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Theory of mind and social inference in children and adolescents with bipolar disorder

Published online by Cambridge University Press:  14 January 2008

L. S. Schenkel ,
M. Marlow-O'Connor ,
M. Moss ,
J. A. Sweeney  and
M. N. Pavuluri
L. S. Schenkel*
Affiliation:
Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
M. Marlow-O'Connor
Affiliation:
Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
M. Moss
Affiliation:
Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
J. A. Sweeney
Affiliation:
Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
M. N. Pavuluri
Affiliation:
Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA
*
*Address for correspondence: Dr L. S. Schenkel, Rochester Institute of Technology, 92 Lomb Memorial Drive, Rochester, NY, 14623, USA. (Email: [email protected])
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Summary

Background

Deficits in theory of mind (ToM), or the ability to infer what another person is thinking or feeling, have been reported in manic and euthymic adults with bipolar disorder. To date, there have been no investigations of ToM in pediatric bipolar disorder (PBD). The aim of the current study was to investigate this ability in PBD patients and healthy controls.

Method

PBD patients (n=26) and intellectually and demographically similar healthy comparison subjects (n=20) were administered two ToM tasks. In the Affective Story Task, subjects were read positive-, negative- and neutral-valenced stories, and were assessed on their ability to recognize that a misleading series of events could lead one character to develop a false belief about another character. On the Hinting Task, subjects were required to infer the real intentions behind subtle hints.

Results

The PBD group performed significantly more poorly than controls on the Hinting Task and the positive and negative conditions of the Affective Story Task. In the PBD group only, younger age, earlier illness onset and manic symptoms were associated with poorer ToM performance.

Conclusions

Consistent with past findings in adult bipolar disorder (BD), PBD youth performed more poorly than controls on ToM tasks. Data suggest that ToM ability may be more impaired in affectively charged contexts. Additionally, an earlier onset of illness among PBD youth may interfere with the development of social-cognitive skills. ToM disturbances may be a useful treatment target in PBD, with the aim of facilitating more accurate assessment of social cues and better interpersonal functioning.

Keywords

Pediatric bipolar disordersocial cognitionsocial inferencetheory of mind
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 6 , June 2008 , pp. 791 - 800
Copyright
Copyright © Cambridge University Press 2008

