Rita Roncone

Is Theory of Mind in Schizophrenia More Strongly Associated with Clinical and Social Functioning than with Neurocognitive Deficits

This paper examines the correlations between ‘Theory of Mind’ (ToM) and neurocognitive performance, together with clinical and social functioning, in out-patients with schizophrenic disorders. It was hypothesised that, since the ability to make inferences about the environment and about other peoples’ mental states is a key ingredient of social competence, the assessment of ToM would correlate more strongly with current social functioning than with more traditional neurocognitive measures. ‘Independent raters’ assessed Theory of Mind, neurocognitive and clinical variables as well as community functioning in 44 subjects with schizophrenia. The neuropsychological measures were more closely associated with community functioning than with psychiatric symptoms. These associations remained evident when the effects of intelligence were controlled. Patients with a higher level of competence in making social inferences had better overall community functioning than those who showed less ability in this aspect of social cognition. In a regression model, the capacity to comprehend other people’s mental states (ToM-2) was among the best predictors of global social functioning, together with recent onset of illness, good verbal fluency and low levels of negative and positive symptoms. These results are consistent with other recent findings. ToM measures of social cognition may be a useful addition to neuropsychological assessment when developing programmes for reducing clinical impairments and improving the community functioning of subjects with schizophrenic disorders. Further studies are needed to verify the value of these measures as predictors of the successful application of specific psychosocial rehabilitation strategies.

The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia.

In people suffering from schizophrenia, major areas of everyday life are impaired, including independent living, productive activities and social relationships. Enhanced understanding of factors that hinder real‐life functioning is vital for treatments to translate into more positive outcomes. The goal of the present study was to identify predictors of real‐life functioning in people with schizophrenia, and to assess their relative contribution. Based on previous literature and clinical experience, several factors were selected and grouped into three categories: illness‐related variables, personal resources and context‐related factors. Some of these variables were never investigated before in relationship with real‐life functioning. In 921 patients with schizophrenia living in the community, we found that variables relevant to the disease, personal resources and social context explain 53.8% of real‐life functioning variance in a structural equation model. Neurocognition exhibited the strongest, though indirect, association with real‐life functioning. Positive symptoms and disorganization, as well as avolition, proved to have significant direct and indirect effects, while depression had no significant association and poor emotional expression was only indirectly and weakly related to real‐life functioning. Availability of a disability pension and access to social and family incentives also showed a significant direct association with functioning. Social cognition, functional capacity, resilience, internalized stigma and engagement with mental health services served as mediators. The observed complex associations among investigated predictors, mediators and real‐life functioning strongly suggest that integrated and personalized programs should be provided as standard treatment to people with schizophrenia.

Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience.

Roncone R, Ventura J, Impallomeni M, Falloon IRH, Morosini PL, Chiaravalle E, Casacchia M. Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiatr Scand 1999: 100: 229–236.

Could schizophrenic subjects improve their social cognition abilities only with observation and imitation of social situations

Schizophrenics display impairments in domains of social cognition such as theory of mind and emotion recognition. Recent studies, showing that the relationship of social cognition abilities with functional outcome is more significant than other neuro-cognitive functions, have considered these abilities as a target for intervention research. This article describes preliminary data from a new group-based study focused on Emotion and ToM Imitation Training (ETIT), an imitation treatment aimed at improving social cognition and social functioning in schizophrenia. In the present study, 16 outpatients with schizophrenia completed ETIT assessment and were compared with 17 outpatients who participated to a Problem Solving Training group. Participants were assessed at pre- and post-test on measures of emotion recognition, theory of mind, cognition, flexibility and social functioning. We compared the rehabilitation training effects on neuro-physiological activation through the event-related potentials (ERPs) method, which was recorded pre- and post-rehabilitation training. The results showed that when compared to the control group, ETIT participants improved on every social cognitive measure and showed better social functioning at post-test. Improvement in social cognition, in particular in emotion recognition, is also supported by ERP responses: we recorded an increase in electroactivity of medio-frontal areas only after ETIT treatment. Action observation and imitation could be regarded as a new frontier in rehabilitation.

Optimal Treatment Strategies to Enhance Recovery from Schizophrenia

Objective: The aim of this paper is to examine the base for integrating biomedical, psychological and social strategies in the management of schizophrenia. Method: A review of the literature on schizophrenia with particular emphasis in management considerations. Results: Effective treatment components include psychoeducation, medication strategies, carer-based stress management training, community-based intensive treatment, living skills training, and specific drug and cognitive-behavioural strategies for residual symptoms. Conclusions: Treatment for schizophrenia is best provided by integrating the various and specific psychosocial intervention strategies in addition to the optimal use of medication. Methods for implementing these strategies in outpatient settings include the use of a comprehensive assessment and treatment plan, the training of mental health professionals, and periodic review with assessment packages.

