Criterion B (social dysfunction) in persons with schizophrenia: The puzzle

Current Opinion in Psychiatry

Volumn 20, Issue 6, 2007, Pages 582-587

  Stanghellini, Giovanni ^a,c   Ballerini, Massimo ^b  

^a UNIVERSITY OF CHIETI   (Italy)

^b UNIVERSITY OF FLORENCE   (Italy)

^c NONE   (Italy)

Author keywords

Coping; Emotional experience; Neurocognition; Schizophrenia; Social cognition; Social dysfunction; Stigma

Indexed keywords

COGNITION; COPING BEHAVIOR; EMOTION; EXPERIENCE; FAMILY RELATION; HEALTH CARE FACILITY; HUMAN; MEDICAL RESEARCH; MENTAL HEALTH CARE; REVIEW; SCHIZOPHRENIA; SOCIAL ASPECT; SOCIAL DISABILITY; ADAPTIVE BEHAVIOR; HUMAN RELATION; PERCEPTION; PSYCHOLOGY; SOCIAL ADAPTATION;

ADAPTATION, PSYCHOLOGICAL; COGNITION; EMOTIONS; HUMANS; INTERPERSONAL RELATIONS; SCHIZOPHRENIC PSYCHOLOGY; SOCIAL ADJUSTMENT; SOCIAL PERCEPTION;

EID: 35148842509     PISSN: 09517367     EISSN: None     Source Type: Journal    
DOI: 10.1097/YCO.0b013e3282f0d4e0     Document Type: Review

References (56)

