Disorganisation, thought disorder and socio-cognitive functioning in schizophrenia spectrum disorders

Use of reference markers in the speech of people with schizophrenia spectrum disorders: Evidence from two referential communication tasks manipulating common ground with the interaction partner

Introduction

People with schizophrenia spectrum disorders present with language dysfunctions, yet we know little about their use of reference markers (indefinite markers, definite markers, pronouns or names), a fundamental aspect of efficient speech production.

Methods

Twenty-five (25) participants with a recent-onset schizophrenia spectrum disorder (SZ) and 25 healthy controls (HC) completed two referential communication tasks. The tasks involved presenting to an interaction partner a series of movie characters (character identification task) and movie scenes composed of six images (narration task). A manipulation was introduced such that half of the movies could be considered as Likely-Known by the interaction partner, whereas the other half was Likely-Unknown. The analyses focused on the reference markers used to present the movie characters during the tasks.

Results

During the character identification task, the SZ group used fewer names and more pronouns than the HC. During the narration task, the SZ group used fewer names and more definite references when initially introducing the main story characters, while no group effect emerged for subsequent mentions of the characters. The observed effects of conditions were generally present across both groups, except for a lesser adjustment in the use of definite markers when introducing the story characters.

Conclusions

While some group differences emerged, people with SZ were generally sensitive to the manipulation regarding their interaction partner's likely knowledge of the characters. A better understanding of the conditions in which speech production is affected in SZ could help promote more efficient communication.

Predicting emotions across schizotypy levels

Successfully navigating the social world requires making accurate predictions about others. Individual differences in emotion prediction-the ability to predict someone's subsequent emotion given their current emotional state-can lead to variability in social success. In this study (N = 1024) we found evidence that individuals with heightened schizotypy displayed worse emotion prediction accuracy. This difficulty with emotion prediction was associated with increased loneliness, diminished social support, and smaller social networks, partially mediating some of the social difficulties in individuals with heightened schizotypy. Individuals with heightened schizotypy showed disruptions to key sources of affective information, meaning they had less reliable information about how emotions work when making emotion predictions. Specifically, their own emotion experiences were less typical, and their perception of others' emotions was less accurate. These findings highlight emotion prediction as a key social cognitive construct that should be considered in future research for individuals across the schizophrenia spectrum.

Low Versus High Levels of Social Cognition Impairment and Their Associations With Specific Schizophrenia Symptom Domains

OBJECTIVE

Social cognition is defined as the ability to construct mental representations about oneself, others, and one's relationships with others to guide social behaviors, including referring to mental states (cognitive factor) and understanding emotional states (affective factor). Difficulties in social cognition may be symptoms of schizophrenia. The authors examined associations between two factors of social cognition and specific schizophrenia symptoms, as well as a potential path from low-level affective perceptual social cognition to high-level social cognition, which may be associated with schizophrenia symptoms.

METHODS

The authors compared IQ, executive function, and social cognition scores of 41 patients with schizophrenia with those of a community-based group of 30 healthy individuals by using the Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version, the Movie for the Assessment of Social Cognition-Taiwan version, and the Chinese version of the theory of mind task.

RESULTS

In analyses controlled for IQ and executive function scores, patients with schizophrenia were found to perform more poorly than individuals in the healthy comparison group on all social cognition tasks. Disorganized symptoms were associated with lower accuracy of recognizing happy and angry faces, a lower verbal theory of mind score, and altered low- and high-level social cognition scores. A potential causal link was identified between low-level affective perceptual social cognition and high-level social cognition, resulting in disorganized symptoms.

CONCLUSIONS

These results indicate distinct roles of two factors of social cognition in schizophrenia symptomatology and provide a new direction for alleviating symptoms of this disorder by enhancing social cognition.

Reasoning and interpretation cognitive biases related to psychotic characteristics: An umbrella-review

Cognitive biases have been studied in relation to schizophrenia and psychosis for over 50 years. Yet, the quality of the evidence linking cognitive biases and psychosis is not entirely clear. This umbrella-review examines the quality of the evidence and summarizes the effect sizes of the reasoning and interpretation cognitive biases studied in relation to psychotic characteristics (psychotic disorders, psychotic symptoms, psychotic-like experiences or psychosis risk). It also examines the evidence and the effects of psychological interventions for psychosis on cognitive biases. A systematic review of the literature was performed using the PRISMA guidelines and the GRADE system for 128 analyses extracted from 16 meta-analyses. Moderate to high-quality evidence with medium to large effect sizes were found for the following interpretation biases: externalization of cognitive events and self-serving bias, when people with psychotic symptoms were compared to control conditions. Regarding reasoning biases, moderate to high quality evidence with medium to large effect sizes were found for belief inflexibility when linked to delusion conviction and global severity in people with active delusions, although measures from the MADS, overlapping with symptoms, may have inflated effect sizes. Moderate quality evidence with medium to large effect sizes were found for jumping to conclusion biases when clinical samples with psychosis were compared to controls, when using data-gathering tasks. Other cognitive biases are not supported by quality evidence (e.g., personalizing bias, belief about disconfirmatory evidence), and certain measures (i.e., IPSAQ and ASQ) systematically found no effect or small effects. Psychological interventions (e.g., MCT) showed small effect sizes on cognitive biases, with moderate-high-quality evidence. This umbrella review brings a critical regard on the reasoning and interpretation biases and psychotic symptoms literature-although most biases linked to psychotic symptoms are supported by meta-analyses in some way, some have only demonstrated support with a specific population group (e.g., aberrant salience and hostility attribution in healthy individuals with psychotic-like experiences), whereas other biases are currently insufficiently supported by quality evidence. Future quality studies, particularly with clinical populations with psychotic symptoms, are still warranted to ascertain the psychosis-cognitive bias link for specific biases.

