Functional MRI examination of empathy for pain in people with schizophrenia reveals abnormal activation related to cognitive perspective-taking but typical activation linked to affective sharing.

BACKGROUND: Schizophrenia is associated with important disturbances in empathy that are related to everyday functioning. Empathy is classically defined as including affective (sharing others' emotions) and cognitive (taking others' cognitive perspectives) processes. In healthy individuals, studies on empathy for pain revealed specific brain systems associated with these sets of processes, notably the anterior middle cingulate (aMCC) and anterior insula (AI) for affective sharing and the bilateral temporoparietal junction (TPJ) for the cognitive processes, but the integrity of these systems in patients with schizophrenia remains uncertain. METHODS: Patients with schizophrenia and healthy controls performed a pain empathy task while undergoing fMRI scanning. Participants observed pictures of hands in either painful or nonpainful situations and rated the level of pain while imagining either themselves (self) or an unknown person (other) in these situations. RESULTS: We included 27 patients with schizophrenia and 21 healthy controls in our analyses. For the pain versus no pain contrast, patients showed overall typical activation patterns in the aMCC and AI, with only a small part of the aMCC showing reduced activation compared with controls. For the other versus self contrast, patients showed an abnormal modulation of activation in the TPJ bilaterally (extending to the posterior superior temporal sulcus, referred to as the TPJ/pSTS). LIMITATIONS: The design included an unnecessary manipulation of the visual perspective that reduced the number of trials for analysis. The sample size may not account for the heterogeneity of schizophrenia. CONCLUSION: People with schizophrenia showed relatively intact brain activation when observing others' pain, but showed abnormalities when asked to take the cognitive perspectives of others.

Improving Theory of Mind in Schizophrenia by Targeting Cognition and Metacognition with Computerized Cognitive Remediation: A Multiple Case Study.

Schizophrenia is associated with deficits in theory of mind (ToM) (i.e., the ability to infer the mental states of others) and cognition. Associations have often been reported between cognition and ToM, and ToM mediates the relationship between impaired cognition and impaired functioning in schizophrenia. Given that cognitive deficits could act as a limiting factor for ToM, this study investigated whether a cognitive remediation therapy (CRT) that targets nonsocial cognition and metacognition could improve ToM in schizophrenia. Four men with schizophrenia received CRT. Assessments of ToM, cognition, and metacognition were conducted at baseline and posttreatment as well as three months and 1 year later. Two patients reached a significant improvement in ToM immediately after treatment whereas at three months after treatment all four cases reached a significant improvement, which was maintained through 1 year after treatment for all three cases that remained in the study. Improvements in ToM were accompanied by significant improvements in the most severely impaired cognitive functions at baseline or by improvements in metacognition. This study establishes that a CRT program that does not explicitly target social abilities can improve ToM.

Social representations and contextual adjustments as two distinct components of the Theory of Mind brain network: Evidence from the REMICS task.

Theory of mind (ToM) refers to the ability to infer the mental states of others. Behavioral measures of ToM usually present information about both a character and the context in which this character is placed, and these different pieces of information can be used to infer the character's mental states. A set of brain regions designated as the ToM brain network is recognized to support (ToM) inferences. Different brain regions within that network could however support different ToM processes. This functional magnetic resonance imaging (fMRI) study aimed to distinguish the brain regions supporting two aspects inherent to many ToM tasks, i.e., the ability to infer or represent mental states and the ability to use the context to adjust these inferences. Nineteen healthy subjects were scanned during the REMICS task, a novel task designed to orthogonally manipulate mental state inferences (as opposed to physical inferences) and contextual adjustments of inferences (as opposed to inferences that do not require contextual adjustments). We observed that mental state inferences and contextual adjustments, which are important aspects of most behavioral ToM tasks, rely on distinct brain regions or subregions within the classical brain network activated in previous ToM research. Notably, an interesting dissociation emerged within the medial prefrontal cortex (mPFC) and temporo-parietal junctions (TPJ) such that the inferior part of these brain regions responded to mental state inferences while the superior part of these brain regions responded to the requirement for contextual adjustments. This study provides evidence that the overall set of brain regions activated during ToM tasks supports different processes, and highlights that cognitive processes related to contextual adjustments have an important role in ToM and should be further studied.

Changes in visual perspective influence brain activity patterns during cognitive perspective-taking of other people's pain.

Empathy refers to our capacity to share and understand the emotional states of others. It relies on two main processes according to existing models: an effortless affective sharing process based on neural resonance and a more effortful cognitive perspective-taking process enabling the ability to imagine and understand how others feel in specific situations. Until now, studies have focused on factors influencing the affective sharing process but little is known about those influencing the cognitive perspective-taking process and the related brain activations during vicarious pain. In the present fMRI study, we used the well-known physical pain observation task to examine whether the visual perspective can influence, in a bottom-up way, the brain regions involved in taking others' cognitive perspective to attribute their level of pain. We used a pseudo-dynamic version of this classic task which features hands in painful or neutral daily life situations while orthogonally manipulating: (1) the visual perspective with which hands were presented (first-person versus third-person conditions) and (2) the explicit instructions to imagine oneself or an unknown person in those situations (Self versus Other conditions). The cognitive perspective-taking process was investigated by comparing Other and Self conditions. When examined across both visual perspectives, this comparison showed no supra-threshold activation. Instead, the Other versus Self comparison led to a specific recruitment of the bilateral temporo-parietal junction when hands were presented according to a first-person (but not third-person) visual perspective. The present findings identify the visual perspective as a factor that modulates the neural activations related to cognitive perspective-taking during vicarious pain and show that this complex cognitive process can be influenced by perceptual stages of information processing.

