Self-face recognition and theory of mind in patients with schizophrenia and first-degree relatives

Is self-awareness necessary to have a theory of mind?

Forty years ago, Gallup proposed that theory of mind presupposes self-awareness. Following Humphrey, his hypothesis was that individuals can infer the mental states of others thanks to the ability to monitor their own mental states in similar circumstances. Since then, advances in several disciplines, such as comparative and developmental psychology, have provided empirical evidence to test Gallup's hypothesis. Herein, we review and discuss this evidence.

Subjectively salient faces differ from emotional faces: ERP evidence

The self-face is processed differently than emotional faces. A question arises whether other highly familiar and subjectively significant non-self faces (e.g. partner's face) are also differentiated from emotional faces. The aim of this event-related potential (ERP) study was to investigate the neural correlates of personally-relevant faces (the self and a close-other's) as well as emotionally positive (happy) and neutral faces. Participants were tasked with the simple detection of faces. Amplitudes of N170 were more negative in the right than in the left hemisphere and were not modulated by type of face. A similar pattern of N2 and P3 results for the self-face and close-other's face was observed: they were associated with decreased N2 and increased P3 relative to happy and neutral faces. However, the self-face was preferentially processed also when compared to a close-other's face as revealed by lower N2 and higher P3 amplitudes. Nonparametric cluster-based permutation tests showed an analogous pattern of results: significant clusters for the self-face compared with all other faces (close-other's, happy, neutral) and for close-other's face compared to happy and neutral faces. In summary, the self-face prioritization was observed, as indicated by significant differences between one's own face and all other faces. Crucially, both types of personally-relevant faces differed from happy faces. These findings point to the pivotal role of subjective evaluation of the saliency factor.

Social cognition in first-episode schizophrenia/schizoaffective disorder patients

INTRODUCTION

People with schizophrenia have neurocognitive as well as social cognition deficits. Numerous studies have shown impairment in these domains in patients with chronic schizophrenia. However, these disturbances during the early phase of the disease have been less studied.

OBJECTIVE

The aim of the study is to explore the theory of mind (ToM) and emotional processing in first-episode patients, compared to healthy subjects.

METHOD

Forty patients with a first psychotic episode of less than 5 years' duration, and 40 healthy control subjects matched by age and years of schooling were assessed. The measures of social cognition included four stories of false belief, the Reading the Mind in the Eyes Test (RMET) and the Pictures Of Facial Affect (POFA) series.

RESULTS

The patients with a first psychotic episode performed significantly worse in all tasks of social cognition, compared to the healthy controls. The second-order ToM was impaired whereas the first-order ToM was preserved in the patients. Happiness was the emotion most easily identified by both patients and controls. Fear was most difficult for the patients, while for the controls it was disgust.

CONCLUSIONS

Deficits in ToM and emotional processing are present in patients with a first psychotic episode.

Laterality and hemispheric specialization of self-face recognition

Inspired by the pioneering work of Eran Zaidel beginning in the early 1970's on the role of the two cerebral hemispheres of the human brain in self-related cognition, we review research on self-face recognition from a laterality perspective. The self-face is an important proxy of the self, and self-face recognition has been used as an indicator of self-awareness more broadly. Over the last half century, behavioral and neurological data, along with over two decades of neuroimaging research evidence have accumulated on this topic, generally concluding a right-hemisphere dominance for self-face recognition. In this review, we briefly revisit the pioneering roots of this work by Sperry, Zaidel & Zaidel, and focus on the important body of neuroimaging literature on self-face recognition it has inspired. We conclude with a brief discussion of current models of self-related processing and future directions for research in this area.

The non-human animal reading the mind in the eyes test (NARMET): A new measure for the assessment of social cognition

The Reading the Mind in the Eyes test (RMET) is a widely applied test of social cognition, based on mental state judgments in response to photographs of human eyes, which can elicit impairment in patients with numerous psychiatric and neurological disorders. However, interpretation of task performance is limited without the use of appropriate control tasks. In addition to a matched task requiring age judgments of the RMET stimuli, it was recently shown that a mental state judgment task of comparable difficulty, could be developed using photographs of domestic cat eyes. The current study aimed to further develop a Non-human Animal RMET (NARMET) by testing additional stimuli in the form of photographs of domestic dog eyes. A variety of additional tasks were used alongside the eyes test stimuli in a large sample of healthy young adults, to explore how alexithymia, schizotypal features, and autistic tendencies may differentially influence mental state attribution in response to cat, dog, and human eyes test stimuli. The resulting NARMET features both cat and dog trials, depicting a similar range of complex mental states to the human RMET. It shows favorable psychometric properties as well as being well matched to the RMET in terms of linguistic variables, length and difficulty. However, reading measures predicted performance on the RMET, but not on the NARMET. Although further testing is required in samples with a higher proportion of males, future application of the NARMET in neuropsychiatric populations exhibiting cognitive and behavioral difficulties could offer enhanced assessment of social cognitive skills.

Subjective Cognitive Complaints in Unaffected First-Degree Relatives of Schizophrenia Patients: Relation to Cognitive Performance, Psychotic Experiences, and Social Functioning

BACKGROUND

Neurocognitive deficits are well-documented in patients of schizophrenia and their first-degree relatives (FDRs). Metacognitive awareness of these deficits, called neurocognitive insight (NI), has been found to be poor in schizophrenia patients but has not been assessed in their FDRs. This study evaluated NI and its relationship with objective cognitive performance, a history of psychotic experiences (PEs), and social functioning in unaffected FDRs.

METHODS

This cross-sectional study was conducted at the outpatient department of a tertiary care teaching hospital. A total of 100 FDRs were assessed for PEs and evaluated for subjective cognitive complaints (SCC), objective cognitive performance, and social functioning using the Subjective Scale to Investigate Cognition in Schizophrenia, neurocognitive tests from the National Institute of Mental Health and Neurosciences battery, and SCARF Social Functioning Index, respectively.

RESULTS

Compared to normative data, episodic memory was the most commonly impaired domain (up to 72% of participants), followed by working memory, attention, and executive function. There was no correlation between SCC and neuropsychological test scores in the corresponding cognitive domains, implying poor NI. 15% of participants had a lifetime history of PEs. This group had significantly higher SCC as compared to those without PEs (U = 0.366, P = 0.009, r = 0.26). A regression analysis showed that the FDRs' social functioning reduced by 0.178 units for each unit increase in SCC [F (1,98) = 5.198, P = 0.025].

