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Exploring social cognition in patients with apathy following acquired brain damage. BMC Neurol 2014; 14:18. [PMID: 24450311 PMCID: PMC3943587 DOI: 10.1186/1471-2377-14-18] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 01/17/2014] [Indexed: 12/30/2022] Open
Abstract
Background Research on cognition in apathy has largely focused on executive functions. To the best of our knowledge, no studies have investigated the relationship between apathy symptoms and processes involved in social cognition. Apathy symptoms include attenuated emotional behaviour, low social engagement and social withdrawal, all of which may be linked to underlying socio-cognitive deficits. Methods We compared patients with brain damage who also had apathy symptoms against similar patients with brain damage but without apathy symptoms. Both patient groups were also compared against normal controls on key socio-cognitive measures involving moral reasoning, social awareness related to making judgements between normative and non-normative behaviour, Theory of Mind processing, and the perception of facial expressions of emotion. We also controlled for the likely effects of executive deficits and depressive symptoms on these comparisons. Results Our results indicated that patients with apathy were distinctively impaired in making moral reasoning decisions and in judging the social appropriateness of behaviour. Deficits in Theory of Mind and perception of facial expressions of emotion did not distinguish patients with apathy from those without apathy. Conclusion Our findings point to a possible socio-cognitive profile for apathy symptoms and provide initial insights into how socio-cognitive deficits in patients with apathy may affect social functioning.
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Rapp AM, Langohr K, Mutschler DE, Klingberg S, Wild B, Erb M. Isn't it ironic? Neural correlates of irony comprehension in schizophrenia. PLoS One 2013; 8:e74224. [PMID: 24040207 PMCID: PMC3769349 DOI: 10.1371/journal.pone.0074224] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/25/2013] [Indexed: 12/11/2022] Open
Abstract
Ironic remarks are frequent in everyday language and represent an important form of social cognition. Increasing evidence indicates a deficit in comprehension in schizophrenia. Several models for defective comprehension have been proposed, including possible roles of the medial prefrontal lobe, default mode network, inferior frontal gyri, mirror neurons, right cerebral hemisphere and a possible mediating role of schizotypal personality traits. We investigated the neural correlates of irony comprehension in schizophrenia by using event-related functional magnetic resonance imaging (fMRI). In a prosody-free reading paradigm, 15 female patients with schizophrenia and 15 healthy female controls silently read ironic and literal text vignettes during fMRI. Each text vignette ended in either an ironic (n = 22) or literal (n = 22) statement. Ironic and literal text vignettes were matched for word frequency, length, grammatical complexity, and syntax. After fMRI, the subjects performed an off-line test to detect error rate. In this test, the subjects indicated by button press whether the target sentence has ironic, literal, or meaningless content. Schizotypal personality traits were assessed using the German version of the schizotypal personality questionnaire (SPQ). Patients with schizophrenia made significantly more errors than did the controls (correct answers, 85.3% vs. 96.3%) on a behavioural level. Patients showed attenuated blood oxygen level-dependent (BOLD) response during irony comprehension mainly in right hemisphere temporal regions (ironic>literal contrast) and in posterior medial prefrontal and left anterior insula regions (for ironic>visual baseline, but not for literal>visual baseline). In patients with schizophrenia, the parahippocampal gyrus showed increased activation. Across all subjects, BOLD response in the medial prefrontal area was negatively correlated with the SPQ score. These results highlight the role of the posterior medial prefrontal and right temporal regions in defective irony comprehension in schizophrenia and the mediating role of schizotypal personality traits.
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Affiliation(s)
- Alexander M Rapp
- Department of Psychiatry, University of Tuebingen, Tuebingen, Germany
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Varga E, Simon M, Tényi T, Schnell Z, Hajnal A, Orsi G, Dóczi T, Komoly S, Janszky J, Füredi R, Hamvas E, Fekete S, Herold R. Irony comprehension and context processing in schizophrenia during remission--a functional MRI study. BRAIN AND LANGUAGE 2013; 126:231-242. [PMID: 23867921 DOI: 10.1016/j.bandl.2013.05.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 05/03/2013] [Accepted: 05/26/2013] [Indexed: 06/02/2023]
Abstract
Schizophrenic patients have Theory of Mind (ToM) deficits even during remission, but it is yet unknown whether this could be influenced. We examined the neural correlates of irony understanding in schizophrenic patients, as an indicator of ToM capacity, and evaluated how linguistic help inserted into the context phase could affect irony comprehension. Schizophrenic patients in remission and healthy controls were subjected to event-related functional MRI scanning while performing irony, 'irony with linguistic help', and control tasks. Patients understood irony significantly worse than healthy controls. The patients showed stronger brain activity in the parietal and frontal areas in the early phase of irony task, however the healthy controls exhibited higher activation in frontal, temporal and parietal regions in the latter phase of the irony task. Interestingly the linguistic help not only improved the patients' ToM performance, but it also evoked similar activation pattern to healthy controls.
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Affiliation(s)
- E Varga
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Pécs, Hungary
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Rowse G, McCarthy-Jones S, Knowles R, Corcoran R, Bentall RP. Attributional style and theory of mind in people with Alzheimer disease and persecutory delusions. Am J Geriatr Psychiatry 2013; 21:898-905. [PMID: 23567389 DOI: 10.1016/j.jagp.2013.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 02/28/2012] [Accepted: 04/23/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Between 7% and 40% of people with Alzheimer disease (AD) experience persecutory delusions (PDs) during the course of their dementia. Although attributional style and theory of mind processes have been linked with PDs in people with psychosis, they have not yet been examined in those with AD and PDs. The objective of this study was, hence, to explore the role of these cognitive processes in groups of participants with AD with and without PDs, as well as a nonclinical comparison group. METHOD Measures of attributional style and theory of mind were administered to three groups: people with AD and PDs (n = 22), people with AD without PDs (n = 22), and a nonclinical group (n = 23). RESULTS Although no clear differences in attributional style between the three groups were found, the group with AD and PDs were found to perform worse on the first-order (but not second-order) theory of mind task than the other two groups. CONCLUSIONS Interventions designed to enhance theory of mind skills might be beneficial for individuals with AD and PDs.
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Affiliation(s)
- Georgina Rowse
- Clinical Psychology Unit, The University of Sheffield, Sheffield, United Kingdom
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Martin AK, Robinson G, Dzafic I, Reutens D, Mowry B. Theory of mind and the social brain: implications for understanding the genetic basis of schizophrenia. GENES BRAIN AND BEHAVIOR 2013; 13:104-17. [DOI: 10.1111/gbb.12066] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/22/2013] [Accepted: 07/28/2013] [Indexed: 02/03/2023]
Affiliation(s)
- A. K. Martin
- Queensland Brain Institute; University of Queensland; Brisbane QLD Australia
| | - G. Robinson
- School of Psychology; University of Queensland; Brisbane QLD Australia
| | - I. Dzafic
- Queensland Brain Institute; University of Queensland; Brisbane QLD Australia
| | - D. Reutens
- Centre for Advanced Imaging; University of Queensland; Brisbane QLD Australia
| | - B. Mowry
- Queensland Brain Institute; University of Queensland; Brisbane QLD Australia
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Colle L, Angeleri R, Vallana M, Sacco K, Bara BG, Bosco FM. Understanding the communicative impairments in schizophrenia: a preliminary study. JOURNAL OF COMMUNICATION DISORDERS 2013; 46:294-308. [PMID: 23562700 DOI: 10.1016/j.jcomdis.2013.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/10/2012] [Accepted: 01/21/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED The aim of the present study was to evaluate the pragmatic abilities of patients with schizophrenia in a variety of pragmatic phenomena expressed through different communicative means (language, gestures, and paralinguistic modality). For this purpose we used the Assessment Battery of Communication (ABaCo; Sacco et al., 2008). The ABaCo is a validated clinical tool for assessing pragmatic skills, which comprises five evaluation scales-linguistic, extralinguistic, paralinguistic, context, and conversational-investigating both comprehension and production of the main pragmatic phenomena involved in a communicative exchange, such as direct and indirect speech acts, irony, deceit, the violation of Grice's maxims, topic management, and turn-taking. The battery was administered to a group of seventeen patients with schizophrenia, and matched healthy controls. We expected the clinical group to perform widely worse than the control group in the different pragmatic dimensions investigated. Results showed that patients with schizophrenia performed significantly worse than controls on all the five scales of the battery, both in comprehension and production tasks. Moreover, the results within each scale showed a differentiated performance in the clinical group among the pragmatic phenomena, with irony assessed as the most difficult task. The implications of these results for research and treatment in schizophrenia are discussed. LEARNING OUTCOMES After reading this article, the reader will be able to: (1) summarize thepreliminary assessment of pragmatic impairments in patients with schizophrenia; (2) describea variegated communicative profile regarding different pragmatic phenomena; and (3) discuss the planning and evaluating specific rehabilitation programs.
