Bodnar Anna, Rybakowski Janusz K
Department of Adult Psychiatry, Poznan University of Medical Sciences, ul.Szpitalna 27/33, 60-572, Poznan, Poland.
Int J Bipolar Disord. 2017 Dec 6;5(1):38. doi: 10.1186/s40345-017-0107-3.
A number of studies in bipolar patients have shown a deficit in mentalization (theory of mind), one of the main aspects of social cognition. The aim of current study was to assess both cognitive and affective mentalization in well-defined groups of depressed and manic bipolar patients, compared to healthy control subjects, using a battery of tests measuring mentalization processes. The second aim was to investigate a possible relationship between cognitive and affective mentalization and cognitive functions in bipolar patients during a depressive and manic episode.
The study involved 25 bipolar disorder type I patients (10 male, 15 female) during a depressive episode (mean 24 ± 2 points in the 17-item Hamilton Depression Rating Scale) and 25 patients (10 male, 15 female) during a manic episode (mean 27 ± 4 points in the Young Mania Rating Scale). The control group consisted of 25 healthy subjects (10 male, 15 female) without psychiatric disorders. To measure mentalization, a revised version of the Reading the Mind in the Eyes (R-MET), the Strange Stories (SS), the Faux Pas Recognition (FPR), and the Moving Shapes Paradigm (MSP) tests were used. Assessment of cognitive functioning was made using the Digit Span, Trail Making, and Wisconsin Card Sorting Tests.
In bipolar patients significant deficits in both cognitive and affective mentalization were demonstrated during both acute depressive and manic episodes. The impairment in FPR in manic patients was more severe than that in the depressive ones. On the other hand, in MSP, manic patients showed significantly increased intentionality for non-mentalization animations, compared with depressive patients and for "cause and effect" animations compared with control subjects. A significant relationship was found between the decrease in cognitive and affective mentalization and deficits of cognitive functions during both the depressive and manic episodes.
The results obtained confirm the deficits of mentalization in bipolar I patients, during both acute depressive and manic episodes. We found that in such patients mentalization deficits significantly correlated with cognitive dysfunctions more so during depressive episodes.
多项针对双相情感障碍患者的研究表明，其在心理化（心理理论）方面存在缺陷，心理化是社会认知的主要方面之一。本研究的目的是，与健康对照受试者相比，使用一系列测量心理化过程的测试，评估明确界定的抑郁和躁狂双相情感障碍患者组的认知和情感心理化。第二个目的是研究双相情感障碍患者在抑郁和躁狂发作期间，认知和情感心理化与认知功能之间可能存在的关系。
本研究纳入了25例处于抑郁发作期的Ⅰ型双相情感障碍患者（男性10例，女性15例）（17项汉密尔顿抑郁量表平均得分24±2分）和25例处于躁狂发作期的患者（男性10例，女性15例）（杨氏躁狂量表平均得分27±4分）。对照组由25名无精神疾病的健康受试者（男性10例，女性15例）组成。为测量心理化，使用了修订版的眼神读心测试（R-MET）、离奇故事测试（SS）、失礼识别测试（FPR）和动态形状范式测试（MSP）。使用数字广度测试、连线测试和威斯康星卡片分类测试评估认知功能。
在双相情感障碍患者中，急性抑郁和躁狂发作期间均表现出认知和情感心理化的显著缺陷。躁狂患者的FPR损害比抑郁患者更严重。另一方面，在MSP测试中，与抑郁患者相比，躁狂患者对非心理化动画的意向性显著增加，与对照组相比，对“因果关系”动画的意向性也显著增加。在抑郁和躁狂发作期间，认知和情感心理化的下降与认知功能缺陷之间均发现了显著关系。
所得结果证实了Ⅰ型双相情感障碍患者在急性抑郁和躁狂发作期间均存在心理化缺陷。我们发现，在这类患者中，心理化缺陷与认知功能障碍显著相关，在抑郁发作期间更为明显。
