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Akiyama H, Okubo R, Toyomaki A, Miyazaki A, Hattori S, Nohara M, Sasaki Y, Kubota R, Okano H, Takahashi K, Hasegawa Y, Wada I, Uchino T, Takeda K, Ikezawa S, Nemoto T, Ito YM, Hashimoto N. The evaluation study for social cognition measures in Japan: Psychometric properties, relationships with social function, and recommendations. Asian J Psychiatr 2024; 95:104003. [PMID: 38518537 DOI: 10.1016/j.ajp.2024.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
AIM Patients with schizophrenia can have significant subjective difficulties in social cognition, but few undergo testing or treatment for social cognition. The Social Cognition Psychometric Evaluation (SCOPE) study recommends six social cognitive measures; however, the reliability and validity of these measures in different cultural and linguistic areas has not been adequately examined. We examined the psychometric properties of nine social cognitive measures and the relationship to social function, with the aim of determining the level of recommendation for social cognitive measures in clinical practice in Japan. METHODS For our test battery, an expert panel previously selected nine measures: the Bell Lysaker Emotion Recognition Task (BLERT); Facial Emotion Selection Test (FEST); Hinting Task (Hinting); Metaphor and Sarcasm Scenario Test (MSST); Intentionality Bias Task (IBT); Ambiguous Intentions and Hostility Questionnaire (AIHQ); Social Attribution Task-Multiple Choice (SAT-MC); SAT-MCII; and Biological Motion (BM) task. In total, 121 outpatients with schizophrenia and 70 healthy controls were included in the analysis, and the results were provided to an expert panel to determine the recommendations for each measure. The quantitative psychological indices of each measure were evaluated for practicality, tolerability, test-retest reliability, correlation with social function, and the incremental validity of social function. RESULTS Hinting and FEST received the highest recommendations for use in screening, severity assessment, and longitudinal assessment, followed by BLERT, MSST AIHQ, SAT-MC, and SAT-MCII, with IBT and BM receiving the lowest recommendations. CONCLUSION This study provides a uniform assessment tool that can be used in future international clinical trials for social cognitive impairment.
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Affiliation(s)
- Hisashi Akiyama
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Ryo Okubo
- Department of Psychiatry and Neurology, National Hospital Organization Obihiro Hospital, Obihiro 080-8518, Japan; Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan.
| | - Atsuhito Toyomaki
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Akane Miyazaki
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Sachiko Hattori
- Division of Medical Imaging and Technology, Hokkaido University Hospital, Sapporo 060-8638, Japan
| | - Mariko Nohara
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Yohei Sasaki
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan; Faculty of Human Sciences, Musashino University, Tokyo 135-8181, Japan; Research Institute of Cognitive Behavior Therapy, Musashino University, Tokyo 135-8181, Japan
| | - Ryotaro Kubota
- Department of Forensic Psychiatry, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Hiroki Okano
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Kanami Takahashi
- Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Yumi Hasegawa
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Izumi Wada
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo 143-8541, Japan
| | - Takashi Uchino
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo 143-8541, Japan; Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Tokyo 143-8541, Japan
| | - Kazuyoshi Takeda
- Department of Clinical Data Science, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
| | - Satoru Ikezawa
- Endowed Institute for Empowering Gifted Minds, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo 153-0041, Japan; International Department of Psychiatry, University of Health and Welfare Mita Hospital, Tokyo 108-8329, Japan
| | - Takahiro Nemoto
- Department of Neuropsychiatry, Toho University Faculty of Medicine, Tokyo 143-8541, Japan; Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Tokyo 143-8541, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Naoki Hashimoto
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.
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Frau F, Cerami C, Dodich A, Bosia M, Bambini V. Weighing the role of social cognition and executive functioning in pragmatics in the schizophrenia spectrum: A systematic review and meta-analysis. BRAIN AND LANGUAGE 2024; 252:105403. [PMID: 38593743 DOI: 10.1016/j.bandl.2024.105403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/06/2024] [Accepted: 03/10/2024] [Indexed: 04/11/2024]
Abstract
Pragmatic impairment is diffused in schizophrenia spectrum disorders, but the literature still debates its neurocognitive underpinnings. This systematic review and meta-analysis aimed to investigate the neurocognitive correlates of pragmatic disorders in schizophrenia and determine the weight of social cognition and executive functioning on such disorders. Of the 2,668 records retrieved from the literature, 16 papers were included in the systematic review, mostly focused on non-literal meanings and discourse production in schizophrenia. Ten studies were included in the meta-analysis: pragmatics was moderately associated with both social cognition and executive functions (especially inhibition), but the link with social cognition was stronger. The mediation analysis showed that social cognition mediated the relationship between executive functions and pragmatics. Based on this, we proposed a hierarchical neurocognitive model where pragmatics stems from social cognition, while executive functions are the fertile ground supporting the other two domains, and we discuss its theoretical and clinical implications.
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Affiliation(s)
- Federico Frau
- Laboratory of Neurolinguistics and Experimental Pragmatics (NEP), Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy.
| | - Chiara Cerami
- IUSS Cognitive Neuroscience (ICoN) Center, University School for Advanced Studies IUSS, Pavia, Italy; Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Alessandra Dodich
- Center for Mind/Brain Sciences-CIMeC, University of Trento, Rovereto, Italy
| | - Marta Bosia
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Schizophrenia Research and Clinical Unit, IRCCS San Raffaele Hospital, Milan, Italy
| | - Valentina Bambini
- Laboratory of Neurolinguistics and Experimental Pragmatics (NEP), Department of Humanities and Life Sciences, University School for Advanced Studies IUSS, Pavia, Italy
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Bora E, Eyuboglu MS, Cesim E, Demir M, Yalincetin B, Ermis C, Özbek Uzman S, Sut E, Demirlek C, Verim B, Baykara B, İnal N, Akdede BB. Social cognition and neurocognition in first-episode bipolar disorder and psychosis: The effect of negative and attenuated positive symptoms. J Affect Disord 2024; 351:356-363. [PMID: 38290586 DOI: 10.1016/j.jad.2024.01.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/13/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Schizophrenia and bipolar disorder are associated with neurocognitive and social-cognitive impairments. To date very few studies investigated social cognition in first-episode bipolar disorder (FEBD). Our main aim was to investigate the differences in social cognition and neurocognition between FEBD and first-episode psychosis (FEP). Another aim was to investigate neurocognitive correlates of negative symptoms and attenuated psychotic symptoms in FEBD. METHODS This study included 55 FEBD, 64 FEP and 43 healthy controls. A comprehensive neuropsychological battery assessing social cognition, processing speed, verbal and visual memory, working memory, sustained attention, and executive functions was administered to all participants. RESULTS Both FEBD and FEP were associated with widespread deficits in all neurocognitive domains and social cognition. Both FEP (d = -1.19) and FEBP (d = -0.88) were also impaired in social cognition. In FEP, effect sizes (Cohen's d) of neurocognitive deficits ranged from -0.71 to -1.56. FEBD was also associated with relatively milder but similar neurocognitive deficits (d = -0.61 to-1.17). FEBD group performed significantly better than FEP group in verbal and visual memory, processing speed, and executive function domains (d = -0.40 to-0.52). Negative symptoms and social functioning were associated with neuropsychological impairment in both groups. The severity of attenuated psychotic symptoms was associated with poorer verbal memory in FEBD (r = -0.39, p < 0.01). LIMITATIONS The cross-sectional nature of the current study is the main limitation. CONCLUSIONS Neurocognitive and social-cognitive deficits are evident in both FEBD and FEP. In FEBD, more severe memory deficits might be markers of clinical overlap and shared neurobiological vulnerability with psychotic disorders.
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Affiliation(s)
- E Bora
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia.
| | - M S Eyuboglu
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - E Cesim
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - M Demir
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - B Yalincetin
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - C Ermis
- Queen Silvia Children's Hospital, Department Child and Adolescent Psychiatry, Gothenburg, Sweden
| | - S Özbek Uzman
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - E Sut
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - C Demirlek
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - B Verim
- Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
| | - B Baykara
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - N İnal
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - B B Akdede
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; Department of Neurosciences, Health Sciences Institute, Dokuz Eylul University, Izmir, Turkey
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Chen KW, Lee SC, Chou FHC, Chiang HY, Hsueh IP, Chen PH, Wang SP, Ju YJ, Hsieh CL. Development of a Rasch-calibrated emotion recognition video test for patients with schizophrenia. Arch Clin Neuropsychol 2023:acad098. [PMID: 38163920 DOI: 10.1093/arclin/acad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/31/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Patients with schizophrenia tend to have deficits in emotion recognition (ER) that affect their social function. However, the commonly-used ER measures appear incomprehensive, unreliable and invalid, making it difficult to comprehensively evaluate ER. The purposes of this study were to develop the Computerized Emotion Recognition Video Test (CERVT) evaluating ER ability in patients with schizophrenia. This study was divided into two phases. First, we selected candidate CERVT items/videos of 8 basic emotion domains from a published database. Second, we validated the selected CERVT items using Rasch analysis. Finally, the 269 patients and 177 healthy adults were recruited to ensure the participants had diverse abilities. After the removal of 21 misfit (infit or outfit mean square > 1.4) items and adjustment of the item difficulties of the 26 items with severe differential item functioning, the remaining 217 items were finalized as the CERVT items. All the CERVT items showed good model fits with small eigenvalues (≤ 2) based on the residual-based principal components analysis for each domain, supporting the unidimensionality of these items. The 8 domains of the CERVT had good to excellent reliabilities (average Rasch reliabilities = 0.84-0.93). The CERVT contains items of the 8 basic emotions with individualized scores. Moreover, the CERVT showed acceptable reliability and validity, and the scores were not affected by examinees' gender. Thus, the CERVT has the potential to provide a comprehensive, reliable, valid, and gender-unbiased assessment of ER for patients with schizophrenia.
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Affiliation(s)
- Kuan-Wei Chen
- Department of Occupational Therapy, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Frank Huang-Chih Chou
- Superintendent Office, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hsin-Yu Chiang
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Hsi Chen
- Department of Educational Psychology and Counseling, Institute for Research Excellent in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - San-Ping Wang
- Department of Occupational Therapy, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Jeng Ju
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Vita A, Barlati S, Deste G, Nibbio G, Penn DL, Pinkham AE, McIntyre RS, Harvey PD. Life engagement in people living with schizophrenia: predictors and correlates of patient life engagement in a large sample of people living in the community. Psychol Med 2023; 53:7943-7952. [PMID: 37522514 PMCID: PMC10755242 DOI: 10.1017/s0033291723002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/24/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Life engagement represents a holistic concept that encompasses outcomes reflecting life-fulfilment, well-being and participation in valued and meaningful activities, which is recently gaining attention and scientific interest. Despite its conceptual importance and its relevance, life engagement represents a largely unexplored domain in schizophrenia. The aims of the present study were to independently assess correlates and predictors of patient life engagement in a large and well-characterized sample of schizophrenia patients. METHODS To assess the impact of different demographic, clinical, cognitive and functional parameters on life engagement in a large sample of patients with schizophrenia, data from the social cognition psychometric evaluation project were analyzed. RESULTS Overall schizophrenia and depressive symptom severity, premorbid IQ, neurocognitive performance, social cognition performance both in the emotion processing and theory of mind domains, functional capacity, social skills performance and real-world functioning in different areas all emerged as correlates of patient life engagement. Greater symptom severity and greater impairment in real-world interpersonal relationships, social skills, functional capacity and work outcomes emerged as individual predictors of greater limitations in life engagement. CONCLUSIONS Life engagement in people living with schizophrenia represents a holistic and complex construct, with several different clinical, cognitive and functional correlates. These features represent potential treatment targets to improve the clinical condition and also facilitate the process of recovery and the overall well-being of people living with schizophrenia.