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References

Adolphs, R (2001). The neurobiology of social cognition. Current Opinion in Neurobiology 11, 231–239.CrossRefGoogle ScholarPubMed
Adolphs, R (2002). Neural systems for recognizing emotion. Current Opinion in Neurobiology 12, 169–177.CrossRefGoogle ScholarPubMed
Altshuler, L, Bookheimer, S, Proenza, MA, Townsend, J, Sabb, F, Firestine, A, Bartzokis, G, Mintz, J, Mazziotta, J, Cohen, MS (2005). Increased amygdala activation during mania: a functional magnetic resonance imaging study. American Journal of Psychiatry 156, 1986–1988.Google Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Blair, J (2003). Neurobiological basis of psychopathy. British Journal of Psychiatry 182, 5–7.CrossRefGoogle ScholarPubMed
Baron-Cohen, S (2000). Theory of mind and autism: a fifteen year review. In Understanding Other Minds, 2nd edn (ed. Baron-Cohen, S., Tager-Flushberg, H. and Cohen, D. J.), pp. 3–20. Oxford University Press: New York.Google Scholar
Baron-Cohen, S, Belmonte, MK (2005). Autism: a window onto the development of the social and the analytic brain. Annual Review of Neuroscience 28, 109–126.CrossRefGoogle ScholarPubMed
Berthoz, S, Blair, RJR (2002). Emotions: from neuropsychology to functional imaging. International Journal of Psychology 37, 193–203.CrossRefGoogle Scholar
Blumberg, HP, Stern, E, Ricketts, S, Martinez, D, de Asis, J, White, T, Epstein, J, Isenberg, N, McBride, PA, Kemperman, I, Emmerich, S, Dhawan, V, Eidelberg, D, Kocsis, JH, Silbersweig, DA (1999). Rostral and orbital prefrontal cortex dysfunction in the manic state of bipolar disorder. American Journal of Psychiatry 156, 1986–1988.CrossRefGoogle ScholarPubMed
Bora, E, Vahip, S, Gonul, AS, Akdeniz, F, Alkan, M, Ogut, M, Eryavuz, A (2005). Evidence for theory of mind deficits in euthymic patients with bipolar disorder. Acta Psychiatrica Scandinavica 112, 110–116.CrossRefGoogle ScholarPubMed
Carter, TD, Mundo, E, Parikh, SV, Kennedy, JL (2003). Early age at onset as a risk factor for poor outcome of bipolar disorder. Journal of Affective Disorders 37, 297–303.Google ScholarPubMed
Chang, K, Adleman, NE, Dienes, K, Simeonova, DI, Menon, V, Reiss, A (2004). Anomalous prefrontal-subcortical activation in familial pediatric bipolar disorder. Archives of General Psychiatry 61, 781–792.CrossRefGoogle ScholarPubMed
Craney, JL, Geller, B (2003). A prepubertal and early adolescent bipolar disorder-I phenotype: review of phenomenology and longitudinal course. Bipolar Disorders 5, 243–256.CrossRefGoogle ScholarPubMed
Corcoran, R (2000). Theory of mind in other clinical conditions: is a selective ‘theory of mind’ deficit exclusive to autism? In Understanding Other Minds, 2nd edn (ed. Baron-Cohen, S., Tager-Flushberg, H. and Cohen, D. J.), pp. 391–421. Oxford University Press: New York.Google Scholar
Corcoran, R, Frith, CD (1996). Conversational conduct and the symptoms of schizophrenia. Cognitive Neuropsychiatry 1, 305–318.Google Scholar
Corcoran, R, Mercer, G, Frith, CD (1995). Schizophrenia, symptomatology and social inference: investigating ‘theory of mind’ in people with schizophrenia. Schizophrenia Research 17, 5–13.CrossRefGoogle ScholarPubMed
Dickstein, DP, Nelson, EE, McClure, EB, Grimley, ME, Knopf, L, Brotman, MA, Rich, BA, Pine, DS, Leibenluft, E (2007). Cognitive flexibility in phenotypes of pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 46, 341–355.CrossRefGoogle ScholarPubMed
Dickstein, DP, Treland, JE, Snow, J, McClure, EB, Mehta, MS, Towbin, KE, Pine, DS, Leibenluft, E (2004). Neuropsychological performance in pediatric bipolar disorder. Biological Psychiatry 55, 32–39.CrossRefGoogle ScholarPubMed
Doyle, AE, Wilens, TE, Kwon, A, Seidman, LJ, Farone, SV, Fried, R, Swezey, A, Snyder, L, Beiderman, J (2005). Neuropsychological functioning in youth with bipolar disorder. Biological Psychiatry 58, 540–548.CrossRefGoogle ScholarPubMed
Dunn, J, Brown, J, Slomkowski, C, Tesla, C, Youngblade, L (1991). Young children's understanding of other people's feelings and beliefs: individual differences and their antecedents. Child Development 62, 1352–1366.CrossRefGoogle ScholarPubMed
Flavell, JH (1999). Cognitive development: children's knowledge about the mind. Annual Review of Psychology 50, 21–45.CrossRefGoogle ScholarPubMed
Flavell, JH, Flavell, ER, Green, FL (1999). Development of children's understanding of connections between thinking and feeling. Psychological Science 12, 430–432.CrossRefGoogle Scholar
