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Cited by 278Neural and Behavioral Psychology StudiesAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesFace Recognition and Perception

Systematic review of the neural basis of social cognition in patients with mood disorders

Open access
Cusi, Andrée M., Nazarov, Anthony, Holshausen, Katherine, MacQueen, Glenda M., McKinnon, Margaret C.·2012·Journal of Psychiatry and Neuroscience
DOI 10.1503/jpn.100179PMC PMC3341408
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Abstract

Background: This review integrates neuroimaging studies of 2 domains of social cognition — emotion comprehension and theory of mind (ToM) — in patients with major depressive disorder and bipolar disorder. The influence of key clinical and method variables on patterns of neural activation during social cognitive processing is also examined. Methods: Studies were identified using PsycINFO and PubMed (January 1967 to May 2011). The search terms were “fMRI,” “emotion comprehension,” “emotion perception,” “affect comprehension,” “affect perception,” “facial expression,” “prosody,” “theory of mind,” “mentalizing” and “empathy” in combination with “major depressive disorder,” “bipolar disorder,” “major depression,” “unipolar depression,” “clinical depression” and “mania.” Results: Taken together, neuroimaging studies of social cognition in patients with mood disorders reveal enhanced activation in limbic and emotion-related structures and attenuated activity within frontal regions associated with emotion regulation and higher cognitive functions. These results reveal an overall lack of inhibition by higher-order cognitive structures on limbic and emotion-related structures during social cognitive processing in patients with mood disorders. Critically, key variables, including illness burden, symptom severity, comorbidity, medication status and cognitive load may moderate this pattern of neural activation. Limitations: Studies that did not include control tasks or a comparator group were included in this review. Conclusion: Further work is needed to examine the contribution of key moderator variables and to further elucidate the neural networks underlying altered social cognition in patients with mood disorders. The neural networks underlying higher-order social cognitive processes, including empathy, remain unexplored in patients with mood disorders.

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  • Findingown data

    Sixty-five studies met the review's criteria and were included.

    “A total of 65 studies met the appropriate criteria and were included in this review.”
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  • Findingnone given

    Domains of social cognition such as empathy and moral reasoning have not been investigated in patients with mood disorders.

    “Other domains of social cognition, including empathy and moral reasoning, remain unexplored in these patients.”
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  • Findingcitation

    Some studies find a negative bias in facial expression recognition and detection in acutely depressed patients, including identifying neutral faces as sad in those with moderate to severe symptoms compared with healthy controls.

    “Other studies have reported evidence of a negative bias during facial expression recognition and detection tasks, 138,140,149-156 including a tendency to identify neutral faces as sad in patients with moderate to severe depressive symptoms compared with healthy controls.[157][158][159]”
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    • Rests on an assumption: The reviewed studies are sufficiently comparable in methods, tasks, and samples to be combined into a single pattern of neural activation.
  • Findingcitation

    A small number of studies show reduced amygdala activation in response to positive stimuli in MDD.

    “By contrast, reduced amygdala activation in response to positive stimuli has been demonstrated across a small number of studies.71,99”
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    • Rests on an assumption: The reviewed studies are sufficiently comparable in methods, tasks, and samples to be combined into a single pattern of neural activation.
    • Rests on an assumption: fMRI activation in the brain regions examined is a valid index of social cognitive processing.
  • Findingcitation

    Depression severity correlates negatively with activation in fusiform gyrus, anterior cingulate cortex, and amygdala in response to happy and negative faces.

    “For example, level of depression severity has been shown to correlate negatively with the extent of activation in the fusiform gyrus, 43,47 anterior cingulate cortex 48 and amygdala 71,74 in response to happy and negative faces.62”
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    • Rests on an assumption: The reviewed studies are sufficiently comparable in methods, tasks, and samples to be combined into a single pattern of neural activation.
    • Rests on an assumption: fMRI activation in the brain regions examined is a valid index of social cognitive processing.
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    Findingown data

    Across the reviewed neuroimaging studies, patients with mood disorders show greater activation in limbic and emotion-related regions and weaker activity in frontal regions tied to emotion regulation and higher cognitive functions during social cognition tasks.

