Bipolar and social cognition

1. Bipolar disorder and Social
Cognition

2. Contents :
I. Introduction
II. Social cognition
a. Types
b. Grades
III. Bipolar disorder
IV. Studies comparing relation
V. Conclusion

3. 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).

4. 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)

5.  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

6. 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.

7. Emotional Processing
 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.

8. Social
Cognition
Lower Order
Intermediate
Order
Higher Order
(Premack, 1978; Brüne, 2003)

9. 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.

10. 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.

11. 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.

12. Bipolar Disorder

13. 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.

14. 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).

15. 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 Derntl
et al.(2009) found that overall emotion
recognition performance was preserved in
subsyndromal BDII and impaired in BD1

16. 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).

17. 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

18. 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

21. Conclusion
 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).

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