Discriminating autism spectrum disorders from schizophrenia by investigation of mental state attribution on an on-line mentalizing task: A review and meta-analysis

Neural circuit disruptions of eye gaze processing in autism spectrum disorder and schizophrenia: An activation likelihood estimation meta-analysis

BACKGROUND

Impairment in social cognition, particularly eye gaze processing, is a shared feature common to autism spectrum disorder (ASD) and schizophrenia. However, it is unclear if a convergent neural mechanism also underlies gaze dysfunction in these conditions. The present study examined whether this shared eye gaze phenotype is reflected in a profile of convergent neurobiological dysfunction in ASD and schizophrenia.

METHODS

Activation likelihood estimation (ALE) meta-analyses were conducted on peak voxel coordinates across the whole brain to identify spatial convergence. Functional coactivation with regions emerging as significant was assessed using meta-analytic connectivity modeling. Functional decoding was also conducted.

RESULTS

Fifty-six experiments (n = 30 with schizophrenia and n = 26 with ASD) from 36 articles met inclusion criteria, which comprised 354 participants with ASD, 275 with schizophrenia and 613 healthy controls (1242 participants in total). In ASD, aberrant activation was found in the left amygdala relative to unaffected controls during gaze processing. In schizophrenia, aberrant activation was found in the right inferior frontal gyrus and supplementary motor area. Across ASD and schizophrenia, aberrant activation was found in the right inferior frontal gyrus and right fusiform gyrus during gaze processing. Functional decoding mapped the left amygdala to domains related to emotion processing and cognition, the right inferior frontal gyrus to cognition and perception, and the right fusiform gyrus to visual perception, spatial cognition, and emotion perception. These regions also showed meta-analytic connectivity to frontoparietal and frontotemporal circuitry.

CONCLUSION

Alterations in frontoparietal and frontotemporal circuitry emerged as neural markers of gaze impairments in ASD and schizophrenia. These findings have implications for advancing transdiagnostic biomarkers to inform targeted treatments for ASD and schizophrenia.

Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction

BYLEMANS, T., et al. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. NEUROSCI BIOBEHAV REV, 2022. - This review focuses on autistic adults and serves 4 purposes: (1) providing an overview of their difficulties regarding mentalizing (understanding others' mental states) and narrative coherence (structured storytelling), (2) highlighting the relations between both skills by examining behavioral observations and shared neural substrates, (3) providing an integrated perspective regarding novel diagnostic tools and support services, and (4) raising awareness of adult autism. We suggest that mentalizing and narrative coherence are related at the behavioral level and neural level. In addition to the traditional mentalizing network, the cerebellum probably serves as an important hub in shared cerebral networks implicated in mentalizing and narrative coherence. Future autism research and support services should tackle new questions within a framework of social cerebellar (dys)functioning.

Unreasonable minds and imperfect self-defense

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

Qualitative Differences in Attribution of Mental States to Other People in Autism and Schizophrenia: What are the Tools for Differential Diagnosis?

The differential diagnosis between schizophrenia spectrum disorders (SSD) and autism spectrum disorders (ASD) remains an important clinical question, because they have overlap in clinical diagnosis. This study explored the differences between ASD (n = 44) and SSD patients (n = 59), compared to typically developing peers (n = 63), in completing an advanced Theory of Mind (ToM) task. The outcome found several differences between groups. The SSD patients showed greater difficulty in understanding social scenarios, while ASD individuals understood the stories, but did not correctly identify the protagonist's intention. The interesting aspect of the results is that some ToM stories are more informative about the mentalistic reasoning of the two clinical groups, namely, the stories that investigate pretend, persuasion, double bluff and ironic joke constructs.

Assessment and correlates of autistic symptoms in Schizophrenia Spectrum Disorders measured with the PANSS Autism Severity Score: A systematic review

Schizophrenia Spectrum Disorders (SSD) and Autism Spectrum Disorders (ASD) are considered separate entities, but the two spectra share important similarities, and the study of these areas of overlap represents a field of growing scientific interest. The PANSS Autism Score (PAUSS) was recently developed specifically to assess autistic symptoms in people living with SSD reliably and quickly. The aims of the present systematic review were to provide a comprehensive assessment of the use of the PAUSS scale in available literature and to systematically analyze cognitive, functional and neurobiological correlates of autistic symptoms measured with this instrument in SSD. The systematic literature search included three electronic databases (PubMed, Scopus and PsycINFO) as well as a manual search in Google Scholar and in reference lists of included papers. Screening and extraction were conducted by at least two independent reviewers. Out of 213 identified records, 22 articles referring to 15 original studies were included in the systematic review. Studies were conducted in several different countries by independent groups, showing consistent scientific interest in the use of the scale; most works focused on cognitive and functional correlates of ASD symptoms, but some also considered neurobiological features. Results of included studies showed that autistic symptoms in people with SSD are consistently associated with worse cognitive performance, especially in the social cognition domain, and with worse psychosocial functioning. However, the presence of autistic symptoms appears to also have a protective role, particularly on functioning, in subjects with more severe psychotic symptoms. Further exploring the impact of autistic symptoms could be of significant scientific and clinical interest, allowing the development of tailored interventions to improve treatment for people living with SSDs.

