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Chen KW, Lee SC, Chou FHC, Chiang HY, Hsueh IP, Chen PH, Wang SP, Ju YJ, Hsieh CL. Development of a Rasch-calibrated emotion recognition video test for patients with schizophrenia. Arch Clin Neuropsychol 2024; 39:724-731. [PMID: 38163920 DOI: 10.1093/arclin/acad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/31/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Patients with schizophrenia tend to have deficits in emotion recognition (ER) that affect their social function. However, the commonly-used ER measures appear incomprehensive, unreliable and invalid, making it difficult to comprehensively evaluate ER. The purposes of this study were to develop the Computerized Emotion Recognition Video Test (CERVT) evaluating ER ability in patients with schizophrenia. This study was divided into two phases. First, we selected candidate CERVT items/videos of 8 basic emotion domains from a published database. Second, we validated the selected CERVT items using Rasch analysis. Finally, the 269 patients and 177 healthy adults were recruited to ensure the participants had diverse abilities. After the removal of 21 misfit (infit or outfit mean square > 1.4) items and adjustment of the item difficulties of the 26 items with severe differential item functioning, the remaining 217 items were finalized as the CERVT items. All the CERVT items showed good model fits with small eigenvalues (≤ 2) based on the residual-based principal components analysis for each domain, supporting the unidimensionality of these items. The 8 domains of the CERVT had good to excellent reliabilities (average Rasch reliabilities = 0.84-0.93). The CERVT contains items of the 8 basic emotions with individualized scores. Moreover, the CERVT showed acceptable reliability and validity, and the scores were not affected by examinees' gender. Thus, the CERVT has the potential to provide a comprehensive, reliable, valid, and gender-unbiased assessment of ER for patients with schizophrenia.
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Affiliation(s)
- Kuan-Wei Chen
- Department of Occupational Therapy, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
- Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Frank Huang-Chih Chou
- Superintendent Office, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Hsin-Yu Chiang
- Department of Occupational Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Hsi Chen
- Department of Educational Psychology and Counseling, Institute for Research Excellent in Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - San-Ping Wang
- Department of Occupational Therapy, Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Jeng Ju
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Department of Occupational Therapy, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Csukly G, Orbán-Szigeti B, Suri K, Zsigmond R, Hermán L, Simon V, Kabaji A, Bata B, Hársfalvi P, Vass E, Csibri É, Farkas K, Réthelyi J. Theta-burst rTMS in schizophrenia to ameliorate negative and cognitive symptoms: study protocol for a double-blind, sham-controlled, randomized clinical trial. Trials 2024; 25:269. [PMID: 38632647 PMCID: PMC11025264 DOI: 10.1186/s13063-024-08106-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/10/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Treatment effects of conventional approaches with antipsychotics or psychosocial interventions are limited when it comes to reducing negative and cognitive symptoms in schizophrenia. While there is emerging clinical evidence that new, augmented protocols based on theta-burst stimulation can increase rTMS efficacy dramatically in depression, data on similar augmented therapies are limited in schizophrenia. The different patterns of network impairments in subjects may underlie that some but not all patients responded to given stimulation locations. METHODS Therefore, we propose an augmented theta-burst stimulation protocol in schizophrenia by stimulating both locations connected to negative symptoms: (1) the left dorsolateral prefrontal cortex (DLPFC), and (2) the vermis of the cerebellum. Ninety subjects with schizophrenia presenting negative symptoms and aging between 18 and 55 years will be randomized to active and sham stimulation in a 1:1 ratio. The TBS parameters we adopted follow the standard TBS protocols, with 3-pulse 50-Hz bursts given every 200 ms (at 5 Hz) and an intensity of 100% active motor threshold. We plan to deliver 1800 stimuli to the left DLPFC and 1800 stimuli to the vermis daily in two 9.5-min blocks for 4 weeks. The primary endpoint is the change in negative symptom severity measured by the Positive and Negative Syndrome Scale (PANSS). Secondary efficacy endpoints are changes in cognitive flexibility, executive functioning, short-term memory, social cognition, and facial emotion recognition. The difference between study groups will be analyzed by a linear mixed model analysis with the difference relative to baseline in efficacy variables as the dependent variable and treatment group, visit, and treatment-by-visit interaction as independent variables. The safety outcome is the number of serious adverse events. DISCUSSION This is a double-blind, sham-controlled, randomized medical device study to assess the efficacy and safety of an augmented theta-burst rTMS treatment in schizophrenia. We hypothesize that social cognition and negative symptoms of patients on active therapy will improve significantly compared to patients on sham treatment. TRIAL REGISTRATION The study protocol is registered at "ClinicalTrials.gov" with the following ID: NCT05100888. All items from the World Health Organization Trial Registration Data Set are registered. Initial release: 10/19/2021.
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Affiliation(s)
- Gábor Csukly
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary.
| | - Boglárka Orbán-Szigeti
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Karolin Suri
- Department of Cognitive Science, Faculty of Natural Sciences, Budapest University of Technology and Economics, Budapest, Hungary
| | - Réka Zsigmond
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Levente Hermán
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Viktória Simon
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Anita Kabaji
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Barnabás Bata
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Péter Hársfalvi
- Department of Biostatistics, University of Veterinary Medicine Budapest, Budapest, Hungary
- BiTrial Clinical Research, Budapest, Hungary
| | - Edit Vass
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Éva Csibri
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - Kinga Farkas
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
| | - János Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa 6, Budapest, 1083, Hungary
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Deng F, Bueber MA, Cao Y, Tang J, Bai X, Cho Y, Lee J, Lin Z, Yang Q, Keshavan MS, Stone WS, Qian M, Yang LH, Phillips MR. Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression. Psychol Med 2024; 54:847-873. [PMID: 38173096 DOI: 10.1017/s0033291723003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.
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Affiliation(s)
- Fei Deng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- University of Nottingham School of Economics (Ningbo China), Zhejiang, China
| | - Marlys A Bueber
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yourong Cao
- Guangxi Medical University School of Public Health, Guangxi, China
- The Reproductive Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Jeff Tang
- New York University, New York, NY, USA
| | - Xinyu Bai
- Guangxi Medical University School of Public Health, Guangxi, China
- Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi, China
| | - Young Cho
- New York State Psychiatric Institute, New York, NY, USA
| | - Jiwon Lee
- Teachers College, Columbia University, New York, NY, USA
| | - Zhuozhi Lin
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Qi Yang
- Ningxia Medical University School of Public Health, Ningxia, China
| | - Matcheri S Keshavan
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - William S Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lawrence H Yang
- New York University, New York, NY, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Michael R Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
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Velthorst E, Socrates A, Alizadeh BZ, van Amelsvoort T, Bartels-Velthuis AA, Bruggeman R, Cahn W, de Haan L, Schirmbeck F, Simons CJP, van Os J, Fett AK. Age-Related Social Cognitive Performance in Individuals With Psychotic Disorders and Their First-Degree Relatives. Schizophr Bull 2023; 49:1460-1469. [PMID: 37210736 PMCID: PMC10686369 DOI: 10.1093/schbul/sbad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Social cognitive impairment is a recognized feature of psychotic disorders. However, potential age-related differences in social cognitive impairment have rarely been studied. STUDY DESIGN Data came from 905 individuals with a psychotic disorder, 966 unaffected siblings, and 544 never-psychotic controls aged 18-55 who participated in the Genetic Risk and Outcome of Psychosis (GROUP) study. Multilevel linear models were fitted to study group main effects and the interaction between group and age on emotion perception and processing (EPP; degraded facial affect recognition) and theory of mind (ToM; hinting task) performance. Age-related differences in the association between socio-demographic and clinical factors, and EPP and ToM were also explored. STUDY RESULTS Across groups, EPP performance was associated with age (β = -0.02, z = -7.60, 95% CI: -0.02, -0.01, P < .001), with older participants performing worse than younger ones. A significant group-by-age interaction on ToM (X2(2) = 13.15, P = .001) indicated that older patients performed better than younger ones, while no age-related difference in performance was apparent among siblings and controls. In patients, the association between negative symptoms and ToM was stronger for younger than older patients (z = 2.16, P = .03). CONCLUSIONS The findings point to different age-related performance patterns on tests of 2 key social cognitive domains. ToM performance was better in older individuals, although this effect was only observed for patients. EPP was less accurate in older compared with younger individuals. These findings have implications with respect to when social cognitive training should be offered to patients.
