Social Competence In Schizophrenia Research Articles

Neurocognitive and theory of mind deficits and poor social competence in schizophrenia: The moderating role of social disinterest attitudes

Neurocognitive and theory of mind deficits, dysfunctional attitudes, and negative symptoms have all been linked to poor functioning in schizophrenia, but interactions among these factors have not been extensively examined. We investigated whether dysfunctional attitudes (e.g., defeatist performance beliefs and social disinterest attitudes) moderated associations between neurocognition and theory of mind and poor everyday functioning and social competence in 146 participants with schizophrenia. We examined whether cognitive deficits are more likely to influence functioning in participants with more severe dysfunctional attitudes. Social disinterest, but not defeatist performance, attitudes were found to moderate associations between cognitive deficits and social competence but not everyday functioning, such that neurocognition and theory of mind deficits were only associated with poorer social competence in participants with more severe social disinterest attitudes. In contrast, no significant moderation effects were found for defeatist performance beliefs. Findings indicate that deficits in abilities were less likely to impact social competence in participants with greater interest in socializing. It may be that greater motivation for socializing engenders increased practice and engagement in social interactions, which then leads to greater social competence despite poor cognitive abilities. Treatments that target social disinterest attitudes may lead to greater social competence and engagement.

62.4 Asocial Beliefs Moderate Associations Between Impairments in Neurocognition and Social Cognition and Poor Social Competence in Schizophrenia

62.4 Asocial Beliefs Moderate Associations Between Impairments in Neurocognition and Social Cognition and Poor Social Competence in Schizophrenia

Performance-Based Empathy Mediates the Influence of Working Memory on Social Competence in Schizophrenia

Empathic deficits have been linked to poor functioning in schizophrenia, but this work is mostly limited to self-report data. This study examined whether performance-based empathy measures account for incremental variance in social competence and social attainment above and beyond self-reported empathy, neurocognition, and clinical symptoms. Given the importance of working memory in theoretical models of empathy and in the prediction of functioning in schizophrenia, we also examined whether empathy mediates the relationship between working memory and functioning. Sixty outpatients and 45 healthy controls were compared on performance-based measures of 3 key components of empathic responding, including facial affect perception, emotional empathy (affective responsiveness), and cognitive empathy (emotional perspective-taking). Participants also completed measures of self-reported empathy, neurocognition, clinical symptoms, and social competence and attainment. Patients demonstrated lower accuracy than controls across the 3 performance-based empathy measures. Among patients, these measures showed minimal relations to self-reported empathy but significantly correlated with working memory and other neurocognitive functions as well as symptom levels. Furthermore, cognitive empathy explained significant incremental variance in social competence (∆R (2) = .07, P < .05) and was found to mediate the relation between working memory and social competence. Performance-based measures of empathy were sensitive to functionally relevant disturbances in schizophrenia. Working memory deficits appear to have an important effect on these disruptions in empathy. Empathy is emerging as a promising new area for social cognitive research and for novel recovery-oriented treatment development.

Mental state attribution, neurocognitive functioning, and psychopathology: What predicts poor social competence in schizophrenia best?

Background Research into mental state attribution has repeatedly shown that patients with schizophrenia are impaired in their capacity to reflect upon their own and others' beliefs, knowledge and intentions, with important confounds being executive functioning, intelligence, duration of illness, and medication. Furthermore, the extent to which impaired mental state attribution, neurocognition and psychopathology explain abnormal social behavior in schizophrenic patients has been a matter of debate. We sought to determine whether mental state attribution in schizophrenia predicts poor social competence better than “non-social” cognitive factors or psychopathology. Methods Intelligence, executive functioning, mental state attribution, psychopathology and social behavior were assessed in 38 patients diagnosed with schizophrenia according to DSM-IV criteria and compared with 29 healthy controls paralleled for age and sex. All patients received antipsychotic treatment, and all participants had no history of substance abuse or traumatic brain injury. Results In the entire schizophrenia group impaired mental state attribution alone accounted for about 50% of the variance of deviant social behavior, whereas the PANSS positive score and the duration of illness contributed an additional small amount of variance. This effect was even more pronounced in a subgroup of patients with at least normal intelligence, where neither the PANSS score nor the chronicity of the disorder remained significant predictors of poor social competence. Medication was not associated with any one of the neurocognitive measures including mental state attribution, psychopathology or social behavior. Conclusions Impaired capacity to appreciate one's own and others' mental states is the single-best predictor of poor social competence in schizophrenia, and should perhaps be included in future definitions of the “core” symptomatology of schizophrenic disorders.

Retrogression of schizophrenia?

