Deficits in social cognition in first episode psychosis: A review of the literature

Staging's determinants in early intervention youth: a retrospective study

OBJECTIVES

Since 2019 our early intervention unit has assessed help-seekers, mainly referred by psychiatric departments, and we have conducted a descriptive retrospective study. Our objective was to identify clinical determinants associated to staging at assessment for our three groups: "no psychosis", "ultra-high risk" and "first episode psychosis".

METHODS

One hundred and thirteen participants (mean age 20.05±3.28) were enrolled, mainly referred by adult psychiatry (81.4%). We tested the association of each group with the following determinants: age, gender, family history of psychosis, referral (adolescent or adult psychiatry), cognitive, depressive complaint, cannabis active consumption, and current activity (scholar or employment).

RESULTS

Multivariate analyses showed significant association with depressive symptoms (P=0.019) but an absence of family history of psychosis (P=0.002) or current activity (P=0.09) for "no psychosis" group. "Ultra-high risk" was significantly correlated with a family history of psychosis (P=0.001) and adolescent psychiatry referral (P=0.044) but an absence of depressive complaint (P=0.04). As for "first episode psychosis", we found significant cognitive complaint (P=0.026), family history (P=0.024) and current activity (0.026).

CONCLUSIONS

As all our participants were seen in tertiary care, adolescent psychiatrists were more efficient in detecting a high-risk state. "No psychosis" help-seekers presented in fact mood issues, which have been confused with attenuated psychotic symptoms by their addressers, who have probably been misled by their absence of activity integration. High-risk and characterized psychotic episodes were logically correlated with family history. Surprisingly, "first episode psychosis" youth were currently integrated in scholarly or professional life despite an active cognitive complaint. Robust studies, especially prospective cohorts, are needed to test these associations.

Emotional intelligence and neurocognition profiles in first-episode psychosis: A two-year follow-up study

Emotional intelligence (EI) and neurocognition (NC) impairments are common in first-episode psychosis (FEP), yet their evolution over time remains unclear. This study identified patient profiles in EI and NC performance in FEP. 98 adult FEP patients and 128 healthy controls (HCs) were tested on clinical, functional, EI, and NC variables at baseline and two-year follow-up (FUP). A repeated-measures ANOVA compared the effects of group (patients and HCs) and time on EI. Significant EI improvements were observed in both groups. Four groups were created based on NC and EI performance at baseline and FUP in patients: impairment in NC and EI, impairment in NC only, impairment in EI only, and no impairment. At FUP, patients impaired in NC and EI showed less cognitive reserve (CR), greater negative and positive symptoms, and poorer functional outcomes. At FUP, three group trajectories were identified: (I) maintain dual impairment (II) maintain no impairment or improve, (III) maintain sole impairment or worsen. The maintain dual impairment group had the lowest levels of CR. EI and NC impairments progress differently in FEP. Greater CR may protect against comorbid EI/NC impairment. Identifying these patient characteristics could contribute to the development of personalised interventions.

Mentalizing impairments and hypermentalizing bias in individuals with first-episode schizophrenia-spectrum disorder and at-risk mental state: the differential roles of neurocognition and social anxiety

Mentalizing, or theory of mind (ToM), impairments and self-referential hypermentalizing bias are well-evident in schizophrenia. However, findings compared to individuals with at-risk mental states (ARMS) are inconsistent, and investigations into the relationship between social cognitive impairments and social anxiety in the two populations are scarce. This study aimed to examine and compare these deficits in first-episode schizophrenia-spectrum disorder (FES) and ARMS, and to explore potential specific associations with neurocognition and symptomatology. Forty patients with FES, 40 individuals with ARMS, and 40 healthy controls (HC) completed clinical assessments, a battery of neurocognitive tasks, and three social cognitive tasks. The comic strip and hinting tasks were used to measure non-verbal and verbal mentalizing abilities, and the gaze perception task was employed to assess self-referential hypermentalizing bias. FES and ARMS showed comparable mentalizing impairments and self-referential hypermentalizing bias compared to HC. However, only ambiguous self-referential gaze perception (SRGP) bias remained significantly different between three groups after controlling for covariates. Findings suggested that self-referential hypermentalizing bias could be a specific deficit and may be considered a potential behavioral indicator in early-stage and prodromal psychosis. Moreover, working memory and social anxiety were related to the social cognitive impairments in ARMS, whereas higher-order executive functions and positive symptoms were associated with the impairments in FES. The current study indicates the presence of stage-specific mechanisms of mentalizing impairments and self-referential hypermentalizing bias, providing insights into the importance of personalized interventions to improve specific neurocognitive domains, social cognition, and clinical outcomes for FES and ARMS.

Cognitive insight in first-episode psychosis: Exploring the complex relationship between executive functions and social cognition

Social cognition (SC) and executive function (EF) have been described as important variables for social functioning and recovery of patients with psychosis. However, the relationship between SC and EF in first-episode psychosis (FEP) deserves further investigation, especially focusing on gender differences.

AIMS

To investigate the relationship between EF and different domains of SC in FEP patients and to explore gender differences in the relationship between these domains.

METHODS

A cross-sectional study of 191 patients with new-onset psychosis recruited from two multicenter clinical trials. A comprehensive cognitive battery was used to assess SC (Hinting Task, Face Test and IPSAQ) and EF (TMT, WSCT, Stroop Test and digit span - WAIS-III). Pearson correlations and linear regression models were performed.

RESULTS

A correlation between Theory of Mind (ToM), Emotional Recognition (ER) and EF was found using the complete sample. Separating the sample by gender showed different association profiles between these variables in women and men.

CONCLUSIONS

A relationship between different domains of SC and EF is found. Moreover, women and men presented distinct association profiles between EF and SC. These results should be considered in order to improve the treatment of FEP patients and designing personalized interventions by gender.

Neuropsychological profiles in first-episodes psychosis and their relationship with clinical, metacognition and social cognition variables

An increasing interest in the assessment of neuropsychological performance variability in people with first-episode psychosis (FEP) has emerged. However, its association with clinical and functional outcomes requires further study. Furthermore, FEP neuropsychological subgroups have not been characterized by clinical insight or metacognition and social cognition domains. The aim of this exploratory study was to identify specific groups of patients with FEP based on neuropsychological variables and to compare their sociodemographic, clinical, metacognition and social cognition profiles. A sample of 149 FEP was recruited from adult mental health services. Neuropsychological performance was assessed by a neuropsychological battery (WAIS-III; TMT; WSCT; Stroop Test; TAVEC). The assessment also included sociodemographic characteristics, clinical, functional, metacognition and social cognition variables. Two distinct neuropsychological profiles emerged: one neuropsychological impaired cluster (N = 56) and one relatively intact cluster (N = 93). Significant differences were found between both profiles in terms of sociodemographic characteristics (age and level of education) (p = 0.001), clinical symptoms (negative, positive, disorganized, excitement and anxiety) (p = 0.041-0.001), clinical insight (p = 0.038-0.017), global functioning (p = 0.014), as well as in social cognition domains (emotional processing and theory of mind) (p = 0.001; p = 0.002). No significant differences were found in metacognitive variables (cognitive insight and 'jumping to conclusions' bias). Relationship between neurocognitive impairment, social cognition and metacognition deficits are discussed. Early identifying of neuropsychological profiles in FEP, characterized by significant differences in clinical and social cognition variables, could provide insight into the prognosis and guide the implementation of tailored early-intervention.

