Abstract
Objectives
Bipolar disorder (BD) is a chronic psychiatric disorder that begins with a mood episode which usually occurs during adolescence. In the present study, it was aimed to compare the euthymic adolescents diagnosed with BD with healthy adolescents in terms of social cognition and emotion regulation.
Materials and Methods
In this study, 27 adolescents diagnosed with BD who applied to İzmir Katip Çelebi University Faculty of Medicine, Department of Child Psychiatry were included as the case group, and 28 adolescents similar in age and gender were included as the control group. Faces, eyes and faux pas tests, among theory of mind tests, were applied to the case and control groups to evaluate social cognition. Emotion regulation difficulties were evaluated with the difficulties in emotion regulation scale (DERS).
Results
The control group received statistically significantly higher scores than the case group in all three theory of mind tests: faces, eyes and faux pas test. Additionally the case group received statistically significantly higher scores than the control group in both the total score and subscales of the DERS. The relationship between the total score of DERS and theory of mind tests of the case and control groups was examined with the Pearson correlation test, and a significant negative relationship was found between them.
Conclusion
In our study, it was shown that adolescents diagnosed with BD had more difficulties in emotional regulation and also had difficulties in theory of mind skills. Emotion regulation difficulties were also found to be related to difficulties in theory of mind skills.
Keywords: Bipolar disorder, emotion regulation, social cognition, theory of mind
References
Stepanova E, Findling RL. Psychopharmacology of bipolar disorders in children and adolescents. Pediatr Clin North Am. 2017;64:1209-1222.
Bauer M, Pfennig A. Epidemiology of bipolar disorders. Epilepsia. 2005;46:8-13.
Lish JD, Dime-Meenan S, Whybrow PC, Price RA, Hirschfeld RM. The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord. 1994;31:281-294.
Frías Á, Palma C, Farriols N. Comorbidity in pediatric bipolar disorder: prevalence, clinical impact, etiology and treatment. J Affect Disord. 2015;174:378-389.
Goldstein BI, Birmaher B. Prevalence, clinical presentation and differential diagnosis of pediatric bipolar disorder. Isr J Psychiatry Relat Sci. 2012;49:3-14.
Hauser M, Galling B, Correll CU. Suicidal ideation and suicide attempts in children and adolescents with bipolar disorder: a systematic review of prevalence and incidence rates, correlates, and targeted interventions. Bipolar Disord. 2013;15:507-523.
Vlad M, Raucher-Chéné D, Henry A, Kaladjian A. Functional outcome and social cognition in bipolar disorder: is there a connection? Eur Psychiatry. 2018;52:116-125.
Weightman MJ, Knight MJ, Baune BT. A systematic review of the impact of social cognitive deficits on psychosocial functioning in major depressive disorder and opportunities for therapeutic intervention. Psychiatry Res. 2019;274:195-212.
Henderson AR. The impact of social cognition training on recovery from psychosis. Curr Opin Psychiatry. 2013;26:429-432.
Hoertnagl CM, Hofer A. Social cognition in serious mental illness. Curr Opin Psychiatry. 2014;27:197-202.
Martino DJ, Strejilevich SA, Fassi G, Marengo E, Igoa A. Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders. Psychiatry Research. 2011;189:379-384.
Baron-Cohen S. The theory of mind deficit in autism: how specific is it? Br J Dev Psychol. 1991;9:301-314.
Bora E, Bartholomeusz C, Pantelis C. Meta-analysis of theory of mind (ToM) impairment in bipolar disorder. Psychol Med. 2016;46:253-264.
Cusi AM, Nazarov A, Holshausen K, Macqueen GM, McKinnon MC. Systematic review of the neural basis of social cognition in patients with mood disorders. J Psychiatry Neurosci. 2012;37:154-169.
de Siqueira Rotenberg L, Beraldi GH, Okawa Belizario G, Lafer B. Impaired social cognition in bipolar disorder: a meta-analysis of theory of mind in euthymic patients. Aust N Z J Psychiatry. 2020;54:783-796.
Samamé C, Martino DJ, Strejilevich SA. Social cognition in euthymic bipolar disorder: systematic review and meta-analytic approach. Acta Psychiatr Scand. 2012;125:266-280.
Bozorg B, Tehrani-Doost M, Shahrivar Z, Fata L, Mohamadzadeh A. Facial emotion recognition in adolescents with bipolar disorder. Iran J Psychiatry. 2014;9:20-24.
Schenkel LS, Marlow-O’Connor M, Moss M, Sweeney JA, Pavuluri MN. Theory of mind and social inference in children and adolescents with bipolar disorder. Psychol Med. 2008;38:791-800.
De Prisco M, Oliva V, Fico G, Fornaro M, de Bartolomeis A, Serretti A, Vieta E, Murru A. Defining clinical characteristics of emotion dysregulation in bipolar disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2022;142:104914.
Dodd A, Lockwood E, Mansell W, Palmier-Claus J. Emotion regulation strategies in bipolar disorder: a systematic and critical review. J Affect Disord. 2019;246:262-284.
Thompson RA. Emotion dysregulation: a theme in search of definition. Dev Psychopathol. 2019;31:805-815.
Oliva V, De Prisco M, Fico G, Possidente C, Fortea L, Montejo L, Anmella G, Hidalgo-Mazzei D, Grande I, Murru A, Fornaro M, de Bartolomeis A, Dodd A, Fanelli G, Fabbri C, Serretti A, Vieta E, Radua J. Correlation between emotion dysregulation and mood symptoms of bipolar disorder: a systematic review and meta-analysis. Acta Psychiatr Scand. 2023;148:472-490.
Kaufman J, Birmaher B, Brent D, Rao UM, Flynn C, Moreci P, Williamson D, Ryan N. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. 1997;36:980-988.
