Social Cognition In Schizophrenia Research Articles

Functional connectivity associated with improvement in emotion management after cognitive enhancement therapy in early-course schizophrenia.

The ability to manage emotions is an important social-cognitive domain impaired in schizophrenia and linked to functional outcome. The goal of our study was to examine the impact of cognitive enhancement therapy (CET) on the ability to manage emotions and brain functional connectivity in early-course schizophrenia. Participants were randomly assigned to CET (n = 55) or an enriched supportive therapy (EST) control group (n = 45). The resting-state functional magnetic resonance imaging scans and measures of emotion management performances were collected at baseline, 9, and 18 months follow-up. The final sample consisted of 37 CET and 25 EST participants, including 19 CET and 12 EST participants with imaging data. Linear mixed-effects models investigated the impact of treatment on emotion management and functional connectivity from the amygdala to ventrolateral and dorsolateral prefrontal cortex (dlPFC). The CET group showed significant improvement over time in emotion management compared to EST. Neither functional connectivity changes nor main group differences were observed following treatment. However, a significant between-group interaction showed that improved emotion management ability was associated with increased functional connectivity between the left amygdala and the left dlPFC in the CET group exclusively. Our results replicate the previous work demonstrating that CET is effective at improving some aspects of social cognition in schizophrenia. We found evidence that improvement in emotion management may be associated with a change in amygdala-dlPFC connectivity. This fronto-limbic circuit may provide a mechanistic link between the biology of emotion management processes that can be enhanced in individuals with schizophrenia.

Social Cognition Training for Enhancing Affective and Cognitive Theory of Mind in Schizophrenia: A Systematic Review and a Meta-Analysis

People with schizophrenia disorder show the presence of a deficit in social cognition (SC). Several proposals of intervention for social cognitive deficits in schizophrenia have been raised. The present study aimed to provide an update to the state-of-the-art of SC training in schizophrenia, with specific analysis on their efficacy on ToM, which is deeply involved with social dysfunction in this disorder. Furthermore, we proposed to investigate the efficacy of SC training both on ToM cognitive and affective components. We conducted a systematic review, screening 5251 articles; 26 studies met our inclusion criteria. Interventions included were very heterogeneous. To test the efficacy of SC training on ToM domain, we conducted a meta-analysis. Our results showed that SC multidimensional training programs have a positive effect on ToM domain, with a moderate effect on both cognitive and affective ToM subcomponents. Future investigations about which could be the best option for the enhancement of SC in schizophrenia are needed, contributing to expanding the state-of-the-art of SC training in this disorder.

The Factor Structure of Social Cognition in Schizophrenia: A Focus on Replication With Confirmatory Factor Analysis and Machine Learning

Social cognition has become a major focus in psychosis research aimed at explaining heterogeneity in functional outcome and developing interventions oriented to functional recovery. However, there is still no consensus on the structure of social cognition in psychosis, and research in this area has been plagued by lack of replication. Our first goal was to replicate the factor structure of social cognition using nearly identical tasks in independent samples. Our second goal was to externally validate the factors as they relate to nonsocial cognition and various symptoms in the prediction of functioning using machine learning. Confirmatory factor analyses validated a three-factor model for social cognition in psychosis (low-level, high-level, attributional bias factor). A least absolute shrinkage and selection operator regression and cross-validation provided evidence for external validity of data-driven linear models including the social-cognitive factors, nonsocial cognition, and symptoms. We addressed the replicability problems that have impeded research in this area, and our results will guide future psychosis studies.

Reduced activation of the ventromedial prefrontal cortex during self-referential processing in individuals at ultra-high risk for psychosis.

