Longitudinal stability of social cognition in schizophrenia: A 5-year follow-up of social perception and emotion processing

BACKGROUND

Individuals with schizophrenia exhibit marked and disproportional impairment in social cognition, which is associated with their level of community functioning. However, it is unclear whether social cognitive impairment is stable over time, or if impairment worsens as a function of illness chronicity. Moreover, little is known about the longitudinal associations between social cognition and community functioning.

METHOD

Forty-one outpatients with schizophrenia completed tests of emotion processing (Mayer-Salovey-Caruso Emotional Intelligence Test, MSCEIT) and social perception (Relationships Across Domains, RAD) at baseline and approximately five years later. Stability of performance was assessed using paired t-tests and correlations. Longitudinal associations between social cognition and community functioning (Role Functioning Scale, RFS) were assessed using cross-lagged panel correlation analysis.

RESULTS

Performance on the two social cognition tasks were stable over follow-up. There were no significant mean differences between assessment points [p's≥0.20, Cohen'sd's≤|0.20|], and baseline performance was highly correlated with performance at follow-up [ρ's≥0.70, ICC≥0.83, p's<0.001]. The contemporaneous association between social cognition and community functioning was moderately large at follow-up [ρ=0.49, p=0.002]. However, baseline social cognition did not show a significant longitudinal influence on follow-up community functioning [z=0.31, p=0.76].

CONCLUSIONS

These data support trait-like stability of selected areas of social cognition in schizophrenia. Cross-lagged correlations did not reveal a significant unidirectional influence of baseline social cognition on community functioning five years later. However, consistent with the larger literature, a moderately large cross-sectional association between social cognition and community functioning was observed. Based on stability and cross-sectional associations, these results suggest that social cognition might have short-term implications for functional outcome rather than long-term consequences.

Social cognition and functional outcome in schizophrenia: The moderating role of cardiac vagal tone

Individuals with schizophrenia face significant challenges in daily functioning, and although social cognition predicts how well patients respond to these challenges, associated physiological mechanisms remain unspecified. The present study draws from polyvagal theory and tested the hypothesis that respiratory sinus arrhythmia (RSA), an established indicator of the capacity to self-regulate and adapt to environmental demands, combines with social cognition to predict functional outcome. Using data from 41 schizophrenia patients and 36 healthy comparison subjects, we replicated group differences in RSA and social cognition and also demonstrated that RSA and social cognition interact to predict how effectively patients manage work and independent living activities. Specifically, RSA did not enhance functional outcomes when social cognition was already strong, but higher levels of RSA enabled effective role functioning when social-cognitive performance was impaired. Jointly, RSA and social cognition accounted for 40% of the variance in outcome success, compared with 21% when evaluating social cognition alone. As polyvagal theory suggests, physiological flexibility and self-regulatory capacity may compensate for poorer social-cognitive skills among schizophrenia patients.

An intact social cognitive process in schizophrenia: situational context effects on perception of facial affect

BACKGROUND

Impaired facial affect recognition is the most consistent social cognitive finding in schizophrenia. Although social situations provide powerful constraints on our perception, little is known about how situational context modulates facial affect recognition in schizophrenia.

METHODS

Study 1 was a single-site study with 34 schizophrenia patients and 22 healthy controls. Study 2 was a 2-site study with 68 schizophrenia patients and 28 controls. Both studies administered a Situational Context Facial Affect Recognition Task with 2 conditions: a situational context condition and a no-context condition. For the situational context condition, a briefly shown face was preceded by a sentence describing either a fear- or surprise-inducing event. In the no-context condition, a face was presented without a sentence. For both conditions, subjects rated how fearful or surprised the face appeared on a 9-point Likert scale.

RESULTS

For the situational context condition of study 1, both patients and controls rated faces as more afraid when they were paired with fear-inducing sentences and as more surprised when they were paired with surprise-inducing sentences. The degree of modulation was comparable across groups. For the no-context condition, patients rated faces comparably to controls. The findings of study 2 replicated those from study 1.

CONCLUSIONS

Despite previous abnormalities in other types of context paradigms, this study found intact situational context processing in schizophrenia, suggesting that patients benefit from situational context when interpreting ambiguous facial expression. This area of relative social cognitive strength in schizophrenia has implications for social cognitive training programs.

