Jonathan McGuire

Remediation of Facial Emotion Recognition in Schizophrenia: Functional Predictors, Generalizability, and Durability

Impaired recognition of facial emotion in schizophrenia is associated with poor social functioning. Evidence shows that targeted emotion recognition training (ERT) can improve perception of facial emotions in schizophrenia for up to 1 week after training. This study investigated whether (a) improved recognition generalizes to novel faces, (b) training effects are durable over 1 month, and (c) baseline functioning levels predict the extent of improvement. Thirty-nine participants with schizophrenia received ERT using Ekmans Micro-Expression Training Tool (METT; 2003). Emotion recognition was assessed using METT face stimuli and other face stimuli not used in training (static faces shown at 100% and 50% intensity and dynamic stimuli). Baseline ratings of interpersonal and cognitive functioning were collected; a subgroup of 10 participants was followed up at 1 month posttraining. Post-METT training, participants showed improved perception of METT faces and novel faces. The subgroup followed over 1 month showed improved recognition of novel faces and dynamic stimuli 1 month after training, but not immediately after training. Baseline measures of interpersonal and social functioning and general face processing and working memory abilities (50% intensity expressions only) predicted improvement in facial affect recognition immediately after METT training. These findings suggest that the effectiveness of ERT in schizophrenia is influenced by pretraining levels of social functioning and that general face processing abilities and working memory may affect the ability to accurately process subtle facial expressions. Furthermore, improved recognition generalizes to novel faces but only over time, which might indicate an increasing awareness of facial emotion after ERT, at least in people with better baseline social functioning.

An open clinical trial assessing a novel training program for social cognitive impairment in schizophrenia

Objective: Social cognition is profoundly impaired in patients with schizophrenia. This study describes ‘Mental-State Reasoning Training for Social Cognitive Impairment’ (SoCog-MSRT), a 5-week program developed to improve social cognition in patients with schizophrenia. We aimed to investigate the feasibility of implementing SoCog-MSRT in a rehabilitation setting and to evaluate whether our training methods produced improvements. Method The feasibility and benefits of SoCog-MSRT were evaluated in an open clinical trial with 14 participants with schizophrenia or schizoaffective disorder. Training comprised 10 twice-weekly sessions, for 5 weeks, with a pre- and post-training assessment. Results: There were significant improvements on: (a) a classic false-belief test of Theory of Mind (ToM); (b) inferring complex mental states from the eyes; and (c) a self-reported measure of social understanding. Some of these improvements were associated with baseline levels of working memory and premorbid Intelligence Quotient (IQ). Conclusions SoCog-MSRT can improve ToM abilities and social understanding, but individuals with poorer working memory and lower premorbid IQ may be less able to benefit from this type of training.

Clinical correlates of olfactory hallucinations in schizophrenia

OBJECTIVES. Olfactory hallucinations (OHs) are underrepresented in conventional clinical instruments, infrequently researched, and poorly understood. To advance understanding of OHs, we examined their past-month prevalence and co-occurring symptoms in two datasets. DESIGN. One dataset comprised categorical codes and was examined using homogeneity analysis and logistic regression; the other dataset comprised numeric ratings and was examined using principal components analyses and linear regression. METHOD. The two datasets included: (1) 962 cases with Present State Examination - 9th Edition (PSE-9), codes (recoded present/absent) from the World Health Organization 10 Country (WHO-10) Study and (2) 265 cases with ratings on Scales for Assessing Positive/Negative Symptoms of Schizophrenia (SAPS/SANS). Two PSE-9 items (external- and self-smells) were recoded into a single OH item to examine consistency with the SAPS/SANS dataset, which contained a single OH item. RESULTS. Prevalence of OHs and hallucinations in other modalities differed according to the WHO-10 international centre. Across centres, OHs were present in 13% of the WHO-10 dataset, similar to the 17% prevalence rate in the SAPS/SANS dataset. Referential/control delusions and other hallucinations (particularly, somatic/tactile/gustatory hallucinations) were significant independent correlates of OHs in both datasets. OHs also co-occurred with social anxiety and depression in the WHO-10 dataset, with self-smells being particularly associated with self-depreciation. CONCLUSIONS. Sociocultural factors may modulate the self-reporting and/or detection of OHs and hallucinations in other modalities. Referential/control delusions promote the generation and/or maintenance of OHs independent of factors shared with other hallucinations. OHs and hallucinations of taste, touch, and bodily sensation frequently co-occur. Self-smells warrant sensitive probing.

Re-examining Kohlberg's conception of morality in schizophrenia

Introduction. Early clinical descriptions of and research with people with schizophrenia described apparent difficulties in moral judgement and sensitivity. However, this research failed to take into account the effect of cognitive deficits and symptoms on task performance. Methods. We assessed people with schizophrenia on the Moral Judgement Interview, a task used in the earlier literature, alongside a battery of neuro- and social-cognitive tasks. Results. Whereas people with schizophrenia perform more poorly on this task than controls, this is mediated by memory and declarative theory of mind, and also impacted by negative symptoms. Conclusions. These results indicate that performance deficits on moral judgement tasks are not a universal feature of schizophrenia, but rather due to associated difficulties such as those in social cognition.

