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 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.

Social cognition and social functioning in nonclinical paranoia.

INTRODUCTION: Persons with nonclinical paranoia show many of the same biases as those with clinical paranoia, suggesting that paranoia exists on a continuum. However, little is known about the various social cognitive processes found in paranoia and how these relate to social functioning and social behaviours in general. This study will examine performance on emotion perception and attributional style measures and their relationship to social functioning, social problem solving, and social skill. A key element in this study will be the incorporation of ambiguity in the perception of emotional expressions and the assignment of attributional blame, which appears to be an important, yet neglected, construct in paranoia. METHODS: Twenty-six persons with high levels of nonclinical paranoia and 31 persons with low levels of paranoia completed measures of emotion perception, attributional style, social functioning, and social problem solving. Salient and subtle emotional expressions were used to examine how ambiguity impacts emotion perception in paranoia. RESULTS: The group high in nonclinical paranoia showed reduced accuracy for subtle negative emotional expressions and showed more perceived hostility and blame for ambiguous social situations as compared to the group low in nonclinical paranoia. Also, the high nonclinical paranoia group reported less social engagement, fewer social contacts, and more problems in social perception and social skill than the group low in nonclinical paranoia. CONCLUSION: Social cognitive and social functioning biases are found in persons with high levels of nonclinical paranoia. Possible mechanisms of these biases and relevance for treatment approaches are discussed.

Effects of diminished positive mood and depressed mood upon verbal learning and memory among people with multiple sclerosis.

Objective: Cognitive impairment affects as many as 65% of people with multiple sclerosis (PWMS), and memory impairment confers greater severity of disability and functional impairment. Depression is also common among PWMS, and lifetime prevalence rates are as high as 50%. Research has yet to clearly define the relationship between memory dysfunction and depression among PWMS, and may reflect incomplete assessment of depressive symptoms. The present study examined different aspects of depressive symptoms including anhedonia (i.e., diminished positive mood) and their relationships with verbal learning and memory among PWMS.Method: Participants were 48 healthy individuals and 96 PWMS. They were primarily Caucasian (90.3%) and female (75.0%). Participants completed the California Verbal Learning Test-2 (CVLT-2) to assess verbal learning and memory and the Chicago Multiscale Depression inventory to assess depressed mood (CMDI-Mood) and diminished positive mood (CMDI-DPM).Results: Linear regression revealed that the main effect of CMDI-DPM and the interaction of CMDI-DPM and CMDI-Mood significantly explained variance across learning, recall, and recognition CVLT-2 indices. Follow-up analyses indicated that CMDI-DPM was only significant in the absence of high CMDI-Mood scores. CMDI-Mood explained variance in only CVLT-2 Trial B.Conclusions: Depressed mood had little direct effect upon memory performance in PWMS. In the absence of severe depressed mood, higher levels of positive mood corresponded to better memory performance. However, the impact of diminished positive mood was rendered null among those endorsing high levels of depressed mood. These data may imply that anhedonia corresponds with poorer memory function among PWMS, and suggests that investigators and clinicians should assess multiple mood dimensions among PWMS.

Perceptions of hostility by persons with and without persecutory delusions.

INTRODUCTION: Current models of paranoia propose that ambiguous situations, in which cues regarding the intentions of others are lacking, may be perceived as hostile by persons with persecutory delusions (PD). Thus, a social-cognitive bias for the perception of hostility may be present. In this study, the Ambiguous Intentions Hostility Questionnaire (AIHQ) was used to present situations that are ambiguous regarding the intentions of others. It was predicted that on the AIHQ, persons with PD would show greater levels of perceived hostility, blame, and aggression than both psychiatric and nonpsychiatric controls. METHODS: The sample comprised 32 persons with PD, 28 persons without PD (psychiatric controls), and 50 healthy participants (nonpsychiatric controls). Participants completed the AIHQ along with measures of paranoia, attributional style, depression, anxiety, self-esteem, and public self-consciousness. RESULTS: As predicted, the group with PD showed greater perceptions of hostility, blame, and aggression scores for ambiguous situations on the AIHQ. Also, the AIHQ Hostility bias score was predictive of paranoid ideation. CONCLUSIONS: Persons with PD showed a social-cognitive bias for perceiving hostility in ambiguous situations. The bias appears to be specific as it was not found in the psychiatric or nonpsychiatric control groups. Suggestions for future research are discussed.

Attentional-shaping as a means to improve emotion perception deficits in schizophrenia.