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Affiliation(s)
- Eva Velthorst
- Department of Research, Mental Health Organization “GGZ Noord-Holland-Noord,”Heerhugowaard, The Netherlands
| | - Adam Socrates
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Seaver Center for Autism Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Behrooz Z Alizadeh
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Agna A Bartels-Velthuis
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Wiepke Cahn
- University Medical Center Utrecht, Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University, Utrecht, The Netherlands
- Altrecht, General Mental Health Care, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Seaver Center for Autism Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arkin, Institute for Mental Health, Amsterdam, The Netherlands
| | - Frederike Schirmbeck
- Seaver Center for Autism Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Arkin, Institute for Mental Health, Amsterdam, The Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- GGzE Institute for Mental Health Care, Eindhoven, The Netherlands
| | - Jim van Os
- University Medical Center Utrecht, Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht University, Utrecht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, King’s Health Partners, London, UK
| | - Anne-Kathrin Fett
- Department of Psychology, City, University of London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Sağlam Y, Ermiş Ç, Tunçtürk M, Turan S, Karakuş OB, Alarslan S, Karaçetin G. Neurocognitive and social cognitive impairments in remission and symptomatic states of early-onset schizophrenia spectrum disorders. Eur Child Adolesc Psychiatry 2023; 32:1621-1631. [PMID: 35316416 DOI: 10.1007/s00787-022-01977-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/11/2022] [Indexed: 11/30/2022]
Abstract
Previous studies demonstrated neurocognitive impairments in early-onset schizophrenia (EOS) and other psychotic spectrum disorders (PSD). This study aimed to compare remitted and symptomatic cases in terms of neurocognition and theory of mind (ToM). 50 healthy controls (HC) and 106 patients diagnosed schizophrenia in remission (EOS-R, n = 38), symptomatic schizophrenia (EOS-S, n = 34), and other PSD (n = 34) were included in our study. The Positive and Negative Symptom Scale, Columbia-Suicide Severity Rating Scale, Reactive and Proactive Aggression Questionnaire were used to evaluate psychopathology. A cognitive battery was conducted to measure verbal learning/memory, visual learning/memory, executive functions (EF), inhibition, processing speed (PS), verbal fluency skills. Reading Mind in Eyes Test (RMET) and Faux-Pas tests were implemented to assess ToM. Principal Component Analysis was used to identify cognitive domain scores. Patient groups had poorer performance in cognitive domains than the HC group. The cognitive impairment and psychopathology levels of EOS-R and the PSD groups were comparable for all cognitive domains. The EOS-S group also had poorer scores in Rey verbal learning score (d = 0.87), RMET (d = 0.72), verbal fluency (d = 0.66), PS/EF (d = 0.82) and visual learning/memory (d = 0.83) test scores than the PSD group. Only RMET (d = 0.72) and executive function/processing speed domain (d = 0.63) were significantly impaired in the EOS-S group than the EOS-R group Cognitive impairments seen in remitted psychotic disorders were on the same continuum. Impaired EF/PS and ToM skills could be a cognitive marker for symptomatic illness in youth.
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Affiliation(s)
- Yeşim Sağlam
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Çağatay Ermiş
- Department of Child and Adolescent Psychiatry, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Mustafa Tunçtürk
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Serkan Turan
- Department of Child and Adolescent Psychiatry, Uludag University School of Medicine, 16400, Bursa, Turkey.
| | - Oğuz Bilal Karakuş
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Sezen Alarslan
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
| | - Gül Karaçetin
- Department of Child and Adolescent Psychiatry, Neurology and Neurosurgery, University of Health Sciences, Bakirkoy Prof Dr Mazhar Osman Research and Training Hospital for Psychiatry, Istanbul, Turkey
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Mørch-Johnsen L, Jørgensen KN, Barth C, Nerland S, Bringslid IK, Wortinger LA, Andreou D, Melle I, Andreassen OA, Agartz I. Thalamic nuclei volumes in schizophrenia and bipolar spectrum disorders - Associations with diagnosis and clinical characteristics. Schizophr Res 2023; 256:26-35. [PMID: 37126979 DOI: 10.1016/j.schres.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/16/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND The thalamus is central to brain functions ranging from primary sensory processing to higher-order cognition. Structural deficits in thalamic association nuclei such as the pulvinar and mediodorsal nuclei have previously been reported in schizophrenia. However, the specificity with regards to clinical presentation, and whether or not bipolar disorder (BD) is associated with similar alterations is unclear. METHODS We investigated thalamic nuclei volumes in 334 patients with schizophrenia spectrum disorders (SSD) (median age 29 years, 59 % male), 322 patients with BD (30 years, 40 % male), and 826 healthy controls (HC) (34 years, 54 % male). Volumes of 25 thalamic nuclei were extracted from T1-weighted magnetic resonance imaging using an automated Bayesian segmentation method and compared between groups. Furthermore, we explored associations with clinical characteristics across diagnostic groups, including psychotic and mood symptoms and medication use, as well as diagnostic subtype in BD. RESULTS Significantly smaller volumes were found in the mediodorsal, pulvinar, and lateral and medial geniculate thalamic nuclei in SSD. Similarly, smaller volumes were found in BD in the same four regions, but mediodorsal nucleus volume alterations were limited to its lateral part and pulvinar alterations to its anterior region. Smaller volumes in BD compared to HC were seen only in BD type I, not BD type II. Across diagnoses, having more negative symptoms was associated with smaller pulvinar volumes. CONCLUSIONS Structural alterations were found in both SSD and BD, mainly in the thalamic association nuclei. Structural deficits in the pulvinar may be of relevance for negative symptoms.
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Affiliation(s)
- Lynn Mørch-Johnsen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry & Department of Clinical Research, Østfold Hospital, Grålum, Norway.
| | - Kjetil Nordbø Jørgensen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, Telemark Hospital, Skien, Norway
| | - Claudia Barth
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Stener Nerland
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ida Kippersund Bringslid
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laura A Wortinger
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Dimitrios Andreou
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ingrid Melle
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
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Thibaudeau E, Rae J, Raucher-Chéné D, Bougeard A, Lepage M. Disentangling the Relationships Between the Clinical Symptoms of Schizophrenia Spectrum Disorders and Theory of Mind: A Meta-analysis. Schizophr Bull 2023; 49:255-274. [PMID: 36244001 PMCID: PMC10016420 DOI: 10.1093/schbul/sbac150] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND HYPOTHESIS Previous studies have suggested links between clinical symptoms and theory of mind (ToM) impairments in schizophrenia spectrum disorders (SSD), but it remains unclear whether some symptoms are more strongly linked to ToM than others. STUDY DESIGN A meta-analysis (Prospero; CRD42021259723) was conducted to quantify and compare the strength of the associations between ToM and the clinical symptoms of SSD (Positive, Negative, Cognitive/Disorganization, Depression/Anxiety, Excitability/Hostility). Studies (N = 130, 137 samples) including people with SSD and reporting a correlation between clinical symptoms and ToM were retrieved from Pubmed, PsycNet, Embase, Cochrane Library, Science Direct, Proquest, WorldCat, and Open Gray. Correlations for each dimension and each symptom were entered into a random-effect model using a Fisher's r-to-z transformation and were compared using focused-tests. Publication bias was assessed with the Rosenthal failsafe and by inspecting the funnel plot and the standardized residual histogram. STUDY RESULTS The Cognitive/Disorganization (Zr = 0.28) and Negative (Zr = 0.24) dimensions revealed a small to moderate association with ToM, which was significantly stronger than the other dimensions. Within the Cognitive/Disorganization dimension, Difficulty in abstract thinking (Zr = 0.36) and Conceptual disorganization (Zr = 0.39) showed the strongest associations with ToM. The association with the Positive dimension (Zr = 0.16) was small and significantly stronger than the relationship with Depression/Anxiety (Zr = 0.09). Stronger associations were observed between ToM and clinical symptoms in younger patients, those with an earlier age at onset of illness and for tasks assessing a combination of different mental states. CONCLUSIONS The relationships between Cognitive/Disorganization, Negative symptoms, and ToM should be considered in treating individuals with SSD.
