Assessment of empathy in first-episode psychosis and meta-analytic comparison with previous studies in schizophrenia

Abstract

Empathy is a multidimensional construct that relies on affective and cognitive component processes. A few studies have reported impairments of both cognitive and affective empathy components in patients with schizophrenia. It is, however, not known whether these difficulties are already present at psychosis onset. The affective and cognitive components of empathy were thus assessed in 31 patients with first-episode psychosis (FEP) and 31 matched healthy controls using the Interpersonal Reactivity Index (IRI). Our results were then compared to previous studies of empathy in patients with more chronic schizophrenia via a meta-analysis. In addition, we also assessed the relationship between empathy ratings, Mentalizing performance and clinical symptoms. Contrary to what has been reported in people with more chronic schizophrenia, the IRI ratings did not significantly differ between FEP and controls in our study, though a trend was observed for the Personal distress scale. For the Perspective taking scale, our meta-analysis revealed a significantly lower effect size in this study with FEP patients relative to previous schizophrenia studies. In the FEP group, the IRI ratings were not related to positive, negative or general psychopathology symptoms, but a significant relationship emerged between the Liebowitz Social Anxiety Scale and Perspective taking (negative correlation). In addition, a significant positive correlation was observed between the Empathic concern subscale and our theory of mind task. This study supports the idea that the cognitive component of empathy is less affected in patients with first-episode psychosis relative to patients with more chronic schizophrenia, and the impairments reported in previous reports with more chronic populations should be interpreted in light of a possible deterioration of this cognitive skill. The findings also provide some insight into the relationship between empathy and clinical symptoms such as social anxiety.

Affective empathy in schizophrenia: a meta-analysis

“…Several studies have found an association between affective or overall empathy and negative symptoms (Bora et al, 2008;Kucharska-Pietura et al, 2012;Lincoln et al, 2011;Shamay-Tsoory et al, 2007;Smith et al, 2014;Sparks et al, 2010); associations have also been found with positive symptoms (Konstantakopoulos et al, 2014;Lysaker et al, 2013;Smith et al, 2014;Sparks et al, 2010), depression (Abramowitz et al, 2014;Didehbani et al, 2012;Horan et al, 2015), anxiety (Achim et al, 2011), and insight (Didehbani et al, 2012;Lysaker et al, 2013;Pijnenborg et al, 2013). However, though several studies report significant relationships with symptoms, as many studies have reported no association (Corbera et al, 2013;Derntl et al, 2012a;Derntl et al, 2012b;Fresán et al, 2015;Fujino et al, 2014;Fujiwara et al, 2008;Lam et al, 2014;Lehmann et al, 2014;McCormick et al, 2012;Montag et al, 2007).…”

“…Other systematic reviews have examined the abilities of people with schizophrenia to experience emotions, indicating they are able to experience emotions in the same way as healthy controls, but results could not inform whether emotions are felt in an empathic context (Cohen and Minor, 2010;Kring and Moran, 2008). Of note, one meta-analysis was published (Achim et al, 2011) including only reports using the Interpersonal Reactivity Index (IRI), a commonly used self-report measure of empathy, but this study did not claim to be a comprehensive meta-analysis of affective empathy studies and included only six articles informing empathy deficits. Several studies published since that meta-analysis indicate that people with schizophrenia display reduced affective empathy (Abramowitz et al, 2014;Benedetti et al, 2009), though others do not detect this difference (Achim et al, 2011;Lehmann et al, 2014).…”

“…Of note, one meta-analysis was published (Achim et al, 2011) including only reports using the Interpersonal Reactivity Index (IRI), a commonly used self-report measure of empathy, but this study did not claim to be a comprehensive meta-analysis of affective empathy studies and included only six articles informing empathy deficits. Several studies published since that meta-analysis indicate that people with schizophrenia display reduced affective empathy (Abramowitz et al, 2014;Benedetti et al, 2009), though others do not detect this difference (Achim et al, 2011;Lehmann et al, 2014). Further, some newer performance-based measures have shown stronger effects than are typically shown with self-report scales (Derntl et al, 2012b;Lee et al, 2010).…”

Schizophrenia and Social Cognition: From Conceptual Bases to Therapeutic Approaches

“…Intellectual deficits seem to influence the impairment of ToM in patients in remission (Bora 2009). Achim et al (2010) evaluated the relationship between levels of empathy, performance in mentalization and clinical symptoms of first psychotic episode, and healthy individuals. These results were also compared with previous studies in patients with chronic schizophrenia through meta-analysis.…”

La falta de empatía: ¿Un síntoma específico de la esquizofrenia? [Lack of empathy: a specific symptom of schizophrenia?]

“…Se ha tratado de relacionar los défi cits en diferentes ámbitos de la cognición en estos pacientes con la pérdi-da de la capacidad empática (Soderstrom, 2003;Brüne, 2005). Los trabajos realizados con población esquizofrénica vienen a demostrar que efectivamente existe una disminución de los niveles de empatía, en comparación con la población normal (Achim, Ouellet, Roy y Jackson, 2011). El déficit empático se ha encontrado también en la esquizotipia, asociado a un pobre funcionamiento social y a un incremento de la afectividad negativa (Henry, Bailey y Rendell, 2008).…”