Psykisk sygdom og socialkognitive vanskeligheder

I de senere år er der kommet et øget fokus på såkaldte socialkognitive vanskeligheder hos patienter med psykiatriske lidelser (Cotter et al., 2018). Social kognition handler om de komplekse færdigheder, som mennesker anvender, når de interagerer med hinanden. Det drejer sig for eksempel om forståelsen af andre menneskers sindstilstand, ønsker og behov samt en forståelse af, at andre mennesker ikke nødvendigvis tænker og føler det samme, som man selv gør. Social kognition er et stort og omfattende felt, og det er derfor af stor interesse at undersøge, hvilke områder der især kan give udfordringer hos mennesker med svær psykisk sygdom. Fokus for dette temanummer er en beskrivelse af de socialkognitive vanskeligheder, som kan være til stede hos mennesker med forskellige former for svær psykisk sygdom, særligt autismespektrumlidelser og skizofreni, samt de metoder, som kan anvendes ved undersøgelse af vanskelighedernes art og omfang

Hyper- and hypo-mentalizing in patients with first-episode schizophrenia: fMRI and behavioural studies

Background: Historically, research investigating neural correlates of mentalizing deficits in schizophrenia has focused on patients who have been ill for several years with lengthy exposure to medication. Little is known about the neural and behavioural presentations of theory-of-mind deficits in schizophrenia, shortly after the first episode of psychosis. Methods: We investigated social cognition in seventeen recently diagnosed first-episode schizophrenia (FES) patients with little or no exposure to antipsychotic medication and 1:1 matched healthy controls. We recorded behavioural and neural responses to the Animated Triangles Task (ATT), which is a non-verbal validated mentalizing task that measures the ascription of intentionality to the movements of objects. Results: FES patients under-interpreted social cues and over-interpreted non-social cues. These effects were influenced by current intelligence (IQ). Control group and FES neural responses replicated earlier findings in healthy adults. However, a region of anterior medial prefrontal cortex (amPFC) of FES patients showed a different response pattern to that of controls. Unlike healthy controls, patients increased activity in this social cognition region while studying ‘random’ movements of shapes, as compared to the study of movements normally interpreted as ‘intentional’. Conclusions: Mentalizing deficits in FES consists of hypo- and hyper-mentalizing. The neural pattern of FES patients is consistent with deficits in the ability to switch off mentalizing processes in potentially social contexts, instead increasing them when intentionality is not forthcoming. Overall, results demonstrate complexities of theory of mind deficits in schizophrenia that should be considered when offering social cognitive training programs

Distinguishing Oneself from Others: Spontaneous Perspective- Taking in First Episode Schizophrenia and its relation to Mentalizing and Psychotic Symptoms

Characteristic symptoms of schizophrenia such as thought broadcasting, verbal hallucinations and delusions of being controlled suggest a failure in distinguishing between oneself and others. In addition, patients frequently experience mentalizing deficits, which could be related to such a failure. Here we investigated the tendency to distinguish self and other with a visual perspective-taking task that measures to what extent individuals spontaneously take another’s perspective when having to process their own (altercentric intrusion) or vice versa (egocentric intrusion). This was done in 22 patients with first episode schizophrenia and 23 matched healthy controls. We assessed whether patients displayed altered altercentric or egocentric intrusion and whether such alterations are related to mentalizing deficits – as measured with the Animated Triangles Task (ATT) and The Awareness of Social Inference Task (TASIT) – and/or specific psychotic symptoms, suggestive of problems with self-other distinction. The results showed that patients display similar egocentric intrusion and increased altercentric intrusion compared to controls. Degree of altercentric intrusion was associated with severity of delusions and hallucinations that have been tied to problems with self-other distinction but not with unrelated delusions and hallucinations or negative symptom severity. Higher altercentric intrusion was also associated with better TASIT performance in both patients and controls; suggesting that it may also be beneficial. In conclusion, patients display difficulties inhibiting representations of the other when having to process self-relevant information. A failure to control or distinguish the two representations could give rise to the experience that others have access to and control of your thoughts and actions