Psychometric Properties of the Italian Mentalization Questionnaire: Assessing Structural Invariance and Construct Validity

Mentalization is an important interpersonal ability, necessary for adaptive interpersonal relationships and emotion regulation. Deficits in mentalization have been associated with poor psychological outcomes and have been observed in patients with Borderline Personality Disorder. The Mentalization Questionnaire (MZQ) has been developed as self-report measure of mentalization deficit. The aim of the study was to investigate the dimensionality of the MZQ in a nonclinical sample composed of Italian adults from the general population and to analyze its performance in categorizing individuals with higher risk of borderline symptoms. A non-clinical sample of 1,015 adults (709 women and 306 men) was administered the Italian versions of the MZQ, the Reflective Functioning Questionnaire (RFQ), and a measure of borderline psychopathology. A revised single-factor solution fitted the data well and demonstrated metric invariance across gender. The internal consistency (Ordinal α = 0.87) and stability (r = 0.84) were satisfactory. The MZQ was moderately associated with the RFQ dimensions. The ROC curve analysis showed that the MZQ was able to discriminate satisfactorily people with higher risk for borderline symptomatology from those with lower risk. The MZQ may, therefore, be considered a reliable and valid measure of mentalization for categorizing people at higher risk for borderline pathology.

Kinematics and observer-animator kinematic similarity predict mental state attribution from Heider-Simmel style animations

The ability to ascribe mental states, such as beliefs or desires to oneself and other individuals forms an integral part of everyday social interaction. Animations tasks, in which observers watch videos of interacting triangles, have been extensively used to test mental state attribution in a variety of clinical populations. Compared to control participants, individuals with clinical conditions such as autism typically offer less appropriate mental state descriptions of such videos. Recent research suggests that stimulus kinematics and movement similarity (between the video and the observer) may contribute to mental state attribution difficulties. Here we present a novel adaptation of the animations task, suitable to track and compare animation generator and -observer kinematics. Using this task and a population-derived stimulus database, we confirmed the hypotheses that an animation’s jerk and jerk similarity between observer and animator significantly contribute to the correct identification of an animation. By employing random forest analysis to explore other stimulus characteristics, we reveal that other indices of movement similarity, including acceleration- and rotation-based similarity, also predict performance. Our results highlight the importance of movement similarity between observer and animator and raise new questions about reasons why some clinical populations exhibit difficulties with this task.

Social Cognitive Performance in Schizophrenia Spectrum Disorders Compared With Autism Spectrum Disorder: A Systematic Review, Meta-analysis, and Meta-regression

IMPORTANCE

Schizophrenia spectrum disorders (SSDs) and autism spectrum disorder (ASD) both feature social cognitive deficits; however, these disorders historically have been examined separately using a range of tests and subdomain focus and at different time points in the life span. Moving beyond diagnostic categories and characterizing social cognitive deficits can enhance understanding of shared pathways across these disorders.

OBJECTIVE

To investigate how deficits in social cognitive domains diverge or overlap between SSDs and ASD based on the extant literature.

DATA SOURCES

Literature searches were conducted in MEDLINE, PsycInfo, Embase, and Web of Science from database inception until July 26, 2020.

STUDY SELECTION

Original research articles were selected that reported performance-based measures of social cognition in both SSDs and ASD samples. Selected articles also had to be published in English and use International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, DSM-IV, or more recent diagnostic criteria.

DATA EXTRACTION AND SYNTHESIS

This systematic review and meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology reporting guidelines, including data extraction and quality assessment using a modified version of the Newcastle-Ottawa Scale. Data were pooled using a random-effects model.

MAIN OUTCOMES AND MEASURES

Effect sizes were calculated as Hedges g (SSDs vs ASD). The primary outcomes were performance on emotion processing tasks, theory of mind (ToM) tasks, and the Reading the Mind in the Eyes Test (RMET) in SSDs compared with ASD. Meta-regressions were performed for age difference, publication year, quality assessment scores, and antipsychotic medication use.

RESULTS

Of the 4175 screened articles, 36 studies directly comparing social cognitive performance in individuals with SSDs vs ASD were included in the qualitative analysis (n = 1212 for SSDs groups and n = 1109 for ASD groups), and 33 studies were included in the quantitative analyses (n = 1113 for SSDs groups and n = 1015 for ASD groups). Most study participants were male (number of studies [k] = 36, 72% [878 of 1212] in SSDs groups and 82% [907 of 1109] in ASD groups), and age (k = 35) was older in SSDs groups (mean [SD], 28.4 [9.5] years) than in ASD groups (mean [SD], 23.3 [7.6] years). Included studies highlighted the prevalence of small, male-predominant samples and a paucity of cross-disorder clinical measures. The meta-analyses revealed no statistically significant differences between SSDs and ASD on emotion processing measures (k = 15; g = 0.12 [95% CI, -0.07 to 0.30]; P = .21; I2 = 51.0%; 1 outlier excluded), ToM measures (k = 17; g = -0.01 [95% CI, -0.21 to 0.19]; P = .92; I2 = 56.5%; 1 outlier excluded), or the RMET (k = 13; g = 0.25 [95% CI, -0.04 to 0.53]; P = .10; I2 = 75.3%). However, SSDs vs ASD performance differences between studies were statistically significantly heterogeneous, which was only minimally explained by potential moderators.

CONCLUSIONS AND RELEVANCE

In this analysis, similar levels of social cognitive impairment were present, on average, in individuals with SSDs and ASD. Cross-disorder studies of social cognition, including larger samples, consensus batteries, and consistent reporting of measures, as well as data across multiple levels of analysis, are needed to help identify subgroups within and across disorders that may be more homogeneous in etiology and treatment response.

