David L. Roberts

Social Cognition in Schizophrenia: An Overview

The purpose of this column is to provide an overview of social cognition in schizophrenia. The column begins with a short introduction to social cognition. Then, we describe the application of social cognition to the study of schizophrenia, with an emphasis on key domains (i.e., emotion perception, Theory of Mind, and attributional style). We conclude the column by discussing the relationship of social cognition to neurocognition, negative symptoms, and functioning, with an eye toward strategies for improving social cognition in schizophrenia.

Social Cognition and Interaction Training (SCIT) for inpatients with schizophrenia spectrum disorders: Preliminary findings

Individuals with schizophrenia exhibit consistent deficits in social cognition such as emotion perception, attributional style, and theory of mind, which may be targets of psychosocial treatments. Previous intervention studies have typically focused on only one aspect of social cognition and have not assessed generalization of treatment to improvements in social functioning. This paper describes preliminary data from a new group-based treatment, Social Cognition and Interaction Training (SCIT), aimed at improving social cognition in schizophrenia. Eighteen inpatients with schizophrenia spectrum disorders completed SCIT and were compared with 10 inpatients who completed a coping skills group. Participants were assessed at pre-test and post-test on measures of emotion and social perception, theory of mind, attributional style (e.g., blame, hostility, and aggression), cognitive flexibility, and social relationships. We also collected data on the frequency of aggressive incidents on the treatment ward. The results showed that compared to the control group, SCIT participants improved on all of the social cognitive measures and showed better self-reported social relationships and fewer aggressive incidents on the treatment unit at post-test. Importantly, this change was independent of changes in clinical symptoms over time and supports the unique role of SCIT in improving social cognitive deficits in schizophrenia.

Social cognition and interaction training (SCIT) for outpatients with schizophrenia: a preliminary study.

Social functioning deficits (e.g., social skill, community functioning) are a core feature of schizophrenia. These deficits are only minimally improved via the frontline treatments for schizophrenia (e.g. medication, social skills training, cognitive-behavioral therapy). Social cognition is a promising treatment target in this regard as it may be more strongly related to social functioning outcomes than traditional neurocognitive domains [Couture, S., Penn, D.L., Roberts, D.L., 2006. The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin (Suppl. 1), S-44-63]. Social cognition and interaction training (SCIT) is a 20-week, manualized, group treatment designed to improve social functioning in schizophrenia by way of improved social cognition. This article reports preliminary data from a quasi-experimental study comparing SCIT + treatment as usual (TAU; n=20) to TAU alone (n=11) among outpatients. Results using analysis of variance (ANOVA) suggest SCIT-related improvements in emotion perception and social skill.

A pilot study of social cognition and interaction training (SCIT) for schizophrenia

A pilot study of social cognition and interaction training (SCIT) for schizophrenia Dear Editors, There has been growing interest in the role of social cognition in schizophrenia (Penn et al., 1997). Much of the enthusiasm is due to the functional significance of social cognition; social cognition contributes variance beyond neurocognition to social functioning in schizophrenia (Brune, 2005; Vauth et al., 2004). Such findings have led to the measurement of social cognition in the MATRICS neurocognitive battery (Nuechterlein et al., 2004). The importance of social cognition has also led to interventions that seek to improve social cognitive functioning. These interventions can be conceptualized as either btargeted,Q that focus on a specific social cognitive ability (e.g., emotion perception; Silver et al., 2004), or bbroad-based,Q that typically include cognitive remediation (e.g., Hogarty et al., 2004). Targeted interventions ignore the range of social cognitive deficits in schizophrenia, while broad-based interventions raise questions about whether cognitive remediation is a necessary first step. These issues led us to develop an intervention that focuses specifically on the key domains of social cognition that are impaired in schizophrenia: emotion perception , attributional style, and theory of mind (Green et al., in press). Below, we report pilot data on this new intervention, Social Cognition and Interaction Training (SCIT). SCIT is a manual-based, group intervention designed for individuals with schizophrenia spectrum disorders, particularly individuals with paranoia. Three phases comprise SCIT: (1) Understanding emotions (6 sessions); (2) Social cognitive biases (7 sessions); and (3) Integration (5 sessions). In phase one, we introduce social cognition by asking participants to discuss times when they have gotten social situations bwrongQ (e.g., thinking someone was mad at them when they were not). The remainder of phase one is devoted to defining basic emotions, including suspiciousness, and linking facial expressions to emotions. This latter task is conducted in part with the Emotion Trainer, a computer program which has been shown to improve emotion perception in schizophrenia (Silver et al., 2004). Phase two is devoted to strategies for avoiding the pitfalls associated with bjumping to conclusions ,Q a common problem for clients with paranoia. This concept is illustrated via videotaped interactions of actors who draw conclusions from events without having adequate information. We tell clients that our goal is to make them better social detectives, so as not to bconvictQ based on initial evidence. To achieve this goal, clients are taught to brainstorm multiple possible explanations, first …

