Marieke Pijnenborg

Impaired recognition and expression of emotional prosody in schizophrenia: Review and meta-analysis

BACKGROUND Deficits in emotion processing may be one of the most pervasive disturbances in schizophrenia that may contribute to social isolation. In this report we focus on vocal emotion processing. This function bears upon two corner stones of social functioning, language and emotion, which have both been found to be impaired in schizophrenia. METHODS We used meta-analysis to integrate findings of studies published between 1980 and June 2007 on perception of emotional prosody in schizophrenia. 17 studies provided sufficient information to be included. A mean weighted effect size was computed in the random effects model. Publication bias was tested using funnel plots and fail-safe number of studies. Seven studies were included in an analysis on the expression (i.e. production) of emotional prosody in schizophrenia. RESULTS A significant and stable mean weighted effect size was found for the perception of emotional prosody, d=-1.24, 95% CI=-1.55 to -0.93. The effect was also found in the early stages of the illness. Expression of emotional prosody was also significantly impaired, d=-1.11, 95% CI=-1.78 to -0.43. CONCLUSIONS Results indicate that individuals with schizophrenia are impaired in the perception and expression of emotional prosody, with a large effect size. As a growing body of evidence shows that impaired social cognition in schizophrenia may be an important predictor of social outcome, training programs that aim at the recognition of emotional prosody should be developed.

Insight and Psychosis

Impaired insight into illness, associated with worse treatment outcome, is common in schizophrenia. Insight has been related to the self‐reflective processing, centred on the medial frontal cortex. We hypothesized that anatomical and functional routes to and from the ventromedial prefrontal cortex (vmPFC) would differ in patients according to their degree of impaired insight. Forty‐five schizophrenia patients and 19 healthy subjects performed a self‐reflection task during fMRI, and underwent diffusion tensor imaging. Using dynamic causal modelling we observed increased effective connectivity from the posterior cingulate cortex (PCC), inferior parietal lobule (IPL), and dorsal mPFC (dmPFC) towards the vmPFC with poorer insight and decrease from vmPFC to the IPL. Stronger connectivity from the PCC to vmPFC during judgment of traits related to self was associated with poorer insight. We found small‐scale significant changes in white matter integrity associated with clinical insight. Self‐reflection may be influenced by synaptic changes that lead to the observed alterations in functional connectivity accompanied by the small‐scale but measurable alterations in anatomical connections. Our findings may point to a neural compensatory response to an impairment of connectivity between self‐processing regions. Similarly, the observed hyper‐connectivity might be a primary deficit linked to inefficiency in the component cognitive processes that lead to impaired insight. We suggest that the stronger cognitive demands placed on patients with poor insight is reflected in increased effective connectivity during the task in this study. Hum Brain Mapp 36:4859–4868, 2015.

Inhibit yourself and understand the other: neural basis of distinct processes underlying Theory of Mind.

Taking the perspective of somebody else (Theory of Mind; ToM) is an essential human ability depending on a large cerebral network comprising prefrontal and temporo-parietal regions. Recently, ToM was suggested to consist of two processes: (1) self-perspective inhibition and (2) belief reasoning. Moreover, it has been hypothesized that self-perspective inhibition may build upon basic motor response inhibition. This study tested both hypotheses for the first time using functional Magnetic Resonance Imaging (fMRI), through administering both a ToM and a stop-signal paradigm in the same subjects. Both self-perspective and motor response inhibition yielded bilateral inferior frontal gyrus (IFG) activation, suggesting a common inhibitory mechanism, while belief reasoning was mediated by the superior temporal gyrus (STG) and temporo-parietal junction (TPJ). Thus, we provide neurobiological evidence for a subdivision of ToM into self-perspective inhibition and belief reasoning. Furthermore, evidence for partially shared neural mechanisms for inhibition in complex social situations and basic motor response inhibition was found.

