Negative symptoms and the formation of social affiliative bonds in schizophrenia

Blunted ventral striatal reactivity to social reward is associated with more severe motivation and pleasure decits in psychosis

Among individuals living with psychotic disorders, social impairment is common, debilitating, and challenging to treat. While the roots of this impairment are undoubtedly complex, converging lines of evidence suggest that social motivation and pleasure (MAP) deficits play a key role. Yet most neuroimaging studies have focused on monetary rewards, precluding decisive inferences. Here we leveraged parallel social and monetary incentive delay fMRI paradigms to test whether blunted reactivity to social incentives in the ventral striatum-a key component of the distributed neural circuit mediating appetitive motivation and hedonic pleasure-is associated with more severe MAP symptoms in a transdiagnostic sample enriched for psychosis. To maximize ecological validity and translational relevance, we capitalized on naturalistic audiovisual clips of an established social partner expressing positive feedback. Although both paradigms robustly engaged the ventral striatum, only reactivity to social incentives was associated with clinician-rated MAP deficits. This association remained significant when controlling for other symptoms, binary diagnostic status, or ventral striatum reactivity to monetary incentives. Follow-up analyses suggested that this association predominantly reflects diminished striatal activation during the receipt of social reward. These observations provide a neurobiologically grounded framework for conceptualizing the social-anhedonia symptoms and social impairments that characterize many individuals living with psychotic disorders and underscore the need to establish targeted intervention strategies.

Differential deficits in social versus monetary reinforcement learning in schizophrenia: Associations with facial emotion recognition

Despite evidence that individuals with schizophrenia (SZ) have an intact desire for social relationships, they have small social networks and report high levels of loneliness. Difficulty with reinforcement learning (RL), the ability to update behavior based on feedback, may inhibit the formation and maintenance of social relationships in SZ. However, impaired RL in SZ has largely been demonstrated via monetary tasks. Thus, it remains unclear whether SZ are similarly impaired in social and monetary RL, or whether social-specific factors may further inhibit their ability to learn from social feedback. Thirty-one individuals with SZ and 31 healthy controls (HCs) participated in a RL paradigm to test hypotheses about social versus monetary RL. SZ exhibited impaired RL compared to HCs in both social and monetary tasks. Further, a Group × Task interaction demonstrated that SZ was more impaired when learning from social than monetary reinforcement, F(1, 59) = 5.99, p = .017. This differential deficit to social RL was not accounted for by reported pleasure from social feedback, which did not differ between groups. Instead, SZ had poorer emotion recognition than HCs, t(1, 60) = 4.80, p < .001, particularly for negative emotions, and controlling for this eliminated the differential social RL impairment. These results suggest the possibility that difficulty recognizing social cues, especially those indicating negative feedback, may relate to a reduced ability to learn from others' feedback. Thus, future research could elucidate whether targeting these emotion recognition difficulties in treatment could serve as a potential mechanism for improving social functioning in SZ. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cell adhesion molecules in the pathogenesis of the schizophrenia

The causes of schizophrenia remain obscure and complex to identify. Alterations in dopaminergic and serotonergic neurotransmission are, to date, the primary pharmacological targets in treatment. Underlying abnormalities in neural networks have been identified as cell adhesion molecules (CAMs) involved in synaptic remodeling and interplay between neurons-neurons and neurons-glial cells. Among the CAMs, several families have been identified, such as integrins, selectins, cadherins, immunoglobulins, nectins, and the neuroligin-neurexin complex. In this paper, cell adhesion molecules involved in the pathogenesis of schizophrenia will be described.

Do People With Schizophrenia Enjoy Social Activities as Much as Everyone Else? A Meta-analysis of Consummatory Social Pleasure

BACKGROUND

The "emotion paradox" of schizophrenia suggests people with schizophrenia demonstrate deficits when reporting anticipated and retrospective pleasure; yet, in-the-moment, consummatory pleasure is largely intact. It is uncertain how these findings extend to social situations. This meta-analysis aimed to (1) determine the mean difference in consummatory social pleasure between people with schizophrenia and healthy controls, and (2) examine moderators of this effect, including study design and clinical characteristics of participants.

