Social cognition psychometric evaluation (SCOPE) in people with early psychosis: A preliminary study

Reliability of Theory of Mind Tasks in Schizophrenia, ASD, and Nonclinical Populations: A Systematic Review and Reliability Generalization Meta-analysis

Though theory of mind (ToM) is an important area of study for different disciplines, however, the psychometric evaluations of ToM tasks have yielded inconsistent results across studies and populations, raising the concerns about the accuracy, consistency, and generalizability of these tasks. This systematic review and meta-analysis examined the psychometric reliability of 27 distinct ToM tasks across 90 studies involving 2771 schizophrenia (SZ), 690 autism spectrum disorder (ASD), and 15,599 nonclinical populations (NC). Findings revealed that while all ToM tasks exhibited satisfactory internal consistency in ASD and SZ, about half of them were not satisfactory in NC, including the commonly used Reading the Mind in the Eye Test and Hinting Task. Other than that, Reading the Mind in the Eye Test showed acceptable reliability across populations, whereas Hinting Task had poor test-retest reliability. Notably, only Faux Pas Test and Movie for the Assessment of Social Cognition had satisfactory reliability across populations albeit limited numbers of studies. However, only ten studies examined the psychometric properties of ToM tasks in ASD adults, warranting additional evaluations. The study offered practical implications for selecting ToM tasks in research and clinical settings, and underscored the importance of having a robust psychometric reliability in ToM tasks across populations.

Facial emotion perception in individuals with clinical high risk for psychosis compared with healthy controls, first-episode psychosis, and in predicting psychosis transition: A systematic review and meta-analysis

Facial emotion perception deficits, a possible indicator of illness progression and transdiagnostic phenotype, were examined in high-risk psychosis (CHR) patients through a systematic review and meta-analysis of 35 studies (2567 CHR individuals, 1103 non-transitioned [CHR-NT], 212 transitioned [CHR-T], 512 first-episode psychosis [FEP], and 1936 healthy controls [HC]). CHR showed overall (g = -0.369 [95 % CI, -0.485 to -0.253]) and specific impairments in detecting anger, disgust, fear, happiness, neutrality, and sadness compared to HC, except for surprise. FEP revealed a general deficit than CHR (g = -0.378 [95 % CI, -0.509 to -0.247]), and CHR-T displayed more pronounced baseline impairments than CHR-NT (g = -0.217 [95 % CI, -0.365 to -0.068]). FEP only exhibited a poorer ability to perceive fear, but not other individual emotions, compared to CHR. Similar performances in perceiving individual emotions were observed regardless of transition status (CHR-NT and CHR-T). However, literature comparing the perception of individual emotions among FEP, CHR-T, and CHR is limited. This study primarily characterized the general and overall impairments of facial emotion perception in CHR which could predict transition risk, emphasizing the need for future research on multimodal parameters of emotion perception and associations with other psychiatric outcomes.

Measuring social cognition within the university: The Social Cognition Psychometric Evaluation (SCOPE) battery in an undergraduate sample

Many social cognitive assessments that were developed specifically for use in clinical populations are now being widely used in undergraduate populations, either to provide a comparison for clinical groups or to explore performance across the continuum from healthy to subclinical populations. However, the appropriateness of using these assessments in the general population is unclear. The current study, therefore, seeks to determine whether the Social Cognition Psychometric Evaluation (SCOPE) battery retains its psychometric properties when used in an undergraduate sample.The initial SCOPE battery was administered to 265 undergraduate participants, and the utility of the tasks was measured by assessing floor and ceiling effects. Internal consistency, discriminant and convergent validity are reported for each task, and the relationship between task performance and neurocognition and social functioning were assessed.Several of the tasks demonstrated limited utility, with the Hinting Task specifically demonstrating a pronounced ceiling effect. Only two measures of social cognitive biases achieved satisfactory internal consistency. Select tasks demonstrated small, but significant relationships with social functioning outcomes and significantly predicted 2-3% of variance above neurocognition alone.Despite the association with social functioning, results indicate that the psychometric properties demonstrated in the initial SCOPE study with a clinical sample do not fully extend to a healthy undergraduate population and highlight the need for social cognitive tasks that validly assess ability across the continuum.

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

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

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

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

Social cognition and psychosocial functioning in schizophrenia and bipolar disorder: Theory of mind as a key to understand schizophrenia dysfunction

Functional impairment is a common symptom in schizophrenia (SZ) and bipolar disorder (BD). Pharmacological treatments have limited functional recovery in both disorders. Social cognition, a cognitive process, has been associated with functioning in mental disorders. Theory of mind (ToM) is considered a key factor in understanding the social cognitive deficits in SZ and BD. Our study aimed to investigate the relationship between ToM and functioning in SZ, BD, and healthy controls (HC) and compare ToM and functioning impairments between groups. A total of 208 participants (HC n = 69; BD n = 89; SZ n = 50) were evaluated with the Functioning Assessment Short Test (FAST), Reading the Mind in the Eyes Test (RMET), the Vocabulary subtest of the Wechsler Abbreviated Scale for Intelligence (WASI) and the Hopkins Verbal Learning Test - Revised (HVLT-R). Comparisons of RMET between low- and high-functioning individuals and multiple linear regression analyses were conducted for each group. Multiple regression analysis revealed that the association between ToM and psychosocial functioning was observed only in SZ (β = -1.352, p = 0.008). Low-functioning SZ participants showed a lower ToM performance compared to participants with high-functioning SZ (t = 1.80, p = 0.039, Cohen's d = 0.938). No significant associations were found in the other groups. ToM is essential to understand the functional impairment in SZ, more than in BD. Furthermore, ToM may be a primary target for intervention strategies in improving functioning in SZ.

Reading the mind in the eyes and cognitive ability in schizophrenia- and autism spectrum disorders

BACKGROUND

Schizophrenia (SZ) and autism spectrum disorders (ASD) are characterized by difficulties in theory of mind (ToM). We examined group differences in performance on a ToM-related test and associations with an estimated IQ.

METHODS

Participants [N = 1227, SZ (n = 563), ASD (n = 159), and controls (n = 505), 32.2% female] completed the Reading the Mind in the Eyes Test (RMET) and assessments of cognitive ability. Associations between IQ and group on RMET were investigated with regression analyses.

