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
Source: PubMed


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
    • "However, there are inconsistent findings regarding the persistence of ToM deficits during euthymia, as both positive and negative findings have been reported. In their meta-analyses of social cognition in BP, Samamé et al. (2012, 2013) also conducted a preliminary analysis of 9 and 11 ToM studies, respectively, in 'remitted' BP patients and found significant but modest impairments. However, in these meta-analyses strict euthymia criteria were not used and a number of studies comprised mixed patient samples which included subsyndromal depressive/manic or mild depression (Ioannidi et al. 2013; Lee et al. 2013; Thaler * Address for correspondence: Dr E. "
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    ABSTRACT: Background: Theory of mind (ToM) dysfunction is prominent in a number of psychiatric disorders, in particular, autism and schizophrenia, and can play a significant role in poor functioning. There is now emerging evidence suggesting that ToM abilities are also impaired in bipolar disorder (BP); however, the relationship between ToM deficits and mood state is not clear. Method: We conducted a meta-analysis of ToM studies in BP. Thirty-four studies comparing 1214 patients with BP and 1097 healthy controls were included. BP groups included remitted (18 samples, 545 BP patients), subsyndromal (12 samples, 510 BP patients), and acute (manic and/or depressed) (10 samples, 159 BP patients) patients. Results: ToM performance was significantly impaired in BP compared to controls. This impairment was evident across different types of ToM tasks (including affective/cognitive and verbal/visual) and was also evident in strictly euthymic patients with BP (d = 0.50). There were no significant differences between remitted and subsyndromal samples. However, ToM deficit was significantly more severe during acute episodes (d = 1.23). ToM impairment was significantly associated with neurocognitive and particularly with manic symptoms. Conclusion: Significant but modest sized ToM dysfunction is evident in remitted and subsyndromal BP. Acute episodes are associated with more robust ToM deficits. Exacerbation of ToM deficits may contribute to the more significant interpersonal problems observed in patients with acute or subsyndromal manic symptoms. There is a need for longitudinal studies comparing the developmental trajectory of ToM deficits across the course of the illness.
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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.
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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.
    Full-text · Article · Jul 2014 · Schizophrenia Research
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