Social cognitive deficits following stroke

Emotion recognition, ‘theory of mind,’ and social behavior in schizophrenia

Schizophrenia patients experience substantial social cognition deficits across multiple domains in remission

Interventions for the treatment of theory of mind deficits in schizophrenia: Systematic literature review

Background: Recent evidence suggests that depressed patients experience social cognitive deficits (e.g., poor affect recognition). However, very little is known regarding the contribution of social cognitive deficits to psychosocial dysfunction (e.g., occupational functioning). In particular, the mechanistic roles of depression severity and cognitive deficits (e.g., memory) in this domain have not been explored. The current study evaluated the extent to which mood symptoms and cognitive deficits provide a mechanistic explanation for the relationship between social cognitive and psychosocial deficits in major depressive disorder (MDD).Methods: Data were obtained from 111 participants with MDD (75 Female, mean age = 35, 84% Caucasian, 12% Asian, 4% Other) in the Cognitive Function and Mood Study (CoFaM-S), a cross-sectional study of mood, social cognition, cognition, and psychosocial functioning in mood disorders. Social cognitive abilities were assessed using the Social Perception subtest of the Wechsler Adult Intelligence Scale, and psychosocial dysfunction was clinically evaluated with the Functioning Assessment Short Test (FAST).Results: Cognitive deficits and mood symptoms did not significantly mediate relationships between social cognitive ability and psychosocial dysfunction. The exception was executive function, which mediated an indirect relationship between meaning interpretation (i.e., theory of mind) and self-perceived cognitive dysfunction.Conclusion: The results suggest that the relationship between social cognitive deficits and psychosocial dysfunction is not mechanistically explained by mood symptoms or nonsocial cognition. Development of treatment strategies targeting social cognitive deficits in patients with MDD is warranted.

Social cognition (SC) serves an interface between psychology and cognitive neuroscience and its conceptualization has evolved over years. SC broadly refers to a process of encoding and decoding the social information, i.e., how a person thinks about himself/herself and others in his/her social world. The refinement of various constructs of SC as well as the assessment tools has contributed to its better understanding and application in psychiatry. At present, major research groups in this field have agreed on that emotion perception, social perception, theory of mind, and attributional style to be the key domains of SC. A marked growth of evidence for the deficits in SC in various psychiatric disorders has led to the development of a plethora of evaluation tools. Although it has been largely studied in schizophrenia and autism spectrum disorders, lately, an increasing number of researches have been conducted in other psychiatric as well as neurological disorders. Consequent to the evidence of deficits in various domains of SC in psychiatric disorders, a number of targeted interventions have been devised. This article provides an overview of the evolution of concept, definition, and domains of SC, its evaluation, and application in psychiatry.

Social and role functioning are compromised for the majority of individuals at ultra-high risk of psychosis, and it is important to identify factors that contribute to this functional decline. This study aimed to investigate social cognitive abilities, which have previously been linked to functioning in schizophrenia, as potential factors that impact social, role and global functioning in ultra-high risk patients. A total of 30 ultra-high risk patients were recruited from an established at-risk clinical service in Melbourne, Australia, and completed a battery of social cognitive, neurocognitive, clinical and functioning measures. We examined the relationships between all four core domains of social cognition (emotion recognition, theory of mind, social perception and attributional style), neurocognitive, clinical and demographic variables with three measures of functioning (the Global Functioning Social and Role scales and the Social and Occupational Functioning Assessment Scale) using correlational and multiple regression analyses. Performance on a visual theory of mind task (visual jokes task) was significantly correlated with both concurrent role ( r = 0.425, p = 0.019) and global functioning ( r = 0.540, p = 0.002). In multivariate analyses, it also accounted for unique variance in global, but not role functioning after adjusting for negative symptoms and stress. Social functioning was not associated with performance on any of the social cognition tasks. Among specific social cognitive abilities, only a test of theory of mind was associated with functioning in our ultra-high risk sample. Further longitudinal research is needed to examine the impact of social cognitive deficits on long-term functional outcome in the ultra-high risk group. Identifying social cognitive abilities that significantly impact functioning is important to inform the development of targeted intervention programmes for ultra-high risk individuals.

Functional outcome and social cognition in bipolar disorder: Is there a connection?

