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Given its posited role in the often\u2010impaired socio\u2010emotional processes like intention detection, empathy, and imitation, we compared putative MNS\u2010activity in patients with bipolar mania and healthy comparison subjects. We also examined the association between putative MNS\u2010activity and hyper\u2010imitative behaviors in patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We studied 39 medication\u2010free individuals diagnosed with mania and 45 healthy comparison subjects. TMS\u2010evoked motor cortical reactivity was measured via single\u2010 and paired\u2010pulse stimuli (assessing SICI\u2014short and LICI\u2014long interval intracortical inhibition) while subjects viewed a static image and goal\u2010directed actions. Manic symptom severity and imitative behaviors were quantified using the Young's Mania Rating Scale and a modification of the Echolalia Questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two\u2010way repeated measures analysis of variance demonstrated a significant group \u00d7time interaction effect indicating greater facilitation of cortical reactivity during action\u2010observation (putative MNS\u2010activity) in the patient group as compared to the healthy group. While LICI\u2010mediated MNS\u2010activity had a significant association with manic symptom severity (r\u00a0=\u00a00.35, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.038), SICI\u2010mediated MNS\u2010activity was significantly associated with incidental echolalia scores in a subgroup of 17 patients with incidental echolalia (r\u00a0=\u00a00.75, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings demonstrate that putative MNS\u2010activity is heightened in mania, possibly because of disinhibition, and associated with behavioral consequences (incidental echolalia).<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12723","type":"journal-article","created":{"date-parts":[[2018,11,13]],"date-time":"2018-11-13T16:41:48Z","timestamp":1542127308000},"page":"259-269","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Elevated mirror neuron system activity in bipolar mania: Evidence from a transcranial magnetic stimulation study"],"prefix":"10.1111","volume":"21","author":[{"given":"Rakshathi","family":"Basavaraju","sequence":"first","affiliation":[{"name":"Department of Psychiatry National Institute of Mental Health &amp; Neurosciences (NIMHANS) Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2252-9189","authenticated-orcid":false,"given":"Urvakhsh M.","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Psychiatry National Institute of Mental Health &amp; Neurosciences (NIMHANS) Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Pascual\u2010Leone","sequence":"additional","affiliation":[{"name":"Division of Cognitive Neurology Berenson\u2010Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagadisha","family":"Thirthalli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry National Institute of Mental Health &amp; Neurosciences (NIMHANS) Bangalore India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,12]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)00069-8"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2014.660"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.mp.4001585"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2017.03.043"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-5618.2012.01002.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2011.07.004"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cub.2010.02.045"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.286.5449.2526"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1460-9568.2003.02530.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tics.2004.07.002"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/0096-1523.34.3.578"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2009.0066"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/00048670802119747"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.290"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1590\/1516-4446-2016-2101"},{"key":"e_1_2_7_17_1","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1176\/jnp.2009.21.1.59","article-title":"Neuropsychological evidence of impaired cognitive empathy in euthymic bipolar disorder","volume":"21","author":"Shamay\u2010Tsoory S","year":"2009","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00230027"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00227301"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2014.10.040"},{"key":"e_1_2_7_21_1","unstructured":"NIMH RDoC Working Group.NIMH \u00bb Social Processes: Workshop Proceedings [Internet].2012.https:\/\/www.nimh.nih.gov.https:\/\/www.nimh.nih.gov\/research-priorities\/rdoc\/social-processes-workshop-proceedings.shtml. 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