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Le Donne I, Attanasio M, Bologna A, Vagnetti R, Masedu F, Valenti M, Mazza M. Autism and intention attribution test: a non-verbal evaluation with comic strips. Ann Gen Psychiatry 2023; 22:29. [PMID: 37573317 PMCID: PMC10422844 DOI: 10.1186/s12991-023-00461-2] [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: 03/07/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Despite autism spectrum disorder (ASD) and mentalization being two words often associated in the literature, the assessment of this ability in individuals with ASD in the clinical setting is still limited. Indeed, there are no standardized Theory of Mind (ToM) tests that are adaptable to different cognitive profiles, such as individuals with language poverty, and intellectual or memory impairments. This study proposes a non-verbal test (Intentions Attribution-Comic Strip Test; IA-CST) to evaluate the ability to infer the intentions of others, a basic component of ToM, in the clinical setting. METHOD In Study 1, the test was administered to 261 healthy individuals and we performed structural validation using Exploratory Graph Analysis. In Study 2, the final version of the test was administered to 32 individuals with ASD to assess the known group validity of the measure by comparing their scores with a sample of IQ-matched controls. Moreover, we performed logistic regression and ROC curve to preliminarily assess the diagnostic performance of the IA-CST. RESULTS The IA-CST resulted in a 3-dimension measure with good structural stability. Group comparison indicated that the ASD group shows significantly lower performance in intention attribution but not in inferring causal consequences. The test demonstrated known group validity and that, preliminarily, it is suitable for implementation within the clinical practice. CONCLUSIONS The results support the IA-CST as a valid non-verbal task for evaluating intentions attribution in the clinical setting. Difficulties in ToM are early and relevant in ASD, so assessing these aspects is valuable for structuring individualized and evidence-based interventions.
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Affiliation(s)
- Ilenia Le Donne
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy.
| | - Margherita Attanasio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy
| | - Antony Bologna
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy
| | - Roberto Vagnetti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy
| | - Francesco Masedu
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy
| | - Marco Valenti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy
- Regional Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, 67100, L'Aquila, Italy
| | - Monica Mazza
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy
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Rocca P, Rucci P, Montemagni C, Rossi A, Bertolino A, Aguglia E, Altamura CA, Amore M, Andriola I, Bellomo A, Brasso C, Carpiniello B, Del Favero E, Dell'Osso L, Di Fabio F, Fabrazzo M, Fagiolini A, Giordano GM, Marchesi C, Martinotti G, Monteleone P, Pompili M, Roncone R, Rossi R, Siracusano A, Tenconi E, Vita A, Zeppegno P, Galderisi S, Maj M. Does social cognition change? Evidence after 4 years from the Italian Network for Research on Psychoses. Eur Psychiatry 2023; 66:e10. [PMID: 36628577 PMCID: PMC9970151 DOI: 10.1192/j.eurpsy.2022.2356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Deficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up. METHODS The reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up. RESULTS In 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery. CONCLUSIONS The RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery.
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Affiliation(s)
- Paola Rocca
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Cristiana Montemagni
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Bertolino
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Eugenio Aguglia
- Psychiatry Unit, Department of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy
| | | | - Mario Amore
- Section of Psychiatry, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ileana Andriola
- Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
| | - Antonello Bellomo
- Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Claudio Brasso
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Public Health, Clinical and Molecular Medicine, University of Cagliari, Cagliari, Italy
| | - Elisa Del Favero
- Section of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy
| | - Liliana Dell'Osso
- Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Di Fabio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Fagiolini
- Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
| | | | - Carlo Marchesi
- Psychiatry Unit, Department of Neuroscience, University of Parma, Parma, Italy
| | - Giovanni Martinotti
- Department of Neuroscience and Imaging, G. D'Annunzio University, Chieti, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Rita Roncone
- Unit of Psychiatry, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Psychiatry and Clinical Psychology Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Elena Tenconi
- Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
| | - Antonio Vita
- Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy.,Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
| | - Patrizia Zeppegno
- Psychiatric Unit, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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Chakrabarty M, Bhattacharya K, Chatterjee G, Biswas A, Ghosal M. Pragmatic deficits in patients with schizophrenia and right hemisphere damage: A pilot study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:169-188. [PMID: 36073996 DOI: 10.1111/1460-6984.12778] [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: 07/08/2021] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND While pragmatic deficits are well documented in patients with schizophrenia (SCZ) and right hemisphere damage (RHD), there is a paucity of research comparing the pragmatic deficits of these two groups. Do they experience similar cognitive dysfunction or is there a dissociation between the two patient groups? AIMS To investigate the nature of pragmatic deficits in these two groups and to gain an understanding of the underlying cognitive mechanisms that might be associated with these deficits to further future investigations. METHODS & PROCEDURES A total of 60 participants (15 patients with SCZ; 15 with RHD; 30 (15 + 15) healthy controls (HC) were administered the Bengali Audio-Visual Test-Battery for Assessment of Pragmatic Skills. OUTCOMES & RESULTS Both SCZ and RHD patients were found to have significant pragmatic deficits compared with their matched controls. SCZ patients were found to score significantly better than the RHD group in six out of the 10 pragmatic skills when controlled for age and education. Discriminant function analysis was performed and 86.7% of the cases (HC = 100%, SCZ = 73.3% and RHD = 86.7%) were correctly reclassified into their original categories using the test scores. CONCLUSIONS & IMPLICATIONS The study suggests that there is heterogeneity in the nature of the pragmatic breakdown within and across patient groups. Therefore, individualized restorative measures targeting the disrupted cognitive mechanism(s) might help elevate pragmatic competence and enhance the social functioning of patients with pragmatic deficits. WHAT THIS PAPER ADDS What is already known on the subject Pragmatic deficits are common in adults with cognitive impairments of different etiologies. However, few studies have explored pragmatic deficits across clinical populations. Consequently, very little is known about the nature of pragmatic deficits in patients with schizophrenia and right hemisphere damage. What this paper adds to existing knowledge This work offers preliminary data on pragmatic difficulties in patients with schizophrenia and right hemisphere damage. This study overrides the boundaries of traditional classifications and evaluates pragmatic difficulties in these two clinical populations with reference to the underlying cognitive mechanisms, which might be disrupted. What are the potential or actual clinical implications of this work? The study adds a transdiagnostic perspective suggesting that there might be heterogeneity in pragmatic deficits, both within and across patient groups, and stresses the need for individualized therapy.
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Affiliation(s)
| | | | - Garga Chatterjee
- Psychology Research Unit, Indian Statistical Institute, Kolkata, West Bengal, India
| | - Atanu Biswas
- Bangur Institute of Neurosciences, IPGME&R, Kolkata, West Bengal, India
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Lakkireddy SP, Balachander S, Dayalamurthy P, Bhattacharya M, Joseph MS, Kumar P, Kannampuzha AJ, Mallappagari S, Narayana S, Alexander AC, Muthukumaran M, Sheth S, Puzhakkal JC, Ramesh V, Thatikonda NS, Selvaraj S, Ithal D, Sreeraj VS, Mahadevan J, Holla B, Venkatasubramanian G, John JP, Murthy P, Benegal V, Reddy YCJ, Jain S, Viswanath B. Neurocognition and its association with adverse childhood experiences and familial risk of mental illness. Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110620. [PMID: 35995305 PMCID: PMC7615105 DOI: 10.1016/j.pnpbp.2022.110620] [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] [Received: 02/16/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
Environmental factors such as adverse childhood experiences (ACEs) may affect neurocognition, an endophenotype for several mental illnesses. This study examines the effect of ACEs on neurocognitive performance in first-degree relatives (FDRs) of patients with severe mental illness to determine whether familial risk has a moderating effect on the relationship between ACEs and neurocognition. Unaffected FDRs from multiplex families with severe mental illnesses (schizophrenia, bipolar disorder, obsessive-compulsive disorder, or alcohol use disorder) (n = 324) and healthy controls (with no familial risk) (n = 188) underwent neurocognitive tests for processing speed, new learning, working memory and Theory of Mind. ACEs were measured using the WHO ACE-International Questionnaire (ACE-IQ). Regression models were done to predict each neurocognitive domain by the effect of familial risk, ACE-IQ Score and their interaction (familial risk*ACE-IQ score). The main effect of familial risk predicted poor performance in all domains of neurocognition (p < 0.01), and the interaction had a negative association with global neurocognition (β = -0.093, p = 0.009), processing speed (β = -0.109, p = 0.003) and working memory (β = -0.092, p = 0.01). Among the ACEs sub-domains, only maltreatment (specifically the main effect of physical neglect and the interaction effect of sexual abuse with familial risk) predicted poorer neurocognition. In FDRs of schizophrenia and bipolar disorder, only the main effects of familial risk were significantly associated with poorer neurocognition. We conclude that there is a relationship between ACEs (especially maltreatment) and neurocognitive functioning, which is moderated by the familial risk of mental illnesses. Genetic/familial vulnerability may have a stronger association with neurocognition in schizophrenia and bipolar disorder.
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Affiliation(s)
- Sai Priya Lakkireddy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Srinivas Balachander
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
| | - Pavithra Dayalamurthy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mahashweta Bhattacharya
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Mino Susan Joseph
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Pramod Kumar
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Anand Jose Kannampuzha
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sreenivasulu Mallappagari
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Shruthi Narayana
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Alen Chandy Alexander
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Moorthy Muthukumaran
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sweta Sheth
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Joan C Puzhakkal
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vinutha Ramesh
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Navya Spurthi Thatikonda
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sowmya Selvaraj
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Dhruva Ithal
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vanteemar S Sreeraj
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Jayant Mahadevan
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Bharath Holla
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Ganesan Venkatasubramanian
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - John P John
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Pratima Murthy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Vivek Benegal
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Y C Janardhan Reddy
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Sanjeev Jain
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Biju Viswanath
- Accelerator program for Discovery in Brain disorders using Stem cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India.
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Tikka S, Walia T, Agashe S, Tikka D, Ram D, Das B. Irony comprehension in schizophrenia: Development, content validity and “Known-Groups” validity of an Indian, comic-based, computerized task. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_89_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abdo MMM, Mohamed AS, Hammed MAE, Hashem RE, El Nagar ZM. Affective theory of the mind and suicide in women with borderline personality disorder and schizophrenia: a comparative study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Theory of mind (ToM) is one of the essential components of social cognition. Affective ToM enables us to interpret other’s feelings and behaviors. Borderline personality disorder (BPD) and schizophrenia are two distinct mental disorders, yet they have a mutual deficit in interpreting emotions, thoughts, and intentions which may lead to a higher incidence of suicidality. Studies that involved social cognition, particularly ToM in schizophrenia, or BPD have controversial results. Therefore, this study aimed at comparing affective ToM functioning in female patients with BPD, schizophrenia, and healthy controls. In addition, identifying the possible impact and any correlation exists between the affective ToM and liability for suicide in those patients. Sixty individuals were recruited from the Institute of Psychiatry, Ain Shams University, Cairo, Egypt, and assigned into 3 groups where group A involved 20 BPD patients, group B involved 20 schizophrenic patients, and group C were healthy persons as a control. Assessment of affective ToM was done using Reading the Mind in the Eyes Test (RMET), and probability of suicide was measured using Suicide Probability Scale (SPS).