Social cognitive function, involved in the perception, processing, and interpretation of social information, has been shown to be crucial for successful communication and interpersonal relationships, thereby significantly impacting mental health, well-being, and quality of life. In this regard, assessment of social cognition, mainly focusing on four key domains, such as theory of mind (ToM), emotional empathy, and social perception and behavior, has been increasingly evaluated in clinical settings, given the potential implications of impairments of these skills for therapeutic decision-making. With regard to neurodegenerative diseases (NDs), most disorders, characterized by variable disease phenotypes and progression, although similar for the unfavorable prognosis, are associated to impairments of social cognitive function, with consequent negative effects on patients' management. Specifically, in some NDs these deficits may represent core diagnostic criteria, such as for behavioral variant frontotemporal dementia (bvFTD), or may emerge during the disease course as critical aspects, such as for Parkinson's and Alzheimer's diseases. On this background, we aimed to revise the most updated evidence on the neurobiological hypotheses derived from network-based approaches, clinical manifestations, and assessment tools of social cognitive dysfunctions in NDs, also prospecting potential benefits on patients' well-being, quality of life, and outcome derived from potential therapeutic perspectives of these deficits.

Adult patients with the genetic disease neurofibromatosis type 1 (NF1) frequently report social difficulties. To date, however, only two studies have explored whether these difficulties are caused by social cognition deficits, and these yielded contradictory data. The aim of the present study was to exhaustively assess social cognition abilities (emotion, theory of mind, moral reasoning, and social information processing) in adults with NF1, compared with a control group, and to explore links between social cognition and disease characteristics (mode of inheritance, severity, and visibility). We administered a social cognition battery to 20 adults with NF1 (mean age = 26.5 years, SD = 7.4) and 20 healthy adults matched for sociodemographic variables. Patients scored significantly lower than controls on emotion, theory of mind, moral reasoning, and social information processing tasks. No effects of disease characteristics were found. These results appear to confirm that adults with NF1 have a social cognition weaknesses that could explain, at least in part, their social difficulties, although social abilities are not all impaired to the same extent. Regarding the impact of the disease characteristics, the patient sample seemed slightly insufficient for the power analyses performed. Thus, this exploratory study should form the basis of further research, with the objective of replicating these results with larger and more appropriately matched samples.

Background: Individuals who have a psychotic disorder often fnd it dif-fcult to recognize emotions, read others' mental states, and assess social situations. These social cognitive defcits are highly predictive of problems in daily life functioning. Meta-analyses show that social cognition can be improved by social cognition training (SCT) approaches; however, long-term effects appear to be limited. Given that training of cognitive functions is best executed in a manner that resembles and is integrated with participants' daily lives as much as possible, a plausible explanation is that the stimuli and techniques that are typically used in SCT do not suffciently resemble real-life social interactions. Several key characteristics of real-world interactions are absent from these stimuli, most notably interaction with the material. Methods: To improve transference of SCT to daily life functioning and interaction, we have therefore developed a SCT which utilizes Virtual Reality (VR). VR is highly realistic, eliciting genuine psychological reac-tions, and highly interactive: the environment and the virtual people (“avatars”) in it react to the actions of the participant. At the same time, VR is customizable and controllable, allowing for training that is tailored to the individual. Results: A new form of SCT, utilizing VR (called “DiSCoVR”), has been developed. DiSCoVR consists of 16 sessions, provided over the course of 8 weeks, in which the following social cognitive domains are trained: (1) Emotion perception; (2) Social perception and Theory of Mind (ie, understanding the context and interdependence of emotions, thoughts and behavior); and (3) Social interaction training (ie, understanding the other person and choosing an adequate response). These domains are trained in VR, supplemented by coaching from a therapist, and homework assignments. DiSCoVR is currently being piloted amongst 25 mental health service clients and 25 healthy controls in the northern Netherlands. In this pilot, we primarily test the acceptability and feasibility of the intervention. Furthermore, effects of the intervention on several domains of social cognition are investigated. Moreover, social behavior in VR is studied using heart rate and eye tracking data, comparing healthy controls and clients. Conclusion: We will present a theoretical framework for DiSCoVR. Moreover, we will demonstrate the intervention and provide preliminary results of the ongoing pilot study.

