Social cognition in schizophrenia, Part 2: 12-month stability and prediction of functional outcome in first-episode patients

This study evaluated the longitudinal stability and functional correlates of social cognition during the early course of schizophrenia. Fifty-five first-episode schizophrenia patients completed baseline and 12-month follow-up assessments of 3 key domains of social cognition (emotional processing, theory of mind, and social/relationship perception), as well as clinical ratings of real-world functioning and symptoms. Scores on all 3 social cognitive tests demonstrated good longitudinal stability with test-retest correlations exceeding .70. Higher baseline and 12-month social cognition scores were both robustly associated with significantly better work functioning, independent living, and social functioning at the 12-month follow-up assessment. Furthermore, cross-lagged panel analyses were consistent with a causal model in which baseline social cognition drove later functional outcome in the domain of work, above and beyond the contribution of symptoms. Social cognitive impairments are relatively stable, functionally relevant features of early schizophrenia. These results extend findings from a companion study, which showed stable impairments across patients in prodromal, first-episode, and chronic phases of illness on the same measures. Social cognitive impairments may serve as useful vulnerability indicators and early clinical intervention targets.     

Deficits in Domains of Social Cognition in Schizophrenia: A Meta-Analysis of the Empirical Evidence

Objective: Social cognition is strongly associated with functional outcome in schizophrenia, making it an important target for treatment. Our goal was to examine the average magnitude of differences between schizophrenia patients (SCs) and normal comparison (NCs) patients across multiple domains of social cognition recognized by the recent NIMH consensus statement: theory of mind (ToM), social perception, social knowledge, attributional bias, emotion perception, and emotion processing. Method: We conducted a meta-analysis of peer-reviewed studies of social cognition in schizophrenia, published between 1980 and November, 2011. Results: 112 studies reporting results from 3908 SCs and 3570 NCs met our inclusion criteria. SCs performed worse than NCs across all domains, with large effects for social perception (g = 1.04), ToM (g = 0.96), emotion perception (g = 0.89), and emotion processing (g = 0.88). Regression analyses showed that statistically significant heterogeneity in effects within domains was not explained by age, education, or gender. Greater deficits in social and emotion perception were associated with inpatient status, and greater deficits in emotion processing were associated with longer illness duration. Conclusions: Despite the limitations of existing studies, including lack of standardization or psychometric validation of measures, the evidence for deficits across multiple social cognitive domains in schizophrenia is clear. Future research should examine the role of neurobiological and psychosocial factors in models linking various aspects of deficit in schizophrenia, including social cognition, in order to identify targets for intervention.     

Social Cognition Deficits Among Individuals at Familial High Risk for Schizophrenia

Social cognition in young relatives of schizophrenia probands (N = 70) and healthy controls (N = 63) was assessed using the Penn Emotion Recognition Test-40 to examine the presence of social cognitive deficits in individuals at risk for the disorder. Measures of neurocognitive function and prodromal psychopathology were collected to assess the cognitive and clinical correlates of social cognitive impairments in at-risk relatives. Results indicated that when compared with healthy controls, individuals at familial high risk for schizophrenia were significantly more likely to overattribute emotions to neutral faces, with such individuals frequently misinterpreting neutral faces as negative. In addition, at-risk individuals had significantly greater reaction times when completing emotion recognition tasks, regardless of valence. Impairments in neurocognition were largely independent of social cognitive performance, and emotion recognition impairments persisted after adjusting for deficits in neurocognitive function. Further, social cognitive impairments in the interpretation of neutral faces were significantly associated with greater positive and general prodromal psychopathology, whereas neurocognitive impairments were only associated with disorganization. These results suggest that impairments in social cognition may be unique endophenotypes for schizophrenia.     

Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders

The main aim of this study was to compare patients with euthymic bipolar I (BDI) and bipolar II (BDII) disorders and healthy controls in measures of social cognition. Additional aims were to explore the association between social cognition performance with neurocognitive impairments and psychosocial functioning. Eighty one euthymic patients with BDI or BDII and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention, and executive functions. Additionally theory of mind (ToM) and facial emotion recognition measures were included. Psychosocial functioning was assessed with the GAF. Both groups of patients had lower performance than healthy controls in ToM, and a lower recognition of fear facial expression. When neurocognitive impairments and exposure to medications were controlled, performance in ToM and recognition of fear facial expression did not allow predicting if a subject was patient or healthy control. Social cognition measures not enhance variance beyond explained by neurocognitive impairments and they were not independent predictors of psychosocial functioning. Impairments in facial emotion recognition and ToM are mediated, at least partly, by attention-executive functions deficits and exposure to psychotropic medications. Likewise, social cognition measures did not contribute to variance beyond neurocognitive impairments.     

A multidimensional assessment of social cognition in psychometrically defined schizotypy

Individuals with schizophrenia exhibit impairments in multiple social cognitive domains. There is evidence that these impairments may be trait-related vulnerability markers for schizophrenia. However, the literature focusing on individuals vulnerable to developing schizophrenia-spectrum disorders, referred to as schizotypy, has produced inconsistent findings. This study's primary aim was to provide a more comprehensive understanding of social cognitive functioning within schizotypy than previous studies by employing a broad array of measures to assess multiple social cognitive domains, and examine how these domains relate to specific schizotypy traits (i.e., positive, negative, and disorganized) and Quality of Life (QOL). Facial emotion recognition, Theory of Mind (ToM), and aspects of emotional intelligence related to regulating one's own emotions (emotion management) and other's emotions (social management) were measured. Individuals with psychometrically defined schizotypy (n=36) and controls (n=26) were examined. The schizotypy group performed significantly worse than controls on facial emotion recognition, ToM, and emotion management, but not social management. Generally speaking, poorer social cognition performance was not a function of specific schizotypy traits. However, negative traits were associated with poorer facial emotion recognition, and disorganized traits were associated with better social management. Facial emotion recognition was associated with QOL in the schizotypy group.     

The influence of impaired processing speed on cognition in first-episode antipsychotic-naïve schizophrenic patients

BackgroundImpaired cognition is a prominent feature of schizophrenia. To what extent the heterogeneous cognitive impairments can be accounted for by considering only a single underlying impairment or a small number of core impairments remains elusive. This study examined whether cognitive impairments in antipsychotic-naïve, first-episode schizophrenia patients may be determined by a relative slower speed of information processing.MethodForty-eight antipsychotic-naïve patients with first-episode schizophrenia and 48 matched healthy controls were administered a comprehensive battery of neuropsychological tests to assess domains of cognitive impairments in schizophrenia. Composite scores were calculated, grouping tests into cognitive domains.ResultsThere were significant differences between patients and healthy controls on global cognition and all cognitive domains, including verbal intelligence, processing speed, sustained attention, working memory, reasoning and problem solving, verbal learning and memory, visual learning and memory, and reaction time. All these significant differences, except for verbal intelligence and global cognition, disappeared when processing speed was included as a covariate.ConclusionAt the first stage of illness, antipsychotic-naïve patients with schizophrenia display moderate/severe impairments in all the cognitive domains assessed. The results support the contention of a global cognitive dysfunction in schizophrenia that to some extent may be determined by impaired processing speed.     

Could schizophrenic subjects improve their social cognition abilities only with observation and imitation of social situations?

Schizophrenics display impairments in domains of social cognition such as theory of mind and emotion recognition. Recent studies, showing that the relationship of social cognition abilities with functional outcome is more significant than other neuro-cognitive functions, have considered these abilities as a target for intervention research. This article describes preliminary data from a new group-based study focused on Emotion and ToM Imitation Training (ETIT), an imitation treatment aimed at improving social cognition and social functioning in schizophrenia.

