Differences between individuals with schizophrenia or obsessive-compulsive disorder and healthy controls in social cognition and mindfulness skills: A controlled study

Mindfulness-Based Intervention Effects on EEG and Executive Functions: A Systematic Review

Background. Mindfulness-based interventions (MBIs) have emerged as an alternative intervention for symptoms of psychological and psychiatric conditions, such as depression, anxiety, and emotional discomfort. Over the last ten years, MBIs have established a growing body of evidence that shows cognitive and neurophysiological benefits. Depression and anxiety are conditions with a high prevalence in the world population. In developing countries, it is reported that, given the conditions of being at a social disadvantage, anxiety and depression are higher, resulting in compromised psychological well-being and mental health. Objectives. This systematic review aims to quantitatively and qualitatively assess changes in the neuropsychological, particularly executive functioning and social cognition domains, and electroencephalographical (EEG) effects of MBIs. Methods. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in three databases, Web of Science, Scopus, and EBSCO MedLine complete; 14,464 articles were found, 141 articles evaluated the effects of MBI on executive functioning, and 16 included both as in qualitative and quantitative variables. Results. The qualitative results show that the research on the effects of MBI on behavior and cognitive skills, including executive function, social cognition, and EEG analysis, is very scarce but consistent in suggesting strong correlations on cognitive and electrophysiological alpha-beta proportions asymmetry on frontal areas. Undoubtedly, executive functions, as a behavioral regulatory and self-monitoring system, are the most popular study of interest in the literature, including emotional regulation, awareness, planning, social skills, and focused attention. Although there are fewer studies assessing the effects of MBIs on social cognition skills. The funnel plot showed a symmetrical distribution but ranked out of significant correlation. Most estimates of treatment effects are positive (58%); however, the average outcome observed did not significantly differ from zero. Conclusions. This study concludes that the research integrating the analysis of the electrophysiological and executive function effects of MBI shows important methodological variations and clinical conditions, which explains the significant results reported individually. Even when most of the literature reports positive effects of MBIs on several behavioral and neurophysiological domains, there are still confounding factors that must be taken into consideration by researchers and clinicians before attributing possible inaccurate or generalizable benefits.

Theory of mind in trichotillomania: A cross-sectional comparison with healthy controls

BACKGROUND

Theory of mind (ToM) is the ability to make correct inferences from one's own or another person's mental states, such as thoughts, beliefs, desires, and intentions. Although there are a limited number of studies in the literature examining the social cognitive functions of patients with trichotillomania (TTM), no studies have evaluated ToM. This study aimed to compare the ToM skills of patients with TTM and healthy controls.

METHOD

The study included 40 patients who were diagnosed as having TTM according to DSM-5 criteria and 40 healthy controls matched for age, education, and sex. A Sociodemographic and Clinical Data Form, the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Massachusetts General Hospital Hairpulling Scale (MGH-HPS), Toronto Alexithymia Scale (TAS-20), Reading the Mind in the Eyes Test (RMET), and the Dokuz-Eylül Theory of Mind Scale (DEToMS) were administered to the participants.

RESULTS

Patients with TTM performed statistically significantly worse than healthy controls in terms of ToM, metaphor concept, empathic understanding, and faux pas scores. No statistically significant difference was found between the groups in terms of first-degree false belief, second-degree false belief, and irony concept scores. Depression, anxiety, and alexithymia scores of patients with TTM were statistically significantly higher than the control group. No significant correlation was found between ToM tests and anxiety, depression, alexithymia, disease severity, and disease duration in the TTM group.

CONCLUSION

Our findings show that there is an impairment in ToM skills in patients with TTM and that this impairment is independent of clinical features. Studies with larger samples are needed on this subject.

Empathic disequilibrium in schizophrenia: An individual participant data meta-analysis

Schizophrenia involves substantial social difficulties, yet their nature remains unclear. Although empathy has been considered a promising social cognition construct, inconsistent findings have undermined its usefulness as a stable index for schizophrenia. This may be because previous studies overlooked the interdependency between the emotional and cognitive components of empathy. In this study, we investigated whether empathic disequilibrium, the intrapersonal imbalance between emotional and cognitive empathy, could be a meaningful schizophrenia marker. We conducted an individual-participant data meta-analysis, systematically searching the literature for studies involving participants with schizophrenia who completed the Interpersonal Reactivity Index, a validated empathy measure. Using emotional and cognitive empathy to capture empathic disequilibrium and the joint effect of cognitive and emotional empathy, we employed polynomial regression with response surface analysis to predict schizophrenia diagnosis and symptoms. Our analysis comprising ten studies (N = 1,080), revealed a non-linear association with the joint effect of cognitive and emotional empathy, as well as an association with empathic disequilibrium, suggesting emotional empathy overabundance, strongly and consistently predicted schizophrenia diagnosis. Additionally, empathic disequilibrium towards cognitive empathy overabundance was related to greater positive symptoms. The results suggest that empathic disequilibrium provides a stable behavioral marker related to schizophrenia, surpassing the utility of empathy alone. The findings deepen our understanding of schizophrenia phenomenology and can advance clinical and research practices.