CONCLUSION

Similar to schizophrenia patients, FDRs also have poor NI. The severity and progression of SCC could be explored as a possible marker for screening and monitoring FDRs at an ultrahigh risk for psychosis. Importantly, even in unaffected FDRs, SCC could affect socio-occupational functioning and need further research.

The Transdiagnostic Relevance of Self-Other Distinction to Psychiatry Spans Emotional, Cognitive and Motor Domains

Self-other distinction refers to the ability to distinguish between our own and other people's physical and mental states (actions, perceptions, emotions etc.). Both the right temporo-parietal junction and brain areas associated with the human mirror neuron system are likely to critically influence self-other distinction, given their respective contributions to theory of mind and embodied empathy. The degree of appropriate self-other distinction will vary according to the exact social situation, and how helpful it is to feel into, or remain detached from, another person's mental state. Indeed, the emotional resonance that we can share with others affords the gift of empathy, but over-sharing may pose a downside, leading to a range of difficulties from personal distress to paranoia, and perhaps even motor tics and compulsions. The aim of this perspective paper is to consider how evidence from behavioral and neurophysiological studies supports a role for problems with self-other distinction in a range of psychiatric symptoms spanning the emotional, cognitive and motor domains. The various signs and symptoms associated with problematic self-other distinction comprise both maladaptive and adaptive (compensatory) responses to dysfunction within a common underlying neuropsychological mechanism, compelling the adoption of more holistic transdiagnostic therapeutic approaches within Psychiatry.

Self-Processing and Self-Face Reaction Time Latencies: A Review

In this article, we detail the advantages of self-face identification latencies over more traditional tests of mirror self-recognition. Using reaction time latencies (measured in milliseconds) to identify different dimensions of the self, instead of relying on a simple dichotomous pass/fail mirror mark-test outcome, enables investigators to examine individual differences in self-processing time. This is a significant methodological step forward with important implications. The point of departure for our article is to detail research we and others have conducted on latencies for self-face identification, to show how self-processing occurs in the right side of the brain, how schizophrenia is a self-processing disorder, how self-face reaction time latencies implicate the existence of an underlying multiple modal self-processing system, and to explore ideas for future research.

Asymmetrical alterations of grey matter among psychiatric disorders: A systematic analysis by voxel-based activation likelihood estimation

Schizophrenia (SZ), bipolar disorder (BD) and major depression disorder (MDD) have been regarded as highly diverged independent entities in current psychiatric diagnosis. However, ample new evidence suggests that they may have common biological traits. Neuroimaging studies showed that psychiatric disorders might associated with altered grey matter (GM) asymmetry compared to controls; however, the degree to which SZ, BD and MDD have common and/or distinct asymmetrical alterations in GM is still ambiguous. In this study, we analysed 169 voxel-based studies (including 3517 SZ patients, 1575 BD patients, 3280 MDD patients and 9733 controls) using activation likelihood estimation (ALE) meta-analysis to systematically review the existence of similar GM atrophy and asymmetrical alteration patterns among these psychiatric disorders, and the functional association between behaviour domains and topological alterations. We found that the right parahippocampal gyrus and left superior frontal gyrus showed commonly altered GM volume across all three illnesses, but did not identify common asymmetrical alteration. The asymmetrical alteration with leftward bias appeared in SZ and bipolar disorder at different locations, but more asymmetrical alteration with rightward bias appeared in MDD. Moreover, these changes have been confirmed to be associate with several symptoms and may have roles in functional networks. Our findings support the existence of common neurobiological damnification in these psychiatric disorders and provides valuable insights for the neural commonalties among different psychiatric disorders based on a large sample size.

Neural Correlates of Self-other Distinction in Patients with Schizophrenia Spectrum Disorders: The Roles of Agency and Hand Identity

Schizophrenia spectrum disorders (SSD) are characterized by disturbed self-other distinction. While previous studies associate abnormalities in the sense of agency (ie, the feeling that an action and the resulting sensory consequences are produced by oneself) with disturbed processing in the angular gyrus, passive movement conditions to isolate contributions of motor predictions are lacking. Furthermore, the role of body identity (ie, visual features determining whether a seen body part belongs to oneself) in self-other distinction is unclear. In the current study, fMRI was used to assess the roles of agency and hand identity in self-other distinction. Patients with SSD and healthy controls (HC) performed active and passive hand movements (agency manipulation) while seeing their own or someone else's hand moving in accordance with their action (hand identity manipulation). Variable delays (0-417 ms) between movement and feedback had to be detected. Our results showed overall lower delay detection performances during active than passive conditions; however, these differences were reduced in patients when the own hand was displayed. On a neural level, we found that in HC, activation in the right angular gyrus was modulated by agency and hand identity. In contrast, agency and hand identity revealed no overlapping activation in patients, due to reduced effects of agency. Importantly, HC and SSD patients shared similar effects of hand identity in the angular gyrus. Our results suggest that disturbances of self-other distinction in SSD are particularly driven by agency, while self-other distinction based on hand identity might be spared.

Facial Emotion Recognition in Schizophrenia

Deficits in facial emotion recognition are one of the most common cognitive impairments, and they have been extensively studied in various psychiatric disorders, especially in schizophrenia. However, there is still a lack of conclusive evidence about the factors associated with schizophrenia and impairment at each stage of the disease, which poses a challenge to the clinical management of patients. Based on this, we summarize facial emotion cognition among patients with schizophrenia, introduce the internationally recognized Bruce-Young face recognition model, and review the behavioral and event-related potential studies on the recognition of emotions at each stage of the face recognition process, including suggestions for the future direction of clinical research to explore the underlying mechanisms of schizophrenia.

Combined Oxytocin and Cognitive Behavioral Social Skills Training for Social Function in People With Schizophrenia

BACKGROUND

A significant proportion of people with schizophrenia are characterized by impaired ability to socially engage with others. The development of effective interventions for social functioning remains a central therapeutic challenge. Cognitive-behavioral social skills training (CBSST) has been found to improve social functioning in schizophrenia, but with only medium effect sizes. Intranasal oxytocin also has prosocial effects, but also only with modest effect sizes. This study assessed whether the addition of intranasal oxytocin to CBSST can strengthen their impact on social function.

METHODS

Participants (N = 62) with schizophrenia or schizoaffective disorder entered a 24-week, double-blind, placebo-controlled, randomized clinical trial with a 3-month follow-up evaluation at 2 sites: Maryland and San Diego. Participants were randomized to either intranasal oxytocin 36 IU (3 sprays) twice a day (n = 31) or intranasal placebo-oxytocin (3 sprays) twice a day (n = 31). All participants received CBSST plus a social cognition skills training module (48 total sessions).