Theory of mind deficits for processing counterfactual information in persons with chronic schizophrenia

BACKGROUND

Interpersonal communication problems are common among persons with schizophrenia and may be linked, in part, to deficits in theory of mind (ToM), the ability to accurately perceive the attitudes, beliefs and intentions of others. Particular difficulties might be expected in the processing of counterfactual information such as sarcasm or lies.

METHOD

The present study included 50 schizophrenia or schizo-affective out-patients and 44 demographically comparable healthy adults who were administered Part III of The Awareness of Social Inference Test (TASIT; a measure assessing comprehension of sarcasm versus lies) as well as measures of positive and negative symptoms and community functioning.

RESULTS

TASIT data were analyzed using a 2 (group: patients versus healthy adults) x 2 (condition: sarcasm versus lie) repeated-measures ANOVA. The results show significant effects for group, condition, and the group x condition interaction. Compared to controls, patients performed significantly worse on sarcasm but not lie scenes. Within-group contrasts showed that patients performed significantly worse on sarcasm versus lie scenes; controls performed comparably on both. In patients, performance on TASIT showed a significant correlation with positive, but not negative, symptoms. The group and interaction effects remained significant when rerun with a subset of patients with low-level positive symptoms. The findings for a relationship between TASIT performance and community functioning were essentially negative.

CONCLUSIONS

The findings replicate a prior demonstration of difficulty in the comprehension of sarcasm using a different test, but are not consistent with previous studies showing global ToM deficits in schizophrenia.

Development of a measure of relationship perception in schizophrenia

Relationships Across Domains (RAD) is a new measure of competence in relationship perception that may be used to assess clinically stable persons with schizophrenia and healthy persons. The structure and content of the RAD are grounded in relational models theory, a well-validated theory of social relations. The 75-item RAD contains 25 vignettes and can be administered in approximately 35 min. The RAD requires participants to implicitly identify the relational model of a dyad described in a brief vignette and infer how the members of the dyad are likely to behave in three other social contexts. The RAD demonstrated good internal consistency in schizophrenia outpatients and healthy participants matched to the outpatients in age and education. The schizophrenia outpatients performed more poorly on the RAD than two healthy comparison groups, supporting the ability of the RAD to discriminate between clinical and non-clinical populations. The schizophrenia patients' performance on the RAD was moderately related to reading ability and several domains of community functioning.

Emotional intelligence in schizophrenia

BACKGROUND

Deficits in emotion perception have been extensively documented in schizophrenia and are associated with poor psychosocial functioning. However, little is known about other aspects of emotion processing that are critical for adaptive functioning. The current study assessed schizophrenia patients' performance on a theoretically-based, well-validated, multidimensional measure of emotional intelligence, the Mayer-Salovey-Caruso Emotional Intelligence Test (Mayer, J.D., Salovey, P., Caruso, D.R., 2002. Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT): User's Manual. Multi-Health Systems, Inc., Toronto, Ontario).

METHODS

50 schizophrenia outpatients and 39 non-psychiatric controls completed the MSCEIT, a performance measure comprised of subtests that assess four components (branches) of emotional intelligence: Identifying, Using, Understanding, and Managing Emotions. Among patients, associations between MSCEIT scores and measures of clinical symptoms as well as functional outcome were evaluated.

RESULTS

The MSCEIT demonstrated good psychometric properties in both groups. Schizophrenia patients performed significantly worse than controls on the total MSCEIT score, and on three of the four subtests: Identifying, Understanding, and Managing Emotions. Among patients, lower MSCEIT scores significantly correlated with higher negative and disorganized symptoms, as well as worse community functioning.

CONCLUSIONS

The MSCEIT is a useful tool for investigating emotion processing in schizophrenia. Individuals with schizophrenia demonstrate deficits across multiple domains of emotion processing. These deficits have significant links with clinical symptoms of schizophrenia and with how patients function in their daily lives. Further research is required to understand the links between emotional intelligence, clinical symptoms, and functional outcome in schizophrenia.

Social cognition [corrected] and neurocognition: effects of risperidone, olanzapine, and haloperidol

OBJECTIVE

This study examined the short-term effects of first- and second-generation antipsychotic medications on social cognition and basic cognition.

