/2019] [Accepted: 08/31/2019] [Indexed: 01/29/2023]
Abstract
Although neurocognitive deficits and emotion regulation are closely linked within unipolar depression, little research has tested links between these two variables within bipolar disorder. The present study tested whether working memory is related to individual differences in emotion regulation strategies in bipolar disorder and whether working memory and emotion regulation can explain variability in symptoms over time. Fifty-nine euthymic adults with bipolar I disorder completed a working memory span task, symptom interviews assessing depression and mania, and questionnaires assessing brooding rumination, reappraisal, and suppression. At baseline, working memory was unrelated to emotion regulation. Symptom interviews were repeated at six months (n = 41) and 12 months (n = 36) follow-up. At 12 months, baseline working memory significantly interacted with baseline suppression to predict higher mania. Tests of simple slopes showed that at lower working memory levels, low use of suppression was associated with significantly greater mania symptoms. These results help to clarify previous inconsistent findings regarding cognitive functioning and emotion regulation strategies in bipolar disorder, suggesting that deficits in both domains combine to predict outcomes.
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Affiliation(s)
- Andrew D. Peckham
- Corresponding Author. Andrew Peckham is now affiliated with Harvard Medical School and McLean Hospital, 115 Mill Street, Mail Stop 113, Belmont, MA, 02478. Phone: 617-855-2946;
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11
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Zhang B, Wang C, Ma G, Fan H, Wang J, Wang W. Cerebral processing of facial emotions in bipolar I and II disorders: An event-related potential study. J Affect Disord 2018; 236:37-44. [PMID: 29709719 DOI: 10.1016/j.jad.2018.04.098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/13/2018] [Accepted: 04/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Behavioral results have shown that bipolar disorder patients have impaired recognition of facial emotions, but the detailed information processing of facial emotions in patients with bipolar I (BD I) and II (BD II) disorders remain unknown. METHODS We tested the cerebral event-related potentials to the static facial expressions of Neutral, Happiness, Anger and Sadness in 39 adult patients with BD I, 22 BD II, and 54 healthy volunteers. Participants' affective states were measured with the Mood Disorder Questionnaire, the Hypomania Checklist-32, and the Plutchik-van Praag Depression Inventory. RESULTS Over-processed right occipitotemporal cortex during N1 time window to Neutral and Happiness, and during P3b window to Sadness were found in BD I; prolonged N1 latencies to Neutral and Happiness, declined P3b amplitude to Sadness, negative correlation between P3b latency to Sadness and depression, and attenuated superior frontal activity during P3b window to Sadness were found in BD II; and the right-side dominance during facial emotion processing were found in both BD I and BD II. LIMITATIONS We didn't record the personality traits or medication used in patients, nor included other facial emotions such as fear and disgust. CONCLUSIONS When responding to facial emotions, both BD I and BD II showed a right-side processing dominance; BD I displayed enhanced processing in the right occipitotemporal cortex during structural encoding and categorical processing of facial emotions; while BD II displayed generalized impairments, less involvement of superior frontal cortex to negative emotions, and reduced ability to process negative emotions which was associated with depression.
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Affiliation(s)
- Bingren Zhang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Chu Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Guorong Ma
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Hongying Fan
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Jiawei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/School of Public Health, Zhejiang University College of Medicine, Hangzhou, Zhejiang 310058 China.
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12
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Van Rheenen TE. Commentary on "Methodological recommendations for cognition trials in bipolar disorder by the International Society for Bipolar Disorders Targeting Cognition Task Force". Bipolar Disord 2018; 20:72-73. [PMID: 29214732 DOI: 10.1111/bdi.12577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.,Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia.,Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
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13
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Calafiore D, Rossell SL, Van Rheenen TE. Cognitive abilities in first-degree relatives of individuals with bipolar disorder. J Affect Disord 2018; 225:147-152. [PMID: 28829959 DOI: 10.1016/j.jad.2017.08.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/16/2017] [Accepted: 08/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although the study of cognition in first degree relatives (FDRs) is not new, findings in this group are still somewhat inconsistent and much of the research examining FDR populations include individuals under the age of 25, who are arguably still at significant risk to go on to develop BD. The present study aimed to establish the value of cognitive performance as a genuine endophenotypic marker of familial risk for bipolar disorder (BD), by examining cognition in FDRs aged 25 years or older. METHODS The current study compared the cognitive performance of 27 unaffected FDRs to 47 healthy controls (HCs) and 28 BD patients using the MATRICS Consensus Cognitive Battery (MCCB). RESULTS Results indicated that FDRs had impaired verbal learning performance, as well as selective impairments on a measure of speed of processing; and a measure of spatial working memory compared to HC. LIMITATIONS Limitations relate to the potential insensitivity of some of the tests in the MCCB for detecting cognitive deficits that have been previously noted in BD and FDR samples using other batteries. CONCLUSIONS Findings from this study implicate verbal learning, processing speed and working memory performance as promising candidate endophenotypes of familial risk for BD.
