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von Heyden M, Grube P, Sack M, Wiesner J, Frank O, Becker K, Heintz S, Reinhard I, Hohmann S, Hirjak D, Meyer-Lindenberg A, Braun U. Intensive Longitudinal Social Sensing in Patients With Psychosis Spectrum Disorders: An Exploratory Pilot Study. Schizophr Bull 2024:sbae032. [PMID: 38522431 DOI: 10.1093/schbul/sbae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Psychosis spectrum disorders are characterized by significant alterations in social functioning, which is a major factor for patient recovery. Despite its importance, objectively quantifying the complex day-to-day social behavior in real-life settings has rarely been attempted. Here, we conducted a pilot study with wearable sensors that passively and continuously register interactions with other participants. We hypothesized that the amount and pattern of social interaction was associated with the severity of psychotic symptoms. STUDY DESIGN We recruited 7 patients with psychosis spectrum disorders and 18 team members from a Soteria-style ward. Each participant wore a radio frequency identification badge, sending and receiving signals from nearby badges, allowing passive quantification of social interactions. In addition, symptom severity was assessed weekly by the Positive and Negative Syndrome Scale (PANSS). STUDY RESULTS During an 11-week period, we identified 17 970 interactions among patients and staff. On average, patients spent 2.6 h per day interacting, capturing relevant aspects of daily social life. Relative daily interaction time, average interaction duration, and clustering coefficient, a measure of local network integration, were significantly associated with lower PANSS scores. Self-reported interaction time did not correlate with measured interaction time or with PANSS, indicating the importance of objective markers. CONCLUSIONS This pilot study demonstrates the feasibility of passively recording social interaction of patients and staff at high resolution and for a long observation period in a real-life setting in a psychiatric department. We show links between quantified social interaction and psychopathology that may facilitate development and personalization of targeted treatments.
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Affiliation(s)
- Moritz von Heyden
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Paul Grube
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Markus Sack
- Department of Neuroimaging, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Johannes Wiesner
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Oliver Frank
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Kathrin Becker
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Stefan Heintz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- German Center for Mental Health, Partner site Mannheim-Heidelberg-Ulm
| | - Urs Braun
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, University of Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- Hector Institute for Artificial Intelligence in Psychiatry, Central Institute of Mental Health, University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany
- German Center for Mental Health, Partner site Mannheim-Heidelberg-Ulm
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2
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Kamp D, Hartmann N, Frommann N, Lowe A, Pintgen L, Weide K, Wölwer W. The relationship between empathy, theory of mind and facial affect recognition in schizophrenia patients. Int J Neurosci 2024:1-5. [PMID: 38441493 DOI: 10.1080/00207454.2024.2327415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/02/2024] [Indexed: 03/12/2024]
Abstract
Although impairments in social cognition are a core feature in schizophrenia, the relationship between its subcomponents is less clear. Nineteen schizophrenia patients and 20 matched healthy controls were tested for emotion recognition, and for the cognitive and affective subcomponents of empathy and theory of mind (ToM). Patients scored significantly worse than controls on cognitive empathy and both subcomponents of ToM. Group differences disappeared for cognitive empathy and affective ToM when emotion recognition was included as a covariate. Our results indicate that emotion recognition is an important factor involved in the deficits on higher levels of social cognition in schizophrenia.
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Affiliation(s)
- Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Nora Hartmann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Lisa Pintgen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University Düsseldorf, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
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3
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Jimeno N. Language and communication rehabilitation in patients with schizophrenia: A narrative review. Heliyon 2024; 10:e24897. [PMID: 38312547 PMCID: PMC10835363 DOI: 10.1016/j.heliyon.2024.e24897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Language impairments often appear in patients with schizophrenia and are potential targets for rehabilitation. Clinical practice and research should be intimately connected. The aim was to perform a narrative review of the assessment and intervention tools that have been used for the rehabilitation of schizophrenia patients with language and communication impairments. Two types of tools, general and specific, were developed for both purposes. General tools include the Positive and Negative Syndrome Scale for assessment, and the Integrated Psychological Therapy for intervention. The specific tools used to evaluate language and communication impairments include the Scale for the Assessment of Thought, Language and Communication, the Formal Thought Disorder scales (for caregivers and patients), and the Thought and Language Disorder scale. The most recent language-specific intervention tools include the Cognitive Pragmatic Treatment, Conecta-2, Let's talk! Multimodal Speech-Gesture training, Speech Therapy Intervention Group, and PragmaCom. These tools primarily involve psychopathology/psychiatry, psychology, linguistics, speech and language therapy, and nursing. In conclusion, a wide range of assessment and intervention tools are available for the rehabilitation of language and communication impairments associated with schizophrenia. An integrative and interdisciplinary approach should always be considered for rehabilitation of language and communication in patients with schizophrenia throughout their lifetime.
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Affiliation(s)
- Natalia Jimeno
- School of Medicine, University of Valladolid, Av. Ramón y Cajal 7, E-47005 Valladolid, Spain
- Research Group on Clinical Neuroscience of Castile and Leon, Av. Ramón y Cajal 7, E-47005 Valladolid, Spain
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4
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Adraoui FW, Douw L, Martens GJM, Maas DA. Connecting Neurobiological Features with Interregional Dysconnectivity in Social-Cognitive Impairments of Schizophrenia. Int J Mol Sci 2023; 24:ijms24097680. [PMID: 37175387 PMCID: PMC10177877 DOI: 10.3390/ijms24097680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Schizophrenia (SZ) is a devastating psychiatric disorder affecting about 1% of the world's population. Social-cognitive impairments in SZ prevent positive social interactions and lead to progressive social withdrawal. The neurobiological underpinnings of social-cognitive symptoms remain poorly understood, which hinders the development of novel treatments. At the whole-brain level, an abnormal activation of social brain regions and interregional dysconnectivity within social-cognitive brain networks have been identified as major contributors to these symptoms. At the cellular and subcellular levels, an interplay between oxidative stress, neuroinflammation and N-methyl-D-aspartate receptor hypofunction is thought to underly SZ pathology. However, it is not clear how these molecular processes are linked with interregional dysconnectivity in the genesis of social-cognitive symptoms. Here, we aim to bridge the gap between macroscale (connectivity analyses) and microscale (molecular and cellular mechanistic) knowledge by proposing impaired myelination and the disinhibition of local microcircuits as possible causative biological pathways leading to dysconnectivity and abnormal activity of the social brain. Furthermore, we recommend electroencephalography as a promising translational technique that can foster pre-clinical drug development and discuss attractive drug targets for the treatment of social-cognitive symptoms in SZ.
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Affiliation(s)
- Florian W Adraoui
- Biotrial, Preclinical Pharmacology Department, 7-9 rue Jean-Louis Bertrand, 35000 Rennes, France
| | - Linda Douw
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan, 1081 HZ Amsterdam, The Netherlands
| | - Gerard J M Martens
- Donders Centre for Neuroscience (DCN), Department of Molecular Animal Physiology, Faculty of Science, Donders Institute for Brain, Cognition and Behavior, Radboud University, 6525 GA Nijmegen, The Netherlands
- NeuroDrug Research Ltd., 6525 ED Nijmegen, The Netherlands
| | - Dorien A Maas
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan, 1081 HZ Amsterdam, The Netherlands
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5
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Fekete Z, Vass E, Balajth R, Tana Ü, Nagy AC, Domján N, Égerházi A, Kuritárné IS. Regrouping scalets: Psychometric properties of the theory of mind picture stories task in a schizophrenic sample. Neuropsychol Rehabil 2022; 32:2227-2247. [PMID: 34013841 DOI: 10.1080/09602011.2021.1930559] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Theory of mind is one of the most intensively studied phenomena in the development of schizophrenic symptoms and impairments in social adjustment. Complex theory of mind processing requires both visual and verbal aspects of the social-perceptual and social-cognitive components of mind reading. Reliable assessment methods are considered essential for the proper conduct of research. The current study aims at investigating the psychometric properties of the Theory of Mind Picture Stories Task (ToM PST). Forty-seven patients with schizophrenia were enrolled in the study from three sites. Data from ToM PST were used for computing the consistency, reliability, and internal and construct validity of the test.Our preliminary findings showed less appropriate consistency. Therefore, we attempted to carry out structural changes on the task while preserving its scales and subscales, which measure crucial factors of ToM. The newly structured task has four scales. They show proper consistency (Sequencing: Cronbach's α = 0.70, Theory of a Single Person's Mind: α = 0.74, Switching Between Minds: α = 0.70, Comprehension of Misleading Behaviour: α = 0.67, Total: α = 0.80) with appropriate internal and construct validity, a moderate test-retest reliability over a four-month-course, and a proper inter-rater reliability.
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Affiliation(s)
- Zita Fekete
- University of Debrecen, Faculty of Medicine, Institute of Behavioural Sciences, Debrecen, Hungary.,Health Sciences School of Ph.D., University of Debrecen, Debrecen, Hungary
| | - Edit Vass
- Semmelweis University, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Budapest, Hungary
| | - Ramóna Balajth
- Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Jósa András Teaching Hospital, Department of Psychiatry and Psychotherapy, Nyíregyháza, Hungary
| | - Ünige Tana
- URBS Pro Patiente Nonprofit Ltd., Department of Psychiatric Rehabilitation, Budakalász, Hungary
| | | | - Nóra Domján
- University of Szeged, Faculty of Medicine, Department of Psychiatry, Szeged, Hungary
| | - Anikó Égerházi
- Clinical Center, Department of Psychiatry, University of Debrecen, Debrecen, Hungary
| | - Ildikó Szabó Kuritárné
- University of Debrecen, Faculty of Medicine, Institute of Behavioural Sciences, Debrecen, Hungary
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6
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Fekete Z, Vass E, Balajthy R, Tana Ü, Nagy AC, Oláh B, Domján N, Kuritárné IS. Efficacy of metacognitive training on symptom severity, neurocognition and social cognition in patients with schizophrenia: A single-blind randomized controlled trial. Scand J Psychol 2022; 63:321-333. [PMID: 35388496 PMCID: PMC9544200 DOI: 10.1111/sjop.12811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/21/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
Over the past decades, a number of complementary treatments for schizophrenia have emerged. One of these is metacognitive training (MCT), which combines the principles of cognitive‐behavioral therapies, cognitive remediation, and psychoeducation into a hybrid approach placing emphasis on increasing metacognitive awareness. The aim of our study was to investigate the efficacy of MCT on symptom severity, and neurocognitive and social cognitive functioning in schizophrenia; also, attention was paid to the assessment of subjective acceptability. Forty‐six patients diagnosed with schizophrenia were included in our single‐blind randomized controlled trial, who were assigned to the intervention or control group. The intervention group was provided standard MCT, while the control group received treatment as usual. We assessed symptom severity and cognitive functions before and after the training, as well as after a 6‐month follow‐up period. Compared to the control group, the intervention group showed improvement in overall symptom severity, and positive and disorganized symptoms. Training participans showed further improvement at the follow‐up assessment. Regarding neurocognitive functions, improvement in visuospatial functions was observed between pre‐ and post‐intervention assessments compared to the control group. Patients showed excellent adherence, and evaluated the training as useful and interesting. In line with the results of previous studies, our results demonstrate the efficacy of MCT on symptom severity in schizophrenia. Improvements in cognitive functions that are closely related to the onset and prevalence of symptoms of schizophrenia were also found.
