Social cognition in euthymic bipolar disorder: systematic review and meta-analytic approach. Acta Psychiatr Scand

Bipolar Disorder Program, Neurosciences Institute, Favaloro University, CABA, Argentina.
Acta Psychiatrica Scandinavica (Impact Factor: 5.61). 12/2011; 125(4):266-80. DOI: 10.1111/j.1600-0447.2011.01808.x
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Deficits in social cognition have been reported in euthymic subjects with bipolar disorder (BD). However, some studies have failed to find differences favoring controls. As most investigations have been conducted with small samples, they have not had sufficient power to detect statistically significant differences. Furthermore, studies communicating positive results have scarcely attempted to estimate effect sizes for patient-control differences. The aim of this study was to summarize the findings of reports on social cognition in patients with euthymic BD and to combine their data to identify possible deficits and quantify their magnitude.
Systematic literature review and meta-analysis.
Impairments of moderate magnitude (0.5 < d < 0.8) were noted across mentalizing skills, whereas small but significant effect sizes (d < 0.5) were observed for facial emotion recognition. No patient-control differences were found for decision-making.
Meta-analytic findings provide evidence for emotion processing and theory of mind deficits in remitted bipolar patients. However, it is not yet clear whether these areas of impairment are related to neurocognitive dysfunctions or to medication effects. The results are discussed with regard to targets for future neuropsychological research on BDs.

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Available from: Sergio A Strejilevich, May 09, 2014
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    • "Difficulties in understanding social information are a diagnostic criterion for autism spectrum disorder (American Psychiatric Association, 2013), and social cognition impairment is central to schizophrenia (SZ; Savla et al., 2013). It is present in affective disorders such as depression (Kohler et al., 2011) and bipolar disorder (Kohler et al., 2011; Samamé et al., 2012) and in personality disorders (Herpertz and Bertsch, 2014) such as borderline personality disorder (BPD; Roepke et al., 2013). Terminology is somewhat different depending on the mental disorder in question. "
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    ABSTRACT: Although borderline personality disorder (BPD) and schizophrenia (SZ) are notably different mental disorders, they share problems in social cognition-or understanding the feelings, intentions and thoughts of other people. To date no studies have directly compared the social cognitive abilities of individuals with these two disorders. In this study, the social cognitive subdomain theory of mind was investigated in women with BPD (n = 25), women with SZ (n = 25) and healthy women (n = 25). An ecologically valid video-based measure (Movie for the Assessment of Social Cognition) was used. For the overall score, women with SZ performed markedly below both healthy women and women with BPD, whereas women with BPD did not perform significantly different compared to the healthy control group. A statistically significant error type × group interaction effect indicated that the groups differed with respect to kind of errors. Whereas women with BPD made mostly overmentalizing errors, women with SZ in addition committed undermentalizing errors. Our study suggests different magnitude and pattern of social cognitive problems in BPD and SZ.
    Frontiers in Psychology 09/2015; 6:1239. DOI:10.3389/fpsyg.2015.01239 · 2.80 Impact Factor
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    • "Deficits in facial emotion recognition have been reported in SCZ-spectrum disorders, but their prevalence in BD patients with a history of psychosis is less established (Hill et al., 2008; Kohler et al., 2010; Samame et al., 2012). These deficits are apparent at the first episode of psychotic illness in both disorders, and are relatively independent of mood state and antipsychotic treatment (Daros et al., 2014). "
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    ABSTRACT: Difficulty recognizing facial emotions is an important social-cognitive deficit associated with psychotic disorders. It also may reflect a familial risk for psychosis in schizophrenia-spectrum disorders and bipolar disorder.
    Schizophrenia Research 07/2014; 158(1-3). DOI:10.1016/j.schres.2014.07.001 · 3.92 Impact Factor
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    • "Over the last 10–15 years, neuropsychological research has built a robust body of evidence supporting that, compared with healthy controls, euthymic patients with BD have impairments in verbal memory, attention, and executive functions with medium–large effect size (Robinson et al., 2006; Torres et al., 2007; Mann-Wrobel et al., 2011). Cognitive deficits in BD could be extended to different subtypes of the disease (Martino et al., 2011a; Bora et al., 2011) and beyond traditional neurocognitive domains (Martino et al., 2011b; Samamé et al. 2012). Likewise, the association between cognitive deficits and functional outcome reached by the patients with BD has been consistently reported both in cross-sectional (Zubieta et al., 2001; Dickerson et al., 2004; Martinez-Arán et al., 2004) and longitudinal (Jaeger et al., 2007; Tabarés-Seisdedos et al., 2008; Martino et al., 2009) studies. "
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    ABSTRACT: Background: Cross-sectional and meta-analytic studies showed that patients with bipolar disorder (BD) had neurocognitive impairments even during periods of euthymia. The aim of this study was to estimate the prevalence of BD patients with and without clinically significant cognitive impairments, as well as to analyze clinical and functional variables in these subgroups. Methods: Hundred patients with BD and 40 healthy controls were assessed with an extensive neurocognitive assessment. Soft (some cognitive domain with a performance below 1.5 SD of the mean) and hard (at least two domains with values below 2 SD of the mean) criteria were utilized to define clinically significant cognitive impairments. Results: Using both soft and hard criteria, the prevalence of clinically significant cognitive impairments was higher in people with BD than in healthy controls. 70% of patients only showed failures of small effect (d=0.21-0.35) in 2 measures of executive functions. Moreover, 30% of patients were indistinguishable from healthy subjects in terms of both neurocognitive and psychosocial functioning. On the contrary, 30% of the sample showed more severe cognitive deficits than those usually reported in literature and had the worst psychosocial functioning. Conclusions: The fact that cognitive impairments are very heterogeneous among euthymic patients with BD could contribute to understanding differences in functional outcome. Theoretical and practical implications of these findings are discussed.
    Journal of Affective Disorders 06/2014; 167C:118-124. DOI:10.1016/j.jad.2014.05.059 · 3.38 Impact Factor
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