[Social cognition in schizophrenia and autism spectrum disorder: Points of convergence and functional differences]. / Cognition sociale dans la schizophrénie et les troubles du spectre de l'autisme : points de convergences et différences fonctionnelles.

INTRODUCTION: Schizophrenia and autistic spectrum disorder (ASD) are two neurodevelopmental disorders that have different symptom presentations, ages of onset and developmental courses. Both schizophrenia and ASD are characterized by marked deficit in communication, social interactions, affects and emotions. Social cognitive impairments in ASD and schizophrenia were demonstrated separately in both disorders. It was reported that these impairments have direct relation with social deficits of both disorders. The apparent similarity between social cognition impairments in ASD and schizophrenia highlights questions about the existence of common or different neurocognitive mechanisms related to social dysfunctions. In order to examine these questions, the present article provides a comprehensive review of all published studies which directly compare individuals with ASD and schizophrenia on the same cognitive tasks of social cognition. METHODS: The article search was made on Pubmed, PsycInfo and ScienceDirect, with the items: "autism", "Asperger syndrome", "schizophrenia", "social cognition", "theory of mind", "emotional processing", "social perception", "attributions style". All published studies which compared individuals with ASD and schizophrenia, (diagnosed according to DSM-IV (APA, 1994) criteria and IQ≥70), included control group were considered. The cognitive tasks were categorized according to four domains of social cognition defined by SCOPE (Pinkham et al., 2013): theory of mind (ToM), emotional processing (EP), social perception (SP) and attributional style/bias. The results were analyzed in terms of performances, cognitive profile and patterns of neural activations. Twenty-one published studies and two meta-analytic reviews were analyzed. RESULTS: Cognitive performance analysis confirms the convergence of abnormalities of people with autism and people with schizophrenia on 1st and 2nd order theory of mind, emotion processing and social perception. Quantitative results show reduced performance in ASD compared to SZ and Ct groups. Differences were observed between ASD and SZ regarding social situation comprehension, visual orientation and visuospatial exploration strategies, and attributional style highlighting different strategies on intentional process. Brain imaging studies show that people with autism present a reduced cerebral activity in several key regions of theory of mind (cingulate regions, superior temporal sulcus, paracentral lobule), and emotional treatment (primary and secondary somatosensory regions), while people with SZ exhibit an inappropriate increased activity in these regions. CONCLUSION: The present revue of the studies which directly compare individuals with ASD and schizophrenia on different domains of social cognition indicates that both disorders exhibit differences and similarities with regard to behavioral performances. Results in neuroimaging indicate different neurocognitive mechanisms underlie apparently similar social-cognitive impairments. Further studies are needed to better explore and describe divergent neurocognitive mechanisms in ASD and schizophrenia in order to provide treatment and remediation methods that take into account the specificities of neurocognitive processes in the two disorders.

[Can we do therapy without a therapist? Active components of computer-based CBT for depression]. / Peut-on faire une TCC sans thérapeute ? Composantes actives des TCC informatisées pour la dépression.

