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    Impact of childhood trauma on sensorimotor gating in Chinese patients with chronic schizophrenia. Li Xianbin,Tian Qing,Bo Qijing,Zhang Guangping,Zheng Wei,Wen Yujie,Tang Yilang,Wang Chuanyue Psychiatry research We investigated the relationship between childhood trauma (CT) and sensorimotor gating in Chinese patients diagnosed with chronic schizophrenia. Seventy-five patients were assessed with the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and then the modified paradigm, perceived spatial separation-induced prepulse inhibition (PSS PPI) and the perceived spatial co-location PPI (PSC PPI or classical PPI) were applied to test sensorimotor gating. Startling stimuli (90 dB) were presented either alone or preceded by discrete prepulse stimuli of 4 dB in a background 60-dB noise level. Associations between CT and various PPI paradigms were statistically analyzed. Univariate analysis revealed the absence of a significant correlation between CT and PPI paradigms (p > 0.05). However, multiple linear regression analyses revealed that sexual abuse and the positive and negative syndrome scale (PANSS) score were negatively correlated with PSS PPI (p = 0.029 and 0.008, respectively). On the other hand, female sex and history of smoking were positively correlated with PSS PPI (p = 0.044 and 0.043, respectively). In conclusion, the results of this study suggest that CT can be a predisposing factor that affects sensorimotor gating in schizophrenia patients. 10.1016/j.psychres.2018.01.037
    Prevalence of osteoporosis in schizophrenia patients using the osteoporosis self-assessment tool for Asians. Subramaniam Aditya,Lim Susan,Abdin Edimansyah,Chong Siow Ann Journal of mental health (Abingdon, England) OBJECTIVE:The aims of the current study were to investigate the prevalence and socio-demographic correlates of risk of osteoporosis in Singapore among patients with schizophrenia using the osteoporosis self-assessment tool for Asians (OSTA). METHOD:Data for the current study was drawn from a clinical database maintained at the Institute of Mental Health Singapore. The OSTA index was used to calculate the risk for osteoporosis among those aged 50 years and above. RESULTS:A total of 2569 patients were included in the study. About 34.6% met the criteria for osteoporosis using the OSTA cut-off of ≤ -1. Among the males 22.8% met criteria for high risk and 1.5% met criteria for very high risk, while among women 28.2% were at intermediate risk and 14.9% were at high risk of osteoporosis. The logistic regression analysis showed that older age and female gender were significantly associated with a higher risk of osteoporosis, while those with a history of hypertension and hyperlipidemia were less likely to be associated with a risk of osteoporosis. CONCLUSION:The OSTA could be a useful, inexpensive and quick tool to both identify those with osteoporosis as well as to measure the effectiveness of interventions meant to alleviate it. 10.3109/09638237.2016.1167850
    Sex Differences in the Prevalence and Clinical Features of Comorbid Depressive Symptoms in Never-Treated Chinese Patients With First-Episode Schizophrenia. Wang Dong-Mei,Zhang Guang-Ya,Du Xiang-Dong,Jia Qiu-Fang,Qian Zheng-Kang,Yin Guang-Zhong,Chen Da-Chun,Xiu Mei-Hong,Ning Yu-Ping,Huang Xing-Bing,Wu Feng-Chun,Zhang Xiang-Yang The Journal of clinical psychiatry BACKGROUND:Many studies have indicated a sex-specific effect in many aspects of schizophrenia. The presence of depressive symptomatology exists in all phases of schizophrenia. The aim of this study is to investigate the sex differences in the proportion of comorbid depressive symptoms and sex-specific relationships between depressive symptoms and clinical correlates in never-treated Chinese patients with first-episode schizophrenia (NTFE patients), which have not been reported yet. METHODS:Via a cross-sectional design, 240 NTFE inpatients (male/female = 111/129) between ages 16 and 45 years and meeting DSM-IV-TR criteria of schizophrenia were recruited. The Positive and Negative Syndrome Scale (PANSS) was used for the psychopathology, and the 17-item Hamilton Depression Rating Scale (HDRS-17) for the comorbid depressive symptoms. This study was conducted from June 2013 to December 2015. RESULTS:The proportion of patients with depressive symptoms (total score on HDRS-17 ≥ 8) in men was significantly higher than in women (male: 62.2%, female: 48.1%; χ²₁ = 4.28, P = .039). Male patients had significantly greater depressive symptoms as shown on the HDRS-17 than female patients (t1, 238 = 2.75, P = .006). Further, we found that age, the age at onset, smoking rate, and PANSS total and general psychopathology, negative symptoms, and cognitive factor subscores favored significant sex differences in female patients (all P < .05). Interestingly, we found sex differences in the correlation between the HDRS-17 score and clinical phenotype, showing that in male patients, the PANSS general psychopathology subscore (β = 0.75, t = 7.72, P < .001) and total score (β = 0.44, t = 4.81, P < .001) significantly predicted the HDRS-17 total score, while in female patients, the PANSS general psychopathology subscore (β = 0.74, t = 8.45, P < .001), total score (β = 0.47, t = 5.71, P < .001), and cognitive factor subscore (β = 0.24, t = 2.60, P < .001) significantly predicted the HDRS-17 total score. CONCLUSIONS:Our results indicate sex differences in the frequency and severity of comorbid depressive symptoms and in associations between depressive symptoms and clinical correlates in NTFE patients. 10.4088/JCP.19m12780
    Prevalence, Sociodemographic, and Clinical Correlates of Older Chinese Patients With Deficit Schizophrenia. Liu Junjun,He Jinfeng,Cheng Min,Cao Hui,Zhang Xiangrong Journal of geriatric psychiatry and neurology OBJECTIVE:No study has investigated the frequency and risk factors for deficit schizophrenia (DS) in Chinese Han population. We investigated the prevalence of DS among community-dwelling older Chinese patients with schizophrenia and examined the sociodemographic and clinical correlates of DS in this population. METHODS:A total of 326 community-dwelling older patients with schizophrenia were recruited in this cross-sectional study. Deficit schizophrenia was confirmed using the Chinese version of the Schedule for the Deficit Syndrome. Data pertaining to sociodemographic and clinical characteristics were collected. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS). RESULTS:The prevalence of DS in the study population was 26.7% (31.2% among male patients and 21.6% among female patients with schizophrenia). Patients with DS had significantly higher current smoking rate, hospitalizations, PANSS negative score, PANSS total score, and had earlier age at onset than patients with non-deficit schizophrenia (N-DS). The N-DS patients had higher PANSS positive scores and a greater proportion of married patients. Multiple logistic regression analysis indicated that negative PANSS score (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.04-1.16, < .001), male sex (OR = 1.71, 95% CI = 1.53-1.91, = .037), age at onset (OR = 0.88, 95% CI = 0.82-0.94, = .035), and current smoking (OR = 1.37, 95% CI = 1.15-1.63, = .041) were independently associated with DS. CONCLUSION:Deficit schizophrenia is relatively common among older community-dwelling Chinese patients with schizophrenia. High negative symptom scores, male sex, early onset, and smoking were independent correlates for DS. 10.1177/0891988719870321
    Prevalence and clinical demography of hyperhomocysteinemia in Han Chinese patients with schizophrenia. Yang Yating,Wang Juan,Xiong Zulun,Yao Xianhu,Zhang Yulong,Ning Xiaoshuai,Zhong Yi,Liu Zhiwei,Zhang Yelei,Zhao Tongtong,Xia Lei,Zhang Kai,Liu Huanzhong European archives of psychiatry and clinical neuroscience Previous studies have shown that high homocysteine worsens the occurrence, symptoms, and prognosis of patients with schizophrenia. The purpose of this study was to evaluate the prevalence, clinical correlation, and demographic characteristics of hyperhomocysteinemia in Han Chinese schizophrenia patients. In this study, we enrolled 330 schizophrenia patients and 190 healthy controls. Positive and Negative Syndrome Scale (PANSS) was used to evaluate the psychiatric symptoms of patients with schizophrenia. The plasma homocysteine level was measured by the enzyme cycle method and the concentration of homocysteine > 15 μmol/L was defined as hyperhomocysteinemia. The prevalence of hyperhomocysteinemia in Han Chinese schizophrenia patients and healthy controls was 55.05% and 26.98%, respectively. Schizophrenia patients with hyperhomocysteinemia had more male proportion, older age, higher smoking rate, lower HDL level, higher PANSS total score, and higher negative factor than those patients without hyperhomocysteinemia. Binary logical regression result showed that gender and age were the independent risk factors of hyperhomocysteinemia. Han Chinese patients with schizophrenia had high prevalence hyperhomocysteinemia than healthy controls, and elderly male patients have a higher risk of hyperhomocysteinemia. This study was registered in the China Clinical Trial Registration Center (chiCTR 1800017044). 10.1007/s00406-020-01150-x
    Quality of life in stable schizophrenia: the relative contributions of disorganization and cognitive dysfunction. Sigaudo Monica,Crivelli Barbara,Castagna Filomena,Giugiario Michela,Mingrone Cinzia,Montemagni Cristiana,Rocca Giuseppe,Rocca Paola Schizophrenia research OBJECTIVE:The purpose of this study was to examine the relative contributions of disorganization and cognitive dysfunction to quality of life (QOL) in patients with stable schizophrenia. METHODS:A total of 276 consecutive outpatients with stable schizophrenia were enrolled in a cross-sectional study. We performed a mediation analysis to assess the specific effect of disorganization on QOL, as assessed by the Heinrichs-Carpenter Quality of Life Scale (QLS), and the possible mediating role of cognitive dysfunction. RESULTS:Our findings were as follows: (i) disorganization was negatively related to the total QLS score; (ii) disorganization was negatively related to two of the four QLS domains, namely the role-functioning domain (occupational/educational) and the intrapsychic functioning domain (e.g., motivation, curiosity, and empathy); and (iii) verbal memory was a partial mediator of the relationship between disorganization and QLS (the total score and the two above-mentioned domains). CONCLUSIONS:Disorganization demonstrated direct and indirect effects via verbal memory on two domains of functioning, as measured by the QLS. These results highlight the importance of improving disorganization and cognition (particularly verbal memory) to improve the functional outcomes of patients with schizophrenia. 10.1016/j.schres.2014.01.013
    The Relation Between Empathy and Insight in Psychiatric Disorders: Phenomenological, Etiological, and Neuro-Functional Mechanisms. Thirioux Bérangère,Harika-Germaneau Ghina,Langbour Nicolas,Jaafari Nematollah Frontiers in psychiatry Lack of insight, i.e., unawareness of one's mental illness, is frequently encountered in psychiatric conditions. Insight is the capacity to recognize (psychical insight) and accept one's mental illness (emotional insight). Insight growth necessitates developing an objective perspective on one's subjective pathological experiences. Therefore, insight has been posited to require undamaged self-reflexion and cognitive perspective-taking capacities. These enable patients to look objectively at themselves from the imagined perspective of someone else. Preserved theory-of-mind performances have been reported to positively impact insight in psychosis. However, some patients with schizophrenia or obsessive-compulsive disorders, although recognizing their mental disease, are still not convinced of this and do not accept it. Hence, perspective-taking explains psychical insight (recognition) but not emotional insight (acceptance). Here, we propose a new conceptual model. We hypothesize that insight growth relies upon the association of intact self-reflexion and empathic capacities. Empathy (feeling into someone else) integrates heterocentered visuo-spatial perspective (feeling ), embodiment, affective ( into) and cognitive processes, leading to internally experience the other's thought. We posit that this subjective experience enables to better understand the other's thought about oneself and to affectively adhere to this. We propose that the process of objectification, resulting from empathic heterocentered, embodiment, and cognitive processes, generates an objective viewpoint on oneself. It enables to recognize one's mental illness and positively impacts psychical insight. The process of subjectification, resulting from empathic affective processes, enables to accept one's illness and positively impacts emotional insight. That is, affectively experiencing the thought of another person about oneself reinforces the adhesion of the emotional system to the objective recognition of the disease. Applying our model to different psychiatric disorders, we predict that the negative effect of impaired self-reflexion and empathic capacities on insight is a transnosographic state and that endophenotypical differences modulate this common state, determining a psychiatric disease as specific. 10.3389/fpsyt.2019.00966
    Alexithymia Is a Key Mediator of the Relationship Between Magical Thinking and Empathy. Eddy Clare M,Hansen Peter C Frontiers in psychiatry Thought action fusion (TAF), whereby internal thoughts are perceived to exert equivalent effects to external actions, is a form of magical thinking. Psychiatric disorders associated with TAF (e.g. schizophrenia; obsessive compulsive disorder) can feature atypical social cognition. We explored relationships between TAF and empathy in 273 healthy young adults. TAF was directly correlated with higher personal distress, but not perspective taking, fantasy or empathic concern. TAF moral (the belief that thinking about an action/behaviour is morally equivalent to actually performing that behaviour) was predicted by emotion contagion, alexithymia and need for closure. TAF likelihood (the belief that simply having a thought about an event makes that event more likely to occur) was predicted by personal distress, sense of agency and alexithymia. Both cognitive (TAF and negative sense of agency) and emotional (emotion contagion, alexithymia) factors contributed to personal distress. TAF, negative sense of agency and personal distress mediated the effect of emotion contagion on alexithymia. Our findings reveal complex relationships between emotional processes and TAF, shedding further light on the social cognitive profile of disorders associated with magical thinking. Furthermore, they emphasise the potential importance of alexithymia and emotion contagion as mediators or potential risk factors in the development of psychiatric symptoms linked to TAF, such as intrusive thoughts about harm to others. 10.3389/fpsyt.2021.719961
    Female specific anterior cingulate abnormality and its association with empathic disability in schizophrenia. Fujiwara Hironobu,Shimizu Mitsuaki,Hirao Kazuyuki,Miyata Jun,Namiki Chihiro,Sawamoto Nobukatsu,Fukuyama Hidenao,Hayashi Takuji,Murai Toshiya Progress in neuro-psychopharmacology & biological psychiatry Evidence suggests that impairments of empathy are present in schizophrenia and that such deficits lead to social dysfunction. However, the relationship between brain morphological abnormalities of the disorder and empathic disabilities has not been fully investigated. As the anterior cingulate cortex (ACC) is one of the critical structures for empathy processing, the pathology of this structure might be a major source of social dysfunction, including interpersonal miscommunication in schizophrenia. In addition, as recent studies suggest that different facets of empathic ability depend on different subdivisions of the ACC, pathology of each subdivision would affect the empathic disability of schizophrenia differentially. Structural MRI data were acquired at 3.0 T from 24 schizophrenic patients and 20 healthy participants, and the volumes of ventral and dorsal ACC were measured and compared between the groups. Subjects' empathic abilities were evaluated using a multidimensional questionnaire, the Interpersonal Reactivity Index (IRI). The relationships of structural abnormalities with empathic disabilities were investigated, by correlating ACC subdivisional volumes with each IRI subscale score. Female schizophrenic patients exhibited volume reductions in the ventral ACC bilaterally and in the left dorsal ACC compared with healthy subjects. Schizophrenic patients performed poorly on fantasy and personal distress subscales of the IRI. Furthermore, volumes of the left dorsal ACC were inversely correlated with personal distress subscale scores within female patients with schizophrenia. These results suggest that pathology of specific ACC subdivisions would have an impact on specific empathic disabilities in schizophrenia, with potential gender specificity. 10.1016/j.pnpbp.2008.07.013