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Affiliation(s)
- Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Amy E. Pinkham
- Department of Psychology, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Roger S. McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
- Brain and Discovery Foundation (BCDF), Toronto, Canada
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Miami VA Healthcare System, Miami, FL, USA
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Eriksdotter M, Joutsimäki K, Johnsson P. Knowing me, knowing you: a scoping review assessing the current field of social cognition in schizophrenia. Nord J Psychiatry 2023; 77:627-640. [PMID: 37366305 DOI: 10.1080/08039488.2023.2226114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Impaired social cognition (SC) occurs frequently in schizophrenia (SCZ), yet compared to autism spectrum disorder (ASD), the research on SC in SCZ is sparse and methodologically heterogeneous. To accurately assess between-group SC differences it is further necessary to establish the relationship between nonsocial cognition (NSC) and SC, particularly as this may not be identical across disorders. PURPOSE The present study aimed to map, index and assess the quality of research published between 2014-2021 investigating SC in SCZ, and to summarize existing limitations and recommendations for future research. METHOD Following the PRISMA guidelines for scoping reviews (PRISMA-ScR) fifteen (n = 15) case-control studies were identified and included across three electronic databases. Studies additionally utilizing ASD samples were included because of their clinical utility. RESULTS Most studies reported significant SC impairments in SCZ relative to healthy controls (HC) with varying effect sizes. Significant differences between SCZ and ASD were not found in most studies including both samples. Weak-to-moderate correlations between SC and NSC were often found, although often only within patient samples. Across studies, SC tests were inconsistently described as measurements of "social cognition", "mentalization" and, most frequently and varyingly, "theory of mind". Most studies lacked methodological transparency. Limitations related to sample sizes and test reliability were most frequently mentioned. CONCLUSIONS The current research on SC in SCZ is limited by conceptual and methodological uncertainties. Future research should focus on ensuring clear and valid definitions of key terms, evaluating and clarifying SC outcome measures and further untangling the relationship between SC and NSC.
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Affiliation(s)
| | | | - Per Johnsson
- Department of Psychology, Lund University, Lund, Sweden
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Meins IA, Muijsson-Bouwman DC, Nijman SA, Greaves-Lord K, Veling W, Pijnenborg GHM, van der Stouwe ECD. VR-SOAP, a modular virtual reality treatment for improving social activities and participation of young people with psychosis: a study protocol for a single-blind multi-centre randomized controlled trial. Trials 2023; 24:278. [PMID: 37061694 PMCID: PMC10105944 DOI: 10.1186/s13063-023-07241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/13/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Causes of these problems are multifaceted, but culminate in difficulties with interacting in daily life social situations. Current treatments have only moderate effects on social functioning and often target one specific domain. Virtual reality (VR) has the potential to improve the treatment of social interaction difficulties. We developed a modular VR treatment for social functioning and participation (VR-SOAP). In this study, the effect of this intervention will be investigated in a randomized controlled trial (RCT). METHODS A total of 116 participants (age 18-40) with a DSM-5 diagnosis of schizophrenia spectrum or other psychotic disorder and problems with social functioning will be recruited from mental healthcare institutes in the Netherlands. Participants will be randomized to the experimental condition (VR-SOAP) or active VR control condition (VRelax). VR-SOAP consists of 14 sessions and 5 modules addressing causes of impaired social functioning: four optional modules (1-4) and one fixed module (5). Vrelax consists of 14 sessions that entail psychoeducation, stress management, relaxation techniques, and the exploration of relaxing environments in VR. Primary outcomes are quantity and quality of social contacts, leisure activities and social participation, measured with the experience sampling method (ESM). Secondary outcomes are psychiatric symptoms, social behaviour, social cognition, self-esteem, self-stigma and paranoid thoughts. Treatment effects will be compared at pre-treatment (baseline), post-treatment and at 6-month follow-up. DISCUSSION If VR-SOAP proves to be effective, it provides therapists with a much-needed tool to improve social functioning of young adults with a psychotic disorder. Additionally, since the treatment consists of multiple modules targeting different transdiagnostic factors, this trial might provide input for new treatments to improve social functioning in a range of symptoms and disorders, e.g. mood, autism spectrum and anxiety disorders. TRIAL REGISTRATION On the 10th of November 2021, this trial was registered prospectively in the Dutch Trial Register as NL9784 .
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Affiliation(s)
- Ivo Alexander Meins
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands.
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands.
| | | | - Saskia Anne Nijman
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands
| | | | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands
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Abstract
OBJECTIVE Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning. METHOD In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests. RESULTS In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments. CONCLUSION We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.
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Affiliation(s)
- Skye McDonald
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Travis Wearne
- School of Psychology, University of Western Sydney, Penrith South, Australia
| | - Michelle Kelly
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
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Depp CA, Kamarsu S, Filip TF, Parrish EM, Harvey PD, Granholm EL, Chalker S, Moore RC, Pinkham A. Ecological momentary facial emotion recognition in psychotic disorders. Psychol Med 2022; 52:2531-2539. [PMID: 33431072 PMCID: PMC8621678 DOI: 10.1017/s0033291720004419] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cognitive tasks delivered during ecological momentary assessment (EMA) may elucidate the short-term dynamics and contextual influences on cognition and judgements of performance. This paper provides initial validation of a smartphone task of facial emotion recognition in serious mental illness. METHODS A total of 86 participants with psychotic disorders (non-affective and affective psychosis), aged 19-65, were administered in-lab 'gold standard' affect recognition, neurocognition, and symptom assessments. They subsequently completed 10 days of the mobile facial emotion recognition task, assessing both accuracy and self-assessed performance, along with concurrent EMA of psychotic symptoms and mood. Validation focused on task adherence and predictors of adherence, gold standard convergent validity, and symptom and diagnostic group variation. RESULTS The mean rate of adherence to the task was 79%; no demographic or clinical variables predicted adherence. Convergent validity was observed with in-lab measures of facial emotion recognition, and no practice effects were observed on the mobile facial emotion recognition task. EMA reports of more severe voices, sadness, and paranoia were associated with worse performance, whereas mood more strongly associated with self-assessed performance. CONCLUSION The mobile facial emotion recognition task was tolerated and demonstrated convergent validity with in-lab measures of the same construct. Social cognitive performance, and biased judgements previously shown to predict function, can be evaluated in real-time in naturalistic environments.
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Affiliation(s)
- Colin A Depp
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Snigdha Kamarsu
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Tess F Filip
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Emma M Parrish
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Philip D Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Bruce W. Carter VA Medical Center, Miami, FL, USA
| | - Eric L Granholm
- University of California San Diego Department of Psychiatry, San Diego, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Samantha Chalker
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Raeanne C Moore
- University of California San Diego Department of Psychiatry, San Diego, California, USA
| | - Amy Pinkham
- The University of Texas at Dallas, Dallas, TX, USA
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10
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Hyatt CJ, Wexler BE, Pittman B, Nicholson A, Pearlson GD, Corbera S, Bell MD, Pelphrey K, Calhoun VD, Assaf M. Atypical Dynamic Functional Network Connectivity State Engagement during Social-Emotional Processing in Schizophrenia and Autism. Cereb Cortex 2022; 32:3406-3422. [PMID: 34875687 PMCID: PMC9376868 DOI: 10.1093/cercor/bhab423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 01/30/2023] Open
Abstract
Autism spectrum disorder (ASD) and schizophrenia (SZ) are separate clinical entities but share deficits in social-emotional processing and static neural functional connectivity patterns. We compared patients' dynamic functional network connectivity (dFNC) state engagement with typically developed (TD) individuals during social-emotional processing after initially characterizing such dynamics in TD. Young adults diagnosed with ASD (n = 42), SZ (n = 41), or TD (n = 55) completed three functional MRI runs, viewing social-emotional videos with happy, sad, or neutral content. We examined dFNC of 53 spatially independent networks extracted using independent component analysis and applied k-means clustering to windowed dFNC matrices, identifying four unique whole-brain dFNC states. TD showed differential engagement (fractional time, mean dwell time) in three states as a function of emotion. During Happy videos, patients spent less time than TD in a happy-associated state and instead spent more time in the most weakly connected state. During Sad videos, only ASD spent more time than TD in a sad-associated state. Additionally, only ASD showed a significant relationship between dFNC measures and alexithymia and social-emotional recognition task scores, potentially indicating different neural processing of emotions in ASD and SZ. Our results highlight the importance of examining temporal whole-brain reconfiguration of FNC, indicating engagement in unique emotion-specific dFNC states.
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Affiliation(s)
- Christopher J Hyatt
- Address correspondence to Christopher J. Hyatt, PhD, Olin Neuropsychiatry Research Center, Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, USA.
| | - Bruce E Wexler
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Brian Pittman
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Alycia Nicholson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT 06106, USA
| | - Godfrey D Pearlson
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT 06106, USA
- Department of Psychiatry and Neuroscience, School of Medicine, Yale University, New Haven, CT 06510, USA
| | - Silvia Corbera
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06510, USA
- Department of Psychological Science, Central Connecticut State University, New Britain, CT 06050, USA
| | - Morris D Bell
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06510, USA
- Department of Psychiatry, VA Connecticut Healthcare System West Haven, West Haven, CT 06516, USA
| | - Kevin Pelphrey
- Department of Neurology, University of Virginia, Charlottesville, VA 22903, USA
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS) Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA 30303, USA
| | - Michal Assaf
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, CT 06106, USA
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06510, USA
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11
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Halverson TF, Pinkham AE, Harvey PD, Penn DL. Brief battery of the Social Cognition Psychometric Evaluation study (BB-SCOPE): Development and validation in schizophrenia spectrum disorders. J Psychiatr Res 2022; 150:307-316. [PMID: 35447524 PMCID: PMC9107509 DOI: 10.1016/j.jpsychires.2022.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to develop an abbreviated social cognition (SC) battery for individuals with schizophrenia spectrum disorders (SSD) to reduce the heterogeneity of and increase the frequency of assessment of SC impairment. To this end, the present study utilized Item Response Theory to develop brief versions of SC tasks administered to individuals with SSD (n = 386) and individuals without a psychiatric diagnosis (n = 292) during the Social Cognition Psychometric Evaluation (SCOPE) Study. Seven brief measures of SC were evaluated (i.e., Ambiguous Intentions and Hostility Questionnaire [AIHQ], Bell Lysaker Emotion Recognition Task [BLERT], Penn Emotion Recognition Task, Reading the Mind in the Eyes Task, Hinting Task, Intentionality Bias Task, Relationships Across Domains Task), and the existing brief version of The Awareness of Social Inference Test was reviewed. Psychometric properties for each brief SC measure were evaluated and compared to the original measures. Based on psychometric properties and relationships with other measures of SC, neurocognition, and functioning, two brief tasks (AIHQ, BLERT) and the full-length Hinting task were recommended for inclusion in a brief battery of SC tasks from the SCOPE Study (BB-SCOPE). The resulting BB-SCOPE is efficient, with an estimated administration time of 15 min, and comprehensively assesses three domains of SC (i.e., attributional bias, emotion processing, theory of mind) to identify severe SC impairment. Scoring of BB-SCOPE is also straightforward and includes a recommended cut-point of 60 for identifying SC impairment.
