Social Cognition In Bipolar Disorder Research Articles

Childhood trauma and social cognition in participants with bipolar disorder: The moderating role of attachment

• Child traumas, attachment styles and social cognition were assessed in bipolar adults. • Participants were grouped: secure vs insecure (anxious, avoidant) attachment styles. • Participants with insecure attachment styles had more psychiatric hospitalizations. • Attachment anxiety was associated with childhood trauma but improved social cognition. • Social cognition in bipolar disorder is associated with the quality of early relational context. • Limitations include cross-sectional study design, use of self-report measures. Individuals with Bipolar Disorder (BD) present problems in Social Cognition (SC), a process associated with the quality of early attachment experiences. The experience of traumatic events in childhood threatens the quality of attachment. Attachment theory provides a comprehensive paradigm for understanding the role of early adversity on psychological functioning. However, early experiences have been largely neglected in BD research and clinical practice. We examined the moderating role of attachment in the relationship between childhood traumatic experiences and SC in a sample of 76 adults with BD. Early traumatic experiences were assessed using the Childhood Trauma Questionnaire (CTQ), SC was measured with the Hinting Task Test and attachment was examined using the Experience in Close Relationships questionnaire (ECR). Higher scores on attachment anxiety were positively associated with early traumatic events and better SC performance. Results suggest that attachment anxiety may be acting as an adaptive strategy in bipolar people who have suffered traumatic childhood experiences. The present study was observational and cross-sectional. Therefore, findings cannot be used to infer causality. Additionally, we assessed both attachment and trauma using self-report measures. Future studies should consider longitudinal designs with observer-rated measures such as standardized interviews. Our findings reinforce the importance of early childhood experiences in the development of SC in people with BD, challenging some traditional understandings of SC deficits as part of the genetic dimension of the disorder.

Deficits of social cognition in bipolar disorder: Systematic review and meta-analysis.

The association between impaired social cognition and bipolar disorder (BD) is well established. However, to our knowledge, there has not been a recent systematic review that characterizes disparate dimensions of social cognition in BD. Herein, this systematic review and meta-analysis aimed to synthesize the literature on core aspects of social cognition (i.e., Theory of Mind, emotion recognition, and social judgment) to identify potential areas of impairment. Online databases (i.e., PubMed, Cochrane Libraries, PsycINFO) and Google Scholar were searched from inception to May 2021. Studies with populations ages ≥16 with DSM-IV or DSM-5 defined BD (I or II) either in a euthymic or symptomatic state were included. The risk of bias was measured using the ROBINS-1 tool, and the quality of the sources was evaluated using GRADE criteria. The results of the studies were quantitatively measured by synthesizing Hedge's g effect sizes through a random effects meta-analytic approach. A total of 29 studies were included in the final review (i.e., 12 studies on the Theory of Mind, 11 on emotion recognition, and 6 on social judgment). Overall, results demonstrated social cognition to be moderately impaired in individuals with BD (d=0.59). The individual domains ranged in effect size (0.38<d<0.70), providing evidence for variation in impairment within social cognition. Individuals with BD exhibit clinically significant deficits in social cognition during euthymic and symptomatic states. Social cognition impairments in individuals with BD are an important therapeutic target for treatment discovery and development.

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

BackgroundImpairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. Methods120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. ResultsBoth groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LimitationsThe cross-sectional design does not allow for causal inferences. ConclusionBD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.

Social cognition in bipolar disorder: A proxy of psychosocial function and novel treatment target?

