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Fırat Z, Er F, Noyan H, Ekinci G, Üçok A, Uluğ AM, Aktekin B. Discriminant analysis using MRI asymmetry indices and cognitive scores of women with temporal lobe epilepsy or schizophrenia. Neuroradiology 2024; 66:1083-1092. [PMID: 38416211 DOI: 10.1007/s00234-024-03317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE This study aims to assess the diagnostic power of brain asymmetry indices and neuropsychological tests for differentiating mesial temporal lobe epilepsy (MTLE) and schizophrenia (SCZ). METHODS We studied a total of 39 women including 13 MTLE, 13 SCZ, and 13 healthy individuals (HC). A neuropsychological test battery (NPT) was administered and scored by an experienced neuropsychologist, and NeuroQuant (CorTechs Labs Inc., San Diego, California) software was used to calculate brain asymmetry indices (ASI) for 71 different anatomical regions of all participants based on their 3D T1 MR imaging scans. RESULTS Asymmetry indices measured from 10 regions showed statistically significant differences between the three groups. In this study, a multi-class linear discriminant analysis (LDA) model was built based on a total of fifteen variables composed of the most five significantly informative NPT scores and ten significant asymmetry indices, and the model achieved an accuracy of 87.2%. In pairwise classification, the accuracy for distinguishing MTLE from either SCZ or HC was 94.8%, while the accuracy for distinguishing SCZ from either MTLE or HC was 92.3%. CONCLUSION The ability to differentiate MTLE from SCZ using neuroradiological and neuropsychological biomarkers, even within a limited patient cohort, could make a substantial contribution to research in larger patient groups using different machine learning techniques.
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Affiliation(s)
- Zeynep Fırat
- Department of Radiology, Yeditepe University Hospitals, Kosuyolu, 34718, Istanbul, Turkey.
| | - Füsun Er
- Department of Information Systems Engineering, Piri Reis University, Istanbul, Turkey
| | - Handan Noyan
- Faculty of Social Sciences, Department of Psychology, Beykoz University, 34810, Istanbul, Turkey
| | - Gazanfer Ekinci
- Department of Radiology, Yeditepe University Hospitals, Kosuyolu, 34718, Istanbul, Turkey
| | - Alp Üçok
- Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul University, 34134, Istanbul, Turkey
| | - Aziz M Uluğ
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- CorTechs Labs Inc, San Diego, CA, USA
| | - Berrin Aktekin
- Department of Neurology, Yeditepe University Hospitals, Kosuyolu, 34718, Istanbul, Turkey
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Whitebirch AC, Santoro B, Barnett A, Lisgaras CP, Scharfman HE, Siegelbaum SA. Reduced Cholecystokinin-Expressing Interneuron Input Contributes to Disinhibition of the Hippocampal CA2 Region in a Mouse Model of Temporal Lobe Epilepsy. J Neurosci 2023; 43:6930-6949. [PMID: 37643861 PMCID: PMC10573827 DOI: 10.1523/jneurosci.2091-22.2023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 08/04/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
A significant proportion of temporal lobe epilepsy (TLE) patients experience drug-resistant seizures associated with mesial temporal sclerosis, in which there is extensive cell loss in the hippocampal CA1 and CA3 subfields, with a relative sparing of dentate gyrus granule cells and CA2 pyramidal neurons (PNs). A role for CA2 in seizure generation was suggested based on findings of a reduction in CA2 synaptic inhibition (Williamson and Spencer, 1994) and the presence of interictal-like spike activity in CA2 in resected hippocampal tissue from TLE patients (Wittner et al., 2009). We recently found that in the pilocarpine-induced status epilepticus (PILO-SE) mouse model of TLE there was an increase in CA2 intrinsic excitability associated with a loss of CA2 synaptic inhibition. Furthermore, chemogenetic silencing of CA2 significantly reduced seizure frequency, consistent with a role of CA2 in promoting seizure generation and/or propagation (Whitebirch et al., 2022). In the present study, we explored the cellular basis of this inhibitory deficit using immunohistochemical and electrophysiological approaches in PILO-SE male and female mice. We report a widespread decrease in the density of pro-cholecystokinin-immunopositive (CCK+) interneurons and a functional impairment of CCK+ interneuron-mediated inhibition of CA2 PNs. We also found a disruption in the perisomatic perineuronal net in the CA2 stratum pyramidale. Such pathologic alterations may contribute to an enhanced excitation of CA2 PNs and CA2-dependent seizure activity in the PILO-SE mouse model.SIGNIFICANCE STATEMENT Impaired synaptic inhibition in hippocampal circuits has been identified as a key feature that contributes to the emergence and propagation of seizure activity in human patients and animal models of temporal lobe epilepsy (TLE). Among the hippocampal subfields, the CA2 region is particularly resilient to seizure-associated neurodegeneration and has been suggested to play a key role in seizure activity in TLE. Here we report that perisomatic inhibition of CA2 pyramidal neurons mediated by cholecystokinin-expressing interneurons is selectively reduced in acute hippocampal slices from epileptic mice. Parvalbumin-expressing interneurons, in contrast, appear relatively conserved in epileptic mice. These findings advance our understanding of the cellular mechanisms underlying inhibitory disruption in hippocampal circuits in a mouse model of spontaneous recurring seizures.
