Perceptions of social dominance through facial emotion expressions in euthymic patients with bipolar I disorder.

The ability to accurately perceive dominance in the social hierarchy is important for successful social interactions. However, little is known about dominance perception of emotional stimuli in bipolar disorder. The aim of this study was to investigate the perception of social dominance in patients with bipolar I disorder in response to six facial emotional expressions. Participants included 35 euthymic patients and 45 healthy controls. Bipolar patients showed a lower perception of social dominance based on anger, disgust, fear, and neutral facial emotional expressions compared to healthy controls. A negative correlation was observed between motivation to pursue goals or residual manic symptoms and perceived dominance of negative facial emotions such as anger, disgust, and fear in bipolar patients. These results suggest that bipolar patients have an altered perception of social dominance that might result in poor interpersonal functioning. Training of appropriate dominance perception using various emotional stimuli may be helpful in improving social relationships for individuals with bipolar disorder.

Manic patients exhibit more utilitarian moral judgments in comparison with euthymic bipolar and healthy persons.

Both emotional and cognitive processes are involved in moral judgments. Ventromedial prefrontal lesions are related to impaired prosocial emotions and emotional dysregulation, and patients with these lesions exhibit increased utilitarian judgments of emotionally salient personal moral dilemmas. Bipolar patients experiencing manic episode also have impaired emotional regulation and behavioral control. We investigated the characteristics of moral judgment in manic and euthymic patients with bipolar disorder using the 50 hypothetical moral dilemma task (17 non-moral, 20 personal, and 13 impersonal). Our study included 27 manic bipolar patients, 26 euthymic bipolar patients, and 42 healthy controls. Subjects were instructed to determine whether or not each dilemma was morally acceptable, and their reaction times were recorded. Manic patients showed significantly greater utilitarian judgment than euthymic patients and normal controls for personal moral dilemmas. However, there were no significant between-group differences for the non-moral and impersonal moral dilemmas. Our results suggest that increased utilitarian judgments of personal moral dilemmas may be a state-related finding observed only in manic patients. This difference in moral judgment assessments may reflect the decision-making characteristics and underlying neurobiological mechanisms of bipolar disorder, especially during the manic state.

Autobiographical memory and its association with neuropsychological function in bipolar disorder.

OBJECTIVE: The aim of this study was to investigate the overgeneralization of autobiographical memory (AM) in bipolar disorder (BD) and assess its association with multiple cognitive domains. METHOD: Twenty-eight clinically stable bipolar I patients and an equal number of age- and gender-matched healthy controls (HC) were included. All participants were examined using the autobiographical memory test (AMT) and the neuropsychological battery including the general intelligence, attention, verbal memory, verbal fluency, visual memory, and executive functions domain. Demographic, clinical, and test variables were compared between BD and HC groups. Correlation analyses of AMT scores with cognitive functions were performed within each group, controlling for demographic and clinical variables. RESULTS: Total and negative scores of AMT were significantly lower in BD patients compared to HC individuals. AMT scores were significantly correlated with WAIS similarities, WCST perseverative errors, and WCST categories completed in BD, whereas AMT scores were correlated with verbal memory and verbal fluency in HC. CONCLUSION: Our findings suggest that overgeneral AM is a characteristic of BD and is related to executive function. Future studies should investigate the benefit of additional treatment focusing on overgeneral AM in BD.

Assessment of implicit self-esteem in bipolar manic and euthymic patients using the implicit association test.

OBJECTIVE: Although self-esteem is thought to be an important psychological factor in bipolar disorder, little is known about implicit and explicit self-esteem in manic patients. In this study, we investigated differences in implicit and explicit self-esteem among bipolar manic patients, bipolar euthymic patients, and healthy controls using the Implicit Association Test (IAT). METHODS: Participants included 19 manic patients, 27 euthymic patients, and 27 healthy controls. Participants completed a self-esteem scale to evaluate explicit self-esteem and performed the self-esteem IAT to evaluate implicit self-esteem. RESULTS: There were no differences among groups in explicit self-esteem. However, there were significant differences among groups in implicit self-esteem. Manic patients had higher IAT scores than euthymic patients and a trend toward higher IAT scores than healthy controls. CONCLUSIONS: Our findings suggest that, on the latent level, a manic state is not simply the opposite of a depressed state. Furthermore, there may be a discontinuity of implicit self-esteem between manic and euthymic states. These unexpected results may be due to characteristics of the study participants or the methods used to assess implicit self-esteem. Nevertheless, they provide greater insights on the psychological status of manic patients.

Emotional priming with facial exposures in euthymic patients with bipolar disorder.

