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Millett CE, Corrigan AA, Adamis A, Bonner CR, Lebovitz JG, Palm ST, Majd M, Gunning FM, Burdick KE. The effect of aging on facial emotion recognition in bipolar disorder. Psychiatry Res 2023; 327:115386. [PMID: 37544087 DOI: 10.1016/j.psychres.2023.115386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Convergent data point to an exaggerated negativity bias in bipolar disorder (BD), and little is known about whether people with BD experience the 'positivity effect' with increasing age. METHOD This is a cross sectional study of 202 participants with BD aged 18-65, and a sample (n = 53) of healthy controls (HCs). Participants completed the CANTAB Emotion Recognition Task (ERT). Using analysis of variance, we tested for a main effect of age, diagnosis, and an interaction of age x diagnosis on both negative and positive conditions. RESULTS We observed increased accuracy in identifying positive stimuli in the HC sample as a function of increasing age, a pattern that was not seen in participants with BD. Specifically, there was a significant diagnosis by age cohort interaction on ERT performance that was specific to the identification of happiness, where the Later Adulthood cohort of HCs was more accurate when identifying happy faces relative to the same cohort of BD patients. CONCLUSION Later life looks different for people with BD. With an aging population globally, gaining a clearer picture of the effects of recurrent mood dysregulation on the brain will be critical in guiding efforts to effectively optimize outcomes in older adults with BD.
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Affiliation(s)
- Caitlin E Millett
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Alexandra A Corrigan
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Alexandra Adamis
- Department of Psychology, Vanderbilt University, Nashville, TN, United States of America
| | - Candice Roquemore Bonner
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Julia G Lebovitz
- Department of Psychology, Vanderbilt University, Nashville, TN, United States of America
| | - Stephan T Palm
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Marzieh Majd
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Faith M Gunning
- Department of Psychiatry, Joan & Sanford I. Weill Medical College of Cornell University, New York City, NY, United States of America
| | - Katherine E Burdick
- Mood and Psychosis Research Program, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
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2
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Salazar Kämpf M, Kanske P. Mimicry and affective disorders. Front Psychiatry 2023; 13:1105503. [PMID: 36762295 PMCID: PMC9905714 DOI: 10.3389/fpsyt.2022.1105503] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
Mimicry, the spontaneous imitation of an interaction partner, is an important part of everyday communication, as it has been shown to foster relationships and increase closeness. People with affective disorders often have problems in their interpersonal lives. In this review, we pursue the question if these problems are linked to differences in mimicry behavior. First, we summarize existing evidence on mimicry, depression and mood. Then, based on five theories differing in their core assumptions regarding mechanisms and functionality of mimicry, we derive suggestions on how mimicry might affect people suffering from bipolar disorders, dysthymia or depression. Depending on each theory, a different understanding of affective disorders and mimicry arises, and we show how the evidence fit in with the suggested theories. Previous studies on affective disorders have focused on mimicry behavior of participants watching photos, computer-generated images, or short video sequences. This review sheds light on the fact that evidence on mimicry needs to be broadened systematically for people with affective disorders in interactional settings. Mimicry represents a novel and important yet underestimated source for diagnostic, intervention and evaluation processes in affective disorders.
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Affiliation(s)
- Maike Salazar Kämpf
- Clinical Psychology and Behavioral Neuroscience, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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3
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Wenzel M, Althen H, Veeh J, Reif A. Euthymic patients with predominantly manic polarity avoid happy faces in a dot probe task. Int J Bipolar Disord 2022; 10:16. [PMID: 35739323 PMCID: PMC9226225 DOI: 10.1186/s40345-022-00262-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Some studies suggest a mood-congruent attentional bias in bipolar patients. However, for euthymic patients, especially in dependence on the predominant polarity, there is little and inconsistent data. A clearer understanding of emotion-related attentional biases and their relationship to dysfunctional emotion regulation could help improving the diagnostics and treatment of bipolar disorder (BD). Twenty bipolar patients in a depressive state (BP-acute-D), 32 euthymic patients with manic (BP-euth-M) or depressive (BP-euth-D) predominant polarity, and 20 healthy control participants (HC) performed a dot-probe task (DPT) with happy and sad faces presented for 250 ms or 1250 ms in two different runs. Emotion regulation strategies were assessed with two questionnaires. Results In the short presentation condition of the DPT, BP-euth-M showed less attention for happy faces than HC (p = .03, r = − 0.48). BP-acute-D scored lower in cognitive reappraisal and putting into perspective and higher in suppression, catastrophizing, and rumination than HC. BP-euth-M scored higher in rumination and BP-euth-D lower in putting into perspective and higher in catastrophizing than HC. In BP-euth-D and HC, bias scores for sad faces in the longer presentation condition and reappraisal scores correlated positively. Conclusions Results of the DPT suggest an avoidance of happy faces for BP-euth-M which we interpret as a protection mechanism for triggers of mania. That individuals who apply more reappraisal show more selective attention to sad faces could on the one hand reflect a mental effort in reevaluating the sad emotional input and on the other hand a greater tolerance for it.
