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Wölwer W, Frommann N, Lowe A, Kamp D, Weide K, Bechdolf A, Brockhaus-Dumke A, Hurlemann R, Muthesius A, Klingberg S, Hellmich M, Schmied S, Meyer-Lindenberg A. Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study). Front Psychiatry 2022; 13:909370. [PMID: 35800017 PMCID: PMC9253387 DOI: 10.3389/fpsyt.2022.909370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes. OBJECTIVES To assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT). METHODS The present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12). DISCUSSION This RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02678858, German Study Register DRKS 00010033.
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Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and Soulspace, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Alzey, Germany.,Department of Psychiatry and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Rene Hurlemann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Oldenburg, Oldenburg, Germany
| | - Ana Muthesius
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Clinical Trials Center, University of Cologne, Cologne, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Social Cognition and Interaction Training (SCIT) versus Training in Affect Recognition (TAR) in patients with schizophrenia: A randomized controlled trial. J Psychiatr Res 2021; 142:101-109. [PMID: 34332374 DOI: 10.1016/j.jpsychires.2021.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/03/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Training in Affect Recognition (TAR) is a "targeted" and computer-aided program that has been shown to effectively attenuate facial affect recognition deficits and improve social functioning in patients with schizophrenia. Social Cognition and Interaction Training (SCIT) is a group "broad-based" intervention, that has also been shown to improve emotion recognition, theory of mind (ToM), and social functioning. To date, no study has compared the efficacy of two different social cognitive interventions. OBJECTIVES We aim to compare the efficacy of TAR and SCIT on schizophrenia patients' performance on facial affect recognition, theory of mind, attributional style and social functioning before, after treatment, and three months thereafter. METHODS One hundred outpatients with a diagnosis of schizophrenia were randomly assigned to the TAR or SCIT condition and completed pre- (T0) and posttreatment (T1) assessments and a 3-month follow up (T2) of emotion recognition (ER-40), theory of mind (Hinting Task), attributional style (AIHQ) and social functioning (PSP). RESULTS The entire sample, receiving TAR or SCIT, showed improvements in theory of mind, attributional style, clinical symptoms and social functioning. This effect was maintained at three-months. The TAR intervention was more efficacious than the SCIT program in improving the recognition of facial emotions (ER-40). The TAR intervention also demonstrated a lower drop-out rate than the SCIT intervention. CONCLUSIONS There were improvements in social cognition, symptomatology and functioning of patients in the entire sample, receiving SCIT or TAR. Both TAR and SCIT appear as valuable treatments for people with schizophrenia and social cognitive deficits.
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van der Stouwe ECD, Pijnenborg GHM, Opmeer EM, de Vries B, Marsman JBC, Aleman A, van Busschbach JT. Neural changes following a body-oriented resilience therapy with elements of kickboxing for individuals with a psychotic disorder: a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2021; 271:355-366. [PMID: 31980899 PMCID: PMC7960594 DOI: 10.1007/s00406-020-01097-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/13/2020] [Indexed: 11/27/2022]
Abstract
Individuals with a psychotic disorder are at an increased risk of becoming the victim of a crime. A body-oriented resilience therapy (BEATVIC) aimed at preventing victimization by addressing putatively underlying factors was developed. One of these factors is social cognition, particularly facial affect processing. The current study investigated neural effects of BEATVIC on facial affect processing using two face processing tasks. Participants were randomized to either BEATVIC or a 'Befriending' control group. Twenty-seven patients completed an Emotional Faces task and the Wall of Faces task during fMRI, pre- and post-intervention. General linear model analyses yielded no differences between groups over time. Independent component analyses revealed increased activation of the salience network to angry and fearful faces in BEATVIC compared to Befriending. Increased activation of the salience network may suggest an increased alertness for potentially dangerous faces.
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Affiliation(s)
- Elisabeth C D van der Stouwe
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
- Department of Neuroscience, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands.
