Identifying social cognition subgroups in euthymic patients with bipolar disorder: a cluster analytical approach.

BACKGROUND: Bipolar disorder (BD) is associated with social cognition (SC) impairments even during remission periods although a large heterogeneity has been described. Our aim was to explore the existence of different profiles on SC in euthymic patients with BD, and further explore the potential impact of distinct variables on SC. METHODS: Hierarchical cluster analysis was conducted using three SC domains [Theory of Mind (ToM), Emotional Intelligence (EI) and Attributional Bias (AB)]. The sample comprised of 131 individuals, 71 patients with BD and 60 healthy control subjects who were compared in terms of SC performance, demographic, clinical, and neurocognitive variables. A logistic regression model was used to estimate the effect of SC-associated risk factors. RESULTS: A two-cluster solution was identified with an adjusted-performance group (N = 48, 67.6%) and a low-performance group (N = 23, 32.4%) with mild deficits in ToM and AB domains and with moderate difficulties in EI. Patients with low SC performance were mostly males, showed lower estimated IQ, higher subthreshold depressive symptoms, longer illness duration, and poorer visual memory and attention. Low estimated IQ (OR 0.920, 95% CI 0.863-0.981), male gender (OR 5.661, 95% CI 1.473-21.762), and longer illness duration (OR 1.085, 95% CI 1.006-1.171) contributed the most to the patients clustering. The model explained up to 35% of the variance in SC performance. CONCLUSIONS: Our results confirmed the existence of two discrete profiles of SC among BD. Nearly two-thirds of patients exhibited adjusted social cognitive abilities. Longer illness duration, male gender, and lower estimated IQ were associated with low SC performance.

Social cognition in bipolar disorder: the role of sociodemographic, clinical, and neurocognitive variables in emotional intelligence.

OBJECTIVE: The main aims of this study were to examine the differences in the Emotional Intelligence (EI), the emotional domain of social cognition (SC), between euthymic patients with bipolar disorder (BD) and healthy controls (HC) and to evaluate the contribution of sociodemographic, clinical, and neuropsychological variables to EI. METHODS: We recruited 202 patients with BD and 50 HC. EI was evaluated using the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). The sociodemographic, clinical, and neurocognitive variables that showed a significant association with EI were entered into hierarchical multiple regression analysis. RESULTS: BD patients obtained significantly lower scores compared to HC in the Emotional Intelligence Quotient (EIQ) and in the Understanding Emotions branch score. The best fitting model for the variables associated with EI in the patients group was a linear combination of gender, estimated IQ, family history of affective diagnosis, and executive function. The model, including these previous variables, explained up to 27.6% of the observed variance (R2  = 0.276, F = 16.406, P < 0.001). CONCLUSIONS: The identification of variables associated with deficit in EI, such as male gender, lower estimated IQ, family history of affective diagnosis. and lower executive function performance, may help in selecting treatment targets to improve SC, and especially EI, in patients with BD.

Hostile attributions in bipolar disorder and schizophrenia contribute to poor social functioning.

OBJECTIVE: To compare the profile of attributional style of a group of out-patients with bipolar disorder (BD) and schizophrenia (SZ), and a group of healthy controls - along with other social cognition domains - such as emotion recognition and theory of mind (ToM). METHOD: A total of 46 out-patients diagnosed with BD, 49 with SZ, and 50 healthy controls were assessed in attributional style (Ambiguous Intentions Hostility Questionnaire), facial emotion recognition (FEIT, FEDT, ER-40), and ToM (Hinting Task). Symptomatology, clinical variables and global functioning were also collected. RESULTS: Both groups with SZ and BD showed hostile social cognitive biases, compared with the control group. Patients with BD also showed a capacity for emotional recognition similar to those with SZ and worse than control subjects. In contrast, patients with SZ showed poorer ToM. Subthreshold depressive symptoms and an attributional style toward hostility appeared as the factors with a strongest association to global functioning in BD. In SZ, PANSS score and a tendency to aggressiveness were the most relevant factors. CONCLUSION: Attributional style (along with other domains of social cognition) is altered in out-patients with BD and SZ. The presence of residual symptoms and a hostile social cognitive bias may contribute to the functional impairment of both groups.