Results
Regarding ToM, the three groups were assessed using RMET and the results revealed a significantly higher mean score (hypermentalization) in BPD patients than both schizophrenic patients and controls. While schizophrenic patients had significantly lower mean scores than the control group (hypomentalization). As well, BPD patients had a significantly higher suicide probability total score than Schizophrenic patients and in all subdomains except for the hostility subdomain that was significantly higher in schizophrenic patients. Interestingly, in BPD, the suicide probability total score was positively correlated with RMET.
Conclusions
BPD patients have enhanced affective ToM and hypermentalization that is significantly associated with increased suicide probability in those patients, while in schizophrenia, hypomentalization could not be linked to increased suicide probability. Rehabilitation and proper management of ToM abnormalities might be a crucial tool in suicide prevention in mental illnesses, particularly, BPD.
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Govindaraj R, Naik SS, Mehta UM, Sharma M, Varambally S, Gangadhar BN. Yoga therapy for social cognition in schizophrenia: An experimental medicine-based randomized controlled trial. Asian J Psychiatr 2021; 62:102731. [PMID: 34098192 DOI: 10.1016/j.ajp.2021.102731] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/20/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022]
Abstract
Negative symptoms and cognitive deficits are difficult-to-treat symptoms of schizophrenia. In this single blind randomized controlled study, we compared change in social cognitive performance in persons with Schizophrenia (PWS) (as per DSM-5), after 6 weeks of yoga intervention with a waitlist control group. We also examined changes in putative Mirror Neuron System (MNS) activity measured by Transcranial Magnetic Stimulation (TMS) in a subset of sample (n = 30). 51 PWS stabilized on antipsychotic medication for at least 6 weeks, were assigned to add-on yoga therapy (YT) (n = 26) or waitlist (WL) (n = 25). Subjects in the YT group received add-on yoga therapy (20 sessions in 6 weeks). Both the groups continued their standard treatment and were assessed at baseline and after 6 weeks for social cognition, clinical symptoms and social disability. RM-ANOVA showed significant interaction between time and group for social cognition composite score (SCCS) (F = 42.09 [1,44], P < 0.001); negative symptoms (SANS) (F = 74.91 [1,45], P < 0.001); positive symptoms (SAPS) (F = 16.05 [1,45], P < 0.001) and social disability (GSDS) (F = 29.91 [1,46], P < 0.001). MNS activity had increased after 6 weeks in both groups but not of statistical significance. This study demonstrates that 6 weeks of add-on yoga therapy could improve social cognition in PWS compared to waitlist control subjects. However, the change in social cognition was not associated with a change in the putative MNS-activity. It necessiatates further studies to investigate the mechanistic processes of yoga and replicate these observations in a larger sample.
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Affiliation(s)
- Ramajayam Govindaraj
- Centre for Consciousness Studies, Department of Neurophysiology, National Institute of Mental Health & Neurosciences, Bengaluru, India.
| | - Shalini S Naik
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India.
| | - Urvakhsh M Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India.
| | - Manjunath Sharma
- Anvesana Research Laboratory, S-VYASA University, Bengaluru, India.
| | - Shivarama Varambally
- Department of Integrative Medicine, National Institute of Mental Health & Neurosciences, Bengaluru, India.
| | - B N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences, Bengaluru, India.
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Pawełczyk A, Łojek E, Żurner N, Kotlicka-Antczak M, Pawełczyk T. Higher order language impairments can predict the transition of ultrahigh risk state to psychosis-An empirical study. Early Interv Psychiatry 2021; 15:314-327. [PMID: 32052573 DOI: 10.1111/eip.12943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/23/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
AIM Higher order language skills, for example, non-literal language, humour, prosody deal with 'what is meant' and they are necessary for communicative exchange and relationships; No study has investigated their link with conversion to psychosis. The purpose of this study was to determine whether such skills could act as predictors of the onset of psychosis, and compare those of individuals converting and non-converting to psychosis with control of cognitive functions. METHODS Seventy-three patients, aged 15 to 32 years, fulfilling ultrahigh risk criteria took part: 14% of whom were receiving antipsychotic drugs. The study was observational, prospective and longitudinal in nature, and scheduled for 60 months. Pragmatic language skills were evaluated using the Polish version of the right hemisphere language battery. The ultrahigh risk (UHR) criteria were evaluated with Comprehensive Assessment of At-Risk Mental States; attention, intelligence and verbal fluency were controlled. RESULTS The conversion rate was 25%; converters demonstrated impaired humour comprehension and metaphor explanation abilities; composite score of pragmatic language was associated with a hazard ratio of 6.0 (95% CI 1.8-20.5) and AUC of .73. Verbal fluency was an independent predictor of conversion, but attention and intelligence were not; pragmatic language skills were associated with social function but not with prodromal symptoms. CONCLUSIONS The results suggest that deficits in humour comprehension and metaphor explanation could predict conversion to psychosis. These findings could improve diagnosis and create implications for speech and language therapy in UHR groups. Further studies on the mechanisms of pragmatic skills should analyze their relationship with abstract measures and semantic coherence.
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Affiliation(s)
- Agnieszka Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland
| | - Emilia Łojek
- Department of Cognitive Neuropsychology, University of Warsaw, Warsaw, Poland
| | - Natalia Żurner
- Child and Adolescent Psychiatry, Central Clinical Hospital of Medical University of Łódź, Łódź, Poland
| | | | - Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland
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González-Ortega I, González-Pinto A, Alberich S, Echeburúa E, Bernardo M, Cabrera B, Amoretti S, Lobo A, Arango C, Corripio I, Vieta E, de la Serna E, Rodriguez-Jimenez R, Segarra R, López-Ilundain JM, Sánchez-Torres AM, Cuesta MJ, Zorrilla I, López P, Bioque M, Mezquida G, Barcones F, De-la-Cámara C, Parellada M, Espliego A, Alonso-Solís A, Grasa EM, Varo C, Montejo L, Castro-Fornieles J, Baeza I, Dompablo M, Torio I, Zabala A, Eguiluz JI, Moreno-Izco L, Sanjuan J, Guirado R, Cáceres I, Garnier P, Contreras F, Bobes J, Al-Halabí S, Usall J, Butjosa A, Sarró S, Landin-Romero R, Ibáñez A, Selva G. Influence of social cognition as a mediator between cognitive reserve and psychosocial functioning in patients with first episode psychosis. Psychol Med 2020; 50:2702-2710. [PMID: 31637990 DOI: 10.1017/s0033291719002794] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Social cognition has been associated with functional outcome in patients with first episode psychosis (FEP). Social cognition has also been associated with neurocognition and cognitive reserve. Although cognitive reserve, neurocognitive functioning, social cognition, and functional outcome are related, the direction of their associations is not clear. Therefore, the main aim of this study was to analyze the influence of social cognition as a mediator between cognitive reserve and cognitive domains on functioning in FEP both at baseline and at 2 years. METHODS The sample of the study was composed of 282 FEP patients followed up for 2 years. To analyze whether social cognition mediates the influence of cognitive reserve and cognitive domains on functioning, a path analysis was performed. The statistical significance of any mediation effects was evaluated by bootstrap analysis. RESULTS At baseline, as neither cognitive reserve nor the cognitive domains studied were related to functioning, the conditions for mediation were not satisfied. Nevertheless, at 2 years of follow-up, social cognition acted as a mediator between cognitive reserve and functioning. Likewise, social cognition was a mediator between verbal memory and functional outcome. The results of the bootstrap analysis confirmed these significant mediations (95% bootstrapped CI (-10.215 to -0.337) and (-4.731 to -0.605) respectively). CONCLUSIONS Cognitive reserve and neurocognition are related to functioning, and social cognition mediates in this relationship.
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Affiliation(s)
- I González-Ortega
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
- The National Distance Education University (UNED), Vitoria, Spain
| | - A González-Pinto
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - S Alberich
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
- The National Distance Education University (UNED), Vitoria, Spain
| | - E Echeburúa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Personality, Assessment and Psychological Treatment, University of the Basque Country, San Sebastián, Spain
| | - M Bernardo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - B Cabrera
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - S Amoretti
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Lobo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - C Arango
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - I Corripio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E Vieta
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - E de la Serna
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - R Rodriguez-Jimenez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - R Segarra
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - J M López-Ilundain
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - A M Sánchez-Torres
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - M J Cuesta
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - I Zorrilla
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - P López
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Araba University Hospital, Bioaraba Research Institute, Vitoria, Spain
- Department of Neurosciences, University of the Basque Country, Bizkaia, Spain
| | - M Bioque
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - G Mezquida
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Barcelona, Spain
| | - F Barcones
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
- Department of Family Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C De-la-Cámara
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Aragon Institute for Health Sciences (IIS Aragón), Zaragoza, Spain
| | - M Parellada
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - A Espliego
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Department, Gregorio Marañón General University Hospital, School of Medicine, Universidad Complutense, IiSGM, Madrid, Spain
| | - A Alonso-Solís
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - E M Grasa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - C Varo
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - L Montejo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Bipolar Disorders Unit, Hospital Clinic, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - J Castro-Fornieles
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - I Baeza
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Child and Adolescent Psychiatry Service, Hospital Clinic of Barcelona, Barcelona, Spain
| | - M Dompablo
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - I Torio
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - A Zabala
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - J I Eguiluz
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Department of Neurosciences, University of the Basque Country, Cruces University Hospital, Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
| | - L Moreno-Izco
- Department of Psychiatry, Navarre Hospital Complex, IdiSNA, Navarre Institute for Health Research, Pamplona, Spain
| | - J Sanjuan
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- INCLIVA, University of Valencia, Hospital Clinico Universitario of Valencia, Spain
| | - R Guirado
- Neurobiology Unit, Department of Cell Biology, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, Valencia, Spain
| | - I Cáceres
- Department of Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - P Garnier
- Department of Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - F Contreras
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - J Bobes
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, University of Oviedo, Oviedo, Spain
| | - S Al-Halabí
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, University of Oviedo, Oviedo, Spain
- Institute of Neurosciences of the Principality of Asturias, INEUROPA, Oviedo, Spain
| | - J Usall
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), Sant Boi de Llobregat, Barcelona, Spain
| | - A Butjosa
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Research Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona (UB), Sant Boi de Llobregat, Barcelona, Spain
| | - S Sarró
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - R Landin-Romero
- FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | - A Ibáñez
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Psychiatry Department, Ramón y Cajal University Hospital, Ramón y Cajal Health Research Institute (IRyCIS), University of Alcalá, Madrid, Spain
| | - G Selva
- Centre for Biomedical Research in the Mental Health Network (CIBERSAM), Madrid, Spain
- Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, INCLIVA Health Research Institute, Valencia, Spain
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Sen MS, Nehra R, Grover S. Social cognition in patients with first episode of psychosis in remission. Indian J Psychiatry 2020; 62:544-554. [PMID: 33678836 PMCID: PMC7909030 DOI: 10.4103/psychiatry.indianjpsychiatry_342_19] [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] [Received: 06/03/2019] [Revised: 01/14/2020] [Accepted: 04/02/2020] [Indexed: 11/21/2022] Open
Abstract
AIM The present study aimed to compare the social cognition (SC) deficits in patients with first-episode psychosis (FEP) and healthy controls and evaluate the association of SC deficits with socio-occupational functioning, insight, quality of life, and stigma. METHODS This study included 30 patients with FEP in remission phase and 26 healthy controls matched for age, gender, education, and intelligent quotient. SC was assessed on the domains of theory of mind (ToM), social perception, and attributional bias. RESULTS Compared to healthy controls, patients with FEP had significantly higher deficits in the domains of second-order ToM (unpaired t = 4.447, P < 0.001) and Faux Pas Composite Index (unpaired t = 2.824, P = 0.007). In the correlation analysis, higher age of patients with FEP was significantly associated with more externalizing bias (Pearson's correlation coefficient = 0.38, P = 0.039) and those with lower level of education had more social cognitive deficits in the domains of Faux Pas Composite Index (Pearson's correlation coefficient = 0.43, P = 0.018), Social Perception Index (Pearson's correlation coefficient = 0.38, P = 0.04), and Nonsocial Perception Index (Pearson's correlation coefficient = 0.5, P = 0.005). Duration of untreated psychosis was associated with higher deficits in the first-order ToM (Pearson's correlation coefficient = -0.38, P = 0.04) and Externalizing Bias Index (Pearson's correlation coefficient = -0.49, P = 0.006). Longer duration of treatment was associated with higher impairment in first-order ToM index (Pearson's correlation coefficient = -0.42, P = 0.02). General psychopathology and total Positive and Negative Syndrome Scale total score correlated significantly with externalizing bias, with a higher level of psychopathology associated with more severe deficits in this domain. There was no correlation of SC with the quality of life, cognitive insight, and stigma (except for occasional correlation of stereotype endorsement and externalizing bias). CONCLUSION The present study suggests that compared to healthy controls, patients with FEP have impairment in the domains of second-order ToM and Faux Pas Composite Index. However, social cognitive deficits have only a few correlations with various psychosocial outcomes of FEP.