| | - Gerdina H M Pijnenborg
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Department of Psychotic Disorders, GGZ-Drenthe, Dennenweg 9, 9404 LA, Assen, The Netherlands
| | - Esther M Opmeer
- Department of Neuroscience, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands
- Department of Health and Social Work, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA, Zwolle, The Netherlands
| | - Bertine de Vries
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Jan-Bernard C Marsman
- Department of Neuroscience, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands
| | - André Aleman
- Department of Neuroscience, Cognitive Neuroscience Center, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 2, 9713 AW, Groningen, The Netherlands
- Department of Clinical Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Jooske T van Busschbach
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA, Zwolle, The Netherlands
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Wiesenfeller J, Flasbeck V, Brown EC, Brüne M. Approach and Avoidance Behavior in Female Patients With Borderline Personality Disorder. Front Behav Neurosci 2020; 14:588874. [PMID: 33335479 PMCID: PMC7736178 DOI: 10.3389/fnbeh.2020.588874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/02/2020] [Indexed: 01/18/2023] Open
Abstract
Objectives Borderline personality disorder (BPD) is portrayed by unstable relationships, fears of abandonment and heightened sensitivity to social rejection. Research has shown that these characteristics may lead to inappropriate social behavior including altered approach-avoidance behavior. However, it has remained unclear how social exclusion may affect approach-avoidance behavior in patients with BPD. Design We assessed social approach-avoidance behavior and the impact of social exclusion in a sample of 38 patients with BPD and 40 healthy control participants. Methods We used an explicit joystick-based approach-avoidance task (AAT) after playing a virtual ball-tossing game (Cyberball), which simulates the exclusion of the participant by two other players. In the AAT, participants were required to push or pull emotional stimuli, more specifically happy and angry facial expressions, with either direct or averted gaze direction. Results Patients with BPD approached happy stimuli less and showed overall less differential approach-avoidance behavior toward individuals expressing positive or negative facial emotions compared to healthy participants, who showed more approach behavior for happy compared to angry facial expressions. Moreover, borderline symptom severity correlated inversely with the AAT score for happy facial expressions and positively with subjective unpleasantness during social exclusion as well as rejection sensitivity. However, social exclusion did not influence approach-avoidance tendencies. Conclusion Patients with BPD showed altered approach-avoidance behavior, which might affect social interactions in the patient’s everyday lives and may therefore impede social interaction.
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Affiliation(s)
- Jana Wiesenfeller
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Vera Flasbeck
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Elliot C Brown
- Department of Decision Neuroscience and Nutrition, German Institute of Human Nutrition, Nuthetal, Germany.,Neuroscience Research Center, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Brüne
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
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Jung M, Baik SY, Kim Y, Kim S, Min D, Kim JY, Won S, Lee SH. Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:362-374. [PMID: 32702215 PMCID: PMC7383013 DOI: 10.9758/cpn.2020.18.3.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Objective While impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship. Methods A total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution. Results Patients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls. Conclusion Our results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia.
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Affiliation(s)
- Minjee Jung
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seung Yeon Baik
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Yourim Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Sungkean Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Dongil Min
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Jeong-Youn Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seunghee Won
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea.,Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Abstract
The significant progress of psychiatry in the 20th century provided a sophisticated theoretical framework to analyze the complex relationships between crime and mental illness. Schizophrenia has been traditionally associated with severe cognitive and affective deficits that heavily influence empathy, judgment capacities, but also control of impulsiveness. Although there is an association between psychotic disorders and absence or decrease of legal responsibility, their relationship is also determined by sociodemographic, developmental, and clinical factors. These disorders are associated not only with abolished criminal responsibility but also with diminished responsibility. We conduct a systematic literature review to examine the relation between schizophrenia and criminal responsibility. We have found that this clinical entity is often associated with diminished or abolished criminal liability. We discuss these findings, focusing on the specific deficits found in patients with schizophrenia and examining how this problem affects their behavior and eventually their accountability for their crimes.
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Bordon N, O'Rourke S, Hutton P. The feasibility and clinical benefits of improving facial affect recognition impairments in schizophrenia: Systematic review and meta-analysis. Schizophr Res 2017; 188:3-12. [PMID: 28095998 DOI: 10.1016/j.schres.2017.01.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/07/2017] [Accepted: 01/07/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND People diagnosed with schizophrenia have significant difficulty accurately recognising emotions expressed by others. This may generate anomalous experiences which, if misinterpreted, could contribute to experiences of social defeat, psychotic symptoms and reduced social functioning. It remains unclear whether this impairment is responsive to non-pharmacological intervention, or what the effect of modifying it is. METHODS We did a systematic review and meta-analysis to examine whether and to what extent facial affect recognition impairments can be improved by psychological intervention and, if so, whether this leads to improvements in psychotic symptoms and social functioning. RESULTS A total of 8 randomised controlled trials (RCTs) consisting of 300 participants were included. Focused yet brief psychological interventions led to very large improvements in facial affect recognition ability in psychosis [k=8, N=300, g=1.26, 95% Confidence Interval (CI) 0.92, 1.60, I2 41%]. Early evidence suggests this may cause large improvements in social functioning (k=3, N=109, g=0.98, 95% CI 0.37, 1.36, I2 38%), but not psychotic symptoms. CONCLUSIONS Facial affect recognition difficulties in schizophrenia are highly responsive to psychological interventions designed to improve them, and there is early evidence that this may lead to large gains in social functioning for this group - but not symptoms. A large-scale high-quality RCT with longer-term follow-up period is now required to overcome the limitations of the existing evidence.
