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.

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.

Attribution bias and social anxiety in schizophrenia.

Studies on attribution biases in schizophrenia have produced mixed results, whereas such biases have been more consistently reported in people with anxiety disorders. Anxiety comorbidities are frequent in schizophrenia, in particular social anxiety disorder, which could influence their patterns of attribution biases. The objective of the present study was thus to determine if individuals with schizophrenia and a comorbid social anxiety disorder (SZ+) show distinct attribution biases as compared with individuals with schizophrenia without social anxiety (SZ-) and healthy controls. Attribution biases were assessed with the Internal, Personal, and Situational Attributions Questionnaire in 41 individual with schizophrenia and 41 healthy controls. Results revealed the lack of the normal externalizing bias in SZ+, whereas SZ- did not significantly differ from healthy controls on this dimension. The personalizing bias was not influenced by social anxiety but was in contrast linked with delusions, with a greater personalizing bias in individuals with current delusions. Future studies on attribution biases in schizophrenia should carefully document symptom presentation, including social anxiety.

Social anxiety disorder in recent onset schizophrenia spectrum disorders: The relation with symptomatology, anxiety, and social rank.

Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia, but questions remain regarding how this comorbidity is related to symptomatology and self-perceptions. Forty-two patients with recent-onset schizophrenia were evaluated for SAD, and assessed with the Positive and Negative Syndrome Scale (PANSS), as well as the Social Comparison Scale (SCS), which assessed how participants perceived themselves in relation with others (i.e., social rank). Eighteen patients met criteria for SAD (SZ+) while 24 patients did not (SZ-). Analysis of symptoms using a five-factor model of the PANSS revealed that the SZ- group had more severe symptoms than SZ+ on the Cognitive/Disorganization factor. Further analyses of individual symptoms demonstrated that the SZ- group was more affected in attention, abstract thinking, and cognitive disorganization (Cognitive/Disorganization symptoms), while the SZ+ group was more severely affected in anxiety, suspiciousness/persecution, and active social avoidance. Interestingly, severity of social anxiety symptom ratings correlated with certain PANSS symptoms only in the SZ- group. Perception of social rank, which was reduced in SZ+, displayed a trend level correlation with the positive symptoms in SZ-. Overall, the results suggest that SZ+ and SZ- may have different clinical profiles that could be important to consider when tailoring treatments for these patients.