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Affiliation(s)
- Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Nehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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11
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Hatkevich C, Venta A, Sharp C. Theory of mind and suicide ideation and attempt in adolescent inpatients. J Affect Disord 2019; 256:17-25. [PMID: 31158712 DOI: 10.1016/j.jad.2019.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Suicide ideation and attempt are alarmingly prevalent in adolescents, and even more so for youth in psychiatric settings. Interpersonal factors have been emphasized as important in the etiology and maintenance of suicide ideation and attempt in adolescents. Evaluating social cognitive deficits offers important insight into processes underlying interpersonal problems associated with suicide ideation and attempt; however little social-cognitive research has been conducted in this area. The aim of the current study was to explore the relation of theory of mind (ToM) impairments and suicide ideation and attempt among adolescent inpatients. METHODS A sample of 391 adolescent inpatients completed measures on ToM, suicidal ideation and attempt, clinical symptoms and sociodemographics. RESULTS Binary logistic regression analyses revealed significant relations between excessive ToM (hypermentalizing) and two suicide outcome variables (suicide ideation in the past four weeks, suicide attempt in the past year), while covarying for sociodemographics and multiple clinical symptom scales. CONCLUSIONS Excessive ToM, or over-attributing the mental/emotional states of others, appears to share a salient relation to recent suicidal thoughts and behavior in adolescent inpatients. Current findings may indicate that interventions incorporating social cognitive components (e.g., Mentalization Based Therapy and Cognitive Behavioral Therapy) may be of promise to treating youth with suicidal thoughts and behaviors and excessive ToM. LIMITATIONS The current study uses cross-sectional data and discrepancies exist in time periods assessed by primary measures.
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Affiliation(s)
- Claire Hatkevich
- Department of Psychiatry, University of Michigan/Michigan Medicine, Ann Arbor, MI, United States of America
| | - Amanda Venta
- Department of Psychology, Sam Houston State University, Huntsville, TX, United States of America
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States of America.
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12
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Deamer F, Palmer E, Vuong QC, Ferrier N, Finkelmeyer A, Hinzen W, Watson S. Non-literal understanding and psychosis: Metaphor comprehension in individuals with a diagnosis of schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2019; 18:100159. [PMID: 31497512 PMCID: PMC6718052 DOI: 10.1016/j.scog.2019.100159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 01/22/2023]
Abstract
Previous studies suggest that understanding of non-literal expressions, and in particular metaphors, can be impaired in people with schizophrenia; although it is not clear why. We explored metaphor comprehension capacity using a novel picture selection paradigm; we compared task performance between people with schizophrenia and healthy comparator subjects and we further examined the relationships between the ability to interpret figurative expressions non-literally and performance on a number of other cognitive tasks. Eye-tracking was used to examine task strategy. We showed that even when IQ, years of education, and capacities for theory of mind and associative learning are factored in as covariates, patients are significantly more likely to interpret metaphorical expressions literally, despite eye-tracking findings suggesting that patients are following the same interpretation strategy as healthy controls. Inhibitory control deficits are likely to be one of multiple factors contributing to the poorer performance of our schizophrenia group on the metaphor trials of the picture selection task.
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Affiliation(s)
| | | | | | | | | | | | - Stuart Watson
- Newcastle University and Northumberland Tyne and Wear NHS Foundation Trust, United Kingdom
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"A circle and a triangle dancing together": Alteration of social cognition in schizophrenia compared to autism spectrum disorders. Schizophr Res 2019; 210:94-100. [PMID: 31178362 DOI: 10.1016/j.schres.2019.05.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/21/2019] [Accepted: 05/27/2019] [Indexed: 11/23/2022]
Abstract
Difficulties in social cognition are present both in persons with schizophrenia (SCZ) and persons with autism spectrum disorders (ASD). However, qualitative similarities and differences in this field remain unclear. The aim of this study was to explore attribution of intentionality in patients with recent onset SCZ in comparison to patients with high functioning ASD, and to explore relationships between alterations in attribution and clinical profile. Animated shapes are a non-verbal Theory of Mind (ToM) task involving the interpretation of geometric figure interactions in three conditions: random, goal-directed and ToM. We compared 51 young adults with SCZ, 32 with ASD and 23 healthy controls (HC) matched for age and gender. In random, goal-directed and ToM conditions, persons with SCZ attributed less intentionality with less appropriate answers than HC, while the same anomalies were only found in the ToM condition in persons with ASD. In SCZ, thought and langage disorganization and earlier age at onset were correlated with intentionality score in the random condition. Moreover, a mixed ToM impairment was found in SCZ, combining undermentalizing (for movements involving a mental state) similar to what was found in ASD, and overmentalizing (for random movements), related to dizorganization and precocity of the first psychotic episode. In the frame of the hypothesis of a continuum, these results underline both similarities and differences between autism and schizophrenia.
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Observation and Imitation of Social Emotions Are Essential for Improving Cognitive and Affective Theory of Mind in Schizophrenia: A Meta-analysis. J Nerv Ment Dis 2019; 207:474-481. [PMID: 31157692 DOI: 10.1097/nmd.0000000000000996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
People with schizophrenia often demonstrate deficits in theory of mind (ToM), which may be addressed via social cognition training that includes observation and imitation of social emotions. We examined the effect of observation and imitation on ToM and whether computerized cognitive training (CCT) can improve ToM. Among 14 controlled trials, 264 of 494 people with schizophrenia received treatment. Observation and imitation of social emotions improved cognitive (g = 0.53; 95% confidence interval [CI], 0.29-0.76) and affective ToM (g = 0.54; 95% CI, 0.34-0.73), versus treatment as usual or cognitive rehabilitation alone. CCT did not significantly enhance affective ToM (p = 0.42); however, cognitive ToM improvements without CCT (g = 1.20; 95% CI, 0.78-1.61) were superior to those with CCT (g = 0.33; 95% CI, 0.02-0.64; p < 0.01). Observation and imitation of social emotions are essential for improving ToM in schizophrenia, but CCT may not improve ToM.
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Pawełczyk A, Kotlicka-Antczak M, Łojek E, Pawełczyk T. Preliminary study of higher-order language and extralinguistic impairments in individuals with high clinical risk of psychosis and first episode of schizophrenia. Early Interv Psychiatry 2019; 13:369-378. [PMID: 28857488 DOI: 10.1111/eip.12482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/09/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022]
Abstract
AIM Higher-order language functions are associated with understanding indirect speech acts, lexical-semantic processes, the understanding and production of prosody, discourse production and comprehension. Only a few studies imply that language abnormalities may be present in individuals at ultra-high risk for psychosis (UHR) and first-episode of schizophrenia (FE). The purpose of this study was to test the presence of higher-order language dysfunctions in UHR and FE subjects using a standardized comprehensive test battery. METHODS Twenty patients experiencing FE schizophrenia, 33 UHR individuals and 20 healthy controls (HC) took part in the study. Higher-order language and extralinguistic abilities were evaluated using the Right Hemisphere Language Battery (RHLB-PL). The battery consisted of tests covering the comprehension of implicit information, lexico-semantic processing, understanding humour, making inappropriate remarks and comments, understanding and explaining metaphors, understanding prosody and appropriateness of behaviour in communication settings. RESULTS The UHR patients scored lower than HC when comprehending implicit information, discourse and in areas associated with the effectiveness of interpersonal communication; however, they scored higher than the FE participants in explanation of metaphors and processing language information in the context of general knowledge. The FE participants scored lower than healthy controls in comprehension of implicit information, explanation of metaphors, discourse understanding, processing language information in the context of general knowledge and effectiveness of interpersonal communication. CONCLUSIONS The higher-order language dysfunctions mediated by the right hemisphere appear to be present in subjects at UHR of schizophrenia and those experiencing their FE. The results may play a crucial role in diagnostic processes.
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Affiliation(s)
- Agnieszka Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Magdalena Kotlicka-Antczak
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Emila Łojek
- Chair of Neuropsychology, Department of Cognitive Neuropsychology, University of Warsaw, Warsaw, Poland
| | - Tomasz Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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Early motor resonance differentiates schizophrenia patients from healthy subjects and predicts social cognition performance. PROGRESS IN BRAIN RESEARCH 2019; 247:353-374. [PMID: 31196441 DOI: 10.1016/bs.pbr.2019.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Diminished motor resonance (facilitation of motor potentials during action observation) is possibly related to social cognition deficits in schizophrenia. Adequate social cognition requires the successful moment-to-moment appraisal of social stimuli over a temporal window. However, similar changes in motor resonance with successive action observation stimuli are unknown. We compared the time-course of motor resonance evoked during successive action observation stimuli between schizophrenia patients (antipsychotic-naïve and medicated) and healthy subjects and examined its association with social cognition performance. METHOD Fifty-four schizophrenia patients (33 antipsychotic-naive) and 45 healthy subjects underwent 10-recordings (T1 to T10) of cortical reactivity, using two single (sp)- and two paired-pulse (pp) transcranial magnetic stimulation (TMS) paradigms, while they observed goal-directed actions and a static image. They also underwent comprehensive social cognition assessments. RESULTS Sp-motor resonance revealed a significant quadratic time effect (initial fall and then rise) in patients and healthy subjects [F=12.21, P=0.001]. Such a pattern was not observed for pp-motor resonance. We categorized motor resonance as early (T1-T3), middle (T4-T7) and late (T8-T10) based on pair-wise comparisons. Early, but not middle or late sp-motor resonance was reduced in antipsychotic naïve patients compared to the medicated patients and healthy subjects (F=3.41, P=0.037). Social cognition composite score had significant correlations with both early sp-motor resonance (r=0.34, P=0.01) and early pp-motor resonance (r=0.314, P=0.02) in the combined patient group. CONCLUSIONS Motor resonance time-courses did not vary across groups. The magnitude of early motor resonance was reduced in the antipsychotic-naïve schizophrenia group, compared to healthy subjects. Early phase motor resonance was associated with social cognition deficits in patients.