Emotional anticipation for dynamic emotional faces is not modulated by schizotypal traits: A Representational Momentum study

Schizotypy, a personality structure that resembles schizophrenia symptoms, is often associated with abnormal facial emotion perception. Based on the prevailing sense of threat in psychotic experiences, and the immediate perceptual history of seeing others' facial expressions, individuals with high schizotypal traits may exhibit a heightened tendency to anticipate anger. To test this, we used insights from Representational Momentum (RM), a perceptual phenomenon in which the endpoint of a dynamic event is systematically displaced forward, into the immediate future. Angry-to-ambiguous and happy-to-ambiguous avatar faces were presented, each followed by a probe with the same (ambiguous) expression as the endpoint, or one slightly changed to express greater happiness/anger. Participants judged if the probe was "equal" to the endpoint and rated how confident they were. The sample was divided into high (N = 46) and low (N = 49) schizotypal traits using the Schizotypal Personality Questionnaire (SPQ). First, a forward bias was found in happy-to-ambiguous faces, suggesting emotional anticipation solely for dynamic faces changing towards a potential threat (anger). This may reflect an adaptative mechanism, as it is safer to anticipate any hostility from a conspecific than the opposite. Second, contrary to our hypothesis, high schizotypal traits did not heighten RM for happy-to-ambiguous faces, nor did they lead to overconfidence in biased judgements. This may suggest a typical pattern of emotional anticipation in non-clinical schizotypy, but caution is needed due to the use of self-report questionnaires, university students, and a modest sample size. Future studies should also investigate if the same holds for clinical manifestations of schizophrenia.

Cognitive Function and Variability in Antipsychotic Drug-Naive Patients With First-Episode Psychosis: A Systematic Review and Meta-Analysis

Importance

Cognitive impairment contributes significantly to clinical outcome and level of function in individuals with psychotic disorders. These impairments are present already at psychosis onset at a group level; however, the question of heterogeneity in cognitive function among patients has not been systematically investigated.

Objective

To provide an updated quantification of cognitive impairment at psychosis onset before patients receive potentially confounding antipsychotic treatment, and to investigate variability in cognitive function compared with healthy controls.

Data Sources

In this systematic review and meta-analysis, PubMed articles were searched up to September 15, 2022.

Study Selection

Original studies reporting data on cognitive function in antipsychotic drug-naive patients with first-episode psychosis (FEP) were included.

Data Extraction and Synthesis

Data were independently extracted by 2 researchers. Cognitive tasks were clustered according to 6 domains of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery and the domain of executive function. Random-effects model meta-analyses of mean differences and coefficient of variation ratios (CVRs) were performed, as well as meta-regressions, assessment of study quality, and publication bias.

Main Outcomes and Measures

The main outcome measure was Hedges g for mean differences in cognition and CVR for within-group variability.

Results

Fifty studies were included in the analysis with a total of 2625 individuals with FEP (mean [SD] age, 25.2 [3.6] years, 60% male; 40% female) and 2917 healthy controls (mean [SD] age, 26.0 [4.6]; 55% male; 45% female). In all cognitive domains, the FEP group displayed significant impairment compared with controls (speed of processing: Hedges g = -1.16; 95% CI, -1.35 to -0.98; verbal learning: Hedges g = -1.08; 95% CI, -1.28 to -0.88; visual learning: Hedges g = -1.05; 95% CI, -1.27 to -0.82; working memory: Hedges g = -1.04; 95% CI, -1.35 to -0.73; attention: Hedges g = -1.03; 95% CI, -1.24 to -0.82; reasoning/problem solving: Hedges g = -0.90; 95% CI, -1.12 to -0.68; executive function: Hedges g = -0.88; 95% CI, -1.07 to -0.69). Individuals with FEP also exhibited a larger variability across all domains (CVR range, 1.34-1.92).

Conclusions and Relevance

Results of this systematic review and meta-analysis identified cognitive impairment in FEP before the initiation of antipsychotic treatment, with large effect sizes. The high variability within the FEP group suggests the need to identify those individuals with more severe cognitive problems who risk worse outcomes and could benefit the most from cognitive remediation.

Relationship between social cognition and premorbid adjustment in psychosis: a systematic review

This systematic review provides a comprehensive overview of the association between premorbid adjustment and social cognition in people with psychotic spectrum disorder. Obtaining evidence of this association will facilitate early detection and intervention before the onset of psychosis. Literature searches were conducted in Scopus, PubMed and PsycINFO. Studies were eligible if they included patients with a psychotic disorder or at a high-risk state; social cognition and premorbid adjustment were measured; and the relationship between premorbid adjustment and social cognition was analysed. The authors independently extracted data from all included articles, and discrepancies were resolved through discussion. Literature searches were conducted in Scopus, PubMed and PsycINFO. Studies were eligible if they included patients with a psychotic disorder or at a high-risk state; social cognition and premorbid adjustment were measured; and the relationship between premorbid adjustment and social cognition was analysed. The authors independently extracted data from all included articles, and discrepancies were resolved through discussion. Of 229 studies identified, 23 met the inclusion criteria. Different methods of assessment were used to measure premorbid adjustment, such as the Premorbid Adjustment Scale or premorbid IQ, among others. Social cognition was assessed as a global measure or by domains using different instruments. A total of 16 articles found a relationship between social cognition (or its domains) and premorbid adjustment: general social cognition (n = 3); Theory of Mind (n  = 12); Emotional Recognition and Social Knowledge (n  = 1). This review shows evidence of a significant relationship between social cognition and premorbid adjustment, specifically between Theory of Mind and premorbid adjustment. Social cognition deficits may already appear in phases prior to the onset of psychosis, so an early individualized intervention with stimulating experiences in people with poor premorbid adjustment can be relevant for prevention. We recommend some future directions, such as carrying out longitudinal studies with people at high-risk of psychosis, a meta-analysis study, broadening the concept of premorbid adjustment, and a consensual assessment of social cognition and premorbid adjustment variables. PROSPERO registration number: CRD42022333886.

Navigating Social Cognitive Impairments in Schizophrenia Spectrum Disorders: Protocol for a Pilot Pre-Post Quasi-Experimental Study for Remote Avatar-Assisted Cognitive Remediation Therapy

BACKGROUND

Social cognitive impairments are prevalent in schizophrenia spectrum disorder (SSD) and have detrimental effects on functioning. Cognitive remediation (CR) has shown its efficacy in improving social cognitive impairments, although the transfer of these skills to daily life and the personalization of these interventions remain challenging. RC2S (Remédiation Cognitive de la Cognition Sociale dans la Schizophrénie; Cognitive remediation of social cognition in Schizophrenia) is a French CR that combines the learning of strategies and practice using paper-and-pencil exercises and digital relational simulations. This French program was designed as an in-person intervention.

OBJECTIVE

This project aims to culturally adapt the RC2S program, in French-Canadian and North American English and to assess the feasibility, acceptability, safety, and implementation of a remote version in people with SSD. An exploratory objective is to assess the preliminary effect of remote RC2S on goal attainment, social cognition, and psychosocial outcomes.

METHODS

We will use a pre-post quasi-experimental design. First, the translation and cultural adaptation in North American English and French-Canadian of RC2S is presented. Then, 20 participants aged ≥18 years with a diagnosis of SSD, presenting with a subjective or an objective impairment in social cognition, will be included to receive RC2S. In addition, 5 therapists will be included as research participants to assess their perspective on RC2S. Participants with SSD will undergo a baseline remote assessment of their social cognition, clinical symptoms, and functioning. They will then start remote RC2S for 24 biweekly individual 1-hour sessions with a therapist. Following the case formulation and goal setting, participants will complete personalized paper-and-pencil exercises to develop strategies and integrative digital relational simulations, during which they will help an avatar navigate through a variety of social contexts and relationships. The last 2 sessions are dedicated to the transfer to daily life. All participants will complete in-session questionnaires assessing therapeutic alliance, motivation, acceptability, feasibility, and implementation. Following RC2S, the participants with SSD will repeat the same assessment as the baseline. Descriptive statistics will be used to summarize the data about acceptability, feasibility, safety, and implementation. To assess the preliminary effect of RC2S, an intention-to-treat approach will be used with linear mixed models for repeated measures with fixed effects of time.

RESULTS

So far, 45% (9/20) of participants with SSD (mean age 37.9, SD 9.3 years) have completed the project. They received a mean of 20.5 out of 24 (SD 3.5) sessions of RC2S. A total of 5 therapists also completed the project.