Frith, CD, Corcoran, R (1996). Exploring ‘theory of mind’ in people with schizophrenia. Psychological Medicine 26, 521–530.CrossRefGoogle ScholarPubMed
Geller, B, Bolhofner, K, Craney, JL, Williams, M, DelBello, MP, Gundersen, K (2000). Psychosocial functioning in a prepubertal and early adolescent bipolar disorder phenotype. Journal of the American Academy of Child and Adolescent Psychiatry 39, 1543–1548.CrossRefGoogle Scholar
Geller, B, Craney, JL, Bolhofner, K, Nickelsburg, MJ, Williams, M, Zimerman, B (2002). Two-year prospective follow-up of children with a prepubertal and early adolescent bipolar disorder phenotype. American Journal of Psychiatry 159, 927–933.CrossRefGoogle ScholarPubMed
Geller, B, Tillman, R, Craney, JL, Bolhofner, K (2004). Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Archives of General Psychiatry 61, 459–467.CrossRefGoogle ScholarPubMed
Geller, B, Warner, K, Williams, M, Zimerman, B (1998). Prepubertal and young adolescent bipolarity versus ADHD: assessment and validity using the WASH-U-KSADS, CBCL, and TRF. Journal of Affective Disorders 51, 93–100.CrossRefGoogle Scholar
Greig, TC, Bryson, GJ, Bell, MD (2004). Theory of mind performance in schizophrenia: diagnostic, symptom, and neuropsychological correlates. Journal of Nervous and Mental Disease 192, 12–18.CrossRefGoogle ScholarPubMed
Hollingshead, AB (1975). Two-Factor Index of Social Position. Sociology Department, Yale University: New Haven, CT.Google Scholar
Hynes, CA, Baird, AA, Grafton, ST (2006). Differential role of the orbital frontal lobe in emotional versus cognitive perspective-taking. Neuropsychologia 44, 374–383.CrossRefGoogle ScholarPubMed
Inoue, Y, Tonookaa, Y, Yamadaa, K, Kanba, S (2004). Deficiency of theory of mind in patients with remitted mood disorder. Journal of Affective Disorders 82, 403–409.CrossRefGoogle ScholarPubMed
Kerr, N, Dunbar, RIM, Bentall, RP (2003). Theory of mind deficits in bipolar affective disorder. Journal of Affective Disorders 73, 253–259.CrossRefGoogle ScholarPubMed
Kronhaus, DM, Lawrence, NS, Williams, AM, Frangou, S, Brammer, MJ, Williams, SC, Andrew, CM, Phillips, MS (2006). Stroop performance in bipolar disorder: further evidence for abnormalities in the ventral prefrontal cortex. Bipolar Disorders 8, 28–39.CrossRefGoogle ScholarPubMed
Kruger, S, Alda, M, Young, LT, Goldapple, K, Parikhs, S, Mayberg, HS (2006). Risk and resilience markers in bipolar disorder: brain responses to emotional challenge in bipolar patients and their healthy siblings. American Journal of Psychiatry 163, 177–179.CrossRefGoogle ScholarPubMed
Leibenluft, E, Charney, DS, Towbin, KE, Bhangoo, RK, Pine, DS (2003). Defining clinical phenotypes of juvenile mania. American Journal of Psychiatry 160, 430–437.CrossRefGoogle ScholarPubMed
Lembke, A, Ketter, TA (2002). Impaired recognition of facial emotion in mania. American Journal of Psychiatry 159, 302–304.CrossRefGoogle ScholarPubMed
Lennox, BR, Jacob, R, Calder, AJ, Lupson, V, Bullmore, ET (2004). Behavioural and neurocognitive responses to sad facial affect are attenuated in patients with mania. Psychological Medicine 34, 795–802.CrossRefGoogle ScholarPubMed
McClure, EB, Pope, K, Hoberman, AJ, Pine, DS, Leibenluft, E (2003). Facial expression recognition in adolescents with mood and anxiety disorders. American Journal Psychiatry 160, 1172–1174.CrossRefGoogle ScholarPubMed
McClure, EB, Treland, JE, Snow, J, Dickstein, DP, Towbin, KE, Charney, DS, Pine, DS, Leibenluft, E (2005 b). Memory and learning in pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 44, 461–469.CrossRefGoogle ScholarPubMed
McClure, EB, Treland, JE, Snow, J, Schmajuk, M, Dickstein, DP, Towbin, KE, Charney, DS, Pine, DS, Leibenluft, E (2005 a). Deficits in social cognition and response flexibility in pediatric bipolar disorder. American Journal of Psychiatry 162, 1644–1651.CrossRefGoogle ScholarPubMed
McGuire, PK, Silbersweig, DA, Frith, CD (1996). Functional neuroanatomy of verbal self-monitoring. Brain 119, 907–917.CrossRefGoogle ScholarPubMed
Meyer, SE, Carlson, GA, Wiggs, EA, Martinez, PE, Ronsaville, D, Klimes-Dougan, B, Gold, W, Radke-Yarrow, M (2004). A prospective study of the association among impaired executive functioning, childhood attentional problems, and the development of bipolar disorder. Development and Psychopathology 16, 461–476.CrossRefGoogle ScholarPubMed
Mitchell, JP, Heatherton, TF, Macrae, CN (2002). Distinct neural systems subserve person and object knowledge. Proceedings of the National Academy of Sciences USA 99, 15238–15243.CrossRefGoogle ScholarPubMed
