Academic journal article Iranian Journal of Psychiatry

Facial Emotion Recognition in Adolescents with Bipolar Disorder

Academic journal article Iranian Journal of Psychiatry

Facial Emotion Recognition in Adolescents with Bipolar Disorder

Article excerpt

Bipolar disorder (BD) which is not uncommon in youth (1) is often characterized by continuous, rapid- cycling, irritable, and mixed symptoms of depression and mania or hypomania. It may co-occur with disruptive behavior disorders, particularly attention deficit hyperactivity disorder (ADHD) or conduct disorder (2). Youths with BD may be explosive and irritable during a mood episode (3) and may have significant impairments in their academic functioning at school (4) and in interpersonal relationships with peers and family (5).

One of the main components for irritable mood in patients with BD is emotional dysregulation (ED) which is defined as an emotional response which is poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to labile mood or mood swings as well (6).The irritability associated with PBD may be an important mechanism of this deficit and may thus represent a major target for treatment (7) Besides the literature supporting ED in pediatric bipolar disorder (PBD), there are new findings which highlight the importance of emotion recognition deficits in this disorder. The ability to recognize facial emotional expressions is a fundamental skill, necessary for successful social interaction. This ability is an innate feature that develops extensively throughout early stages of childhood development. Ability to produce and recognize facial expressions of emotion is an important component of interpersonal communication that makes problems in bipolar patients (8). Certain facial expressions such as happiness, sadness, angry, fear and disgust have been evaluated in patients with bipolar disorder (9) Degabriele et al. (2010) found that adult patients with BD in manic phase demonstrated faster responses to happy faces compared to sad faces, whereas there was no emotional discrimination in the control group (10).Functional imaging studies of adults with BD showed dysfunction within subcortical (striatal- thalamic) and associated limbic regions (11) as well as other abnormalities including over activity in anterior limbic structures in response to fearful or happy facial expressions (12). Some researchers suggest that these parts of the brain show impaired functioning even during euthymic period. Another functional MRI analyses showed that adult patients with BD, compared to a control group, had increased activation in the striatum and anterior cingulate cortex when successfully encoding happy faces and in the orbitofrontal cortex when successfully encoding angry faces (13).

Exaggerated medial prefrontal cortical and subcortical (putamen and amygdala) responses to emotional signals may represent their table neurobiological abnormalities underlying BD. Thus, efforts have been directed towards understanding the cognitive and emotional characteristics of children with PBD . McClure et al. examined 11 children with BD (mean age of 13.7 years), 10 children with anxiety disorders (mean age of 12.9) and 25 children as control group (mean age of 13.5) on tests of facial memory and emotion identification (8).The emotion identification task consisted of 24 photographs of adults and 24 photographs of children in both high and low intensities of happiness, sadness, anger and fear. The patients with BD made more errors in identifying low-intensity faces compared to the normal and anxious groups of children. They also made more errors in recognizing children's faces, over-identifying them as angry faces.

Voelbel et al. described that children with BD had problems with identifying emotion in faces, but they did not specify which emotion was more inaccurately identified (14).

Shankman et al. found that a group of 9 to 18 year old children and adolescents with PBD type I, who were euthymic for a minimum of 4 months, presented reduced activation of right ventro-lateral pre frontal cortex and increased activation of anterior cingulate, amygdala, and paralimbic cortex in response to both angry and happy faces compared to neutral faces. …

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