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Maitra R, Lemmers-Jansen ILJ, Vooren M, Vanes L, Szentgyorgyi T, Crisp C, Mouchlianitis E, Shergill SS. Understanding the mechanisms underlying cognitive control in psychosis. Psychol Med 2024:1-10. [PMID: 38780379 DOI: 10.1017/s0033291724001119] [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: 05/25/2024]
Abstract
BACKGROUND Cognitive control (CC) involves a top-down mechanism to flexibly respond to complex stimuli and is impaired in schizophrenia. METHODS This study investigated the impact of increasing complexity of CC processing in 140 subjects with psychosis and 39 healthy adults, with assessments of behavioral performance, neural regions of interest and symptom severity. RESULTS The lowest level of CC (Stroop task) was impaired in all patients; the intermediate level of CC (Faces task) with explicit emotional information was most impaired in patients with first episode psychosis. Patients showed activation of distinct neural CC and reward networks, but iterative learning based on the higher-order of CC during the trust game, was most impaired in chronic schizophrenia. Subjects with first episode psychosis, and patients with lower symptom load, demonstrate flexibility of the CC network to facilitate learning, which appeared compromised in the more chronic stages of schizophrenia. CONCLUSION These data suggest optimal windows for opportunities to introduce therapeutic interventions to improve CC.
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Affiliation(s)
- R Maitra
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | - I L J Lemmers-Jansen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute for Brain and Behavior Amsterdam (iBBA), Amsterdam, Netherlands
| | - M Vooren
- Faculty of Behavioural and Movement Sciences, Educational Studies, Section Methods and Statistics, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- LEARN! Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Center for Learning Analytics (ACLA), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lucy Vanes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Timea Szentgyorgyi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Crisp
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Elias Mouchlianitis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, University of East London, London, UK
| | - S S Shergill
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Kent and Medway Medical School, University of Kent, Canterbury, UK
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Alvarez R, Velthorst E, Pinkham A, Ludwig KA, Alamansa J, Gaigg SB, Penn DL, Harvey PD, Fett AK. Reading the mind in the eyes and cognitive ability in schizophrenia- and autism spectrum disorders. Psychol Med 2023; 53:7913-7922. [PMID: 37522512 PMCID: PMC10755246 DOI: 10.1017/s0033291723002052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/09/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Schizophrenia (SZ) and autism spectrum disorders (ASD) are characterized by difficulties in theory of mind (ToM). We examined group differences in performance on a ToM-related test and associations with an estimated IQ. METHODS Participants [N = 1227, SZ (n = 563), ASD (n = 159), and controls (n = 505), 32.2% female] completed the Reading the Mind in the Eyes Test (RMET) and assessments of cognitive ability. Associations between IQ and group on RMET were investigated with regression analyses. RESULTS SZ (d = 0.73, p < 0.001) and ASD (d = 0.37, p < 0.001) performed significantly worse on the RMET than controls. SZ performed significantly worse than ASD (d = 0.32, p = 0.002). Adding IQ to the model, SZ (d = 0.60, p < 0.001) and ASD (d = 0.44, p < 0.001) continued to perform significantly worse than controls, but no longer differed from each other (d = 0.13, p = 0.30). Small significant negative correlations between symptom severity and RMET performance were found in SZ (PANSS positive: r = -0.10, negative: r = -0.11, both p < 0.05). A small non-significant negative correlation was found for Autism Diagnostic Observation Schedule scores and RMET in ASD (r = -0.08, p = 0.34). CONCLUSIONS SZ and ASD are characterized by impairments in RMET. IQ contributed significantly to RMET performance and accounted for group differences in RMET between SZ and ASD. This suggests that non-social cognitive ability needs to be included in comparative studies of the two disorders.
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Affiliation(s)
- Rebecca Alvarez
- Department of Psychology, City, University of London, London, UK
| | - Eva Velthorst
- Community Mental Health Department GGZ Noord-Holland-Noord, Heerhugowaard, the Netherlands
| | - Amy Pinkham
- Department of Psychology, The University of Texas at Dallas, Richardson, TX, USA
| | - Kelsey A. Ludwig
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Jorge Alamansa
- Department of Psychology, City, University of London, London, UK
| | | | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Victoria, Australia
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Bruce W. Carter Medical Center, Miami, FL, USA
| | - Anne-Kathrin Fett
- Department of Psychology, City, University of London, London, UK
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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Lemmers-Jansen I, Velthorst E, Fett AK. The social cognitive and neural mechanisms that underlie social functioning in individuals with schizophrenia - a review. Transl Psychiatry 2023; 13:327. [PMID: 37865631 PMCID: PMC10590451 DOI: 10.1038/s41398-023-02593-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/23/2023] Open
Abstract
In many individuals with a diagnosis of schizophrenia social functioning is impaired across the lifespan. Social cognition has emerged as one of the possible factors that may contribute to these challenges. Neuroimaging research can give further insights into the underlying mechanisms of social (cognitive) difficulties. This review summarises the evidence on the associations between social cognition in the domains of theory of mind and emotion perception and processing, and individuals' social functioning and social skills, as well as associated neural mechanisms. Eighteen behavioural studies were conducted since the last major review and meta-analysis in the field (inclusion between 7/2017 and 1/2022). No major review has investigated the link between the neural mechanisms of social cognition and their association with social functioning in schizophrenia. Fourteen relevant studies were included (from 1/2000 to 1/2022). The findings of the behavioural studies showed that associations with social outcomes were slightly stronger for theory of mind than for emotion perception and processing. Moreover, performance in both social cognitive domains was more strongly associated with performance on social skill measures than questionnaire-based assessment of social functioning in the community. Studies on the underlying neural substrate of these associations presented mixed findings. In general, higher activation in various regions of the social brain was associated with better social functioning. The available evidence suggests some shared regions that might underlie the social cognition-social outcome link between different domains. However, due to the heterogeneity in approaches and findings, the current knowledge base will need to be expanded before firm conclusions can be drawn.