    “Taken together, neuroimaging studies of social cognition in patients with mood disorders reveal enhanced activation in limbic and emotion-related structures and attenuated activity within frontal regions associated with emotion regulation and higher cognitive functions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The reviewed studies are sufficiently comparable in methods, tasks, and samples to be combined into a single pattern of neural activation.
    • Rests on an assumption: fMRI activation in the brain regions examined is a valid index of social cognitive processing.

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    Findingnone given

    The neural networks supporting higher-order social cognitive processes such as empathy have not been studied in patients with mood disorders.

    “The neural networks under lying higher-order social cognitive processes, including empathy, remain unexplored in patients with mood disorders.”
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    Findingcitation

    The same group found that amygdala-DLPFC connectivity was significantly associated with illness severity, with reduced connectivity linked to a more severe and pervasive course.

    “However, the same study group found that amygdala-DLPFC connectivity was significantly associated with illness severity, indicating that patients with MDD with reduced connectivity between these regions had a more pervasive and severe course of illness.58”
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    Findingcitation

    Victor and colleagues found that remitted MDD patients had exaggerated amygdala responses to masked sad faces and no amygdala response to masked happy faces compared with controls.

    “A recent study by Victor and colleagues, 73 however, found that remitted patients with MDD showed exaggerated responses in the amygdala to masked sad faces and a lack of amygdalar response to masked happy faces compared with controls.”
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    Findingcitation

    Fu and colleagues found reduced activation in subcortical, limbic, and extrastriate regions in acutely ill MDD patients, which was attenuated after fluoxetine treatment.

    “For example, a recent study by Fu and colleagues 43 examined responding to positive stimuli in patients with MDD compared with matched controls and found reduced activation in subcortical (basal ganglia), limbic (hippocampus) and extrastriate regions among acutely ill patients with MDD; this pattern was attenuated following treatment with fluoxetine.”
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    Findingcitation

    Norbury and colleagues found elevated DLPFC activation to fearful faces in euthymic MDD patients compared with controls, with no difference in amygdala activation.

    “Preliminary findings by Norbury and colleagues 68 demonstrate elevated DLPFC activation in response to fearful faces in euthymic patients compared with controls.Levels of amygdala activation did not differ between patients and matched controls during the presentation of fearful faces.”
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    • Rests on an assumption: fMRI activation in the brain regions examined is a valid index of social cognitive processing.

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    Findingcitation

    Keedwell and colleagues found that severely depressed patients had increased visual cortex responses to sad faces and reduced responses to happy faces early in antidepressant treatment, and these patterns reversed after continued treatment and clinical improvement.

    “Similarly, Keedwell and colleagues 61 found that severely depressed patients showed increased visual cortex responses to sad faces and reduced neural response in these same regions to happy faces in the early stages of antidepressant treatment.Following continued antidepressant therapy and clinical improvement, these patterns were reversed.”
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    Findingcitation

    Neuroimaging studies in children and adolescents with MDD show heightened amygdala and OFC activation in response to emotional facial expressions, though conflicting findings exist.

    “Neuroimaging studies conducted in children and adolescents with MDD also show heightened activation in the amygdala 56,60,74 and OFC 74 in response to emotional facial expressions (for conflicting findings, see Thomas and colleagues 42 ).”
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    Findingnone given

    To date, few studies have included separate groups with MDD and with bipolar disorder and have directly compared patterns of neural activation between these groups; most studies included relatively small samples of patients with MDD or bipolar disorder.

    “to date, few studies have included separate groups with MDD and with bipolar disorder and have directly compared patterns of neural activation between these groups; most studies included relatively small samples of patients with MDD or bipolar disorder.”
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    Findingcitation

    On average, neural activity is most commonly decreased in the DLPFC and increased in the left amygdala, the fusiform gyrus and the inferior frontal gyrus in patients with mood disorders.

    “On average, neural activityis most commonly decreased in the DLPFC 30,59,68,76 and increased in the left amygdala, 55,74,76,79,98,99 the fusiform gyrus 82,93,98 and the inferior frontal gyrus 82,90,98 in patients with mood disorders.”
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    Findingnone given

    Studies of the neural correlates of theory of mind processing in mood disorders have been limited to bipolar disorder, with two preliminary investigations in euthymic bipolar patients.

