Eur Arch Psychiatry Clin Neurosci DOI 10.1007/s00406-013-0477-1
LETTER TO THE EDITOR
Attentional deficits and emotional bias in bipolar disorders: comparison at different stages of the disease S. Montel • J. Scott • M. Dubois • K. M’bailara C. Henry
•
Received: 12 November 2013 / Accepted: 7 December 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Introduction Most of the studies have demonstrated impaired selective attention in bipolar disorder (BD) suggesting the presence of residual deficits in selective attention even in euthymic BD subjects [1–3]. However, others found opposite results [4, 5]. Moreover, most of those studies have included small samples of subjects. Eventually, few studies have investigated emotional bias in BD. The aim of our study was to investigate both selective attention and emotional bias in a large sample of BD subjects at different stage of the disease.
Method Depressed BD (N = 51), manic BD (N = 55) and euthymic BD (N = 53) subjects were compared regarding their performance (mean time in seconds) on the stroop-colour
word task (SCWT) and the emotional stroop task (EST) while sociodemographic and clinical data (age, gender, disease duration, level of education and anxiety) were controlled. Euthymic BD were defined as stabilised subjects who still presented residual symptoms (DSM-IV-R criteria). The SCWT [6] as well as the French version of EST adapted for BD [7] were, respectively, used for rating attentional and emotional interference. The version of the SCWT used was made up of four different cards: colour-patch naming condition (XXX); word-reading condition (colour words printed in black); the congruent condition (colour-congruent words); and the incongruent condition (colour-incongruent words). The EST is making up of four emotional categories: neutral, paranoid, depressive and manic. Each category include four words: chaise (chair), chaussure (shoe), car (bus), tartine (toast) for the neutral; mensonges (lies), fou (mad), envahi (invaded), hostile
S. Montel (&) Department of Psychology, University Paris 8, 2 rue de la Liberte´, 93200 Saint-Denis, France e-mail: [email protected]
K. M’bailara Department of Psychology, University Bordeaux 2, Bordeaux, France
S. Montel M. Dubois K. M’bailara C. Henry Fondation FondaMental, Creteil, France
K. M’bailara Department of Psychiatry, Charles Perrens Hospital, Bordeaux, France
S. Montel EA 2027, Laboratory of Psychopathology and Neuropsychology, Saint-Denis, France
C. Henry U 995, IMRB, Psychiatry Genetics, INSERM, Creteil, France
J. Scott Institute of Neuroscience, Newcastle University, Newcastle, UK M. Dubois Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France
C. Henry Faculty of Medicine, IFR10, University Paris 12, Creteil, France C. Henry Department of Psychiatry, AP-HP, Henri Mondor-Albert Chenevier Hospitals, Creteil, France
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Eur Arch Psychiatry Clin Neurosci Table 1 Mean colour-naming times (seconds) on the Stroop task Group
Colour-naming condition (SD)
Word-reading condition (SD)
Congruent condition (SD)
Incongruent condition (SD)
Depressed BD (N = 51)
35.46 (10.54)
25.62 (6.09)
27.38 (6.06)
76.16 (38.93)
Manic BD (N = 55)
36.49 (8.86)
25.61 (8.03)
27.37 (7.34)
76.60 (21.85)
Euthymic BD (N = 53)
33.58 (9.40)
26.17 (6.73)
27.87 (6.77)
69.60 (22.03)
MANOVA between groups: R Rao (12,492) = 2.99, p \ .001. Evaluated at covariates: Age, gender, disease duration, level of education and anxiety (HAMA). Post hoc analysis (LSD test): * p \ .05; ** p \ .01 after Bonferroni’s corrections
Table 2 Mean colour-naming times (seconds) for neutral-, paranoid-, manic- and depressive-related words Group/Valence condition
Neutral condition (SD)
Paranoid condition (SD)
Manic condition (SD)
Depressive condition (SD)
Depressed BD (N = 50)
45.40 (14.24)
40.24 (10.79)
43.28 (14.63)
44.43 (13.55)
Manic BD (N = 54)
46.68 (11.83)
44.53 (10.74)
45.75 (10.70)
47.49 (13.07)
Euthymic BD (N = 53)
41.80 (15.34)
41.82 (16.62)
40.58 (15.02)
42.42 (17.06)
MANOVA between groups: R Rao (12,492) = 1.43, p \ .17. Evaluated at covariates: Age, gender, disease duration, level of education and anxiety (HAMA). Post hoc analysis (LSD test): * p \ .05; ** p \ .01 after Bonferroni’s corrections
(hostile) for the paranoid; triste (sad), bas (down), abandonne´ (abandoned), de´prime´ (depressed) for the depressive; and joyeux (happy), content (glad), gai (cheerful), agitation (agitation) for the manic.
