Latent factor modeling of four schizotypy dimensions with theory of mind and empathy

Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression

The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.

Empathic accuracy in individuals with schizotypal personality traits

Empirical research using the Empathic Accuracy Task (EAT) has suggested that schizophrenia patients and people with schizotypal personality disorder exhibit lower empathic accuracy than healthy people. However, empathic accuracy in a subclinical sample with high levels of schizotypy has seldom been studied. Our study aimed to investigate empathy in a subclinical sample using the Chinese version of the EAT and a self-report empathy measure. Forty participants with high levels of schizotypy (HS participants) and 40 with low levels of schizotypy (LS participants), as measured by the Schizotypal Personality Questionnaire (SPQ), were recruited. All participants completed the Chinese version of the EAT and the self-report Questionnaire of Cognitive and Affective Empathy. Empathic accuracy (EA) scores and the intra-individual variability of EA scores were calculated. Independent samples t tests and Pearson correlation analyses were performed to examine group differences in empathy and the relationship between empathy and schizotypy respectively. HS participants exhibited reduced EA for both positive and negative videos, and larger intra-individual variability of EA for negative videos than LS participants. However, HS and LS participants did not differ in self-report cognitive empathy. Moreover, the interpersonal dimension of the SPQ was negatively correlated with EAT performance and self-report cognitive empathy in LS participants. Individuals with HS show poorer performance-based EA but relatively intact self-report cognitive empathy. This study provides empirical evidence for the ontogeny of empathy deficits in subclinical populations at risk of developing schizophrenia, supporting early interventions for social cognitive deficits.

Cold executive function processes and their hot analogs in schizotypy

OBJECTIVE

To examine cold (based on logical reasoning) versus hot (having emotional components) executive function processes in groups with high individual schizotypal traits.

METHOD

Two-hundred and forty-seven participants were administered the Schizotypal Personality Questionnaire and were allocated into schizotypal (cognitive-perceptual, paranoid, negative, disorganized) or control groups according to pre-specified criteria. Participants were also administered a battery of tasks examining working memory, complex selective attention, response inhibition, decision-making and fluid intelligence and their affective counterparts. The outcome measures of each task were reduced to one composite variable thus formulating five cold and five hot cognitive domains. Between-group differences in the cognitive domains were examined with repeated measures analyses of covariance.

RESULTS

For working memory, the control and the cognitive-perceptual groups outperformed negative schizotypes, while for affective working memory controls outperformed the disorganized group. Controls also scored higher compared with the disorganized group in complex selective attention, while both the control and the cognitive-perceptual groups outperformed negative schizotypes in complex affective selective attention. Negative schizotypes also had striking difficulties in response inhibition, as they scored lower compared with all other groups. Despite the lack of differences in fluid intelligence, controls scored higher compared with all schizotypal groups (except from cognitive-perceptual schizotypes) in emotional intelligence; the latter group reported higher emotional intelligence compared with negative schizotypes.

CONCLUSION

Results indicate that there is no categorical association between the different schizotypal dimensions with solely cold or hot executive function processes and support impoverished emotional intelligence as a core feature of schizotypy.

Concussion-Related Decision-Making by Certified Athletic Trainers: Implications for Concussion Prevention and Care

Concussions are a common sport-related injury that require appropriate initial care. Athletic trainers, often a primary source of healthcare for student-athletes, are key individuals involved in initial concussion diagnostic and management decisions. Challenges exist within the athletic environment that may hinder the consistency, efficacy, and/or effectiveness of concussion-related decision-making by athletic trainers, thereby impacting secondary concussion prevention and patient health. The purpose of this study was to identify factors that impact the intentions of athletic trainers to make appropriate concussion-related decisions under various circumstances. Overall, 1029 participants completed a survey examining educational precursors (quantity and quality of healthcare communication educational focus), demographic precursors (age, gender, educational degree, and employment setting), theory-based mediators (attitudes, perceived norms, and personal agency), and external mediators (knowledge, salience, and communication/collaboration practices) on appropriate concussion-related decision-making intentions. Data were analyzed using a two-step structural equation modeling approach. Quality of healthcare communication educational focus indirectly impacted appropriate concussion-related decision-making intentions via perceived behavioral control and communication/collaboration practices. Additionally, several factors impacted intentions to make appropriate concussion-related decisions directly including employment setting, self-efficacy, and general attitudes towards decision-making and concussions. Concussion prevention is aided by the initial and appropriate action taken by a healthcare professional to reduce immediate consequences; however, this action may be influenced by stakeholder relationships. These influential factors of decision-making may place athletes at further injury risk and negatively impact overall athlete health. As such, a sound theoretical framework incorporating the complexity of factors that may influence decision-making is needed.