A dominance analysis on the relationship between schizotypy and loneliness type

BACKGROUND

This study investigated how individual differences in schizotypy differentially predicted types of loneliness - direct, social, emotional, and existential loneliness (in relationships and meaninglessness in life).

METHODS

We presented participants with the brief version of the Oxford-Liverpool Inventory of Feelings and Experiences and the de Jong Giervald loneliness scale and used dominance analysis to evaluate the dominant predictors of schizotypy on loneliness. We also evaluated the impact of depression on each model.

RESULTS

In our preregistered analysis we found evidence to suggest that cognitive disorganization and introvertive anhedonia are consistently the most dominant of the schizotypy predictors. Introvertive anhedonia was the most dominant predictor for social loneliness and existential loneliness in relationships, and cognitive disorganization was the most dominant predictor of direct, emotional and existential meaninglessness in life loneliness. Depression became the most dominant predictor of all types of loneliness when added to the models.

LIMITATIONS

This research is limited by the cross-sectional nature of the data which is unable to account for changes in loneliness over time, and we acknowledge that the relationship between predictors and outcome is likely bi-directional.

CONCLUSIONS

Our findings highlight the diverse relationship between schizotypy and loneliness type and suggest that schizotypy domains linked to social anxiety and withdrawal are key predictors of loneliness. These findings are important for the development of focused interventions and the prevention of clinical disorder development.

Impaired thyroid hormone sensitivity exacerbates the effect of PM2.5 and its components on dyslipidemia in schizophrenia

BACKGROUND

Dyslipidemia in schizophrenia causes a serious loss of healthy life expectancy, making it imperative to explore key environmental risk factors. We aimed to assess the effect of PM2.5 and its constituents on dyslipidemia in schizophrenia, identify the critical hazardous components, and investigate the role of impaired thyroid hormones (THs) sensitivity in this association.

METHODS

We collected disease data on schizophrenia from the Anhui Mental Health Center from 2019 to 2022. Logistic regression was constructed to explore the effect of average annual exposure to PM2.5 and its components [black carbon (BC), organic matter (OM), sulfate (SO42-), ammonium (NH4+), and nitrate (NO3-)] on dyslipidemia, with subgroup analyses for age and gender. The degree of impaired THs sensitivity in participants was reflected by the Thyroid Feedback Quantile-based Index (TFQI), and its role in the association of PM2.5 components with dyslipidemia was explored.

RESULTS

A total of 5125 patients with schizophrenia were included in this study. Exposure to PM2.5 and its components (BC, OM, SO42-, NH4+, and NO3-) were associated with dyslipidemia with the odds ratios and 95 % confidence interval of 1.13 (1.04, 1.23), 1.16 (1.07, 1.26), 1.15 (1.06, 1.25), 1.11 (1.03, 1.20), 1.09 (1.00, 1.18), 1.12 (1.04, 1.20), respectively. Mixed exposure modeling indicated that BC played a major role in the effects of the mixture. More significant associations were observed in males and groups <45 years. In addition, we found that the effect of PM2.5 and its components on dyslipidemia was exacerbated as impaired THs sensitivity in the patients.

CONCLUSIONS

Exposure to PM2.5 and its components is associated with an increased risk of dyslipidemia in schizophrenia, which may be exacerbated by impaired THs sensitivity. Our results suggest a new perspective for the management of ambient particulate pollution and the protection of thyroid function in schizophrenia.

Evaluating the clinical utility of speech analysis and machine learning in schizophrenia: A pilot study

BACKGROUND

Schizophrenia is a serious mental disorder that significantly impacts social functioning and quality of life. However, current diagnostic methods lack objective biomarker support. While some studies have indicated differences in audio features between patients with schizophrenia and healthy controls, these findings are influenced by demographic information and variations in experimental paradigms. Therefore, it is crucial to explore stable and reliable audio biomarkers for an auxiliary diagnosis and disease severity prediction of schizophrenia.

METHOD

A total of 130 individuals (65 patients with schizophrenia and 65 healthy controls) read three fixed texts containing positive, neutral, and negative emotions, and recorded them. All audio signals were preprocessed and acoustic features were extracted by a librosa-0.9.2 toolkit. Independent sample t-tests were performed on two sets of acoustic features, and Pearson correlation on the acoustic features and Positive and Negative Syndrome Scale (PANSS) scores of the schizophrenia group. Classification algorithms in scikit-learn were used to diagnose schizophrenia and predict the level of negative symptoms.

