Emotion In Bipolar Disorder Research Articles

An fMRI Study of Neural Activities Associated With Affective Processing Under Long-Term Affective Film Triggering

Dynamic functional connectivity (dFC) based on resting-state fMRI has attracted interest in the field of bipolar disorder (BD), because dFC can better capture the evolving processes of emotion and cognition, which are typically impaired in BD. However, previous dFC studies of BD have typically focused on specific seed brain regions or specific functional brain networks, and they have ignored global dynamic information interaction in the whole brain. This study is aimed to reveal aberrant and interpretable whole-brain dFC patterns of BD.The resting-state fMRI data collected from 35 euthymic BD patients and 30 healthy people. We developed a new dFC inference pipeline, including the sliding-window method, k-means clustering, a new permutation with zero-inflated Poisson regression method, and a similarity analysis for interpretable states, to examine the different patterns of dFC states between BD patients and healthy participants.BD patients had significantly more frequent transitions between two specific dFC states, which were respectively close to high-level cognitive networks and low-level sensory networks, than healthy controls (p < 0.05, FDR).The size of samples and other BD types need to be expanded to validate the results of this study. Possible confounding effect of medication.This study detected aberrant dFC pattern of BD, which indicated the increased lability of the processes of cognition and emotion in BD, and this finding could improve our understanding of the neuropathological mechanism of BD.

Abnormal transitions of dynamic functional connectivity states in bipolar disorder: A whole-brain resting-state fMRI study

BackgroundDynamic functional connectivity (dFC) based on resting-state fMRI has attracted interest in the field of bipolar disorder (BD), because dFC can better capture the evolving processes of emotion and cognition, which are typically impaired in BD. However, previous dFC studies of BD have typically focused on specific seed brain regions or specific functional brain networks, and they have ignored global dynamic information interaction in the whole brain. This study is aimed to reveal aberrant and interpretable whole-brain dFC patterns of BD. MethodsThe resting-state fMRI data collected from 35 euthymic BD patients and 30 healthy people. We developed a new dFC inference pipeline, including the sliding-window method, k-means clustering, a new permutation with zero-inflated Poisson regression method, and a similarity analysis for interpretable states, to examine the different patterns of dFC states between BD patients and healthy participants. ResultsBD patients had significantly more frequent transitions between two specific dFC states, which were respectively close to high-level cognitive networks and low-level sensory networks, than healthy controls (p < 0.05, FDR). LimitationsThe size of samples and other BD types need to be expanded to validate the results of this study. Possible confounding effect of medication. ConclusionsThis study detected aberrant dFC pattern of BD, which indicated the increased lability of the processes of cognition and emotion in BD, and this finding could improve our understanding of the neuropathological mechanism of BD.

Motivations for Emotions in Bipolar Disorder

Recent work has begun to examine the link between motivation for specific emotions and psychopathology. Yet research on this topic to date has focused primarily on depression. To understand patterns of motivation for emotions within and across affective disorders, we assessed motivation for emotions in adults at increased risk for and diagnosed with bipolar disorder (BD). We focused on motivation for negative (i.e., sadness) and positive (i.e., happiness) emotions and for emotional instability using self-report and behavioral measures. Both increased BD risk and diagnosis of BD were associated with increased motivation for sadness and decreased motivation for happiness as assessed by behavioral measures. Such motivational tendencies were less consistent when assessed by self-reports. Higher BD risk was associated with increased self-reported motivation for emotional instability (Studies 1–3), although this association was not evident in BD (Study 4). Findings suggest both similarities and differences in motivation for emotions in affective disorders.

Intrinsic functional connectivity during continuous maintenance and suppression of emotion in bipolar disorder.

Resting-state connectivity studies, which examine unconstrained low frequency BOLD fluctuations, have reported inconsistent abnormalities in bipolar disorder (BP). In this study, we investigated intrinsic brain connectivity under the constraints of a Continuous Emotion Regulation Task (CERT) in BP patients in depressed (BPD) and manic (BPM) states, along with healthy control participants. Medication-free participants, with either a diagnosis of BP (BPD = 27, BPM = 30) or healthy controls (N = 33) were included. We collected 2 fMRI scans using the CERT paradigm, in which participants continuously watched negative pictures and either maintained emotions (MAINTAIN) or suppressed emotion using reappraisal techniques (SUPPRESS). Network-based statistic and graph theory analyses were examined for (i) the main effect of condition (within-group) and (ii) group and condition interactions. In healthy participants, MAINTAIN largely involved occipital and parietal cortices (p < .001), whereas SUPPRESS also recruited the frontal and cingulate cortices (p = .023). The interaction between group (BPD vs. BPM) and condition revealed a network involving the inferior frontal lobe which was stronger during MAINTAIN for BPD and during SUPPRESS for BPM (p = .037). Graph theory properties (i.e., clustering coefficient) for key nodes also evidenced significant group by condition interactions. We observed BP-related changes in network properties involved in normal and abnormal emotion regulation, which provide insights into the neural bases for affective disturbances in BP.

