Social identification and paranoia

Paranoia is associated with variation in social behaviour, such as lower inclination to trust others or to behave generously in economic game settings. Such variation may stem, in part, from a reduced tendency to socially identify with others, although previous studies have reported mixed results. We tested whether paranoia involves altered social identification in a pre-registered online study investigating the relationship between a measure of social identification, paranoia, and social behaviours in economic games. We successfully manipulated social identification, but paranoia was associated with slightly increased social identification overall. Neither paranoia nor social identification predicted behaviour in the economic games, and there was no interaction between paranoia and social identification regarding trusting and cooperative behaviours. Our results converge with recent work suggesting that more paranoid individuals may harbour a higher tendency to perceive themselves as having similar beliefs to others. We discuss some key areas for future research to progress understanding in this area.

Understanding the mechanisms underlying cognitive control in psychosis

BACKGROUND

Cognitive control (CC) involves a top-down mechanism to flexibly respond to complex stimuli and is impaired in schizophrenia.

METHODS

This study investigated the impact of increasing complexity of CC processing in 140 subjects with psychosis and 39 healthy adults, with assessments of behavioral performance, neural regions of interest and symptom severity.

RESULTS

The lowest level of CC (Stroop task) was impaired in all patients; the intermediate level of CC (Faces task) with explicit emotional information was most impaired in patients with first episode psychosis. Patients showed activation of distinct neural CC and reward networks, but iterative learning based on the higher-order of CC during the trust game, was most impaired in chronic schizophrenia. Subjects with first episode psychosis, and patients with lower symptom load, demonstrate flexibility of the CC network to facilitate learning, which appeared compromised in the more chronic stages of schizophrenia.

CONCLUSION

These data suggest optimal windows for opportunities to introduce therapeutic interventions to improve CC.

Value Representations of Spite Sensitivity in Psychosis on the Minnesota Trust Game

BACKGROUND

Spite sensitivity provides a valuable construct to understand persecutory ideation and its underlying neural mechanisms. We examined the relationship between persecution and spite sensitivity in psychosis to identify their neural substrates.

METHODS

In a 3T magnetic resonance imaging scanner, 49 participants with psychosis played the Minnesota Trust Game, in which they decided whether to take a small amount of money or trust a partner to choose between fair and unfair distributions of money. In some conditions, the partner benefited from the unfair option, while in others, the partner lost money. Participants who were untrusting in the second condition (suspiciousness) showed heightened sensitivity to spite. Behavioral measures included mistrust during the 2 conditions of the game, which were compared with Brief Psychiatric Rating Scale persecution and computational modeling. Functional connectivity and blood oxygen level-dependent analyses were also conducted on a priori regions during spite-sensitive decisions.

RESULTS

Behavioral results replicated previous findings; participants who experienced more persecutory ideation trusted less, specifically in the suspiciousness condition. Functional connectivity findings showed that decreased connectivity between the orbitofrontal cortex-insula and the left frontoparietal network was associated with increased persecutory ideation and estimated spite-guilt (a marker of spite sensitivity). Additionally, we found differences between conditions in caudate nucleus, medial prefrontal cortex, and lateral orbitofrontal cortex activation.

CONCLUSIONS

These findings provide a new perspective on the origin of positive symptoms by identifying primary brain circuits that are related to both spite sensitivity and persecutory ideation.

The effects of paranoia and dopamine on perception of cohesion and conspiracy: a pre-registered, double-blind, placebo-controlled experiment

Paranoia is a common symptom of psychotic disorders but is also present on a spectrum of severity in the general population. Although paranoia is associated with an increased tendency to perceive cohesion and conspiracy within groups, the mechanistic basis of this variation remains unclear. One potential avenue involves the brain's dopaminergic system, which is known to be altered in psychosis. In this study, we used large-N online samples to establish the association between trait paranoia and perceptions of cohesion and conspiracy. We further evaluated the role of dopamine on perceptions of cohesion and conspiracy using a double-blind, placebo-controlled laboratory experiment where participants received levodopa or a placebo control. Our results were mixed: group perceptions and perceptions of cohesion were higher among more paranoid individuals but were not altered under dopamine administration. We outline the potential reasons for these discrepancies and the broader implications for understanding paranoia in terms of dopamine dysregulation.

The social cognitive and neural mechanisms that underlie social functioning in individuals with schizophrenia - a review

In many individuals with a diagnosis of schizophrenia social functioning is impaired across the lifespan. Social cognition has emerged as one of the possible factors that may contribute to these challenges. Neuroimaging research can give further insights into the underlying mechanisms of social (cognitive) difficulties. This review summarises the evidence on the associations between social cognition in the domains of theory of mind and emotion perception and processing, and individuals' social functioning and social skills, as well as associated neural mechanisms. Eighteen behavioural studies were conducted since the last major review and meta-analysis in the field (inclusion between 7/2017 and 1/2022). No major review has investigated the link between the neural mechanisms of social cognition and their association with social functioning in schizophrenia. Fourteen relevant studies were included (from 1/2000 to 1/2022). The findings of the behavioural studies showed that associations with social outcomes were slightly stronger for theory of mind than for emotion perception and processing. Moreover, performance in both social cognitive domains was more strongly associated with performance on social skill measures than questionnaire-based assessment of social functioning in the community. Studies on the underlying neural substrate of these associations presented mixed findings. In general, higher activation in various regions of the social brain was associated with better social functioning. The available evidence suggests some shared regions that might underlie the social cognition-social outcome link between different domains. However, due to the heterogeneity in approaches and findings, the current knowledge base will need to be expanded before firm conclusions can be drawn.

Deficits in Key Brain Network for Social Interaction in Individuals with Schizophrenia

Individuals with schizophrenia (SZ) show impairment in social functioning. The reward network and the emotional salience network are considered to play important roles in social interaction. The current study investigated alterations in the resting-state (rs-) amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo) and functional connectivity (fc) in the reward network and the emotional salience network in SZ patients. MRI scans were collected from 60 subjects, including 30 SZ patients and 30 matched healthy controls. SZ symptoms were measured using the Positive and Negative Syndrome Scale (PANSS). We analyzed the ALFF, fALFF and ReHo in key brain regions in the reward network and emotional salience network as well as rs-fc among the bilateral amygdala, lateral orbitofrontal cortex (OFC), medial OFC and insula between groups. The SZ patients demonstrated increased ALFF in the right caudate and right putamen, increased fALFF and ReHo in the bilateral caudate, putamen and pallidum, along with decreased fALFF in the bilateral insula. Additionally, reduced rs-fc was found between the right lateral OFC and the left amygdala, which simultaneously belong to the reward network and the emotional salience network. These findings highlight the association between impaired social functioning in SZ patients and aberrant resting-state ALFF, fALFF, ReHo and fc. Future studies are needed to conduct network-based statistical analysis and task-state fMRI, reflecting live social interaction to advance our understanding of the mechanism of social interaction deficits in SZ.

Social Motivation in Schizophrenia: What's Effort Got to Do With It?

BACKGROUND AND HYPOTHESIS

Social motivation, defined as the fundamental human desire to seek out, engage in, and maintain interpersonal bonds, has become a growing area of research in schizophrenia. The major focus has been on understanding the impact of social reward-related processes. An obvious but rarely acknowledged fact is that social interactions, much like other goal-directed acts, require the exertion of effort. In this Review Article, we argue that social motivation in schizophrenia can be conceptualized through the lens of an established framework: effort-based decision-making (EBDM).

STUDY DESIGN

We conducted a literature review on social reward processing in schizophrenia, then extended these findings by applying concepts and insights from the literature on EBDM to the study of social motivation.