RESULTS

Significant differences were observed between the two groups in the mfcc_8, mfcc_11, and mfcc_33 of mel-frequency cepstral coefficient (MFCC). Furthermore, a significant correlation was found between mfcc_7 and the negative PANSS scores. Through acoustic features, we could not only differentiate patients with schizophrenia from healthy controls with an accuracy of 0.815 but also predict the grade of the negative symptoms in schizophrenia with an average accuracy of 0.691.

CONCLUSIONS

The results demonstrated the considerable potential of acoustic characteristics as reliable biomarkers for diagnosing schizophrenia and predicting clinical symptoms.

The other side of the social interaction: Theory of mind impairments in people with schizophrenia are linked to other people's difficulties in understanding them

BACKGROUND

People with schizophrenia (SZ) often present with theory of mind (ToM) deficits and with speech production deficits. While a link has been established between ToM abilities and symptoms of thought disorder, much less is known about other aspects of speech production in SZ.

STUDY DESIGN

This is a case-control study in which 25 stable outpatients with recent-onset SZ (27.1 years, 22 men) and 22 matched healthy controls (25.6 years, 16 men) performed a collaborative, verbal production task with a real interaction partner. Blind raters scored how easy participants made it to understand them (Facility ratings), how interesting they were to listen to (Interest ratings) and how expressive they were (Expressivity ratings). ToM was assessed with the Combined Stories Test and Sarfati's cartoon task. Symptoms were assessed with the PANSS five-factor version.

STUDY RESULTS

Compared to healthy controls, SZ received significantly lower ratings for all three aspects of their verbal productions (Facility, Interest and Expressivity), despite the raters being blind to group membership. Interestingly, the Facility ratings were linked to ToM performance in the SZ group, which suggest that SZ participants who have difficulties understanding others (ToM deficits) also make it harder for others to understand them. Other notable findings include a strong link between the Expressivity ratings and the Interest ratings for both groups, and significant correlations between the Facility ratings and Cognitive/Disorganisation symptoms, and between the Expressivity ratings and both Negative and Depression/Anxiety symptoms in SZ.

CONCLUSION

Studying speech production during real, collaborative social interactions could help move beyond the individual approach to SZ deficits, making it possible to involve the interaction partners to promote more efficient communication for people with schizophrenia.

Clinical and computational speech measures are associated with social cognition in schizophrenia spectrum disorders

In this study, we compared three domains of social cognition (emotion processing, mentalizing, and attribution bias) to clinical and computational language measures in 63 participants with schizophrenia spectrum disorders. Based on the active inference model for discourse, we hypothesized that emotion processing and mentalizing, but not attribution bias, would be related to language disturbances. Clinical ratings for speech disturbance assessed disorganized and underproductive dimensions. Computational features included speech graph metrics, use of modal verbs, use of first-person pronouns, cosine similarity of adjacent utterances, and measures of sentiment; these were represented by four principal components. We found that higher clinical ratings for disorganized speech were predicted by greater impairments in both emotion processing and mentalizing, and that these relationships remained significant when accounting for demographic variables, overall psychosis symptoms, and verbal ability. Similarly, a computational speech component reflecting insular speech was consistently predicted by impairment in emotion processing. There were notable trends for computational speech components reflecting underproductive speech and decreased content-rich speech predicting mentalizing ability. Exploratory longitudinal analyses in a small subset of participants (n = 17) found that improvements in both emotion processing and mentalizing predicted improvements in disorganized speech. Attribution bias did not demonstrate strong relationships with language measures. Altogether, our findings are consistent with the active inference model of discourse and suggest greater emphasis on treatments that target social cognitive and language systems.

Disorganization in first episode affective psychosis: Treatment response and clinical considerations from a 2-year follow-up study in a "real world" setting

INTRODUCTION

Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the longitudinal course of disorganization in young people with first episode affective psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an "Early Intervention in Psychosis" (EIP) protocol along the follow-up period.

MATERIALS AND METHODS

Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's rank correlation coefficients were calculated.

RESULTS

During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment.

CONCLUSIONS

Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.

Deficits in Analytic and Common-Sense Reasoning in Schizophrenia

ABSTRACT

Human rationality has a dual nature including analytic and common-sense thinking. Symptoms of schizophrenia have been suggested to be related to deficits in these aspects of logical reasoning. However, empirical studies investigating logical reasoning errors in schizophrenia and their clinical and neurocognitive correlates are scarce. Formal thought disorder and theory of mind (ToM) might be particularly important for understanding logical reasoning errors in schizophrenia. The current study compared the performances of 80 patients with schizophrenia with those of 49 healthy controls on syllogistic and counterfactual reasoning tasks and investigated clinical, neuropsychological, and social cognitive correlates of logical reasoning in schizophrenia. Patients with schizophrenia were impaired in both analytic and common-sense thinking. ToM impairment was a significant predictor of analytic reasoning abilities in schizophrenia. Executive functions and verbal memory were also significantly associated with analytic reasoning in schizophrenia. Further studies investigating logical reasoning errors in the early phases of the illness are needed.

