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Tsui HKH, Liao Y, Hsiao J, Suen YN, Yan EWC, Poon LT, Siu MW, Hui CLM, Chang WC, Lee EHM, Chen EYH, Chan SKW. Mentalizing impairments and hypermentalizing bias in individuals with first-episode schizophrenia-spectrum disorder and at-risk mental state: the differential roles of neurocognition and social anxiety. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01830-y. [PMID: 38960910 DOI: 10.1007/s00406-024-01830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/10/2024] [Indexed: 07/05/2024]
Abstract
Mentalizing, or theory of mind (ToM), impairments and self-referential hypermentalizing bias are well-evident in schizophrenia. However, findings compared to individuals with at-risk mental states (ARMS) are inconsistent, and investigations into the relationship between social cognitive impairments and social anxiety in the two populations are scarce. This study aimed to examine and compare these deficits in first-episode schizophrenia-spectrum disorder (FES) and ARMS, and to explore potential specific associations with neurocognition and symptomatology. Forty patients with FES, 40 individuals with ARMS, and 40 healthy controls (HC) completed clinical assessments, a battery of neurocognitive tasks, and three social cognitive tasks. The comic strip and hinting tasks were used to measure non-verbal and verbal mentalizing abilities, and the gaze perception task was employed to assess self-referential hypermentalizing bias. FES and ARMS showed comparable mentalizing impairments and self-referential hypermentalizing bias compared to HC. However, only ambiguous self-referential gaze perception (SRGP) bias remained significantly different between three groups after controlling for covariates. Findings suggested that self-referential hypermentalizing bias could be a specific deficit and may be considered a potential behavioral indicator in early-stage and prodromal psychosis. Moreover, working memory and social anxiety were related to the social cognitive impairments in ARMS, whereas higher-order executive functions and positive symptoms were associated with the impairments in FES. The current study indicates the presence of stage-specific mechanisms of mentalizing impairments and self-referential hypermentalizing bias, providing insights into the importance of personalized interventions to improve specific neurocognitive domains, social cognition, and clinical outcomes for FES and ARMS.
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Affiliation(s)
- Harry Kam Hung Tsui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Yingqi Liao
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Janet Hsiao
- Division of Social Science, Hong Kong University of Science & Technology, Clear Water Bay, Hong Kong SAR, China
| | - Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | | | - Lap-Tak Poon
- Department of Psychiatry, United Christian Hospital, Kwun Tong, Hong Kong SAR
| | - Man Wah Siu
- Department of Psychiatry, Kwai Chung Hospital, Kwai Chung, Hong Kong SAR
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR.
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Ma CF, Chien WT, Luo H, Bressington D, Chen EYH, Chan SKW. Impact of Severe Acute Respiratory Syndrome, Coronavirus Disease 2019, and Social Unrest on Adult Psychiatric Admissions in Hong Kong: A Comparative Population-Based Study. J Nerv Ment Dis 2023; 211:968-973. [PMID: 38015187 DOI: 10.1097/nmd.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
ABSTRACT In Hong Kong, two infectious disease outbreaks occurred in 2003 (SARS) and 2020 (COVID-19), and a large-scale social unrest happened in 2019. These were stressful societal events that influenced the mental well-being of the public. We aimed to explore the impact of these events on psychiatric admissions in Hong Kong. Socioeconomic and population-based psychiatric hospital admission data were retrieved from the government and Hospital Authority. Negative binomial time-series regression analysis was applied and we found overall significant reductions of psychiatric admissions during both the SARS and COVID-19 periods (-7.4% to -16.8%). Particularly, the admissions for unipolar disorders (-16.2% to -39.7%) and neuroses (-20.9% to -31.9%) were greatly reduced during the infection outbreaks. But an increase of admissions for schizophrenia (12.0%) was seen during the social unrest period. These findings support introducing early and targeted community mental health care strategies to the vulnerable people during the stressful societal events.
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Affiliation(s)
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong
| | - Hao Luo
- Department of Social Work and Social Administration, Faculty of Social Science, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Australia
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Zaviazkina NV, Balashevych OK, Korotkevych YY. PECULIARITIES OF PERCEPTION OF NON-VERBAL STIMULI BY PATIENTS WITH SCHIZOPHRENIA: SUBJECTIVE UNDERSTANDING, INTEREST AND EMOTIONS. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1966-1977. [PMID: 37898932 DOI: 10.36740/wlek202309110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVE The aim: The main purpose of this article was to investigate the subjective understanding, interest, and emotional perception of non-verbal stimuli by schizophrenic patients. PATIENTS AND METHODS Materials and methods: For this study, the clinical interview method was used, in which all questions were presented in Ukrainian. The questionnaire form was divided into three main blocks: socio-demographic, mental anamnesis, and non-verbal stimulus assessment. 50 respondents took part in the study. The experimental group, i.e., respondents with schizophrenia spectrum disorders, made up 58% (n = 29) of the total number of respondents, and the control group, respondents with other diagnoses, made up 42% (n = 21). RESULTS Results: The results showed that in both groups the level of abstractness or objectivity of the drawings affected the understanding of what was depicted. Patients with schizophrenia had a better understanding of images that didn't have a single semantic and compositional whole. The abstractness of the drawings and their detailing affected the appearance of interest in the image in people who have disorders on the schizophrenia spectrum. In addition, the more realistic the objects in the picture were, the less interesting it was for people with schizophrenia spectrum disorders. CONCLUSION Conclusions: In conclusion, schizophrenic patients found stereotypical signs of emotions much more easily than respondents with other diagnoses, and facial expressions were the most important factor in determining the emotional component of drawings.
