Neurocognitive and social cognitive predictors of interpersonal skill in schizophrenia

Social dysfunction is among the major criteria for receiving a diagnosis of schizophrenia, and research indicates that the impairments in social functioning experienced by individuals with schizophrenia are strongly related to deficits in interpersonal skills. In turn, these deficits in interpersonal skills have been linked to impairments in general cognitive abilities and impairments in social cognition. This study explored the relationship between neurocognition, social cognition, and interpersonal skills in 49 outpatients with schizophrenia and 44 non-clinical control participants. Results indicate that individuals with schizophrenia demonstrated impaired performance across several domains of neurocognitive and social cognitive functioning as well as interpersonal skills. In addition, among the participants with schizophrenia, social cognition significantly contributed unique variance to interpersonal skill beyond that of neurocognition. This pattern was not observed in the non-clinical control sample. These findings have implications for the treatment of the disorder and represent an important step in understanding the role of social cognition in schizophrenia.     

Social cognition in schizophrenia: relationships with neurocognition and negative symptoms

Despite the growing importance of social cognition in schizophrenia, fundamental issues concerning the nature of social cognition in schizophrenia remain unanswered. One issue concerns the strength of the relationships between social cognition and key features of the disorder such as neurocognitive deficits and negative symptoms. The current study employed structural equation modeling to examine three key questions regarding the nature of social cognition in schizophrenia: 1) Are social cognition and neurocognition in schizophrenia better modeled as one or two separate constructs? 2) Are social cognition and negative symptoms in schizophrenia better modeled as one or two separate constructs?, and 3) When social cognition, neurocognition, and negative symptoms are included in a single model, is social cognition more closely related to neurocognition or to negative symptoms? In this cross sectional study, one hundred outpatients with schizophrenia or schizoaffective disorder were administered measures of social cognition, neurocognition, and negative symptoms. A two-factor model that represented social cognition and neurocognition as separate constructs fit the data significantly better than a one-factor model, suggesting that social cognition and neurocognition are distinct, yet highly related, constructs. Likewise, a two-factor model that represented social cognition and negative symptoms as separate constructs fit the data significantly better than a one-factor model, suggesting that social cognition and negative symptoms are distinct constructs. A three-factor model revealed that the relationship between social cognition and neurocognition was stronger than the relationship between social cognition and negative symptoms. The current findings start to provide insights into the structure of social cognition, neurocognition, and negative symptoms in schizophrenia.     

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.     

Social cognition in first-degree relatives of people with schizophrenia: A meta-analysis

Social cognition is affected in people with schizophrenia, but whether this is the case for healthy relatives of these patients is less clear. The presence of social cognition impairments in relatives would suggest a potential genetic role of social cognition in schizophrenia. To determine whether social cognition is affected in first-degree relatives of people with schizophrenia and examine the impact of potential moderator variables, a meta-analysis of studies investigating at least one domain of social cognition (mentalizing, emotional processing, social perception, social knowledge and/or attributional style) in adult first-degree relatives of patients with schizophrenia was performed. Our inclusion criteria were satisfied by 29 studies, of which 11 evaluated mentalizing, 20 emotional processing, and two social perception. Moderate mean effect sizes were obtained for these three components. Across all studies, effect sizes were significantly correlated with IQ and age differences between groups, calling for careful group matching for future studies. Overall, the results from this meta-analysis highlight that social cognition is globally affected in first-degree relatives of people with schizophrenia, suggesting that social cognition deficits in schizophrenia may be related to a genetic vulnerability for the disorder.     

A functional magnetic resonance imaging study of social cognition in schizophrenia during an acute episode and after recovery

OBJECTIVE: Difficulty with social interactions is a characteristic of schizophrenia. The authors used functional magnetic resonance imaging (fMRI) to investigate brain activation changes during a social cognition paradigm in patients with schizophrenia during and after an acute episode and their association with social and executive function. METHOD: In a longitudinal study design, 14 patients with schizophrenia experiencing an acute episode had an fMRI scan. They returned for a follow-up scan after clinical improvement. Fourteen healthy comparison subjects were also scanned twice with approximately the same time interval between scans as in the patient group. The authors employed a social cognition fMRI paradigm involving empathic and forgivability judgments. Schizophrenia symptoms, social functioning and illness insight scales, and the Wisconsin Card Sorting Test were used to examine whether improvement on these measures was associated with recovery of brain activation in response to the social cognition paradigm. RESULTS: After recovery from the acute episode, patients exhibited increased activation in the left medial prefrontal cortex, which was, in turn, significantly correlated with improved insight and social functioning. Decreased symptom severity and improved performance on the Wisconsin Card Sorting Test were not significantly associated with increased left medial prefrontal cortex activation. CONCLUSIONS: This is the first study to the authors' knowledge to use a social cognition paradigm to reveal improved left medial prefrontal cortex activation in schizophrenia after recovery from an acute episode. These results suggest that restored left medial prefrontal cortex activation may mediate improvement of insight and social functioning in patients with schizophrenia.     

Implications for the neural basis of social cognition for the study of schizophrenia

OBJECTIVE: The study of social cognition in schizophrenia has received growing attention in recent years. At the same time, a large body of work has explored the neural basis of social cognition in both nonclinical and clinical groups, other than those with schizophrenia. The gap between these two literatures is considerable and may slow progress in creating a comprehensive social cognitive model of schizophrenia. This article attempts to bridge this gap by discussing how the neural basis of social cognition may inform future clinical research in schizophrenia. METHOD: PsycINFO and MEDLINE were systematically searched for articles pertaining to the neural basis of social cognition and social cognition in schizophrenia. Relevant studies were obtained and synthesized into a comprehensive review and integrative formulation. RESULTS: Striking parallels between these two areas of research were found. CONCLUSIONS: These parallels might help to better elucidate the underlying mechanisms for social cognitive and social behavioral impairments in schizophrenia as well as provide potential targets for treatment and drug development.     

Social cognition,social competence,negative symptoms and social outcomes: Inter-relationships in people with schizophrenia

Social deficits are common in people with schizophrenia and the treatment of deficits in social competence has been a long-time treatment strategy. However, negative symptoms and social cognitive deficits also contribute to social dysfunction. In this study, we examined the correlations between everyday social outcomes, a performance based measure of social competence, and performance on 8 different social cognition tests in 179 patients with schizophrenia. Social cognition, social competence, and motivation-related negative symptoms accounted for 32% of the variance in real-world social outcomes. In addition, two different social cognition tests, along with expression-related negative symptoms accounted for 32% of the variance in performance-based assessments of social competence. These data suggest that negative symptoms exert an important influence on social outcomes and social competence, but not social cognition, and that social cognition and social competence exert separable influences on real-world social outcomes. Improving social outcomes seems to require a multi-faceted approach which considers social cognition, social competence, and negative symptoms.     

Metacognitive and social cognition deficits in patients with significant psychiatric and medical adversity: a comparison between participants with schizophrenia and a sample of participants who are HIV-positive

Research exploring metacognition and social cognition in schizophrenia has tended to use control groups experiencing relatively little adversity. Therefore, it remains unclear whether the deficits found among persons with schizophrenia are merely the result of greater life adversity. To explore this issue, we assessed metacognition and social cognition among 40 participants with schizophrenia and 25 adults with HIV. We chose to explore this phenomenon in people with HIV given the literature suggesting that this group experiences significant adversity. Measures of metacognition and social cognition included the Metacognition Assessment Scale (MAS), the Hinting test, and the Bell-Lysaker Emotion Recognition Test (BLERT). After controlling for education, years since diagnosis, and memory, the schizophrenia group performed more poorly on the MAS and the Hinting test. No differences were found on the BLERT. The results are consistent with the possibility that schizophrenia is linked to decrements in metacognition and some forms of social cognition.     

Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia

OBJECTIVE: The potential of social cognition as a mediator of relations between neurocognition and functional status in schizophrenia has been suggested by correlational studies that link neurocognition to social cognition or link social cognition to functional status. The authors used structural equation modeling to test more directly whether one aspect of social cognition (social perception) mediates relations between basic visual perception and functional status in patients with schizophrenia. METHOD: Seventy-five outpatients with schizophrenia were administered measures of early visual processing (computerized visual masking procedures), social perception (Half Profile of Nonverbal Sensitivity), and functional status (Role Functioning Scale). RESULTS: Structural equation modeling supported social perception as a mediator of relations between early visual processing and functional status in schizophrenia. The mediation model indicated that early visual processing is linked to functional status through social perception, thereby supporting a significant indirect relationship. The direct relationship between early visual processing and functional status was significant in a model that did not include social perception but was not significant in the mediation model that included social perception. CONCLUSIONS: Social cognition appears to be a key determinant of functional status in schizophrenia. Using a very basic measure of visual perception, the present study found that social perception mediates the influence of early visual processing on functional status in schizophrenia.     

General and social cognition in first episode schizophrenia: identification of separable factors and prediction of functional outcome using the IntegNeuro test battery

OBJECTIVE: It is increasingly recognized that cognitive assessments, unlike symptom ratings, provide a reliable predictor of functional outcome in schizophrenia. This study evaluated the utility of the 'IntegNeuro' computerized test battery for assessing cognition in first episode schizophrenia. We determined the presence of separable factors of general and social cognition, their equivalence to the consensus domains identified by the NIMH MATRICS project, and their effectiveness in predicting real world functional outcomes. METHOD: Fifty six first episode schizophrenia (FES) patients and 112 matched healthy controls were assessed on the touchscreen-based 'IntegNeuro' cognitive test battery and FES patients for social functioning (SOFAS) and quality of life (WHOQOL-BREF). RESULTS: Principal components analysis identified i) six factors corresponding to MATRICS domains of general cognition ('Information Processing Speed', 'Verbal Recall', 'Working Memory Capacity', 'Sustained Attention/Vigilance', 'Verbal Processing', 'Executive Function'), ii) an 'Emotional Intelligence' factor corresponding to the MATRICS social cognition domain, and iii) an additional 'Sensori-Motor Function' factor of general cognition and 'Negativity' factor of social cognition. Patients showed impairments relative to controls across all factors, but especially for Working Memory Capacity, followed by Verbal Memory, Sustained Attention/Vigilance and Negativity. These factors strongly predicted poorer social functioning in FES, along with poorer quality of life in psychological, social, and health satisfaction facets. CONCLUSION: The IntegNeuro battery has utility for assessing separable domains of general and social cognition in FES, which are predictive of real world outcomes. Thus, it may be appropriate for clinical application, including in multi-center trials targeting new treatments for cognition in schizophrenia.     

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.     

Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia

It has been suggested in the research literature that facial affect processing (FAP) and theory of mind (ToM) are both potential mediators of the well-established relationship between cognition and functional outcome among people with schizophrenia. The current project tests the mediating potency of these two domains of social cognition among deaf and hearing people with schizophrenia. Sixty-five people (34 deaf, 31 hearing) were assessed using measures of verbal and visual memory, attention, visual processing, FAP, and ToM. The results suggest that each domain of cognition, save vigilance, exerts an effect on functional outcome indirectly through its influence on social cognition. The patterns of mediation varied when the samples were broken down by hearing status and analyzed separately. Namely, the cognitive tasks directly involving linguistic ability (early visual processing [EVP] and word memory) were best mediated by social cognition for hearing subjects. For deaf subjects, the nonlinguistic cognitive tasks (e.g., visual-spatial memory-recall and copy [VSM-recall and VSM-copy]) were best mediated by social cognition. While FAP and ToM were equally effective as mediators for hearing subjects, FAP was a more potent mediator than ToM for deaf subjects. This study extends prior work in the area of social cognition and schizophrenia and indicates that the development of cognitive rehabilitation strategies should include not only interventions targeting specific cognitive abilities, such as attention and memory, but should include an emphasis on social-cognitive domains, including FAP and ToM. Further, deaf and hearing subjects may benefit from interventions addressing aspects of cognition that support linguistic ability, especially as they relate to social cognition.     

Developmental theory for a cognitive enhancement therapy of schizophrenia

Recent findings on psychosocial and neurodevelopmental anomalies in schizophrenia patients indicate that deficits related to social cognition-the ability to act wisely in social interactions-may be important constraints on complete social and vocational recovery. Social cognition is acquired over many decades and appears to be partially independent of formal IQ and neuropsychological problems. It invites a more developmental approach to the rehabilitation of schizophrenia, one that we call Cognitive Enhancement Therapy (CET). CET draws on an emerging literature that implicates both pre- and postonset neurodevelopmental difficulties, as well as a complementary literature on diffuse neuropsychological impairments that supports the notion of a neurodevelopmental insult. We analyzed evidence for an associated developmental basis to social cognitive impairment in the context of a model that addressed both the acquisition of interpersonal wisdom and the adaptive process that might follow developmental failures. A contemporary model of human cognition is then used to identify the metacognitive functions that characterize the developmental acquisition of normal cognition and, by inference, the associated difficulties of many patients with schizophrenia. A rehabilitation strategy for schizophrenia, designed to facilitate the metacognitive transition from prepubertal to young adult social cognition, would thus emphasize developmental learning experiences during the remediation of social cognitive deficits. A "gistful" appraisal of interpersonal behavior and novel social contexts best reflects the theoretical intent of this new intervention.     