Defects in self-referential processing and perspective-taking are core characteristics that may underlie psychotic symptoms and impaired social cognition in schizophrenia. Here, we investigated the neural correlates of self-referential processing regardless of the perspective taken and third-person perspective-taking regardless of the target person to judge relevance in individuals at ultra-high risk for psychosis. We also explored relationships between alterations in neural activity and neurocognitive function and basic self ('ipseity') disorder. Twenty-two ultra-high-risk individuals and 28 healthy controls completed a functional magnetic resonance imaging task. While being scanned, participants were asked to take a first-person perspective or to put themselves in their close relative's place thereby adopting a third-person perspective during judgments of the relevance of personality trait adjectives to one's self and a close relative. For self-referential (vs other-referential) processing, ultra-high-risk individuals showed less neural activity in the left ventromedial prefrontal cortex/medial orbitofrontal cortex, which was correlated with poor working memory performance. When taking a third-person perspective (vs first-person perspective), ultra-high-risk individuals showed more activity in the middle occipital gyrus. Taken together, our findings suggest that ultra-high-risk individuals already show aberrant neural activity during self-referential processing which may possibly be related to engagement of working memory resources.

Neurocognition functioning as a prerequisite to intact social cognition in schizophrenia

ABSTRACTIntroduction: There are mixed findings regarding the relationships between neurocognition and social cognition in schizophrenia. This study aims to provide new empirical evidence to help determine the relationships between these constructs in schizophrenia.Methods: 299 stabilised patients with schizophrenia aged 18–65 years old were recruited. After having into account exclusion criteria, final sample was contained 284 patients. The Emotion Recognition Assessment Test (ERAT) was used to assess six basic emotions. To assess the theory of mind (ToM), the Hinting Task and the Faux-Pas Test were used, and the Screen for Cognitive Impairment in Psychiatry (SCIP) was administered to assess cognitive functioning. Bivariate and multivariate analyses (partial correlations, canonical correlation, regression analysis, and confirmatory and exploratory factor analysis) were conducted.Results: Statistically significant relationships were found between the subtests of the SCIP and social cognitive measures. The redundancy coefficient in the canonical analysis was 0.13. The CFA analysis showed that the best model has a two-factor structure, in which neurocognition and social cognition are correlated factors. Less than 10% of patients with impaired cognitive functioning have a performance within normal range on social cognition tests.Conclusions: The findings show that neurocognition and social cognition are independent but related constructs.

Social cognition in schizophrenia: A network-based approach to a Taiwanese version of the Reading the Mind in the Eyes test

This study aimed to examine social-cognitive impairments in patients with schizophrenia using the Eyes test. In contrast to previous methods using the correct answers, we developed the Taiwanese version of the Eyes test and constructed the response network to explore impairments in the emotional aspects of theory of mind in patients with schizophrenia. Eighteen patients with schizophrenia and 18 healthy controls were recruited to examine their performance of the Eyes test. To explore the internal structures of mental states, we used network analysis to construct the networks of choice patterns (i.e. participants' answers) by using two network indicators, including density (an index of structure diversity of a network) and centrality (an index of the choice patterns within a network). Moreover, we divided all the choices into negative, positive, and neutral item groups based on emotion polarity. The patient group was slower and less accurate than the control group. Moreover, there was a negative correlation between accuracy and blunted affect, and there were positive correlations between reaction time and emotional withdrawal and apathetic social withdrawal. As compared to healthy controls, patients with schizophrenia showed larger density in the network structure and higher centrality than controls. Also, patients showed poorer performance on negative words than healthy controls. Our results demonstrated more diversity to recognize negative emotions from patients' choice patterns as compared to those in the control group. These findings suggest that deficits on recognizing negative emotions might be associated with the dysfunctions of mental states in schizophrenia.

Linking resting-state networks and social cognition in schizophrenia and bipolar disorder.