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Affiliation(s)
- Elisabeth Thibaudeau
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Research Centre, Montreal, Canada
| | - Jesse Rae
- Douglas Research Centre, Montreal, Canada
- McGill University, Department of Psychology, Montreal, Canada
| | - Delphine Raucher-Chéné
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Research Centre, Montreal, Canada
- Cognition, Health, and Society Laboratory (EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Academic Department of Psychiatry, University Hospital of Reims, EPSM Marne, Reims, France
| | | | - Martin Lepage
- McGill University, Department of Psychiatry, Montreal, Canada
- Douglas Research Centre, Montreal, Canada
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Zouraraki C, Karamaouna P, Giakoumaki SG. Facial emotion recognition and schizotypal traits: A systematic review of behavioural studies. Early Interv Psychiatry 2023; 17:121-140. [PMID: 35840128 DOI: 10.1111/eip.13328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/19/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Chrysoula Zouraraki
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
| | - Penny Karamaouna
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
| | - Stella G Giakoumaki
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
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9
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Eddy CM. The non-human animal reading the mind in the eyes test (NARMET): A new measure for the assessment of social cognition. Front Psychiatry 2023; 14:1129252. [PMID: 37020731 PMCID: PMC10069677 DOI: 10.3389/fpsyt.2023.1129252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/28/2023] [Indexed: 04/07/2023] Open
Abstract
The Reading the Mind in the Eyes test (RMET) is a widely applied test of social cognition, based on mental state judgments in response to photographs of human eyes, which can elicit impairment in patients with numerous psychiatric and neurological disorders. However, interpretation of task performance is limited without the use of appropriate control tasks. In addition to a matched task requiring age judgments of the RMET stimuli, it was recently shown that a mental state judgment task of comparable difficulty, could be developed using photographs of domestic cat eyes. The current study aimed to further develop a Non-human Animal RMET (NARMET) by testing additional stimuli in the form of photographs of domestic dog eyes. A variety of additional tasks were used alongside the eyes test stimuli in a large sample of healthy young adults, to explore how alexithymia, schizotypal features, and autistic tendencies may differentially influence mental state attribution in response to cat, dog, and human eyes test stimuli. The resulting NARMET features both cat and dog trials, depicting a similar range of complex mental states to the human RMET. It shows favorable psychometric properties as well as being well matched to the RMET in terms of linguistic variables, length and difficulty. However, reading measures predicted performance on the RMET, but not on the NARMET. Although further testing is required in samples with a higher proportion of males, future application of the NARMET in neuropsychiatric populations exhibiting cognitive and behavioral difficulties could offer enhanced assessment of social cognitive skills.
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Affiliation(s)
- Clare M. Eddy
- BSMHFT National Centre for Mental Health, Birmingham, United Kingdom
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Clare M. Eddy, ,
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10
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Zonp Z, Bilgin H. The effectiveness of metacognitive training on impairments in social cognition in patients with schizophrenia: mental health nursing practice in a community mental health center. Nord J Psychiatry 2022; 76:295-306. [PMID: 34428118 DOI: 10.1080/08039488.2021.1965653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Social cognition is an independent structure from the positive symptoms of schizophrenia and contributes to negative symptoms, neurocognitive impairment, and social functioning. AIM To examine the effectiveness of the metacognitive training intervention on social cognition in people with schizophrenia. DESIGN This study was conducted as a randomized quasi-experimental (pre-test/post-test and follow-up) design with a control group. METHODS Thirty-nine patients with schizophrenia were enrolled and randomly assigned to either the control group (n = 19) or the metacognitive training group (n = 20). A 10-week metacognitive training program was offered to the intervention group. The study involved a pre-test/post-test design with a 3-month follow-up assessment. The primary outcome was social cognition, as measured by the Facial Emotion Discrimination/Identification Tests, Reading the Mind in the Eyes Test, and Attributional Style Questionnaire. The secondary outcome was measured by the metacognitive training subjective efficacy form. RESULTS Completion at follow-up was high (92.3%). The results show that the changes over time in the False Belief Task 1st level, Attributional Style Questionnaire negative events global-specific dimension, and positive events stable-unstable dimension mean scores, time interaction, were statistically significant. Metacognitive Training was efficacious on the theory of mind and in performing more functional attributions. Patients in the intervention group showed high-level positive feedback. CONCLUSION Metacognitive Training applied by psychiatric and mental health nurses demonstrated a user and practitioner-friendly, safe and effective program on social cognition. Also, the social and cultural feasibility and effectiveness of the Metacognitive Training program were shown for the first time in a Turkish population.
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Affiliation(s)
- Zeynep Zonp
- Postdoctoral Resesarch Fellow, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Health Science Faculty, Kocaeli University, Kocaeli, Turkey
| | - Hülya Bilgin
- Professor, Florence Nightingale School of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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11
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Dong R, Zhao NO, Wu HE, Yu L, Zhang XY. Sex differences in the association between serum BDNF and cognitive impairment in schizophrenia patients using various antipsychotics. J Psychiatr Res 2021; 138:492-499. [PMID: 33971483 DOI: 10.1016/j.jpsychires.2021.04.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/25/2021] [Accepted: 04/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment is one of the core symptoms of schizophrenia patients. There are often various differences in the efficacy of different antipsychotics in the treatment of cognitive impairment by sex. The purpose of this study was to explore whether there are gender differences in the association between serum BDNF levels and cognitive performance in patients with schizophrenia taking different antipsychotics. METHODS We used Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to assess the cognitive function of three groups of schizophrenia patients (420 on clozapine, 183 on risperidone, 215 on typical antipsychotic drugs) and 467 healthy controls. Positive and Negative Syndrome Scale (PANSS) was used to assess schizophrenia symptoms of patients. Enzyme-Linked ImmunoSorbent Assay was used to measure serum brain-derived neurotrophic factor (BDNF) levels. RESULTS Among the patients taking clozapine and typical antipsychotic drugs, the RBANS total score, immediate memory, attention, and delayed memory subscores in females were higher than those in males (all p < 0.05). The RBANS total score and the delayed memory subscores in female patients taking risperidone were higher than those in male patients (all p < 0.05). Significant correlation between BDNF and cognition only existed in male patients taking clozapine, male patients taking risperidone, and male and female patients taking typical antipsychotic drugs (all p < 0.05). CONCLUSION Regardless of antipsychotic effect, the cognitive function of female patients is better compared to that of male patients. For male patients, the association between BDNF and cognitive performance exists in each medication group. For female patients, this significant association was only shown in the typical antipsychotic group, but not in the clozapine and risperidone groups.
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Affiliation(s)
- Rui Dong
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China
| | - Ning Olivia Zhao
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Liling Yu
- Department of Medical Psychology, School of Medical Humanities, Capital Medical University, Beijing, China.
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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12
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Luo H, Zhao Y, Fan F, Fan H, Wang Y, Qu W, Wang Z, Tan Y, Zhang X, Tan S. A bottom-up model of functional outcome in schizophrenia. Sci Rep 2021; 11:7577. [PMID: 33828168 PMCID: PMC8027854 DOI: 10.1038/s41598-021-87172-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/10/2021] [Indexed: 02/01/2023] Open
Abstract
Schizophrenia results in poor functional outcomes owing to numerous factors. This study provides the first test of a bottom-up causal model of functional outcome in schizophrenia, using neurocognition, vocal emotional cognition, alexithymia, and negative symptoms as predictors of functional outcome. We investigated a cross-sectional sample of 135 individuals with schizophrenia and 78 controls. Using a series of structural equation modelling analyses, a single pathway was generated among scores from the MATRICS Consensus Cognitive Battery (MCCB), vocal emotion recognition test, Toronto Alexithymia Scale (TAS), Brief Negative Symptom Scale, and the Personal and Social Performance Scale. The scores for each dimension of the MCCB in the schizophrenia group were significantly lower than that in the control group. The recognition accuracy for different emotions (anger, disgust, fear, sadness, surprise, and satire, but not calm was significantly lower in the schizophrenia group than in the control group. Moreover, the scores on the three dimensions of TAS were significantly higher in the schizophrenia group than in the control group. On path analysis modelling, the proposed bottom-up causal model showed a strong fit with the data and formed a single pathway, from neurocognition to vocal emotional cognition, to alexithymia, to negative symptoms, and to poor functional outcomes. The study results strongly support the proposed bottom-up causal model of functional outcome in schizophrenia. The model could be used to better understand the causal factors related to the functional outcome, as well as for the development of intervention strategies to improve functional outcomes in schizophrenia.
