Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-22T22:52:30.309Z Has data issue: false hasContentIssue false
  • English
  • Français

Combined social cognitive and neurocognitive rehabilitation strategies in schizophrenia: neuropsychological and psychopathological influences on Theory of Mind improvement

Published online by Cambridge University Press:  11 June 2015

M. Bechi ,
M. Bosia ,
M. Spangaro ,
M. Buonocore ,
F. Cocchi ,
A. Pigoni ,
M. Piantanida ,
C. Guglielmino ,
L. Bianchi  and
E. Smeraldi
...Show all authors
M. Bechi*
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
M. Bosia
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy Università Vita - Salute San Raffaele, Milan, Italy
M. Spangaro
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy Università Vita - Salute San Raffaele, Milan, Italy
M. Buonocore
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
F. Cocchi
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
A. Pigoni
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
M. Piantanida
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
C. Guglielmino
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
L. Bianchi
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
E. Smeraldi
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy Università Vita - Salute San Raffaele, Milan, Italy
R. Cavallaro
Affiliation:
Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
*
*Address for correspondence: Dr M. Bechi, Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127 Milano, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Neurocognitive and social cognitive impairments represent important treatment targets in schizophrenia, as they are significant predictors of functional outcome. Different rehabilitative interventions have recently been developed, addressing both cognitive and psychosocial domains. Although promising, results are still heterogeneous and predictors of treatment outcome are not yet identified. In this study we evaluated the efficacy of two newly developed social cognitive interventions, respectively based on the use of videotaped material and comic strips, combined with domain-specific Cognitive Remediation Therapy (CRT). We also analysed possible predictors of training outcome, including basal neurocognitive performance, the degree of cognitive improvement after CRT and psychopathological variables.

Method

Seventy-five patients with schizophrenia treated with CRT, were randomly assigned to: social cognitive training (SCT) group, Theory of Mind Intervention (ToMI) group, and active control group (ACG).

Results

ANOVAs showed that SCT and ToMI groups improved significantly in ToM measures, whereas the ACG did not. We reported no influences of neuropsychological measures and improvement after CRT on changes in ToM. Both paranoid and non-paranoid subjects improved significantly after ToMI and SCT, without differences between groups, despite the better performance in basal ToM found among paranoid patients. In the ACG only non-paranoid patients showed an improvement in non-verbal ToM.

Conclusion

Results showed that both ToMI and SCT are effective in improving ToM in schizophrenia with no influence of neuropsychological domains. Our data also suggest that paranoid symptoms may discriminate between different types of ToM difficulties in schizophrenia.