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Affiliation(s)
- Livia Colle
- Center for Cognitive Science, University and Polytechnic of Turin, Italy
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Jeon IH, Kim KR, Kim HH, Park JY, Lee M, Jo HH, Koo SJ, Jeong YJ, Song YY, Kang JI, Lee SY, Lee E, An SK. Attributional style in healthy persons: its association with 'theory of mind' skills. Psychiatry Investig 2013; 10:34-40. [PMID: 23482524 PMCID: PMC3590428 DOI: 10.4306/pi.2013.10.1.34] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/22/2012] [Accepted: 11/16/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Attributional style, especially external personal attribution bias, was found to play a pivotal role in clinical and non-clinical paranoia. The study of the relationship of the tendency to infer/perceive hostility and blame with theory of mind skills has significant theoretical importance as it may provide additional information on how persons process social situations. The aim of this study was whether hostility perception bias and blame bias might be associated with theory of mind skills, neurocognition and emotional factors in healthy persons. METHODS Total 263 participants (133 male and 130 female) were recruited. The attributional style was measured by using the Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were requested to complete a Brüne's Theory of Mind Picture Stories task, neurocognitive task including Standard Progressive Matrices (SPM) and digit span, and other emotional dysregulation trait scales including Rosenberg's self-esteem, Spielberg's trait anxiety inventory, and Novaco anger scale. RESULTS Multiple regression analysis showed that hostility perception bias score in ambiguous situation were found to be associated with theory of mind questionnaire score and emotional dysregulation traits of Novaco anger scale. Also, composite blame bias score in ambiguous situation were found to be associated with emotional dysregulation traits of Novaco anger scale and Spielberg's trait anxiety scale. CONCLUSION The main finding was that the attributional style of hostility perception bias might be primarily contributed by theory of mind skills rather than neurocognitive function such as attention and working memory, and reasoning ability. The interpretations and implications would be discussed in details.
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Affiliation(s)
- Im Hong Jeon
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Ran Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hwan Hee Kim
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Park
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mikyung Lee
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Hyun Jo
- Seoul Total Health Care Center, Kangbuk Samsung Hospital, Seoul, Republic of Korea
| | - Se Jun Koo
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Jeong
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yun Young Song
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jee In Kang
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Su Young Lee
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Section of Affect and Neuroscience, Institute of Behavioural Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Bechi M, Spangaro M, Bosia M, Zanoletti A, Fresi F, Buonocore M, Cocchi F, Guglielmino C, Smeraldi E, Cavallaro R. Theory of Mind intervention for outpatients with schizophrenia. Neuropsychol Rehabil 2013; 23:383-400. [PMID: 23379271 DOI: 10.1080/09602011.2012.762751] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Social disability is one of the critical areas known to be a predictor of daily functioning in schizophrenia. Recent studies showed that impairments in Theory of Mind (ToM) contribute to real-world social functioning and are more strongly associated with community outcomes than other neuropsychological domains of cognition. Several experiments revealed an improving potential of social cognition targeted training, particularly through introduction of verbalisation and explicit manipulation of information about others' mental states. Based on these data, we evaluated longitudinally, with a controlled trial, the feasibility and efficacy of ToM training and the possible influences of daily functioning and IQ on the enhancement of ToM abilities. Thirty outpatients with schizophrenia were recruited and randomly allocated to two groups: ToM Intervention (ToMI), based on verbalisation of selected comic strips representing ToM scenarios, or active control group (ACG). Results showed a significant improvement of ToM abilities among subjects allocated to ToMI compared to ACG, confirming the hypothesis of the enhancing potential of training methods targeting ToM functions. Moreover, we observed no influences of neuropsychological and functional variables on ToM improvement. Development of future studies should take into account possible effects of ToM training on functional outcome, according to the strong associations between ToM abilities and real-world social functioning.
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Affiliation(s)
- Margherita Bechi
- San Raffaele Scientific Institute, Department of Clinical Neurosciences, Universitary Scientific Institute Hospital, Milan, Italy.
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Peyroux É, Gaudelus B, Franck N. Remédiation cognitive des troubles de la cognition sociale dans la schizophrénie. EVOLUTION PSYCHIATRIQUE 2013. [DOI: 10.1016/j.evopsy.2013.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mashal N, Vishne T, Laor N, Titone D. Enhanced left frontal involvement during novel metaphor comprehension in schizophrenia: evidence from functional neuroimaging. BRAIN AND LANGUAGE 2013; 124:66-74. [PMID: 23291493 DOI: 10.1016/j.bandl.2012.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 11/18/2012] [Accepted: 11/19/2012] [Indexed: 06/01/2023]
Abstract
The neural basis involved in novel metaphor comprehension in schizophrenia is relatively unknown. Fourteen people with schizophrenia and fourteen controls were scanned while they silently read novel metaphors, conventional metaphors, literal expressions, and meaningless word-pairs. People with schizophrenia showed reduced comprehension of both novel and conventional metaphors. Furthermore, while controls showed enhanced brain activation in right inferior frontal gyrus (IFG) for novel metaphors versus meaningless word-pairs, people with schizophrenia showed an over-activation of left IFG and middle frontal gyrus (MFG). Direct comparison between the groups revealed greater activation in left precuneus for both novel metaphors and literal expressions vs. baseline for individuals with schizophrenia. Direct comparison for novel metaphors vs. literal expressions also revealed increased activation for individuals with schizophrenia in left MFG. These results suggest that the inefficient processing of novel metaphors in schizophrenia involves compensatory recruitment of additional brain regions that include the left MFG and left precuneus.
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Affiliation(s)
- N Mashal
- School of Education, Bar-Ilan University, Ramat-Gan, Israel.
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Skodlar B, Henriksen MG, Sass LA, Nelson B, Parnas J. Cognitive-behavioral therapy for schizophrenia: a critical evaluation of its theoretical framework from a clinical-phenomenological perspective. Psychopathology 2013; 46:249-65. [PMID: 23038150 DOI: 10.1159/000342536] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 08/09/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) has played an increasingly important role in psychotherapy for schizophrenia since the 1990s, but it has also encountered many theoretical and practical limitations. For example, methodologically rigorous meta-analyses have recently found only modest overall effect sizes of CBT treatment, and therefore questions have emerged about forwhat and for whom it actually works. METHOD The focus of the present paper is to elucidate the theoretical assumptions underlying CBT for schizophrenia and to examine their consistency with abnormalities of experience and self-awareness frequently reported by schizophrenia patients and systematically studied in phenomenological psychopathology from the beginning of the 20th century. RESULTS We argue that a strong theoretical emphasis on cognitive appraisals with only subsidiary attention devoted to affective and behavioral processes - as is characteristic of many forms of CBT - cannot satisfactorily account for the complex subjective experiences of schizophrenia patients. We further argue that certain theoretical strategies widely employed in CBT to explore and explain mental disorders, which involve atomization and, at times, a reification of mental phenomena, can be problematic and may result in a loss of explanatory potential. Finally, we provide a detailed account of how negative symptoms and delusions are conceptualized in CBT and consider the question of how these concepts fit the actual phenomenology of schizophrenia. CONCLUSION We suggest that further advancement of CBT theory and practice can benefit from a dialogue with phenomenological psychiatry in the search for effective psychotherapeutic strategies for schizophrenia patients.