RESULTS

SZ (d = 0.73, p < 0.001) and ASD (d = 0.37, p < 0.001) performed significantly worse on the RMET than controls. SZ performed significantly worse than ASD (d = 0.32, p = 0.002). Adding IQ to the model, SZ (d = 0.60, p < 0.001) and ASD (d = 0.44, p < 0.001) continued to perform significantly worse than controls, but no longer differed from each other (d = 0.13, p = 0.30). Small significant negative correlations between symptom severity and RMET performance were found in SZ (PANSS positive: r = -0.10, negative: r = -0.11, both p < 0.05). A small non-significant negative correlation was found for Autism Diagnostic Observation Schedule scores and RMET in ASD (r = -0.08, p = 0.34).

CONCLUSIONS

SZ and ASD are characterized by impairments in RMET. IQ contributed significantly to RMET performance and accounted for group differences in RMET between SZ and ASD. This suggests that non-social cognitive ability needs to be included in comparative studies of the two disorders.

Age-Related Social Cognitive Performance in Individuals With Psychotic Disorders and Their First-Degree Relatives

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.

The social cognitive and neural mechanisms that underlie social functioning in individuals with schizophrenia - a review

In many individuals with a diagnosis of schizophrenia social functioning is impaired across the lifespan. Social cognition has emerged as one of the possible factors that may contribute to these challenges. Neuroimaging research can give further insights into the underlying mechanisms of social (cognitive) difficulties. This review summarises the evidence on the associations between social cognition in the domains of theory of mind and emotion perception and processing, and individuals' social functioning and social skills, as well as associated neural mechanisms. Eighteen behavioural studies were conducted since the last major review and meta-analysis in the field (inclusion between 7/2017 and 1/2022). No major review has investigated the link between the neural mechanisms of social cognition and their association with social functioning in schizophrenia. Fourteen relevant studies were included (from 1/2000 to 1/2022). The findings of the behavioural studies showed that associations with social outcomes were slightly stronger for theory of mind than for emotion perception and processing. Moreover, performance in both social cognitive domains was more strongly associated with performance on social skill measures than questionnaire-based assessment of social functioning in the community. Studies on the underlying neural substrate of these associations presented mixed findings. In general, higher activation in various regions of the social brain was associated with better social functioning. The available evidence suggests some shared regions that might underlie the social cognition-social outcome link between different domains. However, due to the heterogeneity in approaches and findings, the current knowledge base will need to be expanded before firm conclusions can be drawn.

Social cognition in first-episode schizophrenia/schizoaffective disorder patients

INTRODUCTION

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Calling on clinicians to get social and emotional

OBJECTIVE

Disorders of social cognition, such as difficulties with emotion perception, alexithymia, Theory of Mind (ToM), empathy and disorders of emotion regulation, are prevalent and pervasive problems across many neurological, neurodevelopmental and neuropsychiatric conditions. Clinicians are familiar with how these difficulties present but assessment and treatment has lagged behind other traditional cognitive domains, such as memory, language and executive functioning.

METHOD

In this paper, we review the prevalence and degree of impairment associated with disorders of social cognition and emotion regulation across a range of clinical conditions, with particular emphasis on their relationship to cognitive deficits and also real-world functioning. We reported effects sizes from published meta-analyses for a range of clinical disorders and also review test usage and available tests.

RESULTS

In general, many clinical conditions are associated with impairments in social cognition and emotion regulation. Effect sizes range from small to very large and are comparable to effect sizes for impairments in nonsocial cognition. Socio-emotional impairments are also associated with social and adaptive functioning. In reviewing prior research, it is apparent that the standardized assessment of social cognition, in particular, is not routine in clinical practice. This is despite the fact that there are a range of tools available and accruing evidence for the efficacy of interventions for social cognitive impairments.

CONCLUSION

We are using this information to urge and call for clinicians to factor social cognition into their clinical assessments and treatment planning, as to provide rigorous, holistic and comprehensive person-centred care.

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

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

Hostile attribution bias in schizophrenia-spectrum disorders: narrative review of the literature and persisting questions

BACKGROUND

Social cognition is often aberrant or impaired in psychotic disorders and related to functional outcomes. In particular, one core social cognitive bias - hostile attribution bias - is proposed to be implicated in paranoia, anxiety, mood disturbances and interpersonal conflict outcomes. However, questions remain about this domain's specificity to psychosis and its relationship to general functional outcomes.

AIMS

The present paper offers a descriptive and critical review of the literature on hostile attribution bias in psychotic disorders, in order to examine (1) its impact on persecutory symptoms in schizophrenia-spectrum disorders, (2) impact on other related psychopathology among those experiencing psychosis and (3) relationship to functioning.

METHODS

Twenty-eight studies included in this review after parallel literature searches of PsycINFO and PubMed.

RESULTS

Evidence from these studies highlighted that hostile attribution bias is elevated in schizophrenia, and that it is related to anxiety, depression and interpersonal conflict outcomes.

CONCLUSION

While results suggest that hostile attributions are elevated in schizophrenia and associated with symptoms and functioning, there exist numerous persisting questions in the study of this area, including identifying which measures are most effective and determining how it presents: as a state or trait-like characteristic, via dual processes, and its situational variation.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Metacognitive Skills Training and Computerized Cognitive Remediation among Individuals with First-Episode Psychosis: Influence on Social Cognition

Background

Metacognitive skills training (MST) is often integrated into cognitive remediation programs for psychosis. Social cognition - the mental processes underlying social perception and behavior - is robustly related to outcomes in psychosis and is increasingly addressed with targeted treatments. Though metacognition and social cognition are related constructs, little is known about how MST may influence social cognition among individuals with psychosis participating in broad-based, non-social cognitive remediation.

Methods

Individuals with first-episode psychosis who completed six months of metacognitive remediation (MCR; n=12) were compared to a historical control group who received six months of computerized cognition remediation (CCR; n=10) alone (ClinicalTrials.gov Identifier NCT01570972).

Results

Though individuals receiving MCR experienced gains in emotion processing and theory of mind, these changes were not significantly different when compared to individuals receiving CCR. MST did not contribute to social cognitive change in the context of CCR.