Inability to recognize emotional expressions of others (emotion perception) is one of the most common impairments observed among individuals with schizophrenia. Such deficits presumably contribute much to the social dysfunction characteristic of schizophrenia. This study examined the efficacy of a novel attentional-shaping intervention to improve emotion perception abilities. Sixty participants with schizophrenia were randomly assigned to one of three intervention conditions: 1) attentional-shaping, 2) contingent monetary reinforcement, or 3) repeated practice. Participants completed the Face Emotion Identification Test (FEIT) at pre-test, intervention, post-test, and one week follow-up. Participants also completed the Bell-Lysaker Emotion Recognition Test (BLERT) and the Social Behavior Scale at pre-test and follow-up to measure generalization. The results showed that the attentional-shaping condition had significantly higher scores on the FEIT at intervention, post-test, and follow-up compared to monetary reinforcement and repeated practice. Improvement was also found on the BLERT and a trend was found for improved social behaviors at one-week follow-up. Results will be discussed in terms of face scanning and attentional deficits present in schizophrenia and potential uses of this intervention in the remediation of emotion perception deficits.

Subtypes of social perception deficits in schizophrenia.

Persons with schizophrenia exhibit consistent deficits in emotion perception (recognizing the emotional expressions of others), but it is currently unclear if their performance represents a specific deficit in identifying emotions only or is a more generalized deficit across different perception tasks. To address this question, it is important to compare emotion perception with face and general visual perception to assess the type of deficit present. The equivocal nature of previous research may suggest the presence of subtypes with different levels and patterns of performance on social perception measures. In this study, we administered measures of emotion, face, and general perception to a sample of 100 persons with schizophrenia. These scores were then subjected to a cluster analysis to determine if different subtypes were present. Two distinct subtypes were identified, and both subtypes scored lower than normal controls across all three measures of perception, suggesting the presence of a generalized performance deficit. One subtype was characterized by mild to moderate impairment and the other showed more severe impairment. The cluster solution was stable, and the subtypes also differed on other variables not used in the cluster analysis (external validation). More specifically, persons in the mild to moderately impaired subtype reported fewer positive symptoms, and this subtype contained more persons with paranoid schizophrenia as compared to the more severely impaired subtype. The implications of the results for the study of social cognition in schizophrenia are discussed.

Social Cognition and Interaction Training (SCIT) for inpatients with schizophrenia spectrum disorders: preliminary findings.

Individuals with schizophrenia exhibit consistent deficits in social cognition such as emotion perception, attributional style, and theory of mind, which may be targets of psychosocial treatments. Previous intervention studies have typically focused on only one aspect of social cognition and have not assessed generalization of treatment to improvements in social functioning. This paper describes preliminary data from a new group-based treatment, Social Cognition and Interaction Training (SCIT), aimed at improving social cognition in schizophrenia. Eighteen inpatients with schizophrenia spectrum disorders completed SCIT and were compared with 10 inpatients who completed a coping skills group. Participants were assessed at pre-test and post-test on measures of emotion and social perception, theory of mind, attributional style (e.g., blame, hostility, and aggression), cognitive flexibility, and social relationships. We also collected data on the frequency of aggressive incidents on the treatment ward. The results showed that compared to the control group, SCIT participants improved on all of the social cognitive measures and showed better self-reported social relationships and fewer aggressive incidents on the treatment unit at post-test. Importantly, this change was independent of changes in clinical symptoms over time and supports the unique role of SCIT in improving social cognitive deficits in schizophrenia.

Capacity for financial decision making in multiple sclerosis.

INTRODUCTION: Cognitive impairment often occurs in people with multiple sclerosis (MS), and dysfunction involving executive function, new learning, and working memory is especially common. Compromised activities of daily living are linked to this cognitive impairment, and people with MS are apt to be unemployed and struggle to manage domestic responsibilities. Financial decision making is an important activity of daily living, and no study has examined whether it is compromised by neuropsychological dysfunction in people with MS. METHOD: A battery of neuropsychological tests and a measure of financial decision making (Financial Capacity Instrument, FCI: Marson, D. C. 2001. Loss of financial capacity in dementia: Conceptual and empirical approaches. Aging, Neuropsychology, and Cognition, 8, 164-181) were administered to 50 participants (34 patients with MS and 16 cognitively healthy adults). Based on the neuropsychological test results, 14 patients were classified as having cognitive impairment, and 20 had no significant impairment. RESULTS: The impaired MS patients performed significantly worse than unimpaired patients and the healthy comparison group on most financial tasks. The impaired group retained abilities to count money and display adequate financial judgment. Regression analyses showed that measures of mental flexibility and working memory correlated most strongly with performance on the FCI domains across groups. CONCLUSIONS: Cognitively impaired patients with MS have degraded financial skills, which are linked to executive function and working memory deficits.

