Unit:
Τομέας Κοινωνικής Ιατρικής - Ψυχιατρικής και ΝευρολογίαςLibrary of the School of Health Sciences
Author:
Nikoleta Ioannidi
Dissertation committee:
Δημήτρης Πλουμπίδης, Ομότιμος Καθηγητής Ψυχιατρικής, Ιατρική Σχολή, ΕΚΠΑ
Χαράλαμπος Παπαγεωργίου, Καθηγητής Ψυχιατρικής, Ιατρική Σχολή, ΕΚΠΑ
Δημήτρης Δικαίος, Καθηγητής Ψυχιατρικής, Ιατρική Σχολή, ΕΚΠΑ
Θωμάς Παπαρρηγόπουλος, Καθηγητής Ψυχιατρικής, Ιατρική Σχολή, ΕΚΠΑ
Ελευθερία Τσάλτα, Καθηγήτρια Πειραματικής Ψυχολογίας, Ιατρική Σχολή, ΕΚΠΑ
Κωνσταντίνος Ψάρρος, Αναπληρωτής Καθηγητής Ψυχιατρικής, Ιατρική Σχολή, ΕΚΠΑ
Μαρία Τυπάλδου, Επίκουρη Καθηγήτρια Κλινικής Ψυχολογίας, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Κλινική και νευροψυχολογική διερεύνηση της λειτουργίας της Θεωρίας του Νου κατά την πορεία της διπολικής συναισθηματικής διαταραχής
Translated title:
Clinical and neuropsychological investigation of Theory of Mind deficits in the course of bipolar affective disorder
Summary:
Previous studies in bipolar disorder (BD) suggest patients‟ deficient performance in Theory of Mind (ToM) tasks, both during manic or depressive episodes and in remission. However, most of the extant studies were cross-sectional and did not control for potential confounders such as residual symptoms, history or presence of psychotic symptoms or co-existent deficits in other cognitive functions. The present study is the first prospective study that assessed the effect of remission on ToM in patients with BD controlling for clinical variables and other cognitive deficits.
ToM was assessed in 71 patients with BD type I during an episode of the illness (32 BD-DEP and 39 BD-ΜA) and in remission as well as in 48 healthy controls. The two groups were matched for gender, age and education level. Three tests with different levels of complexity were used to assess ToM: First Order False Belief Task, Hinting Task and Faux Pas Recognition Test. Concomitantly, a comprehensive battery of neuropsychological tests was administered to all participants assessing general intelligence, working memory, attention, speed processing, verbal learning and memory and executive functions. The clinical scales Hamilton Depression Rating Scale, Young Mania Rating Scale and Brief Psychiatric Rating Scale were also administered to the patients. Differences on neuropsychological tests between patients – in acute phase and in remission – and the control group were tested using one-way ANOVA with post hoc Bonferroni corrections. The effect of other clinical and cognitive deficits on patients‟ ToM dysfunction was controlled for using general linear models.
The patients showed significantly lower performance in all ToM tests, as well as at the two aspects of ToM (cognitive and affective), during the acute phases as compared to the control group. Moreover, these impairments persisted during remission in all ToM tests, except patients‟ poor performance on the First Order False Belief Task. However the type and the effect size of ToM dysfunction was different between acute phases and remission. Additionally, the two episode types differed in the correlation between clinical variables and ToM dysfunction. The severity of clinical symptoms during acute phase was correlated with ToM dysfunction only in manic and not in depression episodes. Moreover, there was a mild effect of clinical symptoms on patients‟ performance in ToM tests, mainly in remission. The type of episode (depression or mania) was not correlated with ToM dysfunction. The history of psychotic symptoms was not correlated with any ToM performance neither in acute phase nor in remission. Regarding the effect of cognitive functions, none of them was strongly correlated with patients‟ ToM performance neither in acute phase nor in remission. They were some significant correlations of moderate effect size between all ToM tests and cognitive functions (general intelligence, visuospatial ability, working memory, attention, speed processing, verbal learning and memory and executive functions). As none of the patients‟ cognitive performances was strongly correlated with any ToM performances in both acute phase and remission, it is not likely ToM impairment in BD to be exclusively due to cognitive dysfunction, but it is certainly affected by it. However, ToM impairment in remission is partially affected by deficits in verbal memory and learning, attention, working memory, processing speed and cognitive functions.
The findings of current study are in favor of the existence of a specific and stable ToM deficit (trait) as it is not fully justified by the effect of underlying cognitive deficits that were controlled for. Nonetheless patients‟ performance in ToM tests is sometimes affected in a significant level – depended on the complexity of the tasks – by deficits in cognitive functions.
Main subject category:
Health Sciences
Other subject categories:
Psychiatry and psychology
Keywords:
Τheory of Mind, Social cognition, Cognitive dysfunction, Bipolar disorder, Remission
