Abstract

ContextImpaired social cognition is a cardinal feature of Autism Spectrum Disorders (ASD) and Schizophrenia (SZ). However, the functional neuroanatomy of social cognition in either disorder remains unclear due to variability in primary literature. Additionally, it is not known whether deficits in ASD and SZ arise from similar or disease-specific disruption of the social cognition network.ObjectiveTo identify regions most robustly implicated in social cognition processing in SZ and ASD.Data SourcesSystematic review of English language articles using MEDLINE (1995–2010) and reference lists.Study SelectionStudies were required to use fMRI to compare ASD or SZ subjects to a matched healthy control group, provide coordinates in standard stereotactic space, and employ standardized facial emotion recognition (FER) or theory of mind (TOM) paradigms.Data ExtractionActivation foci from studies meeting inclusion criteria (n = 33) were subjected to a quantitative voxel-based meta-analysis using activation likelihood estimation, and encompassed 146 subjects with ASD, 336 SZ patients and 492 healthy controls.ResultsBoth SZ and ASD showed medial prefrontal hypoactivation, which was more pronounced in ASD, while ventrolateral prefrontal dysfunction was associated mostly with SZ. Amygdala hypoactivation was observed in SZ patients during FER and in ASD during more complex ToM tasks. Both disorders were associated with hypoactivation within the Superior Temporal Sulcus (STS) during ToM tasks, but activation in these regions was increased in ASD during affect processing. Disease-specific differences were noted in somatosensory engagement, which was increased in SZ and decreased in ASD. Reduced thalamic activation was uniquely seen in SZ.ConclusionsReduced frontolimbic and STS engagement emerged as a shared feature of social cognition deficits in SZ and ASD. However, there were disease- and stimulus-specific differences. These findings may aid future studies on SZ and ASD and facilitate the formulation of new hypotheses regarding their pathophysiology.

Highlights

  • Autism and psychotic disorders have historically been considered as related diagnostic entities

  • Both disorders were associated with hypoactivation within the Superior Temporal Sulcus (STS) during Theory of mind (ToM) tasks, but activation in these regions was increased in autism spectrum disorders (ASD) during affect processing

  • Disease-specific differences were noted in somatosensory engagement, which was increased in SZ and decreased in ASD

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Summary

Introduction

Autism and psychotic disorders have historically been considered as related diagnostic entities. One of the innovations of the DSM-III in the late 1970s was to separate autism spectrum disorders (ASD) from schizophrenia (SZ) into different diagnostic categories. This distinction has many practical advantages, it is currently being reconsidered in view of emerging evidence about common neurobiological processes in both disorders [1,2,3]. Facial emotion recognition (FER) relates to the ability to infer the emotional state of others, and it measures a core dimension of ToM, it is usually mentioned separately. We will follow this convention here for ease of reference to the existing literature. We will use the term ToM to collectively refer to tasks of epistemic (e.g. false beliefs) or intention attribution and tasks that involve more than one ToM domain (e.g. the attribution of mental states and intentions to animated geometric figures)

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