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Affiliation(s)
- B Skodlar
- University Psychiatric Clinic Ljubljana, University of Ljubljana, Ljubljana, Slovenia
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Xia H, Wu N, Su Y. Investigating the genetic basis of theory of mind (ToM): the role of catechol-O-methyltransferase (COMT) gene polymorphisms. PLoS One 2012; 7:e49768. [PMID: 23209597 PMCID: PMC3507837 DOI: 10.1371/journal.pone.0049768] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/12/2012] [Indexed: 11/19/2022] Open
Abstract
The ability to deduce other persons' mental states and emotions which has been termed ‘theory of mind (ToM)’ is highly heritable. First molecular genetic studies focused on some dopamine-related genes, while the genetic basis underlying different components of ToM (affective ToM and cognitive ToM) remain unknown. The current study tested 7 candidate polymorphisms (rs4680, rs4633, rs2020917, rs2239393, rs737865, rs174699 and rs59938883) on the catechol-O-methyltransferase (COMT) gene. We investigated how these polymorphisms relate to different components of ToM. 101 adults participated in our study; all were genetically unrelated, non-clinical and healthy Chinese subjects. Different ToM tasks were applied to detect their theory of mind ability. The results showed that the COMT gene rs2020917 and rs737865 SNPs were associated with cognitive ToM performance, while the COMT gene rs5993883 SNP was related to affective ToM, in which a significant gender-genotype interaction was found (p = 0.039). Our results highlighted the contribution of DA-related COMT gene on ToM performance. Moreover, we found out that the different SNP at the same gene relates to the discriminative aspect of ToM. Our research provides some preliminary evidence to the genetic basis of theory of mind which still awaits further studies.
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Affiliation(s)
- Haiwei Xia
- Department of Psychology, Peking University, Beijing, China
| | - Nan Wu
- Department of Psychology, Peking University, Beijing, China
| | - Yanjie Su
- Department of Psychology, Peking University, Beijing, China
- * E-mail:
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Bragado-Jimenez MD, Taylor PJ. Empathy, schizophrenia and violence: a systematic review. Schizophr Res 2012; 141:83-90. [PMID: 22917950 DOI: 10.1016/j.schres.2012.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/29/2012] [Accepted: 07/16/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND A small but significant association between schizophrenia and violence is open to a number of explanations. Impaired empathy has been associated with schizophrenia, and with violence in the general population. Our aim was to conduct a systematic review of any research into relationships between schizophrenia, empathy and violence. METHODS The electronic databases Medline, Psychinfo, Embase, Cochrane and DARE were searched using combinations of terms for schizophrenia, empathy and violence, as were selected journals and reference lists of relevant articles. Selection of studies and data extraction was done by each of us, blind to the other. RESULTS Six studies were identified, but sample selection, research procedures and empathy, illness and violence measures differed sufficiently between them that only descriptive analysis was possible. Apart from one single case study, sample sizes were between 24 (12 violent) and 116 (35 violent). A component of emotional empathy (emotion recognition) was measured in three of the studies, all of which showed some specific dysfunctional recognition related to violence. Cognitive empathy was measured in three studies, two linking impairments to violence and one not. Emotional responsiveness was measured in one study and no association with violence was found. CONCLUSION Although evidence is inconclusive on empathy impairment as a mediator of violence by people with chronic psychosis, it's likely relevance is most apparent in the better controlled studies. Larger scale studies are indicated with rigorous control for comorbidities.
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Affiliation(s)
- Maria D Bragado-Jimenez
- Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, 1st Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK.
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Abstract
The aim of this study was to investigate selected measures of creativity in schizophrenic patients and their relationship with neurocognitive executive functions Forty-three inpatients with paranoid schizophrenia who were in symptomatic remission (a total of 60) and 45 healthy control participants were included. Creativity was assessed using the Barron-Welsh Art Scale (BWAS) and the inventiveness part of the Berlin Intelligence Structure Test (BIS). Executive functions were measured by means of the Wisconsin Card Sorting Test (WCST). Schizophrenic patients gave responses on the BWAS, had lower total score on the BIS and in the figural test, and performed worse on all domains of the WCST compared with control subjects. Their lower scores on the BIS correlated with lower scores on the WCST. Our results indicate that remitted schizophrenic patients perform worse on selected measures of creativity than healthy subjects and that executive dysfunctions may partially explain these deficits.
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Bosco FM, Bono A, Bara BG. Recognition and repair of communicative failures: the interaction between Theory of Mind and cognitive complexity in schizophrenic patients. JOURNAL OF COMMUNICATION DISORDERS 2012; 45:181-197. [PMID: 22402250 DOI: 10.1016/j.jcomdis.2012.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 11/21/2011] [Accepted: 01/27/2012] [Indexed: 05/31/2023]
Abstract
UNLABELLED The aim of the present research is to perform a detailed and empirical investigation of schizophrenia patients' deficits in recognizing and recovering a communicative failure. In particular, this paper investigates the role of Theory of Mind (ToM) and of the complexity of the mental representations involved in explaining patients' deficits in recognizing and recovering different kinds of communicative failures, i.e. failure of the expressive act, failure of communicative meaning and failure of the communicative effect. Twenty-two patients with schizophrenia and an equal number of healthy controls took part in the experiment. The experimental protocol consisted of videotaped stories in which two agents interact, showing a communicative failure; the participants were asked to recognize and repair the observed failure. Some classical ToM tests (Sally and Ann, Modified Smarties and a selection of six Strange Stories) were also administered. Our results revealed a deficit in patients, when compared with healthy controls, in recognizing and recovering communicative failures. Furthermore, focusing on schizophrenia patients' performance per se, we observed a trend with regard to the increasing difficulty of understanding and recognizing different kinds of communicative failures, i.e. failure of expression act, failure of communicative meaning, and failure of the communicative effect. LEARNING OUTCOMES The reader becomes aware that schizophrenic patients perform less well than healthy controls in recognizing and recovering different kinds of communicative failures, and of the role played by Theory of Mind, and representational complexity involved in such different kinds of failures, in explaining patients' performance.
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Affiliation(s)
- Francesca M Bosco
- Center for Cognitive Science, Department of Psychology, University of Turin, and Neuroscience Institute of Turin, Italy
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Adaptación al español de la prueba de teoría de la mente Hinting Task. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2012; 5:79-88. [DOI: 10.1016/j.rpsm.2011.11.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 11/25/2011] [Accepted: 11/30/2011] [Indexed: 11/24/2022]
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Gil D, Fernández-Modamio M, Bengochea R, Arrieta M. Adaptation of the Hinting Task theory of the mind test to Spanish. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.rpsmen.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cermolacce M, Lazerges P, Da Fonseca D, Fakra E, Adida M, Belzeaux R, Azorin JM. [Theory of mind and schizophrenia]. Encephale 2012; 37 Suppl 2:S117-22. [PMID: 22212840 DOI: 10.1016/s0013-7006(11)70037-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In social cognition, the notion of Theory of Mind (ToM) is widely studied among people with schizophrenia to give an account for intersubjective disturbances. ToM is classically defined as the ability to make inferences about other persons'mental states, as beliefs, thoughts or intentions. However, ToM is not understood or explored as a homogeneous notion. First, this review briefly describes main theoretical models, as well as experimental tasks of ToM. Second, clinical results strongly suggest that patients with schizophrenia present impaired ToM performances. However, the presence of a robust relationship between ToM and schizophrenic symptomatology, or clinical course, is still controversial. Third, we highlight main findings from functional brain imaging studies based on ToM. Finally and in a more critical perspective, we suggest a few theoretical and experimental limitations regarding impaired ToM as a core feature of schizophrenic disturbances in social interactions.
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Affiliation(s)
- M Cermolacce
- Pôle universitaire de psychiatrie, hôpital Sainte-Marguerite, 270 bd Sainte-Marguerite, 13274 Marseille cedex 09, France.
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Abstract
Cognitive functioning is moderately to severely impaired in patients with schizophrenia. This impairment is the prime driver of the significant disabilities in occupational, social, and economic functioning in patients with schizophrenia and an important treatment target. The profile of deficits in schizophrenia includes many of the most important aspects of human cognition: attention, memory, reasoning, and processing speed. While various efforts are under way to identify specific aspects of neurocognition that may lie closest to the neurobiological etiology and pathophysiology of the illness, and may provide relevant convergence with animal models of cognition, standard neuropsychological measures continue to demonstrate the greatest sensitivity to functionally relevant cognitive impairment.The effects of antipsychotic medications on cognition in schizophrenia and first-episode psychosis appear to be minimal. Important work on the effects of add-on pharmacologic treatments is ongoing. Very few of the studies completed to date have had sufficient statistical power to generate firm conclusions; recent studies examining novel add-on treatments have produced some encouraging findings. Cognitive remediation programs have generated considerable interest as these methods are far less costly than pharmacologic treatment and are likely to be safer. A growing consensus suggests that these interventions produce modest gains for patients with schizophrenia, but the efficacy of the various methods used has not been empirically investigated.