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Affiliation(s)
- Zita Fekete
- Faculty of Medicine, Institute of Behavioural Sciences, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Edit Vass
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Ramóna Balajthy
- Department of Psychiatry and Psychotherapy, Jósa András Teaching Hospital, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Ünige Tana
- Department of Psychiatric Rehabilitation, URBS Pro Patiente Nonprofit Ltd., Budakalász, Hungary
| | - Attila Csaba Nagy
- Faculty of Public Health, Faculty of Public Health, Debrecen, Hungary
| | - Barnabás Oláh
- Faculty of Medicine, Institute of Behavioural Sciences, University of Debrecen, Debrecen, Hungary
| | - Nóra Domján
- Faculty of Medicine, Department of Psychiatry, University of Szeged, Szeged, Hungary
| | - Ildikó Szabó Kuritárné
- Faculty of Medicine, Institute of Behavioural Sciences, University of Debrecen, Debrecen, Hungary
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7
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Advances in Cognitive Remediation Training in Schizophrenia: A Review. Brain Sci 2022; 12:brainsci12020129. [PMID: 35203893 PMCID: PMC8870375 DOI: 10.3390/brainsci12020129] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/14/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive Remediation Training (CRT) in schizophrenia has made great strides since its introduction in the 1990s. CRT was developed with the aim of improving the everyday functioning of individuals living with cognitive impairment. MEDLINE, PsychINFO, and Google Scholar were searched to extract peer-reviewed randomized controlled trials to produce the current review article. The aim of the present review is to summarize CRT effects on addressing cognitive changes in patients undergoing CRT as defined by the Cognitive Remediation Experts Workshop and to describe the areas of greatest impact in specific cognitive domains. Another area of this review aims to summarize the modalities of intervention (paper and pencil; computerized; home bound), the persistence of improvements, and their generalization to other domains of functioning. Finally, this review delineates barriers for wider dissemination of CRT, such as the transfer of research findings into clinical everyday practice and future developments of CRT.
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8
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Palumbo D, Caporusso E, Piegari G, Mencacci C, Torriero S, Giuliani L, Fabrazzo M, Pinto D, Galderisi S. Social Cognition Individualized Activities Lab for Social Cognition Training and Narrative Enhancement in Patients With Schizophrenia: A Randomized Controlled Study to Assess Efficacy and Generalization to Real-Life Functioning (Prot. n°: NCT05130853). Front Psychiatry 2022; 13:833550. [PMID: 35444577 PMCID: PMC9015661 DOI: 10.3389/fpsyt.2022.833550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Subjects affected by schizophrenia present significant deficits in various aspects of social cognition, such as emotion processing, social perception and theory of mind (ToM). These deficits have a greater impact than symptoms on occupational and social functioning. Therefore, social cognition represents an important therapeutic target in people with schizophrenia. Recent meta-analyses showed that social cognition training (SCT) is effective in improving social cognition in subjects with schizophrenia; however, real-life functioning is not always ameliorated. Integration of SCT with an intervention targeting metacognitive abilities might improve the integration of social cognitive skills to daily life functioning. Our research group has implemented a new individualized rehabilitation program: the Social Cognition Individualized Activities Lab, SoCIAL, which integrates SCT with a module for narrative enhancement, an intervention targeting metacognitive abilities. The present multi-center randomized controlled study will compare the efficacy of SoCIAL and treatment as usual (TAU) in subjects diagnosed with a schizophrenia-spectrum disorder. The primary outcome will be the improvement of social cognition and real-life functioning; while the secondary outcome will be the improvement of symptoms, functional capacity and neurocognition. The results of this study will add empirical evidence to the benefits and feasibility of SCT and narrative enhancement in people with schizophrenia-spectrum disorders.
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Affiliation(s)
- Davide Palumbo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Edoardo Caporusso
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giuseppe Piegari
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Claudio Mencacci
- Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Sara Torriero
- Department of Psychiatry and Addiction, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Luigi Giuliani
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Dario Pinto
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "Luigi Vanvitelli," Naples, Italy
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9
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Wölwer W, Frommann N, Lowe A, Kamp D, Weide K, Bechdolf A, Brockhaus-Dumke A, Hurlemann R, Muthesius A, Klingberg S, Hellmich M, Schmied S, Meyer-Lindenberg A. Efficacy of Integrated Social Cognitive Remediation vs. Neurocognitive Remediation in Improving Functional Outcome in Schizophrenia: Concept and Design of a Multicenter, Single-Blind RCT (The ISST Study). Front Psychiatry 2022; 13:909370. [PMID: 35800017 PMCID: PMC9253387 DOI: 10.3389/fpsyt.2022.909370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Although clinically effective treatment is available for schizophrenia, recovery often is still hampered by persistent poor psychosocial functioning, which in turn is limited by impairments in neurocognition, social cognition, and social behavioral skills. Although cognitive remediation has shown general efficacy in improving cognition and social functioning, effects still need to be improved and replicated in appropriately powered, methodologically rigorous randomized controlled trials (RCTs). Existing evidence indicates that effects can most likely be optimized by combining treatment approaches to simultaneously address both social cognitive and social behavioral processes. OBJECTIVES To assess whether Integrated Social Cognitive and Behavioral Skill Therapy (ISST) is more efficacious in improving functional outcome in schizophrenia than the active control treatment Neurocognitive Remediation Therapy (NCRT). METHODS The present study is a multicenter, prospective, rater-blinded, two-arm RCT being conducted at six academic study sites in Germany. A sample of 180 at least partly remitted patients with schizophrenia are randomly assigned to either ISST or NCRT. ISST is a compensatory, strategy-based program that targets social cognitive processes and social behavioral skills. NCRT comprises mainly drill and practice-oriented neurocognitive training. Both treatments consist of 18 sessions over 6 months, and participants are subsequently followed up for another 6 months. The primary outcome is all-cause discontinuation over the 12-month study period; psychosocial functioning, quality of life, neurocognitive and social cognitive performance, and clinical symptoms are assessed as secondary outcomes at baseline before randomization (V1), at the end of the six-month treatment period (V6), and at the six-month follow-up (V12). DISCUSSION This RCT is part of the German Enhancing Schizophrenia Prevention and Recovery through Innovative Treatments (ESPRIT) research network, which aims at using innovative treatments to enhance prevention and recovery in patients with schizophrenia. Because this study is one of the largest and methodologically most rigorous RCTs on the efficacy of cognitive remediation approaches in schizophrenia, it will not only help to identify the optimal treatment options for improving psychosocial functioning and thus recovery in patients but also allow conclusions to be drawn about factors influencing and mediating the effects of cognitive remediation in these patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02678858, German Study Register DRKS 00010033.
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Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Nicole Frommann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Agnes Lowe
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Kamp
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Karolin Weide
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating FRITZ and Soulspace, Vivantes Klinikum Am Urban, Berlin, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Alzey, Germany.,Department of Psychiatry and Psychotherapy, LVR-Klinik Bonn, Bonn, Germany
| | - Rene Hurlemann
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Psychiatry and Psychotherapy, University of Oldenburg, Oldenburg, Germany
| | - Ana Muthesius
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Sabine Schmied
- Clinical Trials Center, University of Cologne, Cologne, Germany
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute for Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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10
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Chapellier V, Pavlidou A, Mueller DR, Walther S. Brain Stimulation and Group Therapy to Improve Gesture and Social Skills in Schizophrenia-The Study Protocol of a Randomized, Sham-Controlled, Three-Arm, Double-Blind Trial. Front Psychiatry 2022; 13:909703. [PMID: 35873264 PMCID: PMC9301234 DOI: 10.3389/fpsyt.2022.909703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED An important component of nonverbal communication is gesture performance, which is strongly impaired in 2/3 of patients with schizophrenia. Gesture deficits in schizophrenia are linked to poor social functioning and reduced quality of life. Therefore, interventions that can help alleviate these deficits in schizophrenia are crucial. Here, we describe an ongoing randomized, double-blind 3-arm, sham-controlled trial that combines two interventions to reduce gesture deficits in schizophrenia patients. The combined interventions are continuous theta burst stimulation (cTBS) and social cognitive remediation therapy (SCRT). We will randomize 72 patients with schizophrenia spectrum disorders in three different groups of 24 patients. The first group will receive real cTBS and real SCRT, the second group will receive sham cTBS and real SCRT, and finally the third group will receive sham SCRT. Here, the sham treatments are, as per definition, inactive interventions that mimic as closely as possible the real treatments (similar to placebo). In addition, 24 age- and gender-matched controls with no interventions will be added for comparison. Measures of nonverbal communication, social cognition, and multimodal brain imaging will be applied at baseline and after intervention. The main research aim of this project will be to test whether the combination of cTBS and SCRT improves gesture performance and social functioning in schizophrenia patients more than standalone cTBS, SCRT or sham psychotherapy. We hypothesize that the patient group receiving the combined interventions will be superior in improving gesture performance. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT04106427].
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Affiliation(s)
- Victoria Chapellier
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Daniel R Mueller
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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11
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Social Cognition and Interaction Training (SCIT) versus Training in Affect Recognition (TAR) in patients with schizophrenia: A randomized controlled trial. J Psychiatr Res 2021; 142:101-109. [PMID: 34332374 DOI: 10.1016/j.jpsychires.2021.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/03/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Training in Affect Recognition (TAR) is a "targeted" and computer-aided program that has been shown to effectively attenuate facial affect recognition deficits and improve social functioning in patients with schizophrenia. Social Cognition and Interaction Training (SCIT) is a group "broad-based" intervention, that has also been shown to improve emotion recognition, theory of mind (ToM), and social functioning. To date, no study has compared the efficacy of two different social cognitive interventions. OBJECTIVES We aim to compare the efficacy of TAR and SCIT on schizophrenia patients' performance on facial affect recognition, theory of mind, attributional style and social functioning before, after treatment, and three months thereafter. METHODS One hundred outpatients with a diagnosis of schizophrenia were randomly assigned to the TAR or SCIT condition and completed pre- (T0) and posttreatment (T1) assessments and a 3-month follow up (T2) of emotion recognition (ER-40), theory of mind (Hinting Task), attributional style (AIHQ) and social functioning (PSP). RESULTS The entire sample, receiving TAR or SCIT, showed improvements in theory of mind, attributional style, clinical symptoms and social functioning. This effect was maintained at three-months. The TAR intervention was more efficacious than the SCIT program in improving the recognition of facial emotions (ER-40). The TAR intervention also demonstrated a lower drop-out rate than the SCIT intervention. CONCLUSIONS There were improvements in social cognition, symptomatology and functioning of patients in the entire sample, receiving SCIT or TAR. Both TAR and SCIT appear as valuable treatments for people with schizophrenia and social cognitive deficits.
