Poor Social Functioning In Schizophrenia Research Articles

T227. VIRTUAL REALITY SOCIAL SKILLS TRAINING IMPROVES SOCIAL ATTENTION IN INDIVIDUALS WITH SCHIZOPHRENIA

BackgroundSocial impairment is a core feature of schizophrenia presenting a major barrier to recovery. Although antipsychotic medications can reduce psychotic symptoms, social impairments often persist, contributing to poor outcome. Validated interventions, such as Social Skills Training (Bellack et al., 2004), target a broad range of social domains but they yield only modest effect sizes for social outcome (Pfammatter et al, 2006). Moreover, conventional social interventions suffer from high burden on the clients and therapists, low adherence, lack of personalization, and low generalizability. Importantly, social interventions are not widely available. Virtual reality (VR) offers a viable alternative to conventional therapies with several advantages including high acceptability, an extensive repertoire of stimuli, low-burden, low-cost and safety (Strickland, 1997). Importantly, VR allows for a precise targeting of social cognitive mechanisms. Social attention, the fast orientation and allocation of resources to social stimuli can be indexed by tracking eye movements. Abnormal eye scanning behavior during social interactions has been linked to poor social functioning in schizophrenia (Brunet-Gouet & Decety, 2006). We designed a VR-based social skills training game to directly target social attention in schizophrenia.MethodsEighteen individuals with schizophrenia (SZ) participated in the VR training game twice a week for 5 weeks. Eye movement patterns were recorded throughout the training. Subjects were required to solve social “missions” (e.g., obtain personal information through conversations with avatars) in different naturalistic scenarios. To start a mission, participants had to fixate on the chosen avatar. The latency to engage in a social interaction was indexed by the fixation time (social engagement latency). Each session consisted of 12 missions. We compared social engagement latency and eye gaze patterns pre- and post-training to assess the efficacy of the VR social skills training program.ResultsSocial engagement latency significantly decreased after 10 sessions (d=0.78). This result suggests that prosocial attention benefitted from VR training. We also found that the standard deviation of dwell time (i.e., proportion of time spent looking at the avatar’s face during a conversation) significantly increased across training sessions (d=0.56). This result suggests an increased modulation of interpersonal engagement during social interaction. Additionally, participants’ emotion recognition ability significantly increased (η2 = 0.27), and negative symptoms significantly decreased (η2=0.34) from pre- to post- training. Importantly, these changes in social attention correlated with improvement in negative symptoms.DiscussionSimulated and targeted social interactions with avatars in VR significantly improved social attention in individuals with schizophrenia. Importantly, improvements in negative symptoms and emotion perception after training suggest that this training protocol has an impact on a broad range of social functions. VR training is a promising alternative to traditional psychosocial interventions to target specific mechanisms underlying social functioning in schizophrenia.

Cortisol response to stress in schizophrenia: Associations with oxytocin, social support and social functioning

Previous studies reported attenuated cortisol reactivity as one explanation for poor social functioning in schizophrenia. Recent research has demonstrated that both glucocorticoid and oxytocin systems are central to stress regulation. Here, we studied the associations between basal oxytocin, stress-induced cortisol levels, and social functioning and social support in schizophrenia. A mock job interview was used as an ecologically-valid social stressor in 32 schizophrenia patients. Blood samples were taken before and after stress induction to assess basal oxytocin and cortisol levels. In addition social functioning and social support scales were collected. Patients were divided into cortisol responders and non-responders according to percentage change following stress induction. Our findings revealed a possible subgroup of patients who did not exhibit attenuated cortisol responses. Importantly, cortisol responders had generally better social functioning, but perceived social support was not different between groups. There was also no evidence of a relationship between cortisol and oxytocin. This study highlights the heterogeneity of cortisol responses to stress in a schizophrenia population, and the importance of the relationship between social functioning and cortisol reactivity. These findings could be relevant when considering therapeutic interventions that manipulate endocrinology in order to improve real-world functioning.

Limbic Interference During Social Action Planning in Schizophrenia.