CONCLUSIONS

Improving social cognitive impairments is an important target in SSD to promote functional recovery. Using digital technologies to address these impairments and deliver the intervention is a promising approach to increase the ecological validity of CR and access to the intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05017532; https://classic.clinicaltrials.gov/ct2/show/NCT05017532.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/54251.

Combining transcranial magnetic stimulation with training to improve social cognition impairment in schizophrenia: a pilot randomized controlled trial

Schizophrenia is a severe, chronic mental disorder that profoundly impacts patients' everyday lives. The illness's core features include positive and negative symptoms and cognitive impairments. In particular, deficits in the social cognition domain showed a tighter connection to patients' everyday functioning than the other symptoms. Social remediation interventions have been developed, providing heterogeneous results considering the possibility of generalizing the acquired improvements in patients' daily activities. In this pilot randomized controlled trial, we investigated the feasibility of combining fifteen daily cognitive and social training sessions with non-invasive brain stimulation to boost the effectiveness of the two interventions. We delivered intermittent theta burst stimulation (iTBS) over the left dorsolateral prefrontal cortex (DLPFC). Twenty-one patients were randomized into four groups, varying for the assigned stimulation condition (real vs. sham iTBS) and the type of cognitive intervention (training vs. no training). Clinical symptoms and social cognition tests were administered at five time points, i.e., before and after the treatment, and at three follow-ups at one, three, and six months after the treatments' end. Preliminary data show a trend in improving the competence in managing emotion in participants performing the training. Conversely, no differences were found in pre and post-treatment scores for emotion recognition, theory of mind, and attribution of intentions scores. The iTBS intervention did not induce additional effects on individuals' performance. The methodological approach's novelty and limitations of the present study are discussed.

Cerebral and cerebellar correlates of social cognitive impairment in schizophrenia

Social cognition is a broad construct encompassing the ways in which individuals perceive, process, and use information about other people. Social cognition involves both lower- and higher-level processes such as emotion recognition and theory of mind, respectively. Social cognitive impairments have been repeatedly demonstrated in schizophrenia spectrum illnesses and, crucially, are related to functional outcomes. In this review, we summarize the literature investigating the brain networks implicated in social cognitive impairments in schizophrenia spectrum illnesses. In addition to cortical and limbic loci and networks, we also discuss evidence for cerebellar contributions to social cognitive impairment in this population. We conclude by synthesizing these two literatures, with an emphasis on current knowledge gaps, particularly in regard to cerebellar influences, and future directions.

Psychological/Personal recovery and its correlates in patients with first episode psychosis

BACKGROUND

Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP.

AIM

To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission.

METHODOLOGY

One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales.

RESULTS

The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization.

CONCLUSION

The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

Cognitive subgroups and the relationships with symptoms, psychosocial functioning and quality of life in first-episode non-affective psychosis: a cluster-analysis approach

Introduction

Prior research examining cognitive heterogeneity in psychotic disorders primarily focused on chronic schizophrenia, with limited data on first-episode psychosis (FEP). We aimed to identify distinct cognitive subgroups in adult FEP patients using data-driven cluster-analytic approach, and examine relationships between cognitive subgroups and a comprehensive array of illness-related variables.

Methods

Two-hundred-eighty-nine Chinese patients aged 26-55 years presenting with FEP to an early intervention program in Hong Kong were recruited. Assessments encompassing premorbid adjustment, illness-onset profile, symptom severity, psychosocial functioning, subjective quality-of-life, and a battery of cognitive tests were conducted. Hierarchical cluster-analysis was employed, optimized with k-means clustering and internally-validated by discriminant-functional analysis. Cognitive subgroup comparisons in illness-related variables, followed by multivariable multinominal-regression analyzes were performed to identify factors independently predictive of cluster membership.

Results

Three clusters were identified including patients with globally-impaired (n = 101, 34.9%), intermediately-impaired (n = 112, 38.8%) and relatively-intact (n = 76, 26.3%) cognition (GIC, IIC and RIC subgroups) compared to demographically-matched healthy-controls' performance (n = 50). GIC-subgroup was older, had lower educational attainment, greater positive, negative and disorganization symptom severity, poorer insight and quality-of-life than IIC- and RIC-subgroups, and higher antipsychotic-dose than RIC-subgroup. IIC-subgroup had lower education levels and more severe negative symptoms than RIC-subgroup, which had better psychosocial functioning than two cognitively-impaired subgroups. Educational attainment and disorganization symptoms were found to independently predict cluster membership.

Discussion

Our results affirmed cognitive heterogeneity in FEP and identified three subgroups, which were differentially associated with demographic and illness-related variables. Further research should clarify longitudinal relationships of cognitive subgroups with clinical and functional outcomes in FEP.

Social cognition in first-episode schizophrenia/schizoaffective disorder patients

INTRODUCTION

People with schizophrenia have neurocognitive as well as social cognition deficits. Numerous studies have shown impairment in these domains in patients with chronic schizophrenia. However, these disturbances during the early phase of the disease have been less studied.

OBJECTIVE

The aim of the study is to explore the theory of mind (ToM) and emotional processing in first-episode patients, compared to healthy subjects.

METHOD

Forty patients with a first psychotic episode of less than 5 years' duration, and 40 healthy control subjects matched by age and years of schooling were assessed. The measures of social cognition included four stories of false belief, the Reading the Mind in the Eyes Test (RMET) and the Pictures Of Facial Affect (POFA) series.

RESULTS

The patients with a first psychotic episode performed significantly worse in all tasks of social cognition, compared to the healthy controls. The second-order ToM was impaired whereas the first-order ToM was preserved in the patients. Happiness was the emotion most easily identified by both patients and controls. Fear was most difficult for the patients, while for the controls it was disgust.

CONCLUSIONS

Deficits in ToM and emotional processing are present in patients with a first psychotic episode.

Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review

Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.

Metabolic profile in first episode drug naïve patients with psychosis and its relation to cognitive functions and social cognition: a case control study

1st episode drug naïve patients with psychosis might be at higher risk for cardiometabolic disturbances which could affect the different cognitive, and executive functions and domains of social cognition. This study aimed to study the metabolic parameters in 1st episode drug naïve patients with psychosis, to evaluate the relation of these cardiometabolic domains to the cognitive, executive functions, and social cognition. Socio-demographic characteristics of 150 first episode drug naïve patients with psychosis and 120 matched healthy control groups were collected. The current study also assessed the cardiometabolic profile and cognitive functions in both groups. Social cognition was examined by Edinburgh Social Cognition Test. The study revealed a statistically significant difference in parameters of metabolic profile among the studied groups (p < 0.001*), the scores of cognitive and executive tests were statistically significantly different (p < 0.001*). In addition, the patient's group has lowered scores of domains of social cognition (p < 0.001*). Also, the mean affective theory of mind was negatively correlated with the conflict cost of the Flanker test (r = -.185* p value = .023). The total cholesterol level (r = - 0.241**, p value = .003) and level of triglycerides (r = - 0.241**, p value = 0.003) were negatively correlated with the interpersonal domain of social cognition, the total cholesterol level is positively correlated to the total score of social cognition (r = 0.202*, p value = 0.013). Patients with 1st episode drug naïve psychosis showed disturbed cardiometabolic parameters which have deleterious effects on cognitive functions and social cognition.