Keywords

Neurocognitionparanoiarehabilitationschizophreniasocial cognitionTheory of Mind
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 15 , November 2015 , pp. 3147 - 3157
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abu-Akel, A, Abushua'leh, K (2004). ‘Theory of mind’ in violent and nonviolent patients with paranoid schizophrenia. Schizophrenia Research 69, 45–53.Google ScholarPubMed
Abu-Akel, A, Bailey, AL (2000). The possibility of different forms of theory of mind impairment in psychiatric and developmental disorders. Psychological Medicine 30, 735–738.Google ScholarPubMed
Aghotor, J, Pfueller, U, Moritz, S, Weisbrod, M, Roesch-Ely, D (2010). Metacognitive training for patients with schizophrenia (MCT): feasibility and preliminary evidence for its efficacy. Journal of Behavior Therapy and Experimental Psychiatry 41, 207–211.CrossRefGoogle ScholarPubMed
Anselmetti, S, Poletti, S, Ermoli, E, Bechi, M, Cappa, S, Venneri, A, Smeraldi, E, Cavallaro, R (2008). The Brief Assessment of Cognition in Schizophrenia. Normative data for the Italian population. Neurological Science 29, 85–92.CrossRefGoogle ScholarPubMed
Barbato, M, Liu, L, Penn, DL, Keefe, RS, Perkins, DO, Woods, SW, Addington, J (2013). Social cognition as a mediator between neurocognition and functional outcome in individuals at clinical high risk for psychosis. Schizophrenia Research 150, 542–546.Google ScholarPubMed
Bechi, M, Riccaboni, R, Ali, S, Fresi, F, Buonocore, M, Bosia, M, Cocchi, F, Smeraldi, E, Cavallaro, R (2012). Theory of mind and emotion processing training for patients with schizophrenia: preliminary findings. Psychiatry Research 198, 371–377.Google ScholarPubMed
Bechi, M, Spangaro, M, Bosia, M, Zanoletti, A, Fresi, F, Buonocore, M, Cocchi, F, Guglielmino, C, Smeraldi, E, Cavallaro, R (2013). Theory of Mind intervention for outpatients with schizophrenia. Neuropsychological Rehabilitation 23, 383–400.Google ScholarPubMed
Bell, M, Bryson, G, Greig, T, Corcoran, C, Wexler, BE (2001). Neurocognitive enhancement therapy with work therapy: effects on neuropsychological test performance. Archives of General Psychiatry 58, 763–768.Google ScholarPubMed
Brekke, J, Kay, DD, Lee, KS, Green, MF (2005). Biosocial pathways to functional outcome in schizophrenia. Schizophrenia Research 80, 213–225.CrossRefGoogle ScholarPubMed
Brekke, JS, Hoe, M, Long, J, Green, MF (2007). How neurocognition and social cognition influence functional change during community-based psychosocial rehabilitation for individuals with schizophrenia. Schizophrenia Bulletin 33, 1247–1256.Google ScholarPubMed
Brothers, L, Ring, B (1992) A neuroethological framework for the representation of minds. Journal of Cognitive Neuroscience 4, 107–118.CrossRefGoogle ScholarPubMed
Brüne, M (2003 a). Social cognition and behavior in schizophrenia. In The Social Brain. Evolution and Pathology (ed. Brune, M., Ribbert, H. and Schiefenhovel, W.), pp. 277–313. Wiley and Sons: Chichester, UK.CrossRefGoogle Scholar
Brüne, M (2003 b). Theory of mind and role of IQ in chronic disorganized schizophrenia. Schizophrenia Research 60, 57–64.CrossRefGoogle ScholarPubMed
Cavallaro, R, Anselmetti, S, Poletti, S, Bechi, M, Ermoli, E, Cocchi, F, Stratta, P, Vita, A, Rossi, A, Smeraldi, E (2009). Computer-aided neurocognitive remediation as an enhancing strategy for schizophrenia rehabilitation. Psychiatry Research 169, 191–196.CrossRefGoogle ScholarPubMed
Chan, KK, Chen, EY (2011). Theory of mind and paranoia in schizophrenia: a game theoretical investigation framework. Cognitive Neuropsychiatry 16, 505–529.Google ScholarPubMed
Cohen, J (1998). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Erlbaum: Hillsdale, NJ.Google Scholar
Corcoran, R, Bentall, RP, Rowse, G, Moore, R, Cummins, S, Blackwood, N, Howard, R, Shryane, NM (2011). Making sense of theory of mind and paranoia: the psychometric properties and reasoning requirements of a false belief sequencing task. Cognitive Neuropsychiatry 16, 547–561.Google ScholarPubMed
Corcoran, R, Kaiser, SL (2008). Persecutory delusions and theory of mind: long-standing debates and emerging issues. In Persecutory Delusions: Assessment, Theory, and Treatment (ed. Freeman, D., Bentall, R. and Garety, P.), pp. 207–222. Oxford University Press: Oxford, UK.Google Scholar
Fanning, JR, Bell, MD, Fiszdon, JM (2012). Is it possible to have impaired neurocognition but good social cognition in schizophrenia? Schizophrenia Research 135, 68–71.CrossRefGoogle ScholarPubMed
Fett, AK, Viechtbauer, W, Dominguez, MD, Penn, DL, van Os, J, Krabbendam, L (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience & Biobehavioral Reviews 35, 573–588.CrossRefGoogle ScholarPubMed
Frith, CD, Corcoran, R (1996). Exploring ‘theory of mind’ in people with schizophrenia. Psychological Medicine 26, 521–530.Google ScholarPubMed
Frith, U, Frith, CD (2003) Development and neurophysiology of mentalizing. Philosophical Transactions of the Royal Society B: Biological Sciences 358, 459–473.Google ScholarPubMed
