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Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation

Published online by Cambridge University Press:  21 April 2008

Brendan A. Rich*
Affiliation:
National Institute of Mental Health
Mary E. Grimley
Affiliation:
National Institute of Mental Health
Mariana Schmajuk
Affiliation:
National Institute of Mental Health
Karina S. Blair
Affiliation:
National Institute of Mental Health
R. J. R. Blair
Affiliation:
National Institute of Mental Health
Ellen Leibenluft
Affiliation:
National Institute of Mental Health
*
Address correspondence and reprint requests to: Brendan A. Rich, National Institute of Mental Health, National Institutes of Health, Building 15K, Room 204, MSC 2670, Bethesda, MD 20892-2670; E-mail: [email protected].

Abstract

Children with narrow phenotype bipolar disorder (NP-BD; i.e., history of at least one hypomanic or manic episode with euphoric mood) are deficient when labeling face emotions. It is unknown if this deficit is specific to particular emotions, or if it extends to children with severe mood dysregulation (SMD; i.e., chronic irritability and hyperarousal without episodes of mania). Thirty-nine NP-BD, 31 SMD, and 36 control subjects completed the emotional expression multimorph task, which presents gradations of facial emotions from 100% neutrality to 100% emotional expression (happiness, surprise, fear, sadness, anger, and disgust). Groups were compared in terms of intensity of emotion required before identification occurred and accuracy. Both NP-BD and SMD youth required significantly more morphs than controls to label correctly disgusted, surprised, fearful, and happy faces. Impaired face labeling correlated with deficient social reciprocity skills in NP-BD youth and dysfunctional family relationships in SMD youth. Compared to controls, patients with NP-BD or SMD require significantly more intense facial emotion before they are able to label the emotion correctly. These deficits are associated with psychosocial impairments. Understanding the neural circuitry associated with face-labeling deficits has the potential to clarify the pathophysiology of these disorders.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

This research was supported by the Intramural Research Program of the NIH, NIMH. We gratefully acknowledge the children and families of patients and controls without whose participation this research would not have been possible. We also thank the staff of the Section on Bipolar Spectrum Disorders at the NIMH.

References

Addington, J. & Addington, D. (1998). Facial affect recognition and information processing in schizophrenia and bipolar disorder. Schizophrenia Research, 32, 171181.CrossRefGoogle ScholarPubMed
Adolphs, R. (2002). Neural systems for recognizing emotion. Currrent Opinion in Neurobiology, 12, 169177.CrossRefGoogle ScholarPubMed
Adolphs, R., & Tranel, D. (2004). Impaired judgments of sadness but not happiness following bilateral amygdala damage. Journal of Cognitive Neuroscience, 16, 453462.CrossRefGoogle Scholar
Adolphs, R., Tranel, D., Hamann, S., Young, A. W., Calder, A. J., Phelps, E. A., et al. (1999). Recognition of facial emotion in nine individuals with bilateral amygdala damage. Neuropsychologia, 37, 11111117.CrossRefGoogle ScholarPubMed
Althoff, R. R., Faraone, S. V., Rettew, D. C., Morley, C. P., & Hudziak, J. J. (2005). Family, twin, adoption, and molecular genetic studies of juvenile bipolar disorder. Bipolar Disorder, 7, 598609.CrossRefGoogle ScholarPubMed
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
Baron-Cohen, S., Ring, H. A., Wheelwright, S., Bullmore, E. T., Brammer, M. J., Simmons, A., et al. (1999). Social intelligence in the normal and autistic brain: an fMRI study. European Journal Neuroscience, 11, 18911898.CrossRefGoogle Scholar