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Rossetti I, Brambilla P, Papagno C. Metaphor Comprehension in Schizophrenic Patients. Front Psychol 2018; 9:670. [PMID: 29867648 PMCID: PMC5954116 DOI: 10.3389/fpsyg.2018.00670] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/18/2018] [Indexed: 11/17/2022] Open
Abstract
People with schizophrenia often exhibit difficulties to comprehend figurative expressions, such as irony, proverbs, metaphors and idioms, with a general proneness to neglect the figurative meaning and to accept the more literal one. This inability is usually referred to as concretism and it constitutes a clinical manifestation of the broader language dysfunction called Formal Thought Disorder. The current review focuses on the neuropsychological and neuroanatomical underpinnings of schizophrenics’ misinterpretation of a subgroup of figurative expressions, i.e., metaphors. Metaphors are heterogeneous in nature, classifiable according to various criteria; for instance, metaphors can be conventional and familiar, or conversely, novel and unusual. These linguistic distinctions are substantial because the comprehension of the different types of metaphor entails partially different cognitive strategies and neural substrates. This review gathers studies that have directly investigated which neurocognitive deficits explain the inefficient comprehension of metaphor in schizophrenia. Several impairments have been put forward, such as general intelligence, executive functions and theory of mind deficits. Moreover, the neural correlates of metaphor comprehension in schizophrenia, like the left inferior/medial frontal gyrus and the temporal lobe, match those cortices affected by the neuropathology of schizophrenia. Even though the causal defective mechanism is still a matter of investigation, we provide an attempt to integrate existing findings.
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Affiliation(s)
- Ileana Rossetti
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy
| | - Paolo Brambilla
- Scientific Institute IRCCS "E. Medea", Bosisio Parini, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Costanza Papagno
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy.,Center for Mind/Brain Sciences and Centro di Riabilitazione Neurocognitiva, University of Trento, Trento, Italy
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Pawełczyk A, Kotlicka-Antczak M, Łojek E, Ruszpel A, Pawełczyk T. Schizophrenia patients have higher-order language and extralinguistic impairments. Schizophr Res 2018; 192:274-280. [PMID: 28438437 DOI: 10.1016/j.schres.2017.04.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/13/2017] [Accepted: 04/16/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The extralinguistic and paralinguistic aspects of the language refer to higher-order language functions such as lexical-semantic processes, prosody, indirect speech acts or discourse comprehension and production. Studies suggest that these processes are mediated by the Right Hemisphere (RH) and there is also some evidence of RH dysfunctions in schizophrenia. The aim of the paper is to investigate the extralinguistic and paralinguistic processing mediated by Right Hemisphere in schizophrenia patients using a validated and standardized battery of tests. METHODS Two groups of participants were examined: a schizophrenia sample (40 participants) and a control group (39 participants). Extralinguistic and paralinguistic processing was assessed in all subjects by the Polish version of the Right Hemisphere Language Battery (RHLB-PL), which measures comprehension of implicit information, naming, understanding humor, inappropriate remarks and comments, explanation and understanding of metaphors, understanding emotional and language prosody and discourse understanding. RESULTS Schizophrenia patients scored significantly lower than controls in subtests measuring comprehension of implicit information, interpretation of humor, explanation of metaphors, inappropriate remarks and comments, discernment of emotional and language prosody and comprehension of discourse. No differences were observed in naming, understanding metaphors or in processing visuo-spatial information. CONCLUSIONS Extralinguistic and paralinguistic dysfunctions appear to be present in schizophrenia patients and they suggest that RH processing may be disturbed in that group of patients. As the disturbances of higher-order language processes mediated by the RH may cause serious impairments in the social communication of patients, it is worth evaluating them during clinical examination.
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Affiliation(s)
- Agnieszka Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Poland.
| | | | - Emila Łojek
- Department of Cognitive Neuropsychology, University of Warsaw, Poland
| | - Anna Ruszpel
- Department of Cognitive Neuropsychology, University of Warsaw, Poland
| | - Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Poland
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19
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Perlini C, Bellani M, Finos L, Lasalvia A, Bonetto C, Scocco P, D'Agostino A, Torresani S, Imbesi M, Bellini F, Konze A, Veronese A, Ruggeri M, Brambilla P. Non literal language comprehension in a large sample of first episode psychosis patients in adulthood. Psychiatry Res 2018; 260:78-89. [PMID: 29175503 DOI: 10.1016/j.psychres.2017.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/22/2017] [Accepted: 11/08/2017] [Indexed: 01/28/2023]
Abstract
To date no data still exist on the comprehension of figurative language in the early phases of psychosis. The aim of this study is to investigate for the first time the comprehension of metaphors and idioms at the onset of the illness. Two-hundred-twenty eight (228) first episode psychosis (FEP) patients (168 NAP, non-affective psychosis; 60 AP, affective psychosis) and 70 healthy controls (HC) were assessed. Groups were contrasted on: a) type of stimulus (metaphors vs idioms) and b) type of response (OPEN = spontaneous explanations vs CLOSED = multiple choice answer). Moreover, a machine learning (ML) approach was adopted to classifying participants. Both NAP and AP had a poorer performance on OPEN metaphors and idioms compared to HC, with worse results on spontaneous interpretation of idioms than metaphors. No differences were observed between NAP and AP in CLOSED tasks. The ML approach points at CLOSED idioms as the best discriminating variable, more relevant than the set of pre-frontal and IQ scores. Deficits in non-figurative language may represent a core feature of psychosis. The possibility to identify linguistic features discriminating FEP may support the early recognition of patients at risk to develop psychosis, guiding provision of personalized and timely interventions.
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Affiliation(s)
- Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Italy
| | - Marcella Bellani
- UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - Livio Finos
- Department of Developmental Psychology and Socialization, University of Padua, Italy
| | - Antonio Lasalvia
- UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Paolo Scocco
- Department of Mental Health, AULSS 6 Euganea, Padua, Italy
| | - Armando D'Agostino
- Department of Health Sciences, San Paolo University Hospital, University of Milan, Milano, Milan, Italy
| | - Stefano Torresani
- Department of Psychiatry, ULSS, Bolzano Suedtiroler Sanitaetbetrieb- Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | | | | | - Angela Konze
- SOC Radiology - S.Maria Nuova Hospital, Usl Central Tuscany, Florence, Italy
| | | | - Mirella Ruggeri
- UOC of Psychiatry, Azienda Ospedaliera Universitaria Integrata (AOUI) of Verona, Italy; Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Psychiatric Clinic, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, TX, USA.
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20
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Rapp AM, Felsenheimer AK, Langohr K, Klupp M. The Comprehension of Familiar and Novel Metaphoric Meanings in Schizophrenia: A Pilot Study. Front Psychol 2018; 8:2251. [PMID: 29354082 PMCID: PMC5760836 DOI: 10.3389/fpsyg.2017.02251] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 12/11/2017] [Indexed: 12/13/2022] Open
Abstract
Miscomprehension of nonliteral (“figurative”) language like metaphors, proverbs, idioms, and ironic expressions by patients with schizophrenia is a phenomenon mentioned already in historical psychiatric descriptions. However, it was only recently that studies did differentiate between novel and conventional metaphors, a factor that is known to influence the difficulty of comprehension in healthy subjects. Further, familiarity with stimuli is an important factor for comprehension, which was not recommended in utmost previous studies. In this study, 23 patients with DSM IV schizophrenia and 19 healthy control subjects performed a newly-developed German metaphor comprehension test with three types of stimuli: novel metaphors, conventional German metaphors, and meaningless statements. During the test procedure, participants indicated familiarity with the stimulus and then matched the meaning with one out of four given alternatives. Familiarity rankings did not significantly differ between patients and control subjects. However, on descriptive level, there was a tendency for healthy controls to be more familiar with conventional metaphors than schizophrenic patients. Further, comprehension of conventional and novel metaphors differed significantly between the groups, with higher performance in healthy controls. Considering only those metaphors that had been ranked as familiar, patients only revealed significant lower performance opposed to controls regarding novel metaphors, while they did not differ in conventional metaphors. Taken together, the results indicate that patients with schizophrenia might show an altered way of comprehension in novel metaphors, leading to more misunderstandings. However, their previously reported impairments in conventional metaphors might rather be due to a lack of familiarity with the stimuli—making conventional metaphors to novel metaphors in the individual case.
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Affiliation(s)
- Alexander M Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Anne K Felsenheimer
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Karin Langohr
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Magdalena Klupp
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
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21
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Fukuhara K, Ogawa Y, Tanaka H, Nagata Y, Nishida S, Haga D, Nishikawa T. Impaired Interpretation of Others' Behavior is Associated with Difficulties in Recognizing Pragmatic Language in Patients with Schizophrenia. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2017; 46:1309-1318. [PMID: 28500472 DOI: 10.1007/s10936-017-9497-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Much attention has been paid to the pragmatic language function in schizophrenia. This study of Japanese patients with schizophrenia examined the relationship between impaired interpretation of the behaviors of other people in social contexts and the ability to recognize metaphor and irony. We assessed 34 patients with schizophrenia and 34 normal subjects using first- and second-order theory of mind tasks, the Metaphor and Sarcasm Scenario Test, and the Dewey Story Test (which tests the ability to judge others' social behaviors). We compared the performance between the groups and analyzed correlations between the tasks. All tasks revealed significant deficits in the patients compared with the controls. In the patient group, metaphor comprehension was correlated with the ability to judge normal behaviors, and irony comprehension was correlated with the ability to judge abnormal behaviors, suggesting that deficits of social cognition in schizophrenia include these two types of factors associated with pragmatic language.
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Affiliation(s)
- Keita Fukuhara
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan
- Department of Psychiatric Day Care, Mikiwakai Orange Hospital, Osaka, Japan
| | - Yasuhiro Ogawa
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan
- Day Care Center, Hokutokai Sawa Hospital, Osaka, Japan
| | - Hiroyuki Tanaka
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan
| | - Yuma Nagata
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan
| | - Saiji Nishida
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan
| | - Daisuke Haga
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan
- Day Care Center, Hokutokai Sawa Hospital, Osaka, Japan
| | - Takashi Nishikawa
- Department of Clinical Rehabilitation, Osaka Prefecture University Graduate School of Comprehensive Rehabilitation, 3-7-30 Habikino, Habikino-City, Osaka, 5838555, Japan.