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Affiliation(s)
- Natalie Bordon
- Department of Clinical Psychology, The State Hospital, Carstairs, Lanarkshire, UK
| | - Suzanne O'Rourke
- Department of Clinical Psychology, The State Hospital, Carstairs, Lanarkshire, UK; Department of Clinical and Health Psychology, School of Health in Social Science, Doorway 6, Medical School Quad, Teviot Place, University of Edinburgh, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh EH11 4BN, UK.
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Bratton H, O'Rourke S, Tansey L, Hutton P. Social cognition and paranoia in forensic inpatients with schizophrenia: A cross-sectional study. Schizophr Res 2017; 184:96-102. [PMID: 27979698 DOI: 10.1016/j.schres.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/25/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND People diagnosed with schizophrenia have difficulties in emotion recognition and theory of mind, and these may contribute to paranoia. The aim of this study was to determine whether this relationship is evident in patients residing in a secure forensic setting. METHOD Twenty-seven male participants with a diagnosis of schizophrenia and a history of offending behaviour were assessed using The Awareness of Social Inference Test (TASIT), The Ambiguous Intentions Hostility Questionnaire (AIHQ) and The Green et al. Paranoid Thought Scales (G-PTS). Individuals were recruited from two medium secure and one high secure forensic hospital in Scotland. RESULTS Correlation, logistic and multiple regression analyses did not find that emotion recognition and theory of mind were associated with indices of paranoid thinking. CONCLUSION Social cognition did not appear to be related to indices of paranoia in this forensic sample. Although participants reported low levels of paranoia overall, the results are consistent with recent conclusions that theory of mind impairments are not specifically linked to paranoia in people diagnosed with schizophrenia.
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Affiliation(s)
- Helen Bratton
- Forensic Clinical Psychology, Forensic Community Mental Health Service, Ward 17 Falkirk Community Hospital, Westburn Avenue, Falkirk FK1 5SU, United Kingdom.
| | - Suzanne O'Rourke
- Department of Clinical and Health Psychology, The School of Health in Social Science, University of Edinburgh, United Kingdom
| | - Louise Tansey
- The Orchard Clinic, NHS Lothian, Edinburgh, United Kingdom
| | - Paul Hutton
- Department of Clinical and Health Psychology, The School of Health in Social Science, University of Edinburgh, United Kingdom
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Campos C, Santos S, Gagen E, Machado S, Rocha S, Kurtz MM, Rocha NB. Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review. Neuropsychol Rev 2016; 26:310-328. [PMID: 27541742 DOI: 10.1007/s11065-016-9326-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/27/2016] [Indexed: 01/24/2023]
Abstract
Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.
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Affiliation(s)
- Carlos Campos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal. .,Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.
| | - Susana Santos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal
| | - Emily Gagen
- Department of Psychology, University of North Carolina-Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3720, USA
| | - Sérgio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.,Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Rua Marechal Deodoro, 263 - Centro, Niterói, Brazil
| | - Susana Rocha
- School of Accounting and Administration of Porto, Polytechnic Institute of Porto, Rua Jaime Lopes Amorim, s/n, 4465-004 S, Mamede de Infesta, Portugal
| | - Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, 45 Wyllys Ave, Middletown, CT, 06459, USA.,Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Nuno Barbosa Rocha
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal.
