The relationship between residual mood symptoms in remitted bipolar-i patients and executive functions, emotion recognition from faces and theory of mind

Objective: Bipolar Disorder is a mood disorder with a genetic basis, characterized by recurrent periods of exacerbation and remission, causing loss of ability and decreased quality of life. (1) Residual mood symptoms may be observed in patients diagnosed with Bipolar Disorder while in remission. Residual symptoms are important in terms of predicting the recurrence of the disease. Residual symptoms in Bipolar Disorder have been addressed in various studies in the fields of cognitive domain, functionality domain and mood level. In our study, we aimed to investigate the relationship between residual mood symptoms and executive functions, emotion recognition from faces and ToM functions. Materials and Method: Our study was a two-center, cross-sectional study. Forty- seven randomly selected patients with Bipolar Disorder Type 1 who were over 18 years of age, who applied to the Psychiatry outpatient clinic of our hospital, whose verbal and written informed consent was obtained, and 27 healthy subjects randomly selected among the hospital staff and their relatives who accepted the study were included in the study. The groups were matched in terms of education. Sociodemographic and Clinical Interview Form, General Assessment of Functioning Scale, Clinical Global Monitoring Scale, Hamilton Depression Scale, Young Mania Scale, BPRS, Reading Mind Through Eyes Test, September Nine Theory of Mind Scale, Ekman Facial Emotion Recognition Scale, Winsconsin Card Matching Test and Stroop Test were administered to the participants. Results: Bipolar disorder patients had significantly lower scores in terms of executive functions, facial emotion recognition function and ToM skills compared to healthy controls. While 46.8% of the patients had residual depressive symptoms, 10.6% had residual manic symptoms. When BP patients with and without residual mood symptoms were compared, no difference was found in terms of executive functions and emotion recognition function from faces, while the scores of the BP group with residual symptons were lower in terms of level 1 theory of mind. While a decreased Ekman total score predicted being in the bipolar group, an incresed number of depressive episodes predicted being in the BP group with residual symptoms. And as depression scores decreased and empathic understanding skill- which was one of the ToM skills- improved, the level of functionality increased. Conclusion: Executive functions, facial emotion recognition and ToM skills in BP patients in remission period can not reach the level of healthy controls. In addition, ToM functions were negatively affected in BP patients with residual symptoms. Treatment of residual symptoms in BP patients in remission period may contribute positively to the improvement of ToM functions and general functioning. Keywords: Bipolar Disorder, residual mood symptoms, executive functions, emotion recognition from faces, ToM