Enhancing tolerability of a measure of social perception in schizophrenia: comparison of short and long Norwegian versions of the Relationships Across Domains test

Social cognitive training among individuals with schizophrenia: Identifying responders to treatment

In this follow-up study of a previous randomized controlled trial of targeted facial affect recognition training among individuals with schizophrenia, reliable change indices (RCIs) were employed to identify responders to treatment. The original study found improved theory of mind at 3-month follow-up. The current study included 15 participants who received the intervention and who completed all three assessment points in the original study. Six of them had RCIs over the cutoff (≥+1.64), indicating that they had a clinically meaningful and statistically reliable improvement in ToM. The responders had significantly higher psychotic symptom level at baseline, but no other group differences between responders and nonresponders were identified. The study found no support for suggested moderators of treatment effect of social cognitive training (sex, education). As no consistently replicated barriers to treatment gains have been identified, we suggest that social cognitive training, where available, should be offered to interested clients.

An Evaluation of Cross-Cultural Adaptations of Social Cognition Testing: A Systematic Review

Social cognition remains one of the most difficult cognitive domains to assess in diverse populations due to a lack of culturally appropriate tools. This study systematically reviewed literature on neuropsychological tests for social cognition that have been translated, adapted, are cross-cultural, or are assembled for diverse, specifically "Global South," populations. The aim was to identify assessments appropriate for diverse populations, outline and evaluate their methodological approaches, and provide procedural recommendations for future research. The PRISMA systematic review search strategy produced 10,957 articles, of which 287 were selected for full-text screening. The study had to include a neuropsychological assessment of social cognition. The full text of the resulting 287 articles was then screened; the study had to include a translated, adapted, cross-cultural test, or an assembled test for Global South populations. Eighty-four articles were included in this study: 24 for emotion recognition, 45 for theory of mind, 9 for moral reasoning, and six for social cognition in general. Overall, there were 31 translations, 27 adaptations, 14 cross-cultural tests, and 12 assembled tests for Global South populations. Regarding quality, 35 were of low quality, 27 were of moderate quality, and 22 were high quality. This study provides an overview of social cognition tests modified or assembled for diverse populations and gives examples of methodological procedures. It highlights the variability in procedure quality and provides possible reasons for this variability. Finally, it suggests a need to report rigorous modification and assembly procedure in order to have modified and assembled social cognition tests appropriate for diverse populations.

Sex differences in social cognition among individuals with schizophrenia and in healthy control participants: a secondary analysis of published data

PURPOSE

Sex differences are present among individuals experiencing schizophrenia. Whether these differences extend to social cognition is unclear. In this study, we investigated sex differences in emotion perception, social perception and theory of mind (ToM).

METHODS

We examined sex differences between males and females with schizophrenia on five social cognitive tests. Healthy male and female control participants were included to examine if any sex difference was illness-specific. Emotion perception was measured with Pictures of Facial Affect (PFA) and Emotion in Biological Motion (EmoBio); social perception with the Relationships Across Domains Test (RAD); and ToM with the Movie for the Assessment of Social Cognition (MASC) and Hinting Task.

RESULTS

Two-way analyses of variance revealed overall group differences for all tests, with healthy controls outperforming individuals with schizophrenia. Significant sex effects were present for PFA and Hinting Task. There were no significant interaction effects. Within-group independent samples t-tests yielded one significant sex difference, i.e., among healthy controls for PFA.

CONCLUSIONS

Females had better facial emotion perception than males. This sex difference was statistically significant among healthy controls and medium-large among individuals experiencing schizophrenia. There were no significant sex differences for other social cognitive domains. The study did not find evidence for a general female advantage in social cognition.

Social cognitive heterogeneity in schizophrenia: A cluster analysis

This study examined social cognitive heterogeneity in Norwegian sample of individuals with schizophrenia (n = 82). They were assessed with three social cognitive tests: Emotion in Biological Motion (emotion processing), Relationships Across Domains (social perception), and Movie for the Assessment of Social Cognition (theory of mind). Hierarchical and k-means cluster analyses using standardized scores on these three tests provided two clusters. The first cluster (68 %) had mild social cognitive impairments (<0.5 standard deviations below healthy comparison participants). The second cluster (32 %) had severe social cognitive impairments (>2 standard deviations below healthy comparison participants). Validity of the two social cognitive subgroups was indicated by significant differences in functioning, symptom load and nonsocial cognition. Our study shows that social cognitive tests can be used for clinical and cognitive subtyping. This is of potential relevance for treatment.

