title: Theory of Mind in Bipolar Disorder, with Comparison to the Impairments Observed in Schizophrenia.
abstract: Our ability to make sense of information on the potential intentions and dispositions of others is of paramount importance for understanding their communicative intent, and for judging what an appropriate reaction might be. Thus, anything that impinges on this ability has the potential to cause significant social impairment, and compromise an individual's level of functioning. Both bipolar disorder and schizophrenia are known to feature theory of mind impairment. We conducted a theoretical review to determine the extent and types of theory of mind impairment in bipolar disorder, and evaluate their relationship to medication and symptoms. We also considered possible mediatory mechanisms, and set out to discover what else could be learnt about the impairment in bipolar disorder by comparison to the profile of impairment in schizophrenia. The literature established that in bipolar disorder (i) some form of theory of mind impairment has been observed in all mood states, including euthymia, (ii) the form of theory of mind assessed and task used to make the assessment influence the impairment observed, and (iii) there might be some relationship to cognitive impairment, although a relationship to standard clinical variables was harder to establish. What also became clear in the literature on bipolar disorder itself was the possible relationship of theory of mind impairment to history of psychotic symptoms. Direct comparative studies, including patients with schizophrenia, were thus examined, and provided several important directions for future research on the bases of impairment in bipolar disorder. Particularly prominent was the issue of whether theory of mind impairment could be considered a candidate endophenotype for the psychoses, although current evidence suggests that this may be premature. The differences in impairment across schizophrenia and bipolar disorder may, however, have genuine differential effects on social functioning and the likely success of remediation.
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK.
authors.forename: Rachel L C
authors.initials: RL
authors.lastname: Mitchell
authors.affiliation: Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK.
authors.forename: Allan H
authors.initials: AH
authors.lastname: Young
keywords: bipolar disorder; psychoses; schizophrenia; social cognition; theory of mind
references.citation: Psychol Aging. 2010 Dec;25(4):811-21
references.pmid: 20718538
references.citation: Rev Bras Psiquiatr. 2013 Oct-Dec;35(4):435-8
references.pmid: 24402219
references.citation: Schizophr Res. 2011 Dec;133(1-3):212-7
references.pmid: 21996265
references.citation: Psychopathology. 2014;47(6):425-36
references.pmid: 25376756
references.citation: Rev Psiquiatr Salud Ment. 2013 Apr-Jun;6(2):67-74
references.pmid: 23084796
references.citation: Child Dev. 2001 May-Jun;72(3):655-84
references.pmid: 11405571
references.citation: Cogn Neuropsychiatry. 2005 Nov;10(5):347-59
references.pmid: 16571466
references.citation: J Clin Psychiatry. 2014;75 Suppl 2:14-9
references.pmid: 24919166
references.citation: Eur Neuropsychopharmacol. 2015 Mar;25(3):283-94
references.pmid: 25595029
references.citation: J Clin Exp Neuropsychol. 2009 Jul;31(5):523-32
references.pmid: 18720179
references.citation: Schizophr Bull. 2014 May;40(3):602-16
references.pmid: 23686020
