Table 2.
Overview of theory of mind research in studies assessing patients with bipolar disorder with direct comparison to patients with schizophrenia.
| Study | Samplea | Diagnostic criteria | Participant characteristics | Details of medication supplied | ToM Taskb | Key results |
|---|---|---|---|---|---|---|
| Bazin et al. (104) | N = 15 MAN; N = 12 DEP; N = 15 SCHIZ; N = 12 HC | DSM-IV; stable outpatients | MAN: mean age 36.1 years; 86.7% M/13.3% F DEP: mean age 46.7 years; 50% M/50% F SCHIZ: mean age 35.4 years; 12M/3F HC: mean age 30.1 years; 5M/10F |
MAN/DEP: mood stabilizers, antipsychotics and/or antidepressants SCHIZ: antipsychotics |
The Versailles-Situational Intention Reading task (V-SIR): video excerpts depicting complex real-life scenes social interactions. Also non-verbal comic-strip task (see Sarfati entry below) | MAN impaired relative to HC. Performance of MAN and DEP not distinguishable. Trend toward SCHIZ performing worse than MAN. No effect of group for comic-strip task |
| Caletti et al. (105) | N = 18 EUTH (10 BP1, 8 BP2); N = 30 SCHIZ; N = 18 HC | DSM-IV-TR; outpatients | EUTH: mean age 42.2 years; 22.2% M/77.8% F SCHIZ: mean age 42.5; 80% M/20% F HC: mean age 36.1; 33.3% M/66.7% F |
EUTH: atypical antipsychotic (16/18); typical antipsychotic (3/18); mood stabilizer (18/18); antidepressant (8/18); sedative (5/18) SCHIZ: atypical antipsychotic (19/30); typical antipsychotic (11/30); Mood stabilizer (4/30); antidepressant (2/30); sedative (8/30) |
The Reading the Mind in the Eyes Task; the Faux Pas test | Both SCHIZ and EUTH performed worse than HC. SCHIZ performed worse than EUTH in both tasks |
| Donohoe et al. (16) | N = 132 BP; N = 208 SCHIZ; N = 132 HC | DSM-IV; outpatients | BP: mean age 44.8 years; 54.5% M/45.5% F SCHIZ: mean age 41.1 years; 72.3% M/27.7% F HC: mean age 37.5 years; 39.9% M/60.1% F |
BP: 269.8 mg chlorpromazine equivalents SCHIZ: 555.9 mg chlorpromazine equivalents |
The Reading the Mind in the Eyes Task; the Hinting Task | BP impaired on Reading the Mind in the Eyes Task; performance comparable to SCHIZ. More subtle impairment in BP relative to SCHIZ for Hinting Task |
| Doody et al. (106) | N = 12 AFF (10 MDD/2 DEP); N = 28 SCHIZ. No HC | DSM-III-R. BP: inpatients; SCHIZ outpatients | AFF: mean age 42.3 years, 8.3% M/91.7% F SCHIZ: mean age 46.3 years; 60.7% M/39.3% F HC: mean age 20.4 years; 45% M/55% F |
Not specified | The Sally-Anne Task (first-order ToM); the Ice-Cream Van Test (second-order ToM) | Both SCHIZ and AFF performed Sally-Anne Task normally. SCHIZ impaired on Ice-Cream Van Test, but not AFF |
| Guastella et al. (90) | N = 40 BP; N = 23 SCHIZ/FEP/SAD. No HC | DSM-IV-TR; stable outpatients | BP: mean age 21.7 years; 27% M/73% F SCHIZ/FEP/SAD: mean age 22.8 years; 83% M/17% F |
BP: antipsychotic (24/40); antidepressant (24/40); mood stabilizer (16/40) SCHIZ/FEP/SAD: antipsychotic (20/23); antidepressant (3/23); mood stabilizer (1/23) |
The Reading the Mind in the Eyes Task | SCHIZ/FEP/SAD more impaired than BP. Across diagnostic groups, performance correlated with psychotic but not affective symptoms |
| Lahera et al. (107) | N = 46 BP; N = 49 SCHIZ; N = 50 HC | DSM-IV-TR; stable outpatients | BP: mean age 38.6 years; 37% M/63% F SCHIZ: mean age 40.4 years; 57.1% M/42.9% F HC: mean age 43.3 years; 42% M/58% F |