The Relationship between Motor Symptoms, Signs, and Parkinsonism with Facial Emotion Recognition Deficits in Individuals with 22q11.2 Deletion Syndrome at High Genetic Risk for Psychosis

Background. The 22q11.2 Deletion Syndrome (22q11.2DS) is a genetic condition at high risk of developing both psychosis and motor disorders. Social Cognition (SC) deficits have been associated not only with schizophrenia but also with Parkinson’s disease (PD). The present study assessed SC deficits in 22q11.2DS and investigated the interaction between motor symptoms and deficits in Facial Emotion Expressions (FEE) recognition and in Theory of Mind (ToM) tasks in people with 22q11.2DS. Methods. We recruited 38 individuals with 22q11.2DS without psychosis ( $N=38$ , DEL) and 18 with 22q11.2DS and psychosis ( $N=18$ , DEL_SCZ). The Positive And Negative Syndrome Scale (PANSS), Ekman’s 60 Faces Test (EK-60F), the Awareness of Social Inference Test (TASIT EmRec), and the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale part III (UPDRS III) were administered. Correlations were sought between UPDRS III and both TASIT EmRec and EK-60F scores. Analyses were conducted separately for each psychopathological subgroup. Results. Higher UPDRS III ( $p=0.04$ ) and lower EK-60F ( $p=0.025$ ) scores were observed in the DEL_SCZ group. We found inverse correlations between UPDRS III and both TASIT EmRec ( $r=-0.289$ , $p=0.031$ ) and EK-60F ( $r=-0.387$ , $p=0.006$ ) scores in the whole sample. Correlations were no longer significant in the DEL_SCZ group (UPDRS III-TASIT EmRec $p=0.629$ ; UPDRS III-EK60F $p=0.933$ ) whilst being stronger in the DEL group (TASIT EmRec, $r=-0.560$ , $p<0.001$ ; EK60F, $r=-0.542$ , $p<0.001$ ). Analyses were adjusted for CPZ Eq and IQ. Conclusions. A modulation between FEE recognition deficits and motor symptoms and signs was observed in the 22q11.2DS group, likely affecting patients’ quality of life.

A randomized controlled trial of social cognition and interaction training for persons with first episode psychosis in Hong Kong

Social cognitive impairment is a core limiting factor of functional recovery among persons with first episode psychosis (FEP). Social Cognition and Interaction Training (SCIT) is a group-based, manualized training with demonstrated evidence in improving social cognitive performance among people with schizophrenia. However, there are few studies on the effect of SCIT for people with FEP and for people in non-Western societies. This study evaluated the feasibility, acceptability and initial effectiveness of the locally-adapted SCIT in improving social cognitive functioning in Chinese people with FEP. The SCIT was delivered two sessions per week over a 10-weeks period, each session lasted for 60-90 min. A total of 72 subjects with FEP were recruited from an outpatient clinic and randomized to conventional rehabilitation ("Rehab") and experimental ("SCIT and Rehab") groups. Primary outcome measures included four social cognitive domains including emotion perception, theory-of-mind, attributional bias and jumping-to-conclusion, and secondary measures included neurocognition, social competence and quality of life. Participants were assessed at baseline, post-treatment, and 3-months post-treatment. Repeated measures ANCOVAs, with baseline scores as covariates, were used to compare the group differences in various outcomes across time. The results showed that the SCIT was well-accepted, with a satisfactory completion rate and subjective ratings of relevance in the experimental group. Moreover, treatment completers (n = 28) showed evidence of an advantage, over conventional group (n = 31), in reduced attributional bias and jumping-to-conclusions at treatment completion, lending initial support for the SCIT in Chinese people with FEP. Future research should address the limitations of this study, using more refined outcome measurements and higher treatment intensity of the SCIT.

Associations between acceptance of the implausible bias, theory of mind and delusions in first-episode psychosis patients; A longitudinal study

Multiple different cognitive biases, among them the liberal acceptance (LA) bias, have been suggested to contribute to reality distortion in psychotic disorders. Earlier studies have been cross-sectional and considered a limited set of cognitive correlates of psychosis, thus the relationship between LA bias and psychosis remains poorly known. We studied a similar bias (acceptance of the implausible (AOI)) in 62 first-episode psychosis (FEP) patients and 62 control subjects, who watched movie scenes with varying degrees of realism and were asked to evaluate the probability of these events occurring in real life. We assessed theory of mind (ToM) performance using the Hinting task and delusion severity using Brief Psychiatric Rating Scale item 11. We correlated the magnitude of AOI with the severity of delusions and performance in the ToM task. Furthermore, we used 1-year follow-up data from 40 FEP patients and 40 control subjects to disentangle state vs trait-like characteristics of AOI. At baseline FEP patients expressed more AOI than control subjects, and the magnitude of AOI correlated positively with the severity of delusions and negatively with ToM performance. At the one-year follow-up, when most patients were in remission, patients still displayed increased AOI, which no longer correlated with delusions. These findings support the notion that the AOI bias could represent a trait rather than a state feature and support further studies to test the hypothesis that it could be one of the causal factors of psychotic disorders, possibly associated with ToM.

Severe childhood trauma and emotion recognition in males and females with first-episode psychosis

AIM

Childhood trauma increases social functioning deficits in first-episode psychosis (FEP) and is negatively associated with higher-order social cognitive processes such as emotion recognition (ER). We investigated the relationship between childhood trauma severity and ER capacity, and explored sex as a potential factor given sex differences in childhood trauma exposure.

METHODS

Eighty-three FEP participants (52 males, 31 females) and 69 nonclinical controls (49 males, 20 females) completed the CogState Research Battery. FEP participants completed the Childhood Trauma Questionnaire. A sex × group (FEP, controls) ANOVA examined ER differences and was followed by two-way ANCOVAs investigating sex and childhood trauma severity (none, low, moderate, and severe) on ER and global cognition in FEP.

RESULTS

FEP participants had significantly lower ER scores than controls (p = .035). No significant sex × group interaction emerged for ER F(3, 147) = .496, p = .438 [95% CI = -1.20-0.57], partial η²  = .003. When controlling for age at psychosis onset, a significant interaction emerged in FEP between sex and childhood trauma severity F(3, 71) = 3.173, p = .029, partial η²  = .118. Males (n = 9) with severe trauma showed ER deficits compared to females (n = 8) (p = .011 [95% CI = -2.90 to -0.39]). No significant interaction was observed for global cognition F(3, 69) = 2.410, p = .074, partial η²  = .095.

CONCLUSIONS

These preliminary findings provide support for longitudinal investigations examining whether trauma severity differentially impacts ER in males and females with FEP.

Facial emotion recognition and schizotypal traits: A systematic review of behavioural studies

AIM

Previous research has indicated that individuals expressing high schizotypal traits and patients with Schizotypal Personality Disorder (SPD), show deficits in facial emotion recognition, compared to low schizotypal or control groups. On the other hand, non-significant findings also exist and the association of facial emotion recognition deficits with the different schizotypal dimensions is not well defined, thus limiting any conclusive outcomes. Therefore, the aim of this systematic review was to further clarify this relationship.

METHODS

PsychInfo, Web of Science, Scopus and PubMed were systematically searched, and 23 papers with a cross-sectional design were selected. Nineteen studies examined individuals with high schizotypal traits and four studies evaluated SPD individuals with behavioural facial emotion recognition paradigms and self-report measures or clinical interviews for schizotypal traits. All selected studies were published between 1994 and August 2020.

RESULTS

According to the evidence of studies, high schizotypal individuals and SPD patients have poorer performance in facial emotion recognition tasks. Negative schizotypy was related to lower accuracy for positive and negative emotions and faster emotion labeling while positive schizotypy was associated with worse accuracy for positive, negative and neutral emotions and more biases. Disorganized schizotypy was associated with poorer accuracy for negative emotions and suspiciousness with higher accuracy for disgust faces but lower total accuracy.

CONCLUSIONS

These findings are consistent with the vulnerability for schizophrenia spectrum disorders and support the idea that emotion recognition deficits are trait markers for these conditions. Thus, the effectiveness of early-intervention programmes could increase by also targeting this class of deficits.