METHOD

One hundred patients with schizophrenia or schizoaffective disorder participated in an 8 week, double-blind study of risperidone, olanzapine, and haloperidol. Participants were administered multiple measures of social cognition, basic cognition, and clinical symptoms at baseline, the end of week 4, and the end of week 8. Seventy-three patients completed the baseline assessment and at least one other assessment. Data were analyzed with mixed-effects analyses of covariance. For data reduction, the social cognitive measures were clustered into a summary score, and the cognitive measures were clustered into two summary scores: general cognitive ability and processing speed.

RESULTS

There were no treatment-related differences on any of the three summary scores. Social cognition did not show within-group changes over time either by itself or after control for the cognitive clusters. One cognitive score (general cognitive ability) increased during the study period for all three medication groups.

CONCLUSIONS

The present study included a rather thorough assessment of social cognition and did not find any evidence of between-group or within-group effects of antipsychotic medication on social cognition.

An analysis of categorical perception of facial emotion in schizophrenia

BACKGROUND

Emotion perception deficits have been extensively documented in schizophrenia and are associated with poor social functioning. Yet fundamental questions about the nature and scope of these impairments remain unanswered from commonly used experimental tasks. An alternative categorical perception paradigm that focuses on distinguishing boundaries between emotions was used to evaluate whether schizophrenia patients demonstrate atypical patterns of categorical perception and a negativity bias in the identification of ambiguous facial expressions.

METHOD

47 schizophrenia outpatients and 31 nonpsychiatric controls completed a forced-choice emotion identification task. Stimuli consisted of a series of digitized facial images that were morphed in 10% signal intensity increments along continua between pairs of emotions (happy-sad; fearful-happy; angry-fearful; angry-sad) and presented in a random order. For each emotion continuum, measures of the response slope and the location of the boundary shift point between emotions were calculated for each group.

RESULTS

The schizophrenia group demonstrated significantly shallower response curves than controls across all emotion continua. Despite these generally less precise demarcations between emotions, patients did not significantly differ from controls in the location of the shift point between emotions on any of the continua.

CONCLUSIONS

Schizophrenia patients demonstrated impaired categorical perception of facial expressions with generally less sharp categorizations of ambiguous stimuli to one emotion category or another. However, patients did not demonstrate a negativity bias in their processing of ambiguous facial expressions. The emotional continuum paradigm can help to clarify the nature and boundaries of affect perception deficits in schizophrenia.

Cross-ethnic differences in perception of emotion in schizophrenia

BACKGROUND

The purpose of this study was to examine cross-ethnic differences in Perception of Emotion (POE) in schizophrenia. POE is an emerging construct in schizophrenia and involves the recognition and accurate identification of emotion in the facial and vocal expression of others. It has been implicated as relevant to instrumental functioning in schizophrenia, as well as a potential core deficit or marker for the disorder. Studies have shown the role of culture in shaping the expression and perception of emotion in non-clinical samples. It was hypothesized that ethnic minorities would have lower POE scores than Caucasians, and that the differences on POE would remain significant after controlling for neurocognition.

METHOD

Individuals, 131, diagnosed with schizophrenia or schizoaffective disorder participated in the study. There were 59 Euro-American Caucasian, 56 were African-American, and 16 were Latino. Neurocognition was measured as a standardized sum of five neuropsychological measures. Perception of Emotion was measured with facial and voice recognition tasks.

RESULTS

Both Latinos and African-Americans scored lower on POE than Caucasians. The cross-ethnic differences on POE remained significant after controlling for neurocognition and overall symptom level. Post hoc analyses showed some support for the predictive validity of the POE measure across cultural contexts.

CONCLUSIONS

These results suggest that POE in schizophrenia is influenced by ethnicity, and that the ethno-cultural mechanisms influencing POE transcend the shared variation of POE and neurocognition. These results have implications for theories of cross-cultural emotion recognition, measurement bias in POE research, and for the place of culture in the study of POE in schizophrenia.

Do the siblings of schizophrenia patients demonstrate affect perception deficits?

