Objective: This study aimed to investigate the relationship between zonulin and intestinal fatty acid-binding protein (I-FABP), biomarkers of intestinal permeability, and cognitive functions in patients with bipolar disorder (BD) compared to healthy controls (HCs). Methods: The study included 40 individuals diagnosed with BD and HCs. Cognitive functions were evaluated using the Stroop Test, Trail Making Test, Öktem Verbal Memory Processes Test, Wisconsin Card Sorting Test, and Digit Span Test. Serum zonulin and I-FABP levels were measured. Results: Zonulin and I-FABP levels were significantly higher in the BD group than in HCs (p ＜ 0.001). After correction for multiple comparisons, significant associations remained between zonulin levels and cognitive performance measures, including the Stroop effect (r = 0.46, p ＜ 0.001), delayed recall (r = −0.41, p ＜ 0.001), and recognition performance (r = 0.42, p ＜ 0.001). No significant correlations were found between I-FABP levels and cognitive test results. Conclusion The observed associations between zonulin levels and cognitive performance suggests a potential relationship of intestinal barrier integrity and gut microbiota with cognitive functions in BD. These findings should be interpreted as associative rather than causal, and future longitudinal studies are required to explore the direction of these relationships.

OBJECTIVE: This study compared the effects of cognitive behavioral therapy (CBT), existential psychotherapy (ExP) and supportive counseling (SUP) on facial emotion recognition among mildly and moderately depressed patients. METHODS: 21 patients for CBT, and 20 each for ExP and SUP groups with 60 healthy controls were investigated. Eight consecutive weekly sessions and following two monthly boosters were performed. Prior to the sessions, all subjects received Sociodemographic Data Form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), and Facial Emotion Recognition Test (FERT). Patients received Hamilton Depression Rating Scale (HDRS) and FERT at the onset and after weekly and booster sessions. RESULTS: Patients' ability to recognize surprised and neutral emotions were lower than controls. ExP group improved recognition of almost all emotions, CBT group improved only happy emotions and SUP group did not improve any emotions. HDRS scores declined in all patient groups, ExP and CBT groups had lower scores than SUP. CONCLUSION: MDD patients recognized surprised and neutral emotions lower than controls. ExP improved ability to recognize almost all emotions, CBT improved only happy emotions, SUP did not improve at all. ExP, CBT and SUP all led to a reduction in MDD. ExP and CBT had comparable effects and both were more helpful than SUP.
Cognitive Therapy ; Counseling ; Depression ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Psychotherapy