Social Cognition and Social Disability in Schizophrenia: The Role of Emotional Intelligence

Schizophrenia is a severe and persistent mental illness that results in substantial burden and disability for the individuals who suffer from it, their families, and society. Social disability, in particular, is one of the most crippling aspects of the disorder that dramatically limits functioning and quality of life. Recently, social-cognitive impairments in emotional intelligence have shown to be promising potential contributors to social disability in schizophrenia, and consequently might serve as effective targets for treatment. However, measurement in this area has been limited, and no study has examined the longitudinal relationship between emotional intelligence and social disability in schizophrenia within an experimental context. This study makes use of baseline and 1 year follow-up data from an outpatient sample of individuals in the early course of schizophrenia (n = 57 at baseline, n = 47 at year 1) participating in a randomized-controlled trial of Cognitive Enhancement Therapy to investigate the psychometric properties of a promising new measure of emotional intelligence, the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), and elucidate its longitudinal relations with social disability in this population. A comprehensive psychometric analysis was used to examine the reliability, discriminant validity, and factor structure of the instrument with individuals with schizophrenia; and general linear modeling, including hierarchical linear regression, was used to examine the cross-sectional and longitudinal relations between MSCEIT performance and social disability after accounting for demographic, clinical, and cognitive confounds. Psychometric results generally supported the reliability and discriminant validity of the MSCEIT when applied to individuals with schizophrenia, but also revealed a potential shift in the latent factor structure of the instrument in this population. Analyses of relations with social disability indicated little to no cross-sectional associations between MSCEIT performance and social disability, and modest longitudinal associations between changes in these domains. In particular, significant relationships were observed between longitudinal improvements in emotion regulation and reductions in overall social disability (r = -.31) and household/family relationship problems (r = -.34). These relationships persisted after adjusting for demographic characteristics, neurocognitive function, and psychopathology. Tentative evidence from mediator analyses pointed to the possibility of longitudinal improvements in emotion regulation to serve as a mechanism by which Cognitive Enhancement Therapy achieves its beneficial effects on social disability, although reverse mediation could not be ruled out. Together these findings suggest that changes in emotion regulation may be uniquely associated with changes in social disability in schizophrenia. Future research will need to replicate these findings with larger and more heterogeneous samples, and focus on the development of additional measures to study broader domains of social cognition, beyond emotional intelligence, that may also bear relevance to social disability

Cognitive Remediation and Psychosocial Rehabilitation for Individuals with Severe Mental Illness

Published versio

Cognitive Enhancement Therapy Improves Frontolimbic Regulation of Emotion in Alcohol and/or Cannabis Misusing Schizophrenia: A Preliminary Study

Individuals with schizophrenia who misuse substances are burdened with impairments in emotion regulation. Cognitive enhancement therapy (CET) may address these problems by enhancing prefrontal brain function. A small sample of outpatients with schizophrenia and alcohol and/or cannabis substance use problems participating in an 18-month randomized trial of CET (n = 10) or usual care (n = 4) completed posttreatment functional neuroimaging using an emotion regulation task. General linear models explored CET effects on brain activity in emotional neurocircuitry. Individuals treated with CET had significantly greater activation in broad regions of the prefrontal cortex, limbic, and striatal systems implicated in emotion regulation compared to usual care. Differential activation favoring CET in prefrontal regions and the insula mediated behavioral improvements in emotional processing. Our data lend preliminary support of CET effects on neuroplasticity in frontolimbic and striatal circuitries, which mediate emotion regulation in people with schizophrenia and comorbid substance misuse problems

Cognitive Remediation and Psychosocial Rehabilitation for Individuals with Severe Mental Illness

Published versio

Feasibility and preliminary efficacy data from a computerized cognitive intervention in children with chromosome 22q11.2 deletion syndrome

Children with chromosome 22q11.2 deletion syndrome (22q11DS) are significantly impaired in their academic performance and functionality due to cognitive deficits, especially in attention, memory, and other facets of executive function. Compounding these cognitive deficits is the remarkably high risk of major psychoses, occurring in 25% of adolescents and adults with the disorder. There are currently no evidence-based interventions designed to improve the cognitive deficits in these individuals. We implemented a neuroplasticity-based computerized cognitive remediation program for 12 weeks in 13 adolescents with 22q11DS, assessed feasibility, and measured changes in cognition before and after the intervention compared to a control group of 10 age- and gender-matched children with 22q11DS. Our results indicated that despite their cognitive impairments, this intervention is feasible in children with 22q11DS, with high rates of adherence and satisfaction. Our preliminary analyses indicate that gains in cognition occur with the intervention. Further study in a larger randomized controlled trial would enable assessment of efficacy of this novel intervention

