Aim of the study:
In bipolar disorder (BD), evidence for both cognitive impairment and deficit in emotion recognition has been found. Several investigations indicate that cognition and face processing can be interrelated. In this study, we assessed the correlations between cognitive functioning and emotion recognition (face expression) in patients with BD during an acute manic and depressive episode as well as in remission using a large battery of neurocognitive tests.

Subject or material and methods:
Twenty-four manic subjects, 21 with bipolar depression, and 22 euthymics, age-, sex-, and education-matched were included. Cognitive functions were assessed by the Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT, Stroop Color-Word Interference Test (SCWT), California Verbal Learning Test (CVLT), Benton Visual Memory Test (BVRT), Rey-Osterreich Complex Figure Test (ROFT), d2 test and Verbal Fluency Test (VFT). For emotion recognition, the Penn Emotion Recognition Test and Penn Emotion Discrimination Test were employed.

Results:
In mania, performances on selected measures of the WCST, TMT, SCWT, CVLT, ROFT, d2 test, and VFT, achieved 19 positive correlations with better recognition of happiness. In depression, conducting these tests obtained 20 correlations with finer recognition of sadness. In remission, such performances acquired 18 correlations with greater identification of sadness (10 replicated those obtained in depression).

Discussion:
Better emotion recognition in manic patients concerns mostly happiness, while in depression and remission, mainly sadness.

Conclusions:
Better neuropsychological performance can facilitate emotion recognition. We hypothesize that the identification of sadness could be considered a biological marker of mood disorders.