Symptoms, course of Illness, and comorbidity as predictors of expressed emotion in bipolar disorder

High levels of expressed emotions (EE) reflect the amount of criticism and/or over-involvement in families and has been linked to relapse risk in various psychiatric disorders including bipolar disorder (BD). Less clear is which factors contribute to the development and/or maintenance of EE. Therefore, we tested whether patient characteristics, specifically clinical features and personality disorder traits in BD predicted key aspects of EE as assessed by patients and their relatives. Patients with remitted BD and their relatives were asked to complete the Family Attitude Scale (FAS) and the Perceived Criticism Measure (PCM). Patient characteristics were assessed with a variety of measures including SCID I and II. The FAS and PCM shared 25% of the variance for patients and 14% for relatives, suggesting a conceptual overlap, but they may not assess identical constructs. The number of previous mood episodes, current self-rated manic symptoms, and comorbid symptoms of Cluster C personality disorder predicted patient-rated FAS. Relative-rated FAS was only predicted by comorbid symptoms of Cluster A personality disorder. In BD, specific patient characteristics seem to be linked to key aspects of EE even when in remission. However, it might depend whether the patient, his/her relative, or a neutral observer assessed EE.

Neural Activation During Tonic Pain and Interaction Between Pain and Emotion in Bipolar Disorder: An fMRI Study.

Objective: Pain and affective disorders have clear clinical relevance; however, very few studies have investigated the association between pain and bipolar disorder. This study investigated the brain activity of patients with bipolar disorder (BPs) undergoing tonic pain and assessed the interaction between pain and emotion.Methods: Ten BPs and ten healthy controls (HCs) were exposed to emotional pictures (positive, neutral, or negative), tonic pain only (pain session), and emotional pictures along with tonic pain (combined session). A moderate tonic pain was induced by the infusion of hypertonic saline (5% NaCl) into the right masseter muscle with a computer-controlled system. Whole-brain blood oxygenation level dependent (BOLD) signals were acquired using 3T functional resonance imaging (fMRI).Results: Ten BPs and ten healthy participants were included in the final analysis. During the pain session, BPs accepted more saline, but showed lower pain rating scores than HCs. When experiencing pain, BPs showed a significant decrease in the BOLD signal in the bilateral insula, left inferior frontal gyrus (IFG), and left cerebellum as compared with HCs. In the combined session, the activated regions for positive mood (pain with positive mood > baseline) in BPs were the left cerebellum, right temporal gyrus, and left occipital gyrus; the activated regions for negative mood (pain with negative mood > baseline) were the right occipital gyrus, left insula, left IFG, and bilateral precentral gyrus.Conclusions: This study presents the preliminary finding of the interaction between pain and emotion in BPs. BPs exhibited lower sensitivity to pain, and the activation of insula and IFG may reflect the interaction between emotion and pain stimulus.

The Relationship between the Number of Manic Episodes and Oxidative Stress Indicators in Bipolar Disorder.