    Neuroimaging studies of social cognition in schizophrenia. Fujiwara Hironobu,Yassin Walid,Murai Toshiya Psychiatry and clinical neurosciences Impaired social cognition is considered a core contributor to unfavorable psychosocial functioning in schizophrenia. Rather than being a unitary process, social cognition is a collection of multifaceted processes that recruit multiple brain structures, thus structural and functional neuroimaging techniques are ideal methodologies for revealing the underlying pathophysiology of impaired social cognition. Many neuroimaging studies have suggested that in addition to white-matter deficits, schizophrenia is associated with decreased gray-matter volume in multiple brain areas, especially fronto-temporal and limbic regions. However, few schizophrenia studies have examined associations between brain abnormalities and social cognitive disabilities. During the last decade, we have investigated structural brain abnormalities in schizophrenia using high-resolution magnetic resonance imaging, and our findings have been confirmed by us and others. By assessing different types of social cognitive abilities, structural abnormalities in multiple brain regions have been found to be associated with disabilities in social cognition, such as recognition of facial emotion, theory of mind, and empathy. These structural deficits have also been associated with alexithymia and quality of life in ways that are closely related to the social cognitive disabilities found in schizophrenia. Here, we overview a series of neuroimaging studies from our laboratory that exemplify current research into this topic, and discuss how it can be further tackled using recent advances in neuroimaging technology. 10.1111/pcn.12258
    Effect of a socıal defeat experıence on prefrontal actıvıty ın schızophrenıa. Baskak Bora,Baran Zeynel,Devrimci-Özgüven Halise,Münir Kerim,Öner Özgür,Özel-Kızıl Tuğba Psychiatry research The social defeat (SD) hypothesis of schizophrenia posits that repeated experiences of SD may lead to sensitization of the mesolimbic dopaminergic system and to precipitation of psychosis. Based on previous definitions adapted to a human experimental paradigm, we prepared a computer simulation of SD to mimic this subjective experience. We measured prefrontal cortex (PFC) activity in subjects with schizophrenia and healthy controls during exposure to a single SD experience with functional near infrared spectroscopy. PFC activity declined in both groups. Compared with the control condition, SD exposure was associated with a broader decline in left ventromedial, right medial and right lateral PFC activity in healthy controls (n=25), and a sharper decline in right ventrolateral PFC activity in subjects with schizophrenia (n=25). The activity in the right ventrolateral PFC, was significantly lower in patients compared with controls. This may be due to a deficiency in emotion regulation or self-control, or it may be related to impaired empathy in schizophrenia. Different patterns of brain activity during the SD experience in subjects with schizophrenia versus healthy controls may provide indirect evidence regarding the SD hypothesis of schizophrenia. 10.1016/j.pscychresns.2015.07.017
    Self-reported empathic abilities in schizophrenia. Montag C,Heinz A,Kunz D,Gallinat J Schizophrenia research BACKGROUND:Increasing evidence indicates impairments of empathic abilities in schizophrenia that may impact outcome and course of the disease. While there is consensus on the presence of deficits in 'theory of mind' in this disorder, i.e. cognitive aspects of mental state attribution, the ability to infer emotional experiences of others, i.e. affective empathy, has not been investigated so far. METHODS:We assessed multiple dimensions of empathy in 45 schizophrenic patients and 45 healthy controls, matched for age and gender, with a self-rating instrument, the Interpersonal Reactivity Index (IRI). To control for modulating effects of cognitive deficits, a neuropsychological test battery was employed. RESULTS:Schizophrenic patients showed significantly lower scores in cognitive empathy ('perspective taking': F=12.176, df=1, p=0.001) but more self-related aversive feelings in response to the distress of others ('personal distress: F=16.477, df=1, p<0.001). Self-ratings of affective empathy, i.e. concern for others, did not differ between groups. Results in the domains of empathy were not explained by symptoms or neurocognition as revealed by regression analysis. However, lower scores in 'perspective taking' were found with advancing duration of illness (r=-0.453, p=0.002). CONCLUSIONS:Results indicate reductions of cognitive empathy but relatively preserved emotional empathic abilities in schizophrenia. Although previous studies observed deficits in emotion perception and expression, our findings support the concept of differentially disturbed abilities in cognitive and emotional empathy in schizophrenia. 10.1016/j.schres.2007.01.024
    Cortical activity measured by functional near infrared spectroscopy during a theory of mind task in subjects with schizophrenia, bipolar disorder and healthy controls. Sayar-Akaslan Damla,Baskak Bora,Kir Yagmur,Kusman Adnan,Yalcinkaya Busra,Çakmak Işık Batuhan,Munir Kerim Journal of affective disorders Theory of Mind (ToM) deficits interfere in social cognitive functioning in schizophrenia (SCZ) and are increasingly recognized to do so in bipolar disorder (BD), however their clinical and neurobiological correlates remain unclear. This study represents the first direct comparison of subjects with SCZ (N = 26), BD (N = 26) and healthy controls (N = 33) in cortical activity during the Reading the Mind in the Eyes Task (RMET) using functional Near Infrared Spectroscopy (fNIRS) with the control condition (CC) involving gender identification via the same stimuli. The three groups were compared with a comprehensive ToM battery and assessed in terms of the relationship of ToM performance with clinical symptoms, insight and functioning. The controls scored higher than the SCZ and BD groups in ToM assessments, with SCZ group showing the worse performance in terms of meta-representation and empathy. The SCZ group ToM scores inversely correlated with negative symptom severity and positively correlated with insight; BD group ToM scores negatively correlated with subclinical mania symptoms and projected functioning. Cortical activity was higher during the ToM condition compared to the CC in the pre-motor and supplementary-motor cortices, middle and superior temporal gyri, and the primary somatosensory cortex. Group x Condition interaction was detected whereby activity was higher during the ToM condition among controls with no detected difference between SCZ and BD groups. The results suggest that ToM is represented similarly in cortical activity in SCZ and BD compared to healthy controls pointing to possible neurobiological convergence of SCZ and BD in underlying impairments of social cognition. 10.1016/j.jad.2020.12.094
    The BAT: A videotaped battery to assess theory of mind in schizophrenia. Serra-Mayoral Anna,Mareca Cèlia,Cano Ramon,Romaguera Anna,Alsina Montserrat,Gutiérrez Lina,Valls Èlia,Sarró Salvador,McKenna Peter J,Pomarol-Clotet Edith,Calderón Caterina Psychiatry research The ability of attributing mental states to oneself and to the others (theory of mind, ToM) is impaired in schizophrenia. ToM is not a monolithic function, it includes different capacities: some implies the decoding of affective states, others the reasoning about mental states. We have developed the BAT, a Battery to Assess Theory of mind abilities in adult psychotic subjects in an ecological audiovisual format. The performance on the BAT and three other test of social cognition was compared in a sample of schizophrenic patients with a control group. The samples were matched in terms of age and premorbid IQ. The BAT was sensitive to detect the ToM impairments in schizophrenia, showed good internal consistency and concurrent validity. The area under the ROC curves established a cutoff point that would correctly classify controls and patients in a 96.6% of cases. The factorial analysis isolated two factors: empathy and reasoning, with a good adjustment. Our results showed that the BAT could be a valid, ecological and usable tool to assess ToM in psychotic patients, with good psychometric properties, that would allow obtaining a more complete profile of their impairment. 10.1016/j.psychres.2021.113709
    Neural substrates of empathic accuracy in people with schizophrenia. Harvey Philippe-Olivier,Zaki Jamil,Lee Junghee,Ochsner Kevin,Green Michael F Schizophrenia bulletin INTRODUCTION:Empathic deficits in schizophrenia may lead to social dysfunction, but previous studies of schizophrenia have not modeled empathy through paradigms that (1) present participants with naturalistic social stimuli and (2) link brain activity to "accuracy" about inferring other's emotional states. This study addressed this gap by investigating the neural correlates of empathic accuracy (EA) in schizophrenia. METHODS:Fifteen schizophrenia patients and 15 controls were scanned while continuously rating the affective state of another person shown in a series of videos (ie, targets). These ratings were compared with targets' own self-rated affect, and EA was defined as the correlation between participants' ratings and targets' self-ratings. Targets' self-reported emotional expressivity also was measured. We searched for brain regions whose activity tracked parametrically with (1) perceivers' EA and (2) targets' expressivity. RESULTS:Patients showed reduced EA compared with controls. The left precuneus, left middle frontal gyrus, and bilateral thalamus were significantly more correlated with EA in controls compared with patients. High expressivity in targets was associated with better EA in controls but not in patients. High expressivity was associated with increased brain activity in a large set of regions in controls (eg, fusiform gyrus, medial prefrontal cortex) but not in patients. DISCUSSION:These results use a naturalistic performance measure to confirm that schizophrenic patients demonstrate impaired ability to understand others' internal states. They provide novel evidence about a potential mechanism for this impairment: schizophrenic patients failed to capitalize on targets' emotional expressivity and also demonstrate reduced neural sensitivity to targets' affective cues. 10.1093/schbul/sbs042
    Oxytocin-augmented social cognitive skills training in schizophrenia. Davis Michael C,Green Michael F,Lee Junghee,Horan William P,Senturk Damla,Clarke Angelika D,Marder Stephen R Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology Impairments in social cognition are common in schizophrenia and predict poor functional outcome. The purpose of this proof-of-concept randomized, parallel group clinical trial was to assess whether intranasal oxytocin (OT), given before social cognitive training, enhances learning of social cognitive skills. Twenty seven male outpatients with schizophrenia participated in a 6-week (12 session) training on social cognitive skills. Training focused on three domains: facial affect recognition, social perception, and empathy. Subjects were randomly assigned (double blind) to receive either intranasal OTor placebo 30 min before each session. Participants did not receive OT between sessions or on the day of assessments. We evaluated scores on social-cognition measures, as well as clinical symptoms and neurocognition, at baseline, 1 week following the final training session, and 1 month later. Our prespecified primary outcome measure was a social-cognition composite score comprised of five individual measures. There were main effects of time (indicating improvement across the combined-treatment groups) on the social-cognition composite score at both 1 week and 1 month following completion of training. Subjects receiving OT demonstrated significantly greater improvements in empathic accuracy than those receiving placebo at both posttreatment and 1 month follow up. There were no OT-related effects for the other social cognitive tests, clinical symptoms, or neurocognition. This study provides initial support for the idea that OT enhances the effectiveness of training when administered shortly before social cognitive training sessions. The effects were most pronounced on empathic accuracy, a high-level social cognitive process that is not easily improved in current social cognitive remediation programs. 10.1038/npp.2014.68
    Social cognition in schizophrenia. Green Michael F,Horan William P,Lee Junghee Nature reviews. Neuroscience Individuals with schizophrenia exhibit impaired social cognition, which manifests as difficulties in identifying emotions, feeing connected to others, inferring people's thoughts and reacting emotionally to others. These social cognitive impairments interfere with social connections and are strong determinants of the degree of impaired daily functioning in such individuals. Here, we review recent findings from the fields of social cognition and social neuroscience and identify the social processes that are impaired in schizophrenia. We also consider empathy as an example of a complex social cognitive function that integrates several social processes and is impaired in schizophrenia. This information may guide interventions to improve social cognition in patients with this disorder. 10.1038/nrn4005
    Negative symptom configuration within and outside schizophrenia spectrum disorders: results from the "Parma Early Psychosis" program. Pelizza Lorenzo,Maestri Davide,Leuci Emanuela,Quattrone Emanuela,Azzali Silvia,Paulillo Giuseppina,Pellegrini Pietro Psychiatry research The identification of discrete dimensions underlining negative symptoms in First Episode Psychosis (FEP) may be useful in the treatment strategy for such severe symptomatology. Aim of this research was to investigate the negative symptom configuration in FEP patients and to compare the emerging factor solutions between individuals with and without Schizophrenia Spectrum Disorders (non-SSD vs SSD). Two-hundred-seventy-four participants (144 non-SSD and 130 SSD), aged 13-35 years, completed the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Confirmatory and exploratory factor analyses were then performed to examine PANSS negative symptom configuration in both SSD and non-SSD samples. In SSD, a 3-factor model solution (i.e. "Experiential Deficits", "Volition/Empathy Deficits" and "Motor/Affective Expression Deficits" domains) was identified. A different 2-factor configuration (with "Social/Communicative Withdrawal" and "Motor/Affective/Motivational Deficits" dimensions) was more appropriate in non-SSD. In conclusion, our results show differences in negative symptom factor models between non-SSD and SSD. Thus, a different specificity and significance of negative symptom solutions in FEP populations with diagnoses other than schizophrenia (compared to those with SSD) must be realistically considered. 10.1016/j.psychres.2020.113519
    Empathy, social functioning and schizotypy. Henry Julie D,Bailey Phoebe E,Rendell Peter G Psychiatry research Whilst affective empathy is concerned with one's emotional response to the affective state of another, cognitive empathy refers to one's understanding of another's mental state, and deficits in both are believed to contribute to the social behavioral abnormalities associated with schizophrenia. The present study aimed to test whether individual differences in normally distributed schizotypal personality traits are related to cognitive and affective empathy, and whether any observed association between schizotypy and empathy mediates the relationship between schizotypy and (reduced) social functioning. Non-clinical volunteers (N=223) completed measures of schizotypal personality, cognitive and affective empathy, social functioning and negative affect. The results indicated that higher schizotypy was associated with reduced empathy, poorer social functioning and increased negative affect. Of the specific schizotypal dimensions (positive, negative and disorganized), only negative schizotypy was significantly associated with social functioning, and this relationship persisted even after controlling for negative affect. Further, affective empathy functioned as a partial mediator in this relationship. These data show that the relationship between negative schizotypy and social functioning is at least partially attributable to deficits in affective empathy. 10.1016/j.psychres.2007.04.014
    Social and nonsocial cognition in bipolar disorder and schizophrenia: relative levels of impairment. Lee Junghee,Altshuler Lori,Glahn David C,Miklowitz David J,Ochsner Kevin,Green Michael F The American journal of psychiatry OBJECTIVE:This study aimed to determine the relative extent of impairment in social and nonsocial cognitive domains in patients with bipolar disorder compared with schizophrenia patients and healthy comparison subjects. METHODS:Sixty-eight clinically stable outpatients with bipolar disorder, 38 clinically stable outpatients with schizophrenia, and 36 healthy comparison subjects completed a range of social (facial affect perception, emotional regulation, empathic accuracy, mental state attribution, and self-referential memory) and nonsocial (speed of processing, attention/vigilance, working memory, verbal memory, visual memory, and reasoning/problem solving) cognitive tasks. RESULTS:For each social cognitive task, patients with bipolar disorder did not differ significantly from comparison subjects, and both groups performed better than schizophrenia patients. Within the bipolar group, clinical features and medication status were not related to social cognitive performance. Bipolar patients showed performance patterns across tasks (i.e., profiles) that were similar to those of comparison subjects on both social and nonsocial cognitive domains, whereas both groups differed from schizophrenia patients for both domains. Regarding relative impairment across the two cognitive domains, results revealed a significant group-by-domain interaction in which bipolar patients showed less impaired social than nonsocial cognition, while schizophrenia patients showed the opposite pattern. CONCLUSIONS:Bipolar patients showed less impairment on social relative to nonsocial cognitive performance, whereas schizophrenia patients showed more impairment on social relative to nonsocial cognitive performance. These results suggest that these two cognitive domains play different roles in bipolar disorder compared with in schizophrenia. 10.1176/appi.ajp.2012.12040490
