Assessing cognitive-related disability in schizophrenia: Reliability, validity and underlying factors of the evaluation of cognitive processes involved in disability in schizophrenia scale

<p><b>Purpose:</b> We have developed a new scale that assesses disability caused by cognitive impairments in schizophrenia, in order to evaluate the functional impact of schizophrenia and help the prescription of rehabilitation interventions. The aim of the study was to assess its psychometrical properties.</p> <p><b>Materials and methods:</b> Mental healthcare professionals and relatives of individuals with schizophrenia developed and rated the evaluation of cognitive processes involved in disability in schizophrenia scale, which included 13 items. Its construct validity was assessed through a factorial analysis; its concurrent validity was evaluated based on ecological outcomes, its convergent validity was tested against the World Health Organization Disability Assessment Schedule (WHODAS II), and its reliability was estimated based on internal consistency and inter-rater reliability.</p> <p><b>Results:</b> Overall, 215 patients were included. Our findings supported a two-factor structure which accounted for 46% of the variance. The internal consistency and inter-rater reliability were good. The convergent validity showed a strong correlation with the WHODAS II. The concurrent validity showed strong relationships with work status, independent living, level and adequacy of institutional care.</p> <p><b>Conclusions:</b> The good psychometric properties of the scale suggest a role for this tool in assessing schizophrenia-related disability and evaluating the need for cognitive remediation.Implication for Rehabilitation</p><p>Schizophrenia is a chronic disorder leading to a severe psychiatric handicap.</p><p>The scale showed good psychometric properties in individuals with schizophrenia and severe psychiatric disability.</p><p>The scale is easy and quick to administer (about 15 min).</p><p>The scale may help to identify targets for rehabilitation interventions in individuals with schizophrenia.</p><p></p> <p>Schizophrenia is a chronic disorder leading to a severe psychiatric handicap.</p> <p>The scale showed good psychometric properties in individuals with schizophrenia and severe psychiatric disability.</p> <p>The scale is easy and quick to administer (about 15 min).</p> <p>The scale may help to identify targets for rehabilitation interventions in individuals with schizophrenia.</p

Regions of interest (ROIs).

<p>We grouped electrodes in seven ROIs: antero-frontal (AF), dorso-frontal (DF), frontal midline (FM), temporal (T), centro-parietal (CP), occipital (O) and centro-posterior midline (M) groups of electrodes. ROIs were further subdivided by hemispheres (except for M).</p

Scatterplots illustrating simple regressions corresponding to significant multiple regressions.

<p>(A) Scatterplots of the regression on the response times. Response times tend to be higher as the social skills scores decrease. (B) Scatterplots of the regressions on the N400 incongruence effect, in the left O and DF ROI. In the O ROI, the N400 incongruence effect appears increased for high cognitive empathy scores and linearly decreases until it reverses for low cognitive empathy scores. A reversed pattern is observed in the DF ROI but might be the counterpart of the effect in the O ROI. C: In the left O ROI, the N400 effect also appears to barely decrease as the social skills scores increase.</p

Neuroelectric Correlates of Pragmatic Emotional Incongruence Processing: Empathy Matters

<div><p>The emotions people feel can be simulated internally based on emotional situational contexts. In the present study, we assessed the behavioral and neuroelectric effects of seeing an unexpected emotional facial expression. We investigated the correct answer rate, response times and Event-Related Potential (ERP) effects during an incongruence paradigm between emotional faces and sentential contexts allowing emotional inferences. Most of the 36 healthy participants were recruited from a larger population (1 463 subjects), based on their scores on the Empathy Questionnaire (EQ). Regression analyses were conducted on these ratings using EQ factors as predictors (cognitive empathy, emotional reactivity and social skills). Recognition of pragmatic emotional incongruence was less accurate (<i>P</i> < .05) and slower (<i>P</i> < .05) than recognition of congruence. The incongruence effect on response times was inversely predicted by social skills. A significant N400 incongruence effect was found at the centro-parietal (<i>P</i> < .001) and centro-posterior midline (<i>P</i> < .01) electrodes. Cognitive empathy predicted the incongruence effect in the left occipital region, in the N400 time window. Finally, incongruence effects were also found on the LPP wave, in frontal midline and dorso-frontal regions, (<i>P</i> < .05), with no modulation by empathy. Processing pragmatic emotional incongruence is more cognitively demanding than congruence (as reflected by both behavioral and ERP data). This processing shows modulation by personality factors at the behavioral (through self-reported social skills) and neuroelectric levels (through self-reported cognitive empathy).</p></div

