Theory of mind impairment and its clinical correlates in patients with schizophrenia, major depressive disorder and bipolar disorder

Yan-Yu Wang; Yi Wang; Ying-Min Zou; Ke Ni; Xue Tian; Hong-Wei Sun; Simon S Y Lui; Eric F C Cheung; John Suckling; Raymond C K Chan

doi:10.1016/j.schres.2017.11.003

Theory of mind impairment and its clinical correlates in patients with schizophrenia, major depressive disorder and bipolar disorder

Schizophr Res. 2018 Jul:197:349-356. doi: 10.1016/j.schres.2017.11.003. Epub 2017 Nov 7.

Authors

Yan-Yu Wang¹, Yi Wang², Ying-Min Zou³, Ke Ni⁴, Xue Tian⁵, Hong-Wei Sun⁵, Simon S Y Lui⁶, Eric F C Cheung⁷, John Suckling⁸, Raymond C K Chan⁹

Affiliations

¹ Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, Weifang Medical University, Shandong 261053, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China.
² Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China. Electronic address: wangyi@psych.ac.cn.
³ Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China.
⁴ Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China; Mental Health Center of Qiqihar city, Heilongjiang 161006, China.
⁵ Department of Psychology, Weifang Medical University, Shandong 261053, China.
⁶ Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Castle Peak Hospital, Hong Kong Special Administrative Region, China.
⁷ Castle Peak Hospital, Hong Kong Special Administrative Region, China.
⁸ Department of Psychiatry, University of Cambridge and Cambridgeshire and Peterborough NHS Trust, Cambridge CB2 0SZ, United Kingdom.
⁹ Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing 100048, China. Electronic address: rckchan@psych.ac.cn.

PMID: 29122405
DOI: 10.1016/j.schres.2017.11.003

Abstract

Background: Although Theory of Mind (ToM) impairment has been observed in patients with a wide range of mental disorders, the similarity and uniqueness of these deficits across diagnostic groups has not been thoroughly investigated.

Methods: We recruited 35 participants with schizophrenia (SCZ), 35 with bipolar disorder (BD), 35 with major depressive disorder (MDD), and 35 healthy controls in this study. All participants were matched in age, gender proportion and IQ estimates. The Yoni task, capturing both the cognitive and affective components of ToM at the first- and second-order level was administered. Repeated-measure ANOVA and MANOVA were conducted to compare the group differences in ToM performance. A network was then constructed with ToM performances, psychotic and depressive symptoms, and executive function as nodes exploring the clinical correlates of ToM.

Results: Overall, ToM impairments were observed in all patient groups compared with healthy controls, with patients with SCZ performing worse than those with BD. In second-order conditions, patients with SCZ and MDD showed deficits in both cognitive and affective conditions, while patients with BD performed significantly poorer in cognitive conditions. Network analysis showed that second-order affective ToM performance was associated with psychotic and depressive symptoms as well as executive dysfunction, while second-order affective ToM performance and negative symptoms showed relatively high centrality in the network.

Conclusions: Patients with SCZ, MDD and BD exhibited different types and severity of impairments in ToM sub-components. Impairment in higher-order affective ToM appears to be closely related to clinical symptoms in both psychotic and affective disorders.

Keywords: Bipolar disorder; Cross-diagnostic; Major depressive disorder; Network analysis; Schizophrenia; Theory of mind.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Affect / physiology*
Bipolar Disorder / complications
Bipolar Disorder / physiopathology*
Cognitive Dysfunction / etiology
Cognitive Dysfunction / physiopathology*
Depressive Disorder, Major / complications
Depressive Disorder, Major / physiopathology*
Executive Function / physiology*
Facial Expression*
Female
Humans
Male
Schizophrenia / complications
Schizophrenia / physiopathology*
Social Perception*
Theory of Mind / physiology*
Young Adult