though clinically stabilised, euthymic BD subjects continue to treat information in a way that do not differ from manic or depressed BD subjects. If this specific way of treating the information may be a potential predictor of emotional vulnerability, we can foresee how important it is to focus on this issue in order to better prevent relapses.
Results Post hoc analysis (LSD test) showed that in all conditions of the SCWT, no significant differences were observed between BD groups (p [ .05). After Bonferroni’s corrections, the post hoc analysis underlined that in all EST conditions, no significant differences were observed between BD groups (p [ .05). In order to check the validity of our data, we have compared BD patients with a population of students. Logically, the results showed that all patients whatever the stages of their disease were significantly slower than students on all conditions of the SCWT and EST (p \ .01) (Tables 1 and 2).
Discussion Our findings in a population of 159 BD subjects confirmed previous studies with smaller samples of patients. It underlines the importance of attentional and emotional biases in euthymic BD subjects despite their apparent clinical improving, suggesting how it is important to continue to follow these patients carefully even though they are clinically stabilised. These findings seem to sustain the hypothesis that emotional biases reflect a trait abnormality rather than a state abnormality [8, 9]. Definitely, even
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Acknowledgments We thanks the medical staff of the three French BD expert centres (Mondor/Cheneviers Cre´teil, Charles Perrens Bordeaux and Sainte Marguerite Marseille) for having included the subjects of this study.
References 1. Kerr N, Scott J, Philips ML (2005) Patterns of attentional deficits and emotional bias in bipolar and major depressive disorder. Br J Clin Psychol 44:343–356 2. Torres IJ, BoudreauVG Yatham LN (2007) Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 434:17–26 3. Lex C, Meyer TD, Marquart B, Thau K (2008) No strong evidence for abnormal levels of dysfunctional attitudes, automatic thoughts, and emotional information-processing biases in remitted bipolar I affective disorder. Psychol Psychother 81:1–13 4. Cavanagh JTO, Van Beck M, Muir W, Blackwood DHR (2000) Case control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania. Br J Psychiatry 180:320–326 5. Van Gorp WG, Altschuler L, Theberge DC, Wilkins J, Dixon W (1998) Cognitive impairments in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study. Arch Gen Psychiatry 1:41–46 6. Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662 7. Besnier N, Kaladjian A, Mazzola-Pomietto P, Adida M, Fakra E, Jeannigros R et al (2008) Se´lection du mate´riel pour l’e´laboration d’un test de Stroop Emotionnel adapte´ aux troubles schizophre´niques et bipolaires. Revue Canadienne de Psychiatrie 53:177–188
Eur Arch Psychiatry Clin Neurosci 8. Martı´nez-Ara´n A, Vieta E, Colom F, Torrent C, Sa´nchez-Moreno J, Reinares M et al (2004) Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 6(3):224–232
9. Besnier N, Kaladjian A, Mazzola-Pomitto P, Adida M, Fakra E, Jeanningros R (2011) Differential responses to emotional interference in paranoid schizophrenia and bipolar mania. Psychopathology 44(1):1–11
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LETTER TO THE EDITOR
Attentional deficits and emotional bias in bipolar disorders: comparison at different stages of the disease S. Montel • J. Scott • M. Dubois • K. M’bailara C. Henry
•
Received: 12 November 2013 / Accepted: 7 December 2013 Ó Springer-Verlag Berlin Heidelberg 2013
Introduction Most of the studies have demonstrated impaired selective attention in bipolar disorder (BD) suggesting the presence of residual deficits in selective attention even in euthymic BD subjects [1–3]. However, others found opposite results [4, 5]. Moreover, most of those studies have included small samples of subjects. Eventually, few studies have investigated emotional bias in BD. The aim of our study was to investigate both selective attention and emotional bias in a large sample of BD subjects at different stage of the disease.