Relationship between cognition and suicidal behavior in recent-onset psychosis

Suicidal behavior (SB) is common in first-episode psychosis (FEP), and cognitive impairment has also been described in psychosis. Despite well-established risk factors for SB in psychosis, the role of cognition and insight remains unclear. This study aimed to explore the relationship between history of SB and cognition in recent-onset FEP, distinguishing between neurocognition, social cognition, and metacognition, and including cognitive insight (CI) as a metacognitive variable. The sample consisted of 190 participants with recent-onset FEP recruited from two multicentric studies. Two groups were formed based on presence/absence of a history of SB. Demographic, clinical, and cognitive data were compared by group, including significance level adjustments and size effect calculation. No differences were found regarding demographic, clinical, neurocognitive, social cognition, and metacognitive variables except for CI (18.18 ± 4.87; t = -3.16; p = 0.0020; d = -0.635), which showed a medium effect size. Small to medium effect size were found for attributional style (externalizing bias) (1.15 ± 3.94; t = 2.07; d = 0.482), theory of mind (ToM) (1.73 ± 0.22; t = 2.04; d = -0.403), jumping to conclusions bias (JTC) (23.3 %; X² = 0.94; V = 0.178). In recent-onset psychosis, neurocognitive functioning was not related to the history of SB. As novelty, individuals with previous SB showed higher CI. Also, regarding social cognition and metacognition, individuals with prior SB tended to present extremely low externalizing bias, better ToM, and presence of JTC.

Does social cognition change? Evidence after 4 years from the Italian Network for Research on Psychoses

BACKGROUND

Deficits in social cognition (SC) are significantly related to community functioning in schizophrenia (SZ). Few studies investigated longitudinal changes in SC and its impact on recovery. In the present study, we aimed: (a) to estimate the magnitude and clinical significance of SC change in outpatients with stable SZ who were assessed at baseline and after 4 years, (b) to identify predictors of reliable and clinically significant change (RCSC), and (c) to determine whether changes in SC over 4 years predicted patient recovery at follow-up.

METHODS

The reliable change index was used to estimate the proportion of true change in SC, not attributable to measurement error. Stepwise multiple logistic regression models were used to identify the predictors of RCSC in a SC domain (The Awareness of Social Inference Test [TASIT]) and the effect of change in TASIT on recovery at follow-up.

RESULTS

In 548 participants, statistically significant improvements were found for the simple and paradoxical sarcasm of TASIT scale, and for the total score of section 2. The reliable change index was 9.8. A cut-off of 45 identified patients showing clinically significant change. Reliable change was achieved by 12.6% and RCSC by 8% of participants. Lower baseline TASIT sect. 2 score predicted reliable improvement on TASIT sect. 2. Improvement in TASIT sect. 2 scores predicted functional recovery, with a 10-point change predicting 40% increase in the probability of recovery.

CONCLUSIONS

The RCSC index provides a conservative way to assess the improvement in the ability to grasp sarcasm in SZ, and is associated with recovery.

Facial affect recognition in first-episode psychosis is impaired but not associated with psychotic symptoms

Introduction

Aims

Method

Results

Discussion

•

Impaired affect recognition (FAR) present already in first episode psychosis (FEP).

•

Preserved FAR of happiness found in individuals with FEP.

•

Individuals with FEP mainly have impaired FAR of negative affects.

•

Both FEP and controls mainly mistook negative affects for other negative affects.

•

Psychotic symptoms are not associated with FAR in individuals with FEP.

Perceptions of and subjective difficulties with social cognition in schizophrenia from an internet survey: Knowledge, clinical experiences, and awareness of association with social functioning

AIM

Social cognition impacts social functioning in schizophrenia; however, little is known about how patients with schizophrenia themselves perceive social cognition. This study, using an internet survey, aimed to investigate their knowledge of social cognition, clinical experiences related to social cognition, awareness of social cognition's role in one's social life, and the relationships between subjective difficulties with social cognition and social functioning.

METHODS

Data from 232 outpatients with schizophrenia (SZ) and 494 healthy controls (HC) were obtained through an internet survey and were weighted according to the demographics of the national population. A newly developed survey questionnaire on knowledge, experience, and awareness of social cognition was administered. Subjective difficulties were evaluated using the Self-Assessment of Social Cognition Impairments and the Observable Social Cognition Rating Scale.

RESULTS

Less than a quarter of both groups were familiar with the term or concept of social cognition. Less than 5% of both groups had experienced being assessed or treated for social cognition. More than half of both groups were aware of the relationship between social cognition and social functioning. The SZ group had higher levels of subjective difficulties than the HC group across all social cognitive domains. The attributional bias domain of subjective difficulties was negatively associated with social functioning.

CONCLUSION

Patients with schizophrenia had substantial subjective difficulties in social cognition, which they perceived as being related to social functioning. However, their knowledge of social cognition was limited, and the assessment and treatment might not be widespread in regular clinical practice.

Theory of mind in schizophrenia: a comparison of subgroups with low and high IQ

BACKGROUND

Social cognitive impairment is common in schizophrenia, but it is unclear if it is present in individuals with high IQ. This study compared theory of mind (ToM) in schizophrenia participants with low or high IQ to healthy controls.

METHODS

One hundred and nineteen participants (71 healthy controls, 17 high IQ (IQ ≥115), and 31 low IQ (IQ ≤95) schizophrenia participants) were assessed with the Movie for the Assessment of Social Cognition, providing scores for total, cognitive, and affective ToM, along with overmentalizing, undermentalizing, and no-mentalizing errors. IQ was measured with Wechsler Abbreviated Scale of Intelligence; clinical symptoms with the Positive and Negative Syndrome Scale.

RESULTS

Healthy controls performed better than the low IQ schizophrenia group for all ToM scores, and better than the high IQ schizophrenia group for the total score and under- and no-mentalizing errors. The high IQ group made fewer overmentalizing errors and had better total and cognitive ToM than the low IQ group. Their number of overmentalizing errors was indistinguishable from healthy controls.

CONCLUSION

Global ToM impairment was present in the low IQ schizophrenia group. Overmentalizing was not present in the high IQ group and appears related to lower IQ. Intact higher-level reasoning may prevent the high IQ group from making overmentalizing errors, through self-monitoring or inhibition. We propose that high IQ patients are chiefly impaired in lower-level ToM, whereas low IQ patients also have impaired higher-level ToM. Conceivably, this specific impairment could help explain the lower functioning reported in persons with intact IQ.

The effect of schizotypy on spatial learning in an environment with a distinctive shape

In two experiments, participants completed the Oxford-Liverpool Inventory of Feelings and Experiences measuring schizotypal traits across four dimensions (unusual experiences, cognitive disorganization, introvertive anhedonia, and impulsive non-conformity). They then took part in a virtual navigation task where they were required to learn about the position of a hidden goal with reference to geometric cues of a rectangular arena or rely on colored wall panels to find the hidden goal in a square-shaped arena. Unusual experience and cognitive disorganization were significant predictors of the use of geometric cues, but no significant predictors were found for the use of wall panels. Implications to hippocampal function and the clinical domain are considered.

Altered Surface Area Covariance in the Mentalizing Network in Schizophrenia: Insight Into Theory of Mind Processing

BACKGROUND

Theory of mind (ToM), the cognitive capacity to attribute mental states to self and others, is robustly affected in schizophrenia. The neural substrates of ToM impairment have been largely studied with functional imaging, but little is known about structural abnormalities. We compared structural covariance (between-subjects correlations of brain regional measures) of magnetic resonance imaging-based cortical surface area between patients with schizophrenia and healthy control subjects and between schizophrenia subgroups based on the patients' ToM ability to examine ToM-specific effects on structural covariance in schizophrenia.

METHODS

T1-weighted structural images were acquired on a 3T magnetic resonance imaging scanner, and ToM was assessed with the Hinting Task for 104 patients with schizophrenia and 69 healthy control subjects. The sum of surface area was computed for 12 regions of interest selected and compared between groups to examine structural covariance within the often reported mentalizing network: rostral and caudal middle frontal gyrus, inferior parietal lobule, precuneus, and middle and superior temporal gyrus. High and low ToM groups were defined using a median split on the Hinting Task.

RESULTS

Cortical surface contraction was observed in the schizophrenia group, predominantly in temporoparietal regions. Patients with schizophrenia also exhibited significantly stronger covariance between the right rostral middle frontal gyrus and the right superior temporal gyrus than control subjects (r = 4.015; p < .001). Direct comparisons between high and low ToM subgroups revealed stronger contralateral frontotemporal covariances in the low ToM group.