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Affiliation(s)
- Hongge Luo
- grid.440734.00000 0001 0707 0296School of Public Health, North China University of Science and Technology, Tangshan, China ,grid.440734.00000 0001 0707 0296College of Psychology, North China University of Science and Technology, Tangshan, China
| | - Yanli Zhao
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Fengmei Fan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Hongzhen Fan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yunhui Wang
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Wei Qu
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Zhiren Wang
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Yunlong Tan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
| | - Xiujun Zhang
- grid.440734.00000 0001 0707 0296School of Public Health, North China University of Science and Technology, Tangshan, China
| | - Shuping Tan
- grid.11135.370000 0001 2256 9319Beijing Huilongguan Hospital, Peking University Huilongguan Clinical Medical School, Beijing, China
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Deng F, Phillips MR, Cai B, Yu G, Qian M, Grivel MM, Chen H, Ouyang X, Xue F, Zhao M, Kegeles LS, Susser ES, Keshavan MS, Stone WS, Yang LH. Comparison of social cognition using an adapted Chinese version of the Reading the Mind in the Eyes Test in drug-naive and regularly medicated individuals with chronic schizophrenia and healthy controls in rural China. Psychol Med 2021; 52:1-13. [PMID: 33722309 PMCID: PMC10352022 DOI: 10.1017/s003329172100043x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Social cognition has not previously been assessed in treatment-naive patients with chronic schizophrenia, in patients over 60 years of age, or in patients with less than 5 years of schooling. METHODS We revised a commonly used measure of social cognition, the Reading the Mind in the Eyes Test (RMET), by expanding the instructions, using both self-completion and interviewer-completion versions (for illiterate respondents), and classifying each test administration as 'successfully completed' or 'incomplete'. The revised instrument (RMET-CV-R) was administered to 233 treatment-naive patients with chronic schizophrenia (UT), 154 treated controls with chronic schizophrenia (TC), and 259 healthy controls (HC) from rural communities in China. RESULTS In bivariate and multivariate analyses, successful completion rates and RMET-CV-R scores (percent correct judgments about emotion exhibited in 70 presented slides) were highest in HC, intermediate in TC, and lowest in UT (adjusted completion rates, 97.0, 72.4, and 49.9%, respectively; adjusted RMET-CV-R scores, 45.4, 38.5, and 34.6%, respectively; all p < 0.02). Stratified analyses by the method of administration (self-completed v. interviewer-completed) and by education and age ('educated-younger' v. 'undereducated-older') show the same relationship between groups (i.e. NC>TC>UT), though not all differences remain statistically significant. CONCLUSIONS We find poorer social cognition in treatment-naive than in treated patients with chronic schizophrenia. The discriminant validity of RMET-CV-R in undereducated, older patients demonstrates the feasibility of administering revised versions of RMET to patients who may otherwise be considered ineligible due to education or age by changing the method of test administration and carefully assessing respondents' ability to complete the task successfully.
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Affiliation(s)
- Fei Deng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- University of Nottingham School of Economics (Ningbo, China), Zhejiang, China
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Bing Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gary Yu
- New York University Rory Meyers College of Nursing, New York, New York
| | - Min Qian
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | | | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyi Ouyang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Xue
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingru Zhao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Lawrence S. Kegeles
- Department of Psychiatry, Columbia University, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- New York State Psychiatric Institute, New York, New York
| | - Matcheri S. Keshavan
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - William S. Stone
- Harvard Medical School Department of Psychiatry at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lawrence H. Yang
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- New York University School of Global Public Health, New York, New York
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Kittel AFD, Olderbak S, Wilhelm O. Sty in the Mind's Eye: A Meta-Analytic Investigation of the Nomological Network and Internal Consistency of the "Reading the Mind in the Eyes" Test. Assessment 2021; 29:872-895. [PMID: 33645295 DOI: 10.1177/1073191121996469] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The Reading the Mind in the Eyes Test (RMET) is the most popular adult measure of individual differences in theory of mind. We present a meta-analytic investigation of the test's psychometric properties (k = 119 effect sizes, 61 studies, ntotal = 8,611 persons). Using random effects models, we found the internal consistency of the test was acceptable (α = .73). However, the RMET was more strongly related with emotion perception (r = .33, ρ = .48) relative to alternative theory of mind measures (r = .29, ρ = .39), and weakly to moderately related with vocabulary (r = .25, ρ = .32), cognitive empathy (r = .14, ρ = .20), and affective empathy (r = .13, ρ = .19). Overall, we conclude that the RMET operates rather as emotion perception measure than as theory of mind measure, challenging the interpretation of RMET results.
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15
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Clark CB, Armstrong J, Ballout MH, Ewy R. Examining the link between facial affect recognition and violent offending: A comparison between web-recruited volunteers with histories of violent and non-violent offending. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2020; 30:228-239. [PMID: 32744391 DOI: 10.1002/cbm.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 03/02/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The link between facial affect recognition and criminal justice involvement has been extensively researched, yet there are virtually no data on the capacity for facial affect recognition in post-incar+cerated individuals, and the results of many studies are limited due to a narrow focus on psychopathy rather than offence category. AIMS To test the first hypothesis that individuals reporting a history of a violent offence would show a deficit in facial affect recognition and the second hypothesis that the violent offender's deficit would be exclusive to recognition of negative expressions, not affecting positive or neutral expressions. METHOD Post-incarcerated individuals (N = 298) were recruited online through Qualtrics and completed questionnaires assessing their criminal justice background and demographics. They completed measures of facial affect recognition, anxiety and depression, and components of aggression. RESULTS A logistic regression, including sex, ethnicity, age and years of education and depression/anxiety scores, indicated that committing a violent offence was independently associated with lower facial affect recognition scores as well as male gender and a trait-based propensity towards physical aggression, but no other co-variable. These data provided no evidence that this deficit was specific to negative emotions. CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH/PRACTICE Our study is one of the first to examine facial affect recognition in a post-incarcerated sample. It suggests that deficits in facial affect recognition, already well documented among violent prisoners, persist. While acknowledging that these may be relatively fixed characteristics, this study also suggests that, for these people, nothing happening during their imprisonment was touching this. Improving capacity in facial affect recognition should be considered as a target of intervention for violent offenders, developing or revising in-prison programmes as required.
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Affiliation(s)
- C Brendan Clark
- Department of Psychology, Wichita State University, Wichita, Kansas, USA
| | - Jacob Armstrong
- Department of Psychology, Wichita State University, Wichita, Kansas, USA
| | | | - Ryley Ewy
- Department of Psychology, Wichita State University, Wichita, Kansas, USA
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16
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Lee SC, Liu CC, Kuo CJ, Hsueh IP, Hsieh CL. Sensitivity and specificity of a facial emotion recognition test in classifying patients with schizophrenia. J Affect Disord 2020; 275:224-229. [PMID: 32734912 DOI: 10.1016/j.jad.2020.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 06/01/2020] [Accepted: 07/04/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Schizophrenia is a debilitating mental illness that causes significant disability. However, the lack of evidence for functional decline yields difficulty in distinguishing patients with schizophrenia from healthy adults. Since patients with schizophrenia demonstrate severe facial emotion recognition deficit (FERD), FERD measurement appears to be a promising solution for the aforementioned challenge.We aimed to develop a FERD-based screening tool to differentiates patients with schizophrenia from healthy adults. METHODS Patients' responses were extracted from a previous study. The most discriminative index was determined by comparing the area under the receiver operating characteristic curve (AUC) of patients' FER scores in 7 domains individually and collectively. The best cut-off score was selected only for the most discriminative index to provide both high sensitivity and specificity (≥ 0.90). RESULTS The "number of domains failed" showed the highest discriminative value (AUC = 0.92). Since high sensitivity and specificity could not be achieved simultaneously, two sub-optimal cut-off scores were recommended for prospective users. For users prioritizing sensitivity, the "≥ 2 domains failed" index yields high sensitivity (0.96) with modest specificity (0.66). For users targeting specificity, the "≥ 4 domains failed" indexachieves high specificity (0.92) with acceptable sensitivity (0.72). LIMITATIONS Convenience sampling with mild clinical severity and younger healthy adults (< 20 years old) may limit the generalizability. CONCLUSION The FERD screener seems to be a discriminative tool with changeable cut-off scores achieving high sensitivity or specificity. Therefore, it may be useful in detecting patients and ruling out adults erroneously suspected of having schizophrenia.