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Wright AC, McGurk SR, Shaya Y, Feldman K, Mueser KT. Does comprehensive cognitive remediation improve emotion perception? Cogn Neuropsychiatry 2021; 26:343-356. [PMID: 34180363 DOI: 10.1080/13546805.2021.1946386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Social cognition, including emotion perception, is impaired in people with serious mental illnesses (SMI), and is associated with cognitive and community functioning. Cognitive remediation can improve neurocognition, but the impact on emotion perception has been less well studied. The current study aimed to evaluate the efficacy of a cognitive remediation programme in improving emotion perception.Methods: Thirty-seven people with SMI and a history of difficulties obtaining employment were randomised to either vocational rehabilitation only, or vocational rehabilitation combined with cognitive remediation. Participants were assessed at baseline and post-treatment on a neurocognitive battery, work history, and emotion perception.Results: The cognitive remediation group did not improve more than the vocational rehabilitation only group on either measure of emotion perception, despite significantly greater gains in cognitive functioning. Baseline emotion identification, but not discrimination, was significantly associated with cognition and work history.Conclusions: Despite associations between social and neurocognition, there was no evident transfer of cognitive gains to performance on measures of emotion perception. The findings, though limited by a small sample size, are important in expanding the research indicating that the effects of cognitive remediation tend to be limited to the specific cognitive domains targeted in the program.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial & Systemic Research, Department of Psychiatry, Massachusetts General Hospital. Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan R McGurk
- Departments of Occupational Therapy, Psychological and Brain Sciences, The Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Yaniv Shaya
- Department of Emergency Medicine, Staten Island University Hospital, Staten Island, NY, USA
| | | | - Kim T Mueser
- Departments of Occupational Therapy, Psychological and Brain Sciences, The Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
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13
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Zhang Q, Wu R, Zhu S, Le J, Chen Y, Lan C, Yao S, Zhao W, Kendrick KM. Facial emotion training as an intervention in autism spectrum disorder: A meta-analysis of randomized controlled trials. Autism Res 2021; 14:2169-2182. [PMID: 34286900 DOI: 10.1002/aur.2565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/11/2022]
Abstract
A large number of computer-based training programs have been developed as an intervention to help individuals with autism spectrum disorders (ASD) improve their facial emotion recognition ability, as well as social skills. However, it is unclear to what extent these facial emotion training programs can produce beneficial, long-lasting, and generalizable results. Using standard meta-analytic techniques, we investigated the effects of facial emotion training including generalization and maintenance restricted to randomized control trial studies comprising a total of 595 individuals with ASD. Our findings revealed that the intervention resulted in a robust improvement in emotion recognition for individuals receiving training compared with controls. However, while there was also some evidence for generalization of training effects, the small number of studies which conducted follow-ups and assessed social skills reported that improvements were not maintained and there was no evidence for general improvement in social skills. Overall, the analysis revealed a medium effect size in training improvement indicating that facial emotion training may be an effective method for enhancing emotion recognition skills in ASD although more studies are required to assess maintenance of effects and possible general improvements in social skills. LAY SUMMARY: Facial emotion training as an intervention may be a potential way to help improve emotion recognition in autism spectrum disorder (ASD), however robust empirical support for its efficacy has not been sufficiently established. Here, we conducted a meta-analysis of previous studies to summarize the effects of facial emotion training on ASD. Our results show that the training produces a robust improvement in subsequent emotion recognition, while maintenance and generalization effects still need further investigation. To date, no experimentally verified improvements in social skills have been reported.
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Affiliation(s)
- Qianqian Zhang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Renjing Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Siyu Zhu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiao Le
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuanshu Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunmei Lan
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shuxia Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Weihua Zhao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Keith M Kendrick
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for NeuroInformation of Ministry of Education, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Pancotti F, Mele S, Callegari V, Bivi R, Saracino F, Craighero L. Efficacy of Facial Exercises in Facial Expression Categorization in Schizophrenia. Brain Sci 2021; 11:brainsci11070825. [PMID: 34206553 PMCID: PMC8301751 DOI: 10.3390/brainsci11070825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
Embodied cognition theories suggest that observation of facial expression induces the same pattern of muscle activation, and that this contributes to emotion recognition. Consequently, the inability to form facial expressions would affect emotional understanding. Patients with schizophrenia show a reduced ability to express and perceive facial emotions. We assumed that a physical training specifically developed to mobilize facial muscles could improve the ability to perform facial movements, and, consequently, spontaneous mimicry and facial expression recognition. Twenty-four inpatient participants with schizophrenia were randomly assigned to the experimental and control group. At the beginning and at the end of the study, both groups were submitted to a facial expression categorization test and their data compared. The experimental group underwent a training period during which the lip muscles, and the muscles around the eyes were mobilized through the execution of transitive actions. Participants were trained three times a week for five weeks. Results showed a positive impact of the physical training in the recognition of others’ facial emotions, specifically for the responses of “fear”, the emotion for which the recognition deficit in the test is most severe. This evidence suggests that a specific deficit of the sensorimotor system may result in a specific cognitive deficit.
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Affiliation(s)
- Francesco Pancotti
- Department of Neuroscience and Rehabilitation, University of Ferrara, via Fossato di Mortara 19, 44121 Ferrara, Italy;
| | - Sonia Mele
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy;
| | - Vincenzo Callegari
- Integrated Department of Mental Health and Addictive Behavior, Local Health Trust of Ferrara, 44124 Ferrara, Italy; (V.C.); (R.B.); (F.S.)
| | - Raffaella Bivi
- Integrated Department of Mental Health and Addictive Behavior, Local Health Trust of Ferrara, 44124 Ferrara, Italy; (V.C.); (R.B.); (F.S.)
| | - Francesca Saracino
- Integrated Department of Mental Health and Addictive Behavior, Local Health Trust of Ferrara, 44124 Ferrara, Italy; (V.C.); (R.B.); (F.S.)
| | - Laila Craighero
- Department of Neuroscience and Rehabilitation, University of Ferrara, via Fossato di Mortara 19, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-0532-455928
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15
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Caruana N, Seymour K. Bottom-up processing of fearful and angry facial expressions is intact in schizophrenia. Cogn Neuropsychiatry 2021; 26:183-198. [PMID: 33752551 DOI: 10.1080/13546805.2021.1902794] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Judgments of emotion from faces are reportedly impaired in schizophrenia. However, it is unclear whether this is due to a top-down cognitive deficit in evaluating sensory information or a fundamental bottom-up perturbation in the early stages of face encoding. This study examined whether deficits in emotion processing reflect imprecision in the initial preconscious registration of emotional face expressions within the visual system. METHODS Using continuous flash suppression (CFS), we presented participants (18 patients with schizophrenia, 8M/10F; 20 healthy controls, 13M/7F) with fearful and angry faces. Previous CFS research on healthy participants reveals that fearful facial expressions gain privileged access to awareness over angry faces-demonstrating the visual system's ability to discriminate these emotions at a preconscious level. We used this same approach to probe the integrity of early emotion encoding whilst minimising the potential contribution of any top-down cognitive biases on perceptual judgments. RESULTS In both groups, fearful faces were perceived faster than angry faces, with no differences observed between patients and controls. CONCLUSIONS Emotion processing difficulties in schizophrenia are unlikely to reflect an early sensory deficit, but rather a deficit in social cognition that has a top-down impact on the conscious evaluation of facial expressions.
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Affiliation(s)
- Nathan Caruana
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,Perception in Action Research Centre, Macquarie University, Sydney, Australia
| | - Kiley Seymour
- School of Psychology, Western Sydney University, Sydney, Australia.,The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Sydney, Australia.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany
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16
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d’Arma A, Isernia S, Di Tella S, Rovaris M, Valle A, Baglio F, Marchetti A. Social Cognition Training for Enhancing Affective and Cognitive Theory of Mind in Schizophrenia: A Systematic Review and a Meta-Analysis. THE JOURNAL OF PSYCHOLOGY 2020; 155:26-58. [DOI: 10.1080/00223980.2020.1818671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Alessia d’Arma
- IRCCS Fondazione Don Carlo Gnocchi
- Università Cattolica del Sacro Cuore
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Nijman SA, Veling W, van der Stouwe ECD, Pijnenborg GHM. Social Cognition Training for People With a Psychotic Disorder: A Network Meta-analysis. Schizophr Bull 2020; 46:1086-1103. [PMID: 32162658 PMCID: PMC7505203 DOI: 10.1093/schbul/sbaa023] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Deficits in social cognition are common in people with psychotic disorders and negatively impact functioning. Social Cognition Training (SCT) has been found to improve social cognition and functioning, but it is unknown which interventions are most effective, how characteristics of treatments and participants moderate efficacy, and whether improvements are durable. This meta-analysis included 46 randomized studies. SCTs were categorized according to their focus (targeted/broad-based) and inclusion of cognitive remediation therapy (CRT). Network meta-analysis was conducted, using both direct (original) and indirect (inferred from the network of comparisons) evidence. All SCT types were compared to treatment as usual (TAU; the chosen reference group). Moderators of outcome were investigated with meta-regression and long-term efficacy with multivariate meta-analysis. Compared to TAU, emotion perception was improved by targeted SCT without CRT (d = 0.68) and broad-based SCT without CRT (d = 0.46). Individual treatments worked better for emotion perception. All treatments significantly improved social perception (active control, d = 0.98, targeted SCT with and without CRT, d = 1.38 and d = 1.36, broad-based SCT with and without CRT, d = 1.45 and d = 1.35). Only broad-based SCT (d = 0.42) improved ToM. Broad-based SCT (d = 0.82 without and d = 0.41 with CRT) improved functioning; group treatments worked significantly better. Male gender was negatively related to effects on social functioning and psychiatric symptoms. At follow-up, a moderate effect on social functioning (d = 0.66) was found. No effect was found on attribution, social cognition (miscellaneous), and psychiatric symptoms. While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produces the best overall outcomes. CRT did not enhance SCT effects.
