CNTRICS final task selection: social cognitive and affective neuroscience-based measures

Examining the impact of a group treatment using cognitive and social cognition remediation for young offenders: The justice health NSW school-link advantage pilot study

AIM

Young offenders experience higher rates of neurodevelopmental and mental health disorders than the general population, and significant access barriers to health treatment. Treatment combining Cognitive Remediation Therapy (CRT) and Social Cognition Remediation Therapy (SCRT) has demonstrated benefits for functional improvements and social development. However, there is limited information regarding group treatment programs in custodial settings for young offenders. This pilot study explores the effectiveness and feasibility of a group treatment program for youth offenders with cognitive deficits and mental health concerns in youth detention.

METHODS

The School-Link Advantage pilot study designed and tested a 10-week group treatment program combining CRT and SCRT for young offenders in custody. The closed groups incorporated interactive activities focussed on emotional recognition and regulation skills, optimizing executive functioning, understanding values, exploring belief systems, improving relationships, and safety planning.

RESULTS

Of the 22 male participants recruited in an Australian Youth Justice Centre, 12 completed all aspects of the treatment program, reflecting a 54.5% completion rate in a typically challenging to engage population cohort. Results demonstrated significant improvements in the ability to store and retrieve information, recognize information, and control emotions. Planning and organizing skills also showed considerable development.

CONCLUSIONS

This pilot study suggests that a combined CRT and SCRT group treatment program has the potential to effectively target cognitive challenges associated with mental health disorders in young offenders in custody. These promising outcomes suggest exploring randomized controlled trials with increased cultural sensitivity for diverse populations.

Online Assessment of Social Cognition in a Population of Gamers and Gamblers: Results of the eSMILE Study

The purpose of the eSMILE study was to explore social cognition (SC) in the two behavioural addictions (BAs) included in international classifications: gaming disorder and gambling disorder. In these disorders, cognitive functioning is involved in the development and maintenance of addiction. Nevertheless, SC have received less attention than other cognitive functions. The eSMILE study was conducted online and included 105 participants (gamers and gamblers). This study included: the Penn emotion recognition task, the Condensed and Revised Multifaced Empathy Test, the Interpersonal Reactivity Index, the Chicken Game, social metacognition questions, and the Toronto Alexithymia Scale. We analysed the relationships among SC measures, addiction levels, and behaviour frequency. For gamers, we showed that the higher their level of addiction was, the lower their self-confidence following the identification of basic emotions, although the more frequently they played, the better their performance on this task. Additionally, we found lower performance on the identification of more complex emotions by gamblers, which seems to be the result of their levels of addiction rather than the frequency of their gambling behaviour. This study contributes to our understanding of the cognitive processes underlying BAs. Additionally, working on SC abilities may be an additional management mode for BAs that could be added to existing treatments.

The relevance of social anxiety for understanding social functioning and facial emotion recognition in individuals at clinical high-risk for psychosis

AIM

Individuals at clinical high risk (CHR) for psychosis often experience poor social functioning and impaired facial emotion recognition (FER); however, the impact of frequently comorbid symptoms upon these processes is underexplored. In particular, social anxiety is characteristic of this population and also related to poor social functioning and FER biases, such as misinterpreting neutral faces as negative or threatening; however, little is known about how social anxiety relates to these processes in CHR individuals. The present study examined the overlap of social anxiety, social functioning, and FER accuracy and bias.

METHOD

Participants (CHR N = 62, healthy controls N = 52) completed the self-report Social Interaction Anxiety Scale (SIAS), Penn Emotion Recognition-40 (ER-40) behavioural task, and interviewer-rated Global Functioning Scale-Social (GFS-S). The ER-40 was used to assess both FER accuracy (e.g., overall number of correct responses) and bias (e.g., mislabelling neutral faces as angry).

RESULTS

Consistent with previous research, relative to controls, CHR participants had more social anxiety (d = -1.07), poorer social functioning (d = -1.62), and performed more poorly on the FER task (e.g., d = -.37). Within CHR participants, social anxiety was related to an anger detection bias (r = .28), above and beyond positive symptom severity, which in turn was related to FER accuracy (r = .26) and social functioning (r = -.28).

CONCLUSION

These findings suggest that ongoing work examining social processes within CHR individuals needs to account for social anxiety and that social anxiety may be a useful preventive intervention target.

Developing and Validating a Facial Emotion Recognition Task With Graded Intensity

Facial emotion recognition (FER) tasks are often digitally altered to vary expression intensity; however, such tasks have unknown psychometric properties. In these studies, an FER task was developed and validated-the Graded Emotional Face Task (GEFT)-which provided an opportunity to examine the psychometric properties of such tasks. Facial expressions were altered to produce five intensity levels for six emotions (e.g., 40% anger). In Study 1, 224 undergraduates viewed subsets of these faces and labeled the expressions. An item selection algorithm was used to maximize internal consistency and balance gender and ethnicity. In Study 2, 219 undergraduates completed the final GEFT and a multimethod battery of validity measures. Finally, in Study 3, 407 undergraduates oversampled for borderline personality disorder (BPD) completed the GEFT and a self-report BPD measure. Broad FER scales (e.g., overall anger) demonstrated evidence of reliability and validity; however, more specific subscales (e.g., 40% anger) had more variable psychometric properties. Notably, ceiling/floor effects appeared to decrease both internal consistency and limit external validity correlations. The findings are discussed from the perspective of measurement issues in the social cognition literature.

Construction of a computerized adaptive test (CAT-CCNB) for efficient neurocognitive and clinical psychopathology assessment

BACKGROUND

Traditional paper-and-pencil neurocognitive evaluations and semi-structured mental health interviews can take hours to administer and score. Computerized assessment has decreased that burden substantially, and contemporary psychometric tools such as item response theory and computerized adaptive testing (CAT) allow even further abbreviation.

NEW METHOD

The goal of this paper was to describe the application of CAT and related methods to the Penn Computerized Neurocognitive Battery (CNB) and a well-validated clinical assessment in order to increase efficiency in assessment and relevant domain coverage. To calibrate item banks for CAT, N = 5053 participants (63% female; mean age 45 years, range 18-80) were collected from across the United States via crowdsourcing, providing item parameters that were then linked to larger item banks and used in individual test construction. Tests not amenable to CAT were abbreviated using complementary short-form methods.

RESULTS

The final "CAT-CCNB" battery comprised 21 cognitive tests (compared to 14 in the original) and five adaptive clinical scales (compared to 16 in the original).

COMPARISON WITH EXISTING METHODS

This new battery, derived with contemporary psychometric approaches, provides further improvements over existing assessments that use collections of fixed-length tests developed for stand-alone administration. The CAT-CCNB provides an improved version of the CNB that shows promise as a maximally efficient tool for neuropsychiatric assessment.

CONCLUSIONS

We anticipate CAT-CCNB will help satisfy the clear need for broad yet efficient measurement of cognitive and clinical domains, facilitating implementation of large-scale, "big science" approaches to data collection, and potential widespread clinical implementation.

Social cognition training improves recognition of distinct facial emotions and decreases misattribution errors in healthy individuals

Facial emotion recognition is a key component of social cognition. Impaired facial emotion recognition is tied to poor psychological wellbeing and deficient social functioning. While previous research has demonstrated the potential for social cognition training to improve overall facial emotion recognition, questions remain regarding what aspects of emotion recognition improve. We report results from a randomized controlled trial that evaluates whether computerized social cognition training can improve recognition of distinct facial emotions in healthy participants. This investigation was designed to better understand the therapeutic potential of social cognition training for individuals with neuropsychiatric disorders. Fifty-five healthy adult participants were randomly assigned to an internet-based intervention during which they either completed social cognition training (SCT) or played control computer games (CON) for 10.5 h over 2-3 weeks. Facial emotion recognition was measured with the Penn ER-40, which was conducted before and after training. The following variables were collected and analyzed: facial emotion recognition accuracy for each emotion (i.e., anger, fear, happy, neutral (no emotional expression), and sad), reaction times for each emotion, and response error types (i.e., frequency of an emotion being chosen incorrectly, frequency of an emotion being missed, and frequency of an emotion being confused for another particular emotion). ANOVAs and t-tests were used to elucidate intervention effects both within and between groups. Results showed that the SCT group improved their accuracy for angry and neutral faces. They also improved their reaction times for neutral, fearful, and sad faces. Compared to the CON group, the SCT group had significantly faster reaction times to neutral faces after training. Lastly, the SCT group decreased their tendency to confuse angry faces for no emotional expression and to confuse no emotional expression for sad faces. In contrast, the CON group did not significantly improve their accuracy or reaction times on any emotional expression, and they did not improve their response error types. We conclude that social cognition training can improve recognition of distinct emotions in healthy participants and decrease response error patterns, suggesting it has the potential to improve impaired emotion recognition and social functioning in individuals with facial emotion recognition deficits.