Social Cognition and Interaction Training (SCIT) versus Training in Affect Recognition (TAR) in patients with schizophrenia: A randomized controlled trial.

INTRODUCTION: Training in Affect Recognition (TAR) is a "targeted" and computer-aided program that has been shown to effectively attenuate facial affect recognition deficits and improve social functioning in patients with schizophrenia. Social Cognition and Interaction Training (SCIT) is a group "broad-based" intervention, that has also been shown to improve emotion recognition, theory of mind (ToM), and social functioning. To date, no study has compared the efficacy of two different social cognitive interventions. OBJECTIVES: We aim to compare the efficacy of TAR and SCIT on schizophrenia patients' performance on facial affect recognition, theory of mind, attributional style and social functioning before, after treatment, and three months thereafter. METHODS: One hundred outpatients with a diagnosis of schizophrenia were randomly assigned to the TAR or SCIT condition and completed pre- (T0) and posttreatment (T1) assessments and a 3-month follow up (T2) of emotion recognition (ER-40), theory of mind (Hinting Task), attributional style (AIHQ) and social functioning (PSP). RESULTS: The entire sample, receiving TAR or SCIT, showed improvements in theory of mind, attributional style, clinical symptoms and social functioning. This effect was maintained at three-months. The TAR intervention was more efficacious than the SCIT program in improving the recognition of facial emotions (ER-40). The TAR intervention also demonstrated a lower drop-out rate than the SCIT intervention. CONCLUSIONS: There were improvements in social cognition, symptomatology and functioning of patients in the entire sample, receiving SCIT or TAR. Both TAR and SCIT appear as valuable treatments for people with schizophrenia and social cognitive deficits.

Social Cognition in Autism and Schizophrenia Spectrum Disorders: The Same but Different?

Social cognition impairment is a core shared phenotype in both schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD). This study compares social cognition performance through four different instruments in a sample of 147 individuals with ASD or SSD and in healthy controls. We found that both clinical groups perform similarly to each other and worse than healthy controls in all social cognition tasks. Only performance on the Movie for the Assessment of Social Cognition (MASC) test was independent of age and intelligence. Proportionately, individuals in the control group made significantly more overmentalization errors than both patients group did and made fewer undermentalization errors than patients with SSD did. AUC analyses showed that the MASC was the instrument that best discriminated between the clinical and control groups. Multivariate analysis showed negative symptom severity as a potential mediator of the association between social cognition deficit and poor global functioning.

P300 event-related potential in euthymic patients with bipolar disorder.

Auditory P300 event-related potential (ERP) and performance on Sustained Attention were evaluated in 24 euthymic bipolar patients and 38 healthy volunteers. There were no significant differences between groups, and performance in sustained attention had no significant influence in the P300 responses. P300 response might be driven by the presence of mood symptoms.

[The public perception of depression in Spain]. / Percepción de la población española sobre la depresión.

BACKGROUND: Depression is one of the main causes of disability worldwide. The aim of this study was to determine the opinions of the Spanish population regarding this disease, its relation to suicide, its symptoms, its causes, the people who suffer from it, the professionals who treat it and antidepressant medication Methods. A questionnaire designed by experts was administered to a representative sample of 1,700 people aged 18 and over in all Spanish autonomous communities using multistage sampling procedure, stratified by clusters, with a random selection of municipalities and population by sex, age and economic activity in a representative way at a national level. RESULTS: Eighteen percent of the people surveyed said they had depression or had suffered from it previously, 86% thought of it is a disease and 85% considered it to be a cause of suicide. The most well-known symptoms (>95%) were sadness and apathy. The people surveyed expressed certain stigmatizing attitudes towards people who suffer from it (60% unstable and 49% weak) and most stated that the causes of this disease are of external origin (95% due to adverse life events), thought that a psychologist is a more appropriate health specialist for treating depression than a psychiatrist (47 vs. 29%) and that antidepressant medication generates dependency (72%) despite being effective (62%); 67% of depressed patients reported taking it. CONCLUSIONS: It is suggested that the relevant health administrations should conduct campaigns aimed at informing the public about the true nature of depression, to reduce stigmatizing attitudes and to clarify the efficacy and possible adverse effects of antidepressant medication.