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Abstract
BACKGROUND Paranoid delusions are a common and difficult-to-manage feature of Alzheimer's disease (AD). We investigated the neuroanatomical correlates of paranoid delusions in a cohort of AD patients, using magnetic resonance imaging (MRI) to measure regional volume and regional cortical thickness. METHODS 113 participants with probable AD were assessed for severity of disease, cognitive and functional impairment. Presence and type of delusions were assessed using the Neuropsychiatric Inventory (NPI). Structural MRI images were acquired on a 1.5 T scanner, and were analyzed using an automated analysis pipeline. RESULTS Paranoid delusions were experienced by 23 (20.4%) of the participants. Female participants with paranoid delusions showed reduced cortical thickness in left medial orbitofrontal and left superior temporal regions, independently of cognitive decline. Male participants with delusions did not show any significant differences compared to males without delusions. An exploratory whole brain analysis of non-hypothesized regions showed reduced cortical thickness in the left insula for female participants only. CONCLUSION Frontotemporal atrophy is associated with paranoid delusions in females with AD. Evidence of sex differences in the neuroanatomical correlates of delusions as well as differences in regional involvement in different types of delusions may be informative in guiding management and treatment of delusions in AD.
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71
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Chan KKS, Chen EYH. Theory of mind and paranoia in schizophrenia: a game theoretical investigation framework. Cogn Neuropsychiatry 2011; 16:505-29. [PMID: 21563010 DOI: 10.1080/13546805.2011.561576] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION. Ample evidence already shows that theory of mind (ToM) is impaired in people with schizophrenia. Our aim was to critically review this literature. METHOD. We completed a selected review of the research literature on ToM in schizophrenia. RESULTS. Gaps in ToM research were identified. A specific relationship between impaired ToM and paranoid delusions, although intuitively reasonable from a theoretical basis, has only been demonstrated in a few studies. Psychometric properties of ToM tasks employed in these studies may be a confounding factor in drawing conclusions about the relationship. Because most ToM measures have focused on the third-person perspective, participants are not actively interacting. The tasks fail to capture the cognitive demands faced by individuals in real-life situations, and, in effect, are not a direct measure of ToM. CONCLUSIONS. Potential research areas are discussed. Since game theoretical paradigms require the direct involvement of the first person and situate the participant's interpersonal reasoning within an interactive context, they provide more ecologically valid experimental platforms than conventional questionnaire measures to assess ToM in schizophrenia research.
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72
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Mehta UM, Thirthalli J, Naveen Kumar C, Mahadevaiah M, Rao K, Subbakrishna DK, Gangadhar BN, Keshavan MS. Validation of Social Cognition Rating Tools in Indian Setting (SOCRATIS): A new test-battery to assess social cognition. Asian J Psychiatr 2011; 4:203-9. [PMID: 23051118 DOI: 10.1016/j.ajp.2011.05.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 05/27/2011] [Accepted: 05/31/2011] [Indexed: 12/01/2022]
Abstract
Social cognition is a cognitive domain that is under substantial cultural influence. There are no culturally appropriate standardized tools in India to comprehensively test social cognition. This study describes validation of tools for three social cognition constructs: theory of mind, social perception and attributional bias. Theory of mind tests included adaptations of, (a) two first order tasks [Sally-Anne and Smarties task], (b) two second order tasks [Ice cream van and Missing cookies story], (c) two metaphor-irony tasks and (d) the faux pas recognition test. Internal, Personal, and Situational Attributions Questionnaire (IPSAQ) and Social Cue Recognition Test were adapted to assess attributional bias and social perception, respectively. These tests were first modified to suit the Indian cultural context without changing the constructs to be tested. A panel of experts then rated the tests on likert scales as to (1) whether the modified tasks tested the same construct as in the original and (2) whether they were culturally appropriate. The modified tests were then administered to groups of actively symptomatic and remitted schizophrenia patients as well as healthy comparison subjects. All tests of the Social Cognition Rating Tools in Indian Setting had good content validity and known groups validity. In addition, the social cure recognition test in Indian setting had good internal consistency and concurrent validity.
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Affiliation(s)
- Urvakhsh M Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India
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73
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Insights into theory of mind in schizophrenia: the impact of cognitive impairment. Schizophr Res 2011; 130:130-6. [PMID: 21602031 DOI: 10.1016/j.schres.2011.04.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 03/26/2011] [Accepted: 04/18/2011] [Indexed: 11/21/2022]
Abstract
The ability to mentalize and attribute beliefs, intentions and desires to others has been found by the vast majority of studies to be impaired in patients with schizophrenia. However, it is not yet clear if this deficit in Theory of Mind (ToM) is independent of their also well established deficits in basic cognitive functioning. In the present study, we sought to clarify the above relationship by exploring patients' ToM impairment after controlling for their putative cognitive deficits. We examined 36 patients with schizophrenia and 30 healthy matched controls on first and second order tasks of ToM and on commonly used neuropsychological tests. Patients performed poorly on ToM tasks even after controlling for their cognitive deficits, particularly on second order ToM. The present findings contribute to the understanding of the mechanism of ToM, suggesting that ToM deficits are core characteristics in schizophrenia and relatively independent of patients' cognitive impairment.
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74
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Abstract
Given the importance of social dysfunction in schizophrenia, many studies have explored how social cognition, and, particularly, Theory of Mind (ToM) may affect patients' social interactions. In the present study, we investigated the impact of ToM deficits on social interactions, taking into account overall neuropsychological functioning as well as clinical and demographic characteristics. We assessed 28 patients with schizophrenia and 30 healthy participants on a series of tasks including tests of ToM, neuropsychological tests focused on functions potentially relevant to ToM and role plays as an indicator of social interactions. Patients performed more poorly than healthy controls across most ToM and some of the neuropsychological tests. Correlations and hierarchical regression analyses indicated the impact of some, but not all, facets of ToM on patients' social interactions, over and above neuropsychological functioning, positive and negative symptom ratings, duration of illness and demographic characteristics. These findings suggest that remediation of ToM deficits in patients with schizophrenia may help to improve their social interactions.
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75
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Montag C, Dziobek I, Richter IS, Neuhaus K, Lehmann A, Sylla R, Heekeren HR, Heinz A, Gallinat J. Different aspects of theory of mind in paranoid schizophrenia: evidence from a video-based assessment. Psychiatry Res 2011; 186:203-9. [PMID: 20947175 DOI: 10.1016/j.psychres.2010.09.006] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 09/13/2010] [Accepted: 09/17/2010] [Indexed: 11/25/2022]
Abstract
In schizophrenia, impairments of theory of mind (ToM) may be due to excessive ('overmentalizing') or defective ('undermentalizing') attribution of mental states. However, most ToM tests differentiate neither between 'overmentalizing' and 'undermentalizing' nor between cognitive and affective ToM in schizophrenia. This study aimed at differentiating these aspects of ToM in 80 patients diagnosed with paranoid schizophrenia and 80 matched healthy controls using the 'Movie for the Assessment of Social Cognition' (MASC). Outcome parameters comprised 1) error counts representing 'undermentalizing' or 'overmentalizing', 2) decoding of cognitive or emotional mental states and 3) non-social inferencing. Multivariate analysis of covariance (MANCOVA) showed significantly abnormal scores for two dimensions of 'undermentalizing' as well as for cognitive and emotional ToM that were not explained by global cognitive deficits. Scores for 'overmentalizing' did not differ between groups, when age, gender, non-social reasoning and memory were controlled. In schizophrenic patients, negative symptoms were associated with a lack of a mental state concept, while positive symptoms like delusions were associated with 'overmentalizing', supporting respective etiological concepts of delusions.
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Affiliation(s)
- Christiane Montag
- Charité University Medicine Berlin, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany.