references.citation: Bipolar Disord. 2007 Feb-Mar;9(1-2):144-57
references.pmid: 17391357
references.citation: Dialogues Clin Neurosci. 2010;12(3):289-303
references.pmid: 20954426
references.citation: Psychiatry Res. 2011 Oct 30;189(3):379-84
references.pmid: 21620484
references.citation: Psychiatry Res. 2014 May 30;216(3):291-302
references.pmid: 24656516
references.citation: Psychol Med. 2015;45(12):2461-80
references.pmid: 25858580
references.citation: Psychol Med. 2016 Jan;46(2):253-64
references.pmid: 26456502
references.citation: Psychiatry Res. 2012 Dec 30;200(2-3):258-64
references.pmid: 22854176
references.citation: J Psychiatry Neurosci. 2012 May;37(3):154-69
references.pmid: 22297065
references.citation: Bipolar Disord. 2012 Jun;14(4):326-39
references.pmid: 22631618
references.citation: Psychol Med. 1998 Mar;28(2):397-405
references.pmid: 9572096
references.citation: J Affect Disord. 2013 Dec;151(3):1132-4
references.pmid: 23916306
references.citation: Curr Opin Psychiatry. 2015 Mar;28(2):133-40
references.pmid: 25630050
references.citation: J Affect Disord. 2013 Apr 25;146(3):295-309
references.pmid: 23218848
references.citation: Acta Psychiatr Scand. 2005 Aug;112(2):110-6
references.pmid: 15992392
references.citation: Neurosci Biobehav Rev. 2014 May;42:132-47
references.pmid: 24603026
references.citation: Psychol Med. 1996 May;26(3):521-30
references.pmid: 8733211
references.citation: Psychol Assess. 2013 Mar;25(1):117-26
references.pmid: 22731676
references.citation: Am J Psychiatry. 2013 Mar;170(3):334-41
references.pmid: 23450289
references.citation: Front Psychol. 2014 Apr 29;5:388
references.pmid: 24808885
references.citation: J Affect Disord. 2013 Dec;151(3):1113-9
references.pmid: 23896318
references.citation: Psychiatry Res. 2010 Jun 30;178(1):1-9
references.pmid: 20452051
references.citation: J Psychiatr Res. 2013 Dec;47(12):2004-10
references.pmid: 24112946
references.citation: BMC Psychiatry. 2013 May 17;13:141
references.pmid: 23683146
references.citation: Schizophr Bull. 2008 Nov;34(6):1211-20
references.pmid: 18184635
references.citation: Cogn Neuropsychiatry. 2013;18(1-2):115-28
references.pmid: 22991963
references.citation: J Autism Dev Disord. 1994 Apr;24(2):129-54
references.pmid: 8040158
references.citation: J Head Trauma Rehabil. 2003 May-Jun;18(3):219-38
references.pmid: 12802165
references.citation: Schizophr Res. 2009 Apr;109(1-3):1-9
references.pmid: 19195844
references.citation: Cogn Neuropsychiatry. 1997 Aug;2(3):167-93
references.pmid: 25419601
references.citation: Dev Sci. 2016 Mar;19(2):208-20
references.pmid: 25939730
references.citation: Psychol Med. 2008 Jun;38(6):791-800
references.pmid: 18208632
references.citation: Psychiatry Res. 2009 May 15;167(1-2):28-35
references.pmid: 19346006
references.citation: Psicothema. 2013;25(4):440-5
references.pmid: 24124775
references.citation: J Affect Disord. 2003 Feb;73(3):253-9
references.pmid: 12547294
references.citation: Br J Psychiatry. 1978 Nov;133:429-35
references.pmid: 728692
references.citation: Acta Psychiatr Scand. 2014 Nov;130(5):397-405
references.pmid: 24841325
references.citation: Bipolar Disord. 2010 Jun;12(4):364-75
references.pmid: 20636633
references.citation: Acta Psychiatr Scand. 2015 Jun;131(6):472-82
references.pmid: 25645449
references.citation: Bipolar Disord. 2012 Nov;14(7):743-8
references.pmid: 23020773
references.citation: J Neuropsychiatry Clin Neurosci. 2009 Winter;21(1):59-67
references.pmid: 19359453
