Performance in multiple domains of social cognition in parents of patients with schizophrenia

Theory of Mind as an endophenotype for schizophrenia spectrum disorder: Study in first episode of psychosis patients and first-degree relatives

BACKGROUND

Deficits in Theory of Mind (ToM) had been suggested as a possible endophenotype for unaffected relatives of first episode of psychosis (FEP) patients. There are a limited number of studies which have evaluated ToM deficits among the siblings and parents of FEP patients.

AIM

This study aimed to explore ToM deficits and its correlates among FEP patients, their siblings, parents, and controls.

METHODOLOGY

FEP patients (N=102), their parents (N=135), siblings (N=97), and controls (N=167) were evaluated on ToM performance with the Reading the Mind in the Eyes Test (Eyes Test). Interview for sociodemographic variables of age, sex, years of education, and IQ estimation and neurocognitive tests were administered to all groups.

RESULTS

FEP patients had a significantly lower performance on the Eyes Test compared to their siblings and controls. However, no significant differences were found between siblings and parents or siblings and controls.

CONCLUSION

Attending our results, we found no evidence for ToM deficits as an endophenotype of SSDs. Furthermore, ToM accuracy may be mediated by interaction with other cognitive domains and play a protective role against psychosis in unaffected siblings.

Systematic review and meta-analysis of the relationship between genetic risk for schizophrenia and facial emotion recognition

BACKGROUND

Recent research has highlighted that facial emotion recognition deficits are more common in people with schizophrenia, but the reason for this association is not well understood. Comparing facial recognition deficits in unaffected individuals at higher genetic risk for schizophrenia with individuals at lower genetic risk could increase our understanding of this relationship.

METHODS

We systematically reviewed studies reporting on the relationship between genetic risk of schizophrenia and facial emotion recognition deficits. Meta-analyses were performed where sufficient data were available, otherwise we conducted narrative summaries. Meta-analyses were performed both for generalised and specific facial emotion recognition deficits.

RESULTS

34 studies were included in this review with 23 included in meta-analyses. Meta-analysis indicated strong evidence of a deficit in facial emotion recognition in first-degree relatives of people with schizophrenia compared with controls (SMD 0.38 95% CI 0.26 to 0.51, p ≤ 0.001). Further meta-analyses demonstrated strong evidence of a deficit in the recognition of negative valence facial expressions (SMD 0.19 CI 0.06 to 0.32, p = 0.004) but no evidence of deficit in the recognition of neutral or positive valance.

CONCLUSIONS

There is strong evidence of facial emotion recognition deficits in first-degree relatives of people with schizophrenia. Our findings suggest that such deficits in people with schizophrenia arise prior to the onset of the disorder, though cannot inform whether that association is causal or due to confounding. Emotion recognition deficits, particularly to negative emotions, might be useful predictors of schizophrenia risk.

What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations

Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.

Reliability of two social cognition tests: The combined stories test and the social knowledge test

Deficits in social cognition are common in psychiatric disorders. Validated social cognition measures with good psychometric properties are necessary to assess and target social cognitive deficits. Two recent social cognition tests, the Combined Stories Test (COST) and the Social Knowledge Test (SKT), respectively assess theory of mind and social knowledge. Previous studies have shown good psychometric properties for these tests, but the test-retest reliability has never been documented. The aim of this study was to evaluate the test-retest reliability and the inter-rater reliability of the COST and the SKT. The COST and the SKT were administered twice to a group of forty-two healthy adults, with a delay of approximately four weeks between the assessments. Excellent test-retest reliability was observed for the COST, and a good test-retest reliability was observed for the SKT. There was no evidence of practice effect. Furthermore, an excellent inter-rater reliability was observed for both tests. This study shows a good reliability of the COST and the SKT that adds to the good validity previously reported for these two tests. These good psychometrics properties thus support that the COST and the SKT are adequate measures for the assessment of social cognition.