DESIGN

A literature search using PsycINFO, Web of Science, Pubmed, and EMBASE databases was conducted. Studies measuring consummatory social pleasure using experience sampling methods and laboratory social simulations were included. Random effects meta-analyses were conducted using Hedge's g.

RESULTS

Meta-analysis of 26 studies suggests people with schizophrenia exhibited a small, significant deficit in consummatory social pleasure (g = -0.38, 90% CI [-0.53, -0.22]). There was significant heterogeneity in effect sizes; magnitude was moderated by study design and type of measure used to assess social pleasure.

CONCLUSIONS

Overall, people with schizophrenia seem to exhibit less consummatory social pleasure than controls. However, this deficit is smaller than in studies of anticipated and retrospective pleasure. Thus, consummatory social pleasure may not be quite as impaired in people with schizophrenia as traditional anhedonia research suggests. Moreover, pleasure deficits observed in people with schizophrenia may result from differences in the quality of their daily social experiences rather than differences in their capacity for social pleasure. Results have important implications for clinical interventions that address barriers to social engagement, low-pleasure beliefs, and cognitive remediation to treat schizophrenia.

Correlates of Social Isolation in Forensic Psychiatric Patients with Schizophrenia Spectrum Disorders: An Explorative Analysis Using Machine Learning

The detrimental effects of social isolation on physical and mental health are well known. Social isolation is also known to be associated with criminal behavior, thus burdening not only the affected individual but society in general. Forensic psychiatric patients with schizophrenia spectrum disorders (SSD) are at a particularly high risk for lacking social integration and support due to their involvement with the criminal justice system and their severe mental illness. The present study aims to exploratively evaluate factors associated with social isolation in a unique sample of forensic psychiatric patients with SSD using supervised machine learning (ML) in a sample of 370 inpatients. Out of >500 possible predictor variables, 5 emerged as most influential in the ML model: attention disorder, alogia, crime motivated by ego disturbances, total PANSS score, and a history of negative symptoms. With a balanced accuracy of 69% and an AUC of 0.74, the model showed a substantial performance in differentiating between patients with and without social isolation. The findings show that social isolation in forensic psychiatric patients with SSD is mainly influenced by factors related to illness and psychopathology instead of factors related to the committed offences, e.g., the severity of the crime.

Decoupling between hub-connected functional connectivity of the social brain network and real-world social network in individuals with social anhedonia

Altered hub regions in brain network have been consistently reported in patients with schizophrenia. However, it is unclear whether similar altered hub regions of the brain would be exhibited in individuals with subclinical features of schizophrenia such as social anhedonia (SA). In this study, we examined the hub regions of resting-state social brain network (SBN) of 35 participants with SA and 50 healthy controls (HC). We further examined the prediction effect of hub-connected FCs with SBN on the real-life social network characteristics. Our findings showed that the right amygdala, left temporal lobe and right media superior frontal gyrus were the hub regions of SBN both in SA and HC groups. In the SA group, the left temporal lobe connected functional connectivity (FC) did not predict social network characteristics, while the other FCs strengthened the association with social network characteristics. These findings were replicated in an independent sample of 33 SA and 32 HC. These findings suggested that the left temporal lobe as one of the hub regions of SBN exhibited the abnormality of their connected FCs in the association with social network characteristics in individuals with SA.

