Facial Expression Recognition Research Of Patients With Bipolar Disorder In Bipolar Mania,Depression,and Euthymia

Objective:In order to explore the characteristics of facial expression recognition function and its associated factors in patients with bipolar disorder in different periods,it is important to examine the differences in accuracy,reaction time,and categorization errors of facial expression recognition in patients with bipolar disorder during bipolar mania,depression,and euthymia.Method:This study contained four groups,comprising a bipolar mania group,a bipolar depression group,a bipolar remission group,and a healthy control group,each with23 individuals,which were balanced and comparable in terms of age,gender,and educational attainment.Among them,patients with bipolar disorder met the diagnostic criteria of the MINI-International Neuropsychiatric Interview(M.I.N.I.).All participants were assessed on the Hamilton Depression Scale and the Young Mania Scale.The negative,neutral,and positive face expression images from the Chinese Emotional Face System were chosen as the facial expressions recognize stimulus materials.The experimental paradigm was a classic learning-recognition task,and a self-designed facial expression recognition software was used to present the experimental paradigm and record the behavioral data;SPSS 27 software was employed for data analysis,and ANOVA was used for measurement data and a chi-square test was used for count data.Results:1.There was no difference in facial expression recognition reaction time in BD patients compared to healthy controls(all P>0.05).Compared to patients with BD in depressive episodes,total facial expression reaction time(P<0.05)and fear expression(P<0.05)reaction time were significantly longer in patients with BD in remission and anger expression reaction time(P<0.05)and fear expression reaction time(P<0.05)were also significantly longer in patients with BD in manic episodes;2.The accuracy of recognition of fearful expressions was lower in BD manic episode patients than in healthy controls(P<0.05);the accuracy of recognition in total facial expressions and happy expressions was lower in BD manic episode patients than in BD remission patients(all P<0.05).There was no statistical difference in the recognition accuracy of angry,sadness,and disgust expressions among the four groups of subjects(all P>0.05);3.There was no statistical difference in the difficulty of categorizing neutral,sad,disgusted and angry expressions between the four groups of subjects(all P>0.05).BD manic episode patients were more likely to identify happy(P<0.05)and fear(P<0.05)expression as a neutral expression than the healthy population and BD remission patients;4.Correlation analysis revealed that total reaction time for facial expression recognition was negatively correlated with HAMD score(r=-0.246,P=0.018)and number of mild manic episodes(r=-0.257,P=0.033)and positively correlated with age(r=0.296,P=0.004),age of first symptom presentation(r=0.350,P=0.003),age of the first medical visit(r=0.337,P=0.005)and number of manic episodes(r=0.299,P=0.012);reaction time of happy expressions was positively correlated with age of the first medical visit(r=0.259,P=0.032)and the number of manic episodes(r=0.243,P=0.044);reaction time for neutral expressions was positively correlated with YMRS score(r=0.249,P=0.017);reaction time for sad expressions was negatively correlated with the number of mild manic episodes(r=-0.270 and P=0.025)and positive in relation to the number of manic episodes(r=0.439,P<0.001);reaction time to angry expressions was negatively correlated with HAMD scores(r=-0.207,P=0.047),with age(r=0.445,P<0.001),age of first symptom(r=0.393,P=0.001),age of the first medical visit(r=0.354,P=0.003)and duration of illness(r=0.263,P=0.029);reaction time for fearful expressions was positively associated with YMRS(r=0.207,P=0.048)and HAMD scores(r=0.301,P=0.004).The overall accuracy of facial expression recognition was negatively correlated with YMRS scores(r=-0.351,P=0.001);the accuracy of happy expressions was negatively correlated with YMRS scores(r=-0.265,P=0.011)and number of hospitalizations(r=-0.247,P=0.040);the accuracy of neutral expressions was negatively correlated with YMRS scores(r=-0.259,P=0.013);the accuracy of sad expressions was negatively correlated with the number of manic episodes(r=-0.286,P=0.017);accuracy of anger expressions was negatively correlated with YMRS score(r=-0.308,P=0.003);accuracy of disgusted expressions was negatively correlated with YMRS score(r=-0.226,P=0.030);accuracy of fear expressions was negatively correlated with YMRS score(r=-0.277,P=0.007),number of suicides(r=-0.382,P=0.020)and number of hospitalizations(r=-0.239,P=0.048).Reaction time of disgusted expressions did not correlate with clinical characteristics,YMRS,and HAMD scores(r=-0.221 to 0.205,all P>0.05).Conclusion:1.Compared to the healthy population,patients with BD manic episodes had significantly lower accuracy in recognizing facial expressions of fear;as well,patients with BD manic episodes had significantly lower accuracy in recognizing all facial expressions and happy expressions than patients with BD in remission;2.The reaction time for facial expression recognition was not significantly different in BD patients compared to the healthy population.However,compared to BD depressive episode patients,the total reaction time and the reaction time for fearful expressions in BD remission patients and the reaction time for angry and fearful expressions in BD manic episode patients were both significantly longer;3.In comparison to the healthy population and BD remission patients,BD manic episode patients were more likely to identify happy and fear expression as a neutral expression.