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Affiliation(s)
- Saskia A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elisabeth C D van der Stouwe
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Assen, the Netherlands
- Department of Clinical and Developmental Neuropsychology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
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18
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Bègue I, Kaiser S, Kirschner M. Pathophysiology of negative symptom dimensions of schizophrenia – Current developments and implications for treatment. Neurosci Biobehav Rev 2020; 116:74-88. [DOI: 10.1016/j.neubiorev.2020.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/13/2020] [Accepted: 06/02/2020] [Indexed: 02/06/2023]
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19
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Jung M, Baik SY, Kim Y, Kim S, Min D, Kim JY, Won S, Lee SH. Empathy and Social Attribution Skills Moderate the Relationship between Temporal Lobe Volume and Facial Expression Recognition Ability in Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:362-374. [PMID: 32702215 PMCID: PMC7383013 DOI: 10.9758/cpn.2020.18.3.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/21/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Objective While impaired facial expression recognition has been closely associated with reduced temporal lobe volume in patients with schizophrenia, this study aimed at examining whether empathy and social attribution affect such a relationship. Methods A total of 43 patients with schizophrenia and 43 healthy controls underwent a facial expression recognition task (FERT) and magnetic resonance imaging. Basic empathy scale and the social attribution task-multiple choice were used to measure empathy and social attribution. Results Patients with schizophrenia showed significant positive correlations between the total temporal lobe volume and the FERT-accuracy (FERT-ACC). Diminished temporal lobe volume predicted the impaired facial emotion recognition ability. Both empathy and social attribution played roles as moderators of the path from the left amygdala volume, left fusiform gyrus volume, both sides of the superior temporal gyrus volume, and left middle temporal gyrus volume to the FERT-ACC. In contrast, empathy alone functioned as a moderator between the right fusiform gyrus volume, right middle temporal gyrus volume, and FERT-ACC. No significant interaction was found for healthy controls. Conclusion Our results suggest that social cognition remediation training on empathy and social attribution, could buffer the negative effects of small temporal lobe volume on interpersonal emotional communication in patients with schizophrenia.
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Affiliation(s)
- Minjee Jung
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seung Yeon Baik
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Yourim Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Sungkean Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Dongil Min
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Jeong-Youn Kim
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea
| | - Seunghee Won
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Clinical Emotion and Cognition Research Laboratory, Inje University College of Medicine, Goyang, Korea.,Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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García-Fernández L, Cabot-Ivorra N, Romero-Ferreiro V, Pérez-Martín J, Rodriguez-Jimenez R. Differences in theory of mind between early and chronic stages in schizophrenia. J Psychiatr Res 2020; 127:35-41. [PMID: 32460156 DOI: 10.1016/j.jpsychires.2020.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 01/01/2023]
Abstract
The evolution of social cognition throughout the course of schizophrenia is unclear not being possible to state whether it remains stable from early stages to chronicity, or it changes as the disease develops. For this purpose, 90 patients with schizophrenia and 139 healthy controls have been compared establishing 4 different groups paired by age and gender: first episode of psychosis patients (FEP), young healthy controls (YHC), chronic patients with schizophrenia (CS) and adult healthy controls (AHC). Performance in Theory of Mind (ToM) has been assessed using The Hinting Task and The Reading the Mind in the Eyes Test (RMET). In the Hinting Task, when comparing patients with their respective control group, differences found between CS patients and their corresponding controls (p < .001) are much bigger (almost twice) than differences between FEP patients and young controls (p = .001). In fact, young and adult healthy controls did not significantly differ in their scores, while the CS group showed significant worse performance than the FEP group. In the Reading the Mind in the Eyes test (RMET), patients globally performed worse than controls (p < .001). However, the Cohort × Diagnosis interaction was not significant (p = .27). In this task, there were no differences between CS and FEP scores. In conclusion, data suggest poor performance in all phases of the disease with a probable worsening related to chronicity especially in the aspects of social cognition measured by the Hinting Task.
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Affiliation(s)
- Lorena García-Fernández
- Department of Clinical Medicine, Universidad Miguel Hernández, Edificio Muhammad Al-Shafra, Campus de San Juan, Ctra. de Valencia, Km 87, 03550, San Juan, Alicante, Spain; Department of Psychiatry, Hospital Universitario de San Juan, Alicante. Ctra. Nacional. 332, S/n, 03550, San Juan, Alicante, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain.
| | - Nuria Cabot-Ivorra
- Doctoral School, Universidad Católica de Valencia San Vicente Mártir, C/ Guillem de Castro, 65 bajo, 46008, Valencia, Spain.
| | - Verónica Romero-Ferreiro
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Brain Mapping Unit, Instituto Pluridisciplinar, Complutense University of Madrid, Paseo Juan XXIII, 1, 28040, Madrid, Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Av. Córdoba S/n, 28041, Madrid, Spain.
| | - Jorge Pérez-Martín
- Department of Psychiatry, Hospital Universitario de San Juan, Alicante. Ctra. Nacional. 332, S/n, 03550, San Juan, Alicante, Spain.
| | - Roberto Rodriguez-Jimenez
- CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas 12), Av. Córdoba S/n, 28041, Madrid, Spain; CogPsy-Group. Universidad Complutense (UCM), Madrid, Spain.
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21
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Nahum M, Lee H, Fisher M, Green MF, Hooker CI, Ventura J, Jordan JT, Rose A, Kim SJ, Haut KM, Merzenich MM, Vinogradov S. Online Social Cognition Training in Schizophrenia: A Double-Blind, Randomized, Controlled Multi-Site Clinical Trial. Schizophr Bull 2020; 47:108-117. [PMID: 32614046 PMCID: PMC7825077 DOI: 10.1093/schbul/sbaa085] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Social cognition (SC), the mental operations underlying social functioning, are impaired in schizophrenia. Their direct link to functional outcome and illness status have made them an important therapeutic target. However, no effective treatment for these deficits is currently applied as a standard of care. To address this need, we have developed SocialVille-an online, plasticity-based training program that targets SC deficits in schizophrenia. Here we report the outcomes of a double-blind, controlled, randomized, multi-site clinical trial of SocialVille. Outpatients with schizophrenia were randomized to complete 40 sessions of either SocialVille (N = 55 completers) or active control (computer games; N = 53 completers) from home. The a priori co-primary outcome measures were a social cognitive composite and a functional capacity outcome (UCSD Performance-based Skills Assessment [UPSA-2]). Secondary outcomes included a virtual functional capacity measure (VRFCAT), social functioning, quality of life, and motivation. Linear mixed models revealed a group × time interaction favoring the treatment group for the social cognitive composite (b = 2.81; P < .001) but not for the UPSA-2 measure. Analysis of secondary outcome measures showed significant group × time effects favoring the treatment group on SC and social functioning, on the virtual functional capacity measure and a motivation subscale, although these latter findings were nonsignificant with FDR correction. These results provide support for the efficacy of a remote, plasticity-based social cognitive training program in improving SC and social functioning in schizophrenia. Such treatments may serve as a cost-effective adjunct to existing psychosocial treatments. Trial Registration: NCT02246426.
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Affiliation(s)
- Mor Nahum
- School of Occupational Therapy, Faculty of Medicine, Hebrew University, Jerusalem, Israel,Department of Research and Development, Posit Science Inc., San Francisco, CA,To whom correspondence should be addressed; School of Occupational Therapy, Faculty of Medicine, The Hebrew University, PO Box 24026, Mount Scopus, Jerusalem, 91240, Israel; tel: +972-54-732-6655, fax: +972-2-5325345, e-mail:
| | - Hyunkyu Lee
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Melissa Fisher
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
| | - Michael F Green
- VA Greater Los Angeles, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Christine I Hooker
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Joshua T Jordan
- Department of Psychiatry, University of California, San Francisco, CA
| | - Annika Rose
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Sarah-Jane Kim
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Kristen M Haut
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL
| | - Michael M Merzenich
- Department of Research and Development, Posit Science Inc., San Francisco, CA
| | - Sophia Vinogradov
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN
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Abstract
OBJECTIVE To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research. METHOD First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed. RESULTS Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition). CONCLUSIONS The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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23
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A randomized controlled trial of training of affect recognition (TAR) in schizophrenia shows lasting effects for theory of mind. Eur Arch Psychiatry Clin Neurosci 2019; 269:611-620. [PMID: 30826974 DOI: 10.1007/s00406-019-00997-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/22/2019] [Indexed: 01/24/2023]
Abstract
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.
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Biagianti B, Merchant J, Brambilla P, Lewandowski KE. The effects of cognitive remediation in patients with affective psychosis: A systematic review: Special Section on "Translational and Neuroscience Studies in Affective Disorders". Section Editor, Maria Nobile MD, PhD. This Section of JAD focuses on the relevance of translational and neuroscience studies in providing a better understanding of the neural basis of affective disorders. The main aim is to briefly summaries relevant research findings in clinical neuroscience with particular regards to specific innovative topics in mood and anxiety disorders. J Affect Disord 2019; 255:S0165-0327(18)32460-1. [PMID: 30878159 PMCID: PMC6591034 DOI: 10.1016/j.jad.2019.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/19/2019] [Accepted: 03/07/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Schizophrenia, schizoaffective disorder, and related illnesses are associated with significant impairment in cognitive functioning which is among the strongest predictors of disability and poor quality of life. Cognitive remediation (CR) was developed as a set of behavioral interventions directly targeting cognitive symptoms. Studies have shown that CR produces cognitive improvements in patients with schizophrenia and bipolar disorder that may be associated with improvements in functioning. However, the relative efficacy of CR across diagnoses has not been established. Indirect evidence suggests that CR is effective in patients with affective illness as well as patients with schizophrenia (SZ); however, the one study to evaluate the effects of diagnosis on outcomes directly in patients with SZ versus schizoaffective disorder (SZA) found no differences by diagnosis. METHODS In this systematic review, we evaluated cognitive and functional outcomes after CR in studies including patients with SZA, and examined specificity of training content to outcomes. RESULTS Sixteen studies met inclusion criteria: 10 studies that compared CR to a control condition (n = 779) and 6 comparative effectiveness studies. None of the studies explicitly compared patients by diagnosis. Studies included a mixture of patients with SZA or SZ. Of the CR versus control studies, effect sizes for cognitive outcomes were moderate-large (d = .36-.94). Studies comparing CR paradigms targeting different cognitive domains showed specificity of training focus to outcomes. Five of studies reported significant functional improvement after CR as secondary outcomes. CONCLUSIONS In this review, we found support for the use of CR paradigms in patients with affective psychosis, with evidence that reported treatment effects in mixed affective and non-affective samples are at or above the levels previously reported in SZ. However, lack of availability of data directly comparing patients by diagnosis or examining moderator or mediator effects of diagnosis or diagnosis-related patient characteristics limits our understanding of the relative efficacy of CR across patient group.