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Affiliation(s)
- Alexander C Whitebirch
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
| | - Bina Santoro
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
| | - Anastasia Barnett
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
| | - Christos Panagiotis Lisgaras
- Department of Child & Adolescent Psychiatry, New York University Langone Health, New York, New York 10016
- Department of Neuroscience & Physiology, New York University Langone Health, New York, New York 10016
- Department of Psychiatry, New York University Langone Health, New York, New York 10016
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Helen E Scharfman
- Department of Child & Adolescent Psychiatry, New York University Langone Health, New York, New York 10016
- Department of Neuroscience & Physiology, New York University Langone Health, New York, New York 10016
- Department of Psychiatry, New York University Langone Health, New York, New York 10016
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York 10962
| | - Steven A Siegelbaum
- Departments of Neuroscience and Pharmacology, Kavli Institute for Brain Science, Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University Irving Medical Center, New York, New York 10027
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Social Cognition in Temporal and Frontal Lobe Epilepsy: Systematic Review, Meta-analysis, and Clinical Recommendations. J Int Neuropsychol Soc 2023; 29:205-229. [PMID: 35249578 DOI: 10.1017/s1355617722000066] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Despite the importance of social cognitive functions to mental health and social adjustment, examination of these functions is absent in routine assessment of epilepsy patients. Thus, this review aims to provide a comprehensive overview of the literature on four major aspects of social cognition among temporal and frontal lobe epilepsy, which is a critical step toward designing new interventions. METHOD Papers from 1990 to 2021 were reviewed and examined for inclusion in this study. After the deduplication process, a systematic review and meta-analysis of 44 and 40 articles, respectively, involving 113 people with frontal lobe epilepsy and 1482 people with temporal lobe epilepsy were conducted. RESULTS Our results indicated that while patients with frontal or temporal lobe epilepsy have difficulties in all aspects of social cognition relative to nonclinical controls, the effect sizes were larger for theory of mind (g = .95), than for emotion recognition (g = .69) among temporal lobe epilepsy group. The frontal lobe epilepsy group exhibited significantly greater impairment in emotion recognition compared to temporal lobe. Additionally, people with right temporal lobe epilepsy (g = 1.10) performed more poorly than those with a left-sided (g = .90) seizure focus, specifically in the theory of mind domain. CONCLUSIONS These data point to a potentially important difference in the severity of deficits within the emotion recognition and theory of mind abilities depending on the laterlization of seizure side. We also suggest a guide for the assessment of impairments in social cognition that can be integrated into multidisciplinary clinical evaluation for people with epilepsy.
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Okruszek Ł, Chrustowicz M, Jarkiewicz M, Krawczyk M, Manera V, Piejka A, Schudy A, Wiśniewska M, Wysokiński A. Mentalizing abilities mediate the impact of the basic social perception on negative symptoms in patients with schizophrenia. J Psychiatr Res 2022; 155:85-89. [PMID: 35995018 DOI: 10.1016/j.jpsychires.2022.07.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 10/31/2022]
Abstract
Social cognitive deficits are currently considered as one of the main predictors of clinical symptoms and functional outcome in patients with schizophrenia. Multiple studies have suggested that a two-factor solution (low-level vs. high-level) best describes the structure of social cognitive processes in patients. While higher-order processes have been repeatedly linked to negative symptoms, no such association was found for lower-level processes. Thus, the aim of the current study is to examine whether the association between basic social perception processes and symptoms in patients with schizophrenia is mediated by mentalizing abilities. One hundred thirty-nine patients have completed basic social perception (Communicative Interactions Database task CID-12) and mentalizing (Reading the Mind in the Eyes task) tasks. In line with our hypothesis, we have observed full mediation of the effects of basic social perception abilities on negative symptoms via mentalizing abilities in patients. This effect suggests that, similarly as in the case of positive symptoms, a hierarchical nature of social cognitive processes should be considered while investigating negative symptoms of schizophrenia.
