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Deng F, Bueber MA, Cao Y, Tang J, Bai X, Cho Y, Lee J, Lin Z, Yang Q, Keshavan MS, Stone WS, Qian M, Yang LH, Phillips MR. Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression. Psychol Med 2024; 54:847-873. [PMID: 38173096 DOI: 10.1017/s0033291723003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.
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Affiliation(s)
- Fei Deng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- University of Nottingham School of Economics (Ningbo China), Zhejiang, China
| | - Marlys A Bueber
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yourong Cao
- Guangxi Medical University School of Public Health, Guangxi, China
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jeff Tang
- New York University, New York, NY, USA
| | - Xinyu Bai
- Guangxi Medical University School of Public Health, Guangxi, China
- Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Young Cho
- New York State Psychiatric Institute, New York, NY, USA
| | - Jiwon Lee
- Teachers College, Columbia University, New York, NY, USA
| | - Zhuozhi Lin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Qi Yang
- Ningxia Medical University School of Public Health, Ningxia, China
| | - Matcheri S Keshavan
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William S Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence H Yang
- New York University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Konstantakopoulos G, Ioannidi N, Psarros C, Patrikelis P, Stefanatou P, Kravariti E. The impact of neurocognition on mentalizing in euthymic bipolar disorder versus schizophrenia. Cogn Neuropsychiatry 2020; 25:405-420. [PMID: 33050828 DOI: 10.1080/13546805.2020.1829579] [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] [Indexed: 12/21/2022]
Abstract
Introduction: Theory of mind (ToM) or mentalizing deficits have been found in schizophrenia (SZ) and bipolar disorder (BD), but their relationships to patients' coexistent neurocognitive deficits are still unclear. The present study aimed to explore the possible differential involvement of neurocognitive deficits in ToM impairments in SZ and euthymic BD. Methods: Fifty-three euthymic patients with BD type I, 54 clinically stable patients with SZ, and 53 healthy participants were assessed with an advanced ToM task (Faux Pas Recognition Test) which measures cognitive and affective ToM components, and a comprehensive battery of neuropsychological measures. The three groups were matched for gender, age and education. Results: Patients with BD showed significant impairment, comparable to that in SZ, only in the cognitive facet of ToM, whereas SZ patients had significantly poorer performance than both BD patients and healthy participants in overall and affective ToM. In both SZ and euthymic BD, ToM performance was related to deficits in particular cognitive functions. After controlling for coexistent neurocognitive deficits, overall and affective ToM in SZ were still impaired whereas the cognitive ToM impairment in BD and SZ did not remained statistically significant. Conclusions: Our findings suggest a different profile of ToM deficits between SZ and BD and an independence of ToM dysfunction from concurrent neurocognitive deficits in SZ but not in BD.
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Affiliation(s)
- George Konstantakopoulos
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital, Athens, Greece.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nikoleta Ioannidi
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Constantin Psarros
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Panayiotis Patrikelis
- Department of Neurosurgery, National & Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - Pentagiotissa Stefanatou
- First Department of Psychiatry, National & Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Eugenia Kravariti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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de Siqueira Rotenberg L, Beraldi GH, Okawa Belizario G, Lafer B. Impaired social cognition in bipolar disorder: A meta-analysis of Theory of Mind in euthymic patients. Aust N Z J Psychiatry 2020; 54:783-796. [PMID: 32447967 DOI: 10.1177/0004867420924109] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To conduct a meta-analysis of Theory of Mind studies exclusively in euthymic patients with bipolar disorder. METHOD After the exclusion of studies evaluating symptomatic patients during acute episodes, we performed a meta-analysis including a total of 30 studies, comparing 1294 euthymic bipolar disorder patients and 1116 healthy controls. RESULTS Patients with bipolar disorder presented a significant impairment in Theory of Mind performance when compared to controls (Hedge's g = -0.589, 95% confidence interval: -0.764 to -0.414, Z = -6.594, p < 0.001). When compared to controls, Theory of Mind was impaired in patients with both bipolar disorder I (Hedge's g = -0.663, 95% confidence interval: -0.954 to -0.372, Z = -4.462, p < 0.001) and bipolar disorder II (Hedge's g = -1.165, 95% confidence interval: -1.915 to -0.415, Z = -3.044, p = 0.002). Theory of Mind impairments were also significantly more severe in verbal tasks (Hedge's g = -1.077, 95% confidence interval: -1.610 to -0.544, Z = -3.961 p < 0.001) than visual tasks (Hedge's g =-0.614, 95% confidence interval: -0.844 to -0.384, Z = -5.231, p < 0.001) when compared to controls. CONCLUSION The results obtained confirm that Theory of Mind is impaired in remitted bipolar disorder patients, being a potential endophenotype for bipolar disorder. Moreover, we found higher deficits in verbal Theory of Mind, compared with visual Theory of Mind. Since most studies were cross-sectional, there is a need for longitudinal studies to evaluate whether the deficits detected in Theory of Mind are progressive over the course of the illness.