Discussion

Though MST may be relevant to facilitating social cognitive gains within broader cognitive remediation programs for first-episode psychosis, these benefits are limited and may not exceed those conferred by standard cognitive remediation. Opportunities for investigation of other potential mechanisms of social cognitive response to interventions remain.

Examining the association of life course neurocognitive ability with real-world functioning in schizophrenia-spectrum disorders

There is considerable variability in neurocognitive functioning within schizophrenia-spectrum disorders, and neurocognitive performance ranges from severe global impairment to normative performance. Few investigations of neurocognitive clusters have considered the degree to which deterioration relative to premorbid neurocognitive abilities is related to key illness characteristics. Moreover, while neurocognition and community functioning are strongly related, understanding of the sources of variability in the association between these two domains is also limited; it is unknown what proportion of participants would over-perform or under-perform the level of functioning expected based on current neurocognitive performance vs. lifelong attainment. This study examined data from 954 outpatients with schizophrenia-spectrum disorders across three previous studies. Neurocognition, community functioning, and symptoms were assessed. Neurocognitive subgroups were created based on current neurocognition, estimated premorbid IQ, and degree of deterioration from premorbid using z-score cut-offs; functional subgroups were created with cluster analysis based on the Specific Level of Functioning Scale and current neurocognition. The sample was neurocognitively heterogeneous; 65% displayed current neurocognitive impairment and 84% experienced some level of deterioration. Thirty percent of our sample was relatively higher functioning despite significant neurocognitive impairment. Individuals with better community functioning, regardless of neurocognitive performance, had lower symptom severity compared to those with worse functioning. These results highlight the variability in neurocognition and its role in functioning. Understanding individual differences in neurocognitive and functional profiles and the interaction between prior and current cognitive functioning can guide individualized treatment and selection of participants for clinical treatment studies.

Emotional Processing Profile in Patients with First Episode Schizophrenia: The Influence of Neurocognition

This study sought to investigate the influence of neurocognition on the emotional processing profiles of patients with first-episode schizophrenia, using the 4-branch Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) (Perceiving Emotions; Facilitating Emotions; Understanding Emotions and Managing Emotions). A sample of 78 patients with first-episode schizophrenia and a group of 90 non-psychiatric control subjects were included in this work. The initial results showed that patients had lower scores than controls for the “Understanding Emotions” and “Managing Emotions” MSCEIT branches. However, after controlling for neurocognition, the only deficits were found on the “Managing Emotions” branch of the MSCEIT. This branch can be considered as measuring a more sophisticated level of emotional processing, which may constitute a deficit in itself. In conclusion, patients with first-episode schizophrenia present deficits in social cognition at the highest level that seem to be independent from neurocognition. These findings support the inclusion of the “Managing Emotions” branch of the MSCEIT as part of the MCCB.

Development of an Ecologically Valid Assessment for Social Cognition Based on Real Interaction: Preliminary Results

Many social cognitive assessment measures that are appropriate for clinical use are currently available, but there is a general concern about their ecological validity. This study aimed to develop an applicable real interaction-based test to assess social cognition. A sample of 50 subjects (mean age 22 ± 5.8, 56% women) took the Social Interaction Test as well as two instruments for assessing social cognition: (1) the Movie for Assessment of Social Cognition (MASC) and (2) branch 4 from the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). The test showed no incidence on its application. The reliability of the 18-item final version of the test was a medium-high level (Cronbach’s alpha = 0.701). To assess the internal structure of the test, a multidimensional scaling procedure was used. The common space of coordinates for the two-dimensional solution showed a normalized raw stress of 0.076 and Tucker’s congruence coefficient of 0.965. The social interaction test showed stronger association with MASC (more realistic, video-based format) than with MSCEIT (less realistic, paper-based format). The Social Interaction Test is applicable and feasible to use it to assess social cognition in the general population.

Patients and physician’s self-assessment regarding clinical stability in severe mental disorders: a cross-sectional study

ABSTRACT Objective This study explores the relationship between patients’ self-assessment and physicians’ evaluation regarding clinical stability. Methods This cross-sectional study was carried out at the general outpatient clinic of the Instituto de Psiquiatria da Universidade Federal do Rio de Janeiro (IPUB-UFRJ) in a large sample (1,447) of outpatients, of which 67.9% were patients with severe mental disorders (SMD). We collected information using a structured questionnaire developed for this purpose, filled in by the patient’s physician. Clinical stability was assessed by means of five psychiatric instability criteria and by the physician’s global clinical impression over the six previous months. The patients’ self-assessment was based on a question about how they evaluated their health status: stable/better, worse, does not know. For the analyses, patients’ self-evaluation was considered as our standard. Results The sample was composed of 824 (57%) women with an average age of 49 years. The most prevalent diagnoses within the SMD category corresponded to 937 patients, of whom 846 (90.3%) assessed themselves as stable/better. The physicians’ evaluations agreed more with patients with bipolar disorders and less with schizophrenics regarding stability. As for patients with depressive disorder, physicians agreed more with them regarding instability. Conclusion The data analysis confirms our hypothesis that the self-assessment made by patients with SMD was accurate regarding their health condition, and that the self-assessment made by patients who considered themselves stable agree with the physicians’ evaluation.

Voice, Body Cues and Facial Expression in Emotion Recognition of Spanish Children and Adolescents: The Validation of Bell-Lysaker Emotion Recognition Test

Emotion recognition has been traditionally measured trough the recognition of emotional expressions of static faces. Studies suggest that emotion recognition is progressively acquired from early stages in our infancy. However, the literature regarding other emotional domains such as voice or body movements is scarce. Additionally, the number of tools that integrate several domains is limited, especially in children and adolescents, and none of them tested in Spanish samples. Therefore, this study aimed to define the psychometric properties of the Bell-Lysaker Emotion Recognition Task (BLERT) and a new-designed alternate version providing normative data in Spanish children and adolescents (from 8 to 15 years old corresponding to 3th). Moreover, we aim to describe the emotional acquisition trajectory of children and adolescents with a tool that integrates voice, face expressions and body movements. For that purpose, BLERT was translated into Spanish (BLERT-SI) and an alternate version was created (BLERT-SII). A total of 545 children and adolescents from 8 to 15 year-old participated in the study (250 male/295 female). All participants fulfilled BLERT-SI and BLERT-SII within two weeks of difference. Order of presentation was counterbalanced. Results showed that BLERT-SI and SII have good internal consistency (α = .70 and 71 respectively). Test-retest reliability showed a moderate correlation (r = .45; p < .001). Percentages equivalences per age are provided. Age correlated with BLERT-SI (r = .31; p < .001) and BLERT-SII (r = .21; p < .001), showing a progressive acquisition and development of emotion recognition during this period. BLERT-SI and SII are useful tools when studying the follow-up of children and adolescents.