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76
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Time to abandon the bio-bio-bio model of psychosis: Exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiol Psychiatr Sci 2011. [PMID: 20170043 DOI: 10.1017/s1121189x00000257] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AbstractMental health services and research have been dominated for several decades by a rather simplistic, reductionistic focus on biological phenomena, with minimal consideration of the social context within which genes and brains inevitably operate. This ‘medical model’ ideology, enthusiastically supported by the pharmaceutical industry, has been particularly powerful in the field of psychosis, where it has led to unjustified and damaging pessimism about recovery. The failure to find robust evidence of a genetic predisposition for psychosis in general, or ‘schizophrenia’ in particular, can be understood in terms of recently developed knowledge about how epigenetic processes turn gene transcription on and off through mechanisms that are highly influenced by the individual's socio-environmental experiences. To understand the emerging evidence of the relationship between adverse childhood events and subsequent psychosis, it is necessary to integrate these epigenetic processes, especially those involving the stress regulating functions of the HPA axis, with research about the psychological mechanisms by which specific types of childhood trauma can lead to specific types of psychotic experiences. The implications, for research, mental health services and primary prevention, are profound.Declaration of Interest: None of the authors have any conflicts of interest in relation to this paper.
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77
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Brüne M, Schaub D. Mental state attribution in schizophrenia: what distinguishes patients with "poor" from patients with "fair" mentalising skills? Eur Psychiatry 2011; 27:358-64. [PMID: 21288697 DOI: 10.1016/j.eurpsy.2010.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/29/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Although many patients with schizophrenia are impaired in mental states attribution abilities, a significant number perform within normal or near-normal ranges in mental state attribution tasks. No studies have analysed cognitive or behavioural differences between patients with - to some extent - preserved mental state attribution skills and those with poor mentalising abilities. MATERIAL AND METHODS To examine characteristics of "poor" and "fair" mentalisers, 58 patients with schizophrenia performed a mental state attribution task, a test of general intelligence, and two executive functioning tests. "Poor" and "fair" mentalising skills were defined according to a median-split procedure; the median score in the patient group was also within two standard deviations of the control group. In addition, patients' social behavioural skills and psychopathological profiles were rated. RESULTS Patients performing within normal or near normal ranges on the mental state attribution task had fewer social behavioural abnormalities than patients with poor mentalising abilities (even when controlled for intelligence), but did not differ in executive functioning. Fair mental state performers showed less disorganisation and excitement symptoms than poor performers. The degree of disorganisation mediated the influence of mental state attribution on social behavioural skills. CONCLUSIONS Schizophrenia patients with (partially) preserved mentalising skills have fewer behavioural problems in the social domain than patients with poor mentalising abilities. Conceptual disorganisation mediates the prediction of social behavioural skills through mentalising skills, suggesting that disorganised patients may require special attention regarding social-cognitive skills training.
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Affiliation(s)
- M Brüne
- Research Department of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital, Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Germany.
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78
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Abstract
INTRODUCTION Social cognition refers to how people conceive, perceive, and draw inferences about mental and emotional states of others in the social world. Previous studies suggest that the concept of social cognition involves several abilities, including those related to affect and cognition. The present study analyses the deficits of individuals with schizophrenia in two areas of social cognition: Theory of Mind (ToM) and emotion recognition and processing. Examining the impairment of these abilities in patients with schizophrenia has the potential to elucidate the neurophysiological regions involved in social cognition and may also have the potential to aid rehabilitation. METHODS Two experiments were conducted. Both included the same five tasks: first- and second-level false-belief ToM tasks, emotion inferencing, understanding of irony, and matrix reasoning (a WAIS-R subtest). The matrix reasoning task was administered to evaluate and control for the association of the other tasks with analytic reasoning skills. Experiment 1 involved factor analysis of the task performance of 75 healthy participants. Experiment 2 compared 30 patients with schizophrenia to an equal number of matched controls. Results. (1) The five tasks were clearly divided into two factors corresponding to the two areas of social cognition, ToM and emotion recognition and processing. (2) Schizophrenics' performance was impaired on all tasks, particularly on those loading heavily on the analytic component (matrix reasoning and second-order ToM). (3) Matrix reasoning, second-level ToM (ToM2), and irony were found to distinguish patients from controls, even when all other tasks that revealed significant impairment in the patients' performance were taken into account. CONCLUSIONS The two areas of social cognition examined are related to distinct factors. The mechanism for answering ToM questions (especially ToM2) depends on analytic reasoning capabilities, but the difficulties they present to individuals with schizophrenia are due to other components as well. The impairment in social cognition in schizophrenia stems from deficiencies in several mechanisms, including the ability to think analytically and to process emotion information and cues.
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Affiliation(s)
- Ido Ziv
- School of Behavioral Sciences, Academic College of Tel Aviv-Yafo, Israel.
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79
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Stanghellini G, Ballerini M. What is it like to be a person with schizophrenia in the social world? A first-person perspective study on Schizophrenic dissociality--part 1: state of the art. Psychopathology 2011; 44:172-82. [PMID: 21412031 DOI: 10.1159/000322637] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 11/09/2010] [Indexed: 11/19/2022]
Abstract
This is a critical review of research on the subjective experience of social dysfunction in persons with schizophrenia. Studies from the phenomenological and cognitive paradigms are examined, and significant outcomes and shortcomings are pointed out. Clinical phenomenologists have mainly interpreted schizophrenic dissociality as an anomaly of prereflexive attunement. The main shortcoming of phenomenological research is that it lacks adequate methodology to collect reliable data since most studies are based on the analysis of a few typical cases. Cognitivism has reliably documented disorders of social functioning in large-scale experimental studies. The main shortcoming of most cognitive paradigms is that they do not properly investigate the personal level of experience in real-world functioning. We conclude that there is a need to reliably collect data through quantitative as well as qualitative methodology as established and accepted by the scientific community in the area of schizophrenic dissociality, reflecting the subjective experiences of people with schizophrenia in the real world.
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80
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Rodríguez Sosa JT, Acosta Ojeda M, Rodríguez Del Rosario L. Teoría de la mente, reconocimiento facial y procesamiento emocional en la esquizofrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2011; 4:28-37. [DOI: 10.1016/j.rpsm.2010.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 11/09/2010] [Accepted: 11/21/2010] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE To explore how reasoning biases in schizophrenic patients respond to treatment. Patients with schizophrenia, especially those with delusions, show not only cognitive deficits but also "reasoning biases," namely, "jumping to conclusions," reduced belief flexibility, an externalizing attributional style, and an impaired "theory of mind." METHODS This is a systematic review of 17 longitudinal and cross-sectional studies. RESULTS "Jumping to conclusions" and reduced "belief flexibility" are most closely related to the severity of delusions, whereas "theory of mind" is better related to negative symptoms and "attributional style" to overall psychopathology. Antipsychotic treatment leads to an improvement in belief flexibility and theory of mind, with the suggestion that "belief flexibility" may be mediating the treatment response. On the other hand, the "jumping to conclusions" bias is likely a stable "trait" factor, which does not change with treatment, although it may moderate the outcome of response. The findings above are offered with the caveat that most of the available studies are small, often uncontrolled, few are longitudinal, that the measurement of some of the reasoning measures varies across studies, and that their relationship to the more established "cognitive" deficits remains unclear. CONCLUSIONS The fact that these reasoning biases could be moderators and mediators of treatment outcome provides a greater impetus to study them systematically.
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82
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Bora E, Yücel M, Pantelis C. Theory of mind impairment: a distinct trait-marker for schizophrenia spectrum disorders and bipolar disorder? Acta Psychiatr Scand 2009; 120:253-64. [PMID: 19489747 DOI: 10.1111/j.1600-0447.2009.01414.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The aim of this study was to critically review the literature in order to determine if Theory of Mind (ToM) impairment can be considered a trait-marker for schizophrenia spectrum disorders and bipolar disorder (BD). METHOD After a thorough literature search, we reviewed the empirical studies investigating ToM impairments in remitted schizophrenia patients, first episode patients, subjects at high-risk (HR) for psychosis and first-degree relatives of schizophrenia patients. Studies investigating ToM impairment in other schizophrenia spectrum conditions, affective psychosis and BD were also reviewed. RESULTS ToM abnormalities exist at onset and continue throughout the course of schizophrenia, persist into remission, and while less severe, are apparent in HR populations. Mentalizing impairments are also observed in other forms of psychotic illness and BD. CONCLUSION Mentalizing impairment in schizophrenia spectrum disorders and BD might reflect underlying general cognitive deficits and residual symptom expression, rather than representing a specific trait-marker.