The factor structure of social cognition in schizophrenia: Weak evidence for separable domains

This study examined the factor structure of social cognition in a Norwegian sample of individuals diagnosed with schizophrenia (n = 83). Eight variables from three social cognitive tests from three theoretical domains were included: emotion processing, social perception and theory of mind. Factor analysis with maximum likelihood extraction and oblique rotation resulted in two factors using Kaiser's criterion. Although the two-factor model had better fit than a unifactorial model, it did not represent the data well. Two social cognitive variables did not load on either factor. The two extracted factors did not correspond to an expected distinction between low and high level of processing or between affective and cognitive processes. A non-negligible number of nonredundant residuals between observed and computed correlations suggested poor model fit. In conclusion, this study failed to identify separable dimensions of social cognition in spite of including measures from different theoretical domains.

Social Perception Predicts Awareness of Illness in Persons With Schizophrenia

Lack of clinical insight in patients with schizophrenia is an obstacle to optimal treatment. Social cognition is one of several variables central to insight deficits in schizophrenia. The aim of this study was to investigate clinical insight in relation to one domain of social cognition, social perception, while controlling for effects of nonsocial cognition and symptom severity. Clinical insight was measured in 55 patients with schizophrenia or schizoaffective disorder, using the Birchwood Insight Scale. Relationships across domains were used to assess social perception. Social perception predicted one of three subscales of clinical insight, "awareness of illness," and was the only unique contributor to this subscale. This indicates that social perception is linked to clinical insight through awareness of illness. More research is needed to fully understand the relationship between social and nonsocial cognition and symptoms in relation to clinical insight.

Social Cognition Analyzer Application-A New Method for the Analysis of Social Cognition in Patients Diagnosed With Schizophrenia

Introduction: Because of the importance of the assessment of social cognitive impairments in schizophrenia in clinical settings, a new computer application called SCAN (Social Cognition Analyzer applicatioN) was developed. Our first aim was to examine if patients diagnosed with schizophrenia could be differentiated from healthy individuals based on the results of SCAN, taking into consideration both response rates and response times. Our second aim was to create Scanalizer, as part of SCAN, to produce social cognitive profiles of individual patients. Materials and Methods: 86 patients (SG) and 101 healthy participants (CG) were examined with SCAN. The domains were: ToM, irony, metaphor, emotion perception from prosody and social perception. SCAN displayed the tasks, recorded the answers and the response times. For the differentiation of the two groups a two-dimensional scatter plot was used. For the graphical presentation of the social cognitive profile of patients, the calculation of the distributions of CG's results was made with Kolmogorov-Smirnov Goodness-of-fit Test and with the sum of squared residuals (SSR). Results: We found that the SG's response rates were significantly lower and the SG's response times were significantly slower compared to the CG in every condition. With the two-dimensional comparison of the summary response rates and the summary response times of the participants, the SG could be differentiated from the CG and this differentiation worked irrespective of age and education. For the graphical representation of social cognitive functions of patients, distributions of the results of the CG were calculated. We found normal distributions in the response times of all conditions and in the response rates of the ToM condition. In the low-end tail of the irony condition, and in the metaphor, social perception and emotional prosody conditions, power-law distributions were found. We also found that the summary response rates of the lowest performing 10% of the CG was in the same range as the summary response rates of all examined patients. Discussion: Scanalizer enables clinicians to measure and analyse social cognitive profiles of patients diagnosed with schizophrenia. Moreover, SCAN could also be used to detect social cognitive disabilities of vulnerable individuals.

A randomized controlled trial of training of affect recognition (TAR) in schizophrenia shows lasting effects for theory of mind

Schizophrenia is characterized by social cognitive impairments that predict functioning. Social cognitive training aims to target these impairments. Although it can improve the targeted social cognitive domain, it is unclear if the training generalizes to non-targeted domains and to functioning, with lasting effects. This randomized controlled trial examined the effect of a targeted facial affect recognition training program, Training of Affect Recognition (TAR), in persons with schizophrenia. Individuals with schizophrenia were randomized to receive treatment as usual and TAR (n = 24) or treatment as usual (n = 24) after assessments with a comprehensive protocol at baseline (T1). Participants were reassessed immediately after the intervention period (T2: after 8 weeks) and at 3-month follow-up (T3). The protocol included tests of social cognition (facial or body affect recognition, theory of mind), nonsocial cognition (Matrics Consensus Cognitive Battery), clinical symptoms (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (self-reported, social or nonsocial functional capacity), self-esteem, self-efficacy and insight. Linear mixed models yielded a significant group × time interaction effect for a non-targeted social cognitive domain (theory of mind) and a trend-level effect for social functional capacity with the intervention group performing better over time. No beneficial effects on nonsocial cognition, other measures of functioning, clinical symptoms, or self-esteem/self-efficacy appeared for the TAR program. This study provides evidence for transfer and durability effects of facial affect recognition training to theory of mind, but also highlights the need for additional treatments to achieve functional benefits.