    Empathic abilities in people with schizophrenia. Bora Emre,Gökçen Sezen,Veznedaroglu Baybars Psychiatry research Although the existence of empathy deficits in schizophrenia is generally accepted, very few studies have directly investigated the issue. The nature of empathy deficits in healthy subjects and psychiatric patients is an understudied subject. The performances of the 30 outpatients with schizophrenia on a psychometric measure, the Empathy Quotient (EQ), were compared with those of 30 control subjects matched for age, duration of education and gender. The relatives or spouses of the patients also filled out the EQ. A neuropsychological battery, including emotion recognition, emotional reasoning and theory of mind tasks, was also administered. Schizophrenia patients had severe empathy dysfunction based on their relative EQ ratings. There was a serious discrepancy between the self and relative/spouse assessments of the empathic skills of schizophrenia patients. Consistent with the previous findings schizophrenia patients were impaired in nearly all cognitive tasks. The empathy deficits of schizophrenia patients were associated with their impairments in other social cognitive tasks. Studies focusing on dysfunctional brain networks underlying empathy deficits and studies using more experimental measures of empathy should be helpful to unravel the true nature of the empathic failure in patients with schizophrenia. 10.1016/j.psychres.2007.05.017
    The relationship between empathy, emotion processing and clinical insight in remitted schizophrenia patients. Bhagyavathi Haralahalli D,Mehta Urvakhsh Meherwan,Thirthalli Jagadisha European archives of psychiatry and clinical neuroscience 10.1007/s00406-013-0484-2
    Empathy, Emotion Recognition, and Paranoia in the General Population. Beals Kendall,Sperry Sarah H,Sheffield Julia M Frontiers in psychology Background:Paranoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition - a very early component of empathic processing - are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia. Methods:Paranoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults ( = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition. Results:Paranoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia ( < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear ( = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition ( = 0.002). All indirect paths through emotion recognition were non-significant. Discussion:These results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations. 10.3389/fpsyg.2022.804178
    Empathy and Its Relationship With Social Functioning in Individuals at Ultra-High Risk for Psychosis. Kuis Daan Jan,van de Giessen Tara,de Jong Steven,Sportel Bouwina Esther,Boonstra Nynke,van Donkersgoed Rozanne,Lysaker Paul H,Hasson-Ohayon Ilanit,Pijnenborg Gerdina Hendrika Maria Frontiers in psychiatry Social functioning is often impaired in the ultra-high-risk (UHR) phase of psychosis. There is some evidence that empathy is also impaired in this phase and that these impairments may underlie difficulties in social functioning. The main aim of this study was to investigate whether cognitive and affective empathy are lower in people in the UHR phase of psychosis in comparison to healthy controls, and whether possible impairments have the same magnitude as in people with schizophrenia. A second aim was to examine whether there is a relationship between empathy and social functioning in individuals in the UHR phase. Forty-three individuals at UHR for psychosis, 92 people with a schizophrenia spectrum disorder, and 49 persons without a psychiatric disorder completed the Interpersonal Reactivity Index (IRI), Questionnaire of Cognitive and Affective Empathy (QCAE), and Faux Pas as instruments to measure empathy. The Time Use survey was used to measure social functioning. MAN(C)OVA was used to analyse differences between groups on empathy and social functioning, and correlations were calculated between empathy measures and social functioning for each group. The UHR group presented significantly lower levels of self-reported cognitive empathy than the healthy controls, but not compared to patients with SSD, while performance-based cognitive empathy was unimpaired in the UHR group. On the affective measures, we found that people with UHR and patients with SSD had significantly higher levels of self-reported distress in interpersonal settings compared to healthy controls. In the UHR group, perspective-taking was negatively associated with time spent on structured social activities. In the SSD group, we found that structured social activities were positively associated with perspective-taking and negatively associated with personal distress in interactions with others. Lastly, in people without mental illness, social activities were positively associated with performance-based perspective-taking. Impairments in subjective cognitive empathy appear to be present in the UHR phase, suggesting that difficulties in interpreting the thoughts and feelings of others precede the onset of psychotic disorders. This can inform future interventions in the UHR phase. 10.3389/fpsyt.2021.730092
    Is self-compassion linked to treatment adherence in schizophrenia? Uzer-Kremers Laura,Bralet Marie-Cécile,Angerville Bernard,Jeanblanc Jérôme,Pierrefiche Olivier,Martinetti Margaret P,Naassila Mickaël,Dervaux Alain Schizophrenia research 10.1016/j.schres.2020.05.058
    The effects of repetitive transcranial magnetic stimulation on empathy: a systematic review and meta-analysis. Yang C-C,Khalifa N,Völlm B Psychological medicine Empathy is a multi-dimensional concept with affective and cognitive components, the latter often referred to as Theory of Mind (ToM). Impaired empathy is prevalent in people with neuropsychiatric disorders, such as personality disorder, psychopathy, and schizophrenia, highlighting the need to develop therapeutic interventions to address this. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive therapeutic technique that has been effective in treating various neuropsychiatric conditions, can be potentially used to modulate empathy. To our knowledge, no systematic reviews or meta-analyses in this field have been conducted. The aim of the current study was to review the literature on the use of rTMS to modulate empathy in adults. Seven electronic databases (AMED, Cochrane library, EMBASE, Medline, Pubmed, PsycInfo, and Web of Science) were searched using appropriate search terms. Twenty-two studies were identified, all bar one study involved interventions in healthy rather than clinical populations, and 18 of them, providing results for 24 trials, were included in the meta-analyses. Results showed an overall small, but statistically significant, effect in favour of active rTMS in healthy individuals. Differential effects across cognitive and affective ToM were evident. Subgroup analyses for cognitive ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Subgroup analyses for affective ToM revealed significant effect sizes on excitatory rTMS, offline paradigms, and non-randomised design trials. Meta-regression revealed no significant sources of heterogeneity. In conclusion, rTMS may have discernible effects on different components of empathy. Further research is required to examine the effects of rTMS on empathy in clinical and non-clinical populations, using appropriate empathy tasks and rTMS protocols. 10.1017/S003329171700232X
    How does family intervention improve the outcome of people with schizophrenia? Girón Manuel,Nova-Fernández Francisco,Mañá-Alvarenga Sonia,Nolasco Andreu,Molina-Habas Antonia,Fernández-Yañez Antonio,Tabarés-Seisdedos Rafael,Gómez-Beneyto Manuel Social psychiatry and psychiatric epidemiology BACKGROUND:There is strong evidence of the efficacy of family psychosocial interventions for schizophrenia, but evidence of the role played by the attitudes of relatives in the therapeutic process is lacking. METHOD:To study the effect of a family intervention on family attitudes and to analyse their mediating role in the therapeutic process 50 patients with schizophrenia and their key relatives undergoing a trial on the efficacy of a family psychosocial intervention were studied by means of the Affective Style Coding System, the Scale of Empathy, and the Relational Control Coding System. Specific statistical methods were used to determine the nature of the relationship of the relatives' attitudes to the outcome of family intervention. RESULTS:Family psychosocial intervention was associated with a reduction in relatives' guilt induction and dominance and an improvement in empathy. Empathy and lack of dominance were identified as independent mediators of the effect of family psychosocial intervention. The change in empathy and dominance during the first 9 months of the intervention predicted the outcome in the following 15 months. CONCLUSION:Relatives' empathy and lack of dominance are mediators of the beneficial effect of family psychosocial intervention on patient's outcome. 10.1007/s00127-014-0942-9
    Performance in multiple domains of social cognition in parents of patients with schizophrenia. Lavoie Marie-Audrey,Plana India,Jackson Philip L,Godmaire-Duhaime Florence,Bédard Lacroix Jacinthe,Achim Amélie M Psychiatry research 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. 10.1016/j.psychres.2014.07.055
    Impaired empathic abilities and reduced white matter integrity in schizophrenia. Fujino Junya,Takahashi Hidehiko,Miyata Jun,Sugihara Genichi,Kubota Manabu,Sasamoto Akihiko,Fujiwara Hironobu,Aso Toshihiko,Fukuyama Hidenao,Murai Toshiya Progress in neuro-psychopharmacology & biological psychiatry Empathic abilities are impaired in schizophrenia. Although the pathology of schizophrenia is thought to involve disrupted white matter integrity, the relationship between empathic disabilities and altered white matter in the disorder remains unclear. The present study tested associations between empathic disabilities and white matter integrity in order to investigate the neural basis of impaired empathy in schizophrenia. Sixty-nine patients with schizophrenia and 69 age-, gender-, handedness-, education- and IQ level-matched healthy controls underwent diffusion-weighted imaging. Empathic abilities were assessed using the Interpersonal Reactivity Index (IRI). Using tract-based spatial statistics (TBSS), the associations between empathic abilities and white matter fractional anisotropy (FA), a measure of white matter integrity, were examined in the patient group within brain areas that showed a significant FA reduction compared with the controls. The patients with schizophrenia reported lower perspective taking and higher personal distress according to the IRI. The patients showed a significant FA reduction in bilateral deep white matter in the frontal, temporal, parietal and occipital lobes, a large portion of the corpus callosum, and the corona radiata. In schizophrenia patients, fantasy subscales positively correlated with FA in the left inferior fronto-occipital fasciculi and anterior thalamic radiation, and personal distress subscales negatively correlated with FA in the splenium of the corpus callosum. These results suggest that disrupted white matter integrity in these regions constitutes a pathology underpinning specific components of empathic disabilities in schizophrenia, highlighting that different aspects of empathic impairments in the disorder would have, at least partially, distinct neuropathological bases. 10.1016/j.pnpbp.2013.09.018
    Functional and structural brain correlates of theory of mind and empathy deficits in schizophrenia. Benedetti Francesco,Bernasconi Alessandro,Bosia Marta,Cavallaro Roberto,Dallaspezia Sara,Falini Andrea,Poletti Sara,Radaelli Daniele,Riccaboni Roberta,Scotti Giuseppe,Smeraldi Enrico Schizophrenia research BACKGROUND:Patients affected by schizophrenia show deficits in social cognition, with abnormal performance on tasks targeting theory of mind (ToM) and empathy (Emp). Brain imaging studies suggested that ToM and Emp depend on the activation of brain networks mainly localized at the superior temporal lobe and temporo-parietal junction. METHODS:Participants included 24 schizophrenia patients and 20 control subjects. We used brain blood oxygen level dependent fMRI to study the neural responses to tasks targeting ToM and Emp. We then studied voxel-based morphometry of grey matter in areas where diagnosis influenced functional activation to both tasks. Outcomes were analyzed in the context of the general linear model, with global grey matter volume as nuisance covariate for structural MRI. RESULTS:Patients showed worse performance on both tasks. We found significant effects of diagnosis on neural responses to the tasks in a wide cluster in right posterior superior temporal lobe (encompassing BA 22-42), in smaller clusters in left temporo-parietal junction and temporal pole (BA 38 and 39), and in a white matter region adjacent to medial prefrontal cortex (BA 10). A pattern of double dissociation of the effects of diagnosis and task on neural responses emerged. Among these areas, grey matter volume was found to be reduced in right superior temporal lobe regions of patients. CONCLUSIONS:Functional and structural abnormalities were observed in areas affected by the schizophrenic process early in the illness course, and known to be crucial for social cognition, suggesting a biological basis for social cognition deficits in schizophrenia. 10.1016/j.schres.2009.06.021
    Generalized deficit in all core components of empathy in schizophrenia. Derntl Birgit,Finkelmeyer Andreas,Toygar Timur K,Hülsmann Anna,Schneider Frank,Falkenberg Dania I,Habel Ute Schizophrenia research Empathy is a multidimensional construct composed of several components such as emotion recognition, emotional perspective taking and affective responsiveness. Patients with schizophrenia demonstrate deficits in several domains of emotion processing and perspective taking, thus suggesting a dysfunctional emotional competence. We assessed empathic abilities via three paradigms measuring emotion recognition, perspective taking and affective responsiveness as well as self-report empathy questionnaires in 24 (12 females, 12 males) schizophrenia patients meeting the DSM-IV criteria for schizophrenia and 24 matched healthy volunteers. Patients were recruited from the Department of Psychiatry and Psychotherapy, RWTH Aachen University and healthy volunteers were recruited via advertisement. Groups were matched for age, gender and parental education. Data analysis indicates a significant empathic deficit in patients, reflected in worse performance in all three domains. This deficit was only partly reflected in the self-report empathy questionnaires. Comparing the different tasks, emotional perspective taking was the most difficult task for all subjects and symptomatology worsened affective responsiveness. Schizophrenia patients not only struggle to correctly identify emotions, but also have difficulties in spontaneously simulating another person's subjective world (perspective taking) and might not be able to respond adequately in terms of their own emotional experience (affective responsiveness), which are not caused by emotion perception deficits. The results suggest that all domains of empathy are affected in schizophrenia and have to be addressed independently in behavioral therapies, thereby offering a possibility to improve socio-occupational life. 10.1016/j.schres.2008.11.009
    Empathy in schizophrenia: impaired resonance. Haker Helene,Rössler Wulf European archives of psychiatry and clinical neuroscience Resonance is the phenomenon of one person unconsciously mirroring the motor actions as basis of emotional expressions of another person. This shared representation serves as a basis for sharing physiological and emotional states of others and is an important component of empathy. Contagious laughing and contagious yawning are examples of resonance. In the interpersonal contact with individuals with schizophrenia we can often experience impaired empathic resonance. The aim of this study is to determine differences in empathic resonance-in terms of contagion by yawning and laughing-in individuals with schizophrenia and healthy controls in the context of psychopathology and social functioning. We presented video sequences of yawning, laughing or neutral faces to 43 schizophrenia outpatients and 45 sex- and age-matched healthy controls. Participants were video-taped during the stimulation and rated regarding contagion by yawning and laughing. In addition, we assessed self-rated empathic abilities (Interpersonal Reactivity Index), psychopathology (Positive and Negative Syndrome Scale in the schizophrenia group resp. Schizotypal Personality Questionnaire in the control group), social dysfunction (Social Dysfunction Index) and executive functions (Stroop, Fluency). Individuals with schizophrenia showed lower contagion rates for yawning and laughing. Self-rated empathic concern showed no group difference and did not correlate with contagion. Low rate of contagion by laughing correlated with the schizophrenia negative syndrome and with social dysfunction. We conclude that impaired resonance is a handicap for individuals with schizophrenia in social life. Blunted observable resonance does not necessarily reflect reduced subjective empathic concern. 10.1007/s00406-009-0007-3