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Affiliation(s)
- Shih-Chieh Lee
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4., No.17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100, Taiwan (R.O.C.)
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei City 100, (R.O.C.); Department of Psychiatry, College of Medicine, National Taiwan University, No.1, Jen Ai Rd., Taipei City 100, Taiwan (R.O.C.)
| | - Chian-Jue Kuo
- Songde Branch (Taipei City Psychiatric Center), Taipei City Hospital, Zhengzhou Rd., Datong Dist., Taipei City 103, Taiwan (R.O.C.); Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei City 110, Taiwan (R.O.C.); Psychiatric Research Center, Taipei Medical University Hospital, No. 252 Wu-Xing Street, Taipei City 110, Taiwan (R.O.C.); Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Rd., Taipei City 100, Taiwan (R.O.C.)
| | - I-Ping Hsueh
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4., No.17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100, Taiwan (R.O.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.7, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei City 100, Taiwan (R.O.C.)
| | - Ching-Lin Hsieh
- School of Occupational Therapy, College of Medicine, National Taiwan University, F4., No.17, Xuzhou Rd., Zhongzheng Dist., Taipei City 100, Taiwan (R.O.C.); Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.7, Chung Shan S. Rd. (Zhongshan S. Rd.), Zhongzheng Dist., Taipei City 100, Taiwan (R.O.C.); Department of Occupational Therapy, College of Medical and Health Science, Asia University, No. 500, Lioufeng Rd., Wufeng, Taichung 413, Taiwan (R.O.C.).
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Giralt-López M, Miret S, Soler J, Campanera S, Parellada M, Fañanás L, Fatjó-Vilas M. The role of schizotypal traits and the OXTR gene in theory of mind in schizophrenia: A family-based study. Eur Psychiatry 2020; 63:e15. [PMID: 32093796 PMCID: PMC7315883 DOI: 10.1192/j.eurpsy.2019.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is consistent evidence that theory of mind (ToM) is impaired in schizophrenia (SZ); however, it remains unclear whether such deficits are trait- or state-dependent. We evaluated ToM in patients with schizophrenia spectrum disorders (SSDs), their healthy first-degree relatives, and controls to test its suitability as an endophenotypic marker. We also studied the modifying effect of markers of clinical and genetic liability to SZ (schizotypy and genetic variability in the oxytocin receptor gene: OXTR) on ToM in healthy individuals. METHODS The sample included 38 stable SSD patients, 80 unaffected first-degree relatives, and 81 controls. ToM was assessed using the Hinting Task (HT) and schizotypy via the Schizotypal Personality Questionnaire-Brief (SPQ-B), which generates interpersonal (SPQ-IP), cognitive-perceptual (SPQ-CP), and disorganization (SPQ-D) scores. The polymorphism rs53576 of OXTR was genotyped. RESULTS Patients presented poorer HT performance than relatives and controls (p = 0.003 and p < 0.001). High SPQ-IP and SPQ-CP scores correlated with poorer ToM performance in relatives (p = 0.010 and p = 0.030), but not in controls. OXTR was not associated with HT scores, but it showed a modifying effect within controls; high SPQ-CP was related to HT poorer performance conditional to GG genotype (p = 0.007). CONCLUSIONS ToM deficits were present in patients but not in unaffected relatives or controls. However, our data indicate the usefulness of clinical and genetic liability markers to characterize differences in ToM abilities within healthy individuals. Then, the observed link between ToM and SZ liability suggests the putative role of ToM as an endophenotypic marker. Nevertheless, new analyses in larger samples are needed.
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Affiliation(s)
- M Giralt-López
- Servei de Psiquiatria, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - S Miret
- Centre de Salut Mental d'Adults de Lleida, Servei de Psiquiatria, Salut Mental i Addiccions, Hospital Universitari Santa Maria, Lleida, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - J Soler
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
| | - S Campanera
- Centre de Salut Mental d'Adults de Lleida, Servei de Psiquiatria, Salut Mental i Addiccions, Hospital Universitari Santa Maria, Lleida, Spain
| | - M Parellada
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departamento de Psiquiatría del Niño y del Adolescente, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - L Fañanás
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain
| | - M Fatjó-Vilas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain.,Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, Universitat de Barcelona, Institut de Biomedicina de la Universitat de Barcelona (IBUB), Barcelona, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
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18
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Zhao Y, Xiao W, Chen K, Zhan Q, Ye F, Tang X, Zhang X. Neurocognition and social cognition in remitted first-episode schizophrenia: correlation with VEGF serum levels. BMC Psychiatry 2019; 19:403. [PMID: 31842818 PMCID: PMC6915945 DOI: 10.1186/s12888-019-2397-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Accumulating evidence suggests that serum vascular endothelial growth factor (VEGF) in many neurobiological processes potentially contributes to the pathophysiology of psychiatric disorders, particularly cognitive decline. The purpose of this study was to explore the differences in neurocognition, social cognition and VEGF among remitted first-episode schizophrenic patients, non-remitters and normal control subjects. Moreover, we investigated the association between serum VEGF levels and cognitive functions. METHOD 65 remission (RS) and 45 nonremission patients (NRS) after first-episode schizophrenia, as well as 58 healthy controls (HC) were enrolled in this study. Social cognition was assessed using the Chinese Facial Emotion Test (CFET); neurocognition was measured with a test battery consisting of Hopkins Verbal Learning Test-Revised, Verbal Fluency Test, Trail Making Tests, Digit Span Tests (DST) and Stroop Tests. Blood samples were collected for VEGF measurements. Data was analyzed with SPSS 22.0 (Chicago, IL, USA). RESULTS On nearly all neurocognitive tests (except for DST), RS performed significantly worse than HC but better than NRS (P < 0.05). NRS, but not RS, exhibited markedly poorer social cognition than HC (except for Happiness and Surprise subscales of the CFET) (P < 0.05). VEGF levels showed a gradient change among three groups (HC > RS > NRS). CONCLUSION Compared to HC, RS demonstrated poorer neurocognitive but intact social cognition functioning. These results indicate that VEGF levels decreased gradually with the severity of cognitive impairment in schizophrenia. VEGF may be involved in the pathological mechanism of cognitive performance in RS.
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Affiliation(s)
- Yaqin Zhao
- grid.268415.cDepartment of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003 People’s Republic of China
| | - Wenhuan Xiao
- grid.268415.cDepartment of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003 People’s Republic of China
| | - Kuanyu Chen
- 0000 0001 0238 8414grid.411440.4Huzhou University, Huzhou, 313000 Zhejiang China
| | - Qiongqiong Zhan
- grid.268415.cDepartment of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003 People’s Republic of China
| | - Fei Ye
- grid.268415.cDepartment of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu 225003 People’s Republic of China
| | - Xiaowei Tang
- 0000 0000 9255 8984grid.89957.3aNanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029 Jiangsu China
| | - Xiaobin Zhang
- Department of Psychiatry, Affiliated WuTaiShan Hospital of Medical College of Yangzhou University, Yangzhou, Jiangsu, 225003, People's Republic of China. .,Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, 215137, People's Republic of China. .,School of mental health, Jining medical University, Jining, 272000, Shandong, China.