Individuals with schizophrenia and bipolar disorder show alterations in functional neural connectivity during rest. However, resting-state network (RSN) disruptions have not been systematically compared between the two disorders. Further, the impact of RSN disruptions on social cognition, a key determinant of functional outcome, has not been studied. Forty-eight individuals with schizophrenia, 46 with bipolar disorder, and 48 healthy controls completed resting-state functional magnetic resonance imaging. An atlas-based approach was used to examine functional connectivity within nine RSNs across the cortex. RSN connectivity was assessed via nonparametric permutation testing, and associations with performance on emotion perception, mentalizing, and emotion management tasks were examined. Group differences were observed in the medial and lateral visual networks and the sensorimotor network. Individuals with schizophrenia demonstrated reduced connectivity relative to healthy controls in all three networks. Individuals with bipolar disorder demonstrated reduced connectivity relative to controls in the medial visual network and connectivity within this network was significantly positively correlated with emotion management. In healthy controls, connectivity within the medial and lateral visual networks positively correlated with mentalizing. No significant correlations were found for either visual network in schizophrenia. Results highlight the role of altered early visual processing in social cognitive deficits in both schizophrenia and bipolar disorder. However, individuals with bipolar disorder appear to compensate for disrupted visual network connectivity on social cognitive tasks, whereas those with schizophrenia do not. The current study adds clarity on the neurophysiology underlying social cognitive deficits that result in impaired functioning in serious mental illness.

“A circle and a triangle dancing together”: Alteration of social cognition in schizophrenia compared to autism spectrum disorders

Difficulties in social cognition are present both in persons with schizophrenia (SCZ) and persons with autism spectrum disorders (ASD). However, qualitative similarities and differences in this field remain unclear. The aim of this study was to explore attribution of intentionality in patients with recent onset SCZ in comparison to patients with high functioning ASD, and to explore relationships between alterations in attribution and clinical profile. Animated shapes are a non-verbal Theory of Mind (ToM) task involving the interpretation of geometric figure interactions in three conditions: random, goal-directed and ToM. We compared 51 young adults with SCZ, 32 with ASD and 23 healthy controls (HC) matched for age and gender. In random, goal-directed and ToM conditions, persons with SCZ attributed less intentionality with less appropriate answers than HC, while the same anomalies were only found in the ToM condition in persons with ASD. In SCZ, thought and langage disorganization and earlier age at onset were correlated with intentionality score in the random condition. Moreover, a mixed ToM impairment was found in SCZ, combining undermentalizing (for movements involving a mental state) similar to what was found in ASD, and overmentalizing (for random movements), related to dizorganization and precocity of the first psychotic episode. In the frame of the hypothesis of a continuum, these results underline both similarities and differences between autism and schizophrenia.

Nonsocial and social cognition in schizophrenia: current evidence and future directions.

Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.

Social cognition in schizophrenia: Validation of an ecological fMRI task

Neuroimaging studies have revealed brain regions involved in social cognition, which reportedly show functional alterations in schizophrenia. However, the social neural network has not been investigated with regards to language perception and social interactions in daily life. Here we developed and validated an integrative fMRI task to explore the neural basis of social cognition with regards to language perception in schizophrenia. The task comprised listening to film extracts and inferring mental states to characters. We first identified the functional network activated during the task in 28 healthy controls (HC). Next, we evaluated the reproducibility of Blood-Oxygen-Level Dependent (BOLD) variations in 14 HC participants. Finally, we investigated network impairment in 20 patients with schizophrenia (SZ) compared to HC. The HC group exhibited bilateral activation in the superior and middle temporal gyri (including the poles and the temporo-parietal junction). Overall, our novel integrative task induced activation of a functional network with good reproducibility and involved in language conveying social information. Compared to the HC group, the SZ group showed decreased recruitment of the right temporo-parietal junction. These findings may be useful for testing the impact of remediation on the brain, particularly on the network of language conveying social information.

Responding to joint attention bids in schizophrenia: An interactive eye-tracking study.