Moral cognition in schizophrenia

Introduction. Disordered moral behaviour and understanding of moral rules were described early in the literature on schizophrenia; however, moral cognition has received scant attention in spite of a large literature focused on social cognitive impairments and violent behaviour in schizophrenia. Methods. We conducted a narrative synthesis of the literature on violence, moral judgement and schizophrenia. Results. Initial empirical research into moral cognition in schizophrenia did not fully account for the basic- and social-cognitive deficits now known to characterise schizophrenia. Importantly, research into moral cognition in autism and psychopathy, disorders in part characterised by social cognitive impairments indicates subtle patterns of difference to the moral cognition of control participants. Recent neuroeconomic studies of moral cognition in schizophrenia have indicated that individuals with schizophrenia display subtle dysfunction in their fairness-related behaviours, but not in their propensity to engage in altruistic punishment. Conclusions. Further research has the potential to broaden our understanding of what is intact and what is impaired in moral cognition in schizophrenia and also to inform our theories of the structures subserving moral judgement in the general population. Furthermore, a more thorough understanding of moral cognitive impairments in schizophrenia may have implications for both legal process and psychosocial rehabilitation.

The Relationship Between Schizotypy and Reactive Aggression in Western Adults Is Mediated by Victimization.

Abstract A large body of literature suggests that schizophrenia and nonclinical schizotypal personality traits, or “schizotypy,” are associated with increased aggression. However, recent studies focused on school-aged Asian samples have examined the relationship between schizotypal personality and 2 distinct forms of aggression: reactive and proactive aggression. This study aimed to investigate whether schizotypal personality traits would be associated more strongly with reactive, compared with proactive, aggression in an adult Western sample and whether victimization experiences mediated the schizotypy-reactive aggression relation. One hundred twenty-one Australian university undergraduates completed self-report inventories measuring levels of schizotypal personality, reactive and proactive aggression, and victimization. Results showed that, as hypothesized, schizotypal personality traits were more strongly associated with reactive than proactive aggression and that victimization experiences mediated the schizotypy-reactive aggression relationship. While acknowledging the limitations of nonclinical schizotypy research, the findings are discussed with regard to possible implications for the treatment of aggression in schizophrenia.

Assessing early processing of eye gaze in schizophrenia: measuring the cone of direct gaze and reflexive orienting of attention

ABSTRACT Introduction: The accurate discrimination of another person’s eye-gaze direction is vital as it provides a cue to the gazer’s focus of attention, which in turn supports joint attention. Patients with schizophrenia have shown a “direct gaze bias” when judging gaze direction. However, current tasks do not dissociate an early perceptual bias from high-level top-down effects. We investigated early stages of gaze processing in schizophrenia by measuring perceptual sensitivity to fine deviations in gaze direction (i.e., the cone of direct gaze: CoDG) and ability to reflexively orient to locations cued by the same deviations. Methods: Twenty-four patients and 26 controls completed a CoDG discrimination task that used realistic direct-face images with six fine degrees of deviation (i.e., 3, 6 or 9 pixels to the left and right) and direct gaze, and a gaze cueing task that assessed reflexive orienting to the same fine-grained deviations. Results: Our data showed patients exhibited no impairment in gaze discrimination, nor did we observe a reduced orienting response. Conclusions: These results suggest that while patients may suffer deficits associated with interpreting another person’s gaze, the earliest processes concerned with detecting averted gaze and reflexively orienting to the gazed-at location are intact.

Empathy in the context of moral reasoning in schizophrenia

Background: Cardiovascular and metabolic problems combined with a bad lifestyle are a major cause of a shortened life expectancy in chronic psychotic disorders. While the incidence of cannabis use is twice as high in psychosis compared to the general population, use of cannabis has been associated with better outcomes on cardiometabolic risk factors. This study investigates whether this effect is mediated by the AKT1 gene, as activation of the related enzyme by cannabis may cause changes in metabolism. Methods: Patients with a recent onset psychosis (n=623) were included from a cohort study (GROUP). Cannabis use, based on self-report and urine screening, was related to Body Mass index (BMI). Next the mediating effects of six AKT1 polymorphisms (rs1130214, rs1130233, rs2494732, rs2498784, rs3730358 and rs3803300) were investigated. Results: There was a strong, negative association between BMI and cannabis use. Moreover, two SNPs (rs1130233 and rs2494732) showed an association with cannabis use, but did not mediate the effect of cannabis on BMI. Conclusion: In conclusion, cannabis use results in a lower body weight in patients with a psychosis. While AKT1 is related to cannabis use, it does not affect body mass via AKT1. Instead, AKT1 risk alleles may increase the incidence of cannabis use. Future studies may investigate whether other genes mediate the effect between cannabis and metabolic risk factors.