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Affiliation(s)
- Martina Wenzel
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany. .,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Würzburg, Würzburg, Germany. .,Department of Neurology, Technical University of Munich (TU), Munich, Germany.
| | - Heike Althen
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - Julia Veeh
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Würzburg, Würzburg, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital, University of Würzburg, Würzburg, Germany
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5
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Koenders M, Dodd A, Karl A, Green M, Elzinga B, Wright K. Understanding bipolar disorder within a biopsychosocial emotion dysregulation framework. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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6
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Dam VH, Thystrup CK, Jensen PS, Bland AR, Mortensen EL, Elliott R, Sahakian BJ, Knudsen GM, Frokjaer VG, Stenbæk DS. Psychometric Properties and Validation of the EMOTICOM Test Battery in a Healthy Danish Population. Front Psychol 2019; 10:2660. [PMID: 31849772 PMCID: PMC6901831 DOI: 10.3389/fpsyg.2019.02660] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/11/2019] [Indexed: 01/23/2023] Open
Abstract
Disruptions in hot cognition, i.e., the processing of emotionally salient information, are prevalent in most neuropsychiatric disorders and constitute a potential treatment target. EMOTICOM is the first comprehensive neuropsychological test battery developed specifically to assess hot cognition. The aim of the study was to validate and establish a Danish language version and reference data for the EMOTICOM test battery. To evaluate the psychometric properties of 11 EMOTICOM tasks, we collected data from 100 healthy Danish participants (50 males, 50 females) including retest data from 49 participants. We assessed test-retest reliability, floor and ceiling effects, task-intercorrelations, and correlations between task performance and relevant demographic and descriptive factors. We found that test-retest reliability varied from poor to excellent while some tasks exhibited floor or ceiling effects. Intercorrelations among EMOTICOM task outcomes were low, indicating that the tasks capture different cognitive constructs. EMOTICOM task performance was largely independent of age, sex, education, and IQ as well as current mood, personality, and self-reported motivation and diligence during task completion. Overall, many of the EMOTICOM tasks were found to be useful and objective measures of hot cognition although select tasks may benefit from modifications to avoid floor and ceiling effects in healthy individuals.
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Affiliation(s)
- Vibeke H. Dam
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christa K. Thystrup
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Peter S. Jensen
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Amy R. Bland
- Neuroscience and Psychiatric Unit, The University of Manchester, Manchester, United Kingdom
| | - Erik L. Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Rebecca Elliott
- Neuroscience and Psychiatric Unit, The University of Manchester, Manchester, United Kingdom
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Gitte M. Knudsen
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibe G. Frokjaer
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dea S. Stenbæk
- Neurobiology Research Unit, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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7
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Looking on the bright side and seeing it vividly: interpretation bias and involuntary mental imagery are related to risk for bipolar disorder. Behav Cogn Psychother 2019; 48:203-215. [PMID: 31597584 DOI: 10.1017/s1352465819000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Involuntary mental imagery is elevated among people with bipolar disorder, and has been shown to shape biases in interpretation of ambiguous information. However, it is not clear whether biases in interpretation of ambiguous scenarios can be observed in those at risk for bipolar disorder, or whether involuntary imagery is related to such a bias. AIMS In the present study, we extended a prominent model of bipolar cognition to an at-risk sample. We specifically tested whether positive interpretation bias and involuntary mental imagery are linked to a greater risk of bipolar disorder. METHOD Young adults (N = 169) completed measures of risk for bipolar disorder (the Hypomanic Personality Scale [HPS]), interpretation bias, and involuntary mental imagery. RESULTS Higher scores on the HPS were significantly correlated with more positive interpretations of ambiguous scenarios (β = 0.29, p <. 01) and more frequent involuntary mental imagery (β = 0.22, p < .01). There was no evidence of an interaction between interpretation bias and mental imagery in predicting HPS score, β = .04, p = .62. CONCLUSIONS Further research is warranted to determine if intrusive imagery or interpretation bias influence the development of bipolar disorder over time in those at risk.
