Theory of mind in bipolar disorder: a review

AIM: Bipolar disorder (DB) is associated with an impairment in socio-cognitive functioning in both the acute and, to a lesser extent, the euthymic phase. Several neuroimaging and behavioral studies have evaluated social cognition, especially theory of mind (ToM), in people with bipolar disorder, in attempt to identify clinical features, its role and severity. METHODS: A bibliographical research of controlled studies from January 1999 to April 2018 was completed in PubMed and PsycINFO using the keywords "Bipolar Disorder" and "Theory of mind", "Mirror neuron system". RESULTS: During the euthymic phase patients with bipolar disorder show a different pattern in different ToM tasks, compared to healthy controls. Some studies show how these anomalies also involve the mirror neuron system, a network closely connected to the neural structures underlying the ToM. LIMITATIONS: The studies evaluate only one component of social cognition and not all studies include a control group. CONCLUSIONS: Research supports the role of ToM deficits in DB as a relevant clinical element in the complex model of this disorder, especially in interpersonal functioning, offering possibilities for further research and treatment integration.