STUDY RESULTS

Within the EBDM framework, decisions about whether or not to pursue social interactions are bound by cost/benefit calculations. That is, people do not pursue social behaviors when the estimated "cost" of the required effort outweighs the anticipated "benefit" or reward. We propose that people with schizophrenia are less likely to engage in social interaction compared with healthy samples because they: (1) underestimate the benefits of relationships (based on expectations of reward/punishment), (2) overestimate the effort costs associated with social interaction, and/or (3) fail to integrate cost-benefit information in an optimal manner.

CONCLUSIONS

EBDM is an especially promising framework of social motivation that goes beyond the current focus on social reward processing to include a focus on effort.

Trust and psychosis: a systematic review and meta-analysis

BACKGROUND

Impaired trust in other humans is commonly seen in psychosis and it leads to poor societal functioning. However, examining trust behavior in an experimental setting is challenging. Investigators have used the trust game, a neuro-economic game to assess trust behavior in psychosis. However, the findings are inconsistent. Hence, we systematically reviewed the existing literature and conducted a meta-analysis to examine trust behavior in patients with psychosis, their relatives, and those at high risk for psychosis.

METHODS

We searched electronic databases for studies that have examined trust game in patients with psychosis, published up to November 2021. The primary outcome measure was the baseline trust in a trust game by patients and controls. The meta-analysis was performed if at least three data sets of control and patient groups were available for that measure/design. We conducted meta-analyses with a random-effects model. The results were described narratively wherever meta-analysis was not possible due to paucity of studies.

RESULTS

The searches across the databases including cross-references yielded 465 publications of which 10 studies were included in the final analysis. Baseline trust in the trust game was significantly lower in patients with psychosis compared to controls (SMD 0.39, 95% CI -0.14 to 0.64, p -0.002). However, a similar decrease in baseline trust was not present in relatives of patients (SMD 0.08, 95% CI -0.20 to 0.36, p -0.58).

CONCLUSIONS

The current meta-analysis suggests significant trust deficits in patients with psychosis. Future studies with a bigger sample size are required to understand the nature of trust deficits and factors affecting this impairment.

Blocking D2/D3 dopamine receptors in male participants increases volatility of beliefs when learning to trust others

The ability to learn about other people is crucial for human social functioning. Dopamine has been proposed to regulate the precision of beliefs, but direct behavioural evidence of this is lacking. In this study, we investigate how a high dose of the D2/D3 dopamine receptor antagonist sulpiride impacts learning about other people's prosocial attitudes in a repeated Trust game. Using a Bayesian model of belief updating, we show that in a sample of 76 male participants sulpiride increases the volatility of beliefs, which leads to higher precision weights on prediction errors. This effect is driven by participants with genetically conferred higher dopamine availability (Taq1a polymorphism) and remains even after controlling for working memory performance. Higher precision weights are reflected in higher reciprocal behaviour in the repeated Trust game but not in single-round Trust games. Our data provide evidence that the D2 receptors are pivotal in regulating prediction error-driven belief updating in a social context.

Neuroimaging glutamatergic mechanisms differentiating antipsychotic treatment-response

Glutamatergic dysfunction is associated with failure to respond to antipsychotic medication in individuals with schizophrenia. Our objective was to combine neurochemical and functional brain imaging methods to investigate glutamatergic dysfunction and reward processing in such individuals compared with those with treatment responsive schizophrenia, and healthy controls. 60 participants played a trust task, while undergoing functional magnetic resonance imaging: 21 classified as having treatment-resistant schizophrenia, 21 patients with treatment-responsive schizophrenia, and 18 healthy controls. Proton magnetic resonance spectroscopy was also acquired to measure glutamate in the anterior cingulate cortex. Compared to controls, treatment responsive and treatment-resistant participants showed reduced investments during the trust task. For treatment-resistant individuals, glutamate levels in the anterior cingulate cortex were associated with signal decreases in the right dorsolateral prefrontal cortex when compared to those treatment-responsive, and with bilateral dorsolateral prefrontal cortex and left parietal association cortex when compared to controls. Treatment-responsive participants showed significant signal decreases in the anterior caudate compared to the other two groups. Our results provide evidence that glutamatergic differences differentiate treatment resistant and responsive schizophrenia. The differentiation of cortical and sub-cortical reward learning substrates has potential diagnostic value. Future novel interventions might therapeutically target neurotransmitters affecting the cortical substrates of the reward network.

Neuroimaging oxytocin modulation of social reward learning in schizophrenia

BACKGROUND

Conventional pharmacological approaches have limited effectiveness for schizophrenia. There is interest in the application of oxytocin, which is involved in social cognition. Clinical trials have yielded mixed results, with a gap in understanding neural mechanisms.

AIMS

To evaluate the behavioural impact of oxytocin administration on a social learning task in individuals with schizophrenia, and elucidate any differential neural activity produced.

METHOD

We recruited 20 clinically stable right-handed men diagnosed with schizophrenia or schizoaffective disorder. In a double-blind cross-over randomised controlled study, 40 IU of oxytocin or placebo were administered before functional magnetic resonance imaging of participants playing a multi-round economic exchange game of trust. Participants had the role of investors (investment trials) receiving repayment on their investments (repayment trials), playing one session against a computer and a second against a player believed to be human.

RESULTS

During investment trials, oxytocin increased neural signalling in the right lateral parietal cortex for both human and computer player trials, and attenuated signalling in the right insula for human player trials. For repayment trials, oxytocin elicited signal increases in left insula and left ventral caudate, and a signal decrease in right amygdala during the human player trials; conversely it resulted in right dorsal caudate activation during the computer player trials. We did not find a significant change in behavioural performance associated with oxytocin administration, or any associations with symptoms.

CONCLUSIONS

During a social learning task oxytocin modulates cortical and limbic substrates of the reward-processing network. These perturbations can be putatively linked to the pathoaetiology of schizophrenia.

Adult outcome of preterm birth: Implications for neurodevelopmental theories of psychosis

Preterm birth is associated with an elevated risk of developmental and adult psychiatric disorders, including psychosis. In this review, we evaluate the implications of neurodevelopmental, cognitive, motor, and social sequelae of preterm birth for developing psychosis, with an emphasis on outcomes observed in adulthood. Abnormal brain development precipitated by early exposure to the extra-uterine environment, and exacerbated by neuroinflammation, neonatal brain injury, and genetic vulnerability, can result in alterations of brain structure and function persisting into adulthood. These alterations, including abnormal regional brain volumes and white matter macro- and micro-structure, can critically impair functional (e.g. frontoparietal and thalamocortical) network connectivity in a manner characteristic of psychotic illness. The resulting executive, social, and motor dysfunctions may constitute the basis for behavioural vulnerability ultimately giving rise to psychotic symptomatology. There are many pathways to psychosis, but elucidating more precisely the mechanisms whereby preterm birth increases risk may shed light on that route consequent upon early neurodevelopmental insult.

