The role of the cerebellum in sequencing and predicting social and non-social events in patients with bipolar disorder

Libera Siciliano; Giusy Olivito; Michela Lupo; Nicole Urbini; Andrea Gragnani; Marco Saettoni; Roberto Delle Chiaie; Maria Leggio

doi:10.3389/fncel.2023.1095157

The role of the cerebellum in sequencing and predicting social and non-social events in patients with bipolar disorder

Front Cell Neurosci. 2023 Feb 15:17:1095157. doi: 10.3389/fncel.2023.1095157. eCollection 2023.

Authors

Libera Siciliano^{1

2}, Giusy Olivito^{1

2}, Michela Lupo³, Nicole Urbini^{1

2}, Andrea Gragnani^{4

5}, Marco Saettoni^{4

6}, Roberto Delle Chiaie⁷, Maria Leggio^{1

2}

Affiliations

¹ Department of Psychology, Sapienza University of Rome, Rome, Italy.
² Ataxia Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy.
³ Servizio di Tutela della Salute Mentale e Riabilitazione dell'Età Evolutiva ASL, Rome, Italy.
⁴ Scuola di Psicoterapia Cognitiva SPC, Grosseto, Italy.
⁵ Associazione Psicologia Cognitiva (APC)/Scuola di Psicoterapia Cognitiva (SPC), Rome, Italy.
⁶ Unità Funzionale Salute Mentale Adulti ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy.
⁷ Department of Neuroscience and Mental Health-Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy.

Abstract

Introduction: Advances in the operational mode of the cerebellum indicate a role in sequencing and predicting non-social and social events, crucial for individuals to optimize high-order functions, such as Theory of Mind (ToM). ToM deficits have been described in patients with remitted bipolar disorders (BD). The literature on BD patients' pathophysiology reports cerebellar alterations; however, sequential abilities have never been investigated and no study has previously focused on prediction abilities, which are needed to properly interpret events and to adapt to changes.

Methods: To address this gap, we compared the performance of BD patients in the euthymic phase with healthy controls using two tests that require predictive processing: a ToM test that require implicit sequential processing and a test that explicitly assesses sequential abilities in non-ToM functions. Additionally, patterns of cerebellar gray matter (GM) alterations were compared between BD patients and controls using voxel-based morphometry.

Results: Impaired ToM and sequential skills were detected in BD patients, specifically when tasks required a greater predictive load. Behavioral performances might be consistent with patterns of GM reduction in cerebellar lobules Crus I-II, which are involved in advanced human functions.

Discussion: These results highlight the importance of deepening the cerebellar role in sequential and prediction abilities in patients with BD.

Keywords: bipolar disorder; cerebellar atrophy; prediction; sequential processing; theory of mind; voxel-based morphometry.

Grants and funding

This work was partially financed by grants from the Sapienza University of Rome to Giusy Olivito (Grant No. AR22117A8588AB00) and from the Italian Ministry of Education, University and Research - MUR (PRIN) to MLe (Grant No. 20203LT7H3).