Face masks affect perception of happy faces in deaf people

The SARS-CoV-2 pandemic has led significant social repercussions and forced people to wear face masks. Recent research has demonstrated that the human ability to infer emotions from facial configurations is significantly reduced when face masks are worn. Since the mouth region is specifically crucial for deaf people who speak sign language, the current study assessed the impact of face masks on inferring emotional facial expressions in a population of adult deaf signers. A group of 34 congenitally deaf individuals and 34 normal-hearing individuals were asked to identify happiness, sadness, fear, anger, and neutral expression on static human pictures with and without facial masks presented through smartphones. For each emotion, the percentage of correct responses with and without face masks was calculated and compared between groups. Results indicated that face masks, such as those worn due to the SARS-CoV-2 pandemic, limit the ability of people to infer emotions from facial expressions. The negative impact of face masks is significantly pronounced when deaf people have to recognize low-intensity expressions of happiness. These findings are of essential importance because difficulties in recognizing emotions from facial expressions due to mask wearing may contribute to the communication challenges experienced by the deaf community during the SARS-CoV-2 pandemic, generating feelings of frustration and exclusion.

Separate pathways to violent behavior in schizophrenia and in the general population

Violence in schizophrenia is best investigated within the broader context of violent behavior in the general population. Two important domains of general pathology which allow us to take such an approach include impairment in emotion processing, as manifested by faulty facial emotion recognition, and aggressive reactivity which consists of heightened sensitivity to provocation. To test this approach, we included 135 subjects: 38 violent (VS's) and 33 nonviolent patients with schizophrenia, 32 healthy controls and 32 non-psychotic violent subjects (NPV's). We measured violence with the Life History of Aggression Scale, recognition of facial emotions with the Emotion Recognition Task, and aggressive reactivity through the Buss-Perry Aggression Questionnaire. Adolescent antisocial behavior was evaluated as a potential precursor to these deficits. We found that impairment in fear recognition (IFR) and aggressive reactivity have a significant effect on violence in the violent groups. These two impairments interact in different ways in these groups. In NPV's they contribute in an additive fashion to violence, whereas in VS's they represent separate pathways; aggressive reactivity leads to violence only when there is no IFR. Adolescent antisocial behavior has a differential effect on these 2 impairments in the 2 groups. Thus, these findings provide insights on the differential role of IFR and aggressive reactivity for violence in schizophrenia compared to the general population. In NPV's, both dysfunctions represent antisocial features and contribute jointly to violence. In schizophrenia, they have different etiologies and constitute alternative pathways to violence. This has important implications for the conceptualization and treatment of violence.

Examining facial emotion recognition as an intermediate phenotype for psychosis: Findings from the EUGEI study

BACKGROUND

Social cognition impairments, such as facial emotion recognition (FER), have been acknowledged since the earliest description of schizophrenia. Here, we tested FER as an intermediate phenotype for psychosis using two approaches that are indicators of genetic risk for schizophrenia: the proxy-genetic risk approach (family design) and the polygenic risk score for schizophrenia (PRS-SCZ).

METHODS

The sample comprised 2039 individuals with schizophrenia, 2141 siblings, and 2049 healthy controls (HC). The Degraded Facial Affect Recognition Task (DFAR) was applied to measure the FER accuracy. Schizotypal traits in siblings and HC were assessed using the Structured Interview for Schizotypy-Revised (SIS-R). The PRS-SCZ was trained using the Psychiatric Genomics Consortium results. Regression models were applied to test the association of DFAR with psychosis risk, SIS-R, and PRS-SCZ.

RESULTS

The DFAR-total scores were lower in individuals with schizophrenia than in siblings (RR = 0.97 [95% CI 0.97, 0.97]), who scored lower than HC (RR = 0.99 [95% CI 0.99-1.00]). The DFAR-total scores were negatively associated with SIS-R total scores in siblings (B = -2.04 [95% CI -3.72, -0.36]) and HC (B = -2.93 [95% CI -5.50, -0.36]). Different patterns of association were observed for individual emotions. No significant associations were found between DFAR scores and PRS-SCZ.

CONCLUSIONS

Our findings based on a proxy genetic risk approach suggest that FER deficits may represent an intermediate phenotype for schizophrenia. However, a significant association between FER and PRS-SCZ was not found. In the future, genetic mechanisms underlying FER phenotypes should be investigated trans-diagnostically.

COVID-19 and psychiatric disorders: The impact of face masks in emotion recognition face masks and emotion recognition in psychiatry

Since the outbreak of the COVID-19 pandemic, reading facial expressions has become more complex due to face masks covering the lower part of people's faces. A history of psychiatric illness has been associated with higher rates of complications, hospitalization, and mortality due to COVID-19. Psychiatric patients have well-documented difficulties reading emotions from facial expressions; accordingly, this study assesses how using face masks, such as those worn for preventing COVID-19 transmission, impacts the emotion recognition skills of patients with psychiatric disorders. To this end, the current study asked patients with bipolar disorder, major depressive disorder, schizophrenia, and healthy individuals to identify facial emotions on face images with and without facial masks. Results demonstrate that the emotion recognition skills of all participants were negatively influenced by face masks. Moreover, the main insight of the study is that the impairment is crucially significant when patients with major depressive disorder and schizophrenia had to identify happiness at a low-intensity level. These findings have important implications for satisfactory social relationships and well-being. If emotions with positive valence are hardly understood by specific psychiatric patients, there is an even greater requirement for doctor-patient interactions in public primary care.

Face processing of social cognition in patients with first episode psychosis: Its deficits and association with the right subcallosal anterior cingulate cortex

The clinical importance of social cognition is well acknowledged in patients with psychosis, in particular those with first episode psychosis (FEP). Nevertheless, its brain substrates and circuitries remain elusive, lacking precise analysis between multimodal brain characteristics and behavioral sub-dimensions within social cognition. In the present study, we examined face processing of social cognition in 71 FEP patients and 77 healthy controls (HCs). We looked for a possible correlation between face processing and multimodal MRI characteristics such as resting-state functional connectivity (rsFC) and brain volume. We observed worse recognition accuracy, longer recognition response time, and longer memory response time in FEP patients when compared with HCs. Of these, memory response time was selectively correlated with specific rsFCs, which included the right subcallosal sub-region of BA24 in the ACC (scACC), only in FEP patients. The volume of this region was also correlated with memory response time in FEP patients. The scACC is functionally and structurally important in FEP-associated abnormalities of face processing measures in social cognition.

White matter association tracts underlying language and theory of mind: An investigation of 809 brains from the Human Connectome Project

Language and theory of mind (ToM) are the cognitive capacities that allow for the successful interpretation and expression of meaning. While functional MRI investigations are able to consistently localize language and ToM to specific cortical regions, diffusion MRI investigations point to an inconsistent and sometimes overlapping set of white matter tracts associated with these two cognitive domains. To further examine the white matter tracts that may underlie these domains, we use a two-tensor tractography method to investigate the white matter microstructure of 809 participants from the Human Connectome Project. 20 association white matter tracts (10 in each hemisphere) are uniquely identified by leveraging a neuroanatomist-curated automated white matter tract atlas. The fractional anisotropy (FA), mean diffusivity (MD), and number of streamlines (NoS) are measured for each white matter tract. Performance on neuropsychological assessments of semantic memory (NIH Toolbox Picture Vocabulary Test, TPVT) and emotion perception (Penn Emotion Recognition Test, PERT) are used to measure critical subcomponents of the language and ToM networks, respectively. Regression models are constructed to examine how structural measurements of left and right white matter tracts influence performance across these two assessments. We find that semantic memory performance is influenced by the number of streamlines of the left superior longitudinal fasciculus III (SLF-III), and emotion perception performance is influenced by the number of streamlines of the right SLF-III. Additionally, we find that performance on both semantic memory & emotion perception is influenced by the FA of the left arcuate fasciculus (AF). The results point to multiple, overlapping white matter tracts that underlie the cognitive domains of language and ToM. Results are discussed in terms of hemispheric dominance and concordance with prior investigations.

