Social Cognition Individualized Activities Lab for Social Cognition Training and Narrative Enhancement in Patients With Schizophrenia: A Randomized Controlled Study to Assess Efficacy and Generalization to Real-Life Functioning (Prot. n°: NCT05130853)

Subjects affected by schizophrenia present significant deficits in various aspects of social cognition, such as emotion processing, social perception and theory of mind (ToM). These deficits have a greater impact than symptoms on occupational and social functioning. Therefore, social cognition represents an important therapeutic target in people with schizophrenia. Recent meta-analyses showed that social cognition training (SCT) is effective in improving social cognition in subjects with schizophrenia; however, real-life functioning is not always ameliorated. Integration of SCT with an intervention targeting metacognitive abilities might improve the integration of social cognitive skills to daily life functioning. Our research group has implemented a new individualized rehabilitation program: the Social Cognition Individualized Activities Lab, SoCIAL, which integrates SCT with a module for narrative enhancement, an intervention targeting metacognitive abilities. The present multi-center randomized controlled study will compare the efficacy of SoCIAL and treatment as usual (TAU) in subjects diagnosed with a schizophrenia-spectrum disorder. The primary outcome will be the improvement of social cognition and real-life functioning; while the secondary outcome will be the improvement of symptoms, functional capacity and neurocognition. The results of this study will add empirical evidence to the benefits and feasibility of SCT and narrative enhancement in people with schizophrenia-spectrum disorders

FEF Excitability in Attentional Bias: A TMS-EEG Study

The role of distinct cortical regions in guiding social orienting needs further investigation. Our aim was to explore the contribution of the frontal eye field (FEF) in early orienting of attention towards stimuli with social value. We used a TMS-EEG approach to investigate event related potentials (ERPs; no-TMS block) and TMS evoked potentials (TEPs; TMS block) during the cueing phase of a modified version of the dot-probe task, comparing competing (face vs. house) and not competing (house vs. house) conditions. Our results revealed an increased amplitude of ERP components in the competing condition, showing greater posterior N170 and fronto-central vertex positive potential (VPP) and an enhanced frontal negative component at 250–270 ms from cue onset. TMS pulses over the FEF induced similar N170 and VPP amplified components. In addition, in the ERPs, a reduced positivity at 400 ms was shown when the face appeared on the left side vs. the right side of space. In contrast, in the TMS blocks, we found lateralized effects on N170 depending on the side of face presentation. The enhanced cortical excitability induced by TMS over the right FEF significantly correlated with the performance on the behavioral task, suggesting a link between the FEF activity during the cueing phase of the dot-probe task and the subsequent behavioral response times to the targets

Motor and Linguistic Linking of Space and Time in the Cerebellum

Background: Recent literature documented the presence of spatial-temporal interactions in the human brain. The aim of the present study was to verify whether representation of past and future is also mapped onto spatial representations and whether the cerebellum may be a neural substrate for linking space and time in the linguistic domain. We asked whether processing of the tense of a verb is influenced by the space where response takes place and by the semantics of the verb. Principal Findings: Responses to past tense were facilitated in the left space while responses to future tense were facilitated in the right space. Repetitive transcranial magnetic stimulation (rTMS) of the right cerebellum selectively slowed down responses to future tense of action verbs; rTMS of both cerebellar hemispheres decreased accuracy of responses to past tense in the left space and to future tense in the right space for non-verbs, and to future tense in the right space for state verbs. Conclusions: The results suggest that representation of past and future is mapped onto spatial formats and that motor action could represent the link between spatial and temporal dimensions. Right cerebellar, left motor brain networks could be part of the prospective brain, whose primary function is to use past experiences to anticipate future events. Bot

Can high-frequency transcranial magnetic stimulation enhance cognition and negative symptoms in schizophrenia? A pilot study.

Schizophrenia (SCZ) is a chronic psychiatric disorder that severely impacts patients’ everyday functioning and quality of life. Unlike positive symptoms, cognitive impairment and negative symptoms can’t be treated pharmacologically and represent consistent predictors of illness prognosis and everyday patients’ functioning. Previous studies suggested that transcranial magnetic stimulation can effectively reduce SCZ’s negative symptoms. In contrast, findings on cognitive impairment remain heterogeneous, possibly due to the variability in stimulation protocols and patients’ characteristics. In the present study, we combined intermittent theta burst stimulation (iTBS) with cognitive training to improve negative symptoms and cognitive impairment in patients with a disorder in the schizophrenic spectrum. Twenty-one participants were randomized into four groups, varying on the stimulation condition (real vs. sham iTBS) and cognitive remediation (training vs. no training). Fifteen sessions of real or sham iTBS were delivered over the left dorsolateral prefrontal cortex once a day for three weeks, followed - or not - by 1-hour cognitive training. Clinical and cognitive assessments took place before and after the intervention, plus at three follow-ups 1, 3, and 6 months after the end of the treatment. Mixed-model analyses were run on patients’ cognitive performance and negative symptoms and stimulation condition, training, and time were added as fixed factors. A by-subject random intercept was included. The feasibility and limitations of the methodological approach and preliminary data are discussed

