Amélie M. Achim

How Prevalent Are Anxiety Disorders in Schizophrenia? A Meta-Analysis and Critical Review on a Significant Association

OBJECTIVE The presence of anxiety disorders (AD) in schizophrenia (SZ) is attracting increasing interest. However, published studies have yielded very broad variations in prevalence rates across studies. The current meta-analysis sought to (1) investigate the prevalence of co-occurring AD in SZ by reporting pooled prevalence rates and (2) identify potential sources of variations in reported rates that could guide our efforts to identify and treat these co-occurring disorders in patients with SZ. METHODS We performed a systematic search of studies reporting prevalence of AD in SZ and related psychotic disorders. Mean prevalence rates and 95% confidence intervals (CIs) were first computed for each disorder. We then examined the impact of potential moderators related to patient sampling or to AD assessment methods on these rates. RESULTS Fifty-two eligible studies were identified. Pooled prevalence rates and CIs were 12.1% (7.0%-17.1%) for obsessive-compulsive disorders, 14.9% (8.1%-21.8%) for social phobia, 10.9% (2.9%-18.8%) for generalized AD, 9.8% (4.3%-15.4%) for panic disorders, and 12.4% (4.0%-20.8%) for post-traumatic stress disorders. For all disorders, we found significant heterogeneity in rates across studies. This heterogeneity could at least partially be explained by the effect of moderator variables related to patient characteristics or assessment methods. CONCLUSIONS AD are highly prevalent in SZ, but important variations in rates are observed between studies. This meta-analysis highlights several factors that affect risk for, or detection of AD in SZ, and could, thus, have an important impact on treatment and outcome of SZ patients.

Assessment of empathy in first-episode psychosis and meta-analytic comparison with previous studies in schizophrenia

Empathy is a multidimensional construct that relies on affective and cognitive component processes. A few studies have reported impairments of both cognitive and affective empathy components in patients with schizophrenia. It is, however, not known whether these difficulties are already present at psychosis onset. The affective and cognitive components of empathy were thus assessed in 31 patients with first-episode psychosis (FEP) and 31 matched healthy controls using the Interpersonal Reactivity Index (IRI). Our results were then compared to previous studies of empathy in patients with more chronic schizophrenia via a meta-analysis. In addition, we also assessed the relationship between empathy ratings, Mentalizing performance and clinical symptoms. Contrary to what has been reported in people with more chronic schizophrenia, the IRI ratings did not significantly differ between FEP and controls in our study, though a trend was observed for the Personal distress scale. For the Perspective taking scale, our meta-analysis revealed a significantly lower effect size in this study with FEP patients relative to previous schizophrenia studies. In the FEP group, the IRI ratings were not related to positive, negative or general psychopathology symptoms, but a significant relationship emerged between the Liebowitz Social Anxiety Scale and Perspective taking (negative correlation). In addition, a significant positive correlation was observed between the Empathic concern subscale and our theory of mind task. This study supports the idea that the cognitive component of empathy is less affected in patients with first-episode psychosis relative to patients with more chronic schizophrenia, and the impairments reported in previous reports with more chronic populations should be interpreted in light of a possible deterioration of this cognitive skill. The findings also provide some insight into the relationship between empathy and clinical symptoms such as social anxiety.

Social cognition in first-degree relatives of people with schizophrenia: a meta-analysis.

Social cognition is affected in people with schizophrenia, but whether this is the case for healthy relatives of these patients is less clear. The presence of social cognition impairments in relatives would suggest a potential genetic role of social cognition in schizophrenia. To determine whether social cognition is affected in first-degree relatives of people with schizophrenia and examine the impact of potential moderator variables, a meta-analysis of studies investigating at least one domain of social cognition (mentalizing, emotional processing, social perception, social knowledge and/or attributional style) in adult first-degree relatives of patients with schizophrenia was performed. Our inclusion criteria were satisfied by 29 studies, of which 11 evaluated mentalizing, 20 emotional processing, and two social perception. Moderate mean effect sizes were obtained for these three components. Across all studies, effect sizes were significantly correlated with IQ and age differences between groups, calling for careful group matching for future studies. Overall, the results from this meta-analysis highlight that social cognition is globally affected in first-degree relatives of people with schizophrenia, suggesting that social cognition deficits in schizophrenia may be related to a genetic vulnerability for the disorder.