CONCLUSIONS

Our results provide evidence for structural changes underlying ToM impairments in schizophrenia that need to be confirmed to develop new therapeutic perspectives.

Emotion identification and mentalization in non-psychotic first-degree relatives of young adult patients with schizophrenia disorder

Background

Social cognition is a multi-factorial construct defined as the ability to process social information for adaptive functioning. A large body of evidence acknowledges deficits in social cognition as important features in schizophrenia and that such impairment represent a trait deficit. The aim of this study is to assess two social cognitive functions (emotional identification and mentalization) in young non-psychotic first-degree relatives of patients with schizophrenia; and to compare their performance with that of young patients with schizophrenia as well as with young healthy controls. This a comparative, cross-sectional study including 30 young patients with age range 15–25 with schizophrenia disorder, Thirty young non-psychotic siblings of the patients and 30 young healthy subjects. The patients were subjected to PANNNS to assess severity of psychotic symptoms. Selected tests for assessment of basic cognitive abilities and social cognitive functions (using Reading Mind in the Eye Test, Emotion Identification Test and Emotional Intelligence scale) were used for the three groups.

Results

the relatives group show better performance than the patients groups and worse performance than the control group in subtests of basic cognition and social cognition functions using Reading Mind in the Eye Test and Ekman, in addition, there was negative correlation between severity of negative psychotic features and facial emotional identification as measured by Ekman.

Conclusion

Youth who are first-degree relatives of schizophrenia patients show social cognitive deficits, supporting the hypothesis of the role of social cognition impairment as endophenotypic trait in schizophrenia disorder.

Influence of Menstrual Cycle Length and Age at Menarche on Symptoms, Cognition, Social Cognition, and Metacognition in Patients with First-Episode Psychosis

A protective effect has traditionally been attributed to estrogen in psychotic disorders. The aim of this study was to investigate cumulative lifetime estrogen by assessing the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and the age of menarche, measuring their effects on symptoms, cognition, social cognition, and metacognition. As it was not possible to directly measure cumulative estrogen levels over the lifetime of a patient, the study sample was composed of 42 women with first-episode psychosis; estrogen levels were inferred by the menstrual cycle length, age at menarche, and years of difference between the onset of psychotic symptoms and menarche. All patients were assessed with a battery of questionnaires using the BDI, PSYRATS, PANSS, STROOP, TAVEC, WSCT, IPSAQ, and BCIS questionnaires. The results related to menstrual cycle length showed a relationship with memory; specifically, shorter cycles with semantic strategies (p = 0.046) and longer cycles with serial strategies in the short term (p = 0.005) as well as in the long term (p = 0.031). The results also showed a relationship with perseverative errors (p = 0.035) and self-certainty (p = 0.049). Only personalized bias (p = 0.030) was found to be significant in relation to the age at menarche. When analyzing the differences in years of difference between the age at menarche and the onset of psychotic symptoms, the results indicated lower scores in women with a smaller difference between both events in memory (short-term (p = 0.050), long-term (p = 0.024), intrusions (p = 0.013), and recognition (p = 0.043)) and non-perseverative errors (p = 0.024). No relationship was found between symptoms and menstrual characteristics. The investigatory outcomes seem to indicate a relationship between estrogen cumulative effects and the memory domain. More in-depth investigations in the field are necessary in order to improve personalized treatment in women with psychosis.

A meta-analysis of social cognitive deficits in schizophrenia: Does world region matter?

Individuals with schizophrenia (SCZs) demonstrate social cognitive (SC) deficits across a variety of social cognitive tasks: affect recognition, social perception, Theory-of-Mind (ToM), and attributional style. These tasks all use socially-relevant words, social scenarios, clothing, faces and voices that may make their application to different cultural contexts problematic. However a paucity of research has investigated the cross-cultural validity of SC measures. We meta-analyzed the literature investigating differences in social cognitive skills SCZs and matched healthy controls (NCs) across different regions of the world using a group of expert-selected, standardized measures of social cognition. Studies of SC in SCZ using these measures published between January 1980 and August 2020 were evaluated. Data were extracted independently by 3 reviewers with excellent reliability; 156 unique studies of 10,235 SCZs and 9924 NCs across 34 countries were identified. Random effects models revealed SCZs demonstrated poorer performance in all domains of SC including emotion processing (g = -0.770), social perception (g = -0.880), ToM (g = -1.090), attributional style (hostility: g = -0.715, aggression: g = -0.209, blame: g = -0.322), as well as a measure of emotion regulation (g = -0.867). Hostile attributional style was more pronounced in European and North American samples (g = 1.054 and g = -0.605, respectively) compared to Asian samples (g = -0.284). Our results revealed that SCZs performed mildly-severely worse than HCs in all domains of SC. With the exception of hostile attributional style, the magnitude of deficits in social cognition was consistent across the globe.

Unreasonable minds and imperfect self-defense

Western legal systems recognize the right to self-defense as a right of individuals, under certain circumstances, to use physical force to defend themselves from an aggressor. This right requires an honest and reasonable belief of the person asserting it regarding the circumstances in which force is used. Some jurisdictions also permit a defense of imperfect self-defense, allowing for reduced culpability for the crime of homicide if a person's beliefs are honest but unreasonable. If the unreasonable belief is based on a mental illness, however, the defense is disallowed in every jurisdiction in the United States. This development relies upon an untenable position that false beliefs produced by mental disorders should be excluded based on erroneous assumptions about psychotic illness. This article argues that the current precedent is incoherent with the core structure of criminal responsibility and in tension with current scientific understandings and should change to do justice.

Exploring the Relationship Between Deficits in Social Cognition and Neurodegenerative Dementia: A Systematic Review

Background

Neurodegenerative diseases might affect social cognition in various ways depending on their components (theory of mind, emotional processing, attribution bias, and social perception) and the subtype of dementia they cause. This review aims to explore this difference in cognitive function among individuals with different aetiologies of dementia.

Methods

The following databases were explored: MEDLINE via PubMed, Cochrane Library, Lilacs, Web of Science, and PsycINFO. We selected studies examining social cognition in individuals with neurodegenerative diseases in which dementia was the primary symptom that was studied. The neurodegenerative diseases included Alzheimer's disease, Lewy body disease and frontotemporal lobar degeneration. The search yielded 2,803 articles.

Results

One hundred twenty-two articles were included in the present review. The summarised results indicate that people with neurodegenerative diseases indeed have deficits in social cognitive performance. Both in populations with Alzheimer's disease and in populations with frontotemporal dementia, we found that emotional processing was strongly affected. However, although theory of mind impairment could also be observed in the initial stages of frontotemporal dementia, in Alzheimer's disease it was only appreciated when performing highly complex task or in advanced stages of the disease.

Conclusions

Each type of dementia has a differential profile of social cognition deterioration. This review could provide a useful reference for clinicians to improve detection and diagnosis, which would undoubtedly guarantee better interventions.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020152562, PROSPERO, identifier: CRD42020152562.

The relationship between jumping to conclusions and social cognition in first-episode psychosis

Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JTC and SC in a sample with FEP. We conducted a cross-sectional study with 121 patients with FEP, with measures to assess JTC (easy, hard, and salient probability tasks) and SC (emotional recognition, attributional style, and theory of mind). We performed Student's t-test and logistic regression in order to analyse these associations.We found a statistically significant and consistent relationship of small-moderate effect size between JTC (all three tasks) and impaired emotional recognition. Also, our results suggest a relationship between JTC and internal attributions for negative events. Relationships between JTC and theory of mind were not found. These results highlight the importance of psychological treatments oriented to work on a hasty reasoning style and on improving processing of social information linked to emotional recognition and single-cause attributions.