Comparative study of emotion recognition and theory of mind between major depressive disorder and schizophrenia

BACKGROUND

Social cognition as a transdiagnostic construct between major depressive disorder (MDD) and schizophrenia (SCZ) is not well understood. This may be attributed to the variability of social cognitive measures indexing the same construct. This study aims to compare emotion recognition and theory of mind domains, known to be impaired in SCZ, between MDD and SCZ.

METHODS

Three groups of participants (N_Total = 150) were enrolled in this study: MDD (n = 51), SCZ (n = 50) and healthy controls (HC; n = 49). Emotion recognition was assessed on the Bell Lysaker Emotion Recognition Task (BLERT) and Penn Emotion Recognition Task (ER40); theory of mind was measured on The Awareness of Social Inference Test (TASIT). Mixed ANCOVAs were utilised to compare social cognitive performance across the groups.

RESULTS

SCZ performed poorer in all 3 social cognition tasks compared to both MDD and HC. No statistically significant difference in social cognitive performance was observed between MDD and HC.

CONCLUSIONS

This study serves as an effort towards employing the same standardised social cognitive measures for direct comparison of performance patterns across diagnostic groups. Future work is needed to extend this in larger samples of different illness severity and diagnostic categories.

Social cognition, neurocognition, symptomatology, functional competences and outcomes in people with schizophrenia - A network analysis perspective

BACKGROUND

Extensive difficulties in reaching functional milestones characterize schizophrenia and related psychotic disorders. These impairments are in part explained by lower social cognitive abilities, cognitive impairment, and current psychopathology. The present study aims to model dynamic associations among social cognition, neurocognition, psychopathology, social skills, functional capacity, and functional outcomes in schizophrenia using network analysis in order to identify those factors that are most central to functioning.

METHODS

The sample consisted of 408 patients with schizophrenia spectrum disorders who were drawn from the SCOPE project. Participants completed a complex battery of state-of-the-art measures of social cognition, neurocognition, and functional outcomes. Gaussian Graphical Modeling was used for estimation of the network structure. Accuracy of the network was evaluated using the Bootstrap method.

RESULTS

Data supported the importance of functional capacity and social skills, which are prerequisites to real - world outcomes. These variables were among the most central in the network. Social cognition was related to functional capacity, social skills, and real - world functioning. Negative symptoms were connected to functional capacity, social skills, and real - world functioning.

CONCLUSIONS

Predictors of functional outcomes are complexly associated with each other. Functional capacity, social - skills, working memory, negative symptoms, mentalizing, and emotion recognition were central nodes that support their importance as potential targets of personalized intervention.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Development, Spanish Normative Data, and Validation of a Social Cognition Battery in Prodromal Alzheimer's Disease and Multiple Sclerosis

OBJECTIVES

The assessment of social cognition changes may be challenging, especially in the earliest stages of some neurodegenerative diseases. Our objective was to validate a social cognition battery from a multidomain perspective. In this regard, we aimed to adapt several tests, collect normative data, and validate them in prodromal Alzheimer's disease (AD) and multiple sclerosis (MS).

METHODS

A total of 92 healthy controls, 25 prodromal AD, and 39 MS patients were enrolled. Age-, gender-, and education-matched control groups were created for comparisons. Social cognition battery was composed of an emotion-labeling task developed from FACES database, the Story-based Empathy test (SET), the Faux Pas test, and the Interpersonal Reactivity Index. Patients were also evaluated with a comprehensive cognitive battery to evaluate the other cognitive domains. Automatic linear modeling was used to predict each social cognition test's performance using the neuropsychological tests examining other cognitive domains.

RESULTS

The reliability of the battery was moderate-high. Significant intergroup differences were found with medium-large effect sizes. Moderate correlations were found between social cognition battery and neuropsychological tests. The emotion labeling task and SET showed moderate correlations with age and education, and age, respectively. Regression-based norms were created considering the relevant demographic variables. Linear regression models including other neuropsychological tests explained between 7.7% and 68.8% of the variance of the social cognition tests performance.

CONCLUSIONS

Our study provides a battery for the assessment of social cognition in prodromal AD and MS with Spanish normative data to improve the evaluation in clinical and research settings.

Improved social functioning following social recovery therapy in first episode psychosis: Do social cognition and neurocognition change following therapy, and do they predict treatment response?

There is a need to develop and refine psychosocial interventions to improve functioning in First Episode Psychosis (FEP). Social cognition and neurocognition are closely linked to functioning in psychosis; examinations of cognition pre- and post- psychosocial intervention may provide insights into the mechanisms of these interventions, and identify which individuals are most likely to benefit.

METHOD

Cognition was assessed within a multi-site trial of Social Recovery Therapy (SRT) for individuals with FEP experiencing poor functioning (<30 h weekly structured activity). Fifty-nine participants were randomly allocated to the therapy group (SRT + Early intervention), and 64 were allocated to treatment as usual group (TAU - early intervention care). Social cognition and neurocognition were assessed at baseline and 9 months; assessors were blind to group allocation. It was hypothesized that social cognition would improve following therapy, and those with better social cognition prior to therapy would benefit the most from SRT.

RESULTS

There was no significant impact of SRT on individual neurocognitive or social cognitive variables, however, joint models addressing patterns of missingness demonstrate improvement across a number of cognitive outcomes following SRT. Further, regression analyses showed those who had better social cognition at baseline were most likely to benefit from the therapy (ß = 0.350; 95% CI = 0.830 to 8.891; p = .019).