Theory of Mind Abilities May Predict Treatment Outcomes in Adolescents With Obsessive-Compulsive Disorder: A Follow-Up Study

AIMS

Researchers report varying levels of cognitive flexibility and theory of mind (ToM) deficiencies in adolescents with obsessive-compulsive disorder (OCD). This research set out to investigate the impact of these variables on the disorder's outcomes.

METHOD

The study involved 39 adolescents with OCD and 40 healthy controls. We assessed the case group at the initial visit to the outpatient clinic and again at the end of the first year of treatment. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was applied to assess OCD symptom distribution and severity. The Reading the Mind in the Eyes of Children Test (RME-CT) was applied to evaluate ToM skills, and the Cognitive Flexibility Scale (CFS) was employed to evaluate cognitive flexibility levels.

RESULTS

Baseline RME-CT and CFS scores were significantly lower in adolescents with OCD compared to the control group (p = 0.002 p = 0.001, respectively). At the end of the 1-year follow-up, RME-CT and CFS scores increased significantly in the adolescents with OCD (p < 0.001, p = 0.003, respectively). A significant negative correlation was observed between the initial RME-CT scores and the Y-BOCS scores at the end of the 1-year follow-up (p < 0.001). The initial RME-CT score had a significant negative predictive effect on the subsequent severity of OCD (β = -0.711, p < 0.001).

CONCLUSIONS

The research revealed poorer long-term prognoses for OCD in adolescents who exhibit low ToM skills. In conclusion, the results indicate that ToM skills may serve as a predictive factor for long-term treatment outcomes among adolescents diagnosed with OCD.

Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression

The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.

Knowing me, knowing you: a scoping review assessing the current field of social cognition in schizophrenia

BACKGROUND

Impaired social cognition (SC) occurs frequently in schizophrenia (SCZ), yet compared to autism spectrum disorder (ASD), the research on SC in SCZ is sparse and methodologically heterogeneous. To accurately assess between-group SC differences it is further necessary to establish the relationship between nonsocial cognition (NSC) and SC, particularly as this may not be identical across disorders.

PURPOSE

The present study aimed to map, index and assess the quality of research published between 2014-2021 investigating SC in SCZ, and to summarize existing limitations and recommendations for future research.

METHOD

Following the PRISMA guidelines for scoping reviews (PRISMA-ScR) fifteen (n = 15) case-control studies were identified and included across three electronic databases. Studies additionally utilizing ASD samples were included because of their clinical utility.

RESULTS

Most studies reported significant SC impairments in SCZ relative to healthy controls (HC) with varying effect sizes. Significant differences between SCZ and ASD were not found in most studies including both samples. Weak-to-moderate correlations between SC and NSC were often found, although often only within patient samples. Across studies, SC tests were inconsistently described as measurements of "social cognition", "mentalization" and, most frequently and varyingly, "theory of mind". Most studies lacked methodological transparency. Limitations related to sample sizes and test reliability were most frequently mentioned.

CONCLUSIONS

The current research on SC in SCZ is limited by conceptual and methodological uncertainties. Future research should focus on ensuring clear and valid definitions of key terms, evaluating and clarifying SC outcome measures and further untangling the relationship between SC and NSC.

A meta-analysis of mentalizing in anxiety disorders, obsessive-compulsive and related disorders, and trauma and stressor related disorders

BACKGROUND

The number of studies that have researched the ability to mentalize in individuals with anxiety and related disorders is limited. Often, no distinction is made between different anxiety and related disorders in the examination of mentalization.

OBJECTIVE

The goal of this study was to obtain insight into mentalization in anxiety and related disorders, and to compare this ability between these disorders.

METHOD

A systematic literature search was performed to identify studies in which performance on a mentalization task was compared between a patient group diagnosed with an anxiety or a related disorder, and a control group. Meta-analyses were performed on the included articles.