Mechanisms Underlying Motivational Dysfunction in Schizophrenia

Negative symptoms are a debilitating feature of schizophrenia which are often resistant to pharmacological intervention. The mechanisms underlying them remain poorly understood, and diagnostic methods rely on phenotyping through validated questionnaires. Deeper endo-phenotyping is likely to be necessary in order to improve current understanding. In the last decade, valuable behavioural insights have been gained through the use of effort-based decision making (EBDM) tasks. These have highlighted impairments in reward-related processing in schizophrenia, particularly associated with negative symptom severity. Neuroimaging investigations have related these changes to dysfunction within specific brain networks including the ventral striatum (VS) and frontal brain regions. Here, we review the behavioural and neural evidence associated with negative symptoms, shedding light on potential underlying mechanisms and future therapeutic possibilities. Findings in the literature suggest that schizophrenia is characterised by impaired reward based learning and action selection, despite preserved hedonic responses. Associations between amotivation and reward-processing deficits have not always been clear, and may be mediated by factors including cognitive dysfunction or dysfunctional or self-defeatist beliefs. Successful endo-phenotyping of negative symptoms as a function of objective behavioural and neural measurements is crucial in advancing our understanding of this complex syndrome. Additionally, transdiagnostic research–leveraging findings from other brain disorders, including neurological ones–can shed valuable light on the possible common origins of motivation disorders across diseases and has important implications for future treatment development.

Pharmacological Treatment for Social Cognition: Current Evidence

Cognitive impairment is currently considered a core feature of schizophrenia (SZ) and is gaining attention as a fundamental therapeutic target. Standard treatment for SZ involves the use of antipsychotics that are successfully used to control positive symptoms and disorganized behaviour. However, it is still unclear whether they are effective on social cognition (SC) impairment. Furthermore, different medications are currently being studied to improve SC in patients with SZ. A literature search on this topic was conducted using the PubMed database. All kinds of publications (i.e., reviews, original contributions and case reports) written in English and published in the last 15 years were included. The aim of our literature review is to draw a picture of the current state of the pharmacological treatment of SC impairment in SZ.

Masking Emotions: Face Masks Impair How We Read Emotions

To date, COVID-19 has spread across the world, changing our way of life and forcing us to wear face masks. This report demonstrates that face masks influence the human ability to infer emotions by observing facial configurations. Specifically, a mask obstructing a face limits the ability of people of all ages to infer emotions expressed by facial features, but the difficulties associated with the mask’s use are significantly pronounced in children aged between 3 and 5 years old. These findings are of essential importance, as they suggest that we live in a time that may potentially affect the development of social and emotion reasoning, and young children’s future social abilities should be monitored to assess the true impact of the use of masks.

The functional significance of cognitive empathy and theory of mind in early and chronic schizophrenia

Theoretical models suggest that it is the interplay between social cognitive processes that result in adaptive social functioning in schizophrenia. This study explored the relative contributions of, and interplay between, cognitive empathy, affective theory of mind (ToM), neurocognition, and severity of clinical symptoms, in predicting the social functioning of individuals with schizophrenia. Clinical participants (early schizophrenia n = 26, chronic schizophrenia n = 32) were administered an ecologically valid measure of ToM (viz., the Virtual Assessment of Mentalising Ability or VAMA) and the Empathy Quotient (EQ) as part of a larger neuropsychological and social functioning assessment battery. Results indicated that individuals with early schizophrenia reported significantly better cognitive empathy than individuals with chronic schizophrenia. ToM was found to have added value in predicting both community functioning and functional capacity that was beyond that accounted for by cognitive empathy, clinical symptoms, and neurocognition for both clinical groups. Further, our results indicated that the capacity to demonstrate empathic understanding of another's situation (i.e., cognitive empathy) mediates the relationship between ToM and social functioning. Together, our findings highlight the intricate and compounding nature of social cognition constructs, and their effect on social functioning for individuals with schizophrenia.

Comparison of social cognition using an adapted Chinese version of the Reading the Mind in the Eyes Test in drug-naive and regularly medicated individuals with chronic schizophrenia and healthy controls in rural China

BACKGROUND

Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling.

METHODS

We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as 'successfully completed' or 'incomplete'. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China.

RESULTS

In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age ('educated-younger' v. 'undereducated-older') show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant.

CONCLUSIONS

We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully.

Amygdala connectivity during emotional face perception in psychotic disorders

Emotional face perception (EFP) deficits have been identified as a significant feature of psychotic disorders and are associated with symptoms and real-world functioning in these disorders. The amygdala is frequently implicated in EFP and bears extensive structural connectivity with other brain regions supporting EFP. Amygdala functional connectivity during attentional control of implicitly processed emotional faces in psychotic disorders is well examined. However, it is unclear whether amygdala functional connectivity while explicitly processing emotional faces contributes to EFP deficits in psychotic disorders. Further, it is unclear whether these connectivity differences are associated with symptoms or functioning and if these relationships are transdiagnostic across psychotic disorders. We used functional magnetic resonance imaging (fMRI) and seed-based functional connectivity analyses to examine connectivity of amygdala to other regions of the face processing network during an EFP task. The sample consisted of 55 cases with psychotic disorders and 29 participants with no history of psychosis (NP). Results indicated that, compared to NP, cases showed worse accuracy, greater inferior frontal gyrus (IFG) activation, and greater amygdala-insula connectivity while matching emotional and neutral faces. Additionally, worse accuracy, greater IFG activation, greater amygdala-insula and amygdala-IFG connectivity during emotional vs. neutral faces was associated with worse negative symptoms and greater deficits in social and global functioning in cases. Importantly, these relationships transcended diagnostic categories, and applied across psychotic disorders. The present study presents compelling evidence relating alterations in amygdala functional connectivity during explicit EFP with clinical and functioning deficits seen across psychotic disorders.

Test-retest reliability of the Turkish translation of the Penn Computerized Neurocognitive Battery

Psychiatric disorders are associated with cognitive dysfunction (CD), and reliable screening and follow-up of CD is essential both for research and clinical practice globally; yet, most assessments are in Western languages. We aimed to evaluate the test-retest reliability of the Turkish version of the Penn Computerized Neurocognitive Battery (PennCNB) to guide confident interpretation of results. Fifty-eight healthy individuals completed the PennCNB Turkish version in two sessions. After quality control, reliability analysis was conducted using Intraclass Correlation Coefficients (ICC), corrected for practice effects. Most measures were not significantly different between the sessions and had acceptable ICC values, with several exceptions. Scores were improved considerably for some memory measures, including immediate Facial Memory and Spatial Memory, and for incorrect responses in abstraction and mental flexibility, with correspondingly acceptable ICCs. Test-retest assessment of the Turkish version of the PennCNB shows that it can be used as a reliable real-time measurement of cognitive function in snapshot cross-sectional or longitudinal determinations. Preliminary validity assessment in this normative sample showed expected positive correlations with education level and negative correlations with age. Thus, the Turkish version of the PennCNB can be considered a reliable neuropsychological testing tool in research and clinical practice. Practice effects should be considered, especially when applied in short intervals. Significantly better performances in the retest, beyond practice effect, likely reflect nonlinear improvements in some participants who "learned how to learn" the memory tests or had insight on solving the abstraction and mental flexibility test.

