Social functioning as vulnerability marker in adolescents at high risk for Bipolar Disorder.
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Background: Bipolar disorder (BD) is associated with deficits in social behavior and social cognition. The disorder typically begins to manifest in early adolescence, but the early symptoms are clinically difficult to distinguish from behavior during normal adolescence. In this study, adolescents at high risk to develop BD are investigated using behavioural, neuropsychological, and functional brain measures of social functioning to identify early vulnerability factors for BD. Methods: 47 offsprings of BD patients and 32 healthy controls (HC) aged between 10-16 years are included in this study. Social behaviour is measured using standardized ratings of the Social Responsiveness Scale and the ‘Junior Nederlandse Persoonlijkheids Vragenlijst’, social cognitive performance is measured by the ANT, and functional MRI data are acquired during an emotional rating task. Results: Adolescents at high risk for BD displayed impaired social behaviour compared to HC. Their scores were still below cut-off for actual problems in social functioning. No difference between adolescents at high risk and HC in social cognitive functioning was found. Finally, adolescents at high risk showed hyperactivation in the amygdala and hypoactivation in the orbitofrontal cortex (OFC) during affective processing. Conclusion: These results show that adolescents at high risk for developing BD already show deficits related to social functioning in a period essential for social development. The combination of behavioural, neuropsychological, and functional brain data may provide sensitive markers to identify vulnerability factors for the development of BD. These combined measures may guide novel treatments in adolescents geared towards preventing or minimizing the impact of BD.