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Higher order theory of mind in patients with bipolar disorder and schizophrenia/schizoaffective disorder

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Abstract

Some evidence suggests that patients with bipolar disorder (BD) have better Theory of Mind (ToM) skills than patients with schizophrenia/schizoaffective disorder (SCH). However, this difference is not consistently reported across studies, so rather than being global, it may be restricted to specific aspects of ToM. Our primary objective was to compare higher order ToM performance between BD and SCH patients using the Hinting Task (HT). Ninety-four remitted patients were recruited (BD = 47, SCH = 47). Intelligence quotient (IQ), attention, memory, executive functions, and processing speed were also assessed. Patients with BD performed better on the HT than patients with SCH, even when the analysis was adjusted for IQ and neurocognition (p < 0.001, \(\eta_{p}^{2}\) = 0.144). Regression analysis in the total sample showed that a diagnosis of SCH and lower IQ were associated with lower HT scores (R2 = 0.316, p < 0.001). In the BD group, verbal memory and processing speed were the main predictors of HT performance (R2 = 0.344, p < 0.001). In the SCH group, no variable was significant in explaining HT performance. In the context of previous studies that found no significant differences in the most basic aspects of ToM (e.g., understand other people's thoughts/beliefs), our results suggest that differences between the two disorders might be limited to the more challenging aspects (e.g., understand the intended meaning of indirect requests). No causal inferences can be made in this cross-sectional study. However, regression analyses show that whereas in BD patients, ToM functioning would be partially modulated by neurocognitive performance, in SCH patients, it could be largely independent of the well-known neurocognitive impairment.

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Acknowledgements

We would like to thank the staff of the Department of Mental Health of the Parc Taulí University Hospital in Sabadell, Catalonia (Spain), for their assistance in this study, specifically Sara Crivillés, Carmen Massons and Wanda Zabala for their help in patient recruitment, and Joan Carles Oliva for his technical assistance in statistical analysis. We thank the patients who participated in the study for their kind cooperation.

Funding

The work was supported by the Instituto de Salud Carlos III (Madrid, Spain) and the European Regional Development Fund (European Commission) (grant #PI15/01478). The funders played no role in study design, data collection and analysis, manuscript preparation, or decision to publish.

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MJ and NC designed the study and wrote the protocol. GNV, JC and JMC recruited the patients and conducted the clinical assessment. GNV, MVG, MSB and SFG conducted the cognitive assessment. GNV, XG and NC run the statistical analysis. GNV drafted the first version of the manuscript. All authors contributed to data interpretation, critically reviewed the article for important intellectual content, approved the final version for publication, and participated sufficiently in the work to take public responsibility for appropriate portions of the content.

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Correspondence to Narcís Cardoner.

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The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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The study was approved by the Ethics Committee of the Parc Taulí University Hospital in Sabadell, Catalonia (Spain) (#2017/579), and was conducted in accordance with the principles of the Declaration of Helsinki of 1964 and its subsequent amendments.

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All patients gave written informed consent prior to inclusion in the study.

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Navarra-Ventura, G., Vicent-Gil, M., Serra-Blasco, M. et al. Higher order theory of mind in patients with bipolar disorder and schizophrenia/schizoaffective disorder. Eur Arch Psychiatry Clin Neurosci 272, 497–507 (2022). https://doi.org/10.1007/s00406-021-01265-9

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