Authors:

Lennox, B.R., CALDER, A.J., Lupson, V., Bisbrown Chippendale, R. & Bullmore, E.T.

Reference:

Year of publication:

2006

CBU number:

6436

Abstract:

Background: Difficulty in recognizing facial emotion is a key abnormality in psychotic disorders. It has been suggested as being a trait abnormality associated with a poor prognosis in schizophrenia (1). We have shown previously that in the manic phase of bipolar disorder, patients misidentify negative emotions of fear and sadness, with associated underactivation of amygdala and subgenual pre- frontal cortex (2). In this study we investigated patients longitudin-ally using a wider range of facial emotions to explore the trait and state related abnormalities in facial emotion processing in patients with bipolar disorder and matched controls. Methods: 11 patients with bipolar I disorder, current episode manic were recruited from inpatient units in Cambridge. 11 age and sex matched controls were recruited. Subjects were scanned using fMRI on up to 3 occasions: when manic, when euthymic and then if they became depressed. Facial emotions (sadness, happiness, fear, disgust, surprise and anger) were presented during scanning at a range of intensities. Subjects rated the intensity of emotion presented. Results: Manic patients consistently underrated the intensity of negatively valenced facial emotions (fear, anger, sadness). When euthymic, there were no significant behavioural differences between patients and controls. When depressed, patients overrated the inten- sity of negative emotion. Conclusions: The abnormal recognition of negatively valenced facial emotion is a state related abnormality in bipolar disorder, with no trait related abnormality detected in euthymic patients. The recov-ered ability to process emotion between episodes may underlie the improved functional recovery seen in bipolar disorder compared with schizophrenia.