Ultrasound-Induced Prenatal Stress: New Possibilities for Modeling Mental Disorders

The development of animal models of mental disorders is an important task since such models are useful for studying the neurobiological mechanisms of psychopathologies and for trial of new therapeutic drugs. One way to model pathologies of the nervous system is to impair fetal neurodevelopment through stress of the pregnant future mother, or prenatal stress (PS). The use of variable frequency ultrasound (US) in rodents is a promising method of imitating psychological stress, to which women in modern society are most often subjected. The aim of our study was to investigate the effect of PS induced by exposure to variable frequency ultrasound (US PS) throughout the gestational period on the adult rat offspring, namely, to identify features of behavioral alterations and neurochemical brain parameters that can be associated with certain mental disorders in humans, to determine the possibility of creating a new model of psychopathology. Our study included a study of some behavioral characteristics of male and female rats in the elevated plus maze, open-field test, object recognition test, social interaction test, sucrose preference test, latent inhibition test, Morris water maze, forced swimming test, acoustic startle reflex, and prepulse inhibition tests. We also determined the activity of the serotonergic, dopaminergic, and noradrenergic neurotransmitter systems in the hippocampus and frontal cortex by HPLC-ED. Concentration of norepinephrine, dopamine, DOPAC, serotonin, and HIAA, as well as DOPAC/dopamine and HIAA/serotonin ratios were determined. A correlation analysis of behavioral and neurochemical parameters in male and female rats was performed based on the data obtained. The results of the study showed that US PS altered the behavioral phenotype of the rat offspring. US PS increased the level of anxious behavior, impaired orientation-research behavior, increased grooming activity, decreased the desire for social contacts, shifted behavioral reactions from social interaction to interaction with inanimate objects, impaired latent inhibition, and decreased the startle reflex. US PS activated the serotonergic, dopaminergic, and noradrenergic neurotransmitter systems of the rat frontal cortex and hippocampus. A correlation between neurochemical and behavioral parameters was revealed. Our study showed that US PS leads to a certain dysfunction on behavioral and neurochemical levels in rats that is most closely associated with symptoms of schizophrenia or autism. We hypothesize that this could potentially be an indicator of face validity for a model of psychopathology based on neurodevelopmental impairment.

Altered empathy correlates with reduced social and non-social reward anticipation in individuals with high social anhedonia

This study examined the correlations of affective and cognitive components of empathy with reward anticipation toward monetary and social incentives in individuals with social anhedonia (SocAnh). According to the scores on the Revised Social Anhedonia Scale, 109 participants were divided into high (n = 57) and low (n = 52) SocAnh groups. Empathy was assessed with the Questionnaire of Cognitive and Affective Empathy (QCAE) and the Interpersonal Reactivity Index (IRI) Scale. Social and non-social reward anticipations were assessed by the Social and Monetary Incentive Delay Tasks, respectively. We performed independent-sample t tests and repeated-measures ANOVAs to examine the group differences on empathy and reward anticipation. Correlation analyses between empathy and reward anticipation were conducted. Results showed that the high SocAnh group reported reduced scores on empathy and reward anticipation for monetary and social incentives compared to their low SocAnh counterparts. Correlation analysis further indicated that monetary reward anticipation correlated with cognitive empathy, while social reward anticipation correlated with affective empathy. Our findings suggested that participants with high SocAnh exhibited poorer empathy and reduced reward anticipation than those with low SocAnh level. More importantly, social and non-social reward anticipation may distinctly contribute to affective and cognitive components of empathy.

A comparative study of theory of mind in taxon-like clusters of psychometric schizotypes and individuals at genetic risk for schizophrenia

Introduction: Clinical and family studies suggest that alterations of theory of mind (ToM) represent a marker of genetic liability to schizophrenia. Findings regarding ToM in schizotypy are less consistent. The study aimed to explore whether this might be due to an insufficient account of the heterogeneity of schizotypy in prior research and/or the fact that in psychometric schizotypy ToM alterations could manifest as subtle peculiarities rather than overt errors of mentalising.Methods: Individuals without a family history of psychosis (n = 150) were assigned to low, positive, negative, and high mixed schizotypy classes based on a cluster analysis of 1322 subjects who completed the Schizotypal Personality Questionnaire. The classes were compared on their performance of faux pas tasks with 77 adult first-degree relatives of schizophrenia patients, who represent individuals at genetic risk for schizophrenia. Besides overt errors, subtle alterations in ToM were analysed using expert judgment.Results: The relatives tended to make overt errors and demonstrated specific features of intentional reasoning. None of the schizotypal classes showed similar trends.Conclusions: The results complement the literature on the subjective-objective disjunction in psychometric schizotypes and did not provide evidence that ToM anomalies are a marker of genetic liability to schizophrenia in this cohort.

