Facial Emotion Recognition Deficient in Bipolar Disorder

February 1, 2016 · Posted in Peer-Reviewed Published Data · Comment 

facial expressionsemotions

In the past decade, several studies have indicated that people with bipolar disorder have less ability to recognize the emotions expressed on people’s faces than do healthy controls. A 2013 meta-analysis by Cecilia Samamé and colleagues concluded that facial emotion recognition was deficient in people with bipolar disorder regardless of their current state. A 2011 quantitative review article by Christian G. Kohler and colleagues revealed that this difficulty distinguishing emotions is general, rather than specific to any one emotion.

A 2015 study by Esther Vierck and colleagues in the journal Psychiatry Research showed that both euthymic patients with bipolar disorder and their first-degree relatives without bipolar disorder performed worse on tests of emotion recognition than did normal controls. The findings in healthy relatives suggest that the deficit may be a familial risk factor for the development of bipolar disorder.

These deficits in facial emotion recognition have also been seen in 4 out of 5 studies of children with early-onset bipolar disorder, including those who are euthymic. 2008 studies by Melissa A. Brotman and colleagues showed that even children just at high risk for bipolar disorder due to a family history of the disorder had deficient emotion recognition.

This literature indicates that deficiencies in facial emotion recognition consistently accompany bipolar disorder and may also be a sign that a child or teenager is at risk for bipolar disorder. Since these deficits can create social and interpersonal difficulties, it may be useful to teach better emotion recognition skills to people with bipolar disorder or those at high risk for the illness.

Reduced Cognitive Function and Other Abnormalities in Pediatric Bipolar Disorder

January 6, 2016 · Posted in Course of Illness, Risk Factors · Comment 

pediatric bipolar disorderAt the 2015 meeting of the International Society for Bipolar Disorders, Ben Goldstein described a study of cognitive dysfunction in pediatric bipolar disorder. Children with bipolar disorder were three years behind in executive functioning (which covers abilities such as planning and problem-solving) and verbal memory.

There were other abnormalities. Youth with bipolar disorder had smaller amygdalas, and those with larger amygdalas recovered better. Perception of facial emotion was another area of weakness for children (and adults) with bipolar disorder. Studies show increased activity of the amygdala during facial emotion recognition tasks.

Goldstein reported that nine studies show that youth with bipolar disorder have reduced white matter integrity. This has also been observed in their relatives without bipolar disorder, suggesting that it is a sign of vulnerability to bipolar illness. This could identify children who could benefit from preemptive treatment because they are at high risk for developing bipolar disorder due to a family history of the illness.

There are some indications of increased inflammation in pediatric bipolar disorder. CRP, a protein that is a marker of inflammation, is elevated to a level equivalent to those in kids with juvenile rheumatoid arthritis before treatment (about 3 mg/L). CRP levels may be able to predict onset of depression or mania in those with minor symptoms, and is also associated with depression duration and severity. Goldstein reported that TNF-alpha, another inflammatory marker, may be elevated in children with psychosis.

Goldstein noted a study by Ghanshyam Pandey that showed that improvement in pediatric bipolar disorder was related to increases in BDNF, a protein that protects neurons. Cognitive flexibility interacted with CRP and BDNF—those with low BDNF had more cognitive impairment as their CRP increased than did those with high BDNF.

Oxytocin Improves Social Cognition In Schizophrenia

May 20, 2013 · Posted in Potential Treatments · Comment 

facial expressionsResearcher Josh Woolley and colleagues at the University of California, San Francisco have found that intranasal oxytocin (at doses of 40 IU) improved social cognition in patients with schizophrenia when compared with placebo. Oxytocin is a hormone that facilitates social bonding. Social cognition refers to the way we understand what emotions other people are communicating through facial expression, voice, etc.

Interestingly, less complicated aspects of social cognition like recognizing affect and distinguishing between sincerity and sarcasm were not affected by the oxytocin treatment. However, more complex types of social inference (such as decoding whether an actor intended sarcasm versus telling a white lie) were substantially improved. These tasks evaluate “theory of mind”—the ability to attribute mental states to oneself and others, and to recognize that another person’s mental state may be different from one’s own. These abilities are sometimes lacking in those with schizophrenia and other disorders, such as autism. Given that these abilities have been related to real world social functioning, Woolley and colleagues suggest that oxytocin could, for example, help these individuals to make more friends.

Oxytocin, the Social Affiliation Drug, Has Interesting Effects in Autism and Now Schizophrenia

January 20, 2011 · Posted in Potential Treatments · Comment 

facesIn 2007, investigator E. Hollander from Mt. Sinai published data indicating that intranasal oxytocin was associated with increases in target behaviors in patients with autism.

Now a study by David Feifel of the University of California, San Diego presented at the 65th Annual Scientific Convention of the Society of Biological Psychiatry showed that patients with schizophrenia showed improvement in symptomatology and increases in the recognition of positive facial affect after oxytocin was added to their antipsychotics regimen. Morris Goldman of Northwestern University reported that patients with schizophrenia, who often make mistakes assessing fear on facial emotion recognition tests, described fewer faces as fearful after receiving intranasal oxytocin.

Editors note: These new findings are built on the pioneering preclinical work of Tom Insel.  He found marked differences in oxytocin and its receptors in the brains of mountain voles (who are largely asocial) compared to prairie voles (who are highly social and form lifelong bonds with their mates).  Although these oxytocin findings have not yet produced a treatment for any psychiatric syndrome, they illustrate the potential of general scientific findings to inform new approaches to human illnesses.

Consistent Deficits In Facial Emotion Recognition Found in Non-Ill Children of Parents with Bipolar Disorder

November 2, 2010 · Posted in Diagnosis, Risk Factors · Comment 

facial expressions

Children with bipolar parents may have difficulty identifying the emotions they see on another person’s face.  Aditya Sharma of Newcastle University presented a poster at the Pediatric Bipolar Conference in Cambridge, Massachusetts in March, which indicated that children without bipolar disorder but at risk because a parent has the illness showed deficits in facial emotion recognition. Similar results were reported by Brotman et al. in the American Journal of Psychiatry in 2008. Since children of bipolar parents are at increased risk of developing the disease, this deficit in labeling facial emotion may be a marker of early bipolar disorder or a risk factor for its onset.

Editor’s Note: These types of deficits in facial emotion recognition have been consistently observed in adults and children diagnosed with bipolar disorder, so assessing whether children can successfully identify others’ facial emotions could become part of the assessment of risk for bipolar disorder. This deficit could also be targeted for psychosocial intervention and rehabilitative training to enhance emotion recognition skills. Such an approach could improve interpersonal communication and lessen hypersensitive responses to perceived emotional threats and negative emotional experiences.