People with bipolar disorder have abnormal emotional processing. We investigated the automatic and controlled emotional processing via a priming paradigm with subliminal and supraliminal facial exposure. We compared 20 euthymic bipolar patients and 20 healthy subjects on their performance in subliminal and supraliminal tasks. Priming tasks consisted of three different primes according to facial emotions (happy, sad, and neutral) followed by a neutral face as a target stimulus. The prime stimuli were presented subliminally (17 msec) or supraliminally (1000 msec). In subliminal tasks, both patients and controls judged the neutral target face as significantly more unpleasant (negative judgment shift) when presented with negative emotion primes compared with positive primes. In supraliminal tasks, bipolar subjects showed significant negative judgment shift, whereas healthy subjects did not. There was a significant group × emotion interaction for the judgment rate in supraliminal tasks. Our finding of persistent affective priming even at conscious awareness may suggest that bipolar patients have impaired cognitive control on emotional processing rather than automatically spreading activation of emotion.

Altered behavioral and electrophysiological responses to social fairness in manic and euthymic patients with bipolar disorder.

BACKGROUND: Individuals with bipolar disorder show mood instability, including heightened anger and impulsivity. The Ultimatum Game (UG) is a tool used to evaluate emotional and social decision-making strategies. We investigated behavioral and electrophysiological responses to subjectively fair or unfair offers in the UG in patients with bipolar I disorder. METHODS: Twenty-four manic patients, 20 euthymic patients, and 30 healthy controls participated in this study. We analyzed their behaviors and collected electroencephalography data with which to analyze feedback-related negativity (FRN) as they played in the UG as responders. RESULTS: Manic patients exhibited significantly higher rejection rates for unfair offers than euthymic patients and healthy controls. Healthy individuals exhibited a greater (i.e., more negative) FRN amplitude in response to unfair offers than to fair offers, whereas euthymic patients exhibited a greater FRN amplitude in response to fair offers compared with unfair offers. Manic patients exhibited no difference in FRN amplitudes between fair and unfair offers. CONCLUSIONS: The current data suggest that different behavioral responses and FRN amplitude patterns can be associated with characteristic manifestations of mood instability in manic bipolar patients. In addition, electrophysiological alterations in response to unfair offers may be a trait abnormality independent of mood state.

Perception bias of disgust in ambiguous facial expressions in obsessive-compulsive disorder.

Impaired recognition of facial expressions of disgust has been suggested for patients with obsessive-compulsive disorder (OCD). This study aimed to compare the perception of negative emotions by OCD patients and controls using both non-ambiguous and ambiguous facial expressions. Forty-one OCD patients and thirty-seven controls performed the computerised emotion perception task. There were no differences between OCD patients and controls in the frequency of correct identification of non-ambiguous facial expressions. However, OCD patients were more likely to perceive disgust and less likely to perceive anger in response to ambiguous facial expressions when controlling for covariates. In OCD patients, a higher cleaning dimension was associated with a lower perception of anger and a higher perception of disgust when presented with ambiguous facial expressions. The domains of core disgust and contamination-based disgust domains of disgust sensitivity were positively correlated with the perception of ambiguous facial expressions as disgust, as well as cleaning symptom dimension scores. Our findings suggest that OCD patients, particularly those with higher washing/contamination symptoms, are more likely to perceive disgust in ambiguous facial expressions.

Behavioral and Electrophysiological Alterations for Reinforcement Learning in Manic and Euthymic Patients with Bipolar Disorder.

AIMS: Bipolar disorder is characterized by behavioral changes such as risk-taking and increasing goal-directed activities, which may result from altered reward processing. Patients with bipolar disorder show impaired reward learning in situations that require the integration of reinforced feedback over time. In this study, we examined the behavioral and electrophysiological characteristics of reward learning in manic and euthymic patients with bipolar disorder using a probabilistic reward task. METHODS: Twenty-four manic and 20 euthymic patients with bipolar I disorder and 24 healthy control subjects performed the probabilistic reward task. We assessed response bias (RB) as a preference for the stimulus paired with the more frequent reward and feedback-related negativity (FRN) to correct identification of the rich stimulus. RESULTS: Both manic and euthymic patients showed significantly lower RB scores in the early learning stage (block 1) in comparison with the late learning stage (block 2 or block 3) of the task, as well as significantly lower RB scores in the early stage compared to healthy subjects. Relatively more negative FRN amplitude is elicited by no presentation of an expected reward, compared to that elicited by presentation of expected feedback. The FRN became significantly more negative from the early (block 1) to the later stages (blocks 2 and 3) in both manic and euthymic patients, but not in healthy subjects. Changes in RB scores and FRN amplitudes between blocks 2 and 3 and block 1 correlated positively in healthy controls, but correlated negatively in manic and euthymic patients. The severity of manic symptoms correlated positively with reward learning scores and negatively with the FRN. CONCLUSIONS: These findings suggest that patients with bipolar disorder during euthymic or manic states have behavioral and electrophysiological alterations in reward learning compared to healthy subjects. This dysfunctional reward processing may be related to the abnormal decision-making or altered goal-directed activities frequently seen in patients with bipolar disorder.

