Department of Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, International Excellence Campus, Bellaterra, Cerdanyola del Vallès, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
Department of Mental Health, Hospital Universitari Parc Taulí, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Catalonia, Spain.
Compr Psychiatry. 2021 Aug;109:152258. doi: 10.1016/j.comppsych.2021.152258. Epub 2021 Jul 5.
Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences.
120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions.
Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief.
The cross-sectional design does not allow for causal inferences.
BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.
在双相情感障碍（BD）和精神分裂症/分裂情感障碍（SCH）中，社会认知受损已得到证实。在健康个体中，女性在某些子领域的表现优于男性。然而，在 BD 和 SCH 中，结果却各不相同。我们的目的是比较 BD、SCH 和健康受试者的情绪识别、情感心理理论（ToM）以及一阶和二阶认知 ToM，并探讨性别差异。
招募了 120 名患者（BD=60，SCH=60）和 40 名健康受试者。情绪识别通过面部表情图片测试（POFA）进行评估，情感心理理论通过“读心术测试”（RMET）进行评估，认知心理理论通过几个错误信念故事进行评估。使用参数（POFA、RMET）和非参数（错误信念故事）测试分析组间和性别差异。使用一系列线性/逻辑回归检查年龄、智商（IQ）和临床变量对患者表现的影响。
两组患者在 POFA、RMET 和二阶错误信念（p<0.001）上的表现均不如健康受试者，但两组之间无差异。相反，他们的缺陷与年龄较大和/或智商较低有关（p<0.01）。亚临床抑郁与一阶错误信念失败的风险增加 6 倍相关（p<0.001）。仅在健康受试者中发现性别差异，女性在 POFA 和 RMET 上的表现优于男性（p≤0.012），但在一阶/二阶错误信念上则不然。
横断面设计不允许进行因果推断。
BD 和 SCH 患者在情绪识别、情感心理理论和二阶认知心理理论方面存在缺陷，但他们的表现彼此相当，这表明他们之间的差异可能比之前认为的更为微妙。一阶认知心理理论仍然完整，但亚临床抑郁改变了他们的正常功能。我们的研究结果表明，健康女性在社会认知的情感和情感方面的优势在 BD 和 SCH 中不会得到维持。
