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Social cognition in people with schizophrenia: a cluster-analytic approach

Published online by Cambridge University Press:  20 September 2016

P. Rocca ,
S. Galderisi ,
A. Rossi ,
A. Bertolino ,
P. Rucci ,
D. Gibertoni ,
C. Montemagni ,
M. Sigaudo ,
A. Mucci  and
P. Bucci
...Show all authors
P. Rocca*
Affiliation:
Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
S. Galderisi
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
A. Rossi
Affiliation:
Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
A. Bertolino
Affiliation:
Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy
P. Rucci
Affiliation:
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
D. Gibertoni
Affiliation:
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
C. Montemagni
Affiliation:
Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
M. Sigaudo
Affiliation:
Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy
A. Mucci
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
P. Bucci
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
T. Acciavatti
Affiliation:
Department of Neuroscience and Imaging, Chair of Psychiatry, G. d'Annunzio University, Chieti, Italy
E. Aguglia
Affiliation:
Department of Clinical and Molecular Biomedicine, Psychiatry Unit, University of Catania, Catania, Italy
M. Amore
Affiliation:
Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
A. Bellomo
Affiliation:
Department of Medical Sciences, Psychiatry Unit, University of Foggia, Foggia, Italy
D. De Ronchi
Affiliation:
Department of Biomedical and Neuromotor Sciences, Section of Psychiatry, University of Bologna, Bologna, Italy
L. Dell'Osso
Affiliation:
Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
F. Di Fabio
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
P. Girardi
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
A. Goracci
Affiliation:
Department of Molecular Medicine and Clinical Department of Mental Health, University of Siena, Siena, Italy
C. Marchesi
Affiliation:
Department of Neuroscience, Psychiatry Unit, University of Parma, Parma, Italy
P. Monteleone
Affiliation:
Department of Medicine and Surgery, Chair of Psychiatry, University of Salerno, Salerno, Italy
C. Niolu
Affiliation:
Department of Systems Medicine, Chair of Psychiatry, Tor Vergata University of Rome, Rome, Italy
F. Pinna
Affiliation:
Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry, University of Cagliari, Cagliari, Italy
R. Roncone
Affiliation:
Department of Life, Health and Environmental Sciences, Unit of Psychiatry, University of L'Aquila, L'Aquila, Italy
E. Sacchetti
Affiliation:
Psychiatric Unit, School of Medicine, University of Brescia, Brescia, Italy Department of Mental Health, Spedali Civili Hospital, Brescia, Italy
P. Santonastaso
Affiliation:
Psychiatric Clinic, Department of Neurosciences, University of Padua, Padua, Italy
P. Zeppegno
Affiliation:
Department of Translational Medicine, Psychiatric Unit, University of Eastern Piedmont, Novara, Italy
M. Maj
Affiliation:
Department of Psychiatry, University of Naples SUN, Naples, Italy
*
*Address for correspondence: P. Rocca, M.D., Department of Neuroscience, Unit of Psychiatry, University of Turin, Via Cherasco 11, 10126 Turin, Italy. (Email: [email protected])
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Abstract

Background

The study aimed to subtype patients with schizophrenia on the basis of social cognition (SC), and to identify cut-offs that best discriminate among subtypes in 809 out-patients recruited in the context of the Italian Network for Research on Psychoses.

Method

A two-step cluster analysis of The Awareness of Social Inference Test (TASIT), the Facial Emotion Identification Test and Mayer–Salovey–Caruso Emotional Intelligence Test scores was performed. Classification and regression tree analysis was used to identify the cut-offs of variables that best discriminated among clusters.

Results

We identified three clusters, characterized by unimpaired (42%), impaired (50.4%) and very impaired (7.5%) SC. Three theory-of-mind domains were more important for the cluster definition as compared with emotion perception and emotional intelligence. Patients more able to understand simple sarcasm (⩾14 for TASIT-SS) were very likely to belong to the unimpaired SC cluster. Compared with patients in the impaired SC cluster, those in the very impaired SC cluster performed significantly worse in lie scenes (TASIT-LI <10), but not in simple sarcasm. Moreover, functioning, neurocognition, disorganization and SC had a linear relationship across the three clusters, while positive symptoms were significantly lower in patients with unimpaired SC as compared with patients with impaired and very impaired SC. On the other hand, negative symptoms were highest in patients with impaired levels of SC.