Cognitive impairments exist in a large proportion of remitted patients with bipolar disorder (BD). However, no study has investigated the cognitive trajectories across neurocognitive subgroups of patients or their unaffected first-degree relatives (UR).Newly diagnosed BD patients, UR and healthy controls (HC) underwent comprehensive cognitive testing at baseline and at 16-months follow-up. Hierarchical cluster analysis was conducted to identify homogeneous subgroups of patients based on their neurocognitive profile at baseline. Cognitive change across subgroups of patients and UR was assessed with linear mixed-model analyses.Data from baseline and follow-up were collected from 152 patients, 53 UR and 135 HC. Patients were clustered into three discrete neurocognitive subgroups: ‘cognitively normal' (43%), ‘mild-moderately impaired’ (33%) and ‘globally impaired’ (24%). While ‘mild-moderately impaired’ patients and HC showed normative cognitive improvement over time in global cognition (p < .001), ‘globally impaired’ patients showed greater improvement than all groups (p < .001), whereas ‘cognitively normal' patients showed a lack of normative improvement (p = .17). UR of impaired patients showed a lack of normative improvement in executive functions (p = .01). ‘Globally impaired’ patients also presented with stable impairments in facial expression recognition and emotion regulation.Follow-up data was available for 62% of participants, possibly reflecting a selection bias.The greater cognitive improvement in ‘globally impaired’ patients partly speaks against neuroprogression. However, the lack of normative improvement in ‘cognitively normal' patients could indicate negative effects of illness. Further follow-up assessments are warranted to clarify whether lack of normative improvement in executive function in UR represents an illness risk-marker.

Impaired social cognition in bipolar disorder: A meta-analysis of Theory of Mind in euthymic patients.

To conduct a meta-analysis of Theory of Mind studies exclusively in euthymic patients with bipolar disorder. 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. 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. 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.

P.218 Social cognition in bipolar disorder: a cluster analysis

P.218 Social cognition in bipolar disorder: a cluster analysis

Social cognition in bipolar disorder: the role of sociodemographic, clinical, and neurocognitive variables in emotional intelligence.

The main aims of this study were to examine the differences in the Emotional Intelligence (EI), the emotional domain of social cognition (SC), between euthymic patients with bipolar disorder (BD) and healthy controls (HC) and to evaluate the contribution of sociodemographic, clinical, and neuropsychological variables to EI. We recruited 202 patients with BD and 50 HC. EI was evaluated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). The sociodemographic, clinical, and neurocognitive variables that showed a significant association with EI were entered into hierarchical multiple regression analysis. BD patients obtained significantly lower scores compared to HC in the Emotional Intelligence Quotient (EIQ) and in the Understanding Emotions branch score. The best fitting model for the variables associated with EI in the patients group was a linear combination of gender, estimated IQ, family history of affective diagnosis, and executive function. The model, including these previous variables, explained up to 27.6% of the observed variance (R2 =0.276, F=16.406, P<0.001). The identification of variables associated with deficit in EI, such as male gender, lower estimated IQ, family history of affective diagnosis. and lower executive function performance, may help in selecting treatment targets to improve SC, and especially EI, in patients with BD.

Functional outcome and social cognition in bipolar disorder: Is there a connection?

BackgroundInterest in social cognition in bipolar disorder (BD) has increased considerably over the past decade, with studies highlighting major impairments, especially in mental state reasoning, even during euthymia. A causal relationship between social cognition deficits and social functioning has already been established in individuals with schizophrenia, but there is still little information about links between social cognition and social functioning in BD. Our aim was therefore to review the relationship between functional outcome and social cognition in patients with BD. MethodsWe conducted a systematic review of the literature. Relevant articles were identified through literature searches in the MEDLINE/PubMed, EBSCOHost and Google Scholar databases for the years 2000–2017, using the keywords bipolar, social cognition, theory of mind, mentalizing, emotion recognition, emotion processing, and functioning. A total of 20 studies met our inclusion/exclusion criteria. ResultsWe found that functioning was significantly correlated with three domains of social cognition (ToM, emotion processing, and attribution bias). Twelve of 13 studies reported a correlation with emotion processing, but a correlation with ToM was only found in three of the 11 studies that assessed it. Six studies found an effect of depressive symptoms on emotion processing and no significant association was found with manic symptomatology. ConclusionsTo the best of our knowledge, the present review is the first to specifically explore the relationship between social cognition and social functioning in patients with BD. This exploration is of interest, as it enhances current understanding of this disorder and, by so doing, should improve patient outcomes.