RESULTS

There were no significant treatment group differences in social functioning, positive symptoms, negative symptoms, defeatist beliefs, or asocial beliefs. The interpretation of treatment effects was complicated by site effects, whereby participants in San Diego began the trial with greater severity of impairments and subsequently showed greater improvements compared with participants in Maryland.

CONCLUSIONS

The results did not support the utility of add-on intranasal oxytocin to psychosocial rehabilitation interventions like CBSST for improvement in social function (ClinicalTrials.gov trial number: NCT01752712).

Cortical Pathways or Mechanism in the Face Inversion Effect in Patients with First-Episode Schizophrenia

OBJECTIVE

Impaired face perception is considered as a hallmark of social disability in schizophrenia. It is widely believed that inverted faces and upright faces are processed by distinct mechanisms. Previous studies have identified that individuals with schizophrenia display poorer face processing than controls. However, the mechanisms underlying the face inversion effect (FIE) in patients with first-episode schizophrenia (FSZ) remain unclear.

METHODS

We designed an fMRI task to investigate the FIE mechanism in patients with schizophrenia. Thirty-four patients with FSZ and thirty-five healthy controls (CON) underwent task-related fMRI scanning, clinical assessment, anhedonia experience examination, and social function and cognitive function evaluation.

RESULTS

The patients with FSZ exhibited distinct functional activity regarding upright and inverted face processing within the cortical face and non-face network. These results suggest that the differences in quantitative processing might mediate the FIE in schizophrenia. Compared with controls, affected patients showed impairments in processing both upright and inverted faces; and for these patients with FSZ, upright face processing was associated with more severe and broader impairment than inverted face processing. Reduced response in the left middle occipital gyrus for upright face processing was related to poorer performance of social function outcomes evaluated using the Personal and Social Performance Scale.

CONCLUSION

Our data suggested that patients with FSZ exhibited similar performance in processing inverted faces and upright faces, but were less efficient than controls; and for these patients, inverted faces are processed less efficiently than upright faces. We also provided a clue that the mechanism under abnormal FIE might be related to an aberrant activation of non-face-selective areas instead of abnormal activation of face-specific areas in patients with schizophrenia. Finally, our study indicated that the neural pathway for upright recognition might be relevant in determining the functional outcomes of this devastating disorder.

Predictors of performance on the Reading the Mind in the Eyes Test

We explored factors associated with performance on the Reading the Mind in the Eyes Test (RMET). 180 undergraduate students completed the human RMET requiring forced-choice mental state judgment; a control human Age Eyes Test (AET) requiring age judgment; a Cat Eyes Test (CET) requiring mental state judgment; and measures of executive function, empathy and psychopathology. Versions of the CET and AET were created that matched the RMET for difficulty (accuracy 71%). RMET and CET performance were strongly correlated after accounting for AET performance. Working memory, schizotypal personality and empathy predicted RMET accuracy but not CET scores. Liking dogs predicted higher accuracy on all eyes tasks, whereas liking cats predicted greater mentalizing but reduced emotional expression. Importantly, we replicated our core findings relating to accuracy and correlations between the CET and RMET in a second sample of 228 students. In conclusion, people can apply similar skills when interpreting cat and human expressions. As RMET and CET performance were found to be differentially affected by executive function and psychopathology, the use of social cognitive measures featuring non-human animals may be of particular use in future clinical research.

The role of schizotypal traits and the OXTR gene in theory of mind in schizophrenia: A family-based study

BACKGROUND

There is consistent evidence that theory of mind (ToM) is impaired in schizophrenia (SZ); however, it remains unclear whether such deficits are trait- or state-dependent. We evaluated ToM in patients with schizophrenia spectrum disorders (SSDs), their healthy first-degree relatives, and controls to test its suitability as an endophenotypic marker. We also studied the modifying effect of markers of clinical and genetic liability to SZ (schizotypy and genetic variability in the oxytocin receptor gene: OXTR) on ToM in healthy individuals.

METHODS

The sample included 38 stable SSD patients, 80 unaffected first-degree relatives, and 81 controls. ToM was assessed using the Hinting Task (HT) and schizotypy via the Schizotypal Personality Questionnaire-Brief (SPQ-B), which generates interpersonal (SPQ-IP), cognitive-perceptual (SPQ-CP), and disorganization (SPQ-D) scores. The polymorphism rs53576 of OXTR was genotyped.

RESULTS

Patients presented poorer HT performance than relatives and controls (p = 0.003 and p < 0.001). High SPQ-IP and SPQ-CP scores correlated with poorer ToM performance in relatives (p = 0.010 and p = 0.030), but not in controls. OXTR was not associated with HT scores, but it showed a modifying effect within controls; high SPQ-CP was related to HT poorer performance conditional to GG genotype (p = 0.007).

CONCLUSIONS

ToM deficits were present in patients but not in unaffected relatives or controls. However, our data indicate the usefulness of clinical and genetic liability markers to characterize differences in ToM abilities within healthy individuals. Then, the observed link between ToM and SZ liability suggests the putative role of ToM as an endophenotypic marker. Nevertheless, new analyses in larger samples are needed.

Social cognition in schizophrenia: A network-based approach to a Taiwanese version of the Reading the Mind in the Eyes test

BACKGROUND

This study aimed to examine social-cognitive impairments in patients with schizophrenia using the Eyes test. In contrast to previous methods using the correct answers, we developed the Taiwanese version of the Eyes test and constructed the response network to explore impairments in the emotional aspects of theory of mind in patients with schizophrenia.

METHODS

Eighteen patients with schizophrenia and 18 healthy controls were recruited to examine their performance of the Eyes test. To explore the internal structures of mental states, we used network analysis to construct the networks of choice patterns (i.e. participants' answers) by using two network indicators, including density (an index of structure diversity of a network) and centrality (an index of the choice patterns within a network). Moreover, we divided all the choices into negative, positive, and neutral item groups based on emotion polarity.

RESULTS

The patient group was slower and less accurate than the control group. Moreover, there was a negative correlation between accuracy and blunted affect, and there were positive correlations between reaction time and emotional withdrawal and apathetic social withdrawal. As compared to healthy controls, patients with schizophrenia showed larger density in the network structure and higher centrality than controls. Also, patients showed poorer performance on negative words than healthy controls.