    “To date, studies examining the neural correlates of ToM processing in patients with mood disorders have been confined to investigations of patients with bipolar disorder; 2 prelim inary investigations have examined euthymic patients with bipolar disorder.”
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    Findingnone given

    Findings on the impact of symptom severity among actively ill patients have been inconsistent and, on average, have not revealed a relation between severity of active illness and patterns of neural activation.

    “Findings concerning the impact of symptom severity among actively ill patients have been less consistent and, on average, have failed to reveal a relation between severity of active illness and patterns of neural activation”
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    Findingnone given

    The effect of illness burden and age on neuronal activation during theory of mind performance in patients with mood disorders remains underexplored.

    “The effect of illness burden and age on neuronal activation during ToM performance in patients with mood disorders remains an underexplored area of research.”
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    Interpretationreasoning

    Because bipolar patients more often have depression, their bipolar depression may be misdiagnosed as MDD.

    “which may result in the misdiag nosis of bipolar depression as MDD, 37,38”
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    Premisecitation

    Theoretical models propose that prefrontal regions including lateral prefrontal cortex, mPFC, OFC, and dorsal anterior cingulate modulate subcortical and limbic activity.

    “These models posit that prefrontal regions, such as the lateral prefrontal cortex, mPFC, OFC and dorsal anterior cingulate, modulate activity in subcortical (e.g., amygdala) and limbic regions.106,113”
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    Premisecitation

    Illness burden, illness state, medication status, age, cognitive load, and comorbidity are thought to moderate cognitive performance in patients with mood disorders.

    “Where possible, neuroimaging findings involving patients with mood disorders are contextualized based on several key variables, including illness burden (e.g., number of affective episodes), illness state (e.g., active v. remitted), medication status, age, cognitive load and comorbidity, thought to moderate cognitive performance in patients with mood disorders.29”
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    Interpretationnone given

    Illness burden, symptom severity, comorbidity, medication status, and cognitive load may moderate the neural activation pattern seen during social cognition in mood disorders.

    “Critically, key variables, including illness burden, symptom severity, comorbidity, medication status and cognitive load may moderate this pattern of neural activation.”
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    • Rests on an assumption: The reviewed studies are sufficiently comparable in methods, tasks, and samples to be combined into a single pattern of neural activation.

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    Premisecitation

    Theoretical models and empirical evidence indicate that recognizing another person's emotion is important for theory of mind.

    “For example, theoretical models propose that the ability to recognize another's emotion is critical to ToM, 8 with empirical evidence supporting this view.”
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    Study design and conductreasoning

    Because few papers examined theory of mind in mood disorders, the review used a liberal inclusion approach for that domain.

    “Given the dearth of papers investigating the domains of ToM in patients with mood disorders, we adopted a liberal approach to the inclusion of relevant articles in these domains.”
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    Interpretationreasoning

    Studies that failed to detect a relation between depression level and neural response likely had limited sample sizes and included patients with varying depression levels.

    “These studies were likely not able to detect a relation between this illness variable and neuronal response because of their limited sample sizes and the inclusion of patients with varying levels of depression.”
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    Interpretationreasoning

    During active depression, patients show a processing bias with increased attention to and recognition of negative faces, and may mislabel positive faces as sad and overestimate negative emotion in faces.

    “Overall, these studies point toward a processing bias involving enhanced attention to and recognition of negatively valenced faces during active states of depression that may be accompanied by a tendency to mislabel positively valenced faces as sad and to misjudge (i.e., amplify) the amount of negative emotion conveyed in faces.”
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    Premisecitation

    Recognizing facial expressions is essential for intact interpersonal functioning.

    “Given the ubiquitous nature of facial expressions, the ability to recognize facial expressions is crucial for intact interpersonal functioning.123”
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    Interpretationreasoning

    A null finding of no neural activation differences in a heterogeneous depression sample may have resulted from including first-episode patients.

    “it is possible that this null finding stemmed from the inclusion of first-episode patients in the mood disorders group.”
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    Premisecitation

    Neural response to sad faces was modulated by level of attentional processing: implicit processing was associated with enhanced activation in the amygdala, anterior cingulate cortex, lateral temporal cortex and mPFC, whereas explicit processing was associated with attenuation of these same regions.

