SOCIAL COGNITION AND FUNCTIONAL OUTCOME AS SEPARATE DOMAINS IN SCHIZOPHRENIA

Abstract

Background: Deficits in social cognition are recognised as an important feature of schizophrenia, mainly due to their close association with poor functional outcome. Impaired functioning in the domains of processing of emotions and interpretation of behaviour of others in the social milieu appears to impact functional outcome in individuals with schizophrenia. Impairments in cognition generally cooccur in these individuals and the magnitudes of deficits in social cognition and cognition are usually strongly associated. Furthermore, whereas cognitive deficits reportedly account for 10%-40% of the variance in functional outcome, social cognition has been shown to have a unique relationship to functional outcome, beyond that of cognitive function. In otherwords, social cognitionmay be amediating factor through which cognition impacts functional outcome. However, both social cognition and functional outcome are broad constructs encompassing multiple abilities. The fact that there is a wide range of measures used to test the above domains further complicates an understanding of the association between social cognition and functional outcome. The purpose of this study was to investigate the factorial validity of social cognitive constructs against that of functional outcome in schizophrenia. Methods: The subjects were 103 individuals with schizophrenia. Facial Emotion Identification Test (FEIT), the Facial Emotion Discrimination Test (FEDT), the Social Cue Recognition Test (SCRT) and the Situational Features Recognition Test (SFRT) were used as measures of social cognition. Cognitive tests were chosen in order to assess a wide range of cognitive domains and were consistent with batteries generally used in the schizophrenia literature. Functional outcome was assessed using two measures: the Quality of Life Scale (QLS) and the Social Functioning Scale (SFS). The Assessment of Interpersonal Problem Solving (AIPPS) scale, which consists of three subscales, was used as a measure of social problem solving. Symptoms were assessed with the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Results: Using a Principal Component Analysis (PCA) with varimax rotation all social cognitive tasks (i.e. FAIT, FADT, SCRT and SFRT) loaded on factor 1 (SOC COG), all three AIPPS sub-scales loaded on factor 2 (SOCPROBLEM), andbothSFS andQLS loadedon factor 3 (SOC FUNCTION). SOC COG was significantly associated with cognition (r=.54, p<0.001) and with positive (r=-.28, p<0.01) and negative symptoms (r=-.23, p<0.5). SOC PROBLEM was associated with positive (r=-.22, p<0.05) andnegative symptoms (r=-.26, p<0.05) andSOCFUNCTIONwas significantlyassociatedwithpositive (r=-.47, p<0.001) and negative symptoms (r=-.54, p<0.001). Discussion: The factor analysis clearly suggests that social cognition and social functioning are separate constructs. Interestingly a measure of social problem solving that has been at times considered a measure of functioning was differentiated from both social cognition and social functioning. Social cognition was the only factor that was significantly associated with cognition suggesting cognitive underpinning to social perception, social knowledge, and the ability to recognise affect in others. Further, all three factors correlated with both positive and negative symptoms suggesting that interpretation and evaluation of events in the social environment as well as social interactions in schizophrenia may depend on the level of psychotic symptoms.