CONCLUSION

Our results demonstrated more diversity to recognize negative emotions from patients' choice patterns as compared to those in the control group. These findings suggest that deficits on recognizing negative emotions might be associated with the dysfunctions of mental states in schizophrenia.

Social cognitions in siblings of patients with schizophrenia: a comparison with patients with schizophrenia and healthy controls - a cross-sectional study

BACKGROUND

There are limited number of studies which have evaluated social cognitive deficits among the siblings of patients with schizophrenia.

AIM

This study aimed to evaluate the social cognitive deficits and its correlates among siblings of patients with schizophrenia.

METHODOLOGY

Patients of schizophrenia (N = 34), their siblings (N = 34) and healthy control subjects (N = 31) matched for age, gender, education and intelligence quotient were evaluated on social cognition rating tools in Indian setting (SOCRATIS). Patients were additionally evaluated on Positive and Negative Symptom Scale (PANSS). Siblings were assessed on Comprehensive Assessment for at risk mental state (CAARMS) scale and Short Wisconsin Schizotypy scale. Neurocognitive test battery was applied to all the groups.

RESULTS

Patients with schizophrenia performed the worst and the healthy controls performed the best, with siblings falling intermediate on all the subtests of social cognition (except for externalizing bias and personalized bias) and neurocognition. There were negative correlation between some of the domains of social cognition and various domains of CAARMS. Higher level of schizotypy was associated with higher level of social cognitive deficits.

CONCLUSION

Social cognitive deficits can act as an important endophenotype for estimating the risk of schizophrenia in at risk siblings. Further, social cognitive deficits must be considered as important target for intervention among the at risk siblings to improve their outcome.

The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: effects on symptoms and comparison with healthy control

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.

Bodily self-disturbance in schizophrenia-spectrum populations: Introducing the Benson et al. Body Disturbances Inventory (B-BODI)

Anomalous or weakened sense of self was central to early theories of schizophrenia. Recent studies have also documented disturbances in body ownership and increased susceptibility for dissociative experiences, such as the out-of-body experience in individuals with schizophrenia, but further research is necessary to clarify components of bodily self-disturbances in the schizophrenia spectrum, and the stability of these experiences over time. With respect to methodology, self-disturbances research in schizophrenia tends to rely exclusively on verbal self-report questionnaires and interviews. Given that individuals with schizophrenia suffer from language and communication difficulties, verbal self-report measures may be insufficient. To bridge this gap, we have developed a new picture-based instrument, the Benson et al. Body Disturbances Inventory (B-BODI), designed to quantify bodily self-disturbances with respect to the frequency and vividness of these experiences, as well as the degree of distress associated with them. Drawings that depicted different aspects of aberrant bodily self-experiences were presented with accompanying captions. Participants were asked to indicate the frequency, vividness, and distressfulness of the experience captured by the picture using a 5-point scale. Individuals with schizophrenia, older healthy controls, and college students participated in two alternative versions of the B-BODI. Participants were also asked to complete a battery of established questionnaires that probed psychosis proneness and a range of self, body, and perceptual aberrations. The results suggest that the B-BODI is a useful tool that accurately captures bodily self-disturbances and has the potential to predict psychosis risk in healthy young individuals. Furthermore, anomalous self-disturbances seem to be relatively stable across time in individuals with chronic schizophrenia.

Intact prioritisation of unconscious face processing in schizophrenia

INTRODUCTION

Faces provide a rich source of social information, crucial for the successful navigation of daily social interactions. People with schizophrenia suffer a wide range of social-cognitive deficits, including abnormalities in face perception. However, to date, studies of face perception in schizophrenia have primarily employed tasks that require patients to make judgements about the faces. It is, thus, unclear whether the reported deficits reflect an impairment in encoding visual face information, or biased social-cognitive evaluative processes.

METHODS

We assess the integrity of early unconscious face processing in 21 out-patients diagnosed with Schizophrenia or Schizoaffective Disorder (15M/6F) and 21 healthy controls (14M/7F). In order to control for any direct influence of higher order cognitive processes, we use a behavioural paradigm known as breaking continuous flash suppression (b-CFS), where participants simply respond to the presence and location of a face. In healthy adults, this method has previously been used to show that upright faces gain rapid and privileged access to conscious awareness over inverted faces and other inanimate objects.

RESULTS

Here, we report similar effects in patients, suggesting that the early unconscious stages of face processing are intact in schizophrenia.

CONCLUSION

Our data indicate that face processing deficits reported in the literature must manifest at a conscious stage of processing, where the influence of mentalizing or attribution biases might play a role.

Uncanny Mirroring: A Developmental Perspective on the Neurocognitive Origins of Self-Disorders in Schizophrenia

Varieties of anomalous subjective experiences, i.e. "basic self-disorders" (SDs), have been empirically demonstrated as core clinical features of schizophrenia spectrum disorders, predating full-blown psychotic symptoms. However, the clinical stage in which SDs emerge and their putative neurocognitive origins remain unsolved issues. Focusing on a prototypical anomalous mirror experience (i.e., a stable, trait-like subjective feeling of nonexisting while looking at oneself in the mirror) reported by an 11-year-old boy at familial high risk for schizophrenia and diagnosed as attenuated psychosis syndrome, we outline some possible developmental pathways leading to SDs. Such pathways are hypothesized in accordance with the documented early impairments in perceptual integration across distinct modalities in children at risk for schizophrenia spectrum disorders and to the specific features of mirror experience as provided by phenomenological and developmental psychology perspectives. We conclude that SDs could presumably have an early developmental origin, although children become progressively more aware of them. Although further hypothesis testing in clinical samples and longitudinal empirical investigation of at-risk children is badly needed, we propose that age-appropriate, phenomenologically oriented assessment of SDs could be useful for the early identification of psychotic risk.