    “whereas implicit processing of sad faces was associated with enhanced activation in the amygdala, anterior cingulate cortex, lateral temporal cortex and mPFC, explicit processing of sad faces was associated with attenuation of these same regions.”
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    Premisecitation

    A contrasting pattern of reduced amygdala and subgenual cingulate activation in response to sad but not happy facial expressions has been reported in manic patients, in conjunction with a mood-congruent deficit in recognizing sad facial affect.

    “a contrasting pattern of reduced amygdala and subgenual cingulate activation in response to sad but not happy facial expressions has been reported in conjunction with a mood-congruent deficit in recognizing sad facial affect.”
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    Premisecitation

    Depressed patients with bipolar disorder have shown elevated amygdala activity and attenuated responses in the OFC and DLPFC to neutral and negative faces.

    “Depressed patients with bipolar disorder have also shown elevated activity in the amygdala 102 and attenuated responses in the OFC and DLPFC to neutral and negative (e.g., angry, fearful, sad) faces.”
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    In euthymic patients with bipolar disorder compared with healthy controls, studies have demonstrated increased hippocampal activity along with enhanced amygdala activity and diminished DLPFC activation when viewing fearful faces.

    “In euthymic patients with bipolar disorder compared with healthy controls, studies have demonstrated increased hippocampal activity 82 along with enhanced amygdala activity 76 and diminished DLPFC activation when viewing fearful faces 76,82,86”
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    Interpretationcitation

    Conventional antidepressants and novel treatments may reduce hyperactive responses to negative stimuli and increase the salience of positive stimuli.

    “Overall, these results suggest that conventional antidepressants and novel treatments may dampen hyperactive responses to negative stimuli and enhance the salience of positive stimuli.”
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    Premisecitation

    Studies of patients with bipolar disorder in a depressed phase reveal a mood-congruent bias in emotion perception tasks, including difficulty labelling happy faces and a tendency to misinterpret neutral facial stimuli as sad and happy faces as angry.

    “studies examining patients with bipolar disorder in a depressed phase of illness reveal a mood congruent bias in emotion perception tasks, including difficulties labelling happy faces 97,102 and a tendency to misinterpret neutral facial stimuli as sad 144,183 and happy faces as angry.”
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    Premisecitation

    Foland et al. found reduced functional connectivity between the ventrolateral prefrontal cortex and the amygdala during a facial emotional labelling task in bipolar patients, consistent with reduced inhibitory frontal control over amygdala reactivity.

    “Foland and colleagues 84 also found reduced functional connectivity between the ventrolateral prefrontal cortex and the amygdala during a facial emotional labelling task in line with reduced inhibitory frontal control over amygdala reactivity.”
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    It is plausible that the discrepant findings in subcortical activations in both actively ill and euthymic patients may stem from failure to account for comorbid disorders.

    “It is plausible that the discrepant findings in subcortical activations in both actively ill and euthymic patients may stem from failure to account for comorbid disorders.”
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    Interpretationreasoning

    Severity of depressive or manic symptoms may influence neural response to affective facial stimuli in patients with bipolar disorder, although the evidence is inconsistent.

    “Severity of depressive or manic symptoms may influence neural response to affective facial stimuli in patients with bipolar disorder, although the evidence is inconsistent.”
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    Premisecitation

    Greater left amygdala-OFC connectivity in response to sad faces and reduced bilateral connectivity between these regions in response to happy faces has been reported in depressed but not euthymic patients with bipolar disorder.

    “Evidence of greater left amygdala-OFC connectivity in response to sad faces and reduced bilateral connectivity between these same regions in response to happy faces has also been reported in depressed but not euthymic patients with bipolar disorder.”
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    In a sample of bipolar patients with mixed illness states, amygdala activity in response to happy faces was greater in unmedicated patients but lower in medicated patients compared with controls.

    “In a sample of patients with bipolar disorder with mixed illness states, amygdala activity in response to happy faces was greater in unmedicated patients but lower in medicated patients compared with controls.”
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    Premisecitation

    Emotion-specific impairments in identifying sadness, disgust and fear, as well as a more generalized facial emotion recognition deficit, have been reported in actively manic patients.