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Affiliation(s)
- Bruno Biagianti
- Posit Science Inc.,160 Pine Street Suite 200, 94111 San Francisco, CA, USA.
| | - Jaisal Merchant
- Schizophrenia and Bipolar Disorder Program, McLean
Hospital, Belmont, MA, USA
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation,
University of Milan, Milan, Italy,Department of Psychiatry, IRCCS Fondazione Ca’
Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy;,Department of Psychiatry and Behavioral Sciences, The
University of Texas Health Science Center at Houston, McGovern Medical School,
Houston, TX, USA
| | - Kathryn E Lewandowski
- Schizophrenia and Bipolar Disorder Program, McLean
Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston,
MA, USA
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Bozikas VP, Dardagani A, Parlapani E, Ntouros E, Lagoudis A, Tsotsi S. Improved facial affect recognition in patients with first-episode psychosis. Early Interv Psychiatry 2019; 13:977-983. [PMID: 30298549 DOI: 10.1111/eip.12738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/10/2018] [Accepted: 09/09/2018] [Indexed: 12/01/2022]
Abstract
AIM The present study aimed at assessing whether impaired facial affect recognition (FAR) in patients with first-episode psychosis (FEP) would improve after a brief intervention targeting FAR specifically. METHODS Thirty-five outpatients and 38 healthy controls were administered an intervention which involved training to recognize emotional information, conveyed by changes in facial features. Using a pre- and post-intervention design, two measurements of FAR were conducted using an experimental procedure with alternative sets of stimuli. RESULTS We found improved overall FAR performance in both participant groups with marked effects in recognizing anger, disgust and fear. Patients' post-intervention performance was comparable to healthy participants' baseline performance. CONCLUSIONS The present improvement in facial affects recognition in FEP patients, despite only somewhat impaired, emphasizes the importance of early targeted interventions for FAR in psychosis. Further research is needed to assess whether this improvement will generalize to global social functioning.
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Affiliation(s)
- Vasilios P Bozikas
- Second Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Dardagani
- Second Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Parlapani
- First Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelos Ntouros
- Second Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Lagoudis
- Second Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Tsotsi
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
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Nuño L, Guilera G, Coenen M, Rojo E, Gómez-Benito J, Barrios M. Functioning in schizophrenia from the perspective of psychologists: A worldwide study. PLoS One 2019; 14:e0217936. [PMID: 31170249 PMCID: PMC6553782 DOI: 10.1371/journal.pone.0217936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia is a severe mental disorder associated with impairment in functioning. A multidisciplinary approach is essential to help individuals with this health condition, and psychological interventions are considered a priority. The International Classification of Functioning, Disability and Health (ICF) offers a theoretical framework for assessing functioning and disability. The ICF Core Sets for schizophrenia are a list of ICF categories describing the most common problems in functioning of persons affected by this health condition. This study aimed to explore the content validity of these ICF Core Sets and to identify the most common problems in people with schizophrenia from the perspective of psychologists. Psychologists with experience of schizophrenia treatment were recruited for a three-round Delphi study in order to gather their views regarding the problems commonly presented by these patients. A total of 175 psychologists from 46 countries covering the six WHO regions answered the first-round questionnaire, and 137 completed all three rounds. The 7,526 concepts extracted from first-round responses were linked to 412 ICF categories and 53 personal factors. Consensus (≥75% agreement) was reached for 76 ICF categories and 28 personal factors. Seventy-three of the 97 ICF categories that form the Comprehensive ICF Core Set for schizophrenia achieved consensus, and only three categories that yielded consensus do not feature in this Core Set. These results support the content validity of these ICF Core Sets from the perspective of psychologists. This provides further evidence of the suitability of the ICF framework for describing functioning and disability in persons with schizophrenia.
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Affiliation(s)
- Laura Nuño
- Clinical Institute of Neurosciences (ICN), Hospital Clinic, Barcelona, Spain
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Georgina Guilera
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology–IBE, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications in Germany (at DIMDI), Munich, Germany
| | - Emilio Rojo
- Hospital Benito Menni CASM, Sisters Hospitallers, Sant Boi de Llobregat, Spain
- Department of Psychiatry, International University of Catalonia, Barcelona, Spain
| | - Juana Gómez-Benito
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maite Barrios
- Department of Social Psychology and Quantitative Psychology, University of Barcelona, Barcelona, Spain
- Group on Measurement Invariance and Analysis of Change (GEIMAC), Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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Observation and Imitation of Social Emotions Are Essential for Improving Cognitive and Affective Theory of Mind in Schizophrenia: A Meta-analysis. J Nerv Ment Dis 2019; 207:474-481. [PMID: 31157692 DOI: 10.1097/nmd.0000000000000996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
People with schizophrenia often demonstrate deficits in theory of mind (ToM), which may be addressed via social cognition training that includes observation and imitation of social emotions. We examined the effect of observation and imitation on ToM and whether computerized cognitive training (CCT) can improve ToM. Among 14 controlled trials, 264 of 494 people with schizophrenia received treatment. Observation and imitation of social emotions improved cognitive (g = 0.53; 95% confidence interval [CI], 0.29-0.76) and affective ToM (g = 0.54; 95% CI, 0.34-0.73), versus treatment as usual or cognitive rehabilitation alone. CCT did not significantly enhance affective ToM (p = 0.42); however, cognitive ToM improvements without CCT (g = 1.20; 95% CI, 0.78-1.61) were superior to those with CCT (g = 0.33; 95% CI, 0.02-0.64; p < 0.01). Observation and imitation of social emotions are essential for improving ToM in schizophrenia, but CCT may not improve ToM.
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Mele S, Bivi R, Borra L, Callegari V, Caracciolo S, Tugnoli S, Craighero L. Efficacy of theatre activities in facial expression categorization in schizophrenia. ARTS IN PSYCHOTHERAPY 2019. [DOI: 10.1016/j.aip.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vass E, Fekete Z, Simon V, Simon L. Interventions for the treatment of theory of mind deficits in schizophrenia: Systematic literature review. Psychiatry Res 2018; 267:37-47. [PMID: 29883859 DOI: 10.1016/j.psychres.2018.05.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/17/2022]
Abstract
Theory of Mind (ToM) plays a central role in regulating social interactions and its impairment is consistently reported in schizophrenia. Regarding schizophrenia, ToM is usually discussed as a sub-domain of social cognition. Since social cognitive deficits have drawn the attention of researchers, a variety of novel treatment techniques and approaches targeting social cognitive deficits have been developed. Encouraging results have repeatedly been reported on the modifiability of social cognitive impairment through these techniques. However, emotional perception seems to be over-represented in these approaches at the expense of other areas, such as ToM. This article presents a systematic review on the social cognitive interventions of the last 10 years, which focused on the remediation of ToM or used techniques primarily focusing on one or more social cognitive domains other than ToM, but with hypothetical effects on it. The aim of our systematic review was to compare these intervention techniques in order to see how effective they are in the remediation of ToM, and to find the best techniques to ameliorate ToM deficits in schizophrenia. According to our findings targeted ToM intervention produced more improvement in ToM tasks, while data regarding non-ToM interventions showed contradictory results with limited effects on ToM.
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Affiliation(s)
- Edit Vass
- Semmelweis University, Mental Health Sciences School of Ph. D., Üllői út 26, Budapest H-1083, Hungary; Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, Jósa András Teaching Hospital, Department of Psychiatry and Psychotherapy, Szent I. utca 68., Nyíregyháza H-4400, Hungary.
| | - Zita Fekete
- University of Debrecen, Institute of Behavioral Sciences, Móricz Zsigmond körút. 32., Debrecen H-4028, Hungary.
| | - Viktória Simon
- Semmelweis University, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Balassa út 6., Budapest H-1083, Hungary
| | - Lajos Simon
- Semmelweis University, Faculty of Medicine, Department of Psychiatry and Psychotherapy, Balassa út 6., Budapest H-1083, Hungary.
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30
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Tan BL, Lee SA, Lee J. Social cognitive interventions for people with schizophrenia: A systematic review. Asian J Psychiatr 2018; 35:115-131. [PMID: 27670776 DOI: 10.1016/j.ajp.2016.06.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 11/17/2022]
Abstract
Social cognition is the mental process which underpins social interactions. Increasingly, it has been recognized to be impaired in people with schizophrenia, resulting in functional problems. Correspondingly, the past ten years have seen huge developments in the study of interventions to ameliorate social cognitive deficits among people with schizophrenia. In the present review, we systematically reviewed published studies on social cognitive interventions from 2005 to 2015. Of the 61 studies included in this review, 20 were on broad-based social cognitive interventions, which incorporated neurocognitive training, specialized learning technique or virtual reality social skills training. On the other hand, 31 studies on targeted interventions either focused on specific social cognitive domains, or a range of domains. Improvements in emotion processing and theory of mind were often reported, while social perception and attributional style were less frequently measured. Both broad-based and targeted interventions achieved gains in social functioning, albeit inconsistently. Lastly, nine studies on the use of oxytocin and one study on transcranial direct current stimulation reported positive preliminary results in higher-order cognition and facial affect recognition respectively. This review revealed that a wide range of social cognitive interventions is currently available and most have shown some promise in improving social cognition outcomes. However, there is a need to use a common battery of measurements for better comparisons across interventions. Future research should examine combination therapies and the sustainability of gains beyond the intervention period.
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Affiliation(s)
- Bhing-Leet Tan
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore; Singapore Institute of Technology, 10 Dover Drive, Singapore 138683, Singapore.
| | - Sara-Ann Lee
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
| | - Jimmy Lee
- Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore; Office of Clinical Sciences, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
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Popova P, Rockstroh B, Miller GA, Wienbruch C, Carolus AM, Popov T. The impact of cognitive training on spontaneous gamma oscillations in schizophrenia. Psychophysiology 2018; 55:e13083. [PMID: 29624694 DOI: 10.1111/psyp.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 03/08/2018] [Accepted: 03/08/2018] [Indexed: 12/27/2022]
Abstract
Schizophrenia patients exhibit less gamma-frequency EEG/MEG activity (>30 Hz), a finding interpreted as evidence of poor temporal neural organization and functional network communication. Research has shown that neuroplasticity-oriented training can improve task-related oscillatory dynamics, indicating some reorganization capacity in schizophrenia. Demonstrating a generalization of such task training effects to spontaneous oscillations at rest would not only enrich understanding of this neuroplastic potential but inform the interpretation of spontaneous gamma oscillations in the service of normal cognitive function. In the present study, neuromagnetic resting-state oscillatory brain activity and cognitive performance were assessed before and after training in 61 schizophrenia patients, who were randomly assigned to 4 weeks of neuroplasticity-oriented targeted cognitive training or treatment as usual (TAU). Gamma power of 40-90 Hz increased after training, but not after TAU, in a frontoparietal network. Across two types of training, this increase was related to improved cognitive test performance. These results indicate that abnormal oscillatory dynamics in schizophrenia patients manifested in spontaneous gamma activity can be changed with neuroplasticity-oriented training parallel to cognitive performance.
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Affiliation(s)
- Petia Popova
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | | | - Gregory A Miller
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Almut M Carolus
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Tzvetan Popov
- Department of Psychology, University of Konstanz, Konstanz, Germany
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Zeppegno P, Gramaglia C, Feggi A, Marangon D, Bergamasco P, Vecchi C, Girardi L, Venesia A, Gambaro E, Torre E. Group Activities to Promote Early Rehabilitation in an Acute Psychiatric Ward: A Relationship-Based Approach Focusing on Movies. Int J Group Psychother 2018; 68:147-162. [PMID: 38475635 DOI: 10.1080/00207284.2017.1383162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Our Psychiatry Institute has a long-standing tradition of providing training in the importance of relational and emotional skills and helping relationships. Here we describe techniques that are routinely used on our psychiatric ward (Maggiore della Carità Hospital, Novara, Italy) to promote early rehabilitation of acute psychiatric inpatients. We focus on the Cinema group, which is typical of our approach to informal, therapeutic group activity. Targeting social and relational issues as adjunct to treatment as usual is useful in acute settings and can begin at an early stage of hospitalization. Our intervention is designed to improve patients' coping strategies, relational and communication skills, and overall quality of life.