In the present study, 16 outpatients with schizophrenia completed ETIT assessment and were compared with 17 outpatients who participated to a Problem Solving Training group. Participants were assessed at pre- and post-test on measures of emotion recognition, theory of mind, cognition, flexibility and social functioning. We compared the rehabilitation training effects on neuro-physiological activation through the event-related potentials (ERPs) method, which was recorded pre- and post-rehabilitation training. The results showed that when compared to the control group, ETIT participants improved on every social cognitive measure and showed better social functioning at post-test. Improvement in social cognition, in particular in emotion recognition, is also supported by ERP responses: we recorded an increase in electroactivity of medio-frontal areas only after ETIT treatment. Action observation and imitation could be regarded as a new frontier in rehabilitation.     

The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

Background: In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. Methods: Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. Results: Expert surveys identified 4 core domains of social cognition—emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. Discussion: While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area.Key words: schizophrenia, measurement, emotion processing, social perception, theory of mind, attributions, SCOPE     

Impairments of facial emotion recognition and theory of mind in methamphetamine abusers

Chronic use of methamphetamine is related to behavioral disturbances including depression, aggressive behavior, and social isolation. These alterations of social behavior may be attributable to impairments in social cognition. However, few studies have evaluated social cognition in methamphetamine (MA) abusers. Therefore, the aim of the present study was to investigate whether MA abusers exhibit social cognition deficits in terms of facial emotion recognition and theory of mind (ToM). We also assessed cognitive flexibility by using the Wisconsin Card Sorting Test (WCST) to evaluate the impact of this function on social cognition. Twenty-eight MA abusers and twenty-seven healthy subjects enrolled in this study. All participants performed the Facial Emotion Recognition Task and advanced ToM tasks such as the Eye Test and Hinting Task. The Korean Wechsler Adult Intelligence Scale—Revised and computerized versions of the WCST were also administrated. The performances of MA abusers on the Facial Emotion Recognition Task and Eyes Test were lower than those of healthy subjects. In the WCST, MA abusers completed significantly fewer categories and made more total and perseverative errors than healthy subjects did. In addition, impairments in cognitive flexibility are correlated with impairments in facial emotion recognition and ToM within MA abusers. These findings lend further support to the assertion that the capacity to identify emotions from facial expression and infer mental state of others is impaired in MA abusers. Therefore, treatment and rehabilitation for MA abusers must consider role of social cognition and include relearning social interactions and behaviors.     

Cognition sociale dans la schizophrénie et les troubles du spectre de l’autisme : points de convergences et différences fonctionnelles

Introduction

Schizophrenia and autistic spectrum disorder (ASD) are two neurodevelopmental disorders that have different symptom presentations, ages of onset and developmental courses. Both schizophrenia and ASD are characterized by marked deficit in communication, social interactions, affects and emotions. Social cognitive impairments in ASD and schizophrenia were demonstrated separately in both disorders. It was reported that these impairments have direct relation with social deficits of both disorders. The apparent similarity between social cognition impairments in ASD and schizophrenia highlights questions about the existence of common or different neurocognitive mechanisms related to social dysfunctions. In order to examine these questions, the present article provides a comprehensive review of all published studies which directly compare individuals with ASD and schizophrenia on the same cognitive tasks of social cognition.

Emotion-elicited gamma synchrony in patients with first-episode schizophrenia: a neural correlate of social cognition outcomes

Background

Schizophrenia may be understood as a disorder of neural synchrony. There is also increasing evidence that emotional and social cognitive impairments are central to this disorder. In patients with first-episode schizophrenia, we examined whether emotion perception is associated with disruptions to high-frequency (40 Hz) gamma synchrony and whether these disruptions predict self-regulatory adaptive compensations reflected in social cognitive behaviours.

Methods

We obtained electroencephalography recordings from 28 patients with first-episode schizophrenia and matched healthy controls during perception of facial emotion under both conscious and nonconscious conditions. We extracted gamma-band synchrony from the electroencephalogram. We also used behavioural measures of emotion identification, emotional intelligence, negativity bias and social function, along with ratings of first-episode schizophrenia symptoms. We analyzed group differences and predicted social cognition to assess the potential contribution of medication.