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22
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23
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Kato Y, Shoji Y, Morita K, Inoue M, Ishii Y, Sato M, Yamashita Y, Okawa J, Uchimura N. Evaluation of changes in oxyhemoglobin during Shiritori task in elderly subjects including those with Alzheimer‧s disease. Psychogeriatrics 2017; 17:238-246. [PMID: 28130872 DOI: 10.1111/psyg.12226] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 07/23/2016] [Accepted: 08/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent years, as the prevalence of Alzheimer‧s disease (AD) has increased rapidly, demand has increased for early detection and treatment. Therefore, discovery and treatment intervention at the mild cognitive impairment stage are important. Dysfunction of the working memory is known to be conspicuously present in AD patients or mild cognitive impairment subjects from an early stage. Near-infrared spectroscopy (NIRS) is a method to measure hemoglobin concentration changes during an activation task. In the present study, we evaluated the cognitive function of elderly subjects, including those with AD, by means of NIRS. METHODS The subjects were divided into three groups-the AD group, the intermediate group, and the healthy group (HG)-based on assement of dementia using the Hasegawa‧s Dementia Scale-Revised, Mini-Mental State Examination, and Clinical Dementia Rating. The intermediate group was divided into two groups-the high score group (HSMG) and the low score group (LSMG)-based on Hasegawa‧s Dementia Scale-Revised and Mini-Mental State Examination scores. In this study, during Shiritori tasks using single-event-related NIRS, we analyzed oxyhemoglobin changes in an area, the peak amplitude, and latency, and compared them among four groups: AD group, HSMG, LSMG, and HG. RESULT In the AD group, the area at left channel (Ch)9, 11, and 19, the area at right Ch22, and the peak ampulitude at left Ch11 and 19 and right Ch5,12, and 22 were significantly smaller than those in HSMG and HG. Furthermore, the latency of the AD group was significantly longer than that of HSMG and HG at all region of interests. However, no significant difference was observed between the AD group and LSMG. CONCLUSION These findings suggest that analysis of changes in oxyhemoglobin during Shiritori tasks may be a useful neuropsychological index for the early diagnosis of AD. Detailed studies will be conducted in LSMG to facilitate the early introduction of NIRS as a screening tool for cognitive impairment.
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Affiliation(s)
- Yusuke Kato
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - Yoshihisa Shoji
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - Kiichiro Morita
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - Masayuki Inoue
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Yohei Ishii
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Mamoru Sato
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - Yuuji Yamashita
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - Junji Okawa
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Cognitive and Molecular Research Institute of Brain Diseases, Kurume University, Kurume, Japan
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Ozguven HD, Oner O, Baskak B, Oktem F, Olmez S, Munir K. Theory of Mind in Schizophrenia and Asperger's Syndrome: Relationship with Negative Symptoms. ACTA ACUST UNITED AC 2016; 20:5-13. [DOI: 10.1080/10177833.2010.11790628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Ozgur Oner
- Doktor Sami Ulus Kadın ve Çocuk Hastalıkları Hastanesi
| | - Bora Baskak
- Ankara Üniversitesi Tıp Fakültesi, Psikiyatri AD, Ankara-Turkey
| | - Ferhunde Oktem
- Hacettepe Üniversitesi Tıp Fakültesi Çocuk ve Ergen Psikiyatrisi AD, İstanbul-Turkey
| | - Senay Olmez
- Ankara Üniversitesi Tıp Fakültesi, Psikiyatri AD, Ankara-Turkey
| | - Kerim Munir
- Harvard Medical School, Children's Hospital, Boston
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25
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Caldiroli A, Buoli M, Serati M, Cahn W, Altamura AC. General and social cognition in remitted first-episode schizophrenia patients: a comparative study. Eur Arch Psychiatry Clin Neurosci 2016; 266:639-47. [PMID: 27250978 DOI: 10.1007/s00406-016-0701-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/23/2016] [Indexed: 02/03/2023]
Abstract
The aim of this paper was to investigate whether both neurocognitive and social cognitive performances were different between remitted first-episode schizophrenia patients, non-remitters and healthy controls (HC). We assessed social cognition (Degraded Facial Affect Recognition Task-DFAR and Emotional Mentalizing Task-EMT) and neurocognition (Wechsler Adult Intelligence Scale and Word Learning Test-WLT) in 174 remitted first-episode schizophrenia patients, 110 non-remitted first-episode schizophrenia patients and 320 HC. Multivariate analyses of variance with age, gender and IQ as covariates (MANCOVA) were performed to compare mean cognitive test scores between the three groups. Remitted first-episode schizophrenia patients performed significantly worse than HC only in one verbal memory task (WLT immediate recall; p = 0.004); in the same test, they were significantly better than non-remitters (p = 0.027). Non-remitted first-episode schizophrenia patients, differently from remitters, performed significantly worse than HC in terms of social cognition (EMT-p < 0.05 and DFAR-p < 0.05). Remitted first-episode schizophrenia patients presented worse cognitive performance than HC in verbal memory tasks, but not in facial affect recognition and in ToM, while non-remitters did; these results suggest that neurocognitive deficits are the core hallmark of schizophrenia and that social cognition is relatively unaffected in remitted patients after their first episode.
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Affiliation(s)
- Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
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26
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A contextual behavioral approach to the study of (persecutory) delusions. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2016. [DOI: 10.1016/j.jcbs.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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27
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Abstract
An influential theory of schizophrenia proposes that it can be explained by an inability to understand and reason about the mental states of others. In particular, an inability to correctly infer the mental states of others is believed to give rise to delusions and other psychotic symptoms. Our recent research has shown that patients adequately represent their own and others’ mental states and use this competence to communicate successfully in naturalistic social interaction. In talk with delusional content, patients recognize that others do not agree with their delusional claims and are not persuaded by the justification they provide for these claims. Importantly, they recognize their own and others’ discomfort at the disagreement this causes. However, they do not revise their claims. It is the tenacity with which delusional claims are held that is striking. This is all the more interesting given their ability to appreciate and respond appropriately to others’ mental states and their evident discomfort in the face of others’ disagreement. Questions for further research are whether this incorrigibility is specific to delusions, psychotic symptoms or the condition generally, and why patients are so tenacious in disregarding others’ accounts of their problems.
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Abstract
Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The "un-Cartesian" cognitive-linguistic hypothesis maintains (a) that there is no thought separate from language, that is, there is no distinct mental space removed from language where "thinking" takes place; and (b) that a somewhat broadened concept of grammar is responsible for bestowing meaning on propositions, and this among other things gives them their quality of being true or false. It is argued that a loss of propositional meaning explains why delusions are false, impossible and sometimes fantastic. A closely related abnormality, failure of linguistic embedding, can additionally account for why delusions are held with fixed conviction and are not adequately justified by the patient. The un-Cartesian linguistic approach to delusions has points of contact with Frith's theory that inability to form meta-representations underlies a range of schizophrenic symptoms. It may also be relevant to the nature of the "second factor" in monothematic delusions in neurological disease. Finally, it can inform the current debate about whether or not delusions really are beliefs.
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Affiliation(s)
- Wolfram Hinzen
- Catalan Institute for Advanced Studies and Research (ICREA), Departament de Traducció i Ciències del Llenguatge, Universitat Pompeu Fabra, Barcelona, Spain,Department of Linguistics, University of Barcelona, Barcelona, Spain,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,CIBERSAM, Barcelona, Spain,Department of Philosophy, Durham University, Durham, UK
| | - Joana Rosselló
- Department of Linguistics, University of Barcelona, Barcelona, Spain
| | - Peter McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain,CIBERSAM, Barcelona, Spain, Peter McKenna
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29
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Galland D, Jonas C, Jardri R, Wilquin M, Cottencin O, Thomas P, Rolland B. Comparaison du concept de « responsabilité » en neurosciences et en droit pénal : une revue croisée de littérature pour l’expertise psychiatrique. Presse Med 2016; 45:559-66. [DOI: 10.1016/j.lpm.2016.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/16/2016] [Accepted: 03/03/2016] [Indexed: 11/15/2022] Open
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30
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Sullivan SA, Hollen L, Wren Y, Thompson AD, Lewis G, Zammit S. A longitudinal investigation of childhood communication ability and adolescent psychotic experiences in a community sample. Schizophr Res 2016; 173:54-61. [PMID: 26972475 PMCID: PMC4847740 DOI: 10.1016/j.schres.2016.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/03/2022]
Abstract
BACKGROUND Some childhood speech and language impairments precede psychosis but it is not clear whether they also precede adolescent psychotic experiences and whether this association is specific to psychotic experiences. METHODS Pragmatic language and expressive speech and language (parent-assessed using the Children's Communication Checklist) at age 9 and psychotic experiences and depression at ages 12 and 18 were investigated in 7659 participants from the Avon Longitudinal Study of Parents and Children. Associations were investigated using multivariate modelling. RESULTS Poorer pragmatic language at 9years was associated with psychotic experiences at both ages (12years OR 1.22, 95% CI 1.11, 1.34; 18years OR 1.25, 95% CI 1.10, 1.41) but only with depression at 18years (OR 1.10, 95% CI 1.00, 1.22). Poorer expressive speech and language ability was not associated with psychotic experiences or depression at either age. There was evidence that pragmatic language was specifically associated with psychotic experiences at age 12 but no evidence that the strength of any of the associations changed over time. CONCLUSIONS Deficits in pragmatic language precede early and late adolescent psychotic experiences and early adolescent depression. Interventions aimed at helping children improve pragmatic language skills may reduce the incidence of adolescent psychopathology and associated psychological disorder and dysfunction later in life.
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Affiliation(s)
- Sarah A Sullivan
- Centre for Academic Mental Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK; CLAHRC West, Whitefriars, Lewins Mead, Bristol, UK.
| | - Linda Hollen
- Centre for Child and Adolescent Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK.
| | - Yvonne Wren
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Frenchay Hospital, Bristol, UK.
| | - Andrew D Thompson
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK.
| | - Glyn Lewis
- Division of Psychiatry, University College London Charles Bell House, Gower St, London, UK.
| | - Stan Zammit
- Centre for Academic Mental Health, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK; Institute of Psychological Medicine and Clinical Neurosciences, University of Cardiff, Haydn Ellis Building, Maindy Road, Cardiff, UK.
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31
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Ho KKY, Lui SSY, Hung KSY, Wang Y, Li Z, Cheung EFC, Chan RCK. Theory of mind impairments in patients with first-episode schizophrenia and their unaffected siblings. Schizophr Res 2015; 166:1-8. [PMID: 26049215 DOI: 10.1016/j.schres.2015.05.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Theory of mind (ToM) impairment has been consistently demonstrated in patients with schizophrenia, but whether ToM impairments exist in unaffected siblings of patients with schizophrenia remains unclear. Few studies have examined the affective and cognitive components of ToM in schizophrenia. This study aimed to examine whether ToM impairments exist in patients with first-episode schizophrenia and their unaffected siblings, and whether there is any dissociation between the affective and cognitive components of ToM. METHOD We adopted a family-based case-control design. Participants were 41 patients with first-episode schizophrenia, 43 unaffected siblings, and 42 healthy controls. The Yoni Task which measures the participants' ability to understand first- and second-order affective versus cognitive ToM and the Faux Pas Task which taps into integration of the affective and cognitive components of ToM were administered. Multivariate and univariate ANCOVAs were used to examine the group differences in ToM, while controlling for other neurocognitive functions. RESULTS Compared with controls, patients with schizophrenia and their unaffected siblings performed poorer on the Faux Pas Task (p<0.001), with siblings having intermediate performance between patients and controls. Patients with schizophrenia performed worse than controls on second-order affective condition of the Yoni Task (p=0.004), but their unaffected siblings did not (p=0.063). We did not find any significant Group-by-Condition interaction in the Yoni Task (p=0.358). CONCLUSION Patients with first-episode schizophrenia and their unaffected siblings exhibit ToM impairments, but no dissociation between affective and cognitive component of ToM was found. Our findings support the notion that ToM deficit may be a trait marker of schizophrenia.
