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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Available from: Kenneth L Subotnik
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    • "The RAD specifically examines the understanding of social relationships. Poorer competence in relationship perception compared to HC participants observed in this study has previously been reported in CHR individuals (Green et al., 2012). Furthermore, inappropriate use of the relationship model, Authority Ranking, has been found to be associated with psychosis proneness (Allen et al., 2005), again fitting with our findings. "
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    ABSTRACT: Deficits in social cognition are well established in schizophrenia and have been observed prior to the illness onset. Compared to healthy controls (HCs), individuals at clinical high risk of psychosis (CHR) are said to show deficits in social cognition similar to those observed in patients experiencing a first episode of psychosis. These deficits have been observed in several domains of social cognition, such as theory of mind (ToM), emotion perception and social perception. In the current study, the stability of three domains of social cognition (ToM, social perception and facial emotion perception) was assessed over time along and their association with both clinical symptoms and the later development of psychosis. Six hundred and seventy-five CHR individuals and 264 HC participants completed four tests of social cognition at baseline. Of those, 160 CHR and 155 HC participants completed assessments at all three time points (baseline, 1 year and 2 years) as part of their participation in the North American Prodrome Longitudinal Study. The CHR group performed poorer on all tests of social cognition across all time points compared to HCs. Social cognition was not associated with attenuated positive symptoms at any time point in the study. CHR individuals who developed a psychotic disorder during the course of the study did not differ in social cognition compared to those who did not develop psychosis. This longitudinal study demonstrated mild to moderate, but persistent ToM and social perception impairments in those at CHR for psychosis compared to HCs.
    Full-text · Article · Jan 2016 · Schizophrenia Research
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    • "Behavioural deficits in facial emotion recognition are observed in schizophrenia patients across a wide array of experimental paradigms over the past three decades (Kohler et al., 2010) and are attributable to impairments in both emotion recognition and general face perception (Chan et al., 2010). These impairments in emotion recognition appear to be present across different stages of the disorder (Addington et al., 2006; Green et al., 2012) and are predictive of functional outcome in schizophrenia patients (Kucharska-Pietura et al., 2005; Addington et al., 2008; Amminger et al., 2012; Comparelli et al., 2013; Kohler et al., 2014). This suggests that facial emotion recognition may serve as an important biological marker for schizophrenia (Horan et al., 2012). "
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    ABSTRACT: Schizophrenia is associated with deficits in face perception and emotion recognition. Despite consistent behavioural results, the neural mechanisms underlying these cognitive abilities have been difficult to isolate, in part due to differences in neuroimaging methods used between studies for identifying regions in the face processing system. Given this problem, we aimed to validate a recently developed fMRI-based dynamic functional localizer task for use in studies of psychiatric populations and specifically schizophrenia. Previously, this functional localizer successfully identified each of the core face processing regions (i.e. fusiform face area, occipital face area, superior temporal sulcus), and regions within an extended system (e.g. amygdala) in healthy individuals. In this study, we tested the functional localizer success rate in 27 schizophrenia patients and in 24 community controls. Overall, the core face processing regions were localized equally between both the schizophrenia and control group. Additionally, the amygdala, a candidate brain region from the extended system, was identified in nearly half the participants from both groups. These results indicate the effectiveness of a dynamic functional localizer at identifying regions of interest associated with face perception and emotion recognition in schizophrenia. The use of dynamic functional localizers may help standardize the investigation of the facial and emotion processing system in this and other clinical populations.
    Full-text · Article · Jan 2016 · Psychiatry Research: Neuroimaging
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    • "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. "
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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.
    Full-text · Article · Dec 2015 · Schizophrenia Research
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