Sensitivity to expressions of pain in schizophrenia patients

Dynamic and/or multimodal assessments for social cognition in neuropsychology: Results from a systematic literature review

Objective: Despite the prevalence of socio-cognitive disturbances, and their important diagnostic/therapeutic implications, the assessment of these disturbances remains scarce. This systematic review aims to identify available social cognition tools for adult assessment that use multimodal and/or dynamic social cues, specifying their strengths and limitations (e.g. from a methodological, psychometric, ecological, and clinical perspective). Method: An electronic search was conducted in Pubmed, PsychINFO, Embase and Scopus databases for articles published up to the 3th of January 2023 and the first 200 Google Scholar results on the same date. The PRISMA methodology was applied, 3884 studies were screened based on title and abstract and 329 full texts were screened. Articles using pseudo-dynamic methodologies (e.g. morphing), reported only subjective or self-reported measures, or investigated only physiological or brain activity responses were excluded. Results: In total, 149 works were included in this review, representing 65 assessment tools (i.e. 48% studying emotion recognition (n = 31), 32% Theory of Mind (n = 21), 5% empathy (n = 3), 1.5% moral cognition/social reasoning (n = 1), and 14% being multimodal (n = 9)). For each study, the tool's main characteristics, psychometric properties, ecological validity indicators and available norms are reported. The tools are presented according to social-cognitive process assessed and communication channels used. Conclusions: This study highlights the lack of validated and standardized tools. A few tools appear to partially meet some clinical needs. The development of methodologies using a first-person paradigm and taking into account the multidimensional nature of social cognition seems a relevant research endeavour for greater ecological validity.

Insensitivity to Suffering: Psychopathic Traits and Perception of Others' Pain

Despite growing evidence that psychopathy entails reduced emotional processing, the relationship between psychopathic traits and third-person pain perception is poorly understood. This study directly examined perception of others' pain in a sample of male and female students (N = 105) who completed the Self-Report Psychopathy scale (SRP-III) and the Toronto Empathy Questionnaire (TEQ). Participants watched a video of 60 one-second clips of other people experiencing pain. Following each clip, participants rated the perceived level of pain intensity and pain unpleasantness. Psychopathic traits were unrelated to response bias, suggesting that individuals high in psychopathic traits were no more or less likely to impute pain to others. However, higher levels of psychopathic traits, particularly callous affect and antisocial behavior, were associated with a decreased ability to discriminate others' pain. Sensitivity and response bias were unrelated to TEQ scores. These findings provide novel insights into the influence of psychopathic traits on emotional processing.

Alexithymia Is a Key Mediator of the Relationship Between Magical Thinking and Empathy

Thought action fusion (TAF), whereby internal thoughts are perceived to exert equivalent effects to external actions, is a form of magical thinking. Psychiatric disorders associated with TAF (e.g. schizophrenia; obsessive compulsive disorder) can feature atypical social cognition. We explored relationships between TAF and empathy in 273 healthy young adults. TAF was directly correlated with higher personal distress, but not perspective taking, fantasy or empathic concern. TAF moral (the belief that thinking about an action/behaviour is morally equivalent to actually performing that behaviour) was predicted by emotion contagion, alexithymia and need for closure. TAF likelihood (the belief that simply having a thought about an event makes that event more likely to occur) was predicted by personal distress, sense of agency and alexithymia. Both cognitive (TAF and negative sense of agency) and emotional (emotion contagion, alexithymia) factors contributed to personal distress. TAF, negative sense of agency and personal distress mediated the effect of emotion contagion on alexithymia. Our findings reveal complex relationships between emotional processes and TAF, shedding further light on the social cognitive profile of disorders associated with magical thinking. Furthermore, they emphasise the potential importance of alexithymia and emotion contagion as mediators or potential risk factors in the development of psychiatric symptoms linked to TAF, such as intrusive thoughts about harm to others.

