"Accidental, really?" Attributional bias in patients with Parkinson's disease

CBT for psychosis in Parkinson's disease: A framework for how and why

Psychosis is a serious comorbidity to Parkinson's disease associated with high levels of distress and disability but access to effective treatments remain limited, leading to high rates of emergency hospitalization. Here, we propose a new framework for how cognitive behavioural therapy (CBT) may be used to treat Parkinson's disease psychosis. We note specific adaptions, including aims that focus on reducing distress and disability and extending quality of life; tailored psychoeducation; assessment and formulation that additionally includes disease course, medication effects and side-effects, and Parkinson's specific social factors; addressing anxiety and depression alongside cognitive appraisals for the types of psychotic symptoms more common in Parkinson's disease; appropriate reality testing sensitive to disease progression; and trigger monitoring and management for hallucinations and delusions that carefully distinguishes this from avoidant coping. We review preliminary case study-level evidence for the successful use of CBT for Parkinson's disease psychosis and suggest a road map for its formal evaluation before integration into evidence-based healthcare.

Basal ganglia contributions to social cognition: evidence from movement disorders

Introduction and method: Over the last few decades many studies have demonstrated that various populations with movement disorder exhibit a variety of difficulties with social cognition. This brief review paper summarises the major findings of social cognitive research conducted in various hypo- and hyper-kinetic movement disorders (Parkinson's disease, Huntington's disease and Tourette syndrome), with a focus on findings that may shed new light on the functions of the basal ganglia.Results: Task impairments include more predictable difficulties with embodied processes involving the motor system, such as problems with facial expressions and other non-verbal gestures. The cognitive and emotional changes associated with broader frontostriatal dysfunction may also explain some deficits, particularly difficulties with verbal tasks or perspective taking, with impacts varying according to the type of disorder and disease stage. Most intriguingly, transdiagnostic comparisons reveal patterns implying that the role of the basal ganglia in social cognition may be more important than previously recognised.Conclusions: Movement disorders show remarkable overlap in terms of atypical intention attribution across various tasks, as well as relationships between social cognition and behavioural or motivational symptoms (e.g., apathy; anhedonia; impulsivity). The possible mechanisms underlying these similarities are explored with a view to guiding future research.

Hostile attributional biases in severe alcohol use disorder: replication, gender specificity, and mechanistic insights

AIMS

Despite their importance in the emergence and persistence of severe alcohol use disorder (SAUD), social cognition impairments remain understudied in this population. Hostile attributional biases (HAB), a key component of social cognition, may be involved in interpersonal problems and SAUD maintenance. However, current evidence for HAB in SAUD is highly preliminary, as it relies on a single study based on a small sample and on a task that cannot dissociate increased hostile from reduced benign attributions. We therefore used an improved methodology to further characterize this bias and disentangle underlying mechanisms. In addition, we explored potential gender differences.

METHOD

A total of 56 patients (28 women) diagnosed with SAUD and 66 (27 women) demographically matched controls completed the Word-Sentence Association Paradigm-Hostility, which provides a valid, spontaneous, and relatively implicit assessment of both hostile and benign social attributions related to ambiguous situations. They also completed self-report measures of psychopathology and interpersonal problems.

RESULTS

At the group-level, patients with SAUD presented higher HAB than controls, without group differences for benign attributions. Gender analyses revealed that this effect selectively emerged in men with SAUD. Further, patients' benign attributions did not differ from their hostile attributions. Finally, HAB (not benign attributions) were associated with interpersonal problems and state anxiety in patients.

CONCLUSIONS

The association between SAUD and HAB at the group level is genuine and replicable across samples and tasks. This association may further selectively emerge in men. Our results also confirm the functional significance of HAB in SAUD, and point to potential mechanisms and clinical recommendations.

Social Cognition in Parkinson's Disease: A Case-Control Study

Background

Social cognition is the study of how people make sense of themselves and others. Impairment in several domains of social cognition is increasingly being recognized in Parkinson's disease (PD).

Objectives

We aimed to study multiple domains of social cognition in Indian PD patients using a culturally appropriate, validated instrument.

Methods

We recruited 52 individuals with PD and 31 healthy volunteers (HV) and used the Social Cognition Rating Tools in Indian Setting (SOCRATIS) tool to assess theory of mind (ToM), attributional biases and social cue perception. Quality of life (QoL) was assessed using the PDQOL scale.

Results

Baseline characteristics were comparable between PD and HV. The mean (SD) FOT index (first order ToM index) was 0.86(0.18) in PD and 0.99(0.07) in HV [P < 0.001]. The PD group showed higher Externalizing Bias [EB, 4.42(3.91)], compared to HV [1.58(3.22), P = 0.001]. The mean (SD) Faux Pas Composite Index (FPCI ALT) was 0.69(0.09) in PD and 0.78(0.13) in HV [P < 0.001]. Social cognition indices were not associated with QoL in PD. Clinical parameters-age, gender, HAM-D, MOCA, education, levodopa equivalent daily dose of medication, number of PD drugs and trihexyphenidyl use did not predict social cognition.

Conclusion

PD patients were less successful than age, gender matched controls in understanding social situations and other's thought processes and had higher tendency to attribute undesirable events to external causes. Deficits in social cognition did not impair the quality of life.