From “under” to “over” social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms?

Abstract

Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning.

Cognitive and Affective Theory of Mind in Positive Schizotypy: Relationship to Schizotypal Traits and Psychosocial Functioning

“…We found that intent overmentalization was related to cognitive-perceptual traits and emotion overmentalization was related to interpersonal traits. These findings are broadly consistent with the schizophrenia literature showing that affective ToM is related to negative symptoms and cognitive ToM is related to positive symptoms (Montag et al, 2011;Shamay-Tsoory et al, 2007), as well as studies showing that undermentalization is related to negative symptoms and overmentalization is related to positive symptoms (Fretland et al, 2015;Montag et al, 2011;Peyroux et al, 2019). Notably, however, no schizophrenia study has differentiated between cognitive overmentalization/undermentalization and affective overmentalization/undermentalization.…”

“…Although both studies found some evidence for cognitive and affective deficits, Kocsis-Bogár and colleagues found that schizotypes make undermentalization errors, whereas we found that schizotypes make overmentalization errors. The results of the current study are consistent with models for ToM in schizophrenia as well as studies finding a relationship between overmentalization and positive symptoms in schizophrenia (Fretland et al, 2015;Montag et al, 2011;Peyroux et al, 2019). Nonetheless, the different pattern of errors across these studies suggests that moderators might be influencing the relationship between schizotypy and ToM errors.…”

“…Undermentalization refers to the complete lack of mental state attribution or overly simplistic mental state attributions, whereas overmentalization refers to inaccurate, excessive mental state attribution that goes above and beyond the provided social cues. Studies in schizophrenia show that patients primarily exhibit undermentalization errors (Andreou et al, 2015;Engelstad et al, 2019;Martinez et al, 2017;Montag et al, 2011;Vaskinn et al, 2015Vaskinn et al, , 2018, although some studies have also found a relationship between overmentalization and positive symptoms (Fretland et al, 2015;Montag et al, 2011;Peyroux et al, 2019). Much less is known about ToM errors among individuals at risk for schizophrenia.…”

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

“…In line with our present findings, several studies found significant impairments in ToM, emotion perception and social perception in schizophrenia (2,20,48,49), as well as in response times in tasks requiring social cognitive abilities (7-9, 10, 11). However, our study is the first one that took into consideration both response rates and response times for the representation of social cognitive performance in patients diagnosed with schizophrenia.…”

Improving social function with real-world social-cognitive remediation in schizophrenia: Results from the RemedRugby quasi-experimental trial

“…A seven-point improvement during clinical trials is considered to be clinically significant [26]. Social perception and knowledge (PerSo) The PerSo [31] measures competence in the perception of social situations depicted in four pictures taken from the material "ColorCards-Social Behavior." Participants are firstly asked to describe all the elements in the picture allowing the calculation of global "fluency score."…”