Berument, S. K., Rutter, M., Lord, C., Pickles, A., & Bailey, A. (1999). Autism Screening Questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444451.CrossRefGoogle ScholarPubMed
Biederman, J., Faraone, S. V., Chu, M. P., & Wozniak, J. (1999). Further evidence of a bidirectional overlap between juvenile mania and conduct disorder in children. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 468476.CrossRefGoogle ScholarPubMed
Bishop, D. V. (1998). Development of the Children's Communication Checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. Journal of Child Psychology and Psychiatry, 39, 879891.CrossRefGoogle ScholarPubMed
Bishop, D. V., & Baird, G. (2001). Parent and teacher report of pragmatic aspects of communication: Use of the children's communication checklist in a clinical setting. Developmental Medicine and Child Neurology, 43, 809818.CrossRefGoogle ScholarPubMed
Blair, R. J., & Coles, M. (2000). Expression recognition and behavioural problems in early adolescence. Cognitive Development, 15, 421434.CrossRefGoogle Scholar
Blair, R. J., Colledge, E., Murray, L., & Mitchell, D. G. (2001). A selective impairment in the processing of sad and fearful expressions in children with psychopathic tendencies. Journal of Abnormal Child Psychology, 29, 491498.CrossRefGoogle ScholarPubMed
Blair, R. J., Jones, L., Clark, F., & Smith, M. (1997). The psychopathic individual: A lack of responsiveness to distress cues? Psychophysiology, 34, 192198.CrossRefGoogle ScholarPubMed
Blair, R. J., Morris, J. S., Frith, C. D., Perrett, D. I., & Dolan, R. J. (1999). Dissociable neural responses to facial expressions of sadness and anger. Brain, 122, 883893.CrossRefGoogle ScholarPubMed
Blumberg, H. P., Fredericks, C., Wang, F., Kalmar, J. H., Spencer, L., Papademetris, X., et al. (2005). Preliminary evidence for persistent abnormalities in amygdala volumes in adolescents and young adults with bipolar disorder. Bipolar Disorders, 7, 570576.CrossRefGoogle Scholar
Blumberg, H. P., Kaufman, J., Martin, A., Whiteman, R., Zhang, J. H., Gore, J. C., et al. (2003). Amygdala and hippocampal volumes in adolescents and adults with bipolar disorder. Archives of General Psychiatry, 60, 12011208.CrossRefGoogle ScholarPubMed
Blumberg, H. P., Martin, A., Kaufman, J., Leung, H. C., Skudlarski, P., Lacadie, C., et al. (2003). Frontostriatal abnormalities in adolescents with bipolar disorder: Preliminary observations from functional MRI. American Journal of Psychiatry, 160, 13451347.CrossRefGoogle ScholarPubMed
Bozikas, V. P., Tonia, T., Fokas, K., Karavatos, A., & Kosmidis, M. H. (2006). Impaired emotion processing in remitted patients with bipolar disorder. Journal of Affective Disorders, 91, 5356.CrossRefGoogle ScholarPubMed
Brody, L. (1985). Gender differences in emotional development: A review of theories and research. Journal of Personality, 53, 102149.CrossRefGoogle Scholar
Brotman, M. A., Kassem, L., Reising, M., Guyer, A. E., Dickstein, D. P., Rich, B. A., et al. (2007). Parental diagnoses in youth with narrow phenotype bipolar disorder or severe mood dysregulation. American Journal of Psychiatry, 164, 12381241.CrossRefGoogle ScholarPubMed
Brotman, M. A., Schmajuk, M., Rich, B. A., Dickstein, D. P., Guyer, A. E., Costello, A. J., et al. (2006). Prevalence, clinical correlates, and longitudinal course of severe mood and behavioral dysregulation in children. Biological Psychiatry, 60, 991997.CrossRefGoogle ScholarPubMed
Cadesky, E. B., Mota, V. L., & Schachar, R. J. (2000). Beyond words: How do children with ADHD and/or conduct problems process nonverbal information about affect? Journal of the American Academy of Child & Adolescent Psychiatry, 39, 11601167.CrossRefGoogle ScholarPubMed