Social cognition and self-other distinctions in neuropsychiatry: Insights from schizophrenia and Tourette syndrome

Impairments in social cognition may reflect dysfunction of disorder specific or disorder general mechanisms. Although cross-disorder comparison may prove insightful, few studies have compared social cognition in different neuropsychiatric disorders. Parallel investigation of schizophrenia and Tourette syndrome (TS) is encouraged by similarities including the presence of problematic social behavior, echophenomena, emotional dysregulation and dopamine dysfunction. Focusing on tests of social cognition administered in both disorders, this review aims to summarize behavioral, neurophysiological and neuroimaging findings, before exploring how these may contribute to clinical symptoms. Studies investigating social cognition (imitation, emotion recognition, and understanding of beliefs or intentions) in patients with schizophrenia or TS were identified through Web of Science and PubMed searches. Although findings indicate that social cognitive deficits are more apparent in schizophrenia, adults with TS can exhibit similar task performance to patients with paranoia. In both disorders, behavioral and neuroimaging findings raise the possibility of increased internal simulation of others' actions and emotions, in combination with a relative under-application of mentalizing. More specifically, dysfunction in neurobiological substrates such as temporo-parietal junction and inferior frontal gyrus may underlie problems with self-other distinctions in both schizophrenia and TS. Difficulties in distinguishing between actions and mental states linked to the self and other may contribute to a range of psychiatric symptoms, including emotional dysregulation, paranoia, social anhedonia and socially disruptive urges. Comparing different patient populations could therefore reveal common neuro-cognitive risk factors for the development of problematic social behaviors, in addition to markers of resilience, coping strategies and potential neuro-compensation mechanisms.

Advanced Parkinson disease patients have impairment in prosody processing

BACKGROUND

The ability to recognize and interpret emotions in others is a crucial prerequisite of adequate social behavior. Impairments in emotion processing have been reported from the early stages of Parkinson's disease (PD). This study aims to characterize emotion recognition in advanced Parkinson's disease (APD) candidates for deep-brain stimulation and to compare emotion recognition abilities in visual and auditory domains.

METHOD

APD patients, defined as those with levodopa-induced motor complications (N = 42), and healthy controls (N = 43) matched by gender, age, and educational level, undertook the Comprehensive Affect Testing System (CATS), a battery that evaluates recognition of seven basic emotions (happiness, sadness, anger, fear, surprise, disgust, and neutral) on facial expressions and four emotions on prosody (happiness, sadness, anger, and fear). APD patients were assessed during the "ON" state. Group performance was compared with independent-samples t tests.

RESULTS

Compared to controls, APD had significantly lower scores on the discrimination and naming of emotions in prosody, and visual discrimination of neutral faces, but no significant differences in visual emotional tasks.

CONCLUSION

The contrasting performance in emotional processing between visual and auditory stimuli suggests that APD candidates for surgery have either a selective difficulty in recognizing emotions in prosody or a general defect in prosody processing. Studies investigating early-stage PD, and the effect of subcortical lesions in prosody processing, favor the latter interpretation. Further research is needed to understand these deficits in emotional prosody recognition and their possible contribution to later behavioral or neuropsychiatric manifestations of PD.

Exploring the Response Shift Effect on the Quality of Life of Patients with Schizophrenia

Background. Interpretation of quality of life (QoL) scores over time can be difficult because of possible changes in internal standards, values, and conceptualization of QoL by individuals. This effect is called a response shift (RS). The purpose of this study was to examine whether an RS effect occurred over a 24-mo period in patients who were suffering from schizophrenia. Methods. The random forest method was applied to detect any RS reprioritization in a multicenter cohort study. QoL was recorded using a generic questionnaire (SF36) at baseline (T0), 12 mo (T12), and 24 mo (T24). Patients were categorized into 3 groups based on psychotic symptoms and relapse (stable, improved, and worsened groups) from their clinical profiles. The random forest method was performed to predict the General Health score of the SF36 from the other QoL domain scores of the SF36. We estimated the average variable importance of the QoL domain for each of the 3 groups. Results. A total of 124 (53.2%) patients were defined as stable, 59 (25.3%) as improved, and 50 (21.5%) as worsened. Among the stable group, the Social Functioning domain became more important over time. Of those classified as improved, the Mental Health domain became more important over time, while the Vitality domain became less important. Among those in the group who worsened, the Mental Health domain became less important while the Vitality and Bodily Pain domains became more important. Conclusions. Our study identified differential RS reprioritization among patients with different clinical profiles. Further work is needed to determine whether RS should be interpreted as a measurement bias or as an effect integrated in a true change.