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Affiliation(s)
- Ł Okruszek
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Poland.
| | - M Chrustowicz
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Poland
| | | | - M Krawczyk
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Poland
| | | | - A Piejka
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Poland
| | - A Schudy
- Faculty of Psychology, University of Warsaw, Poland
| | - M Wiśniewska
- Social Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Poland
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Qi L, Zhao J, Zhao P, Zhang H, Zhong J, Pan P, Wang G, Yi Z, Xie L. Theory of mind and facial emotion recognition in adults with temporal lobe epilepsy: A meta-analysis. Front Psychiatry 2022; 13:976439. [PMID: 36276336 PMCID: PMC9582667 DOI: 10.3389/fpsyt.2022.976439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/16/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Mounting studies have investigated impairments in social cognitive domains (including theory of mind [ToM] and facial emotion recognition [FER] in adult patients with temporal lobe epilepsy (TLE). However, to date, inconsistent findings remain. METHODS A search of PubMed, Web of Science, and Embase databases was conducted until December 2021. Hedges g effect sizes were computed with a random-effects model. Meta-regressions were used to assess the potential confounding factors of between-study variability in effect sizes. RESULTS The meta-analysis included 41 studies, with a combined sample of 1,749 adult patients with TLE and 1,324 healthy controls (HCs). Relative to HCs, adult patients with TLE showed large impairments in ToM (g = -0.92) and cognitive ToM (g = -0.92), followed by medium impairments in affective ToM (g = -0.79) and FER (g = -0.77). Besides, no (statistically) significant differences were observed between the magnitude of social cognition impairment in adult with TLE who underwent and those who did not undergo epilepsy surgery. Meta-regressions exhibited that greater severity of executive functioning was associated with more severe ToM defects, and older age was associated with more severe FER defects. CONCLUSIONS Results of this meta-analysis suggest that adult patients with TLE show differential impairments in the core aspects of social cognitive domains (including ToM and FER), which may help in planning individualized treatment with appropriate cognitive and behavioral interventions.
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Affiliation(s)
- Liang Qi
- Department of Neurosurgery, The Affiliated Huai'an Hospital of Xuzhou Medical University, The Second People's Hospital of Huai'an, Huaian, China
| | - Jing Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - PanWen Zhao
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - Hui Zhang
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China.,Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - GenDi Wang
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
| | - LiLi Xie
- Department of Neurology, The Sixth Affiliated Hospital of Nantong University, Yancheng Third People's Hospital, Yancheng, China
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Kozunova G, Novikov A, Stroganova T, Chernyshev B. Intolerance of Uncertainty and Challenges in Decision-making in Adults with High-Functioning Autism. КЛИНИЧЕСКАЯ И СПЕЦИАЛЬНАЯ ПСИХОЛОГИЯ 2022. [DOI: 10.17759/cpse.2022110402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
<p style="text-align: justify;">Individuals with high-functioning autism have difficulties in decision-making in face of incomplete or ambiguous information, particularly in the context of social interaction. Tasks demanding an immediate response or deviation from the usual behavior make them feel excessive anxiety which restricts their social and professional activity. Attempts to camouflage their conservatism to others are one of the risk factors for comorbid depression. Therefore, they avoid new and non-routine situations, thus restricting their own social activity and professional development. On the other hand, insisting on sameness and clarity may give individuals with autism an advantage in long-lasting monotonous tasks. The aim of this review is to consider these symptoms from the perspective of predictive coding. A range of experimental studies has shown that most of the subjects with autism have difficulty in predicting the outcomes based on the cumulative history of interacting with the environment, as well as updating expectations as new evidence becomes available. These peculiarities of the analysis and pragmatic weighting of information may cause the trait intolerance of uncertainty and novelty avoidance of most people with autism.</p>