What Is Going On? The Process of Generating Questions about Emotion and Social Cognition in Bipolar Disorder and Schizophrenia with Cartoon Situations and Faces.

Regarding the notion of putative “best” practices in social neuroscience and science in general, we contend that following established procedures has advantages, but prescriptive uniformity in methodology can obscure flaws, bias thinking, stifle creativity, and restrict exploration. Generating hypotheses is at least as important as testing hypotheses. To illustrate this process, we describe the following exploratory study. Psychiatric patients have difficulties with social functioning that affect their quality of life adversely. To investigate these impediments, we compared the performances of patients with schizophrenia and those with bipolar disorder to healthy controls on a task that involved matching photographs of facial expressions to a faceless protagonist in each of a series of drawn cartoon emotion-related situations. These scenarios involved either a single character (Nonsocial) or multiple characters (Social). The Social scenarios were also Congruent, with everyone in the cartoon displaying the same emotion, or Noncongruent (with everyone displaying a different emotion than the protagonist should). In this preliminary study, both patient groups produced lower scores than controls (p < 0.001), but did not perform differently from each other. All groups performed best on the social-congruent items and worst on the social-noncongruent items (p < 0.001). Performance varied inversely with illness duration, but not symptom severity. Complete emotional, social, cognitive, or perceptual inability is unlikely because these patient groups could still do this task. Nevertheless, the differences we saw could be meaningful functionally and clinically significant and deserve further exploration. Therefore, we stress the need to continue developing novel, alternative ways to explore social cognition in patients with psychiatric disorders and to clarify which elements of the multidimensional process contribute to difficulties in daily functioning.

Eye gaze perception in bipolar disorder: Self-referential bias but intact perceptual sensitivity.

Deficits in social cognition predict poor functional outcome in severe mental illnesses such as schizophrenia and autism. However, research findings on social cognition in bipolar disorder (BD) are sparse and inconsistent. This study aimed to characterize a critical social cognitive process-eye gaze perception-and examine its functional correlates in BD to inform psychopathological mechanisms. Thirty participants with BD, 37 healthy controls (HC), and 46 psychiatric controls with schizophrenia (SZ) completed an eye-contact perception task. They viewed faces with varying gaze directions, head orientations, and emotion, and made eye-contact judgments. Psychophysics methods were used to estimate perception thresholds and the slope of the perception curve, which were then compared between the groups and correlated with clinical and functional measures using Bayesian inference. Compared with HC, patients with BD over-perceived eye contact when gaze direction was ambiguous, and this self-referential bias was similar to that in SZ. Patients with BD had lower thresholds (i.e., needed weaker eye-contact signal to start perceiving gaze as self-directed) but a similar slope compared with HC. Regression analyses showed that steeper slope predicted better socio-emotional functioning in HC and SZ, but not in BD. The psychopathology of social dysfunction was fundamentally different between BD and SZ in this modest sample. Eye gaze perception in BD was characterized by a self-referential bias but preserved perceptual sensitivity, the latter of which distinguished BD from SZ. The relationship between gaze perception and broader socio-emotional functioning in SZ and HC was absent in BD.

P.2.d.005 - Social cognition in bipolar disorder: exploring emotional intelligence

P.2.d.005 - Social cognition in bipolar disorder: exploring emotional intelligence