Performance in multiple domains of social cognition in parents of patients with schizophrenia.

Social cognition refers to a set of cognitive abilities that allow us to perceive and interpret social stimuli. Social cognition is affected in schizophrenia and impairments have also been documented in unaffected relatives, suggesting that social cognition may be related to a genetic vulnerability to the disease. This study aims to investigate potential impairments in four domains of social cognition (mentalizing, emotion recognition, social knowledge and empathy) in the same group of relatives in order to gather a more complete picture of social cognition difficulties in this population. The Batterie Intégrée de Cognition Sociale (BICS) (mentalizing, emotion recognition, and social knowledge) and the Interpersonal Reactivity Index (IRI) (empathy) were administered to 31 parents of patients with a psychotic disorder and 38 healthy controls. Parents of patients performed significantly worse than controls on the mentalizing test but significantly better on the social knowledge test. No significant between-group differences were observed for emotion recognition and empathy. This study is the first to evaluate four social cognition domains in this population. The results precise which social cognition processes may be impaired or preserved in unaffected relatives of patients and lead us to propose an hypothesis about a mechanism that could underlie the mentalizing difficulties observed in this population.

A meta-analysis and scoping review of social cognition performance in social phobia, posttraumatic stress disorder and other anxiety disorders.

Social cognition deficits are observed in a variety of psychiatric illnesses. However, data concerning anxiety disorders are sparse and difficult to interpret. This meta-analysis aims at determining if social cognition is affected in social phobia (SP) or posttraumatic stress disorder (PTSD) compared to non-clinical controls and the specificity of such deficits relatively to other anxiety disorders. The scoping review aims to identify research gaps in the field. Forty studies assessing mentalizing, emotion recognition, social perception/knowledge or attributional style in anxiety disorders were included, totalizing 1417 anxious patients and 1321 non-clinical controls. Results indicate distinct patterns of social cognition impairments: people with PTSD show deficits in mentalizing (effect size d = -1.13) and emotion recognition (d = -1.6) while other anxiety disorders including SP showed attributional biases (d = -0.53 to d = -1.15). The scoping review identified several under investigated domains of social cognition in anxiety disorders. Some recommendations are expressed for future studies to explore the full range of social cognition in anxiety disorders and allow direct comparisons between different disorders.

Social cognition in first-degree relatives of people with schizophrenia: a meta-analysis.

Social cognition is affected in people with schizophrenia, but whether this is the case for healthy relatives of these patients is less clear. The presence of social cognition impairments in relatives would suggest a potential genetic role of social cognition in schizophrenia. To determine whether social cognition is affected in first-degree relatives of people with schizophrenia and examine the impact of potential moderator variables, a meta-analysis of studies investigating at least one domain of social cognition (mentalizing, emotional processing, social perception, social knowledge and/or attributional style) in adult first-degree relatives of patients with schizophrenia was performed. Our inclusion criteria were satisfied by 29 studies, of which 11 evaluated mentalizing, 20 emotional processing, and two social perception. Moderate mean effect sizes were obtained for these three components. Across all studies, effect sizes were significantly correlated with IQ and age differences between groups, calling for careful group matching for future studies. Overall, the results from this meta-analysis highlight that social cognition is globally affected in first-degree relatives of people with schizophrenia, suggesting that social cognition deficits in schizophrenia may be related to a genetic vulnerability for the disorder.

Impact of social anxiety on social cognition and functioning in patients with recent-onset schizophrenia spectrum disorders.

UNLABELLED: Schizophrenia patients display important rates of comorbid social anxiety disorder (SAD) but few studies have directly examined how SAD affects the presentation of schizophrenia, notably social cognition deficits and functioning. AIMS: To compare social cognition performance of schizophrenia patients who meet the diagnostic criteria for a comorbid SAD (SZ+) relative to patients without such comorbidity (SZ-) and to determine if the impact of social cognition performance on functioning is moderated by that comorbidity. METHOD: Social cognition performance (emotion recognition, social knowledge, and mentalizing), a control non-social reasoning task, as well as clinical symptoms and functioning were assessed in 26 patients with comorbid SAD (SZ+), 29 SZ- and 84 healthy controls. RESULTS: Patient groups significantly differed from each other on social knowledge performance, but not in levels of symptoms or overall functioning. Relative to healthy controls, SZ+ were impaired uniquely on mentalizing, whereas SZ- showed a more encompassing social cognition deficit that included mentalizing, social knowledge and non-social reasoning impairments. Mentalizing was the best predictor of functioning across both patient groups. Importantly, non-social reasoning negatively influenced mentalizing and in turn functioning only in the SZ- group. CONCLUSIONS: The overall pattern of results indicates common mentalizing deficits in SZ+ and SZ-; however, these deficits appear linked to different underlying deficits and different pathways to functional impact in the two patient subgroups. This study highlights some distinctive characteristics of schizophrenia patients with comorbid SAD and signals a need for further investigations into the sources of the mentalizing and functioning impairments in SZ+ patients.