Chang, K., Adleman, N. E., Dienes, K., Simeonova, D. I., Menon, V., & Reiss, A. (2004). Anomalous prefrontal–subcortical activation in familial pediatric bipolar disorder: A functional magnetic resonance imaging investigation. Archives of General Psychiatry, 61, 781792.CrossRefGoogle ScholarPubMed
Chang, K., Karchemskiy, A., Barnea-Goraly, N., Garrett, A., Simeonova, D. I., & Reiss, A. (2005). Reduced amygdalar gray matter volume in familial pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 565573.CrossRefGoogle ScholarPubMed
Chen, B. K., Sassi, R., Axelson, D., Hatch, J. P., Sanches, M., Nicoletti, M., et al. (2004). Cross-sectional study of abnormal amygdala development in adolescents and young adults with bipolar disorder. Biological Psychiatry, 56, 399405.CrossRefGoogle Scholar
Cicchetti, D., Ackerman, B., & Izard, C. (1995). Emotions and emotion regulation in developmental psychopathology. Development and Psychopathology, 7, 110.CrossRefGoogle Scholar
Cicchetti, D., & Curtis, W. J. (2005). An event-related potential study of the processing of affective facial expressions in young children who experienced maltreatment during the first year of life. Developmental Psychopathology, 17, 641677.CrossRefGoogle ScholarPubMed
Constantino, J. N., Gruber, C. P., Davis, S., Hayes, S., Passanante, N., & Przybeck, T. (2004). The factor structure of autistic traits. Journal of Child Psychology and Psychiatry, 45, 719726.CrossRefGoogle ScholarPubMed
Constantino, J. N., & Todd, R. D. (2003). Autistic traits in the general population: a twin study. Archives of General Psychiatry, 60, 524530.CrossRefGoogle ScholarPubMed
Corbett, B., & Glidden, H. (2000). Processing affective stimuli in children with attention-deficit hyperactivity disorder. Child Neuropsychology, 6, 144155.CrossRefGoogle ScholarPubMed
Dalton, K. M., Nacewicz, B. M., Johnstone, T., Schaefer, H. S., Gernsbacher, M. A., Goldsmith, H. H., et al. (2005). Gaze fixation and the neural circuitry of face processing in autism. Nature Neuroscience, 8, 519526.CrossRefGoogle ScholarPubMed
De Sonneville, L. M., Verschoor, C. A., Njiokiktjien, C., Op het Veld, V., Toorenaar, N., & Vranken, M. (2002). Facial identity and facial emotions: Speed, accuracy, and processing strategies in children and adults. Journal of Clinical and Experimental Neuropsychology, 24, 200213.CrossRefGoogle ScholarPubMed
Delbello, M. P., Zimmerman, M. E., Mills, N. P., Getz, G. E., & Strakowski, S. M. (2004). Magnetic resonance imaging analysis of amygdala and other subcortical brain regions in adolescents with bipolar disorder. Bipolar Disorders, 6, 4352.CrossRefGoogle ScholarPubMed
Dickstein, D. P., Milham, M. P., Nugent, A. C., Drevets, W. C., Charney, D. S., Pine, D. S., et al. (2005). Frontotemporal alterations in pediatric bipolar disorder: Results of a voxel-based morphometry study. Archives of General Psychiatry, 62, 734741.CrossRefGoogle ScholarPubMed
Dickstein, D. P., Nelson, E. E., McClure, E. B., Grimley, M. E., Knopf, L., Brotman, M. A., et al. (2007). Cognitive flexibility in phenotypes of pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 341355.CrossRefGoogle ScholarPubMed
Dodge, K. A., Lansford, J. E., Burks, V. S., Bates, J. E., Pettit, G. S., Fontaine, R., et al. (2003). Peer rejection and social information-processing factors in the development of aggressive behavior problems in children. Child Development, 74, 374393.CrossRefGoogle ScholarPubMed
Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Fries, A. B., Ziegler, T. E., Kurian, J. R., Jacoris, S., & Pollak, S. D. (2005). Early experience in humans is associated with changes in neuropeptides critical for regulating social behavior. Proceedings of the National Academy of Sciences of the United States of America, 102, 1723717240.CrossRefGoogle Scholar
Geller, B., Bolhofner, K., Craney, J. L., Williams, M., Delbello, M. P., & Gundersen, K. (2000). Psychosocial functioning in a prepubertal and early adolescent bipolar disorder phenotype. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 15431548.CrossRefGoogle Scholar
Getz, G. E., Shear, P. K., & Strakowski, S. M. (2003). Facial affect recognition deficits in bipolar disorder. Journal of the International Neuropsychological Society, 9, 623632.CrossRefGoogle ScholarPubMed
Goldstein, T. R., Miklowitz, D. J., & Mullen, K. L. (2006). Social skills knowledge and performance among adolescents with bipolar disorder. Bipolar Disorders, 8, 350361.CrossRefGoogle ScholarPubMed
Gorno-Tempini, M. L., Pradelli, S., Serafini, M., Pagnoni, G., Baraldi, P., Porro, C., et al. (2001). Explicit and incidental facial expression processing: An fMRI study. NeuroImage, 14, 465473.CrossRefGoogle ScholarPubMed
Gross, A. L., & Ballif, B. (1991). Children's understanding of emotion from facial expression and situations: A review. Developmental Review, 11, 368398.CrossRefGoogle Scholar
Guyer, A. E., McClure, E. B., Adler, A., Brotman, M. A., Rich, B. A., Pine, D. S., et al. (2007). Specificity of facial expression labeling deficits in childhood psychopathology. Journal of Clinical Psychology and Psychiatry, 48, 863871.CrossRefGoogle ScholarPubMed
Harmer, C. J., Grayson, L., & Goodwin, G. M. (2002). Enhanced recognition of disgust in bipolar illness. Biological Psychiatry, 51, 298304.CrossRefGoogle ScholarPubMed
Harrigan, J. (1984). The effects of task order on children's identification of facial expressions. Motivation and Emotion, 8, 157169.CrossRefGoogle Scholar
Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., et al. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980988.CrossRefGoogle ScholarPubMed
Kaur, S., Sassi, R. B., Axelson, D., Nicoletti, M., Brambilla, P., Monkul, E. S., et al. (2005). Cingulate cortex anatomical abnormalities in children and adolescents with bipolar disorder. American Journal of Psychiatry, 162, 16371643.CrossRefGoogle ScholarPubMed
Keller, M. B., Lavori, P. W., Friedman, B., Nielsen, E., Endicott, J., McDonald-Scott, P. et al. (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry, 44, 540548.CrossRefGoogle ScholarPubMed
Killgore, W. D., & Yurgelun-Todd, D. A. (2004). Activation of the amygdala and anterior cingulate during nonconscious processing of sad versus happy faces. NeuroImage, 21, 12151223.CrossRefGoogle ScholarPubMed
Klinnert, M. D., Emde, R. N., Butterfield, P., & Campos, J. J. (1987). Social referencing: The infant's use of emtoional signals from a friendly adult with mother present. Annual Progress in Child Psychiatry and Child Development, 22, 427432.Google Scholar
Kowatch, R. A., Youngstrom, E. A., Danielyan, A., & Findling, R. L. (2005). Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disorders, 7, 483496.CrossRefGoogle ScholarPubMed
Leibenluft, E., Charney, D. S., Towbin, K. E., Bhangoo, R. K., & Pine, D. S. (2003). Defining clinical phenotypes of juvenile mania. American Journal of Psychiatry, 160, 430437.CrossRefGoogle ScholarPubMed
Leibenluft, E., Rich, B. A., Vinton, D. T., Nelson, E. E., Fromm, S. J., Berghorst, L. H., et al. (2007). Neural circuitry engaged during unsuccessful motor inhibition in pediatric bipolar disorder. American Journal of Psychiatry, 164, 5260.CrossRefGoogle ScholarPubMed
Lembke, A. & Ketter, T. A. (2002). Impaired recognition of facial emotion in mania. American Journal of Psychiatry, 159, 302304.CrossRefGoogle ScholarPubMed