CONCLUSION

It is not clear if SRT impacts on social cognitive or neurocognitive function, however, SRT may be beneficial in those with better social cognition at baseline.

Functional Impairments and Theory of Mind Deficits in Schizophrenia: A Meta-analysis of the Associations

Schizophrenia is associated with major functioning difficulties. Theory of mind (ToM), the ability to infer the mental states of others, is an important determinant of functioning. However, the contribution of ToM to each specific domain of functioning remains to be better understood. The objectives of this meta-analysis were to document and compare the magnitude of the associations between ToM and (1) different domains of functioning (social functioning, productive activities, and instrumental activities of daily living), each assessed separately for functional performance and functional outcome and (2) different aspects of functioning (functional performance and functional outcome) in schizophrenia. Fifty-nine studies (N = 4369) published between 1980 and May 2019 targeting patients with schizophrenia or schizoaffective disorder aged between 18 and 65 years old were included. Studies were retrieved from seven databases. Correlations were extracted from the articles, transformed into effect sizes Zr and combined as weighted and unweighted means. The strength of the associations between the domains and aspects of functioning were compared using focused tests. A moderate association was observed between ToM and all domains of functioning, with a stronger association between ToM and productive activities compared with social functioning (only for functional outcome [χ2(2) = 6.43, P = 0.040]). Regarding the different aspects of functioning, a stronger association was observed between ToM and functional performance, compared with functional outcome, for overall functioning (χ2(1) = 13.77, P < 0.001) and social functioning (χ2(1) = 18.21, P < 0.001). The results highlight a stronger association of ToM with productive activities and with functional performance, which should be considered in future studies to improve functional recovery in schizophrenia.

Co-occurring Deficits in Clinical and Cognitive Insight in Prolonged Schizophrenia-Spectrum Disorders: Relationship to Metacognitive Deficits

People diagnosed with schizophrenia have been broadly observed to experience deficits in clinical and cognitive insight; however, less is understood about how these deficits are related. One possibility is that these deficits co-occur among people when other deficits in cognition are present, such as in executive function, social cognition, and metacognition, which may either promote the development of both forms of poor insight or allow one to negatively influence the other. To explore this possibility, we conducted a cluster analysis using assessments of clinical and cognitive insight among 95 adults with a schizophrenia spectrum disorder. As predicted, this analysis yielded a group with concurrently poor clinical and cognitive insight (n = 36). Additional groups were found with concurrently good clinical and cognitive insight (n = 28) and poor clinical insight and good cognitive insight (n = 31). Groups were then compared on assessments of executive function, social cognition, and metacognition. The group with concurrently lower levels of cognitive and clinical insight had significantly poorer metacognition relative to the other groups. In particular, they tended to form more fragmented and less integrated ideas about themselves and others. No differences were found for executive function or social cognition. The result may suggest that while clinical and cognitive insight is partially orthogonal phenomena, relatively lower levels of metacognition, or difficulties forming integrated ideas about oneself and others, maybe a condition leading to the confluence of lower clinical and cognitive insight. Interventions targeting metacognition may be of particular use for this group.

Neighborhood socioeconomic status and racial disparities in schizophrenia: An exploration of domains of functioning

Black Americans are disproportionately diagnosed with schizophrenia and experience worse objective functional outcomes (e.g., hospitalizations) than their White counterparts. However, we have a limited understanding of the psychological pathways through which Black Americans with schizophrenia reach worse outcomes. This study assessed race and domains of functioning (e.g., neurocognition, functional capacity) known to be associated with objective outcomes in a sample of 108 non-Hispanic Black and 61 non-Hispanic White individuals with schizophrenia-spectrum disorders from the Social Cognition Psychometric Evaluation (SCOPE) study. Three primary findings emerged: First, Black participants showed lower scores than White participants on measures of neurocognition(NC), social cognition(SC), and everyday living skills, but not social skills or community functioning. Second, neighborhood socioeconomic status (SES) explained 21% of the relationship between race and NC but did not mediate the relationship between race and SC or everyday living skills. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals. Finally, prior research has established that NC, SC, social skills, and everyday living skills predict community functioning in individuals with schizophrenia. In our sample, after controlling for neighborhood SES, race did not moderate the relationships of NC, SC, social skills, or everyday living skills to community functioning. This indicates that relationships between these domains are comparably strong across Black and White Americans. Taken together, these findings show that NC, SC, and everyday living skills may be important areas to explore in regards to racial disparities in schizophrenia. More research, especially incorporating nuanced race- and SES-related variables, is needed to understand how to best intervene and improve real-world outcomes for Black Americans with schizophrenia.

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.

Psychometric assessment of social cognitive tasks

Although there has been a marked increase in interest in social cognition (SC) in recent years, psychometric data relating to many tasks used to measure its components remain limited in healthy populations with only five articles published to date. It is accordingly premature to speak of a consensus concerning the specific components, or best tests of the components, and possible cultural differences. The present study sought to partially fill that gap, examining the psychometric properties of a battery of SC tasks in a sample of 100 healthy adults aged 18-85 years old. Initially, nine tasks assessing four SC components were selected: emotion recognition, theory of mind, attributional bias, and social judgment. Construct validity and criterion-related validity were assessed using factor and correlational analyses. Performance across age and sex groups was also investigated. Reliability was assessed through internal consistency, interrater and intercoder agreement. Results indicated satisfactory properties for the Ambiguous Intentions Hostility Questionnaire-blame score, the Social Judgment Task, the Facial Emotions Recognition Test, and a modified version of the Strange Stories Task. Statistically significant differences were found between the groups with regard to age and sex after accounting for demographic and cognitive factors. However, the correlations of these measures with relationship quality were mostly very low, raising questions about their concomitant validity. Other tasks showed sub-optimal properties, suggesting that some frequently used tests require further validation or modifications to ensure the quality of research findings. Based on the results, recommended measures for future studies and limitations are discussed.