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The Effects of Electroconvulsive Therapy Augmentation of Antipsychotic Treatment on Cognitive Functions in Patients With Treatment-Resistant Schizophrenia. J ECT 2018; 34:31-34. [PMID: 29053485 DOI: 10.1097/yct.0000000000000463] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Treatment-resistant schizophrenia (TRS) continues to be a challenge in modern psychiatry. Most of these patients have severe neurocognitive deficits. Electroconvulsive therapy (ECT) has proved effective and safe in the treatment of TRS, but because of potential neurocognitive adverse effects, it is associated with many controversies. The aim of this prospective, open study was to evaluate the effects of ECT augmentation of antipsychotics on cognitive functions in patients with TRS. METHODS Overall, 31 inpatients with TRS were included, 16 men, with an average (SD) age of 34.1 (11.187) years. The evaluation of clinical symptoms and global impression, as well as verbal memory, visual memory, working memory, psychomotor speed, verbal fluency, and executive functioning, was conducted before and after the completion of ECT treatment. RESULTS We ran a series of paired-samples t tests, and the Bonferroni adjustment for multiple comparisons reduced the significance level to P = 0.004. The neurocognitive domains that demonstrated statistically significant improvement were immediate and delayed verbal memory, and executive functioning, whereas statistical trend was observed for visual memory and psychomotor speed. None of the neurocognitive functions exhibited significant deterioration after the ECT treatment. Electroconvulsive therapy was effective in reducing general symptoms of schizophrenia, resulting in more than 30% decrease in the overall symptom severity measured by the Positive and Negative Syndrome Scale. CONCLUSIONS Notwithstanding some limitations of this study, the combination of ECT and antipsychotics has improved several neurocognitive domains, without evidence of worsening of any cognitive functions.
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Social cognition intervention in schizophrenia: Description of the training of affect recognition program - Indian version. Asian J Psychiatr 2018; 31:36-40. [PMID: 29358102 DOI: 10.1016/j.ajp.2017.12.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 12/08/2017] [Accepted: 12/26/2017] [Indexed: 11/22/2022]
Abstract
Social cognition refers to mental operations involved in processing of social cues and includes the domains of emotion processing, Theory of Mind (ToM), social perception, social knowledge and attributional bias. Significant deficits in ToM, emotion perception and social perception have been demonstrated in schizophrenia which can have an impact on socio-occupational functioning. Intervention modules for social cognition have demonstrated moderate effect sizes for improving emotion identification and discrimination. We describe the Indian version of the Training of Affect Recognition (TAR) program and a pilot study to demonstrate the feasibility of administering this intervention program in the Indian population. We also discuss the cultural sensibilities in adopting an intervention program for the Indian setting. To the best of our knowledge this is the first intervention program for social cognition for use in persons with schizophrenia in India.
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Sevos J, Grosselin A, Gauthier M, Carmona F, Gay A, Massoubre C. Cinemotion, a Program of Cognitive Remediation to Improve the Recognition and Expression of Facial Emotions in Schizophrenia: A Pilot Study. Front Psychiatry 2018; 9:312. [PMID: 30083110 PMCID: PMC6064953 DOI: 10.3389/fpsyt.2018.00312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/25/2018] [Indexed: 11/18/2022] Open
Abstract
Objective: Patients with schizophrenia exhibit impaired social cognition, especially in the recognition and expression of facial emotions, aspects of communication profoundly interlinked in an embodied approach of cognition. Nevertheless, many training programs have been developed that focus on either of these deficits but not both. We therefore designed a training program, Cinemotion, intended to remedy the 2 deficits and investigated its feasibility and effects in patients with schizophrenia. Design: Thirty-one patients undergoing treatment for schizophrenia and presenting deficit in emotion recognition were randomized to a group of 16 to undergo Cinemotion training, delivered in weekly group sessions, and to a control treatment group of 15. At the conclusion of training or after 10 weeks in controls, we reassessed and compared original and final results to determine improvement. Methods: Facial emotions recognition (TREF), empathy (Questionnaire of Cognitive and Affective Empathy, QCAE), and attributional style (Ambiguous Intentions Hostility Questionnaire, AIHQ) were assessed before (T0) and after (T1) the program. External evaluators also assessed ability and accuracy of Cinemotion participants to self-generate facial emotion expression in response to verbal instruction. Results: Between T0 and T1, Cinemotion participants significantly improved total TREF, sadness, disgust, and anger scores, compared to findings in control treatment group. They also improved their ability and accuracy to self-generate facial expressions, especially sadness and fear, with no significant improvement in other components of social recognition. Conclusions: Our findings show the apparent efficacy of training using the Cinemotion program to improve the recognition and expression of facial emotions in schizophrenia.
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Affiliation(s)
- Jessica Sevos
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France.,TAPE Laboratory, EA 7423, University of Jean Monnet, Saint-Etienne, France
| | - Anne Grosselin
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France.,TAPE Laboratory, EA 7423, University of Jean Monnet, Saint-Etienne, France
| | - Michael Gauthier
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Florian Carmona
- Referal Center of Psychosocial Rehabilitation, Saint-Etienne, France
| | - Aurélia Gay
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France.,TAPE Laboratory, EA 7423, University of Jean Monnet, Saint-Etienne, France
| | - Catherine Massoubre
- Department of Psychiatry, University Hospital of Saint-Etienne, Saint-Etienne, France.,TAPE Laboratory, EA 7423, University of Jean Monnet, Saint-Etienne, France
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Maroño Souto Y, Vázquez Campo M, Díaz Llenderrozas F, Rodríguez Álvarez M, Mateos R, García Caballero A. Randomized Clinical Trial with e-MotionalTraining ® 1.0 for Social Cognition Rehabilitation in Schizophrenia. Front Psychiatry 2018. [PMID: 29535646 PMCID: PMC5834490 DOI: 10.3389/fpsyt.2018.00040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Schizophrenia patients present deficits in social cognition (SC), emotion and social perception, theory of mind (ToM), and attributional style. This study tested the efficacy, in real clinical conditions, of a online self-training program in SC, e-Motional Training®, in comparison with treatment as usual. METHOD A randomized single-blinded multicenter clinical trial was conducted with 60 schizophrenia stable outpatients. All patients (control and intervention) were treated with drug therapy, case management, and individual and group psychotherapy (not focused on SC). Intervention group was treated with e-Motional Training®, an online program devised for SC rehabilitation. STATISTICAL ANALYSIS A descriptive analysis and parametric/non-parametric tests were used to compare both groups at baseline. Analysis of covariance was used to compared post-pre changes in SC between the two interventions. If the group effect was significant, follow-up univariate test (t-test for dependent samples) was carried out in each group to verify whether the effect was due to improvement in the intervention group or deterioration in the control group. We considered statistically significant differences with P < 0.05. RESULTS Significant improvements were obtained in the intervention group in emotion recognition and most ToM variables in comparison with the control group. DISCUSSION e-Motional Training® seems to be a promising online training tool for SC deficits in schizophrenia, covering the lack of similar intervention instruments in our community.
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Affiliation(s)
- Yolanda Maroño Souto
- Department of Psychobiology and Clinical Psychology, Psychology School, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miriam Vázquez Campo
- Department of Psychiatry, Instituto Biomédico Galicia Sur, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | | | - Marina Rodríguez Álvarez
- Department of Psychobiology and Clinical Psychology, Psychology School, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Raimundo Mateos
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alejandro García Caballero
- Department of Psychiatry, Instituto Biomédico Galicia Sur, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Complexo Hospitalario Universitario de Ourense, Ourense, Spain.,Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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Javed A, Charles A. The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia. Front Psychiatry 2018; 9:157. [PMID: 29740360 PMCID: PMC5928350 DOI: 10.3389/fpsyt.2018.00157] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/09/2018] [Indexed: 12/11/2022] Open
Abstract
Social cognition has become recognized as an important driver of functional outcomes and overall recovery in patients with schizophrenia, mediating the relationship between neurocognition and social functioning. Since antipsychotic therapy targeting remission of clinical symptoms has been shown to have a limited impact on social cognition, there has been an increasing drive to develop therapeutic strategies to specifically improve social cognition in schizophrenia. We sought to review current evidence relating to social cognition in schizophrenia and its clinical implications, including interventions designed to target the core domains of social cognition (emotion processing, theory of mind, attributional bias, and social perception) as a means of improving functional outcomes and thereby increasing the likelihood of recovery. Relevant articles were identified by conducting a literature search in PubMed using the search terms "schizophrenia" AND "cognition" AND "social functioning," limited to Title/Abstract, over a time period of the past 10 years. Current evidence demonstrates that schizophrenia is associated with impairments in all four core domains of social cognition, during the pre-first-episode, first-episode, early, and chronic phases of the disease, and that such impairments are important determinants of functional outcome. Interventions targeting the four core domains of social cognition comprise psychosocial approaches (social cognition training programs) and pharmacological therapies. Social cognition training programs targeting multiple and specific core domains of social cognition have shown promise in improving social cognition skills, which, in some cases, has translated into improvements in functional outcomes. Use of some psychosocial interventions has additionally resulted in improvements in clinical symptoms and/or quality of life. Pharmacological therapies, including oxytocin and certain antipsychotics, have yielded more mixed results, due in part to the confounding impact of factors including variation in receptor genetics, bioavailability, pharmacokinetics, and drug-drug interactions, and inconsistencies between study designs and medication dosages. Additional research is required to advance our understanding of the role of social cognition in schizophrenia, and to further establish the utility of targeted interventions in this setting.
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Affiliation(s)
- Afzal Javed
- Jepson House, Coventry and Warwickshire Partnership NHS Trust, Nuneaton, United Kingdom
| | - Asha Charles
- Caludon Centre, Coventry and Warwickshire Partnership NHS Trust, Coventry, United Kingdom
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Bordon N, O'Rourke S, Hutton P. The feasibility and clinical benefits of improving facial affect recognition impairments in schizophrenia: Systematic review and meta-analysis. Schizophr Res 2017; 188:3-12. [PMID: 28095998 DOI: 10.1016/j.schres.2017.01.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/07/2017] [Accepted: 01/07/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND People diagnosed with schizophrenia have significant difficulty accurately recognising emotions expressed by others. This may generate anomalous experiences which, if misinterpreted, could contribute to experiences of social defeat, psychotic symptoms and reduced social functioning. It remains unclear whether this impairment is responsive to non-pharmacological intervention, or what the effect of modifying it is. METHODS We did a systematic review and meta-analysis to examine whether and to what extent facial affect recognition impairments can be improved by psychological intervention and, if so, whether this leads to improvements in psychotic symptoms and social functioning. RESULTS A total of 8 randomised controlled trials (RCTs) consisting of 300 participants were included. Focused yet brief psychological interventions led to very large improvements in facial affect recognition ability in psychosis [k=8, N=300, g=1.26, 95% Confidence Interval (CI) 0.92, 1.60, I2 41%]. Early evidence suggests this may cause large improvements in social functioning (k=3, N=109, g=0.98, 95% CI 0.37, 1.36, I2 38%), but not psychotic symptoms. CONCLUSIONS Facial affect recognition difficulties in schizophrenia are highly responsive to psychological interventions designed to improve them, and there is early evidence that this may lead to large gains in social functioning for this group - but not symptoms. A large-scale high-quality RCT with longer-term follow-up period is now required to overcome the limitations of the existing evidence.