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Affiliation(s)
- Tate F. Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, NC, USA
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Research Services, Miami VA Healthcare System, Miami, FL, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,School of Behavioral and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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12
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Frawley E, Cowman M, Cella M, Cohen D, Ryan E, Hallahan B, Bowie C, McDonald C, Fowler D, Wykes T, Donohoe G. Cognitive Remediation and Social Recovery in Early Psychosis (CReSt-R): protocol for a pilot randomised controlled study. Pilot Feasibility Stud 2022; 8:109. [PMID: 35610711 PMCID: PMC9126749 DOI: 10.1186/s40814-022-01064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Psychosis, even in its early stages, is associated with significant disability, causing it to be ranked ahead of paraplegia and blindness in those aged 18-35 in terms of years lived with disability. Current pharmacological and psychological interventions intervention have focused primarily on the reduction of positive symptoms (hallucinations and delusions), with little benefit to domains of psychosis such as cognitive difficulties and social and occupational functioning. METHODS/DESIGN The CReSt-R intervention trial is a single center, pilot randomised controlled study based at the National University of Ireland (NUI), Galway. The trial will recruit participants from four clinical sites with assessment and intervention completed by the primary NUI Galway team. The trial will explore the feasibility, acceptability, and effectiveness of a novel psychosocial intervention for early psychosis based on a combined cognitive remediation training and cognitive behavioural therapy approach focused on social recovery. Participants, aged 16-35 within the first 5 years of a diagnosed psychotic disorder, will be recruited from the Children and Adolescent Mental Health Service and the Adult Mental Health Services in the region. DISCUSSION Cognitive remediation training (for improving cognition) and social recovery focused cognitive behavioural therapy, have both separately demonstrated effectiveness. This trial will evaluate the feasibility, acceptability, and explore the efficacy of a treatment approach that combines both approaches as part of an integrated, multicomponent intervention. TRIAL REGISTRATION Cognitive Remediation & Social Recovery in Early Psychosis (CReSt-R): ClincialTrials.gov Identifier NCT04273685. Trial registered Feb 18th, 2020. Last updated April 14th, 2021.
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Affiliation(s)
- E Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - M Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - M Cella
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, England
| | - D Cohen
- South Galway Child & Adolescent Mental Health Service, Health Service Executive, Merlin Park Hospital, Galway, Ireland
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - E Ryan
- Psychology Service, Adult Mental Health Service, University Hospital Galway, Galway, Ireland
| | - B Hallahan
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - C Bowie
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - C McDonald
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - D Fowler
- Department of Psychology, University of Sussex, Brighton, England
| | - T Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, England
| | - G Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland.
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13
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Hajdúk M, Pinkham AE, Penn DL, Harvey PD, Sasson NJ. Heterogeneity of social cognitive performance in autism and schizophrenia. Autism Res 2022; 15:1522-1534. [PMID: 35460541 DOI: 10.1002/aur.2730] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/16/2022] [Accepted: 04/11/2022] [Indexed: 11/06/2022]
Abstract
Autistic adults and those with schizophrenia (SCZ) demonstrate similar levels of reduced social cognitive performance at the group level, but it is unclear whether these patterns are relatively consistent or highly variable within and between the two conditions. Seventy-two adults with SCZ (52 male, Mage = 28.2 years) and 94 with diagnoses on the autism spectrum (83 male, Mage = 24.2 years) without intellectual disability completed a comprehensive social cognitive battery. Latent profile analysis identified four homogeneous subgroups that were compared on their diagnosis, independent living skills, neurocognition, and symptomatology. Two groups showed normative performance across most social cognitive tasks but were differentiated by one having significantly higher hostility and blaming biases. Autistic participants were more likely to demonstrate fully normative performance (46.8%) than participants with SCZ, whereas normative performance in SCZ was more likely to co-occur with increased hostility and blaming biases (36.1%). Approximately 43% of participants in the full sample were classified into the remaining two groups showing low or very low performance. These participants tended to perform worse on neurocognitive tests and have lower IQ and fewer independent living skills. The prevalence of low performance on social cognitive tasks was comparable across clinical groups. However, nearly half of autistic participants demonstrated normative social cognitive performance, challenging assumptions that reduced social cognitive performance is inherent to the condition. Subgrouping also revealed a meaningful distinction between the clinical groups: participants with SCZ were more likely to demonstrate hostility biases than autistic participants, even when social cognitive performance was otherwise in the typical range. LAY SUMMARY: Social cognition refers to the perception and interpretation of social information. Previous research has shown that both autistic people and those with schizophrenia demonstrate reduced performance on traditional social cognitive tasks, which we replicate here at the group level. However, we also found that almost half of autistic participants performed in the normal range. Over a third of participants with schizophrenia did as well, but for them this performance was accompanied by a hostility bias not commonly found in the autistic sample. Taken together, findings challenge assumptions that difficulties in social cognition are a uniform characteristic of these clinical conditions in those without intellectual disability.
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Affiliation(s)
- Michal Hajdúk
- Department of Psychology, Faculty of Arts, Comenius University in Bratislava, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia.,Science Park UK, Center for Psychiatric Disorders Research, Bratislava, Slovakia
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.,Research Service, Miami VA Healthcare System, Miami, Florida, USA
| | - Noah J Sasson
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, Texas, USA
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14
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Bornheimer LA, Martz ME, Suzuki T, Tso IF, Burton CZ, Li Verdugo J, Grove T, Heitzeg MM, Taylor SF. Affective Dysregulation Precedes Emergence of Psychosis-Like Experiences in a Community Sample of Young Adults. Schizophr Bull 2022; 48:664-672. [PMID: 35190837 PMCID: PMC9077429 DOI: 10.1093/schbul/sbac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Affective dysregulation (AD) among persons with schizophrenia spectrum disorders, involving the tendency to exhibit sensitivity to minor stress and negative affective states, is an important diagnostic feature and relates to poorer functional and clinical outcomes. Studies of persons with elevated risk for psychosis demonstrate similar AD to those with schizophrenia, and literature suggest a potential influence of AD in the transition from psychosis-like symptoms (PLEs) to disorder. Cross-sectional investigations to date have supported the link between AD and psychosis, and longitudinal studies have mostly yielded mixed findings without demonstration of potential causal relationships between AD and psychosis. This study examined the concurrent and predictive relationships between AD and PLE in a community sample of youth (n = 630) with attention to distinct facets of AD as a latent construct, including low resiliency, low reactive control, and negative emotionality, using structural equation to estimate a longitudinal cross-lagged and autoregressive model across 3 study waves from 15 to 24 years of age. As hypothesized, AD in the mid-teen years predicted subsequent PLE 3 years later. In addition, we found that increasing PLE in the end of the teen years related to a subsequent increase in AD in the early 20s. A cross-sectional relationship between AD and PLE in the mid-teen years was also supported. Findings overall describe important relationships between AD and PLE that appear to vary with developmental stage, implicating various factors to inform approaches for identifying youth who may be at risk for subsequent PLE or other mental health conditions.
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Affiliation(s)
- Lindsay A Bornheimer
- To whom correspondence should be addressed; 1080 South University Ave, Ann Arbor, MI 48109; tel: (734) 615-2915, fax: 1 (734) 936-1961, e-mail:
| | - Meghan E Martz
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Takakuni Suzuki
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ivy F Tso
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Cynthia Z Burton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Tyler Grove
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Mary M Heitzeg
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stephan F Taylor
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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15
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Zierhut M, Böge K, Bergmann N, Hahne I, Braun A, Kraft J, Ta TMT, Ripke S, Bajbouj M, Hahn E. The Relationship Between the Recognition of Basic Emotions and Negative Symptoms in Individuals With Schizophrenia Spectrum Disorders - An Exploratory Study. Front Psychiatry 2022; 13:865226. [PMID: 35573376 PMCID: PMC9091587 DOI: 10.3389/fpsyt.2022.865226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Current research suggests that emotion recognition is impaired in individuals affected by schizophrenia spectrum disorders (SSD). However, the specific impact of negative symptoms on the ability to recognize single basic emotions has not yet been explored sufficiently and is the aim of the present study. A sample of N = 66 individuals diagnosed with SSD was recruited at the Charité - Universitätsmedizin Berlin. In a first step, correlation analyses were conducted between seven different negative symptom subdomains of the Positive and Negative Syndrome Scale (PANSS) and the accuracy and latency in recognizing the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task (ERT) of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The significant correlations were subjected to linear regression models that controlled for the significant covariates diagnoses, age, sex, and education. Results revealed that in individuals with SSD the negative symptom domain of blunted affect significantly predicted the accuracy of emotion recognition performance (p < 0.05), particularly, when recognizing happiness (p < 0.05). Additionally, we found that stereotyped thinking also predicted the performance of emotion recognition, especially the response latency (p < 0.05) and difficulty in abstract thinking predicted the recognition of fear (p < 0.05). However, the nominal significances did not withstand correction for multiple tests and therefore need to be followed up in further studies with a larger sample.
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Affiliation(s)
- Marco Zierhut
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charitè Junior Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Niklas Bergmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Inge Hahne
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Braun
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Kraft
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Ripke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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16
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Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, Zanca F, Giordano GM, Birkedal Glenthøj L, Nordentoft M, Galderisi S. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry 2022; 65:e58. [PMID: 36059109 PMCID: PMC9532219 DOI: 10.1192/j.eurpsy.2022.2316] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Impairment in a wide range of cognitive abilities has been consistently reported in individuals with schizophrenia. Both neurocognitive and social cognitive deficits are thought to underlie severe functional disabilities associated with schizophrenia. Despite the key role in schizophrenia outcome, cognition is still poorly assessed in both research and clinical settings. Methods In this guidance paper, we provide a systematic review of the scientific literature and elaborate several recommendations for the assessment of cognitive functions in schizophrenia both in research settings and in real-world clinical practice. Results Expert consensus and systematic reviews provided guidance for the optimal assessment of cognitive functions in schizophrenia. Based on the reviewed evidence, we recommend a comprehensive and systematic assessment of neurocognitive and social cognitive domains in schizophrenia, in all phases of the disorder, as well as in subjects at risk to develop psychosis. This European Psychiatric Association guidance recommends not only the use of observer reports but also self-reports and interview-based cognitive assessment tools. The guidance also provides a systematic review of the state of the art of assessment in the first episode of psychosis patients and in individuals at risk for psychosis. Conclusion The comprehensive review of the evidence and the recommendations might contribute to advance the field, allowing a better cognitive assessment, and avoiding overlaps with other psychopathological dimensions. The dissemination of this guidance paper may promote the development of shared guidelines concerning the assessment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to obtain recovery.