Social cognition and self-other distinctions in neuropsychiatry: Insights from schizophrenia and Tourette syndrome

Impairments in social cognition may reflect dysfunction of disorder specific or disorder general mechanisms. Although cross-disorder comparison may prove insightful, few studies have compared social cognition in different neuropsychiatric disorders. Parallel investigation of schizophrenia and Tourette syndrome (TS) is encouraged by similarities including the presence of problematic social behavior, echophenomena, emotional dysregulation and dopamine dysfunction. Focusing on tests of social cognition administered in both disorders, this review aims to summarize behavioral, neurophysiological and neuroimaging findings, before exploring how these may contribute to clinical symptoms. Studies investigating social cognition (imitation, emotion recognition, and understanding of beliefs or intentions) in patients with schizophrenia or TS were identified through Web of Science and PubMed searches. Although findings indicate that social cognitive deficits are more apparent in schizophrenia, adults with TS can exhibit similar task performance to patients with paranoia. In both disorders, behavioral and neuroimaging findings raise the possibility of increased internal simulation of others' actions and emotions, in combination with a relative under-application of mentalizing. More specifically, dysfunction in neurobiological substrates such as temporo-parietal junction and inferior frontal gyrus may underlie problems with self-other distinctions in both schizophrenia and TS. Difficulties in distinguishing between actions and mental states linked to the self and other may contribute to a range of psychiatric symptoms, including emotional dysregulation, paranoia, social anhedonia and socially disruptive urges. Comparing different patient populations could therefore reveal common neuro-cognitive risk factors for the development of problematic social behaviors, in addition to markers of resilience, coping strategies and potential neuro-compensation mechanisms.

Investigating gaze processing in euthymic bipolar disorder: Impaired ability to infer mental state and intention, but preservation of social attentional orienting

Euthymic bipolar disorder (BD) has been associated with subtle impairment in face processing. However, it is not known whether their difficulties extend to the processing of gaze. In the present study, two tasks, both of which rely on the ability to make use of the eye region of a pictured face, were used: the Reading the Mind in the Eyes test and the Eye-gaze cueing task. Compared to healthy controls, BD patients were impaired at judging mental state from images of the face but showed normal susceptibility to the direction of gaze as an attentional cue. These findings suggest that BD patients present selective gaze processing impairment, limited to the sensitivity to intention and emotion. This impairment could account at least partially for the higher levels of interpersonal problems generally observed in BD.

I Am There … but Not Quite: An Unfaithful Mirror That Reduces Feelings of Ownership and Agency

The experience of seeing one's own face in a mirror is a common experience in daily life. Visual feedback from a mirror is linked to a sense of identity. We developed a procedure that allowed individuals to watch their own face, as in a normal mirror, or with specific distortions (lag) for active movement or passive touch. By distorting visual feedback while the face is being observed on a screen, we document an illusion of reduced embodiment. Participants made mouth movements, while their forehead was touched with a pen. Visual feedback was either synchronous (simultaneous) with reality, as in a mirror, or asynchronous (delayed). Asynchronous feedback was exclusive to touch or movement in different conditions and incorporated both in a third condition. Following stimulation, participants rated their perception of the face in the mirror, and perception of their own face, on questions that tapped into agency and ownership. Results showed that perceptions of both agency and ownership were affected by asynchrony. Effects related to agency, in particular, were moderated by individual differences in depersonalisation and auditory hallucination-proneness, variables with theoretical links to embodiment. The illusion presents a new way of investigating the extent to which body representations are malleable.

Abnormal Brain Activation During Theory of Mind Tasks in Schizophrenia: A Meta-Analysis

Social cognition abilities are severely impaired in schizophrenia (SZ). The current meta-analysis used foci of 21 individual studies on functional abnormalities in the schizophrenic brain in order to identify regions that reveal convergent under- or over-activation during theory of mind (TOM) tasks. Studies were included in the analyses when contrasting tasks that require the processing of mental states with tasks which did not. Only studies that investigated patients with an ICD or DSM diagnosis were included. Quantitative voxel-based meta-analyses were done using Seed-based d Mapping software. Common TOM regions like medial-prefrontal cortex and temporo-parietal junction revealed abnormal activation in schizophrenic patients: Under-activation was identified in the medial prefrontal cortex, left orbito-frontal cortex, and in a small section of the left posterior temporo-parietal junction. Remarkably, robust over-activation was identified in a more dorsal, bilateral section of the temporo-parietal junction. Further abnormal activation was identified in medial occipito-parietal cortex, right premotor areas, left cingulate gyrus, and lingual gyrus. The findings of this study suggest that SZ patients simultaneously show over- and under-activation in TOM-related regions. Especially interesting, temporo-parietal junction reveals diverging activation patterns with an under-activating left posterior and an over-activating bilateral dorsal section. In conclusion, SZ patients show less specialized brain activation in regions linked to TOM and increased activation in attention-related networks suggesting compensatory effects.

Decoding emotion of the other differs among schizophrenia patients and schizoaffective patients: A pilot study

The deficit in ability to attribute mental states such as thoughts, beliefs, and intentions of another person is a key component in the functional impairment of social cognition in schizophrenia. In the current study, we compared the ability of persons with first episode schizophrenia (FE-SZ) and individuals with schizophrenia displaying symptomatic remission (SZ-CR) to decode the mental state of others with healthy individuals and schizoaffective patients. In addition, we analyzed the effect of dopamine-related genes polymorphism on the ability to decode the mental state of another, and searched for different genetic signatures. Our results show that overall, individuals with schizophrenia performed worse in the "Reading the Mind in the Eyes" (eyes) test, a simple well-defined task to infer the mental state of others than healthy individuals. Within the schizophrenia group, schizoaffective scored significantly higher than FE-SZ, SZ-CR, and healthy individuals. No difference was observed in performance between FE-SZ and SZ-CR subjects. Interestingly, FE-SZ and SZ-CR, but not schizoaffective individuals, performed worse in decoding negative and neutral emotional valance than the healthy control group. At the genetic level, we observed a significant effect of the DAT genotype, but not D4R genotype, on the eyes test performance. Our data suggest that understanding the mental state of another person is a trait marker of the illness, and might serve as an intermediate phenotype in the diagnostic process of schizophrenia disorders, and raise the possibility that DA-related DAT gene might have a role in decoding the mental state of another person.

Mirror self-face perception in individuals with schizophrenia: Feelings of strangeness associated with one's own image

Self-face recognition is crucial for sense of identity and for maintaining a coherent sense of self. Most of our daily life experiences with the image of our own face happen when we look at ourselves in the mirror. However, to date, mirror self-perception in schizophrenia has received little attention despite evidence that face recognition deficits and self abnormalities have been described in schizophrenia. Thus, this study aims to investigate mirror self-face perception in schizophrenia patients and its correlation with clinical symptoms. Twenty-four schizophrenia patients and twenty-five healthy controls were explicitly requested to describe their image in detail during 2min whilst looking at themselves in a mirror. Then, they were asked to report whether they experienced any self-face recognition difficulties. Results showed that schizophrenia patients reported more feelings of strangeness towards their face compared to healthy controls (U=209.5, p=0.048, r=0.28), but no statistically significant differences were found regarding misidentification (p=0.111) and failures in recognition (p=0.081). Symptoms such as hallucinations, somatic concerns and depression were also associated with self-face perception abnormalities (all p-values>0.05). Feelings of strangeness toward one's own face in schizophrenia might be part of a familiar face perception deficit or a more global self-disturbance, which is characterized by a loss of self-other boundaries and has been associated with abnormal body experiences and first rank symptoms. Regarding this last hypothesis, multisensorial integration might have an impact on the way patients perceive themselves since it has an important role in mirror self-perception.