Rehabilitation of theory of mind deficit in schizophrenia: a pilot study of metacognitive strategies in group treatment

People affected by schizophrenia show major deficits in theory of mind (ToM) and in social cognition. Rehabilitation interventions based on non-social metacognitive functions are most likely to provide successful results. Social cognition, neurocognition, clinical variables, and community functioning were assessed in 20 people with schizophrenia. Ten people were randomly assigned to a six-month rehabilitation programme based on a metacognitive strategy for a social cognition rehabilitation. Results suggest that patients would benefit from rehabilitation in terms of their competence in social interactions.

Pragmatic language and theory of mind deficits in people with schizophrenia and their relatives.

Background: Deficits in theory of mind have frequently been observed in people affected by illnesses characterized by disrupted social behaviour like autism and psychoses. In schizophrenia, a pragmatic deficit in expressive language can also be observed. The present study was designed in order to assess the suitability of theory of mind and pragmatic conversation abilities as possible cognitive endophenotypes of schizophrenia. Methods: First- and second-order false belief tasks and pragmatic deficits in expressive language were examined in 38 patients with schizophrenia, in 34 non-psychotic relatives and in 44 healthy controls. An extensive clinical and neuropsychological assessment was also conducted. Results: Schizophrenic people and their first-degree relatives performedworse than the normal control subjects in false belief and pragmatic conversation tasks. General cognitive ability and neuropsychological measures of executive functions were not related to social cognition tasks. Conclusions: Theory of mind disorders and failing to understand the gricean conversational maxims are associated with schizophrenia liability.

Deficit of social cognition in subjects with surgically treated frontal lobe lesions and in subjects affected by schizophrenia

The ability of humans to predict and explain other people’s behaviour by attributing independent mental states such as desires and beliefs to them, is considered to be due to our ability to construct a “Theory of Mind”. Recently, several neuroimaging studies have implicated the medial frontal lobes as playing a critical role in a dedicated “mentalizing” or “Theory of Mind” network in the human brain. In this study we compare the performance of patients with right and left medial prefrontal lobe lesions in theory of mind and in social cognition tasks, with the performance of people with schizophrenia.We report a similar social cognitive profile between patients with prefrontal lobe lesions and schizophrenic subjects in terms of understanding of false beliefs, in understanding social situations and in using tactical strategies. These findings are relevant for the functional anatomy of “Theory of Mind”.

The interhemispheric transcallosal-transversal approach to the lesions of the anterior and middle third ventricle: Surgical validity and neuropsychological evaluation of the outcome

Based on the observation of the course of callosal fibres and of their artero-venous support as appearing in a microanatomic study, the Authors propose a variant of standard callosotomy procedure by the introduction of the transverse section of callosal fibres. This technique would allow the surgeon to spare a larger number of callosal fibres by the combined effect of a lower direct mechanical traction on fibres and a lower impact on artero-venous microcircle. The neuropsychological outcome of the patients who underwent this kind of procedure was evaluated. Fourteen patients affected by occupying-space lesions involving the anterior and middle third ventricle were included in the study. Ten patients underwent transverse callosotomy, four subjects received standard sagittal callosotomy. A control group was also included in the study. All patients underwent a pre-operative and six months post-operative neuropsychological evaluation focused on performance at cognitive and attentional tasks. No disturbances in executive function were observed in either group. Patients receiving transverse callosotomy performed as well as control group subjects in attentive tasks, which is not the case of patients undergoing sagittal callosotomy who show a marked deficit in selective attention for left side visual field. The observed more favourable neuropsychological outcome supports transverse callosotomy as a valid alternative method to standard longitudinal callosotomy in third ventricle surgery.

Family Interventions for Schizophrenia: A Review of Long-term Benefits of International Studies

Abstract Clinical, social, family and economic benefits are achieved by adding psychosocial family interventions, based on the vulnerability/stress model of mental disorders, to pharmacotherapy and case management for schizophrenic disorders. Twenty-two controlled studies with treatment extending for at least 6 months (including 14 randomized, controlled comparisons with good quality methodology) have documented the benefits of structured types of family approaches. A re-analysis of the effectiveness of these approaches, with outcome variables that included all major psychotic and affective episodes, deaths, hospital admissions, and serious non-compliance or withdrawal from drug or psychosocial interventions as indices of poor outcome, showed significantly better results for the addition of family-based stress management to medication and case management alone. Although fewer studies examined social and family benefits, the trends supported the family-based approaches. Further delays in implementing these...