Language abnormality in deaf people with schizophrenia: a problem with classifiers

Introduction: Although there is evidence for language abnormality in schizophrenia, few studies have examined sign language in deaf patients with the disorder. This is of potential interest because a hallmark of sign languages is their use of classifiers (semantic or entity classifiers), a reference-tracking device with few if any parallels in spoken languages. This study aimed to examine classifier production and comprehension in deaf signing adults with schizophrenia.

Method: Fourteen profoundly deaf signing adults with schizophrenia and 35 age- and IQ-matched deaf healthy controls completed a battery of tests assessing classifier and noun comprehension and production.

Results: The patients showed poorer performance than the healthy controls on comprehension and production of both nouns and entity classifiers, with the deficit being most marked in the production of classifiers. Classifier production errors affected handshape rather than other parameters such as movement and location.

Conclusions: The findings suggest that schizophrenia affects language production in deaf patients with schizophrenia in a unique way not seen in hearing patients.     

Integration of emotional and cognitive aspects of theory of mind in schizophrenia and its relation to prefrontal neurocognitive performance

Introduction. There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). Whereas previous studies have focused on general ToM abilities, the present study is aimed at testing the underlying behavioural and neurocognitive mechanisms of the impaired integration of affective and cognitive aspects of ToM (the integration of emotional information with mentalising) in patients with schizophrenia.

Methods. Twenty-six patients with schizophrenia and 35 healthy controls were tested on two ToM tasks involving the integration of affective and cognitive ToM abilities: “Faux Pas” and “reading the mind in the eyes” tasks. To assess the neurocognitive bases of impaired ToM, the ID/ED test (intradimensional/extradimensional shifting test from the CANTAB) was administered.

Results. Patients performed poorly on both the cognitive-affective integration ToM tasks and the ID/ED task as compared to controls. Furthermore, patients’ ToM scores were selectively correlated with the reversal trials, which are believed to be associated with orbitofrontal functioning. In addition, more than 50% of the variance in recognising and understanding Faux Pas could be explained by patients’ symptomatology. Performance on orbitofrontal related tasks was correlated with subjects’ Faux Pas scores in the patients group, but not in the healthy control group.

Conclusions. Schizophrenic patients appear to have considerable impairment in affective and cognitive ToM integration, which may be related to orbitofrontal dysfunction. These results are in line with previous findings regarding empathy and the importance of the orbitofrontal area in the integration of cognition and affect.     

Emotional management and 5-HT2A receptor gene variance in patients with schizophrenia

Individuals with schizophrenia exhibit impaired social cognitive functions, particularly emotion management. Emotion management may be partially regulated by the serotoninergic system; the −1438 A/G polymorphism in the promoter region of the 5-HT2A gene can modulate 5-HT2A activity and is linked to certain emotional traits and anger- and aggression-related behaviors. The current study aimed to investigate whether this 5-HT2A genetic variance is associated with social cognitive function, particularly the management of emotions. One hundred and fifteen patients with chronic schizophrenia were stabilized with an optimal-dose of antipsychotic treatment. All were genotyped for the −1438 A/G polymorphism and assessed with symptom rating scales, neurocognitive instruments, and the “Managing Emotions” section of Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). Multiple regression showed that patients with the A/G genotype performed better than those with G/G in managing emotion (p = 0.018) but did not differ from those with the A/A genotype. Regarding the two subtasks of the Managing Emotions section, the A/G heterozygotes also performed better than the G/G homozygotes in the emotion management (p = 0.026) and emotional relations (p = 0.027) subtasks. The results suggest that variability in the 5-HT2A gene may influence emotion management in patients with schizophrenia.     

Assessing early processing of eye gaze in schizophrenia: measuring the cone of direct gaze and reflexive orienting of attention

Introduction: The accurate discrimination of another person’s eye-gaze direction is vital as it provides a cue to the gazer’s focus of attention, which in turn supports joint attention. Patients with schizophrenia have shown a “direct gaze bias” when judging gaze direction. However, current tasks do not dissociate an early perceptual bias from high-level top-down effects. We investigated early stages of gaze processing in schizophrenia by measuring perceptual sensitivity to fine deviations in gaze direction (i.e., the cone of direct gaze: CoDG) and ability to reflexively orient to locations cued by the same deviations.

Methods: Twenty-four patients and 26 controls completed a CoDG discrimination task that used realistic direct-face images with six fine degrees of deviation (i.e., 3, 6 or 9 pixels to the left and right) and direct gaze, and a gaze cueing task that assessed reflexive orienting to the same fine-grained deviations.