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Wang H, Zhao P, Zhao J, Zhong J, Pan P, Wang G, Yi Z. Theory of Mind and Empathy in Adults With Epilepsy: A Meta-Analysis. Front Psychiatry 2022; 13:877957. [PMID: 35573343 PMCID: PMC9093035 DOI: 10.3389/fpsyt.2022.877957] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/04/2022] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence suggests that social cognitive abilities [including theory of mind (ToM) and empathy] are impaired in adult patients with epilepsy. Although the deficits in overall ToM in epilepsy have been documented well, the effects of epilepsy on empathic ability and specific subcomponents of ToM remain unclear. The primary aim of this study was to provide the first meta-analytic integration of ToM and empathy in adult patients with epilepsy, and to decompose these constructs to clearly differentiate their distinct (cognitive ToM and affective empathy) and overlapping (affective ToM/cognitive empathy) components. This meta-analysis included 28 studies. Adult patients with temporal lobe epilepsy (TLE) and frontal lobe epilepsy (FLE) showed impairments in cognitive ToM and affective ToM/cognitive empathy compared to the healthy controls (HCs); no group differences were identified for affective empathy. Besides, cognitive ToM was impaired in adult patients with idiopathic generalized epilepsy (IGE) and focal seizures (caused by epileptogenic foci) outside the temporal and frontal lobes (extra-TLE/FLE) and no group differences were evident for affective ToM/cognitive empathy compared to the HCs. Moreover, relative to the HCs, no group differences were identified for affective empathy in adult patients with IGE. Additionally, no (statistically) significant difference was observed between the magnitude of ToM/empathy impairment in adult patients who underwent and those who did not undergo epilepsy surgery. These quantitative findings suggest differential impairment of the core aspects of social cognitive processing in adult patients with epilepsy, which may contribute to the development of structured cognitive interventions (i.e., social cognitive training) for adult patients with epilepsy.
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Affiliation(s)
- HongZhou Wang
- Department of Neurology, Anting Hospital, Shanghai, China
| | - PanWen Zhao
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - Jing Zhao
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China.,Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - GenDi Wang
- Department of Neurology, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
| | - ZhongQuan Yi
- Department of Central Laboratory, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, China
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Michael P, Luke D, Robinson O. An Encounter With the Other: A Thematic and Content Analysis of DMT Experiences From a Naturalistic Field Study. Front Psychol 2021; 12:720717. [PMID: 34975614 PMCID: PMC8716686 DOI: 10.3389/fpsyg.2021.720717] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/15/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction: N,N-dimethyltryptamine (DMT) is an endogenous serotonergic psychedelic capable of producing radical shifts in conscious experience. Increasing trends in its use, as well as new trials administering DMT to patients, indicate the growing importance of a thorough elucidation of the qualitative content, over and above structure, which the drug occasions. This is particularly in light of the hyper-real, otherworldly, and often ontologically challenging yet potentially transformative, nature of the experience, not least encounters with apparently non-self social agents. Laboratory studies have been limited by clinical setting and lacking qualitative analyses of experiential content, while online surveys' limitations lie in retrospective design, uncontrolled use, and both of which not guaranteeing 'breakthrough' experiences, i.e., producing very strong psychoactive effects. Methods: We report on the first naturalistic field study of DMT use including its qualitative analysis. Screened, healthy, anonymised and experienced DMT users were observed during their non-clinical use of the drug at home (40-75 mg inhaled). In-depth semi-structured interviews (inspired by the micro-phenomenological technique) were employed immediately after their experience. This paper reports on the thematic analysis of one major domain of the breakthrough experiences elicited, the 'other'. Thirty-six post-DMT experience interviews with mostly Caucasian (83%) males (eight female) of average 37 years were predominantly inductively coded. Results: Invariably, profound and highly intense experiences occurred. The first overarching category comprised the encounter with other 'beings' (94% of reports), encompassing super-ordinate themes including the entities' role, appearance, demeanour, communication and interaction; while the second overarching category comprised experiences of emerging into other 'worlds' (100% of reports), encompassing super-ordinate themes of the scene, the contents and quality of the immersive spaces. Many further mid-level themes and subthemes also illuminate the rich content of the DMT experience. Discussion: The present study provides a systematic and in-depth analysis of the nuanced content of the otherworldly encounter within the breakthrough DMT experience, as well as elaborating on the resonances both with previous DMT studies focusing on entity encounters and other types of extraordinary experiences entailing such encounters. These include the alien abduction, folkloric, shamanic and near-death experience. Putative neural mechanisms of these features of the DMT experience and its promise as a psychotherapeutic agent are discussed in light of such findings.