Disturbances of Shared Intentionality in Schizophrenia and Autism

Schizophrenia and autism are today considered complex spectrum disorders characterized by difficulties in social behavior. Drawing on recent advances in collective or shared intentionality studies, we present a novel theoretical approach to these social difficulties by exploring them from the angle of shared intentionality. We begin by describing two forms of shared intentionality: joint intentionality and we-intentionality. Joint intentionality crucially relies on the agents' mentalizing abilities such as mind reading and the ability to factor in (or "to be moved" by) their partner's intentions in deliberation and action planning. By contrast, we-intentionality relies on the agents' capacity to understand themselves as group members and to adopt the group's perspective. In schizophrenia spectrum disorders, we propose that joint intentionality remains unaffected, but we-intentionality may be impaired. In severe autism spectrum disorder (i.e., infantile autism), we propose that both forms of shared intentionality are impaired. We suggest that the source of the problems affecting we-intentionality in schizophrenia spectrum disorders lies primarily in trait-like, anomalous self-experiences. In severe autism spectrum disorder, we suggest that problems with mind reading, the ability to "be moved" by others' intentions, and with the capacity for perspective-taking impede both forms of shared intentionality.

The Relationship Between Different Aspects of Theory of Mind and Symptom Clusters in Psychotic Disorders: Deconstructing Theory of Mind Into Cognitive, Affective, and Hyper Theory of Mind

Background: Several meta-analyses highlight pronounced problems in general Theory of Mind (ToM), the ability to infer other persons' mental states, in patients with psychosis in comparison to non-clinical controls. In addition, first studies suggest associations between Hyper-ToM, an exaggerated inference of mental states to others, and delusions. Research on different ToM subtypes (Cognitive ToM, Affective ToM, and Hyper-ToM) and symptom clusters of psychosis (positive, negative, and disorganized symptoms) have gathered conflicting findings. Thus, the present study examined group differences between patients with psychosis and non-clinical controls concerning Cognitive ToM/Affective ToM and Hyper-ToM. Further, the association between ToM subtypes and symptom clusters (positive, negative, and disorganized symptoms) were examined. Methods: Patients with psychotic disorders (n = 64, 1/3 with present delusions indicated by a minimum score of four in the PANSS P1 item) and non-clinical controls (n = 21) were examined with assessments of Cognitive ToM and Affective ToM abilities and Hyper-ToM errors using the Frith-Happé animations. Psychopathology was assessed using the Positive and Negative Syndrome Scale. Results: Patients with psychosis presented more pronounced problems in Cognitive and Affective ToM in comparison to non-clinical controls, whereas there were no group differences with regard to Hyper-ToM errors. Furthermore, deficits in Cognitive ToM were associated with general delusions, whereas problems in Affective ToM were associated with negative and disorganized symptoms. In addition, there was no association between Hyper-ToM errors and any symptoms when controlling for years of education. Conclusions: Our findings suggest that deficits in ToM subtypes might not be directly related to delusions and positive symptoms and are in line with more recently developed cognitive models of delusions. In addition, our results support the well-established finding of associations between ToM alterations and negative or disorganized symptoms. Our results shed light on the role of different dimensions of ToM in specific symptoms of psychosis.

Consensus Paper: Cerebellum and Social Cognition

The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed that the cerebellum supports also nonmotor functions such as cognition and affect, only during the last 5 years it has become evident that the cerebellum also plays an important social role. This role is evident in social cognition based on interpreting goal-directed actions through the movements of individuals (social "mirroring") which is very close to its original role in motor learning, as well as in social understanding of other individuals' mental state, such as their intentions, beliefs, past behaviors, future aspirations, and personality traits (social "mentalizing"). Most of this mentalizing role is supported by the posterior cerebellum (e.g., Crus I and II). The most dominant hypothesis is that the cerebellum assists in learning and understanding social action sequences, and so facilitates social cognition by supporting optimal predictions about imminent or future social interaction and cooperation. This consensus paper brings together experts from different fields to discuss recent efforts in understanding the role of the cerebellum in social cognition, and the understanding of social behaviors and mental states by others, its effect on clinical impairments such as cerebellar ataxia and autism spectrum disorder, and how the cerebellum can become a potential target for noninvasive brain stimulation as a therapeutic intervention. We report on the most recent empirical findings and techniques for understanding and manipulating cerebellar circuits in humans. Cerebellar circuitry appears now as a key structure to elucidate social interactions.

Aberrant effective connectivity is associated with positive symptoms in first-episode schizophrenia

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We use DCM in patients newly diagnosed with schizophrenia.

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Patients were naïve to therapeutic antipsychotics, but not completely drug naïve.

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Patients have stronger feedforward connectivity than matched healthy controls.

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Stronger positive symptoms are associated with disinhibition in the temporal lobe.

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In active inference, this may relate to aberrant precision and prediction errors.

Schizophrenia is a neurodevelopmental psychiatric disorder thought to result from synaptic dysfunction that affects distributed brain connectivity, rather than any particular brain region. While symptomatology is traditionally divided into positive and negative symptoms, abnormal social cognition is now recognized a key component of schizophrenia. Nonetheless, we are still lacking a mechanistic understanding of effective brain connectivity in schizophrenia during social cognition and how it relates to clinical symptomatology. To address this question, we used fMRI and dynamic causal modelling (DCM) to test for abnormal brain connectivity in twenty-four patients with first-episode schizophrenia (FES) compared to twenty-five matched controls performing the Human Connectome Project (HCP) social cognition paradigm. Patients had not received regular therapeutic antipsychotics, but were not completely drug naïve. Whilst patients were less accurate than controls in judging social stimuli from non-social stimuli, our results revealed an increase in feedforward connectivity from motion-sensitive V5 to posterior superior temporal sulcus (pSTS) in patients compared to matched controls. At the same time, patients with a higher degree of positive symptoms had more disinhibition within pSTS, a region computationally involved in social cognition. We interpret these findings the framework of active inference, where increased feedforward connectivity may encode aberrant prediction errors from V5 to pSTS and local disinhibition within pSTS may reflect aberrant encoding of the precision of cortical representations about social stimuli.

