Bipolar disorder and Social

Cognition

Contents :

I. Introduction

II. Social cognition a. Types

b. Grades

III. Bipolar disorder

IV. Studies comparing relation

V. Conclusion

Introduction

It is now widely accepted that a considerable percentage of people affected by bipolar disorders (BDs) exhibit significant impairments in social and vocational adjustment (Huxley and Baldessarini,2007; Jansenetal.,2012), resulting in more than 75% of the total socio-economic burden that such disorder scarry (Das Gupta and Guest, 2002).

Social Cognition

Social cognition is a multifaceted construct concerned with the cognitive processes required by people to come to know themselves and understand other people's behavioural intentions (FiskeandTaylor,1991;Ochsner,2008).

It is meaningful to place social cognitive capacities along a continuum of increasing complexity and synthesis (Adolphs,2001;Adolphs,2010).

Social cognition is the sum of the processes that allow a person to live in the society and manifest mainly through the ability to create effective relationships with others and through interacting with them (Christopher and Uta Frith)

In order to provide an organizing framework, the

National Institute of Mental Health has delimited

five dimensions within this construct

(Greenetal.,2008) :

Social cognition

Theory Of Mind

Social Perception

Social Knowledge

Attribution bias

Emotion Processing

Theory Of Mind

Shamay – Tsoory et al postulate the existence of a cognitive and affective aspect of this ability.

◦ Socio-cognitive : Ability to infer on mental states of other people. Based on observation of behaviour one can infer on thoughts, intentions and beliefs.

◦ Socio-perceptive : Based on the ability to recognize emotions. It is linked to affective system and allows to distinguish people from other objects, and for inferring about mental states of other people, based on facial expressions and body movements.

As for emotional processing, this domain refers broadly to the processes that enable an individual to perceive and utilize emotions (Greenetal.,2008).

Over the last decade, an emotion processing paradigm gaining attention and influence has been conceptualized as emotional intelligence (Mayeretal.,2002), which not only involves the ability to monitor, recognize, and discriminate one's own and other people's emotions, but also to use this emotional information to guide reasoning and behaviour in the social environment.

Emotional Processing

Social Cognition

Lower OrderIntermediate

OrderHigher Order

(Premack, 1978; Brüne, 2003)

Lower Order

Lower-order social cognitive ability

encompasses the ability to identify

and categorize and manifest affective

stimuli, e.g. facial display of basic

emotions, biological motion and

speech prosody. Processing at this

level is characterized by being fast,

implicit and domain specific.

Intermediate Order

Intermediate order – The abilities to

make inferences about the mental

states of conspecifics including their

beliefs, desires and intentions,

commonly known as theory of mind

(ToM) and perspective taking.

Higher Order

Higher-order social cognition captures the ability to reflect and reason about the mental and affective states of oneself and others, moreover, utilizing such understanding to solve problems and master subjective suffering.

This level is often referred to as mentalization(Choi-Kainand Gunderson, 2008) or metacognition (Dimaggioetal., 2009), which compared to lower-order abilities is a more controlled, creative and imaginative process rendering it more sensitive to contextual influences.

Bipolar Disorder

Unipolar depression

Research has suggested that depressed patients are burdened with social cognitive impairment in the areas of ToM (Inoue et al., 2004; Zobel et al., 2010; Cusi et al., 2012) and in the decoding of affective stimuli (e.g. identifying emotions displayed by faces) (Leppänen, 2006; Stuhrmann et al., 2011). In case of the latter, mood congruent biases have consistently been documented.

Bipolar Depression

The bipolar-depressed patients made excessively global and stable attributions for negative events (Robins & Hayes, 1995), showed slowed color naming for depression-related words (Gotlib & Hammen, 1992), endorsed more negative trait words in comparison with the normal participants, and also recalled more negative trait words (Davenport et al., 1979; Dent & Teasdale, 1988; Hammen et al., 1985, 1986; J. M. G. Williams et al., 1990).

BD1 vs BD11

The largest study comparing bipolar subtypes with regard to social cognition(Martino et al.,2011) did not find any differences for the labelling of six basic emotions, Faux Pas, or the Eyes Test. Contrarily, a small study by Lembke and Ketter (2002) found that, although both bipolar sub- groups exhibited preserved emotion processing performance, euthymic BDII patients outperformed BDI subjects on fear recognition, whereas Derntlet al.(2009) found that overall emotion recognition performance was preserved in subsyndromal BDII and impaired in BD1

Relation duration and

episodes Though the analyses were limited by the small number

of studies reviewed and the lack of information on possible moderators in many of the reports, these results are in keeping with different pieces of evidence at the primary study level showing no association between years of illness evolution and social cognition (Bora et al., 2005; Wolf et al. , 2010; Martino et al., 2011). Unfortunately, we could not explore the relationship between social cognition and the number of affective episodes. However, evidence from primary studies has not shown any association between these variables (Bora et al., 2005; Martino et al., 2011; Barrera et al., 2012). Such findings are also in accordance with evidence from a recent meta-analysis suggesting an on progressive evolution of cognitive features in BDs (Samaméetal.,2014).

Specific Tests

The Pragmatic Inference Task (PIT) was used to measure covert attributional style, whereas the Attributional Style Questionnaire (parallel form; ASQpf) measured overt attributional style.

Responses on these tests were similar to those of the bipolar-depressed patients. Like the normal participants, the manic patients showed a robust self-serving bias on the ASQpf. On the PIT, however, they attributed negative events more to self, a finding that is consistent with Winters and Neale's (1985) observations of manic patients in remission. Like bipolar depressed patients and hypomanic normal participants (Bentall & Thompson, 1990; French et al., 1996), the manic patients showed slowed color naming for depression-related but not euphoria related words on the EST (Emotional Stroop Task). The manic patients also showed most variability in Stroop times, which was evident

BD and Psychosis

Recent studies have also indicated

that patients with BD with a history of

psychosis exhibit selective

impairments in social/ emotion

processing. Using the same sample,

our group has demon- strated that

individuals with psychosis share

similar misattributions

Regardless of whether these impairments are primary or secondary, this profile of neuropsychological functioning in BDs, characterized by quite preserved social cognitive abilities in comparison to neuro-cognition, contrasts with that of schizophrenia patients, for which an opposite pattern with more conspicuous deficits in social cognitive skills has been shown (Calettietal., 2013; Leeetal., 2013; Martino and Strejilevich, 2014).

Conclusion

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