1. Pinkham AE, Penn DL, Perkins DO, Lieberman J. Implications for the neural basis of social cognition for the study of schizophrenia. Am J Psychiatry 2003; 160:815-824.
2. Schmael C, Georgi A, Krumm B, et al. Premorbid adjustment in schizophrenia: an important aspect of phenotype definition. Schizophr Res 2007; 92:50-62. The authors argue that pre-morbid adjustment is in itself a valuable phenotype characteristic and may represent a specific biological phenotype that may be of value in subsample selection.
3. Uzelac S, Jaeger J, Berns S, Gonzales C. Premorbid adjustment in bipolar disorder: comparison with schizophrenia. J Nerv Ment Dis 2006; 194:654-658. This paper shows that schizophrenic patients, but not manic depressive ones, exhibit poor pre-morbid adjustment, here evaluated within the domain of school adaptation and social-sexual functioning.
4. American Psychiatric Association. DSM IV-TR: diagnostic and statistical manual of mental disorders. 4th ed, Text Revision. Washington, DC: American Psychiatric Association; 2000.
5. Stanghellini G, Ballerini M. Dis-sociality: the phenomenological approach to social dysfunction in schizophrenia. World Psychiatry 2002; 1:102-106.
6. Bellack AS, Morrison RL, Wixted JT, Mueser KT. An analysis of social competence in schizophrenia. Br J Psychiatry 1990; 156:809-818.
7. Wiersma D. Measuring social disabilities in mental health. In: Thornicroft G, Tansella M, editors. Mental health outcome measures. Berlin: Springer; 1996.
8. Hogarty GE, Fleischer S. Developmental theory for a cognitive enhancement therapy of schizophrenia. Schizophr Bull 1999; 25:677-692.
9. Lysaker PH, Bell MD, Bryson GJ, Kaplan E. Insight and interpersonal function in schizophrenia. J Nerv Ment Dis 1998; 186:432-436.
10. Stanghellini G, Ballerini M. Autism: disembodied existence. Philosophy. Psychiatry Psychol 2004; 11:259-268.
11. Milev P, Ho B-H, Arndt S, Andreasen NC. Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 2005; 162:495-506.
12. Buchanan RW, Davis M, Goff D, et al. A summary of the FDA-NIMH-MATRICS workshop on clinical trial design for neurocognitive drugs for schizophrenia. Schizophr Bull 2005; 31:5-19.
13. Dickerson FB, Parente F, Ringel N. The relationship among three measures of social functioning in outpatients with schizophrenia. J Clin Psychol 2000; 56:1509-1519.
14. Cohen AS, Forbes CB, Mann MC, Blanchard JJ. Specific cognitive deficits and differential domains of social functioning impairment in schizophrenia. Schizophr Res 2006; 81:227-238. Social functioning is a multidimensional construct. Microsocial and macrosocial measures are only modestly correlated. Community social functioning (macrosocial), but not role play test (microsocial), is significantly associated with social cognition.
15. Stanghellini G, Ballerini M. Values in persons with schizophrenia. Schizophr Bull 2007; 33:131-141. This paper explores the value system of persons with schizophrenia. The aim is to improve our understanding of the 'meaning' of schizophrenic experiences and beliefs, and to enhance the specificity and validity of psychotic symptoms (especially bizarre delusions) and of social and occupational dysfunction through detailed description of the anthropological and existential matrix from which they arise.
16. Couture SM, Penn DL, Roberts DL. The functional significance of social cognition in schizophrenia: a review. Schizophr Bull 2006; 32 (Suppl 1):44-63. This is a very interesting review of the concept of social cognition. It argues that the relationship between social outcome and ToM requires further and extensive examination.
17. Nuechterlein KH, Barch DM, Gold JM, et al. Identification of separable cognitive factors in schizophrenia. Schizophr Res 2004; 72:29-39.
18. Green MF, Kern RS, Braff DL, Mintz J. Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"? Schizophr Bull 2000; 26:119-136.
19. Green MF, Kern RS, Heaton RK. Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res 2004; 72:41-51.
20. Matza LS, Buchanan R, Purdon S, et al. Measuring changes in functional status among patients with schizophrenia: the link with cognitive impairment. Schizophr Bull 2006; 32:666-678. This is an excellent review of the link between neurocognition and social functioning. It shows inconsistent findings across studies, indicating that research in this area is still preliminary.
21. Green MF. What are the functional consequences of neurocognitive deficits in schizophrenia? Am J Psychiatry 1996; 153:321-330.
22. Laes JR, Sponheim SR. Does cognition predict community function only in schizophrenia? A study of schizophrenia patients, bipolar affective disorder patients, and community control subjects. Schizophr Res 2006; 84:121-131.
23. Prouteau A, Verdoux H, Briand C, et al. The crucial role of sustained attention in community functioning in outpatients with schizophrenia. Psychiatry Res 2004; 129:171-177.
24. Addington J, Addington D. Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study. Schizophr Res 2000; 44:47-56.
25. Verdoux H, Liraud F, Assens F, et al. Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients. Schizophr Res 2002; 56:149-159.
26. Stirling J, White C, Lewis S, et al. Neurocognitive function and outcome in first-episode schizophrenia: a 10-year follow-up of an epidemiological cohort. Schizophr Res 2003; 65:75-86.
27. Holthausen EA, Wiersma D, Cahn W, et al. Predictive value of cognition for different domains of outcome in recent-onset schizophrenia. Psychiatry Res 2007; 149:71-80.
28. Addington J, Saeedi H, Addington D. Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. Br J Psychiatry 2006; 189:373-378. This elegant study demonstrates that social cognition mediates between neurocognition and social functioning.
29. Brothers L. The social brain: a project for integrating primate behavior and neurophysiology in a new domain. Concepts Neurosci 1990; 1:27-51.