Core of sensory gating deficits in first-episode schizophrenia: attention dysfunction

Background

Sensory gating deficits are a common feature of schizophrenia and may be indicative of higher-order psychopathological impairments. It has been proposed that incorporating subjective attention components into prepulse inhibition (PPI) measures may improve the accuracy of assessing these deficits. This study aimed to investigate the relationship between modified PPI and cognitive function, with a specific focus on subjective attention, to gain a better understanding of the underlying mechanisms of sensory processing deficits in schizophrenia.

Methods

Fifty-four unmedicated first-episode schizophrenia (UMFE) patients and 53 healthy controls participated in this study. The modified Prepulse Inhibition paradigm, including Perceived Spatial Separation PPI (PSSPPI) and Perceived Spatial Colocation PPI (PSCPPI), was used to evaluate sensorimotor gating deficits. Cognitive function was assessed in all participants using the Chinese version of the MATRICS Consensus Cognitive Suite Test (MCCB).

Results

UMFE patients had lower MCCB scores and deficient PSSPPI scores than healthy controls. PSSPPI was negatively correlated with total PANSS scores and positively correlated with the speed of processing, attention/ vigilance, and social cognition. Multiple linear regression analysis showed that the PSSPPI at 60 ms had a significant effect on attentional/ vigilance and social cognition, even after controlling for gender, age, years of education, and smoking.

Conclusion

The study revealed notable impairments in sensory gating and cognitive function in UMFE patients, best reflected by the PSSPPI measure. Specifically, PSSPPI at 60 ms was significantly associated with both clinical symptoms and cognitive performance, suggesting that PSSPPI at 60 ms may capture psychopathological symptoms related to psychosis.

Does social cognition change? Evidence after 4 years from the Italian Network for Research on Psychoses

BACKGROUND

Deficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up.

METHODS

The reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up.

RESULTS

In 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery.

CONCLUSIONS

The RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery.

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.

What areas of everyday functioning are affected by theory of mind deficits in recent-onset schizophrenia spectrum disorders?

AIM

Functional recovery is now a recognized treatment goal for schizophrenia. It is therefore important to better understand the cognitive and psychological factors that influence functioning. Theory of mind (ToM) deficits are common in schizophrenia and have been linked to greater impairments in functioning. The current study aimed to identify which specific areas of functioning are linked to ToM in a group of 54 patients with a recent-onset of a schizophrenia spectrum disorder.

METHODS

ToM was assessed with the Combined Stories Test (COST). Several areas of functioning were rated based on an extensive semi-structured interviews.

RESULTS

Among the different areas of functioning that were examined, ToM showed a significant, positive relationship with ratings for productive activities (e.g. work or school) as well as with collaboration to psychiatric care.

CONCLUSION

These results suggest that ToM can impair functioning especially in situations in which patients need to collaborate with others, including the interactions with the clinical team.

Relationship between the domains of theory of mind, social dysfunction, and oxytocin in schizophrenia

Social dysfunction, manifested by impaired social cognition, is contributing to poorer prognosis of patients with schizophrenia. Growing evidence indicates that oxytocin acts as a neurotransmitter in the regulation of social cognition. It still lacks a thorough understanding of how oxytocin is linked with deficits in social cognition and social functioning in schizophrenia. To this end, we aimed to study the role of plasma oxytocin levels in the relationship between subdomains of social cognition and social dysfunction in patients with schizophrenia. Social Functioning Scale was administered to measure social dysfunction while Faux Pas Recognition Test was used to assess the Theory of Mind (ToM) in 40 patients with schizophrenia and 40 age-matched healthy controls. Patients with schizophrenia exhibited more deficits in ToM, more severe social dysfunction, and had lower plasma oxytocin levels, relative to healthy controls. A pooled correlation analysis of all participants revealed significant effects of plasma oxytocin levels on the ToM and social dysfunction. In patients with schizophrenia, plasma oxytocin levels were positively correlated with the affective but not cognitive component of the ToM, and the effects of plasma oxytocin levels on social functioning were partially mediated by affective ToM. Our findings underscore the importance of oxytocin as a potential predictor of ToM and social functioning in patients with schizophrenia. It may be worthwhile for future studies of oxytocin in schizophrenia to focus on an affected behavioral domain, e.g., social cognition, rather than diagnosis, and the targeted domain should be deconstructed into more detailed subdomains.

