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Updated: Jul 21, 2025

Brain Imaging Investigation of the Neural Correlates of Emotion Regulation
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Network dysfunction of sadness facial expression processing and morphometry in euthymic bipolar disorder.

Alessandro Miola1, Nicolò Trevisan1, Margherita Salvucci1

  • 1Department of Neuroscience (DNS), University of Padova, Via Giustiniani 5, Padua, Italy.

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Summary

Facial emotion recognition (FER) is impaired in bipolar disorder (BD). Bipolar I disorder (BD-I) patients show distinct deficits in recognizing sadness, linked to brain structure changes.

Keywords:
Bipolar disorderEmotional processingNetwork analysisROI-based morphometrySocial cognitionVoxel-based morphometry

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Area of Science:

  • Neuroscience
  • Psychiatry
  • Neuroimaging

Background:

  • Facial emotion recognition (FER) is crucial for social interaction.
  • Bipolar disorder (BD) is associated with altered emotional processing.
  • The neural underpinnings and clinical correlations of FER deficits in BD subtypes are not well understood.

Purpose of the Study:

  • To investigate facial emotion recognition (FER) performance in euthymic patients with bipolar I disorder (BD-I) and bipolar II disorder (BD-II) compared to healthy controls.
  • To explore the relationship between FER abilities, brain structure (gray matter volume), and clinical variables in BD.
  • To examine subtype-specific differences in FER and associated neurobiological correlates.

Main Methods:

  • Recruited 20 BD-I patients, 28 BD-II patients, and 45 healthy controls.
  • Administered a facial emotion recognition (FER) test.
  • Acquired 3D-T1-weighted magnetic resonance imaging (MRI) to assess gray matter volume (GMV) in cortico-limbic regions.
  • Utilized network analysis to investigate relationships between FER performance and GMV.

Main Results:

  • Patients with BD-I exhibited significantly poorer overall and sadness-specific FER performance compared to BD-II patients and controls.
  • In BD-I, impaired FER was associated with longer illness duration and poorer global functioning.
  • Sadness recognition deficits in BD-I correlated with a higher number of previous manic episodes.
  • Network analysis revealed reduced GMV association in frontal-insular-occipital regions in BD-I patients.
  • A stronger positive association between sadness recognition and amygdala GMV was observed in BD-I patients relative to controls.

Conclusions:

  • Facial emotion recognition (FER), especially for sadness, is distinctly impaired in Bipolar I Disorder (BD-I).
  • Altered network connectivity in frontal-insular-occipital regions and enhanced amygdala-sadness FER relationship in BD-I may indicate disrupted cortical-limbic modulation.
  • These neurobiological alterations likely contribute to emotional dysregulation in BD-I.
  • Further longitudinal research on mood state effects on FER in BD is recommended.