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17
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Social cognition, neurocognition, symptomatology, functional competences and outcomes in people with schizophrenia - A network analysis perspective. J Psychiatr Res 2021; 144:8-13. [PMID: 34592511 PMCID: PMC8665006 DOI: 10.1016/j.jpsychires.2021.09.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/25/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Extensive difficulties in reaching functional milestones characterize schizophrenia and related psychotic disorders. These impairments are in part explained by lower social cognitive abilities, cognitive impairment, and current psychopathology. The present study aims to model dynamic associations among social cognition, neurocognition, psychopathology, social skills, functional capacity, and functional outcomes in schizophrenia using network analysis in order to identify those factors that are most central to functioning. METHODS The sample consisted of 408 patients with schizophrenia spectrum disorders who were drawn from the SCOPE project. Participants completed a complex battery of state-of-the-art measures of social cognition, neurocognition, and functional outcomes. Gaussian Graphical Modeling was used for estimation of the network structure. Accuracy of the network was evaluated using the Bootstrap method. RESULTS Data supported the importance of functional capacity and social skills, which are prerequisites to real - world outcomes. These variables were among the most central in the network. Social cognition was related to functional capacity, social skills, and real - world functioning. Negative symptoms were connected to functional capacity, social skills, and real - world functioning. CONCLUSIONS Predictors of functional outcomes are complexly associated with each other. Functional capacity, social - skills, working memory, negative symptoms, mentalizing, and emotion recognition were central nodes that support their importance as potential targets of personalized intervention.
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18
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Deste G, Vita A, Nibbio G, Barlati S, Penn DL, Pinkham AE, Harvey PD. Autistic symptoms in people with schizophrenia: Neurocognitive, socio-cognitive, clinical and real-world functional characteristics of individuals without autistic features. Schizophr Res 2021; 236:12-18. [PMID: 34364032 DOI: 10.1016/j.schres.2021.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/27/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Autism spectrum disorders (ASD) symptoms are frequent in people living with schizophrenia spectrum disorders (SSD) and have a relevant impact on their daily life. However, current literature is mostly focused on investigating correlates of high levels of ASD symptoms, leaving largely unexplored the clinical, neurocognitive, socio-cognitive and functional characterization of individuals with minimal or absent ASD symptoms, which may represent a peculiar sub-population. METHODS A total of 361 patients (mean age 41.7 years; 117 females) included in the SCOPE study were assessed with clinical, neurocognitive, socio-cognitive, functional capacity, social skills and real-world functioning measures. The severity of ASD symptoms was assessed with the PANSS Autism Severity Scale (PAUSS): individuals with a PAUSS score < 10 were considered without significant ASD symptoms. RESULTS Seventy-two (19.95%) participants had no significant ASD symptoms and presented a less severe clinical status, as well as a better cognitive and socio-cognitive performance and functional profile. Lower non-autistic SSD symptoms severity and better social skills, functional capacity, global cognitive and Theory of Mind/Mental State Attribution (as measured by the Hinting task) performance and real-world social relationships emerged as predictors of non-ASD symptoms status in the logistic regression analyses. CONCLUSION Individuals without ASD symptoms represent a minority of people diagnosed with SSD that appears to be characterized by specific correlates, resulting in a less severe situation and more positive outcomes. As these factors could have a relevant impact on treatment response, assessing the severity of ASD symptoms could be an important step required to define a personalized treatment.
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Affiliation(s)
- Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - David L Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, United States of America; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia.
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States of America; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States of America.
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America; Research Service, Miami VA Healthcare System, United States of America.
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19
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Muñoz Ladrón de Guevara C, Reyes Del Paso GA, Fernández-Serrano MJ, Duschek S. Facial Emotion Recognition and Executive Functions in Fibromyalgia. PAIN MEDICINE 2021; 22:1619-1629. [PMID: 33538840 DOI: 10.1093/pm/pnab024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The ability to accurately identify facial expressions of emotions is crucial in human interaction. Although a previous study suggested deficient emotional face recognition in patients with fibromyalgia, not much is known about the origin of this impairment. Against this background, the present study investigated the role of executive functions. Executive functions refer to cognitive control mechanisms enabling implementation and coordination of basic mental operations. Deficits in this domain are prevalent in fibromyalgia. METHODS Fifty-two fibromyalgia patients and thirty-two healthy individuals completed the Ekman-60 Faces Test, which requires classification of facial displays of happiness, sadness, anger, fear, surprise, and disgust. They also completed eight tasks assessing the executive function components of shifting, updating, and inhibition. Effects of comorbid depression and anxiety disorders, as well as medication use, were tested in stratified analyses of patient subgroups. RESULTS Patients made more errors overall than controls in classifying the emotional expressions. Moreover, their recognition accuracy correlated positively with performance on most of the executive function tasks. Emotion recognition did not vary as a function of comorbid psychiatric disorders or medication use. CONCLUSIONS The study supports impaired facial emotion recognition in fibromyalgia, which may contribute to the interaction problems and poor social functioning characterizing this condition. Facial emotion recognition is regarded as a complex process, which may be particularly reliant on efficient coordination of various basic operations by executive functions. As such, the correlations between cognitive task performance and recognition accuracy suggest that deficits in higher cognitive functions underlie impaired emotional communication in fibromyalgia.
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Affiliation(s)
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT Tirol-University for Health Sciences Medical Informatics and Technology, Hall in Tirol, Austria
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20
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Virtual reality facial emotion recognition in social environments: An eye-tracking study. Internet Interv 2021; 25:100432. [PMID: 34401391 PMCID: PMC8350588 DOI: 10.1016/j.invent.2021.100432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/20/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Virtual reality (VR) enables the administration of realistic and dynamic stimuli within a social context for the assessment and training of emotion recognition. We tested a novel VR emotion recognition task by comparing emotion recognition across a VR, video and photo task, investigating covariates of recognition and exploring visual attention in VR. METHODS Healthy individuals (n = 100) completed three emotion recognition tasks; a photo, video and VR task. During the VR task, emotions of virtual characters (avatars) in a VR street environment were rated, and eye-tracking was recorded in VR. RESULTS Recognition accuracy in VR (overall 75%) was comparable to the photo and video task. However, there were some differences; disgust and happiness had lower accuracy rates in VR, and better accuracy was achieved for surprise and anger in VR compared to the video task. Participants spent more time identifying disgust, fear and sadness than surprise and happiness. In general, attention was directed longer to the eye and nose areas than the mouth. DISCUSSION Immersive VR tasks can be used for training and assessment of emotion recognition. VR enables easily controllable avatars within environments relevant for daily life. Validated emotional expressions and tasks will be of relevance for clinical applications.
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Pharmacological Treatment for Social Cognition: Current Evidence. Int J Mol Sci 2021; 22:ijms22147457. [PMID: 34299076 PMCID: PMC8307511 DOI: 10.3390/ijms22147457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022] Open
Abstract
Cognitive impairment is currently considered a core feature of schizophrenia (SZ) and is gaining attention as a fundamental therapeutic target. Standard treatment for SZ involves the use of antipsychotics that are successfully used to control positive symptoms and disorganized behaviour. However, it is still unclear whether they are effective on social cognition (SC) impairment. Furthermore, different medications are currently being studied to improve SC in patients with SZ. A literature search on this topic was conducted using the PubMed database. All kinds of publications (i.e., reviews, original contributions and case reports) written in English and published in the last 15 years were included. The aim of our literature review is to draw a picture of the current state of the pharmacological treatment of SC impairment in SZ.
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Sedgwick O, Hardy A, Greer B, Newbery K, Cella M. "I wanted to do more of the homework!"-Feasibility and acceptability of blending app-based homework with group therapy for social cognition in psychosis. J Clin Psychol 2021; 77:2701-2724. [PMID: 34101177 DOI: 10.1002/jclp.23193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Evidence suggests social-cognitive difficulties are linked to poor community functioning in people with psychosis, however, there is limited evidence that social-cognition interventions improve functioning. This may be due to poor generalization of therapy learning; digital technologies may be useful to support this. This study evaluates the feasibility of a brief, blended intervention (group therapy plus app) for individuals with psychosis. METHODS A total of 14 clients diagnosed with psychosis-spectrum difficulties participated. Feasibility was assessed by referral, adherence and completion rates, and acceptability via semi-structured interview (thematically analyzed). RESULTS The procedures were considered feasible and acceptable. The face-to-face component of the intervention was particularly valued, and participants reported benefits to their daily lives. The app was experienced as helpful, alongside some difficulties. CONCLUSIONS Development of blended interventions may prove an important avenue to maximize the adherence and reach of psychological interventions. The results of this study reinforce the need to maintain face-to-face components alongside digital.
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Affiliation(s)
- Ottilie Sedgwick
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Greer
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie Newbery
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Klein HS, Vanneste S, Pinkham AE. The limited effect of neural stimulation on visual attention and social cognition in individuals with schizophrenia. Neuropsychologia 2021; 157:107880. [PMID: 33961863 DOI: 10.1016/j.neuropsychologia.2021.107880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research demonstrates a relationship between faulty visual attention and poorer social cognition in schizophrenia. One potential explanatory model suggests abnormal neuromodulation in specific neural networks may result in reduced attention to socially important cues, leading to poorer understanding of another's emotional state or intentions. OBJECTIVE The current study experimentally manipulated neural networks using tDCS to examine this potential causal mechanism. The primary aim was to determine whether stimulation to the right temporoparietal junction (rTPJ) improves visual attention, and secondary aims were to determine whether 1) stimulation improves social cognitive performance and 2) visual attention moderates this improved performance. METHOD Using a double-blind crossover design, 69 individuals with schizophrenia underwent both active and sham stimulation to either the rTPJ of the ventral attention network (n = 36) or the dorsomedial prefrontal cortex of the social brain network (dmPFC; n = 33). Following stimulation, participants completed tasks assessing emotion recognition and mentalizing. Concurrent eye tracking assessed visual attention, measuring proportion of time spent attending to areas of interest. RESULTS For emotion recognition, stimulation failed to impact either visual attention or social cognitive task accuracy. Similarly, neurostimulation failed to affect visual attention on the mentalizing task. However, exploratory analyses demonstrated that mentalizing accuracy significantly improved after stimulation to the active comparator, dmPFC, with no improvement after stimulation to rTPJ. CONCLUSION Results demonstrate limited effect of a single stimulation session on visual attention and emotion recognition accuracy but provide initial support for an alternate neural mechanism for mentalizing, highlighting the importance of executive functions over visual attention.
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Affiliation(s)
- Hans S Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.
| | - Sven Vanneste
- Trinity College Institute for Neuroscience, Trinity College Dublin, Ireland
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX,, USA
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Evaluation of Social Cognition Measures for Japanese Patients with Schizophrenia Using an Expert Panel and Modified Delphi Method. J Pers Med 2021; 11:jpm11040275. [PMID: 33917377 PMCID: PMC8067370 DOI: 10.3390/jpm11040275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 04/04/2021] [Indexed: 11/21/2022] Open
Abstract
Social cognition is strongly linked to social functioning outcomes, making it a promising treatment target. Because social cognition measures tend to be sensitive to linguistic and cultural differences, existing measures should be evaluated based on their relevance for Japanese populations. We aimed to establish an expert consensus on the use of social cognition measures in Japanese populations to provide grounds for clinical use and future treatment development. We assembled a panel of experts in the fields of schizophrenia, social psychology, social neuroscience, and developmental disorders. The panel engaged in a modified Delphi process to (1) affirm expert consensus on the definition of social cognition and its constituent domains, (2) determine criteria to evaluate measures, and (3) identify measures appropriate for Japanese patients with a view toward future quantitative research. Through two online voting rounds and two online video conferences, the panel agreed upon a definition and four-domain framework for social cognition consistent with recent literature. Evaluation criteria for measures included feasibility and tolerability, reliability, clinical effectiveness, validity, and international comparability. The panel finally identified nine promising measures, including one task originally developed in Japan. In conclusion, we established an expert consensus on key discussion points in social cognition and arrived at an expert-selected set of measures. We hope that this work facilitates the use of these measures in Japanese clinical scenarios. We plan to further examine these measures in a psychometric evaluation study.