Method Depressed BD (N = 51), manic BD (N = 55) and euthymic BD (N = 53) subjects were compared regarding their performance (mean time in seconds) on the stroop-colour
word task (SCWT) and the emotional stroop task (EST) while sociodemographic and clinical data (age, gender, disease duration, level of education and anxiety) were controlled. Euthymic BD were defined as stabilised subjects who still presented residual symptoms (DSM-IV-R criteria). The SCWT [6] as well as the French version of EST adapted for BD [7] were, respectively, used for rating attentional and emotional interference. The version of the SCWT used was made up of four different cards: colour-patch naming condition (XXX); word-reading condition (colour words printed in black); the congruent condition (colour-congruent words); and the incongruent condition (colour-incongruent words). The EST is making up of four emotional categories: neutral, paranoid, depressive and manic. Each category include four words: chaise (chair), chaussure (shoe), car (bus), tartine (toast) for the neutral; mensonges (lies), fou (mad), envahi (invaded), hostile
S. Montel (&) Department of Psychology, University Paris 8, 2 rue de la Liberte´, 93200 Saint-Denis, France e-mail: [email protected]
K. M’bailara Department of Psychology, University Bordeaux 2, Bordeaux, France
S. Montel M. Dubois K. M’bailara C. Henry Fondation FondaMental, Creteil, France
K. M’bailara Department of Psychiatry, Charles Perrens Hospital, Bordeaux, France
S. Montel EA 2027, Laboratory of Psychopathology and Neuropsychology, Saint-Denis, France
C. Henry U 995, IMRB, Psychiatry Genetics, INSERM, Creteil, France
J. Scott Institute of Neuroscience, Newcastle University, Newcastle, UK M. Dubois Department of Psychiatry, Sainte Marguerite Hospital, Marseille, France
C. Henry Faculty of Medicine, IFR10, University Paris 12, Creteil, France C. Henry Department of Psychiatry, AP-HP, Henri Mondor-Albert Chenevier Hospitals, Creteil, France
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Eur Arch Psychiatry Clin Neurosci Table 1 Mean colour-naming times (seconds) on the Stroop task Group
Colour-naming condition (SD)
Word-reading condition (SD)
Congruent condition (SD)
Incongruent condition (SD)
Depressed BD (N = 51)
35.46 (10.54)
25.62 (6.09)
27.38 (6.06)
76.16 (38.93)
Manic BD (N = 55)
36.49 (8.86)
25.61 (8.03)
27.37 (7.34)
76.60 (21.85)
Euthymic BD (N = 53)
33.58 (9.40)
26.17 (6.73)
27.87 (6.77)
69.60 (22.03)
MANOVA between groups: R Rao (12,492) = 2.99, p \ .001. Evaluated at covariates: Age, gender, disease duration, level of education and anxiety (HAMA). Post hoc analysis (LSD test): * p \ .05; ** p \ .01 after Bonferroni’s corrections
Table 2 Mean colour-naming times (seconds) for neutral-, paranoid-, manic- and depressive-related words Group/Valence condition
Neutral condition (SD)
Paranoid condition (SD)
Manic condition (SD)
Depressive condition (SD)
Depressed BD (N = 50)
45.40 (14.24)
40.24 (10.79)
43.28 (14.63)
44.43 (13.55)
Manic BD (N = 54)
46.68 (11.83)
44.53 (10.74)
45.75 (10.70)
47.49 (13.07)
Euthymic BD (N = 53)
41.80 (15.34)
41.82 (16.62)
40.58 (15.02)
42.42 (17.06)
MANOVA between groups: R Rao (12,492) = 1.43, p \ .17. Evaluated at covariates: Age, gender, disease duration, level of education and anxiety (HAMA). Post hoc analysis (LSD test): * p \ .05; ** p \ .01 after Bonferroni’s corrections
(hostile) for the paranoid; triste (sad), bas (down), abandonne´ (abandoned), de´prime´ (depressed) for the depressive; and joyeux (happy), content (glad), gai (cheerful), agitation (agitation) for the manic.
