Assessing social skills in individuals at ultra-high risk for psychosis: Validation of the High Risk Social Challenge task (HiSoC).

BACKGROUND: Individuals at ultra-high risk (UHR) for psychosis exhibit deficits in social functioning that may relate to efficacy of social skills performance. There is, though, a scarcity of objective measures assessing social skills performance in the UHR state. This study assessed the psychometric properties of a relatively new social skills measure, the High Risk Social Challenge Task (HiSoC), in an UHR population. METHODS: Exploratory factor analysis was used to assess the factor structure of the HiSoC task in 102 UHR individuals and 66 healthy controls (HC). Convergent and discriminant validity of the HiSoC was assessed. RESULTS: Our findings revealed a three-factor structure comprising the factors "Affect", "Odd Behaviour and Language", and "Social-Interpersonal". The test showed excellent inter-rater reliability (ICC between 0.88 and 0.98). The HiSoC correlated significantly, as expected, with measures of global and social functioning demonstrating construct validity and utility as a social skills assessment tool in the UHR population. The HiSoC task discriminated between UHR and HC with large effect sizes (Cohen's d range=1.40-1.94). DISCUSSION: Our findings provide evidence for a three-factor structure of the HiSoC task corresponding to the original American version of the task. Additionally, our findings reveal the HiSoC to be sensitive to social skills impairments in the UHR population and suggest it to be a suitable screening tool for social skills deficits in UHR states. The robust correlations with real-life functioning indicate social skills to be an important target for assessment and intervention within the UHR population.

Observable Social Cognition--A Rating Scale: an interview-based assessment for schizophrenia.

INTRODUCTION: Individuals with schizophrenia consistently show impairments in social cognition (SC). SC has become a potential treatment target due to its association with functional outcomes. An alternative method of assessment is to administer an observer-based scale incorporating an informant's "first hand" impressions in ratings. METHODS: The present study used the Observable Social Cognition: A Rating Scale (OSCARS) in 62 outpatients and 50 non-psychiatric controls (NPCs) to assess performance in domains of SC (e.g. emotion perception, theory of mind). RESULTS: The OSCARS demonstrated sufficient internal consistency and test-retest reliability. Construct validity was assessed through an exploratory factor analysis. Patient OSCARS indices were not significantly correlated with measures of SC with the exception of aggressive attributional style. Individuals with less impairment in SC reacted more aggressively to ambiguous situations. NPC OSCARS were significantly correlated with measures of theory of mind and attributional style. In a combined sample of patients and controls, six of eight items were significantly correlated with the SC task assessing the same domain, providing modest evidence of convergent validity. In patients, the OSCARS was significantly correlated with measures of functional outcome and neurocognition. Last, the OSCARS was found to be significantly associated with functional outcome after the influence of objective measures of SC was statistically removed. CONCLUSIONS: The present study provides preliminary evidence that the OSCARS may be useful for clinicians in collecting data about patients' potential real-world SC deficits, in turn increasing the degree to which these impairments may be targeted in treatment.

A pilot six-week randomized controlled trial of oxytocin on social cognition and social skills in schizophrenia.

The current study explored whether oxytocin can improve social cognition and social skills in individuals with schizophrenia using a six-week, double-blind design. Fourteen participants with schizophrenia were randomized to receive either intranasal oxytocin or a placebo solution and completed a battery of social cognitive, social skills and clinical psychiatric symptom measures. Results showed within group improvements in fear recognition, perspective taking, and a reduction in negative symptoms in the oxytocin group. These preliminary findings indicate oxytocin treatment may help improve certain components of functioning in schizophrenia. Implications for the treatment of social functioning in schizophrenia are discussed.

A randomized, controlled trial of Social Cognition and Interaction Training (SCIT) for outpatients with schizophrenia spectrum disorders.

OBJECTIVES: In schizophrenia, the ability to adaptively infer the thoughts and feelings of others (i.e., social cognition) is strongly associated with community functioning. Researchers have designed psychosocial interventions to improve social cognition with the aim of improving downstream social functioning. Social Cognition and Interaction Training (SCIT) is one such intervention. Previous research on SCIT has been promising, but has consisted largely of smaller trials with insufficient experimental control. DESIGN: Randomized, controlled trial. METHODS: The current article reports on a controlled trial of 66 adults with schizophrenia randomized to receive either SCIT (n = 33), delivered in weekly group sessions, or treatment as usual (n = 33) for 6 months. Participants completed assessments of social cognition, social functioning, neurocognition and symptoms at baseline, post-treatment, and 3-month follow-up. RESULTS: Primary analyses suggest that SCIT may improve social functioning, negative symptoms, and possibly hostile attributional bias. Post-hoc analyses suggest a dose-response effect. CONCLUSIONS: Findings are discussed in the context of continuing to refine and improve social cognitive interventions for schizophrenia. PRACTITIONER POINTS: Social cognitive intervention is a feasible and promising approach to improving social functioning among individuals with schizophrenia-spectrum disorders. Dose-response findings suggest that delivering social cognitive interventions with greater frequency may maximize their benefit to patients. Research on social cognitive interventions is still young and effects from well-controlled trials have been inconsistent. It is not yet clear which components of social cognitive training may be the key active ingredients.

Intranasal oxytocin reduces psychotic symptoms and improves Theory of Mind and social perception in schizophrenia.

Oxytocin has numerous prosocial and antipsychotic-like effects in animals. Prosocial effects of acute intranasal oxytocin administration have also been reported in human subjects. We conducted a randomized, placebo-controlled trial testing the effects of twice daily intranasal oxytocin treatment for 14 days on psychotic symptoms and social cognition in patients with schizophrenia. PANSS scores declined significantly and several social cognition measures improved significantly or nearly significantly in oxytocin (N=11) but not placebo (N=9) recipients. Our results suggest that, in addition to reducing classic psychotic symptoms, oxytocin may diminish certain social cognition deficits that are not improved by current antipsychotic medications.

Social skill and social cognition in adolescents at genetic risk for psychosis.

Adolescents at genetic high risk (GHR) for schizophrenia have shown social skill impairments and there is some evidence to suggest they have Theory of Mind (ToM) deficits; however no research has used a standardized, performance-based behavioral measure to assess social functioning in this population nor evaluated ToM with a well-validated measure. We evaluated the psychometric properties of a new, theoretically-derived assessment of social functioning in GHR adolescents: the "High-Risk Social Challenge" task (HiSoC). The second aim was to explore whether GHR adolescents would show social skill and ToM deficits as compared to a non-psychiatric control (NPC) group. The present study evaluated social functioning with the HiSoC and ToM with the Eyes Test in 23 GHR adolescents and 31 NPCs. The HiSoC demonstrated high levels of reliability and validity. The GHR adolescents showed social skill impairments, but not ToM deficits. The results suggest that the HiSoC is a potentially useful new measure of social functioning in GHR adolescents. Furthermore, the findings add to the current body of literature that indicates that social skill impairments are related to schizophrenia vulnerability.