Effects of bilateral, bipolar-nonbalanced, frontal transcranial Direct Current Stimulation (tDCS) on negative symptoms and neurocognition in a sample of patients living with schizophrenia: Results of a randomized double-blind sham-controlled trial

Negative symptoms (NS), conceived as Avolition-Apathy (AA) and Expressive Deficit (EXP) domains, and neurocognitive impairments represent unmet therapeutic needs for patients with schizophrenia. The present study investigated if bilateral bipolar-nonbalanced frontal transcranial Direct Current Stimulation (tDCS) could improve these psychopathological dimensions. This randomized, double-blind, sham-controlled study (active-tDCS versus sham-tDCS, both, n = 25) included 50 outpatients diagnosed with schizophrenia clinically stabilized. Patients received 20-min 2 mA active-tDCS or sham-tDCS (anode: left Dorsolateral Prefrontal Cortex; cathode: right orbitofrontal region). Primary outcomes included: PANSS-Negative subscale, Negative Factor (Neg-PANSS), AA and EXP domains; neurocognitive performance at Brief Assessment of Cognition in Schizophrenia. Secondary outcomes included: PANSS subscales and total score, Disorganized/Concrete (DiscC-PANSS) and Positive Factors, Clinical Global Impression (CGI) scores, clinical insight at Scale to Assess Unawareness of Mental Disorder (SUMD). Analysis of covariance (ANCOVA) was performed evaluating between-group changes over time. Significant improvements following active-tDCS were observed for all NS measures (all, p < 0.001; d > 0.8) and for working memory (p = 0.025, d = 0.31). Greater variations following to active treatment emerged also for PANSS-General Psychopathology subscale (p < 0.001; d = 0.54), PANSS total score (p < 0.001; d = 0.69), CGI indexes (all, p < 0.001; d > 0.6), DiscC-PANSS (p < 0.001; d = 0.80) and SUMD-general Unawareness index (p = 0.005; d = 0.15) but not for positive symptoms and others insight measures. Good safety/tolerability profiles were found. Bilateral bipolar-nonbalanced frontal-tDCS is a non-pharmacological approach in schizophrenia effectively improving NS, particularly the AA and EXP domains, probably acting by modulating dysfunctional cortical-subcortical networks. Preliminary results also suggest working memory improvements following tDCS. Further studies are needed to confirm the neurobiological basis of these results.

Loneliness, positive, negative and disorganised Schizotypy before and during the COVID-19 pandemic

Loneliness is common in psychosis and occurs along a continuum. Here we investigate inter-relationships between loneliness, three-dimensional schizotypy, and depressive symptoms before and during the COVID-19 pandemic.

The sample included 507 university students (48.3% participated before and 51.7% during the COVID-19 pandemic) who completed the Multidimensional Schizotypy Scale-Brief, the Counseling Center Assessment of Psychological Symptoms depression scale and the University of California, Los Angeles Loneliness Scale. Schizotypy and depression scores were regressed onto loneliness individually and in multiple regressions.

The cohorts did not differ in any of the schizotypy domains (all p > .29). Depressive symptoms (p = .05) and loneliness (p = .006) were higher during the pandemic than before. Across cohorts, loneliness was significantly associated with positive (β = 0.23, p < .001), negative (β = 0.44, p < .001), and disorganised schizotypy (β = 0.44, p < .001), and with depression (β = 0.72, p < .001). Schizotypy together explained a significant amount of variance in loneliness (R² = 0.26), with significant associations with positive (β = −0.09, p = .047), negative (β = 0.31, p < .001) and disorganised schizotypy (β = 0.34, p < .001). When depression was included (β = 0.69, p < .001), only positive (β = −0.09, p = .008) and negative schizotypy (β = 0.22, p < .001) significantly predicted loneliness.

When all schizotypy dimensions and depression were considered together, only negative schizotypy and depression significantly predicted loneliness. Loneliness and depressive symptoms were higher during the pandemic, but this did not relate to cohort differences in schizotypy.

•

Loneliness is uniquely associated with negative schizotypy and depression, but not disorganised schizotypy.

•

Certain aspects of positive schizotypy may protect against loneliness.

•

Loneliness and depressive symptoms were higher in students during the COVID-19 pandemic than before.

•

Cohorts of students assessed before and during the pandemic showed similar levels of schizotypy.

Examining disorganization in patients with first episode psychosis: Findings from a 1-year follow-up of the 'Parma early psychosis' program

AIM

Disorganization has been considered as a clinical domain close to the core of psychosis. However, it has received poor attention, especially at the illness onset. Moreover, most of the studies examining disorganized symptoms have been conducted in patients with chronic psychosis and research in the early stages of illness is still relatively scarce. Thus, the aims of this study were (a) to longitudinally monitor the stability of disorganization in patients with first episode psychosis (FEP) across a 1-year follow-up period, and (b) to investigate any relevant association of disorganized symptoms with functioning, psychopathology and the specific treatment components of an 'early intervention in psychosis' (EIP) program along the 1 year of follow-up.

METHODS

At baseline, 312 FEP participants (aged 12-35 years) completed the positive and negative syndrome scale (PANSS) and the global assessment of functioning (GAF). Spearman's correlations and multiple linear regression analysis were used.

RESULTS

At baseline, disorganization showed significant associations with all PANSS subscores, and a relevant negative correlation with GAF score. Across the follow-up, FEP individuals showed a significant improvement in disorganization severity. This decrease was specifically related to both baseline antipsychotic dosage and the number of individual cognitive-behavioural therapy sessions offered across the 1-year follow-up period.

