Facial emotion recognitions and its correlation to executive functions in young bipolar I patients

Abstract

Background: The ability to recognize facial emotions is considered a fundamental skill for a successful social interaction. Bipolar Disorders (BD) symptomatic treatments itself do not guarantee improvements in social functioning and quality of life of patients. Social functioning is one of the factors that determine the evolution of BD because it reflects patients’ ability to manage the environ- ment and their social reintegration. Impairments in social function- ing may increase relapse rates of BD, worsening morbidity. The ability to recognize facial emotions is altered in patients with BD, as well as cognitive functioning in mood swings and even in euthy- mia. However, it is unclear whether the ability to recognize facial emotions has some correlation with the cognitive deficits in BD. The objective was evaluated Facial Emotion Recognitions (FER) and its correlation to executive functions (EF) in young bipolar I patients during mania, depression or euthymia compared to healthy controls. Methods: A total of 110 patients with BD-I (75 females), age 18 – 40 years old were included (41 in manic episode; 31 in depressive episode and 38 euthymic), and assessed for FER and EF. Ninety-six healthy volunteers (18 to 40 y/o) were recruited from the University of Sao Paulo. Results: The findings from our study suggest that BD patients process FER differently as compared to healthy controls and the measures of EF impact on measures of FER in both bipolar patients and in controls. BD-I patients have an inferior FER performance compared to controls and manic patients has underperformed the control group in HEX total test score (p = 0.0001), in fear subtests (p = 0.0001), happiness (p = 0.039) and surprise test HEX (p = 0.001), total score on the test EK60 (p = 0.0001) and the subtest EK60 fear test (p = 0.0001). In the same direction, the group of euthymic patients showed significantly lower performance compared to the control group in HEX total test score (p = 0.0001), in HEX subtest fear test (p = 0.0001) and total score test EK60 (p = 0.0001). BD-I manic patients showed inferior performance on EF compared to controls. Comparing EF between the groups we found that the manic group provides lower performance than control group nearly in all measures WCST, with the mania group having a higher number of preservatives responses (p = 0.008), error (p = 0.001), preservative errors (p = 0.0001) and non-preservative (p = 0.017), fewer completed categories (p = 0.003) and conceptual level responses (p = 0.001). Discussion: Our findings suggest that BD-1 patients, even during remission, have psychosocial problems caused not only by residual symptoms, but also by cognitive deficits and difficulties to recognize emotions in human faces. Both BD-1 groups showed a significant impairment in FER compared with a similar sample of healthy volunteers and we suggest that FER is influenced by EF.