Article

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

ABSTRACT

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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    • "For example, major depressive disorder in adults is associated with lower RF, both generally (Fischer-Kern et al., 2013) and specifically regarding experiences of rejection and loss (Staun, Kessler, Buchheim, Kächele, & Taubner, 2010). There is also evidence of ToM deficits in adults with chronic (Zobel et al., 2010), unipolar (Lee, Harkness, Sabbagh, & Jacobson, 2005;Wang, Wang, Chen, Zhu, & Wang 2008), and remitted (Bora et al., 2005;Inoue, Tonooka, Yamada, & Kanba, 2004;Montag et al., 2010) depression. There is also a dearth of literature regarding RF and externalising behaviour difficulties. "
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    ABSTRACT: Background: Sexual abuse is a well-recognised risk factor for child psychopathology. Little is known regarding whether child and maternal mentalization can be considered a potential resource or protective factor in this context, respectively, mediating or moderating the relationship between sexual abuse and psychopathology. Objective: The aims of this study were (1) to explore the relationships between child and maternal mentalizing, measured as reflective functioning (RF), and child depressive symptoms and externalising difficulties; and (2) to examine whether child mentalizing mediates the relationship between child sexual abuse (CSA) and psychopathology. Method: A total of 168 children aged 7-12 years and their mothers participated in the study. The sample included 74 dyads where children had experienced sexual abuse. The Child Attachment Interview was rated by using the Child Reflective Functioning Scale to assess children's mentalization, and the Child Depression Inventory was used to assess depressive symptoms. Mothers completed the Parent Development Interview to assess maternal RF and the Child Behavior Checklist to assess their child's externalising difficulties. A model involving direct and indirect paths from CSA, child and maternal RF to child psychopathology was examined using Mplus software. Results: Child mentalization partially mediated the relationships between CSA and depressive symptoms, as well as the relationship between CSA and externalising difficulties. Maternal mentalization was an independent predictor of child externalising difficulties, with higher maternal RF associated with less externalising difficulties. Discussion: The findings indicate that by ages 7-12, child mentalization is an important inner resource associated with lower depression and externalising. In addition, this study provides new evidence of the importance of the parent's mentalizing stance for the development of self-regulation and externalising difficulties in both abused and non-abused children. The clinical implications are discussed.
    Full-text · Article · Jan 2016
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    • "For example, major depressive disorder in adults is associated with lower RF, both generally (Fischer-Kern et al., 2013) and specifically regarding experiences of rejection and loss (Staun, Kessler, Buchheim, Kächele, & Taubner, 2010). There is also evidence of ToM deficits in adults with chronic (Zobel et al., 2010), unipolar (Lee, Harkness, Sabbagh, & Jacobson, 2005;Wang, Wang, Chen, Zhu, & Wang 2008), and remitted (Bora et al., 2005;Inoue, Tonooka, Yamada, & Kanba, 2004;Montag et al., 2010) depression. There is also a dearth of literature regarding RF and externalising behaviour difficulties. "

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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.
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