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Affiliation(s)
- Daniela Calafiore
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Tamsyn E Van Rheenen
- Centre for Mental Health, Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia.
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14
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Bodnar A, Rybakowski JK. Mentalization deficit in bipolar patients during an acute depressive and manic episode: association with cognitive functions. Int J Bipolar Disord 2017; 5:38. [PMID: 29209876 PMCID: PMC6155478 DOI: 10.1186/s40345-017-0107-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/29/2017] [Indexed: 01/17/2023] Open
Abstract
Background A number of studies in bipolar patients have shown a deficit in mentalization (theory of mind), one of the main aspects of social cognition. The aim of current study was to assess both cognitive and affective mentalization in well-defined groups of depressed and manic bipolar patients, compared to healthy control subjects, using a battery of tests measuring mentalization processes. The second aim was to investigate a possible relationship between cognitive and affective mentalization and cognitive functions in bipolar patients during a depressive and manic episode. Methods The study involved 25 bipolar disorder type I patients (10 male, 15 female) during a depressive episode (mean 24 ± 2 points in the 17-item Hamilton Depression Rating Scale) and 25 patients (10 male, 15 female) during a manic episode (mean 27 ± 4 points in the Young Mania Rating Scale). The control group consisted of 25 healthy subjects (10 male, 15 female) without psychiatric disorders. To measure mentalization, a revised version of the Reading the Mind in the Eyes (R-MET), the Strange Stories (SS), the Faux Pas Recognition (FPR), and the Moving Shapes Paradigm (MSP) tests were used. Assessment of cognitive functioning was made using the Digit Span, Trail Making, and Wisconsin Card Sorting Tests. Results In bipolar patients significant deficits in both cognitive and affective mentalization were demonstrated during both acute depressive and manic episodes. The impairment in FPR in manic patients was more severe than that in the depressive ones. On the other hand, in MSP, manic patients showed significantly increased intentionality for non-mentalization animations, compared with depressive patients and for “cause and effect” animations compared with control subjects. A significant relationship was found between the decrease in cognitive and affective mentalization and deficits of cognitive functions during both the depressive and manic episodes. Conclusions The results obtained confirm the deficits of mentalization in bipolar I patients, during both acute depressive and manic episodes. We found that in such patients mentalization deficits significantly correlated with cognitive dysfunctions more so during depressive episodes.
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Affiliation(s)
- Anna Bodnar
- Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, 60-572, Poznan, Poland
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, 60-572, Poznan, Poland.