    Insight and empathy in schizophrenia. Didehbani Nyaz,Shad Mujeeb U,Tamminga Carol A,Kandalaft Michelle R,Allen Tandra T,Chapman Sandra B,Krawczyk Daniel C Schizophrenia research 10.1016/j.schres.2012.09.010
    Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy. Michaels Tania M,Horan William P,Ginger Emily J,Martinovich Zoran,Pinkham Amy E,Smith Matthew J Psychiatry research Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n=52) and healthy comparison (n=37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocognition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocognition and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed. 10.1016/j.psychres.2014.08.054
    Empathy in individuals clinically at risk for psychosis: brain and behaviour. Derntl Birgit,Michel Tanja Maria,Prempeh Pamela,Backes Volker,Finkelmeyer Andreas,Schneider Frank,Habel Ute The British journal of psychiatry : the journal of mental science BACKGROUND:Empathy is a basic human ability, and patients with schizophrenia show dysfunctional empathic abilities on the behavioural and neural level. AIMS:These dysfunctions may precede the onset of illness; thus, it seems mandatory to examine the empathic abilities in individuals at clinical high risk for psychosis. METHOD:Using functional magnetic resonance imaging, we measured 15 individuals at clinical high risk of psychosis (CHR group) and compared their empathy performance with 15 healthy volunteers and 15 patients with schizophrenia. RESULTS:Behavioural data analysis indicated no significant deficit in the CHR group. Functional data analysis revealed hyperactivation in a frontotemporoparietal network including the amygdala in the CHR group compared with the other two groups. CONCLUSIONS:Despite normal behavioural performance, the CHR group activated the neural empathy network differently and specifically showed hyperactivation in regions critical for emotion processing. This could suggest a compensatory mechanism reflecting emotional hypersensitivity or dysfunctional emotion regulation. Further investigations should clarify the role of these neural alterations for development and exacerbation of psychosis. 10.1192/bjp.bp.114.159004
    Patients with schizophrenia are less prone to interpret virtual others' empathetic questioning as helpful. Berrada-Baby Zina,Oker Ali,Courgeon Matthieu,Urbach Mathieu,Bazin Nadine,Amorim Michel-Ange,Martin Jean-Claude,Passerieux Christine,Roux Paul,Brunet-Gouet Eric Psychiatry research Individuals with schizophrenia are impaired in their neurocognition and present cognitive biases. These impairments may lead to a deficit in recognizing helping intentions of others. To investigate recognition of help, we designed a card-guessing game (Virtual Help Recognition Paradigm) involving two successive virtual agents asking questions to the participant at different moments of the game. These questions were either empathetic (i.e. on the subject's feelings) or non-empathetic (i.e. on technical aspects of the game). We assessed how much the participant felt that the virtual agent had helped him and, her attitude and personality traits. We measured how much the participant trusted the virtual agent with a monetary allocation procedure. Twenty individuals with schizophrenia and twenty healthy controls were recruited. The controls' ratings demonstrated that they interpreted empathetic questioning as helping and rewarded it positively with an increased monetary allocation. Participants with schizophrenia had a reduced perception of the differences between the two agents. Only the rating concerning the "interest/attention" of the agent toward these participants yielded significant differences among conditions. Hypothetically, individuals with schizophrenia take into account the fact they are the object of another's attention, but may fail to infer a helping intention and to behave accordingly. 10.1016/j.psychres.2016.05.022
    Exploring functioning in schizophrenia: Predictors of functional capacity and real-world behaviour. Bechi Margherita,Bosia Marta,Spangaro Marco,Buonocore Mariachiara,Cavedoni Silvia,Agostoni Giulia,Bianchi Laura,Cocchi Federica,Guglielmino Carmelo,Smeraldi Enrico,Cavallaro Roberto Psychiatry research Impairment in daily functioning still represents a major treatment issue in schizophrenia and a more in-depth knowledge of underlying constructs is crucial for interventions to translate into better outcomes. This study aims to model factors influencing both functional capacity and real-life behaviour in a sample of outpatients with chronic schizophrenia, through a comprehensive assessment including evaluations of psychopathology, cognitive and social cognitive abilities, premorbid adjustment, family environment and early childhood experiences. No significant correlation was observed between functional capacity and real-life behaviour. Functional capacity was significantly predicted by IQ, while real-life behaviour was significantly predicted by empathy, affect recognition and symptoms. Functional capacity seems mainly related to neurocognition, whereas real-life behaviour appears more complex, requiring the integration of different factors including symptoms, with a major role of empathy. Results thus support a divergence between the two constructs of functioning and their underlying components and highlight the need to target both dimensions through individualized sequential rehabilitation programs in order to optimize functional outcome. 10.1016/j.psychres.2017.02.019
    The relative contributions of social cognition and self-reflectiveness to clinical insight in enduring schizophrenia. Béland Sophie,Lepage Martin Psychiatry research Poor clinical insight represents a major barrier to recovery in schizophrenia. Research suggests that higher-order social cognitive abilities such as theory of mind (TOM) and metacognition contribute to levels of clinical insight. However, few studies have examined whether social cognitive abilities other than TOM are related to clinical insight. Moreover, to date, no investigation has attempted to determine whether the contribution of metacognitive ability to clinical insight can be differentiated from the contribution of higher-order social cognition, despite their conceptual similarity. Therefore, the purpose of this study was to examine the relative contribution of different social cognitive abilities, as well as metacognition, to clinical insight in a large sample of 139 enduring schizophrenia patients, and controlling for established predictors of clinical insight. Hierarchical regression analyses were used to evaluate the portion of variance explained by 3 social cognitive abilities: emotion recognition, TOM, and affective empathy, and the metacognitive ability of self-reflectiveness. Clinical insight levels were assessed using the Schedule for the Assessment of Insight-Expanded version. Results indicated that affective empathy and self-reflectiveness are the strongest predictors of clinical insight. These results provide insights on the development of targeted interventions for improving clinical insight in this population. 10.1016/j.psychres.2017.09.082
    The relationship between clinical insight and cognitive and affective empathy in schizophrenia. Atoui Mia,El Jamil Fatima,El Khoury Joseph,Doumit Mark,Syriani Nathalie,Khani Munir,Nahas Ziad Schizophrenia research. Cognition BACKGROUND:Schizophrenia is often associated with poor clinical insight (unawareness of mental illness and its symptoms) and deficits in empathy, which are important for social functioning. Cognitive empathy has been linked to clinical insight while affective empathy and its role in insight and pathology have received mixed evidence. METHODS:Instruments assessing symptomatology (Positive and Negative Syndrome Scale; PANSS), clinical insight (Scales to assess awareness of mental disorders; SUMD), and cognitive and affective empathy were administered to 22 participants with first episode and chronic schizophrenia and 21 healthy controls. Self-report, parent-report, and performance based measures were used to assess cognitive and affective empathy (The interpersonal reactivity index; IRI/Reading the Mind in the Eyes Test/Faux Pas) to reduce bias and parse shared variance. RESULTS:Age of onset, gender, and symptomatology emerged as significant predictors of poor clinical insight. Additionally, the fantasy subscale of the IRI as reported by parents emerged as a positive predictor while the personal distress (parent report) subscale emerged as a negative predictor of awareness into mental illness. There were significant differences on performance-based measures of empathy between the control and schizophrenia groups. CONCLUSION:Findings suggest that affective empathy is relatively intact across phases of illness whereas cognitive empathy abilities are compromised and could be targets for psychotherapy intervention. 10.1016/j.scog.2018.02.004
    Cognitive fusion and affective isolation: Blurred self-concept and empathy deficits in schizotypy. Kállai János,Rózsa Sándor,Hupuczi Ernő,Hargitai Rita,Birkás Béla,Hartung István,Martin László,Herold Róbert,Simon Mária Psychiatry research This is a cross-sectional nonclinical sample study to examine the different levels of the Ipsiety Disturbance Model (IDM) for schizophrenia spectrum disorders (introduced by Sass and Parnas, 2003). Three faces of schizotypy were studied: diminished self-presence, hyper-reflexivity, and distortion in experience of own self and another person's self-discrimination. A sample of college students (N = 1312) was provided a questionnaire packet that contained the Schizotypy Personality Questionnaire Brief-Revisited (SPQ-BR), the Self-Concept Clarity Sale, the Tellegen Absorption Scale, and Interpersonal Reactivity Index measures. Results: higher absorption capabilities predict higher scores on both the SPQ-BR cognitive and SPQ-BR disorganization factors. High scores in cognitive empathy predicted a low score on both SPQ-BR cognitive and SPQ-BR interpersonal scores. In contrast, higher affective empathy predicted high scores on the SPQ-BR interpersonal factor. The deficiency in self-concept clarity predicted an elevated score on the SPQ-BR cognitive, interpersonal, and disorganization schizotypy symptoms. We argue that a lack of self-concept clarity manifested in both the hyperreflexivity level (measured by absorption) and the metallization level (measured by empathy). We argue that the IDM is a reliable way to interpret functioning with different levels of schizotypy. 10.1016/j.psychres.2018.11.045
    Confirmation of a Two-Factor Solution to the Questionnaire of Cognitive and Affective Empathy in a French Population of Patients With Schizophrenia Spectrum Disorders. Brunet-Gouet Eric,Myszkowski Nils,Ehrminger Mickael,Urbach Mathieu,Aouizerate Bruno,Brunel Lore,Capdevielle Delphine,Chereau Isabelle,Dubertret Caroline,Dubreucq Julien,Fond Guillaume,Lançon Christophe,Leignier Sylvain,Mallet Jasmina,Misdrahi David,Pires Sylvie,Schneider Priscille,Schurhoff Franck,Yazbek Hanan,Zinetti-Bertschy Anna,Bazin Nadine,Passerieux Christine,Zenasni Franck,Roux Paul Frontiers in psychiatry The Questionnaire of Cognitive and Affective Empathy (QCAE) is a tool for self-assessing the cognitive and emotional components of empathy. A study showed that a two-factor model fits the data of patients with schizophrenia, whereas other reports on healthy subjects have suggested a five-factor decomposition. We aimed to replicate the model of et al. in a French population with schizophrenia spectrum disorders (i.e., schizophrenia and schizoaffective disorders) participating in the EVACO Study (NCT02901015). In total, 133 patients were assessed with the QCAE, the (PANSS), the (PSP), and the (S-QoL). The two-factor model demonstrated an adequate fit with the data, comparable to that reported by Horan . Males scored higher on the Affective subscore than females. After correction for multiple tests, psychopathology (PANSS) and functioning (PSP) did not correlate significantly with the QCAE subscores. However, quality of life (S-QoL) correlated positively with the Emotional Contagion subscore. Thus, the variability of empathetic disposition in schizophrenia may be considered through the cognitive affective dichotomy and properly investigated with the QCAE. The results support further investigation of the relationship between QCAE scores and subjective outcome measurements, such as quality of life, and emphasize the importance of cross-cultural comparisons. 10.3389/fpsyt.2019.00751
    The interactive effect of metacognition and self-compassion on predicting meaning in life among individuals with schizophrenia. Bercovich Asaf,Goldzweig Gil,Igra Libby,Lavi-Rotenberg Adi,Gumley Andrew,Hasson-Ohayon Ilanit Psychiatric rehabilitation journal OBJECTIVE:Metacognition among people with schizophrenia is associated with desired outcomes but can also lead to the experience of psychological pain, affecting the individual's sense of meaning in life. The aim of the current study was to investigate whether the effect of metacognition on meaning in life was dependent on one's level of self-compassion. Hypotheses were that both metacognition and self-compassion would be positively associated with meaning in life, and that the association between metacognition and meaning in life would be greater among people with high self-compassion than among people with low self-compassion. METHOD:The baseline data of 33 adults with schizophrenia, who were enrolled in a metacognitive reflection insight therapy (MERIT) trial, were used. Participants filled out self-report questionnaires regarding meaning in life and self-compassion, and were interviewed for an assessment of their metacognitive abilities. Analysis included a calculation of correlations and multiple linear regression models. RESULTS:Correlational analysis showed that 2 subscales of self-compassion (self-kindness and mindfulness) and 1 subscale of metacognition (mastery) were related to meaning in life. Consistent with our hypotheses, regression analysis showed a moderating effect of self-compassion. Metacognition was found to have a positive significant correlation with meaning in life among participants who reported high levels of self-compassion. This effect was insignificant among participants reporting low or moderate levels of self-compassion. CONCLUSIONS:Among individuals with schizophrenia, self-compassion seems to be crucial in the ability to successfully utilize metacognition for attaining meaning in life. Implications for psychotherapy with people who have schizophrenia are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved). 10.1037/prj0000413
    Applying network analysis to investigate the links between dimensional schizotypy and cognitive and affective empathy. Wang Yi,Shi Hai-Song,Liu Wen-Hua,Zheng Hong,Wong Keri Ka-Yee,Cheung Eric F C,Chan Raymond C K Journal of affective disorders BACKGROUND:Although impairment in empathy has been reported in schizophrenia spectrum disorders, little is known about the relationship between empathy and schizotypal traits. This study examines this relationship by applying network analysis to a large sample collected at 18-months follow-up in a longitudinal dataset. METHODS:One thousand four hundred and eighty-six college students were recruited and completed a set of self-reported questionnaires on empathy, schizotypy, depression, anxiety and stress. Networks were constructed by taking the subscale scores of these measures as nodes and partial correlations between each pair of nodes as edges. Network Comparison Tests were performed to investigate the differences between individuals with high and low schizotypy. RESULTS:Cognitive and affective empathy were strongly connected with negative schizotypy in the network. Physical and social anhedonia showed high centrality measured by strength, closeness and betweenness while anxiety and stress showed high expected influence. Predictability ranged from 22.4% (personal distress) to 79.9% (anxiety) with an average of 54.4%. Compared with the low schizotypy group, the high schizotypy group showed higher global strength (S = 0.813, p < 0.05) and significant differences in network structure (M = 0.531, p < 0.001) and strength of edges connecting empathy with schizotypy (adjusted ps < 0.05). LIMITATIONS:Only self-rating scales were used, and disorganized schizotypy was not included. CONCLUSIONS:Our findings suggest that the cognitive and affective components of empathy and dimensions of schizotypy are closely related in the general population and their network interactions may play an important role in individuals with high schizotypy. 10.1016/j.jad.2020.08.030
    Multi-level comparison of empathy in schizophrenia: an fMRI study of a cartoon task. Lee Seung Jae,Kang Do Hyung,Kim Chi-Won,Gu Bon Mi,Park Ji-Young,Choi Chi-Hoon,Shin Na Young,Lee Jong-Min,Kwon Jun Soo Psychiatry research Empathy deficits might play a role in social dysfunction in schizophrenia. However, few studies have investigated the neuroanatomical underpinnings of the subcomponents of empathy in schizophrenia. This study investigated the hemodynamic responses to three subcomponents of empathy in patients with schizophrenia (N=15) and healthy volunteers (N=18), performing an empathy cartoon task during functional magnetic resonance imaging. The experiment used a block design with four conditions: cognitive, emotional, and inhibitory empathy, and physical causality control. Data were analyzed by comparing the blood-oxygen-level-dependent (BOLD) signal activation between the two groups. The cognitive empathy condition activated the right temporal pole to a lesser extent in the patient group than in comparison subjects. In the emotional and inhibitory conditions, the patients showed greater activation in the left insula and in the right middle/inferior frontal cortex, respectively. These findings add to our understanding of the impaired empathy in patients with schizophrenia by identifying a multi-level cortical dysfunction that underlies a deficit in each subcomponent of empathy and highlighting the importance of the fronto-temporal cortical network in ability to empathize. 10.1016/j.pscychresns.2009.08.003
