Community-Based Psychosocial Treatment Has an Impact on Social Processing and Functional Outcome in Schizophrenia

Abstract

Schizophrenic patients have serious impairments in social cognition, which often persists after significant reduction in clinical symptoms. Community-based psychosocial treatments aim to recover social functioning for mentally ill individuals. Our aim was to examine prospective changes in social cognition and functional outcomes in two groups of schizophrenic patients involved in two forms of community-based psychosocial treatments namely case management (CM) and community-based club (CC) compared to a matched, treatment as usual (TAU) group of patients. We hypothesized that CC and CM groups would exhibit better functional and social cognitive outcomes after a 6-month long psychosocial treatment period. Seventy-five patients participated either in CC, CM or TAU. Both CC and CM took part in community-based psychosocial treatment programs including trainings, such as communication and assertiveness trainings. In addition, CC provided group therapeutic treatments and a continuously available day care where patients had the possibility to participate in various social interactions. All participants were in remission, and on maintenance antipsychotic treatment. Participants were assessed on all study variables at two time points: baseline and after 6 months with a battery of questionnaires that examined affective face perception, affective prosody perception, pragmatic language comprehension and ToM. Our results showed that functional outcomes improved significantly in the CC as well as in the CM groups, in contrast to the TAU group. While analyzing summary scores of social cognition, it was found that only the CC group increased its performance in social cognition. In addition, a significant between-group difference in social cognitive function was found after 6 months between the three groups, with the CC group performing best. When investigating associations between changes in social cognition and changes in functional outcomes during a 6-month long treatment period, we found significant correlations between the two variables both in the CC and in the CM groups. Based on our results, we suggest that a rich interpersonal network and social support have highly beneficial effects on social cognition and we would like to emphasize the necessity of offering community-based psychosocial treatments beside antipsychotic medications as early as possible as a crucial part of the complex therapy of schizophrenia.

The Ability of Patients With Schizophrenia to Comprehend and Produce Sincere, Deceitful, and Ironic Communicative Intentions: The Role of Theory of Mind and Executive Functions

“…First, we found that in all investigated tasks, the individuals with schizophrenia performed worse than the controls, except for the comprehension of linguistic and extralinguistic sincere communicative acts, which were the easiest tasks analyzed. This pattern of results in line with the relevant literature, confirming that communicative-pragmatic difficulty is a core contributor to the deficits exhibited by most patients with schizophrenia (Langdon et al, 2002; Tavano et al, 2008; Colle et al, 2013; Bambini et al, 2016; Cummings, 2017; Bucca, 2018; Parola et al, 2018; Varga et al, 2018).…”

“…Impairment in communicative-pragmatic ability is another well-documented impairment associated with schizophrenia (Cummings, 2017; Bucca, 2018). Several studies have pointed out that the performance of persons with schizophrenia significantly differed from that of controls in the comprehension of communicative acts that implied a gap between the literal and communicative meaning, such as indirect speech acts (Corcoran, 2003), irony (Langdon et al, 2002; Tavano et al, 2008; Varga et al, 2018) and other forms of figurative language, such as metaphors, idioms and proverbs (Schettino et al, 2010; Haas et al, 2014; Moro et al, 2015). Patients with schizophrenia also show difficulty in other pragmatic domains, such as recognition and recovery of communicative failures (Bosco et al, 2012), narrative production (Marini et al, 2008), deceit (Frith and Corcoran, 1996), and scalar implicatures (Wampers et al, 2018).…”

Emotional Prosody Processing in Schizophrenic Patients: A Selective Review and Meta-Analysis

“…For example, a recent systematic review and meta-analysis concluded that future clinical trials should consider applying a cognition remediation program that combines social cognition training elements and psychiatric rehabilitation [ 14 ]. An empirical study also demonstrated that schizophrenic patients were able to improve their affective prosody perception while being involved in community-based psychosocial rehabilitation programs [ 13 ]. Cognitive ability such as melodic discrimination and the factors influencing cognition such as acoustic features of the stimuli were also valued as crucial targets of cognitive remediation in schizophrenia [ 39 , 49 ].…”

“…There is a growing amount of evidence showing schizophrenic patients’ impairments in social cognition, which can be regarded as a powerful predictor of patients’ impaired social functioning [ 7 , 10 ]. Some researchers further identified comparable social cognition disorders between schizophrenic patients and patients with other psychotic disorders such as bipolar disorder [ 11 ], and highlighted the importance of continuous psychosocial support and social cognition analysis techniques and training programs [ 12 , 13 , 14 ].…”

Social Cognition Analyzer Application—A New Method for the Analysis of Social Cognition in Patients Diagnosed With Schizophrenia

“…This population usually conceived as an important target of psychosocial interventions aiming to improve social cognition, and hence a better outcome of the disorder. The feasibility of this approach is partly supported by our earlier data on the effect of social interaction on social cognition in a very similar patient population (77). However it would be important that future studies address these questions, as the relationships between these variables are rather controversial.…”