Fronto-Limbic Brain Dysfunction during the Regulation of Emotion in Schizophrenia

Schizophrenia is characterized by significant and widespread impairments in the regulation of emotion. Evidence is only recently emerging regarding the neural basis of these emotion regulation impairments, and few studies have focused on the regulation of emotion during effortful cognitive processing. To examine the neural correlates of deficits in effortful emotion regulation, schizophrenia outpatients (N = 20) and age- and gender-matched healthy volunteers (N = 20) completed an emotional faces n-back task to assess the voluntary attentional control subprocess of emotion regulation during functional magnetic resonance imaging. Behavioral measures of emotional intelligence and emotion perception were administered to examine brain-behavior relationships with emotion processing outcomes. Results indicated that patients with schizophrenia demonstrated significantly greater activation in the bilateral striatum, ventromedial prefrontal, and right orbitofrontal cortices during the effortful regulation of positive emotional stimuli, and reduced activity in these same regions when regulating negative emotional information. The opposite pattern of results was observed in healthy individuals. Greater fronto-striatal response to positive emotional distractors was significantly associated with deficits in facial emotion recognition. These findings indicate that abnormalities in striatal and prefrontal cortical systems may be related to deficits in the effortful emotion regulatory process of attentional control in schizophrenia, and may significantly contribute to emotion processing deficits in the disorder

Psychiatric Symptoms and Quality of Life in Schizophrenia: A Meta-Analysis

Quality of life (QoL) has been recognized as an important outcome of schizophrenia treatment, yet the determinants of QoL for individuals with schizophrenia are not well known. Research has consistently found psychiatric symptoms to be negatively related to QoL, however, findings concerning the strength of these relationships have been mixed, making it difficult to determine the degree to which such symptoms are related to poor QoL. This research presents a systematic meta-analysis of studies examining the relationship between psychiatric symptoms and QoL in schizophrenia, in an effort to elucidate the determinants of QoL for this population. A total of 56 studies were extracted from literature searches of relevant databases for empirical reports published between 1966 and 2005 examining the relationship between positive, negative, and/or general psychiatric symptoms and QoL. Weighted effect size analyses revealed small relationships between psychiatric symptoms and QoL, with general psychopathology showing the strongest negative associations across all QoL indicators. Moderator analyses indicated that variation in effect sizes could be accounted for by differing operationalizations of QoL, study design, sample, and participant treatment setting. In particular, positive and negative symptoms were more strongly related to poor QoL among studies of schizophrenia outpatients, whereas general psychopathology showed a consistent negative relationship with QoL across all study samples and treatment settings. Implications for future research and treatment development are discussed

Gerard E. Hogarty (1935–2006): Combining Science and Humanism to Improve the Care of Persons With Schizophrenia

Gerard E. Hogarty was a scholar and clinician whose career was dedicated to improving the lives of persons with schizophrenia through the rigorous development and testing of novel psychosocial treatment approaches. During the course of his career, he is credited with the development of many of the psychosocial treatments that have become the pillars of evidence-based practices for schizophrenia today. This review outlines the evolution of Hogarty's contributions to the development of psychosocial approaches for schizophrenia by presenting a chronological history of the 4 distinct treatments he developed during the course of his career. These include major role therapy, an early precursor to clinical case management; family psychoeducation, an approach to ally with and educate family members to reduce intrafamilial distress; personal therapy, a flexible, individual psychotherapy, aimed at teaching patients stress management and affective regulation techniques; and finally, cognitive enhancement therapy, a comprehensive, developmental approach to the remediation of social- and nonsocial-cognitive deficits. Each of these treatments built upon the findings of the previous one, and as a consequence, each significantly improved the lives of persons with schizophrenia and expanded the treatment possibilities available to such individuals. These efforts represent a lifelong dedication to advancing the treatment of schizophrenia through rigorous scientific inquiry and exemplify a unique combination of science and humanism that has left a lasting impact on the field and the lives of many individuals suffering from this disease