From the Group to the Individual in Schizophrenia Spectrum Disorders: Biomarkers of Social Cognitive Impairments and Therapeutic Translation

People with schizophrenia spectrum disorders (SSDs) often experience persistent social cognitive impairments, associated with poor functional outcome. There are currently no approved treatment options for these debilitating symptoms, highlighting the need for novel therapeutic strategies. Work to date has elucidated differential social processes and underlying neural circuitry affected in SSDs, which may be amenable to modulation using neurostimulation. Further, advances in functional connectivity mapping and electric field modeling may be used to identify individualized treatment targets to maximize the impact of brain stimulation on social cognitive networks. Here, we review literature supporting a roadmap for translating functional connectivity biomarker discovery to individualized treatment development for social cognitive impairments in SSDs. First, we outline the relevance of social cognitive impairments in SSDs. We review machine learning approaches for dimensional brain-behavior biomarker discovery, emphasizing the importance of individual differences. We synthesize research showing that brain stimulation techniques, such as repetitive transcranial magnetic stimulation, can be used to target relevant networks. Further, functional connectivity-based individualized targeting may enhance treatment response. We then outline recent approaches to account for neuroanatomical variability and optimize coil positioning to individually maximize target engagement. Overall, the synthesized literature provides support for the utility and feasibility of this translational approach to precision treatment. The proposed roadmap to translate biomarkers of social cognitive impairments to individualized treatment is currently under evaluation in precision-guided trials. Such a translational approach may also be applicable across conditions and generalizable for the development of individualized neurostimulation targeting other behavioral deficits.

Neurocognitive functioning and impulsivity in first-episode psychosis with suicidal ideation and behavior: A systematic review

BACKGROUND

The prevalence of suicidal ideation (SI) and behavior (SB) among people suffering from psychotic disorders is a public health issue. Most suicide attempts (SAs) occur before or during the early phases of first-episode psychosis (FEP). Improving knowledge about the suicide risk in the early stages is essential to develop therapeutic and prevention strategies. We conducted a systematic review to investigate an association between neurocognitive impairments or a history of impulsive behavior and SI or SB among patients with FEP.

METHOD

PRISMA guidelines were followed. Ten databases were searched using MeSH terms or key-words related to FEP, impulsivity or cognitive functioning measures and SI or SB, without restrictions for study design or length of follow-up. Included studies evaluated at least one cognitive function with neuropsychological tests or validated questionnaires, or provided records of impulsive behavior.

RESULTS

Twenty one research papers were included from databases, bibliographic references or expert opinions. Among patients with FEP, seven studies showed more pronounced neuropsychological impairments, especially regarding attention, processing speed, executive functioning and theory of mind in patients that had attempted suicide. No association was found between cognitive impairments on neuropsychological tests and SI. Previous non-suicidal impulsive behaviors were associated with SAs and suicide.

CONCLUSION

Our review suggests an association between neurocognitive impairments and SAs among patients with FEP. Records of impulsive behavior are also associated with SB in that population. Further research on the neuropsychology of FEP is necessary to identify how these impairments facilitate SB and evaluate their potential utility as therapeutic targets.

The Impact of Poor Nonverbal Social Perception on Functional Capacity in Schizophrenia

Background

Nonverbal social perception is the ability to interpret the intentions and dispositions of others by evaluating cues such as facial expressions, body movements, and emotional prosody. Nonverbal social perception plays a key role in social cognition and is fundamental for successful social interactions. Patients with schizophrenia have severe impairments in nonverbal social perception leading to social isolation and withdrawal. Collectively, these aforementioned deficits affect patients' quality of life. Here, we compare nonverbal social perception in patients with schizophrenia and controls and examine how nonverbal social perception relates to daily functioning.

Methods

We compared nonverbal social perception in 41 stable outpatients with schizophrenia and 30 healthy controls using the Mini Profile of Nonverbal Sensitivity (Mini-PONS). The participants evaluated 64 video clips showing a female actor demonstrating various nonverbal social cues. Participants were asked to choose one of two options that best described the observed scenario. We correlated clinical ratings (Positive and Negative Syndrome Scale, Brief Negative Syndrome Scale), Self-report of Negative Symptoms, and functional assessments (functional capacity and functional outcome) with Mini-PONS scores.

Results

Patients performed significantly poorer in the Mini-PONS compared to controls, suggesting deficits in nonverbal social perception. These deficits were not associated with either positive symptoms or negative symptoms (including self-report). However, impaired nonverbal social perception correlated with distinctive domains of BNSS (mainly avolition and blunted affect), as well as functional capacity and functional outcome in patients.

Conclusion

We demonstrate that nonverbal social perception is impaired in stable outpatients with schizophrenia. Nonverbal social perception is directly related to specific negative symptom domains, functional capacity and functional outcome. These findings underline the importance of nonverbal social perception for patients' everyday life and call for novel therapeutic approaches to alleviate nonverbal social perception deficits.

Males and females with first episode psychosis present distinct profiles of social cognition and metacognition

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Negative symptoms correlate with altered brain structural asymmetry in amygdala and superior temporal region in schizophrenia patients

Negative symptoms play an important role in development and treatment of schizophrenia. However, brain changes relevant to negative symptoms are still unclear. This study examined brain structural abnormalities and their asymmetry in schizophrenia patients and the association with negative symptoms. Fifty-nine schizophrenia patients and 66 healthy controls undertook structural brain scans. Schizophrenia patients were further divided into predominant negative symptoms (PNS, n = 18) and non-PNS (n = 34) subgroups. Negative symptoms were assessed by the Negative Symptom Assessment (NSA). T1-weighted images were preprocessed with FreeSurfer to estimate subcortical volumes, cortical thickness and surface areas, asymmetry Index (AI) was then calculated. MANOVA was performed for group differences while partial correlations in patients were analyzed between altered brain structures and negative symptoms. Compared to healthy controls, schizophrenia patients exhibited thinner cortices in frontal and temporal regions, and decreased leftward asymmetry of superior temporal gyrus (STG) in cortical thickness. Patients with PNS exhibited increased rightward asymmetry of amygdala volumes than non-PNS subgroup. In patients, AI of cortical thickness in the STG was negatively correlated with NSA-Emotion scores (r = -0.30, p = 0.035), while AI of amygdala volume was negatively correlated with NSA-Communication (r = -0.30, p = 0.039) and NSA-Total scores (r = -0.30, p = 0.038). Our findings suggested schizophrenia patients exhibited cortical thinning and altered lateralization of brain structures. Emotion and communication dimensions of negative symptoms also correlated with the structural asymmetry of amygdala and superior temporal regions in schizophrenia patients.

The Association Between Emotion Recognition, Affective Empathy, and Structural Connectivity in Schizophrenia Patients

INTRODUCTION

Emotion processing deficits often occur in patients with schizophrenia. We investigate whether patients and controls differ in the association between facial emotion recognition and experience of affective empathy and whether performance on these emotion processing domains differently relates to white matter connectivity.

MATERIALS AND METHODS

Forty-seven patients with schizophrenia and 47 controls performed an emotion recognition and affective empathy task. T1-weighted and diffusion-tensor images (DTI) of the brain were acquired. Using Tracula 5.3, ten fibers were reconstructed and fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were extracted. Groups were compared on task performance, white matter measures and their interactions using ANCOVAs. Correction for multiple comparisons was applied.

RESULTS

Patients scored lower on emotion recognition (p = 0.037) and reported higher levels of affective empathy (p < 0.001) than controls. Patients with poor emotion recognition (PT-low) experienced stronger affective empathy than patients with similar emotion recognition performance as controls (PT-normal; p = 0.011), who in turn reported stronger affective empathy than controls (p = 0.043). We found a significant interaction between emotion recognition, affective empathy and anterior thalamic radiation AD (p = 0.017, d = 0.43). Post hoc analyses revealed that the correlation between AD and empathy differed significantly between all groups (empathy/AD in PT-low < empathy/AD in PT-normal < empathy/AD in controls).