references.citation: Compr Psychiatry. 2011 Mar-Apr;52(2):126-31
references.pmid: 21295217
references.citation: Expert Rev Neurother. 2012 Jan;12(1):71-81
references.pmid: 22149657
references.citation: Neurosci Biobehav Rev. 2012 Oct;36(9):2147-64
references.pmid: 22819986
references.citation: Schizophr Res. 2013 Sep;149(1-3):77-82
references.pmid: 23845388
references.citation: Curr Opin Psychiatry. 2013 Jan;26(1):54-9
references.pmid: 23154642
references.citation: Lancet. 2013 May 11;381(9878):1663-71
references.pmid: 23663952
references.citation: Schizophr Res. 2007 Feb;90(1-3):274-83
references.pmid: 17182218
references.citation: J Affect Disord. 2015 Mar 1;173:146-53
references.pmid: 25462409
references.citation: Psychiatriki. 2015 Jan-Mar;26(1):17-27
references.pmid: 25880380
references.citation: Psychol Med. 2010 Nov;40(11):1861-9
references.pmid: 20102664
references.citation: Scand J Psychol. 2014 Dec;55(6):585-92
references.pmid: 24954681
references.citation: Schizophr Bull. 2012 Sep;38(5):1092-104
references.pmid: 21525166
references.citation: Emotion. 2012 Jun;12(3):529-39
references.pmid: 22251048
references.citation: Psychiatry Res. 2014 Mar 30;215(3):694-9
references.pmid: 24445165
references.citation: Neurosci Biobehav Rev. 2006;30(4):437-55
references.pmid: 16239031
references.citation: Front Psychiatry. 2014 Dec 11;5:179
references.pmid: 25566100
references.citation: Psychiatry Res. 2008 Dec 15;161(3):309-17
references.pmid: 18996602
references.citation: Pediatr Res. 2011 May;69(5 Pt 2):101R-8R
references.pmid: 21289541
references.citation: Soc Neurosci. 2011;6(5-6):515-36
references.pmid: 21961831
references.citation: Australas Psychiatry. 2009 Apr;17(2):117-22
references.pmid: 19296272
references.citation: Schizophr Bull. 2014 May;40(3):516-22
references.pmid: 24574307
references.citation: Psychopathology. 2008;41(4):264-70
references.pmid: 18441528
references.citation: J Clin Psychiatry. 2010 Dec;71(12):1689-95
references.pmid: 21190640
references.citation: Clin Psychol Rev. 2012 Dec;32(8):724-40
references.pmid: 23059624
references.citation: Compr Psychiatry. 2014 Nov;55(8):1809-19
references.pmid: 25091283
references.citation: Psychol Aging. 2010 Dec;25(4):779-87
references.pmid: 21186914
references.citation: Adv Child Dev Behav. 2015;48:185-217
references.pmid: 25735945
references.citation: Curr Opin Psychiatry. 2013 Sep;26(5):429-32
references.pmid: 23867660
references.citation: Schizophr Res. 1995 Sep;17(1):5-13
references.pmid: 8541250
references.citation: Curr Opin Psychiatry. 2014 May;27(3):197-202
references.pmid: 24613983
references.citation: Psychiatry Res. 2014 Dec 15;220(1-2):309-14
references.pmid: 25200189
references.citation: Neuroimage. 2014 Oct 1;99:301-11
references.pmid: 24844746
references.citation: Neuropsychologia. 2006;44(3):374-83
references.pmid: 16112148
references.citation: J Affect Disord. 2004 Nov 1;82(3):403-9
references.pmid: 15555691
references.citation: J Autism Dev Disord. 1999 Oct;29(5):407-18
references.pmid: 10587887
references.citation: Bipolar Disord. 2005;7 Suppl 5:43-52
references.pmid: 16225560
references.citation: Psychopathology. 2008;41(4):206-13
references.pmid: 18408416
references.citation: Front Hum Neurosci. 2013 Oct 17;7:661
references.pmid: 24146642
references.citation: Acta Psychiatr Scand. 2009 Oct;120(4):253-64
references.pmid: 19489747
references.citation: Psychol Med. 1999 May;29(3):613-20
references.pmid: 10405082
references.citation: Front Psychol. 2013 Jan 11;3:607