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Affiliation(s)
- Imke Lemmers-Jansen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (iBBA) Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eva Velthorst
- GGZ Noord-Holland-Noord, Heerhugowaard, The Netherlands
| | - Anne-Kathrin Fett
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- Department of Psychology, City, University of London, London, UK.
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Wenzel J, Dreschke N, Hanssen E, Rosen M, Ilankovic A, Kambeitz J, Fett AK, Kambeitz-Ilankovic L. Ecological momentary assessment (EMA) combined with unsupervised machine learning shows sensitivity to identify individuals in potential need for psychiatric assessment. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01668-w. [PMID: 37715784 DOI: 10.1007/s00406-023-01668-w] [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] [Received: 01/27/2023] [Accepted: 07/31/2023] [Indexed: 09/18/2023]
Abstract
Ecological momentary assessment (EMA), a structured diary assessment technique, has shown feasibility to capture psychotic(-like) symptoms across different study groups. We investigated whether EMA combined with unsupervised machine learning can distinguish groups on the continuum of genetic risk toward psychotic illness and identify individuals with need for extended healthcare. Individuals with psychotic disorder (PD, N = 55), healthy individuals (HC, N = 25) and HC with first-degree relatives with psychosis (RE, N = 20) were assessed at two sites over 7 days using EMA. Cluster analysis determined subgroups based on similarities in longitudinal trajectories of psychotic symptom ratings in EMA, agnostic of study group assignment. Psychotic symptom ratings were calculated as average of items related to hallucinations and paranoid ideas. Prior to EMA we assessed symptoms using the Positive and Negative Syndrome Scale (PANSS) and the Community Assessment of Psychic Experience (CAPE) to characterize the EMA subgroups. We identified two clusters with distinct longitudinal EMA characteristics. Cluster 1 (NPD = 12, NRE = 1, NHC = 2) showed higher mean EMA symptom ratings as compared to cluster 2 (NPD = 43, NRE = 19, NHC = 23) (p < 0.001). Cluster 1 showed a higher burden on negative (p < 0.05) and positive (p < 0.05) psychotic symptoms in cross-sectional PANSS and CAPE ratings than cluster 2. Findings indicate a separation of PD with high symptom burden (cluster 1) from PD with healthy-like rating patterns grouping together with HC and RE (cluster 2). Individuals in cluster 1 might particularly profit from exchange with a clinician underlining the idea of EMA as clinical monitoring tool.
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Affiliation(s)
- Julian Wenzel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nils Dreschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Esther Hanssen
- Hersencentrum Mental Health Institute, Amsterdam, The Netherlands
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Andrej Ilankovic
- Department of Psychiatry, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Anne-Kathrin Fett
- Department of Psychology, City, University of London, London, UK.
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Faculty of Psychology and Educational Sciences, Department of Psychology, Ludwig-Maximilian University, Munich, Germany
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Prasannakumar A, Kumar V, Rao NP. Trust and psychosis: a systematic review and meta-analysis. Psychol Med 2023; 53:5218-5226. [PMID: 35975354 DOI: 10.1017/s0033291722002562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Impaired trust in other humans is commonly seen in psychosis and it leads to poor societal functioning. However, examining trust behavior in an experimental setting is challenging. Investigators have used the trust game, a neuro-economic game to assess trust behavior in psychosis. However, the findings are inconsistent. Hence, we systematically reviewed the existing literature and conducted a meta-analysis to examine trust behavior in patients with psychosis, their relatives, and those at high risk for psychosis. METHODS We searched electronic databases for studies that have examined trust game in patients with psychosis, published up to November 2021. The primary outcome measure was the baseline trust in a trust game by patients and controls. The meta-analysis was performed if at least three data sets of control and patient groups were available for that measure/design. We conducted meta-analyses with a random-effects model. The results were described narratively wherever meta-analysis was not possible due to paucity of studies. RESULTS The searches across the databases including cross-references yielded 465 publications of which 10 studies were included in the final analysis. Baseline trust in the trust game was significantly lower in patients with psychosis compared to controls (SMD 0.39, 95% CI -0.14 to 0.64, p -0.002). However, a similar decrease in baseline trust was not present in relatives of patients (SMD 0.08, 95% CI -0.20 to 0.36, p -0.58). CONCLUSIONS The current meta-analysis suggests significant trust deficits in patients with psychosis. Future studies with a bigger sample size are required to understand the nature of trust deficits and factors affecting this impairment.
