Linking social cognition with social interaction: Non-verbal expressivity, social competence and "mentalising" in patients with schizophrenia spectrum disorders.

BACKGROUND: Research has shown that patients with schizophrenia spectrum disorders (SSD) can be distinguished from controls on the basis of their non-verbal expression. For example, patients with SSD use facial expressions less than normals to invite and sustain social interaction. Here, we sought to examine whether non-verbal expressivity in patients corresponds with their impoverished social competence and neurocognition. METHOD: Fifty patients with SSD were videotaped during interviews. Non-verbal expressivity was evaluated using the Ethological Coding System for Interviews (ECSI). Social competence was measured using the Social Behaviour Scale and psychopathology was rated using the Positive and Negative Symptom Scale. Neurocognitive variables included measures of IQ, executive functioning, and two mentalising tasks, which tapped into the ability to appreciate mental states of story characters. RESULTS: Non-verbal expressivity was reduced in patients relative to controls. Lack of "prosocial" nonverbal signals was associated with poor social competence and, partially, with impaired understanding of others' minds, but not with non-social cognition or medication. CONCLUSION: This is the first study to link deficits in non-verbal expressivity to levels of social skills and awareness of others' thoughts and intentions in patients with SSD.

Theory of mind in schizophrenia: the role of clinical symptomatology and neurocognition in understanding other people's thoughts and intentions.

A wealth of studies has demonstrated that patients with schizophrenia are impaired in "theory of mind" (ToM). Here, we used a novel five-factor model of the Positive and Negative Syndrome Scale (PANSS) to test the hypothesis that selectivity of ToM deficits in schizophrenia depends on the predominating symptoms. We predicted that ToM impairments would be non-selective in patients with pronounced negative (NF) or disorganized symptoms (DF), whereas selective ToM impairment would occur in patients with predominant positive symptoms (PF). We recruited 50 patients diagnosed with schizophrenia or schizoaffective disorder and examined premorbid intelligence, executive functioning, ToM and psychopathology in comparison to a group of 29 healthy controls. Compared with healthy controls, patients performed more poorly on tasks involving executive functioning and ToM abilities. Using a novel PANSS five-factor model, we found a significant association of ToM deficits with the "disorganization" factor. Moreover, several individual PANSS items that were included within the disorganization factor correlated with impaired ToM, albeit the majority of correlations disappeared when controlled for executive functioning, and, to a lesser degree, when controlled for IQ. In addition, in the patient group we found interactions of poor ToM with symptoms belonging to the "emotional distress" factor of the PANSS. Contrary to expectations, associations of impaired ToM with positive symptoms were absent, and poor with regards to negative symptoms. This study lends further support to the assumption of differential associations of ToM deficits with individual symptoms and symptom clusters in schizophrenia.

Nonverbal behavior during standardized interviews in patients with schizophrenia spectrum disorders.

Several studies have consistently shown that patients with schizophrenia or schizophrenia spectrum disorders (SSD) can be distinguished from normal controls on the basis of their nonverbal behavior during standardized interviews, with considerable interactions between negative symptoms and poor facial expressivity. However, most studies have examined unmedicated patients, and gender of both interviewer and interviewee has not been taken into account. In this study we assessed the nonverbal behavior of male and female patients with SSD who were receiving second-generation antipsychotic medication (SGA) using the Ethological Coding System for Interviews (Troisi, 1998). In addition, we used a novel 5-factor model of the Positive and Negative Symptom Scale (PANSS, van der Gaag et al., 2006) to correlate nonverbal behavior with standard psychopathology ratings. Our findings strongly resembled results of previous studies into nonverbal behavior of patients with SSD, despite differences in cultural backgrounds and gender of the interviewer. Negative symptoms were inversely correlated with several of the nonverbal behavioral dimensions. Medication dose did not correlate with any one of the behavioral or psychopathological measures. Patients with SSD make less use of their nonverbal behavioral repertoire compared with controls, independent of antipsychotic treatment. Culture-specific nonverbal expressivity seems to play an additional (minor) role in distinguishing patients from healthy controls.

Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best?

BACKGROUND: Research into mental state attribution has repeatedly shown that patients with schizophrenia are impaired in their capacity to reflect upon their own and others' beliefs, knowledge and intentions, with important confounds being executive functioning, intelligence, duration of illness, and medication. Furthermore, the extent to which impaired mental state attribution, neurocognition and psychopathology explain abnormal social behavior in schizophrenic patients has been a matter of debate. We sought to determine whether mental state attribution in schizophrenia predicts poor social competence better than "non-social" cognitive factors or psychopathology. METHODS: Intelligence, executive functioning, mental state attribution, psychopathology and social behavior were assessed in 38 patients diagnosed with schizophrenia according to DSM-IV criteria and compared with 29 healthy controls paralleled for age and sex. All patients received antipsychotic treatment, and all participants had no history of substance abuse or traumatic brain injury. RESULTS: In the entire schizophrenia group impaired mental state attribution alone accounted for about 50% of the variance of deviant social behavior, whereas the PANSS positive score and the duration of illness contributed an additional small amount of variance. This effect was even more pronounced in a subgroup of patients with at least normal intelligence, where neither the PANSS score nor the chronicity of the disorder remained significant predictors of poor social competence. Medication was not associated with any one of the neurocognitive measures including mental state attribution, psychopathology or social behavior. CONCLUSIONS: Impaired capacity to appreciate one's own and others' mental states is the single-best predictor of poor social competence in schizophrenia, and should perhaps be included in future definitions of the "core" symptomatology of schizophrenic disorders.