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Affiliation(s)
- Pascal Michael
- School of Human Sciences, Old Royal Naval College, University of Greenwich, London, United Kingdom
| | - David Luke
- School of Human Sciences, Old Royal Naval College, University of Greenwich, London, United Kingdom
- Department of Brain Sciences, Faculty of Medicine, Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Oliver Robinson
- School of Human Sciences, Old Royal Naval College, University of Greenwich, London, United Kingdom
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Fóthi Á, Soorya L, Lőrincz A. The Autism Palette: Combinations of Impairments Explain the Heterogeneity in ASD. Front Psychiatry 2020; 11:503462. [PMID: 33343403 PMCID: PMC7738611 DOI: 10.3389/fpsyt.2020.503462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/23/2020] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neuropsychiatric condition traditionally defined by core symptoms in social behavior, speech/communication, repetitive behavior, and restricted interests. Beyond the core symptoms, autism has strong association with other disorders such as intellectual disability (ID), epilepsy, schizophrenia among many others. This paper outlines a theory of ASD with capacity to connect heterogeneous "core" symptoms, medical and psychiatric comorbidities as well as other etiological theories of autism in a unifying cognitive framework rooted in neuroscience and genetics. Cognition is embedded into an ever-developing structure modified by experiences, including the outcomes of environment influencing behaviors. The key constraint of cognition is that the brain can handle only 7±2 relevant variables at a time, whereas sensory variables, i.e., the number of sensory neurons is orders of magnitude larger. As a result, (a) the extraction, (b) the encoding, and (c) the capability for the efficient cognitive manipulation of the relevant variables, and (d) the compensatory mechanisms that counteract computational delays of the distributed components are critical. We outline our theoretical model to describe a Cartesian Factor (CF) forming, autoencoder-like cognitive mechanism which breaks combinatorial explosion and is accelerated by internal reinforcing machineries and discuss the neural processes that support CF formation. Impairments in any of these aspects may disrupt learning, cognitive manipulation, decisions on interactions, and execution of decisions. We suggest that social interactions are the most susceptible to combinations of diverse small impairments and can be spoiled in many ways that pile up. Comorbidity is experienced, if any of the many potential impairments is relatively strong. We consider component spoiling impairments as the basic colors of autism, whereas the combinations of individual impairments make the palette of autism. We put forth arguments on the possibility of dissociating the different main elements of the impairments that can appear together. For example, impairments of generalization (domain general learning) and impairments of dealing with many variable problems, such as social situations may appear independently and may mutually enhance their impacts. We also consider mechanisms that may lead to protection.
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Affiliation(s)
- Ábel Fóthi
- Institute of Enzymology, Research Centre for Natural Sciences, Budapest, Hungary
- Department of Artificial Intelligence, Faculty of Informatics, Eötvös Loránd University, Budapest, Hungary
| | - Latha Soorya
- Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, IL, United States
| | - András Lőrincz
- Department of Artificial Intelligence, Faculty of Informatics, Eötvös Loránd University, Budapest, Hungary
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Thibaudeau É, Achim AM, Parent C, Turcotte M, Cellard C. A meta-analysis of the associations between theory of mind and neurocognition in schizophrenia. Schizophr Res 2020; 216:118-128. [PMID: 31899095 DOI: 10.1016/j.schres.2019.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/27/2022]
Abstract
Theory of mind (ToM) refers to the ability to infer the mental states of others. ToM is impaired in schizophrenia and these deficits seem to hinder functional recovery. ToM is thus an important, but complex treatment target, supported by several processes. A large number of studies report significant associations between ToM and neurocognition (e.g. memory, attention), but the neurocognitive domains that are most closely linked to ToM remain to be identified. A meta-analysis was conducted to estimate the magnitude of the associations between ToM and neurocognition in people with schizophrenia. Correlations were extracted from the relevant literature, transformed into effect sizes Zr and pooled as weighted means. Focused-tests were employed to test for differences between neurocognitive domains and for differences linked to the characteristics of ToM tasks. Ninety-one studies (N = 5462) were included. Moderate associations emerged between ToM and each neurocognitive domain (Zrs 0.27-0.43), with no significant difference between domains (χ2(8) = 11.89, p = 0.156). Within the domain of executive functions, abstraction showed a stronger association with ToM (χ2(4) = 18.93, p = 0.001). Several ToM tasks characteristics (e.g. modality of stimuli, type of mental state), were significantly related to the magnitude of the associations between ToM and executive functions, visuospatial/problem solving, attention and episodic memory. These results suggest that ToM is linked to a wide range of neurocognitive abilities in schizophrenia, and that ToM tasks are a significant moderator of these associations. The assessment and treatment of ToM should consider the neurocognitive profile of each patient to understand his difficulties and to tailor interventions.