though clinically stabilised, euthymic BD subjects continue to treat information in a way that do not differ from manic or depressed BD subjects. If this specific way of treating the information may be a potential predictor of emotional vulnerability, we can foresee how important it is to focus on this issue in order to better prevent relapses.
Results Post hoc analysis (LSD test) showed that in all conditions of the SCWT, no significant differences were observed between BD groups (p [ .05). After Bonferroni’s corrections, the post hoc analysis underlined that in all EST conditions, no significant differences were observed between BD groups (p [ .05). In order to check the validity of our data, we have compared BD patients with a population of students. Logically, the results showed that all patients whatever the stages of their disease were significantly slower than students on all conditions of the SCWT and EST (p \ .01) (Tables 1 and 2).
Discussion Our findings in a population of 159 BD subjects confirmed previous studies with smaller samples of patients. It underlines the importance of attentional and emotional biases in euthymic BD subjects despite their apparent clinical improving, suggesting how it is important to continue to follow these patients carefully even though they are clinically stabilised. These findings seem to sustain the hypothesis that emotional biases reflect a trait abnormality rather than a state abnormality [8, 9]. Definitely, even
123
Acknowledgments We thanks the medical staff of the three French BD expert centres (Mondor/Cheneviers Cre´teil, Charles Perrens Bordeaux and Sainte Marguerite Marseille) for having included the subjects of this study.
References 1. Kerr N, Scott J, Philips ML (2005) Patterns of attentional deficits and emotional bias in bipolar and major depressive disorder. Br J Clin Psychol 44:343–356 2. Torres IJ, BoudreauVG Yatham LN (2007) Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 434:17–26 3. Lex C, Meyer TD, Marquart B, Thau K (2008) No strong evidence for abnormal levels of dysfunctional attitudes, automatic thoughts, and emotional information-processing biases in remitted bipolar I affective disorder. Psychol Psychother 81:1–13 4. Cavanagh JTO, Van Beck M, Muir W, Blackwood DHR (2000) Case control study of neurocognitive function in euthymic patients with bipolar disorder: an association with mania. Br J Psychiatry 180:320–326 5. Van Gorp WG, Altschuler L, Theberge DC, Wilkins J, Dixon W (1998) Cognitive impairments in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study. Arch Gen Psychiatry 1:41–46 6. Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662 7. Besnier N, Kaladjian A, Mazzola-Pomietto P, Adida M, Fakra E, Jeannigros R et al (2008) Se´lection du mate´riel pour l’e´laboration d’un test de Stroop Emotionnel adapte´ aux troubles schizophre´niques et bipolaires. Revue Canadienne de Psychiatrie 53:177–188
Eur Arch Psychiatry Clin Neurosci 8. Martı´nez-Ara´n A, Vieta E, Colom F, Torrent C, Sa´nchez-Moreno J, Reinares M et al (2004) Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 6(3):224–232
9. Besnier N, Kaladjian A, Mazzola-Pomitto P, Adida M, Fakra E, Jeanningros R (2011) Differential responses to emotional interference in paranoid schizophrenia and bipolar mania. Psychopathology 44(1):1–11
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