Social Cognition in a Research Domain Criteria Perspective: A Bridge Between Schizophrenia and Autism Spectra Disorders

Schizophrenia and autism spectra disorders are currently conceptualized as distinct clinical categories. However, the relationship between these two nosological entities has been revisited in recent years due to the evidence that they share some important clinical and neurobiological features, putting into question the nature and the extent of their commonalities and differences. In this respect, some core symptoms that are present in both disorders, such as social cognitive deficits, could be a primary target of investigation. This review briefly summarizes the commonalities and overlapping features between schizophrenia and autism spectra disorders in social cognitive functions, considering this construct in a Research Domain Criteria perspective. The clinical manifestation of deficits in social cognition are similar in schizophrenia spectrum disorders and autism spectrum disorders, and brain areas that appear to be altered in relation to these impairments are largely shared; however, the results of various studies suggest that, in some cases, the qualitative nature of these alterations may be different in the two spectra. Moreover, relevant differences could be present at the level of brain networks and connections. More research is required in this field, regarding molecular and genetic aspects of both spectra, to better define the neurobiological mechanisms involved in social cognition deficits, with the objective of developing specific and targeted treatments.

Default mode network modulation by mentalizing in young adults with autism spectrum disorder or schizophrenia

Schizophrenia and autism spectrum disorder (ASD) are nosologically distinct neurodevelopmental disorders with similar deficits in social cognition, including the ability to form mental representations of others (i.e., mentalizing). However, the extent of patient deficit overlap in underlying neural mechanisms is unclear. Our goal was to examine deficits in mentalizing task-related (MTR) activity modulation in schizophrenia and ASD and the relationship of such deficits with social functioning and psychotic symptoms in patients. Adults, ages 18-34, diagnosed with either ASD or schizophrenia, and typically developed controls (n = 30/group), performed an interactive functional MRI Domino task. Using independent component analysis, we analyzed game intervals known to stimulate mentalizing in the default mode network (DMN), i.e., medial prefrontal cortex (MPFC), posterior cingulate cortex (PCC), precuneus, and temporoparietal junction (TPJ), for group differences in MTR activity and associations between MTR activity and social and psychosis measures. Compared to controls, both schizophrenia and ASD groups showed MTR activity deficits in PCC and TPJ. In TPJ and MPFC, MTR activity modulation was associated with social communication impairments only in ASD. In precuneus, MTR activity was associated with increased self-reported fantasizing only in schizophrenia. In schizophrenia, we found no indication of over-mentalizing activity or an association between MTR activity and psychotic symptoms. Results suggest shared neural deficits between ASD and schizophrenia in mentalizing-associated DMN regions; however, neural organization might correspond to different dimensional social deficits. Our results therefore indicate the importance of examining both categorical-clinical diagnosis and social functioning dimensional constructs when examining neural deficits in schizophrenia and ASD.

Attribution of Mental States in Glossolalia: A Direct Comparison With Schizophrenia

Glossolalia (“speaking in tongues”) is a rhythmic utterance of pseudo-words without consistent semantic meaning and syntactic regularities. Although glossolalia is a culturally embedded religious activity, its connection with psychopathology (e.g., psychotic thought disorder and altered mental state attribution/mentalization) is still a matter of debate. To elucidate this issue, we investigated 32 glossolalists, 32 matched control participants, and 32 patients with schizophrenia using the Animated Triangle Test (ATT) and the Reading the Mind in the Eyes Test (RMET). The ATT can detect hypo- and hypermentalization using animations of two moving triangles. Healthy adults describe these as random movements (e.g., bouncing), willed actions (e.g., playing), or they mentalize (e.g., tricking). We found that glossolalists provided more mentalizing descriptions in the ATT random and intentional movement animations relative to the control participants. They also recognized more mental states in the RMET than the controls. None of them had a diagnosis of mental disorders. In contrast, patients with schizophrenia hypermentalized only in the ATT random movement condition, whereas they showed hypomentalization in the ATT intentional movement condition and in the RMET relative the control subjects. Hypermentalization in the ATT positively correlated with intrinsic religiosity in the glossolalia group. In conclusion, our results demonstrated a substantial difference in the mentalizing ability of glossolalists (generalized hypermentalization) and patients with schizophrenia (both hypo- and hypermentalization).

Machine Learning for Differential Diagnosis Between Clinical Conditions With Social Difficulty: Autism Spectrum Disorder, Early Psychosis, and Social Anxiety Disorder

Differential diagnosis in adult cohorts with social difficulty is confounded by comorbid mental health conditions, common etiologies, and shared phenotypes. Identifying shared and discriminating profiles can facilitate intervention and remediation strategies. The objective of the study was to identify salient features of a composite test battery of cognitive and mood measures using a machine learning paradigm in clinical cohorts with social interaction difficulties. We recruited clinical participants who met standardized diagnostic criteria for autism spectrum disorder (ASD: n = 62), early psychosis (EP: n = 48), or social anxiety disorder (SAD: N = 83) and compared them with a neurotypical comparison group (TYP: N = 43). Using five machine-learning algorithms and repeated cross-validation, we trained and tested classification models using measures of cognitive and executive function, lower- and higher-order social cognition and mood severity. Performance metrics were the area under the curve (AUC) and Brier Scores. Sixteen features successfully differentiated between the groups. The control versus social impairment cohorts (ASD, EP, SAD) were differentiated by social cognition, visuospatial memory and mood measures. Importantly, a distinct profile cluster drawn from social cognition, visual learning, executive function and mood, distinguished the neurodevelopmental cohort (EP and ASD) from the SAD group. The mean AUC range was between 0.891 and 0.916 for social impairment versus control cohorts and, 0.729 to 0.781 for SAD vs neurodevelopmental cohorts. This is the first study that compares an extensive battery of neuropsychological and self-report measures using a machine learning protocol in clinical and neurodevelopmental cohorts characterized by social impairment. Findings are relevant for diagnostic, intervention and remediation strategies for these groups.