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8
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Gago B, Perea M, Sierra P, Livianos L, Cañada-Martínez A, García-Blanco A. Do affective episodes modulate moral judgment in individuals with bipolar disorder? J Affect Disord 2019; 245:289-296. [PMID: 30419529 DOI: 10.1016/j.jad.2018.11.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 10/04/2018] [Accepted: 11/03/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bipolar disorder (BD) patients experience altered emotional states and deficits in social adaptation that may also be involved in deontological moral judgments in which participants have to choose whether to sacrifice one person in order to save the lives of a greater number. METHODS In the present study we compared the utilitarian responses of BD patients in their different states (euthymia, mania, depression) and healthy controls to moral dilemmas with low (impersonal dilemma) and high (personal dilemma) emotional saliency. RESULTS Our findings revealed an increased tendency to utilitarian judgments in the three groups of BD patients in impersonal dilemmas relative to healthy individuals. In addition, utilitarian responses were increased during manic and depressive episodes in personal moral dilemmas relative to control group. Furthermore, we found no differences in social adaptation between utilitarian and deontological BD responders, though the depressive BD had a lower adaptation than the euthymic individuals. LIMITATIONS The recording of response times, the exhaustive control of medication effect, or the inclusion of a non-moral condition in the battery of moral dilemmas would provide a better characterization of moral judgment in BD. CONCLUSIONS For impersonal dilemmas, BD patients exhibited more utilitarian reasoning, which is also affected by emotional engagement for personal dilemmas during acute episodes of mania and depression. Social adaptation is not associated to utilitarian reasoning, but is rather influenced by mood state.
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Affiliation(s)
- Belén Gago
- University of Valencia, Valencia, Spain; "Institut Pere Mata" University Hospital, Reus, Spain
| | | | - Pilar Sierra
- University of Valencia, Valencia, Spain; "La Fe" University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Lorenzo Livianos
- University of Valencia, Valencia, Spain; "La Fe" University and Polytechnic Hospital, Avda. Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | | | - Ana García-Blanco
- University of Valencia, Valencia, Spain; "La Fe" Health Research Institute, Valencia, Spain.
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9
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Abstract
While impairments in cognitive emotional processing are key to the experience of mood disorders, little is understood of their shared and distinct features across major depressive disorder (MDD) and bipolar disorder (BD). In this review, we discuss the similarities and differences in abnormal emotional processing associated with mood disorders across the cognitive domains of perception, attention, memory, and reward processing, with a particular focus on how these impairments relate to the clinical profile of the disorders. We consider behavioral and neuroimaging evidence, especially that of the growing consensus surrounding mood-congruent biases in cognition, in combination with state- and trait-related characteristics in an attempt to provide a more comprehensive and translational overview of mood disorders. Special consideration is given to the shared phenomenon of mood instability and its role as a potential transdiagnostic marker across the prodrome and maintenance of mood disorders.
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10
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Meyer TD, Hautzinger M, Bauer IE. A mania-related memory bias is associated with risk for relapse in bipolar disorder<sup/>. J Affect Disord 2018; 235:557-564. [PMID: 29698917 DOI: 10.1016/j.jad.2018.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/31/2018] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Previous work has shown that neuropsychological performance can predict outcome of psychotherapy. The present paper explores whether an affective bias in verbal memory is associated with recurrence of mood episodes in patients with Bipolar Disorder (BD). METHOD 76 euthymic adult patients with BD were randomly assigned to either 9 months of Cognitive Behavioral Therapy (CBT) or Support Therapy (ST), and followed up for 2 years after completing therapy. At baseline, affective learning memory (Emotional Auditory Verbal Learning Test; EMO-AVLT) and other measures were assessed. Recurrence of a mood episode was the primary outcome. RESULTS The survival analyses revealed that the interaction between therapy condition, more specifically ST, and a recognition bias in favor of mania-related, but not depression-related words predicted recurrence of mania. Recurrence of depression was predicted by neither affective memory bias nor their interaction with treatment. CONCLUSIONS A mania-related memory bias emerged as a predictor of mania recurrence, specifically in an unstructured setting such as ST. Perhaps mania-related schemata are more salient or more easily activated in those at high risk for recurrence. Interventions targeting patients' insight into their internal states as potential indicators of prodromal manic symptoms could be the key to improve the outcome of psychological interventions in BD. Additional research in the role of cognitive factors in relapse prevention is warranted.