Objective: Social functioning is an important outcome dimension in schizophrenia. Measures of social skills frequently rely on self-report, and most measures which directly assess social functioning are time consuming. Here we describe a brief performance-based measure, the Social Skills Performance Assessment (SSPA), modified from an instrument published by Bellack et al. (Bellack, A., Morrison, R., Wixted, J., Mueser, K., 1990. An analysis of social competence in schizophrenia. Br. J. Psychiatry 156, 809–818). Method: 83 middle-aged and elderly patients with schizophrenia or schizoaffective disorder, and 52 normal comparison subjects (NCs) were rated on two standardized role plays, one requiring introduction to a stranger and another requiring assertive behavior with their landlord. Ratings in eight areas ranging from ‘social appropriateness’ to ‘grooming’ were made. Results: SSPA required about 12 min to complete both role play and ratings, and had excellent interrater reliability, and good test–retest reliability. Patients demonstrated significantly greater disability in all areas of social functioning compared with NCs. Social performance was related to severity of negative symptoms and cognitive deficits, but not that of positive or depressive symptoms. SSPA scores were significantly correlated with health-related quality of well-being and observed performance on activities of daily living, but not to a self-reported measure of social functioning. Conclusion: The SSPA is a reliable and useful instrument. Direct assessment of social skills may provide a more accurate picture of functioning than self-report measures among patients who frequently lack insight into their own behavior.

Social skills performance assessment among older patients with schizophrenia

Objective: Social functioning is an important outcome dimension in schizophrenia. Measures of social skills frequently rely on self-report, and most measures which directly assess social functioning are time consuming. Here we describe a brief performance-based measure, the Social Skills Performance Assessment (SSPA), modified from an instrument published by Bellack et al. (Bellack, A., Morrison, R., Wixted, J., Mueser, K., 1990. An analysis of social competence in schizophrenia. Br. J. Psychiatry 156, 809–818). Method: 83 middle-aged and elderly patients with schizophrenia or schizoaffective disorder, and 52 normal comparison subjects (NCs) were rated on two standardized role plays, one requiring introduction to a stranger and another requiring assertive behavior with their landlord. Ratings in eight areas ranging from ‘social appropriateness’ to ‘grooming’ were made. Results: SSPA required about 12 min to complete both role play and ratings, and had excellent interrater reliability, and good test–retest reliability. Patients demonstrated significantly greater disability in all areas of social functioning compared with NCs. Social performance was related to severity of negative symptoms and cognitive deficits, but not that of positive or depressive symptoms. SSPA scores were significantly correlated with health-related quality of well-being and observed performance on activities of daily living, but not to a self-reported measure of social functioning. Conclusion: The SSPA is a reliable and useful instrument. Direct assessment of social skills may provide a more accurate picture of functioning than self-report measures among patients who frequently lack insight into their own behavior.

Affect Recognition in Schizophrenia: A Synthesis of Findings across Three Studies

The results of three studies of affect recognition in schizophrenia, all using the same measures (the Face Emotion Identification Test, the Face Emotion Discrimination Test, and the Test of Facial Recognition), are reviewed. The studies differed on two important subject characteristics: patient chronicity and medication status. One study examined chronically ill, unmedicated patients (Kerr and Neale 1993); a second study included chronically ill, medicated patients (Mueser et al. 1996); and a third study examined acutely ill, medicated patients (Bellack, Blanchard and Mueser 1996). Results across the three studies suggest that chronicity of the illness, but not medication status, was related to poor performance on the affect recognition tests. Furthermore, chronically ill patients tended to perform poorly on the control task (the Test of Facial Recognition) as well as the affect perception tasks, suggesting a generalized impairment in facial perception. The implications of the findings for research on social perception are considered, as well as for interventions designed to improve social competence in schizophrenia.

Social skills training for schizophrenia: Review and future directions

A significant amount of progress has been made in documenting the effectiveness of social skills training strategies for schizophrenia. In an effort to update the literature, the authors first discuss definitions of social skill, competence, and adjustment. Following this, the skills training studies of the past decade are reviewed. These studies indicate several areas in which skills training approaches are useful, and also many areas wherein further modification of techniques is required. Future directions are proposed, with recommendations made regarding the need for: (a) highly focused training protocols; (b) more rigorous assessment of skill generalization and outcome; (c) strategies for clarifying the interrelationships between schizophrenic symptoms, antipsychotic medications, and social skills; and (d) documentation of the increasingly important role of neurocognition in mediating social skill, skill acquisition, and social competence in schizophrenia.

Memory and social skill in schizophrenia: the role of gender

The relationship between social skill and memory was examined in a group of patients with schizophrenia and schizoaffective disorder. There were few or no differences between male and female patients in history of the illness, symptomatology, memory, other cognitive factors, or social skill. Despite the absence of differences, impaired memory was related to poorer social skills for the women, but not the men. Reanalysis of data on social skill and memory from an earlier study (Mueser et al., 1991) revealed a similar pattern of results. The findings suggest that the contribution of cognitive factors to impaired social competence in schizophrenia may differ in men and women. Alternatively, the results may reflect sampling bias, whereby more severely ill women are studied than men, relative to their respective populations.

