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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.
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.
Social 
Cognition 
Lower Order 
Intermediate 
Order 
Higher 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 Derntl 
et 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
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).
Bibliography 
 1. Addington J, Addington D. Facial affect recognition and information processing in 
schizophrenia and bipolar disorder. Schizophrenia research. 1998;32(3):171–81. 
 2. Bodnar A, Andrzejewska M, Rybakowski J. Social Cognition Disorder in schizophrenia 
and bipolar disorder–similarities and differences. Psychiatr Pol. 2014;48(3):515–26. 
 3. Brüne M, Ribbert H, Schiefenhövel W. The social brain: evolution and pathology. 
Chichester: Wiley; 2003. 
 4. Ladegaard N, Lysaker PH, Larsen ER, Videbech P. A comparison of capacities for 
social cognition and metacognition in first episode and prolonged depression. Psychiatry 
Research. 2014 Dec;220(3):883–9. 
 5. Lyon HM, Startup M, Bentall RP. Social cognition and the manic defense: attributions, 
selective attention, and self-schema in bipolar affective disorder. Journal of abnormal 
psychology. 1999;108(2):273. 
 6. Porcerelli JH, Shahar G, Blatt SJ, Ford RQ, Mezza JA, Greenlee LM. Social cognition 
and object relations scale: Convergent validity and changes following intensive inpatient 
treatment. Personality and Individual Differences. 2006 Aug;41(3):407–17. 
 7. Samamé C, Martino DJ, Strejilevich SA. An individual task meta-analysis of social 
cognition in euthymic bipolar disorders. Journal of Affective Disorders. 2015 Mar;173:146– 
53. 
 8. Thaler NS, Sutton GP, Allen DN. Social cognition and functional capacity in bipolar 
disorder and schizophrenia. Psychiatry Research. 2014 Dec;220(1-2):309–14.

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Bipolar disorder 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.
  • 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
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  • 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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