Schizophrenia is characterized by social interaction deficits contributing to poor functional outcome. Hand gesture use is particularly impaired, linked to frontal lobe dysfunction and frontal grey matter deficits. The functional neural correlates of impaired gesturing are currently unclear. We therefore investigated aberrant brain activity during impaired gesturing in schizophrenia. We included 22 patients with schizophrenia and 25 healthy control participants matched for age, gender, and education level. We obtained functional magnetic resonance imaging data using an event-related paradigm to assess brain activation during gesture planning and execution. Group differences in whole brain effects were calculated using factorial designs. Gesture ratings were performed by a single rater, blind to diagnoses and clinical presentation. During gesture planning and execution both groups activated brain areas of the praxis network. However, patients had reduced dorsolateral prefrontal cortex (DLPFC) and increased inferior parietal lobe (IPL) activity. Performance accuracy was associated with IPL activity in patients. Furthermore, patients activated temporal poles, amygdala and hippocampus during gesture planning, which was associated with delusion severity. Finally, patients demonstrated increased dorsomedial prefrontal cortex activity during planning of novel gestures. We demonstrate less prefrontal, but more IPL and limbic activity during gesturing in schizophrenia. IPL activity was associated with performance accuracy, whereas limbic activity was linked to delusion severity. These findings may reflect impaired social action planning and a limbic interference with gestures in schizophrenia contributing to poor gesture performance and consequently poor social functioning in schizophrenia.

Theory of Mind and social functioning in schizophrenia: correlation with figurative language abnormalities, clinical symptoms and general intelligence.

Over past few decades, studies displayed Theory of Mind (ToM) as a system, including cognitive and affective features, rather than an unitary process. Within domains defining social cognition, ToM stands for the best predictor of poor social functioning in schizophrenia. The current study aimed to explore competence in ToM tasks, in metaphorical and idiomatic language identification tasks and in a conversational rules observance test, as well as relationship with social functioning, in a group of outpatients suffering from schizophrenia. METHODS.: 30 outpatients diagnosed with schizophrenia and 24 healthy subjects have been recruited. Both groups underwent TIB as premorbid IQ evaluation, PANSS, Theory of Mind Picture Sequencing Task, a metaphors and idiomatic expressions comprehension test and a conversational test. Social functioning was assessed with PSP. Results.Mean values of premorbid IQ showed no significant difference between patients and control group. In ToM and pragmatic competence tasks, differences between groups resulted in high significance, due to patients' lower performance. A correlation between metaphors and idiomatic expressions comprehension and second order false beliefs was detected. PSP showed a correlation with PANSS and cognitive-ToM, whereas leaving aside affective-ToM. Results showed how people affected with schizophrenia, in stable clinical condition, do have clear impairments in ToM and figurative language comprehension assignments. In our theoretical framework, correlation arisen between cognitive-ToM, pragmatic deficits, clinical status and social functioning level suggests usefulness of rehabilitative interventions to recover metacognitive functions and pragmatic abilities, in order to reduce social disability in schizophrenia.

Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy

Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n=52) and healthy comparison (n=37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocognition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocognition and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed.

Alterations in Brain Activation During Cognitive Empathy Are Related to Social Functioning in Schizophrenia

Impaired cognitive empathy (ie, understanding the emotional experiences of others) is associated with poor social functioning in schizophrenia. However, it is unclear whether the neural activity underlying cognitive empathy relates to social functioning. This study examined the neural activation supporting cognitive empathy performance and whether empathy-related activation during correctly performed trials was associated with self-reported cognitive empathy and measures of social functioning. Thirty schizophrenia outpatients and 24 controls completed a cognitive empathy paradigm during functional magnetic resonance imaging. Neural activity corresponding to correct judgments about the expected emotional expression in a social interaction was compared in schizophrenia subjects relative to control subjects. Participants also completed a self-report measure of empathy and 2 social functioning measures (social competence and social attainment). Schizophrenia subjects demonstrated significantly lower accuracy in task performance and were characterized by hypoactivation in empathy-related frontal, temporal, and parietal regions as well as hyperactivation in occipital regions compared with control subjects during accurate cognitive empathy trials. A cluster with peak activation in the supplementary motor area (SMA) extending to the anterior midcingulate cortex (aMCC) correlated with social competence and social attainment in schizophrenia subjects but not controls. These results suggest that neural correlates of cognitive empathy may be promising targets for interventions aiming to improve social functioning and that brain activation in the SMA/aMCC region could be used as a biomarker for monitoring treatment response.