Prefrontal and temporo-parietal involvement in taking others’ perspective: TMS evidence. Behav Neurol

Abstract. Introduction: Understanding the mental states of others entails a number of cognitive processes known as Theory of Mind (ToM). Behavioural and functional neuroimaging evidence suggests that prefrontal and temporo-parietal cortices are involved in these abilities. The present study was aimed at investigating the role of the dorsolateral prefrontal cortex and temporo-parietal junction in ToM by using a repetitive transcranial magnetic stimulation (rTMS) paradigm. Material and methods: Eleven healthy subjects participated in the study. The experimental ToM procedure was constituted by false belief and faux-pas written stories. Subjects were evaluated in baseline condition (Sham) and after 1Hz rTMS over the left/right dorsolateral prefrontal cortex and temporo-parietal junction. A score for accuracy and response times were recorded. Results: As regards false beliefs, rTMS over right prefrontal and temporo-parietal areas significantly interfered with response times (p < 0.05). The application of rTMS over right/left prefrontal and right temporo-parietal cortices also significantly worsened accuracy in the ability to take the others' perspective in faux-pas tasks as compared to Sham (p 0.05 in all cases). Conclusions: The results of the present study are consistent with previous findings supporting the hypothesis that prefrontal and temporo-parietal regions are part of a neural network specifically underpinning the ability to attribute mental states to others

Prefrontal and Temporo-Parietal Involvement in Taking Others’ Perspective: TMS Evidence

INTRODUCTION: Understanding the mental states of others entails a number of cognitive processes known as Theory of Mind (ToM). Behavioural and functional neuroimaging evidence suggests that prefrontal and temporo-parietal cortices are involved in these abilities. The present study was aimed at investigating the role of the dorsolateral prefrontal cortex and temporo-parietal junction in ToM by using a repetitive transcranial magnetic stimulation (rTMS) paradigm. MATERIAL AND METHODS: Eleven healthy subjects participated in the study. The experimental ToM procedure was constituted by false belief and faux-pas written stories. Subjects were evaluated in baseline condition (Sham) and after 1Hz rTMS over the left/right dorsolateral prefrontal cortex and temporo-parietal junction. A score for accuracy and response times were recorded. RESULTS: As regards false beliefs, rTMS over right prefrontal and temporo-parietal areas significantly interfered with response times (p<0.05$). The application of rTMS over right/left prefrontal and right temporo-parietal cortices also significantly worsened accuracy in the ability to take the others' perspective in faux-pas tasks as compared to Sham (p <or= 0.05 in all cases). CONCLUSIONS: The results of the present study are consistent with previous findings supporting the hypothesis that prefrontal and temporo-parietal regions are part of a neural network specifically underpinning the ability to attribute mental states to others

Gender Differences in Misdiagnosis and Delayed Diagnosis among Adults with Autism Spectrum Disorder with No Language or Intellectual Disability

Autism Spectrum Disorder (ASD) is often unrecognized, especially in mild forms and in women. Studies evaluating features associated with missed/misdiagnosis in men and women with ASD are warranted. 61 subjects (22 females, 39 males, age 28.5 ± 10.8 years) with ASD with no language/intellectual deficit were enrolled in the service for the treatment of psychiatric comorbidities in adults with ASD of the ASST Fatebenefratelli-Sacco in Milan (Italy). A detailed clinical history was gathered, and two self-report questionnaires (Autism Spectrum Quotient-AQ and Adult Autism Subthreshold Spectrum-AdAS Spectrum) were administered. 75.4% received their ASD diagnosis average eight years later than the first evaluation by mental health services. Compared to males, females showed a significantly greater delay in referral to mental health services and a significantly higher age at diagnosis of ASD. Among men, diagnostic delay inversely correlated with scores on the AdAS Spectrum total, Verbal communication, Empathy and Inflexibility and adherence to routine domains. Among women, diagnostic delay positively correlated with the Attention to detail score while the age at diagnosis of ASD positively correlated with the AdAS Spectrum Verbal communication and Restricted interests and rumination domain scores. Females were less likely to be correctly diagnosed and more likely to be misdiagnosed at first evaluation than men. Females reported significantly higher scores than men in the Hyper/Hyporeactivity to sensory input domain only among subjects who were misdiagnosed. Our findings provide gender-specific information about ASD patients seeking help for comorbid conditions and might be a primary ground for future research