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Bachofner H, Scherer KA, Vanbellingen T, Bohlhalter S, Stegmayer K, Walther S. Validation of the Apraxia Screen TULIA (AST) in Schizophrenia. Neuropsychobiology 2022; 81:311-321. [PMID: 35367989 PMCID: PMC9533426 DOI: 10.1159/000523778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deficits in social interaction and community functioning, including impaired use, performance, and perception of hand gestures, are key features in schizophrenia. A well-established tool to assess gesture deficits is the test of upper limb apraxia (TULIA). However, given its time-consuming application based on video analyses, research has proposed the bedside apraxia screen of TULIA (AST). This study aims to test the validity and reliability of the AST to detect gesture abnormalities at bedside in a sample of 27 patients diagnosed with schizophrenia, schizotypal disorder, acute and transient psychotic disorders, or schizoaffective disorder. METHODS Patients completed the 48-item TULIA and the 12-item AST. Two different raters assessed the AST: one at bedside (online) and the other based on the video recordings. RESULTS The total AST scores demonstrated a high parallel reliability, moderate inter-rater reliability on a single-item level, and good construct validities. CONCLUSIONS The psychometric properties of the AST suggest it can well be used for the clinical assessment of gesture deficits in schizophrenia. However, when detailed information is required, the AST rated from video or conducting the full TULIA is recommended. The findings call for refining the selection of the TULIA items for a psychosis-AST bedside test to increase specificity.
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Affiliation(s)
- Hanta Bachofner
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland,*Hanta Bachofner,
| | - Konstantin A. Scherer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland,University Hospital, University of Zurich, Zurich, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Riedl L, Nagels A, Sammer G, Choudhury M, Nonnenmann A, Sütterlin A, Feise C, Haslach M, Bitsch F, Straube B. Multimodal speech-gesture training in patients with schizophrenia spectrum disorder: Effects on quality of life and neural processing. Schizophr Res 2022; 246:112-125. [PMID: 35759877 DOI: 10.1016/j.schres.2022.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/25/2022] [Accepted: 06/11/2022] [Indexed: 12/30/2022]
Abstract
Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia spectrum disorder (SSD) that severely affects quality of life. Interpreting abstract speech and integrating nonverbal information is particularly affected. Considering the difficulty to treat communication dysfunctions with usual intervention, we investigated the possibility to apply a multimodal speech-gesture (MSG) training. In the MSG training, we offered 8 sessions (60 min each) including perceptive and expressive tasks as well as meta-learning elements and transfer exercises to 29 patients with SSD. In a within-group crossover design, patients were randomized to a TAU-first (treatment as usual first, then MSG training) group (N = 20) or a MSG-first (MSG training first, then TAU only) group (N = 9), and were compared to healthy controls (N = 17). Outcomes were quality of life and related changes in the neural processing of abstract speech-gesture information, which were measured pre-post training through standardized psychological questionnaires and functional Magnetic Resonance Imaging, respectively. Pre-training, patients showed reduced quality of life as compared to controls but improved significantly during the training. Strikingly, this improvement was correlated with neural activation changes in the middle temporal gyrus for the processing of abstract multimodal content. Improvement during training, self-report measures and ratings of relatives confirmed the MSG-related changes. Together, we provide first promising results of a novel multimodal speech-gesture training for patients with schizophrenia. We could link training induced changes in speech-gesture processing to changes in quality of life, demonstrating the relevance of intact communication skills and gesture processing for well-being.
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Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University, Giessen, Germany.
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Momoko Choudhury
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Annika Nonnenmann
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Anne Sütterlin
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Chiara Feise
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Maxi Haslach
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Florian Bitsch
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University, Giessen, Germany
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Pavlidou A, Chapellier V, Maderthaner L, von Känel S, Walther S. Using dynamic point light display stimuli to assess gesture deficits in schizophrenia. Schizophr Res Cogn 2022; 28:100240. [PMID: 35242609 PMCID: PMC8866720 DOI: 10.1016/j.scog.2022.100240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/27/2022] [Accepted: 01/27/2022] [Indexed: 12/29/2022]
Abstract
Background Gesture deficits are ubiquitous in schizophrenia patients contributing to poor social communication and functional outcome. Given the dynamic nature of social communications, the current study aimed to explore the underlying socio-cognitive processes associated with point-light-displays (PLDs) of communicative gestures in the absence of any other confounding visual characteristics, and compare them to other well-established stimuli of gestures such as pictures by examining their association with symptom severity and motor-cognitive modalities. Methods We included 39-stable schizophrenia outpatients and 27-age-gender matched controls and assessed gesture processing using two tasks. The first task used static stimuli of pictures of a person performing a gesture. The limbs executing the gesture were missing and participants' task was to choose the correct gesture from three-options provided. The second task included videos of dynamic PLDs interacting with each other. One PLD performed communicative gestures, while the other PLD imitated/followed these performed gestures. Participants had to indicate, which of the two PLDs was imitating/following the other. Additionally, we evaluated symptom severity, as well as, motor and cognitive parameters. Results Patients underperformed in both gesture tasks compared to controls. Task performance for static stimuli was associated with blunted affect, motor coordination and sequencing domains, while PLD performance was associated with expressive gestures and sensory integration processes. Discussion Gesture representations of static and dynamic stimuli are associated with distinct processes contributing to poor social communication in schizophrenia, requiring novel therapeutic interventions. Such stimuli can easily be applied remotely for screening socio-cognitive deficits in schizophrenia.
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Affiliation(s)
- Anastasia Pavlidou
- Corresponding author at: Psychiatric Services University of Bern, University Hospital of Psychiatry and Psychotherapy, Division of Systems Neuroscience of Psychopathology, Translational Research Center, Bollingerstr. 111, CH-3000 Bern 60, Switzerland.