DISCUSSION

In patients with poor emotion recognition, the negative association between anterior thalamic radiation AD and affective empathy was stronger than in patients with normal emotion recognition capacity. Possibly, axonal damage in fronto-thalamic structural connections, as part of a larger frontotemporal network, underlies the association between poor emotion recognition and higher levels of affective empathy in schizophrenia patients.

Persons with first episode psychosis have distinct profiles of social cognition and metacognition

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions.

Are There Gender Differences in Social Cognition in First-Episode Psychosis?

The aim of this study was to explore gender differences in social cognition in a sample of first-episode psychosis (FEP). An observational descriptive study was performed with 191 individuals with FEP. Emotion perception was assessed using the Faces Test, theory of mind was assessed using the Hinting Task, and attributional style was assessed using the Internal, Personal and Situational Attributions Questionnaire. No gender differences were found in any of the social cognitive domains. Our results suggest that men and women with FEP achieve similar performances in social cognition. Therefore, targeting specific needs in social cognition regarding gender may not be required in early interventions for psychosis.

Moderators of cognitive insight outcome in metacognitive training for first-episode psychosis

Metacognitive training (MCT) is a promising treatment for improving cognitive insight associated with delusional beliefs in individuals with psychotic disorders. The aim of this study was to examine potential moderators of cognitive insight in individuals with first-episode psychosis (FEP) who received either MCT or psychoeducation. The present study was based on data from a randomized control trial comparing MCT to psychoeducation. Baseline sociodemographic and clinical characteristics in a sample of 122 patients with FEP were examined as potential moderators of the self-reflectiveness and self-certainty dimensions of cognitive insight using the SPSS PROCESS macro. The only variable that moderated self-reflectiveness at the post-treatment evaluation was age of onset (b = -0.27, p = .025). The effect of MCT in reducing self-certainty was stronger in women (b = -3.26, p = .018) and in individuals with average or above average baseline self-esteem (b = -0.30, p = .007). Overall, our findings support the generalization of MCT to a variety of sociodemographic and clinical profiles. While some patient profiles may require targeted interventions such as MCT to improve cognitive insight, others may do equally as well with less demanding interventions such as a psychoeducational group.

Social cognition and its relationship with sociodemographic, clinical, and psychosocial variables in first-episode psychosis

People with first episode of psychosis (FEP) show deficits in social cognition, which have been linked to several sociodemographic, clinical, and psychosocial variables. The aim of the present research was to study social cognition as a whole measure in people with FEP comparing it with a healthy control sample, to study gender differences, and to examine the relationship between sociodemographic, clinical, and psychosocial variables and social cognition in the onset of psychosis. A descriptive, cross-sectional study was performed. The study sample consisted of 63 people (18 females; 45 males) with a diagnosis of FEP and a healthy control group (78 participants: 38 females; 40 males). All the participants were assessed with the social cognitive domain of the MATRICS Consensus Cognitive Battery (MCCB) and several questionnaires related to studied variables. Our results indicated that compared with healthy controls, people with FEP showed social cognition deficits. Furthermore, premorbid IQ was the most relevant variable in social cognition performance in FEP sample. The findings of the present research may be taken into account in clinical practice to improve the intervention with people with FEP.

Predictors of social and role outcomes in first episode psychosis: A prospective 12-month study of social cognition, neurocognition and symptoms

BACKGROUND

Poor functioning is common in psychosis, with predictors of poor outcome including negative symptoms and deficits in neurocognition (NC) and social cognition (SC). The extent to which these variables contribute unique variance in social and role trajectories remains inconclusive. Identifying robust predictors of outcome will inform targeted interventions in early psychosis, where functional trajectories are being set.

METHOD

Prospective 12-month follow-up study investigating the predictive values of NC and SC on social and role functioning in individuals with first-episode psychosis (FEP), within the context of clinical variables. 98 individuals with FEP (mean age = 24; male = 77) were assessed within the first year of diagnosis on functioning (social and role), cognition (SC and NC) and psychosis symptoms.

RESULTS

Negative symptoms were the only significant predictor of 12-month social (χ²  = 9.59, P = .002, OR = 1.12) and role (χ²  = 10.86, P < .001, OR = 1.16) functioning in FEP. In exploratory analyses, negative symptoms mediated the relationship between baseline social knowledge and social functioning (Z = 1.92, P = .05; d = 0.56), and between baseline logical memory and role functioning (Z = 2.40, P = .02; d = 0.80) at 12-month follow-up.

CONCLUSION

Although social and role trajectories in early psychosis appear somewhat distinct, negative symptoms were the best prognostic marker of social and role outcome in FEP, and mediated the relationship between SC and social outcome, and NC and role outcome; these relationships may be important when considering interventions to improve functional outcome in early psychosis.

Language proficiency and mental disorders among migrants: A systematic review

BACKGROUND

In this review, we aimed to evaluate the association between language proficiency (LP) and the prevalence and severity of mental disorders in migrants. Secondarily, we aimed to consider whether sociodemographic and migration-related factors may affect the correlation between LP and mental disorders.

METHODS

MEDLINE, PsycArticles, EMBASE, and PsycInfo were systematically searched in April 2020 to identify original studies reporting prevalence of psychiatric symptoms or disorders among migrants and taking into account linguistic factors.

RESULTS

The search of electronic databases initially yielded 1,944 citations. Of the 197 full texts assessed for eligibility, 41 studies were selected for inclusion in the systematic review. Thirty-five of the papers included reported a significant negative association between low LP and prevalence and/or severity of psychiatric symptoms or disorders, whereas only two records found the opposite relationship and four papers reported no association between them. Inadequate LP was consistently associated with several mental disorders in migrants, including psychotic, mood, anxiety, and post-traumatic stress disorders. Notably, all the four longitudinal studies that met inclusion criteria for this review reported a positive effect of LP acquisition over time on prevalence or symptom severity of mental disorders.

CONCLUSIONS

Even though larger prospective studies are needed to better evaluate the relationship between LP and psychiatric disorders among migrants, we believe that the present findings could be inspiring for authorities to provide support and courses to improve migrants' language proficiency upon arrival.

A meta-analysis of the effects of social-cognitive training in schizophrenia: The role of treatment characteristics and study quality

OBJECTIVES

This meta-analysis was designed to assess the effects of social-cognitive training (SCT) and whether study quality, treatment approach, treatment context, and sample characteristics influence these effects.

METHODS

Electronic databases were searched up to 5 August 2020 using variants of keywords: 'social cognition', 'training', 'rehabilitation', 'remediation', and 'schizophrenia'. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors. This study was pre-registered on PROSPERO (CRD42020154026).

RESULTS

Forty-two controlled trials with 1,868 participants were identified. The meta-analysis revealed moderate effects on emotion recognition, mental state attribution, and social perception. No significant effects were evident on psychiatric symptoms or social functioning. A small signal was evident for the generalization of treatment gains to executive function. Moderator analyses revealed that studies of lower methodological quality reported larger effects, and samples with lower mean years of education were associated with larger effects of SCT on mental state attribution. Treatment effects did not differ by other moderator variables such as treatment context and intervention types.

CONCLUSIONS

SCT benefits people with schizophrenia on a variety of social-cognitive outcomes. Differences in baseline symptoms, gender distribution, antipsychotic medication dose, IQ, and other sample features did not create barriers to treatment benefits. Future studies should aim to enhance the generalization of training effects on broader clinical outcomes.

Pharmacological Treatment for Social Cognition: Current Evidence

Cognitive impairment is currently considered a core feature of schizophrenia (SZ) and is gaining attention as a fundamental therapeutic target. Standard treatment for SZ involves the use of antipsychotics that are successfully used to control positive symptoms and disorganized behaviour. However, it is still unclear whether they are effective on social cognition (SC) impairment. Furthermore, different medications are currently being studied to improve SC in patients with SZ. A literature search on this topic was conducted using the PubMed database. All kinds of publications (i.e., reviews, original contributions and case reports) written in English and published in the last 15 years were included. The aim of our literature review is to draw a picture of the current state of the pharmacological treatment of SC impairment in SZ.