A Model of Trust

Trust is central to a large variety of social interactions. Different research fields have empirically and theoretically investigated trust, observing trusting behaviors in different situations and pinpointing their different components and constituents. However, a unifying, computational formalization of those diverse components and constituents of trust is still lacking. Previous work has mainly used computational models borrowed from other fields and developed for other purposes to explain trusting behaviors in empirical paradigms. Here, I computationally formalize verbal models of trust in a simple model (i.e., vulnerability model) that combines current and prospective action values with beliefs and expectancies about a partner’s behavior. By using the classic investment game (IG)—an economic game thought to capture some important features of trusting behaviors in social interactions—I show how variations of a single parameter of the vulnerability model generates behaviors that can be interpreted as different “trust attitudes”. I then show how these behavioral patterns change as a function of an individual’s loss aversion and expectations of the partner’s behavior. I finally show how the vulnerability model can be easily extended in a novel IG paradigm to investigate inferences on different traits of a partner. In particular, I will focus on benevolence and competence—two character traits that have previously been described as determinants of trustworthiness impressions central to trust. The vulnerability model can be employed as is or as a utility function within more complex Bayesian frameworks to fit participants’ behavior in different social environments where actions are associated with subjective values and weighted by individual beliefs about others’ behaviors. Hence, the vulnerability model provides an important building block for future theoretical and empirical work across a variety of research fields.

Psychological Dimensions Relevant to Motivation and Pleasure in Schizophrenia

Motivation and pleasure deficits are common in schizophrenia, strongly linked with poorer functioning, and may reflect underlying alterations in brain functions governing reward processing and goal pursuit. While there is extensive research examining cognitive and reward mechanisms related to these deficits in schizophrenia, less attention has been paid to psychological characteristics that contribute to resilience against, or risk for, motivation and pleasure impairment. For example, psychological tendencies involving positive future expectancies (e.g., optimism) and effective affect management (e.g., reappraisal, mindfulness) are associated with aspects of reward anticipation and evaluation that optimally guide goal-directed behavior. Conversely, maladaptive thinking patterns (e.g., defeatist performance beliefs, asocial beliefs) and tendencies that amplify negative cognitions (e.g., rumination), may divert cognitive resources away from goal pursuit or reduce willingness to exert effort. Additionally, aspects of sociality, including the propensity to experience social connection as positive reinforcement may be particularly relevant for pursuing social goals. In the current review, we discuss the roles of several psychological characteristics with respect to motivation and pleasure in schizophrenia. We argue that individual variation in these psychological dimensions is relevant to the study of motivation and reward processing in schizophrenia, including interactions between these psychological dimensions and more well-characterized cognitive and reward processing contributors to motivation. We close by emphasizing the value of considering a broad set of modulating factors when studying motivation and pleasure functions in schizophrenia.

Social isolation and psychosis: an investigation of social interactions and paranoia in daily life

Social isolation has been suggested to foster paranoia. Here we investigate whether social company (i.e., being alone vs. not) and its nature (i.e., stranger/distant vs. familiar other) affects paranoia differently depending on psychosis risk. Social interactions and paranoid thinking in daily life were investigated in 29 patients with clinically stable non-affective psychotic disorders, 20 first-degree relatives, and 26 controls (n = 75), using the experience sampling method (ESM). ESM was completed up to ten times daily for 1 week. Patients experienced marginally greater paranoia than relatives [b = 0.47, p = 0.08, 95% CI (- 0.06, 1.0)] and significantly greater paranoia than controls [b = 0.55, p = 0.03, 95% CI (0.5, 1.0)], but controls and relatives did not differ [b = 0.07, p = 0.78, 95% CI (- 0.47, 0.61)]. Patients were more often alone [68.5% vs. 44.8% and 56.2%, respectively, p = 0.057] and experienced greater paranoia when alone than when in company [b = 0.11, p = 0.016, 95% CI (0.02, 0.19)]. In relatives this was reversed [b = - 0.17, p < 0.001, 95% CI (- 0.28, - 0.07)] and in controls non-significant [b = - 0.02, p = 0.67, 95% CI (- 0.09, 0.06)]. The time-lagged association between being in social company and subsequent paranoia was non-significant and paranoia did not predict the likelihood of being in social company over time (both p's = 0.68). All groups experienced greater paranoia in company of strangers/distant others than familiar others [X2(2) = 4.56, p = 0.03] and being with familiar others was associated with lower paranoia over time [X2(2) = 4.9, p = 0.03]. Patients are frequently alone. Importantly, social company appears to limit their paranoia, particularly when being with familiar people. The findings stress the importance of interventions that foster social engagement and ties with family and friends.

Neural, behavioural and real-life correlates of social context sensitivity and social reward learning during interpersonal interactions in the schizophrenia spectrum

OBJECTIVE

Recent findings suggest that diminished processing of positive contextual information about others during interactions may contribute to social impairment in the schizophrenia spectrum. This could be due to general social context processing deficits or specific biases against positive information. We studied the impact of positive and negative social contextual information during social interactions using functional neuroimaging and probed whether these neural mechanisms were associated with real-life social functioning in schizophrenia spectrum disorders.

METHODS

Patients with a schizophrenia spectrum disorder (N = 23) and controls disorder (N = 25) played three multi-round trust games during functional magnetic resonance imaging scanning, with no, positive and negative information about the counterpart's trustworthiness, while all counterparts were programmed to behave trustworthy. The main outcome variable was the height of the shared amount in the trust game, i.e. investment, representing an indication of trust. The first investment in the game was considered to be basic trust, since no behavioural feedback was given yet. We performed region-of-interest analyses and examined the association with real-life social functioning using the experience sampling method.

RESULTS

Social contextual information had no effect on patients' first investments, whereas controls made the lowest investment after negative and the highest investments after positive contextual information was provided. Over trials, patients decreased investments, suggesting reduced social reward learning, whereas controls increased investments in response to behavioural feedback in the negative context. Patients engaged the dorsolateral prefrontal cortex less than controls during context presentation and showed reduced activity within the caudate during repayments. In patients, lower investments were associated with more time spent alone and social exclusion and lower caudate activation was marginally significantly associated with higher perceived social exclusion.

CONCLUSION

The failure to adapt trust to positive and negative social contexts suggests that patients have a general insensitivity to prior social information, indicating top-down processing impairments. In addition, patients show reduced sensitivity to social reward, i.e. bottom-up processing deficits. Moreover, lower trust and lower neural activation were related to lower real-life social functioning. Together, these findings indicate that improving trust and social interactions in schizophrenia spectrum needs a multi-faceted approach that targets both mechanisms.

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.

Exploring the association between social behaviour, trust, and its neural correlates in first episode psychosis patients and in individuals at clinical high risk for psychosis

OBJECTIVES

Psychosis is characterized by paranoid delusions, social withdrawal, and distrust towards others. Trust is essential for successful social interactions. It remains unknown which aspects of social functioning are associated with reduced trust in psychosis. Therefore, we investigated the association between social behaviour, trust, and its neural correlates in a group of individuals with psychotic symptoms (PS-group), consisting of first episode psychosis patients combined with individuals at clinical high risk.

METHODS

We compared 24 PS individuals and 25 healthy controls. Affect and social withdrawal were assessed using the Experience Sampling Method. Trust was measured during functional magnetic resonance imaging (fMRI) scanning, using a trust game with a cooperative and unfair counterpart.

RESULTS

The PS-group showed lower baseline trust compared to controls and reported less positive and more negative general affect. Social withdrawal did not differ between the groups. Social withdrawal and social reactivity in affect (i.e., changes in affect when with others compared to when alone) were not associated with trust. On the neural level, in controls but not in the PS-group, social withdrawal was associated with caudate activation during interactions with an unfair partner. An increase in positive social reactivity, was associated with reduced insula activation in the whole sample.

CONCLUSIONS

Social withdrawal and social reactivity were not associated with reduced initial trust in the PS-group. Like controls, the PS-group showed a positive response in affect when with others, suggesting a decrease in emotional distress. Supporting patients to keep engaging in social interactions, may alleviate their emotional distress.