Conclusions

If replicated, the identification of such subtypes in clinical practice may help in tailoring rehabilitation efforts to the person's strengths to gain more benefit to the person.

Keywords

Cluster analysisItalian Network for Research on Psychosesschizophreniasocial cognitiontheory of mind
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 13 , October 2016 , pp. 2717 - 2729
Copyright
Copyright © Cambridge University Press 2016 

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References

Abdel-Hamid, M, Lehmkämper, C, Sonntag, C, Juckel, G, Daum, I, Brüne, M(2009). Theory of mind in schizophrenia: the role of clinical symptomatology and neurocognition in understanding other people's thoughts and intentions. Psychiatry Research 165, 19–26.CrossRefGoogle ScholarPubMed
Addington, J, Girard, TA, Christensen, BK, Addington, D (2010). Social cognition mediates illness-related and cognitive influences on social function in patients with schizophrenia-spectrum disorders. Journal of Psychiatry and Neuroscience 35, 49–54.Google Scholar
Adolphs, R (2009). The social brain: neural basis of social knowledge. Annual Review of Psychology 60, 693–716.CrossRefGoogle ScholarPubMed
Aldenderfer, MS, Blashfield, RK (1984). Cluster Analysis. Sage Publications: Newbury Park, CA.CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Bell, MD, Corbera, S, Johannesen, JK, Fiszdon, JM, Wexler, BE (2013). Social cognition impairment and negative symptoms in schizophrenia; are there subtypes with distinct functional correlates? Schizophrenia Bulletin 39, 186–196.CrossRefGoogle ScholarPubMed
Biedermann, F, Frajo-Apor, B, Hofer, A (2012). Theory of mind and its relevance in schizophrenia. Current Opinion in Psychiatry 25, 71–75.Google Scholar
Bora, E, Pantelis, C (2013). Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: systematic review and meta-analysis. Schizophrenia Research 144, 31–36.CrossRefGoogle ScholarPubMed
Brekke, J, Kay, DD, Lee, KS, Green, MF (2005). Biosocial pathways to functional outcome in schizophrenia. Schizophrenia Research 80, 213–225.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Erlbaum: Hillsdale, NJ.Google Scholar
Couture, SM, Granholm, EL, Fish, SC (2011). A path model investigation of neurocognition, theory of mind, social competence, negative symptoms and real-world functioning in schizophrenia. Schizophrenia Research 125, 152–160.Google Scholar
Couture, SM, Penn, DL, Roberts, DL (2006). The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin 32 (Suppl. 1), S44–S63.Google Scholar
Cummings, JL, Mega, MS (2003). Visuospatial, visuoperceptual, and right hemisphere disturbances. In Neuropsychiatry and Behavioral Neuroscience (ed. Cummings, J. L. and Mega, M. S.), pp. 114–127. Oxford University Press: New York.Google Scholar
de Achával, D, Costanzo, EY, Villarreal, M, Jáuregui, IO, Chiodi, A, Castro, MN, Fahrer, RD, Leiguarda, RC, Chu, EM, Guinjoan, SM (2010). Emotion processing and theory of mind in schizophrenia patients and their unaffected first-degree relatives. Neuropsychologia 48, 1209–1215.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.Google Scholar
Fett, AK, Maat, A; GROUP Investigators (2013). Social cognitive impairments and psychotic symptoms: what is the nature of their association? Schizophrenia Bulletin 39, 77–85.Google Scholar
Fett, AKJ, Viechtbauer, W, Dominguez, MG, Penn, DL, van Os, J, Krabbendam, L (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neuroscience and Biobehavioral Reviews 35, 573–588.Google Scholar
