Theory of mind deficits in chronically depressed patients

Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Hauptstrasse 5, Freiburg im Breisgau, Germany.
Depression and Anxiety (Impact Factor: 4.41). 09/2010; 27(9):821-8. DOI: 10.1002/da.20713
Source: PubMed


Poor theory of mind (ToM) performance has been found in patients with mood disorders, but it has not been examined in the subgroup of chronic depression where ToM deficits may be even more persistent than in acute depressive episodes. The aim of this study was to compare the ToM performance of chronically depressed patients with a healthy control group and to clarify the relation of ToM to other cognitive functions.
ToM performance was assessed in 30 chronically depressed patients and 30 matched healthy controls by two cartoon picture story tests. In addition, logical memory, alertness, and executive functioning were evaluated.
Chronically depressed patients were markedly impaired in all ToM- and neuropsychological tasks compared to healthy controls. Performance in the different ToM tests was significantly correlated with at least one other cognitive variable. After controlling for logical memory and working memory, no ToM tasks predicted being a patient.
Patients with chronic depression present significant deficits in "reading" social interactions, which may be associated with general cognitive impairments.

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    • "Patients have also been found to struggle to recognize emotions on the basis of facial expression (Csukly, Czobor, Szily, Tak acs, & Simon, 2009; Langenecker et al., 2005; Persad & Polivy, 1993) and to present with a mood-congruent processing bias with hyperactivation towards sad or negative facial expressions and hypoactivation towards happy facial expressions (Anderson et al., 2011; Bourke, Douglas, & Porter, 2010; Stuhrmann, Suslow, & Dannlowski, 2011). Concerning intermediate forms of social cognition, depressed patients have been found to perform more poorly than nondepressed controls on tasks which call for them to discern the mental states of others in cartoons (Inoue, Tonooka, Yamada, & Kanba, 2004; Zobel et al., 2010), humour (Uekermann et al., 2008), and animated geometric shapes (Ladegaard, Larsen, Videbech, & Lysaker, 2014). Others have found depressed patients to perform significantly more poorly than healthy controls when making judgments about paradoxical sarcastic intent (Ladegaard, Larsen, et al., 2014) and cognitive and emotional mental state attributions in video clips (Wolkenstein, Sch€ onenberg, Schirm, & Hautzinger, 2011). "
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    ABSTRACT: Objectives: Research has suggested that patients suffering from major depressive disorder (MDD) experience deficits in the related domains of social cognition and metacognition. Most research has focused on detecting deficits among persons who are acutely symptomatic. Thus, little is known about whether these deficits persist after symptoms have remitted. As a first, this study investigated social cognitive and metacognitive deficits in patients with MDD in the acute and remitted state. Design: Longitudinal case–control. Methods. Forty-four drug-na€ ıve depressed patients and an equal number of matched healthy controls were assessed in multiple domains of social cognition including theory of mind, social perception, and metacognition. Additionally, a comprehensive neurocogni-tive (non-social) test battery was utilized. Following baseline assessment, patients were enrolled in an outpatient treatment programme. Patients reaching remission within 6 months (n = 29) were reassessed 6 months post-remission. Included for analysis were only patients who followed a course of remission (n = 29) and their paired healthy controls (n = 29). Results: Analyses of variance revealed that remitted patients performed significantly better at retest than at baseline on nearly all measures. These effects withstood adjusting for test–retest effects. Moreover, remitted patients performed up to level of healthy controls on some but not all social cognitive tasks and metacognition at retest. Conclusions: Overall, results suggests that social cognitive and metacognitive ability may improve with symptom remission in major depression although it may not reach a level equal to persons who have never experienced depression.
    British Journal of Clinical Psychology 11/2015; DOI:10.1111/bjc.12097 · 1.90 Impact Factor
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    • "involves an insufficient attention to the emotional states of others and a disconnection from social feedback . However , studies examining this postulated deficit in chronic depression are scarce and have so far yielded inconsistent results . Whereas one study found such deficits in chronically depressed patients as compared to healthy controls ( Zobel et al . , 2010 ) , two other studies found no such impairments ( Wilbertz et al . , 2010 ; van Randenborgh et al . , 2012 ) . Worthy of note , only one out of these three studies compared chronically and non - chronically depressed patients in this manner and found no group differences ( van Randenborgh et al . , 2012 ) . However , these studies unifo"
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    ABSTRACT: Self-focused attention (SFA) is considered a cognitive bias that is closely related to depression. However, it is not yet well understood whether it represents a disorder-specific or a trans-diagnostic phenomenon and which role the valence of a given context is playing in this regard. Computerized quantitative text-analysis offers an integrative psycho-linguistic approach that may help to provide new insights into these complex relationships. The relative frequency of first-person singular pronouns in natural language is regarded as an objective, linguistic marker of SFA. Here we present two studies that examined the associations between SFA and symptoms of depression and anxiety in two different contexts (positive vs. negative valence), as well as the convergence between pronoun-use and self-reported aspects of SFA. In the first study, we found that the use of first-person singular pronouns during negative but not during positive memory recall was positively related to symptoms of depression and anxiety in patients with anorexia nervosa with varying levels of co-morbid depression and anxiety. In the second study, we found the same pattern of results in non-depressed individuals. In addition, use of first-person singular pronouns during negative memory recall was positively related to brooding (i.e., the assumed maladaptive sub-component of rumination) but not to reflection. These findings could not be replicated in two samples of depressed patients. However, non-chronically depressed patients used more first-person singular pronouns than healthy controls, irrespective of context. Taken together, the findings lend partial support to theoretical models that emphasize the effects of context on self-focus and consider SFA as a relevant trans-diagnostic phenomenon. In addition, the present findings point to the construct validity of pronoun-use as a linguistic marker of maladaptive self-focus.
    Frontiers in Psychology 11/2015; 6. DOI:10.3389/fpsyg.2015.01564 · 2.80 Impact Factor
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    • "Expanding on this finding, using an array of cartoon stories with currently depressed patients, Zobel et al. (2010) found impairment across a spectrum of socialcognitive processes (i.e., understanding others' belief and intentions). Additionally, depressed patients were poorer at providing narratives for the stories, using fewer words and identifying fewer mental states in the stories' characters. "
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    ABSTRACT: Traditional social-cognitive approaches for investigating interpersonal problems in adolescent depression are limited. An important functional domain studied in adolescent depression is reward, but experimental paradigms have largely been nonsocial. In this article, we propose the methods and concepts of neuroeconomics may address this gap. We begin by discussing a well-established social reward model for vulnerability to adolescent depression. We then show how neuroeco-nomics may extend this model by offering the tools to examine the mechanics of social exchanges, in behav-ioral and neural terms, that maintain (or pose vulnerability to) depression. In doing so, we propose a neuroeconomic model of adolescent depression in which depression is defined as a perturbation of inter-personal motivational/reward exchange. This model serves to guide future research.
    Clinical Psychology Science and Practice 09/2015; 22(3):255-276. DOI:10.1111/cpsp.12106 · 2.92 Impact Factor
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