Social Connectedness in Schizotypy: The Role of Cognitive and Affective Empathy.

Social connectedness is increasingly understood to be a resilience factor that moderates vulnerability to poor physical and mental health. This study examines cognitive and affective processes that support normal socialization and social connectedness, and the impact of schizotypy, in well-functioning college students. In this study, a total of 824 college students completed a series of self-report questionnaires, and structural equation modeling was then employed to identify relationships between cognitive and affective empathy, alexithymia, distress tolerance, social connectedness, and schizotypy. Schizotypy is a trait-like condition, presumed to be genetic in origin, associated with the risk for schizophrenia. Like schizophrenia, schizotypy is thought to have three distinct dimensions or categories, termed positive, negative, and disorganized. Results indicate that the respective dimensions of schizotypy have different pathways to social connectedness, through both direct and indirect effects. Positive schizotypy exerts a counterintuitive positive influence on social connectedness, mediated by positive effects on cognitive empathy, but this is obscured by the high correlations between the schizotypal dimensions and the strong negative influences on empathy and social connectedness of the negative and disorganized dimensions, unless all those intercorrelations are taken into account. Overall, the pathways identified by structural equation modeling strongly support the role of empathy in mediating the impact of schizotypy on social connectedness. Implications for the etiology of social impairments in schizotypy, and for interventions to enhance social connectedness to improve quality of life and reduce health disparities in people at risk for severe mental illness, are discussed.

Treatment of Cognition in the Schizophrenia Spectrum: The Context of Psychiatric Rehabilitation.

Evidence-based approaches and modalities for targeting and treating the cognitive impairments of schizophrenia have proliferated over the past 15 years. The impairments targeted are distributed across the cognitive spectrum, from elemental perception, attention, and memory, to complex executive and social-cognitive functioning. Cognitive treatment is most beneficial when embedded in comprehensive programs of psychiatric rehabilitation. To personalize comprehensive treatment and rehabilitation of schizophrenia spectrum disorders, practitioners and participants must select from a rapidly expanding array of particular modalities and apply them in the broad context of the participant's overall recovery. At present, no particular treatment, cognitive or otherwise, can be considered more important or primary than the context in which it is applied. Persistent difficulty in dissemination of new technology for severe and disabling mental illness compounds the significance of the context created by a full treatment array. In this article, a case-study of a mental health service system is described, showing the broad-ranging effects of degrading the rehabilitative context of treatments, obviating the benefits of cognitive treatment and other modalities. To realize the promise of cognitive treatment, the problems that prevent dissemination and maintenance of complete psychiatric rehabilitation programs have to be addressed.

Emotional context processing in severe mental illness: scale development and preliminary construct validity.

There is growing recognition that emotional context may play an important role in emotion perception and severe mental illness (SMI). Limited instruments directly assess and adequately account for emotional context processing. To measure this construct in schizophrenia research, this study aimed to develop and validate the Emotional Context Processing Scale (ECOS) using cartoon portrayals originally developed by Masuda et al. (2008). In Study 1, we piloted the measure with 99 college students and selected 20 cartoon portrayals (4 simple emotions only+16 simple emotions with contextual emotions). In Study 2, we confirmed the emotion-specificity and factor structure of the measure by administering it to 73 individuals with SMI. Item response theory (IRT) modeling confirmed a 4-factor structure of the ECOS, providing evidence that emotional context processing is specific to particular emotions. Internal consistency of the ECOS subscales ranged from 0.61 to 0.83. In Study 3, we examined the convergent and divergent validity of the ECOS in a separate sample of 36 individuals with SMI. Even after controlling for facial affect perception, the ECOS is uniquely related to multi-modal emotion perception and executive functioning measures.

Child abuse rating system for archival information in severe mental illness.

BACKGROUND: Assessing and addressing child abuse histories are one of the grand challenges in psychiatric rehabilitation. Archival information, e.g., comprehensive psychosocial evaluations, objective testing, court documents, and medical chart information can provide useful and objective historical accounts. It is essential to develop a reliable and valid child abuse rating system for archival information. PURPOSE AND METHODS: This study aimed to examine the reliability and predictive validity of a highly structured and specific child abuse rating system used to code archival information for 150 psychiatric inpatients with severe mental illness (SMI). RESULTS: The child abuse rating system produced reliable ratings across raters and subtypes of child abuse were highly inter-related. More than half (56.5%) of the sample with SMI was identified to have one or more types of child abuse history; specifically, child sexual abuse (CSA, 36%), child physical abuse (CPA, 27.3%), emotional maltreatment (EM, 36%), failure to provide (FTP, 10.7%), and lack of supervision (LOS, 32%). Female participants (50%) with SMI had higher rates of CSA than male participants (20.8%). Subtypes of child abuse history were related to poorer premorbid functioning, but the relationships varied across different types of child abuse. In addition, CSA and EM were related to greater suspiciousness/hostility. CONCLUSION: The child abuse rating system for archival data fills an important gap in existing methodology and, in conjunction with a self-report measure, is expected to improve the assessment and understanding of the prevalence of child abuse among adults with SMI. Potential limitations and recommendations for future research are discussed.

Thinking about the future cognitive remediation therapy--what works and could we do better?

This article reviews progress in the development of effective cognitive remediation therapy (CRT) and its translational process. There is now enough evidence that cognitive difficulties experienced by people with schizophrenia can change and that the agenda for the next generation of studies is to increase these effects systematically through cognitive remediation. We examine the necessary steps and challenges of moving CRT to treatment dissemination. Theories which have been designed to explain the effects of cognitive remediation, are important but we conclude that they are not essential for dissemination which could progress in an empirical fashion. One apparent barrier is that cognitive remediation therapies look different on the surface. However, they still tend to use many of the same training procedures. The only important marker for outcome identified in the current studies seems to be the training emphasis. Some therapies concentrate on massed practice of cognitive functions, whereas others also use direct training of strategies. These may produce differing effects as noted in the most recent meta-analyses. We recommend attention to several critical issues in the next generation of empirical studies. These include developing more complex models of the therapy effects that take into account participant characteristics, specific and broad cognitive outcomes, the study design, as well as the specific and nonspecific effects of treatment, which have rarely been investigated in this empirical programme.