Social cognition in bipolar disorder: Focus on emotional intelligence

BackgroundThe present study aims to characterize emotional intelligence (EI) variability in a sample of euthymic bipolar disorder (BD) patients through the Mayer- Salovey-Caruso Emotional Intelligence Test (MSCEIT). MethodA total of 134 euthymic BD outpatients were recruited and divided into three groups according to the total Emotional Intelligence Quotient (EIQ) score of the MSCEIT, following a statistical criterion of scores 1.5SDs above/below the normative group mean, as follows: a low performance (LP) group (EIQ <85), a normal performance (NP) group (85≤EIQ≤115), and a high performance (HP) group (EIQ >115). Afterwards, main sociodemographic, clinical, functional and neurocognitive variables were compared between the groups. ResultsThree groups were identified: 1) LP group (n=16, 12%), 2) NP group (n=93, 69%) and 3) HP group (n=25, 19%). There were significant differences between the groups in premorbid intelligence quotient (IQ) (p=0.010), axis II comorbidity (p=0.008), subthreshold depressive symptoms (p=0.027), general functioning (p=0.013) and in four specific functional domains: autonomy, occupation, interpersonal relations and leisure time. Significant differences in neurocognitive performance were found between groups with the LP group showing the lowest attainments. LimitationsThe cross-sectional design of the study. ConclusionOur results suggest that EI variability among BD patients, assessed through MSCEIT, is lower than expected. EI could be associated with premorbid IQ, subthreshold depressive symptoms, neurocognitive performance and general functioning. The identification of different profiles of SC may help guide specific interventions for distinct patient subgroups aimed at improving social cognition, neurocognitive performance and psychosocial functioning.

The effects of cigarette smoking behavior and psychosis history on general and social cognition in bipolar disorder.

Several studies have documented the prevalence and effects of cigarette smoking on cognition in psychotic disorders; fewer have focused on bipolar disorder (BD). Cognitive and social dysfunction are common in BD, and the severity of these deficits may be related both to illness features (e.g., current symptoms, psychosis history) and health-related behaviors (e.g., smoking, alcohol use). The current study assessed the influence of cigarette smoking on general and social cognition in a BD cohort, accounting for illness features with a focus on psychosis history. We assessed smoking status in 105 euthymic patients with BD, who completed a comprehensive battery including social (facial affect recognition, emotional problem-solving, and theory of mind) and general (the MATRICS Consensus Cognitive Battery and executive functioning) cognitive measures. We compared smokers vs nonsmokers on cognitive performance and tested for the effects of psychosis history, premorbid intellectual functioning, substance use, and current affective symptoms. Within the nonpsychotic subgroup with BD (n=45), smokers generally outperformed nonsmokers; by contrast, for subjects with BD with a history of psychosis (n=41), nonsmokers outperformed smokers. This pattern was noted more globally using a general composite cognitive score and on social/affective measures assessing patients' ability to identify emotions of facial stimuli and solve emotional problems. Cigarette smoking differentially affects performance on both general and social cognition in patients with BD as a function of psychosis history. These results suggest that there may be at least partially divergent underlying neurobiological causes for cognitive dysfunction in patients with BD with and without psychosis.

Social functioning and social cognition in bipolar disorder: Is there a connection?

IntroductionThe research interest in social cognition in bipolar disorder has increased in a significant way in the last decade showing major impairments, especially in mental state reasoning, even during euthymia (Samamé et al., 2012; Samamé et al., 2015). Social cognitive processes in humans describe the ways individuals draw inferences about other people's beliefs and the ways they weigh social situational factors in making these inferences (Green et al., 2008). A causal relationship between social cognition deficits and global functioning has been already established in schizophrenic populations (Green et al., 2015). But there is still little information regarding the relation between social cognition and social functioning in bipolar disorder.AimsTo review the relationship between general/social functioning and social cognitive impairments in bipolar patients.MethodsA systematic review of literature was conducted. Relevant articles were identified through literature searches in PubMed/Medline, EBSCOHost and Google Scholar databases dating from 2000 to 2015 using the keywords “bipolar”, “social cognition”, “theory of mind”, “mentalizing”, “emotion recognition”, “emotion processing”, “functioning” and “quality of life”.ResultsThe findings of the review will be discussed, regarding the specificity of the thymic state of the patients and the social cognition instruments used.ConclusionsTo the best of our knowledge, the present review is the first to explore specifically the relation between the social cognition deficits and the general/social functioning of bipolar patients. This exploration is of interest for a better comprehension of this disorder to improve the outcome of the patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neural basis of social cognition in bipolar disorder