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Affiliation(s)
- Luisa de Siqueira Rotenberg
- Bipolar Disorder Research Program (PROMAN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program (PROMAN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Gabriel Okawa Belizario
- Bipolar Disorder Research Program (PROMAN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
| | - Beny Lafer
- Bipolar Disorder Research Program (PROMAN), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brazil
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Eddy CM. What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations. Front Psychiatry 2019; 10:425. [PMID: 31354534 PMCID: PMC6636467 DOI: 10.3389/fpsyt.2019.00425] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022] Open
Abstract
Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.
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Affiliation(s)
- Clare M. Eddy
- Research and Innovation, BSMHFT National Centre for Mental Health, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Herrmann AS, Beutel ME, Gerzymisch K, Lane RD, Pastore-Molitor J, Wiltink J, Zwerenz R, Banerjee M, Subic-Wrana C. The impact of attachment distress on affect-centered mentalization: An experimental study in psychosomatic patients and healthy adults. PLoS One 2018; 13:e0195430. [PMID: 29672540 PMCID: PMC5908075 DOI: 10.1371/journal.pone.0195430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 03/23/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction We investigated the impact of attachment distress on affect-centered mentalization in a clinical and a non-clinical sample, comparing mentalization in a baseline condition to mentalization under a condition of attachment distress. Methods The sample consisted of 127 adults who underwent inpatient psychosomatic treatment, and 34 mentally healthy adults. Affect-centered mentalization was assessed by analyzing participants’ narratives on interpersonal situations in a baseline condition with the Levels of Emotional Awareness Scale (LEAS), and an experimental condition inducing attachment distress with the Adult Attachment Projective Picture System (AAP). Unlike the LEAS, the AAP is specifically designed to trigger attachment distress. In both conditions, the narratives were evaluated using the LEAS scoring system. Additionally, we assessed the impact of childhood trauma on affect-centered mentalization with the Childhood Trauma Questionnaire (CTQ). Results While the non-clinical sample displayed the same level of affect-centered mentalization in both conditions, the majority of the clinical sample reached higher scores in the attachment distress condition. There was no strong relationship between reported trauma and mentalization scores. Discussion Our findings lend strong empirical support to the assumption that affect-centered mentalization is modulated by attachment-related distress. Several possible explanations for the differences between and within the clinical and the non-clinical sample are discussed.
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Affiliation(s)
- Anna S Herrmann
- DFG Research Training Group "Life Sciences, Life Writing" (GRK2015/1) / Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Katharina Gerzymisch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Richard D Lane
- Department of Psychiatry, The University of Arizona College of Medicine, Tucson, Arizona, United States of America
| | - Janine Pastore-Molitor
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Mita Banerjee
- Department of English and Linguistics, University of Mainz, Mainz, Germany
| | - Claudia Subic-Wrana
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Espinós U, Fernández-Abascal EG, Ovejero M. What your eyes tell me: Theory of mind in bipolar disorder. Psychiatry Res 2018; 262:536-541. [PMID: 28969860 DOI: 10.1016/j.psychres.2017.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess social- perceptual Theory of Mind in bipolar disorder (BD). 112 euthymic participants with BD I or BD II (65 with BD I and 47 with BD II) were compared to a group of 112 persons with no psychiatric diagnosis and 43 with unipolar depression (UD). They completed the task of the "Reading the Mind in the Eyes" (RMET). The results show that participants with BD, I and II, as well as the group with UD performed significantly more poorly than the control group. As for the wrong answers, BDs mostly chose positive valence stimuli, while the UD group chose negative valence items. The main limitation of this research is related to the characteristics of the cross-sectional study. It cannot detect at what time of the disorder these differences in emotion processing will appear with more intensity. As for future research, we suggest interventions to improve the deficits in ToM in bipolar persons. The use of the RMET in the first stages of BD II could help to facilitate a correct diagnosis.
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Affiliation(s)
- Usue Espinós
- Universidad Nacional de Educación a Distancia (UNED), Calle de Juan del Rosal 10, 28040 Madrid, Spain.
| | | | - Mercedes Ovejero
- Universidad Complutense de Madrid (UCM), Campus de Somosaguas, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain.
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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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