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Affiliation(s)
- Akash Prasannakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vijay Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Sijtsma H, van Buuren M, Hollarek M, Walsh RJ, Lee NC, Braams BR, Krabbendam L. Social network position, trust behavior, and neural activity in young adolescents. Neuroimage 2023; 268:119882. [PMID: 36652976 DOI: 10.1016/j.neuroimage.2023.119882] [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: 09/01/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 01/19/2023] Open
Abstract
Our social interactions take place within numerous social networks, in which our relationships with others define our position within these networks. In this study, we examined how the centrality of positions within social networks was associated with trust behavior and neural activity in 49 adolescents (Mage = 12.8 years, SDage = 0.4 years). The participants played a trust game with a cartoon animation as a partner, which showed adaptive behavior in response to the participant and was generally untrustworthy. Social network positions were obtained in secondary school classrooms where the participants and their classmates reported on who their friends were. Using social network analysis, a score was calculated that indicated the centrality of everyone's position within the friendship network. The results showed that more central social network positions were associated with higher levels of initial trust behavior, although no evidence was found for a relationship between network position and the adaptation of trust behavior. The results of the functional MRI analyses showed that the centrality of the network positions was positively associated with caudate activity when making trust decisions. Furthermore, the adolescents with more central network positions also showed stronger increases of caudate activity when the partner's return was processed compared to the adolescents with less central network positions. The current study provides initial evidence that social network positions in friendship networks relate to socio-cognitive behavior and neural activity in adolescents.
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Affiliation(s)
- Hester Sijtsma
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands.
| | - Mariët van Buuren
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands
| | - Miriam Hollarek
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands
| | - Reubs J Walsh
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands
| | - Nikki C Lee
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands
| | - Barbara R Braams
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands
| | - Lydia Krabbendam
- Section of Clinical Developmental Psychology, Research Institute LEARN, Institute for Brain and Behavior, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam the Netherlands
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Wisman-van der Teen A, Lemmers-Jansen ILJ, Oorschot M, Krabbendam L. Exploring the association between social behaviour, trust, and its neural correlates in first episode psychosis patients and in individuals at clinical high risk for psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:629-646. [PMID: 34529860 PMCID: PMC9541290 DOI: 10.1111/bjc.12327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/09/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Psychosis is characterized by paranoid delusions, social withdrawal, and distrust towards others. Trust is essential for successful social interactions. It remains unknown which aspects of social functioning are associated with reduced trust in psychosis. Therefore, we investigated the association between social behaviour, trust, and its neural correlates in a group of individuals with psychotic symptoms (PS-group), consisting of first episode psychosis patients combined with individuals at clinical high risk. METHODS We compared 24 PS individuals and 25 healthy controls. Affect and social withdrawal were assessed using the Experience Sampling Method. Trust was measured during functional magnetic resonance imaging (fMRI) scanning, using a trust game with a cooperative and unfair counterpart. RESULTS The PS-group showed lower baseline trust compared to controls and reported less positive and more negative general affect. Social withdrawal did not differ between the groups. Social withdrawal and social reactivity in affect (i.e., changes in affect when with others compared to when alone) were not associated with trust. On the neural level, in controls but not in the PS-group, social withdrawal was associated with caudate activation during interactions with an unfair partner. An increase in positive social reactivity, was associated with reduced insula activation in the whole sample. CONCLUSIONS Social withdrawal and social reactivity were not associated with reduced initial trust in the PS-group. Like controls, the PS-group showed a positive response in affect when with others, suggesting a decrease in emotional distress. Supporting patients to keep engaging in social interactions, may alleviate their emotional distress. PRACTITIONER POINTS Individuals with psychotic symptoms show reduced initial trust towards unknown others. Trust in others is not associated with social withdrawal and reported affect when with others, nor when alone. Like controls, individuals with psychotic symptoms showed reduced negative affect and increased positive affect when with others compared to when alone. We emphasize to support individuals with psychotic symptoms to keep engaging in social interactions, given it may reduce social withdrawal and alleviate their emotional distress.
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Affiliation(s)
- Amanda Wisman-van der Teen
- Yulius Mental Health, Dordrecht, The Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, The Netherlands
| | - Imke L J Lemmers-Jansen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Lydia Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, The Netherlands
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