Moral Judgment and Inferential Reasoning in Patients with Bipolar Disorder and Schizophrenia

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Introduction: Previous studies demonstrated that both emotional and cognitive processes are involved in moral judgments. In this study we analyse moral judgment in two psychiatric pathologies to explain the greater use of the utilitarian judgment in moral dilemma, to recognize a selective sense moral disorder or a consequence of Theory of Mind impairment. Methods: We investigated the characteristics of moral judgment in patients with bipolar disorder and schizophrenia using personal dilemma (“Footbridge” Dilemma) and impersonal dilemma (“Trolley” Dilemma). Our study included 19 bipolar patients, 18 schizophrenic patients, and 21 healthy controls. Subjects were instructed to determine whether or not each dilemma was morally acceptable. Results: All subjects performed two Theory of Mind (ToM) tasks: the Eyes Test for emotional components and the Fauxpas Test for cognitive components.Bipolar patients performed lower than controls on all ToM tasks and on two moral dilemmas. Patients with schizophrenia performed lower than controls on all ToM tasks and on the personal moral dilemma. Conclusions: Ourresults provide evidence that inferential reasoning and moral judgments (personal and impersonal) are two different cognitive abilities and in psychiatric people their impairments can coexist and they can be linked when emotional processing is involved.