Galderisi, S, Rossi, A, Rocca, P, Bertolino, A, Mucci, A, Bucci, P, Rucci, P, Gibertoni, D, Aguglia, E, Amore, M, Bellomo, A, Biondi, M, Brugnoli, R, Dell'Osso, L, De Ronchi, D, Di Emidio, G, Di Giannantonio, M, Fagiolini, A, Marchesi, C, Monteleone, P, Oldani, L, Pinna, F, Roncone, R, Sacchetti, E, Santonastaso, P, Siracusano, A, Vita, A, Zeppegno, P, Maj, M; Italian Network For Research on Psychoses (2014). The influence of illness-related variables, personal resources and context-related factors on real-life functioning of people with schizophrenia. World Psychiatry 13, 275–287.CrossRefGoogle ScholarPubMed
Green, MF, Bearden, CE, Cannon, TD, Fiske, AP, Hellemann, GS, Horan, WP, Kee, K, Kern, RS, Lee, J, Sergi, MJ, Subotnik, KL, Sugar, CA, Ventura, J, Yee, CM, Nuechterlein, KH (2012). Social cognition in schizophrenia, Part 1: performance across phase of illness. Schizophrenia Bulletin 38, 854–864.Google Scholar
Green, MF, Horan, WP (2010). Social cognition in schizophrenia. Current Directions in Psychological Science 19, 243–248.CrossRefGoogle Scholar
Green, MF, Penn, DL, Bentall, R, Carpenter, WT, Gaebel, W, Gur, RC, Kring, AM, Park, S, Silverstein, SM, Heinssen, R (2008). Social cognition in schizophrenia: an NIMH workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin 34, 1211–1220.Google Scholar
Hardy-Baylé, MC, Sarfati, Y, Passerieux, C (2003). The cognitive basis of disorganization symptomatology in schizophrenia and its clinical correlates: toward a pathogenetic approach to disorganization. Schizophrenia Bulletin 29, 459–471.Google Scholar
Harvey, PD (2013). Assessment of everyday functioning in schizophrenia: implications for treatments aimed at negative symptoms. Schizophrenia Research 150, 353–355.Google Scholar
Harvey, PD, Penn, DL (2010). Social cognition: the key factor predicting social outcome in people with schizophrenia? Psychiatry 7, 41–44.Google ScholarPubMed
Harvey, PD, Raykov, T, Twamley, EW, Vella, L, Heaton, RK, Patterson, TL (2011). Validating the measurement of real-world functional outcomes: phase I results of the VALERO study. American Journal of Psychiatry 168, 1195–1201.Google Scholar
Harvey, PD, Sabbag, S, Prestia, D, Durand, D, Twamley, EW, Patterson, TL (2012). Functional milestones and clinician ratings of everyday functioning in people with schizophrenia: overlap between milestones and specificity of ratings. Journal of Psychiatric Research 46, 1546–1552.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.Google Scholar
Horton, HK, Silverstein, SM (2008). Social cognition as a mediator of cognition and outcome among deaf and hearing people with schizophrenia. Schizophrenia Research 105, 125–137.Google Scholar
Italian National Census Bureau (2015). National demographic balance year 2014 (http://www.istat.it/en/files/2015/06/EN_National_demographic_balance2014_def.pdf). Accessed June 2015.Google Scholar
Javitt, DC (2009). When doors of perception close: bottom-up models of disrupted cognition in schizophrenia. Annual Review of Clinical Psychology 5, 249–275.Google Scholar
Kee, KS, Kern, RS, Green, MF (1998). Perception of emotion and neurocognitive functioning in schizophrenia: what's the link? Psychiatry Research 81, 57–65.Google Scholar
Kern, RS, Nuechterlein, KH, Green, MF, Baade, LE, Fenton, WS, Gold, JM, Keefe, RS, Mesholam-Gately, R, Mintz, J, Seidman, LJ, Stover, E, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, part 2: co-norming and standardization. American Journal of Psychiatry 165, 214–220.CrossRefGoogle ScholarPubMed