Research suggests that mindfulness can induce changes in the social domain, such as enhancing emotional connection to others, prosocial behavior, and empathy. However, despite growing interest in mindfulness in social psychology, very little is known about the effects of mindfulness on social cognition. Consequently, the aim of this study was to explore the relationship between mindfulness and social cognition by comparing meditators with non-meditators on several social cognition measures. A total of 60 participants (meditators, n = 30; non-meditators, n = 30) were matched on sex, age, and ethnic group, and then asked to complete the following assessment measures: Mindful Awareness Attention Scale (MAAS), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Interpersonal Reactivity Index (IRI), Revised Eyes Test, Hinting Task, Ambiguous Intentions and Hostility Questionnaire (AIHQ), Hospital Anxiety and Depression Scale (HADS), and Screening for Cognitive Impairment in Psychiatry (SCIP). The results showed that meditators reported higher empathy (except for the personal distress subscale), higher emotional recognition, higher theory of mind (ToM), and lower hostile attributional style/bias. The findings also demonstrated that dispositional mindfulness (both total score assessed with MAAS and mindfulness facets using the FFMQ) was associated with social cognition, although it was not equally correlated with all social cognition outcomes, and correlation patterns differ when analyses were conducted separately for meditators and non-meditators. In addition, results showed potential predictors for each social cognition variable, highlighting non-reactivity to inner experience as a key component of mindfulness in order to explain social cognition performance. In summary, the findings indicated that the meditator sample performed better on certain qualities (i.e., empathy, emotional recognition, ToM, hostile attributional style/bias) in comparison to non-meditators and, furthermore, support the notion that mindfulness is related to social cognition, which may have implications for the design of mindfulness-based approaches for use in clinical and non-clinical settings.

More than a century ago, Emil Kraepelin proposed the concept of schizophrenia as dementia praecox, or premature dementia, in order to capture the young age of onset and inevitable decline into a state of dementia which he observed to be characteristic of this population. In the modern age, Kraepelin’s dementia praecox may correspond to a small group of severely-unwell and treatment-resistant patients with chronic schizophrenia. This subtype of schizophrenia has been termed Kraepelinian schizophrenia. Compared to the broader community-dwelling chronic schizophrenia group, this poorly-functioning subpopulation may be subjected to recurrent hospitalisations and dependency on others in daily living. Carer reports of functional and cognitive decline often raise the suspicion of an underlying dementia. In the research literature, parallels have been drawn between the clinical, cognitive, and neuroimaging profiles of patients with schizophrenia and patients with behavioural variant frontotemporal dementia (FTD). However, no study has comprehensively compared neurocognition and social cognition in these two patient populations, particularly between hospitalised patients with schizophrenia who are chronically and severely unwell (i.e., the Kraepelinian schizophrenia subtype) and FTD. The overall aim of this thesis was to compare patients with severe chronic schizophrenia and patients with FTD in a number of neurocognitive and social cognitive domains in a series of three studies. In the first study, retrospective neuropsychological data was compared between 26 inpatients with severe chronic schizophrenia and 34 inpatients with FTD. Out of 16 cognitive domains, group differences were significant only in the executive function subdomain of set-shifting,with a 45% overlap in score distributions between groups. Differences in several domains were associated with small-to-moderate effect sizes and less than 85% overlap. In the second study, 7 inpatients with severe chronic schizophrenia, 13 outpatients with chronic schizophrenia who maintained community-living, 12 patients with FTD, and 18 healthy controls were administered a battery of neuropsychological measures. Across 16 cognitive domains, the inpatient schizophrenia-FTD groups were found to share more similar profiles than the outpatient schizophrenia-FTD groups. Differences between the inpatient schizophrenia and FTD groups were not significant, although medium and large effect sizes were observed in several domains. In the third study, the same groups from the second study were administered a social cognition battery consisting of measures for emotion recognition, theory of mind, and empathy. The FTD group demonstrated pervasive deficits across social cognitive domains, the inpatient schizophrenia group was similarly impaired but to a lesser degree, and the outpatient schizophrenia group showed more circumscribed deficits. The studies here are the only ones to have comprehensively investigated various domains of cognition in the two disorders. There are several important clinical and research implications of the current findings. Taken together, the findings demonstrate that hospitalised chronic schizophrenia patients and patients with FTD share more similarities than differences in their cognitive profiles. The findings support the Kraepelinian-non-Kraepelinian dichotomy and highlight the value of adopting a subtyping approach in schizophrenia research.