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Affiliation(s)
- Élisabeth Thibaudeau
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
| | - Amélie M Achim
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 4873, G1V 0A6 Québec, Québec, Canada.
| | - Carolane Parent
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 4873, G1V 0A6 Québec, Québec, Canada.
| | - Mélissa Turcotte
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
| | - Caroline Cellard
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
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Besag FMC, Vasey MJ. Social cognition and psychopathology in childhood and adolescence. Epilepsy Behav 2019; 100:106210. [PMID: 31196824 DOI: 10.1016/j.yebeh.2019.03.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 02/04/2019] [Accepted: 03/10/2019] [Indexed: 11/16/2022]
Abstract
There is a substantial body of research on social cognition in adults with epilepsy, and in broad categories such as focal and generalized epilepsies, but much less has been written about social cognition in children with epilepsy (CWE), and in childhood-onset epilepsy syndromes specifically. In several of these syndromes, autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), two disorders with social cognitive impairments, are reported. There is strong evidence for social cognitive deficits in juvenile myoclonic epilepsy (JME). There is also a considerable amount of evidence for such deficits in a number of syndromes that may be associated with ASD or ADHD, including West syndrome (WS), Dravet syndrome (DS), and the Landau-Kleffner syndrome (LKS). However, the evidence is of variable quality and incomplete across the range of childhood epilepsy syndromes. In some syndromes, childhood epilepsy substantially increases the risk of severe social cognitive impairment, which may persist after the seizures remit. This paper presents an overview of current research on social cognition in childhood epilepsy, with a particular focus on syndromes with a high prevalence of autistic and behavioral comorbidities. Social cognitive impairments represent a considerable additional challenge for patients and caregivers. Early diagnosis and intervention might significantly improve long-term social cognitive outcomes, highlighting the need for greater awareness among clinicians of this important topic. This article is part of the Special Issue "Epilepsy and social cognition across the lifespan".
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Affiliation(s)
- Frank M C Besag
- East London Foundation NHS Trust, 5-7 Rush Court, Bedford MK40 3JT, UK; University College, London, UK; King's College, London, UK.
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Eddy CM. What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations. Front Psychiatry 2019; 10:425. [PMID: 31354534 PMCID: PMC6636467 DOI: 10.3389/fpsyt.2019.00425] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/29/2019] [Indexed: 12/12/2022] Open
Abstract
Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.
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Affiliation(s)
- Clare M. Eddy
- Research and Innovation, BSMHFT National Centre for Mental Health, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Prenatal treatment with methylazoxymethanol acetate as a neurodevelopmental disruption model of schizophrenia in mice. Neuropharmacology 2019; 150:1-14. [DOI: 10.1016/j.neuropharm.2019.02.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/26/2022]
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Mogi T, Tsunoda T, Yoshino A. Altered upright face recognition and presence of face inversion effect in temporal lobe epilepsy: An event-related potential study. Psychiatry Clin Neurosci 2019; 73:269-276. [PMID: 30734399 DOI: 10.1111/pcn.12829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/14/2018] [Accepted: 02/05/2019] [Indexed: 12/19/2022]
Abstract
AIM Facial recognition can be assessed by examining an event-related potential component, namely the N170. The amplitude of the N170 is larger in response to inverted faces than to upright faces. To examine facial processing in patients with temporal lobe epilepsy (TLE), we investigated the amplitude of the N170, the face inversion effect, and the association between social functioning and face-specific configuration processing. METHODS Sixteen patients with TLE and 17 normal controls (NC) participated in this study. Event-related potentials in response to upright or inverted neutral faces and bicycles were recorded. Social functioning was assessed by the socioeconomic status of the participants using the 5-point Hollingshead-Redlich Scale. RESULTS Compared with NC, patients with TLE had decreased N170 amplitudes. The inversion effect was observed for face stimuli in both groups; however, no inversion effect was observed for bicycle stimuli. Additionally, in TLE patients, but not in NC, socioeconomic status was significantly correlated with the N170 amplitudes in response to upright faces. CONCLUSION In a social context, upright faces are processed as a whole. This process is impaired in TLE. Conversely, inverted faces are processed analytically. This function is normal in TLE. Abnormal face-specific configuration processing may contribute to lower social functioning in TLE.