    “emotionspecific impairments in the identification of sadness, 77 disgust 181 and fear 181 as well as a more generalized deficit in facial emotion recognition have been reported in actively manic patients.”
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    Interpretationcitation

    These findings indicate that antidepressant treatment improves the negative bias toward sad faces and produces a positive bias toward happy faces.

    “These findings indicate that the negative bias toward sad faces improves and a positive bias toward happy faces emerges with antidepressant treatment.”
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    Premisecitation

    Recent work has demonstrated significant associations between an earlier illness onset and both amygdala hyperactivity and decreased activity within the DLPFC in bipolar disorder.

    “Recent work has demonstrated significant associations between an earlier illness onset and both amygdala hyperactivity 86 and decreased activity within the DLPFC.”
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    Premisecitation

    Thomas et al. found that during passive viewing of fearful versus neutral faces, MDD patients showed right amygdala hypoactivation while patients with heterogeneous anxiety disorders showed hyperactivation of that region.

    “Thomas and colleagues 42 found that during passive viewing of fearful versus neural faces, patients with MDD showed hypoactivation of the right amygdala, whereas hyperactivation of this region was observed in patients with heterogeneous anxiety disorders (generalized anxiety disorder and/or panic disorder).”
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    Premisenone given

    Amygdala hyperactivity in response to negative facial stimuli has been demonstrated across numerous studies of MDD patients, and a small number of studies indicate hypoactivity in this region in response to positive facial stimuli.

    “Hyperactivity in the amygdala in response to negative facial stimuli has been demonstrated across numerous studies of patients with MDD, and a small number of studies indicate hypoactivity in this region in response to positive facial stimuli.”
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    Premisecitation

    The posterior superior temporal sulcus, involved in biological motion perception and socially relevant gaze cues, and the adjacent temporoparietal junction, involved in attributing beliefs to others, are critical for theory of mind.

    “Moreover, neuroimaging evidence also implicates the posterior superior temporal sulcus, which is involved in biological motion perception, 223,224 including socially relevant directional cues such as the eye gaze of others, 225,226 and the adjacent temporoparietal junction, which is involved in the attribution of beliefs to others, 227 as critical for ToM ability.7,228,229”
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    Interpretationreasoning

    Because neuroimaging studies are inherently under temporal constraint, a decreased number of trials may be used to shorten the scan duration, consequently decreasing the statistical power during between- and within-group comparisons.

    “as neuroimaging studies are inherently under temporal constraint, a decreased number of trials may be used to shorten the scan duration, consequently decreasing the statistical power during between-and within-group comparisons.”
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    Interpretationcitation

    Although patients with mood disorders may perform comparably to controls on behavioural measures, the neural processing of that information is extensively altered.

    “although patients with mood disorders may perform comparably to controls on behavioural measures, the neural processing of that information is extensively altered”
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    Premisecitation

    During passive viewing paradigms, patients with bipolar disorder and those with MDD demonstrate hypoactivity in the DLPFC and OFC and hyperactivity in the amygdala and anterior cingulate (subgenual and pregenual), although evidence is less consistent for subcortical regions such as the amygdala and paralimbic regions.

    “During passive viewing paradigms, patients with bipolar disorder and those with MDD demonstrate hypoactivity in the DLPFC and OFC and hyperactivity in the amygdala and anterior cingulate (subgenual and pregenual), although evidence is less consistent for subcortical regions such as the amygdala and paralimbic regions.”
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    Recognition of emotional prosody is thought to draw on multiple processing resources mediated by a complex neural network found primarily in the right superior temporal region.

    “Recognition of emotional prosody is thought to draw on multiple processing resources mediated by a complex neural network found primarily in the right superior temporal region.”
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    Interpretationreasoning

    Taken together, the different paradigms tend to converge on a pattern of decreased activation in prefrontal cortical regions associated with emotion regulation and cognitive control (e.g., DLPFC) and increased activation in prefrontal, limbic and subcortical regions associated with affective processing.

    “Taken together, these different paradigms tend to converge on a pattern of decreased activation in prefrontal cortical regions associated with emotion regulation and cognitive control (e.g., DLPFC) and increased activation in prefrontal, limbic and subcortical regions associated with affective processing.”
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  • May combine two claims.

