Theory of mind impairments in euthymic bipolar patients.
BACKGROUND
Deficits in social cognition, e.g. theory of mind (ToM) represent core characteristics involved in the etiology of psychopathological symptoms and an important predictor of social competence. In bipolar affective disorder, evidence for ToM deficits is scant, although brain imaging studies and impairments in non-social neurocognitive domains indicate deficits of prefrontal functions.


METHODS
Twenty-nine euthymic patients with bipolar affective disorder and 29 matched healthy controls were examined with the 'Movie for the Assessment of Social Cognition' (MASC). Target parameters comprised 1) 'cognitive' and 'emotional' ToM scores, 2) qualitative analysis of errors brought about by 'undermentalizing' or 'overmentalizing' strategies and 3) non-social inferencing as a control factor.


RESULTS
Patients compared to controls scored significantly lower for 'cognitive' (F=9.417, df=1, p=0.003) but not for 'emotional' ToM. Bipolar patients showed significantly higher 'undermentalizing' (F=4.830, df=1, p=0.032) but not 'overmentalizing' scores. A significant correlation (controlled for age) between the number of (hypo)manic episodes and 'undermentalizing' (r=0.527, p=0.030) as well as 'emotional' ToM (r=-0.546, p=0.023) was observed.


CONCLUSIONS
Sample size did not allow for the analysis of medication effects.


CONCLUSIONS
This is the first study of ToM in euthymic bipolar patients with a realistic video-based examination. Independently from basic cognitive dysfunctions, patients displayed a pronounced deficit in the cognitive domain of ToM with preserved emotional mentalizing abilities. The correlation with the number of manic episodes may indicate an increase of the deficit with disease progression. It can be assumed that social cognition reflects an important dimension of the persisting cognitive deficits in bipolar disorder with possible impact on disease outcome.
Montag
Christiane
C
Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany. christiane.montag@charite.de
Ehrlich
André
A
Neuhaus
Kathrin
K
Dziobek
Isabel
I
Heekeren
Hauke R
HR
Heinz
Andreas
A
Gallinat
Jürgen
J
D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D018187:Personal Construct Theory; D012917:Social Adjustment; D055815:Young Adult
D018692:Antimanic Agents