Results: Our data showed patients exhibited no impairment in gaze discrimination, nor did we observe a reduced orienting response.

Conclusions: These results suggest that while patients may suffer deficits associated with interpreting another person’s gaze, the earliest processes concerned with detecting averted gaze and reflexively orienting to the gazed-at location are intact.     

Factor Structure of the Neurocognitive Tests: An Application of the Confirmative Factor Analysis in Stabilized Schizophrenia Patients

The purpose of the present study was to identify the factor structure of neurocognitive tests used on schizophrenia patients by using the confirmative factor analysis, and to assess the factor score differences of schizophrenia patients and healthy controls. Comprehensive neurocognitive tests were administered to stabilized schizophrenia patients (N=114) and healthy controls (N=120). In the results of factor analyses on patients, the multifactorial-6-factor model, which included the speed of processing, working memory, verbal learning and memory, visual learning and memory, attention/vigilance, and reasoning/problem solving as suggested by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS), showed the better goodness of fit than any of the other models tested. And assessing the group differences of factor scores, we found the patients performed worse than the controls in all factors, but the result showed meaningful variations of impairments across the cognitive factors. Our study identifies the six major domains with multifactorial structure of cognitive abilities in schizophrenia patients and confirms the distinctive impairment patterns of each cognitive domain. These results may have utility in better understanding the pathology of schizophrenia as well as in genetic studies.     

阿立哌唑与利培酮治疗女性精神分裂症患者的对照研究

目的探讨阿立哌唑对女性精神分裂症患者的远期疗效。方法将60例女性精神分裂症患者按入院顺序分配到阿立哌唑组与利培酮组,进行为期6周的临床对照研究和1年的随访研究。采用简明精神病量表(BPRS)、治疗时出现的症状量表(TESS)及实验室检查研究疗效和安全性。结果治疗6周后两组BPRS评分均较治疗前显著下降且有显著差异(t=2.37,2.58;P<0.01),6周内各时点两组间BPRS总分无统计学差异;阿立哌唑组和利培酮组治疗有效率均为90%,两组均未发生严重不良反应。出院1年后,利培酮组BPRS分明显上升,与阿立哌唑组相比有显著差异(t=2.34,P<0.05);阿立哌唑组和利培酮组的复发率和再住院率分别为(16.7%,10%)、(36.7%,23.3%),两组比较均有显著差异(χ2=4.69,6.58;P<0.05)。结论阿立哌唑能较好地控制精神症状;不良反应小,对女性精神分裂症患者有较好的远期治疗效果。     

Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes

Introduction: Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes.

Methods: Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations.

Results: Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance.

Discussion: We argue that impaired IA, affecting 25–50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.     

缓解期精神分裂症患者生活质量及其与社会支持等因素的相关研究

目的了解缓解期精神分裂症患者的生活质量及其社会支持等因素对缓解期精神分裂症患者生活质量的影响。方法采用生活质量综合评定问卷（GQOL-74）对50例缓解期精神分裂症综合评定并与50名正常人进行对照，对缓解期精神分裂症患者同时施测社会支持评定量表（SSAS）、阳性与阴性症状量表（PANSS）和药物不良反应量表（TESS）。结果①生活质量总分和社会功能维度分研究组显著低于对照组；②社会支持与生活质量总分及躯体功能、心理功能和社会功能维度存在显著正相关；⑧药物副反应与生活质量总分及躯体功能和心理功能雄度存在显著负相关；④阳性症状与生活质量总分及心理功能维度存在显著负相关，阴性症状与生活质量总分及物质生活、躯体功能、心理功能和社会功能维度均存在显著负相关。结论缓解期精神分裂症患者的生活质量低于正常对照组，并且与社会支持、药物副反应和精神症状密切相关。     

Body language reading of emotion and outcome in schizophrenia

Introduction: Although considered a promising design for testing social cognition, it is not clear to what extent the EmoBio test of emotion recognition actually predicts community functioning. It is also not clear whether the test measures something unique or different from nonsocial cognition. The present study tests whether EmoBio accounts for GAF function score and two operationalised community outcome measures. The study also analyses cognitive predictors of EmoBio performance, testing whether stimulus modality affects prediction.

Methods: Eighty-three patients with schizophrenia were tested with EmoBio, the cognitive battery MCCB and WAIS-IV.