    Social cognition, empathy and functional outcome in schizophrenia. Sparks Amy,McDonald Skye,Lino Bianca,O'Donnell Maryanne,Green Melissa J Schizophrenia research Social and occupational functioning difficulties are a characteristic feature of schizophrenia, and a growing body of evidence suggests that deficits in social cognition contribute significantly to these functional impairments. The present study sought to investigate whether the association between social cognition and social functioning in schizophrenia would be mediated by self-reported levels of empathy. Thirty outpatients with a diagnosis of schizophrenia or schizoaffective disorder, and twenty-five healthy controls completed a well-validated facial affect processing task (Ekman 60-faces facial task from the Facial Expressions of Emotion - Stimuli and Tests; FEEST), The Awareness of Social Inference Test (TASIT; to assess emotion perception and complex social cognitive skills such as the detection of sarcasm and deceit, from realistic social exchanges), and measures of self-reported empathy and social functioning. Participants with schizophrenia performed more poorly than controls in identifying emotional states from both FEEST and TASIT stimuli, and were impaired in their ability to comprehend counterfactual information in social exchanges, including sarcasm and lies, on the TASIT. Impairment in the comprehension of sarcasm was associated with higher empathic personal distress, and lower recreational functioning. Impairment in the identification of the emotions of others was found to be associated with lower satisfaction and lower empathic fantasy. However, empathy could not be explored as a mediator of associations between social cognition and functional outcome, due to lack of common associations with functional outcome measures. These findings have implications for the remediation of specific social cognitive deficits with respect to improving functional outcomes in schizophrenia. 10.1016/j.schres.2010.06.011
    Self-reported empathy deficits are uniquely associated with poor functioning in schizophrenia. Smith Matthew J,Horan William P,Karpouzian Tatiana M,Abram Samantha V,Cobia Derin J,Csernansky John G Schizophrenia research BACKGROUND:Social cognitive deficits have been proposed to be among the causes of poor functional outcome in schizophrenia. Empathy, or sharing and understanding the unique emotions and experiences of other people, is one of the key elements of social cognition, and prior studies suggest that empathic processes are impaired in schizophrenia. The current study examined whether impairments in self-reported empathy were associated with poor functioning, above and beyond the influences of neurocognitive deficits and psychopathology. METHODS:Individuals with schizophrenia (n=46) and healthy controls (n=37) completed the Interpersonal Reactivity Index (IRI), a measure of emotional and cognitive empathy. Participants also completed a neuropsychological test battery, clinical ratings of psychopathology, and functional outcome measures assessing both functional capacity and community functioning. After testing for between-group differences, we assessed the relationships between self-reported empathy and the measures of functioning, neurocognition, and psychopathology. Regression analyses examined whether empathic variables predicted functional outcomes. RESULTS:Individuals with schizophrenia reported lower IRI scores for perspective-taking and empathic concern, and higher IRI scores for personal distress than controls. Among individuals with schizophrenia, lower perspective-taking, greater disorganized symptoms, and deficits in working memory and episodic memory were correlated with poorer functional capacity and community functioning. Lower scores for perspective-taking explained significant incremental variance in both functional capacity (ΔR(2)=.09, p<.05) and community functioning (ΔR(2)=.152, p<.01) after accounting for relevant neurocognitive and psychopathological variables. CONCLUSIONS:Impaired perspective-taking, a component of cognitive empathy, is associated with poor functioning even after taking into account the influences of neurocognitive deficits and psychopathology. These findings support further efforts to clarify the underlying causes of empathic disturbances and suggest that treatments for these disturbances may help functional recovery in schizophrenia. 10.1016/j.schres.2012.01.012
    Clinical characteristics of patients who have recovered from schizophrenia: the role of empathy and positive-self schema. Chung Young-Chul,Kim Hyun-Min,Lee Keon-Hak,Zhao Tong,Huang Guang-Biao,Park Tae-Won,Yang Jong-Chul Early intervention in psychiatry AIM:This article compares the socio-demographic and clinical characteristics of patients with schizophrenia who recovered with those who achieved remission. METHODS:Participants were classified based on predetermined criteria for recovery and remission. Data on demographic characteristics, information on duration of untreated psychosis, and assessments of current and historical symptom profiles and socio-occupational functioning emerged from careful chart review and direct interviews. Cross-sectional assessments of clinical variables were derived from the Positive and Negative Syndrome Scale, the Scale for the Assessment of Negative Symptoms, the Personal and Social Performance Scale, the Social Functioning Questionnaire, the Schizophrenia Cognition Rating Scale (ScoRS), the Basic Empathy Scale, and the Brief Core Schema Scales (BCSS). RESULTS:We found no significant differences between recovered and remitted groups with respect to demographic variables or duration of untreated psychosis. Cognitive and total empathy scores, positive-self schema score on the BCSS, and global score on the ScoRS were significantly higher in the recovered than the remitted group. Furthermore, patients with good levels of empathy and positive-self schema and intact neurocognitive functioning were more likely to achieve recovery. CONCLUSION:These results suggest that empathy, positive-self schema and neurocognitive functioning may serve as important clinical characteristics distinguishing those patients who have recovered from those who have achieved only remission. 10.1111/j.1751-7893.2012.00378.x
    Catechol-O-methyltransferase (COMT) genotype biases neural correlates of empathy and perceived personal distress in schizophrenia. Poletti Sara,Radaelli Daniele,Cavallaro Roberto,Bosia Marta,Lorenzi Cristina,Pirovano Adele,Smeraldi Enrico,Benedetti Francesco Comprehensive psychiatry BACKGROUND:The catechol-O-methyltransferase (COMT) Val(108/158)Met polymorphism (rs4680) influences enzyme activity with valine (Val) allele associated with higher enzymatic activity. Several studies suggest that factors influencing dopaminergic transmission could control response to stressful situations. Empathy is an essential element of human behavior, requires the ability to adopt another person's perspective, and has been found to be dysfunctional in schizophrenia. METHODS:Twenty-eight schizophrenic patients underwent functional magnetic resonance imaging performing an empathy task. Perceived empathy has been evaluated with the Interpersonal Reactivity Index. RESULTS:An effect of COMT on perceived distress subscale has been shown, with methionine (Met)/Met subjects reporting lower rates of stress compared with Val/Val. Moreover, imaging results showed an effect of genotype on empathy processing in the anterior cingulate with Val/Val subjects showing the lowest activation. DISCUSSION:This is the first study of the effect of rs4680 on interpersonal distress and neural correlates of empathy in schizophrenia. We found a decrease in neural responses in areas that ensure a cognitive control of emotion that is paralleled by perceived distress in interpersonal situation; this functional pattern seems to be influenced by rs4680 COMT polymorphism. 10.1016/j.comppsych.2012.06.008
    Empathy, schizophrenia and violence: a systematic review. Bragado-Jimenez Maria D,Taylor Pamela J Schizophrenia research BACKGROUND:A small but significant association between schizophrenia and violence is open to a number of explanations. Impaired empathy has been associated with schizophrenia, and with violence in the general population. Our aim was to conduct a systematic review of any research into relationships between schizophrenia, empathy and violence. METHODS:The electronic databases Medline, Psychinfo, Embase, Cochrane and DARE were searched using combinations of terms for schizophrenia, empathy and violence, as were selected journals and reference lists of relevant articles. Selection of studies and data extraction was done by each of us, blind to the other. RESULTS:Six studies were identified, but sample selection, research procedures and empathy, illness and violence measures differed sufficiently between them that only descriptive analysis was possible. Apart from one single case study, sample sizes were between 24 (12 violent) and 116 (35 violent). A component of emotional empathy (emotion recognition) was measured in three of the studies, all of which showed some specific dysfunctional recognition related to violence. Cognitive empathy was measured in three studies, two linking impairments to violence and one not. Emotional responsiveness was measured in one study and no association with violence was found. CONCLUSION:Although evidence is inconclusive on empathy impairment as a mediator of violence by people with chronic psychosis, it's likely relevance is most apparent in the better controlled studies. Larger scale studies are indicated with rigorous control for comorbidities. 10.1016/j.schres.2012.07.019
    Physiological evidence of a deficit to enhance the empathic response in schizophrenia. Corbera S,Ikezawa S,Bell M D,Wexler B E European psychiatry : the journal of the Association of European Psychiatrists Empathy is crucial for maintaining effective social interactions. Research has identified both an early-emotional sharing and a late-cognitive component of empathy. Although considered a functionally vital social cognition process, empathy has scarcely been studied in schizophrenia (SZ). We used event-related potentials (ERPs) to study the temporal dynamics of empathic response in 19 patients with SZ and 18 matched healthy controls (HC) using an empathy for physical pain paradigm. Participants responded to pictures of hands in neutral and painful situations in an active empathic condition and one manipulated by task demands. Additionally, subjective ratings of the stimuli and empathic self-reports were collected. People with SZ had (1) decreased early-emotional ERP responses to pictures of others in pain; (2) decreased modulation by attention of late-cognitive ERP responses; (3) lower ratings of perspective taking and higher ratings of personal distress which were both related to decreased modulation of late-cognitive empathic responses; (4) a significant relationship between high affective overlap between somebody else's pain and their own pain and decreased modulation of late-cognitive empathic responses; (5) a distinct relationship between regulatory deficits in late-cognitive empathy and functioning. Patients had present but reduced early and late empathy-related ERPs. Patients also reported increased personal distress when faced with distress in others. The late ERP responses are thought to be associated with self-regulation and response modulation. The magnitude of these late responses was inversely associated with reported levels of personal distress in both patients and controls. Additionally, regulatory deficits in cognitive empathy were highly related with deficits in functioning. Decreased ability to regulate one's own emotional engagement and response to emotions of others may be an important source of distress and dysfunction in social situations for patients with schizophrenia. 10.1016/j.eurpsy.2014.01.005
    Influence of empathetic pain processing on cognition in schizophrenia. Hu Kesong,Lijffijt Marijn,Beauchaine Theodore P,Fan Zhiwei,Shi Hui,He Shuchang European archives of psychiatry and clinical neuroscience Deficits in both empathy and cognition have been reported widely in patients with schizophrenia. However, little is known about how these deficits interact among such patients. In the present study, we used pain portraying pictures preceding a color-word Stroop task to investigate the effect of empathetic pain observation on cognition among patients with schizophrenia. Twenty patients with schizophrenia and twenty healthy controls were included. The control group showed increased Stroop facilitation and decreased interference during the empathetic pain condition compared with the non-empathetic condition. Although patients with schizophrenia exhibited deficits in cognition, they demonstrated a similar empathy effect to controls on Stroop facilitation, but a somewhat larger empathy effect on Stroop interference (a more decreased effect). In particular, the groups did not differ in either automatic or controlled processing during the non-empathetic condition, suggesting general rather than specific cognitive deficits in schizophrenia. Together, we interpret our findings in terms of two opposing effects of empathy on cognition in schizophrenia, with possible neuromodulatory mechanism. Whereas prior studies showed empathy to be impaired, our outcomes indicate that at least some components of empathetic pain processing are preserved in such patients. 10.1007/s00406-014-0565-x
    The role of oxytocin in empathy to the pain of conflictual out-group members among patients with schizophrenia. Abu-Akel A,Fischer-Shofty M,Levkovitz Y,Decety J,Shamay-Tsoory S Psychological medicine BACKGROUND:Oxytocin (OT) is associated with our ability to empathize and has been shown to play a major role in mediating social behaviors within the context of intergroup dynamics. Schizophrenia is associated with impaired empathy, and with a dysfunctional oxytocinergic system. The effect of OT on the empathic responses of patients with schizophrenia within the context of intergroup relationships has not been studied. The present study examined the effect of OT on the patients' empathic responses to pain experienced by in-group, conflictual out-group and neutral out-group members. METHOD:In a double-blind, placebo-controlled, within-subject cross-over design, the responses on the Pain Evaluation Task of 28 male patients with schizophrenia were compared to 27 healthy male controls. All participants received a single intranasal dose of 24 IU OT or placebo, 1 week apart. RESULTS:OT induced an empathy bias in the healthy controls towards the conflictual out-group members. Although this effect was absent in the patient group, OT seems to heighten an empathic bias in the patient group towards the in-group members when rating non-painful stimuli. CONCLUSIONS:The study demonstrates that the administration of OT can result in empathic bias towards adversary out-group members in healthy controls but not in patients with schizophrenia. However, the OT-induced bias in both the patients (in the no-pain condition towards the in-group members) and the healthy controls (in the no-pain and pain conditions towards the adversary out-group) suggests that OT enhances the distinction between conflictual in-group and out-group members. 10.1017/S003329171400097X
    Cognitive and emotional empathy in individuals at clinical high risk of psychosis. Montag C,Brandt L,Lehmann A,De Millas W,Falkai P,Gaebel W,Hasan A,Hellmich M,Janssen B,Juckel G,Karow A,Klosterkötter J,Lambert M,Maier W,Müller H,Pützfeld V,Schneider F,Stützer H,Wobrock T,Vernaleken I B,Wagner M,Heinz A,Bechdolf A,Gallinat J Acta psychiatrica Scandinavica BACKGROUND:Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. METHODS:Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. RESULTS:Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. CONCLUSION:Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored. 10.1111/acps.13178
    Self perception of empathy in schizophrenia: emotion recognition, insight, and symptoms predict degree of self and interviewer agreement. Lysaker Paul H,Hasson-Ohayon Ilanit,Kravetz Shlomo,Kent Jerillyn S,Roe David Psychiatry research Many with schizophrenia have been found to experience difficulties recognizing a range of their own mental states including memories and emotions. While there is some evidence that the self perception of empathy in schizophrenia is often at odds with objective observations, little is known about the correlates of rates of concordance between self and rater assessments of empathy for this group. To explore this issue we gathered self and rater assessments of empathy in addition to assessments of emotion recognition using the Bell Lysaker Emotion Recognition Task, insight using the Scale to Assess Unawareness of Mental Disorder, and symptoms using the Positive and Negative Syndrome Scale from 91 adults diagnosed with schizophrenia spectrum disorders. Results revealed that participants with better emotion recognition, better insight, fewer positive symptoms and fewer depressive symptoms produced self ratings of empathy which were more strongly correlated with assessments of empathy performed by raters than participants with greater deficits in these domains. Results suggest that deficits in emotion recognition along with poor insight and higher levels of positive and depressive symptoms may affect the degree of agreement between self and rater assessments of empathy in schizophrenia. 10.1016/j.psychres.2012.10.021