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25
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Milic B, Feller C, Schneider M, Debbané M, Loeffler-Stastka H. Social cognition in individuals with 22q11.2 deletion syndrome and its link with psychopathology and social outcomes: a review. BMC Psychiatry 2021; 21:130. [PMID: 33676445 PMCID: PMC7936464 DOI: 10.1186/s12888-020-02975-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is a genetic syndrome that results in a highly variable profile of affected individuals of which impairments in the social domain and increased psychopathology are the most prominent. Notably, 25-30% of affected individuals eventually develop schizophrenia/psychosis, predisposing persons with the syndrome to increased risk for this disorder. Because social cognition is considered to underlie social behavior and to be related to psychopathology, this systematic review investigated social cognition in individuals with 22q11DS and examined reported links across its domains with psychopathology and social outcomes. This can provide the basis for a closer understanding of the path from risk to disorder and will inform on the specific domains that can be targeted with preventive intervention strategies. METHOD Systematic literature review of studies that reported the links between social cognitive domains and psychopathology and/or social outcomes in individuals with 22q11DS. Electronic databases searched were PubMed and PsycINFO. RESULTS Defined eligibility criteria identified a total of ten studies to be included in the present review. Selected studies investigated links between two domains of social cognition (emotion processing and theory of mind (ToM)) and psychopathology and/or social outcomes. With respect to the links to psychopathology, two aspects of social cognition were related primarily to negative symptoms. Results regarding the associations to positive and emotional symptoms (anxiety/depression) are limited and require further investigation. Even though both aspects of social cognition were associated with social outcomes, several studies also found no links between these two domains. Both reports invite for an additional examination of reported results and specific considerations regarding chosen constructs. CONCLUSION Although equivocal, results of the present review provide sufficient evidence that social cognition is a useful domain for the closer elucidation of clinical outcomes and social difficulties in this population. At the same time, longitudinal studies and consideration of other variables are also necessary for a timely understanding of affected persons in this respect.
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Affiliation(s)
- Branka Milic
- Clinic for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Clémence Feller
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Fundora C, Cruz M, Barone K, Penn DL, Jarskog LF, Pinkham AE, Harvey PD. Lifetime employment in schizophrenia: correlates of developing long term unemployment after being employed before. Cogn Neuropsychiatry 2021; 26:95-106. [PMID: 33380266 DOI: 10.1080/13546805.2020.1865896] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Challenges in employment are highly prevalent among people with schizophrenia regardless of their employment history. Although supportive employment can be effective, few participants sustain meaningful competitive employment. Our goal was to identify the correlates of developing sustained unemployment. METHODS We examined employment outcomes by comparing clinical, neurocognitive, and social cognitive features in 234 participants with Schizophrenia Spectrum Disorders across t competitive employment outcomes: currently employed, participants who had never worked for a year, and those who had been employed but developed long-term unemployment. We examined social cognition and neurocognition, as well as positive and negative schizophrenia symptoms, and premorbid functioning and demographic factors. RESULTS We found significant differences in age, race, premorbid functioning, cognitive performance, and social cognition between currently and formerly employed patients. When individual tasks were examined, emotion recognition and verbal working memory performance were the domains differentiating the groups. Older African Americans were over-represented in the formerly employed group. CONCLUSIONS There were minimal differences other than age and race between formerly employed patients and those who had never worked. These data suggest the possibility that deterioration in employment outcomes may also co-occur with declines in other abilities. Opportunities and disparities may also be a contributor to re-entering the work force.
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Affiliation(s)
- Cynthia Fundora
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Maria Cruz
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Katelyn Barone
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David L Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA
| | - L Frederik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richordson, TX, USA.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA.,Research Service, Miami VA Healthcare System, Miami, FL, USA
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Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, Guloksuz S, Harvey PD, Jones PB, Malaspina D, McGorry P, Miettunen J, Murray RM, Nuechterlein KH, Peralta V, Thornicroft G, van Winkel R, Ventura J. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 2021; 20:4-33. [PMID: 33432763 PMCID: PMC7801854 DOI: 10.1002/wps.20809] [Citation(s) in RCA: 123] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
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Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, LVR-Klinikum Düsseldorf, and WHO Collaborating Center on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Ichan Medical School at Mount Sinai, New York, NY, USA
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jouko Miettunen
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Keith H Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine, and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Valaparla VL, Nehra R, Mehta UM, Grover S. Social cognitive deficits in schizophrenia and their neurocognitive correlates across the different phases of illness. Asian J Psychiatr 2021; 55:102501. [PMID: 33296864 DOI: 10.1016/j.ajp.2020.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/01/2020] [Accepted: 11/19/2020] [Indexed: 11/16/2022]
Abstract
AIM This study aimed to assess the relationship between neurocognition (NC) and social cognition (SC) in patients with schizophrenia during the symptomatic phase and the phase of clinical remission. METHODOLOGY Thirty-two patients were assessed on Color trail test (CTT), Hopkins verbal learning test (HVLT), Controlled oral word association (COWA) test, Wisconsin card sorting test (WCST), Ravens standard progressive matrices (SPM) and Social cognition rating tool in Indian setting (SOCRATIS) during symptomatic and remission phases of illness at least 3 months apart. RESULTS Compared to baseline assessment, even after controlling for PANSS scores except for social perception index all other domains of SC showed significant improvement at the time of remission. Although there was significant improvement in a few subtests of verbal learning, IQ and number of correct responses of COWA, colour trail test, no significant difference was seen in performance on WCST. Although second order theory of mind task had some association with IQ at the baseline assessment, no association was seen between SC and NC in the remission phase. CONCLUSIONS To conclude, present study suggests that impairments in all the domains of SC (except for social perception index) and NC (except for WCST) improve in the remission phase.
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Affiliation(s)
| | - Ritu Nehra
- Department of Psychiatry, PGIMER, Chandigarh, 160012, India
| | | | - Sandeep Grover
- Department of Psychiatry, PGIMER, Chandigarh, 160012, India.
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Mervis JE, Bonfils KA, Cooper SE, Wiesepape C, Lysaker PH. Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits. SCHIZOPHRENIA BULLETIN OPEN 2021; 2:sgab034. [PMID: 34901868 PMCID: PMC8650079 DOI: 10.1093/schizbullopen/sgab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.
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Affiliation(s)
- Joshua E Mervis
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Kelsey A Bonfils
- School of Psychology, University of Southern Mississippi, Hattiesburg, MS, USA
| | - Samuel E Cooper
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana State University, Terre Haute, IN, USA
| | - Paul H Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
- To whom correspondence should be addressed; 1481 W 10th St, Indianapolis, IN 46202, USA; tel: (317) 988-2546, e-mail:
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Lee SC, Lin GH, Liu CC, Chiu EC, Hsieh CL. Development of the CAT–FER: A Computerized Adaptive Test of Facial Emotion Recognition for Adults With Schizophrenia. Am J Occup Ther 2020; 75:7501205140p1-7501205140p11. [DOI: 10.5014/ajot.2020.043463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Importance: The most frequently used measures of facial emotion recognition (FER) are insufficiently comprehensive, reliable, valid, and efficient; moreover, the impact of gender on scoring has not been controlled.
Objective: To develop a computerized adaptive test of FER for adults with schizophrenia.
Design: First, we selected photographs from a published database. Second, items that fitted well to a Rasch model were used to form the item bank. Third and last, we determined the best administration mode for prospective users to achieve both high reliability and efficiency.
Setting: Psychiatric hospitals and the community.
Participants: Adults living with schizophrenia (n = 351) and adults without diagnosed mental illness (n = 101).
Results: After removal of misfit items (infit or outfit ≥1.4), the remaining 165 items were selected to form an item bank. Among them, 39 showed severe gender bias, so the item difficulties were adjusted accordingly. On the basis of the item bank, two administration modes were recommended for prospective users. The reliable mode required approximately 128 items (nearly 20 min) to achieve reliability (.72–.81), similar to that of the entire item bank. The efficient mode required approximately 73 items (approximate 11 min) to provide acceptable reliability (.69–.73) for the seven domain scores.
Conclusions and Relevance: Our newly developed measure provides comprehensive, valid, and unbiased (to examinees’ gender) assessments of FER in adults living with schizophrenia. In addition, the administration modes can be flexibly changed to optimize the reliability or efficiency for prospective users.
What This Article Adds: This newly developed FER measure can help occupational therapists identify deficits in recognizing specific basic emotions and plan corresponding interventions to manage the impact on their clients’ social functions.
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Affiliation(s)
- Shih-Chieh Lee
- Shih-Chieh Lee, PhD, is Postdoctoral Researcher, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Gong-Hong Lin
- Gong-Hong Lin, PhD, is Assistant Professor, Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan. At the time this article was submitted, Lin was Postdoctoral Researcher, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chung Liu
- Chen-Chung Liu, MD, PhD, is Psychiatrist, Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan, and Associate Professor, Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - En-Chi Chiu
- En-Chi Chiu, PhD, is Associate Professor, Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;
| | - Ching-Lin Hsieh
- Ching-Lin Hsieh, PhD, is Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan; and Adjunct Professor, Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung, Taiwan; clhs
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Pinkham AE, Morrison KE, Penn DL, Harvey PD, Kelsven S, Ludwig K, Sasson NJ. Comprehensive comparison of social cognitive performance in autism spectrum disorder and schizophrenia. Psychol Med 2020; 50:2557-2565. [PMID: 31576783 DOI: 10.1017/s0033291719002708] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) and schizophrenia (SCZ) are separate neurodevelopmental disorders that are both characterized by difficulties in social cognition and social functioning. Due to methodological confounds, the degree of similarity in social cognitive impairments across these two disorders is currently unknown. This study therefore conducted a comprehensive comparison of social cognitive ability in ASD and SCZ to aid efforts to develop optimized treatment programs. METHODS In total, 101 individuals with ASD, 92 individuals with SCZ or schizoaffective disorder, and 101 typically developing (TD) controls, all with measured intelligence in the normal range and a mean age of 25.47 years, completed a large battery of psychometrically validated social cognitive assessments spanning the domains of emotion recognition, social perception, mental state attribution, and attributional style. RESULTS Both ASD and SCZ performed worse than TD controls, and very few differences were evident between the two clinical groups, with effect sizes (Cohen's d) ranging from 0.01 to 0.34. For those effects that did reach statistical significance, such as greater hostility in the SCZ group, controlling for symptom severity rendered them non-significant, suggesting that clinical distinctions may underlie these social cognitive differences. Additionally, the strength of the relationship between neurocognitive and social cognitive performance was of similar, moderate size for ASD and SCZ. CONCLUSIONS Findings largely suggest comparable levels of social cognitive impairment in ASD and SCZ, which may support the use of existing social cognitive interventions across disorders. However, future work is needed to determine whether the mechanisms underlying these shared impairments are also similar or if these common behavioral profiles may emerge via different pathways.