Affect perception deficits have been extensively documented in schizophrenia and are associated with the social dysfunction that is characteristic of this disorder. The two previous studies examined facial affect perception in genetically at-risk samples and yielded mixed results. The current study was designed to provide a rigorous test of affect perception abilities among schizophrenia patients (n=58), their biological siblings without psychosis (n=51), and nonpsychiatric controls (n=49). Participants completed three measures of affect perception, including facial, vocal, and combined modality. Schizophrenia patients performed significantly worse than controls on two of the three affect perception tests as well as a composite index based on all three tests. The performance of the sibling group fell between the patient and control groups on each of the affect perception tests. However, group differences achieved statistical significance only for the composite index with the siblings performing significantly worse than controls and significantly better than the schizophrenia group. These findings demonstrate that subtle deficits in affect perception are detectable in the unaffected siblings of schizophrenia patients when multiple measures of different types of affect perception abilities are used in combination.

Is emotion processing a predictor of functional outcome in schizophrenia?

Deficits in the ability to perceive facial and vocal emotion expression are common in schizophrenia. However, relatively little is known about how such deficits might affect functional outcomes. This prospective study examined cross-sectional and longitudinal relationships between perception of emotion and aspects of psychosocial functioning, including family relationships, social relationships, work functioning, and independent living/self-care in 94 clinically stabilized schizophrenia outpatients from five community-based rehabilitation programs. Emotion perception (facial emotion, voice emotion, and affect perception) and psychosocial outcome (Strauss and Carpenter Outcome Scale and Role Functioning Scale) were assessed at baseline and after 12 months of psychosocial rehabilitation. Significant associations were found between perception of emotion and work functioning/independent living both cross-sectionally and prospectively over the 12 months. Causal explanatory models suggested that perception of emotion might cause work functioning/independent living outcome over 1 year. The results remained significant when conceptual disorganization was statistically controlled. We did not find differences between men and women in the correlations between emotion perception and work functioning/independent living. Associations between social functioning/family relationships and perception of emotion were not significant. These findings suggest that emotion processing is a key determinant of work functioning/independent living for individuals with serious mental illness.

Perception of emotion and neurocognitive functioning in schizophrenia: what's the link?

In schizophrenia, relatively little is known about the association between deficits in emotion perception and basic neurocognitive functioning. The present study examined perception of emotion and a discrete set of neurocognitive functions in 28 treatment-resistant schizophrenic patients. Measures of emotion perception included a facial emotion identification test (still photographs presented on videotape), a voice emotion identification test (audiotape), and an affect perception test (brief interpersonal vignettes presented on videotape). Measures of neurocognitive functioning were selected based on hypothesized relationships to perception of emotion. These measures included: (a) Span of Apprehension task, a measure of early visual processing, visual scanning, and iconic read-out; (b) Degraded-Stimulus Continuous Performance Test, a measure of visual vigilance; and (c) Digit Span Distractibility Test, a measure of immediate or working memory. Among these measures, performance on the Span of Apprehension strongly correlated with performance on all three emotion perception tasks. The associations between perception of emotion and the other two measures were in the same direction, but were significantly smaller than those of the Span of Apprehension. These findings implicate the importance of early perceptual processing (i.e. visual scanning) in the ability of schizophrenic individuals to perceive emotion.

Risperidone versus haloperidol for perception of emotion in treatment-resistant schizophrenia: preliminary findings

Currently, little is known about the pharmacological effects of the new generation of antipsychotic medications on perception of emotion in schizophrenia. The present study was designed to compare the effects of risperidone versus haloperidol on the ability to perceive emotion in 20 treatment-resistant schizophrenia patients, using a double-blind design. Measures of emotion perception included a facial emotion identification test (still photographs presented on videotape), a voice emotion identification test (audiotape), and an affect perception test (brief interpersonal vignettes presented on videotape). These measures were administered during the final week of baseline and after 8 weeks of double-blind medication. Risperidone treatment produced a greater effect on patients' ability to perceive emotion compared with haloperidol treatment. Additionally, all patients who received risperidone demonstrated improvement in performance between baseline and retest, compared with four of the nine patients who received haloperidol. When changes in positive symptoms were statistically controlled, the results remained significant. These findings suggest that resperidone may facilitate patients' ability to accurately perceive emotion, an effect which may be mediated either directly by risperidone's pharmacological action or perhaps indirectly by its influence on basic neurocognition.