Galderisi, S, Piegari, G, Mucci, A, Acerra, A, Luciano, L, Rabasca, AF, Santucci, F, Valente, A, Volpe, M, Mastantuono, P, Maj, M (2010). Social skills and neurocognitive individualized training in schizophrenia: comparison with structured leisure activities. European Archives of Psychiatry and Clinical Neuroscience 260, 305–315.CrossRefGoogle ScholarPubMed
Heinrichs, DW, Hanlon, TE, Carpenter, WT (1984). The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophrenia Bulletin 10, 388–398.CrossRefGoogle ScholarPubMed
Hoe, M, Nakagami, E, Green, MF, Brekke, JS (2012). The causal relationships between neurocognition, social cognition and functional outcome over time in schizophrenia: a latent difference score approach. Psychological Medicine 42, 2287–2299.CrossRefGoogle ScholarPubMed
Hogarty, GE, Flesher, S, Ulrich, R, Carter, M, Greenwald, D, Pogue-Geile, M, Kechavan, M, Cooley, S, DiBarry, AL, Garrett, A, Parepally, H, Zoretich, R (2004). Cognitive enhancement therapy for schizophrenia. Effects of a 2-year randomized trial on cognition and behavior. Archives of General Psychiatry 61, 866–876.CrossRefGoogle ScholarPubMed
Kahn, RS, Keefe, RS (2013). Schizophrenia is a cognitive illness: time for a change in focus. JAMA Psychiatry 70, 1107–1112.CrossRefGoogle ScholarPubMed
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Keefe, RS, Goldberg, TE, Harvey, PD, Gold, JM, Poe, MP, Coughenour, L (2004). The brief assessment of cognition in schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery. Schizophrenia Research 68, 283–297.Google ScholarPubMed
Lindenmayer, JP, McGurk, SR, Khan, A, Kaushik, S, Thanju, A, Hoffman, L, Valdez, G, Wance, D, Herrmann, E (2013). Improving social cognition in schizophrenia: a pilot intervention combining computerized social cognition training with cognitive remediation. Schizophrenia Bulletin 39, 507–517.CrossRefGoogle ScholarPubMed
Mazza, M, DeRisio, A, Surian, L, Roncone, R, Casacchia, M (2001). Selective impairments of theory of mind in people with schizophrenia. Schizophrenia Research 47, 299–308.CrossRefGoogle ScholarPubMed
Medalia, A, Saperstein, AM (2013). Does cognitive remediation for schizophrenia improve functional outcomes? Current Opinion in Psychiatry 26, 151–157.CrossRefGoogle ScholarPubMed
Mehta, UM, Thirthalli, J, Subbakrishna, DK, Gangadhar, BN, Eack, SM, Keshavan, MS (2013). Social and neuro-cognition as distinct cognitive factors in schizophrenia: a systematic review. Schizophrenia Research 148, 3–11.CrossRefGoogle ScholarPubMed
Moritz, S, Woodward, T (2007). Metacognitive training for schizophrenia patients (MCT): a pilot study on feasibility, treatment adherence, and subjective efficacy. German Journal of Psychiatry 10, 69–78.Google Scholar
Penn, DL, Corrigan, PW, Bentall, RP, Racenstein, JM, Newman, L (1997 a). Social cognition in schizophrenia. Psychological Bulletin 121, 114–132.Google ScholarPubMed
Penn, DL, Spaulding, W, Reed, D, Sullivan, M, Mueser, KT, Hope, DA (1997 b). Cognition and social functioning in schizophrenia. Psychiatry 60, 281–291.CrossRefGoogle ScholarPubMed
Pickup, GJ, Frith, CD (2001). Theory of mind impairments in schizophrenia: symptomatology, severity and specificity. Psychological Medicine 31, 207–220.Google ScholarPubMed
Poletti, S, Anselmetti, S, Bechi, M, Ermoli, E, Bosia, M, Smeraldi, E, Cavallaro, R (2010). Computer-aided neurocognitive remediation in schizophrenia: durability of rehabilitation outcomes in a follow-up study. Neuropsychological Rehabilitation 20, 659–674.Google ScholarPubMed
Shamay-Tsoory, SG, Shur, S, Harari, H, Levkovitz, Y (2007) Neurocognitive basis of impaired empathy in schizophrenia. Neuropsychology 21, 431–438.Google ScholarPubMed
Stewart, SL, Corcoran, R, Drake, RJ (2008). Alignment and theory of mind in schizophrenia. Cognitive Neuropsychiatry 13, 431–448.CrossRefGoogle ScholarPubMed
Stratta, P, Arduini, L, Daneluzzo, E, Rinaldi, O, Di Genova, A, Rossi, A (2004). Relationship of good and poor Wisconsin Card Sorting Test performance to illness duration in schizophrenia: a cross-sectional analysis. Psychiatry Research 121, 219–227.Google ScholarPubMed
Ventura, J, Wood, RC, Hellemann, GS (2013). Symptom domains and neurocognitive functioning can help differentiate social cognitive processes in schizophrenia: a meta-analysis. Schizophrenia Bulletin 39, 102–111.CrossRefGoogle ScholarPubMed
Wechsler, D (2006). Wechsler Adult Intelligence Scale-Revised (WAIS-R). Psychological Corporation: San Antonio, TX.Google Scholar
Wölwer, W, Frommann, N (2011). Social-cognitive remediation in schizophrenia: generalization of effects of the Training of Affect Recognition (TAR). Schizophrenia Bulletin 37 (Suppl. 2): S63–S70.Google ScholarPubMed
Supplementary material: File

Bechi supplementary material

Figure S1

Download Bechi supplementary material(File)
File 36.9 KB