Faces.

<p>Facial expressions of joy, anger, sadness, fear and the neutral faces were created using M.A.R.C. software (LIMSI). All of the faces are presented here.</p

Illustration of the procedure used as regards empathy.

<p>Illustration of the procedure used as regards empathy.</p

Experimental procedure.

<p>A sentence presenting someone in an emotional (joyful, fearful, angry, sad) or neutral context was displayed, followed by a face expressing an emotion (joy, fear, anger, sadness) or no emotion (neutral). Participants were asked to answer “Same” if the emotion expressed by the face corresponded to the emotion suggested by the sentence, and “Different” if this was not the case. Here, the angry face is incongruent with the sentence “Today she left on the trip of her dreams”.</p

Overall average ERPs for congruent and incongruent conditions (all participants combined).

<p>In the CP and M ROIs, the amplitude of the Early N400 is significantly lowered by incongruence. The incongruence-related N400 deflection is significantly lower than the congruence-related deflection in CP and M ROIs. The incongruence-related late wave deflection is more positive-going than the congruence deflection in DF and FM ROIs. Reversed effect observed in the right AF ROI (early N400), AF ROI (N400), CP and M ROIs (LPP) are supposedly electrical counterparts to the effects found in regions where effects are classical.</p

Topographical maps of ERP grand averages.

<p>The maps represent the Early N400, N400 and LPP time windows in: A—the congruent condition; B—the incongruent condition; and C—the differences between the incongruent and congruent conditions.</p

Supplementary_Information_3 – Supplemental material for Screening for cognitive deficits with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale

<p>Supplemental material, Supplementary_Information_3 for Screening for cognitive deficits with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale by Paul Roux, Mathieu Urbach, Sandrine Fonteneau, Fabrice Berna, Lore Brunel, Delphine Capdevielle, Isabelle Chereau, Julien Dubreucq, Catherine Faget-Agius, Guillaume Fond, Sylvain Leignier, Claire-Cécile Perier, Raphaëlle Richieri, Priscille Schneider, Franck Schürhoff, Anne Marie Tronche, Hanan Yazbek, Anna Zinetti-Bertschy, the FondaMental Advanced Centers of Expertise in Schizophrenia (FACE-SCZ) Collaborators, Christine Passerieux, Eric Brunet-Gouet, M Andrianarisoa, B Aouizerate, N Bazin, F Berna, O Blanc, L Brunel, E Bulzacka, D Capdevielle, I Chereau-Boudet, G Chesnoy-Servanin, JM Danion, T D’Amato, A Deloge, C Delorme, H Denizot, JM Dorey, C Dubertret, J Dubreucq, C Faget, C Fluttaz, G Fond, S Fonteneau, F Gabayet, E Giraud-Baro, D Lacelle, C Lançon, H Laouamri, M Leboyer, T Le Gloahec, Y Le Strat, PM Llorca, J Mallet, E Metairie, D Misdrahi, I Offerlin-Meyer, C Passerieux, P Peri, S Pires, C Portalier, L Ramet, R Rey, C Roman, A Schandrin, F Schürhoff, A Tessier, AM Tronche, M Urbach, F Vaillant, A Vehier, P Vidailhet, E Vilà, H Yazbek and A Zinetti-Bertschy in Clinical Rehabilitation</p