Background: Patients with schizophrenia have impairments in social functioning and are readmitted to healthcare institutions frequently. Individuals at ultra-high risk (UHR) for psychosis already present poor social functioning; among those individuals, the conversion rate from the putative prodromal phase to overt psychosis is 20%–30% within 1–2 years. Here, we analyzed the factor structure of self-related variables and neuro- and socio-cognitive function, and investigated whether these factors were associated with psychosocial function and prognostic outcome in individuals with recent-onset schizophrenia (ROSPR) or at UHR for psychosis. Methods: We evaluated 60 individuals at UHR for psychosis, 47 individuals with ROSPR, and 71 healthy controls using a comprehensive neurocognitive test battery and self-reported attribution scales, self-esteem, resilience, aberrant subjective experiences of schizotypy (physical anhedonia, social anhedonia, magical ideation, and perceptual aberration), and basic symptoms. We assessed psychosocial function with the Quality of Life Scale (QLS). Results: Factor analysis of all subjects revealed a four-factor structure comprising social-cognitive bias, reflective self, neurocognition, and pre-reflective self factors. Multiple regression analysis at baseline revealed that the factor structure predicted QLS. In the UHR group, social-cognitive bias, reflective self, neurocognition, and negative symptoms were significant determinants, explaining 38.0% of total QLS score variance. In the ROSPR group, reflective self and negative symptoms were significant determinants, explaining 54.4% of total QLS score variance. During follow-up, 13 individuals at UHR for psychosis developed psychosis (cumulative prevalence: 31.2% ± 7.6% at 6 years), with neurocognition score at baseline remaining a significant predictor of conversion [χ 2 (1) = 4.009, p = 0.045; hazard ratio 0.56, 95% confidence interval 0.31–0.99, p = 0.048]. Five patients with schizophrenia were (re)admitted during follow-up (cumulative prevalence: 16.1% ± 7.1% at 6 years); no factor was found to predict (re)admission. Conclusion: Factor analysis revealed an intrinsic four-factor structure of social-cognitive bias, reflective self, neurocognition, and pre-reflective self. The four factors were associated with social functioning at baseline and prodrome-to-psychosis conversion during follow-up, indicating the clinical significance of the four-factor structure. These findings provide a framework for understanding schizophrenia.
Background: Patients with schizophrenia and individuals at ultra-high risk for psychosis (UHR) have been reported to exhibit impaired recognition of facial emotion expressions. This impairment has involved both inaccuracy and negative bias of facial emotion recognition. The present study aimed to investigate whether UHR individuals display both types of impaired facial emotion recognition and to explore correlations between these impairments and schizotypy, as well as paranoia levels, in these individuals. Methods: A total of 43 UHR individuals and 57 healthy controls (HC) completed a facial emotion recognition task consisting of 60 standardized facial photographs. To explore correlations, we assessed schizotypy using the Revised Physical Anhedonia Scale and Magical Ideation Scale and paranoia level using the Paranoia Scale and persecution/ suspicious item of the Positive and Negative Syndrome Scale in UHR individuals. Results: Compared with HC, UHR individuals exhibited less accuracy for facial emotion recognition (70.6% vs. 75.6%, p=0.010) and a higher rate of "fear" responses for neutral faces (14.5% vs. 6.0%, p=0.003). In UHR individuals, inaccuracy was significantly correlated with schizotypy scores, but not with paranoia level. Conversely, "disgust" response for neutral faces was the only fear response correlated with paranoia level, and no threat-related emotion response correlated with schizotypy scores. Discussion: UHR individuals exhibited inaccuracy and negative bias of facial emotion recognition. Furthermore, schizotypy scores were associated with inaccuracy but not with negative bias of facial emotion recognition. Paranoia level was correlated with "disgust" responses for neutral faces but not with inaccuracy. These findings suggest that inaccuracy and negative bias of facial emotion recognition reflect different underlying processes, and that inaccuracy may be a vulnerability marker for schizophrenia.
ObjectiveThis study aimed to investigate whether aberrant tendency of noncurrent emotion was present in individuals at ultra-high risk (UHR) for psychosis and to explore its associations with various clinical profiles. MethodsFifty-seven individuals at UHR and 49 normal controls were enrolled. The tendency of experiencing noncurrent emotion was assessed using various noncurrent emotional self-reported formats, including trait [Neuroticism and Extraversion of the Eysenck Personality Questionnaire], hypothetical (Chapman’s Revised Physical and Social Anhedonia Scales), and retrospective [Anhedonia-Asociality Subscale of the Scale for the Assessment of Negative Symptoms (SANS)] measures. Self-related beliefs (Self-Perception Scale), clinical positive and negative symptoms (SA Positive Symptoms and SANS), psychosocial function (Global Functioning Scale: Role Function and Global Functioning Scale: Social Function) were also examined. ResultsSubjects at UHR for psychosis reported more trait unpleasant and less trait pleasant emotions, more hypothetical physical and social anhedonia, and more retrospective anhedonia than normal controls. In UHR, self-perception was correlated to trait unpleasant emotion and hypothetical physical and social anhedonia. Negative symptoms in UHR were associated with hypothetical physical anhedonia and retrospective anhedonia. Global social functioning was related to trait pleasant emotion, hypothetical physical and social anhedonia, and retrospective anhedonia. Neurocognitive function, positive symptoms, and global role functioning were not related with any noncurrent emotional experience measures in UHR. ConclusionThese findings suggest that the aberrant tendency of noncurrent emotional experience may be present at the ‘putative’ prodromal phase and are grossly associated with self-related beliefs and psychosocial functioning but not neurocognitive functioning.
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