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Pollux P. Improved categorization of subtle facial expressions modulates Late Positive Potential. Neuroscience 2016; 322:152-63. [DOI: 10.1016/j.neuroscience.2016.02.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/11/2016] [Accepted: 02/13/2016] [Indexed: 11/25/2022]
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Isaac C, Januel D. Neural correlates of cognitive improvements following cognitive remediation in schizophrenia: a systematic review of randomized trials. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2016; 6:30054. [PMID: 26993787 PMCID: PMC4799394 DOI: 10.3402/snp.v6.30054] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/31/2015] [Accepted: 02/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Cognitive impairments are a core feature in schizophrenia and are linked to poor social functioning. Numerous studies have shown that cognitive remediation can enhance cognitive and functional abilities in patients with this pathology. The underlying mechanism of these behavioral improvements seems to be related to structural and functional changes in the brain. However, studies on neural correlates of such enhancement remain scarce. OBJECTIVES We explored the neural correlates of cognitive enhancement following cognitive remediation interventions in schizophrenia and the differential effect between cognitive training and other therapeutic interventions or patients' usual care. METHOD We searched MEDLINE, PsycInfo, and ScienceDirect databases for studies on cognitive remediation therapy in schizophrenia that used neuroimaging techniques and a randomized design. Search terms included randomized controlled trial, cognitive remediation, cognitive training, rehabilitation, magnetic resonance imaging, positron emission tomography, electroencephalography, magnetoencephalography, near infrared spectroscopy, and diffusion tensor imaging. We selected randomized controlled trials that proposed multiple sessions of cognitive training to adult patients with a schizophrenia spectrum disorder and assessed its efficacy with imaging techniques. RESULTS In total, 15 reports involving 19 studies were included in the systematic review. They involved a total of 455 adult patients, 271 of whom received cognitive remediation. Cognitive remediation therapy seems to provide a neurobiological enhancing effect in schizophrenia. After therapy, increased activations are observed in various brain regions mainly in frontal - especially prefrontal - and also in occipital and anterior cingulate regions during working memory and executive tasks. Several studies provide evidence of an improved functional connectivity after cognitive training, suggesting a neuroplastic effect of therapy through mechanisms of functional reorganization. Neurocognitive and social-cognitive training may have a cumulative effect on neural networks involved in social cognition. The variety of proposed programs, imaging tasks, and techniques may explain the heterogeneity of observed neural improvements. Future studies would need to specify the effect of cognitive training depending on those variables.
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Affiliation(s)
- Clémence Isaac
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France;
| | - Dominique Januel
- Unité de Recherche Clinique, EPS Ville Evrard, Neuilly-Sur-Marne, France
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Stroth S, Kamp D, Drusch K, Frommann N, Wölwer W. Training of Affect Recognition impacts electrophysiological correlates of facial affect recognition in schizophrenia: Analyses of fixation-locked potentials. World J Biol Psychiatry 2015. [PMID: 26212691 DOI: 10.3109/15622975.2015.1051110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Training of Affect Recognition (TAR) is a useful approach to restoring cognitive function in schizophrenic patients. Along with improving visual exploration of faces and altering central information processing in relevant brain areas, TAR attenuates impairments in facial affect recognition. In the present study, we investigate the effects of TAR on early electrophysiological correlates of facial affect recognition in schizophrenia. METHODS The study population comprised 12 schizophrenic patients and 14 healthy controls. In each individual, we carried out EEG, concomitant measurements of scanning eye movements and fixation-based low resolution electromagnetic tomography (sLORETA) analyses of brain electric activity. All analyses were performed at baseline and after participation in TAR. RESULTS In patients, brain activation patterns significantly changed after completing the TAR. Functional improvements were particularly pronounced in the superior parietal and inferior parietal lobes, where trained patients showed a larger increase in activation than untrained healthy controls. CONCLUSIONS The TAR activates compensatory brain processes involved in the perception, attention and evaluation of emotional stimuli. This may underlie the established behavioral effects of the TAR in schizophrenic patients, which include improvements in facial affect recognition and alterations of visual exploration strategies.
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Affiliation(s)
- Sanna Stroth
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Daniel Kamp
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Katharina Drusch
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Nicole Frommann
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
| | - Wolfgang Wölwer
- a Department of Psychiatry and Psychotherapy , Medical Faculty, Heinrich Heine University Düsseldorf , Düsseldorf , Germany
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Abstract
PURPOSE OF REVIEW Deficits in social cognition are an important determinant of social functioning in schizophrenia, a core feature of the illness that persists despite treatment. Recent research in neuroplasticity-based therapeutics shows that neural systems supporting core cognitive skills improve after targeted cognitive training, suggesting that social cognition, and concomitant social functioning, may be improved by targeting the neural systems supporting social cognition. However, the success of this approach depends on the extent to which the social brain is malleable. We review the neural effects of training programs focused on improving social cognition in healthy, schizophrenia, and other clinical samples. RECENT FINDINGS The current literature suggests that the neural mechanisms underlying social cognition show neuroplastic changes after behavioral training and these neural changes confer concomitant benefits to social cognition and social behavior. Most research in schizophrenia has focused on emotion recognition, and although emotion recognition training has behavioral and neural benefits for schizophrenia, more advanced social cognitive processes need to be examined. SUMMARY The data suggest that targeting neural systems underlying social cognition through socially focused behavioral interventions may improve social functioning impairments in schizophrenia. Questions remain regarding how to optimize training, which should be addressed in future work.