30. Penn DL, Combs DR, Ritchie M, et al. Emotion recognition in schizophrenia: further investigation of generalized versus specific deficit models. J Abnorm Psychol 2000; 109:512-516.
31. Schneider F, Gur RC, Koch K, et al. Impairment in the specificity of emotion processing in schizophrenia. Am J Psychiatry 2006; 163:442-447. Impairments in emotion recognition may lead to misunderstanding in social communication and underlie problems in social adjustment. Persons with schizophrenia and normal individuals were shown emotional and non-emotional faces and asked to discriminate between happiness, sadness, anger and fear (emotional stimuli), and age (non-emotional). Persons with schizophrenia exhibited more specific impairments in the processing of emotional faces than did normal individuals, whereas both have problems in discriminating age. This suggests that the problem in processing stimuli is not a perceptive but an emotional one.
32. Edwards J, Pattison PE, Jackson HJ, Wales RJ. Facial affect and affective prosody recognition in first-episode schizophrenia. Schizophr Res 2001; 48:235-253.
33. Kohler CG, Bilker W, Hagendoorn M, et al. Emotion recognition deficit in schizophrenia: association with symptomatology and cognition. Biol Psychiatry 2000; 48:127-136.
34. Kohler CG, Turner TH, Bilker WB, et al. Facial emotion recognition in schizophrenia: intensity effects and error pattern. Am J Psychiatry 2003; 160:1768-1774.
35. Bigelow NO, Paradiso S, Adolphs R, et al. Perception of socially relevant stimuli in schizophrenia. Schizophr Res 2006; 83:257-267. The specificity and circumscription of impairments of emotion recognition suggest that different underlying neurological dysfunctions may underline social cognition.
36. Kee KS, Horan WP, Wynn JK, et al. An analysis of categorical perception of facial emotion in schizophrenia. Schizophr Res 2006; 87:228-237.
37. Archer J, Hay DC, Young W. Movement face processing and schizophrenia: evidence of a differential deficit in expression analysis. Br J Clin Psychol 1994; 33:517-528.
38. Corrigan PW, Davies-Farmer RM, Stolley MR. Social clue recognition in schizophrenia under variable levels of arousal. Cognit Ther Res 1990; 14:353-361.
39. Sergi MJ, Rassowsky Y, Neuchterlein KH, Green MF. Social perception as a mediator of the influence of early visual processing on functional status in schizophrenia. Am J Psychiatry 2006; 163:448-454. Social cognition is a mediator between basic cognitive abilities (visual processing) and functional status (role functioning).
40. Gallagher S. How the body shapes the mind. Oxford: Oxford University Press; 2005.
41. Harrington L, Siegert RJ, McClure J. Theory of mind in schizophrenia: a critical review. Cognit Neuropsychiatry 2005; 10:249-286.
42. Bora E, Vahip S, Gonul AS, et al. Evidence for theory of mind deficits in euthymic patients with bipolar disorder. Acta Psychiatr Scand 2005; 112:110-116.
43. McCabe R, Leudar I, Antaki C. Do people with schizophrenia display theory of mind deficits in clinical interactions? Psychol Med 2004; 34:401-412.
44. Lysaker PH, Bryson GJ, Marks K, et al. Coping style in schizophrenia: association with neurocognitive deficits and personality. Schizophr Bull 2004; 30:113-121.
45. Ventura J, Nuechterlein KH, Subtonik KL, et al. Self-efficacy and neurocognition may be related to coping responses in recent-onset schizophrenia. Schizophr Res 2004; 1:343-352.
46. Lysaker PH, Davis LW, Lightfoot J, et al. Association of neurocognition, anxiety, positive and negative symptoms with coping preference in schizophrenia spectrum disorders. Schizophr Res 2005; 80:163-171.
47. Velligan DI, Kern RS, Gold JM. Cognitive rehabilitation for schizophrenia and the putative role of motivation and expectancies. Schizophr Bull 2006; 32:474-485. The authors argue that we must go beyond cognitive factors and consider motivation and expectancies if we are to understand the reasons for schizophrenic disability. The implications for rehabilitation are discussed.
48. Sander D, Koenig O, Georgieff N, et al. Emotional processes in schizophrenia: investigation of the evaluative component [in French]. Encephale 2005; 31:672-682.
49. Burbridge JA, Barch DM. Anhedonia and the experience of emotion in individuals with schizophrenia. Abnorm Psychol 2007; 116:30-42. Persons with schizophrenia report experiencing less arousal for negative stimuli than normal individuals. The authors suggest that there is a link between disturbances in working memory and physical anhedonia.
50. Miller P, Byrne M, Hodges A, et al. Schizotypal components in people at risk of developing schizophrenia: early findings from the Edinburgh High-Risk Study. Br J Psychiatry 2002; 180:179-184.
51. Kretschmer E. Body structure and character [in German]. Berlin: Springer; 1921.
52. Stanghellini G. Psychopathological roots of early schizophrenia: adolescent vulnerability, hebephrenia and heboidophrenia. Curr Opin Psychiatry 2004; 17:471-477.
53. Suslow T, Roestel C, Ohrmann P, Arolt V. The experience of basic emotions in schizophrenia with and without affective negative symptoms. Compr Psychiatry 2003; 44:303-310.
54. Herbener ES, Harrow M, Hill SK. Change in the relationship between anhedonia and functional deficits over a 20-year period in individuals with schizophrenia. Schizophr Res 2005; 75:97-105.
55. Montag C, Heinz A, Kunz D, Gallinat J. Self-reported empathic abilities in schizophrenia. Schizophr Res 2007; 92:85-89. The authors of this paper emphasize that empathy has two components: a cognitive and an affective one. ToM studies mainly investigate the first component.
56. •]. Because the discrepancy in findings may be ascribed to different research designs, an accurate comparison of data is required to establish a general theory of empathy.