Clinical pain in schizophrenia: a systematic review

Studies about clinical pain in schizophrenia are rare. Conclusions on pain sensitivity in people with schizophrenia are primarily based on experimental pain studies. This review attempts to assess clinical pain, that is, everyday pain without experimental manipulation, in people with schizophrenia. PubMed, PsycINFO, Embase.com, and Cochrane were searched with terms related to schizophrenia and pain. Methodological quality was assessed with the Mixed Methods Appraisal Tool. Fourteen studies were included. Persons with schizophrenia appear to have a diminished prevalence of pain, as well as a lower intensity of pain when compared to persons with other psychiatric diseases. When compared to healthy controls, both prevalence and intensity of pain appear to be diminished for persons with schizophrenia. However, it was found that this effect only applies to pain with an apparent medical cause, such as headache after lumbar puncture. For less severe situations, prevalence and intensity of pain appears to be comparable between people with schizophrenia and controls. Possible underlying mechanisms are discussed. Knowledge about pain in schizophrenia is important for adequate pain treatment in clinical practice.

PERSPECTIVE

This review presents a valuable insight into clinical pain in people with schizophrenia.

Pain conditions among veterans with schizophrenia or bipolar disorder

OBJECTIVE

The purpose of this study was to assess the rates of chronic, noncancer pain conditions in patients with schizophrenia or bipolar disorder within the Veterans Health Administration (VHA) System.

METHOD

This cross-sectional study used administrative data extracted from VHA treatment records of all individuals receiving VHA services in fiscal year 2008 (N=5,195,551). The associations between severe psychiatric disorders (schizophrenia and bipolar disorder) and chronic pain (arthritis, back pain, chronic pain, migraine, headache, psychogenic and neuropathic) were evaluated using a series of logistic regression analyses.

RESULTS

Veterans with schizophrenia [odds ratio (OR)=1.21] and bipolar disorder (OR=2.17) were significantly more likely to have chronic pain overall relative to veterans without these psychiatric conditions. These associations were slightly lower than for the association between depression and pain in this sample (OR=2.61). The highest associations between specific psychiatric diagnosis and pain condition were found with chronic pain, headache and psychogenic pain.

CONCLUSIONS

Noncancer pain conditions occur in elevated rates among patients with schizophrenia and bipolar disorder. Future research could further examine possible barriers to adequate pain treatment among people with serious mental illness, as well as the extent to which chronic pain might impact mental health recovery.

Alteration of pain recognition in schizophrenia

BACKGROUND

Schizophrenia patients display impaired recognition of their own emotions and those of others and deficits in several domains of empathy. The first-person experience of pain and observing others in pain normally trigger strong emotional mechanisms. We therefore hypothesized that schizophrenia patients would display impaired recognition and categorization of both their own pain and the pain of others.

METHODS

We studied 29 patients (18 men/11 women; 36 ± 13 years old) with paranoid schizophrenia-spectrum disorder and 27 healthy volunteers (20 men/7 women; 31 ± 9 years old) matched for age, gender, IQ and socio-cultural level. We assessed symptom severity and theory of mind. The participants' ability to detect and categorize pain in others was assessed with the sensitivity to expressions of pain (STEP) test, which is based on facial expressions, and another dynamic test involving a series of video sequences showing various pain-inducing events. The ability of patients to evaluate their own pain was assessed with the situational pain questionnaire (SPQ), which includes a series of questions assessing how one would expect to feel in different imaginary situations. Empathic tendencies were assessed with the interpersonal reactivity index.

RESULTS

Patients and controls differed significantly in STEP, pain video and SPQ scores. By contrast with control subjects, the patients' pain judgements were not correlated with their affective or cognitive empathic capacities.

CONCLUSIONS

Schizophrenic patients have a deficit of the identification and categorization of pain both in themselves and in others.

Pain and analgesia: the value of salience circuits

Evaluating external and internal stimuli is critical to survival. Potentially tissue-damaging conditions generate sensory experiences that the organism must respond to in an appropriate, adaptive manner (e.g., withdrawal from the noxious stimulus, if possible, or seeking relief from pain and discomfort). The importance we assign to a signal generated by a noxious state, its salience, reflects our belief as to how likely the underlying situation is to impact our chance of survival. Importantly, it has been hypothesized that aberrant functioning of the brain circuits which assign salience values to stimuli may contribute to chronic pain. We describe examples of this phenomenon, including 'feeling pain' in the absence of a painful stimulus, reporting minimal pain in the setting of major trauma, having an 'analgesic' response in the absence of an active treatment, or reporting no pain relief after administration of a potent analgesic medication, which may provide critical insights into the role that salience circuits play in contributing to numerous conditions characterized by persistent pain. Collectively, a refined understanding of abnormal activity or connectivity of elements within the salience network may allow us to more effectively target interventions to relevant components of this network in patients with chronic pain.