Altered social-emotional processing and decision-making in Central Diabetes Insipidus: The role of vasopressin deficiency.

BACKGROUND

Arginine vasopressin (AVP) regulates homeostasis and social behavior. Damage to AVP neurons causes central diabetes insipidus (CDI), now termed arginine vasopressin deficiency (AVP-D), a rare disorder potentially linked to social deficits. This study examined how AVP deficiency affects social, emotional, and psychological functioning in AVP-D patients.

METHODS

Twelve AVP-D patients and twelve matched controls participated. Blood samples measured copeptin and other hormones. Participants completed behavioral tasks assessing social exclusion (Cyberball paradigm), emotion recognition (Reading the Mind in Films), prosocial behavior (Social Discounting Task), fairness (Ultimatum Game), and approach-avoidance (Stop Distance Paradigm). Questionnaires assessed mood, anxiety, aggression, alexithymia, and empathy.

RESULTS

Hormone analysis showed AVP-D patients had lower copeptin and lower ACTH levels. Psychometric tests indicated increased depression, aggression, and alexithymia. Both groups felt negative after social exclusion, but AVP-D patients adjusted less emotionally, showing smaller changes in insecurity and team spirit. AVP-D patients also struggled more with emotion recognition, linked to lower copeptin and higher alexithymia. Fairness sensitivity differences were minor and not significant. Both groups donated less as social distance grew, though AVP-D patients' decline was less steep. In approach-avoidance behavior, AVP-D patients kept greater distances from human faces with friendly or aggressive expressions, unlike with animal targets.

CONCLUSIONS

AVP-D patients exhibit socioemotional impairments like poor emotion recognition and depression, highlighting the need for routine screening. Early detection enables targeted interventions, and addressing central AVP pathways is crucial, underscoring the need for treatments beyond hormone replacement.