Males and females with first episode psychosis present distinct profiles of social cognition and metacognition.

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis.

BACKGROUND: Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome. METHOD: A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition. RESULTS: Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032). CONCLUSIONS: MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.

Persons with first episode psychosis have distinct profiles of social cognition and metacognition.

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions.

Exploring the Components of Advanced Theory of Mind in Autism Spectrum Disorder.

Performance of a group of 35 youth and adults with High-Functioning Autism (HFA) was compared with a typical developing (TD) group on three Advanced Theory of Mind tests. The distinction between the social-cognitive and social-perceptual components of Theory of Mind was also explored. The HFA group had more difficulties in all tasks. Performance on the two social-cognitive tests was highly correlated in the HFA group, but these were not related with the social-perceptual component. These results suggest that the youth with HFA have difficulties on all the components of social knowledge but may be using different underlying cognitive abilities depending on the nature of the task.

Movie for the Assessment of Social Cognition (MASC): Spanish validation.

We present the Spanish validation of the "Movie for the Assessment of Social Cognition" instrument (MASC-SP). We recruited 22 adolescents and young adults with Asperger syndrome and 26 participants with typical development. The MASC-SP and three other social cognition instruments (Ekman Pictures of Facial Affect test, Reading the Mind in the Eyes Test, and Happé's Strange Stories) were administered to both groups. Individuals with Asperger syndrome had significantly lower scores in all measures of social cognition. The MASC-SP showed strong correlations with all three measures and relative independence of general cognitive functions. Internal consistency was optimal (0.86) and the test-retest was good. The MASC-SP is an ecologically valid and useful tool for assessing social cognition in the Spanish population.

Awareness of cognitive impairment in schizophrenia and its relationship to insight into illness.

BACKGROUND: Patients with schizophrenia have been found to show unawareness of cognitive impairment. However, its frequency and its relationship to lack of insight into illness are uncertain. METHOD: Forty-two patients with chronic schizophrenia were given tests of executive function and memory. Awareness of cognitive impairment was measured by means of discrepancy scores--differences between patient and psychologist ratings of memory and frontal/executive failures in daily life. Insight into illness was assessed using the Scale to Assess Unawareness of Mental Disorder (SUMD). RESULTS: A majority of the patients were found to underestimate their cognitive impairment; however, some overestimated it. Unawareness of cognitive impairment and lack of clinical insight loaded on different factors in a factor analysis, but these two factors were themselves correlated. CONCLUSIONS: The findings suggest that both unawareness and overestimation of cognitive impairment characterise patients with schizophrenia, although the former is more common. Awareness of cognitive impairment occurs independently of insight into illness at the clinical level, although the two phenomena may be linked at a deeper level.

[Spanish adaptation of the Scale to Asses Unawareness of Mental Disorder (SUMD)]. / Adaptación al español de la escala de valoración de la no conciencia de trastorno mental (SUMD).

INTRODUCTION: The aim of this paper is to examine the reliability and external validity of the Spanish adaptation of the Scale to Assess Unawareness of Mental Disorder (SUMD). METHOD: A translation-backtranslation of the original scale was elaborated, and a panel of professionals participated to assess conceptual equivalence and naturality. The scale consists of 3 general items: awareness of mental disorder, awareness of the effects of medication and awareness of the social consequences of the disorder; and of 17 items related to specific symptoms, which make up two subscales: awareness and attribution. Thirty-two patients diagnosed of schizophrenic or schizoaffective disorder following DSM-IV criteria were evaluated. The evaluations were performed using interviews with an observer. Intraclass Correlation Coefficient (ICC) was calculated for the reliability analysis and the Spearman correlation coefficient between the SUMD scores and one independent score of global insight for external validity. RESULTS: The ICC were all over 0.70. Convergent validity with the independent global measurement of insight was found for the general items of awareness of mental disorder and awareness of the effects of medication, and for the subscale on awareness of symptoms. The awareness of the social consequences of the disorder and the subscale on attribution did not correlate significantly with the global measurement of awareness (insight). These results are consistent with the hypothesis that awareness (insight) is a multidimensional phenomenon. CONCLUSION: The Spanish adaptation of the SUMD scale is conceptually equivalent and displays a similar reliability and external validity as the original version.

[Poor premorbid adjustment linked to deterioration in theory of mind skills: a study in stabilised schizophrenic patients]. / Ajuste premórbido pobre vinculado al deterioro en habilidades de teoría de la mente: estudio en pacientes esquizofrénicos estabilizados.

INTRODUCTION: Previous studies suggest that there is a deficit in theory of mind (ToM) in stabilised schizophrenic patients. More specifically, it has been claimed that poor premorbid adjustment covaries with the abnormalities in ToM skills detected in such patients. It has also been suggested that this deficit could be a trait marker for schizophrenic disorders. PATIENTS AND METHODS: The aim of this study was to examine the performance in mentalistic skills in 36 stabilised schizophrenic patients in comparison to a standard control group. We also sought to examine the relation between ToM skills and premorbid adjustment in our target sample. Premorbid adjustment was evaluated using the modified Cannon-Spoor premorbid adjustment scale, and ToM measurements were obtained by means of first- and second-order verbal experimental tasks. RESULTS: Schizophrenic patients presented statistically significant poorer performances in first- and second-order ToM tasks, although no differences were observed between these patients and the control sample as regards overall cognitive acuity. Poor premorbid adjustment in areas of social functioning in the patients was also associated with statistically significant poorer performance in both ToM tasks. CONCLUSIONS: Deficient premorbid adjustment in schizophrenia may be linked to a ToM deficit that can be assessed with simple tasks.

Subjective quality of life in schizophrenic outpatients in a Catalan urban site.

The aim of this cross-sectional study was to assess the subjective quality of life of chronic schizophrenic outpatients living in an urban site in Catalonia (Spain) during a stable phase of the illness. We included 44 patients with a DSM-IV diagnosis of psychotic disorder. Sociodemographic, clinical, and treatment variables were obtained and compared with the subjective quality of life as assessed by the Lehman Quality of Life Interview-short version. The descriptive analysis of the subjective quality of life profile obtained in our sample shows moderate levels of satisfaction in most subscales. Results regarding comparisons showed that sociodemographic, clinical, premorbid adjustment and treatment variables were only related to subjective quality of life in particular life domains and in a nonconclusive way. The need to include other relevant variables such as insight or psychological traits in the study of the quality of life phenomenon in schizophrenia is highlighted.