Results

Within 200 ms poststimulus, patients with first-episode schizophrenia showed alterations in gamma synchrony during both conscious and nonconscious emotion perception. Stimulus-locked synchrony was reduced in patients, particularly over the temporal cortex, whereas complementary enhancements in absolute gamma synchrony (independent of stimuli) were more distributed over temporal and left parieto-occipital regions. This pattern of altered synchrony predicted poor performance on each measure of social cognition among these patients. Medication dosage did not correlate significantly with either gamma synchrony or behavioural measures in this group.

Limitations

Limitations to our study include the lack of comparison between medicated and unmedicated patients or between types of medication.

Conclusion

These findings suggest that disruptions in integrative processing of motivationally important stimuli show promise as a potential biological marker of social cognitive impairments, present from the first episode of schizophrenia, and their outcomes.     

Effects of antipsychotic treatment on emotion perception deficits in first-episode schizophrenia

OBJECTIVE: The authors evaluated emotion perception in acutely ill patients experiencing a first episode of schizophrenia. They also investigated the effects of antipsychotic medication on emotion perception. METHOD: Tests of the ability to perceive and discriminate emotional expressions from the Penn Computerized Neuropsychological Battery were given to 13 patients experiencing their first episode of schizophrenia. Patients were also assessed with the Positive and Negative Syndrome Scale. The patients were tested while they were unmedicated and again following clinical stabilization. Healthy individuals were evaluated over a similar time interval. RESULTS: Patients with first-episode schizophrenia demonstrated impairments in emotion perception before treatment and no significant improvement after treatment. Emotion perception deficits were correlated with negative symptoms after clinical stabilization. CONCLUSIONS: Deficits in emotion perception are present at illness onset in schizophrenia and show minimal response to effective antipsychotic treatment.     

Emotion recognition, 'theory of mind,' and social behavior in schizophrenia

Several studies have demonstrated that patients with schizophrenia are impaired in recognizing emotions from facial expressions and in appreciating other people's mental states--the latter commonly referred to as 'theory of mind.' The question as to how social cognitive skills relate to patients' actual social behavior is, however, largely unanswered. This study examined emotion recognition, 'theory of mind,' and social behavior in schizophrenia. Emotion recognition, 'theory of mind,' executive functioning, 'crystallized' verbal intelligence, psychopathology, and social behavior were assessed in patients with schizophrenia compared with a healthy control group. Patients were significantly impaired on all tasks involving executive functioning, emotion recognition, and 'theory of mind.' Impaired executive functioning did, however, only partially account for the deficits in social perception and social cognition. Social perception and cognition in schizophrenia predicted the odds of being a patient significantly better than nonsocial cognition. Severe social behavioral abnormalities were linked to the duration of the illness, and even more so to 'theory of mind' deficits. Considering impaired social perception and social cognition significantly contributes to the understanding of social behavioral problems in schizophrenia.     

The use of narrative sampling in the assessment of social cognition: The Narrative of Emotions Task (NET)

Social cognitive deficits in schizophrenia are well documented and related to functional outcome. Current social cognition measures are often not psychometrically validated, too heterogeneous for standardization, and focus principally on one domain of social cognition rather than the simultaneous activation of multiple domains. Also, few if any allow for personalization of stimuli and interpretation of personally evocative events. An alternative methodology that addresses these limitations is the analysis of samples of personal narratives. The present study evaluates the psychometric properties of a measure called the Narrative of Emotions Task (NET). The NET was used to assess the performance of participants with a diagnosis of schizophrenia or schizoaffective disorder and nonclinical controls. Use of the NET revealed significant impairments in the emotional narratives of participants with schizophrenia. Various NET indices were significantly related to current measures of theory of mind and emotion perception, as well as a social skills role-play, but were not related to measures of attributional style or clinician-rated functioning scales. Overall, the NET?s psychometric properties justify further use of the narrative sampling method of social cognition assessment in this population.     