PRACTITIONER POINTS

Individuals with psychotic symptoms show reduced initial trust towards unknown others. Trust in others is not associated with social withdrawal and reported affect when with others, nor when alone. Like controls, individuals with psychotic symptoms showed reduced negative affect and increased positive affect when with others compared to when alone. We emphasize to support individuals with psychotic symptoms to keep engaging in social interactions, given it may reduce social withdrawal and alleviate their emotional distress.

Telehealth Acceptability and Feasibility Among People Served in a Community Behavioral Health System During the COVID-19 Pandemic

OBJECTIVE

The authors examined the acceptability and feasibility of telehealth services shortly after their rapid introduction into a community behavioral health agency as part of the response to the COVID-19 pandemic.

METHODS

Individuals receiving services during May 8-18, 2020, from behavioral health programs that had introduced telehealth in March 2020, were invited to participate in a survey regarding their perceptions of the telehealth services. Ordinal logistic regressions were used to test for differences in survey responses in three ways: between program types, between the 2020 sample and a 2018 sample, and between individuals reported by staff to be distressed or not distressed by the COVID-19 pandemic.

RESULTS

Of 1,482 survey respondents, >80% reported that their ability to connect to staff, receive support, and get an appointment was at least as great as before the pandemic. Among 80% of respondents indicating interest in continuing remote services after the pandemic ended, 83% preferred a mix of remote and face-to-face services. From February 2020 to April 2020, total service utilization remained stable for treatment, outreach, and housing programs. In addition, mental health-related hospital utilization did not increase.

CONCLUSIONS

The findings of this study suggest that telehealth, including telephone-based services, is an acceptable and even preferred service delivery mode for clients with severe mental illness. Continued investigation into the optimal dosing of face-to-face versus remote services in various settings is needed to inform service practice during and after the COVID-19 pandemic.

The neurochemistry of social reward during development: What have we learned from rodent models?

Social rewards are fundamental to survival and overall health. Several studies suggest that adequate social stimuli during early life are critical for developing appropriate socioemotional and cognitive skills, whereas adverse social experiences negatively affect the proper development of brain and behavior, by increasing the susceptibility to develop neuropsychiatric conditions. Therefore, a better understanding of the neural mechanisms underlying social interactions, and their rewarding components in particular, is an important challenge of current neuroscience research. In this context, preclinical research has a crucial role: Animal models allow to investigate the neurobiological aspects of social reward in order to shed light on possible neurochemical alterations causing aberrant social reward processing in neuropsychiatric diseases, and they allow to test the validity and safety of innovative therapeutic strategies. Here, we discuss preclinical research that has investigated the rewarding properties of two forms of social interaction that occur in different phases of the lifespan of mammals, that is, mother-infant interaction and social interactions with peers, by focusing on the main neurotransmitter systems mediating their rewarding components. Together, the research performed so far helped to elucidate the mechanisms of social reward and its psychobiological components throughout development, thus increasing our understanding of the neurobiological substrates sustaining social functioning in health conditions and social dysfunction in major psychiatric disorders.

Social reward, punishment, and prosociality in paranoia

Paranoia is the exaggerated belief that harm will occur and is intended by others. Although commonly framed in terms of attributing malicious intent to others, recent work has explored how paranoia also affects social decision-making, using economic games. Previous work found that paranoia is associated with decreased cooperation and increased punishment in the Dictator Game (where cooperating and punishing involve paying a cost to respectively increase or decrease a partner's income). These findings suggest that paranoia might be associated with variation in subjective reward from positive and/or negative social decision-making, a possibility we explore using a preregistered experiment with U.S.-based participants (n = 2,004). Paranoia was associated with increased self-reported enjoyment of negative social interactions and decreased self-reported enjoyment of prosocial interactions. More paranoid participants attributed stronger harmful intent to a partner. Harmful intent attributions and the enjoyment of negative social interactions positively predicted the tendency to pay to punish the partner. Cooperation was positively associated with the tendency to enjoy prosocial interactions and increased with participant age. There was no main effect of paranoia on tendency to cooperate in this setting. We discuss these findings in light of previous research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Social reward processing: A biomarker for predicting psychosis risk?

The desire to obtain social rewards (e.g. positive feedback) features prominently in our lives and relationships, and is relevant to understanding psychopathology - where behavior is often impaired. Investigating social rewards within the psychosis-spectrum offers an especially useful opportunity, given the high rates of impaired social functioning and social isolation. The goal of this study was to investigate hedonic experience associated with social reward processing as a potential biomarker for psychosis risk. This study used a task-based functional magnetic resonance imaging (fMRI) paradigm in adolescents at clinical high-risk for the development of psychosis (CHR, n = 19) and healthy unaffected peers (healthy controls - HC, n = 20). Regional activation and connectivity of the ventromedial prefrontal cortex and ventral striatum were examined in response to receiving positive social feedback relative to an ambiguous feedback condition. Expectations of impaired hedonic processes in CHR youth were generally not supported, as there were no group differences in neural response or task-based connectivity. Although interesting relationships were found linking neural reward response and connectivity with social, anticipatory, and consummatory anhedonia in the CHR group, results are difficult to interpret in light of task limitations. We discuss potential implications for future study designs that seek to investigate social reward processing as a biomarker for psychosis risk.

Derationalizing Delusions

Because of the traditional conceptualization of delusion as “irrational belief,” cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition—processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.

Imaging the "social brain" in schizophrenia: A systematic review of neuroimaging studies of social reward and punishment

Decreased social functioning and high levels of loneliness and social isolation are common in schizophrenia spectrum disorders (SSD), contributing to reduced quality of life. One key contributor to social impairment is low social motivation, which may stem from aberrant neural processing of socially rewarding or punishing stimuli. To summarize research on the neurobiology of social motivation in SSD, we performed a systematic literature review of neuroimaging studies involving the presentation of social stimuli intended to elicit feelings of reward and/or punishment. Across 11 studies meeting criteria, people with SSD demonstrated weaker modulation of brain activity in regions within a proposed social interaction network, including prefrontal, cingulate, and striatal regions, as well as the amygdala and insula. Firm conclusions regarding neural differences in SSD in these regions, as well as connections within networks, are limited due to conceptual and methodological inconsistencies across the available studies. We conclude by making recommendations for the study of social reward and punishment processing in SSD in future research.

Grant Report on Social Reward Learning in Schizophrenia †

We report on the ongoing R21 project “Social Reward Learning in Schizophrenia”. Impairments in social cognition are a hallmark of schizophrenia. However, little work has been done on social reward learning deficits in schizophrenia. The overall goal of the project is to assess social reward learning in schizophrenia. A probabilistic reward learning (PRL) task is being used in the MRI scanner to evaluate reward learning to negative and positive social feedback. Monetary reward learning is used as a comparison to assess specificity. Behavioral outcomes and brain areas, included those involved in reward, are assessed in patients with schizophrenia or schizoaffective disorder and controls. It is also critical to determine whether decreased expected value (EV) of social stimuli and/or reward prediction error (RPE) learning underlie social reward learning deficits to inform potential treatment pathways. Our central hypothesis is that the pattern of social learning deficits is an extension of a more general reward learning impairment in schizophrenia and that social reward learning deficits critically contribute to deficits in social motivation and pleasure. We hypothesize that people with schizophrenia will show impaired behavioral social reward learning compared to controls, as well as decreased ventromedial prefrontal cortex (vmPFC) EV signaling at time of choice and decreased striatal RPE signaling at time of outcome, with potentially greater impairment to positive than negative feedback. The grant is in its second year. It is hoped that this innovative approach may lead to novel and more targeted treatment approaches for social cognitive impairments, using cognitive remediation and/or brain stimulation.