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Affiliation(s)
- Karen K Y Ho
- Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Simon S Y Lui
- Castle Peak Hospital, Hong Kong Special Administration Region, China; Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China.
| | - Karen S Y Hung
- Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Zhi Li
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Eric F C Cheung
- Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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Ventura J, Ered A, Gretchen-Doorly D, Subotnik KL, Horan WP, Hellemann GS, Nuechterlein KH. Theory of mind in the early course of schizophrenia: stability, symptom and neurocognitive correlates, and relationship with functioning. Psychol Med 2015; 45:2031-2043. [PMID: 25647289 DOI: 10.1017/s0033291714003171] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Numerous studies have reported links between theory of mind (ToM) deficits, neurocognition and negative symptoms with functional outcome in chronic schizophrenia patients. Although the ToM deficit has been observed in first-episode patients, fewer studies have addressed ToM as a possible trait marker, neurocognitive and symptom correlations longitudinally, and associations with later functioning. METHOD Recent-onset schizophrenia patients (n = 77) were assessed at baseline after reaching medication stabilization, and again at 6 months (n = 48). Healthy controls (n = 21) were screened, and demographically comparable with the patients. ToM was assessed with a Social Animations Task (SAT), in which the participants' descriptions of scenes depicting abstract visual stimuli 'interacting' in three conditions (ToM, goal directed and random) were rated for degree of intentionality attributed to the figures and for appropriateness. Neurocognition, symptoms and role functioning were also assessed. RESULTS On the SAT, patients had lower scores than controls for both intentionality (p < 0.01) and appropriateness (p < 0.01) during the ToM condition, at baseline and 6 months. The ToM deficit was stable and present even in remitted patients. Analyses at baseline and 6 months indicated that for patients, ToM intentionality and appropriateness were significantly correlated with neurocognition, negative symptoms and role functioning. The relationship between ToM and role functioning was mediated by negative symptoms. CONCLUSIONS The ToM deficit was found in recent-onset schizophrenia patients and appears to be moderately trait-like. ToM is also moderately correlated with neurocognition, negative and positive symptoms, and role functioning. ToM appears to influence negative symptoms which in turn makes an impact on role functioning.
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Affiliation(s)
- J Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
| | - A Ered
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
| | - D Gretchen-Doorly
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
| | - K L Subotnik
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
| | - W P Horan
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
| | - G S Hellemann
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
| | - K H Nuechterlein
- UCLA Department of Psychiatry and Biobehavioral Sciences,Semel Institute for Neuroscience and Human Behavior,Los Angeles,CA,USA
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Fretland RA, Andersson S, Sundet K, Andreassen OA, Melle I, Vaskinn A. Theory of mind in schizophrenia: error types and associations with symptoms. Schizophr Res 2015; 162:42-6. [PMID: 25623602 DOI: 10.1016/j.schres.2015.01.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Social cognition is an important determinant of functioning in schizophrenia. However, how social cognition relates to the clinical symptoms of schizophrenia is still unclear. The aim of this study was to explore the relationship between a social cognition domain, Theory of Mind (ToM), and the clinical symptoms of schizophrenia. Specifically, we investigated the associations between three ToM error types; 1) "overmentalizing" 2) "reduced ToM and 3) "no ToM", and positive, negative and disorganized symptoms. METHODS Fifty-two participants with a diagnosis of schizophrenia or schizoaffective disorder were assessed with the Movie for the Assessment of Social Cognition (MASC), a video-based ToM measure. An empirically validated five-factor model of the Positive and Negative Syndrome Scale (PANSS) was used to assess clinical symptoms. RESULTS There was a significant, small-moderate association between overmentalizing and positive symptoms (rho=.28, p=.04). Disorganized symptoms correlated at a trend level with "reduced ToM" (rho=.27, p=.05). There were no other significant correlations between ToM impairments and symptom levels. Positive/disorganized symptoms did not contribute significantly in explaining total ToM performance, whereas IQ did (B=.37, p=.01). Within the undermentalizing domain, participants performed more "reduced ToM" errors than "no ToM" errors. CONCLUSION Overmentalizing was associated with positive symptoms. The undermentalizing error types were unrelated to symptoms, but "reduced ToM" was somewhat associated to disorganization. The higher number of "reduced ToM" responses suggests that schizophrenia is characterized by accuracy problems rather than a fundamental lack of mental state concept. The findings call for the use of more sensitive measures when investigating ToM in schizophrenia to avoid the "right/wrong ToM"-dichotomy.
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Affiliation(s)
- Ragnhild A Fretland
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway.
| | - Stein Andersson
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway
| | - Anja Vaskinn
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway
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Mercedes Perez-Rodriguez M, Mahon K, Russo M, Ungar AK, Burdick KE. Oxytocin and social cognition in affective and psychotic disorders. Eur Neuropsychopharmacol 2015; 25:265-82. [PMID: 25153535 PMCID: PMC4443696 DOI: 10.1016/j.euroneuro.2014.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/10/2014] [Accepted: 07/19/2014] [Indexed: 12/22/2022]
Abstract
Impairments in social cognition are now recognized as core illness features in psychotic and affective disorders. Despite the significant disability caused by social cognitive abnormalities, treatments for this symptom dimension are lacking. Here, we describe the evidence demonstrating abnormalities in social cognition in schizophrenia, major depressive disorder, and bipolar disorder, as well as the neurobiology of social cognition including the role of oxytocin. We then review clinical trials of oxytocin administration in psychotic and affective disorders and the impact of this agent on social cognition. To date, several studies have demonstrated that oxytocin may improve social cognition in schizophrenia; too few studies have been conducted in affective disorders to determine the effect of oxytocin on social cognition in these disorders. Future work is needed to clarify which aspects of social cognition may be improved with oxytocin treatment in psychotic and affective disorders.
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Affiliation(s)
- M Mercedes Perez-Rodriguez
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA; The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA; CIBERSAM, Autonoma University of Madrid, Fundacion Jimenez Diaz Hospital, Spain.
| | - Katie Mahon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Manuela Russo
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Allison K Ungar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Katherine E Burdick
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
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Abstract
The philosophical and interdisciplinary debate about the nature of social cognition, and the processes involved, has important implications for psychiatry. On one account, mindreading depends on making theoretical inferences about another person's mental states based on knowledge of folk psychology, the so-called "theory theory" (TT). On a different account, "simulation theory" (ST), mindreading depends on simulating the other's mental states within one's own mental or motor system. A third approach, "interaction theory" (IT), looks to embodied processes (involving movement, gesture, facial expression, vocal intonation, etc.) and the dynamics of intersubjective interactions (joint attention, joint action, and processes not confined to an individual system) in highly contextualized situations to explain social cognition, and disruptions of these processes in some psychopathological conditions. In this paper, we present a brief summary of these three theoretical frameworks (TT, ST, IT). We then focus on impaired social abilities in autism and schizophrenia from the perspective of the three approaches. We discuss the limitations of such approaches in the scientific studies of these and other pathologies, and we close with a short reflection on the future of the field. In this regard we argue that, to the extent that TT, ST and IT offer explanations that capture different (limited) aspects of social cognition, a pluralist approach might be best.
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Affiliation(s)
- Shaun Gallagher
- Department of Philosophy, University of Memphis, Memphis, TN, USA; School of Humanities, University of Hertfordshire, Hatfield, Hertfordshire, UK; Faculty of Law, Humanities and the Arts, University of Wollongong, Wollongong, NSW, Australia
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Balogh N, Egerházi A, Berecz R, Csukly G. Investigating the state-like and trait-like characters of social cognition in schizophrenia: a short term follow-up study. Schizophr Res 2014; 159:499-505. [PMID: 25305062 DOI: 10.1016/j.schres.2014.08.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 08/16/2014] [Accepted: 08/21/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Controversial findings exist in the literature regarding the state- and trait-like characters of social cognition in schizophrenia. In order to explore the relationship of social cognition with symptom severity in the present study, Theory of mind (ToM) and emotion recognition were tested in an acute phase and later in a clinically stable phase in patients. METHODS ToM and emotion recognition abilities were examined by using the Reading the Mind in the Eyes Test (RMET) and the Ekman 60 Faces Test (FEEST) in 43 patients with schizophrenia and 41 healthy controls. Research diagnoses were based on SCID interviews. Symptom severity in patients was assessed by the Positive and Negative Syndrome Scale (PANSS). RESULTS ToM and emotion recognition deficits improved in the clinically stable phase compared to relapse, but were still found to be impaired compared to healthy controls. Negative symptom severity showed strong correlation with emotion recognition and ToM at both visits. CONCLUSIONS Both ToM and emotion recognition fluctuated together with symptom severity, which confirmed the "state-like" component of these abilities. Our results, taken together with the findings of previous investigations show that social cognition deficits in schizophrenia have both state-like and trait-like components.
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Affiliation(s)
- Nóra Balogh
- Department of Psychiatry, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Anikó Egerházi
- Department of Psychiatry, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Roland Berecz
- Department of Psychiatry, University of Debrecen, Medical and Health Science Center, Debrecen, Hungary
| | - Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest Hungary.
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Mehta UM, Bhagyavathi HD, Thirthalli J, Kumar KJ, Gangadhar BN. Neurocognitive predictors of social cognition in remitted schizophrenia. Psychiatry Res 2014; 219:268-74. [PMID: 24953420 DOI: 10.1016/j.psychres.2014.05.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 05/21/2014] [Accepted: 05/30/2014] [Indexed: 01/04/2023]
Abstract
Knowledge of how specific neurocognition (NC) abilities predict social cognition (SC) in schizophrenia has potential to guide novel integrated cognitive-remediation therapies. The scope of studies conducted in this field is limited as they have not examined a comprehensive set of SC domains and they employ small sample sizes of heterogeneous patient groups. We studied a broad range of NC (sustained attention, processing speed, verbal/visual memory and visual processing/encoding, cognitive flexibility and planning) and SC [different levels of theory of mind (ToM)], attributional bias, emotion recognition and social perception] abilities in 170 remitted schizophrenia patients. Multivariate regression analyses revealed attention and planning as predictors of 1st order ToM. Memory encoding was the strongest predictor of 2nd order ToM. Faux-pas recognition, social perception and emotion recognition were influenced by a combination of cognitive flexibility and memory encoding abilities. Overall, NC predicted anywhere between ~4% and 40% of variance observed in specific SC sub-dimensions of attributional bias (4%), 1st order (19%) and 2nd order (12%) theory of mind, faux-pas recognition (28%), social perception (29%) and emotion recognition (39%). Individual SC abilities are predicted by distinctive as well as shared NC abilities. These findings have important implications for integrated cognitive remediation.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Haralahalli D Bhagyavathi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Keshav J Kumar
- Department of Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
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Mashal N, Vishne T, Laor N. The role of the precuneus in metaphor comprehension: evidence from an fMRI study in people with schizophrenia and healthy participants. Front Hum Neurosci 2014; 8:818. [PMID: 25360101 PMCID: PMC4199320 DOI: 10.3389/fnhum.2014.00818] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022] Open
Abstract
Comprehension of conventional and novel metaphors involves traditional language-related cortical regions as well as non-language related regions. While semantic processing is crucial for understanding metaphors, it is not sufficient. Recently the precuneus has been identified as a region that mediates complex and highly integrated tasks, including retrieval of episodic memory and mental imagery. Although the understanding of non-literal language is relatively easy for healthy individuals, people with schizophrenia exhibit deficits in this domain. The present study aims to examine whether people with schizophrenia differentially recruit the precuneus, extending to the superior parietal (SP) cortex (SPL), to support their deficit in metaphor comprehension. We also examine interregional associations between the precuneus/SPL and language-related brain regions. Twelve people with schizophrenia and twelve healthy controls were scanned while silently reading literal word pairs, conventional metaphors, and novel metaphors. People with schizophrenia showed reduced comprehension of both conventional and novel metaphors. Analysis of functional connectivity found that the correlations between activation in the left precuneus/SPL and activation in the left posterior superior temporal sulcus (PSTS) were significant for both literal word pairs and novel metaphors, and significant correlations were found between activation in the right precuneus/SPL and activation in the right PSTS for the three types of semantic relations. These results were found in the schizophrenia group alone. Furthermore, relative to controls, people with schizophrenia demonstrated increased activation in the right precuneus/SPL. Our results may suggest that individuals with schizophrenia use mental imagery to support comprehension of both literal and metaphoric language. In particular, our findings indicate over-integration of language and non-language brain regions during more effortful processes of novel metaphor comprehension.