Theory of mind subgroups in schizophrenia

Artiklen gennemgår den aktuelle viden om Theory of Mind (ToM)-vanskeligheder ved skizofreni med særligt fokus på subgrupper inden for denne patientkategori. Kun ganske få studier har direkte sammenlignet ToM-færdigheder hos mennesker med autismespektrumforstyrrelser og patienter med skizofreni. Flere metaanalyser har forgæves forsøgt at differentiere mellem de to patientgrupper, idet begge grupper af patienter har interpersonelle vanskeligheder. Det tyder på, at man i langt de fleste studier har sammenlignet en subgruppe af højt fungerende personer med autismespektrumforstyrrelser med en subgruppe af patienter med skizofreni med et mere kronisk sygdomsforløb. Inden for gruppen af patienter med skizofreni er der stor forskel på omfanget af ToM-vanskeligheder. Den aktuelle viden på området tyder på, at visse aspekter af negative symptomer er forbundet med mere udtalte ToM-vanskeligheder. Derimod er der ingen klar sammenhæng mellem ToM-vanskeligheder og psykotiske symptomer. Der er påvist mindre udtalte ToM-vanskeligheder hos patienter med hurtig remission. Men selv hos patienter, som tilsyneladende ikke havde ToM-vanskeligheder, har man påvist ændret hjerneaktivitet i det neurale mentaliseringsnetværk, hvilket tyder på, at patienterne er på mentalt overarbejde, når de interagerer socialt. Den aktuelle forskning indikerer behovet for, at patienter med skizofreni bør udredes for socialkognitive vanskeligheder, herunder ToM, med henblik på at kunne tilbyde den mest optimale behandlingsindsats.This paper gives an overview of state-of-the-art theory of mind (ToM) deficits in schizophrenia and patient subgroups. Only a few studies have directly compared ToM in people with autism spectrum disorders to patients with schizophrenia. Several meta-analyses have had no luck differentiating between ToM deficits in the two disorders. Results indicate that current research has compared high functioning people with autism to patients with a chronic course of schizophrenia. Within the group of patients with schizophrenia, considerable differences in ToM have been found. State-of-the-art  theory of mind suggests that specific aspects of negative symptoms are related to more severe ToM deficits. No clear correlation has been established between the level of psychotic symptoms and ToM. Patients in remission have fewer ToM deficits. However, patients with apparently no ToM deficits have been shown to have abnormal brain activity in the mentalising network. These results indicate that the patients mentally have to work harder when interacting socially with other people. Current evidence indicates that patients with schizophrenia should routinely be social cognitive tested in order to offer the most optimal treatment

Measurement of social cognitive deficits in healthy Danish adults

The aim of this study was a) to examine how healthy Danish adults perform on a selection of social cognitive tasks (TASIT, Animated Triangles, Brünes Picture Arrangement), and b) to examine the potential social cognitive content of two cognitive tasks (Picture Arrangement WAIS-III and Family Pictures WMS-III) that have good Danish norms. 46 Danish, healthy participants aged 20-38 completed a comprehensive test battery. Results showed that the social cognitive tasks differed in quality with regard to the level of complexity and dispersion of scores. The tests did not show any performance variation when allowing for gender. Finally, the results highlighted a great potential in one of the two cognitive tasks with regard to estimating the social cognitive domain of Theory of Mind.I artiklen rapporteres resultater fra et studie, hvis formål var a) at undersøge, hvordan raske danske voksne præsterer på udvalgte socialkognitive tests (TASIT, Animerede Trekanter, Brünes Billedordning), og b) at undersøge det potentielle socialkognitive indhold i to kognitive tests (Billedordning WAIS-III og Familiebilleder WMS-III), der begge har gode danske normer i form af mange besvarelser fra forskellige aldersgrupper, som er repræsentative for den almindelige danske befolkning. 46 raske danske voksne i alderen 20-38 år gennemførte et omfattende testbatteri. Resultaterne viste, at de socialkognitive tests havde meget forskellige psykometriske egenskaber, herunder havde nogle alvorlige problemer med loftseffekt. Billedordning og Familiebilleder havde derimod gode psykometriske egenskaber med fin spredning i deltagernes besvarelser. Vi fandt ingen kønsforskelle i testene. En principal komponentanalyse, Principal Component Analysis (PCA),viste en korrelation mellem de to billedordningstest, hvorimod Familiebilleder korrelerede med de “oprigtige” filmklip fra TASIT. På baggrund af resultaterne fra dette studie kan især Billedordningstesten fra WAIS-III anses for at være en lovende kandidat som socialkognitiv test med gode danske normer. Der er dog stadig behov for mere forskning på området