Design and validation of a brief scale for cognitive evaluation in people with a diagnosis of schizophrenia (BCog-S)

WHAT IS KNOWN ON THE SUBJECT?: Schizophrenia is often related to cognitive deficits. Mental health nurses are involved in health promotion, prevention, treatment and rehabilitation in schizophrenia. However, the nursing literature addressing cognitive rehabilitation from schizophrenia is very limited. Cognition and its domains (communication, information processing, attentiveness, concentration, orientation, memory and calculation skills) are established by the Nursing Outcomes Classification (NOC), but they are difficult to measure. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We present a new standardized cognitive assessment to be administered by nurses to people diagnosed with schizophrenia. The Brief Cognitive Scale for schizophrenia (BCog-S) was validated in people with a diagnosis of schizophrenia (including people with schizoaffective disorder), using as references both the assessment of controls matched by age, sex and educational level, and another brief cognitive battery as the gold standard. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses can effectively use the BCog-S to measure cognition and its domains in people with a diagnosis of schizophrenia. It is a standardized cognitive assessment consisting of a brief battery to be administered by nurses (and other professionals) to people diagnosed with schizophrenia. It is useful for establishing normative reference values for the outcome and its indicators. Using the BCog-S, nurses can determine the cognitive status of the people diagnosed with schizophrenia they care for, measuring cognitive improvements, lapses or stability attributable to their rehabilitation. Nurses can demonstrate their contribution to cognitive rehabilitation with these measurements of improvement or stability. ABSTRACT: Introduction Nurses play a key role in cognitive rehabilitation programs for people diagnosed with schizophrenia. Aim To design and validate a brief battery to assess the cognitive status of people diagnosed with schizophrenia from the nursing perspective. Method Study developed to evaluate a diagnostic test. The Brief Cognitive Scale for schizophrenia (BCog-S) is a hybrid battery composed of previously validated brief tests, designed to meet the dimensions of cognition considered by the NOC. The psychometric properties of the instrument were measured using the Screening for Cognitive Impairment in Psychiatry-Spanish version (SCIP-S) as the gold standard, and against the scores obtained by matched controls. Results About 100 people diagnosed with schizophrenia and 100 controls participated. The battery's internal consistency was 0.70. The Pearson correlation with the SCIP-S was 0.80 (sensitivity = 0.86, specificity = 0.80). The mean T-score of those diagnosed with schizophrenia was 2.2 standard deviations below that of the controls. There were significant differences in educational level, employment and cohabitation. Discussion The BCog-S showed acceptable psychometric properties. It can discriminate cognitive impairment and could be useful for establishing normative reference values. Implications for practice Nurses can use the BCog-S to measure cognition in people with a diagnosis of schizophrenia.

Do we need sex-oriented clinical practice guidelines for the treatment of schizophrenia?

PURPOSE OF REVIEW

Clinical practice guidelines (CPGs) do not usually offer a sex-specific approach for the management of schizophrenia. With this narrative review, we aim to give an integrated and synthesized overview of the current state of knowledge regarding sex-specific aspects in schizophrenia and how this topic may be adapted in the development of CPGs.

RECENT FINDINGS

Recent studies further suggest sex-specific differences in epidemiologic features, the course of illness, underlying pathomechanisms, response likelihood to antipsychotic medication and differences in tolerability. Beyond this, selective estrogen receptor modulators like raloxifene have shown beneficial effects on symptom severity and cognition in women with schizophrenia.

SUMMARY

Sex-specific aspects can already be integrated in clinical guideline recommendations, especially with regard to efficacy and tolerability of antipsychotic treatment. Moreover, these aspects may be used for an individual risk-stratification. Recent studies provide evidence supporting the hypothesis of sex-specific modulation in schizophrenia and build the groundwork for sex-specific novel treatment options. However, there remains a clear need for additional studies focusing on women with schizophrenia to substantiate current findings.

Grant Report on Social Reward Learning in Schizophrenia †

We report on the ongoing R21 project “Social Reward Learning in Schizophrenia”. Impairments in social cognition are a hallmark of schizophrenia. However, little work has been done on social reward learning deficits in schizophrenia. The overall goal of the project is to assess social reward learning in schizophrenia. A probabilistic reward learning (PRL) task is being used in the MRI scanner to evaluate reward learning to negative and positive social feedback. Monetary reward learning is used as a comparison to assess specificity. Behavioral outcomes and brain areas, included those involved in reward, are assessed in patients with schizophrenia or schizoaffective disorder and controls. It is also critical to determine whether decreased expected value (EV) of social stimuli and/or reward prediction error (RPE) learning underlie social reward learning deficits to inform potential treatment pathways. Our central hypothesis is that the pattern of social learning deficits is an extension of a more general reward learning impairment in schizophrenia and that social reward learning deficits critically contribute to deficits in social motivation and pleasure. We hypothesize that people with schizophrenia will show impaired behavioral social reward learning compared to controls, as well as decreased ventromedial prefrontal cortex (vmPFC) EV signaling at time of choice and decreased striatal RPE signaling at time of outcome, with potentially greater impairment to positive than negative feedback. The grant is in its second year. It is hoped that this innovative approach may lead to novel and more targeted treatment approaches for social cognitive impairments, using cognitive remediation and/or brain stimulation.

Deconstructing eye contact perception: Measuring perceptual precision and self-referential tendency using an online psychophysical eye contact detection task

Eye contact perception—the ability to accurately and efficiently discriminate others’ gaze directions—is critical to understanding others and functioning in a complex social world. Previous research shows that it is affected in multiple neuropsychiatric disorders accompanied by social dysfunction, and understanding the cognitive processes giving rise to eye contact perception would help advance mechanistic investigations of psychopathology. This study aims to validate an online, psychophysical eye contact detection task through which two constituent cognitive components of eye contact perception (perceptual precision and self-referential tendency) can be derived. Data collected from a large online sample showed excellent test-retest reliability for self-referential tendency and moderate reliability for perceptual precision. Convergence validity was supported by correlations with social cognitive measures tapping into different aspects of understanding others. Hierarchical regression analyses revealed that perceptual precision and self-referential tendency explained unique variance in social cognition, suggesting that they measure unique aspects of related constructs. Overall, this study provided support for the reliability and validity of the eye contact perception metrics derived using the online Eye Contact Detection Task. The value of the task for future psychopathology research was discussed.

Development and testing of a web-based battery to remotely assess cognitive health in individuals with schizophrenia

Cognitive impairment in schizophrenia is often severe, enduring, and contributes significantly to chronic disability. A standardized platform for identifying cognitive impairments and measuring treatment effects in cognition is a critical aspect of comprehensive evaluation and treatment for individuals with schizophrenia. In this project, we developed and tested a suite of ten web-based, neuroscience-informed cognitive assessments that are designed to enable the interpretation of specific deficits that could signal that an individual is experiencing cognitive difficulties. The assessment suite assays speed of processing, sustained attention, executive functioning, learning and socio-affective processing in the auditory and visual modalities. We have obtained data from 283 healthy individuals who were recruited online and 104 individuals with schizophrenia who also completed formal neuropsychological testing. Our data show that the assessments 1) are acceptable and tolerable to users, with successful completion in an average of under 40 min; 2) reliably measure the distinct theoretical cognitive constructs they were designed to assess; 3) can discriminate schizophrenia patients from healthy controls with a fair degree of accuracy (AUROC > 0.70); and 4) have promising construct, convergent, and external validity. Further optimization and validation work is in progress to finalize the evaluation process prior to promoting the dissemination of these assessments in real-world settings.

Sex and gender differences in schizophrenic psychoses-a critical review

Many sex and gender differences in schizophrenic psychoses have been reported, but few have been soundly replicated. A stable finding is the later age of onset in women compared to men. Gender differences in symptomatology, comorbidity, and neurocognition seem to reflect findings in the general population. There is increasing evidence for estrogens being psychoprotective in women and for hypothalamic-pituitary-gonadal dysfunction in both sexes.More methodologically sound, longitudinal, multi-domain, interdisciplinary research investigating both sex (biological) and gender (psychosocial) factors is required to better understand the different pathogenesis and etiologies of schizophrenic psychoses in women and men, thereby leading to better tailored treatments and improved outcomes.