What is measured by verbal fluency tests in schizophrenia

INTRODUCTION Schizophrenia patients perform below the norm on verbal fluency tests. The causes for this are unknown, but defective memory, executive functioning and psychomotor speed may play a role. METHOD We examined 50 patients with schizophrenia and related disorders, and 25 healthy controls with a cognitive test battery containing tests for verbal memory, executive functioning and psychomotor speed, and a categorical fluency test. RESULTS Patients obtained significantly lower test results than the controls on most cognitive measures including the verbal fluency test. During the fluency test, they formed as many clusters, and switched as often between clusters as the controls did, but they generated fewer words per cluster. Interestingly, in the control group, fluency performance was predicted by memory and executive functioning, but not by psychomotor speed. In patients, verbal fluency was predicted by psychomotor speed, but not by memory or executive functioning. DISCUSSION We conclude that psychomotor speed could be a crucial factor in cognition, and its influence on cognitive test performance should be considered in schizophrenia research. Furthermore, these data illustrate the importance of qualitative analysis of cognitive impairments in schizophrenia patients, as traditional cognitive tests often only provide quantitative information.

The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders: a meta-analysis.

Aims The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. Material and Methods We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters. Results The search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES) = −0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES = −0.52, p<0.0001) and weight-gain-prevention (ES = −0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES = −0.85, p = 0.0002) and weight loss studies (ES = −0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES = −0.95, p = 0.05). Conclusion Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.

Deficits in metacognitive capacity distinguish patients with schizophrenia from those with prolonged medical adversity

Research has suggested that many with schizophrenia experience decrements in synthetic metacognition, or the abilities to form integrated representations of oneself and others and then utilize that knowledge to respond to problems. Although such deficits have been linked with functional impairments even after controlling for symptoms and neurocognition, it is unclear to what extent these deficits can distinguish persons with schizophrenia from others experiencing significant life adversity but without psychosis. To explore this issue we conducted logistic regression analysis to determine whether assessment of metacognition could distinguish between 166 participants with schizophrenia and 51 adults with HIV after controlling for social cognition and education. Metacognition was assessed with the Metacognitive Assessment Scale Abbreviated (MAS-A), and social cognition with the Bell Lysaker Emotion Recognition Test. We observed that the MAS-A total score was able to correctly classify 93.4% of the schizophrenia group, with higher levels of metacognition resulting in increased likelihood of accurate categorization. Additional exploratory analyses showed specific domains of metacognition measured by the MAS-A were equally able to predict membership in the schizophrenia group. Results support the assertion that deficits in the abilities to synthesize thoughts about oneself and others into larger representations are a unique feature of schizophrenia.

Dissociation and social cognition in schizophrenia spectrum disorder

While there is emerging evidence that dissociation is linked with trauma history and possibly symptoms in schizophrenia, it remains unclear whether dissociation represents a symptom dimensions in its own right in schizophrenia and as such is uniquely related to other features of illness. To explore this issue the current study sought to find out whether dissociation was uniquely related to an index of social cognition closely linked to social functioning, namely affect recognition. We hypothesized that dissociation would be linked with affect recognition because symptoms of dissociation may uniquely disrupt processes which are expected to be needed for correctly recognizing emotions. The sample contained 49 participants diagnosed with a schizophrenia spectrum disorder who were in a non-acute phase of disorder. Participants were concurrently administered the Bell-Lysaker Emotion Recognition Task, the Dissociative Experiences Scale, the Post Traumatic Stress Disorder Checklist and the Positive and Negative Symptoms Scale. Stepwise linear regression analyses were performed in which dissociative symptoms were forced to enter after the other symptoms in order to predict deficits in affect recognition. These analyses revealed that greater levels of dissociative symptoms predicted poorer recognition of negative emotions over and above that of positive, negative, cognitive and PTSD symptoms. Results are consistent with the possibility that dissociation represents a unique dimension o f psychopathology in schizophrenia which may be linked to function.