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Affiliation(s)
- Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas At Dallas, Richardson, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Kerrianne E Morrison
- School of Behavioral and Brain Sciences, The University of Texas At Dallas, Richardson, TX, USA
| | - David L Penn
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - Skylar Kelsven
- Department of Psychology, San Diego State University/University of California San Diego, San Diego, CA, USA
| | - Kelsey Ludwig
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Noah J Sasson
- School of Behavioral and Brain Sciences, The University of Texas At Dallas, Richardson, TX, USA
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Nagendra A, Halverson TF, Pinkham AE, Harvey PD, Jarskog LF, Weisman de Mamani A, Penn DL. Neighborhood socioeconomic status and racial disparities in schizophrenia: An exploration of domains of functioning. Schizophr Res 2020; 224:95-101. [PMID: 33190787 DOI: 10.1016/j.schres.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 06/19/2020] [Accepted: 09/24/2020] [Indexed: 01/20/2023]
Abstract
Black Americans are disproportionately diagnosed with schizophrenia and experience worse objective functional outcomes (e.g., hospitalizations) than their White counterparts. However, we have a limited understanding of the psychological pathways through which Black Americans with schizophrenia reach worse outcomes. This study assessed race and domains of functioning (e.g., neurocognition, functional capacity) known to be associated with objective outcomes in a sample of 108 non-Hispanic Black and 61 non-Hispanic White individuals with schizophrenia-spectrum disorders from the Social Cognition Psychometric Evaluation (SCOPE) study. Three primary findings emerged: First, Black participants showed lower scores than White participants on measures of neurocognition(NC), social cognition(SC), and everyday living skills, but not social skills or community functioning. Second, neighborhood socioeconomic status (SES) explained 21% of the relationship between race and NC but did not mediate the relationship between race and SC or everyday living skills. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals with schizophrenia. In our sample, after controlling for neighborhood SES, race did not moderate the relationships of NC, SC, social skills, or everyday living skills to community functioning. This indicates that relationships between these domains are comparably strong across Black and White Americans. Taken together, these findings show that NC, SC, and everyday living skills may be important areas to explore in regards to racial disparities in schizophrenia. More research, especially incorporating nuanced race- and SES-related variables, is needed to understand how to best intervene and improve real-world outcomes for Black Americans with schizophrenia.
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Affiliation(s)
- Arundati Nagendra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA; Center for Psychosocial and Systemic Research / Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA.
| | - Tate F Halverson
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Research Service, Miami VA Healthcare System, Miami, FL, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA; Australian Catholic University, School of Behavioural and Health Sciences, Melbourne, VIC, Australia
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Perez MM, Tercero BA, Penn DL, Pinkham AE, Harvey PD. Overconfidence in social cognitive decision making: Correlations with social cognitive and neurocognitive performance in participants with schizophrenia and healthy individuals. Schizophr Res 2020; 224:51-57. [PMID: 33097367 PMCID: PMC7722219 DOI: 10.1016/j.schres.2020.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/20/2020] [Accepted: 10/11/2020] [Indexed: 11/17/2022]
Abstract
It has been reported that people with schizophrenia are frequently overconfident relative to their performance, a trait observed in healthy individuals as well. In schizophrenia, impaired self-assessments have been found to be associated with functional impairments in various domains. Previous studies examining the correlation of overconfidence and task performance within domains (e.g., social cognition) had found overconfidence was associated with particularly poor performance. This study examines how overconfidence on a social cognitive emotion recognition task is correlated with performance on other social cognitive tests, measures of neurocognition, and intelligence. The sample includes 154 healthy controls and 218 outpatient individuals diagnosed with schizophrenia. For the healthy controls, overconfidence was a significant predictor of poorer performance on social cognitive, but not neurocognitive tasks. For the participants with schizophrenia, overconfidence was a predictor of poorer performance on every performance-based task. In addition, overconfidence in healthy controls was more strongly correlated with intelligence than it was in participants with schizophrenia. The data suggest that a bias toward overestimation of performance aligns with poorer performance social cognitive domains, as well as neurocognitive domains in participants with schizophrenia. In healthy individuals, consistent with previous results, lower general intelligence seems to be a substantial predictor of overconfidence. These data suggest that attention to the accuracy of self-assessment is an area for future clinical interventions in people with schizophrenia.
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Affiliation(s)
- Michelle M. Perez
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - Bianca A. Tercero
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA
| | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, USA,School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 USA,Research Service, Miami VA Healthcare System, Miami, FL, USA,Corresponding Author: Philip D. Harvey, PhD, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 1450, Miami, FL 33136 US (telephone: 305-243-4094; fax: 305-243-1619;
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Lin Y, Ding H, Zhang Y. Multisensory Integration of Emotion in Schizophrenic Patients. Multisens Res 2020; 33:865-901. [PMID: 33706267 DOI: 10.1163/22134808-bja10016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 03/24/2020] [Indexed: 01/04/2023]
Abstract
Multisensory integration (MSI) of emotion has been increasingly recognized as an essential element of schizophrenic patients' impairments, leading to the breakdown of their interpersonal functioning. The present review provides an updated synopsis of schizophrenics' MSI abilities in emotion processing by examining relevant behavioral and neurological research. Existing behavioral studies have adopted well-established experimental paradigms to investigate how participants understand multisensory emotion stimuli, and interpret their reciprocal interactions. Yet it remains controversial with regard to congruence-induced facilitation effects, modality dominance effects, and generalized vs specific impairment hypotheses. Such inconsistencies are likely due to differences and variations in experimental manipulations, participants' clinical symptomatology, and cognitive abilities. Recent electrophysiological and neuroimaging research has revealed aberrant indices in event-related potential (ERP) and brain activation patterns, further suggesting impaired temporal processing and dysfunctional brain regions, connectivity and circuities at different stages of MSI in emotion processing. The limitations of existing studies and implications for future MSI work are discussed in light of research designs and techniques, study samples and stimuli, and clinical applications.
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Affiliation(s)
- Yi Lin
- 1Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, 800 Dong Chuan Rd., Minhang District, Shanghai, 200240, China
| | - Hongwei Ding
- 1Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, 800 Dong Chuan Rd., Minhang District, Shanghai, 200240, China
| | - Yang Zhang
- 2Department of Speech-Language-Hearing Sciences & Center for Neurobehavioral Development, University of Minnesota, Twin Cities, MN 55455, USA
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Nijman SA, Veling W, Greaves-Lord K, Vos M, Zandee CER, Aan Het Rot M, Geraets CNW, Pijnenborg GHM. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for People With a Psychotic Disorder: Single-Group Feasibility and Acceptability Study. JMIR Ment Health 2020; 7:e17808. [PMID: 32763880 PMCID: PMC7442939 DOI: 10.2196/17808] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with a psychotic disorder commonly experience problems in social cognition and functioning. Social cognition training (SCT) improves social cognition, but may inadequately simulate real-life social interactions. Virtual reality (VR) provides a realistic, interactive, customizable, and controllable training environment, which could facilitate the application of skills in daily life. OBJECTIVE We developed a 16-session immersive VR SCT (Dynamic Interactive Social Cognition Training in Virtual Reality [DiSCoVR]) and conducted a single-group feasibility pilot study. METHODS A total of 22 people with a psychotic disorder and reported problems in social cognition participated. Feasibility and acceptability were assessed using a survey for participants and therapists, and by examining relevant parameters (eg, dropouts). We analyzed preliminary treatment effects on social cognition, neurocognition, and psychiatric symptoms. RESULTS A total of 17 participants completed the study. Participants enjoyed DiSCoVR (mean 7.25, SD 2.05; range 3-10), thought it was useful for daily social activities (mean 7.00, SD 2.05; range 3-10), and enjoyed the combination of VR and a therapist (mean 7.85, SD 2.11; range 3-10). The most frequently mentioned strength of DiSCoVR was the opportunity to practice with personalized social situations (14/20, 70%). A significant improvement of emotion perception was observed (Ekman 60 Faces; t16=-4.79, P<.001, d=-0.67), but no significant change was found in other measures of social cognition, neurocognition, psychiatric symptoms, or self-esteem. CONCLUSIONS DiSCoVR was feasible and acceptable to participants and therapists, and may improve emotion perception.
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Affiliation(s)
- Saskia Anne Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Assen, Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Kirstin Greaves-Lord
- Department of Child & Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Rotterdam, Netherlands.,Autism Team Northern-Netherlands of Jonx, Department of (Youth) Mental Health and Autism, Lentis Psychiatric Institute, Groningen, Netherlands.,Department of Yulius Autism, Yulius, Dordrecht, Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Maarten Vos
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Marije Aan Het Rot
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
| | - Chris Neeltje Wil Geraets
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, Netherlands.,Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, Netherlands
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Dark F, Scott JG, Baker A, Parker S, Gordon A, Newman E, Gore-Jones V, Lim CCW, Jones L, Penn DL. Randomized controlled trial of social cognition and interaction training compared to befriending group. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:384-402. [PMID: 32515058 PMCID: PMC7496415 DOI: 10.1111/bjc.12252] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 04/27/2020] [Indexed: 11/30/2022]
Abstract
Background Deficits in social cognition are common in people with schizophrenia and are associated with impaired functioning. Finding effective interventions to address these deficits is a priority. Social Cognition Interaction Training (SCIT) is a psychosocial intervention that has demonstrated acceptability and feasibility in various health care settings. Larger, well‐designed randomized controlled trials are needed to examine the effectiveness of this intervention. Design A randomized controlled trial. Methods One hundred and twenty adults diagnosed with schizophrenia spectrum disorder were randomized to receive SCIT (n = 61) or Befriending Therapy (BT) (n = 59). Both intervention groups were delivered weekly for 2 hr over 12 weeks. Neurocognitive assessment was completed at baseline. Participants completed assessments of social cognition, social functioning, and meta‐cognition at baseline, post‐intervention, and 3‐month follow‐up. Results There were no clinically significant differences between group outcomes on any measure of social cognition or social functioning. There was a trend for both groups to improve over time but not at a level of statistical significance. Conclusions SCIT did not show any additional benefits on measures of social cognition compared to Befriending Therapy for people with schizophrenia spectrum disorder. The findings are discussed in terms of potential improvements to the programme. Practitioner points Effective interventions for the social cognitive deficits of schizophrenia spectrum disorders are still being refined. Social Cognition Interaction Training is a promising therapy but requires further modifications to improve its effectiveness.
