Cristiana Castanho de Almeida Rocca

Facial emotion recognition in bipolar disorder: a critical review

OBJECTIVE Literature review of the controlled studies in the last 18 years in emotion recognition deficits in bipolar disorder. METHOD A bibliographical research of controlled studies with samples larger than 10 participants from 1990 to June 2008 was completed in Medline, Lilacs, PubMed and ISI. Thirty-two papers were evaluated. RESULTS Euthymic bipolar disorder presented impairment in recognizing disgust and fear. Manic BD showed difficult to recognize fearful and sad faces. Pediatric bipolar disorder patients and children at risk presented impairment in their capacity to recognize emotions in adults and children faces. Bipolar disorder patients were more accurate in recognizing facial emotions than schizophrenic patients. DISCUSSION Bipolar disorder patients present impaired recognition of disgust, fear and sadness that can be partially attributed to mood-state. In mania, they have difficult to recognize fear and disgust. Bipolar disorder patients were more accurate in recognizing emotions than depressive and schizophrenic patients. Bipolar disorder children present a tendency to misjudge extreme facial expressions as being moderate or mild in intensity. CONCLUSION Affective and cognitive deficits in bipolar disorder vary according to the mood states. Follow-up studies re-testing bipolar disorder patients after recovery are needed in order to investigate if these abnormalities reflect a state or trait marker and can be considered an endophenotype. Future studies should aim at standardizing task and designs.

Social Dysfunction in Bipolar Disorder: Pilot Study:

Objective: The purpose of the present study was to assess the social skills of euthymic patients with bipolar disorder. Methods: A group of 25 outpatients with bipolar disorder type I were evaluated in comparison with a group of 31 healthy volunteers who were matched in terms of level of education, age, sex and intelligence. Both groups were assessed using a self-report questionnaire, the Brazilian Inventário de Habilidades Sociais (IHS, Social Skills Inventory). Two Wechsler Adult Intelligence Scale subtests (Picture Arrangement and Comprehension) were also used in order to assess subject ability to analyse social situations and to make judgements, respectively. Results: Patients with bipolar disorder had lower IHS scores for the domains that assessed conversational skills/social self-confidence and social openness to new people/situations. Patients with anxiety disorders had high scores for the domain that assessed self-confidence in the expression of positive emotions. No differences were found between patients and controls in performance on the Wechsler Adult Intelligence Scale Picture Arrangement and Comprehension subtests. Conclusions: Euthymic patients with bipolar disorder present inhibited and overattentive behaviour in relation to other people and their environment. This behaviour might have a negative impact on their level of social functioning and quality of life.

Alterações neuropsicológicas no transtorno bipolar

OBJECTIVE: Systematic literature review of the controlled studies published in the last 15 years on neuropsychological deficits in Bipolar Disorder. METHOD: Bibliographical research was completed through Medline, Lilacs, PubMed and ISI, speciafically for 1990 to 2005 period. Selected studies were organized beginning with the comparison among the selected sample (bipolar versus other pathology versus control healthy). We included only controlled studies with a patient sample larger than 10, and 73 papers were found, being that 53 selected for this systematic review. RESULTS: Patients with Bipolar Disorder present difficulties in several cognitive domains which partially persist even after acute episodes acute episodes. The deficits impaired basically the executive functions. When compared to schizophrenia, bipolar patients present milder deficits in the neuropsychological tests, which may explain differences in terms of disease outcome and specific circuitry abnormalities. There was a positive correlation between cognitive deficits and number of episodes or hospitalizations. The medications used for mood stabilization can produce a negative impact on cognition. CONCLUSIONS: The abnormalities suggest a dysfunction in specific frontostriatal circuits, and may partially explain the difficulties in the psychosocial adaptation of these patients. Future studies should evaluate the effectiveness of neuropsychological rehabilitation programs, which seek through cognitive training to minimize the impact of these deficits in the every day life.

Dysfunctional family environment in affected versus unaffected offspring of parents with bipolar disorder

Objective: Children of parents with bipolar disorder (BD) are at heightened risk for developing mood and other psychiatric disorders. We proposed to evaluate the environment of families with at least one parent with BD type I (BDF) with affected offspring (aBDF) and unaffected offspring (uBDF) compared with control families without a history of DSM-IV Axis I disorder (CF). Method: We used the Family Environment Scale (FES) to evaluate 47 BDF (aBDF + uBDF) and 30 CF. Parents were assessed through the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Diagnosis of the offspring was determined through the Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) interview. Results: There were statistically significant differences between aBDF, uBDF and CF in cohesion (p = 0.003), intellectual-cultural orientation (p = 0.01), active-recreational orientation (p = 0.007), conflict (p = 0.001), control (p = 0.01), moral-religious emphasis (p = 0.01) and organization (p = 0.001). The aBDF showed higher levels of control (p = 0.02) when compared to the uBDF. Conclusions: Families with a BD parent presented more dysfunctional interactions among members. Moreover, the presence of BD or other psychiatric disorders in the offspring of parents with BD is associated with higher levels of control. These results highlight the relevance of psychosocial interventions to improve resilience and family interactions.