Olley, AL, Malhi, GS, Bachelor, J, Cahill, CM, Mitchell, PB, Berk, M (2005). Executive functioning and theory of mind in euthymic bipolar disorder. Bipolar Disorders 7, 43–52.CrossRefGoogle ScholarPubMed
Pavuluri, MN, Birmaher, B, Naylor, MW (2005). Pediatric bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry 44, 846–71.CrossRefGoogle ScholarPubMed
Pavuluri, MN, Henry, DB, Devineni, B, Carbray, JA, Birmaher, B (2006 b). Child mania rating scale: development, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry 45, 550–60.CrossRefGoogle ScholarPubMed
Pavuluri, MN, Herbener, ES, Sweeney, JA (2004). Affect regulation: a systems neuroscience perspective. Neuropsychiatric Disease and Treatment 1, 9–15.CrossRefGoogle Scholar
Pavuluri, MN, O'Connor, MM, Harral, E, Sweeney, JA (2007). Affective neural circuitry during facial emotion processing in pediatric bipolar disorder. Biological Psychiatry 62, 158–167.CrossRefGoogle ScholarPubMed
Pavuluri, MN, Schenkel, LS, Aryal, S, Harral, EM, Hill, SK, Herbener, ES, Sweeney, JA (2006 a). Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients. American Journal of Psychiatry 163, 286–293.CrossRefGoogle ScholarPubMed
Phan, KL, Taylor, SF, Welsh, RC, Ho, SH, Britton, JC, Liberzon, I (2004). Neural correlates of individual ratings of emotional salience: a trial-related fMRI study. Neuroimage 21, 768–780.CrossRefGoogle ScholarPubMed
Poznanski, EO, Freeman, LN, Mokros, HB (1985). Children's Depressive Rating Scale–Revised. Psychopharmacology Bulletin 21, 979–989.Google Scholar
Rich, BA, Schmajuk, M, Perez-Edgar, KE, Pine, DS, Fox, NA, Leibenluft, E (2005). The impact of reward, punishment, and frustration on attention in pediatric bipolar disorder. Biological Psychiatry 58, 532–539.CrossRefGoogle ScholarPubMed
Rich, BA, Vinton, DT, Roberson-Nay, R, Hommer, RE, Berghorst, LH, McClure, EB, Fromm, SJ, Pine, DS, Leibenluft, E (2006). Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proceedings of the National Academy of Sciences USA 103, 8900–8905.CrossRefGoogle ScholarPubMed
Rolls, ET (2004). The functions of the orbitofrontal cortex. Brain and Cognition 55, 11–29.CrossRefGoogle ScholarPubMed
Schenkel, LS, Pavuluri, MN, Herbener, ES, Harral, EM, Sweeney, JA (2007). Facial emotion processing in acutely ill and euthymic patients with pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1070–1079.CrossRefGoogle ScholarPubMed
Schenkel, LS, Spaulding, WD, Silverstein, SM (2005). Poor premorbid social functioning and theory mind deficit in schizophrenia: evidence of reduced context processing? Journal of Psychiatric Research 39, 499–508.CrossRefGoogle ScholarPubMed
Schenkel, LS, West, AE, Pavuluri, MN (in press). Parent–child interactions in pediatric bipolar disorder. Journal of Clinical Psychology.Google Scholar
Shamay-Tsoory, SG, Shur, S, Harari, H, Levkovitz, Y (2007). Neurocognitive basis of impaired empathy in schizophrenia. Neuropsychology 21, 431–438.CrossRefGoogle ScholarPubMed
Tager-Flushberg, H, Sullivan, KA (2000). A componential view of theory of mind: evidence from Williams syndrome. Cognition 76, 59–89.CrossRefGoogle Scholar
Uhlhaas, PJ, Phillips, WA, Schenkel, LS, Silverstein, SM (2006). Theory of mind and perceptual context-processing in schizophrenia. Cognitive Neuropsychiatry 11, 416–436.CrossRefGoogle ScholarPubMed
Völlm, BA, Taylor, ANW, Richardson, P, Corcoran, R, Stirling, J, McKie, S, Deakin, JFW, Elliott, R (2006). Neuronal correlates of theory of mind and empathy: a functional magnetic resonance imaging study in a nonverbal task. Neuroimage 29, 90–98.CrossRefGoogle Scholar
Watson, AC, Nixon, CL, Capage, L (1999). Social interaction skills and theory of mind in young children. Developmental Psychopathology 35, 386–391.Google ScholarPubMed
Wechsler, D (1999). Wechsler Abbreviated Scale of Intelligence (WASI). Psychological Corporation, Harcourt Brace & Company: San Antonio, TX.Google Scholar
Wellman, HL, Lagattuta, KH (2000). Developing understandings of mind. In Understanding Other Minds, 2nd edn (ed. Baron-Cohen, S., Tager-Flushberg, H. and Cohen, D. J.), pp. 21–49. Oxford University Press: New York.Google Scholar
Yurgelun-Todd, D, Gruber, S, Kanayama, G, Killgore, D, Baird, A, Young, A (2000). fMRI during affect discrimination in bipolar affective disorder. Bipolar Disorders 2, 237–248.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegeler, VE, Mayer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed