Social Cognition in Schizophrenia, Part 1: Performance Across Phase of Illness

Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095-6968, USA.
Schizophrenia Bulletin (Impact Factor: 8.61). 02/2011; 38(4):854-64. DOI: 10.1093/schbul/sbq171
Source: PubMed

ABSTRACT Social cognitive impairments are consistently reported in schizophrenia and are associated with functional outcome. We currently know very little about whether these impairments are stable over the course of illness. In the current study, 3 different aspects of social cognition were assessed (emotion processing, Theory of Mind [ToM], and social relationship perception) at 3 distinct developmental phases of illness: prodromal, first episode, and chronic. In this cross-sectional study, participants included 50 individuals with the prodromal risk syndrome for psychosis and 34 demographically comparable controls, 81 first-episode schizophrenia patients and 46 demographically comparable controls, and 53 chronic schizophrenia patients and 47 demographically comparable controls. Outcome measures included total and subtest scores on 3 specialized measures of social cognition: (1) emotion processing assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test, (2) ToM assessed with The Awareness of Social Inference Test, and (3) social relationship perception assessed the Relationships Across Domains Test. Social cognitive performance was impaired across all domains of social cognition and in all clinical samples. Group differences in performance were comparable across phase of illness, with no evidence of progression or improvement. Age had no significant effect on performance for either the clinical or the comparison groups. The findings suggest that social cognition in these 3 domains fits a stable pattern that has outcome and treatment implications. An accompanying article prospectively examines the longitudinal stability of social cognition and prediction of functional outcome in the first-episode sample.

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Available from: Kenneth L Subotnik, Aug 13, 2015
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    • "It is worth noting that social perception assessments typically consider the awareness of cues that occur in social situations (Addington et al., 2006); however, studies to date assessing social perception in CHR individuals have typically considered only one aspect of social perception. In this study, we have examined the understanding of social relationships, as assessed by the RAD, and our results are supported by two other studies that demonstrated poor performance on the RAD for both schizophrenia (Green et al., 2012a; Sergi et al., 2009) and CHR samples (Green et al., 2012a). Furthermore, after controlling for IQ, we observed group differences in RAD Authority. "
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    ABSTRACT: Social cognition, the mental operations that underlie social interactions, is a major construct to investigate in schizophrenia. Impairments in social cognition are present before the onset of psychosis, and even in unaffected first-degree relatives, suggesting that social cognition may be a trait marker of the illness. In a large cohort of individuals at clinical high risk for psychosis (CHR) and healthy controls, three domains of social cognition (theory of mind, facial emotion recognition and social perception) were assessed to clarify which domains are impaired in this population. Six-hundred and seventy-five CHR individuals and 264 controls, who were part of the multi-site North American Prodromal Longitudinal Study, completed The Awareness of Social Inference Test, the Penn Emotion Recognition task, the Penn Emotion Differentiation task, and the Relationship Across Domains, measures of theory of mind, facial emotion recognition, and social perception, respectively. Social cognition was not related to positive and negative symptom severity, but was associated with age and IQ. CHR individuals demonstrated poorer performance on all measures of social cognition. However, after controlling for age and IQ, the group differences remained significant for measures of theory of mind and social perception, but not for facial emotion recognition. Theory of mind and social perception are impaired in individuals at CHR for psychosis. Age and IQ seem to play an important role in the arising of deficits in facial affect recognition. Future studies should examine the stability of social cognition deficits over time and their role, if any, in the development of psychosis.
    Schizophrenia Research 12/2015; in press. DOI:10.1016/j.scog.2015.04.004 · 4.43 Impact Factor
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    • "A core impairment in schizophrenia is perceiving emotional information from faces (Chan et al., 2010; Kohler et al., 2010). These deficits are present and relatively stable across illness phases (i.e., prodromal, first-episode, chronic) (Addington et al., 2006; Green et al., 2012). Furthermore , several studies report impaired facial emotion perception performance compared to controls in nonpsychotic first-degree relatives of schizophrenia patients (Lavoie et al., 2013), suggesting that deficits in facial emotion perception are associated with the genetic liability to schizophrenia. "
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    ABSTRACT: Deficits in facial emotion perception in schizophrenia may be a marker of disorder liability. Previous functional magnetic resonance imaging (fMRI) studies investigating these deficits have been limited by task demands that may recruit other impaired cognitive processes in schizophrenia. We used a family study design along with a passive viewing task during fMRI to investigate brain activation abnormalities underlying facial emotion perception in schizophrenia and examine whether such abnormalities are associated with the genetic liability to the disorder. Twenty-eight schizophrenia patients, 27 nonpsychotic relatives, and 27 community controls passively viewed images of facial emotions during an fMRI scan. Analyses revealed hypoactivation in face processing areas for both patients and relatives compared to controls, and hyperactivation in relatives compared to both patients and controls for frontal regions implicated in emotion processing. Results suggest that activation abnormalities during facial emotion perception are manifestations of the genetic liability to schizophrenia, and may be accompanied by compensatory mechanisms in relatives. Studying mechanisms in nonpsychotic relatives is a valuable way to examine effects of the unexpressed genetic liability to schizophrenia on the brain and behaviour. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 07/2015; DOI:10.1016/j.schres.2015.07.012 · 4.43 Impact Factor
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    • "Some researchers argue that schizophrenia is characterised by relatively stable neuropsychological deficits (Rund, 1998; Ekerholm et al., 2012), particularly during an early phase, with degenerative-like process in older age (Kurtz, 2005). Others, however, claim the existence of neuropsychological decline progressing from the premorbid stage to the chronic form of disease (Azadmehr et al., 2013; Meier et al., 2014), varying across cognitive functions, with processing speed, learning, executive, and motor functions being the most susceptible to deterioration with older age, and deficits in verbal abilities, delayed memory, and social cognition that remain stable during the lifespan (Green et al., 2012; Meier et al., 2014). This suggests different pathophysiological mechanisms underlying deficits in specific mental functions and could be a reflection of different age-related brain alterations in different brain structures. "
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    ABSTRACT: In schizophrenia patients, both an older age and earlier age at onset of the disease are related to worse cognitive functioning. As patients with later schizophrenia onset are also older, analysing the two effects separately can be misleading, as they can either be spurious or cancel one another out. The purpose of the present study was to elucidate the effects of age and onset-age on cognition in schizophrenia patients. Individuals with schizophrenia (N = 151), aged 18-59 years, were examined with MATRICS Consensus Cognitive Battery (MCCB) to get a full picture of their cognitive performance. Results showed age and age at onset indeed interrelated. Regression analyses revealed later onset of schizophrenia related to better social cognition. Patients’ older age, was related to a slower performance in symbol coding task, less effective executive functions, worse visual learning, lower attention, and lower total score in the MCCB. In the above regression analyses we controlled for doses of antipsychotic medications. The results suggest that a previously found relationship between older age and social cognition might be spurious, and strengthen observations that it is specifically later onset-age which fosters better social cognition in schizophrenia patients.
    Psychiatry Research 01/2015; 225:197-201. DOI:10.1016/j.psychres.2014.11.024 · 2.68 Impact Factor
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