Neurobiology and treatment of social cognition in schizophrenia: Bridging the bed-bench gap

Social cognition refers to the psychological processes involved in the perception, encoding, storage, retrieval, and regulation of information about others and ourselves. This process is essential for survival and reproduction in complex social environments. Recent evidence suggests that impairments in social cognition frequently occur in schizophrenia, mainly contributing to poor functional outcomes, including the inability to engage in meaningful work and maintain satisfying interpersonal relationships. With the ambiguous definition of social cognition, the neurobiology underlying impaired social cognition remains unknown, and the effectiveness of currently available intervention strategies in schizophrenia remain limited. Considering the advances and challenges of translational research for schizophrenia, social cognition has been considered a high-priority domain for treatment development. Here, we describe the current state of the framework, clinical concerns, and intervention approaches for social cognition in schizophrenia. Next, we introduce translatable rodent models associated with schizophrenia that allow the evaluation of different components of social behaviors, providing deeper insights into the neural substrates of social cognition in schizophrenia. Our review presents a valuable perspective that indicates the necessity of building bridges between basic and clinical science researchers for the development of novel therapeutic approaches in impaired social cognition in schizophrenia.

Parsing positivity in the bipolar spectrum: The effect of context on social decision-making

INTRODUCTION

People with bipolar disorder often show more approach-related behavior and positive appraisals of others during social interactions. This may be due to an increased sensitivity to positive contexts or to tendencies toward positive affectivity. In this study, we investigated the influence of reward versus prosocial positive contexts on social decision-making in people at high (n = 21) and low (n = 111) risk for bipolar disorder.

METHODS

Participants completed a computerized task consisting of two blocks. In the No Context block, participants were presented with a face and asked to make decisions related to approach, appraisal, and trust behavior toward that person. In the Context block, designed to assess the influence of contextual information on decision-making, each face was preceded by a written statement describing a positive or neutral context.

RESULTS

Compared to the low risk group, the high-risk group made significantly higher approach and appraisal ratings, regardless of the context condition. Effects were sustained controlling for positive affect. We did not find any effect of bipolar risk on trust ratings.

LIMITATIONS

The study was conducted in an analogue sample.

DISCUSSION

Taken together, these results suggest risk for bipolar disorder is associated with greater positive social approach and appraisal tendencies, and that these effects are not secondary to social context or positive affect. Implications for understanding social decision-making in the bipolar spectrum are discussed.

Deconstructing Schizophrenia: Advances in Preclinical Models for Biomarker Identification

Schizophrenia is considered to develop as a consequence of genetic and environmental factors impacting on brain neural systems and circuits during vulnerable neurodevelopmental periods, thereby resulting in symptoms in early adulthood. Understanding of the impact of schizophrenia risk factors on brain biology and behaviour can help in identifying biologically relevant pathways that are attractive for informing clinical studies and biomarker development. In this chapter, we emphasize the importance of adopting a reciprocal forward and reverse translation approach that is iteratively updated when additional new information is gained, either preclinically or clinically, for offering the greatest opportunity for discovering panels of biomarkers for the diagnosis, prognosis and treatment of schizophrenia. Importantly, biomarkers for identifying those at risk may inform early intervention strategies prior to the development of schizophrenia.Given the emerging nature of this approach in the field, this review will highlight recent research of preclinical biomarkers in schizophrenia that show the most promise for informing clinical needs with an emphasis on relevant imaging, electrophysiological, cognitive behavioural and biochemical modalities. The implementation of this reciprocal translational approach is exemplified firstly by the production and characterization of preclinical models based on the glutamate hypofunction hypothesis, genetic and environmental risk factors for schizophrenia (reverse translation), and then the recent clinical recognition of the thalamic reticular thalamus (TRN) as an important locus of brain dysfunction in schizophrenia as informed by preclinical findings (forward translation).

Biological motion processing in schizophrenia - Systematic review and meta-analysis

CONTEXT

Patients with schizophrenia show impairments in processing of biological motion. This is especially important since deficits in domains of social cognition has been associated with functional outcome and everyday functioning in this population.

OBJECTIVES

We conducted a systematic review and meta-analysis of studies which have used point-light displays to present whole-body motion to patients with schizophrenia and healthy controls, to evaluate the magnitude of differences between these groups in biological motion processing.

METHOD

Firstly, relevant publications were identified by a systematic search of Google Scholar and PubMed databases. Secondly, we excluded non-relevant studies for the meta-analysis according to our exclusion criteria. Effect sizes were expressed as standardized mean difference (SMD).

RESULTS

15 papers reporting results of 14 different experiments with 571 patients and 482 controls were included in the meta-analysis. The results for the general biological motion perception analysis revealed that patients with schizophrenia (compared with healthy controls) present reduced biological motion processing capacity with the effect size (SMD) of 0.66 (95% CI, -0.79 to -0.54; p<0.001). The results for the specific biological motion-based tasks were also statistically significant with SMD of 0.72 for Basic Biological Motion task (95% CI: -0.94 to -0.51; p<0.001) and SMD of 0.61 for Emotion in Biological Motion task, (95% CI: -0.79 to -0.43; p<0.001) respectively.

CONCLUSION

The findings from our meta-analysis highlight abnormalities in general and specific domains of biological motion perception in schizophrenia patients as compared with healthy controls.

Analysis of LINE-1 Elements in DNA from Postmortem Brains of Individuals with Schizophrenia

Whereas some rare genetic variants convey high risk for schizophrenia (SZ), common alleles conveying even moderate risk remain elusive. Long interspersed element-1s (L1) are mobile retrotransposons comprising ~17% of the human genome. L1 retrotransposition can cause somatic mosaicism during neurodevelopment by insertional mutagenesis. We hypothesized that, compared to controls, patients diagnosed with schizophrenia (PDS) may have increased numbers of deleterious L1 insertions, perhaps occurring de novo, in brain-expressed genes of dorsolateral prefrontal cortex (DLPFC) neurons. Neuronal and non-neuronal nuclei were separated by fluorescence-activated cell sorting from postmortem DLPFC of 36 PDS and 26 age-matched controls. Genomic sequences flanking the 3'-side of L1s were amplified from neuronal DNA, and neuronal L1 libraries were sequenced. Aligned sequences were analyzed for L1 insertions using custom bioinformatics programs. Ontology and pathway analyses were done on lists of genes putatively disrupted by L1s in PDS and controls. Cellular or population allele frequencies of L1s were assessed by droplet digital PCR or Taqman genotyping. We observed a statistically significant increase in the proportion of intragenic novel L1s in DLPFC of PDS. We found over-representation of L1 insertions within the gene ontologies 'cell projection' and 'postsynaptic membrane' in the gene lists derived from PDS samples, but not from controls. Cellular allele frequencies of examined L1 insertions indicated heterozygosity in genomes of DLPFC cells. An L1 within ERI1 exoribonuclease family member 3 (ERI3) was found to associate with SZ. These results extend prior work documenting increased L1 genetic burden in the brains of PDS and also identify unique genes that may provide new insight into the pathophysiology of schizophrenia.

Neural markers of emotional face perception across psychotic disorders and general population

There is considerable variation in negative and positive symptoms of psychosis, global functioning, and emotional face perception (EFP), not only in schizophrenia but also in other psychotic disorders and healthy individuals. However, EFP impairment and its association with worse symptoms and global functioning have been examined largely in the domain of schizophrenia. The present study adopted a dimensional approach to examine the association of behavioral and neural measures of EFP with symptoms of psychosis and global functioning across individuals with schizophrenia spectrum (SZ; N = 28) and other psychotic (OP; N = 29) disorders, and never-psychotic participants (NP; N = 21). Behavioral and functional MRI data were recorded as participants matched emotional expressions of faces and geometrical shapes. Lower accuracy and increased activity in early visual regions, hippocampus, and amygdala during emotion versus shape matching were associated with higher negative, but not positive, symptoms and lower global functioning, across all participants. This association remained even after controlling for group-related (SZ, OP, and NP) variance, dysphoria, and antipsychotic medication status, except in amygdala. Furthermore, negative symptoms mediated the relationship between behavioral and brain EFP measures and global functioning. This study provides some of the first evidence supporting the specific relationship of EFP measures with negative symptoms and global functioning across psychotic and never-psychotic samples, and transdiagnostically across different psychotic disorders. Present findings help bridge the gap between basic EFP-related neuroscience research and clinical research in psychosis, and highlight EFP as a potential symptom-specific marker that tracks global functioning. (PsycINFO Database Record

Proneness to aggression and its inhibition in schizophrenia: Interconnections between personality traits, cognitive function and emotional processing

OBJECTIVE

Research on aggression in schizophrenia has focused on narrowly defined deficits, while ignoring interconnections among these impairments which provide better explanatory power. Our goal was to investigate interrelations among impairments in important domains related to aggression: personality traits, including psychopathy and impulsivity, cognition and processing of emotions.