P600 alteration of syntactic language processing in patients with bipolar mania: Comparison to schizophrenic patients and healthy subjects.

BACKGROUND: Disturbances in thought, speech, and linguistic processing are frequently observed in bipolar manic patients, but the underlying neurophysiological mechanisms are not well understood. P600 is a distinct, positive event-related potential component elicited by syntactic violations. Using the P600 ERP, we examined neural processing of syntactic language comprehension in patients with bipolar mania compared to patients with schizophrenia and healthy people. METHOD: P600s were recorded from 21 manic patients with bipolar disorder, 26 patients with schizophrenia, and 29 healthy subjects during the presentation of 120 auditory sentences with syntactic violations or non-violations. Subjects were asked to judge whether each sentence was correct or incorrect. RESULTS: Patients with mania and schizophrenia had significantly smaller P600 amplitudes associated with syntactic violations compared with healthy subjects. There was no difference in P600 amplitude between patient groups. For behavioral performance, patients with schizophrenia had significantly less accurate rates and longer reaction times compared with healthy subjects, whereas manic patients exhibited no significant differences in accuracy and only showed increased reaction times in comparison with healthy subjects. LIMITATIONS: Psychotropic drug usage and small sample size. CONCLUSION: Patients with bipolar mania have reduced P600 amplitude, comparable to patients with schizophrenia. Our findings may represent the first neurophysiological evidence of abnormal syntactic linguistic processing in bipolar mania.

Further evidence of a dissociation between decision-making under ambiguity and decision-making under risk in obsessive-compulsive disorder.

BACKGROUND: Deficits in decision-making have been suggested as a key concept in understanding the symptoms of obsessive-compulsive disorder (OCD). However, evidence in the extant literature remains inconclusive on whether patients with OCD show inferior performance on laboratory decision-making tasks. The aims of the present study were therefore to (1) assess decision-making under ambiguity and under risk in patients with OCD and (2) study the influence of neuropsychological and clinical variables on decision-making in OCD. METHODS: The sample consisted of 65 patients with OCD and 58 controls. The Iowa gambling task (IGT) and the game of dice task (GDT) were used to examine decision-making under ambiguity and decision-making under risk, respectively. In addition, reversal learning and executive function were assessed in terms of their relationship with decision-making tasks. RESULTS: Patients with OCD showed impairment in the IGT, but not in the GDT. Reversal learning was neither impaired nor correlated with IGT performance. Among the clinical variables, illness severity and depression were associated with IGT scores. Executive function was impaired, but no significant relationship was found between executive function and GDT performance in OCD patients. LIMITATIONS: Almost all OCD patients were on medication when they performed decision-making tasks. CONCLUSIONS: Patients with OCD are impaired in decision-making under ambiguity, but not under risk. These findings demonstrate that decision-making processes are dissociated in OCD.

Internalized stigma and its psychosocial correlates in Korean patients with serious mental illness.

We aimed to examine internalized stigma of patients with mental illness in Korea and identify the contributing factors to internalized stigma among socio-demographic, clinical, and psychosocial variables using a cross-sectional study design. A total of 160 patients were recruited from a university mental hospital. We collected socio-demographic data, clinical variables and administered self-report scales to measure internalized stigma and levels of self-esteem, hopelessness, social support, and social conflict. Internalized stigma was identified in 8.1% of patients in our sample. High internalized stigma was independently predicted by low self-esteem, high hopelessness, and high social conflict among the psychosocial variables. Our finding suggests that simple psychoeducation only for insight gaining cannot improve internalized stigma. To manage internalized stigma in mentally ill patients, it is needed to promote hope and self-esteem. We also suggest that a relevant psychosocial intervention, such as developing coping skills for social conflict with family, can help patients overcome their internalized stigma.

Effects of Color Temperature and Brightness on Electroencephalogram Alpha Activity in a Polychromatic Light-emitting Diode.

OBJECTIVE: It has been reported that working and learning efficiency might be increased through artificially controlling the color temperature and brightness of light. However, the neurological bases of these outcomes are not well established. Our study was designed to observe whether electroencephalogram (EEG) alpha frequency, as a candidate biological marker, demonstrates significant changes in response to alterations of specific light parameters. METHODS: Thirty-two healthy subjects performed cognitive tasks under four different polychromatic light conditions: a combination of two different levels of color temperature (2766K vs. 5918K) and brightness (300 lux vs. 600 lux). Spectrum analyses were performed on alpha frequency. RESULTS: Subjects reported that they felt more pleasant in bright conditions and more relaxed in warm color temperature conditions. Our findings indicate that alpha power increases in warm, low-light and cool, high-light conditions, and there is a significant interaction between color temperature and brightness. CONCLUSION: EEGs might serve as a useful biological marker for further research related to the effects of polychromatic light on cognitive function.