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15
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Branco LD, Cotrena C, Ponsoni A, Salvador-Silva R, Vasconcellos SJL, Fonseca RP. Identification and Perceived Intensity of Facial Expressions of Emotion in Bipolar Disorder and Major Depression. Arch Clin Neuropsychol 2017; 33:491-501. [DOI: 10.1093/arclin/acx080] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 08/22/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- L D Branco
- Department of Psychology, Pontifícal Catholic University of Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - C Cotrena
- Department of Psychology, Pontifícal Catholic University of Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - A Ponsoni
- Department of Psychology, Pontifícal Catholic University of Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - R Salvador-Silva
- Department of Psychology, Pontifícal Catholic University of Rio Grande do Sul. Porto Alegre, RS, Brazil
| | - S J L Vasconcellos
- Department of Psychology, Federal University of Santa Maria. Santa Maria, RS, Brazil
| | - R P Fonseca
- Department of Psychology, Pontifícal Catholic University of Rio Grande do Sul. Porto Alegre, RS, Brazil
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16
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Dargél AA, Godin O, Etain B, Hirakata V, Azorin JM, M'Bailara K, Bellivier F, Bougerol T, Kahn JP, Passerieux C, Aubin V, Courtet P, Leboyer M, Henry C. Emotional reactivity, functioning, and C-reactive protein alterations in remitted bipolar patients: Clinical relevance of a dimensional approach. Aust N Z J Psychiatry 2017; 51:788-798. [PMID: 28374603 DOI: 10.1177/0004867417691850] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Inter-episode mood instability has increasingly been considered in bipolar disorder. This study aimed to investigate emotional reactivity as a major dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms and functional status. This study also aimed to investigate whether high-sensitivity C-reactive protein, a marker of low-grade inflammation, could be a biological marker of emotional dysregulation in bipolar disorder (BD). METHODS Cross-sectional study of 613 subjects who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition criteria for BD recruited from the FondaMental Advanced Centers of Expertise in Bipolar Disorders cohort from 2009 to 2014. All patients had been in remission for at least 3 months before assessment. Patients were classified into three groups according to levels of emotional reactivity. Emotional reactivity was assessed by using the Multidimensional Assessment of Thymic States, and functional status was assessed by the Functioning Assessment Short Test. Clinical characteristics and blood sample were collected from all patients. RESULTS In total, 415 (68%) patients had abnormal emotional reactivity. Independent of potential confounders, including age, gender and subthreshold mood symptoms, serum levels of high-sensitivity C-reactive protein were significantly higher in patients with emotional hyper-reactivity (median = 4.0 mg/L, interquartile range = 2.7-5.6), and with emotional hypo-reactivity (median = 3.0 mg/L, interquartile range = 1-4) compared with patients with normal emotional reactivity (median = 0.95 mg/L, interquartile range = 0.4-1.9, p < 0.001). Patients with emotional hyper-reactivity showed significant cognitive functioning impairment ( p < 0.001). CONCLUSIONS Emotional reactivity appears to be a relevant dimension for better characterizing remitted bipolar patients with subthreshold mood symptoms. Levels of high-sensitivity C-reactive protein may be an objective marker of emotional dysregulation in BD. Further studies are needed to confirm our findings.
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Affiliation(s)
- Aroldo A Dargél
- 1 Unité Perception et Mémoire, Institut Pasteur, Paris, France.,2 Unité Mixte de Recherche, Centre National de la Recherche Scientifique, Paris, France
| | - Ophelia Godin
- 3 INSERM UMRS 943, UPMC Université, Paris, France.,4 Fondation FondaMental, Fondation de cooperation scientifique, Créteil, France
| | - Bruno Etain
- 4 Fondation FondaMental, Fondation de cooperation scientifique, Créteil, France.,5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,6 Université Paris-Est, UMR_S955, UPEC, Créteil, France.,7 Pôle de Psychiatrie, Hôpital H. Mondor-A. Chenevier, AP-HP, Créteil, France
| | - Vânia Hirakata
- 8 Grupo de Pós-Graduação e Pesquisa, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jean-Michel Azorin
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,9 Service de psychiatrie adulte, Centre Expert Trouble Bipolaire, Hôpital Charles Perrens, Bordeaux, France
| | - Katia M'Bailara
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,9 Service de psychiatrie adulte, Centre Expert Trouble Bipolaire, Hôpital Charles Perrens, Bordeaux, France.,10 Laboratory of Psychology 'Health and Quality of Life' EA 4139, Université Bordeaux Segalen, Bordeaux, France
| | - Frank Bellivier
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,11 AP-HP, GH Saint-Louis-Lariboisière-Fernand Widal, Pôle Neurosciences, Paris, France
| | - Thierry Bougerol
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,12 University Joseph Fourier, Grenoble, France.,13 Centre Hospitalier Universitaire de Grenoble, Grenoble, France.,14 Grenoble Institut des Neurosciences (GIN), Inserm U 836, Chemin Fortuné Ferrini, La Tronche, France