This study investigated social cognition in schizophrenia using a virtual reality paradigm to capture the dynamic processes of evaluating and responding to eye gaze as an intentional communicative cue. A total of 21 patients with schizophrenia and 21 age-, gender-, and IQ-matched healthy controls completed an interactive computer game with an on-screen avatar that participants believed was controlled by an off-screen partner. On social trials, participants were required to achieve joint attention by correctly interpreting and responding to gaze cues. Participants also completed non-social trials in which they responded to an arrow cue within the same task context. While patients and controls took equivalent time to process communicative intent from gaze shifts, patients made significantly more errors than controls when responding to the directional information conveyed by gaze, but not arrow, cues. Despite no differences in response times to gaze cues between groups, patients were significantly slower than controls when responding to arrow cues. This is the opposite pattern of results previously observed in autistic adults using the same task and suggests that, despite general impairments in attention orienting or oculomotor control, patients with schizophrenia demonstrate a facilitation effect when responding to communicative gaze cues. Findings indicate a hyper-responsivity to gaze cues of communicative intent in schizophrenia. The possible effects of self-referential biases when evaluating gaze direction are discussed, as are clinical implications.

The interactive effect of autism and psychosis severity on theory of mind and functioning in schizophrenia.

Autism and schizophrenia are characterized by impairments in social cognition and functioning. They can co-occur at both the trait/symptom and diagnostic levels. We investigated the concurrent effect of autism and psychotic symptom severity on social cognition and functioning in schizophrenia. Individuals with schizophrenia or schizoaffective disorder were included (N = 81; 32 women). Symptoms were measured with the Positive and Negative Syndrome Scale using the Positive subscale (PANSSpos; Kay, Fiszbein, & Opler, 1987) and the PANSS Autism Severity Score (PAUSS; Kästner et al., 2015). Theory of mind (ToM) was assessed with the Movie for the Assessment of Social Cognition (MASC; Dziobek et al., 2006), which yields scores for three error types: overmentalizing, undermentalizing, and no mentalizing. Functioning was assessed with the Global Assessment of Functioning (GAF-f; Pedersen, Hagtvet, & Karterud, 2007) and the Social Functioning Scale (SFS; Birchwood, Smith, Cochrane, Wetton, & Copestake, 1990). The sample was bimodally distributed and therefore divided into low and high PAUSS groups. We used generalized linear models to examine the effect of PANSSpos, PAUSS, and their interaction on GAF-f, SFS, and MASC scores. For the entire cohort, the PANSSpos × PAUSS interaction was significantly associated with better GAF-f (p = .005), SFS (p = .029), and overall ToM (p = .035), and for the high-PAUSS group, with reduced overmentalizing errors (p = .002), resulting in better overall ToM. Concurrent elevated levels of autism and positive psychotic symptoms seem to benefit functioning and social cognition in schizophrenia. The results are consistent with the diametric model, which posits that autism and schizophrenia are characterized by opposing patterns in mentalizing, and promote the radical idea that the presence of both disorders may be associated with attenuated impairments. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Body language reading of emotion and outcome in schizophrenia

ABSTRACTIntroduction: Although considered a promising design for testing social cognition, it is not clear to what extent the EmoBio test of emotion recognition actually predicts community functioning. It is also not clear whether the test measures something unique or different from nonsocial cognition. The present study tests whether EmoBio accounts for GAF function score and two operationalised community outcome measures. The study also analyses cognitive predictors of EmoBio performance, testing whether stimulus modality affects prediction.Methods: Eighty-three patients with schizophrenia were tested with EmoBio, the cognitive battery MCCB and WAIS-IV.Results: EmoBio accounted for a significant portion of variance in all three outcome measures. Only EmoBio predicted Lifetime Relationship status, and EmoBio remained a significant predictor of Independent living beyond non-social cognition. All cognitive measures contributed significantly to the variance in EmoBio, but entered together explained only a third of total variance.Conclusion: The study shows that emotion recognition accounts for community outcome. There was no clear effect of test-modality in predicting EmoBio performance, indicating no method invariance problem with EmoBio. It also indicates that the mechanisms underlying impaired social cognition in schizophrenia are different from the hypothesised non-verbal learning deficits in the disorder.