Social cognition in bipolar disorder: Focus on emotional intelligence.

BACKGROUND: The present study aims to characterize emotional intelligence (EI) variability in a sample of euthymic bipolar disorder (BD) patients through the Mayer- Salovey-Caruso Emotional Intelligence Test (MSCEIT). METHOD: A total of 134 euthymic BD outpatients were recruited and divided into three groups according to the total Emotional Intelligence Quotient (EIQ) score of the MSCEIT, following a statistical criterion of scores 1.5SDs above/below the normative group mean, as follows: a low performance (LP) group (EIQ <85), a normal performance (NP) group (85≤EIQ≤115), and a high performance (HP) group (EIQ >115). Afterwards, main sociodemographic, clinical, functional and neurocognitive variables were compared between the groups. RESULTS: Three groups were identified: 1) LP group (n=16, 12%), 2) NP group (n=93, 69%) and 3) HP group (n=25, 19%). There were significant differences between the groups in premorbid intelligence quotient (IQ) (p=0.010), axis II comorbidity (p=0.008), subthreshold depressive symptoms (p=0.027), general functioning (p=0.013) and in four specific functional domains: autonomy, occupation, interpersonal relations and leisure time. Significant differences in neurocognitive performance were found between groups with the LP group showing the lowest attainments. LIMITATIONS: The cross-sectional design of the study. CONCLUSION: Our results suggest that EI variability among BD patients, assessed through MSCEIT, is lower than expected. EI could be associated with premorbid IQ, subthreshold depressive symptoms, neurocognitive performance and general functioning. The identification of different profiles of SC may help guide specific interventions for distinct patient subgroups aimed at improving social cognition, neurocognitive performance and psychosocial functioning.

Percepción de la población española sobre la depresión / The public perception of depression in Spain

Fundamento. La depresión constituye una de las principales causas mundiales de discapacidad. El objetivo de este estudio fue conocer la opinión de la población española sobre esta enfermedad, su relación con el suicidio, su sintomatología, los pacientes que la padecen, sus causas, los profesionales que la tratan y la medicación antidepresiva. Material y métodos. Se administró telefónicamente un cuestionario elaborado ad hoc por expertos a 1.700 personas mayores de edad en todas las comunidades autónomas españolas, mediante muestreo polietápico, estratificado por conglomerados, con selección de los municipios de forma aleatoria y de las personas por cuotas de sexo, edad y actividad económica de manera representativa a nivel nacional. Resultados. El 18% de los encuestados manifestó que padecía o que había padecido depresión, el 86% la consideraba una enfermedad y el 85% que era causa de suicidio. Los síntomas más conocidos (>95%) de este trastorno fueron la tristeza y la apatía. Los encuestados exhibieron algunas actitudes estigmatizadoras hacia las personas con depresión (60% inestabilidad y 49% debilidad), atribuyeron esta dolencia a causas externas (el 95% a acontecimientos adversos de la vida), opinaron que el psicólogo es más adecuado que el psiquiatra para tratarla (47 vs. 29%) y que la medicación antidepresiva genera dependencia (72%) a pesar de ser eficaz (62%); el 67% de los encuestados depresivos manifestó tomarla. Conclusiones. Las administraciones sanitarias competentes deberían realizar campañas dirigidas a informar sobre la verdadera naturaleza de la depresión, reducir las actitudes estigmatizadoras y clarificar la eficacia y eventuales efectos adversos de la medicación antidepresiva