ObjectiveBipolar disorder (BD) is a chronic mood disorder characterized by recurrent episodes that has a lifetime prevalence of 0.4–5.5%. The neurochemical mechanism of BD is not fully understood. Oxidative stress in neurons causes lipid peroxidation in proteins associated with neuronal membranes and intracellular enzymes and it may lead to dysfunction in neurotransmitter reuptake and enzyme activities. These pathological processes are thought to occur in brain regions associated with affective functions and emotions in BD. The relationship between the number of manic episodes and total oxidant-antioxidant capacity was investigated in this study.MethodsEighty-two BD patients hospitalized due to manic symptoms and with no episodes of depression were enrolled in the study. Thirty of the 82 patients had had their first episode of mania, and the other 52 patients had had two or more manic episodes. The control group included 45 socio-demographically matched healthy individuals. Serum total antioxidant capacity (TAC) and total oxidant capacity (TOC) measurements of the participants were performed. The oxidative stress index (OSI) was calculated by TOC/TAC.ResultsThere were no significant differences in OSI scores between BD patients with first-episode mania and BD patients with more than one manic episode. However, OSI scores in both groups were significantly higher than in the control group. TOC levels of BD patients with first-episode mania were found to be significantly higher than TOC levels of BD patients with more than one manic episode and healthy controls. There were no significant differences in TAC levels between BD patients with first-episode mania and BD patients with more than one manic episode. TAC levels in both groups were significantly higher than in the control group.ConclusionSignificant changes in oxidative stress indicators were observed in this study, confirming previous studies. Increased levels of oxidants were shown with increased disease severity rather than with the number of manic episodes. Systematic studies, including of each period of the disorder, are needed for using the findings indicating deterioration of oxidative parameters.

Identification and Perceived Intensity of Facial Expressions of Emotion in Bipolar Disorder and Major Depression.

This study aimed to examine the accuracy in identifying facial expressions and the perceived intensity of emotions of happiness, sadness, disgust, anger, fear, surprise in bipolar disorder (BD), and major depressive disorder (MDD). Ninety-three adult participants (n = 30 BD, 80% female; n = 18 MDD, 72.2% female; n = 45 C, 46.7% female) completed a facial expression task. Stimuli in the task were first presented for 200 ms, followed by 500 ms, and 1000 ms. Participants were asked to identify the emotion expressed by each face and judge its intensity on a Likert scale. Accuracy and perceived intensity of expressions corresponding to each emotion were compared between groups using a repeated measures ANCOVA, with length of stimulus presentation as a within-subjects variable. Expressions of sadness were rated more intensely by patients with BD, and expressions of anger by those with MDD, than control participants. Subjects with BD were less accurate than control participants in identifying expressions of disgust. An interaction effect was also identified for the detection of sadness, whereby patients with BD were significantly less accurate when expressions were shown for 200 ms. The increased intensity with which emotions were perceived by patients with BD and MDD has important repercussions for patient functioning and clinical practice. A tendency to overestimate the intensity of certain facial expressions in mood disorders may lead patients to interpret social cues erroneously and engage in dysfunctional behaviors and cognitive patterns. Future studies should focus on this variable in addition to the accuracy of emotion identification.

Configural and Featural Face Processing Influences on Emotion Recognition in Schizophrenia and Bipolar Disorder.

Emotion recognition impairments have been demonstrated in schizophrenia (Sz), but are less consistent and lesser in magnitude in bipolar disorder (BD). This may be related to the extent to which different face processing strategies are engaged during emotion recognition in each of these disorders. We recently showed that Sz patients had impairments in the use of both featural and configural face processing strategies, whereas BD patients were impaired only in the use of the latter. Here we examine the influence that these impairments have on facial emotion recognition in these cohorts. Twenty-eight individuals with Sz, 28 individuals with BD, and 28 healthy controls completed a facial emotion labeling task with two conditions designed to separate the use of featural and configural face processing strategies; part-based and whole-face emotion recognition. Sz patients performed worse than controls on both conditions, and worse than BD patients on the whole-face condition. BD patients performed worse than controls on the whole-face condition only. Configural processing deficits appear to influence the recognition of facial emotions in BD, whereas both configural and featural processing abnormalities impair emotion recognition in Sz. This may explain discrepancies in the profiles of emotion recognition between the disorders. (JINS, 2017, 23, 287-291).

The recognition of facial emotions in bipolar disorder

Introduction Bipolar disorder is a common chronic psychiatric disorder, marked by the severity and frequency of mood episodes and their impact on the psychosocial functioning of these patients. Even during inter-critical periods, these patients' cognitive functions are altered. Patients diagnosed with bipolar disorder, by definition, have problems with emotional regulation. However, it remains uncertain whether these patients also have a deficit in processing emotions of others. The main objective was to assess social cognition (recognition of facial emotions) in euthymic bipolar subjects by comparing them to a control group. Methodology This is a transversal case-witness study, conducted in consultation with the post-treatment, of 30 euthymic bipolar patients and 30 healthy volunteers matched for age, sex and educational level, with the help of a questionnaire targeting socio-demographic and clinical data, as well as a facial expression recognition test to measure social cognition. Results Our study showed that bipolar patients had deficits in social cognition compared to the volunteers' group. Bipolar patients have more difficulties than healthy subjects to recognize facial emotions of fear, anger and disgust, and assign intentions to others from images. These deficits are even more accentuated in the early onset forms. Conclusion This study shows a disturbance of perception of emotions in bipolar patients. These cognitive deficits could participate in behavioral and social disorders present in bipolar disorder.