The neural mechanisms of social reward in early psychosis

In chronic psychosis, reduced trust is associated with a neural insensitivity to social reward and reduced theory of mind (ToM). Here we investigate whether these mechanisms could underlie emerging social impairments in early psychosis. Twenty-two participants with early psychosis and 25 controls (male, 13–19 years) participated in two interactive trust games against a cooperative and unfair partner. Region of interest neuroimaging analyses included right caudate, medial prefrontal cortex (mPFC) and right temporoparietal junction (rTPJ), involved in reward and ToM processing. Both groups showed similar levels of trust (i.e. investments). However, individuals with psychosis failed to activate the caudate differentially in response to cooperation and unfairness while making decisions to trust. During cooperative returns, patients showed reduced and controls increased caudate activation. Patients demonstrated greater rTPJ activation than controls, possibly pointing towards compensatory mechanisms. Effects were associated with Wechsler Abbreviated Scale of Intelligence vocabulary scores. No group differences emerged in mPFC activation. Early psychosis is associated with an aberrant neural sensitivity to social reward. This could foster reduced social motivation and social isolation. Absent behavioural differences in early, relative to chronic psychosis could indicate that trust is achieved through increased compensatory demand on ToM.

Trust and the city: Linking urban upbringing to neural mechanisms of trust in psychosis

OBJECTIVE

Elevated prevalence of non-affective psychotic disorders is often found in densely populated areas. This functional magnetic resonance imaging study investigates if reduced trust, a component of impaired social functioning in patients with psychotic disorder, is associated with urban upbringing.

METHODS

In total, 39 patients (22 first episode and 17 clinical high risk) and 30 healthy controls, aged 16-29, performed two multi-round trust games, with a cooperative and unfair partner during functional magnetic resonance imaging scanning. Baseline trust was operationalized as the first investment made, and changes of trust as changes in investments made over the 20 trials during the games. Urban exposure during upbringing (0-15 years) was defined as higher urban (≥2500 inhabitants/km²) or lower urban (<2500 inhabitants/km²).

RESULTS

Patients displayed lower baseline trust (first investment) than controls, regardless of urbanicity exposure. During cooperative interactions, lower-urban patients showed increasing investments. In addition, during cooperative interactions, group-by-developmental urbanicity interactions were found in the right and left amygdalae, although for the latter only at trend level. Higher urbanicity was associated with decreased activation of the left amygdala in patients and controls during investments and with increased activation of the right and left amygdalae in patients only, during repayments. During unfair interactions, no associations of urbanicity with behavior or brain activation were found.

CONCLUSION

Urban upbringing was unrelated to baseline trust. Associations with urbanicity were stronger for patients compared to controls, suggesting greater susceptibility to urbanicity effects during the developmental period. Higher-urban patients failed to compensate for the initial distrust specifically during repeated cooperative interactions. This finding highlights potential implications for social functioning. Urban upbringing was linked to differential amygdala activation, suggesting altered mechanisms of feedback learning, but this was not associated with trust game behavior.

Social and non-social reward learning reduced and related to a familial vulnerability in schizophrenia spectrum disorders

Patients with a disorder in the schizophrenia spectrum (SZ) demonstrate impairments in reward learning. A reduced sensitivity to social reward may impede social beyond non-social reward learning mechanisms. The aim of the current study was to investigate social and non-social reward learning in SZ by means of two interactive game-theoretical investment paradigms. Unaffected first-degree relatives of patients were included to examine whether (social) reward-learning impairments are part of a familial vulnerability of SZ. We included 50 patients with a SZ disorder, 20 unaffected first-degree relatives of patients and 49 healthy controls. The trust game (social) and the lottery game (non-social) were used, consisting of 20 game trials each. The game paradigms were programmed to increase the likelihood of higher repayments in response to increased investments. Multilevel regression analyses were used to examine learning over trials in both contexts. The results showed that controls learned equally well in social and non-social contexts, as reflected in an increase of investments over game rounds in both paradigms. In contrast, patients and relatives showed reduced reward learning, regardless of its social or non-social nature, reflected by flatter or decreasing slopes over game rounds in both paradigms. The findings suggest that patients and relatives have a general reduced sensitivity to reward, which appears to reflect a familial vulnerability rather than illness related mechanisms. Results indicate that reward learning may be an important marker for the familial risk to SZ.

A review of neuroeconomic gameplay in psychiatric disorders

Abnormalities in social interaction are a common feature of several psychiatric disorders, aligning with the recent move towards using Research Domain Criteria (RDoC) to describe disorders in terms of observable behaviours rather than using specific diagnoses. Neuroeconomic games are an effective measure of social decision-making that can be adapted for use in neuroimaging, allowing investigation of the biological basis for behaviour. This review summarises findings of neuroeconomic gameplay studies in Axis 1 psychiatric disorders and advocates the use of these games as measures of the RDoC Affiliation and Attachment, Reward Responsiveness, Reward Learning and Reward Valuation constructs. Although research on neuroeconomic gameplay is in its infancy, consistencies have been observed across disorders, particularly in terms of impaired integration of social and cognitive information, avoidance of negative social interactions and reduced reward sensitivity, as well as a reduction in activity in brain regions associated with processing and responding to social information.

Appearance-based trust processing in schizophrenia

OBJECTIVES

Schizophrenia is characterized by impaired social interactions and altered trust. In the general population, trust is often based on facial appearance, with limited validity but enormous social consequences. The aim was to examine trust processing in schizophrenia and specifically to examine how people with schizophrenia use facial appearance as well as actual partner fairness to guide trusting decisions.

DESIGN

An experimental economic game study.

METHODS

Here, we tested how patients with schizophrenia and control participants (each N = 24) use facial trustworthiness appearance and partner fairness behaviour to guide decisions in a multi-round Trust Game. In the Trust Game, participants lent money to 'partners' whose facial appearance was either untrustworthy or trustworthy, and who either played fairly or unfairly. Clinical symptoms were measured as well as explicit trustworthiness impressions.

RESULTS

Overall, the patients with schizophrenia showed unimpaired explicit facial trustworthiness impressions and unimpaired facial appearance biases in the Trust Game. Crucially, patients and controls significantly differed so that the patients with schizophrenia did not learn to discriminate in the Trust Game based on actual partner fairness, unlike control participants.

CONCLUSION

A failure to discriminate trust has important implications for everyday functioning in schizophrenia, as forming accurate trustworthiness beliefs is an essential social skill. Critically, without relying on more valid trust cues, people with schizophrenia may be especially susceptible to the misleading effect of appearance when making trusting decisions.

PRACTITIONER POINTS

Findings People with schizophrenia made very similar facial trustworthiness impressions to healthy controls and also used facial appearance to guide trust decisions similarly to controls. However, the patient group were less able to explicitly distinguish between fair and unfair partners based on their behaviour compared with the control group. Moreover, people with schizophrenia failed to use actual partner fairness to guide their financial decisions in the Trust Game, unlike controls, and this impairment was specific to a social task. People with schizophrenia may be particularly reliant on facial appearance when trusting others, as they may struggle to incorporate more valid trustworthiness information in their decision-making, such as actual partner fairness.