Accuracy of self-reported symptoms in individuals with schizophrenia

Objective: Social functioning is an important outcome dimension in schizophrenia. Measures of social skills frequently rely on self-report, and most measures which directly assess social functioning are time consuming. Here we describe a brief performance-based measure, the Social Skills Performance Assessment (SSPA), modified from an instrument published by Bellack et al. (Bellack, A., Morrison, R., Wixted, J., Mueser, K., 1990. An analysis of social competence in schizophrenia. Br. J. Psychiatry 156, 809–818). Method: 83 middle-aged and elderly patients with schizophrenia or schizoaffective disorder, and 52 normal comparison subjects (NCs) were rated on two standardized role plays, one requiring introduction to a stranger and another requiring assertive behavior with their landlord. Ratings in eight areas ranging from ‘social appropriateness’ to ‘grooming’ were made. Results: SSPA required about 12 min to complete both role play and ratings, and had excellent interrater reliability, and good test–retest reliability. Patients demonstrated significantly greater disability in all areas of social functioning compared with NCs. Social performance was related to severity of negative symptoms and cognitive deficits, but not that of positive or depressive symptoms. SSPA scores were significantly correlated with health-related quality of well-being and observed performance on activities of daily living, but not to a self-reported measure of social functioning. Conclusion: The SSPA is a reliable and useful instrument. Direct assessment of social skills may provide a more accurate picture of functioning than self-report measures among patients who frequently lack insight into their own behavior.

Affect perception in schizophrenia

Objective: Social functioning is an important outcome dimension in schizophrenia. Measures of social skills frequently rely on self-report, and most measures which directly assess social functioning are time consuming. Here we describe a brief performance-based measure, the Social Skills Performance Assessment (SSPA), modified from an instrument published by Bellack et al. (Bellack, A., Morrison, R., Wixted, J., Mueser, K., 1990. An analysis of social competence in schizophrenia. Br. J. Psychiatry 156, 809–818). Method: 83 middle-aged and elderly patients with schizophrenia or schizoaffective disorder, and 52 normal comparison subjects (NCs) were rated on two standardized role plays, one requiring introduction to a stranger and another requiring assertive behavior with their landlord. Ratings in eight areas ranging from ‘social appropriateness’ to ‘grooming’ were made. Results: SSPA required about 12 min to complete both role play and ratings, and had excellent interrater reliability, and good test–retest reliability. Patients demonstrated significantly greater disability in all areas of social functioning compared with NCs. Social performance was related to severity of negative symptoms and cognitive deficits, but not that of positive or depressive symptoms. SSPA scores were significantly correlated with health-related quality of well-being and observed performance on activities of daily living, but not to a self-reported measure of social functioning. Conclusion: The SSPA is a reliable and useful instrument. Direct assessment of social skills may provide a more accurate picture of functioning than self-report measures among patients who frequently lack insight into their own behavior.

Specific skills and social competence in schizophrenia.

Generalization of skills is a major problem in social skills training for schizophrenic patients. Assessment of skills is mostly not based on objective indices of specific skill deficits. The results of this study show that global competence of schizophrenics can be differentiated from specific competence. Global competence was found to be related to symptoms, whereas specific competence was not. No support was found for the assumption that social dysfunctions are caused by negative symptoms. Social perception and positive symptoms did explain a substantial part of the variance of global competence. It is therefore concluded that neither global incompetence nor negative symptoms should be used as an indication for social skills training.

An Analysis of Social Competence in Schizophrenia

Twenty-one schizophrenics with prominent negative symptoms were compared with 37 schizophrenics without them, 33 patients with major affective disorder and 20 non-patient controls on a battery of measures including a role-play test of social skills, the Social Adjustment Scale, and the Quality of Life Scale. The negative schizophrenics were most impaired on every subscale of each measure, followed in order by the non-negative schizophrenics, affective disorder patients, and non-patient controls. The social skill measures were not correlated with positive symptom levels, but were highly correlated with measures of community functioning. The results are consistent with the hypothesis that social dysfunction results from focal deficits in social skills.

Social competence in schizophrenia: Premorbid adjustment, social skill, and domains of functioning

The relations between premorbid adjustment, social skill, and domains of functioning (symptoms, social adjustment) were examined in a group of 107 schizophrenic, schizoaffective, and affective disorder patients. Premorbid sexual adjustment was moderately correlated with social skill in the schizophrenic and schizoaffective patients. Schizophrenic patients had the lowest premorbid adjustment and social skill, followed by schizoaffectives, and then affective patients. Within the schizophrenic group, social skill was significantly related to both current social adjustment and negative symptoms, but not positive symptoms. Similar but weaker effects were found for premorbid adjustment. The results suggest that deficits in social skill are correlated with poor premorbid and morbid social adjustment of schizophrenics.

Age at first hospitalization and premorbid social competence in schizophrenia and affective disorder.

Paranoid schizophrenics were found to be more similar to affective disordered patients than to other types of schizophrenics on age at first hospitalization and premorbid social competence. These findings support an earlier formulation of paranoid schizophrenia as a reflection of underlying affective disorder rather than as a subtype of schizophrenia. In addition, in all the diagnostic groups, women were found to be older than men at first hospitalization.

Assessment of premorbid social competence in schizophrenia: A methodological note.

Assessment of premorbid social competence in schizophrenia: A methodological note.

Assessment of premorbid social competence in schizophrenia: a methodological note.

Assessment of premorbid social competence in schizophrenia: a methodological note.

Premorbid social competence in schizophrenia.

Premorbid social competence in schizophrenia.