Rocco Pollice

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.

Tower of Hanoi and WCST performance in schizophrenia: problem-solving capacity and clinical correlates

We administered a computerized version of WCST, a well established test, sensitive to executive function deficits in schizophrenia that involves many features of cognitive processing, and of Tower of Hanoi, a test that may offer cognitive challenges more specifically related to planning and sequencing, to 28 schizophrenic patients and 28 matched controls to examine a worthwhile question regarding the relative ability of these two tasks to differentiate schizophrenia and normal groups as well as exploring the relationship of these two instruments to clinical variables. The schizophrenic patients performed significantly worse than normal subjects both on Tower of Hanoi test and on WCST. The discriminant analysis identified in a multivariate way a pattern of indexes that differentiate the two groups. This pattern, characterized by specific indexes of WCST and TOH, could suggest the existence of a common underlying factor that determines the cognitive impairment in problem-solving of schizophrenics. These findings and the relationship with positive and negative symptoms have been discussed in the light of the model of the impairment in the internal representation of context information.

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”.

Behavioral neurodevelopment abnormalities and schizophrenic disorder: a retrospective evaluation with the Childhood Behavior Checklist (CBCL)

This study is a retrospective report of childhood and adolescence neurobehavioral assessment in patients with schizophrenia and their healthy siblings using the Childhood Behavior Checklist (CBCL). The CBCL ratings were obtained from retrospective maternal reports, for five age periods (birth to 3years, 4-7years, 8-11years, 12-15years and 16-18years) in a sample of 32 patients with schizophrenia. The patients showed a variety of childhood and adolescence behavioral problems when compared with their siblings, and the various types of problems differed in the developmental course of the disease. Cluster analysis was conducted on the childhood premorbid behavior ratings for the schizophrenic patients, and two subgroups emerged: a cluster with an initially low level of behavioral abnormalities (B.A. ) that increased over the years, and a cluster with a high level of B.A. that remain relatively stable until early adulthood. The latter group showed more severe current negative symptoms.

A factor analysis of signs and symptoms of the manic episode with Bech–Rafaelsen Mania and Melancholia Scales

BACKGROUND Several factor analyses of signs and symptoms of mania have been reported using different rating scales. We propose here that the use of two instruments well known in the European literature may be useful in detecting the structure of manic episodes. METHOD We investigated the pattern of symptoms in a group of 124 bipolar inpatients hospitalised for a manic episode. We conducted a factor analysis of the broad range of psychiatric symptoms covered by the Bech-Rafaelsen Mania Scale (BRMaS) and Melancholia Scale (BRMeS). RESULTS Five eigen values were greater than unity, which determined the number of factors computed. The five factors captured 66.7% of the total variance. Following rotation, five factors were clinically relevant. CONCLUSION This suggests that both euphoric activation and depression are prominent in this sample.

The Supportive Care Task Force at the University of L’Aquila: 2-years experience

The Supportive Care Task Force (SCTF) was established within the Medical Oncology Department at the University of L’Aquila in May 2002. The missions of the SCTF were to allow systematic evaluation and treatment of symptoms, to warrant continuity of care in all phases of disease and to provide medical oncology residents with training in the treatment of symptoms. A medical oncologist, two senior residents in medical oncology and a registered nurse comprised the SCTF. A psychiatrist, two neurologists, a dietician, and two physiotherapists served as consultants or on a part-time basis. Four beds in two-bedded rooms inside the Medical Oncology Department were reserved to SCTF. A close integration with the physicians of the Medical Oncology Department was realised. The only criterion to admission was the presence of uncontrolled symptoms. Patients were evaluated and monitored with the visual analogue scale for pain and with the Edmonton Symptom Assessment Scale (ESAS). The Palliative Prognostic Score (PaP Score) was employed to assess the prognosis. Non-clinical needs were evaluated with the Need Evaluation Questionnaire (NEQ). Protocols for the treatment of common symptoms were available in written form for consultation by physicians, residents and nurses. From 1 May 2002 to 31 May 2004, we observed 208 patients: 111 women and 97 men. The median age was 64.7 (range 28–90) years. Fifty-four patients (25.9%) were admitted more than once, for a total of 285 admissions. One hundred ninety-nine admissions (69.5%) were for supportive care while 86 admissions (30.5%) were for supportive care and active treatment. The most frequent symptoms were asthenia and anorexia. We registered excellent results regarding the treatment of pain, nausea and dyspnea while psychological symptoms, anorexia and asthenia proved more difficult to treat.Two hundred twenty patients were discharged: 142 (49.8%) home; 76 (26.7%) to the Home Care Service and two (0.7%) to others units of the hospital. Sixty-five (22.8%) died in our unit.

New evidence in theory of mind deficits in subjects with chronic schizophrenia and first episode: correlation with symptoms, neurocognition and social function.