Differences in theory of mind between early and chronic stages in schizophrenia

The evolution of social cognition throughout the course of schizophrenia is unclear not being possible to state whether it remains stable from early stages to chronicity, or it changes as the disease develops. For this purpose, 90 patients with schizophrenia and 139 healthy controls have been compared establishing 4 different groups paired by age and gender: first episode of psychosis patients (FEP), young healthy controls (YHC), chronic patients with schizophrenia (CS) and adult healthy controls (AHC). Performance in Theory of Mind (ToM) has been assessed using The Hinting Task and The Reading the Mind in the Eyes Test (RMET). In the Hinting Task, when comparing patients with their respective control group, differences found between CS patients and their corresponding controls (p < .001) are much bigger (almost twice) than differences between FEP patients and young controls (p = .001). In fact, young and adult healthy controls did not significantly differ in their scores, while the CS group showed significant worse performance than the FEP group. In the Reading the Mind in the Eyes test (RMET), patients globally performed worse than controls (p < .001). However, the Cohort × Diagnosis interaction was not significant (p = .27). In this task, there were no differences between CS and FEP scores. In conclusion, data suggest poor performance in all phases of the disease with a probable worsening related to chronicity especially in the aspects of social cognition measured by the Hinting Task.

Nonsocial cognitive underpinnings of theory of mind in schizophrenia

Social cognition is a mediator between nonsocial cognition and functional outcome in schizophrenia. However, the relationship between specific nonsocial cognitive and social cognitive domains is less clear. The aim of this study was to investigate which specific nonsocial cognitive domains best predict theory of mind (ToM) performance in schizophrenia. We indexed ToM by a composite score of the video-based Movie for the Assessment of Social Cognition test (MASCtot) in a sample of 91 individuals with schizophrenia. Nonsocial cognition was measured with the nonsocial cognitive subtests of the MATRICS Consensus Cognitive Battery (MCCB) and the Wechsler Abbreviated Scale of Intelligence (WASI IQ). Bivariate and multiple regression analyses were applied. We found statistically significant bivariate associations between MASCtot and five nonsocial cognitive tests, measuring intelligence, speed of processing, verbal or visual memory, and non-verbal working memory. Together, they accounted for 17% of the variation in MASCtot, but none of the five tests made significant unique contributions to MASCtot in the regression analysis. Our results confirm that nonsocial cognition and ToM are associated, albeit distinct, constructs. The findings suggest that cognitive remediation must include social cognitive targets in order to achieve improved ToM and better functioning.

Integrative cognitive remediation for early psychosis: A 12-month follow-up

In recent years, a growing number of studies have attempted to treat social-cognitive impairment within neurocognitive remediation as means of improving outcome in psychotic disorders with promising results. However, the durability of the effects is still under debate and little is known about the long-term efficacy of integrated neuro- and social-cognitive remediation in early psychosis. The purpose of this study was to examine long-term effects of a 12-week integrative cognitive remediation (ICR) for early psychosis. Thirty-seven patients diagnosed with primary psychotic disorder and previously treated with ICR as part of their standard treatment were assessed on cognitive performance, psychopathology, and functional outcome at baseline, 3 months (posttest) and 12 months (follow-up). After participating in ICT, individuals showed significant improvements on most neurocognitive and social cognitive domains. A significant increase in number of participants employed was found at 12-month. The study suggests ICR may have favorable effect on long-term cognitive improvements and functional gains in early psychosis.

Measuring mentalizing: A comparison of scoring methods for the hinting task

OBJECTIVE

The Social Cognition Psychometric Evaluation (SCOPE) study supported the utility and practicality of the Hinting task as a measure of social cognition/mentalizing in clinical trials, specifically with the SCOPE authors' stringent scoring system. However, it remains unclear whether the SCOPE scoring system is necessary for the task to be judged as psychometrically sound.

METHOD

Independent raters rescored data from the three phases of SCOPE using the Hinting task's original scoring criteria. Psychometric properties of the task when scored with the original criteria versus more stringent SCOPE criteria were compared in a large sample of individuals with chronic schizophrenia (n = 397) and matched controls (n = 300) as well as a smaller sample of individuals with early psychosis (n = 38) and controls (n = 39).

RESULTS

In both samples, SCOPE criteria resulted in lowered average scores and reduced ceiling effects. Further, revised scoring resulted in strengthened relationships between the hinting task and outcome measures in the chronic sample, and better differentiated early psychosis patients from controls. Conversely, test-retest reliability and internal consistency estimates were not improved using revised scoring and remained suboptimal, particularly for healthy controls.

CONCLUSION

Overall, SCOPE scoring criteria improved some psychometric properties and clinical utility, suggesting that these criteria should be considered for implementation.

Cognition, Social Cognition, and Functional Capacity in Early-Onset Schizophrenia

Cognitive impairments are a central feature of schizophrenia. These impairments are present across the course of the illness, from prodromal to more chronic patients. Social cognitive deficits, now known to be related to social outcomes in the real world, are also impaired in cases with early-onset psychosis. Similarly, disability in everyday functions is present and is correlated with impairments in performance on measures of the ability to perform everyday functional and social skills. This constellation of impairments leads to wide-ranging social and functional deficits. Treatments offered for adult-onset cases should be offered to early-onset cases as well."

Theory of mind in schizophrenia and bipolar disorder: psychometric properties of the Norwegian version of the Hinting Task

ABSTRACTIntroduction: The quality of measures used to assess theory of mind (ToM) in severe mental illness has not been sufficiently investigated. This study evaluated the psychometric properties of the Norwegian version of the Hinting Task in schizophrenia, bipolar I and II disorder and healthy controls.Methods: The study included 90 patients and 183 healthy controls. Internal consistency, ceiling effects, discriminatory power and concurrent and construct validity were investigated.Results: The Hinting Task displayed adequate levels of internal consistency for schizophrenia and bipolar I disorder. Ceiling effects emerged in all groups except the schizophrenia group. Schizophrenia patients scored significantly lower than all other groups, but no other significant group differences were detected. In the schizophrenia group, the Hinting Task's concurrent validity was substantiated by significant correlations with measures of neurocognition, symptoms and functional capacity. In the bipolar disorder groups, however, only a few significant relationships were found. Correlations between the Hinting Task and a measure of emotion recognition indicated that construct validity was higher for schizophrenia than bipolar disorder.Conclusions: The results suggest that the Norwegian Hinting Task is suited for use in schizophrenia research and assessment, but caution is warranted when using the test for other populations.