Alteration of complex negative emotions induced by music in euthymic patients with bipolar disorder

BackgroundResearch has shown bipolar disorder to be characterized by dysregulation of emotion processing, including biases in facial expression recognition that is most prevalent during depressive and manic states. Very few studies have examined induced emotions when patients are in a euthymic phase, and there has been no research on complex emotions. We therefore set out to test emotional hyperreactivity in response to musical excerpts inducing complex emotions in bipolar disorder during euthymia. MethodsWe recruited 21 patients with bipolar disorder (BD) in a euthymic phase and 21 matched healthy controls. Participants first rated their emotional reactivity on two validated self-report scales (ERS and MAThyS). They then rated their music-induced emotions on nine continuous scales. The targeted emotions were wonder, power, melancholy and tension. We used a specific generalized linear mixed model to analyze the behavioral data. ResultsWe found that participants in the euthymic bipolar group experienced more intense complex negative emotions than controls when the musical excerpts induced wonder. Moreover, patients exhibited greater emotional reactivity in daily life (ERS). Finally, a greater experience of tension while listening to positive music seemed to be mediated by greater emotional reactivity and a deficit in executive functions. LimitationsThe heterogeneity of the BD group in terms of clinical characteristics may have influenced the results. ConclusionsEuthymic patients with bipolar disorder exhibit more complex negative emotions than controls in response to positive music.

Harnessing happiness? Uncontrollable positive emotion in bipolar disorder, major depression, and healthy adults.

The ability to adaptively exert control over negative emotions is associated with beneficial mental health outcomes. Less is known about the associated emotional sequelae surrounding controllable versus uncontrollable positive emotional experiences. The ability to harness positive emotions is of particular importance in populations involving disrupted positive emotion functioning. In the present study, participants engaged in a relived memory task in which they recalled either a controllable or uncontrollable past positive emotional experience in counterbalanced order, while concurrent experiential and autonomic responses were measured. Participants included adults with bipolar I disorder (BD; n = 32), major depression (MDD; n = 32), and or nonpsychiatric controls (CTLs; n = 31). Across all participants, reliving a controllable positive emotion experience was associated with exhibited increased respiratory sinus arrhythmia, an autonomic marker of regulatory control. Interestingly, only the MDD group reported increased positive emotion and decreased cardiovascular arousal when reliving an event involving uncontrollable positive emotion, compared to the BD and CTL groups. No other group differences emerged. These findings suggest that although controllable positive emotion experiences may be adaptive for most, individuals with a history of restricted affect and depressed mood may actually derive more pleasure from times of unharnessed happiness.

Letting go of the bad: Deficit in maintaining negative, but not positive, emotion in bipolar disorder.

Bipolar disorder is a disorder of emotion regulation. Less is known, however, about the specific processes that foster the maintenance of such prolonged and intense emotions-particularly positive-over time in this disorder. We investigated group-related differences in the ability to maintain positive and negative emotion representations over time using a previously validated emotion working memory task (Mikels et al., 2005, 2008) among individuals with bipolar I disorder (BD; n = 29) compared with both major depressive disorder (MDD; n = 29) and healthy control (n = 30) groups. Results revealed that the BD group exhibited a selective deficit in maintaining negative-but not positive-emotions compared to both the MDD and the control groups. The MDD and control groups did not differ significantly. These findings suggest that the heightened magnitude and duration of positive emotion observed in BD may, in part, be accounted for by difficulties maintaining negative emotions.