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Chapellier V, Pavlidou A, Maderthaner L, von Känel S, Walther S. The Impact of Poor Nonverbal Social Perception on Functional Capacity in Schizophrenia. Front Psychol 2022; 13:804093. [PMID: 35282219 PMCID: PMC8904900 DOI: 10.3389/fpsyg.2022.804093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Nonverbal social perception is the ability to interpret the intentions and dispositions of others by evaluating cues such as facial expressions, body movements, and emotional prosody. Nonverbal social perception plays a key role in social cognition and is fundamental for successful social interactions. Patients with schizophrenia have severe impairments in nonverbal social perception leading to social isolation and withdrawal. Collectively, these aforementioned deficits affect patients’ quality of life. Here, we compare nonverbal social perception in patients with schizophrenia and controls and examine how nonverbal social perception relates to daily functioning. Methods We compared nonverbal social perception in 41 stable outpatients with schizophrenia and 30 healthy controls using the Mini Profile of Nonverbal Sensitivity (Mini-PONS). The participants evaluated 64 video clips showing a female actor demonstrating various nonverbal social cues. Participants were asked to choose one of two options that best described the observed scenario. We correlated clinical ratings (Positive and Negative Syndrome Scale, Brief Negative Syndrome Scale), Self-report of Negative Symptoms, and functional assessments (functional capacity and functional outcome) with Mini-PONS scores. Results Patients performed significantly poorer in the Mini-PONS compared to controls, suggesting deficits in nonverbal social perception. These deficits were not associated with either positive symptoms or negative symptoms (including self-report). However, impaired nonverbal social perception correlated with distinctive domains of BNSS (mainly avolition and blunted affect), as well as functional capacity and functional outcome in patients. Conclusion We demonstrate that nonverbal social perception is impaired in stable outpatients with schizophrenia. Nonverbal social perception is directly related to specific negative symptom domains, functional capacity and functional outcome. These findings underline the importance of nonverbal social perception for patients’ everyday life and call for novel therapeutic approaches to alleviate nonverbal social perception deficits.
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Affiliation(s)
- Victoria Chapellier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Lydia Maderthaner
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sofie von Känel
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Choudhury M, Steines M, Nagels A, Riedl L, Kircher T, Straube B. Neural Basis of Speech-Gesture Mismatch Detection in Schizophrenia Spectrum Disorders. Schizophr Bull 2021; 47:1761-1771. [PMID: 34050672 PMCID: PMC8530401 DOI: 10.1093/schbul/sbab059] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patients with schizophrenia spectrum disorders (SSD) exhibit an aberrant perception and comprehension of abstract speech-gesture combinations associated with dysfunctional activation of the left inferior frontal gyrus (IFG). Recently, a significant deficit of speech-gesture mismatch detection was identified in SSD, but the underlying neural mechanisms have not yet been examined. A novel mismatch-detection fMRI paradigm was implemented manipulating speech-gesture abstractness (abstract/concrete) and relatedness (related/unrelated). During fMRI data acquisition, 42 SSD patients (schizophrenia, schizoaffective disorder, or other non-organic psychotic disorder [ICD-10: F20, F25, F28; DSM-IV: 295.X]) and 36 healthy controls were presented with short video clips of an actor reciting abstract or concrete sentences accompanied by either a semantically related or unrelated gesture. Participants indicated via button press whether they perceived each gesture as matching the speech content or not. Speech-gesture mismatch detection performance was significantly impaired in patients compared to controls. fMRI data analysis revealed that patients showed lower activation in bilateral frontal areas, including the IFG for all abstract > concrete speech-gesture pairs. In addition, they exhibited reduced engagement of the right supplementary motor area (SMA) and bilateral anterior cingulate cortices (ACC) for unrelated > related stimuli. We provide first evidence that impaired speech-gesture mismatch detection in SSD could be the result of dysfunctional activation of the SMA and ACC. Failure to activate the left IFG disrupts the integration of abstract speech-gesture combinations in particular. Future investigations should focus on brain stimulation of the SMA, ACC, and the IFG to improve communication and social functioning in SSD.
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Affiliation(s)
- Momoko Choudhury
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Miriam Steines
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lydia Riedl
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Tilo Kircher
- Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University Giessen, Marburg, Germany,Systems Neuroscience, Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany,Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University Giessen, Marburg, Germany,To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Rudolf-Bultmann-Str. 8, D-35039 Marburg, Germany; tel: +49-(0)6421-58-66429, fax: +49-3212-75-86605, e-mail:
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Abstract
Individuals diagnosed with psychotic disorders exhibit abnormalities in the perception of expressive behaviors, which are linked to symptoms and visual information processing domains. Specifically, literature suggests these groups have difficulties perceiving gestures that accompany speech. While our understanding of gesture perception in psychotic disorders is growing, gesture perception abnormalities and clues about potential causes and consequences among individuals meeting criteria for a clinical high-risk (CHR) syndrome is limited. Presently, 29 individuals with a CHR syndrome and 32 healthy controls completed an eye-tracking gesture perception paradigm. In this task, participants viewed an actor using abstract and literal gestures while presenting a story and eye gaze data (eg, fixation counts and total fixation time) was collected. Furthermore, relationships between fixation variables and both symptoms (positive, negative, anxiety, and depression) and measures of visual information processing (working memory and attention) were examined. Findings revealed that the CHR group gazed at abstract gestures fewer times than the control group. When individuals in the CHR group did gaze at abstract gestures, on average, they spent significantly less time fixating compared to controls. Furthermore, reduced fixation (ie, count and time) was related to depression and slower response time on an attentional task. While a similar pattern of group differences in the same direction appeared for literal gestures, the effect was not significant. These data highlight the importance of integrating gesture perception abnormalities into vulnerability models of psychosis and inform the development of targeted treatments for social communicative deficits.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL,To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL
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Pavlidou A, Walther S. Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia. Front Psychol 2021; 11:607312. [PMID: 33488466 PMCID: PMC7817610 DOI: 10.3389/fpsyg.2020.607312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
Movement abnormalities are prevalent across all stages of schizophrenia contributing to poor social functioning and reduced quality of life. To date, treatments are scarce, often involving pharmacological agents, but none have been shown to improve movement abnormalities effectively. Virtual reality (VR) is a tool used to simulate virtual environments where behavioral performance can be quantified safely across different tasks while exerting control over stimulus delivery, feedback and measurement in real time. Sensory information is transmitted via a head mounted display allowing users to directly interact with virtual objects and bodies using gestures and body movements in the real world to perform different actions, permitting a sense of immersion in the simulated virtual environment. Although, VR has been widely used for successful motor rehabilitation in a variety of different neurological domains, none have been exploited for motor rehabilitation in schizophrenia. The objectives of this article are to review movement abnormalities specific to schizophrenia, and how VR can be utilized to restore and improve motor functioning in patients with schizophrenia. Constructing VR-mediated motor-cognitive interventions that can help in retaining and transferring the learned outcomes to real life are also discussed.