OBJECTIVES: Computer-delivered Cognitive Behavioral Therapies (C-CBT) are emerging as therapeutic techniques which contribute to overcome the barriers of health care access in adult populations with depression. The C-CBTs provide CBT techniques in a highly structured format comprising a number of educational lessons, homework, multimedia illustrations and supplementary materials via interactive computer interfaces. Programs are often administrated with a minimal or regular support provided by a clinician or a technician via email, telephone, online forums, or during face-to-face consultations. However, a lot of C-CBT is provided without any therapeutic support. Several reports showed that C-CBTs, both guided or unguided by a therapist, may be reliable and effective for patients with depression, and their use was recommended as part of the first step of the clinical care. The aim of the present qualitative review is to describe the operational format and functioning of five of the most cited unguided C-CBT programs for depression, to analyze their characteristics according to the CBT's principles, and to discuss the results of the randomized clinical trials (RCT) conducted to evaluate its effectiveness, adherence and user's experience. METHODS: We analyzed five C-CBTs: Beating The Blues (BTB), MoodGYM, Sadness, Deprexis and Overcoming Depression on the Internet (ODIN) and 22 randomized controlled studies according to 5 dimensions: General characteristics; Methodology, structure and organization; Specific modules, themes and techniques: Clinical indications, recruitment mode, type of users with depression, type and mode of therapist's support, overall therapeutic effects, adherence and user's experience. RESULTS: The C-CBT have a secured free or pay-to-use access in different languages (English, German, Dutch, and Chinese) but not in French. The programs may be accessed at a medical center or at home via a CD-ROM or via an Internet connection. Some C-CBTs are very close to textual self-helps provided via an E-learning mode (Sadness, MoodGYM, ODIN), others adopt interactive software technologies (Deprexis, BTB), but their interactivity and the possibility of personalization is low. The C-CBTs use similar principles and techniques as in face-to -face CBT (e.g. self-evaluation, psychoeducation, cognitive restructuring, cognitive restructuring of schema, behavioral activation and agenda setting, problem solving techniques, communication and crisis management techniques, relaxation, principles of positive psychology and relapse prevention, positive reinforcement methods, motivational feedbacks, social learning, homework assignments and progress monitoring). The results of the 22 RCSs showed that both the effectiveness and the adherence of the unguided C-CBT is high with self-referred active help-seekers with major depression, but the latter is low with users who are depressed out-patients referred by general practitioners or clinicians. The presence of therapist support improves the effectiveness and the adherence of the C-CBT, especially in clinical out-patients. CONCLUSIONS: In light of the existing insight of the advantages and the inconvenient of the C-CBT, the actual challenge is to find its optimal clinical indication and the modality of its effective use in clinical populations.

Behavioral measures and event-related potentials reveal different aspects of sentence processing and comprehension in patients with major depression.

BACKGROUND: We used the method of event-related potentials (ERPs) during standard semantic judgment task to explore the functional relationship between the deficit in semantic comprehension in women with depression and the potential dysfunction of brain processes mediating language comprehension. METHOD: Eleven patients with major depression and 13 healthy participants were required to read congruous and incongruous sentences and to judge if they made sense. Accuracy and reaction times for semantic judgment were analyzed conjointly with the latency and the peak amplitudes of N100, P200, N400 and LPC components which were recorded at the final word of correctly judged sentences. RESULTS: Patients were less accurate in semantic judgment in comparison to healthy participants. They exhibited slower reaction times and prolonged latency of the N400 and the LPC. A congruity effect was observed in both groups in P200, N400 and LPC interval. The peak amplitude of the ERP components did not differ between patients and healthy participants. In patients lower accuracy was correlated with more prolonged N400 latency and more negative N400 amplitude for congruous sentence endings. Age correlated with prolonged latency and amplitude reduction of the LPC component. LIMITATIONS: Small number of participants, exclusively female patients. CONCLUSIONS: Combined analyses of behavior and ERP measures of semantic processes in depression showed that semantic impairments, motor slowness and a delay in the timing of neural processes which mediate language comprehension might be functionally related and may be influenced by the age of the patients.

[The understanding of metaphors in schizophrenia and depression. An experimental approach]. / La compréhension des métaphores dans la schizophrénie et la dépression. Une approche expérimentale.