Results: EmoBio accounted for a significant portion of variance in all three outcome measures. Only EmoBio predicted Lifetime Relationship status, and EmoBio remained a significant predictor of Independent living beyond non-social cognition. All cognitive measures contributed significantly to the variance in EmoBio, but entered together explained only a third of total variance.

Conclusion: The study shows that emotion recognition accounts for community outcome. There was no clear effect of test-modality in predicting EmoBio performance, indicating no method invariance problem with EmoBio. It also indicates that the mechanisms underlying impaired social cognition in schizophrenia are different from the hypothesised non-verbal learning deficits in the disorder.     

A multivariate perspective on schizotypy and familial association with schizophrenia: a review

Although generally accepted that schizotypal personality disorder diagnosis is more prevalent among relatives of individuals with schizophrenia and may be associated with genetic liability to schizophrenia, it seems likely that this diagnosis is itself heterogeneous and thus perhaps not as useful in identifying genes that affect schizophrenia risk (i.e. endophenotypes) as it could be. In contrast, symptoms and dimensions of schizotypal personality disorder may be more etiologically homogeneous, and thus more useful in genetic studies. The current review evaluated and consolidated evidence to date regarding specific symptoms and dimensions of schizotypal personality disorder among non-psychotic relatives of schizophrenia patients. Comparisons were made with relatives of affective disorder patients and non-psychiatric controls. Findings indicate strong support for elevation of social-interpersonal schizotypal symptoms among relatives of schizophrenia patients versus other groups along with moderate specificity. Results suggest only a small elevation of cognitive-perceptual and disorganized symptoms in relatives of schizophrenia patients and results for disorganized symptoms were inconsistent across studies. Thus, evidence to date supports further investigation of genetic associations between symptoms of schizotypal personality disorder and schizophrenia, and suggests that social-interpersonal symptoms may be particularly promising in genetic analyses of schizophrenia.     

Numbers are represented in egocentric space: Effects of numerical cues and spatial reference frames on hand laterality judgements

Convergent findings demonstrate that numbers can be represented according to a spatially oriented mental number line. However, it is not established whether a default organization of the mental number line exists (i.e., a left-to-right orientation) or whether its spatial arrangement is only the epiphenomenon of specific task requirements. To address this issue we performed two experiments in which subjects were required to judge laterality of hand stimuli preceded by small, medium or large numerical cues; hand stimuli were compatible with egocentric or allocentric perspectives. We found evidence of a left-to-right number–hand association in processing stimuli compatible with an egocentric perspective, whereas the reverse mapping was found with hands compatible with an allocentric perspective. These findings demonstrate that the basic left-to-right arrangement of the mental number line is defined with respect to the body-centred egocentric reference frame.     

On the specificity of positive emotional dysfunction in psychopathology: Evidence from the mood and anxiety disorders and schizophrenia/schizotypy

We review recent research to establish that the associations between positive emotional experience and major forms of psychopathology show considerable specificity. Although indicators of low positive affect are consistently related to both social anxiety/social phobia and schizophrenia/schizotypy, they are more strongly linked to depression, thereby displaying relative specificity. Moreover, low positive affect actually shows greater specificity than the diagnostic criteria for depression and is most strongly related to those symptoms (anhedonia, dysphoria, lassitude, suicidality) that are specific to the disorder. With regard to social phobia, findings suggest that low positive affect is more strongly related to the generalized subtype than to the non-generalized performance subtype. Analyses of schizophrenia/schizotypy indicate that although low positive affect is consistently associated with the negative symptoms (e.g., constricted affect, social aloofness), it is only weakly related to positive symptoms (e.g., magical thinking, perceptual aberrations, suspiciousness). Other data suggest that schizophrenia is associated with an anticipatory pleasure deficit, such that individuals with the disorder engage in rewarding activities less frequently because they do not expect to derive pleasure from them. Finally, we summarize evidence indicating that elevated positive affect is both a risk factor for bipolar disorder and a concomitant of manic symptoms.     