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Affiliation(s)
- Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
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Wagstaff DL, Van doorn G. The effect of schizotypy on the relationship between women's red clothing and perceived sexual interest. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Danielle L. Wagstaff
- School of Health Science and Psychology, Federation University Australia, Churchill, Victoria, Australia,
| | - George Van doorn
- School of Health Science and Psychology, Federation University Australia, Churchill, Victoria, Australia,
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Gesture deficits and apraxia in schizophrenia. Cortex 2020; 133:65-75. [PMID: 33099076 DOI: 10.1016/j.cortex.2020.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.
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Wei Q, Zhao L, Zou Y, Wang J, Qiu Y, Niu M, Kang Z, Liu X, Tang Y, Li C, Zhang J, Fan X, Huang R, Han Z. The role of altered brain structural connectivity in resilience, vulnerability, and disease expression to schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109917. [PMID: 32169560 DOI: 10.1016/j.pnpbp.2020.109917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Schizophrenia (SCZ) is a highly heritable disorder associated with brain connectivity changes. Although the mechanism of disease expression and vulnerability of SCZ have been reported by previous studies, the mechanism of resilience to SCZ based on the brain structural connectivity is poorly understood. The goal of the present study was to identify the structural brain connectivity related with the resilience to SCZ, which is defined here as the capacity to avoid or delay the onset of SCZ in unaffected siblings of SCZ probands. METHOD We collected diffusion tensor imaging (DTI) data of 49 medication-naive, first-episode SCZ (FE-SCZ) patients, 56 unaffected siblings of SCZ probands (SIB-SCZ), and 90 healthy controls. Then we used graph theoretical approach to calculate the topological properties of the brain structural network, including global, subnetwork, and regional parameters. Finally, we compared the parameters between the three groups, and identified the brain structural network related to the resilience, vulnerability and disease expression to SCZ. RESULTS With respect to resilience, only the SIB-SCZ showed significantly increased connectivity in the subnetworks of the left cuneus-precuneus and left posterior cingulate gyrus-precuneus, and in brain areas of right supramarginal gyrus and right inferior temporal gyrus. With respect to vulnerability, both the FE-SCZ and SIB-SCZ had decreased cluster coefficients and local efficiency, and decreased nodal efficiency in the right medial superior frontal gyrus and right medial orbital superior frontal gyrus compared with the healthy controls. With respect to disease expression, only the FE-SCZ group showed decreased or increased global, subnetwork, and nodal connectivity in broader brain regions compared with the healthy controls. CONCLUSION Difference in the topological properties of brain structural connectivity not only reflect the underlying mechanism of vulnerability but also that of resilience to schizophrenia. Alteration in the brain structural connectivity associating with resilience and disease expression may contribute to the onset of SCZ.
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Affiliation(s)
- Qinling Wei
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Ling Zhao
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, 55 Zhongshan Avenue West, Guangzhou, Guangdong Province, China; Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH University, Aachen, Germany
| | - Yan Zou
- Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Junjing Wang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, 55 Zhongshan Avenue West, Guangzhou, Guangdong Province, China; Department of Applied Psychology, Guangdong University of Foreign Studies, Guangzhou 510006, China
| | - Yong Qiu
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Meiqi Niu
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, 55 Zhongshan Avenue West, Guangzhou, Guangdong Province, China
| | - Zhuang Kang
- Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Xiaojin Liu
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, 55 Zhongshan Avenue West, Guangzhou, Guangdong Province, China
| | - Yanxia Tang
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China; Department of Neurology, Yiyang Central Hospital,118 Kangfu Road,Yiyang, Hunan Province 413000, China
| | - Changhong Li
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, 55 Zhongshan Avenue West, Guangzhou, Guangdong Province, China
| | - Jinbei Zhang
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China
| | - Xiaoduo Fan
- UMass Memorial Medical Center, University of Massachusetts Medical School, One Biotech, Suite 100, 365 Plantation Street, Worcester, MA 01605, United States
| | - Ruiwang Huang
- Center for the Study of Applied Psychology, Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, School of Psychology, South China Normal University, 55 Zhongshan Avenue West, Guangzhou, Guangdong Province, China.
| | - Zili Han
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong Province, China.
