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Nonverbal Social Behaviors of Patients With Bipolar Mania During Interactions With Virtual Humans

Kim, Eosu MD*; Ku, Jeonghun PhD; Kim, Jae-Jin MD, PhD*; Lee, Hyeongrae MS; Han, Kiwan MS; Kim, Sun I. PhD; Cho, Hyun-Sang MD, PhD*

The Journal of Nervous and Mental Disease: June 2009 - Volume 197 - Issue 6 - p 412-418
doi: 10.1097/NMD.0b013e3181a61c3d
Original Article

It has been proposed that positive emotional biases could make bipolar manic (BM) patients maintain abnormally approaching behaviors during social interactions. To test this hypothesis, we measured interpersonal distance (IPD) and gaze angle of BM patients and normal controls (NCs) during social interaction in immersive virtual environment. Overall, IPDs of BM patients (n = 20) were greater than those of normal controls (n = 20). The IPD difference was even greater between NCs and BM patients with psychotic features (n = 11) than those without psychotic features (n = 9). Regardless of the presence of psychotic features, BM patients averted their gazes more than NCs, and even more while speaking than while listening. Our results might suggest negativistic social cognition of bipolar patients, as was previously found even during a manic phase, or the role of paranoid symptoms in avoidant social behaviors, in agreement with prior studies with schizophrenic patients. Use of proper space and gaze might have psychotherapeutic implication in developing secure, two-person relationship with bipolar patients regardless of the presence of disrupting manic symptoms.

*Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea; and †Department of Biomedical Engineering, Hanyang University College of Medicine, Seoul, Korea.

Supported by the Korea Science and Engineering Foundation grant (R01-2004-000-10906-0) and a faculty research grant (6-2004-1118) from the Yonsei University College of Medicine.

Send reprint requests to Hyun-Sang Cho, MD, PhD, Severance Mental Health Hospital, 696-6 Tanbeol-dong, Gwangju-si, Gyeonggi-do 464-100, Korea. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.