Social cognition in patients with schizophrenia spectrum and bipolar disorders with and without psychotic features

Psychological/Personal recovery and its correlates in patients with first episode psychosis

BACKGROUND

Recovery in psychosis is a multidimensional construct. The numbers of studies specially focusing on the recovery aspects in patients with first episode psychosis (FEP) are limited, with no study from India. Further, no study has looked specifically into the variables that affect recovery process in patients with FEP and little is known about factors which influence recovery in patients with FEP.

AIM

To evaluate psychological recovery and its correlates in patients with FEP, currently in clinical remission.

METHODOLOGY

One hundred three patients of FEP in clinical remission were assessed on Recovery Assessment Scale (RAS), Positive and Negative Syndrome Scale for Schizophrenia, Calgary Depression Rating Scale for Schizophrenia, Negative Symptom Assessment 16, Rosenberg Self-esteem Scale, Social and Occupational Functioning Assessment Scale, the Alcohol, Smoking and Substance Involvement Screening Test, Beck Cognitive Insight Scale, Internalized Stigma of Mental Illness Scale, the Everyday discrimination Scale, Subjective Scale to Investigate Cognition in Schizophrenia and social cognitive deficits in theory of mind was evaluated on the Social Cognition Rating Tools in Indian Setting-Theory of Mind. The needs of the participants were assessed on the Camberwell Assessment of Needs - Research version and Supplemental Assessment of Needs. Coping, social support, medication adherence were also assessed by standardized scales.

RESULTS

The mean weighted score was highest for goal and success orientation subscale followed by seeking and relying on social support, personal confidence and hope, overcome the illness and awareness and control over the illness as assessed by 41 items of the RAS. The main factors identified to affect psychological recovery in patients with FEP were duration of untreated psychosis, greater psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigmatization.

CONCLUSION

The present study suggests that treatment of FEP should be started at the earliest and issues such as residual psychopathology, lower self-esteem, total unmet need, feeling of discrimination and stigma during the remission phase should be addressed by psychosocial interventions to promote psychological recovery in patients with first episode psychosis.

The relationship between negative symptoms, social cognition, and social functioning in patients with first episode psychosis

INTRODUCTION

Social functioning is severely affected in psychotic disorders. Negative symptoms and social cognition seem to play an important role in social functioning, although the preponderance and relationship between these three domains is not clear. In this study, we sought to assess the interrelation between social cognition, social functioning, and the expressiveness and experiential factors of negative symptoms in first-episode psychosis (FEP).

SAMPLE AND METHODS

216 patients, participants in a multicentre study (AGES-CM), comprised our study sample. The WHO Disability Assessment Schedule (WHODAS 2.0) was used to assess functioning, whereas the Positive and Negative Schizophrenia Syndrome Scale (PANSS) was used to measure the severity of negative symptoms, and the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) was applied to assess the emotional processing component of social cognition. Network analyses were conducted with the aim of analysing the patterns of relationships between social cognition, social functioning, and the expressiveness and experiential factors of negative symptoms.

RESULTS

Our findings suggest that there is a direct relationship between social cognition and social functioning (weight = -.077), but also an indirect connection between them, mediated by the experiential (but not the expressiveness) factor of negative symptoms (weight = 0.300).

DISCUSSION

The importance of the affectation of subdomains of social cognition, as well as the role of negative symptoms, specifically the experiential factor, in the functioning of patients with FEP seems to be relevant. The inclusion of these factors in prevention and treatment programs would thus allow us to reduce their impact on the social functioning of these patients.

Contributions of executive functions components to affective and cognitive theory of mind in outpatients diagnosed with schizophrenia

Aim was to use a well-stablished Executive Functions (EF) model to test if different EF domains predict performance in affective and cognitive Theory of Mind (ToM) in schizophrenia. Fifty-four outpatients diagnosed with DSM-IV-TR schizophrenia disorder were recruited. Assessment consisted in Trail Making Test Part B (TMT-B) to assess Shifting, WAIS Backwards Digits to assess Updating, Stroop Test Non-congruent trials to assess Inhibition, Reading the Mind in the Eyes Test (RMET), and Hinting Test. Stroop Test Non-congruent predicted RMET scores, while TMT-B predicted Hinting Test scores. Findings suggest that cognitive and affective ToM performance are associated to specific EF processes.