Practical Implications of Metacognitively Oriented Psychotherapy in Psychosis: Findings From a Pilot Study

Abstract In preparation for a multicenter randomized controlled trial, a pilot study was conducted investigating the feasibility and acceptance of a shortened version (12 vs. 40 sessions) of an individual metacognitive psychotherapy (Metacognitive Reflection and Insight Therapy [MERIT]). Twelve participants with a diagnosis of schizophrenia were offered 12 sessions of MERIT. Effect sizes were calculated for changes from baseline to treatment end for metacognitive capacity measured by the Metacognition Assessment Scale—Abbreviated. Nine of twelve patients finished treatment. However, nonsignificant moderate to large effect sizes were obtained on the primary outcome measure. This study is among the first to suggest that patients with schizophrenia will accept metacognitive therapy and evidence improvements in metacognitive capacity. Despite limitations typical to a pilot study, including a small sample size and lack of a control group, sufficient evidence of efficacy was obtained to warrant further investigation.

Psychosis-Proneness and Neural Correlates of Self-Inhibition in Theory of Mind

Impaired Theory of Mind (ToM) has been repeatedly reported as a feature of psychotic disorders. ToM is crucial in social interactions and for the development of social behavior. It has been suggested that reasoning about the belief of others, requires inhibition of the self-perspective. We investigated the neural correlates of self-inhibition in nineteen low psychosis prone (PP) and eighteen high PP subjects presenting with subclinical features. High PP subjects have a more than tenfold increased risk of developing a schizophrenia-spectrum disorder. Brain activation was measured with functional Magnetic Resonance Imaging during a ToM task differentiating between self-perspective inhibition and belief reasoning. Furthermore, to test underlying inhibitory mechanisms, we included a stop-signal task. We predicted worse behavioral performance for high compared to low PP subjects on both tasks. Moreover, based on previous neuroimaging results, different activation patterns were expected in the inferior frontal gyrus (IFG) in high versus low PP subjects in self-perspective inhibition and simple response inhibition. Results showed increased activation in left IFG during self-perspective inhibition, but not during simple response inhibition, for high PP subjects as compared to low PP subjects. High and low PP subjects showed equal behavioral performance. The results suggest that at a neural level, high PP subjects need more resources for inhibiting the self-perspective, but not for simple motor response inhibition, to equal the performance of low PP subjects. This may reflect a compensatory mechanism, which may no longer be available for patients with schizophrenia-spectrum disorders resulting in ToM impairments.

F105. MEASURING EMPATHY IN SCHIZOPHRENIA: THE EMPATHIC ACCURACY TASK AND ITS CORRELATION WITH OTHER EMPATHY MEASURES

Abstract Background Empathy is a complex interpersonal process thought to be impaired in individuals with schizophrenia spectrum disorders. Past studies have mainly used questionnaires or performance-based tasks with static cues to measure cognitive and affective empathy. In contrast, we used an Empathic Accuracy Task (EAT) designed to capture the more dynamic aspects of empathy by using video clips in which perceivers continuously judge emotionally charged stories of various targets. We compared individuals with schizophrenia to healthy controls on the EAT and assessed correlations among the EAT and three other commonly used empathy tasks. Methods Patients (n=92) and healthy controls (n=42) matched for age and education, completed the EAT, the Interpersonal Reactivity Index, the Questionnaire of Cognitive and Affective Empathy and the Faux Pas task. Differences between groups were analyzed and correlations were calculated between empathy measurement instruments. Results The groups differed in EAT performance, with controls outperforming patients. A moderating effect was found for the emotional expressivity of the target: while both patients and controls scored low when judging targets with low expressivity, controls performed better than patients with more expressive targets. Though there were also group differences on the cognitive and affective empathy questionnaires (with lower scores for patients in comparison to controls), EAT performance did not correlate with questionnaire scores. Reduced empathy performance did not seem to be part of a generalized cognitive deficit, as differences between patients and controls on general cognition was not significant. Discussion Individuals with schizophrenia benefit less from the emotional expressivity of other people than controls, which contributes to their impaired empathic accuracy. The lack of correlation between the EAT and the questionnaires suggests a distinction between self-report empathy and actual empathy performance. To explore empathic difficulties in real life, it is important to use instruments that take the interpersonal perspective into account.