Differential alteration of automatic semantic processing in treated patients affected by bipolar mania and schizophrenia: an N400 study.

BACKGROUND: Various formal thought disorders are presented as symptoms by manic patients including pressure of speech, flight of ideas, and more complex speech with strong emotional components. N400 is the event-related potential, in which amplitude is suggested to be a general index of efforts to retrieve stored semantic context, which depends on the stored representation itself and the retrieval cue stimuli. The present study examines N400 components induced by a word-matching task in manic patients, and compare these responses to those induced by the task in schizophrenia and healthy controls. METHODS: Twenty manic patients, twenty schizophrenic patients, and twenty healthy controls performed the word-matching task, in which they were presented with 120 (60 congruent and 60 incongruent) word pairs, they were instructed to discriminate whether each word pair was congruent or incongruent. During the task, we recorded the electroencephalogram. RESULTS: Reaction time analysis revealed a main effect for priming, in which reaction times were longer in response to incongruent words than to congruent words in all three participant groups (F=43.1, p<0.001) with no group effects (F=2.3, p=0.11). N400 analysis showed the main effect for priming (F=30.2, p<0.001), for group (F=5.0, p=0.01), and the interaction of priming×group (F=4.6, p=0.02). Post-hoc analysis of this interaction revealed larger N400 amplitudes to congruent words in manic patients (F=4.0, p=0.02) and smaller N400 to incongruent words in schizophrenic patients than in other groups (F=6.1, p=0.004). No correlations were found between N400 and symptom severity within patient groups. CONCLUSIONS: These findings suggest that priming effects of contextually related word pairs are decreased in patients with bipolar mania, whereas priming N400 responses of contextually unrelated word pairs are increased in schizophrenia. This may be the neurophysiological evidence of abnormal automatic semantic processing in patients with bipolar mania, and it also reflects a qualitative difference in thought and speech disorders between bipolar manic and schizophrenia.

Influence of BDNF and COMT polymorphisms on emotional decision making.

Decision making is an important brain function. Although little is known about the genetic basis of decision making, it has been suggested that it is mediated by the modulation of neurotransmitter systems. We investigated how the BDNF Val66Met and COMT Val158Met polymorphisms affect emotional decision making using the Iowa Gambling Task (IGT). One hundred sixty-eight healthy Korean college students (93 males, 75 females) with a complete dataset were included in the data analysis. The IGT and genotyping for the polymorphisms of BDNF Val66Met and COMT Val158Met were performed. Both Met/Met and Val/Met of the BDNF Val66Met polymorphism were significantly associated with a lower mean score of blocks 3-5 of the IGT and with less improvement from block 1 to block 3-5 than the Val/Val. However, the BDNF was not significantly associated with the score of block 1, and the COMT Val158Met polymorphism produced no significant effect on IGT performance. No interaction effect was observed between the BDNF and the COMT for the IGT. These findings suggest the BDNF Val66Met may affect the emotional decision making performance.

Interaction between serotonin transporter promoter and dopamine receptor D4 polymorphisms on decision making.

Appropriate decision making is an important brain function to maintain our lives. The Iowa gambling task (IGT) is a tool for decision making under ambiguity. The aims of this study were to evaluate the influence of serotonin transporter linked polymorphic region (5-HTTLPR) and dopamine receptor D4 (DRD4) polymorphisms and their interaction on IGT performance. One hundred fifty-nine normal subjects were involved in this study. All subjects performed the IGT and were genotyped for the triallelic 5-HTTLPR and DRD4 48 bp uVNTR polymorphisms. After controlling for gender, age, and impulsiveness, there were no main effects of 5-HTTLPR and DRD4 gene polymorphisms on total IGT score. However, there was a significant effect on the interaction between 5-HTTLPR and DRD4 on total IGT score. In the presence of the 5-HTTLPR S'S' (SS+SL(G)+L(G)L(G)), subjects with the DRD4 2R+ (2 repeat carrier) had higher total IGT score compared to those with the DRD4 2R-. In contrast, in the absence of the 5-HTTLPR S'S', subjects with the DRD4 2R- had higher total IGT score than those with the DRD4 2R+. When we divided IGT scores into the first and second half of trials, the 5-HTTLPRxDRD4 interaction effects were stronger in the second half block (decision under risk) than in the first half block (decision under ambiguity). In conclusion, the DRD4 genotypes might influence decision-making performance differently according to the background genotypes of 5-HTTLPR.