Schizophrenia International Research Society/Nature Publishing Group
Abstract
In spite of significant advances in pharmacological and
psychological treatments, schizophrenia still ranks among the leading
causes of disability worldwide. People suffering from schizophrenia
have significant impairment in major areas of everyday life, such as
interpersonal relationships, work or school and even self-care.
Enhancing the understanding of factors that hinder real-life functioning
is therefore crucial for translating delivered care into more positive
outcomes.
Social cognition, defined as the mental operations that underlie social
interactions, including perceiving, interpreting, and generating
responses to the intentions, dispositions, and behaviors of others,
has been implicated in impaired functioning. It is typically broken
down into four domains: emotion processing, social perception,
attributional bias and theory of mind. Negative symptoms have also
been associated with patients' functional outcome; although generally
conceptualized as a unitary construct, the most recent literature
suggests that these symptoms are heterogeneous and include at least
two factors: amotivation and diminished emotional expression. The
aim of this study was to analyze the relationships between negative
symptoms, social cognition and real-life functioning in people with
schizophrenia.
Methods: 12 patients with diagnosis of schizophrenia according to
ICD-10 criteria were assessed cross-sectionally regarding relevant
dimensions to our study: general psychopathology (Positive and
Negative Syndrome Scale), social cognition (Face and Emotion
Identification Test, Schema Component Sequencing Test - Revised,
Social Perception Scale, Ambiguous Intentions and Hostility Questionnaire,
Reading the Mind in The Eyes Test), negative symptoms
(Clinical Assessment Interview for Negative Symptoms – CAINS) and
general functioning (Personal and Social Performance scale – PSP).
Spearman correlations were examined and regression and mediation
models (Preacher and Hayes bootstrapping methodology) were
performed.
Results: In our preliminary results, emotion processing was the only
social cognition dimension significantly correlated with functioning
(rS = .87) and negative symptoms measured by the CAINS: rS = -.78
with amotivation; -.70 with diminished emotional expression and -.78
with total CAINS score (all Po.01). Both amotivation and diminished
emotional expression, as well as negative symptoms as a whole,
correlated with functioning (rS4.80, Po.01). Emotion processing was
a significant predictor of amotivation, diminished emotional expression
and total CAINS score (all Beta4-.65, p o.05). Both emotion
processing (Beta = .71, P = 0.3) and amotivation (Beta = -.84, P = 0.001)
were significant predictors of functioning. Finally, amotivation was
found to be a partial mediator of the relationship between emotion
processing and functioning (BCA 95% CI = .196 - 7.559).
Discussion: Our results are in partial agreement with previous studies
suggesting that emotional processing is the most relevant dimension
of social cognition to everyday functioning, despite a possible
contribution of theory of mind for such impairment in patients with
schizophrenia.
Regarding negative symptoms, amotivation seems to be the
dimension of most relevance to functioning. Altogether, negative
symptoms seem to be driven by social cognition deficits and, at least
partially, negative symptoms may play a role in the deleterious impact
of impaired social cognition on functional outcome. The complexity of
the crosstalk between negative symptoms, social cognition and
functioning will be better addressed in ongoing studies, as a greater
understanding of underlying mechanisms is critical to development of
effective treatments