Tracking the Development of Bipolar Disorder in Childhood

Tracking the Development of Bipolar Disorder in Childhood

An fMRI study of attentional control in the context of emotional distracters in euthymic adults with bipolar disorder

Inability to modulate attention away from emotional stimuli may be a key component of dysregulated emotion in bipolar disorder (BD). Previous studies of BD indicate abnormalities in neural circuitry underlying attentional control, yet few studies examined attentional control in the context of emotional distracters. We compared activity and connectivity in neural circuitry supporting attentional control and emotion processing among 22 individuals with BD type 1, currently remitted and euthymic, and 19 healthy controls. Participants performed an emotional n-back paradigm, comprising high and low attentional demand conditions, each with either emotional (happy, fearful), neutral or no face flanker distracters. During the high attentional control demand conditions without emotional distracters, BD individuals showed reduced activity relative to controls in dorsolateral prefrontal cortex, dorsal anterior cingulate cortex (dACC), and inferior parietal cortex. During the high attentional control demand conditions with fearful-face distracters, BD individuals showed greater activity than controls in these regions and amygdala and striatum. Relative to controls, BD individuals also showed abnormal patterns of effective connectivity between dACC and amygdala during high attentional control demand with emotional face distracters. Inter-episode bipolar disorder is characterized by abnormal recruitment of attentional control neural circuitry, especially in the context of emotionally distracting information.

An investigation into the experience of self‐conscious emotions in individuals with bipolar disorder, unipolar depression and non‐psychiatric controls

There has been little research into the association of shame and other self-conscious emotions in bipolar disorder, although there is evidence linking shame to various psychopathologies. This research investigates the levels of shame in individuals with bipolar disorder. A cross-sectional design was used to compare 24 individuals with a diagnosis of bipolar disorder to a clinical control group of 18 individuals with unipolar depression, and 23 age-matched non-psychiatric controls on measures of mood (Beck Depression Inventory [BDI] and Self Report Manic Inventory [SRMI]) and of self-conscious emotions (Internalized Shame Scale and Test of Self-Conscious Affect). Higher levels of trait shame and lower guilt-proneness were found in the bipolar group. Higher levels of shame-proneness were found in the unipolar group in comparison to the bipolar and control groups. BDI scores positively correlated with trait shame and shame-proneness, and accounted for a large proportion of the variance in these scores. SRMI scores positively correlated with trait (internalized) shame and negatively correlated with guilt-proneness. There was evidence for the presence of shame within bipolar disorder, but this differed to the evidence for shame in individuals with unipolar depression. Clinical implications are discussed.

Bipolar Disorder Clinical Synthesis: Where Does the Evidence Lead?

Bipolar disorder is a common condition diagnosed by the occurrence of pathological mood elevation but most often dominated by dysphoria states. Over the past 10 years, understanding of bipolar disorder and the number of evidence-based treatments have increased dramatically. This article offers strategies for improving diagnostic confidence and simple benchmarks that facilitate integrating principles of evidence-based medicine into the management of patients with bipolar disorder. Simple systematic assessment techniques such as focusing the evaluation to assess the most extreme episode of mood elevation and longitudinal factors such as age of onset and course of illness can avoid errors of omission and raise diagnostic confidence. An iterative measurement-based treatment model that aims to bring patients and their supports into the collaborative care process for progressively better outcomes is recommended.

Perception of facial expressions of emotion in bipolar disorder.

Some studies have reported deficits in the perception of facial expressions among depressed individuals compared with healthy controls, while others have reported negative biases in expression perception. We examined whether altered perception of emotion reflects an underlying trait-like effect in affective disorder by examining facial expression perception in euthymic bipolar patients. Sensitivity to six different facial expressions, as well as accuracy of emotion recognition, was examined among 17 euthymic bipolar patients and 17 healthy controls using an interactive computer program. No differences were found between euthymic bipolar patients and controls in terms of sensitivity to any particular emotion. Although initial analysis of the data suggested impairment in the recognition of fear among the patients, identification of this emotion was not relatively impaired compared with that of the other emotions. The study did not find any conclusive evidence for trait-like deficits in the perception of facially conveyed emotions in bipolar disorder. Altered perception of facial expressions that has been found to accompany depressed mood may instead reflect mood-congruent biases.

Psychoeducation and expressed emotion in bipolar disorder: preliminary findings

A multifamily psychoeducational intervention was carried out in patients with bipolar disorder. The study explored 1. (1) the effects of the intervention on the level of expressed emotion (EE) of key relatives; 2. (2) the validity of EE defined by a 5-min speech sample as a predictor of relapse; and 3. (3) the evaluations of the intervention program by patients and key relatives. Four key relatives in the treatment group, compared with none in a waiting list control group, changed from high to low EE levels. The change was clinically but not statistically significant, perhaps because of the small sample size. Patients whose key relatives had low EE levels had a significantly lower number of relapses and hospital admissions compared with those whose key relatives had high EE levels. The psychoeducational program was well received by all participants, and there were no dropouts.