references.pmid: 23423878
references.citation: Annu Rev Psychol. 2012;63:287-313
references.pmid: 21838544
references.citation: BMC Psychiatry. 2015 Nov 21;15:298
references.pmid: 26590556
references.citation: Psychiatry Res. 2013 Dec 30;210(3):1275-86
references.pmid: 24075306
references.citation: Acta Psychiatr Scand. 2013 Sep;128(3):163-78
references.pmid: 23550737
references.citation: Psychiatry Res. 2010 May 15;177(1-2):261-2
references.pmid: 20223523
references.citation: Psychiatry Res. 2014 Oct 30;219(2):400-2
references.pmid: 24947917
references.citation: Br J Psychiatry. 2007 Jul;191:5-13
references.pmid: 17602119
references.citation: Neuropsychologia. 2015 Apr;70:1-10
references.pmid: 25687032
references.citation: J Affect Disord. 2013 Mar 20;146(1):132-6
references.pmid: 22840617
references.citation: J Affect Disord. 2010 Jun;123(1-3):264-9
references.pmid: 19748680
references.citation: Psychiatry Res. 2014 Jul 30;223(1):43-8
references.pmid: 24819306
references.citation: Front Hum Neurosci. 2014 Feb 14;8:60
references.pmid: 24592227
references.citation: Psychiatry Res. 2014 Mar 30;215(3):740-6
references.pmid: 24461271
references.citation: Front Psychol. 2015 Oct 31;6:1610
references.pmid: 26582995
references.citation: J Affect Disord. 2015 Jul 1;179:65-73
references.pmid: 25845751
references.citation: Schizophr Res. 2013 Mar;144(1-3):31-6
references.pmid: 23347949
references.citation: PeerJ. 2014 Mar 27;2:e330
references.pmid: 24749009
references.citation: Can J Psychiatry. 2014 Dec;59(12):659-66
references.pmid: 25702367
references.citation: Cogn Neuropsychiatry. 2013;18(5):409-21
references.pmid: 23082765
references.citation: Acta Psychiatr Scand. 2012 Apr;125(4):266-80
references.pmid: 22211280
references.citation: Bipolar Disord. 2010 Jun;12(4):351-63
references.pmid: 20636632
references.citation: J Int Neuropsychol Soc. 2013 Mar;19(3):231-46
references.pmid: 23351330
references.citation: Psychotherapy (Chic). 2014 Sep;51(3):372-80
references.pmid: 24773092
references.citation: CNS Drugs. 2013 May;27(5):335-43
references.pmid: 23533009
references.citation: J Affect Disord. 2013 May 15;148(1):112-7
references.pmid: 23123133
references.citation: Brain Cogn. 2004 Jun;55(1):209-19
references.pmid: 15134854
references.citation: Bipolar Disord. 2010 Sep;12(6):657-66
references.pmid: 20882710
references.citation: J Child Psychol Psychiatry. 2001 Feb;42(2):241-51
references.pmid: 11280420
references.citation: J Vis. 2011 Mar 22;11(3):null
references.pmid: 21427208
references.citation: Schizophr Bull. 2014 May;40(3):504-15
references.pmid: 24567502
references.citation: J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
references.pmid: 14399272
references.citation: Psychol Aging. 2013 Mar;28(1):284-91
references.pmid: 23276219
references.citation: J Affect Disord. 2013 May;147(1-3):44-50
references.pmid: 23122529
references.citation: Child Dev. 2014 Sep-Oct;85(5):1777-94
references.pmid: 24605760
references.citation: Curr Opin Psychiatry. 2012 Mar;25(2):71-5
references.pmid: 22249083
references.citation: J Clin Exp Neuropsychol. 2013;35(6):655-68
references.pmid: 23799244
references.citation: Aust N Z J Psychiatry. 2014 Jan;48(1):26-35
references.pmid: 24126607
references.citation: Front Biosci (Elite Ed). 2014 Jan 01;6:89-103
references.pmid: 24389145
references.citation: J Affect Disord. 2013 Sep 25;150(3):941-7
references.pmid: 23774140
references.citation: J Exp Child Psychol. 2015 Feb;130:67-78
references.pmid: 25462032