Lennox, B. R., Jacob, R., Calder, A. J., Lupson, V., & Bullmore, E. T. (2004). Behavioural and neurocognitive responses to sad facial affect are attenuated in patients with mania. Psychological Medicine, 34, 795802.CrossRefGoogle ScholarPubMed
Lenti, C., Giacobbe, A., & Pegna, C. (2000). Recognition of emotional facial expressions in depressed children and adolescents. Perceptual and Motor Skills, 91, 227236.CrossRefGoogle ScholarPubMed
Lewinsohn, P. M., Seeley, J. R., & Klein, D. N. (2003). Bipolar disorders during adolescence. Acta Psychiatrica Scandinavica Supplementum, 4750.CrossRefGoogle ScholarPubMed
March, J. S., Parker, J. D., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 554565.CrossRefGoogle ScholarPubMed
Markham, R. & Adams, K. (1992). The effect of type of task on childrens' identification of facial expressions. Journal of Nonverbal Behavior, 16, 2139.CrossRefGoogle Scholar
Marshall, P. J., & Fox, N. A. (2004). A comparison of the electroencephalogram between institutionalized and community children in Romania. Journal of Cognitive Neuroscience, 16, 13271338.CrossRefGoogle ScholarPubMed
McClure, E. B. (2000). A meta-analytic review of sex differences in facial expression processing and their development in infants, children, and adolescents. Psychological Bulletin, 126, 424453.CrossRefGoogle ScholarPubMed
McClure, E. B., Treland, J. E., Snow, J., Schmajuk, M., Dickstein, D. P., Towbin, K. E., et al. (2005). Deficits in social cognition and response flexibility in pediatric bipolar disorder. American Journal of Psychiatry, 162, 16441651.CrossRefGoogle ScholarPubMed
Morris, J. S., Frith, C. D., Perrett, D. I., Rowland, D., Young, A. W., Calder, A. J., et al. (1996). A differential neural response in the human amygdala to fearful and happy facial expressions. Nature, 383, 812815.CrossRefGoogle ScholarPubMed
Parker, S. W., & Nelson, C. A. (2005). The impact of early institutional rearing on the ability to discriminate facial expressions of emotion: An event-related potential study. Child Development, 76, 5472.CrossRefGoogle ScholarPubMed
Penn, D. L., Mueser, K. T., Spaulding, W., Hope, D. A., & Reed, D. (1995). Information processing and social competence in chronic schizophrenia. Schizophrenia Bulletin, 21, 269281.CrossRefGoogle ScholarPubMed
Phillips, M. L., Bullmore, E. T., Howard, R., Woodruff, P. W., Wright, I. C., Williams, S. C., et al. (1998). Investigation of facial recognition memory and happy and sad facial expression perception: An fMRI study. Psychiatry Research, 83, 127138.CrossRefGoogle ScholarPubMed
Phillips, M. L., Young, A. W., Senior, C., Brammer, M., Andrew, C., Calder, A. J., et al. (1997). A specific neural substrate for perceiving facial expressions of disgust. Nature, 389, 495498.CrossRefGoogle ScholarPubMed
Pogge, D. L., Wayland-Smith, D., Zaccario, M., Borgaro, S., Stokes, J., & Harvey, P. D. (2001). Diagnosis of manic episodes in adolescent inpatients: Structured diagnostic procedures compared to clinical chart diagnoses. Psychiatry Research, 101, 4754.CrossRefGoogle ScholarPubMed
Pollak, S. D., Cicchetti, D., Hornung, K., & Reed, A. (2000). Recognizing emotion in faces: Developmental effects of child abuse and neglect. Developmental Psychology, 36, 679688.CrossRefGoogle ScholarPubMed
Pollak, S. D., & Kistler, D. J. (2002). Early experience is associated with the development of categorical representations for facial expressions of emotion. Proceedings of the National Academy of Sciences of the United States of America, 99, 90729076.CrossRefGoogle ScholarPubMed