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Affiliation(s)
- Frances Dark
- Metro South Addiction and Mental Health Services, Metro South Addiction and Mental Health Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - James G Scott
- Faculty of Medicine, Level 3 UQ Centre for Clinical Research (UQCCR), Herston, Queensland, Australia.,Early Psychosis Service, Metro North Mental Health, Herston, Queensland, Australia.,Queensland Centre for Mental Health Research, Clinical Support Unit, The Park-Centre for Mental Health, Archerfield, Queensland, Australia
| | - Andrea Baker
- Queensland Centre for Mental Health Research, Clinical Support Unit, The Park-Centre for Mental Health, Archerfield, Queensland, Australia
| | - Stephen Parker
- Postgraduate Training in Psychiatry, Addiction and Mental Health Services I Metro South Health Blg 23, Garden City Office Park, Eight Mile Plains, Queensland, Australia
| | - Anne Gordon
- Early Psychosis Service, Metro North Mental Health, Herston, Queensland, Australia
| | - Ellie Newman
- St Kilda Road Clinic Community Adult Mental Health, Alfred Psychiatry, Melbourne, Victoria, Australia
| | - Victoria Gore-Jones
- Metro South Addiction and Mental Health Services, Metro South Addiction and Mental Health Services, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Carmen C W Lim
- Queensland Centre for Mental Health Research, Clinical Support Unit, The Park-Centre for Mental Health, Archerfield, Queensland, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Lyndall Jones
- Pine Rivers Community Health Centre, Strathpine, Queensland, Australia
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.,Australian Catholic University, Fitzroy, Victoria, Australia
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Weiss EM, Kohler CG, Brensinger CM, Bilker WB, Loughead J, Delazer M, Nolan KA. Gender differences in facial emotion recognition in persons with chronic schizophrenia. Eur Psychiatry 2020; 22:116-22. [PMID: 17137757 DOI: 10.1016/j.eurpsy.2006.05.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 05/09/2006] [Accepted: 05/11/2006] [Indexed: 10/23/2022] Open
Abstract
AbstractBackgroundThe aim of the present study was to investigate possible sex differences in the recognition of facial expressions of emotion and to investigate the pattern of classification errors in schizophrenic males and females. Such an approach provides an opportunity to inspect the degree to which males and females differ in perceiving and interpreting the different emotions displayed to them and to analyze which emotions are most susceptible to recognition errors.MethodsFifty six chronically hospitalized schizophrenic patients (38 men and 18 women) completed the Penn Emotion Recognition Test (ER40), a computerized emotion discrimination test presenting 40 color photographs of evoked happy, sad, anger, fear expressions and neutral expressions balanced for poser gender and ethnicity.ResultsWe found a significant sex difference in the patterns of error rates in the Penn Emotion Recognition Test. Neutral faces were more commonly mistaken as angry in schizophrenic men, whereas schizophrenic women misinterpreted neutral faces more frequently as sad. Moreover, female faces were better recognized overall, but fear was better recognized in same gender photographs, whereas anger was better recognized in different gender photographs.ConclusionsThe findings of the present study lend support to the notion that sex differences in aggressive behavior could be related to a cognitive style characterized by hostile attributions to neutral faces in schizophrenic men.
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Affiliation(s)
- Elisabeth M Weiss
- Department of General Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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Jones MT, Deckler E, Laurrari C, Jarskog LF, Penn DL, Pinkham AE, Harvey PD. Confidence, performance, and accuracy of self-assessment of social cognition: A comparison of schizophrenia patients and healthy controls. Schizophr Res Cogn 2020; 19:002-2. [PMID: 31832336 PMCID: PMC6889550 DOI: 10.1016/j.scog.2019.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/21/2022]
Abstract
Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that reduced awareness of performance may be associated with disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on a social cognitive test, confidence in performance, effort allocated to the task, and correlates of confidence in patients with schizophrenia and healthy controls (HC). Measures included self-reports of depression, social cognitive ability, and social functioning. A performance-based emotion recognition test assessed social cognitive performance and provided the basis for confidence judgments. Although schizophrenia patients had reduced levels of overall confidence, there was a substantial subset of schizophrenic patients who manifested extreme overconfidence and these people had the poorest performance and reported the least depression. Further, a substantial number of HC over-estimated their performance as well. Patients with schizophrenia, in contrast to HC, did not adjust their effort to match task difficulty. Confidence was minimally related to task performance in patients but was associated with more rapid decisions in HC, across both correct and incorrect responses. Performance on social cognitive measures was minimally related to self-reports of social functioning in both samples. These data suggest global self-assessments are based on multiple factors, with confidence affecting self-assessments in the absence of feedback about performance.
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Affiliation(s)
- Mackenzie T. Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Elizabeth Deckler
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Carlos Laurrari
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, United States of America
- School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States of America
- Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States of America
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Research Service, Miami VA Healthcare System, United States of America
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Hilton DC, Jarrett MA, Rondon AT, Tutek J, Mulla MM. Increased Working Memory Load in a Dual-Task Design Impairs Nonverbal Social Encoding in Children with High and Low Attention-Deficit/Hyperactivity Disorder Symptoms. Child Psychiatry Hum Dev 2020; 51:127-137. [PMID: 31359331 DOI: 10.1007/s10578-019-00915-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) are known to have difficulty with peer relations, though the mechanisms by which these children struggle with interpersonal relationships are not well known. The current study examined the relation between working memory (WM) and the encoding of nonverbal social cues using a dual-task paradigm tested in children with High and Low ADHD symptoms. A total of 40 children were recruited (20 High ADHD; 20 Low ADHD) and completed computerized tasks of social encoding and WM in both single- and dual-task conditions. A series of repeated measures mixed-model ANOVAs revealed that both children with High ADHD and Low ADHD performed significantly worse during the dual-task condition compared to the single task conditions. Also, children with High ADHD had significantly lower performance than Low ADHD children on task-based social encoding and WM. This study supports the role of WM in nonverbal social encoding in children.
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Affiliation(s)
- Dane C Hilton
- Department of Psychology, Roanoke College, 221 College Lane, Salem, VA, 24153, USA.
| | - Matthew A Jarrett
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | - Ana T Rondon
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | - Josh Tutek
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
| | - Mazheruddin M Mulla
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA
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Harvey PD, Isner EC. Cognition, Social Cognition, and Functional Capacity in Early-Onset Schizophrenia. Child Adolesc Psychiatr Clin N Am 2020; 29:171-182. [PMID: 31708046 DOI: 10.1016/j.chc.2019.08.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cognitive impairments are a central feature of schizophrenia. These impairments are present across the course of the illness, from prodromal to more chronic patients. Social cognitive deficits, now known to be related to social outcomes in the real world, are also impaired in cases with early-onset psychosis. Similarly, disability in everyday functions is present and is correlated with impairments in performance on measures of the ability to perform everyday functional and social skills. This constellation of impairments leads to wide-ranging social and functional deficits. Treatments offered for adult-onset cases should be offered to early-onset cases as well."
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Affiliation(s)
- Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Research Service, Bruce W. Carter VA Medical Center, 1120 Northwest 14th Street, Suite 1450, Miami, FL 33136, USA.
| | - Elizabeth C Isner
- University of Miami Miller School of Medicine, 1120 Northwest 14th Street, Suite 1450, Miami, FL 33136, USA
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Deste G, Vita A, Nibbio G, Penn DL, Pinkham AE, Harvey PD. Autistic Symptoms and Social Cognition Predict Real-World Outcomes in Patients With Schizophrenia. Front Psychiatry 2020; 11:524. [PMID: 32581892 PMCID: PMC7294984 DOI: 10.3389/fpsyt.2020.00524] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/21/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Real-world functioning is a complex construct influenced by different factors. The impact of social cognition and autism spectrum disorder (ASD) symptoms on different aspects of the life of people with schizophrenia has been demonstrated independently, but it is unclear how these factors are related to functioning when considered concurrently. We hypothesized that ASD symptoms could play a major role in predicting real-world functioning in schizophrenia. METHODS Existent databases from two studies (SCOPE Phase 3 and SCOPE Phase 5), in which a total of 361 patients (mean age 41.7 years; 117 females) were assessed with measures of symptom severity, neuro- and socio-cognitive abilities, functional capacity, social skills, and informant-reported real-world functioning outcomes, were analyzed. RESULTS Active social avoidance, social skills, ASD symptoms, and emotion processing emerged as predictors of real-world interpersonal relationships. Cognitive performance, positive symptoms, and functional capacity emerged as predictors of real-world participation in daily activities. Cognitive performance, emotion processing, positive symptoms severity, and social skills emerged as predictors of real-world work outcomes. CONCLUSION Among other demographic, clinical, and functional capacity variables, increased ASD symptoms emerged as a significant predictor of poorer social relationships and may therefore represent a key factor in predicting real-world social functioning in schizophrenia.
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Affiliation(s)
- Giacomo Deste
- Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, Spedali Civili Hospital, Brescia, Italy.,School of Medicine, University of Brescia, Brescia, Italy
| | | | - David L Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC, United States.,School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States.,Research Service, Miami VA Healthcare System, Miami, FL, United States
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Deste G, Vita A, Penn DL, Pinkham AE, Nibbio G, Harvey PD. Autistic symptoms predict social cognitive performance in patients with schizophrenia. Schizophr Res 2020; 215:113-119. [PMID: 31780344 PMCID: PMC7035981 DOI: 10.1016/j.schres.2019.11.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/30/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022]
Abstract
Schizophrenia spectrum disorders and Autism Spectrum Disorders (ASD) share many similarities. Among those features, social cognitive impairment is recognized as a key characteristic of both ASD and schizophrenia. In this study, the role of ASD symptoms, measured with the PANSS Autism Severity Score (PAUSS), was investigated as a predictor of social cognitive performance in patients with Schizophrenia spectrum disorders. Existent databases from 2 studies (SCOPE Phase 3 and SCOPE Phase 5), in which a total of 361 patients (mean age 41.7 years; 117 females) were assessed with tests of mental state attribution and emotion recognition, were analyzed. Less severe ASD symptoms, as well as younger age, better premorbid IQ, and neurocognition were identified as individual predictors of better social cognitive performance. These results suggest a role of ASD symptoms in affecting social cognitive performance in schizophrenia.
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Affiliation(s)
| | - Antonio Vita
- Spedali Civili Hospital, Brescia, Italy; University of Brescia, School of Medicine, Italy.
| | - David L. Penn
- Department of Psychology, University of North Carolina,
Chapel Hill, NC, United States of America,School of Psychology, Australian Catholic University,
Melbourne, VIC, Australia
| | - Amy E. Pinkham
- School of Behavioral and Brain Sciences, The University of
Texas at Dallas, Richardson, TX, United States of America,Department of Psychiatry, University of Texas Southwestern
Medical School, Dallas, TX, United States of America
| | | | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences,
University of Miami Miller School of Medicine, Miami, FL, United States of
America,Research Service, Miami VA Healthcare System, United
States of America
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Gómez-Gastiasoro A, Peña J, Zubiaurre-Elorza L, Ibarretxe-Bilbao N, Ojeda N. Equivalent short forms of the Situational Feature Recognition Test 2: Psychometric properties and analysis of interform equivalence and test-retest reliability. Int J Methods Psychiatr Res 2019; 28:e1802. [PMID: 31568625 PMCID: PMC7027651 DOI: 10.1002/mpr.1802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/12/2019] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To obtain two equivalent short forms of the "Situational Feature Recognition Test, Version 2," a social perception test, and their psychometric properties. METHODS Patients with schizophrenia (n = 101) were assessed at two different times. Statistical analyses were performed as follows: (1) Cronbach's alpha was used to assess reliability; (2) Spearman correlations, Wilcoxon signed-rank test, and a 2 (form) × 2 (time) repeated measures multivariate analysis of variance were used to analyse interform equivalence; (3) Sensitivity to change was studied by a 2 (group) × 2 (time) repeated measures multivariate analysis of variance; (4) Spearman correlations were employed to assess test-retest reliability, convergent and discriminant validity, and relationship with functionality and symptoms. RESULTS The short forms showed good internal consistency at both times. Significant and moderate correlation between forms was found along with no statistically significant form x time interaction. Hits and false positives of both forms were moderately correlated at both times. Group x time interaction was significant especially for hits when assessing sensitivity to change. Both forms were significantly correlated with other social cognition domains and with functionality. CONCLUSIONS Results of this study support the use of short forms of the Situational Feature Recognition Test, Version 2 especially in clinical trials and longitudinal studies among patients with schizophrenia.
