Eric Brunet-Gouet

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.

Correlations of theory of mind deficits with clinical patterns and quality of life in schizophrenia.

Background: Numerous studies have demonstrated the existence of theory of mind (ToM) impairments in patients with schizophrenia. The clinical consequences of these impairments are currently under debate. Accumulated evidence suggests that ToM deficits are linked to negative and disorganization symptoms, but direct correlations are lacking. Moreover, it is unclear whether ToM deficits are related to reduced quality of life (QoL). Methods: To extend the understanding of objective (i.e., clinical symptoms) and subjective (QoL) correlates of impaired ToM, we assessed 206 patients with schizophrenia based on performance of an ecological task (Versailles-Situational Intention Reading, V-SIR), a Communication Disorders Scale (SCD), the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression rating, and a QoL questionnaire (S-QoL). Statistical inferences were drawn from correlations analyses considering both factors/subscales aggregates and single items. Results: ToM performance was negatively correlated to disorganization and negative PANSS factors. Poor V-SIR performance was correlated with “conceptual disorganization,” “difficulties in abstract thinking,” and “apathy/social withdrawal.” The SCD was correlated with “negative,” “disorganization,” and “anxiety/depression” PANSS factors. The S-QoL total score was not significantly correlated with ToM performance. Only the item “difficulties in expressing feelings” was significantly correlated with poorer V-SIR performance. Conclusion: We discuss the intriguing paucity of the results and what they reveal about the difficulties faced by psychiatrists with patients not expressing complaints about lack of social skills.

Neural basis of semantic priming in schizophrenia during a lexical decision task: A magneto-encephalography study

Numerous behavioral and electrophysiological studies have provided evidence of abnormal semantic processing in schizophrenia. However, the neural basis of these deficits is poorly understood. We investigated magnetic cortical responses elicited by a word-pair lexical decision task in 20 patients with schizophrenia and 12 healthy control subjects. The task involved presentation of a prime word (200 ms), followed by a blank (250 ms), and then a target stimulus (1200 ms); the subject had to decide whether the target was a real word or not. During this task, bilateral temporal and left prefrontal activations were observed in both groups. However, in contrast to controls, patients with schizophrenia did not show increased activation in the left temporal and anterior cingulate cortices between 200 and 450 ms in response to semantic incongruity. These results suggested that schizophrenia was associated with a functional disturbance in some semantic regions that gave rise to the N400 component. Moreover, a significant modulation in the right temporal cortex was observed in patients, but not in controls. This suggested the existence of alternative processes in patients because both groups showed similar behavioral priming. Finally, we elucidated some functional abnormalities in the semantic network during prime word processing in patients, indicated by prolonged activation compared to healthy controls. Thus, in addition to context integration impairment, abnormal activations during the prime word provided new evidence of context processing deficits in schizophrenia.

Neuroelectric Correlates of Pragmatic Emotional Incongruence Processing: Empathy Matters

The emotions people feel can be simulated internally based on emotional situational contexts. In the present study, we assessed the behavioral and neuroelectric effects of seeing an unexpected emotional facial expression. We investigated the correct answer rate, response times and Event-Related Potential (ERP) effects during an incongruence paradigm between emotional faces and sentential contexts allowing emotional inferences. Most of the 36 healthy participants were recruited from a larger population (1 463 subjects), based on their scores on the Empathy Questionnaire (EQ). Regression analyses were conducted on these ratings using EQ factors as predictors (cognitive empathy, emotional reactivity and social skills). Recognition of pragmatic emotional incongruence was less accurate (P < .05) and slower (P < .05) than recognition of congruence. The incongruence effect on response times was inversely predicted by social skills. A significant N400 incongruence effect was found at the centro-parietal (P < .001) and centro-posterior midline (P < .01) electrodes. Cognitive empathy predicted the incongruence effect in the left occipital region, in the N400 time window. Finally, incongruence effects were also found on the LPP wave, in frontal midline and dorso-frontal regions, (P < .05), with no modulation by empathy. Processing pragmatic emotional incongruence is more cognitively demanding than congruence (as reflected by both behavioral and ERP data). This processing shows modulation by personality factors at the behavioral (through self-reported social skills) and neuroelectric levels (through self-reported cognitive empathy).