CONCLUSIONS

Disorganization is clinically relevant in FEP patients, already ate the enrollment in an EIP program. However, it tends to improve over time together with the delivery of specialized, person-tailored FEP interventions within a specific EIP protocol.

Social skills, negative symptoms and real-world functioning in individuals at ultra-high risk of psychosis

BACKGROUND

Impairment in real-world social functioning is observed in individuals at Ultra-High Risk (UHR) of psychosis. Both social skills and negative symptoms appear to influence real-world functioning. This study aims to examine the psychometric properties of a social skills measure, the High-Risk Social Challenge task (HiSoC), and evaluate the relationship between social skills, negative symptoms, and real-world functioning in UHR individuals.

METHODS

HiSoC data was analysed in 87 UHR individuals and 358 healthy controls. Exploratory factor analysis (EFA) was used to evaluate the factor structure of the HiSoC task. Convergent and divergent validity were assessed. Negative symptoms were assessed on the Positive and Negative Syndrome Scale (PANSS) and real-world functioning was indexed by the Global Assessment of Functioning (GAF). Commonality analysis was used to partition unique and shared variance of HiSoC and negative symptoms with real-world functioning.

RESULTS

EFA yielded a three-factor structure of HiSoC consisting of Affect, Odd behaviour and language, and Social-interpersonal. The HiSoC task discriminated UHR and healthy controls (p < 0.001, Cohen's d = 0.437-0.598). Commonality analysis revealed that the unique variance of the social amotivation subdomain of negative symptoms was the strongest predictor of GAF (p < .001, R² = .480). Shared variance of 3.7% between HiSoC Social-interpersonal and social amotivation was observed in relation to functioning.

CONCLUSION

The HiSoC is a psychometrically valid task that is sensitive to identify social skill deficits in UHR. While social skills are related to functioning, experiential negative symptoms appear to be an important target for improving real-world functional outcomes.

Referential communication in people with recent-onset schizophrenia-spectrum disorders

People with schizophrenia present with language production impairments, yet very few studies examine language production in the context of collaborative, verbal interaction tasks performed with a real interaction partner. The current study relied on a referential communication paradigm in which participants with schizophrenia (SZ) and healthy controls (HC) presented a series of movie characters to their interaction partner, whose role was to identify and place the characters in the same order. The HC spontaneously provided more information when presenting characters that their interaction partner was unlikely to know than when presenting very well-known characters, and the magnitude of this adjustment was positively correlated with their performance on a theory of mind task. In contrast, people with SZ showed a significantly reduced (absent) adjustment to the likely-known vs. likely-unknown nature of the characters, and no correlation emerged with ToM. Further examination of the verbal productions revealed that HC often combined movie-related information (ex: character's name or movie title) and descriptive information whereas people with SZ more often used description only to present the characters. Overall, this study adds to our knowledge about referential choices in SZ in the context of collaborative verbal interactions with a real interaction partner.

Social Cognition Impairments in 22q11.2DS Individuals With and Without Psychosis: A Comparison Study With a Large Population of Patients With Schizophrenia

BACKGROUND

22q11.2 Deletion Syndrome (22q11DS) represents one of the most important genetic risk factors for schizophrenia (SCZ) and a reliable biological model to study endophenotypic characters of SCZ. The aim of the study was to investigate Social Cognition impairments in subjects with 22q11.2DS compared to a considerable sample of schizophrenic patients.

METHODS

Forty-four individuals with 22q11.2DS (DEL) and 18 patients with 22q11.2DS and psychosis (DEL_SCZ) were enrolled; these groups were compared to 887 patients with schizophrenia (SCZ) and 780 healthy controls (HCs); the latter groups were recruited by the Italian Network for Research on Psychoses (NIRP) to which our Centre took part. Social cognition was evaluated through The Awareness of Social Inference Test (TASIT). A resampling procedure was employed to balance differences in samples size.

RESULTS

All clinical groups (DEL; DEL_SCZ; and SCZ) showed worse performance on TASIT than HCs, except in Sincere scale. No differences between-clinical groups were found, except for Simple Sarcasm, Paradoxical Sarcasm and Enriched Sarcasm scales.

CONCLUSIONS

SC was impaired in individuals with 22q11.2DS regardless of psychotic symptomatology, similarly to people with SCZ. Therefore, SC deficits may represent potential endophenotypes of SCZ contributing to the vulnerability to psychosis.