Social Cognition in Schizophrenia Patients and Their First-Degree Relatives

INTRODUCTION

Social cognition is a person's ability to configure the designs of relationships between themselves and others and to use these designs to guide social behaviors in a flexible manner. The models that are the most studied and describe social cognition are the theory of mind (ToM) and emotion recognition. This study was aimed to detect ToM and emotion recognition disorders in schizophrenia patients and their first-degree relatives.

METHODS

Thirty schizophrenia patients in remission, the first-degree relatives of schizophrenia patients (n=30), and 30 healthy volunteers who were paired with the patients in terms of age and duration of education were included in the study. The Positive and Negative Symptom Scale (PANSS), Dokuz-Eylül Theory of Mind Scale (DEToMS), Reading the Mind in the Eyes test, Facial Emotion Identification Test (FEIT), and Facial Emotion Discrimination Test (FEDT) were performed by the patients participating in this study.

RESULTS

ToM and emotion recognition were found to be defective in the schizophrenia patients and their relatives. The performances of ToM and emotion recognition were ranked as the schizophrenia group, family group, and control group, from the worst to the best. The schizophrenia group showed poor performance in all sub-components except irony. In the family group, the empathy subcomponent showed similar performance with the control group, whereas the subcomponents of the second-order false belief, metaphor, and faux pas tests showed similar performance with the patient group. There were differences among the three groups in the first-order false belief subscale as well as the total DEToMS. The patient and family groups showed the poorest performances, whereas the control group showed the best performance.

CONCLUSION

The detection of ToM and emotion recognition disorders in the remission period, regardless of the attack period and asymptomatic first-degree relatives, may support the view that the period of schizophrenia is an independent continuous variable.

Social cognition in neuropsychiatric populations: a comparison of theory of mind in schizophrenia and mesial temporal lobe epilepsy

Social cognition deficits are observed both in patients with schizophrenia (SCZ) and in patients with mesial temporal lobe epilepsy (MTLE). This may be due to dysfunction of the amygdala network, which is a common feature of both diseases. In this study, SCZ (n = 48) or MTLE (n = 31) and healthy controls (HC, n = 47) completed assessments of mentalising (Reading Mind in the Eyes Test, RMET) and basic cognitive processing, e.g., working memory, executive functions and psychomotor speed (Trail-Making Test B and Digit Symbol). SCZ were also assessed with the Positive And Negative Syndrome Scale (PANSS). We found that the RMET scores of the two clinical groups were similar (p > 0.05) and lower than in the HCs (SCZ: p < 0.05; MTLE: p < 0.001). In the next step, SCZ were split into two groups with respect to the level of symptoms. Analysis of the RMET scores revealed no differences between the HC (M = 25.7 ± 4.1) and POS-LO (M = 25.3 ± 4.8); both groups outperformed the POS-HI group (M = 21.3 ± 5.2) and the MTLE group (M = 20.8 ± 4.6). No differences were found for the median-split with regard to negative symptoms. In SCZ, the mind-reading deficit appears to be associated with the level of positive symptoms. Both POS-HI and MTLE patients present significant mentalising deficits compared to healthy controls.

Effects of self and familiarity on change detection in patients with schizophrenia

In schizophrenia, processing of self-related stimuli has been shown to be altered. It is unclear whether altered self-processing in schizophrenia is confined to cognitive functions such as self-recognition, or whether it pertains to automatic lower-level perceptual processes. Visual face processing was tested in patients with schizophrenia (n=36) and healthy controls (n=33). Using a change detection paradigm (self, famous, unknown faces), we tested whether self-related stimuli gain access to awareness preferentially. The task was unrelated to face category, thus probing implicit processing of the face identity information. Furthermore we explored hemifield differences, the association of preferential self-processing with disease insight and with schizophrenic symptom severity. Change detection was overall enhanced for one's own face and familiar faces compared to unknown faces. There were no group differences regarding perception of self-related or familiar stimuli. The enhancing effect of self and familiarity on change detection was smaller in patients with more severe symptoms. We found no association between implicit visual self-perception and insight in schizophrenia. The privileged access of self-related visual information is not impaired in patients with schizophrenia. The reduced overall left-hemifield advantage for face-change detection points to an altered lateralization of face processing in patients with schizophrenia.

Association between polygenic risk for schizophrenia, neurocognition and social cognition across development

Breakthroughs in genomics have begun to unravel the genetic architecture of schizophrenia risk, providing methods for quantifying schizophrenia polygenic risk based on common genetic variants. Our objective in the current study was to understand the relationship between schizophrenia genetic risk variants and neurocognitive development in healthy individuals. We first used combined genomic and neurocognitive data from the Philadelphia Neurodevelopmental Cohort (4303 participants ages 8-21 years) to screen 26 neurocognitive phenotypes for their association with schizophrenia polygenic risk. Schizophrenia polygenic risk was estimated for each participant based on summary statistics from the most recent schizophrenia genome-wide association analysis (Psychiatric Genomics Consortium 2014). After correction for multiple comparisons, greater schizophrenia polygenic risk was significantly associated with reduced speed of emotion identification and verbal reasoning. These associations were significant by age 9 years and there was no evidence of interaction between schizophrenia polygenic risk and age on neurocognitive performance. We then looked at the association between schizophrenia polygenic risk and emotion identification speed in the Harvard/MGH Brain Genomics Superstruct Project sample (695 participants ages 18-35 years), where we replicated the association between schizophrenia polygenic risk and emotion identification speed. These analyses provide evidence for a replicable association between polygenic risk for schizophrenia and a specific aspect of social cognition. Our findings indicate that individual differences in genetic risk for schizophrenia are linked with the development of aspects of social cognition and potentially verbal reasoning, and that these associations emerge relatively early in development.

Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives

RATIONALE

Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives.

METHODS

The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both patients and SRs.