Interactive Psychometrics for Autism With the Human Dynamic Clamp: Interpersonal Synchrony From Sensorimotor to Sociocognitive Domains

The human dynamic clamp (HDC) is a human-machine interface designed on the basis of coordination dynamics for studying realistic social interaction under controlled and reproducible conditions. Here, we propose to probe the validity of the HDC as a psychometric instrument for quantifying social abilities in children with autism spectrum disorder (ASD) and neurotypical development. To study interpersonal synchrony with the HDC, we derived five standardized scores following a gradient from sensorimotor and motor to higher sociocognitive skills in a sample of 155 individuals (113 participants with ASD, 42 typically developing participants; aged 5 to 25 years; IQ > 70). Regression analyses were performed using normative modeling on global scores according to four subconditions (HDC behavior "cooperative/competitive," human task "in-phase/anti-phase," diagnosis, and age at inclusion). Children with ASD had lower scores than controls for motor skills. HDC motor coordination scores were the best candidates for stratification and diagnostic biomarkers according to exploratory analyses of hierarchical clustering and multivariate classification. Independently of phenotype, sociocognitive skills increased with developmental age while being affected by the ongoing task and HDC behavior. Weaker performance in ASD for motor skills suggests the convergent validity of the HDC for evaluating social interaction. Results provided additional evidence of a relationship between sensorimotor and sociocognitive skills. HDC may also be used as a marker of maturation of sociocognitive skills during real-time social interaction. Through its standardized and objective evaluation, the HDC not only represents a valid paradigm for the study of interpersonal synchrony but also offers a promising, clinically relevant psychometric instrument for the evaluation and stratification of sociomotor dysfunctions.

Autistic symptoms predict social cognitive performance in patients with schizophrenia

Schizophrenia spectrum disorders and Autism Spectrum Disorders (ASD) share many similarities. Among those features, social cognitive impairment is recognized as a key characteristic of both ASD and schizophrenia. In this study, the role of ASD symptoms, measured with the PANSS Autism Severity Score (PAUSS), was investigated as a predictor of social cognitive performance in patients with Schizophrenia spectrum disorders. Existent databases from 2 studies (SCOPE Phase 3 and SCOPE Phase 5), in which a total of 361 patients (mean age 41.7 years; 117 females) were assessed with tests of mental state attribution and emotion recognition, were analyzed. Less severe ASD symptoms, as well as younger age, better premorbid IQ, and neurocognition were identified as individual predictors of better social cognitive performance. These results suggest a role of ASD symptoms in affecting social cognitive performance in schizophrenia.

The association of autistic traits with Theory of Mind and its training efficacy in patients with schizophrenia

Literature has recently identified a discrete subgroup of patients affected by schizophrenia that also present autistic traits (ATs), showing a peculiar cognitive, clinical and functional profile. Theory of Mind (ToM) represents a core, impaired feature in both schizophrenia and Autism Spectrum Disorder (ASD), ToM in patients with schizophrenia and ATs has yet to be investigated. Thus, this study aims, on the one hand, to assess differences among patients with and without ATs on clinical, cognitive and ToM abilities as well as in daily functioning; on the other hand, to compare the efficacy on mentalizing abilities of a specific ToM training in these two groups.

Ninety-six patients with schizophrenia were enrolled and underwent a broad cognitive, social-cognitive and functional assessment before and after the ToM training.

ANOVAs revealed that patients with schizophrenia and ATs are more impaired in cognition, ToM, in premorbid and daily functioning as well as in clinical features, as compared to patients without ATs. This latter group also showed a general improvement in mentalizing abilities after ToM training, while patients with schizophrenia and ATs did not, with a significant time × group interaction on ToM abilities.

These data shed new light on the relation among schizophrenia and ATs, highlighting that patients with these traits are highly impaired in ToM abilities. Thus, ATs seem to limit the effectiveness of ToM training, having implications in clinical and rehabilitative practice.

"A circle and a triangle dancing together": Alteration of social cognition in schizophrenia compared to autism spectrum disorders

Difficulties in social cognition are present both in persons with schizophrenia (SCZ) and persons with autism spectrum disorders (ASD). However, qualitative similarities and differences in this field remain unclear. The aim of this study was to explore attribution of intentionality in patients with recent onset SCZ in comparison to patients with high functioning ASD, and to explore relationships between alterations in attribution and clinical profile. Animated shapes are a non-verbal Theory of Mind (ToM) task involving the interpretation of geometric figure interactions in three conditions: random, goal-directed and ToM. We compared 51 young adults with SCZ, 32 with ASD and 23 healthy controls (HC) matched for age and gender. In random, goal-directed and ToM conditions, persons with SCZ attributed less intentionality with less appropriate answers than HC, while the same anomalies were only found in the ToM condition in persons with ASD. In SCZ, thought and langage disorganization and earlier age at onset were correlated with intentionality score in the random condition. Moreover, a mixed ToM impairment was found in SCZ, combining undermentalizing (for movements involving a mental state) similar to what was found in ASD, and overmentalizing (for random movements), related to dizorganization and precocity of the first psychotic episode. In the frame of the hypothesis of a continuum, these results underline both similarities and differences between autism and schizophrenia.