Brain Stimulation and Group Therapy to Improve Gesture and Social Skills in Schizophrenia-The Study Protocol of a Randomized, Sham-Controlled, Three-Arm, Double-Blind Trial

An important component of nonverbal communication is gesture performance, which is strongly impaired in 2/3 of patients with schizophrenia. Gesture deficits in schizophrenia are linked to poor social functioning and reduced quality of life. Therefore, interventions that can help alleviate these deficits in schizophrenia are crucial. Here, we describe an ongoing randomized, double-blind 3-arm, sham-controlled trial that combines two interventions to reduce gesture deficits in schizophrenia patients. The combined interventions are continuous theta burst stimulation (cTBS) and social cognitive remediation therapy (SCRT). We will randomize 72 patients with schizophrenia spectrum disorders in three different groups of 24 patients. The first group will receive real cTBS and real SCRT, the second group will receive sham cTBS and real SCRT, and finally the third group will receive sham SCRT. Here, the sham treatments are, as per definition, inactive interventions that mimic as closely as possible the real treatments (similar to placebo). In addition, 24 age- and gender-matched controls with no interventions will be added for comparison. Measures of nonverbal communication, social cognition, and multimodal brain imaging will be applied at baseline and after intervention. The main research aim of this project will be to test whether the combination of cTBS and SCRT improves gesture performance and social functioning in schizophrenia patients more than standalone cTBS, SCRT or sham psychotherapy. We hypothesize that the patient group receiving the combined interventions will be superior in improving gesture performance.

CLINICAL TRIAL REGISTRATION

[www.ClinicalTrials.gov], identifier [NCT04106427].

Comparative study of emotion recognition and theory of mind between major depressive disorder and schizophrenia

BACKGROUND

Social cognition as a transdiagnostic construct between major depressive disorder (MDD) and schizophrenia (SCZ) is not well understood. This may be attributed to the variability of social cognitive measures indexing the same construct. This study aims to compare emotion recognition and theory of mind domains, known to be impaired in SCZ, between MDD and SCZ.

METHODS

Three groups of participants (N_Total = 150) were enrolled in this study: MDD (n = 51), SCZ (n = 50) and healthy controls (HC; n = 49). Emotion recognition was assessed on the Bell Lysaker Emotion Recognition Task (BLERT) and Penn Emotion Recognition Task (ER40); theory of mind was measured on The Awareness of Social Inference Test (TASIT). Mixed ANCOVAs were utilised to compare social cognitive performance across the groups.

RESULTS

SCZ performed poorer in all 3 social cognition tasks compared to both MDD and HC. No statistically significant difference in social cognitive performance was observed between MDD and HC.

CONCLUSIONS

This study serves as an effort towards employing the same standardised social cognitive measures for direct comparison of performance patterns across diagnostic groups. Future work is needed to extend this in larger samples of different illness severity and diagnostic categories.

Disorganization in first episode schizophrenia: Treatment response and psychopathological findings from the 2-year follow-up of the "Parma Early Psychosis" program

OBJECTIVE

Disorganization is a core dimension of schizophrenia, yet it is relatively under-investigated compared to positive and negative ones, especially at the illness onset. Indeed, most of the empirical studies investigating the disorganized domain included patients with prolonged schizophrenia. Therefore, the aims of this research were (1) to monitor the longitudinal stability of disorganized symptoms in young patients with First Episode Schizophrenia (FES) along a 2-year follow-up period, and (2) to examine any significant association of disorganization with functioning, psychopathology and the specific treatment components of an "Early Intervention in Psychosis" (EIP) program across the 2 years of follow-up.

METHODS

At baseline, 159 FES individuals (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's correlation coefficients and multiple linear regression analysis were carried out.

RESULTS

During the follow-up period, disorganization had relevant enduring positive associations with PANSS negative symptoms, lack of judgment/insight and positive symptoms representing delusional thought contents, as well as significant enduring negative correlation with GAF scores. Along the 2 years of follow-up, FES patients also showed a relevant improvement in disorganization symptoms. This reduction was specifically associated with the number of individual psychotherapy sessions provided during the first year of treatment.

CONCLUSION

Disorganization is a prominent clinical feature in FES at the recruitment in specialized EIP services, but its temporal trajectory reveals a decrease over time, together with the delivery of specific, patient-tailored EIP interventions.

More than a biomarker: could language be a biosocial marker of psychosis?

Automated extraction of quantitative linguistic features has the potential to predict objectively the onset and progression of psychosis. These linguistic variables are often considered to be biomarkers, with a large emphasis placed on the pathological aberrations in the biological processes that underwrite the faculty of language in psychosis. This perspective offers a reminder that human language is primarily a social device that is biologically implemented. As such, linguistic aberrations in patients with psychosis reflect both social and biological processes affecting an individual. Failure to consider the sociolinguistic aspects of NLP measures will limit their usefulness as digital tools in clinical settings. In the context of psychosis, considering language as a biosocial marker could lead to less biased and more accessible tools for patient-specific predictions in the clinic.