Reduced neural activity when anticipating social versus nonsocial rewards in schizophrenia: Preliminary evidence from an ERP study

Diminished social motivation is a core feature of schizophrenia that might reflect disturbances in social reward processing. It is not known whether these disturbances reflect anticipatory ("wanting") and/or consummatory ("liking") pleasure deficits. The primary aim of this study was to examine social versus nonsocial reward processing during these temporally distinct substages using event-related potential (ERP) components. Twenty-three schizophrenia participants and 20 healthy participants completed an incentive delay task with social (i.e., smiling expressions) and nonsocial (i.e., money) rewards. We measured two anticipatory ERPs (i.e., "wanting") (target anticipation: Contingent Negative Variation [CNV]; feedback anticipation: Stimulus Preceding Negativity [SPN]) and one consummatory ERP (i.e., "liking") (feedback receipt: P300). As a secondary aim, we examined correlations between the ERPs and interview-rated motivational negative symptoms and social functioning. Schizophrenia participants showed overall less target anticipation (blunted CNV) across all trials (social and nonsocial) than healthy participants. Importantly, schizophrenia participants exhibited less anticipation of social rewards relative to nonsocial rewards (SPN), whereas healthy participants showed similar anticipation for both reward types. Both groups showed similar responses to social and nonsocial reward receipt (P300). Furthermore, social reward anticipation during the incentive delay task was associated with more social approach behaviors in the real-world. Together, these findings provide preliminary evidence for intact social reward "liking" and impaired "wanting" in schizophrenia.

Negative schizotypy attenuates the effect of momentary stress on social dysfunction related to COVID-19 social distancing

Schizotypy is associated with a broad range of motivational and social dysfunctions. However, there is reason to suspect that negative schizotypy may limit social dysfunction in specific contexts that typically increase isolation and loneliness. We analyzed whether positive, negative and disorganized facets of schizotypy would mitigate detrimental reactions to stress in the context of a global stressor (the COVID-19 pandemic) that has widely necessitated social and physical isolation. Responses to two measures of schizotypy were compared to ecological momentary assessments of social dysfunction for 85 undergraduates using multilevel modelling techniques. Negative schizotypy moderated the relation between momentary stress and loss of social support, such that negative schizotypy limited the magnitude of social dysfunction stemming from increases in momentary stress. This pattern was not seen for other facets of schizotypy. Implications for the treatment and measurement of schizotypy symptoms are discussed.

Psychometric Evaluation of a Controlled Social Affiliation Paradigm: Findings From Anxiety, Depressive Disorder, and Healthy Samples

Social impairments are common across many psychiatric conditions. Standardized dyadic assessments intended to elicit social affiliation between unacquainted partners are used to elucidate mechanisms that disrupt relationship formation and inform possible treatment targets; however, the psychometric properties of such paradigms remain poorly understood. This study evaluated the psychometric properties of a controlled social affiliation paradigm intended to induce connectedness between a target participant and trained confederate. Individuals with an anxiety or depressive disorder diagnosis (clinical group; n = 132) and those without (control group; n = 35) interacted face-to-face with a trained confederate; partners took turns answering a series of increasingly intimate questions about themselves. Social connectedness, affect, and affiliative behavior measures were collected during the interaction. Participant symptom and social functioning measures were collected to examine validity. The paradigm elicited escalating social connectedness throughout the task for both participants and confederates. Parallel forms (i.e., different question sets) elicited similar affiliation outcomes. Self-reported (but not behavioral) affiliation differed across some demographic variables (e.g., participant gender, Hispanic ethnicity). Within-task affiliation measures were associated with one another and with global social connectedness and social anxiety symptom measures, but not with somatic anxiety measures. Clinical participants reported lower social affiliation and positive affect reactivity and higher negative affect reactivity than healthy participants. These findings provide initial psychometric support for a standardized and controlled dyadic affiliation paradigm that could be used to reliably probe social disconnection mechanisms across psychopathology.

An Effortful Approach to Social Affiliation in Schizophrenia: Preliminary Evidence of Increased Theta and Alpha Connectivity during a Live Social Interaction

