The role of attention processes in facial affect recognition in schizophrenia

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Introduction

In this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia.

Methods

The Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome.

Results

One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome.

Conclusions

Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.

Socioemotional mechanisms of loneliness in subclinical psychosis

Loneliness is an important predictor of physical and mental health in the general population and in individuals across the psychosis spectrum, including those experiencing subclinical psychotic-like experiences (PLEs). However, the mechanisms underlying loneliness in the psychosis spectrum are not well understood. Emotion processing deficits are well described across the psychosis spectrum, and socioemotional processing biases are critical for the development and maintenance of loneliness through altered social appraisal, including judgements of rejection. Therefore, we propose that PLEs are associated with increased loneliness, and the relationship is mediated by alterations in socioemotional processing. We also explored how this pathway may be affected by mood and anxiety symptoms, which have been associated with loneliness across the psychosis spectrum. As part of the Human Connectome Project, generally healthy adults (n = 1180) reported symptomatology and social functioning and completed the Penn Emotion Recognition Task to assess efficiency in identifying emotions. We found that higher reported PLEs were associated with elevated levels of loneliness and perceived rejection and that these factors were linked by multiple independent pathways. First, anxiety/depression and emotion processing efficiency independently mediated the PLE-loneliness relationship. Second, we found that the association between PLEs and loneliness was serially mediated through inefficient emotion recognition then higher levels of perceived rejection. These separable mechanisms of increased loneliness in subclinical psychosis have implications for treatment and continued study of social functioning in the psychosis spectrum.

Self-assessment of social cognition in a sample of Lebanese in-patients with schizophrenia

Objective

The primary objective was to evaluate social cognitive complaints in a sample of chronic in-patients with schizophrenia and compare it to healthy controls. The secondary objective was to explore factors related to social cognitive complaints in these patients, such as neurocognition, clinical symptoms, depression, and insight.

Methods

A cross-sectional study conducted between July 2019 and March 2020 at the Psychiatric Hospital of the Cross (HPC)-Lebanon enrolled 120 chronic in-patients diagnosed with schizophrenia and schizoaffective disorders and 60 healthy controls. The Self-Assessment of Social Cognition Impairments (ACSo) scale was used to assess social cognitive complaints.

Results

A significant difference was found between schizophrenia patients and healthy controls in all social cognitive complaints: theory of mind complaint, attributional biases complaint, emotional processes complaint, and social perception and knowledge complaint (p < 0.001 for all). All objective cognitive disorders were significantly associated with social cognitive complaints except for attention and speed of information processing. Higher verbal memory and verbal fluency were significantly associated with lower emotional processes complaint scores. The results of the multivariate analysis showed that a higher cognition (Beta = −0.08, p = 0.001) was significantly associated with a lower social cognitive complaint, contrary a higher depression (Beta = 0.38, p = 0.04) was significantly associated with a higher social cognitive complaint, in particular attributional biases complaints.

Conclusion

This study showed that patients with schizophrenia have complaints about their social cognition. It could also demonstrate that subjective social cognitive complaints are correlated with depressive symptoms and objective cognitive deficits among these patients.

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Individuals with schizophrenia often have impairments in social cognition

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Despite low insight, patients report difficulties in their social cognitive skills.

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A correlation exists between neurocognition and subjective social cognition in schizophrenia

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Clinical symptoms (positive and negative symptoms) were not associated with social cognitive complaints

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Social cognitive complaints might help in cognitive remediation and therapy

Higher trait mindfulness is associated with empathy but not with emotion recognition abilities

Mindfulness involves an intentional and non-judgemental attention or awareness of present-moment experiences. It can be cultivated by meditation practice or present as an inherent disposition or trait. Higher trait mindfulness has been associated with improved emotional skills, but evidence comes primarily from studies on emotion regulation. It remains unclear whether improvements extend to other aspects of emotional processing, namely the ability to recognize emotions in others. In the current study, 107 participants (M age = 25.48 years) completed a measure of trait mindfulness, the Five Facet Mindfulness Questionnaire, and two emotion recognition tasks. These tasks required participants to categorize emotions in facial expressions and in speech prosody (modulations of the tone of voice). They also completed an empathy questionnaire and attention tasks. We found that higher trait mindfulness was associated positively with cognitive empathy, but not with the ability to recognize emotions. In fact, Bayesian analyses provided substantial evidence for the null hypothesis, both for emotion recognition in faces and in speech. Moreover, no associations were observed between mindfulness and attention performance. These findings suggest that the positive effects of trait mindfulness on emotional processing do not extend to emotion recognition abilities.

Improved facial affect recognition in patients with first-episode psychosis

AIM

The present study aimed at assessing whether impaired facial affect recognition (FAR) in patients with first-episode psychosis (FEP) would improve after a brief intervention targeting FAR specifically.

METHODS

Thirty-five outpatients and 38 healthy controls were administered an intervention which involved training to recognize emotional information, conveyed by changes in facial features. Using a pre- and post-intervention design, two measurements of FAR were conducted using an experimental procedure with alternative sets of stimuli.

RESULTS

We found improved overall FAR performance in both participant groups with marked effects in recognizing anger, disgust and fear. Patients' post-intervention performance was comparable to healthy participants' baseline performance.

CONCLUSIONS

The present improvement in facial affects recognition in FEP patients, despite only somewhat impaired, emphasizes the importance of early targeted interventions for FAR in psychosis. Further research is needed to assess whether this improvement will generalize to global social functioning.

Improved facial affect recognition in schizophrenia following an emotion intervention, but not training attention-to-facial-features or treatment-as-usual

In schizophrenia, impaired facial affect recognition (FAR) has been associated with patients' overall social functioning. Interventions targeting attention or FAR per se have invariably yielded improved FAR performance in these patients. Here, we compared the effects of two interventions, one targeting FAR and one targeting attention-to-facial-features, with treatment-as-usual on patients' FAR performance. Thirty-nine outpatients with schizophrenia were randomly assigned to one of three groups: FAR intervention (training to recognize emotional information, conveyed by changes in facial features), attention-to-facial-features intervention (training to detect changes in facial features), and treatment-as-usual. Also, 24 healthy controls, matched for age and education, were assigned to one of the two interventions. Two FAR measurements, baseline and post-intervention, were conducted using an original experimental procedure with alternative sets of stimuli. We found improved FAR performance following the intervention targeting FAR in comparison to the other patient groups, which in fact was comparable to the pre-intervention performance of healthy controls in the corresponding intervention group. This improvement was more pronounced in recognizing fear. Our findings suggest that compared to interventions targeting attention, and treatment-as-usual, training programs targeting FAR can be more effective in improving FAR in patients with schizophrenia, particularly assisting them in perceiving threat-related information more accurately.