P.1.j.023 Social cognition and executive deficits in bipolar disorder and schizophrenia: preliminary data

Abstract

Purpose of the study: In the last twenty years the interest in knowing more deeply neurocognitive functioning and social cognition in major psychoses, schizophrenia (SKZ) and bipolar disorder (BD), has increased [1,2]. Social cognition has been defined as a possible mediator between neurocognition and functional domains and theory of mind, in particular, has been associated with functional outcome [3]. This study aimed to determine the extent of impairment in social and non social cognitive domains in an ecological context in patients with BD compared with schizophrenic ones. Methods: 48 Outpatients enrolled at the Department of Psychiatry of the University of Milan, were included in the study and divided into two groups: stable schizophrenic patients (SKZ= 30) and euthymic bipolar patients (BD=18). This study was approved by the Ethics Committee at Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan and informed consent was obtained from all subjects. Participants met the DSM-IVTR diagnostic criteria for SKZ or BD (diagnosed by Structured Clinical Interview for DSM-IV Axis I). If a comorbid disorder was present, the affective nor psychotic disorder had to be the primary condition affecting patient. Patients completed clinical assessment rating scales, the Brief Assessment of Cognition in Schizophrenia (BACS) and the Executive and Social Cognition Battery (ESCB). We incorporate ecological tests of executive and social function in order to better detect cognitive deficits in patients with normal results in standard executive batteries. Results: The two groups differed for the presence of a history of substance abuse, more frequent in SKZ subjects whether no significant differences were found between the groups for sex, age at onset, duration of illness and duration of untreated illness. Patients with BD performed better than schizophrenic patients in verbal memory tests (z = −2.897; p = 0.0038), BACS symbol coding (z = −2.854; p = 0.0043), and in both ToM tests (z = −3.947; p = 0.001 and z = −4.138; p< 0.001 for Eyes test and Faux pas test, respectively). About the ESCB, in the Hotel task SKZ patients attempted to complete significantly less tasks (z = −4.300; p< 0.001), and in Multiple Errands Test (MET), they also showed a greater number of errors with respect to BD patients (z = 0.245; p = 0.0248). Finally, the two groups differed significantly for GAF scores being greater for BD subjects (z = −5.204, p< 0.001). Conclusions: Bipolar patients showed less impairment on cognitive performance with respect to schizophrenic ones, even in ‘ecological’ tests, that mimic real life scenarios. An important goal will be to establish to what extent these deficits affect real life events and global outcome. The limited sample size may limit the confidence in the reported results and further investigations on larger samples are needed.