RESULTS

Interpersonal Relationships and Work Skills were the only functional domains impaired in both patients and SRs. For both domains, functional impairment in patients was found to predict impairment in unaffected relatives, suggesting the involvement of similar illness-related vulnerability factors. In both groups variables significantly associated with Interpersonal Relationships included Social Cognition, Neurocognition, Avolition, Resilience, Disorganization, Perceived Stigma and Gender, and those significantly associated with Work Skills included Social Cognition, Neurocognition and Disorganization.

CONCLUSIONS

Pathways to functional outcome for Interpersonal relationships and Work skills are similar between schizophrenia patients and their unaffected first-degree relatives. These findings validate, in the absence of confounders of clinical cohorts, structural models of determinants of functional outcome in people with schizophrenia.

Auditory top-down control and affective theory of mind in schizophrenia with and without hallucinations

Social cognitive impairments may represent a core feature of schizophrenia and above all are a strong predictor of positive psychotic symptoms. Previous studies could show that reduced inhibitory top-down control contributes to deficits in theory of mind abilities and is involved in the genesis of hallucinations. The current study aimed to investigate the relationship between auditory inhibition, affective theory of mind and the experience of hallucinations in patients with schizophrenia. In the present study, 20 in-patients with schizophrenia and 20 healthy controls completed a social cognition task (the Reading the Mind in the Eyes Test) and an inhibitory top-down Dichotic Listening Test. Schizophrenia patients with greater severity of hallucinations showed impaired affective theory of mind as well as impaired inhibitory top-down control. More dysfunctional top-down inhibition was associated with poorer affective theory of mind performance, and seemed to mediate the association between impairment to affective theory of mind and severity of hallucinations. The findings support the idea of impaired theory of mind as a trait marker of schizophrenia. In addition, dysfunctional top-down inhibition may give rise to hallucinations and may further impair affective theory of mind skills in schizophrenia.

Cognitive bias salience in patients with schizophrenia in relation to social functioning: A four-case observation study

Neurocognition and social cognition are the core deficits influencing social outcomes in patients with schizophrenia. These deficits are present in the prodromal phase, throughout the illness and in first-degree relatives. They are considered in the framework of neurodevelopmental or neurodegenerative models as well as candidates for endophenotypes of schizophrenia. Four clinical cases with patients reflecting different cognitive profiles were chosen to demonstrate heterogeneity of cognitive biases and their influence on social function in vivo. The patients had undergone a number of neurocognitive and social cognitive measures. Better functioning was observed in patients with less affected domains of emotional processing and theory of mind, while neurocognitive statuses were incongruent to levels of social functioning. Further investigation on large samples concerning capacity for empathy and its role in social functioning is needed.

Structural Neural Substrates of Reading the Mind in the Eyes

The ability to read the minds of others in their eyes plays an important role in human adaptation to social environments. Behavioral studies have resulted in the development of a test to measure this ability (Reading the Mind in the Eyes Test, revised version; Eyes Test), and have demonstrated that this ability is consistent over time. Although functional neuroimaging studies revealed brain activation while performing the Eyes Test, the structural neural substrates supporting consistent performance on the Eyes Test remain unclear. In this study, we assessed the Eyes Test and analyzed structural magnetic resonance images using voxel-based morphometry (VBM) in healthy participants. Test performance was positively associated with the gray matter volumes of the dorsomedial prefrontal cortex, inferior parietal lobule (temporoparietal junction), and precuneus in the left hemisphere. These results suggest that the fronto-temporoparietal network structures support the consistent ability to read the mind in the eyes.

Further insight into self-face recognition in schizophrenia patients: Why ambiguity matters

BACKGROUND

Although some studies reported specifically self-face processing deficits in patients with schizophrenia disorder (SZ), it remains unclear whether these deficits rather reflect a more global face processing deficit. Contradictory results are probably due to the different methodologies employed and the lack of control of other confounding factors. Moreover, no study has so far evaluated possible daily life self-face recognition difficulties in SZ. Therefore, our primary objective was to investigate self-face recognition in patients suffering from SZ compared to healthy controls (HC) using an "objective measure" (reaction time and accuracy) and a "subjective measure" (self-report of daily self-face recognition difficulties).

METHOD

Twenty-four patients with SZ and 23 HC performed a self-face recognition task and completed a questionnaire evaluating daily difficulties in self-face recognition. Recognition task material consisted in three different faces (the own, a famous and an unknown) being morphed in steps of 20%.

RESULTS

Results showed that SZ were overall slower than HC regardless of the face identity, but less accurate only for the faces containing 60%-40% morphing. Moreover, SZ and HC reported a similar amount of daily problems with self/other face recognition. No significant correlations were found between objective and subjective measures (p > 0.05).

LIMITATIONS

The small sample size and relatively mild severity of psychopathology does not allow us to generalize our results.

CONCLUSIONS

These results suggest that: (1) patients with SZ are as capable of recognizing their own face as HC, although they are susceptible to ambiguity; (2) there are far less self recognition deficits in schizophrenia patients than previously postulated.

Self-Face Recognition in Schizophrenia: An Eye-Tracking Study

Self-face recognition has been shown to be impaired in schizophrenia (SZ), according to studies using behavioral tasks implicating cognitive demands. Here, we employed an eye-tracking methodology, which is a relevant tool to understand impairments in self-face recognition deficits in SZ because it provides a natural, continuous and online record of face processing. Moreover, it allows collecting the most relevant and informative features each individual looks at during the self-face recognition. These advantages are especially relevant considering the fundamental role played by the patterns of visual exploration on face processing. Thus, this paper aims to investigate self-face recognition deficits in SZ using eye-tracking methodology. Visual scan paths were monitored in 20 patients with SZ and 20 healthy controls. Self, famous, and unknown faces were morphed in steps of 20%. Location, number, and duration of fixations on relevant areas were recorded with an eye-tracking system. Participants performed a passive exploration task (no specific instruction was provided), followed by an active decision making task (individuals were explicitly requested to recognize the different faces). Results showed that patients with SZ had fewer and longer fixations compared to controls. Nevertheless, both groups focused their attention on relevant facial features in a similar way. No significant difference was found between groups when participants were requested to recognize the faces (active task). In conclusion, using an eye tracking methodology and two tasks with low levels of cognitive demands, our results suggest that patients with SZ are able to: (1) explore faces and focus on relevant features of the face in a similar way as controls; and (2) recognize their own face.