METHOD

34 healthy controls, 37 high aggression (HAG) and 31 low aggression (LAG) patients with schizophrenia participated. The Barratt Impulsiveness Scale, Psychopathy Checklist, Wisconsin Card Sorting Test (WCST), and Emotion Recognition Test were administered. Psychiatric symptoms were assessed. Canonical Discriminant Analysis (CDA) was performed to determine how these measures distinguish among the groups and to identify underlying symptom profiles.

RESULTS

CDA revealed two statistically significant profiles of deficits which differentiated the groups. The first comprises impulsivity, psychopathy, and impairments in cognition and fear recognition. It indicates proneness to aggression. The second consists of WCST perseverative errors and facial affect processing impairment; it has an inverse relationship with aggression. These profiles are linked to different psychiatric symptoms in the schizophrenic patients: The first to excitement and poor impulse control; the second to blunted affect and motor retardation. HAG's manifested primarily the first; LAG's had a moderate score on the first and a high score on the second.

CONCLUSION

Proneness to aggression in schizophrenia is characterized by a multivariate confluence of impulsivity, psychopathy, cognitive difficulties and impairment in fear recognition. There exists, however, a second pattern of psychopathology that may suppress expression of aggression. These opposing patterns have important implications for integrated treatments of aggression.

A Theoretical and Clinical Perspective on Social Relatedness and the Patient With Serious Mental Illness

BACKGROUND

A therapeutic relationship forms the basis of care of patients in psychiatric mental health nursing. However, individuals with schizophrenia have difficulty participating in these relationships. Recent research in the area of social cognitive psychology offers that deficits in this area affect the flow of perceiving and relating in interpersonal relationships. This literature has not been applied to nursing.

OBJECTIVE

The objective of this article is to review the theories underpinning therapeutic relationships from a nursing and psychological perspective, including the newest research from social cognitive psychology.

DESIGN

The article presents a literature review of the theories of nursing, psychology, and social cognitive science. Two patient case studies are used as examples of application of the theories.

RESULTS

This article incorporates new knowledge about the components of social cognition to inform nurses as they build therapeutic relationships with patients with chronic and persistent mental illnesses.

CONCLUSIONS

The science of social cognitive psychology offers nursing a new perspective on the evolving therapeutic nurse-patient relationship with patients with chronic and persistent mental illnesses. It has implications for clinicians, educators, and nurse scientists.

Development, Administration, and Structural Validity of a Brief, Computerized Neurocognitive Battery: Results From the Army Study to Assess Risk and Resilience in Servicemembers

The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a research project aimed at identifying risk and protective factors for suicide and related mental health outcomes among Army Soldiers. The New Soldier Study component of Army STARRS included the assessment of a range of cognitive- and emotion-processing domains linked to brain systems related to suicidal behavior including posttraumatic stress disorder, mood disorders, substance use disorders, and impulsivity. We describe the design and application of the Army STARRS neurocognitive test battery to a sample of 56,824 soldiers. We investigate its structural and concurrent validity through factor analysis and correlation of scores with demographics. We conclude that, in addition to being composed of previously well-validated measures, the Army STARRS neurocognitive battery as a whole demonstrates good psychometric properties. Correlations of scores with age and sex differences mostly replicate previously published findings, highlighting moderate to large effect sizes even within this restricted age range. Factor structures of scores conform to theoretical expectations. This neurocognitive battery provides a brief, valid measurement of neurocognition that may be helpful in predicting mental health and military performance. These measures can be integrated with neuroimaging to offer a powerful tool for assessing neurocognition in Servicemembers.

Virtual Avatar for Emotion Recognition in Patients with Schizophrenia: A Pilot Study

Persons who suffer from schizophrenia have difficulties in recognizing emotions in others’ facial expressions, which affects their capabilities for social interaction and hinders their social integration. Photographic images have traditionally been used to explore emotion recognition impairments in schizophrenia patients, but they lack of the dynamism that is inherent to facial expressiveness. In order to overcome those inconveniences, over the last years different authors have proposed the use of virtual avatars. In this work, we present the results of a pilot study that explored the possibilities of using a realistic-looking avatar for the assessment of emotion recognition deficits in patients who suffer from schizophrenia. In the study, 20 subjects with schizophrenia of long evolution and 20 control subjects were invited to recognize a set of facial expressions of emotions showed by both the said virtual avatar and static images. Our results show that schizophrenic patients exhibit recognition deficits in emotion recognition from facial expressions regardless the type of stimuli (avatar or images), and that those deficits are related with the psychopathology. Finally, some improvements in recognition rates (RRs) for the patient group when using the avatar were observed for sadness or surprise expressions, and they even outperform the control group in the recognition of the happiness expression. This leads to conclude that, apart from the dynamism of the shown expression, the RRs for schizophrenia patients when employing animated avatars may depend on other factors which need to be further explored.

Addictions Neuroclinical Assessment: A Neuroscience-Based Framework for Addictive Disorders

This article proposes a heuristic framework for the Addictions Neuroclinical Assessment that incorporates key functional domains derived from the neurocircuitry of addiction. We review how addictive disorders (ADs) are presently diagnosed and the need for new neuroclinical measures to differentiate patients who meet clinical criteria for addiction to the same agent while differing in etiology, prognosis, and treatment response. The need for a better understanding of the mechanisms provoking and maintaining addiction, as evidenced by the limitations of current treatments and within-diagnosis clinical heterogeneity, is articulated. In addition, recent changes in the nosology of ADs, challenges to current classification systems, and prior attempts to subtype individuals with ADs are described. Complementary initiatives, including the Research Domain Criteria project, that have established frameworks for the neuroscience of psychiatric disorders are discussed. Three domains-executive function, incentive salience, and negative emotionality-tied to different phases in the cycle of addiction form the core functional elements of ADs. Measurement of these domains in epidemiologic, genetic, clinical, and treatment studies will provide the underpinnings for an understanding of cross-population and temporal variation in addictions, shared mechanisms in addictive disorders, impact of changing environmental influences, and gene identification. Finally, we show that it is practical to implement such a deep neuroclinical assessment using a combination of neuroimaging and performance measures. Neuroclinical assessment is key to reconceptualizing the nosology of ADs on the basis of process and etiology, an advance that can lead to improved prevention and treatment.

Facial Emotion Recognition in Adolescents With Disabilities: The Effects of Type of Disability and Gender

Emotion recognition is very important for successful social interactions. This study compared adolescents with intellectual disability and adolescents with hearing impairment on a facial emotion recognition task. The sample for this study comprised 78 adolescents (46.2% females, 53.8% males; M age = 16.4, SD = 1.0) divided into three groups (N = 26) of adolescents with intellectual disability, adolescents with hearing impairment, and adolescents without disabilities. Emotion recognition abilities were measured using a computerized Emotion Recognition Test. Adolescents with intellectual disability achieved lower scores on Emotion Recognition Test in comparison with adolescents with hearing impairment and adolescents without disabilities. There were no significant differences on Emotion Recognition Test between adolescents with hearing impairment and adolescents without disabilities. Given the importance of emotion recognition in everyday functioning, it is of crucial importance to have emotional training programs as part of the school curriculum.