Childhood maltreatment has been linked to impairments in social functioning and social cognition in adults with affective disorders. However, conclusions have been limited by inconsistent findings across different maltreatment subtypes and social domains. We conducted a systematic review and meta-analysis to quantify associations between childhood maltreatment (overall and subtypes - physical, emotional and/or sexual abuse, and/or physical and/or emotional neglect) and different domains of social functioning and social cognition in adults with affective disorders (bipolar disorder or major depressive disorder). We also examined effect moderators and mediators of these associations. A systematic search was performed on 12.12.2022 which identified 29 studies included in qualitative synthesis (n = 3022 individuals with affective disorders), of which 27 (n = 2957) were pooled in meta-analyses. Across studies, five social functioning and five social cognition domains were examined, of which four domains of social functioning and two domains of social cognition had sufficient data for meta-analysis (PROSPERO CRD42022288976). Social functioning: childhood maltreatment was associated with lower global social functioning (r = -0.11 to -0.20), poorer interpersonal relations (r = -0.18 to -0.33), and with aggressive behaviour (r = 0.20-0.29) but was unrelated to vocational functioning. Emotional abuse and emotional neglect showed the largest magnitudes of effect. Social cognition: there was no meta-analytic evidence of associations between maltreatment and social cognition domains. Exploratory moderation analyses did not identify any consistent moderators. Narrative synthesis identified attachment style as possible moderator, and sensory patterns, anxiety, and depressive symptoms as possible mediators between childhood maltreatment and social outcomes. Overall, the available evidence was limited, particularly in relation to social cognition. Adults with affective disorders are at risk of social functioning difficulties after childhood maltreatment exposure, an effect observed across multiple maltreatment subtypes, social functioning domains, and diagnoses. Addressing social functioning problems may benefit maltreated adults with both bipolar disorder and major depressive disorder.

Major depressive disorder (MDD) is associated with social cognitive deficits (e.g., poor affect recognition and impaired theory of mind). However, the contribution of social cognitive issues to psychosocial dysfunction in MDD (e.g., occupational functioning and interpersonal relationships) has not been investigated. The current study evaluated the relationship between specific social cognitive domains (e.g., prosody interpretation) and psychosocial dysfunction in subjects with lifetime MDD, as well as currently depressed, remitted, and healthy controls (HCs) subjects. Data were obtained from 213 participants in the Cognitive Function and mood study (CoFaMS), a cross-sectional study of mood, social cognition, cold cognition, and psychosocial functioning in mood disorders. Participants' (current MDD n=42, remitted MDD n=69, and HCs n=102) social cognitive abilities were assessed using the Social Perception subtest of the Wechsler Adult Intelligence Scale, and psychosocial dysfunction was clinically evaluated with the Functioning Assessment Short Test (FAST). The results indicated that prosody interpretation, but not facial affect or meaning interpretation, was associated with psychosocial dysfunction in subjects with lifetime MDD, as well as remitted MDD subjects relative to HCs. In contrast, social cognition was not associated with functioning in participants with current MDD or in HCs. These results suggest that the relationship between social cognition and psychosocial functioning differs between the acute and remitted stage of illness in MDD, and that prosody interpretation should be considered a treatment target in patients with residual psychosocial issues.

BackgroundProblems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve social functioning, as it is a proximal predictor of social functioning. Social Cognition Training (SCT) improves social cognition, but may not generalize (enduringly) to social functioning, perhaps due to insufficient opportunity to practice in daily-life social situations. Using virtual reality (VR) for SCT could address this problem, as VR is customizable, accessible, and interactive. We will test the effect of a VR SCT, ‘DiSCoVR’, on social cognition and social functioning in a randomized controlled trial (RCT).MethodsIn total 100 people with a psychotic disorder and deficits in social cognition will be recruited for this multicenter randomized controlled trial (RCT). Participants will be randomized to VR SCT (DiSCoVR) or VR relaxation training (VRelax; active control). DiSCoVR is a 16-session individual SCT, consisting of three modules: 1) emotion perception (recognizing facial emotions in a virtual shopping street); 2) social perception and theory of mind (observing social interactions between virtual characters and assessing their behavior, emotions and thoughts); and 3) application of higher-order social cognition in social interaction (role-playing personalized situations in VR). People receiving VRelax complete sixteen individual sessions, in which they receive psycho-education about stress, identify personal stressors, learn relaxation techniques, and explore relaxing immersive virtual environments.Assessments will be performed at baseline, post-treatment, and 3-month follow-up. Primary outcomes are emotion perception (Ekman 60 Faces), social perception and theory of mind (The Awareness of Social Inference Test). Secondary outcomes include social functioning (Personal and Social Performance Scale), experiences and social interactions in daily life (experience sampling of emotions, social participation and subjective experience of social situations), psychiatric symptoms (e.g., depression, perceived stress, anxiety, positive and negative symptoms) and self-esteem.DiscussionTo our knowledge, this will be the first RCT testing the efficacy of VR SCT. It will also investigate generalization to daily life social situations, the durability of treatment effects, and moderators and mediators of treatment success.Trial registrationOn December 5, 2017, this trial was registered prospectively in the Dutch Trial Register as NTR6863.