Background. Depression is one of the main causes of disability worldwide. The aim of this study was to determine the opinions of the Spanish population regarding this disease, its relation to suicide, its symptoms, the people who suffer from it, its causes, the professionals who treat it and antidepressant medication Methods. A questionnaire designed by experts was administered by phone to a representative sample of 1,700 people aged 18 and over in all Spanish autonomous communities using multistage sampling procedure, stratified by clusters, with a random selection of municipalities and population by sex, age and economic activity in a representative way at a national level. Results. Eighteen percent of the people surveyed said they had depression or had suffered from it previously, 86% thought of it is a disease and 85% considered it to be a cause of suicide. The most well-known symptoms (>95%) were sadness and apathy. The people surveyed expressed certain stigmatizing attitudes towards people who suffer from it (60% unstability and 49% weakness). Most stated that the causes of this disease are of external origin (95% due to adverse life events), thought that a psychologist is a more appropriate health specialist for treating depression than a psychiatrist (47 vs. 29%) and that antidepressant medication generates dependency (72%) despite being effective (62%); 67% of depressed patients reported taking it. Conclusions. It is suggested that the relevant health administrations should conduct campaigns aimed at informing the public about the true nature of depression, to reduce stigmatizing attitudes and to clarify the efficacy and possible adverse effects of antidepressant medication

Movie for the Assessment of Social Cognition (MASC): Spanish validation.

We present the Spanish validation of the "Movie for the Assessment of Social Cognition" instrument (MASC-SP). We recruited 22 adolescents and young adults with Asperger syndrome and 26 participants with typical development. The MASC-SP and three other social cognition instruments (Ekman Pictures of Facial Affect test, Reading the Mind in the Eyes Test, and Happé's Strange Stories) were administered to both groups. Individuals with Asperger syndrome had significantly lower scores in all measures of social cognition. The MASC-SP showed strong correlations with all three measures and relative independence of general cognitive functions. Internal consistency was optimal (0.86) and the test-retest was good. The MASC-SP is an ecologically valid and useful tool for assessing social cognition in the Spanish population.

Social cognition and interaction training (SCIT) for outpatients with bipolar disorder.

INTRODUCTION: Patients with bipolar disorder show social cognition deficits during both symptomatic and euthymic phases of the illness, partially independent of other cognitive dysfunctions and current mood. Previous studies in schizophrenia have revealed that social cognition is a modifiable domain. Social cognition and interaction training (SCIT) is an 18-week, manual-based, group treatment designed to improve social functioning by way of social cognition. METHOD: 37 outpatients with DSM-IV-TR bipolar and schizoaffective disorders were randomly assigned to treatment as usual (TAU)+SCIT (n=21) or TAU (n=16). Independent, blind evaluators assessed subjects before and after the intervention on Face Emotion Identification Task (FEIT), Face Emotion Discrimination (FEDT), Emotion Recognition (ER40), Theory of Mind (Hinting Task) and Hostility Bias (AIHQ). RESULTS: Analysis of covariance revealed significant group effects for emotion perception, theory of mind, and depressive symptoms. The SCIT group showed a small within-group decrease on the AIHQ Blame subscale, a moderate decrease in AIHQ Hostility Bias, a small increase in scores on the Hinting Task, a moderate increase on the ER40, and large increases on the FEDT and FEIT. There was no evidence of effects on aggressive attributional biases or on global functioning. LIMITATION: No follow up assessment was conducted, so it is unknown whether the effects of SCIT persist over time. CONCLUSION: This trial provides preliminary evidence that SCIT is feasible and may improve social cognition for bipolar and schizoaffective outpatients.

[Differential diagnosis of hoarding behaviors]. / Diagnóstico diferencial de la conducta acumuladora.

Hoarding of objects comprises a continuum from normality to extreme disease. It is important to distinguish between the different disorders that include hoarding behaviors. Compulsive hoarding is a form of obsessive-compulsive disorder (OCD) that is characterized by excessive acquisition of possessions, inability to discard possessions, and excessive clutter. Patients usually display other obsessive features, feel distress if they cannot hoard objects, show a typical cognitive pattern with obsessive features, and their interpersonal relations are mediated by objects. Diogenes syndrome is the combination of severe self-neglect, domestic squalor, social withdrawal, hoarding, and refusal of help, in elderly patients. There is high comorbidity with psychiatric/somatic disorders. Depression and dementia are risk factors for self-neglect. Collectionism is a normal phenomenon that is common in children but also found in adults. It is usually an organized activity, and the objects are kept in specific and structured places. The aim of collecting is to organize and hierarchize a series of objects, not just to hoard them. Collected objects are frequently appreciated by other collectors, and become exchanged to enlarge the collection.