AIM Currently substantial evidence exists about Theory of Mind (ToM) impairment in subjects affected by chronic and first episode schizophrenia. In particular, in order to enhance the validity of our construct, we used in this study classical false beliefs tasks and advanced theory of mind tasks, together with the application of structural equation model, in order to ex-amine whether we are using ToM tasks with good psychometric properties. The main goal of the present study was to examine ToM deficits in a large sample including subjects suffering from chronic schizophrenia, first episode of schizophrenia and nor-mal controls, by observing in the same task the relationship with symptomatological gravity, neurocognition and social function.Materials and methods. A sample of 178 patients with chronic schizophrenia, a sample of 49 subjects with a first episode of psychosis and 484 healthy controls participated to this study. Measures of social cognition included task of false belief and advanced theory of mind task. RESULTS No significant differences were found on ToM tasks between subjects affected by chronic and first episode schizophrenia. Social cognition showed in both groups a strong correlation with negative symptoms and social function, but did not evidence any relationship with neurocognition. CONCLUSION; ToM deficits exist in subjects suffering from chronic and first episode schizophrenia. These impairments do not seem to be a consequence of illness condition, they are likely to be state-independent and appear to be the most important cognitive mediator of social functioning in both groups.

Marked increase in substance use among young people after L’Aquila earthquake

Dear Sirs, On 3 December 2010, a remarkable piece published in the Financial Times reported that ‘‘eighteen months after an earthquake struck the heart of Abruzzo, Italy, killing 309 people, the region’s capital city, L’Aquila (town with a population of 72,000 and a health district of 103,788), is still a ghost town. Buildings and monuments have been secured and all the rubble removed, but the ‘‘red zone’’ in the 13th-century city centre is still a no-go area and its residents, relocated elsewhere, are starting to despair of ever returning’’. The 2009 L’Aquila earthquake (Richter magnitude 6.3) killing 309 residents, injuring over 2,500, leaving 28,000 homeless and 66,000 displaced, caused destruction or serious damage to between 3,000 and 11,000 buildings (the 65% of building and homes). Exposure to destruction and death caused by natural disasters has been shown to lead to psychological disorders and substance use as a byproduct of both the material and spiritual losses [1]. This study provides data on how patterns of substance use changed among young people who survived the earthquake that struck L’Aquila on 6 April 2009. A total of 1,078 young subjects (mean age 21.4 ± 5.6 years) participated in a mental health survey conducted between March and December 2010. They represent 8% of the population with the age range of 16–30 and 1.5% of the general population. They were recruited in different settings: 323 of them self referrals at ‘‘S.M.I.L.E.’’ (a psychiatric service for young people); 123 at SACS (a University Service of guidance and mentoring for students); the rest of them (632) were university and high school students, voluntarily enrolled to this survey. All subjects screened that resulted positive to both the Patient Health Questionnaire (PHQ-9) and the Self-rating Anxiety State (SAS), were further interviewed by a research psychiatrists and than, for some of them, consensus DSMIV diagnoses were made by project psychiatrists according to the Structured Clinical Interview for DSM-IV (SCID I). Of them, 314 (29.1%) had an ICD-10 diagnosis of anxiety disorders (43%), mood disorders (34%), post-traumatic stress disorder (16%), and psychosis (7%). There were 31 participants who had a personal or family history of physical trauma due to the earthquake. Increased substance use was assessed with one question per substance (alcohol, tobacco, cannabis) asking if the users had increased their use in the postearthquake compared with the preearthquake period. To this aim, a 4-point scale was used (none, less than before, equal to before, greater than before). The 12-item General Health Questionnaire (GHQ-12) was used for assessing perceived health. All participants provided their consent to participate in the study and the local ethical committee approved the study protocol. In persons with an ICD-10 diagnosis of psychiatric disorders (n = 314), the use of alcohol, tobacco, and cannabis was reported to be increased in the postearthquake period by 179 (57%), 128 (41%), and 69 (22%) subjects, respectively. Interestingly, none reported a reduced use of these substances following the disaster. In persons without an ICD-10 diagnosis of psychiatric disorders (n = 764), the use of alcohol, tobacco, and cannabis was reported to be increased in the postearthquake period by 374 (49%), 289 (38%), and 138 (18%) subjects, respectively. None of R. Pollice V. Bianchini R. Roncone M. Casacchia Department of Health Sciences, Psychiatric Unit, ‘San Salvatore’ Hospital, University of L’Aquila, L’Aquila, Italy

The questionnaire of family functioning: a preliminary validation of a standardized instrument to evaluate psychoeducational family treatments.

The aim of the study was to develop and preliminarily validate a self-completed questionnaire that could help in the assessment of families before and during psycho-educational interventions. The questionnaire was developed according to the cognitive-behavioural psycho-educational model. From an initial 38-item version of the questionnaire, a final shorter 24-item version was derived. The validation study of the final version was conducted on relatives of schizophrenic and schizoaffective patients: 31 for the test–retest reliability study and 92 for the confirmation of the subscales and convergent validity study vs. SF-36 and the questionnaire on Family Problems, PF. The final questionnaire showed good psychometric properties. The three-core dimensions of Problem-Solving, Communication Skills, and Personal Goals were clearly outlined in the items correlation analysis. The association with family burden and health-related quality of life was as expected. The FF provides a promising assessment of the family functioning pattern that is the object of psychoeducational family interventions. Further studies are needed to confirm the validity of the instrument, that could be helpful both in planning and in monitoring psycho-educational interventions and in mental health promotion projects.