Social Cognition and General Functioning in Bipolar Disorder

Abstract

Introduction:Bipolar patients show a significant degree of psychosocial disfunction even in euthymia. Recent studies have reported deficits in Theory of Mind and emotion recognition in BD. Our hypothesis is that social cognition deficit could be associated with a poor general functioning and psychosocial disadvantage in BD.Methods:A sample of 27 euthymic bipolar patients were recluted. Based on Global Assessment of Functioning, they were divided into two groups: good or low general functioning. Euthymia was defined as YMRS < 6 and HDRS < 8, during a 3-month period. Patients with high (n 18) and low (n 9) functioning were compared on several clinical variables and on social / general cognitive measures. Both verbal and non verbal Theory of Mind capacities were assesed (faux pas test and face emotion recognition test). Finally, sustained attention and executive functions were evaluated (Asarnow Test and WSCT).Results:High- and low-functioning groups did not differ with respect to demographic and clinical variables (age, sex, age at onset, years of evolution of illness, history of prior psychotic symptoms; p = n.s.). However, low-functioning group showed poorer performance than high-functioning group both in faux pas test (U Mann Whitney; p=0.035) and face emotion recognition (U; p = 0.021). In addition, low-functioning group also showed a significant impairment in general cognitive funtions such as sustained attention (U, p = 0.007) and executive funtions (U, p = 0.046).Conclusion:Social cognition deficit is associated with a poorer general functioning and psychosocial disadvantage.

Phenomenological predictors of psychosocial function in bipolar disorder: Is there evidence that social cognitive and emotion regulation abnormalities contribute?

“…Indeed, there is reasonable theoretical rationale for the proposition that social cognitive impairments, like neurocognitive impairments, directly influence adaptive psychosocial function in BD. Results from initial studies partly addressing social cognitive contributions in the disorder also suggest that its influence may occur in a manner that is independent from mood (Hajnal et al, 2010;Hoertnagl et al, 2011;Lahera et al, 2009;Martino et al, 2011b). Conversely, it is likely that abnormalities in emotion regulation perpetuate psychosocial dysfunction in BD by catalysing or exacerbating clinical symptoms.…”

“…Although there is only minimal direct evidence examining the influence of these functions on outcome, the existing BD studies are preliminarily supportive of relationships between these constructs (Hajnal et al, 2010;Lahera et al, 2009;Martino et al, 2011b). That there is reasonable theoretical justification for their association, formulated on the basis of indirect support for an association between these variables from studies of related disorders and healthy populations (Kee et al, 2003;Mathews and Barch, 2010;Sparks et al, 2010), suggests that the influence of social cognition and emotion regulation on psychosocial function in BD are areas worthy of future research.…”

“…Poor theory of mind ability has been associated with poor interpersonal skills (Pinkham and Penn, 2006), severe social behavioural problems (Brüne, 2005), worse overall community social functioning (Pollice et al, 2002) and poor pre-morbid functioning in schizophrenia (Schenkel et al, 2005). In BD too, theory of mind impairments have been preliminarily linked with poor functional outcome in two euthymic BD samples (Hajnal et al, 2010;Lahera et al, 2009). Such associations presumably occur as a result of the maladaptive emotional responses evoked on misinterpretation or misunderstanding of emotional information.…”

“…It is now becoming increasingly clear that patients' ability to develop new skills, respond flexibly to a changing environment and create complex understandings of life are constrained. Consequently, neurocognitive ability has been associated with objective, and to a lesser degree, subjective psychosocial functioning in the disorder in multiple studies, including consistently those examining euthymic samples (Altshuler et al, 2008;Atre-Vaidya et al, 1998;Bonnín et al, 2010;Bowie et al, 2010;Brissos et al, 2008aBrissos et al, , 2008bBurdick et al, 2010;Dickerson et al, 2004Dickerson et al, , 2010Dittmann et al, 2007;Fujii et al, 2004;Jabben et al, 2010;Jaeger et al, 2007;Laes and Sponheim, 2006;Lahera et al, 2009;Malhi et al, 2007;Martínez-Arán et al, 2002Martino et al, 2009Martino et al, , 2011aMur et al, 2009;Sánchez-Morla et al, 2009;Simonsen et al, 2010;Solé et al, 2012;Tabarés-Seisdedos et al, 2008;Torres et al, 2011;Wingo et al, 2010;Yen et al, 2009). Given evidence that neurocognitive deficits perpetuate psychosocial dysfunction independently of affective symptomatology, neurocognition is considered to have a significant, yet clinically separate role in the prediction of functional outcome in BD (Bowie et al, 2010;Burdick et al, 2010;Jaeger et al, 2007;O'Shea et al, 2010;Tabarés-Seisdedos et al, 2008;Torres et al, 2011).…”

The forgotten affective route of social cognition in patients with bipolar disorders

“…These studies revealed that neurocognitive deficits (i.e., executive function, memory, verbal learning, attention, and processing speed) may cause perpetuating psychosocial dysfunction regardless of affective symptomatology (Baune & Malhi, 2015; Bowie et al, 2010; Burdick et al, 2010; Jaeger et al, 2007; O’Shea et al, 2010; Tabarés-Seisdedos et al, 2008; Torres et al, 2011). In addition, other studies have showed that social cognition (SC) plays an important role in psychosocial functioning in bipolar patients (Hajnal et al, 2010; Lahera et al, 2009; Martino et al, 2011; Montag et al, 2010; van Rheenen & Rossell, 2014).…”