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14
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Walther S, Kunz M, Müller M, Zürcher C, Vladimirova I, Bachofner H, Scherer KA, Nadesalingam N, Stegmayer K, Bohlhalter S, Viher PV. Single Session Transcranial Magnetic Stimulation Ameliorates Hand Gesture Deficits in Schizophrenia. Schizophr Bull 2020; 46:286-293. [PMID: 31634401 PMCID: PMC7442336 DOI: 10.1093/schbul/sbz078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social interaction is impaired in schizophrenia, including the use of hand gestures, which is linked to poor social perception and outcome. Brain imaging suggests reduced neural activity in a left-lateralized frontoparietal network during gesture preparation; therefore, gesturing might be improved through facilitation of left hemispheric brain areas or via disruption of interhemispheric inhibition from the right homolog. This study tested whether repetitive transcranial magnetic stimulation (rTMS) protocols would improve gesture performance in schizophrenia. This randomized, placebo-controlled, double-blind, crossover trial applied 3 different protocols of rTMS separated by 48 h. Twenty right-handed schizophrenia patients and 20 matched healthy controls received facilitatory intermittent theta burst stimulation (iTBS) over the left inferior frontal gyrus (IFG), inhibitory continuous theta burst stimulation (cTBS) over right inferior parietal lobe (IPL), and placebo over left IPL in randomized order. Primary outcome was change in the test of upper limb apraxia (TULIA), rated from video recordings of hand gesture performance. Secondary outcome was change in manual dexterity using the coin rotation task. Participants improved on both tasks following rTMS compared with baseline. Only patients improved gesture performance following right IPL cTBS compared with placebo (P = .013). The results of the coin rotation parallel those of the TULIA, with improvements following right IPL cTBS in patients (P = .001). Single sessions of cTBS on the right IPL substantially improved both gesture performance accuracy and manual dexterity. The findings point toward an inhibition of interhemispheric rivalry as a potential mechanism of action.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland,To whom correspondence should be addressed; Translational Research Center, University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, 3008 Bern, Switzerland; tel: 41-31-632-8979, fax: +41 31 632 8950, e-mail:
| | - Maribel Kunz
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Manuela Müller
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Caroline Zürcher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Irena Vladimirova
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Hanta Bachofner
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Konstantin A Scherer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | - Petra V Viher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
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15
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Walther S, Alexaki D, Stegmayer K, Vanbellingen T, Bohlhalter S. Conceptual disorganization impairs hand gesture performance in schizophrenia. Schizophr Res 2020; 215:467-468. [PMID: 31500999 DOI: 10.1016/j.schres.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
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16
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Schülke R, Straube B. Transcranial Direct Current Stimulation Improves Semantic Speech-Gesture Matching in Patients With Schizophrenia Spectrum Disorder. Schizophr Bull 2019; 45:522-530. [PMID: 30304518 PMCID: PMC6483581 DOI: 10.1093/schbul/sby144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with schizophrenia spectrum disorders (SSD) have severe deficits in speech and gesture processing that contribute considerably to the burden of this disorder. Brain imaging shows left inferior frontal gyrus involvement for impaired processing of co-verbal gestures in patients with schizophrenia. Recently, transcranial direct current stimulation (tDCS) of the left frontal lobe has been shown to modulate processing of co-verbal gestures in healthy subjects. Although tDCS has been used to reduce symptoms of patients with SSD, the effects of tDCS on gesture processing deficits remain hitherto unexplored. OBJECTIVE Here we tested the hypothesis that inhibitory cathodal tDCS of the left frontal lobe decreases pathological dysfunction and improves semantic processing of co-verbal gestures in patients with SSD. METHODS We measured ratings and reaction times in a speech-gesture semantic relatedness assessment task during application of frontal, frontoparietal, parietal, and sham tDCS to 20 patients with SSD and 29 healthy controls. RESULTS We found a specific effect of tDCS on speech-gesture relatedness ratings of patients. Frontal compared to parietal and sham stimulation significantly improved the differentiation between related and unrelated gestures. Placement of the second electrode (right frontal vs parietal) did not affect the effect of left frontal stimulation, which reduced the preexisting difference between patients and healthy controls. CONCLUSION Here we show that left frontal tDCS can improve semantic co-verbal gesture processing in patients with SSD. tDCS could be a viable tool to normalize processing in the left frontal lobe and facilitate direct social communicative functioning in patients with SSD.
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Affiliation(s)
- Rasmus Schülke
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany,To whom correspondence should be addressed; Rudolf-Bultmann-Str. 8, Marburg 35039, Germany; tel: +49-(0)-6421-58-66429, fax: +49-(0)-6421-5865406, e-mail:
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17
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Dutschke LL, Stegmayer K, Ramseyer F, Bohlhalter S, Vanbellingen T, Strik W, Walther S. Gesture impairments in schizophrenia are linked to increased movement and prolonged motor planning and execution. Schizophr Res 2018; 200:42-49. [PMID: 28709771 DOI: 10.1016/j.schres.2017.07.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 11/17/2022]
Abstract
Schizophrenia patients present with a variety of impaired nonverbal communication skills. Performance of hand gestures is frequently impaired and associated with ratings of motor abnormalities. However, the impact of motor abnormalities to gesture performance remains unclear. To test the association between quantitative measures of motor behavior and qualitative ratings of gesture performance, we quantified movement parameters semi-automatically in videotaped recordings of gesture assessment. Thirty-one patients with schizophrenia (77.4%), schizophreniform (19.4%) or schizoaffective disorder (3.2%) and 32 healthy controls matched for age, gender and education underwent clinical assessment. Performance of the test of upper limb apraxia (TULIA) was video-taped in all subjects. The videos were analyzed with motion energy analysis software (MEA) to determine motion and time parameters. Patients and controls differed significantly in quantitative gesture performance: patients required more movement and more time to complete the tasks. Differences increased in patients with qualitatively impaired gesture production ratings (p<0.01). Group differences were most pronounced in the pantomime domain, when gestures are performed following verbal instruction. In patients, ratings of motor abnormalities correlated with duration of movement, while behavioral disorganization correlated with the amount of movements during gesture performance. Disorder related motor symptoms, aberrant action observation, planning and monitoring as well as internal clock abnormalities may explain the poor performance of hand gestures in schizophrenia. Quantitative video analysis offers a unique possibility to analyze movement patterns as a direct functional output of the motor system. In the future, it may assist monitoring, staging and prognosis in schizophrenia.