Diagnóstico diferencial de la conducta acumuladora / Differential diagnosis of hoarding behaviors

La acumulación se presenta en un continuum desde la normalidad hasta un extremo patológico. Es importante distinguir entre las distintas patologías que se presentan con conductas de acumulación. El trastorno por acumulación es un subtipo de trastorno obsesivo-compulsivo caracterizado por la adquisición de objetos, la incapacidad para tirarlos y la acumulación. Los pacientes suelen desarrollar otros fenómenos obsesivos, sienten gran angustia si no acumulan, presentan un patrón cognitivo muy típico de características obsesivas y se relacionan interpersonalmente a través de los objetos. El síndrome de Diógenes se define como un abandono extremo del autocuidado, acumulación de basuras, negativa a ser ayudados y aislamiento social en pacientes de edad avanzada. Suelen presentar algún trastorno psiquiátrico y/o somático. La depresión y la demencia constituyen factores de riesgo para el autoabandono. El coleccionismo es un fenómeno normal, común en la población infantil, aunque también presente en adultos. Esta actividad suele estar organizada, guardando los objetos en lugares específicos y estructurados. Coleccionar tiene como fin organizar y jerarquizar una serie de objetos, no meramente acumularlos. Los objetos coleccionados a menudo son apreciados por otros coleccionistas, por lo que se convierten en moneda de cambio para constituir la colección

Hoarding of objects comprises a continuum from normality to extreme disease. It is important to distinguish between the different disorders that include hoarding behaviors. Compulsive hoarding is a form of obsessive-compulsive disorder (OCD) that is characterized by excessive acquisition of possessions, inability to discard possessions, and excessive clutter. Patients usually display other obsessive features, feel distress if they cannot hoard objects, show a typical cognitive pattern with obsessive features, and their interpersonal relations are mediated by objects. Diogenes syndrome is the combination of severe selfneglect, domestic squalor, social withdrawal, hoarding, and refusal of help, in elderly patients. There is high comorbidity with psychiatric/somatic disorders. Depression and dementia are risk factors for self-neglect. Collectionism is a normal phenomenon that is common in children but also found in adults. It is usually an organized activity, and the objects are kept in specific and structured places. The aim of collecting is to organize and hierarchize a series of objects, not just to hoard them. Collected objects are frequently appreciated by other collectors, and become exchanged to enlarge the collection

Prevalencia y tipos de trastorno por estrés postraumático en población general y psiquiátrica / Prevalence and types of PTSD in a psychiatric and general spanish population sample

Este estudio descriptivo transversal se realizó para investigar la prevalencia y tipología de trastorno por estrés postraumático (TEPT) en un grupo de 177 pacientes ingresados de manera consecutiva a lo largo de un año en el servicio de psiquiatría del Hospital General Universitario Gregorio Marañón de Madrid. Los resultados fueron comparados a su vez con los obtenidos en la evaluación del mismo trastorno en otro grupo representativo control de 90 personas extraídas de población general. Se empleó la escala CAPS-DX como instrumento de detección y diagnóstico del trastorno por estrés postraumatico y la escala BPRS y el cuestionario MMSE como instrumentos de selección muestral y evaluación psicopatológica. Se obtuvo una prevalencia global del 8.47 por ciento de TEPT en la población psiquiátrica y un 2.22 por ciento en la población general. Ninguno de los casos había sido previamente diagnosticado ni constaba como diagnóstico de ingreso. El trabajo demuestra la necesidad de aumentar la sensibilidad y práctica diagnóstica del TEPT con el fin de poner en marcha programas de tratamiento especializados (AU)