Disturbances of social cognition in schizophrenia

Social cognition is an ability to perceive socially relevant stimuli and to behave accordingly. It is connected with the processing of information brought about by significant social stimuli. Recently, social cognition is a topic of intensive research in psychology, neurosciences and psychiatry. Processes involved in social cognition include: perception of emotion, input of eye contact, reaction to voice prosody or decision-making in social situations. A particular role is played by the mentalizing capabilities (mind-reading) i.e. ability to interpret behaviour of others by attributing them certain mental states. Such an ability is often conceptualized as the Theory of Mind (ToM). This paper is a review of issues connected with disturbances of social cognition in patients with schizophrenia. Deficits in perceptions of face emotion and disturbances of Theory of Mind function in schizophrenia were discussed with special regard to their potential role as endophenotypes of vulnerability to schizophrenia. Also, relations between social cognition and basic neurocognitive processes were presented, as well as the effect on social cognition of different methods of schizophrenia treatment.     

Facial emotion perception differs in young persons at genetic and clinical high-risk for psychosis

A large body of literature has documented facial emotion perception impairments in schizophrenia. More recently, emotion perception has been investigated in persons at genetic and clinical high-risk for psychosis. This study compared emotion perception abilities in groups of young persons with schizophrenia, clinical high-risk, genetic risk and healthy controls. Groups, ages 13–25, included 24 persons at clinical high-risk, 52 first-degree relatives at genetic risk, 91 persons with schizophrenia and 90 low risk persons who completed computerized testing of emotion recognition and differentiation. Groups differed by overall emotion recognition abilities and recognition of happy, sad, anger and fear expressions. Pairwise comparisons revealed comparable impairments in recognition of happy, angry, and fearful expressions for persons at clinical high-risk and schizophrenia, while genetic risk participants were less impaired, showing reduced recognition of fearful expressions. Groups also differed for differentiation of happy and sad expressions, but differences were mainly between schizophrenia and control groups. Emotion perception impairments are observable in young persons at-risk for psychosis. Preliminary results with clinical high-risk participants, when considered along findings in genetic risk relatives, suggest social cognition abilities to reflect pathophysiological processes involved in risk of schizophrenia.     

Spatial working memory and problem solving in schizophrenia: the effect of symptom stabilization with atypical antipsychotic medication

Reasoning and problem solving in the spatial domain are important aspects of executive function that are reliably impaired in schizophrenia, and the Groton Maze Learning Test(c) (GMLT) provides a valid measure of spatial working memory. In the current study, 34 patients with first-episode schizophrenia and 20 matched controls were assessed for baseline spatial working memory abilities using this hidden maze learning test. Approximately one month after baseline assessment, allowing for symptoms to stabilize in response to treatment with therapeutic doses of atypical antipsychotic medications for individuals with schizophrenia, all participants were again assessed with the GMLT. Prior to pharmacologic intervention, patients with schizophrenia showed significant impairments in performance of all aspects of the GMLT, including measures of learning efficiency and error monitoring. One month of treatment was associated with a reliable improvement in these domains, although impairments in accuracy and error monitoring on this spatial working memory test persisted despite symptomatic improvement. These results indicate that impairments in spatial working memory are present at the earliest stages of the illness, and that such deficits in performance remain present, albeit ameliorated, after treatment with atypical antipsychotic medication.     