RESULTS

The initial search yielded 2844 articles, of which 26 studies on 1056 patients were included. Patients diagnosed with anxiety and related disorders showed a deficit in mentalization when compared to healthy controls (SMD = -0.60, p 0.001). A deficit was found in all patient groups: Patients with anxiety disorders (SMD = -0.39, p = 0.007), obsessive-compulsive and related disorders (SMD = -0.78, p = 0.01), and trauma and stressor related disorders showed significant deficits (SMD = -0.77, p = 0.02) as compared to healthy controls.

CONCLUSION

The results indicated impaired mentalization in anxiety and related disorders, with specific deficiencies in posttraumatic stress disorder, social anxiety, and obsessive-compulsive disorders. Mentalization could provide a clinical target in treatment of these disorders.

Social cognition and empathy in adults with obsessive compulsive disorder: A meta-analysis

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts (obsessions) and compulsions and has been associated with psychosocial impairment. Indeed, a number of studies have highlighted impairments in both social cognitive functions and empathic skills in OCD, despite several inconsistencies. This study aimed to investigate social cognitive dysfunction and empathy deficits in patients with OCD using a meta-analytic approach. A literature search was conducted using the databases Pubmed, PsycINFO, ProQuest and Scopus to identify the relevant studies (January 1980 to March 2020). Following the systematic review of relevant OCD studies, a random-effects meta-analysis was conducted. The current meta-analysis included 25 studies consisting of 1161 patients with OCD and 1329 healthy controls. OCD was associated with decreased performance in theory of mind (ToM). In the facial emotion recognition domain, patients with OCD significantly underperformed healthy controls only in their recognition of disgust. OCD was significantly related to reduced cognitive empathy. OCD was associated with medium-sized impairments in ToM and cognitive empathy, which can likely contribute to psychosocial impairment in this disorder. Further studies are needed to investigate state and trait-related factors using experimental measures of empathy.

Emotion regulation and delusion-proneness relate to empathetic tendencies in a transdiagnostic sample

Empathetic tendencies (i.e., perspective taking and empathic concern) are a key factor in interpersonal relationships, which may be impacted by emotion regulation (i.e., reappraisal and suppression) and mental health symptoms, such as psychotic-like experiences. However, it is unclear if certain psychotic-like experiences, such as delusion-proneness, are still associated with reduced empathetic tendencies after accounting for emotion regulation style and dimensions of psychopathology that are often comorbid. In the current study, linear models tested these associations in a transdiagnostic community sample (N = 128), using the Interpersonal Reactivity Index (IRI), Emotion Regulation Questionnaire, and the Peter's Delusion Inventory. Results indicated that perspective taking was positively associated with reappraisal and negatively associated with delusion-proneness, after controlling for age, sex, race, intelligence, and symptoms of anxiety and depression. A significant change in R 2 supported the addition of delusion-proneness in this model. Specificity analyses demonstrated perspective taking was also negatively associated with suppression, but this relationship did not remain after accounting for the effects of reappraisal and delusion-proneness. Additional specificity analyses found no association between empathic concern and reappraisal or delusion-proneness but replicated previous findings that empathic concern was negatively associated with suppression. Taken together, delusion-proneness accounts for unique variance in perspective taking, which can inform future experimental research and may have important implications for psychosocial interventions.

Adaptive behavior and psychiatric symptoms in university students with ASD: One-year longitudinal study

In recent years, more young adults with ASD are attending post-secondary education, and several support programs have been proposed for this population. However, research regarding the long-term effects of university enrollment on outcomes among students with ASD is scarce. This study examined adaptive behavior and psychiatric symptoms during the first semester of two consecutive academic years (T1, T2) among 39 students with ASD, 29 students without ASD and high levels of social anxiety symptoms (High SA), and 32 students without ASD and low levels of SA symptoms (Low SA). Students with ASD participated in a university support program and resided with a peer mentor student without ASD, which encouraged social interaction. At T1, students with ASD reported lower levels of adaptive behavior and higher levels of social anxiety and obsessive-compulsive symptoms compared to the other groups. However, at follow-up (T2), significantly higher conceptual adaptive skill levels (specifically communication skills) and significantly lower depression symptom levels from T1 were reported only among students with ASD. The levels of social anxiety and obsessive-compulsive symptoms at T1 were negatively associated with adaptive functioning a year later (T2). Implications regarding adults with ASD attending university are discussed.