A Network of Psychopathological, Cognitive, and Motor Symptoms in Schizophrenia Spectrum Disorders

Schizophrenia spectrum disorders (SSDs) are complex syndromes involving psychopathological, cognitive, and also motor symptoms as core features. A better understanding of how these symptoms mutually impact each other could translate into diagnostic, prognostic, and, eventually, treatment advancements. The present study aimed to: (1) estimate a network model of psychopathological, cognitive, and motor symptoms in SSD; (2) detect communities and explore the connectivity and relative importance of variables within the network; and (3) explore differences in subsample networks according to remission status. A sample of 1007 patients from a multisite cohort study was included in the analysis. We estimated a network of 43 nodes, including all the items from the Positive and Negative Syndrome Scale, a cognitive assessment battery and clinical ratings of extrapyramidal symptoms. Methodologies specific to network analysis were employed to address the study's aims. The estimated network for the total sample was densely interconnected and organized into 7 communities. Nodes related to insight, abstraction capacity, attention, and suspiciousness were the main bridges between network communities. The estimated network for the subgroup of patients in remission showed a sparser density and a different structure compared to the network of nonremitted patients. In conclusion, the present study conveys a detailed characterization of the interrelations between a set of core clinical elements of SSD. These results provide potential novel clues for clinical assessment and intervention.

Metacognition, social cognition, and mentalizing in psychosis: are these distinct constructs when it comes to subjective experience or are we just splitting hairs?

Research using the integrated model of metacognition has suggested that the construct of metacognition could quantify the spectrum of activities that, if impaired, might cause many of the subjective disturbances found in psychosis. Research on social cognition and mentalizing in psychosis, however, has also pointed to underlying deficits in how persons make sense of their experience of themselves and others. To explore the question of whether metacognitive research in psychosis offers unique insight in the midst of these other two emerging fields, we have offered a review of the constructs and research from each field. Following that summary, we discuss ways in which research on metacognition may be distinguished from research on social cognition and mentalizing in three broad categories: (1) experimental procedures, (2) theoretical advances, and (3) clinical applications or indicated interventions. In terms of its research methods, we will describe how metacognition makes a unique contribution to understanding disturbances in how persons make sense of and interpret their own experiences within the flow of life. We will next discuss how metacognitive research in psychosis uniquely describes an architecture which when compromised - as often occurs in psychosis - results in the loss of persons' sense of purpose, possibilities, place in the world and cohesiveness of self. Turning to clinical issues, we explore how metacognitive research offers an operational model of the architecture which if repaired or restored should promote the recovery of a coherent sense of self and others in psychosis. Finally, we discuss the concrete implications of this for recovery-oriented treatment for psychosis as well as the need for further research on the commonalities of these approaches.

Meta-Analysis of Sensorimotor Gating Deficits in Patients With Schizophrenia Evaluated by Prepulse Inhibition Test

Prepulse inhibition (PPI) of startle is an operational measure of sensorimotor gating that is often impaired in patients with schizophrenia. Despite the large number of studies, there is considerable variation in PPI outcomes reported. We conducted a systematic review and meta-analysis investigating PPI impairment in patients with schizophrenia compared with healthy control subjects, and examined possible explanations for the variation in results between studies. Major databases were screened for observational studies comparing healthy subjects and patients with schizophrenia for the prepulse and pulse intervals of 60 and 120 ms as primary outcomes, ie, PPI-60 and PPI-120. Standardized mean difference (SMD) and 95% confidence intervals (CI) were extracted and pooled using random effects models. We then estimated the mean effect size of these measures with random effects meta-analyses and evaluated potential PPI heterogeneity moderators, using sensitivity analysis and meta-regressions. Sixty-seven primary studies were identified, with 3685 healthy and 4290 patients with schizophrenia. The schizophrenia group showed reduction in sensorimotor gating for both PPI-60 (SMD = -0.50, 95% CI = [-0.61, -0.39]) and PPI-120 (SMD = -0.44, 95% CI = [-0.54, -0.33]). The sensitivity and meta-regression analysis showed that sample size, gender proportion, imbalance for gender, source of control group, and study continent were sources of heterogeneity (P < .05) for both PPI-60 and PPI-120 outcomes. Our findings confirm a global sensorimotor gating deficit in schizophrenia patients, with overall moderate effect size for PPI-60 and PPI-120. Methodological consistency should decrease the high level of heterogeneity of PPI results between studies.

Deficiencies in Theory of Mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: A systematic review of secondary literature

Deficiencies in Theory of Mind (ToM) are consistently found in individuals with schizophrenia (SZ), major depressive disorder (MDD), and bipolar disorder (BD). However, the character of these deficits and their role in the pathogenesis of mental illness remains poorly understood. This systematic review synthesizes the available secondary literature pertaining to ToM functioning in individuals with MDD, BD, or SZ, and their respective spectrum disorders in order to delineate disorder or symptom specific patterns of ToM impairment. Literature suggests that ToM deficits increase in severity along the affective-psychotic spectrum, with mild deficits in patients with MDD, and severe deficits in patients with mania or psychosis. Furthermore, ToM deficits appear to be part of a broader developmental phenotype associated with SZ and BD, as suggested by findings of attenuated impairments in ToM in remitted patients with SZ or BD, unaffected first-degree relatives of patients, and clinical high-risk groups. Future psychiatric research on ToM should aim to disentangle relationships between ToM deficits and specific symptom dimensions transdiagnostically, and employ standardized, construct-specific ToM tasks.