    Interpretationcitation

    Overall, these data suggest that patients with bipolar depression may be biased toward negative mood-congruent facial expressions, whereas those with unipolar depression have an attentional bias away from positive expressions.

    “Overall, these data suggest that patients with bipolar depression may be biased toward negative mood-congruent facial expressions, whereas those with unipolar depression have an attentional bias away from positive expressions.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [102] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    Relatively small sample sizes and variable emotion processing paradigms employed in these studies may also have contributed to discrepant findings observed in subcortical regions such as the amygdala across mood states.

    “Rela tively small sample sizes and variable emotion processing paradigms employed in these studies may also have contributed to discrepant findings observed in subcortical regions, such as the amygdala, across mood states.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisenone given

    A nascent literature suggests that youth with major depressive disorder and bipolar disorder show impaired performance on tests of facial emotion processing, with early alterations in the neuronal circuitry underlying social cognitive processing.

    “A nascent literature suggests that youth with MDD and with bipolar disorder show impaired performance on tests of facial emotion processing, a finding underscored by studies demonstrating early alterations in the neuronal circuitry under lying social cognitive processing in these samples.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The theory of mind tasks used in the reviewed studies validly measure theory of mind ability.

  • May combine two claims.

    Interpretationreasoning

    Taken together, the results indicate an overall lack of inhibition by higher-order cognitive structures on limbic and emotion-related structures during social cognitive processing in mood disorders, consistent across tasks including facial emotion recognition, prosody recognition and theory of mind.

    “Taken together, these results point toward an overall lack of inhibition by higher-order cognitive structures on limbic and emotion-related structures during social cognitive processing in patients with mood disorders that is consistent across different social cognitive tasks, including recognition of emotion in faces and prosody, as well as ToM.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The functional neuroimaging measures used in the reviewed studies validly index the neural activity underlying social cognitive processing.
    • Rests on an assumption: The core theory of mind network identified in healthy individuals applies to patients with mood disorders.

  • May combine two claims.

    Interpretationcitation

    Patients with bipolar disorder do not show normalization of function despite recovery, with exceptions following treatment with a mood stabilizer.

    “patients with bipolar disorder do not show this normalization of function despite recovery (for exceptions following treatment with a mood stabilizer, see Hassel and colleagues 86 and Robinson and colleagues 90”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [86] source

      Not checked in the free run.

    • cites [90] source

      Not checked in the free run.

    • Rests on an assumption: The functional neuroimaging measures used in the reviewed studies validly index the neural activity underlying social cognitive processing.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Social cognitive tasks that place high demands on cognitive processing resources may engage higher-order cognitive regions more than tasks with lower-order processing demands.

    “social cognitive tasks that place high demands on cognitive processing resources (e.g., executive functioning, working memory) may engage higherorder cognitive regions to a greater extent than those social cognitive tasks having lower-order processing demands”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Including heterogeneous samples of patients with comorbid diagnoses, particularly anxiety disorders, may limit the interpretability of findings.

    “the inclusion of heterogeneous samples of patients with comorbid diag noses, particularly anxiety disorders, may limit the interpretability of findings.”
    Quote in the paperNot a substantial claim
52 of 52

  • The paper relies on this without support.

    The reviewed studies are sufficiently comparable in methods, tasks, and samples to be combined into a single pattern of neural activation.

    “Taken together, neuroimaging studies of social cognition in patients with mood disorders reveal enhanced activation in limbic and emotion-related structures and attenuated activity within frontal regions associated with emotion regulation and higher cognitive functions.”

  • The paper relies on this without support.

    fMRI activation in the brain regions examined is a valid index of social cognitive processing.

    “Given that most studies using neuroimaging technology to examine the neural correlates of social cognitive processing in patients with mood disorders rely on functional magnetic resonance imaging (fMRI), we focused our review on this paradigm.”

  • The paper relies on this without support.

    The included studies without control tasks or comparator groups still provide valid evidence for the review's conclusions.

    “Studies that did not include control tasks or a comparator group were included in this review.”

  • The paper relies on this without support.

    The functional neuroimaging measures used in the reviewed studies validly index the neural activity underlying social cognitive processing.