The Relationship Among Mentalization, Mindfulness, Working Memory, and Schizotypal Personality Traits in the General Population

Individuals with high schizotypal traits are less able to observe, describe, and monitor inner feelings, thoughts, and experiences, commonly referred to as mindfulness and mentalization. High schizotypy is also associated with impaired working memory (WM). However, the relationship among mindfulness, mentalization, WM, and schizotypal traits is unknown. Three hundred individuals from the community (mean age: 38.0 years, SD = 10.5; 49.3% women) completed questionnaires examining schizotypal traits, mindfulness, and mentalization and performed working memory tasks. Results revealed that mentalization was a general predictor of schizotypal traits, including unusual experiences, cognitive disorganization, introverted anhedonia, and impulsive nonconformity, when the effect of mindfulness and working memory was controlled. We also found a positive correlation between mindfulness and mentalization. Low mindfulness and mentalization performances were associated with high schizotypy. However, poor working memory was only weakly linked to cognitive disorganization and introverted anhedonia. These findings suggest that weak mentalization is a core feature of schizotypy independent of mindfulness and working memory.

Clinical characteristics of adults suffering from high-functioning autism and comorbid obsessive-compulsive disorder

Autism spectrum disorder (ASD) is a very heterogeneous disorder. Obsessive compulsive disorder (OCD) comorbidity, frequent in ASD, could be useful to define a specific ASD subtype. Our objective was to explore if adults with ASD and comorbid OCD could present a specific clinical profile of ASD in 89 high functioning-adult ASD patients. We found that adults with ASD and comorbid OCD showed a lower verbal IQ and a more severe impairments in social cognition. ASD with comorbid OCD present a specific clinical profile which could constitute a possible subtype of ASD.

Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia

Motivation and pleasure deficits are common in schizophrenia, strongly linked with poorer functioning, and may reflect underlying alterations in brain functions governing reward processing and goal pursuit. While there is extensive research examining cognitive and reward mechanisms related to these deficits in schizophrenia, less attention has been paid to psychological characteristics that contribute to resilience against, or risk for, motivation and pleasure impairment. For example, psychological tendencies involving positive future expectancies (e.g., optimism) and effective affect management (e.g., reappraisal, mindfulness) are associated with aspects of reward anticipation and evaluation that optimally guide goal-directed behavior. Conversely, maladaptive thinking patterns (e.g., defeatist performance beliefs, asocial beliefs) and tendencies that amplify negative cognitions (e.g., rumination), may divert cognitive resources away from goal pursuit or reduce willingness to exert effort. Additionally, aspects of sociality, including the propensity to experience social connection as positive reinforcement may be particularly relevant for pursuing social goals. In the current review, we discuss the roles of several psychological characteristics with respect to motivation and pleasure in schizophrenia. We argue that individual variation in these psychological dimensions is relevant to the study of motivation and reward processing in schizophrenia, including interactions between these psychological dimensions and more well-characterized cognitive and reward processing contributors to motivation. We close by emphasizing the value of considering a broad set of modulating factors when studying motivation and pleasure functions in schizophrenia.

Similarities and Differences in Brain Activation Between Patients With Schizophrenia and Obsessive-Compulsive Disorder: A Near-Infrared Spectroscopy Study

Schizophrenia (SZ) and obsessive-compulsive disorder (OCD) share several epidemiological and clinical features, but the neurobiological substrates shared by these two diseases remain unclear. This study aimed to explore the similarities and differences in brain function between them using near-infrared spectroscopy (NIRS). Eventually, 130 SZ patients, 70 OCD and 75 normal controls (NCs) were enrolled. A 52-channel NIRS instrument was used to detect the concentration changes in oxygenated hemoglobin ([oxy-Hb]) during the verbal fluency task. Ten regions of interests (ROIs) were defined: the bilateral dorsolateral prefrontal cortex (DLPFC), frontopolar cortex (FPC), orbitofrontal cortex (OFC), inferior prefrontal gyrus (IFG) and temporal gyrus (TG). Through two different analysis strategies based on channels or ROIs, we compared the [oxy-Hb] changes in three groups by one-way analysis of variance (ANOVA) and post-hoc tests. Across 52 channels, compared to the NC group, both SZ and OCD groups exhibited reduced activity in 17 channels, including left FPC, left DLPFC, bilateral OFC, IFG, middle TG, supplementary motor cortex and Broca's area, while SZ showed lower activity in channel 35 (right OFC) than OCD patients. Across all ROIs, compared to the NC group, both SZ and OCD groups showed reduced activity in 7 ROIs, including left FPC, bilateral OFC, IFG and TG, while SZ showed lower activity in the right OFC than OCD group, which were almost consistent with the results based on channels. This study suggests SZ and OCD present with some similar neuropathological changes, while SZ shows more severe impairment in the right OFC than OCD.