How and why affective and reactive virtual agents will bring new insights on social cognitive disorders in schizophrenia? An illustration with a virtual card game paradigm

In recent decades, many studies have shown that schizophrenia is associated with severe social cognitive impairments affecting key components, such as the recognition of emotions, theory of mind, attributional style, and metacognition. Most studies investigated each construct separately, precluding analysis of the interactive and immersive nature of real-life situation. Specialized batteries of tests are under investigation to assess social cognition, which is thought now as a link between neurocognitive disorders and impaired functioning. However, this link accounts for a limited part of the variance of real-life functioning. To fill this gap, advances in virtual reality and affective computing have made it possible to carry out experimental investigations of naturalistic social cognition, in controlled conditions, with good reproducibility. This approach is illustrated with the description of a new paradigm based on an original virtual card game in which subjects interpret emotional displays from a female virtual agent, and decipher her helping intentions. Independent variables concerning emotional expression in terms of valence and intensity were manipulated. We show how several useful dependant variables, ranging from classic experimental psychology data to metacognition or subjective experiences records, may be extracted from a single experiment. Methodological issues about the immersion into a simulated intersubjective situation are considered. The example of this new flexible experimental setting, with regards to the many constructs recognized in social neurosciences, constitutes a rationale for focusing on this potential intermediate link between standardized tests and real-life functioning, and also for using it as an innovative media for cognitive remediation.

Is the Questionnaire of Cognitive and Affective Empathy measuring two or five dimensions? Evidence in a French sample

Although many instruments measure empathy, most of them focus on specific facets (e.g., Spreng et al., 2009) or specific contexts (e.g. Wang et al., 2003) of empathy. For this reason, the Questionnaire of Cognitive and Affective Empathy (QCAE; Reniers et al., 2011) was recently built to grasp the general construct of empathy through its Affective-Cognitive duality, although not providing clear-cut results about the bidimensionality of the scale. In this study, Confirmatory Factor Analyses were conducted on the responses of 418 adults on the French QCAE (backtranslated for this study). A total of 8 models were tested - including the models of the original investigation. The 5-correlated factors model had the best fit, and the pattern of correlations between the factors did not support the Cognitive-Affective distinction. The QCAE is discussed as showing signs of psychometrical robustness, but also as a tool that is more 5-dimensional than bidimensional.

Characterizing an ERP correlate of intentions understanding using a sequential comic strips paradigm

Chronometric properties of theory of mind and intentions understanding more specifically are well documented. Notably, it was demonstrated using magnetoencephalography that the brain regions involved were recruited as soon as 200 ms post-stimulus. We used event-related potentials (ERPs) to characterize an electrophysiological marker of attribution of intentions. We also explored the robustness of this ERP signature under two conditions corresponding to either explicit instructions to focus on others’ intentions or implicit instructions with no reference to mental states. Two matched groups of 16 healthy volunteers each received either explicit or no instructions about intentions and performed a nonverbal attribution of intentions task based on sequential four-image comic strips depicting either intentional or physical causality. A bilateral posterior positive component, ranging from 250 to 650 ms post-stimulus, showed greater amplitude in intentional than in physical condition (the intention ERP effect). This effect occurs during the third image only, suggesting that it reflects the integration of information depicted in the third image to the contextual cues given by the first two. The intention effect was similar in the two groups of subjects. Overall, our results identify a clear ERP marker of the first hundreds of milliseconds of intentions processing probably related to a contextual integrative mechanism and suggest its robustness by showing its blindness to task demands manipulation.