On What Ground Do We Mentalize? Characteristics of Current Tasks and Sources of Information That Contribute to Mentalizing Judgments

Mentalizing is an aspect of social cognition that is garnering increased interest. Although a wide variety of experimental tasks are available to measure mentalizing abilities in adults, the most widely used tasks typically focus on specific aspects of mentalizing, and mentalizing judgments are performed based on a limited set of information about the agent and the context. Here, we present the Eight Sources of Information Framework (8-SIF), a model that describes the sources of information that can contribute to mentalizing judgments both in real life and in the context of mentalizing tasks. This model is then used to systematically review and analyze the most classical mentalizing tasks, with a particular focus on the sources of information provided as a basis for mentalizing judgments in these tasks. Next, mentalizing tasks with improved ecological validity are also examined, highlighting the greater richness and diversity of the sources of information provided in such tasks relative to the most classical tasks. We believe that the 8-SIF is an important first step to increase awareness of the sources of information that can contribute to mentalizing judgments and to favor investigations of the potential impact of these sources of information on mentalizing performance in different populations.

Verbal and Visual Memory Impairments Among Young Offspring and Healthy Adult Relatives of Patients With Schizophrenia and Bipolar Disorder: Selective Generational Patterns Indicate Different Developmental Trajectories

Objective: Memory deficits have been shown in patients affected by schizophrenia (SZ) and bipolar (BP)/mood disorder. We recently reported that young high-risk offspring of an affected parent were impaired in both verbal episodic memory (VEM) and visual episodic memory (VisEM). Understanding better the trajectory of memory impairments from childhood to adult clinical status in risk populations is crucial for early detection and prevention. In multigenerational families densely affected by SZ or BP, our aim was to compare the memory impairments observed in young nonaffected offspring with memory functioning in nonaffected adult relatives and patients. Methods: For 20 years, we followed up numerous kindreds in the Eastern Québec population. After having characterized the Diagnostic and Statistical Manual of Mental Disorders phenotypes, we assessed cognition (N = 381) in 3 subsamples in these kindreds and in controls: 60 young offspring of a parent affected by SZ or BP, and in the adult generations, 92 nonaffected adult relatives and 40 patients affected by SZ or BP. VEM was assessed with the California Verbal Learning Test and VisEM with the Rey figures. Results: The VEM deficits observed in the offspring were also found in adult relatives and patients. In contrast, the VisEM impairments observed in the young offspring were present only in patients, not in the adult relatives. Conclusion: Implications for prevention and genetic mechanisms can be drawn from the observation that VEM and VisEM would show distinct generational trajectories and that the trajectory associated with VisEM may offer a better potential than VEM to predict future risk of developing the disease.

A meta-analysis and scoping review of social cognition performance in social phobia, posttraumatic stress disorder and other anxiety disorders

Social cognition deficits are observed in a variety of psychiatric illnesses. However, data concerning anxiety disorders are sparse and difficult to interpret. This meta-analysis aims at determining if social cognition is affected in social phobia (SP) or posttraumatic stress disorder (PTSD) compared to non-clinical controls and the specificity of such deficits relatively to other anxiety disorders. The scoping review aims to identify research gaps in the field. Forty studies assessing mentalizing, emotion recognition, social perception/knowledge or attributional style in anxiety disorders were included, totalizing 1417 anxious patients and 1321 non-clinical controls. Results indicate distinct patterns of social cognition impairments: people with PTSD show deficits in mentalizing (effect size d = -1.13) and emotion recognition (d = -1.6) while other anxiety disorders including SP showed attributional biases (d = -0.53 to d = -1.15). The scoping review identified several under investigated domains of social cognition in anxiety disorders. Some recommendations are expressed for future studies to explore the full range of social cognition in anxiety disorders and allow direct comparisons between different disorders.