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Affiliation(s)
- Natalie Bordon
- Department of Clinical Psychology, The State Hospital, Carstairs, Lanarkshire, UK
| | - Suzanne O'Rourke
- Department of Clinical Psychology, The State Hospital, Carstairs, Lanarkshire, UK; Department of Clinical and Health Psychology, School of Health in Social Science, Doorway 6, Medical School Quad, Teviot Place, University of Edinburgh, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, 9 Sighthill Court, Edinburgh EH11 4BN, UK.
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García-Casal JA, Goñi-Imizcoz M, Perea-Bartolomé MV, Soto-Pérez F, Smith SJ, Calvo-Simal S, Franco-Martín M. The Efficacy of Emotion Recognition Rehabilitation for People with Alzheimer's Disease. J Alzheimers Dis 2017; 57:937-951. [PMID: 28304290 DOI: 10.3233/jad-160940] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ability to recognize emotional expression is essential for social interactions, adapting to the environment, and quality of life. Emotion recognition is impaired in people with Alzheimer's disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. OBJECTIVE This study sought to establish whether emotion recognition capacity could be rehabilitated in people with AD. METHODS Thirty-six participants with AD were assigned to one of three conditions: an experimental group (EG) that received 20 sessions of rehabilitation of emotion recognition and 20 sessions of cognitive stimulation therapy (CST), a control group (CG) that received 40 sessions of CST, and a treatment as usual group (TAU). RESULTS A positive treatment effect favoring the EG was found; participants were better able to correctly identify emotions (p = 0.021), made fewer errors of commission (p = 0.002), had greater precision of processing (p = 0.021), and faster processing speed (p = 0.001). Specifically, the EG were better able to identify sadness (p = 0.016), disgust (p = 0.005), and the neutral expression (p = 0.014), with quicker processing speed for disgust (p = 0.002). These gains were maintained at one month follow-up with the exception of processing speed for surprise, which improved. CONCLUSION Capacity to recognize facial expressions of emotions can be improved through specific rehabilitation in people with AD, and gains are still present at a one month follow up. These findings have implications for the design of rehabilitation techniques for people with AD that may lead to improved quality of life and social interactions for this population.
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Affiliation(s)
- J Antonio García-Casal
- University of Salamanca, Salamanca, Spain.,Department of Research and Development, Iberian Research Psycho-sciences Institute, INTRAS Foundation, Zamora, Spain
| | | | | | - Felipe Soto-Pérez
- Department of Research and Development, Iberian Research Psycho-sciences Institute, INTRAS Foundation, Zamora, Spain
| | | | | | - Manuel Franco-Martín
- University of Salamanca, Salamanca, Spain.,Department of Psychiatry and Mental Health, Zamora Regional Hospital, Spain
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Grant N, Lawrence M, Preti A, Wykes T, Cella M. Social cognition interventions for people with schizophrenia: a systematic review focussing on methodological quality and intervention modality. Clin Psychol Rev 2017; 56:55-64. [PMID: 28688282 DOI: 10.1016/j.cpr.2017.06.001] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with a diagnosis of schizophrenia have significant social and functional difficulties. Social cognition was found to influences these outcomes and in recent years interventions targeting this domain were developed. This paper reviews the existing literature on social cognition interventions for people with a diagnosis of schizophrenia focussing on: i) comparing focussed (i.e. targeting only one social cognitive domain) and global interventions and ii) studies methodological quality. METHOD Systematic search was conducted on PubMed and PsycInfo. Studies were included if they were randomised control trials, participants had a diagnosis of schizophrenia or schizoaffective disorder, and the intervention targeted at least one out of four social cognition domains (i.e. theory of mind, affect recognition, social perception and attribution bias). All papers were assessed for methodological quality. Information on the intervention, control condition, study methodology and the main findings from each study were extracted and critically summarised. RESULTS Data from 32 studies fulfilled the inclusion criteria, considering a total of 1440 participants. Taking part in social cognition interventions produced significant improvements in theory of mind and affect recognition compared to both passive and active control conditions. Results were less clear for social perception and attributional bias. Focussed and global interventions had similar results on outcomes. Overall study methodological quality was modest. There was very limited evidence showing that social cognitive intervention result in functional outcome improvement. CONCLUSIONS The evidence considered suggests that social cognition interventions may be a valuable approach for people with a diagnosis of schizophrenia. However, evidence quality is limited by measure heterogeneity, modest study methodology and short follow-up periods. The findings point to a number of recommendations for future research, including measurement standardisation, appropriately powered studies and investigation of the impact of social cognition improvements on functioning problems.
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Affiliation(s)
- Nina Grant
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Megan Lawrence
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Antonio Preti
- Genneruxi Medical Center, Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Matteo Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
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Abstract
Mental disorders are among the greatest medical and social challenges facing us. They can occur at all stages of life and are among the most important commonly occurring diseases. In Germany 28 % of the population suffer from a mental disorder every year, while the lifetime risk of suffering from a mental disorder is almost 50 %. Mental disorders cause great suffering for those affected and their social network. Quantitatively speaking, they can be considered to be among those diseases creating the greatest burden for society due to reduced productivity, absence from work and premature retirement. The Federal Ministry of Education and Research is funding a new research network from 2015 to 2019 with up to 35 million euros to investigate mental disorders in order to devise and develop better therapeutic measures and strategies for this population by means of basic and translational clinical research. This is the result of a competitive call for research proposals entitled research network for mental diseases. It is a nationwide network of nine consortia with up to ten psychiatric and clinical psychology partner institutions from largely university-based research facilities for adults and/or children and adolescents. Furthermore, three cross-consortia platform projects will seek to identify shared causes of diseases and new diagnostic modalities for anxiety disorders, attention deficit hyperactivity disorders (ADHS), autism, bipolar disorders, depression, schizophrenia and psychotic disorders as well as substance-related and addictive disorders. The spectrum of therapeutic approaches to be examined ranges from innovative pharmacological and psychotherapeutic treatment to novel brain stimulation procedures. In light of the enormous burden such diseases represent for society as a whole, a sustainable improvement in the financial support for those researching mental disorders seems essential. This network aims to become a nucleus for long overdue and sustained support for a German center for mental disorders.
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Frost BG, Tirupati S, Johnston S, Turrell M, Lewin TJ, Sly KA, Conrad AM. An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges. BMC Psychiatry 2017; 17:22. [PMID: 28095811 PMCID: PMC5240195 DOI: 10.1186/s12888-016-1164-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered. DISCUSSION This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations. CONCLUSIONS Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.
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Affiliation(s)
- Barry G. Frost
- School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308 Australia ,Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia
| | - Srinivasan Tirupati
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | | | - Megan Turrell
- Hunter New England Mental Health, Newcastle, NSW 2300 Australia
| | - Terry J. Lewin
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Ketrina A. Sly
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Agatha M. Conrad
- Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW 2308 Australia ,Hunter New England Mental Health, Newcastle, NSW 2300 Australia ,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
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Palumbo D, Mucci A, Piegari G, D'Alise V, Mazza A, Galderisi S. SoCIAL - training cognition in schizophrenia: a pilot study. Neuropsychiatr Dis Treat 2017; 13:1947-1956. [PMID: 28790830 PMCID: PMC5530058 DOI: 10.2147/ndt.s136732] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of this pilot study was to assess the efficacy of a new social cognition (SC) remediation intervention, the Social Cognition Individualized Activities Lab (SoCIAL), for subjects with schizophrenia. The training includes a module for emotion recognition and one for theory of mind. A comparison with a validated cognitive remediation intervention, the Social Skills And Neurocognitive Individualized Training (SSANIT), was conducted to verify the efficacy of the SoCIAL in improving SC. Ten stabilized patients with schizophrenia accepted to participate. Five patients were randomized to SoCIAL and five to SSANIT. The SoCIAL intervention includes individual sessions of neurocognitive individualized training (NIT) and group sessions of SC training. SSANIT includes individual sessions of NIT and group sessions of social skills individualized training. The interventions were matched for the overall treatment duration (20 weeks) and for the frequency of the sessions (two times a week, one for SoCIAL or social skills individualized training and one for NIT, with a duration of 80 minutes for each session). Results showed a significant treatment effect (effect size: Cohen's d 0.32) on the primary outcome; in fact, only the SoCIAL intervention improved theory of mind. Patients receiving the SoCIAL intervention also showed an improvement of avolition. These preliminary findings support further development of the SoCIAL and suggest that cognitive remediation should include an SC module.
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Affiliation(s)
- Davide Palumbo
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Armida Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Piegari
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Valentina D'Alise
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Annapaola Mazza
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
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Abstract
Social cognitive deficits are common in neuropsychiatric disorders. Given the proximity of social cognition (SC) to everyday functioning, many intervention studies (including targeted, comprehensive, and broad-based approaches) have focussed on SC. The aim of this paper was to quantitatively meta-analyse the efficacy of SC interventions in adult neuropsychiatric patients. Databases Pubmed, PsycINFO, Web of Knowledge, and Embase were searched for controlled SC intervention studies published between 01-01-2003 and 01-01-2016. Forty-one studies, comprising 1,508 patients with schizophrenia, autism spectrum disorders, or acquired brain injury were included. Outcome measures evaluated emotion perception (EP), social perception (SP), Theory of Mind (ToM), and social functioning (SF). The meta-analyses showed that interventions were effective in improving SC (Cohen'sd=.71). Interventions targeting one specific SC function were found to be most effective (d=.89), followed by broad-based interventions, targeting non-SC domains in addition to SC (d=.65), and comprehensive interventions, that target multiple SC processes (d=.61). Targeted interventions were especially effective in improving EP and ToM. Comprehensive interventions were able to ameliorate EP, ToM, and SF. Broad-based interventions were especially effective in improving SF, but also showed effects on EP and ToM.