Pollak, S. D., Klorman, R., Thatcher, J. E., & Cicchetti, D. (2001). P3b reflects maltreated children's reactions to facial displays of emotion. Psychophysiology, 38, 267274.CrossRefGoogle ScholarPubMed
Pollak, S. D., & Tolley-Schell, S. A. (2003). Selective attention to facial emotion in physically abused children. Journal of Abnormal Psychology, 112, 323338.CrossRefGoogle ScholarPubMed
Poznanski, E. O., Grossman, J. A., Buchsbaum, Y., Banegas, M., Freeman, L., & Gibbons, R. (1984). Preliminary studies of the reliability and validity of the Children's Depression Rating Scale. Journal of the American Academy of Child Psychiatry, 23, 191197.CrossRefGoogle ScholarPubMed
Rich, B. A., Schmajuk, M., Perez-Edgar, K. E., Fox, N. A., Pine, D. S., & Leibenluft, E. (2007). Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. American Journal of Psychiatry, 164, 309317.CrossRefGoogle ScholarPubMed
Rich, B. A., Vinton, D., Roberson-Nay, R., Hommer, R., Berghorst, L., McClure, E., et al. (2006). Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proceedings of the National Academy of Sciences of the United States of America, 103, 89008905.CrossRefGoogle ScholarPubMed
Rucklidge, J. J. (2006). Psychosocial functioning of adolescents with and without paediatric bipolar disorder. Journal of Affective Disorders, 91, 181188.CrossRefGoogle ScholarPubMed
Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., et al. (1983). A Children's Global Assessment Scale (CGAS). Archives of General Psychiatry, 40, 12281231.CrossRefGoogle ScholarPubMed
Sprengelmeyer, R., Rausch, M., Eysel, U. T., & Przuntek, H. (1998). Neural structures associated with recognition of facial expressions of basic emotions. Proceedings in Biological Sciences/ The Royal Society, 265, 19271931.CrossRefGoogle ScholarPubMed
Stevens, D., Charman, T., & Blair, R. J. (2001). Recognition of emotion in facial expressions and vocal tones in children with psychopathic tendencies. The Journal of Genetic Psychology, 162, 201211.CrossRefGoogle ScholarPubMed
Taylor, M. J., Batty, M., & Itier, R. J. (2004). The faces of development: A review of early face processing over childhood. Journal of Cognitive Neuroscience, 16, 14261442.CrossRefGoogle ScholarPubMed
Towbin, K. E., Pradella, A., Gorrindo, T., Pine, D. S., & Leibenluft, E. (2005). Autism spectrum traits in children with mood and anxiety disorders. Journal of Child and Adolescent Psychopharmacology, 15, 452464.CrossRefGoogle ScholarPubMed
Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Psychological Corporation.Google Scholar
Whalen, P. J., Rauch, S. L., Etcoff, N. L., McInerney, S. C., Lee, M. B., & Jenike, M. A. (1998). Masked presentations of emotional facial expressions modulate amygdala activity without explicit knowledge. Journal of Neuroscience, 18, 411418.CrossRefGoogle ScholarPubMed
Wilke, M., Kowatch, R. A., Delbello, M. P., Mills, N. P., & Holland, S. K. (2004). Voxel-based morphometry in adolescents with bipolar disorder: First results. Psychiatry Research, 131, 5769.CrossRefGoogle ScholarPubMed
Wilkinson, D. & Halligan, P. (2004). The relevance of behavioural measures for functional-imaging studies of cognition. Nature Reviews. Neuroscience, 5, 6773.CrossRefGoogle ScholarPubMed
Yang, T. T., Menon, V., Eliez, S., Blasey, C., White, C. D., Reid, A. J., et al. (2002). Amygdalar activation associated with positive and negative facial expressions. NeuroReport, 13, 17371741.CrossRefGoogle ScholarPubMed
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. Britsh Journal of Psychiatry, 133, 429435.CrossRefGoogle ScholarPubMed
Yurgelun-Todd, D. A., Gruber, S. A., Kanayama, G., Killgore, W. D., Baird, A. A., & Young, A. D. (2000). fMRI during affect discrimination in bipolar affective disorder. Bipolar Disorders, 2, 237248.CrossRefGoogle ScholarPubMed