Escala de avaliação da reação de retração no bebê: Um estudo de validade

It should take into account the psychopatologic context and the childs development moment to evaluate the baby alarm distress from a standardized instrument. We present the BADS questionnaire validation by its application in 90 children, from 0 to 2 years-old, obtaining a K=0.783 to p<0.01, with a Spearman coeficient of 0.866 and factorial analysis to 4 factors to 63.5% of the population studied. With these psychometrical qualities, the scale shows its importance as a screening but is important its study in others populations.

Attention-based classification pattern, a research domain criteria framework, in youths with bipolar disorder and attention-deficit/hyperactivity disorder

Objective: The National Institute of Mental Health has initiated the Research Domain Criteria (RDoC) project. Instead of using disorder categories as the basis for grouping individuals, the RDoC suggests finding relevant dimensions that can cut across traditional disorders. Our aim was to use the RDoC’s framework to study patterns of attention deficit based on results of Conners’ Continuous Performance Test (CPT II) in youths diagnosed with bipolar disorder (BD), attention-deficit/hyperactivity disorder (ADHD), BD+ADHD and controls. Method: Eighteen healthy controls, 23 patients with ADHD, 10 with BD and 33 BD+ADHD aged 12–17 years old were assessed. Pattern recognition was used to partition subjects into clusters based simultaneously on their performance in all CPT II variables. A Fisher’s linear discriminant analysis was used to build a classifier. Results: Using cluster analysis, the entire sample set was best clustered into two new groups, A and B, independently of the original diagnoses. ADHD and BD+ADHD were divided almost 50% in each subgroup, and there was an agglomeration of controls and BD in group B. Group A presented a greater impairment with higher means in all CPT II variables and lower Children’s Global Assessment Scale. We found a high cross-validated classification accuracy for groups A and B: 95.2%. Variability of response time was the strongest CPT II measure in the discriminative pattern between groups A and B. Conclusion: Our classificatory exercise supports the concept behind new approaches, such as the RDoC framework, for child and adolescent psychiatry. Our approach was able to define clinical subgroups that could be used in future pathophysiological and treatment studies.

Facial emotion recognition in euthymic patients with bipolar disorder and their unaffected first-degree relatives

BACKGROUND Facial emotion recognition (FER) is an important task associated with social cognition because facial expression is a significant source of non-verbal information that guides interpersonal relationships. Increasing evidence suggests that bipolar disorder (BD) patients present deficits in FER and these deficits may be present in individuals at high genetic risk for BD. The aim of this study was to evaluate the occurrence of FER deficits in euthymic BD patients, their first-degree relatives, and healthy controls (HC) and to consider if these deficits might be regarded as an endophenotype candidate for BD. METHODS We studied 23 patients with DSM-IV BD type I, 22 first-degree relatives of these patients, and 27 HC. We used the Penn Emotion Recognition Tests to evaluate tasks of FER, emotion discrimination, and emotional acuity. Patients were recruited from outpatient facilities at the Institute of Psychiatry of the University of Sao Paulo Medical School, or from the community through media advertisements, had to be euthymic, with age above 18years old and a diagnosis of DSM-IV BD type I. RESULTS Euthymic BD patients presented significantly fewer correct responses for fear, and significantly increased time to response to recognize happy faces when compared with HC, but not when compared with first-degree relatives. First-degree relatives did not significantly differ from HC on any of the emotion recognition tasks. CONCLUSION Our results suggest that deficits in FER are present in euthymic patients, but not in subjects at high genetic risk for BD. Thus, we have not found evidence to consider FER as an endophenotype candidate for BD.