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Affiliation(s)
- E Bora
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
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83
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Bazin N, Brunet-Gouet E, Bourdet C, Kayser N, Falissard B, Hardy-Baylé MC, Passerieux C. Quantitative assessment of attribution of intentions to others in schizophrenia using an ecological video-based task: a comparison with manic and depressed patients. Psychiatry Res 2009; 167:28-35. [PMID: 19346006 DOI: 10.1016/j.psychres.2007.12.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 07/28/2007] [Accepted: 12/18/2007] [Indexed: 11/17/2022]
Abstract
Schizophrenia is characterized by the impairment of several facets of social cognition. This has been demonstrated in numerous studies that focused on specific aspects of social cognition such as the attribution of intentions, emotions, or false beliefs to others. However, most of these studies relied on complex verbal descriptions or impoverished social stimuli. In the present study, we evaluated a new task (Versailles-Situational Intention Reading, V-SIR) that is based on video excerpts depicting complex real-life scenes of social interactions. Subjects were required to rate the probabilities of several affirmations of the intentions of one of the characters. The V-SIR task was administered to schizophrenic patients (N=15), depressed patients (N=12), manic patients (N=15), and healthy controls (N=15). The performance of schizophrenic patients was significantly impaired in comparison to healthy and depressed subjects. There was a trend toward a significant difference between schizophrenic and manic patients. Manic patients also demonstrated impaired performance relative to healthy subjects. Schizophrenic patients' V-SIR scores were significantly correlated with their scores on another attribution of intentions task that used comic strips. These results show that tasks based on more ecological stimuli are powerful enough to detect theory-of-mind abnormalities in pathological populations such as schizophrenic patients.
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Affiliation(s)
- Nadine Bazin
- Inserm ERI 15, Université de Versailles-Saint Quentin EA 4047, Centre Hospitalier de Versailles, 177 route de Versailles, 78150 Le Chesnay, France
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84
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Th.o.m.a.s.: An exploratory assessment of Theory of Mind in schizophrenic subjects. Conscious Cogn 2009; 18:306-19. [DOI: 10.1016/j.concog.2008.06.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 06/11/2008] [Accepted: 06/11/2008] [Indexed: 11/17/2022]
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85
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Lahera G, Montes JM, Benito A, Valdivia M, Medina E, Mirapeix I, Sáiz-Ruiz J. Theory of mind deficit in bipolar disorder: is it related to a previous history of psychotic symptoms? Psychiatry Res 2008; 161:309-17. [PMID: 18996602 DOI: 10.1016/j.psychres.2007.08.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 07/17/2007] [Accepted: 08/11/2007] [Indexed: 11/16/2022]
Abstract
It has been hypothesized that a Theory of Mind (ToM) deficit could be a vulnerability marker for psychosis. Recent studies, however, have shown ToM deficits in affective relapses of bipolar disorder as well as in the euthymic phase. This study analyzes the relationship between ToM and a previous history of psychotic symptoms in bipolar disorder. ToM, sustained attention and executive functions were analyzed in 75 bipolar euthymic patients with three or more previous relapses (42 of them had a history of psychotic symptoms and 33 did not) and 48 healthy subjects. ToM was assessed with the Advanced Test by Happé. ToM performance was similar in bipolar patients with or without a history of psychotic symptoms, and in both cases it was significantly reduced as compared with the healthy control group. Similarly, both bipolar groups showed impaired sustained attention and executive functions. This general cognitive deficit partially explains the differences obtained in ToM. The ToM instrument used shows low sensitivity for assessing ToM in bipolar patients and it could partially reflect general cognitive functioning rather than a specific deficit in psychosis. ToM deficit is not a trait marker for psychosis, given that it is present in bipolar disorder regardless of a previous history of psychotic symptoms.
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Affiliation(s)
- Guillermo Lahera
- Psychiatry Department, Principe de Asturias University Hospital, University of Alcalá, Madrid, Spain.
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86
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Shur S, Shamay-Tsoory SG, Levkovitz Y. Integration of emotional and cognitive aspects of theory of mind in schizophrenia and its relation to prefrontal neurocognitive performance. Cogn Neuropsychiatry 2008; 13:472-90. [PMID: 19048440 DOI: 10.1080/13546800802490034] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). Whereas previous studies have focused on general ToM abilities, the present study is aimed at testing the underlying behavioural and neurocognitive mechanisms of the impaired integration of affective and cognitive aspects of ToM (the integration of emotional information with mentalising) in patients with schizophrenia. METHODS Twenty-six patients with schizophrenia and 35 healthy controls were tested on two ToM tasks involving the integration of affective and cognitive ToM abilities: "Faux Pas" and "reading the mind in the eyes" tasks. To assess the neurocognitive bases of impaired ToM, the ID/ED test (intradimensional/extradimensional shifting test from the CANTAB) was administered. RESULTS Patients performed poorly on both the cognitive-affective integration ToM tasks and the ID/ED task as compared to controls. Furthermore, patients' ToM scores were selectively correlated with the reversal trials, which are believed to be associated with orbitofrontal functioning. In addition, more than 50% of the variance in recognising and understanding Faux Pas could be explained by patients' symptomatology. Performance on orbitofrontal related tasks was correlated with subjects' Faux Pas scores in the patients group, but not in the healthy control group. CONCLUSIONS Schizophrenic patients appear to have considerable impairment in affective and cognitive ToM integration, which may be related to orbitofrontal dysfunction. These results are in line with previous findings regarding empathy and the importance of the orbitofrontal area in the integration of cognition and affect.
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Affiliation(s)
- Syvan Shur
- Department of Psychology and Brain and Behaviour Center, University of Haifa, Haifa, Israel.
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87
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Abstract
It has become widely accepted that the psychotic disorders are endpoints of atypical developmental trajectories indexed by abnormal emotional and cognitive development early in life. However, the role of environmental factors in determining these trajectories has received relatively little attention. In this article, we argue that (1) the influence of environment on psychosis can best be understood if we focus on specific types of psychotic experiences such as hallucinations and delusions, (2) these symptoms are the products of specific cognitive biases and deficits, and (3) the development of these particular patterns of cognitive functioning is influenced by specific kinds of environmental adversity. This approach is at variance with more conventional approaches because it suggests that each type of experience, rather than being the manifestation of a common underlying illness process, is a product of a specific set of causal variables. Importantly, these variables include environmental determinants, although not to the exclusion of endogenous factors such as neurodevelopmental impairment or genetic vulnerability. We discuss the implications of this approach for neurobiological and genetic research into psychosis, as well as clinical practice.
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Affiliation(s)
- Richard P Bentall
- School of Psychology, University of Bangor, Brigantia Building, Penrallt Road, Bangor, Gwynedd LL57 2AS, UK.
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88
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Andreasen NC, Calage CA, O'Leary DS, O'Leary DS. Theory of mind and schizophrenia: a positron emission tomography study of medication-free patients. Schizophr Bull 2008; 34:708-19. [PMID: 18559406 PMCID: PMC2632446 DOI: 10.1093/schbul/sbn034] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND "Theory of mind" (TOM) refers to the ability to attribute mental states (ie, beliefs and goals) to one's self and others and to recognize that behaviors are guided by these mental states. This capacity, critical for social competence, is impaired in schizophrenia. We undertook a study of TOM in a group of patients with schizophrenia and healthy controls. METHOD We used positron emission tomography to identify the neural circuits recruited during a verbal task that required participants to attribute mental states to a character in a story of their creation. The comparison task consisted of reading aloud a neutral story, controlling for the speech component of the task. RESULTS Patients and controls generated the same percentage of TOM utterances. However, the two groups had markedly different patterns of brain activation. Compared with controls, patients had a lower blood flow in multiple regions in the left hemisphere including the frontal and visual association cortices, posterior hippocampus, and insula. The flow was also lower in contralateral areas in the lateral cerebellum and vermis, thalamus, and posterior insula. On the other hand, the flow was higher in the patients predominantly in the right hemisphere, including multiple frontal and parietal regions, insula, visual association cortex, and pulvinar. DISCUSSION The areas of lower flow are consistent with previous studies indicating impairment in recruiting cortical-cerebellar circuitry in schizophrenia. The areas of higher flow may reflect a need to draw on the right hemisphere to compensate for deficits in left hemisphere networks that include frontal cortex, anterior cingulate, cerebellum, and thalamus.