A Virtual Reality Study of Help Recognition and Metacognition with an Affective Agent

Advances in the use of virtual affective agents for therapeutic purposes in mental health opened a research avenue to improve the way patients interpret others behavior as helpful instead of menacing. Here, the authors propose an original paradigm based on affective computing and virtual reality technologies requiring the assessment of helping intentions as well as self-monitoring metacognition. Sixteen healthy subjects played a 38-turns card games with a virtual affective agent MARC during which they had to guess between two cards the one that would be color-matched with another card. Their guesses could be oriented by the agents emotional displays. Three subjective ratings on a percentage analog scale were recorded after each trial: helpfulness, self-monitoring, and sympathy. Help recognition and self-monitoring metacognitive ratings raise the question of the importance to enhance both components in therapeutic situations within psychiatric populations. Overall, this study exemplifies the promising use of virtual reality settings for future studies in the medical psychology field.

Psychiatric disability as mediator of the neurocognition-functioning link in schizophrenia spectrum disorders: SEM analysis using the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale

The functional outcome in schizophrenia spectrum disorders is affected by multiple factors such as cognitive performance and clinical symptoms. Psychiatric disability may be another important determinant of functional outcome. The purpose of this study was to test whether schizophrenia symptoms and psychiatric disability mediated the association between cognition and functioning. Between April 2013 and July 2017, we included 108 community-dwelling adults with stable schizophrenia spectrum disorder in a multicenter study. Psychiatric disability was assessed with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale by relatives of patients. ECPDS focused on the broad array of motivational, neurocognitive, sociocognitive, and metacognitive impairments that result in activity restrictions. We used a battery of tests to assess seven cognition domains (processing speed, attention/vigilance, working, verbal and visual memory, reasoning and problem solving, and executive functioning) and cross-sectional structural equation modeling (SEM) for the mediation analyses. We estimated the one-year temporal stability of ECPDS scores in 45 participants. The model provided showed good fit and explained 43.9% of the variance in functioning. The effect of neurocognition on functioning was fully mediated by symptoms (proportion mediated: 36.5%) and psychiatric disability (proportion mediated: 31.3%). The ECPDS score had acceptable one-year temporal stability. The ECPDS scale has satisfactory psychometric properties, and shows significant convergence with neurocognition and functioning, suggesting a role for this tool in the routine evaluation of cognitive remediation needs. Our model validates psychiatric disability as a crucial step from cognitive impairment to restricted participation in life situations.

Screening for cognitive deficits with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale

Objective: This study aimed to evaluate the validity of the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale (ECPDS) to discriminate for cognitive impairment in schizophrenia. Design: This multicentre cross-sectional study used a validation design with receiver operating characteristic (ROC) curve analysis. Settings: The study was undertaken in a French network of seven outward referral centres. Subjects: We recruited individuals with clinically stable schizophrenia diagnosed based on the Structured Clinical Interview for assessing Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; DSM-IV-R) criteria. Main measures: The index test for cognitive impairment was ECPDS (independent variable), a 13-item scale completed by a relative of the participant. The reference standard was a standardized test battery that evaluated seven cognitive domains. Cognitive impairment was the dependent variable and was defined as an average z-score more than 1 SD below the normative mean in two or more cognitive domains. Results: Overall, 97 patients were included (67 with schizophrenia, 28 with schizoaffective disorder, and 2 with schizophreniform disorder). The mean age was 30.2 (SD 7.7) years, and there were 75 men (77.3%). There were 59 (60.8%) patients with cognitive impairment on the neuropsychological battery, and the mean ECPDS score was 27.3 (SD 7.3). The ROC curve analysis showed that the optimal ECPDS cut-off was 29.5. The area under the curve was 0.77, with 76.3% specificity and 71.1% sensitivity to discriminate against cognitive impairment. Conclusion: The ECPDS is a valid triage tool for detecting cognitive impairment in schizophrenia, before using an extensive neuropsychological battery, and holds promise for use in everyday clinical practice.