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Affiliation(s)
- Thomas D Meyer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States.
| | - Martin Hautzinger
- Department of Psychology and Psychotherapy, University of Tübingen, Germany
| | - Isabelle E Bauer
- University of Texas Health Science Center at Houston, McGovern Medical School, Department of Psychiatry and Behavioral Sciences, 77054 Houston, TX, United States
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11
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Purcell JR, Lohani M, Musket C, Hay AC, Isaacowitz DM, Gruber J. Lack of emotional gaze preferences using eye-tracking in remitted bipolar I disorder. Int J Bipolar Disord 2018; 6:15. [PMID: 29968068 PMCID: PMC6161987 DOI: 10.1186/s40345-018-0123-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/30/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Bipolar disorder is associated with heightened and persistent positive emotion (Gruber in Curr Dir Psychol Sci 20:217-221, 2011; Johnson in Clin Psychol Rev 25:241-262, 2005). Yet little is known about information processing biases that may influence these patterns of emotion responding. METHODS The current study adopted eye-tracking methodology as a continuous measure of sustained overt attention to monitor gaze preferences during passive viewing of positive, negative, and neutral standardized photo stimuli among remitted bipolar adults and healthy controls. Percentage fixation durations were recorded for predetermined areas of interest across the entire image presentation, and exploratory analyses were conducted to examine early versus late temporal phases of image processing. RESULTS Results suggest that the bipolar and healthy control groups did not differ in patterns of attention bias. CONCLUSIONS Findings provide insight into apparently intact attention processing despite disrupted emotional responding in bipolar disorder.
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Affiliation(s)
- John R Purcell
- Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St., Bloomington, IN, 47405, USA
| | - Monika Lohani
- Department of Psychology, University of Utah, 201 Presidents Circle, Salt Lake City, UT, 84112, USA
| | - Christie Musket
- Department of Psychology, University of Pittsburgh, 210 South Bouquet St, #4209, Pittsburgh, PA, 15260, USA
| | - Aleena C Hay
- Department of Psychological and Brain Sciences, Boston University, 648 Beacon St., 6th Floor, Boston, MA, 02215, USA
| | - Derek M Isaacowitz
- Department of Psychology, Northeastern University, 360 Huntington Ave., Boston, MA, 02115, USA
| | - June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Muenzinger D321C, Boulder, CO, 80309, USA.
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12
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Bertó C, Ferrin M, Barberá M, Livianos L, Rojo L, García-Blanco A. Abnormal emotional processing in maltreated children diagnosed of Complex Posttraumatic Stress Disorder. CHILD ABUSE & NEGLECT 2017; 73:42-50. [PMID: 28945995 DOI: 10.1016/j.chiabu.2017.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
Maltreated children usually show a specific pattern of emotional and behavioral symptoms that exceed those relating to posttraumatic stress disorder (PTSD). These symptoms have been defined as Complex PTSD (CPTSD). The underlying attentional mechanisms of abnormal emotional processing and their relation to the clinical presentation of CPTSD are not well understood. A visual dot-probe paradigm involving pre-attentive (i.e., 500ms) and attentive (i.e., 1500ms) presentation rates of neutral versus emotional (i.e., angry, happy or sad) facial expressions was applied. Twenty-one maltreated CPTSD children were compared with twenty-six controls. The results are as follows: an attention bias away from threatening faces and an attentional bias towards sad faces were observed in maltreated CPTSD children during pre-attentive and attentive processing. Whereas the attentional bias away from angry faces was associated with social problems, the attentional bias towards sad faces was associated with depressive and withdrawn symptoms. Therefore, CPTSD children develop maladaptive negative cognitive styles, which may underlie not only social problems (by a cognitive avoidance of threatening stimuli) but also depressive symptoms (by a cognitive approach to sad stimuli). Attention processing abnormalities should be considered as therapeutic targets for new treatment approaches in this population.
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Affiliation(s)
- Clara Bertó
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Maite Ferrin
- University of Southampton, UK; Institute of Psychiatry, London, UK
| | - María Barberá
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Lorenzo Livianos
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Luis Rojo
- Department of Psychiatry and Clinical Psychology, University and Polytechnic Hospital La Fe, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Ana García-Blanco
- Neonatal Research Unit, Health Research Institute La Fe, Valencia, Spain; Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.