Theory of Mind in Depressive Disorders: A Review of the Literature

BACKGROUND

Theory of mind (ToM) is the ability to infer the mental states of others in order to understand and predict their behaviour. This ability is thought to be essential to social functioning and interpersonal relationships. As major depression is characterized by considerable social and interpersonal difficulties, exploration of the quality of ToM functioning can be particularly relevant in this and in related disorders. We aim to review the current state of research on ToM in depressive disorders in order to find out the extent to which ToM impairment is associated with these illnesses.

METHODS

An internet database search was carried out to collect all publications on the subject.

RESULTS

A total of 32 publications in English met our inclusion criteria: (a) 17 studies on ToM in major depression, (b) 4 studies on ToM in psychotic depression, (c) 3 studies on ToM in dysphoria or mild depression, (d) 4 studies on ToM in euthymic major depression, (e) 2 studies on ToM in chronic versus episodic depression, and (f) 2 studies on ToM in another psychiatric disorder with comorbid major depression.

CONCLUSIONS

Despite an increased interest in the research of the topic in recent years, no firm conclusions can be drawn, as the reviewed articles present some conflicting results. Acutely depressed patients have been found to be impaired on tasks involving both ToM social-perceptual and social-cognitive components. On the other hand, a number of studies have not reported significant between-group differences between depressed patients and healthy controls or have found minimal differences. Further research is needed in order to confirm and extend these results.

Correlation between neuropsychological and social cognition measures and symptom dimensions in schizophrenic patients

Neurocognitive and social cognition deficits have been largely reported in Schizophrenia (SKZ) but their association with psychopathology remains uncertain. Our purpose was to explore the relationship between symptom dimensions and neuropsychological performances. We enrolled 35 stabilized schizophrenic outpatients of the Department of Psychiatry of Policlinico Hospital, University of Milan, who completed psychiatric Rating Scales, the Brief Assessment of Cognition in Schizophrenia (BACS) and the Executive and Social Cognition Battery (ESCB). Disorganized dimension seems to have the most significant impact on cognition, being associated with performance in several BACS subtests (verbal memory, working memory, motor speed, symbol coding, Tower of London) and ESCB tasks (MET and Hotel task number of tasks attempted, number of broken MET rules, sum of deviations in Hotel Task). Positive dimension correlated with performance in verbal fluency, negative dimension with IOWA Test results, cognitive dimension with MET number of inefficiencies and Eyes test score. Impulsive-aggressive and depressive dimensions weakly correlated only with Faux Pas test. Our study supports the existence of a specific disorganized dimension in SKZ, separated from cognitive dimension evaluated through clinical instruments (e.g. PANSS), but capable of influencing cognitive abilities. Furthermore, it strengthens the validity of ecological tasks in evaluating cognition in SKZ.

Categorical perception of familiarity: Evidence for a hyper-familiarity in schizophrenia

Familiarity is a crucial aspect of recognition that may be perturbed in schizophrenia patients (SZP) and may lead to delusional disorders. However, there are no existing guidelines on how to assess and treat familiarity disorders in schizophrenia. Some experimental studies have investigated familiarity processing in SZP but have produced inconsistent results, which are likely a result of methodological issues. Moreover, these studies only assessed whether familiarity processing is preserved or impaired in SZP, but not the tendency of SZP to consider unfamiliar stimuli to be familiar. By using a familiarity continuum task based on the existence of the categorical perception effect, the objective of this study was to determine whether SZP present hyper- or hypo-familiarity. To this purpose, 15 SZP and 15 healthy subjects (HS) were presented with facial stimuli, which consisted of picture morphs of unfamiliar faces and faces that were personally familiar to the participants. The percentage of the familiar face contained in the morph ranged from 5 to 95%. The participants were asked to press a button when they felt familiar with the face that was presented. The main results revealed a higher percentage of familiarity responses for SZP compared with HS from the stimuli with low levels of familiarity in the morph and a lower familiarity threshold, suggesting a hyper-familiarity disorder in SZP. Moreover, the intensity of this "hyper-familiarity" was correlated with positive symptoms. This finding clearly suggests the need for a more systematic integration of an assessment of familiarity processing in schizophrenia symptoms assessments.

Brain activation induced by psychological stress in patients with schizophrenia

Environmental influences are critical for the expression of genes putatively related to the behavioral and cognitive phenotypes of schizophrenia. Among such factors, psychosocial stress has been proposed to play a major role in the expression of symptoms. However, it is unsettled how stress interacts with pathophysiological pathways to produce the disease. We studied 21 patients with schizophrenia and 21 healthy controls aged 18 to 50years with 3T-fMRI, in which a period of 6min of resting state acquisition was followed by a block design, with three blocks of 1-min control-task, 1-min stress-task and 1-min rest after-task. Self-report of stress and PANSS were measured. Limbic structures were activated in schizophrenia patients by simple tasks and remained active during, and shortly after stress. In controls, stress-related brain activation was more time-focused, and restricted to the stressful task itself. Negative symptom severity was inversely related to activation of anterior cingulum and orbitofrontal cortex. Results might represent the neurobiological aspect of hyper-reactivity to normal stressful situations previously described in schizophrenia, thus providing evidence on the involvement of limbic areas in the response to stress in schizophrenia. Patients present a pattern of persistent limbic activation probably contributing to hypervigilance and subsequent psychotic thought distortions.

Theory of mind network activity is altered in subjects with familial liability for schizophrenia

As evidenced by a multitude of studies, abnormalities in Theory of Mind (ToM) and its neural processing might constitute an intermediate phenotype of schizophrenia. If so, neural alterations during ToM should be observable in unaffected relatives of patients as well, since they share a considerable amount of genetic risk. While behaviorally, impaired ToM function is confirmed meta-analytically in relatives, evidence on aberrant function of the neural ToM network is sparse and inconclusive. The present study therefore aimed to further explore the neural correlates of ToM in relatives of schizophrenia. About 297 controls and 63 unaffected first-degree relatives of patients with schizophrenia performed a ToM task during functional magnetic resonance imaging. Consistent with the literature relatives exhibited decreased activity of the medial prefrontal cortex. Additionally, increased recruitment of the right middle temporal gyrus and posterior cingulate cortex was found, which was related to subclinical paranoid symptoms in relatives. These results further support decreased medial prefrontal activation during ToM as an intermediate phenotype of genetic risk for schizophrenia. Enhanced recruitment of posterior ToM areas in relatives might indicate inefficiency mechanisms in the presence of genetic risk.