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Affiliation(s)
- Nancy C. Andreasen
- Andrew H. Woods Chair of Psychiatry,To whom correspondence should be addressed; Department of Psychiatry, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, Room W278GH, Iowa City, IA 52242-1057; tel: 319-356-1553, fax: 319-353-8300, e-mail:
| | - Chadi A. Calage
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA 52242-1057
| | - Daniel S. O'Leary
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, IA 52242-1057
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89
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Abstract
AbstractThe commentaries on our target article, “Psychosis and Autism as Diametrical Disorders of the Social Brain,” reflect the multidisciplinary yet highly fragmented state of current studies of human social cognition. Progress in our understanding of the human social brain must come from studies that integrate across diverse analytic levels, using conceptual frameworks grounded in evolutionary biology.
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90
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Dilks S, Tasker F, Wren B. Building bridges to observational perspectives: a grounded theory of therapy processes in psychosis. Psychol Psychother 2008; 81:209-29. [PMID: 18302813 DOI: 10.1348/147608308x288780] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study set out to explore therapy processes in psychosis with an initial focus on reflexivity and how this might be expressed in therapy conversations. DESIGN Leiman's (2000) definition of reflexivity was used as a starting-point for an exploratory investigation of the use of language as reflective activity. Grounded theory was chosen as an appropriate methodology to distil an explanatory account across the qualitative data collected. METHOD Six psychologist-client pairs supplied three tapes of therapy sessions spread out across the course of therapy. Each participant was separately interviewed on two occasions to ascertain their views of therapy and of the emerging grounded theory. RESULTS A grounded theory was developed conceptualizing the processes and activities in psychological therapy in psychosis. CONCLUSIONS Building bridges to observational perspectives summarizes the core process in psychological therapy in psychosis. Therapy in psychosis is understood as intimately linking the social and internal world in a dialogical process aimed at enhancing the client's functioning in the social world rather than at specifically developing the private mental experience of reflexivity or mentalizing.
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Affiliation(s)
- Sarah Dilks
- South London and Maudsley NHS Foundation Trust, North CMHT, London, UK.
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91
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Pousa E, Duñó R, Blas Navarro J, Ruiz AI, Obiols JE, David AS. Exploratory study of the association between insight and Theory of Mind (ToM) in stable schizophrenia patients. Cogn Neuropsychiatry 2008; 13:210-32. [PMID: 18484288 DOI: 10.1080/13546800701849066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Poor insight and impairment in Theory of Mind (ToM) reasoning are common in schizophrenia, predicting poorer clinical and functional outcomes. The present study aimed to explore the relationship between these phenomena. METHODS 61 individuals with a DSM-IV diagnosis of schizophrenia during a stable phase were included. ToM was assessed using a picture sequencing task developed by Langdon and Coltheart (1999), and insight with the Scale to Assess Unawareness of Mental Disorder (SUMD; Amador et al., 1993). Multivariate linear regression analysis was carried out to estimate the predictive value of insight on ToM, taking into account several possible confounders and interaction variables. RESULTS No direct significant associations were found between any of the insight dimensions and ToM using bivariate analysis. However, a significant linear regression model which explained 48% of the variance in ToM was revealed in the multivariate analysis. This included the 5 insight dimensions and 3 interaction variables. Misattribution of symptoms--in aware patients with age at onset >20 years--and unawareness of need for medication--in patients with GAF >60--were significantly predictive of better ToM. CONCLUSION Insight and ToM are two complex and distinct phenomena in schizophrenia. Relationships between them are mediated by psychosocial, clinical, and neurocognitive variables. Intact ToM may be a prerequisite for aware patients to attribute their symptoms to causes other than mental illness, which could in turn be associated with denial of need for medication.
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Affiliation(s)
- Esther Pousa
- Psychiatry Department, Parc Taulí Hospital, Sabadell, and Department of Clinical and Health Psychology, Psychopathology and Neuropsychology Research Unit, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
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92
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Fernyhough C, Jones SR, Whittle C, Waterhouse J, Bentall RP. Theory of mind, schizotypy, and persecutory ideation in young adults. Cogn Neuropsychiatry 2008; 13:233-49. [PMID: 18484289 DOI: 10.1080/13546800801936516] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Previous studies of the relation between theory of mind (ToM) and schizotypy have suggested that ToM deficits may be associated with positive signs (e.g., hallucination- and delusion-like experiences). Good theoretical reasons exist to suggest that this relation may be largely due to ToM deficits being predominantly associated with the occurrence of persecutory delusion-like beliefs. This study set out to test this hypothesis and address limitations of previous research. METHOD Online administration of measures to a large nonclinical sample of young adults (N=828) was used to examine schizotypy, assessed by a new 30-item version of the Oxford-Liverpool Inventory of Feelings and Experiences (Mason, Claridge, & Jackson, 1995), persecutory delusion-like beliefs, assessed by the Persecutory Ideation Questionnaire (McKay, Langdon, & Coltheart, 2006), and ToM, indexed by the Hinting task (Corcoran, Mercer, & Frith, 1995) and a cartoon comprehension task (Corcoran, Cahill, & Frith, 1997). RESULTS No relations with ToM were found for global, positive, or negative schizotypy, nor persecutory delusion-like beliefs. This was the case both for whole group correlations and in analyses comparing groups formed by fifth-centile (top-bottom) splits by schizotypy scores. Scores on the two ToM tasks were not strongly correlated. CONCLUSION Our findings point to no correlations with ToM for either schizotypy or persecutory ideation. These findings are discussed in relation to previous research.
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93
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Baas D, Aleman A, Vink M, Ramsey NF, de Haan EH, Kahn RS. Evidence of altered cortical and amygdala activation during social decision-making in schizophrenia. Neuroimage 2008; 40:719-727. [DOI: 10.1016/j.neuroimage.2007.12.039] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 12/17/2007] [Accepted: 12/18/2007] [Indexed: 11/16/2022] Open
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94
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Pousa E, Duñó R, Brébion G, David AS, Ruiz AI, Obiols JE. Theory of mind deficits in chronic schizophrenia: evidence for state dependence. Psychiatry Res 2008; 158:1-10. [PMID: 18166230 DOI: 10.1016/j.psychres.2006.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 03/29/2006] [Accepted: 05/14/2006] [Indexed: 11/30/2022]
Abstract
There is evidence that people with schizophrenia show specific deficits in theory of mind (ToM). However, it is a matter of debate whether these are trait or state dependent, and the nature of the relationship between ToM deficits and particular symptoms is controversial. This study aimed to shed further light on these issues by (1) examining ToM abilities in 61 individuals with chronic schizophrenia during a stable phase as compared with 51 healthy controls matched by gender, age, educational level and current IQ, and (2) exploring the relationship between ToM and symptoms. Second order verbal stories and a non-verbal picture-sequencing task were used as ToM measures. Results showed no differences in ToM performance between patients and controls on either measure. Subsequent subgrouping of patients into remitted and non-remitted showed a worse performance of non-remitted patients only on second order ToM tasks. Specific ToM deficits were found associated with delusions. Association with negative symptoms was found to be less specific and accounted for by illness chronicity and general cognitive impairment. The results from the present study are in line with models which hypothesise that specific ToM deficits in schizophrenia are state dependent and associated with delusions. Such associations may also be task specific.
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Affiliation(s)
- Esther Pousa
- Psychiatry Department, Parc Taulí Hospital, Parc Taulí S/N, 08208 Sabadell, Barcelona, Spain.
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95
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Deficits of social-cognitive and social-perceptual aspects of theory of mind in remitted patients with schizophrenia: effect of residual symptoms. J Nerv Ment Dis 2008; 196:95-9. [PMID: 18277216 DOI: 10.1097/nmd.0b013e318162a9e1] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although ToM deficit in schizophrenia is widely accepted, findings regarding remitted schizophrenia patients are contradictory. Because residual symptoms are present out of psychotic exacerbation periods, the differences between definition of remission may be important to interpret these findings. The purpose of this study was to investigate the relationship between performance of 2 different aspects of theory of mind (ToM) and residual clinical symptoms and other cognitive deficits in schizophrenia. Ninety-one stable outpatients with schizophrenia and 55 healthy controls were assessed with a neuropsychological battery. Both social-cognitive and social-perceptual aspects of ToM were impaired in schizophrenia, even in patients who were totally free of residual symptoms. Still, the results showed that ToM deficit is related to residual symptoms of schizophrenia. Social-cognitive ToM abilities seem to be related to both positive and negative symptoms. The ToM deficits of fully remitted patients without persistent negative symptoms may be secondary to a more general cognitive dysfunction in schizophrenia.