A clinical study comparing manic and mixed episodes in patients with bipolar disorder

OBJECTIVE Mixed episodes have been described as more severe than manic episodes, especially due to their longer duration and their association with higher rates of suicide attempts, hospitalization and psychotic symptoms. The purpose of this study was to compare the severity between mixed and pure manic episodes according to DSM-IV criteria, through the evaluation of sociodemographic data and clinical characteristics. METHOD Twenty-nine bipolar I patients presenting acute mixed episodes were compared to 20 bipolar I patients with acute manic episodes according to DSM-IV criteria. We analyzed (cross-sectionally) episode length, presence of psychotic symptoms, frequency of suicide attempts and hospitalization, Young Mania Rating Scale scores, Hamilton Depression Rating Scale scores and the Clinical Global Assessment Scale scores. RESULTS Young Mania Rating Scale scores were higher in manic episodes than in mixed episodes. There were no differences in gender frequency, CGI scores and rates of hospitalization, suicide attempts and psychotic symptoms, when mixed and manic episodes where compared. Patients with mixed episodes were younger. CONCLUSION In our sample, mixed states occurred at an earlier age than manic episodes. Contrary to previous reports, we did not find significant differences between manic and mixed episodes regarding severity of symptomatology, except for manic symptoms ratings, which were higher in acute manic patients. In part, this may be explained by the different criteria adopted on previous studies.

Lifetime history of suicide attempts is associated with poorer social skills in patients with bipolar disorder type I

Abstract: Background: Lifetime history of suicide attempts is frequently associated with bipolar disorder (BD) and even during remission, patients with bipolar disorder can present social skills deficits. However, no study has been conducted in order to evaluate social skills in bipolar patients with a past history of suicide attempts. Method: We studied a group of 28 euthymic outpatients with BD type I: 12 with a history of suicide attempt and 16 non-attempters subjects. The groups of patients were compared with 31 healthy control in a social skills measure. Results: Patients with a history of suicide attempts presented lower scores for the domains that assessed conversational skills and social self-confidence, social openness to new people and situations and self-control of aggressiveness and individual reactions to aversive stimuli that require the management of anger and aggressiveness when compared with healthy controls and bipolar patients without previous suicide attempts. Conclusions: BPI outpatients with a history of suicide attempts present inhibited behaviour in relation to other people and their environment. Further research may verify if these social skills deficits are associated with other risk factors that may lead to higher suicidality in Bipolar Patients. Key words: bipolar disorder, suicide attempts, social skills, inhibited behaviour. Resumo: Introducao: Tentativas de suicidio ao longo da vida estao frequentemente associadas com transtorno bipolar (TB) e mesmo durante a remissao, pacientes com TB podem apresentar deficits nas habilidades sociais.Entretanto, nenhum estudo explorou ainda as habilidades sociais em pacientes com TB que tem historia passada de tentativas de suicidio. Metodo: Foi estudado um grupo de 28 pacientes com TB tipo I em eutimia: 12 com historia de tentativa de suicidio e 16 que nao tinham tentado suicidio. O grupo de pacientes foi comparado a um grupo controle em uma medida de habilidade social. Resultados: Pacientes com historia de tentativa de suicidio, quando comparados aos controles saudaveis e aos pacientes sem tentativas de suicidio, apresentaram baixos escores nos dominios que avaliavam habilidades de conversacao e desenvoltura social; auto-exposicao a desconhecidos e situacoes novas, e auto controle da agressividade e das reacoes a estimulos aversivos que requerem o manejo da raiva e da agressividade. Conclusoes: Pacientes com TB tipo I com historia de tentativa de suicidio apresentam inibicao do comportamento em relacao as outras pessoas e ao meio ambiente. Pesquisas futuras podem verificar se os deficits nas habilidades sociais estao associados a outros fatores de risco que podem levar a maior suicidalidade em pacientes com TB. Palavras chaves: transtorno bipolar, tentativa de suicidio, habilidades sociais, inibicao do comportamento.

Generating Facial Emotions for Diagnosis and Training

The ability to process and identify facial emotions is an essential factor for an individuals social interaction. There are certain psychiatric disorders that can limit an individuals ability to recognize emotions in facial expressions. This problem could be confronted by making use of computational techniques in order to develop learning environments for the diagnosis, evaluation and training in identifying facial emotions. This paper presents an approach that uses image processing techniques, formal languages, anthropometry and Facial Action Coding System (FACS) to generate caricatures that represent facial movements related to neutral, satisfaction, sadness, anger, disgust, fear and surprise emotions. The rules that define the emotions were determined using an AND-OR graph to enable generating these images in a flexible manner. An evaluation conducted with healthy volunteers showed that some emotions are more easily recognized, while for other emotions the caricatures need to be further improved. This is a promising approach, since the parameters used provide flexibility to define the emotional intensity that must be represented.