Théorie de l’esprit : un médiateur entre symptômes et fonctionnement dans la schizophrénie ?

This literature review aimed to summarize the scientific knowledge concerning the links between psychosocial functioning and social cognition. Social cognition, and particularly Theory of Mind, is strongly disturbed in patients with schizophrenia. There were strong arguments that psychosocial functioning was more strongly associated with Theory of Mind than with neurocognition (defined as nonsocial information processing in contrast to social cognition). The functional capacity mediated this influence. Moreover, longitudinal studies suggested a unidirectional causal pathway with primary neurocognitive disorders leading to secondary deficits in social cognition, which in turn led to disturbances in psychosocial functioning. Studies using structural equation modelling showed that positive, negative and disorganization symptoms were associated with disturbances in psychosocial functioning. Regarding negative symptoms and disorganization, the influences were mediated by social cognition. The influence of positive symptoms on psychosocial functioning was independent of social cognition. This literature review suggests that social cognitive remediation in patients with should improve the psychosocial functioning in patients with schizophrenia.     

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.     

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.     

Social cognition in schizophrenia: recommendations from the measurement and treatment research to improve cognition in schizophrenia new approaches conference

This article summarizes the discussion from a breakout group at the National Institute of Mental Health-Measurement and Treatment Research to Improve Cognition in Schizophrenia New Approaches Conference on social cognition in schizophrenia. During this discussion, the reasons for the recent growth of research on social cognition in schizophrenia were examined. The discussion group established consensus on several points, including the importance of viewing social cognition from interdisciplinary perspectives (including outcomes research, social psychology, cognitive psychology, cognitive neuroscience, and animal models) and the need for clearer definition of terms. There was also general agreement that social cognition is a valuable construct for understanding the nature and disability of schizophrenia. One of the objectives of this group was to generate recommendations for subsequent human and animal studies, and these research agendas are summarized in this report.     

Schizophrenia patients with cognitive deficits: factors associated with costs

Cognitive deficits in people with schizophrenia are associated with poor functioning and lower quality of life. Because few studies have examined their relationship with service use or costs, it is unclear whether effective cognitive remediation interventions have potential for economic impacts. This study examined associations between cognition and costs among people with schizophrenia. Baseline data collected between 1999 and 2002 from a randomized controlled trial of cognitive remediation therapy were analyzed. A total of 85 participants were recruited from a London mental health trust if they had a diagnosis of schizophrenia, evidence of cognitive/social functioning difficulties, and at least 1 year since first contact with psychiatric services. Cognition levels, social functioning, symptoms, sociodemographic characteristics, and retrospective use of health/social care and other resources were measured. Average public sector costs were estimated to be 15 078 pounds(23 824 dollars) for a 6-month period. Associations between health/social care costs and type and severity of cognition were examined using structural equation models. No significant relationships were found between cognition and costs in a model based on 3 independent constituent components of cognition (cognitive shifting, verbal working memory, and response inhibition), although a model with covarying cognition components fitted the observed data well. A model with cognition as a single construct both fitted well and showed a significant relationship. In people with schizophrenia and severe cognitive impairment, improvements in either overall cognition or specific cognitive components may impact on costs. Further investigation in larger samples is needed to confirm this finding and to explore its generalizability to those with less severe deficits.     

Assessment of social judgments and complex mental states in the early phases of psychosis

OBJECTIVES: Social cognition plays an important role in the functioning of individuals with psychosis. In this study, we explored two areas of social cognition not previously investigated early in the course of psychosis. METHOD: Eighty-eight clinical high risk participants, 26 participants diagnosed with schizophrenia for less than 5 years, and 41 non-clinical control participants completed two measures of social cognition. RESULTS: Clinical high risk participants demonstrated biased responses to untrustworthy faces compared to both of the other groups. Early schizophrenia participants performed more poorly on an advanced theory of mind task compared to the clinical high risk and control groups. CONCLUSIONS: There are different patterns of performance on social cognitive tasks in these groups, which require further examination in longitudinal studies.