The Effect of Intranasal Oxytocin on Measures of Social Cognition in Schizophrenia: A Negative Report.

Social cognition is impaired in patients with schizophrenia and is related to functional outcome. Neither current pharmacologic treatments for psychotic symptoms nor psychosocial interventions robustly improves measures of social cognition. Given this, the development of adjunctive treatments to improve functional outcome is a rational approach to treatment research in schizophrenia. The neuropeptide oxytocin is a candidate to treat deficits in social cognition due to its prosocial as well as anxiolytic effects. We report here results from a randomized, double-blind, parallel group 3 week clinical trial with daily administration of adjunctive intranasal oxytocin (20 IU twice daily) (n = 13) or placebo (n = 15). We examined the effect of oxytocin administration on measures of 4 domains of social cognition, as well as social functioning. After 3 weeks of oxytocin/placebo dosing, there was no significant difference favoring oxytocin between treatment groups in any outcome measure. These results add to the body of literature examining the effects of oxytocin on social cognition in schizophrenia. Further study is warranted.

P.3.12 Childhood trauma and social cognition in schizophrenia

P.3.12 Childhood trauma and social cognition in schizophrenia

What are the specificities of social cognition in schizophrenia? A cluster-analytic study comparing schizophrenia with the general population

While social cognition (SC) is widely recognized as being impaired in schizophrenia, little is known about the potential heterogeneity in individuals’ functioning. Using a wide range of SC measures and a cluster-analytic approach, we compared SC profiles in the general population and in people with schizophrenia. A total of 131 healthy controls and 101 participants with schizophrenia were included. Groups were compared on sociodemographic, neurocognition, anxiety and depressive mood variables. Three profiles were identified in healthy controls: one with good SC abilities (Homogeneous SC group) and two with specific weaknesses in complex Facial Emotion Recognition (Low FER group) or Affective Theory of Mind (Low AToM group). However, these patterns were not found in participants with schizophrenia, who were characterized rather by levels of SC functioning (i.e., Low, Medium and High SC groups). Importantly, while the High SC group (47.9% of the sample) exhibited normal performances, the two others were underpinned by different pathological processes (i.e., alexithymia for Medium SC group or neurocognition dysfunctioning for Low SC group). These results have important implications for future research as well as for clinical practice regarding assessment methodology and therapeutic interventions.

From “under” to “over” social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms?

Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning.

Social cognition in schizophrenia: The role of mentalizing in moral dilemma decision-making

BackgroundPatients with schizophrenia have difficulties in several aspects of social cognition, e.g. emotion recognition and mentalizing. It is yet unclear if patients also show deficits in moral decision-making and whether the two aspects interact. Deficits in moral decision-making abilities might put patients in disadvantageous positions in every-day interactions. MethodTwenty-five patients with schizophrenia and twenty-five matched healthy controls participated in six moral dilemma tasks, a standard moral competency test and two mentalizing tasks. In addition, we assessed psychopathology and empathy abilities. In a brief intervention patients were asked to empathize with characters in the moral dilemmas. We expected that the decisions made by patients with schizophrenia would be more out-come-oriented, i.e. utilitarian, as compared to those made by healthy controls. ResultsPatients and healthy controls did not decide significantly differently on the moral dilemmas and patients showed normal moral competencies. Deficits in mentalizing in patients were replicated. Only in a regression analysis, however, we were able to show that PANSS positive scores and the Comic Strip task scores contributed to the moral decisions. Empathy training did not have an altering influence on decision-making. DiscussionAlthough an overlap between social cognition and moral decision-making networks has been proposed, deficits in moral decision-making and explicit associations with mentalizing were not present in patients. Psychopathology together with mentalizing abilities, however, contributed to decision-making in patients. Our findings suggest that in schizophrenia some aspects, e.g. mentalizing, are more strongly impaired while other aspects, e.g. moral decision-making, are preserved. Further research is needed to elucidate the different aspects forming social cognition and their mutual contributions, specifically in schizophrenia.