    “Alterations in social cognitive functioning in patients with mood disorders are likely related to alterations in patterns of neuronal activation observed during performance of these tasks.”

  • The paper relies on this without support.

    The theory of mind tasks used in the reviewed studies validly measure theory of mind ability.

    “A small number of studies conducted in actively depressed patients with MDD suggest that these patients show impairments on ToM tasks that involve decoding mental states from available information, such as facial expressions, tone of voice, gestures and reasoning 232-234”

  • The paper relies on this without support.

    The core theory of mind network identified in healthy individuals applies to patients with mood disorders.

    “These regions have been shown previously to have strong functional connectivity with the temporoparietal junction and superior temporal sulcus, 241 regions thought to be crucial to ToM.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • There is well established evidence indicating structural and functional impairments in brain networks in depression that include abnormalities in regions that play a role in theory of mind such as ventromedial prefrontal and temporoparietal regions.

    “There is well established evidence indicating structural and functional impairments in brain networks in depression that include abnormalities in regions that play a role in ToM such as ventromedial prefrontal and temporoparietal regions (Cusi et al., 2012).”

    From Social functioning in major depressive disorder (2016) · cites this paper as Cusi et al., 2012

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Study showing elevated DLPFC activation is cited for decreased activation

    Minor

    The paper describes study 68 as finding elevated DLPFC activation in euthymic patients, but later includes that study among citations supporting decreased DLPFC activity.

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 11

  1. Brothers L, 1990, Concepts Neurosci, 1, 27
  2. Carr MB, 2005, Adolescence, 40, 601
  3. Awad AG, 2007, J Clin Psychiatry, 9, 195
  4. Dannlowski U, 2007, J Psychiatry Neurosci, 32, 423
  5. Yang TT, 2010, J Am Acad Child Adolesc Psychiatry, 49, 42
  6. Ekman P, 1965, Affect, cognition, and personality, 390
  7. Koschack J, 2003, J Nerv Ment Dis, 191, 175
  8. Lebowitz BK, 2001, Neuropsychiatry Neuropsychol Behav Neurol, 14, 177
  9. Milne AM, 2011, J Psychiatry Neurosci, 36, 110004
  10. Drevets WC, 1992, Psychopharmacol Bull, 28, 261
  11. McClure-Tone EB, 2009, Clin Psychol (New York), 16, 98

Cited by

Sorted by citations

Related

Authors
Cusi, A. M., Nazarov, A., Holshausen, K., MacQueen, G. M., & McKinnon, M. C.
Affiliations
University of Calgary (CA)
ORCID
Venue
Journal of Psychiatry and Neuroscience
Publisher
Canadian Science Publishing
Published
2012-05
Volume
37
Issue
3
Pages
154-169
ISSN
  • 1180-4882 (ISSN-L)
  • 1488-2434
DOI
10.1503/jpn.100179
PMC
PMC3341408
OpenAlex
W2104541524
Cited by
278
References
265
Citations by year
2026: 4 · 2025: 5 · 2024: 73 · 2023: 11 · 2022: 8 · 2021: 17 · 2020: 15 · 2019: 13 · 2018: 25 · 2017: 16 · 2016: 15 · 2015: 20 · 2014: 29 · 2013: 19 · 2012: 7
FWCI
1.84
Type
journal article
Language
en
Open access
Licence
www.nrcresearchpress.com/page/about/CorporateTextAndDataMining (tdm)
Locations
  • Journal of Psychiatry and Neuroscience (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Alliance for Research on Schizophrenia and Depression
  • Canadian Institutes of Health Research
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Face Recognition and Perception
Keywords
social cognition, mood disorders, major depressive disorder, bipolar disorder, emotional understanding, theory of mind, mentalization, empathy, facial expressions, prosody, limbic system, frontal cortex, emotion regulation, moderators, disease burden, symptom severity, comorbidities, medication status, cognitive load
MeSH terms
Affect, Age Factors, Bipolar Disorder, Cognition, Major Depressive Disorder, Facial Expression, Humans, Magnetic Resonance Imaging, Psychotherapy, Social Behavior, Comorbidity, Cost of Illness, Mood Disorders, Theory of Mind

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-04.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-04.

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