The conviction of delusional beliefs scale: reliability and validity.

This study reports on the development of a new measure of delusional belief conviction, the Conviction of Delusional Beliefs Scale (CDBS). Most of the current scales in use assess belief conviction with a single item and primarily reflect the cognitive aspects of conviction. The CDBS represents an improvement over existing scales in that it contains a larger number of test items that can be subjected to psychometric examination. In addition, the CDBS also broadens the concept of belief conviction by incorporating cognitive, emotional, and behavioral items. In the present study, fifty participants with delusions completed the CDBS along with measures of delusional ideation, psychiatric symptomatology, insight, and reading ability. The CDBS showed very good levels of internal consistency and test-retest stability over a six-week period. All of the CDBS items loaded highly on a unitary factor of belief conviction. The CDBS positively correlated with four measures of belief conviction thereby reflecting the convergent validity of the scale. The CDBS was unrelated to other dimensions of delusional ideation, psychiatric symptomatology, insight, and reading ability, which supported the discriminant validity of the scale. The CDBS appears to be a reliable and valid measure of delusional belief conviction that could be used in clinical and research settings.

Paranoia and emotion perception across the continuum.

OBJECTIVES: Persons with high levels of paranoid ideation may be more sensitive to emotional stimuli, particularly negative emotions, reflecting the operation of a paranoid schema. However, this finding has not been consistently supported and needs further study. This study examined the effect of paranoia, as measured on a continuum, on emotion perception. It was predicted that higher levels of paranoia would be associated with improved emotion perception scores with better recognition for negative emotions than positive. DESIGN: A four-group ANOVA design was used to compare participants with clinical and sub-clinical paranoia to reflect the continuum view of paranoia. METHODS: A group with persecutory delusions (N=30) was compared with three sub-clinical groups (N=88) on two posed emotion perception tasks. The sub-clinical participants were divided into high, moderate, and low groups based on scores from the Paranoia Scale, a widely used measure of sub-clinical paranoia. RESULTS: Persons with persecutory delusions had lower overall emotion perception scores than all of the sub-clinical groups. For negative emotions, persons with persecutory delusions had lower identification scores than the moderate and low sub-clinical groups, but were no different than the high sub-clinical group. Anger was especially problematic for clinical participants. There were no differences for positive emotions. CONCLUSIONS: Instead of an enhanced sensitivity for the recognition of emotional states, higher levels of paranoia were linked to a performance deficit on emotion perception tasks. The deficits in emotion perception may reflect the increased skepticism and scrutiny associated with posed emotion tasks (Davis & Gibson, 2000). Research should begin to focus on the underlying mechanisms of emotion perception deficits in paranoia.

Informed consent in schizophrenia: the use of cues in the assessment of understanding.

The purpose of this study was to determine if providing cues could facilitate participant understanding for consent form information. Understanding scores were measured in a group of participants diagnosed with schizophrenia and a control group using cued recognition and uncued recall methods. When understanding was measured with uncued methods, persons with schizophrenia showed lower scores compared to the control group. However, when cues were provided, there was no difference between the two groups on understanding scores, and persons with schizophrenia showed normal levels of understanding. The results suggest that cued methods may be a better alternative to measure participant understanding.

Staying on the job: The relationship between work performance and cognition in individuals diagnosed with multiple sclerosis.

People with multiple sclerosis (MS) are apt to become unemployed as the disease progresses, and most research implies that this is due to diminishing mobility. Some studies have shown that presence of cognitive impairment also predicts employment status. Yet, no studies have examined how neuropsychological factors predict vocational performance among individuals with MS who remain employed. We assessed employer- and self-rated work performance, mobility status, and neuropsychological function in a sample of 44 individuals diagnosed with MS. Results suggest that cognitive impairment is common in these employed individuals, despite largely intact mobility status. Moreover, a significant interaction emerged, such that cognitively impaired individuals' work performance was rated more poorly by supervisors. In contrast, self-ratings of work performance were higher in cognitively impaired than in unimpaired participants. These novel findings suggest that cognitive impairment may influence work performance, even in patients whose physical disability status is relatively intact.

The role of subclinical paranoia on social perception and behavior.