Ünal F, Öktem F, Çetin Çuhadaroğlu F, Çengel Kültür SE, Akdemir D, Foto Özdemir D, Çak, HT, Ünal, D, Tiraş K, Aslan C, Kalayci BM, Aydos BS, Kütük F, Taşyürek E, Karaokur R, Karabucak B, Karakök B, Karaer Y, Artik A. Okul çağı çocukları için duygulanım bozuklukları ve şizofreni görüşme çizelgesi-şimdi ve yaşam boyu şekli-DSM-5 Kasım 2016-Türkçe uyarlamasının (ÇDŞG-ŞY-DSM-5-T) geçerlik ve güvenirliği. Türk Psikiyatri Dergisi. 2019;30;42-50.
Mayes TL, Bernstein IH, Haley CL, Kennard BD, Emslie GJ. Psychometric properties of the children’s depression rating scale-revised in adolescents. J Child Adolesc Psychopharmacol. 2010;20:513-516.
Alşen S. Çocuklar için depresyon değerlendirme ölçeği-gözden geçirilmiş formunun Türkçe uyarlamasının Türk populasyonundaki ergenlerde psikometrik özellikleri (Doctoral dissertation, Dokuz Eylül University (Türkiye). 2012.
Karadağ F, Oral T, Yalçın FA, Erten E. Reliability and validity of Turkish translation of Young Mania Rating Scale. Turk Psikiyatri Derg. 2002;13:107-114.
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess. 2004;26:41-54.
Rugancı RN, Gençöz T. Psychometric properties of a Turkish version of the Difficulties in Emotion Regulation Scale. J Clin Psychol. 2010;66:442-455.
Baron‐Cohen S, Jolliffe T, Mortimore C, Robertson M. Another advanced test of theory of mind: evidence from very high functioning adults with autism or asperger syndrome. J Child Psychol Psychiatry. 1997;38:813-822.
Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I. The “reading the mind in the eyes” test revised version: a study with normal adults, and adults with asperger syndrome or high-functioning autism. The Journal of Child Psychology and Psychiatry and Allied Disciplines. 2001;42:241-251.
Girli A, Tekin D. Investigating false belief levels of typically developed children and children with autism. Procedia Soc Behav Sci. 2010;2:1944-1950.
Baron-Cohen S, O’riordan M, Stone V, Jones R, Plaisted K. Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. J Autism Dev Disord. 1999;29:407-418.
Gershon A, Eidelman P. Inter-episode affective intensity and instability: predictors of depression and functional impairment in bipolar disorder. J Behav Ther Exp Psychiatry. 2015;46:14-18.
Henry C, Van den Bulke D, Bellivier F, Roy I, Swendsen J, M’Baïlara K, Siever LJ, Leboyer M. Affective lability and affect intensity as core dimensions of bipolar disorders during euthymic period. Psychiatry Res. 2008;159:1-6.
Akiskal HS. The prevelant clinical spectrum of bipolars: beyond DSM-IV. J Clin Psychopharmacol. 1996;16:4-15.
Fulford D, Eisner LR, Johnson SL. Differentiating risk for mania and borderline personality disorder: the nature of goal regulation and impulsivity. Psychiatry Res. 2015;227:347-352.
Kafantaris V, Kingsley P, Ardekani B, Saito E, Lencz T, Lim K, Szeszko P. Lower orbital frontal white matter integrity in adolescents with bipolar I disorder. J Am Acade Child Adolesc Psychiatry. 2009;48:79-86.
Chang KD,Wagner C, Garrett A, Howe M, Reis A. Apreliminary functional magnetic resonance imaging study of prefrontal-amygdalaractivation changes in adolescents with bipolar depression treated with lamotrigine. Bipolar Disord. 2008;10:426-431.
Timucin OB, Arabaci M, Cuce F, Karatas B, Onalan S, Yasar M, Yildirim S, Karadag MF. Functional dysconnection of the inferior frontal gyrus in young people with bipolar disorder or at genetic high risk. Biol Psychiatry. 2017; 81:718-727.
Schenkel LS, Pavuluri MN, Herbener ES, Sweeney EM. Facial emotion processing in acutely ill and euthymic patients with pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:1070-1079.
Rowland JE, Hamilton MK, Vella N, Lino BJ, Mitchell PB, Green MJ. Adaptive associations between social cognition and emotion regulation are absent in schizophrenia and bipolar disorder. Front Psychol. 2013;3:607.
Sabbagh MA. Understanding orbitofrontal contributions to theory-of-mind reasoning: implications for autism. Brain Cogn 2004;55:209-219.
Gibson CM, Penn DL, Prinstein MJ, Perkins DO, Belger A. Social skill and social cognition in adolescents at genetic risk for psychosis. Schizophr Res. 2010;122:179-184.
Bora E, Vahip S, Gönül AS, Akdeniz F, Alkan M, Ögüt M, Eryavuz A. Evidence for theory of mind deficits in euthymic patients with bipolar disorder. Acta Psychiatr Scand. 2005;112:110-116.
Halac E, Ciray RO, Turan S, Tuncturk M, Agac N, Elmas FN, Rosson S, Ermis C. Impaired theory of mind and emotion recognition in pediatric bipolar disorder: a systematic review and meta-analysis. J Psychiatr Res. 2021;138:246-255.
Samamé C, Martino DJ, Strejilevich SA. An individual task meta-analysis of social cognition in euthymic bipolar disorders. J Affect Disord. 2015;173:146-153.
van Neerven T, Bos DJ, van Haren NE. Deficiencies in theory of mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: a systematic review of secondary literature. Neurosci Biobehav Rev. 2021;120:249-261.