Social and non-social measures of cognition for predicting self-reported and informant-reported functional outcomes in early psychosis

The main aim of this study was to investigate the individual contributions of neurocognitive and social-cognitive domains to self-reported and informant-reported functional outcome in early psychosis. We also sought to further characterize the nature of cognitive impairments in this sample and explore the interrelationships between the social-cognitive measures and how they correlate with measures of neurocognition and clinical symptoms. In this study, 70 patients (mean age: 24.1; 87.1% males) with primary psychotic disorder diagnosed in the previous 5 years were assessed on multiple neurocognitive (processing speed, attention, working memory, immediate verbal memory, delayed recall, visual reasoning, inhibition, planning, cognitive flexibility), and social-cognitive domains (theory of mind (ToM), emotion recognition, attributional style, metacognitive overconfidence) as well as measures of clinical symptoms. Functional outcome was assessed with three self-reports and two informant-reports. On average, patients performed one or more SD below healthy controls on measures of delayed recall, ToM and metacognitive overconfidence. Emotion recognition and ToM were intercorrelated and correlated with multiple neurocognitive domains and negative symptoms. Attributional style correlated with positive symptoms. In the context of multiple variables, self-reported functional outcomes were predicted by attributional style, whereas emotion recognition and immediate verbal memory predicted variance in informant-reported community functioning. These results support the suggestion of a likely distinction between the predictive factors for self-reported and informant-reported functional outcome in early psychosis and suggest that consideration of self-assessment of functional outcome is critical when attempting to evaluate the effects attributional style has on functional disability.

Integrative cognitive remediation for early psychosis: Results from a randomized controlled trial

Early application of cognitive remediation may help prevent the development of long-term functional impairments that characterize psychotic disorders. Interventions that encompass both neurocognitive and social-cognitive training may work synergistically to bridge the gap between cognitive gains and functional outcomes in early psychosis. We integrated three cognitive remediation approaches: Neuropsychological Educational Approach to Remediation (NEAR), Compensatory Cognitive Training (CCT), and Social Cognition and Interaction Training (SCIT), and evaluated the effects on cognition, clinical symptoms, self-assessed and informant-assessed social functioning in early psychosis. A total of 49 patients diagnosed with primary psychotic disorder seeking service at an early-intervention service in Iceland were randomized to either a waiting-list control group (n = 24) or a 12-week group-based integrative cognitive remediation (n = 25). Neurocognition, social cognition, community functioning and clinical symptoms were assessed at baseline and post-treatment. The intervention group showed significant improvements in verbal memory, cognitive flexibility, working memory, ToM and a significant reduction in hostile attributions, compared to those receiving standard treatment alone, but there were no differences between groups on measures of social functioning or clinical symptoms. The intervention was well tolerated and received high treatment satisfaction ratings. Findings indicate that integrated cognitive remediation has potential to improve neurocognition and social cognition in early psychosis.

Social cognition in early course of schizophrenia: Exploratory factor analysis

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.

Exploring the use of the Hinting Task in first-episode psychosis

INTRODUCTION

The aim of the study was to elucidate the association between performance-related neurocognitive abilities and Theory of Mind (ToM) as measured by the Hinting Task (HT) performance and investigate the psychometric properties of the HT for use in First-Episode Psychosis (FEP).

METHODS

Cross-sectional data of 132 participants with FEP, aged 15-25 years, enrolled in a randomised controlled trial of vocational intervention, were analysed. A comprehensive cognitive battery including social cognitive and neurocognitive measures, a social and occupational functioning measure and psychopathological measures, were used. Psychometric properties were measured through bivariate correlations and associations with neurocognitive domains were assessed through hierarchical regression.

RESULTS

Low convergent validity of the HT with other ToM measures, moderate discriminant validity with an emotion recognition task, low predictive validity with social and occupational functioning, and high internal consistency were revealed. HT performance was significantly associated with verbal reasoning and verbal memory.

CONCLUSION

Results provide preliminary evidence of low convergent validity and moderate discriminant validity of the HT in FEP, and the influence of verbal reasoning and verbal memory on HT performance, indicating that caution is warranted when employing the HT as a screening tool in isolation for detection of ToM deficits in FEP.

An fMRI study of theory of mind in individuals with first episode psychosis

Theory of mind (ToM), the ability to infer one's own and others' mental states, is the social cognitive process shown to have the greatest impact on functional outcome in schizophrenia. It is not yet known if neural abnormalities underlying ToM present early, during the first episode of psychosis (FEP). Fourteen FEP participants and twenty-two healthy control participants, aged 15-25, were included in analyses. All participants had a 3T magnetic resonance imaging scan and completed a block-design picture-story attribution-of-intentions ToM fMRI task, and completed a battery of behavioral social cognitive measures including a ToM task. General linear model analyses were carried out. Post-hoc regression analyses were conducted to explore whether aberrant ToM-related activation in FEP participants was associated with symptomatology and global social and occupational functioning. FEP participants, when compared to healthy controls, had significantly less activity in the right temporoparietal junction, right orbitofrontal cortex and left middle prefrontal/inferior frontal cortex, when making social attributions. Aberrant ToM-related activation in the right temporoparietal junction was associated with severity of overall psychopathology, but not functional outcome. Specific regions of the social brain network, associated with ToM, are dysfunctional in young people with FEP. Future research should determine whether alteration of normal brain functioning in relation to ToM occurs before or during illness onset.

The relationship between theory of mind deficits and neurocognition in first episode-psychosis

Research suggests that theory of mind (ToM) deficits are related to chronic psychosis and to first-episode psychosis (FEP) independently of other neurocognition domains. The aim of this study was to measure the differences in ToM area in a Spanish population of FEP sample (N = 32) and in a healthy control group (N = 32). A further aim was to describe the relationship between different domains of neurocognition, psychotic symptoms and social functioning with ToM in this sample. ToM was assessed with the MASC task. Estimated IQ with a short version of the WAIS III, Rey-Osterrieth Complex figure, Trail Making Test, Stroop test and Wisconsin Carting Sorting test were used to assess neurocognition. Psychotic symptoms were assessed with Community Assessment of Psychic Experiences (CAPE) in both groups and with PANSS scale in FEP group. GAF and Cannon-Spoor scales were used to measure social functioning before and after onset of psychosis. FEP showed important deficits in ToM domain compared to controls. A worse executive functioning was associated with worse scores in ToM task. However, no relation was found between positive or negative psychotic symptoms and ToM or social functioning and ToM. In our sample neurocognition tests were strongly related to ToM domain independently of other variables.