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Affiliation(s)
- Lars Levi Dutschke
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Fabian Ramseyer
- Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
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18
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Okruszek Ł, Wordecha M, Jarkiewicz M, Kossowski B, Lee J, Marchewka A. Brain correlates of recognition of communicative interactions from biological motion in schizophrenia. Psychol Med 2018; 48:1862-1871. [PMID: 29173243 DOI: 10.1017/s0033291717003385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Recognition of communicative interactions is a complex social cognitive ability which is associated with a specific neural activity in healthy individuals. However, neural correlates of communicative interaction processing from whole-body motion have not been known in patients with schizophrenia (SCZ). Therefore, the current study aims to examine the neural activity associated with recognition of communicative interactions in SCZ by using displays of the dyadic interactions downgraded to minimalistic point-light presentations. METHODS Twenty-six healthy controls (HC) and 25 SCZ were asked to judge whether two agents presented only by point-light displays were communicating or acting independently. Task-related activity and functional connectivity of brain structures were examined with General Linear Model and Generalized Psychophysiological Interaction approach, respectively. RESULTS HC were significantly more efficient in recognizing each type of action than SCZ. At the neural level, the activity of the right posterior superior temporal sulcus (pSTS) was observed to be higher in HC compared with SCZ for communicative v. individual action processing. Importantly, increased connectivity of the right pSTS with structures associated with mentalizing (left pSTS) and mirroring networks (left frontal areas) was observed in HC, but not in SCZ, during the presentation of social interactions. CONCLUSION Under-recruitment of the right pSTS, a structure known to have a pivotal role in social processing, may also be of importance for higher-order social cognitive deficits in SCZ. Furthermore, decreased task-related connectivity of the right pSTS may result in reduced use of additional sources of information (for instance motor resonance signals) during social cognitive processing in schizophrenia.
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Affiliation(s)
- Ł Okruszek
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - M Wordecha
- Clinical Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - M Jarkiewicz
- Institute of Psychiatry and Neurology, Warsaw, Poland
| | - B Kossowski
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - J Lee
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - A Marchewka
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
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19
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Strik W, Stegmayer K, Walther S, Dierks T. Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems. Neuropsychobiology 2018; 75:100-116. [PMID: 29258073 DOI: 10.1159/000485221] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Schizophrenia research has been in a deadlock for many decades. Despite important advances in clinical treatment, there are still major concerns regarding long-term psychosocial reintegration and disease management, biological heterogeneity, unsatisfactory predictors of individual course and treatment strategies, and a confusing variety of controversial theories about its etiology and pathophysiological mechanisms. In the present perspective on schizophrenia research, we first discuss a methodological pitfall in contemporary schizophrenia research inherent in the attempt to link mental phenomena with the brain: we claim that the time-honored phenomenological method of defining mental symptoms should not be contaminated with the naturalistic approach of modern neuroscience. We then describe our Systems Neuroscience of Psychosis (SyNoPsis) project, which aims to overcome this intrinsic problem of psychiatric research. Considering schizophrenia primarily as a disorder of interindividual communication, we developed a neurobiologically informed semiotics of psychotic disorders, as well as an operational clinical rating scale. The novel psychopathology allows disentangling the clinical manifestations of schizophrenia into behavioral domains matching the functions of three well-described higher-order corticobasal brain systems involved in interindividual human communication, namely, the limbic, associative, and motor loops, including their corticocortical sensorimotor connections. The results of several empirical studies support the hypothesis that the proposed three-dimensional symptom structure, segregated into the affective, the language, and the motor domain, can be specifically mapped onto structural and functional abnormalities of the respective brain systems. New pathophysiological hypotheses derived from this brain system-oriented approach have helped to develop and improve novel treatment strategies with noninvasive brain stimulation and practicable clinical parameters. In clinical practice, the novel psychopathology allows confining the communication deficits of the individual patient, shifting attention from the symptoms to the intact resources. We have studied this approach and observed important advantages for therapeutic alliances, personalized treatment, and de-escalation strategies. Future studies will further conjoin clinical definitions of psychotic symptoms with brain structures and functions, and disentangle structural and functional deficit patterns within these systems to identify neurobiologically distinct subsyndromes. Neurobiologically homogeneous patient groups may provide new momentum for treatment research. Finally, lessons learned from schizophrenia research may contribute to developing a comprehensive perspective on human experience and behavior that integrates methodologically distinct, but internally consistent, insights from humanities and neuroscience.
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20
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Stegmayer K, Bohlhalter S, Vanbellingen T, Federspiel A, Wiest R, Müri RM, Strik W, Walther S. Limbic Interference During Social Action Planning in Schizophrenia. Schizophr Bull 2018; 44:359-368. [PMID: 28575506 PMCID: PMC5814975 DOI: 10.1093/schbul/sbx059] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Schizophrenia is characterized by social interaction deficits contributing to poor functional outcome. Hand gesture use is particularly impaired, linked to frontal lobe dysfunction and frontal grey matter deficits. The functional neural correlates of impaired gesturing are currently unclear. We therefore investigated aberrant brain activity during impaired gesturing in schizophrenia. We included 22 patients with schizophrenia and 25 healthy control participants matched for age, gender, and education level. We obtained functional magnetic resonance imaging data using an event-related paradigm to assess brain activation during gesture planning and execution. Group differences in whole brain effects were calculated using factorial designs. Gesture ratings were performed by a single rater, blind to diagnoses and clinical presentation. During gesture planning and execution both groups activated brain areas of the praxis network. However, patients had reduced dorsolateral prefrontal cortex (DLPFC) and increased inferior parietal lobe (IPL) activity. Performance accuracy was associated with IPL activity in patients. Furthermore, patients activated temporal poles, amygdala and hippocampus during gesture planning, which was associated with delusion severity. Finally, patients demonstrated increased dorsomedial prefrontal cortex activity during planning of novel gestures. We demonstrate less prefrontal, but more IPL and limbic activity during gesturing in schizophrenia. IPL activity was associated with performance accuracy, whereas limbic activity was linked to delusion severity. These findings may reflect impaired social action planning and a limbic interference with gestures in schizophrenia contributing to poor gesture performance and consequently poor social functioning in schizophrenia.
