Dissociation of understanding from applying others' false beliefs in remitted schizophrenia: evidence from a computerized referential communication task.

BACKGROUND: In research on theory of mind (ToM), false belief paradigms are commonly used. Previous studies have reported that there is heterogeneity in the magnitude of impairment on false belief tasks. Moreover, intact ability to attribute others' false beliefs has been widely reported in patients with remitted schizophrenia. Increasingly, evidence suggests that there may be different cognitive mechanisms underlying the understanding others' false beliefs versus applying one's knowledge of others' false beliefs. Since the role of psychotic symptoms in ToM impairments is an important issue in the study of ToM deficits in schizophrenia, we examined both remitted schizophrenia and non-remitted schizophrenia, with the aim to investigate whether psychotic symptoms in schizophrenia are associated with deficits in understanding others' mental states or difficulties in applying this understanding. METHODS: The present study investigated 29 patients with non-remitted schizophrenia, 19 patients with remitted schizophrenia, and 22 healthy controls with a revised computerized referential communication task. The ability to understand others' false beliefs and the ability to apply others' false beliefs were measured separately. RESULTS: Patients with non-remitted schizophrenia performed significantly worse than patients with remitted schizophrenia and healthy controls on a task of understanding others' false beliefs, whereas no significant difference was found between the patients with remitted schizophrenia and healthy controls. Both the patients with non-remitted schizophrenia and patients with remitted schizophrenia performed significantly worse than healthy controls on a task of applying others' false beliefs. CONCLUSIONS: Our findings suggested a dissociation of understanding others' false beliefs from applying others' false beliefs in remitted schizophrenia. We preliminarily conclude that deficits in the ToM ability of applying knowledge of others' mental states might be state-dependent.

[Natural outcome and risk-prediction model of late-life depression].

OBJECTIVE: To investigate the prevalence and natural outcome of late-life depression in the community and to analyze the risk-prediction models. METHODS: A community in Hang Zhou was selected as a trial. A total of 1 275 persons aged 60 or more in this community were screened by PHQ-9 questionnaire; SCID was used for interviewer to diagnostic interview the people whose PHQ-9 was more than 10 points, 50 % of those whose PHQ-9 was from 5 to 9 points and 5 % of those whose PHQ-9 was less than 5 points, then all those who accepted diagnostically interview were interviewed by PHQ-9 every 3 months in one year, and were diagnostic interviewed by SCID in the last month. Logistic regression analysis was used to explore depressive risk factors in 12 months. RESULTS: There were 141 (11.1%) persons whose PHQ-9 score was more than 10 points, 298 (23.4%) whose PHQ-9 score were 5-9 points, and 836 (65.5%) whose PHQ-9 score were 0 to 4 points in the preliminary survey, 93 were major depressive disorder (MDD). The prevalence of late-life depression was 7.3%. Compared with the PHQ-9 score in one year, 17.6% of those with no depressive symptoms emerged depression; 50% of those who had depressive symptoms declined, 9% developed to significant depressive symptoms, and 41% did not change; 12% of those with significant depressive symptoms were found no depression, 24% reduced, and 64% still had depression. The significant predictors were the accumulation of disease, social support, educational level, daily capacity and baseline of depression. CONCLUSION: The prevalence of late-life depression was high. The rates of recognition, diagnosis and treatment were low. The natural outcome after a year did not relieve apparently. Specialist-community health partnership management model is one of the important ways to prevent and treat late-life depression.