Paranoia and conspiracy: group cohesion increases harmful intent attribution in the Trust Game

Current theories argue that hyper-sensitisation of social threat perception is central to paranoia. Affected people often also report misperceptions of group cohesion (conspiracy) but little is known about the cognitive mechanisms underpinning this conspiracy thinking in live interactions. In a pre-registered experimental study, we used a large-scale game theory approach (N > 1,000) to test whether the social cohesion of an opposing group affects paranoid attributions in a mixed online and lab-based sample. Participants spanning the full population distribution of paranoia played as proposers in a modified Trust Game: they were allocated a bonus and chose how much money to send to a pair of responders which was quadrupled before reaching these responders. Responders decided how much to return to the proposers through the same process. Participants played in one of two conditions: against a cohesive group who communicated and arrived at a joint decision, or a non-cohesive group who made independent decisions. After the exchange, proposers rated the extent to which the responders’ decisions were driven by (i) self-interest and (ii) intent to harm. Although the true motives are ambiguous, cohesive responders were reliably rated by participants as being more strongly motivated by intent to harm, indicating that group cohesion affects social threat perception. Highly paranoid participants attributed harmful intent more strongly overall but were equally reactive to social cohesion as other participants. This suggests that paranoia involves a generally lowered threshold for social threat detection but with an intact sensitivity for cohesion-related group characteristics.

Paranoia and conspiracy: group cohesion increases harmful intent attribution in the Trust Game

Current theories argue that hyper-sensitisation of social threat perception is central to paranoia. Affected people often also report misperceptions of group cohesion (conspiracy) but little is known about the cognitive mechanisms underpinning this conspiracy thinking in live interactions. In a pre-registered experimental study, we used a large-scale game theory approach (N > 1,000) to test whether the social cohesion of an opposing group affects paranoid attributions in a mixed online and lab-based sample. Participants spanning the full population distribution of paranoia played as proposers in a modified Trust Game: they were allocated a bonus and chose how much money to send to a pair of responders which was quadrupled before reaching these responders. Responders decided how much to return to the proposers through the same process. Participants played in one of two conditions: against a cohesive group who communicated and arrived at a joint decision, or a non-cohesive group who made independent decisions. After the exchange, proposers rated the extent to which the responders' decisions were driven by (i) self-interest and (ii) intent to harm. Although the true motives are ambiguous, cohesive responders were reliably rated by participants as being more strongly motivated by intent to harm, indicating that group cohesion affects social threat perception. Highly paranoid participants attributed harmful intent more strongly overall but were equally reactive to social cohesion as other participants. This suggests that paranoia involves a generally lowered threshold for social threat detection but with an intact sensitivity for cohesion-related group characteristics.

Girls-Boys: An Investigation of Gender Differences in the Behavioral and Neural Mechanisms of Trust and Reciprocity in Adolescence

BACKGROUND

Trust and reciprocity toward others have often been found to increase from childhood to adulthood. Gender differences in these social behaviors have been reported in adults. While adolescence is a key-period of change in social behavior, gender differences in trust and reciprocity during this developmental stage have rarely been investigated.

METHODS

Here we investigate age-related gender differences in trust and reciprocity (n = 100, 51 female) and associated neural mechanisms (n = 44, 20 female) in adolescents between 13 and 19 years of age. Participants played two multi-round trust games with a pre-programmed cooperative and an unfair partner. Forty-four of 100 participants completed the trust game while undergoing functional brain imaging.

RESULTS

Participants' investments were greater toward a cooperative than unfair game partner (p < 0.01), showing sensitivity to the degree of trustworthiness. There were no gender or age or related differences in baseline trust. In repeated cooperative interactions no gender differences were found, but younger adolescents showed slightly steeper increase of investments than older adolescents. In unfair interactions, younger males reacted with stronger decrease of investments than older males. Region of interest analysis of brain areas associated with in mentalizing, reward learning, conflict processing, and cognitive control revealed gender-by-age interactions on trusting behavior in the temporo-parietal junction (TPJ) and the caudate, showing stronger influence of age in males than in females during cooperation, and the reverse in unfair interactions. Additionally, main effects of gender were found in the TPJ, with higher activation in males, and in the caudate, with females showing greater activation.

CONCLUSION

In first interactions and during repeated cooperative interactions, adolescent males and females showed similar trusting behavior. Younger males showed stronger responses to unfairness by others. Gender-by-age interactions in specific ROIs suggest differential development in mentalizing and reward related cognitive processes. In conjunction with previous research, our findings suggest the presence of subtle gender and age-related changes in trust and cooperation that are only detectable using larger age windows.

Learning to trust: social feedback normalizes trust behavior in first-episode psychosis and clinical high risk

BACKGROUND

Psychosis is characterized by problems in social functioning that exist well before illness onset, and in individuals at clinical high risk (CHR) for psychosis. Trust is an essential element for social interactions that is impaired in psychosis. In the trust game, chronic patients showed reduced baseline trust, impaired response to positive social feedback, and attenuated brain activation in reward and mentalizing areas. We investigated whether first-episode psychosis patients (FEP) and CHR show similar abnormalities in the neural and behavioral mechanisms underlying trust.

METHODS

Twenty-two FEP, 17 CHR, and 43 healthy controls performed two trust games, with a cooperative and an unfair partner in the fMRI scanner. Region of interest analyses were performed on mentalizing and reward processing areas, during the investment and outcome phases of the games.

RESULTS

Compared with healthy controls, FEP and CHR showed reduced baseline trust, but like controls, learned to trust in response to cooperative and unfair feedback. Symptom severity was not associated with baseline trust, however in FEP associated with reduced response to feedback. The only group differences in brain activation were that CHR recruited the temporo-parietal junction (TPJ) more than FEP and controls during investment in the unfair condition. This hyper-activation in CHR was associated with greater symptom severity.

CONCLUSIONS

Reduced baseline trust may be associated with risk for psychotic illness, or generally with poor mental health. Feedback learning is still intact in CHR and FEP, as opposed to chronic patients. CHR however show distinct neural activation patterns of hyper-activation of the TPJ.

When trust is lost: the impact of interpersonal trauma on social interactions

BACKGROUND

Trauma due to deliberate harm by others is known to increase the likelihood of developing Post-Traumatic Stress Disorder (PTSD). This is the first study investigating basic and dynamic trust in 'interpersonal' PTSD.

METHODS

Thirty-two participants with PTSD and 22 healthy controls played a novel multi-round version of a monetary investment protocol, the so-called 'Trust Game', a task from the behavioural economics literature, which is considered to involve trust and reciprocity. We used two 'Trust Games' including cooperative and unfair partners.

RESULTS

Findings showed an effect for lower basic investment in PTSD compared to healthy controls, that trended towards significance (p = 0.09). All participants showed behavioural flexibility and modified their trust based on behavioural cues from their cooperative and unfair game partners. However, participants with PTSD made significantly lower investments towards the cooperative partner than controls. Investments towards the unfair partner did not differ between groups. Higher trauma scores were associated with lower levels of trust-related investments towards the cooperative but not the unfair game partner.

CONCLUSION

The association between reduced trust towards cooperative others in individuals who experienced interpersonal trauma could indicate acquired insensitivity to social rewards or inflexible negative beliefs about others as a sequel of the traumatic experience, which increases in a dose response relationship with the severity of the trauma. A specific focus on cooperation and trusting behaviour could provide a treatment target for future cognitive and pharmacological interventions.

The neural circuitry of affect-induced distortions of trust

Aversive affect is likely a key source of irrational human decision-making, but still, little is known about the neural circuitry underlying emotion-cognition interactions during social behavior. We induced incidental aversive affect via prolonged periods of threat of shock, while 41 healthy participants made investment decisions concerning another person or a lottery. Negative affect reduced trust, suppressed trust-specific activity in the left temporoparietal junction (TPJ), and reduced functional connectivity between the TPJ and emotion-related regions such as the amygdala. The posterior superior temporal sulcus (pSTS) seems to play a key role in mediating the impact of affect on behavior: Functional connectivity of this brain area with left TPJ was associated with trust in the absence of negative affect, but aversive affect disrupted this association between TPJ-pSTS connectivity and behavioral trust. Our findings may be useful for a better understanding of the neural circuitry of affective distortions in healthy and pathological populations.