Social Cognition in Schizophrenia and Autism Spectrum Disorders: A Systematic Review and Meta-Analysis of Direct Comparisons.

Background: Deficits in social cognition are well-recognized in both schizophrenia and autism spectrum disorders (ASD). However, it is less clear how social cognition deficits differ between both disorders and what distinct mechanisms may underlie such differences. We aimed at reviewing available evidence from studies directly comparing social cognitive performance between individuals with schizophrenia and ASD.Methods: We performed a systematic review of literature up to May 22, 2018 on Pubmed, Web of Science, and Scopus. Search terms included combinations of the keywords “social cognition,” “theory of mind,” “autism,” “Asperger,” “psychosis,” and “schizophrenia.” Two researchers independently selected and extracted data according to PRISMA guidelines. Random-effects meta-analyses were conducted for performance on social cognitive tasks evaluating: (1) emotion perception; (2) theory of mind (ToM); (3) emotional intelligence (managing emotions score of the Mayer-Salovey-Caruso Emotional Intelligence Test); and (4) social skills.Results: We identified 19 eligible studies for meta-analysis including a total of 1,040 patients (558 with schizophrenia and 482 with ASD). Eight studies provided data on facial emotion perception that evidenced a better performance by participants with schizophrenia compared to those with ASD (Hedges' g = 0.43; p = 0.031). No significant differences were found between groups in the Reading the Mind in the Eyes Test (8 studies; Hedges' g = 0.22; p = 0.351), other ToM tasks (9 studies; Hedges' g = −0.03; p = 0.903), emotional intelligence (3 studies; Hedges' g = −0.17; p = 0.490), and social skills (3 studies; Hedges' g = 0.86; p = 0.056). Participants' age was a significant moderator of effect size in emotion perception and RMET analyzes, with larger differences favoring patients with schizophrenia being observed in studies with younger participants.Conclusions: The instruments that are currently available to evaluate social cognition poorly differentiate between individuals with schizophrenia and ASD. Combining behavioral tasks with neurophysiologic assessments may better characterize the differences in social cognition between both disorders.

The effects of combined oxytocin and cognitive behavioral social skills training on social cognition in schizophrenia.

Individuals with schizophrenia have deficits in social cognition that are associated with poor functional outcome. Unfortunately, current treatments result in only modest improvement in social cognition. Oxytocin, a neuropeptide with pro-social effects, has significant benefits for social cognition in the general population. However, studies examining the efficacy of oxytocin in schizophrenia have yielded inconsistent results. One reason for inconsistency may be that oxytocin has typically not been combined with psychosocial interventions. It may be necessary for individuals with schizophrenia to receive concurrent psychosocial treatment while taking oxytocin to have the context needed to make gains in social cognitive skills. The current study tested this hypothesis in a 24-week (48 session) double-blind, placebo-controlled trial that combined oxytocin and Cognitive-Behavioral Social Skills Training (CBSST), which included elements from Social Cognition and Interaction Training (SCIT). Participants included 62 outpatients diagnosed with schizophrenia (placebo n = 31; oxytocin n = 31) who received 36 IU BID, with supervised administration 45 min prior to sessions on CBSST group therapy days. Participants completed a battery of measures administered at 0, 12, and 24 weeks that assessed social cognition. CBSST generally failed to enhance social cognition from baseline to end of study, and there was no additive benefit of oxytocin beyond the effects of CBSST alone. Findings suggest that combined CBSST and oxytocin had minimal benefit for social cognition, adding to the growing literature indicating null effects of oxytocin in multi-dose trials. Methodological and biological factors may contribute to inconsistent results across studies.