The purpose of this study was to investigate the effects of subclinical paranoia on social perception and behavior. Two groups of participants, those high and low in subclinical paranoia, were identified based on extreme scores on the Paranoia Scale (PS). As expected, persons high in subclinical paranoia had greater depression, social anxiety, self-consciousness, and lower self-esteem compared to persons low in subclinical paranoia. In addition, persons high in subclinical paranoia performed worse than persons low in subclinical paranoia on laboratory measures of emotion perception and on an in vivo social perception task. Finally, behavioral differences between these two groups were revealed: Persons high in subclinical paranoia sat further away from the examiner and took longer to read the consent form than low-paranoia persons. These behavioral differences were not due to the group differences in clinical functioning, indicating that level of paranoia generally accounted for these findings.

The role of attention in affect perception: an examination of Mirsky's four factor model of attention in chronic schizophrenia.

Attentional skills among people with schizophrenia may be related to deficits in affect perception. Such deficits can dramatically inhibit appropriate social functioning. We examined attention and affect perception in a sample of 65 people diagnosed with chronic schizophrenia. We used Mirsky's four factor model of attention to assess attentional functioning. To measure affect perception, we used two reliable measures of emotion recognition, the Bell-Lysaker Emotion Recognition Test and the Face Emotion Identification Test. Multiple regression analysis showed that all four attentional factors and a diagnosis of paranoid schizophrenia were significantly predictive of affect perception scores. In contrast, psychiatric symptoms, medication levels, demographic variables, verbal fluency, and face recognition scores were not predictive of affect perception scores. The four factors of attention accounted for 78 percent of the variance in affect perception scores. These results emphasize the role that attentional abilities play in affect perception for people with schizophrenia.

The role of temporal lobe and orbitofrontal cortices in olfactory memory function.

Differences in verbal and nonverbal olfactory identification and recognition were examined among three groups with brain impairment. A left cerebrovascular accident (LCVA) group, a right CVA (RCVA) group, and a traumatic brain injury (TBI) group were compared with two nonimpaired age-matched comparison groups on olfaction identification and recognition abilities. Odors were presented to the left and right nostrils, which maximized hemispheric differences in olfactory processing. Results showed that persons with LCVA demonstrated the greatest impairment on the verbal identification of odors, while persons with RCVA showed the most impairment on the nonverbal identification of odors. Persons with TBI showed an inconsistent impairment across both verbal and nonverbal odor identification tasks. Odor recognition was impaired in both CVA groups as well. In contrast, persons with TBI performed better on the delayed odor recognition tasks. Results are discussed in relation to hemispheric differences in processing olfactory information.

Ethnic differences in subclinical paranoia: an expansion of norms of the paranoia scale.

The Paranoia Scale (PS) was designed to assess subclinical paranoid ideation (A. Fenigstein & P. A. Vanable, 1992). Despite its established validity, the PS has several problems that need to be addressed. There are no normative data on ethnic minority groups such as African Americans, making it difficult to interpret this group's performance on the PS. Data from the present research revealed that African Americans scored higher on the PS than non-Hispanic Whites. However, interpretation of these findings should be tempered as they may reflect other contextual factors such as discrimination and the impact of racism. Implications for using the PS with African Americans and possible explanations for the observed results were discussed.

Pain is associated with prospective memory dysfunction in multiple sclerosis.

Prospective memory (PM) pertains to the execution of a future goal or behavior. Initial research implies that people with multiple sclerosis (MS) are apt to show impaired prospective memory for activities of daily living. Yet, PM impairment does not occur in all people with MS. Thus, some other variable besides disease status alone may contribute to PM dysfunction in people with MS. Chronic pain may be such a variable. Approximately 50-70% of people with MS experience significant pain, and such pain has been thought to diminish memory function. To investigate this possibility, 96 patients with MS and 29 healthy subjects were administered the Memory for Intentions Screening Test (MIST; Woods, S. P., Iudicello, J. E., Moran, L. M, Carey, C. L., Dawson, M. S., & Grant, I. (2008). HIV-associated prospective memory impairment increases risk of dependence in everyday functioning. Neuropsychology, 22, 110-117.), a well-validated measure of prospective memory, and the Medical Outcomes Study Pain Effects Scale (PES; Fischer, J. S., Rudick, R. A., Cutter, G. R., & Reingold, S. C. (1999). The multiple sclerosis functional composite measure (MSFC): An integrated approach to MS clinical outcome assessment. National MS Society Clinical Outcomes Assessment Task Force. Multiple Sclerosis, 5, 244-250.) to assess chronic pain. After controlling for demographic variables and disability severity, subjective pain accounted for significant variance in PM, particularly for time-based intentions over sustained delay periods. These data accord well with assertions that pain may degrade ability to remember new intentions and suggests that pain is associated with PM dysfunction in people with MS.