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Hatkevich C, Venta A, Sharp C. Theory of mind and suicide ideation and attempt in adolescent inpatients. J Affect Disord 2019; 256:17-25. [PMID: 31158712 DOI: 10.1016/j.jad.2019.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/04/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Suicide ideation and attempt are alarmingly prevalent in adolescents, and even more so for youth in psychiatric settings. Interpersonal factors have been emphasized as important in the etiology and maintenance of suicide ideation and attempt in adolescents. Evaluating social cognitive deficits offers important insight into processes underlying interpersonal problems associated with suicide ideation and attempt; however little social-cognitive research has been conducted in this area. The aim of the current study was to explore the relation of theory of mind (ToM) impairments and suicide ideation and attempt among adolescent inpatients. METHODS A sample of 391 adolescent inpatients completed measures on ToM, suicidal ideation and attempt, clinical symptoms and sociodemographics. RESULTS Binary logistic regression analyses revealed significant relations between excessive ToM (hypermentalizing) and two suicide outcome variables (suicide ideation in the past four weeks, suicide attempt in the past year), while covarying for sociodemographics and multiple clinical symptom scales. CONCLUSIONS Excessive ToM, or over-attributing the mental/emotional states of others, appears to share a salient relation to recent suicidal thoughts and behavior in adolescent inpatients. Current findings may indicate that interventions incorporating social cognitive components (e.g., Mentalization Based Therapy and Cognitive Behavioral Therapy) may be of promise to treating youth with suicidal thoughts and behaviors and excessive ToM. LIMITATIONS The current study uses cross-sectional data and discrepancies exist in time periods assessed by primary measures.
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Affiliation(s)
- Claire Hatkevich
- Department of Psychiatry, University of Michigan/Michigan Medicine, Ann Arbor, MI, United States of America
| | - Amanda Venta
- Department of Psychology, Sam Houston State University, Huntsville, TX, United States of America
| | - Carla Sharp
- Department of Psychology, University of Houston, Houston, TX, United States of America.
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Eddy CM. What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations. Front Psychiatry 2019; 10:425. [PMID: 31354534 PMCID: PMC6636467 DOI: 10.3389/fpsyt.2019.00425] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022] Open
Abstract
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.
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Affiliation(s)
- Clare M. Eddy
- Research and Innovation, BSMHFT National Centre for Mental Health, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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21
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Etchepare A, Roux S, Destaillats JM, Cady F, Fontanier D, Couhet G, Prouteau A. What are the specificities of social cognition in schizophrenia? A cluster-analytic study comparing schizophrenia with the general population. Psychiatry Res 2019; 272:369-379. [PMID: 30599441 DOI: 10.1016/j.psychres.2018.12.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 12/28/2022]
Abstract
While social cognition (SC) is widely recognized as being impaired in schizophrenia, little is known about the potential heterogeneity in individuals' functioning. Using a wide range of SC measures and a cluster-analytic approach, we compared SC profiles in the general population and in people with schizophrenia. A total of 131 healthy controls and 101 participants with schizophrenia were included. Groups were compared on sociodemographic, neurocognition, anxiety and depressive mood variables. Three profiles were identified in healthy controls: one with good SC abilities (Homogeneous SC group) and two with specific weaknesses in complex Facial Emotion Recognition (Low FER group) or Affective Theory of Mind (Low AToM group). However, these patterns were not found in participants with schizophrenia, who were characterized rather by levels of SC functioning (i.e., Low, Medium and High SC groups). Importantly, while the High SC group (47.9% of the sample) exhibited normal performances, the two others were underpinned by different pathological processes (i.e., alexithymia for Medium SC group or neurocognition dysfunctioning for Low SC group). These results have important implications for future research as well as for clinical practice regarding assessment methodology and therapeutic interventions.
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Affiliation(s)
- Aurore Etchepare
- Laboratoire de Psychologie EA 4139, Université de Bordeaux, 3ter Place de la Victoire, 33 000 Bordeaux, France; Pôle de Soins de Réhabilitation de la Dordogne (PSRD), Centre Hospitalier Vauclaire, Lieu-dit Vauclaire, 24 700 Montpon-Ménestérol, France.
| | - Solenne Roux
- Laboratoire de Psychologie EA 4139, Université de Bordeaux, 3ter Place de la Victoire, 33 000 Bordeaux, France
| | - Jean-Marc Destaillats
- Département de Psychiatrie Adulte, Hôpital de Jonzac, Domaine des Fossés, 17 500 St Martial de Vitaterne, France
| | - Florian Cady
- Centre d'Evaluation et de Réhabilitation (CER), Centre Hospitalier Esquirol, 39 rue Jean-Baptiste Ruchaud, 87 000 Limoges, France
| | - David Fontanier
- Centre d'Evaluation et de Réhabilitation (CER), Centre Hospitalier Esquirol, 39 rue Jean-Baptiste Ruchaud, 87 000 Limoges, France
| | - Geoffroy Couhet
- Centre de Réhabilitation Psycho-Sociale (CRPS), Tour de Gassies, rue de la Tour-de-Gassies, 33 500 Bruges, France
| | - Antoinette Prouteau
- Laboratoire de Psychologie EA 4139, Université de Bordeaux, 3ter Place de la Victoire, 33 000 Bordeaux, France; Département de Psychiatrie Adulte, Hôpital de Jonzac, Domaine des Fossés, 17 500 St Martial de Vitaterne, France
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22
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Mike L, Guimond S, Kelly S, Thermenos H, Mesholam-Gately R, Eack S, Keshavan M. Social cognition in early course of schizophrenia: Exploratory factor analysis. Psychiatry Res 2019; 272:737-743. [PMID: 30832194 DOI: 10.1016/j.psychres.2018.12.152] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/06/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022]
Abstract
Social cognition is a central contributor to social functioning in schizophrenia. A better understanding of the underlying structure of social cognition in the early course schizophrenia could help us identify more precise targets for intervention in this population. In the present study, we performed an Exploratory Factor Analysis (EFA) on 90 patients within the early course of schizophrenia using 11 validated subtests assessing various domains of social cognitive skills. The factors derived from this analysis were then used to investigate relationships between these distinct domains of social cognition skills and neurocognitive performance, clinical symptoms, and social functioning satisfaction. The results revealed the presence of a 3-factor solution, representing the domains of Emotion Management, Emotion Recognition, and Theory of Mind, together accounting for 55.88% of the variance. Moreover, higher scores on the Theory of Mind factor were significantly related to higher social functioning satisfaction measures as well as with lower clinical symptoms severity. Our findings suggest that social cognitive skills are composed of three separate domains in the early course of schizophrenia and that theory of mind could be an important therapeutic target for early intervention.
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Affiliation(s)
- Luke Mike
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA
| | - Synthia Guimond
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; The Royal's Institute of Mental Health Research, Department of Psychiatry, University of Ottawa, ON, Canada
| | - Sinead Kelly
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heidi Thermenos
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Shaun Eack
- School of Social Work and Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matcheri Keshavan
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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23
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Aloi M, de Filippis R, Grosso Lavalle F, Chiappetta E, Viganò C, Segura-Garcia C, De Fazio P. Effectiveness of integrated psychological therapy on clinical, neuropsychological, emotional and functional outcome in schizophrenia: a RCT study. J Ment Health 2018; 29:524-531. [PMID: 30346226 DOI: 10.1080/09638237.2018.1521948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Cognitive impairment is considered a central feature of schizophrenia (SZ) and several rehabilitation treatments have been developed to try to improve cognitive deficits.Aims: The aim of the present study was to analyze the effectiveness of integrated psychological therapy (IPT) compared with a standard treatment (TAU) in two groups of patients with SZ, using a comprehensive testing battery of clinical, cognitive, social cognition and functional outcome domains.Methods: Forty-one patients with SZ were assigned to IPT or TAU groups in a randomized controlled trial (RCT). Psychopathological, neuropsychological, emotional and functional outcome variables were assessed at baseline and after 36 weeks of treatment.Results: The IPT group showed significant improvements than the TAU group regarding clinical and functional outcome variables. Moreover, the IPT group improved significantly in the cognitive domains and emotional functioning. Finally, linear regression has highlighted that the improvement of cognitive variables depends on having done the IPT treatment.Conclusions: IPT seems to be effective in improving clinical, neuropsychological, emotional and functional outcome in chronic SZ inpatients. Further studies would be desirable to deepen the effectiveness of IPT in the field of the psychiatric rehabilitation pointing to the possibility of recovery from mental illness.