INTRODUCTION: Since the first clinical descriptions of schizophrenia, clinical practitioners have been interested in the difficulties experienced by patients with schizophrenia in interpreting the meaning of metaphors. A long tradition of proverb tests intended either for clinical or experimental use, has revealed that the difficulties in metaphor interpretation experienced by patients with schizophrenia refer to a large number of different types of interpretational errors (eg literality, concretism, or autistic, idiosyncratic and bizarre responses). A number of studies have adopted an experimental approach to investigating the dynamics of the cognitive processes that underlie the difficulties in accessing figurative meaning experienced by patients with schizophrenia. However, limited in the way they operationalise these phenomena and/or by their psycho-linguistic reference models, these studies have focused on only one aspect of metaphor: for example, multiple-choice tasks have tested the tendency of patients with schizophrenia to interpret metaphors literally ("literality bias"), whereas lexical decision tasks have investigated the importance that such patients attach to a single word in the expression ("concretism"). The first aim of our study was to investigate, in parallel and without confound, the respective contributions of the literality and concretism biases in the interpretation of metaphor in patients with schizophrenia. The second aim was to examine the question of the specificity of difficulties in accessing figurative meaning in patients with schizophrenia by comparing their performance profiles with those of patients with depression. The third aim was to examine the influence of the patients' clinical symptomatology on their result profiles. METHOD: The participants consisted of 25 patients with schizophrenia (DSM IV, 1994), 18 patients with major depression (DSM IV) and 22 healthy controls. All the participants were matched on socio-demographic variables (age, vocabulary level and level of education). The participants had to complete a task consisting of 10 metaphorical sentences (eg "Ce milieu est un panier de crabes"=lit. "This place is a basket of crabs", fig. "What a bunch of sharks"). The participants had to choose only one word from a set of 4 responses: the figurative meaning (eg "magouille"=dishonest person), the literal meaning (eg "vivier"="pond"), the concrete meaning of the final word (eg "crustacé"="crustacean") and one unassociated word (eg "journal"=newspaper). The inter-group comparison and the symptomatic assessment of the patients (PANSS, Kay et al., 1987, TLC, Andreasen et al. 1979 for the schizo-phrenic and HAMD, Hamilton, 1960 and ERD, Widlöcher, 1983 for the depressive patients) made it possible to investigate the specificity of these difficulties in metaphor understanding amongst patients with schizophrenia, together with the effect of the severity of the symptomatology on the response profiles. RESULTS: The results reveal that the literality bias and concreteness bias influenced the interpretation of metaphors in both groups of patients when compared with the control subjects. Furthermore, the results reveal a common bias towards literal responses (11%) and to concrete responses (4%) among both the patients with schizophrenia and those with depression. An important finding of our study is the heterogeneity of the performance observed in the schizo-phrenic and the depressive patients. Amongst the patients with schizophrenia, erroneous metaphor interpretation was influenced by the severity of the formal thought disorders (Andreasen et al., 1979), whereas in the patients with depression, it depended on the severity of the depressive symptomatology (Hamilton, 1960) and the psychomotor-retardation (Widlöcher, 1983). DISCUSSION: This study represents a preliminary stage in studying metaphor understanding among patients with schizophrenia and major depression, and addresses new questions for further research, which may enhance exploration of the cognitive bases of these disorders.

Neurocognitive processing of emotion facial expressions in individuals with self-reported depressive symptoms: the role of personality and anxiety.

AIMS OF THE STUDY: Neurocognition may constitute one of the numerous factors that mediate the reciprocal influences between personality and depression. The present study explored the influence of personality and anxiety traits on the neurocognitive processing of emotional faces and specifically focused on personal characteristics related to negative (harm avoidance - HA) and positive affectivity (self-directedness - SD) and to anxiety. MATERIAL AND METHODS: Twenty participants with self-reported depressive symptoms and 18 control participants were selected based on their BDI-II scores. Personality (TCI-R), anxiety and attention were measured and event-related potentials (ERPs) were recorded during an implicit emotional face perception task (fear, sadness, happiness, neutrality). RESULTS: The participants who self-reported depressive symptoms had higher HA, lower SD and higher anxiety compared to controls. Controls showed enhanced P300 and LPP amplitudes for fear. Individuals with self-reported depression showed reduced ERPs amplitudes for happiness. HA did not account for the difference between the groups but high HA and high anxiety were positively correlated with enhanced P300 amplitude for fear in participants with depressive symptoms. In contrast, SD accounted for the difference between the groups but was not correlated to the ERP components' amplitudes recorded for facial expressions. Other personality dimensions (reward dependence, cooperativeness) influenced the ERPs recorded for facial emotions. CONCLUSION: Personality dimensions influence the neurocognitive processing of emotional faces in individuals with self-reported depressive symptoms, which may constitute a cognitive vulnerability to depression.