This article review studies social and interpersonal functioning in patients with bipolar disorder (BD), and reports on the neurobiological underpinnings of the dysfunctions in emotion recognition, i.e. one of the main domains of social cognition. A bibliographical research of controlled studies from 1967 to 2015 was completed in PubMed and PsycINFO using the keywords: "fMRI", "emotion comprehension", "emotion perception", "affect comprehension", "affect perception", "facial expression", "prosody", "theory of mind", "mentalizing", "attributional style", "social perception", "empathy" and "bipolar disorder" or "unipolar depression". Limbic hyperactivity, with a lack of appropriate cortical control, has been reported in subjects with BD during social interactions. This is particularly evident during the acute affective episodes but may persist during the euthymic phases. Deficits in emotion regulation, including neural systems implicated both in voluntary and automatic emotion regulatory subprocesses, are present in DB, particularly for what pertains to social interactions and interpersonal functioning. Patients with bipolar disorder may present a dysfunction in the cortical ability to modulate the limbic system, which may show hyperactivity during social interactions. More studies are needed, including studies to evaluate treatment implications.

Social cognition in patients with schizophrenia spectrum and bipolar disorders with and without psychotic features

BackgroundSocial cognition may be critical to the impoverished social functioning seen in serious mental illness. However, although social-cognitive deficits are consistently demonstrated in schizophrenia spectrum disorders (SSD), studies in bipolar disorder (BD) have produced inconsistent results. This inconsistency may relate to symptom profiles of patients studied, particularly the presence or absence of psychotic features. Thus, we examined social cognition in bipolar disorder with psychotic features (BD+) versus without psychotic features (BD−) relative to SSD and controls. MethodsA sample of 537 SSD patients, 85 BD+ patients, 37 BD− patients, and 309 controls were administered the MATRICS Consensus Cognitive Battery, including a social cognition measure, the managing emotions branch of the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). Analyses of covariance compared MSCEIT performance between diagnostic groups while controlling for race, psychotropic medication status, and neurocognition. ResultsSSD but not BD− or BD+ patients showed significant MSCEIT deficits relative to controls. ConclusionsMSCEIT deficits were found in SSD but not BD− or BD+, suggesting that social cognition may represent an underlying difference between SSD and BD. However, variance in MSCEIT performance among BD patients may also suggest latent BD subgroups characterized by social-cognitive deficits. Findings can help inform future investigations into how social cognition and social brain development differ between SSD and BD.

Poster #S191 THE CHICKEN OR THE EGG? – AN INVESTIGATION OF COGNITIVE AND NON-COGNITIVE IMPAIRMENTS IN SCHIZOPHRENIA IN THE LIGHT OF GOAL-DIRECTED BEHAVIOURS' IMPLEMENTATION

Social cognition may be critical to the impoverished social functioning seen in serious mental illness. However, although social-cognitive deficits are consistently demonstrated in schizophrenia spectrum disorders (SSD), studies in bipolar disorder (BD) have produced inconsistent results. This inconsistency may relate to symptom profiles of patients studied, particularly the presence or absence of psychotic features. Thus, we examined social cognition in bipolar disorder with psychotic features (BD +) versus without psychotic features (BD −) relative to SSD and controls.A sample of 537 SSD patients, 85 BD + patients, 37 BD − patients, and 309 controls were administered the MATRICS Consensus Cognitive Battery, including a social cognition measure, the managing emotions branch of the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). Analyses of covariance compared MSCEIT performance between diagnostic groups while controlling for race, psychotropic medication status, and neurocognition.SSD but not BD − or BD + patients showed significant MSCEIT deficits relative to controls.MSCEIT deficits were found in SSD but not BD − or BD +, suggesting that social cognition may represent an underlying difference between SSD and BD. However, variance in MSCEIT performance among BD patients may also suggest latent BD subgroups characterized by social-cognitive deficits. Findings can help inform future investigations into how social cognition and social brain development differ between SSD and BD.