    Performance-based empathy mediates the influence of working memory on social competence in schizophrenia. Smith Matthew J,Horan William P,Cobia Derin J,Karpouzian Tatiana M,Fox Jaclyn M,Reilly James L,Breiter Hans C Schizophrenia bulletin Empathic deficits have been linked to poor functioning in schizophrenia, but this work is mostly limited to self-report data. This study examined whether performance-based empathy measures account for incremental variance in social competence and social attainment above and beyond self-reported empathy, neurocognition, and clinical symptoms. Given the importance of working memory in theoretical models of empathy and in the prediction of functioning in schizophrenia, we also examined whether empathy mediates the relationship between working memory and functioning. Sixty outpatients and 45 healthy controls were compared on performance-based measures of 3 key components of empathic responding, including facial affect perception, emotional empathy (affective responsiveness), and cognitive empathy (emotional perspective-taking). Participants also completed measures of self-reported empathy, neurocognition, clinical symptoms, and social competence and attainment. Patients demonstrated lower accuracy than controls across the 3 performance-based empathy measures. Among patients, these measures showed minimal relations to self-reported empathy but significantly correlated with working memory and other neurocognitive functions as well as symptom levels. Furthermore, cognitive empathy explained significant incremental variance in social competence (∆R (2) = .07, P < .05) and was found to mediate the relation between working memory and social competence. Performance-based measures of empathy were sensitive to functionally relevant disturbances in schizophrenia. Working memory deficits appear to have an important effect on these disruptions in empathy. Empathy is emerging as a promising new area for social cognitive research and for novel recovery-oriented treatment development. 10.1093/schbul/sbt084
    Affective and cognitive empathy and social quality of life in schizophrenia: a comparison between a parallel process model and an integrative meditation model. Ofir-Eyal Shani,Hasson-Ohayon Ilanit,Kravetz Shlomo Psychiatry research Two alternative models of impaired cognitive and affective processing that may underlie reduced social quality of life (SQoL) of persons with schizophrenia, were examined. According to the parallel process model, impaired cognitive empathy and affective empathy make relatively independent contributions to the symptoms of schizophrenia and to the consequent reduction in SQoL. According to the integrative mediation model, the symptoms of schizophrenia and the reduction in SQoL associated with these symptoms are the products of a process by which impairments of cognitive empathy are contingent on impairments of affective empathy. 90 persons with schizophrenia were assessed for SQoL, symptoms and cognitive and affective empathy. Results support the integrative mediation model only for cognitive empathy and negative psychiatric symptoms. Only the negative links between cognitive empathy and negative symptoms served to mediate the positive relation between affective empathy and SQoL. Positive symptoms had a limited negative impact on SQoL and did not play a role in the paths that linked affective empathy to SQoL. Age had a statistically significant and negative indirect relationship to SQoL. Results are consistent with recent approach that distinguish between cognitive and affective empathy and specify how these two processes are integrated. 10.1016/j.psychres.2014.06.049
    Empathy, depressive symptoms, and social functioning among individuals with schizophrenia. Abramowitz Amy C,Ginger Emily J,Gollan Jackie K,Smith Matthew J Psychiatry research Empathy deficits have been associated with schizophrenia and depression. We compared whether individuals with schizophrenia with and without co-occurring depressive symptoms differed on self-reported and performance-based measures of empathy and social functioning. We also examined the relationships among depressive symptoms, empathy, clinical symptoms, and social functioning. Twenty-eight individuals with schizophrenia and depressive symptoms, 32 individuals with schizophrenia without depressive symptoms, and 44 control subjects were compared on assessments of depressive symptoms, empathy, global neurocognition, clinical symptoms, and social functioning. Both groups of individuals with schizophrenia scored higher than controls on the Interpersonal Reactivity Index personal distress subscale. Individuals with schizophrenia and co-occurring depressive symptoms scored significantly higher than individuals with schizophrenia without depressive symptoms on the personal distress subscale. Personal distress and depressive symptoms were significantly correlated among individuals with schizophrenia and co-occurring depressive symptoms, while both measures negatively correlated with social functioning. Emotional empathy was related to clinical symptoms in both groups of individuals with schizophrenia. Personal distress partially mediated the relationship between co-occurring depressive symptoms and social functioning. Personal distress may be an important implication for social functioning among individuals with schizophrenia and co-occurring depressive symptoms, and should be examined further as a potential treatment target. 10.1016/j.psychres.2014.02.028
    Self-reported empathy and neural activity during action imitation and observation in schizophrenia. Horan William P,Iacoboni Marco,Cross Katy A,Korb Alex,Lee Junghee,Nori Poorang,Quintana Javier,Wynn Jonathan K,Green Michael F NeuroImage. Clinical INTRODUCTION:Although social cognitive impairments are key determinants of functional outcome in schizophrenia their neural bases are poorly understood. This study investigated neural activity during imitation and observation of finger movements and facial expressions in schizophrenia, and their correlates with self-reported empathy. METHODS:23 schizophrenia outpatients and 23 healthy controls were studied with functional magnetic resonance imaging (fMRI) while they imitated, executed, or simply observed finger movements and facial emotional expressions. Between-group activation differences, as well as relationships between activation and self-reported empathy, were evaluated. RESULTS:Both patients and controls similarly activated neural systems previously associated with these tasks. We found no significant between-group differences in task-related activations. There were, however, between-group differences in the correlation between self-reported empathy and right inferior frontal (pars opercularis) activity during observation of facial emotional expressions. As in previous studies, controls demonstrated a positive association between brain activity and empathy scores. In contrast, the pattern in the patient group reflected a negative association between brain activity and empathy. CONCLUSIONS:Although patients with schizophrenia demonstrated largely normal patterns of neural activation across the finger movement and facial expression tasks, they reported decreased self perceived empathy and failed to show the typical relationship between neural activity and self-reported empathy seen in controls. These findings suggest that patients show a disjunction between automatic neural responses to low level social cues and higher level, integrative social cognitive processes involved in self-perceived empathy. 10.1016/j.nicl.2014.06.006
    Subjective experience of emotions and emotional empathy in paranoid schizophrenia. Lehmann Anja,Bahçesular Katja,Brockmann Eva-Maria,Biederbick Sarah-Elisabeth,Dziobek Isabel,Gallinat Jürgen,Montag Christiane Psychiatry research Unlike the cognitive dimensions, alterations of the affective components of empathy in schizophrenia are less well understood. This study explored cognitive and affective dimensions of empathy in the context of the subjective experience of aspects of emotion processing, including emotion regulation, emotional contagion, and interpersonal distress, in individuals with schizophrenia and healthy controls. In addition, the predictive value of these parameters on psychosocial function was investigated. Fifty-five patients with paranoid schizophrenia and 55 healthy controls were investigated using the Multifaceted Empathy Test and Interpersonal Reactivity Index, as well as the Subjective Experience of Emotions and Emotional Contagion Scales. Individuals with schizophrenia showed impairments of cognitive empathy, but maintained emotional empathy. They reported significantly more negative emotional contagion, overwhelming emotions, lack of emotions, and symbolization of emotions by imagination, but less self-control of emotional expression than healthy persons. Besides cognitive empathy, the experience of a higher extent of overwhelming emotions and of less interpersonal distress predicted psychosocial function in patients. People with schizophrenia and healthy controls showed diverging patterns of how cognitive and emotional empathy related to the subjective aspects of emotion processing. It can be assumed that variables of emotion processing are important moderators of empathic abilities in schizophrenia. 10.1016/j.psychres.2014.09.009
    Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy. Michaels Tania M,Horan William P,Ginger Emily J,Martinovich Zoran,Pinkham Amy E,Smith Matthew J Psychiatry research Cognitive empathy impairments have been linked to poor social functioning in schizophrenia. However, prior studies primarily used self-reported empathy measures developed decades ago that are not well-aligned with contemporary models of empathy. We evaluated empathy and its relationship to social functioning in schizophrenia using the recently developed Questionnaire of Cognitive and Affective Empathy (QCAE). Schizophrenia (n=52) and healthy comparison (n=37) subjects completed the QCAE, Interpersonal Reactivity Index (IRI), and measures of neurocognition, symptoms, and social functioning. Between-group differences on the QCAE, and relationships between QCAE and IRI subscales, neurocognition, symptoms, and social functioning were examined. The schizophrenia group reported significantly lower cognitive empathy than comparison subjects, which was driven by low online simulation scores. Cognitive empathy explained significant variance in social functioning after accounting for neurocognition and symptoms. Group differences for affective empathy were variable; the schizophrenia group reported similar proximal responsivity, but elevated emotion contagion relative to comparison subjects. These findings bolster support for the presence and functional significance of impaired cognitive empathy in schizophrenia using a contemporary measure of empathy. Emerging evidence that some aspects of affective empathy may be unimpaired or hyper-responsive in schizophrenia and implications for the assessment and treatment of empathy in schizophrenia are discussed.
    Emotion Regulation Predicts Everyday Emotion Experience and Social Function in Schizophrenia. Moran Erin K,Culbreth Adam J,Barch Deanna M Clinical psychological science : a journal of the Association for Psychological Science While recent evidence has pointed to disturbances in emotion regulation strategy use in schizophrenia, few studies have examined how these regulation strategies relate to emotionality and social behavior in daily life. Using ecological momentary assessment (EMA), we investigated the relationship between emotion regulation, emotional experience and social interaction in the daily lives of individuals with schizophrenia. Participants (N=30) used mobile phones to complete online questionnaires reporting their daily emotional experience and social interaction. Participants also completed self-report measures of habitual emotion regulation. Hierarchical linear modeling revealed that self-reported use of cognitive reappraisal and savoring of emotional experiences were related to greater positive emotion in daily life. In contrast, self-reported suppression was related to greater negative emotion, reduced positive emotion and reduced social interaction in daily life. These findings suggest that individual differences in habitual emotion regulation strategy usage have important relationships to every day emotional and social experiences in schizophrenia. 10.1177/2167702617738827
    Schizophrenia. Owen Michael J,Sawa Akira,Mortensen Preben B Lancet (London, England) Schizophrenia is a complex, heterogeneous behavioural and cognitive syndrome that seems to originate from disruption of brain development caused by genetic or environmental factors, or both. Dysfunction of dopaminergic neurotransmission contributes to the genesis of psychotic symptoms, but evidence also points to a widespread and variable involvement of other brain areas and circuits. Disturbances of synaptic function might underlie abnormalities of neuronal connectivity that possibly involves interneurons, but the precise nature, location, and timing of these events are uncertain. At present, treatment mainly consists of antipsychotic drugs combined with psychological therapies, social support, and rehabilitation, but a pressing need for more effective treatments and delivery of services exists. Advances in genomics, epidemiology, and neuroscience have led to great progress in understanding the disorder, and the opportunities for further scientific breakthrough are numerous--but so are the challenges. 10.1016/S0140-6736(15)01121-6
    Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis. The journal of sexual medicine BACKGROUND:Mounting clinical studies have reported patients with schizophrenia are at high risk of developing sexual dysfunction (SD), but a directly calculated prevalence of SD is currently lacking. AIM:To further quantify the association between schizophrenia and SD. METHODS:MEDLINE (PubMed), Embase (OVID), the Cochrane Library databases, and the PsycINFO were systematically searched for eligible studies reporting the sexual functioning in patients with schizophrenia. This meta-analysis has been registered on PROSPERO (ID: CRD42019121720, http://www.crd.york.ac.uk/PROSPERO). OUTCOMES:The relationship between schizophrenia and SD was detected by calculating the relative risk (RR) with a 95% confidence interval (CI). The GRADE-profiler was employed to rank the quality of the evidence. RESULTS:10 observational studies (3 case-control studies and 7 cross-sectional studies) were finally included, enrolling a total of 3,570 participants (mean age 28.6-46.2 years), of whom 1,161 had schizophrenia and the remainders were the healthy control subjects. Synthetic results indicated that schizophrenia was significantly associated with an increased risk of SD regardless of gender (3 studies reporting both sexes: RR = 2.24, 95%CI: 1.66-3.03, P < .001, heterogeneity: I = 0.0%, P = .431; 7 studies reporting men: RR = 2.63, 95%CI: 1.68-4.13, P < .001, heterogeneity: I = 82.7%, P < .001; 5 studies reporting women: RR = 2.07, 95%CI: 1.46-2.94, P < .001; heterogeneity: I = 79.7%, P = .001). In accordance with the GRADE-profiler, the quality of the evidence of primary outcomes was LOW, MODERATE, and LOW in studies including both sexes, men, and women, respectively. CLINICAL IMPLICATIONS:Our findings confirmed the potential link between schizophrenia and SD. Clinicians should routinely assess the sexual functioning for those patients with schizophrenia and further recommend the preferred antipsychotics for them. STRENGTHS & LIMITATIONS:This is the first meta-analysis investigating the association between schizophrenia and the risks of SD in both sexes. Nonetheless, substantial heterogeneities were identified across the selected studies. CONCLUSION:Robust data from this meta-analysis showed increased rates of SD in patients with schizophrenia compared with the general populations. Therefore, more specific psychological and pharmaceutical interventions are needed to help patients with schizophrenia gain a better sexual life. Zhao S, Wang X, Qiang X, et al. Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis. J Sex Med 2020;17:1476-1488. 10.1016/j.jsxm.2020.03.005
    Structure and correlates of self-reported empathy in schizophrenia. Horan William P,Reise Steven P,Kern Robert S,Lee Junghee,Penn David L,Green Michael F Journal of psychiatric research Research on empathy in schizophrenia has relied on dated self-report scales that do not conform to contemporary social neuroscience models of empathy. The current study evaluated the structure and correlates of the recently-developed Questionnaire of Cognitive and Affective Empathy (QCAE) in schizophrenia. This measure, whose structure and validity was established in healthy individuals, includes separate scales to assess the two main components of empathy: Cognitive Empathy (assessed by two subscales) and Affective Empathy (assessed by three subscales). Stable outpatients with schizophrenia (n = 145) and healthy individuals (n = 45) completed the QCAE, alternative measures of empathy, and assessments of clinical symptoms, neurocognition, and functional outcome. Exploratory and confirmatory factor analyses provided consistent support for a two-factor solution in the schizophrenia group, justifying the use of separate cognitive and affective empathy scales in this population. However, one of the three Affective Empathy subscales was not psychometrically sound and was excluded from further analyses. Patients reported significantly lower Cognitive Empathy but higher Affective Empathy than controls. Among patients, the QCAE scales showed significant correlations with an alternative self-report empathy scale, but not with performance on an empathic accuracy task. The QCAE Cognitive Empathy subscales also showed significant, though modest, correlations with negative symptoms and functional outcome. These findings indicate that structure of self-reported empathy is similar in people with schizophrenia and healthy subjects, and can be meaningfully compared between groups. They also contribute to emerging evidence that some aspects of empathy may be intact or hyper-responsive in schizophrenia. 10.1016/j.jpsychires.2015.04.016