Self-assessment of social cognitive ability in schizophrenia: Association with social cognitive test performance, informant assessments of social cognitive ability, and everyday outcomes

BACKGROUND

Impairments in self-assessment are common in people with schizophrenia and impairments in self-assessment of cognitive ability have been found to predict impaired functional outcome. In this study, we examined self-assessment of social cognitive ability and related them to assessments of social cognition provided by informants, to performance on tests of social cognition, and to everyday outcomes. The difference between self-reported social cognition and informant ratings was used to predict everyday functioning.

METHODS

People with schizophrenia (n=135) performed 8 different tests of social cognition. They were asked to rate their social cognitive abilities on the Observable Social Cognition Rating Scale (OSCARs). High contact informants also rated social cognitive ability and everyday outcomes, while unaware of the patients' social cognitive performance and self-assessments. Social competence was measured with a performance-based assessment and clinical ratings of negative symptoms were also performed.

RESULTS

Patient reports of their social cognitive abilities were uncorrelated with performance on social cognitive tests and with three of the four domains of functional outcomes. Differences between self-reported and informant rated social cognitive ability predicted impaired everyday functioning across all four functional domains. This difference score predicted disability even when the influences of social cognitive performance, social competence, and negative symptoms were considered.

IMPLICATIONS

Mis-estimation of social cognitive ability was an important predictor of social and nonsocial outcomes in schizophrenia compared to performance on social cognitive tests. These results suggest that consideration of self-assessment is critical when attempting to evaluate the causes of disability and when trying to implement interventions targeting disability reduction.

Social Cognition Psychometric Evaluation: Results of the Final Validation Study

Social cognition is increasingly recognized as an important treatment target in schizophrenia; however, the dearth of well-validated measures that are suitable for use in clinical trials remains a significant limitation. The Social Cognition Psychometric Evaluation (SCOPE) study addresses this need by systematically evaluating the psychometric properties of promising measures. In this final phase of SCOPE, eight new or modified tasks were evaluated. Stable outpatients with schizophrenia (n = 218) and healthy controls (n = 154) completed the battery at baseline and 2-4 weeks later across three sites. Tasks included the Bell Lysaker Emotion Recognition Task (BLERT), Penn Emotion Recognition Task (ER-40), Reading the Mind in the Eyes Task (Eyes), The Awareness of Social Inferences Test (TASIT), Hinting Task, Mini Profile of Nonverbal Sensitivity (MiniPONS), Social Attribution Task-Multiple Choice (SAT-MC), and Intentionality Bias Task (IBT). BLERT and ER-40 modifications included response time and confidence ratings. The Eyes task was modified to include definitions of terms and TASIT to include response time. Hinting was scored with more stringent criteria. MiniPONS, SAT-MC, and IBT were new to this phase. Tasks were evaluated on (1) test-retest reliability, (2) utility as a repeated measure, (3) relationship to functional outcome, (4) practicality and tolerability, (5) sensitivity to group differences, and (6) internal consistency. Hinting, BLERT, and ER-40 showed the strongest psychometric properties and are recommended for use in clinical trials. Eyes, TASIT, and IBT showed somewhat weaker psychometric properties and require further study. MiniPONS and SAT-MC showed poorer psychometric properties that suggest caution for their use in clinical trials.

Theory of mind in a first-episode psychosis population using the Hinting Task

Deficiencies in theory of mind (ToM) are common in psychosis and may largely explain impaired social functioning. Currently, it is unclear whether impairments in ToM are explained by the more general cognitive deficits related to psychosis or whether ToM is impaired in psychosis independently of other cognitive deficits. This study examined ToM using the Hinting Task in young adults (n = 66) with first-episode psychosis and matched controls (n = 62). The participants were administered a broad neuropsychological assessment. Participants with psychosis performed worse than controls on the Hinting Task. However, 75% of the variance between the groups was explained by general cognitive deficits, especially impaired processing speed and episodic memory. Hinting Task performance of the best functioning patient group did not differ from that of the control group. When the psychosis group was divided according to diagnosis, the Hinting Task difference between individuals with schizophrenia and controls remained significant even when general cognitive performance was controlled for, suggesting specific verbal ToM deficits in schizophrenia. In contrast, those with other psychotic disorders did not differ from controls. Our results suggest that ToM deficits can be seen in early phases of psychotic disorders, schizophrenia in particular, and are partly independent of other cognitive functions.

Toward a Two-Dimensional Model of Social Cognition in Clinical Neuropsychology: A Systematic Review of Factor Structure Studies

OBJECTIVE

Social cognition has received growing interest in many conditions in recent years. However, this construct still suffers from a considerable lack of consensus, especially regarding the dimensions to be studied and the resulting methodology of clinical assessment. Our review aims to clarify the distinctiveness of the dimensions of social cognition.

METHOD

Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, a systematic review was conducted to explore the factor structure of social cognition in the adult general and clinical populations.

RESULTS

The initial search provided 441 articles published between January 1982 and March 2017. Eleven studies were included, all conducted in psychiatric populations and/or healthy participants. Most studies were in favor of a two-factor solution. Four studies drew a distinction between low-level (e.g., facial emotion/prosody recognition) and high-level (e.g., theory of mind) information processing. Four others reported a distinction between affective (e.g., facial emotion/prosody recognition) and cognitive (e.g., false beliefs) information processing. Interestingly, attributional style was frequently reported as an additional separate factor of social cognition.

CONCLUSIONS

Results of factor analyses add further support for the relevance of models differentiating level of information processing (low- vs. high-level) from nature of processed information (affective vs. cognitive). These results add to a significant body of empirical evidence from developmental, clinical research and neuroimaging studies. We argue the relevance of integrating low- versus high-level processing with affective and cognitive processing in a two-dimensional model of social cognition that would be useful for future research and clinical practice. (JINS, 2018, 24, 391-404).