BP and SCHIZ: receiving unspecified pharmacological treatment | The Hinting Task | SCHIZ performed worse than BP and HC. BP also worse than HC |
| Lee et al. (108) | N = 68 BP (52 EUTH); N = 38 SCHIZ; N = HC | DSM-IV; stable outpatients | BP: mean age 43.9 years; 54.4% M/45.6% F SCHIZ: mean age 44.7 years; 55.3% M/44.7% F HC: mean age 41.4 years; 55.6% M/44.4% F |
BP: antipsychotic (41/68); lithium (13/68) SCHIZ: antipsychotic (38/38) |
The Awareness of Social Inference Test | On lie and sarcasm sub-scales, BP not impaired relative to HC, but SCHIZ performed better than BP and SCHIZ |
| Marjoram et al. (109) | N = 15 AFF (7 BP, 8 MDD); N = 15 SCHIZ; N = 15 HC | DSM-IV; mixed inpatients and outpatients | AFF: mean age 41.7 years; 40% M/60% F SCHIZ: mean age 28.3 years; 86.7% M/13.3% F HC: mean age 34.3 years; 66.7% M/33.3% F |
AFF: antidepressant only (9/15); antidepressant and typical antipsychotic (5/15); antidepressant and atypical antipsychotic (1/15) SCHIZ: typical antipsychotic only (4/15); typical antipsychotic and anticholinergic (5/15); atypical antipsychotic only (5/15); atypical antipsychotic and anticholinergic |
The Hinting Task | BP not impaired relative to HC. SCHIZ worse than HC and AFF. Across diagnostic groups, performance correlated with psychotic (delusions and hallucinations) but not negative symptoms |
| Maróthi and Kéri (110) | N = 23 BP; N = 28 SCHIZ; N = 29 HC. | NB, children of mothers with specified DSM-IV diagnosis | BP: mean age 10.8 years; 78.3% M/21.7% F SCHIZ: mean age 10.6 years; 71.4% M/28.5% F HC: mean age 10.6 years; 55.2% M/44.8% F |
N/A | The Reading the Mind in the Eyes Task | SCHIZ impaired, but BP no different to HC |
| Pawlby et al. (111) | N = 23 DEP; N = 12 MAN; N = 15 SCHIZ; N = 49 HC | DSM-IV; inpatients on mother and baby unit | DEP: mean age 32.2 years; 100% F MAN: mean age 29.0 years; 100% F SCHIZ: mean age 30.5 years; 100% F HC: mean age 30.5 years; 100% F |
Not specified, but mothers undergoing current treatment for a psychiatric condition excluded | Five-minute video recordings of unstructured play session with baby coded | Relative to HD, DEP less likely to comment on baby’s mental state. SCHIZ interactional behavior no different to HC |
| Rossell and Van Rheenen (112) | N = 28 MAN; N = 30 SCHIZ; N = 29 HC | DSM-IV; mixed inpatients and outpatients | MAN: mean age 38.3 years; 40% M/60% F SCHIZ: mean age 36.5 years; 63.3% M/36.7% F HC: mean age 35.9 years; 65.5% M/34.5% F |
MAN: mood stabilizer (5/28); atypical antipsychotic (5/28); typical antipsychotic (1/28); mood stabilizer and atypical antipsychotic (8/28); mood stabilizer and antidepressant (4/28); typical antipsychotic and atypical antipsychotic and anticonvulsant (1/28); atypical antipsychotic and antidepressant (1/28); anticonvulsant and antidepressant (1/28); no medication (3/28) SCHIZ: atypical antipsychotics (21/30); typical antipsychotics (7/30); no medication (2/30) |
The Strange Stories Task | Both patient groups equally impaired. Reduced ToM performance correlated with delusion severity in MAN only |
