Reduced activation in the mirror neuron system during a virtual social cognition task in euthymic bipolar disorder

Eosu Kim, Young Chul Jung, Jeonghun Ku, Jae Jin Kim, Hyeongrae Lee, So Young Kim, Sun I. Kim, Hyun Sang Cho

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57 Citations (Scopus)


Social cognition entails both cognitive and affective processing, and impairments in both have accounted for residual symptoms of bipolar disorder (BD). However, there has been a lack of studies identifying neural substrates responsible for social cognitive difficulties in BD patients. Fourteen euthymic BD patients and 14 healthy normal controls underwent functional MRI while performing a virtual reality social cognition task, which incorporated both cognitive and emotional dimensions, simulating real-world social situations. During the scanning, subjects tried to guess (attribute) possible reasons for expressed emotion of virtual humans (avatars) while viewing their facial expressions, just after observing their verbal and nonverbal (facial) expressions which were emotionally valenced (happy, angry and neutral). BD patients compared to normal controls showed delayed reaction times in emotional conditions, with comparable response accuracy. Healthy normal controls activated the right anterior cingulate cortex, inferior frontal, and insular cortex in emotional conditions contrasted with neutral control conditions, that is, the regions that have been related to empathic processes during viewing others' emotional expression. Relative to normal controls, BD patients showed reduced activations in the 'mirror neuron system', including the right inferior frontal cortex, premotor cortex, and insula, mainly in angry or happy condition. These results may suggest that, even during euthymic state, BD patients have difficulties in recruiting brain regions for the utilization of emotional cues as a means for understanding others. Clinical attention should be paid to emotion-related residual symptoms to help improve social outcomes in these patients.

Original languageEnglish
Pages (from-to)1409-1416
Number of pages8
JournalProgress in Neuro-Psychopharmacology and Biological Psychiatry
Issue number8
Publication statusPublished - 2009 Nov 13

Bibliographical note

Funding Information:
This study was supported by the faculty research grant No. 6-2004-1118 from the Yonsei University College of Medicine and grant No. R01-2005-000-10963-0 from the Basic Research Program of the Korea Science and Engineering Foundation. The authors would like to express their deep appreciation to Dr. Kang Joon Yoon, Director, Department of Neurosurgery, St. Peter's Hospital, Seoul, Korea, for providing the technical support, as well as to Mr. Dong-Su Jang, Research Assistant, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea, for his help with the figures.

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Biological Psychiatry


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