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Haffner P, Quinlivan E, Fiebig J, Sondergeld LM, Strasser ES, Adli M, Moritz S, Stamm TJ. Improving functional outcome in bipolar disorder: A pilot study on metacognitive training. Clin Psychol Psychother 2017; 25:50-58. [PMID: 28857347 DOI: 10.1002/cpp.2124] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/08/2017] [Accepted: 07/16/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Effective group psychological interventions in bipolar disorder are rare. In this study, we present "metacognitive training (MCT) for bipolar disorder"-an adaption of a group intervention that has proven effective in other severe psychiatric disorders. MCT is a structured, interactive approach that addresses cognitive biases, social cognition, and self-esteem. In this pilot study, we investigated psychosocial functioning as primary outcome measure, as well as the feasibility of MCT and its acceptance among bipolar patients. METHODS Thirty-four outpatients with bipolar disorder were recruited. Inclusion criteria were euthymia and psychosocial functioning with a score >11 assessed by the Functional Assessment Short Test. The subjects received eight weekly MCT sessions. Before and after the intervention, psychosocial functioning, quality of life (QoL), and patient views were assessed. RESULTS Patients improved significantly in global psychosocial functioning, with a large effect size from baseline to post-treatment. Over the intervention period, patient QoL improved significantly in terms of their physical health, however not for other QoL subdomains. Treatment adherence was 80%, and patients' appraisal of the training was positive. LIMITATIONS As this study lacks a control group, it is not possible to ascertain whether the positive treatment effects are attributable to MCT. Additionally, it is unclear whether gains in psychosocial functioning would have been maintained long term. CONCLUSIONS This pilot trial conclusively shows that MCT is feasible and provides preliminary evidence for both the acceptance and efficacy of MCT. Further studies with larger samples and control condition will be necessary to build on these findings.
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Affiliation(s)
- Paula Haffner
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Quinlivan
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jana Fiebig
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lene-Marie Sondergeld
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elisa Sophie Strasser
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mazda Adli
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Fliedner Klinik, Berlin, Germany
| | - Steffen Moritz
- Department for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Josef Stamm
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
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14
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Lyoo YC, Park S, Ju S, Shin KS, Hwang J, Yoon S, Kim J, Cho HB, Kim YH, Kim JH, Jeong HS, Kim JE. A performance comparison between the two language versions of the Affective Go/No-Go test: A randomised crossover study. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2017. [PMID: 28634985 DOI: 10.1002/ijop.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this randomised crossover study is to validate the Korean version of the Affective Go/No-go (AGN) test. The Korean words for the AGN test were selected after careful evaluation of emotional valences, word length and frequency. Fifteen Korean advanced learners of English were administered both Korean and English versions, yielding 30 data points. The performance of both language versions was compared for each of the AGN test parameters (response latency, commission error and omission error) using two-way analysis of variance (ANOVA). Intraclass correlation coefficients (ICCs) were estimated to evaluate associations between the two versions. The ICCs were high for response latencies of all valences and commission errors of positive and neutral words, but not for that of negative words and omission errors of all valences. A similar pattern of test results, as revealed by the high ICCs and non-significant interaction effects between language and word valence, suggests that the psychometric properties of the AGN test may be comparable over different language versions.
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Affiliation(s)
- Younghyun C Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea
| | - Shinwon Park
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Sejin Ju
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Graduate School of International Studies, Ewha Womans University, Seoul, South Korea
| | - Kyung-Shik Shin
- School of Business, Ewha Womans University, Seoul, South Korea
| | - Jaeuk Hwang
- Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Han Byul Cho
- The Brain Institute, University of Utah, Salt Lake City, UT, USA
| | - Young Hoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Jihyun H Kim
- Department of Psychiatry, Inha University College of Medicine, Incheon, South Korea
| | - Hyeonseok S Jeong
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jieun E Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea.,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
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Meule A. Reporting and Interpreting Task Performance in Go/No-Go Affective Shifting Tasks. Front Psychol 2017; 8:701. [PMID: 28536544 PMCID: PMC5422529 DOI: 10.3389/fpsyg.2017.00701] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/21/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Adrian Meule
- Department of Psychology, University of SalzburgSalzburg, Austria.,Center for Cognitive Neuroscience, University of SalzburgSalzburg, Austria
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16
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García-Blanco A, García-Blanco MDC, Fernando B, Perea M. Influence of computer feedback on attentional biases to emotional faces in children. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.07.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Bilderbeck AC, Reed ZE, McMahon HC, Atkinson LZ, Price J, Geddes JR, Goodwin GM, Harmer CJ. Associations between mood instability and emotional processing in a large cohort of bipolar patients. Psychol Med 2016; 46:3151-3160. [PMID: 27572660 DOI: 10.1017/s003329171600180x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Aberrant emotional biases have been reported in bipolar disorder (BD), but results are inconsistent. Despite the clinical relevance of chronic mood variability in BD, there is no previous research investigating how the extent of symptom fluctuations in bipolar disorder might relate to emotional biases. This exploratory study investigated, in a large cohort of bipolar patients, whether instability in weekly mood episode symptoms and other clinical and demographic factors were related to emotional bias as measured in a simple laboratory task. METHOD Participants (N = 271, BDI = 206, BDII = 121) completed an 'emotional categorization and memory' task. Weekly self-reported symptoms of depression and mania were collected prospectively. In linear regression analyses, associations between cognitive bias and mood variability were explored together with the influence of demographic and clinical factors, including current medication. RESULTS Greater accuracy in the classification of negative words relative to positive words was associated with greater instability in depressive symptoms. Furthermore, greater negative bias in free recall was associated with higher instability in manic symptoms. Participants diagnosed with BDII, compared with BDI, showed overall better word recognition and recall. Current antipsychotic use was associated with reduced instability in manic symptoms but this did not impact on emotional processing performance. CONCLUSIONS Emotional processing biases in bipolar disorder are related to instability in mood. These findings prompt further investigation into the underpinnings as well as clinical significance of mood instability.