Correlates of preferring a passive role in decision-making among patients with schizophrenia or bipolar disorder

ObjectiveTo assess the factors associated with the persistence of clinician-led style in the therapeutic relationship in cases of serious mental illness, and the conditioning factors that the patients identify as determinants of their health.MethodAssessment of preferences in the decision-making process and health-related control locus of 107 outpatients with DSM-5 diagnosis of schizophrenia or bipolar disorder. Demographic and clinical information was also obtained through review of available records and using several scales.Results64.4 % patients preferred to adopt a passive role in the therapeutic relationship. In the multivariate analysis, the preference of playing a passive role in the decision-making process was significantly associated with the elderly, being disabled, or the view that one’s health depends on doctors (AUC ROC value: 0.80).ConclusionsPatients with severe mental illness more frequently preferred a passive role in the decision-making process. We found several factors associated with a preference for the “expert role” model.Practice implicationsThe identified factors may permit care to be tailored to the most probable expectations as regard decision-making. Since the populations concerned may be vulnerable and suffer inequalities in the provision of health services, promoting participation in the care process could help improve clinical parameters ethically.     

Overinclusive thought and loosening of associations are not unique to schizophrenia and are produced in Alzheimer's dementia

Introduction. Bleuler's concept of loosening of associations which he believed epitomised psychotic thinking can manifest as overinclusion (merging of semantic categories) on semantic categorisation tasks. Overinclusion is explained by excessive activation within the semantic memory network to subordinate features with low associative strength. Therefore patients with degradation of subordinate semantic knowledge (e.g., with Alzheimer's Dementia—AD) should not produce overinclusion errors.

Methods. 22 people with schizophrenia and 26 people with AD (nonpsychotic, semantic memory impairment) were compared on a semantic categorisation test, the Category Generation Test (CGT). The CGT involves free-sorting 45 cards of pictured objects from five taxonomic groups (e.g., animals). Overinclusion and underinclusion (subdivision of categories) errors were recorded and the strategies used in generating these abnormal categories were explored qualitatively.

Results. Two-thirds of both groups generated abnormal categories, including frequent overinclusions. Using a semantic probes test, abnormal categorisations could not be attributed to knowledge degradation as this appeared preserved. Qualitatively, the two groups differed in their sorting strategies.

Conclusions. Loosening of associations is found in nonpsychotic people, who have semantic memory impairments (e.g., AD), using semantic knowledge tasks. However there may be different explanations; atypical semantic categorisation in schizophrenia appears to result from attention to thematic rather than feature-based associations.     

Metacognition and social function in schizophrenia: Associations over a period of five months

Introduction. Deficits in the ability to think about thinking have been widely observed in persons with schizophrenia and linked with concurrent assessments of various forms of function. Less is known though about their links to outcome over time. To address this issue, the current study explores whether Mastery, a domain of metacognition that reflects the ability to use knowledge about one's own mental states and those of others to respond to psychological challenges, is related to the frequency of social contact and persons’ capacity for social relatedness.

Methods. Participants were 72 adults with schizophrenia spectrum disorders enrolled in vocational rehabilitation; these patients completed a baseline assessment as well as a follow-up assessment 5 months later. Mastery was assessed using the Metacognitive Assessment Scale and social functioning by the Quality of Life Scale.

Results. Using structural equation modelling, the proposed model demonstrated acceptable fit even when a range of possible confounding variables were entered as covariates.

Conclusions. Results are consistent with the possibility that certain forms of metacognition affect social function among persons with schizophrenia, both concurrently and over time.     

Enhancing tolerability of a measure of social perception in schizophrenia: comparison of short and long Norwegian versions of the Relationships Across Domains test

Introduction: Relationship perception focuses on social interactions, is reduced in schizophrenia and is related to daily functioning. It can be assessed with the Relationships Across Domains (RAD) test, built on Relational Models Theory which states that people use four relational models to interpret social interaction. RAD is time consuming, low on tolerability and only used in English-speaking countries. We evaluated the psychometric properties of a translated, abbreviated Norwegian version.

Methods: Sixty-two schizophrenia participants and 56 healthy controls underwent assessments of social and non-social cognition. The schizophrenia group completed functional and clinical measures. RAD’s internal consistency was investigated with Cronbach’s alphas, group differences with logistic regressions and associations between study variables with Pearson’s correlations.

Results: RAD was reduced from 25 (Cronbach’s alpha?=?.809) to 12 vignettes (Cronbach’s alpha?=?.815). Schizophrenia participants had significant impairments, with larger effect sizes for the full version. Associations of RAD with study variables were similar for the two versions: smaller for clinical measures and larger for functional and cognitive measures. Results were comparable to results for the English version.

Conclusions: The length of the Norwegian RAD was reduced while retaining its psychometric properties, which were similar to the English version. This suggests the test’s cross-cultural utility.