Colour influences perception of facial emotions but this effect is impaired in healthy ageing and schizophrenia

INTRODUCTION

Social cognition is commonly assessed by identification of emotions in facial expressions. Presence of colour, a salient feature of stimuli, might influence emotional face perception.

METHODS

We administered 2 tests of facial emotion recognition, the Emotion Recognition Test (ER40) using colour pictures and the Penn Emotional Acuity Test using monochromatic pictures, to 37 young healthy, 39 old healthy and 37 schizophrenic men.

RESULTS

Among young healthy individuals recognition of emotions was more accurate and faster in colour than in monochromatic pictures. Compared to the younger group, older healthy individuals revealed impairment in identification of sad expressions in colour but not monochromatic pictures. Schizophrenia patients showed greater impairment in colour than monochromatic pictures of neutral and sad expressions and overall total score compared to both healthy groups. Patients showed significant correlations between cognitive impairment and perception of emotion in colour but not monochromatic pictures.

CONCLUSIONS

Colour enhances perception of general emotional clues and this contextual effect is impaired in healthy ageing and schizophrenia. The effects of colour need to be considered in interpreting and comparing studies of emotion perception. Coloured face stimuli may be more sensitive to emotion processing impairments but less selective for emotion-specific information than monochromatic stimuli. This may impact on their utility in early detection of impairments and investigations of underlying mechanisms.

Performance on a computerized neurocognitive battery in 22q11.2 deletion syndrome: A comparison between US and Israeli cohorts

Increasingly, the effects of copy number variation (CNV) in the genome on brain function and behaviors are recognized as means to elucidate pathophysiology of psychiatric disorders. Such studies require large samples and we characterized the neurocognitive profile of two cohorts of individuals with 22q11.2 deletion syndrome (22q11DS), the most common CNV associated with schizophrenia, in an effort to harmonize phenotyping in multi-site global collaborations. The Penn Computerized Neurocognitive Battery (PCNB) was administered to individuals with 22q11DS in Philadelphia (PHL; n=155, aged 12-40) and Tel Aviv (TLV; n=59, aged 12-36). We examined effect sizes of performance differences between the cohorts and confirmed the factor structure of PCNB performance efficiency in the combined sample based on data from a large comparison community sample. The cohorts performed comparably with notable deficits in executive function, episodic memory and social cognition domains that were previously associated with abnormal neuroimaging findings in 22q11DS. In mixed model analysis, while there was a main effect for site for accuracy (number of correct response) and speed (time to correct response) independently, there were no main site effects for standardized efficiency (average of accuracy and speed). The fit of a structural model was excellent indicating that PCNB tests were related to the targeted cognitive domains. Thus, our results provide preliminary support for the use of the PCNB as an efficient tool for neurocognitive assessment in international 22q11DS collaborations.

Fronto-Limbic Brain Dysfunction during the Regulation of Emotion in Schizophrenia

Schizophrenia is characterized by significant and widespread impairments in the regulation of emotion. Evidence is only recently emerging regarding the neural basis of these emotion regulation impairments, and few studies have focused on the regulation of emotion during effortful cognitive processing. To examine the neural correlates of deficits in effortful emotion regulation, schizophrenia outpatients (N = 20) and age- and gender-matched healthy volunteers (N = 20) completed an emotional faces n-back task to assess the voluntary attentional control subprocess of emotion regulation during functional magnetic resonance imaging. Behavioral measures of emotional intelligence and emotion perception were administered to examine brain-behavior relationships with emotion processing outcomes. Results indicated that patients with schizophrenia demonstrated significantly greater activation in the bilateral striatum, ventromedial prefrontal, and right orbitofrontal cortices during the effortful regulation of positive emotional stimuli, and reduced activity in these same regions when regulating negative emotional information. The opposite pattern of results was observed in healthy individuals. Greater fronto-striatal response to positive emotional distractors was significantly associated with deficits in facial emotion recognition. These findings indicate that abnormalities in striatal and prefrontal cortical systems may be related to deficits in the effortful emotion regulatory process of attentional control in schizophrenia, and may significantly contribute to emotion processing deficits in the disorder.

Development of an itemwise efficiency scoring method: Concurrent, convergent, discriminant, and neuroimaging-based predictive validity assessed in a large community sample

Traditional "paper-and-pencil" testing is imprecise in measuring speed and hence limited in assessing performance efficiency, but computerized testing permits precision in measuring itemwise response time. We present a method of scoring performance efficiency (combining information from accuracy and speed) at the item level. Using a community sample of 9,498 youths age 8-21, we calculated item-level efficiency scores on 4 neurocognitive tests, and compared the concurrent, convergent, discriminant, and predictive validity of these scores with simple averaging of standardized speed and accuracy-summed scores. Concurrent validity was measured by the scores' abilities to distinguish men from women and their correlations with age; convergent and discriminant validity were measured by correlations with other scores inside and outside of their neurocognitive domains; predictive validity was measured by correlations with brain volume in regions associated with the specific neurocognitive abilities. Results provide support for the ability of itemwise efficiency scoring to detect signals as strong as those detected by standard efficiency scoring methods. We find no evidence of superior validity of the itemwise scores over traditional scores, but point out several advantages of the former. The itemwise efficiency scoring method shows promise as an alternative to standard efficiency scoring methods, with overall moderate support from tests of 4 different types of validity. This method allows the use of existing item analysis methods and provides the convenient ability to adjust the overall emphasis of accuracy versus speed in the efficiency score, thus adjusting the scoring to the real-world demands the test is aiming to fulfill. (PsycINFO Database Record

Visual and associated affective processing of face information in schizophrenia: A selective review

Perception of facial features is crucial in social life. In past decades, extensive research showed that the ability to perceive facial emotion expression was compromised in schizophrenia patients. Given that face perception involves visual/cognitive and affective processing, the roles of these two processing domains in the compromised face perception in schizophrenia were studied and discussed, but not clearly defined. One particular issue was whether face-specific processing is implicated in this psychiatric disorder. Recent investigations have probed into the components of face perception processes such as visual detection, identity recognition, emotion expression discrimination and working memory conveyed from faces. Recent investigations have further assessed the associations between face processing and basic visual processing and between face processing and social cognitive processing such as Theory of Mind. In this selective review, we discuss the investigative findings relevant to the issues of cognitive and affective association and face-specific processing. We highlight the implications of multiple processing domains and face-specific processes as potential mechanisms underlying compromised face perception in schizophrenia. These findings suggest a need for a domain-specific therapeutic approach to the improvement of face perception in schizophrenia.

Contribution of sex hormones to gender differences in schizophrenia: A review

Female patients with schizophrenia tend to have a more benign course and better outcomes than males. One proposed explanation is the differential influence of male and female sex hormones, including estrogen, progesterone, testosterone, and dehydroepiandrosterone (DHEA) and its sulfate (DHEAS). Such benefit may be mediated by their effects on neurotransmitters and neuroprotection. Besides altered estrogen and DHEA/DHEAS levels in female patients, data is equivocal on hormonal differences between patients and controls. However, several reports note a mostly negative correlation between estrogen levels and symptom severity in both genders, and a positive correlation between estrogen levels and neurocognition but mainly in females. Adjunctive estrogen appears to improve symptoms in both genders. Progesterone levels have inconsistent links to symptom severity in both genders, and correlate positively with neurocognition but only in males. Estrogen-progesterone combination shows preliminary benefits as augmentation for both symptoms and neurocognition in females. Testosterone levels correlate inversely with negative symptoms in males and have inconsistent associations with neurocognition in both genders. Testosterone augmentation reduced negative symptoms in male patients in a pilot investigation, but has not been evaluated for neurocognition in either gender. DHEA/DHEAS have mixed results for their association with, and clinical utility for, symptoms and neurocognition in both genders. Overall, data on the impact of sex hormones on clinical course or as treatment for schizophrenia is limited, but estrogen has most evidence for positive influence and clinical benefit. The possibly greater tolerability and broader impact of these hormones versus existing medications support further exploration of their use.