People with schizophrenia often experience a profound lack of motivation for social affiliation—a facet of negative symptoms that detrimentally impairs functioning. However, the mechanisms underlying social affiliative deficits remain poorly understood, particularly under realistic social contexts. Here, we investigated subjective reports and electroencephalography (EEG) functional connectivity in schizophrenia during a live social interaction. Individuals with schizophrenia (n = 16) and healthy controls (n = 29) completed a face-to-face interaction with a confederate while having EEG recorded. Participants were randomly assigned to either a Closeness condition designed to elicit feelings of closeness through self-disclosure or a Small-Talk condition with minimal disclosure. Compared to controls, patients reported lower positive emotional experiences and feelings of closeness across conditions, but they showed comparably greater subjective affiliative responses for the Closeness (vs. Small-Talk) condition. Additionally, patients in the Closeness (vs. Small-Talk) condition displayed a global increase in connectivity in theta and alpha frequency bands that was not observed for controls. Importantly, greater theta and alpha connectivity was associated with greater subjective affiliative responding, greater negative symptoms, and lower disorganized symptoms in patients. Collectively, findings indicate that patients, because of pronounced negative symptoms, utilized a less efficient, top-down mediated strategy to process social affiliation.

A Randomized Clinical Trial of Oxytocin or Galantamine in Schizophrenia: Assessing the Impact on Behavioral, Lexical, and Self-Report Indicators of Social Affiliation

Prior studies examining the impact of oxytocin on negative symptoms in schizophrenia have yielded mixed results. The current study explored whether oxytocin can improve more proximal indicators of social affiliation as indicated by changes in behavior, language and subjective indices of social affiliation among individuals with schizophrenia spectrum disorders during a role-play designed to elicit affiliative responses. We tested the hypothesis that daily intranasal oxytocin administered for 6 weeks would improve social affiliation as manifested by increased social skill ratings, use of positive, affiliative, and social words, and subjective responses from a previously published randomized controlled trial. Forty outpatients with schizophrenia or schizoaffective disorder were randomized to the oxytocin, galantamine, or placebo group and completed affiliative role-plays and self-report questionnaires of affect, reactions to the affiliative confederate, and willingness to interact at baseline and post-treatment. Results demonstrated that oxytocin was not effective at improving behavioral or subjective indicators of social affiliation. This study adds to a growing literature that the prosocial effects of oxytocin in schizophrenia are limited or null.

Are Negative Symptoms Merely the "Real World" Consequences of Deficits in Social Cognition?

Many investigations have demonstrated that negative symptoms and social cognitive deficits in schizophrenia play a large role in determining functional outcomes and ultimately long-term prognosis. Given this, there is increasing interest in understanding the relationship between these two symptom domains, particularly since studies have consistently found moderate to large associations between them. This shared variance raises a key question: to what degree do these two categories of symptoms arise from overlapping or identical changes in brain function? In other words, do some or all negative symptoms represent merely the downstream effects of social cognition deficits on daily functioning? In this commentary, the evidence for and against this possibility, limitations of currently validated empirical measurements of these symptoms, and directions for further investigation of this hypothesis are discussed. Understanding the shared and distinct mechanisms of these disabling deficits will have important implications for the design of novel, personalized treatments for psychotic illness.

A Transdiagnostic Perspective on Social Anhedonia

Humans are highly social beings, yet people with social anhedonia experience reduced interest in or reward from social situations. Social anhedonia is a key facet of schizotypal personality, an important symptom of schizophrenia, and increasingly recognized as an important feature in a range of other psychological disorders. However, to date, there has been little examination of the similarities and differences in social anhedonia across diagnostic borders. Here, our goal was to conduct a selective review of social anhedonia in different psychological and life course contexts, including the psychosis continuum, depressive disorder, posttraumatic stress disorder, eating disorders, and autism spectrum disorders, along with developmental and neurobiological factors. Current evidence suggests that the nature and expression of social anhedonia vary across psychological disorders with some groups showing deficient learning about, enjoyment from, and anticipation of the pleasurable aspects of social interactions, while for others, some of these components appear to remain intact. However, study designs and methodologies are diverse, the roles of developmental and neurobiological factors are not routinely considered, and direct comparisons between diagnostic groups are rare-which prevents a more nuanced understanding of the underlying mechanisms involved. Future studies, parsing the wanting, liking, and learning components of social reward, will help to fill gaps in the current knowledge base. Consistent across disorders is diminished pleasure from social situations, subsequent withdrawal, and poorer social functioning in those who express social anhedonia. Nonetheless, feelings of loneliness often remain, which suggests the need for social connection is not entirely absent. Adolescence is a particularly important period of social and neural development and may provide a valuable window on the developmental origins of social anhedonia. Adaptive social functioning is key to recovery from mental health disorders; therefore, understanding the intricacies of social anhedonia will help to inform treatment and prevention strategies for a range of diagnostic categories.