Neurocognitive features in clinical subgroups of bipolar disorder: A meta-analysis

OBJECTIVE

There is a significant cognitive heterogeneity in bipolar disorder (BD). The aim of this systematic review was to examine the potential distinctive neuropsychological of features of clinical subgroups of BD. A literature search investigating cognitive differences between potential subtypes of BD was conducted.

METHODS

It was possible to conduct a meta-analysis of studies investigating the relationship between cognitive deficits and subgroups of DSM-IV BD (type I (BD-I) and type II (BD-II)), subgroups based on history of psychosis (PBD and NPBD). The cognitive domains investigated in this meta-analysis included verbal memory, visual memory, processing speed, executive functions speed (EF-speed), EF-accuracy, attention, working memory, social cognition. Current meta-analysis included 48 reports and compared cognitive performances of 1211 BD-I and 836 BD-II patients. It also compared cognitive functioning in 1017 PBD and 744 NPBD patients.

RESULTS

Both history of psychosis (d = 0.19) and BD-I (d = 0.17) diagnosis were associated with modestly more pronounced global cognitive impairment. In specific domains, BD-I significantly underperformed BD-II in verbal memory, processing speed, EF-speed, EF-accuracy (d = 0.15-0.26). PBD was associated with significantly impaired cognition compared to NPBD in verbal memory, processing speed, EF-speed, EF-accuracy, working memory and social cognition (d = 0.12-0.28).

CONCLUSION

In BD, history of psychosis and full-manic episode are modestly associated with increased cognitive deficits. Neurocognitive differences between clinical subtypes of BD are quite subtle and are not distinctive. Furthermore, other factors reflecting differences in illness severity can explain observed between-group differences. Most of the cognitive heterogeneity in BD cannot be explained by proposed subtypes of BD.

The Cognitive Assessment Interview: A comparative study in first episode and chronic patients with psychosis

The Cognitive Assessment Interview (CAI) is an interview-based instrument to assess cognition considering the impact of cognitive impairment on daily activities. We aimed to explore the associations of the Spanish version of the CAI (CAI-Sp) with a neuropsychological battery and a measure of psychosocial functioning in psychosis. The sample consisted of fifty-six first episode psychosis (FEP) patients and 66 non-FEP patients, who were assessed with a neuropsychological battery, the CAI-Sp and the Short Disability Schedule (DAS-S). Patients also underwent clinical assessment. Additionally, 37 controls were assessed with the neuropsychological battery and CAI-Sp, for normalization purposes. The results showed that CAI-Sp scores were overall correlated with the neuropsychological battery in non-FEP patients. In FEP patients, we found fewer significant correlations. Most associations were maintained after controlling for clinical symptoms. CAI-Sp rater scores contributed to the variance in the DAS-S scores in both groups, as did negative and disorganized symptoms. The CAI-Sp may be a good instrument to assess cognition in non-FEP patients. In FEP patients, it was less effective in capturing cognitive impairments and their functional consequences, probably because cognitive deficits have yet to become evident, due to the recency of illness onset, and no functional disturbances were observed due to these cognitive impairments.

Auditory top-down control and affective theory of mind in schizophrenia with and without hallucinations

Social cognitive impairments may represent a core feature of schizophrenia and above all are a strong predictor of positive psychotic symptoms. Previous studies could show that reduced inhibitory top-down control contributes to deficits in theory of mind abilities and is involved in the genesis of hallucinations. The current study aimed to investigate the relationship between auditory inhibition, affective theory of mind and the experience of hallucinations in patients with schizophrenia. In the present study, 20 in-patients with schizophrenia and 20 healthy controls completed a social cognition task (the Reading the Mind in the Eyes Test) and an inhibitory top-down Dichotic Listening Test. Schizophrenia patients with greater severity of hallucinations showed impaired affective theory of mind as well as impaired inhibitory top-down control. More dysfunctional top-down inhibition was associated with poorer affective theory of mind performance, and seemed to mediate the association between impairment to affective theory of mind and severity of hallucinations. The findings support the idea of impaired theory of mind as a trait marker of schizophrenia. In addition, dysfunctional top-down inhibition may give rise to hallucinations and may further impair affective theory of mind skills in schizophrenia.