The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia.

Afzal Javed,Asha Charles

doi:10.3389/fpsyt.2018.00157

Afzal Javed, Asha Charles

Open Access

https://doi.org/10.3389/fpsyt.2018.00157

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Abstract

Social cognition has become recognized as an important driver of functional outcomes and overall recovery in patients with schizophrenia, mediating the relationship between neurocognition and social functioning. Since antipsychotic therapy targeting remission of clinical symptoms has been shown to have a limited impact on social cognition, there has been an increasing drive to develop therapeutic strategies to specifically improve social cognition in schizophrenia. We sought to review current evidence relating to social cognition in schizophrenia and its clinical implications, including interventions designed to target the core domains of social cognition (emotion processing, theory of mind, attributional bias, and social perception) as a means of improving functional outcomes and thereby increasing the likelihood of recovery. Relevant articles were identified by conducting a literature search in PubMed using the search terms “schizophrenia” AND “cognition” AND “social functioning,” limited to Title/, over a time period of the past 10 years. Current evidence demonstrates that schizophrenia is associated with impairments in all four core domains of social cognition, during the pre-first-episode, first-episode, early, and chronic phases of the disease, and that such impairments are important determinants of functional outcome. Interventions targeting the four core domains of social cognition comprise psychosocial approaches (social cognition training programs) and pharmacological therapies. Social cognition training programs targeting multiple and specific core domains of social cognition have shown promise in improving social cognition skills, which, in some cases, has translated into improvements in functional outcomes. Use of some psychosocial interventions has additionally resulted in improvements in clinical symptoms and/or quality of life. Pharmacological therapies, including oxytocin and certain antipsychotics, have yielded more mixed results, due in part to the confounding impact of factors including variation in receptor genetics, bioavailability, pharmacokinetics, and drug–drug interactions, and inconsistencies between study designs and medication dosages. Additional research is required to advance our understanding of the role of social cognition in schizophrenia, and to further establish the utility of targeted interventions in this setting.

Highlights

The goal of treatment for schizophrenia is “recovery,” rather than just the management of psychotic symptoms
The past few decades have seen concerted multidisciplinary efforts from different fields, including neuroscience, psychiatry, psychology, computer sciences, anthropology, and philosophy, which have markedly changed the ways in which we conceptualize how knowledge is acquired, processed, and used. This area is highly relevant to clinical practice, since impairments in social cognition are consistently found in patients with schizophrenia
There is increasing evidence that social cognition is a direct predictor of functional outcomes, community functioning

Summary

Introduction

The goal of treatment for schizophrenia is “recovery,” rather than just the management of psychotic symptoms. Recovery is a multidimensional concept involving clinical, psychological, and social aspects that broadly encompass occupational, educational and social activities, and the attainment of meaningful interpersonal relationships and independent living [1]. Clinical recovery (or “remission”) refers to the reduction of “symptoms” (e.g., delusions). Psychological recovery refers to developing ways to understand and cope with psychiatric experiences and thereby regain a sense of control and structure in life. Social recovery encompasses involvement in social and vocational activities, the formation of fulfilling social relationships, and gaining access to a good living environment. Precise definitions of recovery vary, but most include “criteria for symptom stability or freedom from psychiatric hospitalization, plus criteria for normalization of social and work/school functioning over a prescribed period of time” [2]. A metaanalysis of 50 studies demonstrated that only 13.5% of patients with schizophrenia and related psychoses attained recovery, when recovery was defined as “improvements in both clinical and social domains, with evidence that improvements in at least one of these two domains had persisted for ≥2 years” [3]

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