Emotion regulation and delusion-proneness relate to empathetic tendencies in a transdiagnostic sample

Empathetic tendencies (i.e., perspective taking and empathic concern) are a key factor in interpersonal relationships, which may be impacted by emotion regulation (i.e., reappraisal and suppression) and mental health symptoms, such as psychotic-like experiences. However, it is unclear if certain psychotic-like experiences, such as delusion-proneness, are still associated with reduced empathetic tendencies after accounting for emotion regulation style and dimensions of psychopathology that are often comorbid. In the current study, linear models tested these associations in a transdiagnostic community sample (N = 128), using the Interpersonal Reactivity Index (IRI), Emotion Regulation Questionnaire, and the Peter's Delusion Inventory. Results indicated that perspective taking was positively associated with reappraisal and negatively associated with delusion-proneness, after controlling for age, sex, race, intelligence, and symptoms of anxiety and depression. A significant change in R 2 supported the addition of delusion-proneness in this model. Specificity analyses demonstrated perspective taking was also negatively associated with suppression, but this relationship did not remain after accounting for the effects of reappraisal and delusion-proneness. Additional specificity analyses found no association between empathic concern and reappraisal or delusion-proneness but replicated previous findings that empathic concern was negatively associated with suppression. Taken together, delusion-proneness accounts for unique variance in perspective taking, which can inform future experimental research and may have important implications for psychosocial interventions.

Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy

Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.

Mediating role of emotion regulation in the relationship between schizotypy and empathy

Schizotypy is a set of personality traits existing in the general population that represents vulnerability for developing psychosis. Previous studies have suggested that negative schizotypy correlates with empathy, but mixed results have been shown for positive schizotypy. The present study aimed to explore the potential mediating role of emotion regulation upon schizotypy and empathy. The valid sample consisted of 595 college students who completed the Interpersonal Reactivity Index, the Emotion Regulation Questionnaire, and the Chapman Psychosis Proneness Scales. Pearson correlations between schizotypy, emotion regulation, and empathy were performed to build potential mediating models. Structural equation modeling and bootstrap analyses were used to examine the mediation effects of emotion regulation. Our results showed that negative schizotypy was correlated with both cognitive and affective empathy whereas positive schizotypy only correlated with the Fantasy and Personal Distress subscales after multiple comparisons corrections. The Cognitive Reappraisal subscale of the Emotion Regulation Questionnaire was positively correlated with empathy whereas the Expressive Suppression subscale was negatively associated with affective empathy. More importantly, there was a significant mediating effect of cognitive reappraisal on the relationship between negative schizotypy and cognitive empathy. Our findings suggest that a higher level of negative schizotypy is associated with poorer cognitive and affective empathy, and cognitive reappraisal may mediate the effect of negative schizotypy on cognitive empathy. These findings highlight the optimal usage of cognitive reappraisal in social interactions, and may help to improve empathy, especially for individuals with a high level of negative schizotypy.

Empathy and Theory of Mind in Ultra-High Risk for Psychosis: Relations With Schizotypy and Executive Function

OBJECTIVE

While recent studies have found deficits in theory of mind (ToM) skills in individuals at ultra-high risk (UHR) for psychosis, empathic tendencies in these subjects remain unclear. The presence of high schizotypy and compromised executive functions, which are found in UHR individuals, would affect ToM skills and empathic tendencies. We investigated the ToM skills and empathic tendencies of UHR individuals and examined their relationship with schizotypy and executive function.

METHODS

This study included 28 UHR individuals and 28 age- and sex-matched healthy controls. All participants completed a self-reported empathic scale (Interpersonal Reactivity Index) and the Wisconsin Schizotypy Scales. Additionally, the ToM Picture Stories Task and Wisconsin Card Sorting Test were conducted.

RESULTS

UHR individuals showed a trend toward lower self-reported empathic tendencies; however, there were no differences in ToM skills between the two groups. Of the four subscales of the IRI, only empathic concern showed a significant difference between the two groups. Empathic concern was inversely associated with negative schizotypy.