Components of schizophrenia liability are not uniformly associated with stress sensitivity, resilience, and coping

Stress sensitization is a candidate final common pathway for the development of schizophrenia. In other psychopathologies, resilience attenuates the stressor-outcome relationships. Therefore, we sought to determine whether resilience moderates the association between stress sensitivity and schizophrenia liability. Undergraduates (n = 230) self-reported cognitive-perceptual, interpersonal, and disorganisation attributes of schizophrenia liability as well as ratings of sensitivity to stress, resilience, and dispositional coping behaviour. Bivariate analyses showed components of schizophrenia liability were significantly predicted by greater stress sensitivity, poor resilience and adaptive coping, and greater maladaptive coping behaviour. However, regression modelling suggested that cognitive-perceptual attributes were uniquely predicted by stress sensitivity in models that include resilience. In contrast, interpersonal attributes had a weaker relationship with stress sensitivity and were strongly predicted by poor resilience. In general, resilience did not moderate the relationship of stress sensitivity with schizophrenia liability. Unexpectedly, some specific attributes of resilience (personal strength, structured style) potentiated the relationship of stress sensitivity with schizophrenia liability. We conclude that the relationships of stress sensitivity, resilience, and coping with attributes of schizophrenia liability are not uniform and speculate that the pattern of associations may reflect the different influences of chronic stress exposures and neurocognitive functioning.

Pathways to functional outcome in subjects with schizophrenia living in the community and their unaffected first-degree relatives

RATIONALE

Variables influencing real-life functioning have repeatedly been modeled in schizophrenia subjects but not systematically investigated in their unaffected first-degree relatives (SRs), in whom milder forms of deficits reported in schizophrenia have been observed, but confounders of clinical cohorts are not in play. Demonstrating that pathways to functional outcome are similar between patients and SRs would validate structural models developed in schizophrenia subjects. The present multicenter study aimed to explore whether variables associated with real-life functioning are similar in schizophrenia patients and their unaffected relatives.

METHODS

The study sample included 921 schizophrenia patients, 379 SRs and 780 healthy controls. Structural Equation Models (SEMs) were used in patients and SRs to test associations of psychopathological dimensions, neurocognition, social cognition, resilience, perceived stigma and functional capacity with real-life functioning domains, impaired in both patients and SRs.

RESULTS

Interpersonal Relationships and Work Skills were the only functional domains impaired in both patients and SRs. For both domains, functional impairment in patients was found to predict impairment in unaffected relatives, suggesting the involvement of similar illness-related vulnerability factors. In both groups variables significantly associated with Interpersonal Relationships included Social Cognition, Neurocognition, Avolition, Resilience, Disorganization, Perceived Stigma and Gender, and those significantly associated with Work Skills included Social Cognition, Neurocognition and Disorganization.

CONCLUSIONS

Pathways to functional outcome for Interpersonal relationships and Work skills are similar between schizophrenia patients and their unaffected first-degree relatives. These findings validate, in the absence of confounders of clinical cohorts, structural models of determinants of functional outcome in people with schizophrenia.

Adjustment of speaker's referential expressions to an addressee's likely knowledge and link with theory of mind abilities

To communicate cooperatively, speakers must determine what constitutes the common ground with their addressee and adapt their referential choices accordingly. Assessing another person's knowledge requires a social cognition ability termed theory of mind (ToM). This study relies on a novel referential communication task requiring probabilistic inferences of the knowledge already held by an addressee prior to the study. Forty participants were asked to present 10 movie characters and the addressee, who had the same characters in a random order, was asked to place them in order. ToM and other aspects of social cognition were also assessed. Participants used more information when presenting likely unknown than likely known movie characters. They particularly increased their use of physical descriptors, which most often accompanied movie-related information. Interestingly, a significant relationship emerged between our ToM test and the increased amount of information given for the likely unknown characters. These results suggest that speakers use ToM to infer their addressee's likely knowledge and accordingly adapt their referential expressions.