Differential correlations between plasma oxytocin and social cognitive capacity and bias in schizophrenia

Social cognitive impairment is related to poor social functioning in schizophrenia. This impairment includes both deficits in emotion perception and theory of mind (ToM), and cognitive biases including attributional bias and jumping to conclusions. Oxytocin (OXT) is a hormone that has been implicated in human social behavior, and that has also been associated with regulation of inflammation. In a cross-sectional study involving 60 patients with schizophrenia and 20 healthy controls, we examined associations between OXT and social cognitive capacity and bias. Secondary analyses examined associations between OXT and inflammation. We found significant correlations between OXT and social cognitive bias in the control group and in patients with delusions, but not in patients without delusions. Social cognitive capacity only correlated significantly with OXT in patients with delusions. A correlation between OXT and inflammation was observed only in patients without delusions. Findings suggest that OXT may be implicated in social cognition both in controls and in patients with delusions, but that this association may be blunted in patients without delusions. Inflammation appears to be related to OXT rather independently of social cognition. Future longitudinal and intervention studies with OXT are needed to clarify causality in the identified associations.

Ecological Momentary Assessment of social functioning in schizophrenia: Impact of performance appraisals and affect on social interactions

Research concerning the complex interplay between factors that contribute to poor social functioning in schizophrenia has been hampered by limitations of traditional measures, most notably the ecological validity and accuracy of retrospective self-report and interview measures. Computerized Ecological Momentary Assessment (EMAc) permits the real-time assessment of relationships between daily life experiences, thoughts, feelings, and behaviors. In the current study, EMAc was used to record daily social interactions, subjective performance appraisals of these interactions (e.g., “I succeeded/failed”; “I was liked/rejected”), and affect in 145 individuals with schizophrenia or schizoaffective disorder. Participants completed electronic questionnaires on a personal digital assistant (PDA) four times per day for one week. Time-lagged multilevel modeling of the data revealed that more positive interaction appraisals at any point in a day were associated with greater positive affect which, in turn, was a strong predictor of more social interactions over subsequent hours. Social functioning, therefore, was linked to positive performance beliefs about social interactions that were associated with greater positive affect. The findings suggest a useful treatment target for cognitive behavioral therapy and other psychosocial interventions that can be used to challenge defeatist beliefs and increase positive affect to enhance social functioning in schizophrenia.

Asocial beliefs as predictors of asocial behavior in schizophrenia

Poor social and vocational outcomes have long been observed in schizophrenia, and therapeutic outcomes have been modest. Most studies have identified neurocognition and emotion perception as important contributors to social functioning. Recent research has suggested that personal beliefs, attitudes, and expectancies contribute to negative symptoms. However, the impact of specific beliefs and expectancies on social withdrawal in schizophrenia has not been examined. The present study explored: 1. whether asocial beliefs made a significant contribution to social functioning after accounting for neurocognitive performance and emotion perception; and, 2. whether asocial beliefs predicted asocial behavior in a longitudinal design. 123 outpatients diagnosed with schizophrenia or schizoaffective disorder completed tests of neurocognitive performance, emotion perception, asocial beliefs, symptomatology, and functional outcome. A subset of 13 outpatients was retested one year after the initial assessment. Hierarchical regression indicated that asocial beliefs accounted for 18% of the variability in social functioning. Depression and negative symptoms explained another 9% of the dispersion. Contrary to expectations, neurocognition and emotion perception accounted for less than 1% of the variance. In the longitudinal study, baseline asocial beliefs predicted asocial behavior one year later. Asocial beliefs predict poor social functioning in schizophrenia, and may be modifiable by psychological interventions.

Anhedonia, positive and negative affect, and social functioning in schizophrenia.

This study examines the relationship between anhedonia and the trait dimensions of positive affect (PA) and negative affect (NA) in schizophrenia. The relationship between poor social functioning in schizophrenia and these individual differences in affectivity is also examined. Schizophrenia outpatients (n = 37) and normal controls (n = 15) were assessed at a baseline evaluation and again approximately 90 days later. Consistent with the hypothesized decrease in hedonic capacity in schizophrenia, patients reported significantly greater physical and social anhedonia and less PA than controls. However, the schizophrenia group also reported significantly greater NA and social anxiety than did controls. In support of the dispositional view of these individual differences in affectivity, trait measures demonstrated test-retest reliability, and group differences between the schizophrenia group and controls were stable over the 90-day followup period. Within the schizophrenia group, physical and social anhedonia were comparably negatively correlated with trait PA; however, social but not physical anhedonia was significantly positively correlated with NA and social anxiety. Poor social functioning in the schizophrenia group was associated with greater physical and social anhedonia and greater NA and social anxiety. Alternatively, greater trait PA was related to better social functioning. These findings indicate that schizophrenia is characterized by both low PA and elevated NA and that these affective characteristics are a stable feature of the illness. The results also suggest important links between affect and social functioning in schizophrenia.