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Quality of life is social – Towards an improvement of social abilities in patients with epilepsy. Seizure 2015; 26:12-21. [DOI: 10.1016/j.seizure.2014.12.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/30/2014] [Accepted: 12/16/2014] [Indexed: 12/20/2022] Open
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Meta-analysis of face processing event-related potentials in schizophrenia. Biol Psychiatry 2015; 77:116-26. [PMID: 24923618 DOI: 10.1016/j.biopsych.2014.04.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/04/2014] [Accepted: 04/29/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Schizophrenia is associated with impaired face processing. N170 and N250 are two event-related potentials that have been studied in relation to face processing in schizophrenia, but the results have been mixed. The aim of this article was to conduct a meta-analysis of N170 and N250 in schizophrenia to evaluate trends and resolve the inconsistencies. METHODS Twenty-one studies of N170 (n = 438 schizophrenia patients, n = 418 control subjects) and six studies of N250 (n = 149 schizophrenia patients, n = 151 control subjects) were evaluated. Hedges' g was calculated for each study, and the overall weighted mean effect size (ES) was calculated for N170 and N250. Homogeneity of the ES distributions, potential publication bias, and impact of potential moderators were also assessed. RESULTS The amplitude of both N170 and N250 to face stimuli was smaller in patients than control subjects (N170 ES = .64; N250 ES = .49; ps < .001). The distributions of the ES were homogeneous (ps > .90), and there was no indication of a publication bias. We found no significant effect of task requirements regarding judgments of the face stimuli. Moreover, we found no significant difference between the ES for N170 and N250. CONCLUSIONS Though findings of individual studies have been mixed, the results of the meta-analysis strongly support disruption of N170 and N250 in schizophrenia. The comparable effect sizes across the two waveforms suggest that the well-established behavioral deficit in face emotion processing is mirrored in an underlying neural impairment for processing faces.
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Popova P, Popov TG, Wienbruch C, Carolus AM, Miller GA, Rockstroh BS. Changing facial affect recognition in schizophrenia: effects of training on brain dynamics. NEUROIMAGE-CLINICAL 2014; 6:156-65. [PMID: 25379427 PMCID: PMC4215531 DOI: 10.1016/j.nicl.2014.08.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/17/2014] [Accepted: 08/31/2014] [Indexed: 11/17/2022]
Abstract
Deficits in social cognition including facial affect recognition and their detrimental effects on functional outcome are well established in schizophrenia. Structured training can have substantial effects on social cognitive measures including facial affect recognition. Elucidating training effects on cortical mechanisms involved in facial affect recognition may identify causes of dysfunctional facial affect recognition in schizophrenia and foster remediation strategies. In the present study, 57 schizophrenia patients were randomly assigned to (a) computer-based facial affect training that focused on affect discrimination and working memory in 20 daily 1-hour sessions, (b) similarly intense, targeted cognitive training on auditory-verbal discrimination and working memory, or (c) treatment as usual. Neuromagnetic activity was measured before and after training during a dynamic facial affect recognition task (5 s videos showing human faces gradually changing from neutral to fear or to happy expressions). Effects on 10–13 Hz (alpha) power during the transition from neutral to emotional expressions were assessed via MEG based on previous findings that alpha power increase is related to facial affect recognition and is smaller in schizophrenia than in healthy subjects. Targeted affect training improved overt performance on the training tasks. Moreover, alpha power increase during the dynamic facial affect recognition task was larger after affect training than after treatment-as-usual, though similar to that after targeted perceptual–cognitive training, indicating somewhat nonspecific benefits. Alpha power modulation was unrelated to general neuropsychological test performance, which improved in all groups. Results suggest that specific neural processes supporting facial affect recognition, evident in oscillatory phenomena, are modifiable. This should be considered when developing remediation strategies targeting social cognition in schizophrenia.
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Affiliation(s)
- Petia Popova
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Tzvetan G. Popov
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Corresponding author: Department of Psychology, University of Konstanz, P.O. Box 905, Konstanz D-78457, Germany.
| | | | - Almut M. Carolus
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Gregory A. Miller
- Departments of Psychology & Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
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