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Affiliation(s)
| | - Z E Reed
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - H C McMahon
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - L Z Atkinson
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - J Price
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - J R Geddes
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - G M Goodwin
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - C J Harmer
- Department of Psychiatry,University of Oxford,Oxford,UK
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18
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Early ERP modulation during mood adjectives processing in patients with affective disorders. Neurosci Lett 2016; 632:62-70. [DOI: 10.1016/j.neulet.2016.08.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/22/2016] [Accepted: 08/13/2016] [Indexed: 11/18/2022]
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19
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Harris DA, Hayes-Skelton SA, Ciaramitaro VM. What's in a Face? How Face Gender and Current Affect Influence Perceived Emotion. Front Psychol 2016; 7:1468. [PMID: 27733839 PMCID: PMC5039177 DOI: 10.3389/fpsyg.2016.01468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
Abstract
Faces drive our social interactions. A vast literature suggests an interaction between gender and emotional face perception, with studies using different methodologies demonstrating that the gender of a face can affect how emotions are processed. However, how different is our perception of affective male and female faces? Furthermore, how does our current affective state when viewing faces influence our perceptual biases? We presented participants with a series of faces morphed along an emotional continuum from happy to angry. Participants judged each face morph as either happy or angry. We determined each participant's unique emotional 'neutral' point, defined as the face morph judged to be perceived equally happy and angry, separately for male and female faces. We also assessed how current state affect influenced these perceptual neutral points. Our results indicate that, for both male and female participants, the emotional neutral point for male faces is perceptually biased to be happier than for female faces. This bias suggests that more happiness is required to perceive a male face as emotionally neutral, i.e., we are biased to perceive a male face as more negative. Interestingly, we also find that perceptual biases in perceiving female faces are correlated with current mood, such that positive state affect correlates with perceiving female faces as happier, while we find no significant correlation between negative state affect and the perception of facial emotion. Furthermore, we find reaction time biases, with slower responses for angry male faces compared to angry female faces.
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Affiliation(s)
- Daniel A. Harris
- Developmental and Brain Sciences, Department of Psychology, University of Massachusetts BostonBoston MA, USA
| | - Sarah A. Hayes-Skelton
- Clinical Psychology, Department of Psychology, University of Massachusetts BostonBoston MA, USA
| | - Vivian M. Ciaramitaro
- Developmental and Brain Sciences, Department of Psychology, University of Massachusetts BostonBoston MA, USA
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20
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Hawken ER, Harkness KL, Lazowski LK, Summers D, Khoja N, Gregory JG, Milev R. The manic phase of Bipolar disorder significantly impairs theory of mind decoding. Psychiatry Res 2016; 239:275-80. [PMID: 27039012 DOI: 10.1016/j.psychres.2016.03.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 03/02/2016] [Accepted: 03/25/2016] [Indexed: 11/28/2022]
Abstract
Bipolar disorder is associated with significant deficits in the decoding of others' mental states in comparison to healthy participants. However, differences in theory of mind decoding ability among patients in manic, depressed, and euthymic phases of bipolar disorder is currently unknown. Fifty-nine patients with bipolar I or II disorder (13 manic, 25 depressed, 20 euthymic) completed the "Reading the Mind in the Eyes" Task (Eyes task) and the Animals Task developed to control for non-mentalistic response demands of the Eyes Task. Patients also completed self-report and clinician-rated measures of depression, mania, and anxiety symptoms. Patients in the manic phase were significantly less accurate than those in the depressed and euthymic phases at decoding mental states in the Eyes task, and this effect was strongest for eyes of a positive or neutral valence. Further Eyes task performance was negatively correlated with the symptoms of language/thought disorder, pressured speech, and disorganized thoughts and appearance. These effects held when controlling for accuracy on the Animals task, response times, and relevant demographic and clinical covariates. Results suggest that the state of mania, and particularly psychotic symptoms that may overlap with the schizophrenia spectrum, are most strongly related to social cognitive deficits in bipolar disorder.