Differentiating implicit and explicit theory of mind and associated neural networks in youth at Clinical High Risk (CHR) for psychosis

BACKGROUND

Theory of mind (ToM) has been shown to be impaired in Clinical High Risk (CHR) for psychosis populations and is linked to functional outcomes and symptom severity. Implicit versus explicit ToM has seldom been differentiated in this group, and underlying neural networks have also gone unexplored.

METHODS

24 CHR and 26 healthy volunteers (HV) completed a behavioral ToM measure called the Short Story Task (SST), as well as a resting state functional MRI scan. SST performance was correlated to attenuated psychosis symptoms. Interactions between group and ToM variables (implicit, explicit, and comprehension) on global efficiency in the Mentalizing (MENT) and Mirror Neuron System (MNS) were also examined.

RESULTS

CHR individuals made significantly fewer spontaneous mental state inferences. There were trend-level associations between ToM variables and symptoms, such that greater ToM performance predicted less severe symptoms. There was an interaction of group by spontaneous mental state inference within MENT bilateral dorsomedial prefrontal cortex (dmPFC), such that CHR individuals that made spontaneous mental state inferences showed greater global efficiency within the MENT network's bilateral dmPFC.

DISCUSSION

Findings suggest implicit ToM deficits are observable prior to psychotic disorder onset, and that these deficits implicate MENT network dmPFC efficiency. Explicit ToM performance was unaltered in the CHR group, and there were no interactions observed within MNS, suggesting specificity of implicit ToM associations with MENT network dmPFC global efficiency. Results identify potential treatment targets for the neural underpinnings of ToM, thus informing prevention and intervention efforts.

Hyper- and Hypomentalizing in Patients with First-Episode Schizophrenia: fMRI and Behavioral Studies

BACKGROUND

Historically, research investigating neural correlates of mentalizing deficits in schizophrenia has focused on patients who have been ill for several years with lengthy exposure to medication. Little is known about the neural and behavioral presentations of theory-of-mind deficits in schizophrenia, shortly after the first episode of psychosis.

METHODS

We investigated social cognition in 17 recently diagnosed first-episode schizophrenia (FES) patients with little or no exposure to antipsychotic medication and 1:1 matched healthy controls. We recorded behavioral and neural responses to the Animated Triangles Task (ATT), which is a nonverbal validated mentalizing task that measures the ascription of intentionality to the movements of objects.

RESULTS

FES patients under-interpreted social cues and over-interpreted nonsocial cues. These effects were influenced by current intelligence (IQ). Control group and FES neural responses replicated earlier findings in healthy adults. However, a region of anterior medial prefrontal cortex (amPFC) of FES patients showed a different response pattern to that of controls. Unlike healthy controls, patients increased activity in this social cognition region while studying "random" movements of shapes, as compared to the study of movements normally interpreted as "intentional".

CONCLUSIONS

Mentalizing deficits in FES consists of hypo- and hypermentalizing. The neural pattern of FES patients is consistent with deficits in the ability to switch off mentalizing processes in potentially social contexts, instead increasing them when intentionality is not forthcoming. Overall, results demonstrate complexities of theory of mind deficits in schizophrenia that should be considered when offering social cognitive training programs.

Do patients with high-functioning autism have similar social cognitive deficits as patients with a chronic cause of schizophrenia?

OBJECTIVE

There is substantial evidence that both patients with schizophrenia and patients with autism spectrum disorders (ASD) have impaired social cognition including theory of mind (ToM) deficits. However, it remains unclear if both verbal (explicit) and non-verbal (implicit) ToM as well as social perception are similarly affected in both disorders.

METHODS

Twenty-one patients diagnosed with schizophrenia and 11 patients diagnosed with ASD were matched one-to-one to healthy controls based on gender, age, and educational level. Social functioning was measured by Personal and Social Performance (PSP) scale. Neurocognition was measured using Brief Assessment of Cognition in Schizophrenia (BACS-DK), and four subtests from Wechsler Adult Intelligence (WAIS-IV) scale were applied to estimate IQ. The Animated Triangles Task was used to measure implicit ToM, while explicit ToM and social perception were measured by The Awareness and Social Inference Test (TASIT).

RESULTS

Patients with schizophrenia had deficits in implicit ToM and complex social perception compared to their matched controls, but no problems with explicit ToM. Surprisingly, patients with ASD solely had deficits with regard to complex social perception compared to their matched controls. The two patient groups were similar regarding estimated IQ, social functioning and years of education, but differed in age and neurocognition. When adjusting the p-values for age and neurocognitive deficits, both patients groups had similar social cognitive deficits.

CONCLUSIONS

Results imply that we compared schizophrenia patients with substantial neurocognitive deficits to a group of high-functioning patients with ASD. However, these two subgroups may have the same level of social cognitive deficits.

High-functioning autism patients share similar but more severe impairments in verbal theory of mind than schizophrenia patients

BACKGROUND

Evidence suggests that autism and schizophrenia share similarities in genetic, neuropsychological and behavioural aspects. Although both disorders are associated with theory of mind (ToM) impairments, a few studies have directly compared ToM between autism patients and schizophrenia patients. This study aimed to investigate to what extent high-functioning autism patients and schizophrenia patients share and differ in ToM performance.