Social Mindfulness and Psychosis: Neural Response to Socially Mindful Behavior in First-Episode Psychosis and Patients at Clinical High-Risk

Background: Psychosis is characterized by problems in social functioning and trust, the assumed glue to positive social relations. But what helps building trust? A prime candidate could be social mindfulness: the ability and willingness to see and consider another person’s needs and wishes during social decision making. We investigated whether first-episode psychosis patients (FEP) and patients at clinical high-risk (CHR) show reduced social mindfulness, and examined the underlying neural mechanisms.

Methods: Twenty FEP, 17 CHR and 46 healthy controls, aged 16–31, performed the social mindfulness task (SoMi) during fMRI scanning, spontaneously and after the instruction “to keep the other’s best interest in mind.” As first of two people, participants had to choose one out of four products, of which three were identical and one was unique, differing in a single aspect (e.g., color).

Results: FEP tended to choose the unique item (unmindful choice) more often than controls. After instruction, all groups significantly increased the number of mindful choices compared to the spontaneous condition. FEP showed reduced activation of the caudate and medial prefrontal cortex (mPFC) during mindful, and of the anterior cingulate cortex (ACC), mPFC, and left dorsolateral prefrontal cortex (dlPFC) during unmindful decisions. CHR showed reduced activation of the ACC compared to controls.

Discussion: FEP showed a trend toward more unmindful choices. A similar increase of mindful choices after instruction indicated the ability for social mindfulness when prompted. Results suggested reduced sensitivity to the rewarding aspects of social mindfulness in FEP, and reduced consideration for the other player. FEP (and CHR to a lesser extent) might perceive unmindful choices as less incongruent with the automatic mindful responses than controls. Reduced socially mindful behavior in FEP may hinder the building of trust and cooperative interactions.

Cooperation and sensitivity to social feedback during group interactions in schizophrenia

Patients with schizophrenia show reduced cooperation and less sensitivity to social cues in pairwise interactions, however, it remains unclear whether these mechanisms are also present in interactions within social groups. We used a public goods game to investigate cooperation and sensitivity to social feedback in group interactions in 27 patients with schizophrenia and 27 healthy controls. Participants played 40 trials in two conditions: 1) no fine (20 trials): participants had the choice of investing into the public good (i.e. cooperating) or not (i.e. defecting), 2) fine (20 trials): participants had the same choice but defectors could be punished by the other players. On the first trial, patients invested less in the public good than healthy controls. In the no fine condition, controls decreased their investments over time, but patients did not. The possibility of being fined for defecting and actually being fined led to significantly higher cooperation in both groups. This shows that the groups were equally sensitive to social enforcement and social feedback. Our findings suggest that patients tend to approach social group interactions with less cooperative behaviour, which could contribute to social dysfunction in daily-life. However, an intact sensitivity to social enforcement and feedback indicates that patients can adjust their behaviour accordingly in group interactions.

Experimentally induced social threat increases paranoid thinking

The ability to attribute intentions to others is a hallmark of human social cognition but is altered in paranoia. Paranoia is the most common positive symptom of psychosis but is also present to varying degrees in the general population. Epidemiological models suggest that psychosis risk is associated with low social rank and minority status, but the causal effects of status and group affiliation on paranoid thinking remain unclear. We examined whether relative social status and perceived group affiliation, respectively, affect live paranoid thinking using two large-N (N = 2030), pre-registered experiments. Interacting with someone from a higher social rank or a political out-group led to an increase in paranoid attributions of harmful intent for ambiguous actions. Pre-existing paranoia predicted a general increase in harmful intent attribution, but there was no interaction with either type of social threat: highly paranoid people showed the same magnitude of increase as non-paranoid people, although from a higher baseline. We conclude social threat in the form of low social status and out-group status affects paranoid attributions, but ongoing paranoia represents a lowered threshold for detecting social threat rather than an impaired reactivity to it.

Conflict and cooperation in paranoia: a large-scale behavioural experiment

BACKGROUND

Paranoia involves thoughts and beliefs about the harmful intent of others but the social consequences have been much less studied. We investigated whether paranoia predicts maladaptive social behaviour in terms of cooperative and punitive behaviour using experimental game theory paradigms, and examined whether reduced cooperation is best explained in terms of distrust as previous studies have claimed.

METHODS

We recruited a large population sample (N = 2132) online. All participants completed the Green et al. Paranoid Thoughts Scale and (i) a Dictator Game and (ii) an Ultimatum Game, the former with an option for costly punishment. Following distrust-based accounts, we predicted highly paranoid people would make higher offers when the outcome depended on receiving a positive response from their partner (Ultimatum Game) but no difference when the partner's response was irrelevant (Dictator Game). We also predicted paranoia would increase punitive responses. Predictions were pre-registered in advance of data collection. Data and materials are open access.

RESULTS

Highly paranoid participants actually made lower offers than non-paranoid participants both in the Dictator Game and in the Ultimatum Game. Paranoia positively predicted punitive responses.

CONCLUSIONS

These findings suggest that distrust is not the best explanation for reduced cooperation in paranoia and alternative explanations, such as increased self-interest, may apply. However, the tendency to attribute harmful intent to partners was important in motivating punitive responses. These results highlight differing motivations underlying adverse social behaviour in paranoia and suggest that accounts based solely on the presenting features of paranoia may need to be rethought.

Social motivation in schizophrenia: How research on basic reward processes informs and limits our understanding

Limited quantity and quality of interpersonal exchanges and relationships predict worse symptomatic and hospitalization outcomes and limit functional recovery in people with schizophrenia. While deficits in social skills and social cognition contribute to much of the impairment in social functioning in schizophrenia, our focus on the current review is social motivation-the drive to connect with others and form meaningful, lasting relationships. We pay particular attention to how recent research on reward informs, and limits, our understanding of the construct. Recent findings that parse out key components of human motivation, especially the temporal nature of reward and effort, are informative for understanding some aspects of social motivation. This approach, however, fails to fully integrate the critical influence of uncertainty and punishment (e.g., avoidance, threat) in social motivation. In the current review, we argue for the importance of experimental paradigms and real-time measurement to capture the interaction between social approach and avoidance in characterizing social affiliation in schizophrenia. We end with suggestions for how researchers might move the field forward by emphasizing the ecological validity of social motivation paradigms, including dynamic, momentary assessment of social reward and punishment using mobile technology and other innovative tools.

Everything you wanted to know about neuroimaging and psychiatry, but were afraid to ask

Recent years have seen a dramatic increase in the advances and applications of medical imaging techniques. Tools with familiar acronyms such as MRI, EEG/MEG and PET/SPECT have provided invaluable information not only about the brain structure and function associated with psychiatric disorders, but increasingly about the mechanisms underpinning these disorders. This evolving understanding of the specific pathophysiology of mental disorder paves the way for improvement in the diagnosis, treatment and prognosis of the disorders managed in everyday clinical practice. This article gives an overview of the main neuroimaging approaches, contemporary applications of this technology to psychiatric disorder and signposts to the exciting possibilities for the future.