Let's Face It: Facial Emotion Processing Is Impaired in Bipolar Disorder

Patients with bipolar disorder (BD) have difficulty in recognizing and discriminating facial emotions. However, beyond this broad finding, existing literature is equivocal about the specific nature of impairments, and progress toward adequately profiling facial emotion processing in BD is hampered by methodological inconsistencies. The current study aimed to advance the literature by comparing 50 BD patients and 52 controls on a series of facial emotion processing tasks. Results indicated that patients with BD had a small, yet consistent impairment in emotion processing overall. This impairment did not vary as a function of specific emotions, tasks, or intensities between groups, and was not influenced by current mood state. These results suggest that past inconsistencies in the literature are unlikely to be attributable to task related artifacts influencing the estimation of an effect. These findings add to our understanding of social cognition in BD, and have important implications for clinicians treating patients with the disorder.

Randomized Placebo-Controlled Adjunctive Study of an Extract ofWithania somniferafor Cognitive Dysfunction in Bipolar Disorder

Cognitive impairments contribute significantly to inadequate functional recovery following illness episodes in bipolar disorder, yet data on treatment interventions are sparse. We assessed the cognitive effects of a standardized extract of the medicinal herb Withania somnifera (WSE) in bipolar disorder. Sixty euthymic subjects with DSM-IV bipolar disorder were enrolled in an 8-week, double-blind, placebo-controlled, randomized study of WSE (500 mg/d) as a procognitive agent added adjunctively to the medications being used as maintenance treatment for bipolar disorder. Study enrollment and data analyses were completed between December 2008 and September 2012. Cognitive testing at baseline and 8 weeks assessed primary efficacy outcomes. Psychopathology and adverse events were monitored at scheduled visits. Fifty-three patients completed the study (WSE, n = 24; placebo, n = 29), and the 2 groups were matched in terms of demographic, illness, and treatment characteristics. Compared to placebo, WSE provided significant benefits for 3 cognitive tasks: digit span backward (P = .035), Flanker neutral response time (P = .033), and the social cognition response rating of the Penn Emotional Acuity Test (P = .045). The size of the WSE treatment effect for digit span backward was in the medium range (Cohen d = 0.51; 95% CI, 0.25-0.77). None of the other cognitive tasks showed significant between-group differences. Mood and anxiety scale scores remained stable, and adverse events were minor. Although results are preliminary, WSE appears to improve auditory-verbal working memory (digit span backward), a measure of reaction time, and a measure of social cognition in bipolar disorder. Given the paucity of data for improving cognitive capacity in bipolar disorder, WSE offers promise, appears to have a benign side-effects profile, and merits further study. ClinicalTrials.gov identifier: NCT00761761.

Social cognition in bipolar disorder versus schizophrenia: comparability in mental state decoding deficits

Neuropsychological studies comparing patients with bipolar disorder (BD) to patients with schizophrenia (SZ) suggest milder cognitive deficits in BD patients and across a smaller range of functions. The present study investigated whether this pattern is also true for social cognition - a range of socially relevant abilities, including emotion perception and recognition, theory of mind, and social attributions - by comparing performance on measures of social cognition in patients with BD, SZ, and healthy participants. One hundred and two patients with BD, 208 patients with SZ, and 132 healthy participants were assessed using a battery of tasks measuring basic neuropsychological and social cognition. We observed significant differences between patients with BD and healthy participants in a test of mental state decoding ('eyes task') that was at a level comparable to deficits seen in patients with SZ. By comparison, BD patients showed more subtle deficits in mental state reasoning ('hinting task') than those shown by patients with SZ. Mental state decoding difficulties are significant in BD. An important direction for further research will be to establish to what extent these deficits affect social and occupational functioning as a potential target for therapeutic intervention.