CONCLUSION

Our findings suggest that UHR individuals show relatively preserved cognitive empathy but compromised emotional empathy. Furthermore, in UHR individuals, the empathic concern subscale of the IRI was associated with negative schizotypy, while ToM skills were related to positive schizotypy and executive function.

Cognitive and Affective Theory of Mind in Positive Schizotypy: Relationship to Schizotypal Traits and Psychosocial Functioning

Theory of mind (ToM) impairments are well documented in schizophrenia, although it remains unclear whether these deficits exist among individuals with schizotypy. The current study sought to shed light on mixed findings in schizotypy by differentiating between various aspects of ToM, (cognitive/affective ToM and overmentalization/undermentalization). A three-group design (positive schizotypy, negative affect, and healthy control) was used to assess ToM performance on the Movie for Assessment of Social Cognition. Results indicated that the positive schizotypy group made greater intent overmentalization errors than both control groups. The schizotypy and negative affect groups made greater emotion overmentalization errors relative to healthy controls. In addition, the authors explored the relationship between ToM, schizotypal traits, and psychosocial functioning. Results demonstrated a significant positive relationship between cognitive-perceptual schizotypal traits and intent overmentalization as well as a significant positive relationship between interpersonal traits and emotion overmentalization. Finally, intent and emotion overmentalization were both related to poorer psychosocial functioning.

Theory of mind in schizotypy: A behavioral and event-related potential (ERP) study

Background

Schizophrenia is known for their theory of mind (ToM) impairment. However, this impairment in schizotypy (schizotypal traits) lacks investigation.

Aims

The present study investigated: (1) whether ToM ability was impaired in schizotypy; (2) whether the ERP amplitudes in nine brain regions of interest associated with ToM (e.g., frontal region) in schizotypy and healthy controls differed; and (3) whether the relationship between ToM performances and ERP amplitudes in schizotypy differed from that in healthy controls.

Method

Forty eight adolescents and young adults (16 schizotypy) with the mean age of 18 years were tested. The Reading the Mind in the Eyes Test (RMET) was used to assess their ToM during which ERP amplitudes were recorded.

Results

The schizotypy group showed significantly lower ERP amplitudes in all conditions of RMET in frontal, frontal-central, central, occipital and temporal regions when compared to those in healthy controls. Also, schizotypy's ERP amplitudes in the frontal, frontal-central, central, occipital, and temporal regions were different from those in the healthy individuals in responding to different types of ToM stimuli (positive, negative and neutral). In schizotypy group, reaction time responding to emotional stimuli was negatively related to ERP amplitudes in the frontal, central-parietal, parietal, occipital, and occipito-temporal regions during RMET while no significant correlations were found in healthy controls.

Conclusion

The present findings inform us with the knowledge regarding the neural and behavioral abnormality of ToM in schizotypy, suggesting that brain activity can be an alternative to detect ToM impairment in schizotypy.

Applying network analysis to investigate the links between dimensional schizotypy and cognitive and affective empathy

BACKGROUND

Although impairment in empathy has been reported in schizophrenia spectrum disorders, little is known about the relationship between empathy and schizotypal traits. This study examines this relationship by applying network analysis to a large sample collected at 18-months follow-up in a longitudinal dataset.

METHODS

One thousand four hundred and eighty-six college students were recruited and completed a set of self-reported questionnaires on empathy, schizotypy, depression, anxiety and stress. Networks were constructed by taking the subscale scores of these measures as nodes and partial correlations between each pair of nodes as edges. Network Comparison Tests were performed to investigate the differences between individuals with high and low schizotypy.

RESULTS

Cognitive and affective empathy were strongly connected with negative schizotypy in the network. Physical and social anhedonia showed high centrality measured by strength, closeness and betweenness while anxiety and stress showed high expected influence. Predictability ranged from 22.4% (personal distress) to 79.9% (anxiety) with an average of 54.4%. Compared with the low schizotypy group, the high schizotypy group showed higher global strength (S = 0.813, p < 0.05) and significant differences in network structure (M = 0.531, p < 0.001) and strength of edges connecting empathy with schizotypy (adjusted ps < 0.05).

LIMITATIONS

Only self-rating scales were used, and disorganized schizotypy was not included.

CONCLUSIONS

Our findings suggest that the cognitive and affective components of empathy and dimensions of schizotypy are closely related in the general population and their network interactions may play an important role in individuals with high schizotypy.