METHODS

Thirty high-functioning autism patients, 30 schizophrenia patients and 30 healthy individuals were recruited. Participants were matched in age, gender and estimated intelligence quotient. The verbal-based Faux Pas Task and the visual-based Yoni Task were utilised to examine first- and higher-order, affective and cognitive ToM. The task/item difficulty of two paradigms was examined using mixed model analyses of variance (ANOVAs). Multiple ANOVAs and mixed model ANOVAs were used to examine group differences in ToM.

RESULTS

The Faux Pas Task was more difficult than the Yoni Task. High-functioning autism patients showed more severely impaired verbal-based ToM in the Faux Pas Task, but shared similar visual-based ToM impairments in the Yoni Task with schizophrenia patients.

CONCLUSIONS

The findings that individuals with high-functioning autism shared similar but more severe impairments in verbal ToM than individuals with schizophrenia support the autism-schizophrenia continuum. The finding that verbal-based but not visual-based ToM was more impaired in high-functioning autism patients than schizophrenia patients could be attributable to the varied task/item difficulty between the two paradigms.

Interoceptive inference: From computational neuroscience to clinic

The central and autonomic nervous systems can be defined by their anatomical, functional and neurochemical characteristics, but neither functions in isolation. For example, fundamental components of autonomically mediated homeostatic processes are afferent interoceptive signals reporting the internal state of the body and efferent signals acting on interoceptive feedback assimilated by the brain. Recent predictive coding (interoceptive inference) models formulate interoception in terms of embodied predictive processes that support emotion and selfhood. We propose interoception may serve as a way to investigate holistic nervous system function and dysfunction in disorders of brain, body and behaviour. We appeal to predictive coding and (active) interoceptive inference, to describe the homeostatic functions of the central and autonomic nervous systems. We do so by (i) reviewing the active inference formulation of interoceptive and autonomic function, (ii) survey clinical applications of this formulation and (iii) describe how it offers an integrative approach to human physiology; particularly, interactions between the central and peripheral nervous systems in health and disease.

Differences in frontotemporal dysfunction during social and non-social cognition tasks between patients with autism spectrum disorder and schizophrenia

Although literature evidence suggests deficits in social and non-social cognition in patients with autistic spectrum disorder (ASD) and schizophrenia (SCZ), the difference in neural correlates of the impairments between the two disorders has not been elucidated. We examined brain function in response to a non-social cognition and a social cognition task using functional near-infrared spectroscopy (fNIRS) in 13 patients with ASD, 15 patients with SCZ, and 18 healthy subjects. We assessed the brain function of participants using a verbal fluency task and an emotional facial recognition task. The patients with ASD showed significantly reduced brain activation in the left frontotemporal area during both tasks compared to healthy subjects. The patients with ASD with larger score in ‘attention to detail’ in the autism spectrum quotient showed lower activation of the left frontotemporal area during the two tasks. The patients with SCZ showed significantly reduced activation, compared to healthy subjects, and greater activation, compared to patients with ASD, in the area during the verbal fluency task. The patients with SCZ with more severe symptoms had lower brain activation during the task in this area. Our results suggest that two distinct areas are involved in the distinctive brain pathophysiology relevant to cognitive processing in patients with ASD and SCZ.

Social Cognition in Schizophrenia and Autism Spectrum Disorders: A Systematic Review and Meta-Analysis of Direct Comparisons

Background: Deficits in social cognition are well-recognized in both schizophrenia and autism spectrum disorders (ASD). However, it is less clear how social cognition deficits differ between both disorders and what distinct mechanisms may underlie such differences. We aimed at reviewing available evidence from studies directly comparing social cognitive performance between individuals with schizophrenia and ASD. Methods: We performed a systematic review of literature up to May 22, 2018 on Pubmed, Web of Science, and Scopus. Search terms included combinations of the keywords "social cognition," "theory of mind," "autism," "Asperger," "psychosis," and "schizophrenia." Two researchers independently selected and extracted data according to PRISMA guidelines. Random-effects meta-analyses were conducted for performance on social cognitive tasks evaluating: (1) emotion perception; (2) theory of mind (ToM); (3) emotional intelligence (managing emotions score of the Mayer-Salovey-Caruso Emotional Intelligence Test); and (4) social skills. Results: We identified 19 eligible studies for meta-analysis including a total of 1,040 patients (558 with schizophrenia and 482 with ASD). Eight studies provided data on facial emotion perception that evidenced a better performance by participants with schizophrenia compared to those with ASD (Hedges' g = 0.43; p = 0.031). No significant differences were found between groups in the Reading the Mind in the Eyes Test (8 studies; Hedges' g = 0.22; p = 0.351), other ToM tasks (9 studies; Hedges' g = -0.03; p = 0.903), emotional intelligence (3 studies; Hedges' g = -0.17; p = 0.490), and social skills (3 studies; Hedges' g = 0.86; p = 0.056). Participants' age was a significant moderator of effect size in emotion perception and RMET analyzes, with larger differences favoring patients with schizophrenia being observed in studies with younger participants. Conclusions: The instruments that are currently available to evaluate social cognition poorly differentiate between individuals with schizophrenia and ASD. Combining behavioral tasks with neurophysiologic assessments may better characterize the differences in social cognition between both disorders.

Impairments of spontaneous and deliberative mentalizing co-occur, yet dissociate, in schizophrenia

OBJECTIVES

Evidence of impairment in explicit mentalizing in people with schizophrenia has inspired interventions to improve awareness of others' mental states in these individuals. Less is known of implicit mentalizing in schizophrenia, with current findings mixed. We sought to resolve previous inconsistencies using Heider & Simmel's (H&S) classic animation to elicit spontaneous mentalizing and examined relations between spontaneous and deliberative mentalizing.