Mentalizing in first-episode psychosis

Mentalizing deficits have often been observed in people with schizophrenia and a few recent studies suggest that such deficits are also present in patients with first episode psychosis (FEP). It is not clear, however, whether these mentalizing deficits in FEP can be accounted for by underlying processes such as social cue recognition, social knowledge and general reasoning. In this study, we assessed mentalizing abilities in 31 people with FEP and 31 matched controls using a novel, comprehensive mentalizing task validated through the present study. We also assessed social cue recognition, social knowledge and non-social (or general) reasoning performance in the same participants in order to determine if the mentalizing deficits in FEP can be at least partly explained by performance in these three underlying processes. Overall, the mentalizing task revealed the greatest impairment in FEP, an impairment that remained significant even after controlling for social cue recognition, social knowledge and non-social reasoning performance. Interestingly, non-social reasoning and social knowledge were both shown to contribute to mentalizing performance. In addition, social cognition measures were linked to social functioning in the FEP group, with the strongest correlation observed with mentalizing performance. Taken together, these results show that mentalizing is an aspect of social cognition that is particularly affected in FEP and might contribute to functional impairments in these patients. These deficits could be a prime target for cognitive remediation in FEP, and our results suggest that this could be done either directly or through improvement of related social and non-social cognitive skills such as social knowledge and general reasoning.

The heterogeneity of cognitive symptoms in Parkinson's disease: a meta-analysis

Several studies have reported heterogeneity in cognitive symptoms associated with specific characteristics of patients with Parkinsons disease (PD). Indeed, researchers have characterised subtypes of patients suffering from PD according to various criteria. Those most frequently used are the type of predominant motor symptoms (tremors or non-tremor symptoms), age at onset and presence of depression. Some characteristics, like the predominant motor subtypes, as well as the presence of depression, are more widely used to categorise cognitive differences between patients. The goal of this study was to analyse the impact of the type of predominant motor symptoms and depression on cognition in PD. A meta-analysis of 27 studies (from 1989 to 2012) was carried out to calculate the average effect size of these factors on the most often used cognitive test during those past years to evaluate cognitive skills, the Mini-Mental State Examination. The studies analysed showed significant mean weighted effect sizes on cognition for the type of motor symptoms (d=0.42; 95% CI 0.30 to 0.54) and for depression (d=0.52; 95% CI 0.38 to 0.66). These results suggested that PD participants with non-tremor predominant motor symptoms or with depression had more or more severe cognitive impairments. Identification of different subtypes in PD is important for a better understanding of the cognitive symptoms associated with this disease. Better knowing the impact of different features of PD subgroups could help to design more appropriate treatments for patients with PD.

Medial temporal lobe activations during associative memory encoding for arbitrary and semantically related object pairs

Previous positron emission tomography (PET) studies have shown greater medial temporal lobe activation (MTL) for associative memory encoding relative to deep item-oriented encoding. Greater MTL activation has also been reported for associative novelty detection. Although it has been suggested that these patterns of MTL activation could reflect the creation of novel associations into memory, it is unclear whether associative encoding and associative novelty detection rely on the same MTL substructures. In this study, we used event-related functional magnetic resonance imaging (er-fMRI) to reproduce previous reports of greater hippocampal activation for associative encoding using both arbitrary and semantically related object pairs. This paradigm allowed us to assess whether the requirement for associative processing at encoding interacts with associative novelty. Contrasting the pattern of activation for associative versus item-oriented encoding revealed greater right hippocampal activation as well as parahippocampal activation bilaterally, reproducing the findings from previous PET experiments. The orthogonal contrast between arbitrary and related pairs revealed greater activation in the left parahippocampal region, but no significant interaction between the type of encoding (associative or item oriented) and the type of pairs (arbitrary or semantically related) was observed in the medial temporal lobe (MTL). These results suggest that both associative processing and associative novelty detection can activate the MTL. Most importantly, this study suggests that associative processing can activate the MTL regardless of the pre-existence of an association between the items of a pair.

The study of social cognition with neuroimaging methods as a means to explore future directions of deficit evaluation in schizophrenia

This article discusses the important advances in a recent field of science dealing with the brain processes implicated in understanding social situations and interacting with others. Many behavioral studies on schizophrenia have shown the impairment of these processes and their preferential relation with disorganization and negative syndromes. Brain imaging is a powerful method to identify brain systems participating in these processes in healthy subjects and will be used increasingly to study mental disorders such as schizophrenia. A few preliminary studies have opened this field of research and allowed for the drawing of some limited conclusions. We emphasize the importance of developing an integrated neurocognitive framework to account for the multifaceted nature of social cognition deficits in schizophrenia. Inspired by contemporary models of empathy and social cognition that identify different components such as shared representation, mentalizing, self/other distinction, we show how schizophrenia affects these components at the behavioral and functional levels. We also outline the interest of this model to understand putative abnormalities of contextual integration within the area of mentalization. Finally, we discuss how specialized measures of brain functions during the performance of these precisely defined mental processes might be used as outcome predictors.