Functional activation abnormalities during facial emotion perception in schizophrenia patients and nonpsychotic relatives

BACKGROUND

Deficits in facial emotion perception in schizophrenia may be a marker of disorder liability. Previous functional magnetic resonance imaging (fMRI) studies investigating these deficits have been limited by task demands that may recruit other impaired cognitive processes in schizophrenia.

METHODS

We used a family study design along with a passive viewing task during fMRI to investigate brain activation abnormalities underlying facial emotion perception in schizophrenia and examine whether such abnormalities are associated with the genetic liability to the disorder. Twenty-eight schizophrenia patients, 27 nonpsychotic relatives, and 27 community controls passively viewed images of facial emotions during an fMRI scan.

RESULTS

Analyses revealed hypoactivation in face processing areas for both patients and relatives compared to controls, and hyperactivation in relatives compared to both patients and controls for frontal regions implicated in emotion processing.

CONCLUSIONS

Results suggest that activation abnormalities during facial emotion perception are manifestations of the genetic liability to schizophrenia, and may be accompanied by compensatory mechanisms in relatives. Studying mechanisms in nonpsychotic relatives is a valuable way to examine effects of the unexpressed genetic liability to schizophrenia on the brain and behaviour.

Intrinsic Functional Connectivity in Salience and Default Mode Networks and Aberrant Social Processes in Youth at Ultra-High Risk for Psychosis

Social processes are key to navigating the world, and investigating their underlying mechanisms and cognitive architecture can aid in understanding disease states such as schizophrenia, where social processes are highly impacted. Evidence suggests that social processes are impaired in individuals at ultra high-risk for the development of psychosis (UHR). Understanding these phenomena in UHR youth may clarify disease etiology and social processes in a period that is characterized by significantly fewer confounds than schizophrenia. Furthermore, understanding social processing deficits in this population will help explain these processes in healthy individuals. The current study examined resting state connectivity of the salience (SN) and default mode networks (DMN) in association with facial emotion recognition (FER), an integral aspect of social processes, as well as broader social functioning (SF) in UHR individuals and healthy controls. Consistent with the existing literature, UHR youth were impaired in FER and SF when compared with controls. In the UHR group, we found increased connectivity between the SN and the medial prefrontal cortex, an area of the DMN relative to controls. In UHR youth, the DMN exhibited both positive and negative correlations with the somatosensory cortex/cerebellum and precuneus, respectively, which was linked with better FER performance. For SF, results showed that sensory processing links with the SN might be important in allowing for better SF for both groups, but especially in controls where sensory processing is likely to be unimpaired. These findings clarify how social processing deficits may manifest in psychosis, and underscore the importance of SN and DMN connectivity for social processing more generally.

Impaired recognition of communicative interactions from biological motion in schizophrenia

BACKGROUND

Patients with schizophrenia are deficient in multiple aspects of social cognition, including biological motion perception. In the present study we investigated the ability to read social information from point-light stimuli in schizophrenia.

METHODOLOGY/PRINCIPAL FINDINGS

Participants with paranoid schizophrenia and healthy controls were presented with a biological motion task depicting point-light actions of two agents either engaged in a communicative interaction, or acting independently of each other. For each stimulus, participants were asked to decide whether the two agents were communicating vs. acting independently of each other (task A), and to select the correct action description among five response alternatives (task B). Participants were also presented with a mental rotation task to assess their visuospatial abilities, and with a facial emotion recognition task tapping social cognition. Results revealed that participants with schizophrenia performed overall worse than controls both in discriminating communicative from non-communicative actions (task A) and in selecting which of the 5 response alternatives best described the observed actions (task B). Interestingly, the impaired performance of schizophrenic participants was mainly due to misclassification of non-communicative stimuli as communicative actions. Correlation analysis revealed that visuospatial abilities predicted performance in task A but not in task B, while facial emotion recognition abilities was correlated with performance in both task A and task B.

CONCLUSIONS/SIGNIFICANCE

These findings are consistent with theories of "overmentalizing" (excessive attribution of intentionality) in schizophrenia, and suggest that processing social information from biological motion does rely on social cognition abilities.

Cognitive Enhancement Therapy Improves Frontolimbic Regulation of Emotion in Alcohol and/or Cannabis Misusing Schizophrenia: A Preliminary Study

Individuals with schizophrenia who misuse substances are burdened with impairments in emotion regulation. Cognitive enhancement therapy (CET) may address these problems by enhancing prefrontal brain function. A small sample of outpatients with schizophrenia and alcohol and/or cannabis substance use problems participating in an 18-month randomized trial of CET (n = 10) or usual care (n = 4) completed posttreatment functional neuroimaging using an emotion regulation task. General linear models explored CET effects on brain activity in emotional neurocircuitry. Individuals treated with CET had significantly greater activation in broad regions of the prefrontal cortex, limbic, and striatal systems implicated in emotion regulation compared to usual care. Differential activation favoring CET in prefrontal regions and the insula mediated behavioral improvements in emotional processing. Our data lend preliminary support of CET effects on neuroplasticity in frontolimbic and striatal circuitries, which mediate emotion regulation in people with schizophrenia and comorbid substance misuse problems.

Altered white matter microstructure is associated with social cognition and psychotic symptoms in 22q11.2 microdeletion syndrome

22q11.2 Microdeletion Syndrome (22q11DS) is a highly penetrant genetic mutation associated with a significantly increased risk for psychosis. Aberrant neurodevelopment may lead to inappropriate neural circuit formation and cerebral dysconnectivity in 22q11DS, which may contribute to symptom development. Here we examined: (1) differences between 22q11DS participants and typically developing controls in diffusion tensor imaging (DTI) measures within white matter tracts; (2) whether there is an altered age-related trajectory of white matter pathways in 22q11DS; and (3) relationships between DTI measures, social cognition task performance, and positive symptoms of psychosis in 22q11DS and typically developing controls. Sixty-four direction diffusion weighted imaging data were acquired on 65 participants (36 22q11DS, 29 controls). We examined differences between 22q11DS vs. controls in measures of fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD), using both a voxel-based and region of interest approach. Social cognition domains assessed were: Theory of Mind and emotion recognition. Positive symptoms were assessed using the Structured Interview for Prodromal Syndromes. Compared to typically developing controls, 22q11DS participants showed significantly lower AD and RD in multiple white matter tracts, with effects of greatest magnitude for AD in the superior longitudinal fasciculus. Additionally, 22q11DS participants failed to show typical age-associated changes in FA and RD in the left inferior longitudinal fasciculus. Higher AD in the left inferior fronto-occipital fasciculus (IFO) and left uncinate fasciculus was associated with better social cognition in 22q11DS and controls. In contrast, greater severity of positive symptoms was associated with lower AD in bilateral regions of the IFO in 22q11DS. White matter microstructure in tracts relevant to social cognition is disrupted in 22q11DS, and may contribute to psychosis risk.

Amotivation in schizophrenia: integrated assessment with behavioral, clinical, and imaging measures

Motivational deficits play a central role in disability caused by schizophrenia and constitute a major unmet therapeutic need. Negative symptoms have previously been linked to hypofunction in ventral striatum (VS), a core component of brain motivation circuitry. However, it remains unclear to what extent this relationship holds for specific negative symptoms such as amotivation, and this question has not been addressed with integrated behavioral, clinical, and imaging measures. Here, 41 individuals with schizophrenia and 37 controls performed a brief, computerized progressive ratio task (PRT) that quantifies effort exerted in pursuit of monetary reward. Clinical amotivation was assessed using the recently validated Clinical Assessment Interview for Negative Symptoms (CAINS). VS function was probed during functional magnetic resonance imaging using a monetary guessing paradigm. We found that individuals with schizophrenia had diminished motivation as measured by the PRT, which significantly and selectively related to clinical amotivation as measured by the CAINS. Critically, lower PRT motivation in schizophrenia was also dimensionally related to VS hypofunction. Our results demonstrate robust dimensional associations between behavioral amotivation, clinical amotivation, and VS hypofunction in schizophrenia. Integrating behavioral measures such as the PRT will facilitate translational efforts to identify biomarkers of amotivation and to assess response to novel therapeutic interventions.