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Affiliation(s)
- Taichi Mogi
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
| | - Tomoya Tsunoda
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan.,Department of Neuropsychiatry, Fukushima Prefectural Yabuki Hospital, Yabuki-machi, Japan
| | - Aihide Yoshino
- Department of Psychiatry, National Defense Medical College, Tokorozawa, Japan
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Abstract
Cognitive impairments in substance use disorders have been extensively researched, especially since the advent of cognitive and computational neuroscience and neuroimaging methods in the last 20 years. Conceptually, altered cognitive function can be viewed as a hallmark feature of substance use disorders, with documented alterations in the well-known "executive" domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognitive (sometimes referred to as "top-down") regulation of downstream motivational processes-whether appetitive (reward, incentive salience) or aversive (stress, negative affect)-is recognized as a fundamental impairment in addiction and a potentially important target for intervention. As addressed in this special issue, cognitive impairment is a transdiagnostic domain; thus, advances in the characterization and treatment of cognitive dysfunction in substance use disorders could have benefit across multiple psychiatric disorders. Toward this general goal, we summarize current findings in the abovementioned cognitive domains of substance use disorders, while suggesting a potentially useful expansion to include processes that both precede (precognition) and supersede (social cognition) what is usually thought of as strictly cognition. These additional two areas have received relatively less attention but phenomenologically and otherwise are important features of substance use disorders. The review concludes with suggestions for research and potential therapeutic targeting of both the familiar and this more comprehensive version of cognitive domains related to substance use disorders.
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Do mentalization skills affect the perception of stigma in patients with epilepsy? Epilepsy Behav 2018; 88:49-53. [PMID: 30241053 DOI: 10.1016/j.yebeh.2018.08.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/17/2018] [Accepted: 08/17/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE We aimed to study the relationship between the mentalizing ability and stigma in patients with epilepsy. METHODS Patients with epilepsy were administered the following battery of tests: Mini-International Neuropsychiatric Interview (MINI) form, Reading the Mind in the Eyes Test (Eyes Test), Stigma Scale of Epilepsy (SSE), Internalized Stigma of Mental Illness (ISMI) Scale, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS Assessment of an association between the Eyes Test score, ISMI Scale total score, and subscale scores revealed a negative significant correlation of Eyes Test scores with approval of stereotypes, perceived discrimination, stigma resistance, and total score. Eyes Test score and BDI scores appears to be significant predictor of internalized stigma among the clinical variables that were studied. A positive significant correlation was detected between BDI score and alienation, perceived discrimination, and total score. CONCLUSION The presence of a correlation between the mentalization and stigma perception in our study demonstrates that these two concepts are connected and that this connection needs further study. In particular, mentalization-based therapy can have an effect on the reduction of the stigma perceptions and in this way can improve the course of the disease, potentially improving the patients' quality of life.
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Abstract
The significant progress of psychiatry in the 20th century provided a sophisticated theoretical framework to analyze the complex relationships between crime and mental illness. Schizophrenia has been traditionally associated with severe cognitive and affective deficits that heavily influence empathy, judgment capacities, but also control of impulsiveness. Although there is an association between psychotic disorders and absence or decrease of legal responsibility, their relationship is also determined by sociodemographic, developmental, and clinical factors. These disorders are associated not only with abolished criminal responsibility but also with diminished responsibility. We conduct a systematic literature review to examine the relation between schizophrenia and criminal responsibility. We have found that this clinical entity is often associated with diminished or abolished criminal liability. We discuss these findings, focusing on the specific deficits found in patients with schizophrenia and examining how this problem affects their behavior and eventually their accountability for their crimes.
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Abstract
OBJECTIVES Impairments of Theory of Mind (ToM) have been repeatedly demonstrated in patients with schizophrenia (SCZ). However, only a handful of studies have explored deficits in affective and cognitive subcomponents of ToM. Thus, this study aims to examine affective and cognitive ToM abilities in SCZ by using a novel, verbal paradigm. METHODS Twenty-four SCZ and 22 healthy comparison subjects (HC) completed a battery of tasks, which consisted of: (i) Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), (ii) three well-established tasks measuring social cognitive abilities, and (iii) original tasks which assess ability to infer cognitive and affective mental states based on everyday verbal social interactions. RESULTS In line with previous findings, SCZ were outperformed by HC in all tasks. However, the interaction effect of the group and the task showed that cognitive (as opposed to affective) ToM was more profoundly impaired in patients with SCZ. CONCLUSIONS It is proposed that in SCZ group cognitive ToM is more impaired as it involves more effortful reflective processes, while affective ToM, which is more automatic and based on reflexive processes, may differentiate patients from healthy comparison subjects to a lesser extent. (JINS, 2018, 24, 305-309).