Kerr, SL, Neale, JM (1993). Emotion perception in schizophrenia: specific deficit or further evidence of generalized poor performance? Journal of Abnormal Psychology 102, 312–318.Google Scholar
Kirkpatrick, B, Strauss, GP, Nguyen, L, Fischer, BA, Daniel, DG, Cienfuegos, A, Marder, SR (2011). The Brief Negative Symptom Scale: psychometric properties. Schizophrenia Bulletin 37, 300–305.Google Scholar
Kohler, CG, Walker, JB, Martin, EA, Healey, KM, Moberg, PJ (2010). Facial emotion perception in schizophrenia: a meta-analytic review. Schizophrenia Bulletin 36, 1009–1019.Google Scholar
Leifker, FR, Patterson, TL, Heaton, RK, Harvey, PD (2011). Validating measures of real-world outcome: the results of the VALERO expert survey and RAND panel. Schizophrenia Bulletin 37, 334–343.Google Scholar
Leslie, AM, Frith, U (1987). Metarepresentation and autism: how not to lose one's marbles. Cognition 27, 291–294.Google Scholar
Mancuso, F, Horan, WP, Kern, RS, Green, MF (2011). Social cognition in psychosis: multidimensional structure, clinical correlates and relationship with functional outcome. Schizophrenia Research 125, 143–151.Google Scholar
Mayer, JD, Salovey, P, Caruso, DR (2002). Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT): Users’ Manual. Multi-Health Systems Inc.: Toronto.Google Scholar
Mazza, M, Costagliola, C, Di Michele, V, Magliani, V, Pollice, R, Ricci, A, Di Giovanbattista, E, Roncone, R, Casacchia, M, Galzio, RJ (2007). Deficit of social cognition in subjects with surgically treated frontal lobe lesions and in subjects affected by schizophrenia. European Archives of Psychiatry and Clinical Neuroscience 257, 12–22.Google Scholar
McDonald, S, Bornhofen, C, Shum, D, Long, E, Saunders, C, Neulinger, K (2006). Reliability and validity of The Awareness of Social Inference Test (TASIT): a clinical test of social perception. Disability and Rehabilitation 28, 1529–1542.CrossRefGoogle ScholarPubMed
Mehta, UM, Bhagyavathi, HD, Thirthalli, J, Kumar, KJ, Gangadhar, BN (2014). Neurocognitive predictors of social cognition in remitted schizophrenia. Psychiatry Research 219, 268–274.Google Scholar
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.Google Scholar
Mucci, A, Galderisi, S, Merlotti, E, Rossi, A, Rocca, P, Bucci, P, Piegari, G, Chieffi, M, Vignapiano, A, Maj, M (2015). Italian Network for Research on Psychoses. The Brief Negative Symptom Scale (BNSS): independent validation in a large sample of Italian patients with schizophrenia. European Psychiatry 30, 641–647.CrossRefGoogle Scholar
Mucci, A, Rucci, P, Rocca, P, Bucci, P, Gibertoni, D, Merlotti, E, Galderisi, S, Maj, M (2014). Italian Network for Research on Psychoses. The Specific Level of Functioning Scale: construct validity, internal consistency and factor structure in a large sample of people with schizophrenia living in the community. Schizophrenia Research 159, 144–150.Google Scholar
Nelson, AL, Combs, DR, Penn, DL, Basso, MR (2007). Subtypes of social perception deficits in schizophrenia. Schizophrenia Research 94, 139–147.Google Scholar
Norušis, MJ (2005). IBM SPSS Statistics 19 Statistical Procedures Companion. Prentice Hall: Upper Saddle River, NJ.Google Scholar
Nuechterlein, KH, Green, MF (2013 a). MATRICS Consensus Cognitive Battery (MCCB): history and development of the battery – translation of chapters 1 and 2 of the MCCB Manual by F Mancuso, A Mucci, S Galderisi. NOOS 2, 83–98.Google Scholar