Social cognitive impairments in first episode psychosis

BACKGROUND: Social cognition is a complex phenomenon involving several distinct processes. Numerous studies have shown that individuals with schizophrenia are largely impaired on this domain of cognition. However, most have focused on a single aspect of social cognition, namely "theory of mind" and/or included patients with long standing illness. OBJECTIVE: The main objective of the present study was to identify social cognition deficits in first episode of schizophrenia spectrum psychosis using a case control design and a comprehensive assessment that allowed the exploration of several dimensions of this phenomenon. SUBJECTS: 36 patients with a first episode of psychosis and 25 healthy controls participated in this study. MATERIAL: Measures of social cognition included the Hinting Task and the Four Factor Test of Social Intelligence. RESULTS: Significant group differences were found on both tasks, but the Four Factor Test of Social Intelligence revealed a stronger group effect and the effects observed remained significant once IQ was covaried. Social cognition did not show any correlations with level of symptoms. CONCLUSION: Social cognition deficits are present during the first episode of psychosis. These impairments do not seem to be a consequence of group differences in overall intellectual functioning and are likely to be state-independent.     

Emotion recognition in individuals at clinical high-risk for schizophrenia

Problems in the perception of emotional material, in particular deficits in the recognition of negative stimuli, have been demonstrated in schizophrenia including in first-episode samples. However, it is largely unknown if emotion recognition impairment is present in people with subthreshold psychotic symptoms. Here, we examined the capacity to recognize facially expressed emotion and affective prosody in 79 individuals at ultra high-risk for psychosis, 30 clinically stable individuals with first-episode schizophrenia assessed as outpatients during the early recovery phase of illness, and 30 unaffected healthy control subjects. We compared (1) scores for a combined fear-sadness aggregate index across face and voice modalities, (2) summary scores of specific emotions across modalities, and (3) scores for specific emotions for each sensory modality. Findings supported deficits in recognition of fear and sadness across both modalities for the clinical groups (the ultra high-risk and first-episode group) as compared with the healthy controls. Furthermore, planned contrasts indicated that compared with the healthy control subjects, both clinical groups had a significant deficit for fear and sadness recognition in faces and for anger recognition in voices. Specific impairments in emotion recognition may be apparent in people at clinical high-risk for schizophrenia before the full expression of psychotic illness. The results suggest a trait deficit and an involvement of the amygdala in the pathology of ultra high-risk states.     

The Effect of Context Processing on Different Aspects of Social Cognition in Schizophrenia

Background: It is well known that individuals with schizophrenia have impaired social cognition. The construct of social cognition involves several components, including perception, interpretation, and the ability to integrate context (Adolphs R. The neurobiology of social cognition. Curr Opin Neurobiol. 2001;11:231–239; Brothers L. The social brain: a project for integrating primate behavior and neurophysiology in a new domain. Concepts Neurosci. 1990;1:27–61). Importantly, a number of studies have suggested that deficits in context processing underlie cognitive dysfunction in schizophrenia (Penn DL, Corrigan PW, Bentall RP, Racenstein JM, Newman L. Social cognition in schizophrenia. Psychol Bull. 1997;121(1):114–132; Green MF, Nuechterlein KH. Should schizophrenia be treated as a neurocognitive disorder? Schizophr Bull. 1999;25:309–319). Thus, the purpose of the current study was to investigate the relationship between context processing and different aspects of social cognition in schizophrenia. Method: Individuals with schizophrenia (n = 41) and the healthy controls (n = 32) participated in this study. The participants completed 2 sections of The Awareness of Social Inference Test: (1) social inference minimal (SI-M) and (2) social inference enriched (SI-E). They also completed face and voice emotion discrimination tasks. In addition, we used the AX-Continuous Performance Test (AX-CPT) to measure context processing and the n-back task to measure working memory more generally. Results: AX-CPT performance in schizophrenia was positively correlated with both SI-M and SI-E performance but not with either the face or the voice discrimination. Furthermore, the correlation between AX-CPT performance and SI-M/SI-E performance was significantly stronger in individuals with schizophrenia than in controls. Conclusion: These results suggest that impairments in context processing are related to inferential components of social cognition in schizophrenia but not to the ability to recognition facial or vocal emotion. As such, deficits in context processing may contribute to deficits in both “hot” and “cold” aspects of cognition in schizophrenia.