Theory of mind profile and cerebellar alterations in remitted bipolar disorder 1 and 2: a comparison study
Open accessAbstract
The literature on social cognition abilities in bipolar disorder (BD) is controversial about the occurrence of theory of mind (ToM) alterations. In addition to other cerebral structures, such as the frontal and limbic areas, the processing of socially relevant stimuli has also been attributed to the cerebellum, which has been demonstrated to be involved in the above-mentioned disorder. Nevertheless, the cerebellar contribution to ToM deficits in bipolar patients needs to be elucidated further. To this aim, two tests assessing different components of ToM were used to evaluate the ability to appreciate affective and mental states of others in 17 individuals with a diagnosis of BD type 1 (BD1) and 13 with BD type 2 (BD2), both in the euthymic phase, compared to healthy matched controls. Cerebellar gray matter (GM) volumes were extracted and compared between BD1 and controls and BD2 and controls by using voxel-based morphometry. The results showed that BD1 patients were compromised in the cognitive and advanced components of ToM, while the BD2 ToM profile resulted in a more widespread compromise, also involving affective and automatic components. Both overlapping and differing areas of cerebellar GM reduction were found. The two groups of patients presented a pattern of GM reduction in cerebellar portions that are known to be involved in the affective and social domains, such as the vermis and Crus I and Crus II. Interestingly, in both BD1 and BD2, positive correlations were detected between lower ToM scores and decreased volumes in the cerebellum. Overall, BD2 patients showed a more compromised ToM profile and greater cerebellar impairment than BD1 patients. The different patterns of structural abnormalities may account for the different ToM performances evidenced, thus leading to divergent profiles between BD1 and BD2.
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The cerebellum plays an abnormal role in the pathophysiology of mood disorders, psychiatric disorders, and predictive impairments.
“The cerebellum was found to play an abnormal role in the patho physiology of mood disorders (Schutter, 2016; Olivito et al., 2022), psychiatric disorders (Escelsior et al., 2019), and predictive impairments (Friston and Herreros, 2016).”
From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Olivito et al., 2022
Olivito et al. is cited for the mood-disorders portion of the sentence, not the separate claims about psychiatric disorders or predictive impairments. The Introduction reports cerebellar alterations in major depressive and bipolar disorders, and the Discussion reports cerebellar atrophy in the study’s bipolar groups. It presents the cerebellum’s contribution to symptoms as a hypothesis, however, rather than establishing an abnormal causal role in the pathophysiology of mood disorders generally. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe reduced performance in social predictive tasks in BD is consistent with previous literature on theory of mind deficits in individuals with BD.
“is consistent with previous literature on the theory of mind deficits in individuals with BD (Bora et al., 2016; Olivito et al., 2022).”
From Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review. (2025) · cites this paper as Olivito et al., 2022
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Predictive coding in neuropsychiatric disorders: a systematic transdiagnostic review.
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- Authors
- Olivito, G., Lupo, M., Siciliano, L., Gragnani, A., Saettoni, M., Pancheri, C., Panfili, M., Pignatelli, F., Delle Chiaie, R., & Leggio, M.
- Affiliations
- Fondazione Santa Lucia (IT)
- ASL Roma (IT)
- Azienda USL Toscana Nord Ovest (IT)
- Policlinico Umberto I (IT)
- Sapienza University of Rome (IT)
- Corresponding author
- Olivito, Giusy
- ORCID
- Venue
- Frontiers in Behavioral Neuroscience
- Publisher
- Frontiers Media SA
- Published
- 2022-09-08
- Volume
- 16
- Pages
- 971244-971244
- ISSN
- 1662-5153 (ISSN-L)
- PMC
- PMC9492864
- OpenAlex
- W4295124051
- Cited by
- 12
- References
- 73
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 1 · 2023: 2
- FWCI
- 1.47
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Behavioral Neuroscience (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Ministero dell’Istruzione, dell’Università e della Ricerca (RG120172B8343252)
- Sapienza Università di Roma (RG120172B8343252)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Keywords
- theory of mind, bipolar I disorder, cerebellum, cerebellar gray matter volume, social cognition, emotional understanding, remitted bipolar disorder, cerebellar vermis, voxel-based morphometry
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