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Affiliation(s)
- Ainara Gómez-Gastiasoro
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Javier Peña
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Leire Zubiaurre-Elorza
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
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Ojeda N, Sánchez P, Gómez-Gastiasoro A, Peña J, Elizagárate E, Ezcurra J, Ibarretxe-Bilbao N, Gutiérrez M. Modelo predictivo de la funcionalidad en la esquizofrenia: una aproximación desde el modelado de ecuaciones estructurales. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 12:232-241. [DOI: 10.1016/j.rpsm.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/11/2018] [Accepted: 01/30/2019] [Indexed: 12/27/2022]
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Sasson NJ, Morrison KE, Kelsven S, Pinkham AE. Social cognition as a predictor of functional and social skills in autistic adults without intellectual disability. Autism Res 2019; 13:259-270. [DOI: 10.1002/aur.2195] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/18/2019] [Accepted: 08/04/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Noah J. Sasson
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
| | - Kerrianne E. Morrison
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
| | - Skylar Kelsven
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
| | - Amy E. Pinkham
- The School of Behavioral and Brain SciencesThe University of Texas at Dallas Richardson Texas
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Kitoko GMB, Maurage P, Peyroux E, Ma Miezi SM, Gillain B, Constant E. Do patients from the Democratic Republic of Congo with schizophrenia have facial emotion recognition deficits? Psychiatry Res 2019; 275:233-237. [PMID: 30933700 DOI: 10.1016/j.psychres.2019.03.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/18/2019] [Accepted: 03/18/2019] [Indexed: 01/30/2023]
Abstract
Patients with schizophrenia can have difficulty recognizing emotion, and the impact of this difficulty on social functioning has been widely reported. However, earlier studies did not thoroughly explore how this deficit may vary according to emotion intensity, or how it may differ among individuals and across cultures. In the present study, our aim was to identify possible deficits in facial emotion recognition across a wide range of emotions of different intensities among patients with schizophrenia from the Democratic Republic of Congo (DRC). Thirty stable patients with schizophrenia and 30 healthy controls matched for age and level of education were evaluated using a validated and integrative facial emotion recognition test (TREF). A total recognition score and an intensity threshold were obtained for each emotion. Patients with schizophrenia had emotion recognition deficits, particularly for negative emotions. These deficits were correlated to the severity of negative symptoms. Patients showed no threshold deficit at the group level, but analysis of individual profiles showed marked heterogeneity across patients for the intensity of the emotion decoding deficit. Our study confirms the existence of deficits in emotion recognition for negative emotions in patients with schizophrenia, generalizes it to DRC patients, and underlines considerable heterogeneity among patients.
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Affiliation(s)
- Germain Manzekele Bin Kitoko
- Department of Psychiatry, Saint-Luc University Hospital and Institute of Neuroscience (IoNS), Université catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium; Department of Psychiatry, University of Kinshasa, Lemba, Kinshasa, Democratic Republic of Congo
| | - Pierre Maurage
- Laboratory for Experimental Psychopathology, Psychological Sciences Research Institute, Université Catholique de Louvain, 10 Place C. Mercier, B-1348 Louvain-la-Neuve, Belgium
| | - Elodie Peyroux
- Department of Psychiatry, Saint-Luc University Hospital and Institute of Neuroscience (IoNS), Université catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium; Service Universitaire de Réhabilitation, SUR - CH Le Vinatier, 4 rue Jean Sarrazin, 69008 Lyon, France
| | | | - Benoit Gillain
- Department of Psychiatry, Clinic Sint Pierre, Ottignies, Belgium
| | - Eric Constant
- Clinique Notre-Dame des Anges, Institute of Neurosciences, IoNS, Université catholique de Louvain, 4000 Liège, Belgium.
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Morrison KE, Pinkham AE, Kelsven S, Ludwig K, Penn DL, Sasson NJ. Psychometric Evaluation of Social Cognitive Measures for Adults with Autism. Autism Res 2019; 12:766-778. [PMID: 30770676 PMCID: PMC6499650 DOI: 10.1002/aur.2084] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/03/2019] [Indexed: 11/08/2022]
Abstract
Although social cognition is frequently identified as a target in clinical trials and psychosocial interventions for adults with autism spectrum disorder (ASD), these efforts are hampered by a lack of consensus and validation of social cognitive measures. The current study provides psychometric evaluation of 11 frequently used measures encompassing different subdomains of social cognition. Adults with autism (N = 103) and typically developing controls (N = 95) completed 11 commonly used social cognitive tasks spanning the domains of emotion processing, social perception, and mentalizing/theory of mind. We examined each measure's internal reliability and sensitivity to group differences, how performance related to general intellectual ability, and alignment of measures with a proposed two-factor structure of social cognition in ASD. Controls outperformed the ASD group on 8 of the 11 social cognitive tasks, with the largest group differences occurring on two mentalizing measures, The awareness of social inference task (TASIT) and hinting task. In ASD, all tasks demonstrated strong internal consistency and avoided ceiling and floor effects. Social cognitive performance was also related to, but not redundant with, intellectual functioning. We also found support for a two-factor structure of social cognition, with basic social perception and emotional processing aligning into a lower-order social perception factor, while mentalizing tasks aligned into a higher-order social appraisal factor. In sum, eight tasks showed adequate to strong psychometric properties. The psychometric data, effect size estimates, and correlations between measures reported here can be used for study planning for social cognitive interventions in autism. Autism Research 2019, 12: 766-778. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: We examined 11 tasks that measure how adults with autism perceive and interpret social information. Eight of the tasks were reliable and showed lower performance in adults with autism compared to typically-developing controls. Task performance was related to but distinguishable from IQ. These measures evaluated here may be useful in assessing the effectiveness of interventions and treatments to improve social abilities in adults with autism.
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Affiliation(s)
- Kerrianne E. Morrison
- School of Behavioral and Brain SciencesThe University Of Texas At DallasRichardsonTexas, 75080
| | - Amy E. Pinkham
- School of Behavioral and Brain SciencesThe University Of Texas At DallasRichardsonTexas, 75080
| | - Skylar Kelsven
- School of Behavioral and Brain SciencesThe University Of Texas At DallasRichardsonTexas, 75080
| | - Kelsey Ludwig
- Department of Psychology and NeuroscienceThe University of North Carolina at Chapel HillChapel HillNorth Carolina, 27599
| | - David L. Penn
- Department of Psychology and NeuroscienceThe University of North Carolina at Chapel HillChapel HillNorth Carolina, 27599
- School of PsychologyAustralian Catholic University3065, MelbourneVICAustralia
| | - Noah J. Sasson
- School of Behavioral and Brain SciencesThe University Of Texas At DallasRichardsonTexas, 75080
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Harvey PD, Deckler E, Jarskog LF, Penn DL, Pinkham A. Predictors of social functioning in patients with higher and lower levels of reduced emotional experience: Social cognition, social competence, and symptom severity. Schizophr Res 2019; 206:271-276. [PMID: 30446271 PMCID: PMC6513726 DOI: 10.1016/j.schres.2018.11.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/01/2018] [Accepted: 11/04/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Deficits in social functioning in schizophrenia are primarily predicted by negative symptoms, social cognition deficits, and social skills deficits. Here we examine those predictive variables across variations in the severity of reduced emotional experience. We hypothesized that in patients with high symptom severity, factors such as social cognition would have reduced importance for predicting social outcomes. METHODS Participants with schizophrenia (n = 312) were tested using five different measures of social cognition. Performance-based assessments and clinical ratings of reduced emotion experience were used to assess social competence. High contact informants rated interpersonal functioning and social acceptability of behavior, while unaware of other patient data. Patients were divided into higher and lower reduced emotional experience using previously validated criteria. RESULTS 33% of the patients had at least moderate symptoms of reduced emotional experience. Patients with greater severity had more social functioning impairment, but not poorer social competence and social cognition. In the patients with lower severity, social cognition accounted for 9% of the variance in interpersonal functioning, while in patients with higher severity, social cognition did not predict any variance. In the patients with lower severity, social cognition accounted for 4% of the variance in social acceptability of behavior, while in patients with higher severity, social cognition also did not predict any variance. IMPLICATIONS The influence of social cognition on social outcomes appears greater in patients with less severe symptoms of reduced emotional experience. As there are treatments for both these symptoms and social cognition with demonstrated efficacy, these data suggest differential application of these interventions based on symptom severity.
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Affiliation(s)
- Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL,Research Service, Miami VA Healthcare System
| | - Elizabeth Deckler
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | | | - David L. Penn
- Department of Psychology, University of North Carolina, Chapel Hill, NC,School of Psychology, Australian Catholic University, Melbourne, VIC
| | - Amy Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX.,Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX
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Cognition, social cognition, and Self-assessment in schizophrenia: prediction of different elements of everyday functional outcomes. CNS Spectr 2019; 24:88-93. [PMID: 30683165 PMCID: PMC6414257 DOI: 10.1017/s1092852918001414] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A growing body of research has shown that two domains of cognition, neurocognition and social cognition, predict different domains of real-world outcomes in people with schizophrenia. Social cognition has been shown to predict social outcomes but not non-social outcomes (e.g. living independently), and neurocognition provides minimal prediction of social outcomes (e.g. interpersonal relationships). The differing predictive value of neurocognition and social cognition has led to an exploration of potential factors that interact with cognition to influence everyday outcomes. Functional skills, negative symptoms, and self-assessment have shown particularly promising relationships with cognitive ability. Several consensus studies have pinpointed valid performance-based assessments. High-contact informant ratings have additionally been shown to be highly accurate. The emerging understanding of divergent patterns of predicting outcomes and reliable assessments present an opportunity to improve treatment targets and real-world outcomes for individuals with schizophrenia. In particular, a recently defined component of metacognition has shown particular promise. Introspective accuracy (IA) addresses how well individuals evaluate their own abilities. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures of neurocognitive skills and has found that IA of social cognition accounts unique variance in real world disability above social cognitive abilities. Intriguingly, IA of neurocognition appears to preferentially predict non-social outcomes while IA of social cognition predicts social outcomes.
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de Sousa P, Sellwood W, Griffiths M, Bentall RP. Disorganisation, thought disorder and socio-cognitive functioning in schizophrenia spectrum disorders. Br J Psychiatry 2019; 214:103-112. [PMID: 30139394 DOI: 10.1192/bjp.2018.160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poor social cognition is prevalent in schizophrenia spectrum disorders. Some authors argue that these effects are symptom-specific and that socio-cognitive difficulties (e.g. theory of mind) are strongly associated with thought disorder and symptoms of disorganisation.AimsThe current review tests the strength of this association. METHOD We meta-analysed studies published between 1980 and 2016 that tested the association between social cognition and these symptoms in schizophrenia spectrum disorders. RESULTS Our search (PsycINFO, MEDLINE and Web of Science) identified 123 studies (N = 9107). Overall effect size as r = -0.313, indicating a moderate association between symptoms and social cognition. Subanalyses yielded a moderate association between symptoms and theory of mind (r = -0.349) and emotion recognition (r = -0.334), but smaller effect sizes for social perception (r = -0.188), emotion regulation (r = -0.169) and attributional biases (r = -0.143). CONCLUSIONS The association is interpreted within models of communication that highlight the importance of mentalisation and processing of partner-specific cues in conversational alignment and grounding.Declaration of interestsNone.
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Affiliation(s)
- Paulo de Sousa
- Department of Clinical Psychology,University of Liverpool,UK
| | - William Sellwood
- Division of Health Research,Faculty of Health and Medicine,Lancaster University,UK
| | | | - Richard P Bentall
- Clinical Psychology Unit,Department of Psychology,University of Sheffield,UK
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