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Affiliation(s)
- Matteo Aloi
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Renato de Filippis
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | | | - Enrico Chiappetta
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Caterina Viganò
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Cristina Segura-Garcia
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatric Unit, Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
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24
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Mier D, Eisenacher S, Rausch F, Englisch S, Gerchen MF, Zamoscik V, Meyer-Lindenberg A, Zink M, Kirsch P. Aberrant activity and connectivity of the posterior superior temporal sulcus during social cognition in schizophrenia. Eur Arch Psychiatry Clin Neurosci 2017; 267:597-610. [PMID: 27770284 DOI: 10.1007/s00406-016-0737-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/25/2016] [Indexed: 12/31/2022]
Abstract
Schizophrenia is associated with significant impairments in social cognition. These impairments have been shown to go along with altered activation of the posterior superior temporal sulcus (pSTS). However, studies that investigate connectivity of pSTS during social cognition in schizophrenia are sparse. Twenty-two patients with schizophrenia and 22 matched healthy controls completed a social-cognitive task for functional magnetic resonance imaging that allows the investigation of affective Theory of Mind (ToM), emotion recognition and the processing of neutral facial expressions. Moreover, a resting-state measurement was taken. Patients with schizophrenia performed worse in the social-cognitive task (main effect of group). In addition, a group by social-cognitive processing interaction was revealed for activity, as well as for connectivity during the social-cognitive task, i.e., patients with schizophrenia showed hyperactivity of right pSTS during neutral face processing, but hypoactivity during emotion recognition and affective ToM. In addition, hypoconnectivity between right and left pSTS was revealed for affective ToM, but not for neutral face processing or emotion recognition. No group differences in connectivity from right to left pSTS occurred during resting state. This pattern of aberrant activity and connectivity of the right pSTS during social cognition might form the basis of false-positive perceptions of emotions and intentions and could contribute to the emergence and sustainment of delusions.
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Affiliation(s)
- Daniela Mier
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany.
| | - Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Franziska Rausch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Martin Fungisai Gerchen
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Vera Zamoscik
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
| | - Peter Kirsch
- Department of Clinical Psychology, Central Institute of Mental Health, University of Heidelberg/Medical Faculty Mannheim, J5, 68159, Mannheim, Germany
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Preti A, Vellante M, Petretto DR. The psychometric properties of the "Reading the Mind in the Eyes" Test: an item response theory (IRT) analysis. Cogn Neuropsychiatry 2017; 22:233-253. [PMID: 28288549 DOI: 10.1080/13546805.2017.1300091] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The "Reading the Mind in the Eyes" Test (hereafter: Eyes Test) is considered an advanced task of the Theory of Mind aimed at assessing the performance of the participant in perspective-takingthat is, the ability to sense or understand other people's cognitive and emotional states. In this study, the item response theory analysis was applied to the adult version of the Eyes Test. METHODS The Italian version of the Eyes Test was administered to 200 undergraduate students of both genders (males = 46%). Modified parallel analysis (MPA) was used to test unidimensionality. Marginal maximum likelihood estimation was used to fit the 1-, 2-, and 3-parameter logistic (PL) model to the data. Differential Item Functioning (DIF) due to gender was explored with five independent methods. RESULTS MPA provided evidence in favour of unidimensionality. The Rasch model (1-PL) was superior to the other two models in explaining participants' responses to the Eyes Test. There was no robust evidence of gender-related DIF in the Eyes Test, although some differences may exist for some items as a reflection of real differences by group. CONCLUSIONS The study results support a one-factor model of the Eyes Test. Performance on the Eyes Test is defined by the participant's ability in perspective-taking. Researchers should cease using arbitrarily selected subscores in assessing the performance of participants to the Eyes Test. Lack of gender-related DIF favours the use of the Eyes Test in the investigation of gender differences concerning empathy and social cognition.
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Affiliation(s)
- Antonio Preti
- a Psychiatry Branch , Centro Medico Genneruxi , Cagliari , Italy.,b Section of Clinical Psychology, Department of Education, Psychology, and Philosophy , University of Cagliari , Cagliari , Italy
| | - Marcello Vellante
- b Section of Clinical Psychology, Department of Education, Psychology, and Philosophy , University of Cagliari , Cagliari , Italy
| | - Donatella R Petretto
- b Section of Clinical Psychology, Department of Education, Psychology, and Philosophy , University of Cagliari , Cagliari , Italy
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26
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Ay R, Böke Ö, Pazvantoğlu O, Şahin AR, Sarisoy G, Arik AC, Güz H. Social Cognition in Schizophrenia Patients and Their First-Degree Relatives. Noro Psikiyatr Ars 2017; 53:338-343. [PMID: 28360809 DOI: 10.5152/npa.2016.10223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/27/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Social cognition is a person's ability to configure the designs of relationships between themselves and others and to use these designs to guide social behaviors in a flexible manner. The models that are the most studied and describe social cognition are the theory of mind (ToM) and emotion recognition. This study was aimed to detect ToM and emotion recognition disorders in schizophrenia patients and their first-degree relatives. METHODS Thirty schizophrenia patients in remission, the first-degree relatives of schizophrenia patients (n=30), and 30 healthy volunteers who were paired with the patients in terms of age and duration of education were included in the study. The Positive and Negative Symptom Scale (PANSS), Dokuz-Eylül Theory of Mind Scale (DEToMS), Reading the Mind in the Eyes test, Facial Emotion Identification Test (FEIT), and Facial Emotion Discrimination Test (FEDT) were performed by the patients participating in this study. RESULTS ToM and emotion recognition were found to be defective in the schizophrenia patients and their relatives. The performances of ToM and emotion recognition were ranked as the schizophrenia group, family group, and control group, from the worst to the best. The schizophrenia group showed poor performance in all sub-components except irony. In the family group, the empathy subcomponent showed similar performance with the control group, whereas the subcomponents of the second-order false belief, metaphor, and faux pas tests showed similar performance with the patient group. There were differences among the three groups in the first-order false belief subscale as well as the total DEToMS. The patient and family groups showed the poorest performances, whereas the control group showed the best performance. CONCLUSION The detection of ToM and emotion recognition disorders in the remission period, regardless of the attack period and asymptomatic first-degree relatives, may support the view that the period of schizophrenia is an independent continuous variable.
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Affiliation(s)
- Rukiye Ay
- Departmen of Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ömer Böke
- Departmen of Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ozan Pazvantoğlu
- Department of Psychiatry, Sokrates Psychiatry Center, İzmir, Turkey
| | - Ahmet Rıfat Şahin
- Departmen of Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Gökhan Sarisoy
- Departmen of Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Ali Cezmi Arik
- Departmen of Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
| | - Hatice Güz
- Departmen of Psychiatry, Ondokuz Mayıs University School of Medicine, Samsun, Turkey
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27
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Helle S, Løberg EM, Gjestad R, Schnakenberg Martin AM, Lysaker PH. The positive link between executive function and lifetime cannabis use in schizophrenia is not explained by current levels of superior social cognition. Psychiatry Res 2017; 250:92-98. [PMID: 28152399 DOI: 10.1016/j.psychres.2017.01.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/26/2022]
Abstract
There has been a growing link between a history of cannabis use and neurocognitive performance in patients with schizophrenia. Fewer neurocognitive deficits may be a marker of the superior social cognition needed to obtain illicit substances, or cannabis use may indicate a distinct path to schizophrenia with less neurocognitive vulnerability. This study sought to determine whether the relationship of cannabis use and executive function exists independently of social cognition. Eighty-seven patients with schizophrenia were administered measures of social cognition and executive function. Social cognition was assessed using the Bell-Lysaker Emotion Recognition Test to measure affect recognition, and the Eyes and Hinting Tests to measure theory of mind. Executive function was assessed by the Mental Flexibility component of the Delis-Kaplan Executive Functioning Scale. The relations between the variables were examined with structural equation modeling. Cannabis use positively related to executive function, negatively related to affect recognition, and had no relationship with theory of mind. There were no indirect effects of other illicit substances on amount of regular cannabis use. Alcohol use was related to worse affect recognition. The relationship between cannabis use and better executive function was supported and was not explained by superior social cognition.