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Affiliation(s)
- Emily R Hawken
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston Ontario, Canada; Department of Psychiatry, Queen's University, Kingston Ontario, Canada
| | - Kate L Harkness
- Department of Psychiatry, Queen's University, Kingston Ontario, Canada; Department of Psychology, Queen's University, Kingston Ontario, Canada
| | - Lauren K Lazowski
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston Ontario, Canada; Department of Psychiatry, Queen's University, Kingston Ontario, Canada; Department of Psychology, Queen's University, Kingston Ontario, Canada; Centre for Neuroscience, Queen's University, Kingston Ontario, Canada
| | - David Summers
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston Ontario, Canada; Department of Psychiatry, Queen's University, Kingston Ontario, Canada; Department of Psychology, Queen's University, Kingston Ontario, Canada; Centre for Neuroscience, Queen's University, Kingston Ontario, Canada
| | - Nida Khoja
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston Ontario, Canada; Department of Psychiatry, Queen's University, Kingston Ontario, Canada; Department of Psychology, Queen's University, Kingston Ontario, Canada; Centre for Neuroscience, Queen's University, Kingston Ontario, Canada
| | | | - Roumen Milev
- Department of Psychiatry, Queen's University, Kingston Ontario, Canada; Department of Psychology, Queen's University, Kingston Ontario, Canada; Centre for Neuroscience, Queen's University, Kingston Ontario, Canada.
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21
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Affective processing bias in youth with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2015; 24:1349-59. [PMID: 25724546 PMCID: PMC6518415 DOI: 10.1007/s00787-015-0686-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/28/2015] [Indexed: 10/23/2022]
Abstract
High rates of comorbidity and overlapping diagnostic criteria between pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) contribute to diagnostic and treatment confusion. To advance what is known about both disorders, we compared effect of emotional stimuli on response control in children with primary BD, primary ADHD and typically developing controls (TDC). Participants included 7-17 year olds with either "narrow-phenotype" pediatric BD (n = 25), ADHD (n = 25) or TDC (n = 25). Groups were matched on participant age and FSIQ. The effect of emotional stimuli on response control was assessed using the Cambridge Neuropsychological Test Automated Battery Affective Go/No-Go task (CANTAB AGN). We found a group by target valence interaction on commission errors [F(2,71) = 5.34, p < 0.01, ƞ p (2) = 0.13] whereby ADHD, but not TDC participants, made more errors on negative than positive words [t(24) = -2.58, p < 0.05, r = 0.47]. In contrast, there was a nonsignificant trend for BD participants to make fewer errors on negative versus positive words compared to ADHD and TDC participants. Between-subjects effects showed that ADHD participants made more errors than TDC, but not BD participants. Our main finding advances what is known about the effect of emotional stimuli on response control in children with ADHD. Our results suggesting a positive affective processing bias in children with ADHD compliment emerging literature show that difficulties with emotional processing and regulation may be core features of ADHD. Further, given the observed pattern of results in children with ADHD compared to BD children, our behavioral results suggest the importance of examining differences in the brain-behavior mechanisms involved in affective processing in children with ADHD compared to BD children.
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22
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Lescalier L, Belzeaux R, Azorin JM, Deruelle C, Mazzola-Pomietto P. Biais de mémorisation dans le trouble bipolaire à l’euthymie : l’effet perturbateur de la joie. ANNEE PSYCHOLOGIQUE 2015. [DOI: 10.3917/anpsy.153.0385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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23
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Biais de mémorisation dans le trouble bipolaire à l’euthymie : l’effet perturbateur de la joie. ANNEE PSYCHOLOGIQUE 2015. [DOI: 10.4074/s0003503315003036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Biais de mémorisation dans le trouble bipolaire à l’euthymie : l’effet perturbateur de la joie. ANNEE PSYCHOLOGIQUE 2015. [DOI: 10.4074/s0003503315000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Little is known about the nature of the relation between information-processing biases and affective traits in bipolar disorder. The present study was designed to investigate whether attentional biases are evident in persons diagnosed with bipolar disorder when they are in a positive mood state, and whether biases are related to indices of emotion regulation and to prior history of mood episodes. Ninety adults diagnosed with bipolar I disorder and 81 controls with no lifetime mood disorder underwent a positive mood induction and then completed an emotion face dot-probe task; participants in the bipolar disorder group also completed a self-report measure of responses to positive affect. Attentional bias was not related to a diagnosis of bipolar disorder or to symptom severity. Consistent with hypotheses, analyses within the bipolar group indicated that greater dampening of positive affect related to significantly less attention paid to the positively valenced faces. Discussion focuses on the potential role of affective traits in shaping attentional bias in bipolar disorder.
