Improving Theory of Mind in Schizophrenia by Targeting Cognition and Metacognition with Computerized Cognitive Remediation: A Multiple Case Study

International perspective on social cognition in schizophrenia: current stage and the next steps

In the last decades, research from cognitive science, clinical psychology, psychiatry, and social neuroscience has provided mounting evidence that several social cognitive abilities are impaired in people with schizophrenia and contribute to functional difficulties and poor clinical outcomes. Social dysfunction is a hallmark of the illness, and yet, social cognition is seldom assessed in clinical practice or targeted for treatment. In this article, 17 international experts, from three different continents and six countries with expertise in social cognition and social neuroscience in schizophrenia, convened several meetings to provide clinicians with a summary of the most recent international research on social cognition evaluation and treatment in schizophrenia, and to lay out primary recommendations and procedures that can be integrated into their practice. Given that many extant measures used to assess social cognition have been developed in North America or Western Europe, this article is also a call for researchers and clinicians to validate instruments internationally and we provide preliminary guidance for the adaptation and use of social cognitive measures in clinical and research evaluations internationally. This effort will assist promoting scientific rigor, enhanced clinical practice, and will help propel international scientific research and collaboration and patient care.

Exploring the effects of COVID-19 on verbal memory function in schizophrenia: Multiple case study and brief literature review

Individuals recovering from COVID-19 may experience persistent impairment in verbal memory performance, potentially due to illness-related hippocampal injury. Although verbal memory dysfunction is central to schizophrenia, the interactions between this vulnerability and COVID-19 remain unclear, with no imaging studies addressing the issue to-date. To explore this gap and generate hypotheses for future research, we adopted a multiple case study approach. Two pairs of individuals with an ICD-10 diagnosis of schizophrenia were selected, each consisting of one case with a positive COVID-19 anamnesis and one without. We calculated the Reliable Change Index to estimate the clinical significance of verbal memory performance changes, with annualized change rates in hippocampal volumes assessed against normative data. Compared to their matches, COVID-19 positive cases did not show mutually consistent changes in verbal memory performance: one case experienced a significant decline in verbal memory and learning, while the other showed a general normalization of test scores. Left hippocampal volumes showed a comparatively slowed increase, while the right hippocampi decreased in volume, although these atrophy rates did not exceed those expected in general population samples. Based on these findings, we hypothesize that COVID-19 alone does not lead to verbal memory decline in schizophrenia. Instead, the relationship between the diseases may depend on additional factors. Our case pairs differed in body mass index, systolic blood pressure, sex, phase of illness, and whole grey matter volume trajectories, leading us to hypothesize that these variables represent additional predictors or moderators of this relationship.

Cognitive biases as an adaptive strategy in autism and schizophrenia spectrum: the compensation perspective on neurodiversity

This article presents a novel theoretical perspective on the role of cognitive biases within the autism and schizophrenia spectrum by integrating the evolutionary and computational approaches. Against the background of neurodiversity, cognitive biases are presented as primary adaptive strategies, while the compensation of their shortcomings is a potential cognitive advantage. The article delineates how certain subtypes of autism represent a unique cognitive strategy to manage cognitive biases at the expense of rapid and frugal heuristics. In contrast, certain subtypes of schizophrenia emerge as distinctive cognitive strategies devised to navigate social interactions, albeit with a propensity for overdetecting intentional behaviors. In conclusion, the paper emphasizes that while extreme manifestations might appear non-functional, they are merely endpoints of a broader, primarily functional spectrum of cognitive strategies. The central argument hinges on the premise that cognitive biases in both autism and schizophrenia spectrums serve as compensatory mechanisms tailored for specific ecological niches.

Associations between theory of mind and clinical symptoms in recent onset schizophrenia spectrum disorders

INTRODUCTION

People with schizophrenia often present with Theory of mind (ToM) deficits, and the link between these deficits and clinical symptoms remains to be refined, for instance through the use of more recent assessment methods. The objective of this study was to examine the associations between a psychometrically sound ToM task and the clinical symptoms of schizophrenia as measured with the five dimensions of the Positive and Negative Syndrome Scale (PANSS) namely positive, negative, cognitive/disorganization, depression/anxiety and excitability/hostility, while controlling for non-social cognitive abilities.

METHODS

Seventy participants with recent-onset schizophrenia spectrum disorders (SSD) were assessed for ToM using the Combined stories task (COST) and for clinical symptoms using the PANSS.

RESULTS

The results revealed significant correlations between ToM and the positive (r = -0.292, p = 0.015) and cognitive/disorganization (r = -0.480, p < 0.001) dimensions when controlling for non-social cognitive abilities. In contrast, the negative symptoms dimension was only significantly correlated with ToM when non-social cognitive abilities were not controlled for (r = -0.278, p = 0.020).

DISCUSSION

Very few prior studies used the five-dimensions of the PANSS to examine the link with ToM and this study is the first to rely on the COST, which includes a non-social control condition. This study highlights the importance of taking non-social cognitive abilities into account when considering the relationship between ToM and symptoms.

Personalized cognitive remediation therapy to facilitate return to work or to school in recent-onset psychosis

Cognitive deficits are barriers to job acquisition or return to school, and can be reduced through Cognitive remediation therapy (CRT). The main goal of this multiple case study was to investigate the effect of personalized CRT on occupational status in three participants with a recent-onset psychosis. Two cases improved their occupational status at post-treatment, and showed improvements in cognitive, psychological, and/or clinical variables. This study suggests that personalized CRT may facilitate job acquisition or return to school. However, the different pathways showed by our cases indicate that personalized CRT may influence occupational status through multiple mechanisms, underlining the relevance of treatment personalization.

How internalised stigma reduces self-esteem in schizophrenia: the crucial role of off-line metacognition

Introduction: Stigma is widely recognised as a major barrier to recovery. In schizophrenia, internalised stigma (IS) strongly impacts self-esteem, but the mechanisms underlying this phenomenon remain poorly understood. In this study, we suggest that IS alters self-esteem by leading people to perceive their cognitive functioning as inefficient. We investigated whether off-line metacognitive complaints mediate the effect of IS on self-esteem in schizophrenia.Methods: We included 78 participants diagnosed with schizophrenia or schizoaffective disorder. IS was measured with the Internalised Stigma of Mental Illness scale, self-esteem by the Rosenberg Self-Esteem scale, and off-line metacognitive complaints with the Subjective Scale to Investigate Cognition in Schizophrenia.Results: Mediation analysis revealed that the effect of IS on self-esteem was mediated by off-line metacognitive complaints.Conclusion: Results suggest that IS reduces self-esteem by negatively impacting metacognition, such as perception of cognitive difficulties. We suggest that taking metacognition into account in the form of metacognitive complaints may be relevant in interventions aiming at reducing IS in psychosis.