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Affiliation(s)
- Nira Mashal
- School of Education, Bar-Ilan University Ramat-Gan, Israel ; Multidisciplinary Brain Research Center, Bar-Ilan University Ramat-Gan, Israel
| | - Tali Vishne
- Tel Aviv-Brull Community Mental Health Center Tel Aviv, Israel
| | - Nathaniel Laor
- Tel Aviv-Brull Community Mental Health Center Tel Aviv, Israel ; Child Study Center, Yale University New Haven, CT, USA
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Pesciarelli F, Gamberoni T, Ferlazzo F, Lo Russo L, Pedrazzi F, Melati E, Cacciari C. Is the comprehension of idiomatic sentences indeed impaired in paranoid Schizophrenia? A window into semantic processing deficits. Front Hum Neurosci 2014; 8:799. [PMID: 25346676 PMCID: PMC4190991 DOI: 10.3389/fnhum.2014.00799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 09/19/2014] [Indexed: 11/13/2022] Open
Abstract
Schizophrenia patients have been reported to be more impaired in comprehending non-literal than literal language since early studies on proverbs. Preference for literal rather than figurative interpretations continues to be documented. The main aim of this study was to establish whether patients are indeed able to use combinatorial semantic processing to comprehend literal sentences and both combinatorial analysis, and retrieval of pre-stored meanings to comprehend idiomatic sentences. The study employed a sentence continuation task in which subjects were asked to decide whether a target word was a sensible continuation of a previous sentence fragment to investigate idiomatic and literal sentence comprehension in patients with paranoid schizophrenia. Patients and healthy controls were faster in accepting sensible continuations than in rejecting non-sensible ones in both literal and idiomatic sentences. Patients were as accurate as controls in comprehending literal and idiomatic sentences, but they were overall slower than controls in all conditions. Once the contribution of cognitive covariates was partialled out, the response times (RTs) to sensible idiomatic continuations of patients did not significantly differ from those of controls. This suggests that the state of residual schizophrenia did not contribute to slower processing of sensible idioms above and beyond the cognitive deficits that are typically associated with schizophrenia.
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Affiliation(s)
- Francesca Pesciarelli
- Department of Biomedical, Metabolic, and Neurological Sciences, University of Modena Modena, Italy
| | - Tania Gamberoni
- Centro Salute Mentale Pavullo Modena, Italy ; Villa Igea Private Hospital Modena, Italy
| | - Fabio Ferlazzo
- Department of Psychology, Sapienza University of Rome Rome, Italy
| | | | | | | | - Cristina Cacciari
- Department of Biomedical, Metabolic, and Neurological Sciences, University of Modena Modena, Italy
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Sullivan S, Lewis G, Mohr C, Herzig D, Corcoran R, Drake R, Evans J. The longitudinal association between social functioning and theory of mind in first-episode psychosis. Cogn Neuropsychiatry 2014; 19:58-80. [PMID: 23777337 DOI: 10.1080/13546805.2013.799463] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION There is some cross-sectional evidence that theory of mind ability is associated with social functioning in those with psychosis but the direction of this relationship is unknown. This study investigates the longitudinal association between both theory of mind and psychotic symptoms and social functioning outcome in first-episode psychosis. METHODS Fifty-four people with first-episode psychosis were followed up at 6 and 12 months. Random effects regression models were used to estimate the stability of theory of mind over time and the association between baseline theory of mind and psychotic symptoms and social functioning outcome. RESULTS Neither baseline theory of mind ability (regression coefficients: Hinting test 1.07 95% CI -0.74, 2.88; Visual Cartoon test -2.91 95% CI -7.32, 1.51) nor baseline symptoms (regression coefficients: positive symptoms -0.04 95% CI -1.24, 1.16; selected negative symptoms -0.15 95% CI -2.63, 2.32) were associated with social functioning outcome. There was evidence that theory of mind ability was stable over time, (regression coefficients: Hinting test 5.92 95% CI -6.66, 8.92; Visual Cartoon test score 0.13 95% CI -0.17, 0.44). CONCLUSIONS Neither baseline theory of mind ability nor psychotic symptoms are associated with social functioning outcome. Further longitudinal work is needed to understand the origin of social functioning deficits in psychosis.
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Affiliation(s)
- Sarah Sullivan
- a Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine , University of Bristol , Bristol , UK
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Mehta UM, Thirthalli J, Basavaraju R, Gangadhar BN, Pascual-Leone A. Reduced mirror neuron activity in schizophrenia and its association with theory of mind deficits: evidence from a transcranial magnetic stimulation study. Schizophr Bull 2014; 40:1083-94. [PMID: 24214933 PMCID: PMC4133670 DOI: 10.1093/schbul/sbt155] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The "mirror-neuron system" has been proposed to be a neurophysiological substrate for social cognition (SC) ability. We used transcranial magnetic stimulation (TMS) paradigms to compare putative mirror neuron activity (MNA) in 3 groups: antipsychotic-naive, medicated schizophrenia patients, and healthy comparison subjects. We also explored the association between MNA and SC ability in patients. METHODS Fifty-four consenting right-handed schizophrenia patients (33 antipsychotic naive) and 45 matched healthy comparison subjects completed a TMS experiment to assess putative premotor MNA. We used 4 TMS paradigms of eliciting motor-evoked potentials (MEP) in the right first dorsal interosseous (FDI) muscle. These were applied while the subjects observed a goal-directed action involving the FDI (actual action and its video) and a static image. The difference in the amplitude of the MEP while they observed the static image and the action provided a measure of MNA. Subjects also underwent SC assessments (theory of mind [ToM], emotion processing, and social perception). RESULTS Two-way repeated measures ANOVA revealed significant group × occasion interaction effect in 3 TMS paradigms, indicating deficient motor facilitation during action observation relative to rest state in antipsychotic-naive schizophrenia patients as compared with the other two groups. Among patients, there were significant direct correlations between measures of MNA and ToM performance. CONCLUSIONS Antipsychotic-naive schizophrenia patients have poorer MNA than medicated patients and healthy controls. Measures of putative MNA had significant and consistent associations with ToM abilities. These findings suggest a possibility of deficient mirror neuron system underlying SC deficits in schizophrenia.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India;
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Bangalore N. Gangadhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Alvaro Pascual-Leone
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA
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Mehta UM, Thirthalli J, Basavaraju R, Gangadhar BN. Association of intracortical inhibition with social cognition deficits in schizophrenia: Findings from a transcranial magnetic stimulation study. Schizophr Res 2014; 158:146-50. [PMID: 25048423 DOI: 10.1016/j.schres.2014.06.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/13/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Abstract
Abnormal cortical-inhibition has been hypothesized to underlie social-cognition deficits in schizophrenia. Studies using transcranial magnetic stimulation (TMS) as a neurophysiological probe have demonstrated cortical-inhibition deficits in this group. We compared TMS-measured short- and long-interval intracortical-inhibition (SICI & LICI) in antipsychotic-naïve (n=33) and medicated (n=21) schizophrenia patients and in healthy comparison subjects (n=45). We also studied the association between cortical-inhibition and social-cognition deficits in the patients. Antipsychotic-naïve patients had significant deficits in SICI (i.e., less inhibitory response). In this group, SICI had significant inverse correlations with emotion processing and a global social-cognition score. Impaired intracortical-inhibition may thus contribute to social-cognition deficits in schizophrenia.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Rakshathi Basavaraju
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
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Cassetta B, Goghari V. Theory of mind reasoning in schizophrenia patients and non-psychotic relatives. Psychiatry Res 2014; 218:12-9. [PMID: 24745472 DOI: 10.1016/j.psychres.2014.03.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/19/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
Abstract
Research consistently demonstrates that schizophrenia patients have theory of mind (ToM) impairments. Additionally, there is some evidence that family members of schizophrenia patients also demonstrate impairments in ToM, suggesting a genetic vulnerability for the disorder. This study assessed ToM abilities (i.e., sarcasm comprehension) in schizophrenia patients and their first-degree biological relatives during video-taped social interactions, to be representative of real-world interactions and to assess for disease-specific and/or genetic liability effects. Additionally, we assessed whether ToM abilities predicted social and global functioning in schizophrenia patients, and whether symptoms were associated with ToM deficits. Schizophrenia patients demonstrated impairments in sarcasm comprehension compared to controls and relatives, whereas relatives showed intact comprehension. Symptoms of schizophrenia significantly predicted worse ToM abilities. Furthermore, in schizophrenia patients, impaired ToM reasoning predicted worse social and global functioning. Given schizophrenia patients demonstrated impairments in ToM reasoning in a task that resembles real-life interactions, this might be a key area for remediation.
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Affiliation(s)
- Briana Cassetta
- Clinical Neuroscience of Schizophrenia Laboratory, Department of Psychology, 2500 University Drive NW, University of Calgary, Calgary, AB, Canada T2N 1N4
| | - Vina Goghari
- Clinical Neuroscience of Schizophrenia Laboratory, Department of Psychology, 2500 University Drive NW, University of Calgary, Calgary, AB, Canada T2N 1N4.
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Mehta UM, Thirthalli J, Bhagyavathi HD, Keshav Kumar J, Subbakrishna DK, Gangadhar BN, Eack SM, Keshavan MS. Similar and contrasting dimensions of social cognition in schizophrenia and healthy subjects. Schizophr Res 2014; 157:70-7. [PMID: 24910445 DOI: 10.1016/j.schres.2014.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/27/2014] [Accepted: 05/15/2014] [Indexed: 11/16/2022]
Abstract
Schizophrenia patients experience substantial impairments in social cognition (SC) and these deficits are associated with their poor functional outcome. Though SC is consistently shown to emerge as a cognitive dimension distinct from neurocognition, the dimensionality of SC is poorly understood. Moreover, comparing the components of SC between schizophrenia patients and healthy comparison subjects would provide specific insights on the construct validity of SC. We conducted principal component analyses of eight SC test scores (representing four domains of SC, namely, theory of mind, emotion processing, social perception and attributional bias) independently in 170 remitted schizophrenia patients and 111 matched healthy comparison subjects. We also conducted regression analyses to evaluate the relative contribution of individual SC components to other symptom dimensions, which are important clinical determinants of functional outcome (i.e., neurocognition, negative symptoms, motivational deficits and insight) in schizophrenia. A three-factor solution representing socio-emotional processing, social-inferential ability and external attribution components emerged in the patient group that accounted for 64.43% of the variance. In contrast, a two-factor solution representing socio-emotional processing and social-inferential ability was derived in the healthy comparison group that explained 56.5% of the variance. In the patient group, the social-inferential component predicted negative symptoms and motivational deficits. Our results suggest the presence of a multidimensional SC construct. The dimensionality of SC observed across the two groups, though not identical, displayed important parallels. Individual components also demonstrated distinct patterns of association with other symptom dimensions, thus supporting their external validity.