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Affiliation(s)
- Andrew D Peckham
- a Department of Psychology , University of California, Berkeley , Berkeley , CA , USA
| | - Sheri L Johnson
- a Department of Psychology , University of California, Berkeley , Berkeley , CA , USA
| | - Ian H Gotlib
- b Department of Psychology , Stanford University , Stanford , CA , USA
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26
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Abstract
Patients with bipolar disorder (BD) experience difficulties in information processing and in the cognitive control of emotions. Mood-congruent biases, which parallel illness episodes, find a neural correlate in abnormal reactivity to stimuli in specific brain regions, and in disrupted functional connectivity among brain areas pertaining to corticolimbic circuitries. It is suggested that a reduced integrity of white matter tracts could underpin dysfunctions in networks implicated in the generation and control of affect. Recent studies using diffusion tensor imaging techniques found that (1) independent of drug treatment, patients with BD show widespread signs of disrupted white matter microstructure, suggesting significant demyelination/dysmyelination without axonal loss, and (2) effective long-term treatment with lithium is associated with increased axial connectivity, proportional to the duration of treatment. These findings suggest that changes of white matter microstructure in specific brain networks could parallel disrupted neural connectivity during illness episodes in BD and that these changes might play a major role in the mechanistic explanation of the biological underpinnings of BD psychopathology.
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27
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Attentional biases toward emotional images in the different episodes of bipolar disorder: an eye-tracking study. Psychiatry Res 2014; 215:628-33. [PMID: 24439518 DOI: 10.1016/j.psychres.2013.12.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 12/24/2013] [Accepted: 12/26/2013] [Indexed: 11/22/2022]
Abstract
Attentional biases toward emotional information may represent vulnerability and maintenance factors in bipolar disorder (BD). The present experimental study examined the processing of emotional information in BD patients using the eye-tracking technology. Bipolar patients in their different states (euthymia, mania, depression) simultaneously viewed four pictures with different emotional valence (happy, neutral, sad, threatening) for 20s while their eye movements were monitored. A group of healthy individuals served as the control. The data revealed the following: (i) a decrease in attention to happy images in BD patients in their depressive episodes compared to healthy individuals, and (ii) an increase in attention to threatening images in BD patients (regardless of their episode) relative to the healthy controls. These biases appeared in the late stages of information processing and were sustained over the 20s interval. Thus, the present findings reveal that attentional biases toward emotional information can be a key feature of BD, in that: (i) an anhedonic lack of sensitivity to positive stimuli during the bipolar depressive episode may be considered a maintaining factor of this clinical state, and (ii) the trait-bias toward threat, even in asymptomatic patients, may reflect a marker of vulnerability in BD.
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28
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García-Blanco AC, Perea M, Salmerón L. Attention orienting and inhibitory control across the different mood states in bipolar disorder: an emotional antisaccade task. Biol Psychol 2013; 94:556-61. [PMID: 24161800 DOI: 10.1016/j.biopsycho.2013.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/24/2022]
Abstract
An antisaccade experiment, using happy, sad, and neutral faces, was conducted to examine the effect of mood-congruent information on inhibitory control (antisaccade task) and attentional orienting (prosaccade task) during the different episodes of bipolar disorder (BD) - manic (n=22), depressive (n=25), and euthymic (n=24). A group of 28 healthy controls was also included. Results revealed that symptomatic patients committed more antisaccade errors than healthy individuals, especially with mood-congruent faces. The manic group committed more antisaccade errors in response to happy faces, while the depressed group tended to commit more antisaccade errors in response to sad faces. Additionally, antisaccade latencies were slower in BD patients than in healthy individuals, whereas prosaccade latencies were slower in symptomatic patients. Taken together, these findings revealed the following: (a) slow inhibitory control in BD patients, regardless of their episode (i.e., a trait), and (b) impaired inhibitory control restricted to symptomatic patients (i.e., a state).
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Affiliation(s)
- Ana C García-Blanco
- Servicio de Psiquiatría, Hospital Universitari i Politècnic "La Fe", Valencia, Spain; ERI-Lectura, Universitat de València, Valencia, Spain.
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