Psychopathy and facial emotion recognition ability in patients with bipolar affective disorder with or without delinquent behaviors.
BACKGROUND
It is well known that patients with bipolar disorder are more prone to violence and have more criminal behaviors than general population. A strong relationship between criminal behavior and inability to empathize and imperceptions to other person's feelings and facial expressions increases the risk of delinquent behaviors. In this study, we aimed to investigate the deficits of facial emotion recognition ability in euthymic bipolar patients who committed an offense and compare with non-delinquent euthymic patients with bipolar disorder.


METHODS
Fifty-five euthymic patients with delinquent behaviors and 54 non-delinquent euthymic bipolar patients as a control group were included in the study. Ekman's Facial Emotion Recognition Test, sociodemographic data, Hare Psychopathy Checklist, Hamilton Depression Rating Scale and Young Mania Rating Scale were applied to both groups.


RESULTS
There were no significant differences between case and control groups in the meaning of average age, gender, level of education, mean age onset of disease and suicide attempt (p>0.05). The three types of most committed delinquent behaviors in patients with euthymic bipolar disorder were as follows: injury (30.8%), threat or insult (20%) and homicide (12.7%). The best accurate percentage of identified facial emotion was "happy" (>99%, for both) while the worst misidentified facial emotion was "fear" in both groups (<50%, for both). The total accuracy rate of recognition toward facial emotions was significantly impaired in patients with delinquent behaviors than non-delinquent ones (p<0.05). The accuracy rate of recognizing the fear expressions was significantly worse in the case group than in the control group (p<0.05). In addition, it tended to be worse toward angry facial expressions in criminal euthymic bipolar patients. The response times toward happy, fear, disgusted and angry expressions had been significantly longer in the case group than in the control group (p<0.05).


CONCLUSIONS
This study is the first, searching the ability of facial emotion recognition in euthymic patients with bipolar disorder who had delinquent behaviors. We have shown that patients with bipolar disorder who had delinquent behaviors may have some social interaction problems i.e., misrecognizing fearful and modestly anger facial emotions and need some more time to response facial emotions even in remission.
Forensic Medicine, Ministry of Justice, Istanbul, Turkey. Electronic address: husrev32@hotmail.com.
Husrev
H
Demirel
Bakırkoy Research and Education Hospital of Mental Health Disorder, Istanbul, Turkey.
Dilek
D
Yesilbas
Council of Forensic Medicine, Ministry of Justice, Istanbul, Turkey.
Ismail
I
Ozver
Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.
Erhan
E
Yuksek
Forensic Medicine, Ministry of Justice, Istanbul, Turkey.
Feyzi
F
Sahin
Forensic Medicine, Ministry of Justice, Istanbul, Turkey.
Suheyla
S
Aliustaoglu
Department of Psychiatry, Medical School of Cerrahpasa, Istanbul University, Istanbul, Turkey.
Murat
M
Emul
D000328:Adult; D001714:Bipolar Disorder / Q000523:psychology*; D057237:Criminals / Q000523:psychology*; D004644:Emotions / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D021641:Recognition, Psychology