Higher Social Anxiety Severity Predicts Better Cognitive Empathy Performance in Women but Not Men

Findings regarding relationships between social anxiety and subtypes of empathy have been mixed, and one study suggested that this may be due to moderation by biological sex. The present study examined whether accounting for general anxiety and biological sex clarifies these relationships. Undergraduates (N = 701, 76% female) completed online self-report measures of cognitive and affective empathy, social and general anxiety severity, and a behavioral measure of cognitive empathy (Reading the Mind in the Eyes Task; MIE). Path analysis examined relationships among social and general anxiety severity and affective and cognitive empathy. Model modification indices showed a significant influence of sex on the path from social anxiety severity to MIE accuracy. When the model was re-estimated with this path freed, more socially anxious women, but not men, showed greater MIE accuracy. Across both sexes, general anxiety severity related negatively to self-reported and behavioral (MIE) cognitive empathy. Affective empathy did not relate to either type of anxiety. The use of path analysis to simultaneously account for overlapping variance among measures of anxiety and empathy helps clarify earlier mixed findings on relationships between social anxiety and empathy subtypes.

Theory of mind and schizotypy: A meta-analysis

Schizotypy is a multi-dimensional personality construct that putatively indicates an individual's liability to psychosis. Schizophrenia is associated with significant deficits in theory of mind (ToM). However, previous studies investigating the relationship between schizotypy and ToM provided inconsistent findings. Following the systematic review of all relevant schizotypy studies between January 1, 1980 and June 30, 2019, a meta-analysis of the relationship between ToM and schizotypy was conducted. Current meta-analysis included 24 studies consisting of 4162 healthy individuals. Overall, there was a significant but a small negative relationship between ToM and schizotypy (d = -0.23, CI = -0.14-0.33). Schizotypy scores were negatively associated with both reasoning (d = -0.24, CI = -0.11-0.38) and decoding (d = -0.21, CI = -0.09-0.32) aspects of ToM. The relationship between ToM and schizotypy was more significant in the studies using extreme-group design (d = -0.31, CI = -0.17-0.45) than non-extreme-group design (d = -0.17, CI = -0.04-0.29). ToM abnormalities were significantly related to both positive and negative schizotypy. Current findings support the continuum between schizotpy and schizophrenia. ToM abnormalities might be vulnerability markers for psychosis.

Exploring the links between alexithymia, empathy and schizotypy in college students using network analysis

Introduction: Impaired empathy is one of the major dysfunctions commonly found in patients with schizophrenia, with alexithymia being one possible underlying factor. Schizotypy represents a set of psychotic-like manifestations, investigation of which may contribute to our understanding of psychosis while minimising the confounding effects of illness chronicity and medication exposure. Few studies have specifically examined the associations among alexithymia, empathy and schizotypy. Methods: We investigated the relationships among alexithymia, empathy and schizotypy in college students using network analysis. The Interpersonal Reactivity Index (IRI), Toronto Alexithymia Scale (TAS), and Chapman Psychosis-Proneness scales were captured, and network based on the subscales were estimated in 552 participants. Strength, closeness and betweenness of nodes were calculated to measure the centrality. Results: Network analyses revealed a pattern connecting alexithymia with empathy and schizotypy. Negative connections between empathy and physical/social anhedonia and positive edges linking alexithymia with empathy and social anhedonia were observed. Conclusions: Network constructed in the study demonstrated alexithymia's role in empathic deficits. Our findings highlighted the connections between components of empathy, alexithymia and schizotypy.

Classification of social anhedonia using temporal and spatial network features from a social cognition fMRI task

Previous studies have suggested that the degree of social anhedonia reflects the vulnerability for developing schizophrenia. However, only few studies have investigated how functional network changes are related to social anhedonia. The aim of this fMRI study was to classify subjects according to their degree of social anhedonia using supervised machine learning. More specifically, we extracted both spatial and temporal network features during a social cognition task from 70 subjects, and used support vector machines for classification. Since impairment in social cognition is well established in schizophrenia-spectrum disorders, the subjects performed a comic strip task designed to specifically probe theory of mind (ToM) and empathy processing. Features representing both temporal (time series) and network dynamics were extracted using task activation maps, seed region analysis, independent component analysis (ICA), and a newly developed multi-subject archetypal analysis (MSAA), which here aimed to further bridge aspects of both seed region analysis and decomposition by incorporating a spotlight approach.We found significant classification of subjects with elevated levels of social anhedonia when using the times series extracted using MSAA, indicating that temporal dynamics carry important information for classification of social anhedonia. Interestingly, we found that the same time series yielded the highest classification performance in a task classification of the ToM condition. Finally, the spatial network corresponding to that time series included both prefrontal and temporal-parietal regions as well as insula activity, which previously have been related schizotypy and the development of schizophrenia.