The valuation of social rewards in schizophrenia

Social impairment in schizophrenia is often thought to reflect poor social cognition. Here we examine responses to social rewards, an aspect of social functioning that is not featured prominently in the literature. The goal of this experiment was to explore whether people with schizophrenia (a) undervalue social rewards, and (b) whether the undervaluation of social rewards was related to motivation and pleasure deficits in schizophrenia and decreased social functioning. People with schizophrenia and healthy participants completed a game (Shore & Heerey, 2011) to explore preferences for different types of social (polite and genuine smiles) and nonsocial (monetary) rewards from computerized opponents. Preferences for reward types were quantified for each participant based on choice behavior during the game. Participants also completed a smile discrimination task to assess their ability to discriminate these types of smiles. Analyses revealed that people with schizophrenia (N = 41) treated genuine smiles as significantly less rewarding than did healthy participants (N = 29), despite showing a similar preference for monetary rewards. The undervaluation of social rewards was not related to the ability to discriminate between the smiles. The current findings provide preliminary evidence of reduced social reward valuation among individuals with schizophrenia, which may have implications for behavior in face-to-face social interactions. (PsycINFO Database Record

Assessing Social Affiliative Behavior: A Comparison of in Vivo and Video Tasks

Social affiliation, or engagement in positive social interactions, is often profoundly impaired in individuals with schizophrenia. Valid measures of social affiliation are needed to understand these impairments and their symptom and functional correlates; however, such measures are limited and have not been validated. This pilot study evaluated one such measure-the video-based Social Affiliation Interaction Task (SAIT)-and a novel in vivo behavioral measure, the Affiliative Conversation Task (ACT). Twenty participants with schizophrenia or schizoaffective disorder (SZ) and 35 nonpsychiatric controls (CT) completed both tasks and measures of negative symptoms and functioning. We explored group differences in social affiliation skills; convergent validity between social affiliation skill ratings from the two tasks; and concurrent validity with social affiliation skill ratings, negative symptoms, and functioning. SZ evidenced lower affiliation skill ratings than CT on the video SAIT, but not on the ACT, and the tasks displayed moderate convergent validity for affiliation skill ratings. Less affiliation skill in the SAIT was correlated with more negative symptoms and less functioning in the SZ group with medium effects, though the results were not significant. Findings suggest that the SAIT may be more sensitive to individual differences in skill level. Future research should continue to examine the SAIT for use in measuring affiliation skills.

The specific social costs of expressive negative symptoms in schizophrenia: reduced smiling predicts interactional outcome

OBJECTIVE

We tested whether people with schizophrenia and prominent expressive negative symptoms (ENS) show reduced facial expressions in face-to-face social interactions and whether this expressive reduction explains negative social evaluations of these persons.

METHOD

We compared participants with schizophrenia with high ENS (n = 18) with participants with schizophrenia with low ENS (n = 30) and with healthy controls (n = 39). Participants engaged in an affiliative role-play that was coded for the frequency of positive and negative facial expression and rated for social performance skills and willingness for future interactions with the respective role-play partner.

RESULTS

Participants with schizophrenia with high ENS showed significantly fewer positive facial expressions than those with low ENS and controls and were also rated significantly lower on social performance skills and willingness for future interactions. Participants with schizophrenia with low ENS did not differ from controls on these measures. The group difference in willingness for future interactions was significantly and independently mediated by the reduced positive facial expressions and social performance skills.

CONCLUSION

Reduced facial expressiveness in schizophrenia is specifically related to ENS and has negative social consequences. These findings highlight the need to develop aetiological models and targeted interventions for ENS and its social consequences.