The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery

Acceptance of the use of glucocorticosteroids in density to control postsurgical inflammation has been impaired by concerns over side effects, adrenal suppression, and efficacy. The pattern of administration generally used is characterized as short-term, high-dose or pulse therapy, which has not been associated with significant side effects or adrenal suppression beyond 10 days. The selection of an appropriate glucocorticosteroid with minimal mineralocorticoid activity and extended biological activity is desirable. Oral and parenteral dosing are possible, and the latter can be administered as acetates (repository) or esters. The efficacy of glucocorticosteroids in reducing pain, swelling, and trismus after third molar surgery is difficult to ascertain because of methodological inconsistencies between investigations. In general, studies that used low dosing schedules have failed to produce dramatic and prolonged results. High-dosing intravenous (IV) studies have demonstrated significant short-term improvements, but the effects were not sustained. Combining IV administration with multiple oral dosing or a single intramuscular (IM) dose may be required to extend short-term improvement. High-dosing IM studies have shown significant and sustained anti-inflammatory effects with a single dose administered either pre- or post-operatively.

A randomized, controlled trial of Social Cognition and Interaction Training (SCIT) for outpatients with schizophrenia spectrum disorders

OBJECTIVES In schizophrenia, the ability to adaptively infer the thoughts and feelings of others (i.e., social cognition) is strongly associated with community functioning. Researchers have designed psychosocial interventions to improve social cognition with the aim of improving downstream social functioning. Social Cognition and Interaction Training (SCIT) is one such intervention. Previous research on SCIT has been promising, but has consisted largely of smaller trials with insufficient experimental control. DESIGN Randomized, controlled trial. METHODS The current article reports on a controlled trial of 66 adults with schizophrenia randomized to receive either SCIT (n = 33), delivered in weekly group sessions, or treatment as usual (n = 33) for 6 months. Participants completed assessments of social cognition, social functioning, neurocognition and symptoms at baseline, post-treatment, and 3-month follow-up. RESULTS Primary analyses suggest that SCIT may improve social functioning, negative symptoms, and possibly hostile attributional bias. Post-hoc analyses suggest a dose-response effect. CONCLUSIONS Findings are discussed in the context of continuing to refine and improve social cognitive interventions for schizophrenia. PRACTITIONER POINTS Social cognitive intervention is a feasible and promising approach to improving social functioning among individuals with schizophrenia-spectrum disorders. Dose-response findings suggest that delivering social cognitive interventions with greater frequency may maximize their benefit to patients. Research on social cognitive interventions is still young and effects from well-controlled trials have been inconsistent. It is not yet clear which components of social cognitive training may be the key active ingredients.

Jail linkage assertive community treatment services for individuals with mental illnesses.

Persons with mental illnesses who are released from jail or prison are at high risk of psychiatric decompensation and re-arrest. This paper describes an ACT jail linkage program for this population that won an American Psychiatric Association Gold Award (2001). Based on interviews with its first 24 participants, we illustrate how they experience factors that contribute to recidivism and decompensation. Pre- and post-data are examined to explore program outcomes. Results suggest that it is possible to identify, engage, and retain people in treatment who struggle with many risk factors. We conclude that this program should be expanded and replicated.

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

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

Social cognition and interaction training for patients with stable schizophrenia in Chinese community settings.

Accumulated evidence suggests that Social Cognition and Interaction Training (SCIT) is associated with improved performance in social cognition and social skills in patients diagnosed with psychotic disorders. The current study examined the clinical utility of SCIT in patients with schizophrenia in Chinese community settings. Adults with stable schizophrenia were recruited from local community health institutions, and were randomly assigned to SCIT group (n = 22) or a waiting-list control group (n = 17). The SCIT group received the SCIT intervention plus treatment-as-usual, whereas the waiting-list group received only treatment-as-usual during the period of the study. All patients were administered the Chinese versions of the Personal and Social Performance Scale (PSP), Face Emotion Identification Task (FEIT), Eyes task, and Attributional Style Questionnaire (ASQ) at baseline of the SCIT treatment period and at follow-up, 6 months after completion of the 20-week treatment period. Patients in SCIT group showed a significant improvement in the domains of emotion perception, theory of mind, attributional style, and social functioning compared to those in waiting-list group. Findings indicate that SCIT is a feasible and promising method for improving social cognition and social functioning among Chinese outpatients with stable schizophrenia.

Can Social Functioning in Schizophrenia Be Improved through Targeted Social Cognitive Intervention

Efforts to use cognitive remediation in psychosocial intervention for schizophrenia have increasingly incorporated social cognition as a treatment target. A distinction can be made in this work between “broad-based” interventions, which integrate social cognitive training within a multicomponent suite of intervention techniques and “targeted” interventions; which aim to enhance social cognition alone. Targeted interventions have the potential advantage of being more efficient than broad-based interventions; however, they also face difficult challenges. In particular, targeted interventions may be less likely to achieve maintenance and generalization of gains made in treatment. A novel potential solution to this problem is described which draws on the social psychological literature on social cognition.