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Affiliation(s)
- Siri Helle
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ashley M Schnakenberg Martin
- Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA; Indiana University - Bloomington, Bloomington, IN, USA
| | - Paul H Lysaker
- Roudebush Veteran Affairs Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
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Social cognition in neuropsychiatric populations: a comparison of theory of mind in schizophrenia and mesial temporal lobe epilepsy. Sci Rep 2017; 7:484. [PMID: 28352126 PMCID: PMC5428695 DOI: 10.1038/s41598-017-00565-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/01/2017] [Indexed: 01/20/2023] Open
Abstract
Social cognition deficits are observed both in patients with schizophrenia (SCZ) and in patients with mesial temporal lobe epilepsy (MTLE). This may be due to dysfunction of the amygdala network, which is a common feature of both diseases. In this study, SCZ (n = 48) or MTLE (n = 31) and healthy controls (HC, n = 47) completed assessments of mentalising (Reading Mind in the Eyes Test, RMET) and basic cognitive processing, e.g., working memory, executive functions and psychomotor speed (Trail-Making Test B and Digit Symbol). SCZ were also assessed with the Positive And Negative Syndrome Scale (PANSS). We found that the RMET scores of the two clinical groups were similar (p > 0.05) and lower than in the HCs (SCZ: p < 0.05; MTLE: p < 0.001). In the next step, SCZ were split into two groups with respect to the level of symptoms. Analysis of the RMET scores revealed no differences between the HC (M = 25.7 ± 4.1) and POS-LO (M = 25.3 ± 4.8); both groups outperformed the POS-HI group (M = 21.3 ± 5.2) and the MTLE group (M = 20.8 ± 4.6). No differences were found for the median-split with regard to negative symptoms. In SCZ, the mind-reading deficit appears to be associated with the level of positive symptoms. Both POS-HI and MTLE patients present significant mentalising deficits compared to healthy controls.
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Caldiroli A, Buoli M, Serati M, Cahn W, Altamura AC. General and social cognition in remitted first-episode schizophrenia patients: a comparative study. Eur Arch Psychiatry Clin Neurosci 2016; 266:639-47. [PMID: 27250978 DOI: 10.1007/s00406-016-0701-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/23/2016] [Indexed: 02/03/2023]
Abstract
The aim of this paper was to investigate whether both neurocognitive and social cognitive performances were different between remitted first-episode schizophrenia patients, non-remitters and healthy controls (HC). We assessed social cognition (Degraded Facial Affect Recognition Task-DFAR and Emotional Mentalizing Task-EMT) and neurocognition (Wechsler Adult Intelligence Scale and Word Learning Test-WLT) in 174 remitted first-episode schizophrenia patients, 110 non-remitted first-episode schizophrenia patients and 320 HC. Multivariate analyses of variance with age, gender and IQ as covariates (MANCOVA) were performed to compare mean cognitive test scores between the three groups. Remitted first-episode schizophrenia patients performed significantly worse than HC only in one verbal memory task (WLT immediate recall; p = 0.004); in the same test, they were significantly better than non-remitters (p = 0.027). Non-remitted first-episode schizophrenia patients, differently from remitters, performed significantly worse than HC in terms of social cognition (EMT-p < 0.05 and DFAR-p < 0.05). Remitted first-episode schizophrenia patients presented worse cognitive performance than HC in verbal memory tasks, but not in facial affect recognition and in ToM, while non-remitters did; these results suggest that neurocognitive deficits are the core hallmark of schizophrenia and that social cognition is relatively unaffected in remitted patients after their first episode.
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Affiliation(s)
- Alice Caldiroli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.
| | - Massimiliano Buoli
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy.,Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marta Serati
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
| | - Wiepke Cahn
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, Italy
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Vogel BD, Brück C, Jacob H, Eberle M, Wildgruber D. Effects of cue modality and emotional category on recognition of nonverbal emotional signals in schizophrenia. BMC Psychiatry 2016; 16:218. [PMID: 27388011 PMCID: PMC4936116 DOI: 10.1186/s12888-016-0913-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Impaired interpretation of nonverbal emotional cues in patients with schizophrenia has been reported in several studies and a clinical relevance of these deficits for social functioning has been assumed. However, it is unclear to what extent the impairments depend on specific emotions or specific channels of nonverbal communication. METHODS Here, the effect of cue modality and emotional categories on accuracy of emotion recognition was evaluated in 21 patients with schizophrenia and compared to a healthy control group (n = 21). To this end, dynamic stimuli comprising speakers of both genders in three different sensory modalities (auditory, visual and audiovisual) and five emotional categories (happy, alluring, neutral, angry and disgusted) were used. RESULTS Patients with schizophrenia were found to be impaired in emotion recognition in comparison to the control group across all stimuli. Considering specific emotions more severe deficits were revealed in the recognition of alluring stimuli and less severe deficits in the recognition of disgusted stimuli as compared to all other emotions. Regarding cue modality the extent of the impairment in emotional recognition did not significantly differ between auditory and visual cues across all emotional categories. However, patients with schizophrenia showed significantly more severe disturbances for vocal as compared to facial cues when sexual interest is expressed (alluring stimuli), whereas more severe disturbances for facial as compared to vocal cues were observed when happiness or anger is expressed. CONCLUSION Our results confirmed that perceptual impairments can be observed for vocal as well as facial cues conveying various social and emotional connotations. The observed differences in severity of impairments with most severe deficits for alluring expressions might be related to specific difficulties in recognizing the complex social emotional information of interpersonal intentions as compared to "basic" emotional states. Therefore, future studies evaluating perception of nonverbal cues should consider a broader range of social and emotional signals beyond basic emotions including attitudes and interpersonal intentions. Identifying specific domains of social perception particularly prone for misunderstandings in patients with schizophrenia might allow for a refinement of interventions aiming at improving social functioning.
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Affiliation(s)
- Bastian D. Vogel
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076 Germany
| | - Carolin Brück
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076 Germany
| | - Heike Jacob
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076 Germany
| | - Mark Eberle
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076 Germany
| | - Dirk Wildgruber
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstraße 14, Tübingen, 72076 Germany
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Fretland RA, Andersson S, Sundet K, Andreassen OA, Melle I, Vaskinn A. Theory of mind in schizophrenia: error types and associations with symptoms. Schizophr Res 2015; 162:42-6. [PMID: 25623602 DOI: 10.1016/j.schres.2015.01.024] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/09/2015] [Accepted: 01/10/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Social cognition is an important determinant of functioning in schizophrenia. However, how social cognition relates to the clinical symptoms of schizophrenia is still unclear. The aim of this study was to explore the relationship between a social cognition domain, Theory of Mind (ToM), and the clinical symptoms of schizophrenia. Specifically, we investigated the associations between three ToM error types; 1) "overmentalizing" 2) "reduced ToM and 3) "no ToM", and positive, negative and disorganized symptoms. METHODS Fifty-two participants with a diagnosis of schizophrenia or schizoaffective disorder were assessed with the Movie for the Assessment of Social Cognition (MASC), a video-based ToM measure. An empirically validated five-factor model of the Positive and Negative Syndrome Scale (PANSS) was used to assess clinical symptoms. RESULTS There was a significant, small-moderate association between overmentalizing and positive symptoms (rho=.28, p=.04). Disorganized symptoms correlated at a trend level with "reduced ToM" (rho=.27, p=.05). There were no other significant correlations between ToM impairments and symptom levels. Positive/disorganized symptoms did not contribute significantly in explaining total ToM performance, whereas IQ did (B=.37, p=.01). Within the undermentalizing domain, participants performed more "reduced ToM" errors than "no ToM" errors. CONCLUSION Overmentalizing was associated with positive symptoms. The undermentalizing error types were unrelated to symptoms, but "reduced ToM" was somewhat associated to disorganization. The higher number of "reduced ToM" responses suggests that schizophrenia is characterized by accuracy problems rather than a fundamental lack of mental state concept. The findings call for the use of more sensitive measures when investigating ToM in schizophrenia to avoid the "right/wrong ToM"-dichotomy.
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Affiliation(s)
- Ragnhild A Fretland
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway.
| | - Stein Andersson
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Ole A Andreassen
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Ingrid Melle
- NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway
| | - Anja Vaskinn
- Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway
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