| | - Jean-Pierre Kahn
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,15 Centre Hospitalier Universitaire de Nancy, Hôpitaux de Brabois, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Christine Passerieux
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,16 Centre Hospitalier de Versailles, Le Chesnay, France.,17 Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - Valerie Aubin
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,18 Pôle de Psychiatrie, Centre Hospitalier Princesse Grace, Monaco, France
| | - Philippe Courtet
- 5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,19 Psychiatric Emergency Department, CHRU Montpellier, France.,20 INSERM U1061, Montpellier University, Montpellier, France
| | - Marion Leboyer
- 4 Fondation FondaMental, Fondation de cooperation scientifique, Créteil, France.,5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,6 Université Paris-Est, UMR_S955, UPEC, Créteil, France.,7 Pôle de Psychiatrie, Hôpital H. Mondor-A. Chenevier, AP-HP, Créteil, France
| | - Chantal Henry
- 1 Unité Perception et Mémoire, Institut Pasteur, Paris, France.,5 INSERM, U955, Equipe 15 Genetic Psychiatry, Créteil, France.,6 Université Paris-Est, UMR_S955, UPEC, Créteil, France.,7 Pôle de Psychiatrie, Hôpital H. Mondor-A. Chenevier, AP-HP, Créteil, France
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17
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Vaskinn A, Lagerberg TV, Bjella TD, Simonsen C, Andreassen OA, Ueland T, Sundet K. Impairment in emotion perception from body movements in individuals with bipolar I and bipolar II disorder is associated with functional capacity. Int J Bipolar Disord 2017; 5:13. [PMID: 28332121 PMCID: PMC5433954 DOI: 10.1186/s40345-017-0083-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/27/2017] [Indexed: 01/08/2023] Open
Abstract
Background Individuals with bipolar disorder present with moderate impairments in social cognition during the euthymic state. The impairment extends to theory of mind and to the perception of emotion in faces and voices, but it is unclear if emotion perception from body movements is affected. The main aim of this study was to examine if participants with bipolar disorder perform worse than healthy control participants on a task using point-light displays of human full figures moving in a manner indicative of a basic emotion (angry, happy, sad, fearful, neutral/no emotion). A secondary research question was whether diagnostic subtypes (bipolar I, bipolar II) and history of psychosis impacted on this type of emotion perception. Finally, symptomatic, neurocognitive, and functional correlates of emotion perception from body movements were investigated. Methods Fifty-three individuals with bipolar I (n = 29) or bipolar II (n = 24) disorder, and 84 healthy control participants were assessed for emotion perception from body movements. The bipolar group also underwent clinical, cognitive, and functional assessment. Research questions were analyzed using analyses of variance and bivariate correlations. Results The bipolar disorder group differed significantly from healthy control participants for emotion perception from body movements (Cohen’s d = 0.40). Analyses of variance yielded no effects of sex, diagnostic subtype (bipolar I, bipolar II), or history of psychosis. There was an effect of emotion, indicating that some emotions are easier to recognize. The lack of a significant group × emotion interaction effect points, however, to this being so regardless of the presence of bipolar disorder. Performance was unrelated to manic and depressive symptom load but showed significant associations with neurocognition and functional capacity. Conclusions Individuals with bipolar disorder had a small but significant impairment in the ability to perceive emotions from body movement. The impairment was global, i.e., affecting all emotions and equally present for males and females. The impairment was associated with neurocognition and functional capacity, but not symptom load. Our findings identify pathopsychological factors underlying the functional impairment in bipolar disorder and suggest the consideration of social cognition training as part of the treatment for bipolar disorder.
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Affiliation(s)
- Anja Vaskinn
- Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway. .,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.
| | - Trine Vik Lagerberg
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Thomas D Bjella
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Carmen Simonsen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Early Intervention in Psychosis Advisory Unit, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Department of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway.,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway.,NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway
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18
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Aparicio A, Santos JL, Jiménez-López E, Bagney A, Rodríguez-Jiménez R, Sánchez-Morla EM. Emotion processing and psychosocial functioning in euthymic bipolar disorder. Acta Psychiatr Scand 2017; 135:339-350. [PMID: 28188631 DOI: 10.1111/acps.12706] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/23/2023]
Abstract
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.
