Academic journal article Iranian Journal of Psychiatry

Theory of Mind in Adolescents with Bipolar Disorder in Euthymic Phase: Using the Strange Stories Test

Academic journal article Iranian Journal of Psychiatry

Theory of Mind in Adolescents with Bipolar Disorder in Euthymic Phase: Using the Strange Stories Test

Article excerpt

Bipolar disorder (BD) has been described with periods of mania, depression and remission. The ?lifetime prevalence of BD type I has been reported to be 1% in adolescents (1, 2). However, ?adolescents with BD type II form 10% of the society and this disorder mostly occur between ?the ages of 14 and 18 years (3) ?.

Evidence shows that 20-50% of the patients with BD have chronic social impairment (4)? and ?difficulty in interaction with others (5) as well as a reduction in social relationships and ?dissatisfaction in family and social interactions (6). Deficits in social relationships in these patients ?continue even during the period of remission (4); however, the existing findings are inconsistent ?? (7).?

To understand the underlying mechanisms of social functioning, social cognition has been ?explored as an advanced mental process essential to understand other's intentions and attitudes ?? (8). Social cognition includes subcategories such as relationship dynamics, social knowledge and ?perception (9).?

Research on social cognition has recently focused on theory of mind (ToM). ToM is a term used ?to describe such mental states conceptualizations as beliefs, desires, intentions and emotions (10). ?ToM also refers to a process through which people predict and interpret others' behaviors (11). ToM related deficits in social ?interactions have been examined repeatedly in autism and schizophrenia spectrum disorders (12), ?and recently in individuals with BD (13). Kerr et al. (2003) (14) compared the ability of ToM ?between BD adult individuals in normal, depressive, and manic phases, and a healthy group. First ?and second false-belief tasks showed that ToM was impaired in the periods of depression and ?mania, but was intact in euthymic phase. Montag et al. (2010) (15) and Olley et al. (2005) (16) did ?not find any ToM impairment in the period of normal mood. However, Bora (2005) (17) showed ?that ToM was weak in people whose mood disorder had been treated. Wollf (2010) (18) found ?that ToM was more impaired in all BD phases compared to the healthy group. A recent meta-?analysis (19) confirmed a significant modest ToM dysfunction in subclinical and remitted BD, and ?a higher ToM dysfunction in acute episodes. These deficits may have an important role in ?interpersonal problems seen in individuals with BD.

Moreover, some studies have found social dysfunction in pediatric BD (20, 21 and 22). Besides, study ?of offspring of parents with BD found social impairment in these youths (23). Whitney et al. ?? (2014) (24) suggested that children and adolescents may show social impairment before they ?experience the onset of mania, a fact consistent with common chronic prodromal period before ?the emergence of pediatric BD (25). Schenkel et al. (2008) (26) conducted the first study on ToM in ?pediatric BD and found that ToM functions of the adolescents with BD during the periods of ?depression and mania were weaker than the healthy group. Moreover, Schenkel et al. (2014) (27) ?showed that poor interpersonal functioning in pediatric BD type I was associated with ToM ?deficits. They did not find any significant differences between pediatric BD type II and healthy ?group in terms of mentalizing ability.?

The ToM literature on euthymic phase of BD in adolescents is still scant and inconsistent. ?Moreover, most studies have used parents reports or / and first or second order false belief tasks to ?test ToM abilities (first order means to infer someone's mental state; second order means to infer ?someone mentalizing about another person's mental state). However, advanced instruments are ?available to evaluate higher levels of mentalizing process. For example, the strange stories test ?assesses individuals' understanding of pretending, double bluffing, lying, persuading, etc. In ?addition, the studies on ToM in Iranian children and adolescents with BD are limited. These ?facts encouraged us to study the underlying mechanisms of impairment in the social relationships ? …

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