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: 8.45). 02/2011; 38(4):854-64. DOI: 10.1093/schbul/sbq171
Source: PubMed


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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    • "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 · 3.92 Impact Factor
    • "In a recently published cross-sectional study, patients with psychotic disorders in different illness phases (ultrahigh risk, first-episode psychosis, and chronic patients with schizophrenia) were compared with healthy controls on different aspects of social cognition , including sarcasm and deception, using the TASIT (Part III). Comprehension of sarcasm and lying was impaired in all three patient groups; performance was comparable across the three phases of illness, with no evidence of progression or improvement (Green et al., 2012). More interestingly, deficits in perception of sarcasm and deception in patients with first-episode psychosis demonstrated longitudinal stability over a 12-month follow up. "
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    ABSTRACT: The aim of the present study was to investigate the effects of comorbid obsessive-compulsive symptoms (OCS) on the perception of insincere speech (e.g., sarcasm and white lies) in patients with first-episode psychosis. Participants were 65 patients with nonaffective first-episode psychosis (FEP) and 47 healthy controls. The patient group was divided into two subgroups, those with (FEP+; n= 38) and those without OCS (FEP-; n = 27). The ability to process sarcasm and lie was assessed with the Perception of Social Inference Test (PESIT). Severity of psychotic symptoms and OCS was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), respectively. Deficits in the perception of sarcasm and lie were confirmed in patients with nonaffective first-episode psychosis compared to healthy controls. In patients, comorbidity with OCS was associated with worse performance on certain aspects of insincere speech (i.e., lie) compared to FEP- patients. Y-BOCS scores correlated significantly with the perception of lying. The cognitive factor of the PANSS predicted accuracy on the perception of sincere speech, paradoxical sarcasm, and white lies, while the presence of OCS predicted accuracy on the perception of sincere speech and white lies. Our finding of impaired counterfactual information processing in patients with first-episode psychosis suggests that these deficits are already present at illness onset. Presence of OCS appears to have additional deleterious effects on the successful interpretation of intentional lying, further supporting that these patients are characterized by more extensive cognitive impairment.
    Journal of Clinical and Experimental Neuropsychology 10/2015; 37(8):842-52. DOI:10.1080/13803395.2015.1064863 · 2.08 Impact Factor
    • "Methodological differences: different phase of illness (first-episode versus chronic), the effects of use over time and lower consumption levels may have contributed to differences in results. The current study examined measures of emotion recognition and theory of mind, two social cognitive domains essential for meaningful social interactions and in guiding social behavior (Comparelli et al., 2013; Green et al., 2012). Supplementary analysis revealed that there was a positive association between recency of cannabis use and a verbal measure of theory of mind. "
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    ABSTRACT: Findings are unclear as to whether cannabis use is associated with better cognitive functioning in individuals with psychosis. To elucidate the association between cannabis use, neurocognition and social cognition in first-episode psychosis (FEP). Secondary data analysis was conducted on data from 133 FEP participants who had enrolled in a randomized controlled trial of a vocational intervention. Participants completed a neurocognitive and social cognitive battery and characteristics of cannabis use were documented (disorder, recency, frequency and dose). Principal axis factor analysis was used to determine the underlying structure of the cognitive batteries. Regression techniques were used to examine cognitive predictors of current cannabis use disorder (CUD), and recency and frequency of cannabis use. Bivariate correlations were used to examine associations between cognition and dose of cannabis consumption. Male gender (p=.037) was the only significant predictor of having a current CUD. Better processing speed (p=.022) and social cognition (p=.039), male gender (p<.001), and fewer negative symptoms (p=.036) predicted recency of cannabis use. Faster processing speed (p=.007) and male gender (p=.006) also predicted frequency of cannabis use. No variables were significantly associated with dose of cannabis consumption. Better social cognition and processing speed abilities predicting recency and frequency of cannabis use are consistent with cannabis users having higher cognitive abilities. A positive relationship between cannabis use and cognition may be the result of more drug taking opportunities in less cognitively impaired individuals with psychosis. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 08/2015; DOI:10.1016/j.schres.2015.07.051 · 3.92 Impact Factor
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