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Affiliation(s)
- A Aparicio
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - J L Santos
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - E Jiménez-López
- Departmentof Psychiatry, Hospital Virgen de La Luz, Cuenca, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - A Bagney
- Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain
| | - R Rodríguez-Jiménez
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain.,Department of Psychiatry, Research Institute of Hospital 12 de Octubre (imas 12), Madrid, Spain
| | - E M Sánchez-Morla
- Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain.,Department of Medicine, School of Medicine, University of Alcalá, Madrid, Spain.,Department of Psychiatry, University Hospital of Guadalajara, Guadalajara, Spain
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19
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Abstract
The present study analyzed the capacity for mentalization of patients with bipolar disorder (BD) and their first-degree relatives (FDR) and examined the implications of clinical variables and cognitive deficits. The study recruited 31 patients with type I BD, 18 FDR, and 31 paired healthy controls. Their capacity for mentalization was explored by means of first- and second-order false-belief tasks, the hinting task, and the Movie for the Assessment of Social Cognition (MASC). Patients and FDR were found to have a theory of mind (ToM) deficit when they were evaluated with the MASC, which was also related to a worse neurocognitive performance and to being a patient or FDR. The evidence of ToM deficits in FDRs supports the hypothesis that these deficits could be an independent trait marker for cognitive deficit. Further research is needed on FDR of patients with BD, using sensitive ToM assessment instruments such as the MASC.
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20
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Haag S, Haffner P, Quinlivan E, Brüne M, Stamm T. No differences in visual theory of mind abilities between euthymic bipolar patients and healthy controls. Int J Bipolar Disord 2016; 4:20. [PMID: 27734416 PMCID: PMC5061679 DOI: 10.1186/s40345-016-0061-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/02/2016] [Indexed: 12/25/2022] Open
Abstract
Background Research on theory of mind (ToM) abilities in patients with bipolar disorder has yielded conflicting results. Meta-analyses point to a stable moderate impairment in remitted patients, but factors such as subsyndromal symptoms, illness severity, and deficits in basic neurocognitive functions might act as confounders. Also, differences in deficits depending on task area (cognitive or affective) or task modality (visual or verbal) have been observed. This study aimed to test the hypothesis that euthymic bipolar patients would perform more poorly than healthy subjects on visual cognitive and visual affective ToM tasks. Furthermore, we aimed to explore the relationship between ToM performance and basic neurocognitive functions, subsyndromal symptom severity, and illness burden. Twenty-nine clinically stable outpatients with bipolar disorder and 29 healthy comparison subjects completed a measure of visual cognitive ToM (Mental State Attribution Task, MSAT), a measure of visual affective ToM (Reading the Mind in the Eyes Test, RMET), and a battery of tests assessing neurocognitive functioning (attention, verbal memory, executive functions, and intelligence). Results Patients did not differ significantly from healthy controls for the ToM tasks or any of the neurocognitive measures, suggesting a high level of neurocognitive functioning in the bipolar group. On average, patients were slower than controls to complete the ToM tasks. Within the bipolar group, ToM performance was moderately correlated with attention, verbal memory and reasoning abilities. Performance on the RMET was positively correlated with clinician-rated depressive symptoms with a small effect. Number of years of illness was weakly and negatively correlated with performance on the MSAT. Overall, no moderate or strong correlations were found between ToM performance, subsyndromal depressive or manic symptoms, illness duration, and number of depressive or (hypo)manic episodes. Moderate correlations between ToM performance and age were found for patients but nor for controls. Conclusions Our findings suggest preserved visual cognitive and affective ToM abilities in euthymic bipolar patients characterized by a high level of neurocognitive functioning.