    Peripheral oxytocin is inversely correlated with cognitive, but not emotional empathy in schizophrenia. Montag Christiane,Schöner Johanna,Speck Lucas Guilherme,Just Sandra,Stuke Frauke,Rentzsch Johannes,Gallinat Jürgen,Majić Tomislav PloS one Endogenous oxytocin has been associated with different aspects of social cognition in healthy subjects and patients with schizophrenia. In this pilot study, we investigated the relationship between plasma oxytocin and oxytocin level changes induced by empathy-eliciting, attachment-related movie scenes with correlates of cognitive and emotional empathy in patients and healthy controls. The Multifaceted Empathy Test (MET) and the Interpersonal Reactivity Index (IRI) were administered to patients with schizophrenia (N = 35, 12 females) and healthy controls (N = 35, 12 females) to estimate dimensions of cognitive and emotional empathy. Peripheral basal oxytocin concentrations and oxytocin responses to movie-based emotional stimuli were assessed using radioimmunoassay with sample extraction. In patients, induced oxytocin level changes were inversely correlated with MET cognitive empathy regarding negative emotional states. Controlling for non-social cognition and age revealed a significant negative association between basal oxytocin levels and MET cognitive empathy for positive emotions. In healthy subjects, oxytocin reactivity was inversely correlated with the IRI subscale "fantasy". Oxytocin was not related to any measure of emotional empathy. A hyper-reactive oxytocin system might be linked to impaired cognitive empathy as a part of a dysfunctional regulative circuit of attachment-related emotions and interpersonal stressors or threats by attribution of meaning. Healthy adults with a disposition to identify with fictional characters showed lower oxytocin reactivity, possibly indicating familiarity with movie-based stimuli. The oxytocinergic system may be involved in maladaptive coping mechanisms in the framework of impaired mentalizing and associated dysfunctional responses to interpersonal challenges in schizophrenia. 10.1371/journal.pone.0231257
    Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls. Kristof Zsuliet,Kresznerits Szilvia,Olah Mate,Gyollai Agoston,Lukacs-Miszler Katalin,Halmai Tamas,Fountoulakis Konstantinos N,Tenyi Tamas,Dome Peter,Gonda Xenia Psychiatry research There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients. 10.1016/j.psychres.2018.07.021
    Childhood Trauma and Insomnia Increase Suicidal Ideation in Schizophrenia Patients: A Cross-Sectional Study. Zhang Yaoyao,Fang Xinyu,Tang Bei,Fan Kaili,Wen Na,Zhao Ke,Xu Weiqian,Tang Wei,Chen Yi Frontiers in psychiatry This study aimed to investigate the effect of childhood trauma, especially its specific dimensions, and clinical risk factors for suicidal ideation in patients with schizophrenia. A total of 83 inpatients with schizophrenia were enrolled and divided into two groups: with suicidal ideation ( = 33) and without suicidal ideation ( = 50). All participants were administered the Childhood Trauma Questionnaire-Short Form, the Insomnia Severity Index, the Beck Scale for Suicide Ideation, the Modified Overt Aggression Scales, the auditory hallucination rating scale, the Hamilton Rating Scale of Depression and the Positive and Negative Syndrome Scale. In our sample, 39.8% of the subjects had suicidal ideation, and 60.6% of them had suffered from childhood trauma. Patients with suicidal ideation had a higher Insomnia Severity Index score, Physical neglect score, the Childhood Trauma Questionnaire-Short Form total score (all < 0.05) compared to those without. The logistic regression analysis revealed that physical neglect in Childhood Trauma Questionnaire was significantly associated with suicidal ideation (OR = 5.46, < 0.05, 95% CI = 0.007-0.483). Further stepwise multiple linear regression identified that insomnia (β = 0.272, = 0.011) and physical neglect (β = 0.257, = 0.017) were strong risk factors for the severity of suicidal ideation in patients with schizophrenia. Mediation analysis showed that insomnia played a complete mediating role between physical neglect and suicidal ideation. Our results indicate that childhood maltreatment of physical neglect is a strong independent risk factor for suicidal ideation in schizophrenia. The risk is probably aggravated by the poor quality of sleep. Early screening and psychosocial treatment are recommended for psychotic individuals with a trauma history. 10.3389/fpsyt.2021.769743
    The effects of systematic psychological nursing on the sleep quality of schizophrenic patients with sleep disorders. Li Manru,Lang Bibo American journal of translational research OBJECTIVE:This study was designed to explore the effects of systematic psychological nursing (SPN) on the sleep quality of schizophrenic patients with sleep disorders. METHODS:A total of 101 schizophrenic patients with sleep disorders were divided into the control group (50 patients who underwent routine nursing) and the observation group (51 patients who underwent SPN, including health education, psychological nursing, cognitive intervention, reasonable entertainment, and family and social support). One month after the nursing, the sleep quality (the Pittsburgh Sleep Quality Index (PSQI) scores), the improvement in the patients' schizophrenic symptoms (their Positive and Negative Syndrome Scale (PANSS) scores), their sense of self-esteem (their Self-Esteem Scale (SES) scores), their medication compliance (their Morisky Medication Adherence Scale (MMAS) scores), their self-efficacy (their Strategies Used by People to Promote Health (SUPPH) scores), and their quality of life (Generic Quality of Life Inventory (GQOLI)-74 scores) were compared between the two groups. RESULTS:After the nursing, the PSQI and PANSS scores in the two groups were decreased, and lower scores were seen in the observation group (both P<0.05). However, there were opposite trends in the SES, MMAS, GQOLI-74, and SUPPH scores (all P<0.05). CONCLUSION:SPN can effectively improve the schizophrenia symptoms and the sleep quality, enhance the sense of self-esteem, and improve the medication compliance, self-efficacy, and quality of life in schizophrenic patients with sleep disorders. Therefore, SPN is worthy of clinical application.
    Integrating Empathy and Interpersonal Emotion Regulation. Zaki Jamil Annual review of psychology When individuals experience empathy they often seek to bolster others' well-being. But what do empathizers want others to feel? Though psychologists have studied empathy and prosociality for decades, this question has yet to be clearly addressed. This is because virtually all existing research focuses on cases in which improving others' well-being also comprises heightening their positive affect or decreasing their negative affect and helping them reach their own emotional goals. In this review, I argue that real-life empathic goals encompass a broader range-including sometimes worsening targets' affect or contravening their wishes in order to improve their well-being-that can be productively integrated into the framework of interpersonal emotion regulation (IER). I review the empathic IER spectrum in a number of contexts, including close relationships, professional caregiving, and group-based emotions. Integrating empathy and IER provides a synthetic and generative way to ask new questions about how social emotions produce prosocial actions. 10.1146/annurev-psych-010419-050830
    Identification of risk factors for suicidal ideation in patients with schizophrenia. Fang Xinyu,Chen Yan,Wang Yewei,Zhang Chen Psychiatry research Patients with schizophrenia have a high risk for suicide, and therefore, identification of risk factors for suicidal ideation (SI) may be helpful to reduce suicide rate. This study aimed to detect which clinical symptoms and biochemical parameters were most strongly associated with SI. A total of 174 patients and 35 healthy controls were enrolled in our study. Patients were evaluated by the Positive and Negative Syndrome Scale (PANSS), Scale of Assessment Negative Symptoms (SANS) and the Calgary Depression Scale for Schizophrenia (CDSS) for psychiatric and depressive symptoms, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for cognitive function. We examined the levels of prolactin (PRL) and metabolic parameters in all participants. Our results showed a significantly increased level of PRL in patients compared to the controls before (t = 10.414, P < 0.001) and after (F = 31.308, P < 0.001) covariates were controlled for. In addition, we found that patients with SI had significantly higher PRL levels than those without SI (t = 2.586, P = 0.011). And there were positive correlations between serum PRL levels (r = 0.194, P = 0.010), serum fasting triglyceride levels (TG) (r = 0.188, P = 0.013), and RBANS visuospatial skill subscores (r = 0.162, P = 0.036) and SI severity. Finally, the stepwise multiple linear regression analysis revealed that SI severity was significantly associated with PRL levels, fasting TG levels and RBANS visuospatial skill subscores. This study provides support that greater cognitive ability, specifically visuospatial skill, PRL and TG, may confer an elevated risk for more severe SI in schizophrenia patients. 10.1016/j.psychres.2018.11.051
    The functional significance of cognitive empathy and theory of mind in early and chronic schizophrenia. Canty Allana L,Cao Yuan,Neumann David,Shum David H K Psychiatry research Theoretical models suggest that it is the interplay between social cognitive processes that result in adaptive social functioning in schizophrenia. This study explored the relative contributions of, and interplay between, cognitive empathy, affective theory of mind (ToM), neurocognition, and severity of clinical symptoms, in predicting the social functioning of individuals with schizophrenia. Clinical participants (early schizophrenia n = 26, chronic schizophrenia n = 32) were administered an ecologically valid measure of ToM (viz., the Virtual Assessment of Mentalising Ability or VAMA) and the Empathy Quotient (EQ) as part of a larger neuropsychological and social functioning assessment battery. Results indicated that individuals with early schizophrenia reported significantly better cognitive empathy than individuals with chronic schizophrenia. ToM was found to have added value in predicting both community functioning and functional capacity that was beyond that accounted for by cognitive empathy, clinical symptoms, and neurocognition for both clinical groups. Further, our results indicated that the capacity to demonstrate empathic understanding of another's situation (i.e., cognitive empathy) mediates the relationship between ToM and social functioning. Together, our findings highlight the intricate and compounding nature of social cognition constructs, and their effect on social functioning for individuals with schizophrenia. 10.1016/j.psychres.2021.113852
    Prevalence, clinical correlates of suicide attempt and its relationship with empathy in patients with schizophrenia. Wang Wenjia,Zhou Yongjie,Wang Jiesi,Xu Hang,Wei Shuochi,Wang Dongmei,Wang Li,Zhang Xiang Yang Progress in neuro-psychopharmacology & biological psychiatry OBJECTIVES:Previous studies have shown that cognitive impairment plays a key role in suicide, an important factor leading to premature death in schizophrenia (SCZ) patients. Empathy has received extensive attention recently; however, the relationship of empathy with suicide in schizophrenia is still unknown. The main aim of this study was to investigate the prevalence of suicide attempts and its association with empathy and other characteristics in Chinese chronic SCZ patients. METHODS:The suicide attempt data, together with demographic characteristics and clinical variables were collected from 627 chronic inpatients with schizophrenia. We utilized the Positive and Negative Syndrome Scale (PANSS) for the psychopathological symptoms, and the Interpersonal Reactivity Index (IRI) for affective and cognitive empathy in this study. RESULTS:We found a suicide attempt rate of 11.3% in chronic SCZ patients. Compared to non-attempters, suicide attempters were more likely to be women, had younger age and higher education levels, as well as higher positive symptoms and depressive factor score, but lower negative symptoms of PANSS (all p < .05). Moreover, after controlling the confounding factors, suicide attempters scored higher in Personal Distress subscale of IRI (F = 5.446, p = .020) than non-attempters. CONCLUSIONS:The prevalence of suicide attempt is high in chronic SCZ patients. Its risk factors include some demographic and clinical variables. Moreover, suicide attempters experienced stronger personal distress, suggesting that stronger empathy may be a risk factor of suicide. 10.1016/j.pnpbp.2020.109863
    An evaluation of the disability, insight and self-care agency of schizophrenia patients. Perspectives in psychiatric care AIM:This study aims to evaluate the disability, insight and self-care agency of schizophrenia patients. DESIGN AND METHOD:This descriptive study was conducted with 100 patients in remission who had a diagnosis of schizophrenia at community mental health centers. RESULTS:The schizophrenia patients had poor insight and moderate self-care agency. The self-care agency of schizophrenia patients is a neglected issue in medicine, and is associated with positive and negative symptoms, insight and disability. IMPLEMENTATION RESULTS:The results can guide community mental health center nurses to increase the quality of life of schizophrenia patients in remission and to help reintegrate them into society. 10.1111/ppc.12877
    The relationship between nurses' empathic tendencies, empathic skills, and individualized care perceptions. Guven Ozdemir Nur,Sendir Merdiye Perspectives in psychiatric care PURPOSE:The study aims to determine the relationship between nurses' empathic tendencies, empathic skills, and individualized care perceptions. DESIGN AND METHODS:This study employed a descriptive and correlational design. Data were collected from nurses in eight training and research hospitals in Turkey. The study sample consisted of 472 nurses who were both volunteered to participate and randomly selected. FINDINGS:A definite high-level relation was determined between nurses' empathic tendencies and individualized care perceptions, but no relation was determined between nurses' empathic skills and individualized care perceptions. PRACTICE IMPLICATIONS:This study can underline practices accounting for empathy and individualized care in nursing research and training programs. 10.1111/ppc.12489
    Social Cognitive Skills Training for Psychosis With Community-Based Training Exercises: A Randomized Controlled Trial. Horan William P,Dolinsky Michelle,Lee Junghee,Kern Robert S,Hellemann Gerhard,Sugar Catherine A,Glynn Shirley M,Green Michael F Schizophrenia bulletin Impairments in social cognition are key determinants of poor functioning in psychosis and an important new target for treatment development. Initial studies support the feasibility and efficacy of training interventions for social cognition, but have been small and have had substantial methodological limitations. This report describes the largest rigorously controlled study of a social cognitive treatment to date. We evaluated the efficacy of a refined version of the 24-session Social Cognitive Skills Training (SCST) program, and whether adding in vivo training sessions in community settings would enhance generalization to functional improvements. One hundred thirty-nine outpatients with psychotic disorders were randomly assigned to one of 3 time- and format-matched conditions: (1) SCST plus in vivo community-based training, (2) SCST plus clinic-based training, or (3) Illness management control condition. SCST targeted the domains of emotion processing, social perception, attributional bias, empathy, and mentalizing. Assessments of social cognition, nonsocial cognition, symptoms, and functioning were completed at baseline, mid-treatment, posttreatment, and 3-month follow-up. On the primary social cognitive outcome measures, there was significant, durable SCST-related improvement in facial emotion identification. There was also a significant SCST benefit for emotional intelligence and an in vivo training effect for empathy, though these improvements were not durable. Further, there were no overall or in vivo-related changes in functioning. This study bolsters and extends support for the efficacy of SCST in a relatively large and rigorously controlled trial, although our effort to enhance generalization to functional improvements through in vivo community-based training was not successful. 10.1093/schbul/sbx167
