Theory of Mind in Bipolar Disorder: A Pilot Descriptive Study
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Objective: Primarily, to determine if affective Theory of Mind (ToM) decoding differs between patients with bipolar disorder who are experiencing mania, euthymia, or depression. Secondarily, to determine if a bias in ToM in patients experiencing different affective episodes is related to a positive, negative, or neutral valence of the target. Finally, to determine if mental state decoding is related to the severity of depressive, manic, or anxious symptoms Methods: A prospective, cross-sectional, study of ToM in patients with bipolar disorder experiencing mania (n = 14), depression (n = 25), or euthymia (n = 20), using the “Reading the Mind in the Eyes Task” (Eyes Task) and the Animal Task developed to control for nonsocial response demands of the Eyes Task. Measures of depressive and anxious symptoms were taken using self-report scales. Interview measures of depressive and manic symptoms were also conducted. A review of patient records was conducted to collect information regarding medications, and course of illness variables. Results: Patients experiencing mania were significantly impaired in mental state decoding compared to euthymic and depressed patients with bipolar disorder. No significant difference was observed between the depressed and euthymic groups. These relationships were maintained when controlling for age of illness onset and Animal Task accuracy. No effect of valence was found. Manic symptom severity was negatively correlated to Animal Task accuracy but no other relationships between Eyes and Animal Tasks and the severity of manic, depressive, or anxious symptoms were found. Group differences in Eyes Task performance were not due to differences in demographics, axis I comorbidities, history of psychosis, or course of illness measures. Limitations: The sample was too small to assess differences between acutely and chronically ill patients. There was no assessment of neurocognition or intelligence using tasks previously validated with manic patients. Conclusions: Patients with bipolar disorder experiencing mania were significantly impaired in mental state decoding compared to patients who were depressed or euthymic. The deficit in ToM decoding in manic patients independent of indicators of illness severity may be indicative of qualitative differences in interpersonal dysfunction between mania, depression, and euthymia in patients with bipolar disorder.