Deficits in Domains of Social Cognition in Schizophrenia: A Meta-Analysis of the Empirical Evidence
TL;DR: The evidence for deficits across multiple social cognitive domains in schizophrenia is clear and the role of neurobiological and psychosocial factors in models linking various aspects of deficit in schizophrenia, including social cognition, should be examined.
Abstract: Objective: Social cognition is strongly associated with functional outcome in schizophrenia, making it an important target for treatment. Our goal was to examine the average magnitude of differences between schizophrenia patients (SCs) and normal comparison (NCs) patients across multiple domains of social cognition recognized by the recent NIMH consensus statement: theory of mind (ToM), social perception, social knowledge, attributional bias, emotion perception, and emotion processing. Method: We conducted a meta-analysis of peer-reviewed studies of social cognition in schizophrenia, published between 1980 and November, 2011. Results: 112 studies reporting results from 3908 SCs and 3570 NCs met our inclusion criteria. SCs performed worse than NCs across all domains, with large effects for social perception (g = 1.04), ToM (g = 0.96), emotion perception (g = 0.89), and emotion processing (g = 0.88). Regression analyses showed that statistically significant heterogeneity in effects within domains was not explained by age, education, or gender. Greater deficits in social and emotion perception were associated with inpatient status, and greater deficits in emotion processing were associated with longer illness duration. Conclusions: Despite the limitations of existing studies, including lack of standardization or psychometric validation of measures, the evidence for deficits across multiple social cognitive domains in schizophrenia is clear. Future research should examine the role of neurobiological and psychosocial factors in models linking various aspects of deficit in schizophrenia, including social cognition, in order to identify targets for intervention.
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TL;DR: Empirical empathy is considered as an example of a complex social cognitive function that integrates several social processes and is impaired in schizophrenia, and interventions to improve social cognition in patients with this disorder are considered.
Abstract: Individuals with schizophrenia exhibit impaired social cognition, which manifests as difficulties in identifying emotions, feeing connected to others, inferring people's thoughts and reacting emotionally to others. These social cognitive impairments interfere with social connections and are strong determinants of the degree of impaired daily functioning in such individuals. Here, we review recent findings from the fields of social cognition and social neuroscience and identify the social processes that are impaired in schizophrenia. We also consider empathy as an example of a complex social cognitive function that integrates several social processes and is impaired in schizophrenia. This information may guide interventions to improve social cognition in patients with this disorder.
982 citations
TL;DR: The paper reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches, and considers areas that are emerging and have the potential to provide future insights.
294 citations
TL;DR: It is concluded that MCT appears to be a worthwhile complement to pharmacotherapy, as the preliminary data suggest that the individual MCT format is especially effective in addressing symptoms, cognitive biases and insight.
267 citations
TL;DR: This meta-analysis demonstrates that MCT exerts a small to moderate effect on delusions and positive symptoms and a large effect on acceptance of the intervention.
Abstract: Metacognitive training (MCT) is a new, widely used intervention for psychosis. The present meta-analysis examines the efficacy of MCT in schizophrenia. Fifteen studies comparing effects of MCT on positive symptoms, delusions or acceptance of MCT with a control group were included in this meta-analysis. These studies comprised a total of 408 patients in the MCT condition and 399 in the control condition. The moderating effects of masking of outcome assessment, randomization, incomplete outcome data, use of an active control intervention, and individual vs group MCT were investigated. Possible effects of sensitivity analyses and publication bias were also examined. The results show a significant overall effect of MCT for positive symptoms (g = -0.34, 95% CI [-0.53, -0.15]), delusions (g = -0.41, 95% CI [-0.74, -0.07]) and acceptance of the intervention (g = -0.84, 95% CI [-1.37, -0.31]). Using only studies being at low risk for bias regarding randomization, masking and incomplete outcome data reduced effect sizes for positive symptoms and delusions (g = -0.28, 95% CI [-0.50, -0.06] and g = -0.18, 95% CI [-0.43, 0.06]), respectively. This meta-analysis demonstrates that MCT exerts a small to moderate effect on delusions and positive symptoms and a large effect on acceptance of the intervention. The effect on delusions is reduced, but remains significant when potential biases are considered.
197 citations
TL;DR: The results suggest that social cognitive deficits appear to be a core cognitive phenotype of many clinical conditions and a need to clarify the ‘real world’ impact of these deficits, and to develop effective transdiagnostic interventions for those individuals that are adversely affected.
193 citations
Cites background from "Deficits in Domains of Social Cogni..."
...Subsequently, deficits in both emotion recognition and ToM have been identified as core cognitive deficits in schizophrenia (Savla et al., 2013; Kohler et al., 2010), and have been reported to be among the strongest predictors of impaired social functioning in this population (Fett et al....
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...Subsequently, deficits in both emotion recognition and ToM have been identified as core cognitive deficits in schizophrenia (Savla et al., 2013; Kohler et al., 2010), and have been reported to be among the strongest predictors of impaired social functioning in this population (Fett et al., 2011;…...
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