Nuechterlein, KH, Green, MF (2013 b). MATRICS Consensus Cognitive Battery (MCCB): reliability, validity and standardization studies – translation of chapters 1 and 2 of the MCCB Manual by F Mancuso, A Mucci, S Galderisi. NOOS 2, 99–116.Google Scholar
Nuechterlein, KH, Green, MF, Kern, RS, Baade, LE, Barch, DM, Cohen, JD, Essock, S, Fenton, WS, Frese, FJ III, Gold, JM, Goldberg, T, Heaton, RK, Keefe, RS, Kraemer, H, Mesholam-Gately, R, Seidman, LJ, Stover, E, Weinberger, DR, Young, AS, Zalcman, S, Marder, SR (2008). The MATRICS Consensus Cognitive Battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203–213.Google Scholar
Palmer, BW, Dawes, SE, Heaton, RK (2009). What do we know about neuropsychological aspects of schizophrenia? Neuropsychological Review 19, 365–384.Google Scholar
Pinkham, AE, Penn, DL, Green, MF, Harvey, PD (2016). Social Cognition Psychometric Evaluation: results of the initial psychometric study. Schizophrenia Bulletin 42, 494–504.Google Scholar
Prouteau, A, Verdoux, H, Briand, C, Lesage, A, Lalonde, P, Nicole, L, Reinharz, D, Stip, E (2005). Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program. Schizophrenia Research 77, 343–353.Google Scholar
Rassovsky, Y, Horan, WP, Lee, J, Sergi, MJ, Green, MF (2011). Pathways between early visual processing and functional outcome in schizophrenia. Psychological Medicine 41, 487–497.Google Scholar
Savla, GN, Vella, L, Armstrong, CC, Penn, DL, Twamley, EW (2013). Deficits in domains of social cognition in schizophrenia: a meta-analysis of the empirical evidence. Schizophrenia Bulletin 39, 979–992.Google Scholar
Schenkel, LS, Spaulding, WD, Silverstein, SM (2005). Poor premorbid social functioning and theory of mind deficit in schizophrenia: evidence of reduced context processing? Journal of Psychiatric Research 39, 499–508.Google Scholar
Schmidt, SJ, Mueller, DR, Roder, V (2011). Social cognition as a mediator variable between neurocognition and functional outcome in schizophrenia: empirical review and new results by structural equation modeling. Schizophrenia Bulletin 37 (Suppl. 2), S41–S54.Google Scholar
Schneider, LC, Struening, EL (1983). SLOF: a behavioral rating scale for assessing the mentally ill. Social Work Research and Abstracts 19, 9–21.Google Scholar
Sergi, MJ, Rassovsky, Y, Nuechterlein, KH, Green, MF (2006). Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. American Journal of Psychiatry 163, 448–454.Google Scholar
Sergi, MJ, Rassovsky, Y, Widmark, C, Reist, C, Erhart, S, Braff, DL, Marder, SR, Green, MF (2007). Social cognition in schizophrenia: relationships with neuro-cognition and negative symptoms. Schizophrenia Research 90, 316–324.Google Scholar
Strauss, GP, Keller, WR, Buchanan, RW, Gold, JM, Fischer, BA, McMahon, RP, Catalano, LT, Culbreth, AJ, Carpenter, WT, Kirkpatrick, B (2012). Next-generation negative symptom assessment for clinical trials: validation of the Brief Negative Symptom Scale. Schizophrenia Research 142, 88–92.Google Scholar
Uhlhaas, PJ, Phillips, WA, Schenkel, LS, Silverstein, SM (2006). Theory of mind and perceptual context-processing in schizophrenia. Cognitive Neuropsychiatry 11, 416–436.Google Scholar
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.Google Scholar
Wallwork, RS, Fortgang, R, Hashimoto, R, Weinberger, DR, Dickinson, D (2012). Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research 137, 246–250.Google Scholar