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96
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Dollfus S, Razafimandimby A, Maiza O, Lebain P, Brazo P, Beaucousin V, Lecardeur L, Delamillieure P, Mazoyer B, Tzourio-Mazoyer N. Functional deficit in the medial prefrontal cortex during a language comprehension task in patients with schizophrenia. Schizophr Res 2008; 99:304-11. [PMID: 18178386 DOI: 10.1016/j.schres.2007.11.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/30/2007] [Accepted: 11/02/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We and others have observed that patients with schizophrenia commonly presented a reduced left recruitment in language semantic brain regions. However, most studies include patients with leftward and rightward lateralizations for language. We investigated whether a cohort comprised purely of patients with typical lateralization (leftward) presented a reduced left recruitment in semantic regions during a language comprehension task. The goal was to reduce the inter-subject variability and thus improve the resolution for studying functional abnormalities in the language network. METHODS Twenty-three patients with schizophrenia (DSM-IV) were matched with healthy subjects in age, sex, level of education and handedness. All patients exhibited leftward lateralization for language. Functional MRI was performed as subjects listened to a story comprising characters and social interactions. Functional MRI signal variations were analyzed individually and compared among groups. RESULTS Although no differences were observed in the recruitment of the semantic language network, patients with schizophrenia presented significantly lower signal variations compared to controls in the medial part of the left superior frontal gyrus (MF1) (x=-6, y=58, z=20; Z(score)=5.6; p<0.001 uncorrected). This region corresponded to the Theory of Mind (ToM) network. Only 5 of the 23 patients (21.7%) and 21 of the 23 (91.3%) control subjects demonstrated a positive signal variation in this area. CONCLUSIONS A left functional deficit was observed in a core region of the ToM network in patients with schizophrenia and typical lateralizations for language. This functional defect could represent a neural basis for impaired social interaction and communication in patients with schizophrenia.
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Affiliation(s)
- Sonia Dollfus
- Groupe d'Imagerie Neurofonctionnelle, UMR 6194 CNRS/CEA/Université de Caen, Université Paris 5, Centre Cyceron, Bl H. Becquerel, Caen, 14000, France.
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97
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Mo S, Su Y, Chan RCK, Liu J. Comprehension of metaphor and irony in schizophrenia during remission: the role of theory of mind and IQ. Psychiatry Res 2008; 157:21-9. [PMID: 17854910 DOI: 10.1016/j.psychres.2006.04.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 02/16/2006] [Accepted: 04/01/2006] [Indexed: 11/17/2022]
Abstract
The study reported herein explored the comprehension of metaphor and irony in schizophrenia during remission, and examined the role of IQ and a theory of mind. Performance of 29 Schizophrenic patients in remission and 22 healthy controls was compared on metaphor and irony comprehension tasks and first- and second-order theory of mind tasks. Participants' IQs were measured using the Wechsler Adult Intelligence Scale-Revised, and the symptoms of individuals with schizophrenia were assessed using the Positive and Negative Syndrome Scale. The results showed that patients with schizophrenia were impaired in their comprehension of metaphor and irony as compared with healthy controls. A theory of mind deficit was found in patients with remitted schizophrenia. The comprehension of metaphor was significantly correlated with second-order false belief understanding and the comprehension of irony was not significantly related to theory of mind. IQ and verbal IQ did not explain the deficit of metaphor and irony comprehension. These findings were not explained by Happé's [Happé, F.G.E., 1993. Communication competence and theory of mind in autism: a test of relevance theory. Cognition 48, 101-119] theory and the shared semantic understanding requirement was discussed.
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Affiliation(s)
- Shuliang Mo
- Department of Psychology, Peking University, 5 Yihe Yuan Road, Beijing, 100871, PR China
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98
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Bertrand MC, Sutton H, Achim AM, Malla AK, Lepage M. Social cognitive impairments in first episode psychosis. Schizophr Res 2007; 95:124-33. [PMID: 17630261 DOI: 10.1016/j.schres.2007.05.033] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 05/17/2007] [Accepted: 05/24/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Social cognition is a complex phenomenon involving several distinct processes. Numerous studies have shown that individuals with schizophrenia are largely impaired on this domain of cognition. However, most have focused on a single aspect of social cognition, namely "theory of mind" and/or included patients with long standing illness. OBJECTIVE The main objective of the present study was to identify social cognition deficits in first episode of schizophrenia spectrum psychosis using a case control design and a comprehensive assessment that allowed the exploration of several dimensions of this phenomenon. SUBJECTS 36 patients with a first episode of psychosis and 25 healthy controls participated in this study. MATERIAL Measures of social cognition included the Hinting Task and the Four Factor Test of Social Intelligence. RESULTS Significant group differences were found on both tasks, but the Four Factor Test of Social Intelligence revealed a stronger group effect and the effects observed remained significant once IQ was covaried. Social cognition did not show any correlations with level of symptoms. CONCLUSION Social cognition deficits are present during the first episode of psychosis. These impairments do not seem to be a consequence of group differences in overall intellectual functioning and are likely to be state-independent.
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Affiliation(s)
- Marie-Claude Bertrand
- Department of Psychology, University of Montréal, 90 Vincent-d'Indy Avenue, Montreal, Quebec, Canada H2V 2S9.
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99
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Bentall RP, Fernyhough C, Morrison AP, Lewis S, Corcoran R. Prospects for a cognitive-developmental account of psychotic experiences. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2007; 46:155-73. [PMID: 17524210 DOI: 10.1348/014466506x123011] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE It has recently been recognized that psychosis represents the end-point of abnormal developmental pathways. The neurodevelopmental framework, within which this observation has typically been interpreted, has a number of limitations, particularly its failure to take account of recent advances in our understanding of the psychology of unusual experiences, such as hallucinations and delusions. The purpose of the present review is to highlight the advantages of considering psychosis within the framework of mainstream developmental psychology. The approach we advocate integrates findings from neurodevelopmental research with research on typical cognitive and sociocognitive development and the psychology of psychotic symptoms. METHOD We review selected research on the developmental precursors of psychosis and on the role of cognitive processes in psychotic symptoms, together with relevant literature addressing the development of these processes in healthy children. RESULTS Developmental psychology provides clues about the cognitive and sociocognitive abnormalities that may be involved in hallucinations and delusions. An integration of these findings with existing knowledge on the neurodevelopment of psychosis suggests new avenues of research for investigators working at both biological and psychological levels of explanation. CONCLUSIONS The literature on typical cognitive and sociocognitive development provides a rich source of hypotheses about the ontogenetic pathways leading to psychosis.
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100
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Montag C, Heinz A, Kunz D, Gallinat J. Self-reported empathic abilities in schizophrenia. Schizophr Res 2007; 92:85-9. [PMID: 17350225 DOI: 10.1016/j.schres.2007.01.024] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2006] [Revised: 01/21/2007] [Accepted: 01/24/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increasing evidence indicates impairments of empathic abilities in schizophrenia that may impact outcome and course of the disease. While there is consensus on the presence of deficits in 'theory of mind' in this disorder, i.e. cognitive aspects of mental state attribution, the ability to infer emotional experiences of others, i.e. affective empathy, has not been investigated so far. METHODS We assessed multiple dimensions of empathy in 45 schizophrenic patients and 45 healthy controls, matched for age and gender, with a self-rating instrument, the Interpersonal Reactivity Index (IRI). To control for modulating effects of cognitive deficits, a neuropsychological test battery was employed. RESULTS Schizophrenic patients showed significantly lower scores in cognitive empathy ('perspective taking': F=12.176, df=1, p=0.001) but more self-related aversive feelings in response to the distress of others ('personal distress: F=16.477, df=1, p<0.001). Self-ratings of affective empathy, i.e. concern for others, did not differ between groups. Results in the domains of empathy were not explained by symptoms or neurocognition as revealed by regression analysis. However, lower scores in 'perspective taking' were found with advancing duration of illness (r=-0.453, p=0.002). CONCLUSIONS Results indicate reductions of cognitive empathy but relatively preserved emotional empathic abilities in schizophrenia. Although previous studies observed deficits in emotion perception and expression, our findings support the concept of differentially disturbed abilities in cognitive and emotional empathy in schizophrenia.
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Affiliation(s)
- C Montag
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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