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Coba MP, Ramaker MJ, Ho EV, Thompson SL, Komiyama NH, Grant SGN, Knowles JA, Dulawa SC. Dlgap1 knockout mice exhibit alterations of the postsynaptic density and selective reductions in sociability. Sci Rep 2018; 8:2281. [PMID: 29396406 PMCID: PMC5797244 DOI: 10.1038/s41598-018-20610-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/16/2018] [Indexed: 11/09/2022] Open
Abstract
The scaffold protein DLGAP1 is localized at the post-synaptic density (PSD) of glutamatergic neurons and is a component of supramolecular protein complexes organized by PSD95. Gain-of-function variants of DLGAP1 have been associated with obsessive-compulsive disorder (OCD), while haploinsufficient variants have been linked to autism spectrum disorder (ASD) and schizophrenia in human genetic studies. We tested male and female Dlgap1 wild type (WT), heterozygous (HT), and knockout (KO) mice in a battery of behavioral tests: open field, dig, splash, prepulse inhibition, forced swim, nest building, social approach, and sucrose preference. We also used biochemical approaches to examine the role of DLGAP1 in the organization of PSD protein complexes. Dlgap1 KO mice were most notable for disruption of protein interactions in the PSD, and deficits in sociability. Other behavioral measures were largely unaffected. Our data suggest that Dlgap1 knockout leads to PSD disruption and reduced sociability, consistent with reports of DLGAP1 haploinsufficient variants in schizophrenia and ASD.
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Affiliation(s)
- M P Coba
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - M J Ramaker
- Department of Psychiatry, University of California, San Diego, USA
| | - E V Ho
- Department of Psychiatry, University of California, San Diego, USA
| | - S L Thompson
- Department of Psychiatry, University of California, San Diego, USA
- Committee on Neurobiology, The University of Chicago, Chicago, USA
| | - N H Komiyama
- Genes to Cognition Program, Centre for Clinical Brain Sciences, Edinburgh University, Edinburgh, Scotland
| | - S G N Grant
- Genes to Cognition Program, Centre for Clinical Brain Sciences, Edinburgh University, Edinburgh, Scotland
| | - J A Knowles
- Department of Psychiatry and the Behavioral Sciences, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - S C Dulawa
- Department of Psychiatry, University of California, San Diego, USA.
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Javed A, Charles A. The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia. Front Psychiatry 2018; 9:157. [PMID: 29740360 PMCID: PMC5928350 DOI: 10.3389/fpsyt.2018.00157] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/09/2018] [Indexed: 12/11/2022] Open
Abstract
Social cognition has become recognized as an important driver of functional outcomes and overall recovery in patients with schizophrenia, mediating the relationship between neurocognition and social functioning. Since antipsychotic therapy targeting remission of clinical symptoms has been shown to have a limited impact on social cognition, there has been an increasing drive to develop therapeutic strategies to specifically improve social cognition in schizophrenia. We sought to review current evidence relating to social cognition in schizophrenia and its clinical implications, including interventions designed to target the core domains of social cognition (emotion processing, theory of mind, attributional bias, and social perception) as a means of improving functional outcomes and thereby increasing the likelihood of recovery. Relevant articles were identified by conducting a literature search in PubMed using the search terms "schizophrenia" AND "cognition" AND "social functioning," limited to Title/Abstract, over a time period of the past 10 years. Current evidence demonstrates that schizophrenia is associated with impairments in all four core domains of social cognition, during the pre-first-episode, first-episode, early, and chronic phases of the disease, and that such impairments are important determinants of functional outcome. Interventions targeting the four core domains of social cognition comprise psychosocial approaches (social cognition training programs) and pharmacological therapies. Social cognition training programs targeting multiple and specific core domains of social cognition have shown promise in improving social cognition skills, which, in some cases, has translated into improvements in functional outcomes. Use of some psychosocial interventions has additionally resulted in improvements in clinical symptoms and/or quality of life. Pharmacological therapies, including oxytocin and certain antipsychotics, have yielded more mixed results, due in part to the confounding impact of factors including variation in receptor genetics, bioavailability, pharmacokinetics, and drug-drug interactions, and inconsistencies between study designs and medication dosages. Additional research is required to advance our understanding of the role of social cognition in schizophrenia, and to further establish the utility of targeted interventions in this setting.
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Affiliation(s)
- Afzal Javed
- Jepson House, Coventry and Warwickshire Partnership NHS Trust, Nuneaton, United Kingdom
| | - Asha Charles
- Caludon Centre, Coventry and Warwickshire Partnership NHS Trust, Coventry, United Kingdom
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