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Affiliation(s)
- Silvia Haag
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany.
| | - Paula Haffner
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Esther Quinlivan
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Brüne
- Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Department of Psychiatry, Psychotherapy, and Preventive Medicine, LWL University Hospital Bochum, Ruhr University Bochum, Alexandrinenstr. 1-3, 44791, Bochum, Germany
| | - Thomas Stamm
- Department of Psychiatry and Psychotherapy, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
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Douglas KM, Van Rheenen TE. Current Treatment Options for Cognitive Impairment in Bipolar Disorder: a Review. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s40501-016-0092-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Taking It at "Face Value": The Use of Face Processing Strategies in Bipolar Disorder and Schizophrenia. J Int Neuropsychol Soc 2016; 22:652-61. [PMID: 27255999 DOI: 10.1017/s1355617716000412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Use of appropriate face processing strategies is important for facial emotion recognition, which is known to be impaired in schizophrenia (SZ) and bipolar disorder (BD). There is preliminary evidence of abnormalities in the use of face processing strategies in the former, but there has been no explicit attempt to assess face processing in patients with BD. METHODS Twenty-eight BD I, 28 SZ, and 28 healthy control participants completed tasks assessing featural and configural face processing. The facial inversion effect was used as a proxy of second order configural face processing and compared to featural face processing performance (which is known to be relatively less affected by facial inversion). RESULTS Controls demonstrated the usual second-order inversion pattern. In the BD group, the absence of a second-order configural inversion effect in the presence of a disproportionate bias toward a featural inversion effect was evident. Despite reduced accuracy performance in the SZ group compared to controls, this group unexpectedly showed a normal second-order configural accuracy inversion pattern. This was in the context of a reverse inversion effect for response latency, suggesting a speed-versus-accuracy trade-off. CONCLUSIONS To our knowledge, this is the first study to explicitly examine and contrast face processing in BD and SZ. Our findings indicate a generalized impairment on face processing tasks in SZ, and the presence of a second-order configural face processing impairment in BD. It is possible that these face processing impairments represent a catalyst for the facial emotion recognition deficits that are commonly reported in the literature. (JINS, 2016, 22, 652-661).
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Van Rheenen TE, Bryce S, Tan EJ, Neill E, Gurvich C, Louise S, Rossell SL. Does cognitive performance map to categorical diagnoses of schizophrenia, schizoaffective disorder and bipolar disorder? A discriminant functions analysis. J Affect Disord 2016; 192:109-15. [PMID: 26720009 DOI: 10.1016/j.jad.2015.12.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/13/2015] [Accepted: 12/14/2015] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Despite known overlaps in the pattern of cognitive impairments in individuals with bipolar disorder (BD), schizophrenia (SZ) and schizoaffective disorder (SZA), few studies have examined the extent to which cognitive performance validates traditional diagnostic boundaries in these groups. METHOD Individuals with SZ (n=49), schizoaffective disorder (n=33) and BD (n=35) completed a battery of cognitive tests measuring the domains of processing speed, immediate memory, semantic memory, learning, working memory, executive function and sustained attention. RESULTS A discriminant functions analysis revealed a significant function comprising semantic memory, immediate memory and processing speed that maximally separated patients with SZ from those with BD. Initial classification scores on the basis of this function showed modest diagnostic accuracy, owing in part to the misclassification of SZA patients as having SZ. When SZA patients were removed from the model, a second cross-validated classifier yielded slightly improved diagnostic accuracy and a single function solution, of which semantic memory loaded most heavily. CONCLUSIONS A cluster of non-executive cognitive processes appears to have some validity in mapping onto traditional nosological boundaries. However, since semantic memory performance was the primary driver of the discrimination between BD and SZ, it is possible that performance differences between the disorders in this cognitive domain in particular, index separate underlying aetiologies.
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Affiliation(s)
- Tamsyn E Van Rheenen
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia; Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia.
| | - Shayden Bryce
- Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Eric J Tan
- Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Erica Neill
- Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Caroline Gurvich
- Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Stephanie Louise
- Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Susan L Rossell
- Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Health, Arts and Design, School of Health Sciences, Swinburne University, Melbourne, Australia; Cognitive Neuropsychiatry Laboratory, Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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Mitchell RLC, Young AH. Theory of Mind in Bipolar Disorder, with Comparison to the Impairments Observed in Schizophrenia. Front Psychiatry 2015; 6:188. [PMID: 26834648 PMCID: PMC4716141 DOI: 10.3389/fpsyt.2015.00188] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/27/2015] [Indexed: 01/10/2023] Open
Abstract
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.
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Affiliation(s)
- Rachel L C Mitchell
- Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK
| | - Allan H Young
- Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK
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