| Rowland et al. (113) | N = 33 BP1; N = 56 SCHIZ; N = 58 HC | DSM-IV; outpatients | BP1: mean age 40.7 years; 54.3% M/45.7% F SCHIZ: mean age 44.6 years; 57.1% M/42.9% F HC: mean age 33.9%; 50% M/50% F |
BP1: antipsychotic (2/33); mood stabilizer (7/33); antipsychotic and mood stabilizer (10/33); antidepressant and mood stabilizer (7/33); antipsychotic and antidepressant and mood stabilizer (2/33) SCHIZ: antipsychotic (18/56); antipsychotic and antidepressant (18/56); antipsychotic and mood stabilizer (5/56); antipsychotic and antidepressant and mood stabilizer (7/56) |
The Awareness of Social Inference Test | Both BP1 and SCHIZ impaired, SCHIZ worse than BP1 |
| Sarfati and Hardy-Bayle (114) | N = 10 MAN; N = 15 SCHIZ with disorganization; N = 10 SCHIZ without disorganization; N = 15 HC | DSM-IV; inpatients | MAN: mean age 33.9 years; 60% M/40% F SCHIZdis: mean age 35.7 years; 33.3% M/66.7% F SCHIZnodis: mean age 29.2 years; 20% M/80% F HC: mean age 28.6 years; 33.3% M/66.7% F |
MAN: antipsychotic (9/10) SCHIZ: antipsychotic (24/25) No difference in dose between groups |
Custom-made comic-strip task; participants select card (from four) most likely to be last cartoon drawing | No impairments in MAN. SCHIZ with disorganization performed worst |
| Thaler et al. (115) | N = 24 BP1 with psychosis; N = 24 BP1 without psychosis; N = 30 SCHIZ; N = 24 HC | DSM-IV; stable patients, but inpatients vs. outpatients not specified | BP1 with psychosis: mean age 37.6 years; 25%M/75% F BP1 without psychosis: mean age 34.1 years; 42% M/58% F |
BP1 with psychosis: antipsychotic (14/24); anticonvulsant (13/24); antidepressant (10/24); mood stabilizer (5/24) BP1 without psychosis: antipsychotic (8/24); anticonvulsant (8/24); antidepressant (10/24); mood stabilizer (2/24) |
The Reading the Mind in the Eyes Task; the Hinting Task | All clinical groups performed worse than HC, but at similar level to one another |
| SCHIZ: mean age 47.9 years; 66% M/33% F HC: mean age 36.1 years; 46% M/54% F |
SCHIZ: antipsychotic (29/30); anticonvulsant (19/30); antidepressant (13/30); mood stabilizer (2/30) | |||||
| Thaler et al. (116) | N = 24 BP with psychosis; N = 24 BP without psychosis; N = 30 SCHIZ. No HC. | DSM-IV; stable patients, but inpatients vs. outpatients not specified. | BP1 with psychosis: mean age 37.6 years; 25%M/75% F BP1 without psychosis: mean age 34.1 years; 42% M/58% F SCHIZ: mean age 47.9 years; 66% M/33% F |
BP with psychosis: antipsychotic (8/24); anticonvulsant (8/24); antidepressant (10/24); mood stabilizer (2/24) BP without psychosis: antipsychotic (14/24); anticonvulsant (13/24); antidepressant (10/24); mood stabilizer (5/24) SCHIZ: antipsychotic (29/30); anticonvulsant (19/30); antidepressant (13/30); mood stabilizer (2/30) |
The Reading the Mind in the Eyes Task; the Hinting Task. | ToM only predicted functional capacity for SCHIZ. |
AFF, affective disorder; BP, bipolar disorder; BP1, bipolar I disorder; BP2, bipolar II disorder; DEP, depressed bipolar patients, DYS, Dysthymia; EUTH, euthymic bipolar patients; FEP, First-episode Psychosis; HC, healthy adult controls, MAN, manic bipolar patients, SAD, Schizoaffective Disorder; SCHIZ, patients with schizophrenia.
aPatient groups outside of the bipolar disorders and the psychoses not included.
bNon-theory of mind tasks not included.