The indirect assessment of social anhedonia in Chinese adolescents: Preliminary findings

Nearly all self-report measures of anhedonia have been developed for use in adults. Recently we developed an age and developmentally appropriate measure of social/interpersonal pleasure for adolescents (ACIPS-A), whereby lower scores are indicative of social anhedonia. However the scale had not been administered to Eastern samples. The adolescent version of the Anticipatory and Consummatory Interpersonal Pleasure Scale (ACIPS-A) was administered to a general, community-derived Chinese adolescent sample of 442 students, including 186 males (44%), who ranged in age from 12 to 18 years old. The 20-item Chinese Temporal Experience of Pleasure (TEPS) was also administered to the sample. Exploratory factor analysis revealed that three factors (Casual bonding, Close relationships, and Shared interests) accounted for nearly 69% of the variance. The total ACIPS-A showed excellent internal consistency, with ordinal alpha = 0.94. Scores on the adolescent version of the ACIPS were positively and significantly associated with total scores on the four Chinese TEPS subscales. The ACIPS-A is a sufficiently robust measure to be useful and valid in Chinese samples as well as in Western (i.e. European and U.S.) samples.

Boys vs. girls: Gender differences in the neural development of trust and reciprocity depend on social context

Trust and cooperation increase from adolescence to adulthood, but studies on gender differences in this development are rare. We investigated gender and age-related differences in trust and reciprocity and associated neural mechanisms in 43 individuals (16-27 years, 22 male). Participants played two multi-round trust games with a cooperative and an unfair partner. Males showed more basic trust towards unknown others than females. Both genders increased trust during cooperative interactions, with no differences in average trust. Age was unrelated to trust during cooperation. During unfair interactions males decreased their trust more with age than females. ROI analysis showed age-related increases in activation in the temporo-parietal junction (TPJ) and dorsolateral prefrontal cortex (dlPFC) during cooperative investments, and increased age-related caudate activation during both cooperative and unfair repayments. Gender differences in brain activation were only observed during cooperative repayments, with males activating the TPJ more than females, and females activating the caudate more. The findings suggest relatively mature processes of trust and reciprocity in the investigated age range. Gender differences only occur in unfair contexts, becoming more pronounced with age. Largely similar neural activation in males and females and few age effects suggest that similar, mature cognitive strategies are employed.

Theory of mind deficits partly mediate impaired social decision-making in schizophrenia

BACKGROUND

Using paradigms from game theory, researchers have reported abnormal decision-making in social context in patients with schizophrenia. However, less is known about the underpinnings of the impairment. This study aimed to test whether theory of mind (ToM) deficits and/or neurocognitive dysfunctions mediate impaired social decision-making in patients with schizophrenia.

METHODS

We compared thirty-five patients with schizophrenia to thirty-eight matched healthy controls with regard to social decision-making using the mini Ultimatum Game (mini UG), a paradigm from game theory. Additionally, we assessed ToM using the Theory of Mind Picture Stories Task, a mental state attribution task, and assessed neurocognition using the Brief Assessment of Cognition in Schizophrenia. Mediation analyses were performed on the data.

RESULTS

In contrast to the behavioral pattern of healthy controls in the mini UG, the patients with schizophrenia significantly accepted more disadvantageous offers and rejected more advantageous offers, and showed reduced sensitivity to the fairness-related context changes in the mini UG. Impaired ToM and neurocognition were also found in the patients. Mediation analyses indicated that ToM but not neurocognition partially mediated the group differences on the disadvantageous and advantageous offers in the mini UG.

CONCLUSIONS

Patients with schizophrenia exhibited impaired social decision-making. This impairment can be partly explained by their ToM deficits rather than neurocognitive deficits. However, the exact nature of the ToM deficits that mediate impaired social decision-making needs to be identified in future.

Reward: From Basic Reinforcers to Anticipation of Social Cues

Reward processing plays a major role in goal-directed behavior and motivation. On the neural level, it is mediated by a complex network of brain structures called the dopaminergic reward system. In the last decade, neuroscientific researchers have become increasingly interested in aspects of social interaction that are experienced as rewarding. Recent neuroimaging studies have provided evidence that the reward system mediates the processing of social stimuli in a manner analogous to nonsocial rewards and thus motivates social behavior. In this context, the neuropeptide oxytocin is assumed to play a key role by activating dopaminergic reward pathways in response to social cues, inducing the rewarding quality of social interactions. Alterations in the dopaminergic reward system have been found in several psychiatric disorders that are accompanied by social interaction and motivation problems, for example autism, attention deficit/hyperactivity disorder, addiction disorders, and schizophrenia.

Neural signatures of trust in reciprocity: A coordinate-based meta-analysis

Trust in reciprocity (TR) is defined as the risky decision to invest valued resources in another party with the hope of mutual benefit. Several fMRI studies have investigated the neural correlates of TR in one-shot and multiround versions of the investment game (IG). However, an overall characterization of the underlying neural networks remains elusive. Here, a coordinate-based meta-analysis was employed (activation likelihood estimation method, 30 articles) to investigate consistent brain activations in each of the IG stages (i.e., the trust, reciprocity and feedback stage). Results showed consistent activations in the anterior insula (AI) during trust decisions in the one-shot IG and decisions to reciprocate in the multiround IG, likely related to representations of aversive feelings. Moreover, decisions to reciprocate also consistently engaged the intraparietal sulcus, probably involved in evaluations of the reciprocity options. On the contrary, trust decisions in the multiround IG consistently activated the ventral striatum, likely associated with reward prediction error signals. Finally, the dorsal striatum was found consistently recruited during the feedback stage of the multiround IG, likely related to reinforcement learning. In conclusion, our results indicate different neural networks underlying trust, reciprocity, and feedback learning. These findings suggest that although decisions to trust and reciprocate may elicit aversive feelings likely evoked by the uncertainty about the decision outcomes and the pressing requirements of social standards, multiple interactions allow people to build interpersonal trust for cooperation via a learning mechanism by which they arguably learn to distinguish trustworthy from untrustworthy partners. Hum Brain Mapp 38:1233-1248, 2017. © 2016 Wiley Periodicals, Inc.

Reduced oxytocin receptor gene expression and binding sites in different brain regions in schizophrenia: A post-mortem study

Schizophrenia is a severe neuropsychiatric disorder with impairments in social cognition. Several brain regions have been implicated in social cognition, including the nucleus caudatus, prefrontal and temporal cortex, and cerebellum. Oxytocin is a critical modulator of social cognition and the formation and maintenance of social relationships and was shown to improve symptoms and social cognition in schizophrenia patients. However, it is unknown whether the oxytocin receptor is altered in the brain. Therefore, we used qRT-PCR and Ornithine Vasotocin Analog ([¹²⁵I]OVTA)-based receptor autoradiography to investigate oxytocin receptor expression at both the mRNA and protein level in the left prefrontal and middle temporal cortex, left nucleus caudatus, and right posterior superior vermis in 10 schizophrenia patients and 6 healthy controls. Furthermore, to investigate confounding effects of long-term antipsychotic medication we treated rats with clozapine or haloperidol for 12weeks and assessed expression of the oxytocin receptor in cortical and subcortical brain regions. In schizophrenia patients, we found a downregulation of oxytocin receptor mRNA in the temporal cortex and a decrease in receptor binding in the vermis. In the other regions, the results showed trends in the same direction, without reaching statistical significance. We found no differences between antipsychotic-treated rats and controls. Downregulated expression and binding of the oxytocin receptor in brain regions involved in social cognition may lead to a dysfunction of oxytocin signaling. Our results support a dysfunction of the oxytocin receptor in schizophrenia, which may contribute to deficits of social cognition.