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45
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Correlation of social cognition and neurocognition on psychotic outcome: a naturalistic follow-up study of subjects with attenuated psychosis syndrome. Sci Rep 2016; 6:35017. [PMID: 27721394 PMCID: PMC5056353 DOI: 10.1038/srep35017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022] Open
Abstract
Neurocognitive decline has been observed in patients with psychosis as well as attenuated psychosis syndrome (APS). We tested the hypothesis that APS increases dependence on neurocognition during the interpretation of others’ mental states and that a combination index of Theory of Mind (ToM) and neurocognition improves the predictive accuracy of psychosis conversion. A sample of 83 APS individuals and 90 healthy controls (HC) were assessed by comprehensive cognitive tests. The cohort also completed a one-year follow-up. In the APS group, ToM was associated with an apparent increase in neurocognition, but this trend was not evident in the HC group. Using the new index of combined neurocognition and ToM scores, the sensitivity for predicting psychosis-proneness was 75% and the specificity was 69%. Our data suggest that the correlations between ToM function and neurocognition in APS subjects were stronger than those in healthy controls. A composite index of neurocognition and ToM could improve the predictive validity of a future conversion to psychosis.
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46
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Restricted attention to social cues in schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 2016; 266:649-61. [PMID: 27305925 DOI: 10.1007/s00406-016-0705-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Deficits of psychosocial functioning are a robust finding in schizophrenia. Research on social cognition may open a new avenue for the development of effective interventions. As a correlate of social perceptive information processing deficits, schizophrenia patients (SZP) show deviant gaze behavior (GB) while viewing emotional faces. As understanding of a social environment requires gathering complex social information, our study aimed at investigating the gaze behavior of SZP related to social interactions and its impact on the level of social and role functioning. GB of 32 SZP and 37 healthy control individuals (HCI) was investigated with a high-resolution eye tracker during an unguided viewing of 12 complex pictures of social interaction scenes. Regarding whole pictures, SZP showed a shorter scanpath length, fewer fixations and a shorter mean distance between fixations. Furthermore, SZP exhibited fewer and shorter fixations on faces, but not on the socially informative bodies nor on the background, suggesting a cue-specific abnormality. Logistic regression with bootstrapping yielded a model including two GB parameters; a subsequent ROC curve analysis indicated an excellent ability of group discrimination (AUC .85). Face-related GB aberrations correlated with lower social and role functioning and with delusional thinking, but not with negative symptoms. Training of spontaneous integration of face-related social information seems promising to enable a holistic perception of social information, which may in turn improve social and role functioning. The observed ability to discriminate SZP from HCI warrants further research on the predictive validity of GB in psychosis risk prediction.
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47
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Iakimova G, Moriano C, Farruggio L, Jover F. Socio-demographic and Clinical Correlates of Facial Expression Recognition Disorder in the Euthymic Phase of Bipolar Patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:633-42. [PMID: 27310226 PMCID: PMC5348087 DOI: 10.1177/0706743716639927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Bipolar patients show social cognitive disorders. The objective of this study is to review facial expression recognition (FER) disorders in bipolar patients (BP) and explore clinical heterogeneity factors that could affect them in the euthymic phase: socio-demographic level, clinical and changing characteristics of the disorder, history of suicide attempt, and abuse. METHOD Thirty-four euthymic bipolar patients and 29 control subjects completed a computer task of explicit facial expression recognition and were clinically evaluated. RESULTS Compared with control subjects, BP patients show: a decrease in fear, anger, and disgust recognition; an extended reaction time for disgust, surprise and neutrality recognition; confusion between fear and surprise, anger and disgust, disgust and sadness, sadness and neutrality. In BP patients, age negatively affects anger and neutrality recognition, as opposed to education level which positively affects recognizing these emotions. The history of patient abuse negatively affects surprise and disgust recognition, and the number of suicide attempts negatively affects disgust and anger recognition. CONCLUSIONS Cognitive heterogeneity in euthymic phase BP patients is affected by several factors inherent to bipolar disorder complexity that should be considered in social cognition study.
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Affiliation(s)
- Galina Iakimova
- Université de Nice Sophia Antipolis, Laboratoire d'Anthropologie et de Psychologie cognitives et sociales (LAPCOS, EA 7278), Nice, France
| | | | - Lisa Farruggio
- Université de Nice Sophia Antipolis, Laboratoire d'Anthropologie et de Psychologie cognitives et sociales (LAPCOS, EA 7278), Nice, France
| | - Frédéric Jover
- Clinique de psychiatrie et de psychologie médicale, CHU de Nice, avenue de la Voie Romaine, Nice cedex, France
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Campos C, Santos S, Gagen E, Machado S, Rocha S, Kurtz MM, Rocha NB. Neuroplastic Changes Following Social Cognition Training in Schizophrenia: A Systematic Review. Neuropsychol Rev 2016; 26:310-328. [PMID: 27541742 DOI: 10.1007/s11065-016-9326-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 07/27/2016] [Indexed: 01/24/2023]
Abstract
Social cognitive impairment is a key feature of schizophrenia and social cognition training (SCT) is a promising tool to address these deficits. Neurobiological dysfunction in schizophrenia has been widely researched, but neuronal changes induced by SCT have been scarcely explored. This review aims to assess the neuroplastic effects of SCT in patients with schizophrenia spectrum disorders. PubMed and Web of Science databases were searched for clinical trials testing the effects of SCT in functional and structural brain measurements of adult patients with schizophrenia or schizoaffective disorders. A total of 11 studies were included: five used fMRI, two used EEG and ERP, one used ERP only, two used MEG and one study used MRI. Data extracting and processing regarding sociodemographic and clinical variables, intervention characteristics, neuroimaging procedures, neuroplastic findings, effect sizes and study quality criteria was completed by two raters. Results indicate a wide range of structural and functional changes in numerous regions and circuits of the social brain, including early perceptual areas, the limbic system and prefrontal regions. Despite the small number of trials currently available, evidence suggests that SCT is associated with neuroplastic changes in the social brain and concomitant improvements in social cognitive performance. There is a lack of extensive knowledge about the neural mechanisms that underlie social cognitive enhancement after treatment, but the reported findings may shed light on the neural substrates of social cognitive impairment in schizophrenia and how improved treatment procedures can be developed and applied.
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Affiliation(s)
- Carlos Campos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal. .,Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.
| | - Susana Santos
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal
| | - Emily Gagen
- Department of Psychology, University of North Carolina-Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599-3720, USA
| | - Sérgio Machado
- Panic and Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Av. Venceslau Brás, 71, Campus da Praia Vermelha, Rio de Janeiro, Brazil.,Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Rua Marechal Deodoro, 263 - Centro, Niterói, Brazil
| | - Susana Rocha
- School of Accounting and Administration of Porto, Polytechnic Institute of Porto, Rua Jaime Lopes Amorim, s/n, 4465-004 S, Mamede de Infesta, Portugal
| | - Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, 45 Wyllys Ave, Middletown, CT, 06459, USA.,Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Nuno Barbosa Rocha
- Polytechnic Institute of Porto, Health School, Rua Valente Perfeito, 332, 4400-330, Vila Nova de Gaia, Portugal.
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49
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Kawohl W, Wyss C, Roser P, Brüne M, Rössler W, Juckel G. [Social psychiatry and neurobiology : A long overdue convergence exemplified by schizophrenia]. DER NERVENARZT 2016; 88:510-519. [PMID: 27491537 DOI: 10.1007/s00115-016-0179-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The proliferation of biological psychiatry has greatly increased over the last two decades. With the possibility to carry out brain research using modern technical methods, it seemed that social influencing factors would lose importance in the development of mental diseases; however, in actual fact this does not seem to be justified. It is necessary to overcome this separation, in that social factors are incorporated into a conceptual framework in the development of mental diseases, which simultaneously also takes the results of current neurobiological research into consideration. OBJECTIVES AND METHODS The aims of this review article are to summarize the current state of sociopsychiatric research and to emphasize the perspectives of the biological principles and their validity with respect to the social dimensions of psychiatry, as exemplified by schizophrenic disorders. The article presents the options for a biosocial approach in social psychiatry and gives an overview of the currently available literature. RESULTS AND CONCLUSION There is an abundance of neurobiological research approaches, which are closely associated with sociopsychiatric topics, such as social cognition. Social psychiatry and biological psychiatry should no longer be considered as diametrically opposed subdisciplines. On the contrary, the options which could emerge from a synthesis must be used in research and clinical practice.
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Affiliation(s)
- W Kawohl
- Zentrum für Soziale Psychiatrie, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Militärstr. 8, Postfach 1930, 8021, Zürich, Schweiz. .,Universität Zürich, Zürich, Schweiz. .,Leuphana Universität Lüneburg, Lüneburg, Deutschland.
| | - C Wyss
- Zentrum für Soziale Psychiatrie, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich, Militärstr. 8, Postfach 1930, 8021, Zürich, Schweiz.,Universität Zürich, Zürich, Schweiz
| | - P Roser
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Brüne
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland.,Forschungsabteilung für Kognitive Neuropsychiatrie und Psychiatrische Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland
| | - W Rössler
- Universität Zürich, Zürich, Schweiz.,Leuphana Universität Lüneburg, Lüneburg, Deutschland
| | - G Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinik, Ruhr-Universität Bochum, Bochum, Deutschland
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Vázquez-Campo M, Maroño Y, Lahera G, Mateos R, García-Caballero A. e-Motional Training®: Pilot study on a novel online training program on social cognition for patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2016; 4:10-17. [PMID: 28740808 PMCID: PMC5506727 DOI: 10.1016/j.scog.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 01/23/2023]
Abstract
Background Patients with schizophrenia have deficits in social cognition (SC), a construct that includes emotion perception (EP), social perception (SP), theory of mind (ToM) and attributive style (AS). The aim of our study was to assess the applicability, identify potential problems and obtain preliminary data on the efficacy of a new online training program on SC called e-Motional Training (ET®), which can be remotely administered and remotely supervised by a clinician. Materials and methods A pre/post intervention pilot study was conducted with 21 patients with schizophrenia in the healthcare area of Ourense, Spain (12 patients were assigned to the intervention group and 9 in the control group). The control group received standard treatment (TAU) (occupational therapy and leisure group). The intervention group received TAU plus 12 sessions (1 hour per week) with ET® (including training modules on emotional perception and a short animated cartoon for ToM and AS training, including automated metacognitive feedback). Endpoints: EP (Ekman 60 Faces Test), ToM (Hinting Task, Faux Pas, Happé), AS (Ambiguous Intentions Hostility Questionnaire). Results ET® was shown to be an understandable, viable and pleasant program for the participants. After the intervention, statistically significant data (p < 0.05) were obtained for the EP, ToM and AS variables. Conclusion ET® enables self-training in SC and online follow-up by the therapist, thereby covering the lack of online intervention instruments validated for patients with SC deficits. Our preliminary results demonstrate the feasibility of ET® and its possible efficacy in improving emotion recognition, ToM and AS.
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Affiliation(s)
- Miriam Vázquez-Campo
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,University Hospital Complex of Ourense, Ourense, Spain
| | - Yolanda Maroño
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties, University of Alcalá IRyCIS, CIBERSAM, Madrid, Spain
| | - Raimundo Mateos
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alejandro García-Caballero
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.,University Hospital Complex of Ourense, Ourense, Spain
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