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Affiliation(s)
- Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - H D Bhagyavathi
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - J Keshav Kumar
- Clinical Psychology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - D K Subbakrishna
- Biostatistics, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Bangalore N Gangadhar
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore 560029, India.
| | - Shaun M Eack
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, USA.
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Rapp AM, Langohr K, Mutschler DE, Wild B. Irony and proverb comprehension in schizophrenia: do female patients "dislike" ironic remarks? SCHIZOPHRENIA RESEARCH AND TREATMENT 2014; 2014:841086. [PMID: 24991434 PMCID: PMC4060160 DOI: 10.1155/2014/841086] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 05/06/2014] [Indexed: 01/19/2023]
Abstract
Difficulties in understanding irony and sarcasm are part of the social cognition deficits in patients with schizophrenia. A number of studies have reported higher error rates during comprehension in patients with schizophrenia. However, the relationships of these impairments to schizotypal personality traits and other language deficits, such as the comprehension of proverbs, are unclear. We investigated irony and proverb comprehension in an all-female sample of 20 schizophrenia patients and 27 matched controls. Subjects indicated if a statement was intended to be ironic, literal, or meaningless and furthermore rated the meanness and funniness of the stimuli and certainty of their decision. Patients made significantly more errors than controls did. Globally, there were no overall differences in the ratings. However, patients rated the subgroup of stimuli with answers given incorrectly as having significantly less meanness and in case of an error indicated a significantly higher certainty than controls. Across all of the study participants, performances in irony (r = -0.51) and proverb (r = 0.56) comprehension were significantly correlated with schizotypal personality traits, suggesting a continuum of nonliteral language understanding. Because irony is so frequent in everyday conversations, this makes irony an especially promising candidate for social cognition training in schizophrenia.
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Affiliation(s)
- Alexander M. Rapp
- Department of Psychiatry, University of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany
| | - Karin Langohr
- Department of Psychiatry, University of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany
| | - Dorothee E. Mutschler
- Department of Psychiatry, University of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany
| | - Barbara Wild
- Department of Psychiatry, University of Tuebingen, Calwerstraße 14, 72076 Tuebingen, Germany
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Rossell SL, Van Rheenen TE. Theory of mind performance using a story comprehension task in bipolar mania compared to schizophrenia and healthy controls. Cogn Neuropsychiatry 2014; 18:409-21. [PMID: 23082765 DOI: 10.1080/13546805.2012.725820] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Theory of mind (ToM) refers to the ability to understand the mental state of self and others. There is limited research into this topic in bipolar disorder (BD), with no previous study examining ToM in a BD group within a psychotic manic phase. METHODS Twenty-eight psychotic manic BD patients were compared with 30 schizophrenia (SCZ) patients and 29 healthy controls (HC). Participants performed a ToM story comprehension task that compared ToM stories and non-ToM stories (which we relabelled non-ToM "semantic" stories). Performance was examined by answering comprehension questions. RESULTS Both patient groups were equally impaired on their scores for ToM stories (scores BD = 10/24, SCZ = 9/24, HC = 14/24, p < .001). Interestingly, both patient groups showed reduced performance on non-ToM semantic stories (scores BD = 12/24, SCZ = 9/24, HC = 15/24, p < .001); SCZ showed a larger deficit. Reduced ToM performance was correlated with delusion severity in the BD group only. CONCLUSIONS ToM performance was impaired in BD patients experiencing psychotic symptoms. Patient performance was also impaired on the control condition (i.e., non-ToM semantic stories) supporting an additional deficit in semantic processing.
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Affiliation(s)
- Susan L Rossell
- a Brain and Psychological Sciences Research Centre, Faculty of Life and Social Sciences , Swinburne University , Melbourne , Australia
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Mossaheb N, Aschauer HN, Stoettner S, Schmoeger M, Pils N, Raab M, Willinger U. Comprehension of metaphors in patients with schizophrenia-spectrum disorders. Compr Psychiatry 2014; 55:928-37. [PMID: 24556517 DOI: 10.1016/j.comppsych.2013.12.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 11/29/2013] [Accepted: 12/31/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Metaphors, mainly proverbs and idiomatic expressions of ordinary life are commonly used as a model for concretism. Previous studies have shown impaired metaphor comprehension in patients with schizophrenia-spectrum disorders compared to either psychiatric or non-psychiatric control subject. The aim of this study was to detect possible quantitative differences in figurative processing between patients with schizophrenia-spectrum disorders and healthy controls. METHODS In order to analyse possible dissociations of different aspects of figurative speech, a range of metaphor tasks was used to distinguish between recognition of familiar metaphors, paraphrasing the meaning of the latter and generating novel metaphors: we used a standard proverb test for conventional metaphors consisting of a multiple-choice and a paraphrasing task, and the Metaphoric Triads Test for the assessment of novel metaphors. We included 40 patients with schizophrenia-spectrum disorders and 43 healthy control subjects. RESULTS Our results showed that patients had impaired figurative speech processing regarding novel and conventional metaphors. Associations with cognitive functions were detected. Performance on the paraphrasing task was associated with the severity of negative symptoms. CONCLUSION We conclude that patients with schizophrenia-spectrum disorders do exhibit impairments in the recognition and paraphrasing of conventional and the generation of novel metaphors and that some cognitive domains as well the extent of negative symptoms might be associated with these deficits.
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Affiliation(s)
- Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division of Social Psychiatry, Medical University Vienna, Austria; Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Austria.
| | - Harald N Aschauer
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University Vienna, Austria
| | | | | | - Nicole Pils
- Department of Neurology, Medical University Vienna, Austria; Landesklinikum Thermenregion Baden, Department of Psychiatry and Psychotherapeutic medicine, Baden bei Wien, Austria
| | - Monika Raab
- Department of Neurology, Medical University Vienna, Austria; SMZ Baumgartner Hoehe, Otto Wagner Hospital, Department of Substance abuse, Vienna, Austria
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Mehta UM, Bhagyavathi HD, Kumar CN, Thirthalli J, Gangadhar BN. Cognitive deconstruction of parenting in schizophrenia: the role of theory of mind. Aust N Z J Psychiatry 2014; 48:249-58. [PMID: 23928275 DOI: 10.1177/0004867413500350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Schizophrenia patients experience impairments across various functional roles. Emotional unresponsiveness and an inability to foster intimacy and display affection may lead to impairments in parenting. A comprehensive cognitive understanding of parenting abilities in schizophrenia has the potential to guide newer treatment strategies. As part of a larger study on functional ability in schizophrenia patients, we attempted a cognitive deconstruction of their parenting ability. METHODS Sixty-nine of the 170 patients who participated in a study on social cognition in remitted schizophrenia were parents (mean age of their children: 11.8 ± 6.2 years). They underwent comprehensive assessments for neurocognition, social cognition (theory of mind, emotion processing, social perception and attributional bias), motivation and insight. A rater blind to their cognitive status assessed their social functioning using the Groningen Social Disabilities Schedule. We examined the association of their functional ability (active involvement and affective relationship) in the parental role with their cognitive performance as well as with their level of insight and motivation. RESULTS Deficits in first- and second-order theory of mind (t = 2.57, p = 0.01; t = 3.2, p = 0.002, respectively), speed of processing (t = 2.37, p = 0.02), cognitive flexibility (t = 2.26, p = 0.02) and motivation (t = 2.64, p = 0.01) had significant association with parental role dysfunction. On logistic regression, second-order theory of mind emerged as a specific predictor of parental role, even after controlling for overall functioning scores sans parental role. CONCLUSIONS Second-order theory of mind deficits are specifically associated with parental role dysfunction of patients with schizophrenia. Novel treatment strategies targeting theory of mind may improve parenting abilities in individuals with schizophrenia.
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Affiliation(s)
- Urvakhsh M Mehta
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Gil-Sanz D, Fernández-Modamio M, Bengochea-Seco R, Arrieta-Rodríguez M, Pérez-Fuentes G. Efficacy of the Social Cognition Training Program in a sample of schizophrenic outpatients. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2014:1-27. [PMID: 24496043 DOI: 10.3371/csrp.gife.013114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Social cognition is recognized to be a deficit in individuals suffering from schizophrenia. Numerous studies have explored the relationship between social cognition and social functioning in outpatients with schizophrenia through the use of different social cognition training programs. This study examines the efficacy of the Social Cognition Training Program (PECS in Spanish) in adults with a diagnosis of schizophrenia. Methods: Data were derived from a sample of 44 non-hospitalized adult patients, who presented with a DSM-IV-R Axis I diagnosis of schizophrenia, and 39 healthy controls. Patients were divided into an experimental group and a control task group, that received cognitive training. Healthy controls did not receive any treatment. Sociodemographic and clinic variables correlates were computed. 2-way ANOVA was conducted to examine differences between groups in pre and post-treatment measures. Intragroup differences were explores using the paired-samples t-test. Results: At the end of the training, patients in the experimental group showed a higher performance compared to patients in the control task group, in the Hinting Task Test and in the emotion recognition of sadness, anger, fear, and disgust. Conclusions: The PECS proved to be effective in the improvement of some areas of theory of mind and emotion recognition, in outpatients with schizophrenia. The PECS is one of the first programs developed in Spanish to train social cognition, and the data obtained support the importance of expand the social cognition programs to non-English language samples.
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Affiliation(s)
- David Gil-Sanz
- Centro de Rehabilitación Psicosocial Padre Menni, Santander, Spain
| | | | | | | | - Gabriela Pérez-Fuentes
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York
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Exploring social cognition in patients with apathy following acquired brain damage. BMC Neurol 2014; 14:18. [PMID: 24450311 PMCID: PMC3943587 DOI: 10.1186/1471-2377-14-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/17/2014] [Indexed: 12/30/2022] Open
Abstract
Background Research on cognition in apathy has largely focused on executive functions. To the best of our knowledge, no studies have investigated the relationship between apathy symptoms and processes involved in social cognition. Apathy symptoms include attenuated emotional behaviour, low social engagement and social withdrawal, all of which may be linked to underlying socio-cognitive deficits. Methods We compared patients with brain damage who also had apathy symptoms against similar patients with brain damage but without apathy symptoms. Both patient groups were also compared against normal controls on key socio-cognitive measures involving moral reasoning, social awareness related to making judgements between normative and non-normative behaviour, Theory of Mind processing, and the perception of facial expressions of emotion. We also controlled for the likely effects of executive deficits and depressive symptoms on these comparisons. Results Our results indicated that patients with apathy were distinctively impaired in making moral reasoning decisions and in judging the social appropriateness of behaviour. Deficits in Theory of Mind and perception of facial expressions of emotion did not distinguish patients with apathy from those without apathy. Conclusion Our findings point to a possible socio-cognitive profile for apathy symptoms and provide initial insights into how socio-cognitive deficits in patients with apathy may affect social functioning.
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