METHODS

Forty-five schizophrenia outpatients and 27 general-community controls completed two explicit theory-of-mind (TOM) tasks and then described the H&S animation (to elicit spontaneous social attributions about emotionally driven, as well as goal-driven, behaviours), before and after an instruction to think of the shapes as people. Accuracy of basic and social facts and frequencies of personification and different mental-state terms were recorded.

RESULTS

Explicit TOM performance was impaired in patients. Patients also generated fewer social (but not basic) facts than controls to describe the H&S animation, and used less mental-state language, before, and even more so, after the 'people' instruction, despite that both groups had used more personification terms after the 'people' instruction. Measures of explicit and spontaneous mentalizing contributed independently to discriminating between groups.

CONCLUSIONS

Patients respond less to the bottom-up signals of agency that ought normally to elicit spontaneous social attributions, even when cued to think of the stimuli as people, and the stimuli depict emotionally driven, as well as goal-driven, behaviour. That impairments of spontaneous and deliberative mentalizing dissociate in schizophrenia suggests that training deliberative mentalizing may not be enough; interventions to improve spontaneous mentalizing are also needed.

PRACTITIONER POINTS

Findings People with schizophrenia were less likely than controls to spontaneously attribute causal mental states when viewing dynamic signals of emotionally driven and goal-driven behaviours. These impairments were even more pronounced when participants were instructed to think of the stimuli as people, suggesting that perceiving others in social roles does not prompt people with schizophrenia to anthropomorphize about others as agents motivated by their own inner worlds. Impairments of spontaneous mentalizing were found to co-occur independently with explicit mentalizing deficits in schizophrenia, consistent with the claim that humans can access two distinct systems for understanding others' minds. Findings suggest that interventions to improve conscious deliberative mentalizing in schizophrenia may not be enough; we also need to target implicit mentalizing processes. Limitations The patient sample was chronic and only mildly symptomatic. As such, findings cannot be generalized to other stages and phases of the illness. All patients were also medicated, allowing for the possibility that automatic responses to socially salient stimuli may have been pharmacologically attenuated. Future research may examine whether unmedicated young people at ultra-high risk of psychosis show a similar profile of mentalizing impairment. Future work may also examine whether impairments of deliberative and spontaneous mentalizing associate differentially with social functioning and different cognitive domains in schizophrenia.

Attachment style moderates theory of mind abilities in depression

INTRODUCTION

Being able to understand other people's emotions and intentions is crucial for social interactions and well-being. Deficits in theory of mind (ToM) functioning hamper this ability and have been observed in depression and other neuropsychiatric disorders. However, results of previous research in depression have been inconclusive, possibly due to the presence of comorbid disorders and the disregarding of other modulating factors.

METHODS

Thirty-eight patients with a major depressive disorder (MDD) and forty healthy matched controls were assessed with a ToM task using animated triangles. Results were correlated with attachment styles, empathy abilities and neurocognitive performance.

RESULTS

Our findings show that 1) healthy female controls performed significantly stronger on the ToM task than female MDD patients, 2) these performance differences were driven by attachment styles and 3) depression severity did not impact task performance.

LIMITATIONS

The pharmacological treatment of the majority of patients might limit the generalizability of this study.

DISCUSSION

Results indicate a gender-specific impact of attachment styles on ToM performance. Future studies should investigate whether impairments in social cognitive tasks pose a risk factor for depression and/or interactional styles or vice versa. Moreover, with regard to remediation programs gender-specific needs should be taken into account.

Discriminating between first- and second-order cognition in first-episode paranoid schizophrenia

INTRODUCTION

An impairment of visually perceiving backward masked stimuli is commonly observed in patients with schizophrenia, yet it is unclear whether this impairment is the result of a deficiency in first or higher order processing and for which subtypes of schizophrenia it is present.

METHODS

Here, we compare identification (first order) and metacognitive (higher order) performance in a visual masking paradigm between a highly homogenous group of young first-episode patients diagnosed with paranoid schizophrenia (N = 11) to that of carefully matched healthy controls (N = 13).

RESULTS

We find no difference across groups in first-order performance, but find a difference in metacognitive performance, particularly for stimuli with relatively high visibility.

CONCLUSIONS

These results indicate that the masking deficit is present in first-episode patients with paranoid schizophrenia, but that it is primarily an impairment of metacognition.

Associations between autistic traits and fractional anisotropy values in white matter tracts in a nonclinical sample of young adults

Whereas a number of studies have examined relationships among brain activity, social cognitive skills, and autistic traits, fewer studies have evaluated whether structural connections among brain regions relate to these traits and skills. Uncinate fasciculus (UF) and inferior longitudinal fasciculus (ILF) are white matter tracts that may underpin the behavioral expression of these skills because they connect regions within or provide sensory information to brain areas implicated in social cognition, and structural differences in these tracts have been associated with autistic traits. We examined relationships among self-reported autistic traits, mentalizing, and water diffusivity in UF and ILF in a nonclinical sample of 24 young adults (mean age = 21.92 years, SD = 4.72 years; 15 women). We measured autistic traits using the Autism-Spectrum Quotient, and we measured mentalizing using the Dynamic Interactive Shapes Clips task. We used Tract-Based Spatial Statistics and randomize to examine relationships among fractional anisotropy (FA) values in bilateral ILF and UF, age, cognitive abilities, autistic traits, and mentalizing. Autistic traits were positively related to FA values in left ILF. No other relationships between FA values and other variables were significant. Results suggest that left ILF may be involved in the expression of autistic traits in individuals without clinical diagnoses.