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Affiliation(s)
- Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland,To whom correspondence should be addressed; University Hospital of Psychiatry, Bolligenstrasse 111, 3060 Bern, Switzerland; tel: +41-31-930-9757, fax: +41-31-930-9404, e-mail:
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, University Hospital, Inselspital, Bern, Switzerland
| | - René M Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
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21
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Viher PV, Stegmayer K, Kubicki M, Karmacharya S, Lyall AE, Federspiel A, Vanbellingen T, Bohlhalter S, Wiest R, Strik W, Walther S. The cortical signature of impaired gesturing: Findings from schizophrenia. NEUROIMAGE-CLINICAL 2017; 17:213-221. [PMID: 29159038 PMCID: PMC5683189 DOI: 10.1016/j.nicl.2017.10.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/18/2017] [Accepted: 10/18/2017] [Indexed: 01/09/2023]
Abstract
Schizophrenia is characterized by deficits in gesturing that is important for nonverbal communication. Research in healthy participants and brain-damaged patients revealed a left-lateralized fronto-parieto-temporal network underlying gesture performance. First evidence from structural imaging studies in schizophrenia corroborates these results. However, as of yet, it is unclear if cortical thickness abnormalities contribute to impairments in gesture performance. We hypothesized that patients with deficits in gesture production show cortical thinning in 12 regions of interest (ROIs) of a gesture network relevant for gesture performance and recognition. Forty patients with schizophrenia and 41 healthy controls performed hand and finger gestures as either imitation or pantomime. Group differences in cortical thickness between patients with deficits, patients without deficits, and controls were explored using a multivariate analysis of covariance. In addition, the relationship between gesture recognition and cortical thickness was investigated. Patients with deficits in gesture production had reduced cortical thickness in eight ROIs, including the pars opercularis of the inferior frontal gyrus, the superior and inferior parietal lobes, and the superior and middle temporal gyri. Gesture recognition correlated with cortical thickness in fewer, but mainly the same, ROIs within the patient sample. In conclusion, our results show that impaired gesture production and recognition in schizophrenia is associated with cortical thinning in distinct areas of the gesture network. Impairments in gesture production and recognition in schizophrenia are related to altered brain structure. Brain alterations in schizophrenia are located in areas that are generally damaged in apraxia. Schizophrenia patients with gesture deficits show cortical thinning of several regions in the gesture network. Deficits of gesture production and recognition are both related to a fronto-parieto-temporal gesture network.
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Affiliation(s)
- Petra Verena Viher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland; Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Marek Kubicki
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Sarina Karmacharya
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Amanda Ellis Lyall
- Department of Psychiatry, Psychiatry Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Department of Clinical Research, Inselspital, Bern, Switzerland; Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland; Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Roland Wiest
- Support Center of Advanced Neuroimaging, Institute of Neuroradiology, University of Bern, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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22
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Prikken M, van der Weiden A, Renes RA, Koevoets MGJC, Heering HD, Kahn RS, Aarts H, van Haren NEM. Abnormal agency experiences in schizophrenia patients: Examining the role of psychotic symptoms and familial risk. Psychiatry Res 2017; 250:270-276. [PMID: 28189096 DOI: 10.1016/j.psychres.2016.10.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 09/01/2016] [Accepted: 10/30/2016] [Indexed: 11/24/2022]
Abstract
Experiencing self-agency over one's own action outcomes is essential for social functioning. Recent research revealed that patients with schizophrenia do not use implicitly available information about their action-outcomes (i.e., prime-based agency inference) to arrive at self-agency experiences. Here, we examined whether this is related to symptoms and/or familial risk to develop the disease. Fifty-four patients, 54 controls, and 19 unaffected (and unrelated) siblings performed an agency inference task, in which experienced agency was measured over action-outcomes that matched or mismatched outcome-primes that were presented before action performance. The Positive and Negative Syndrome Scale (PANSS) and Comprehensive Assessment of Symptoms and History (CASH) were administered to assess psychopathology. Impairments in prime-based inferences did not differ between patients with symptoms of over- and underattribution. However, patients with agency underattribution symptoms reported significantly lower overall self-agency experiences. Siblings displayed stronger prime-based agency inferences than patients, but weaker prime-based inferences than healthy controls. However, these differences were not statistically significant. Findings suggest that impairments in prime-based agency inferences may be a trait characteristic of schizophrenia. Moreover, this study may stimulate further research on the familial basis and the clinical relevance of impairments in implicit agency inferences.
