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.

Download full-text


Available from: Kenneth L Subotnik,
  • Source
    • "Although, when we controlled for age and then for IQ, group differences in ToM and social perception remained significant but there were no longer significant group differences in facial affect recognition. The observed deficit in ToM ability, as shown by a lower total score on the TASIT, confirms previous evidence that individuals at CHR have difficulties with mental states attribution (Bora and Pantelis, 2013; Chung et al., 2008; Green et al., 2012a; Hur et al., 2013). This result remained significant even after controlling for age, and IQ. "
    [Show abstract] [Hide abstract]
    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
    • "Thus, it could be argued that ToM deficits might be phenotypic risk markers of BP and may contribute to the social dysfunction that is observed in many people with BP during remission. There is sufficient evidence supporting such a link between social impairment and ToM deficits in schizophrenia (Bora et al. 2006a; Green et al. 2012). However, very few studies have examined the link between ToM dysfunction and social functioning in BP (Lahera et al. 2012; Caletti et al. 2013; Lee et al. 2013; Purcell et al. 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Theory of mind (ToM) dysfunction is prominent in a number of psychiatric disorders, in particular, autism and schizophrenia, and can play a significant role in poor functioning. There is now emerging evidence suggesting that ToM abilities are also impaired in bipolar disorder (BP); however, the relationship between ToM deficits and mood state is not clear. Method: We conducted a meta-analysis of ToM studies in BP. Thirty-four studies comparing 1214 patients with BP and 1097 healthy controls were included. BP groups included remitted (18 samples, 545 BP patients), subsyndromal (12 samples, 510 BP patients), and acute (manic and/or depressed) (10 samples, 159 BP patients) patients. Results: ToM performance was significantly impaired in BP compared to controls. This impairment was evident across different types of ToM tasks (including affective/cognitive and verbal/visual) and was also evident in strictly euthymic patients with BP (d = 0.50). There were no significant differences between remitted and subsyndromal samples. However, ToM deficit was significantly more severe during acute episodes (d = 1.23). ToM impairment was significantly associated with neurocognitive and particularly with manic symptoms. Conclusion: Significant but modest sized ToM dysfunction is evident in remitted and subsyndromal BP. Acute episodes are associated with more robust ToM deficits. Exacerbation of ToM deficits may contribute to the more significant interpersonal problems observed in patients with acute or subsyndromal manic symptoms. There is a need for longitudinal studies comparing the developmental trajectory of ToM deficits across the course of the illness.
    Psychological Medicine 10/2015; DOI:10.1017/S0033291715001993 · 5.94 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. "
    [Show abstract] [Hide abstract]
    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
Show more