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Affiliation(s)
- Merel Prikken
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | - Robert A Renes
- Utrecht University, Department of Psychology, Utrecht, The Netherlands
| | | | - Henriette D Heering
- Academic Medical Center, Department of Psychiatry, Amsterdam, The Netherlands
| | - René S Kahn
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk Aarts
- Utrecht University, Department of Psychology, Utrecht, The Netherlands
| | - Neeltje E M van Haren
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Walther S, Eisenhardt S, Bohlhalter S, Vanbellingen T, Müri R, Strik W, Stegmayer K. Gesture Performance in Schizophrenia Predicts Functional Outcome After 6 Months. Schizophr Bull 2016; 42:1326-1333. [PMID: 27566843 PMCID: PMC5049539 DOI: 10.1093/schbul/sbw124] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The functional outcome of schizophrenia is heterogeneous and markers of the course are missing. Functional outcome is associated with social cognition and negative symptoms. Gesture performance and nonverbal social perception are critically impaired in schizophrenia. Here, we tested whether gesture performance or nonverbal social perception could predict functional outcome and the ability to adequately perform relevant skills of everyday function (functional capacity) after 6 months. In a naturalistic longitudinal study, 28 patients with schizophrenia completed tests of nonverbal communication at baseline and follow-up. In addition, functional outcome, social and occupational functioning, as well as functional capacity at follow-up were assessed. Gesture performance and nonverbal social perception at baseline predicted negative symptoms, functional outcome, and functional capacity at 6-month follow-up. Gesture performance predicted functional outcome beyond the baseline measure of functioning. Patients with gesture deficits at baseline had stable negative symptoms and experienced a decline in social functioning. While in patients without gesture deficits, negative symptom severity decreased and social functioning remained stable. Thus, a simple test of hand gesture performance at baseline may indicate favorable outcomes in short-term follow-up. The results further support the importance of nonverbal communication skills in subjects with schizophrenia.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland;,*To whom correspondence should be addressed; University Hospital of Psychiatry Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland; tel: +41-31-930-9483; fax: +41-31-930-9958, e-mail:
| | - Sarah Eisenhardt
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland;,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - Tim Vanbellingen
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland;,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - René Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
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Maurya PK, Noto C, Rizzo LB, Rios AC, Nunes SOV, Barbosa DS, Sethi S, Zeni M, Mansur RB, Maes M, Brietzke E. The role of oxidative and nitrosative stress in accelerated aging and major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2016; 65:134-44. [PMID: 26348786 DOI: 10.1016/j.pnpbp.2015.08.016] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/29/2015] [Accepted: 08/30/2015] [Indexed: 12/29/2022]
Abstract
Major depressive disorder (MDD) affects millions of individuals and is highly comorbid with many age associated diseases such as diabetes mellitus, immune-inflammatory dysregulation and cardiovascular diseases. Oxidative/nitrosative stress plays a fundamental role in aging, as well as in the pathogenesis of neurodegenerative/neuropsychiatric disorders including MDD. In this review, we critically review the evidence for an involvement of oxidative/nitrosative stress in acceleration of aging process in MDD. There are evidence of the association between MDD and changes in molecular mechanisms involved in aging. There is a significant association between telomere length, enzymatic antioxidant activities (SOD, CAT, GPx), glutathione (GSH), lipid peroxidation (MDA), nuclear factor κB, inflammatory cytokines with MDD. Major depression also is characterized by significantly lower concentration of antioxidants (zinc, coenzyme Q10, PON1). Since, aging and MDD share a common biological base in their pathophysiology, the potential therapeutic use of antioxidants and anti-aging molecules in MDD could be promising.
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Affiliation(s)
- Pawan Kumar Maurya
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; Amity Institute of Biotechnology, Amity University Uttar Pradesh, Noida, India
| | - Cristiano Noto
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lucas B Rizzo
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Psychiatry, Clinic for Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Adiel C Rios
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sandra O V Nunes
- Graduation Program in Health Sciences, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Décio Sabbatini Barbosa
- Graduation Program in Health Sciences, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Sumit Sethi
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maiara Zeni
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network (UHN), University of Toronto, Toronto, Canada
| | - Michael Maes
- Graduation Program in Health Sciences, Universidade Estadual de Londrina, Londrina, PR, Brazil; Department of Psychiatry, Chulalongkorn University, Bangkok, Thailand
| | - Elisa Brietzke
- Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
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25
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Baez S, García AM, Ibanez A. The Social Context Network Model in Psychiatric and Neurological Diseases. Curr Top Behav Neurosci 2016; 30:379-396. [PMID: 27130326 DOI: 10.1007/7854_2016_443] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The role of contextual modulations has been extensively studied in basic sensory and cognitive processes. However, little is known about their impact on social cognition, let alone their disruption in disorders compromising such a domain. In this chapter, we flesh out the social context network model (SCNM), a neuroscientific proposal devised to address the issue. In SCNM terms, social context effects rely on a fronto-temporo-insular network in charge of (a) updating context cues to make predictions, (b) consolidating context-target associative learning, and (c) coordinating internal and external milieus. First, we characterize various social cognition domains as context-dependent phenomena. Then, we review behavioral and neural evidence of social context impairments in behavioral variant frontotemporal dementia (bvFTD) and autism spectrum disorder (ASD), highlighting their relation with key SCNM hubs. Next, we show that other psychiatric and neurological conditions involve context-processing impairments following damage to the brain regions included in the model. Finally, we call for an ecological approach to social cognition assessment, moving beyond widespread abstract and decontextualized methods.
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Affiliation(s)
- Sandra Baez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, 1126, Buenos Aires, Argentina. .,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina. .,UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile. .,Grupo de Investigación Cerebro Y Cognición Social, Bogotá, Colombia.
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Pacheco de Melo 1860, 1126, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile.,Faculty of Elementary and Special Education (FEEyE), National University of Cuyo (UNCuyo), Mendoza, Argentina
| | - Agustín Ibanez
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina. .,Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina. .,Universidad Autónoma Del Caribe, Barranquilla, Colombia. .,Laboratory of Neuroscience, Adolfo Ibáñez University, Santiago, Chile. .,Australian Research Council (ARC) Centre of Excellence in Cognition and Its Disorders, Sydney, Australia.
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