    Association between empathy and clinical symptoms in chronic schizophrenia: A large sample study based on Chinese Han population. Wang Wenjia,Zhou Yongjie,Liu Ran,Wei Shuochi,Xu Hang,Wang Jiesi,Wang Li,Trinh Tammy H,Wu Hanjing E,Wang Dongmei,Zhang Xiangyang Journal of psychiatric research BACKGROUND:In patients with schizophrenia, clinical symptoms and cognitive impairment are its core features, both of which have a significant impact on the prognosis and functional outcome. Empathy, as an important social cognition, has been found to be associated with the clinical symptoms in schizophrenia, but the conclusions on this issue are inconsistent. Therefore, this study will continue to explore it through a large sample of inpatients with chronic schizophrenia in the Chinese Han population. METHODS:We obtained the sociodemographic characteristics of 987 inpatients, measured their clinical symptoms using the Positive and Negative Syndrome Scale (PANSS), and assessed their self-reported empathy using the Interpersonal Reactivity Index (IRI). The factor score for negative symptoms (FSNS) of PANSS was additionally calculated. RESULTS:Correlation and linear regression analysis showed that patients' PANSS scores were widely correlated with their IRI scores. In particular, the negative symptoms of patients were significantly correlated to IRI total score (r = -0.131, p < .001) and subscales such as Perspective Taking (PT) (r = -0.233, p < .001). FSNS had close relationships with empathy as well. There are also many significant associations between other dimensions, such as general psychopathology and Perspective Taking (PT) or Fantasy (FS) (all p < .05). CONCLUSIONS:Our results indicated that clinical symptoms, especially negative symptoms, were closely related to their current empathy in patients with schizophrenia, suggesting that the severity of clinical symptoms may be a powerful factor in predicting social cognition such as empathy of schizophrenia. 10.1016/j.jpsychires.2021.05.046
    Insight in schizophrenia: associations with empathy. Pijnenborg G H M,Spikman J M,Jeronimus B F,Aleman A European archives of psychiatry and clinical neuroscience Many people with schizophrenia (50-80%) demonstrate impaired insight, something which has been associated with a poorer outcome. Two types of empathy can be distinguished: affective empathy via shared emotions and cognitive empathy, also referred to as Theory of Mind (ToM). ToM can be subdivided into cognitive ToM (knowledge about beliefs of other people via perspective taking) and affective ToM (knowledge about other people's emotions via perspective taking). Recent studies show a relationship between Theory of Mind (ToM) and insight. However, the relationship between affective empathy and insight in schizophrenia was not examined previously. This was the aim of the present study. We expected that affective empathy would show a stronger relationship with insight than both cognitive and affective ToM. We assessed forty-six patients with a diagnosis of schizophrenia, and fifty-three healthy controls were assessed with a test battery consisting of tests of social cognition (a self-rating scale for affective empathy, a ToM task assessing both cognitive and affective ToM, and two tests of emotion perception), verbal memory, executive functioning, psychomotor speed, and intelligence. Insight was assessed with item G12 of the PANSS-interview. A regression equation showed that affective empathy made the strongest unique contribution to insight, followed closely by affective ToM. Together, they explained 45% of the variance in insight. None of the other independent variables made a unique contribution to the prediction of insight. Both affective ToM and affective empathy are associated with insight in schizophrenia. Being able to take empathize with other peoples feeling at both the affective and cognitive level may enhance insight in schizophrenia. 10.1007/s00406-012-0373-0
    Prevalence, demographic and clinical features of comorbid depressive symptoms in drug naïve patients with schizophrenia presenting with first episode psychosis. Dai Jing,Du Xiangdong,Yin Guangzhong,Zhang Yingyang,Xia Haishen,Li Xiaosi,Cassidy Rylan,Tong Qingchun,Chen Dachun,Teixeira Antonio Lucio,Zheng Yingjun,Ning Yuping,Soares Jair C,He Man-Xi,Zhang Xiang Yang Schizophrenia research Depressive symptoms are common in first episode schizophrenia. However, the prevalence and its associations of comorbid depressive symptoms with clinical variables are less well characterized in Chinese Han patients with schizophrenia. In this cross-sectional study, we recruited 240 first-episode and drug naïve (FEDN) inpatients with schizophrenia. All patients were rated on the 17-item Hamilton Depression Rating Scale (HAMD-17) to measure depressive symptoms, and also on the Positive and Negative Syndrome Scale (PANSS) for psychopathology. Our results showed that 131 patients had a total score of 8 or more points on HAMD-17, making the prevalence of comorbid depressive symptoms 54.6%. Fewer women (48.1%, 62 of 129) than men (62.2%, 69 of 111) had comorbid depressive symptoms. Compared to those patients without depressive symptoms, those with depressive symptoms showed higher PANSS total, general psychopathology, cognitive factor and negative symptom scores (all p<0.05). Further stepwise multiple logistic regression analysis indicated that the PANSS general psychopathology, the PANSS total score and gender (all p<0.05) remained significantly associated with depressive symptoms. In addition, correlation analysis showed significant correlations between HAMD total score and the following parameters: the PANSS general psychopathology, total score, and cognitive factor (Bonferroni corrected p's<0.05). Our results suggest that depressive symptoms occur with high prevalence in FEND schizophrenia in a Chinese Han population, and show association with general psychopathology, as well as with cognitive impairment. 10.1016/j.schres.2017.06.029
    Depressive symptoms in Chinese male inpatients with schizophrenia: Prevalence and clinical correlates. Xu Yan-Min,Li Fu,Liu Xiao-Bo,Zhong Bao-Liang Psychiatry research Depression is common in patients with schizophrenia and associated with serious consequences. However, previous studies have mixed findings on characteristics of depression in schizophrenia, partly because of the use of depressive symptom scales that are not specific to schizophrenia. This study examined the prevalence and correlates of depressive symptoms in Chinese patients with schizophrenia. A consecutive sample of 349 male inpatients with schizophrenia was recruited from the largest psychiatric specialty hospital in south-central China. Depressive symptoms and psychopathology of patients were assessed with the Calgary Depression Scale for Schizophrenia and the Positive and Negative Symptom Scale, respectively. Extrapyramidal side effects (EPSs) were assessed with the Simpson Angus Scale, the Barnes Akathisia Rating Scale, and the Abnormal Involuntary Movement Scale. Demographic and other clinical data were also collected. Depressive symptoms were present in 41.8% of male schizophrenia inpatients. Multiple logistic regression analysis revealed that early age at onset (OR [95%CI] = 1.12 [1.01,1.27], p = 0.049), more severe negative symptoms (OR [95%CI] = 1.05 [1.01,1.09], p = 0.034), more severe general psychopathological symptoms (OR [95%CI] = 1.06 [1.01,1.12], p = 0.041), akathisia (OR [95%CI] = 2.87 [1.45,5.69], p = 0.003), and dyskinesia (OR [95%CI] = 3.93 [1.36,11.33], p = 0.011) were significantly associated with depression. Appropriate antipsychotic medication treatment and reducing EPSs of antipsychotics may help prevent or relieve depression of patients with schizophrenia. 10.1016/j.psychres.2018.04.016
    Social cognitive predictors of smoking cessation intentions among smoker employees: the roles of anticipated regret and social norms. Lazuras Lambros,Chatzipolychroni Eleonora,Rodafinos Angelos,Eiser J Richard Addictive behaviors The present study assessed the effects of anticipated regret, social norms, and related social cognitions on smoking cessation intentions among indoor employees in a pro-smoking culture. Overall, 93 daily smokers completed anonymous structured questionnaires assessing attitudinal and health beliefs about tobacco use, social norms, quitting self-efficacy, and anticipated regret. Past quit attempts and tobacco dependence were also measured. Hierarchical linear regression and mediation analyses showed that attitudes toward quitting, self-efficacy and anticipated regret significantly predicted cessation intentions, over and above past quit attempts and tobacco dependence. Unlike in previous studies, tobacco dependence, descriptive norms and smoke-free policies did not directly influence quit intentions in our sample of smokers. Anticipated regret mediated the effects of attitudes and social norms on cessation intentions. 10.1016/j.addbeh.2011.11.008
    Effects of nicotine on social cognition, social competence and self-reported stress in schizophrenia patients and healthy controls. Drusch Katharina,Lowe Agnes,Fisahn Katrin,Brinkmeyer Jürgen,Musso Francesco,Mobascher Arian,Warbrick Tracy,Shah John,Ohmann Christian,Winterer Georg,Wölwer Wolfgang European archives of psychiatry and clinical neuroscience More than 80 % of patients diagnosed with schizophrenia are nicotine-dependent. Self-medication of cognitive deficits and an increased vulnerability to stress are discussed as promoting factors for the development of nicotine dependence. However, the effects of nicotine on social cognition and subjective stress responses in schizophrenia are largely unexplored. A 2 × 2-factorial design (drug × group) was used to investigate the effects of nicotine versus placebo in smoking schizophrenia patients and healthy controls after 24 h of abstinence from smoking. Participants performed a facial affect recognition task and a semi-standardized role-play task, after which social competence and self-reported stress during social interaction were assessed. Data analysis revealed no significant group differences in the facial affect recognition task. During social interaction, healthy controls showed more non-verbal expressions and a lower subjective stress level than schizophrenia patients. There were no significant effects of nicotine in terms of an enhanced recognition of facial affect, more expressive behaviour or reduced subjective stress during social interaction. While schizophrenia patients unexpectedly recognized facial affect not significantly worse than healthy controls, the observed group differences in subjective stress and non-verbal expression during social interaction in the role-play situation are in line with previous findings. Contrary to expectations derived from the self-medication hypothesis, nicotine showed no significant effects on the dependent variables, perhaps because of the dosage used and the delay between the administration of nicotine and the performance of the role-play. 10.1007/s00406-012-0377-9
    Smoking does not impact social and non-social cognition in patients with first episode psychosis. Sánchez-Gutiérrez Teresa,García-Portilla M Paz,Parellada Mara,Bobes Julio,Calvo Ana,Moreno-Izco Lucía,González-Pinto Ana,Lobo Antonio,de la Serna Elena,Cabrera Bibiana,Torrent Carla,Roldán Laura,Sanjuan Julio,Ibáñez Ángela,Sánchez-Torres Ana María,Corripio Iluminada,Bernardo Miquel,Cuesta Manuel J, Schizophrenia research BACKGROUND:Many studies having shown significant improvements in non-social and social cognitive performance in smoking FEP patients compared to non-smoking FEP patients. The findings are controversial. This study analyzed the effects of tobacco use on non-social and social cognitive function in a large group of FEP patients and a matched healthy control group. METHODS:A sample of 335 patients with FEP and 253 healthy controls was divided into four subgroups: control tobacco users (CTU), control non-tobacco users (CNTU), patient tobacco users (PTU) and patient non-tobacco users (PNTU). Demographic variables, tobacco use variables (presence or absence, frequency and duration of tobacco use), neurocognitive (non-social) performance and social cognition were assessed. RESULTS:Comparison of 4 subgroups in non-social cognitive function revealed significant differences after controlling for covariables in executive functions (F=13.45; p≤0.001) and working memory domains (F=4.30; p=0.005). CTU and CNTU subgroups scored higher in all the domains compared to the PTU and the PNTU subgroups respectively. Social cognitive function was also significantly different within the four subgroups, with control subgroups showing better social cognition than patient subgroups. Significant differences in the executive functions domain were observed when comparing PTU and CTU groups (F=19.60; p≤0.001). No significant differences were revealed in the comparison between the patient groups. CONCLUSIONS:This large study suggests that tobacco use in FEP patients is not related to better non-social or social cognitive performance. 10.1016/j.schres.2018.03.025
    Suicidality, self-stigma, social anxiety and personality traits in stabilized schizophrenia patients - a cross-sectional study. Vrbova Kristyna,Prasko Jan,Ociskova Marie,Holubova Michaela,Kantor Krystof,Kolek Antonin,Grambal Aleš,Slepecky Milos Neuropsychiatric disease and treatment BACKGROUND AND AIM:Patients who have schizophrenia are more prone to suicidal behavior than the general population. This study aimed to find connections between suicidality and self-stigma, hope, and personality traits in patients with schizophrenia. METHODS:Forty-eight stabilized outpatients with schizophrenia attended this cross-sectional study. Patients were diagnosed by the Mini International Neuropsychiatric Interview (MINI) using the ICD-10 research diagnostic criteria. The assessments included Positive and Negative Syndrome Scale, objective and subjective Clinical Global Impression, Liebowitz Social Anxiety Scale, Beck Depression Inventory-second edition, Internalized Stigma of Mental Illness, the Temperament and Character Inventory, and Adult Dispositional Hope Scale. RESULTS:The individual rate of suicidality (suicidal index from MINI) strongly positively correlated with self-stigma, level of depression, social anxiety, and harm-avoidance, and negatively correlated with hope, self-directedness, and stigma resistance. CONCLUSION:Individuals with additional symptoms of depression, social anxiety, trait-like anxiety, and self-stigma should be carefully monitored for suicidal ideation. On the opposite side, patients with sufficient hope, self-esteem, and goal-directed attitudes are less likely to have suicidal thoughts and may potentially be role models in group rehabilitation programs, motivating more distressed colleagues and showing them ways to cope. 10.2147/NDT.S162070
    Theory of Mind in first-episode schizophrenia patients: correlations with cognition and personality traits. Koelkebeck Katja,Pedersen Anya,Suslow Thomas,Kueppers Kerstin Annika,Arolt Volker,Ohrmann Patricia Schizophrenia research INTRODUCTION:There is substantial evidence for Theory of Mind (ToM) deficits in patients with schizophrenia. Many psychotic symptoms may best be understood in light of an impaired capacity to infer one's own and other persons' mental states and to relate those to executing behavior. The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning. MATERIALS AND METHODS:A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls. Participants had to describe animated triangles which moved (1) randomly, (2) goal-directed, or (3) in complex, socially interactive ways (ToM video sequences). Neuropsychological functioning, psychopathology, autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance. RESULTS:Compared to healthy controls, first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences. No group differences were revealed for videos with random movements. ToM abilities correlated significantly with positive symptoms, reasoning, verbal memory performance and verbal IQ, but not with empathetic abilities or autistic and alexithymic features. When controlling for reasoning, verbal memory performance and verbal IQ, the correctness of video descriptions was still significantly worse in schizophrenia patients. DISCUSSION:The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia. Only a moderate influence of neurocognitive deficits on ToM performance was observed. Impairment in ToM abilities seems to be predominantly independent of clinical state, alexithymia and empathy. 10.1016/j.schres.2009.12.015
    Theory of mind and schizophrenia in young and middle-aged patients: Influence of executive functions. Croca Marta,Lagodka Aurèlie,Gadel Remi,Bourdel Marie Chantal,Bendjemaa Narjes,Gaillard Raphael,Olié Jean Pierre,Champagne-Lavau M,Krebs Marie Odile,Amado Isabelle Psychiatry research Theory of Mind (ToM) is compromised in schizophrenia, and responsible for social disability. We aim to study the correlation between ToM deficits and Executive Functions (EF), using the Faux Pas Test (FPT) for ToM evaluation, Behavioral Assessment of the Dysexecutive Syndrome (BADS) and Wisconsin Card Sorting Test (WCST) for EF assessment. Two groups of patients with schizophrenia were included: 22 young (18-35 years-old) and 18 middle-aged (>50 years-old) Patients, compared to age-matched Controls. We found worst FPT performances in both groups of patients, but with a more generalized pattern of dysfunction in the middle-aged patient group. This group had worse EF scores than both controls and younger patients. The association of EF with FPT items was uneven. In young patients only empathy (Q6) remained significant after controlling for EF and level of education, while in middle-aged patients faux pas explanation (Q4), false belief (Q5) and total scores remained significant. In young patients only affective TOM was impaired. No correlation was found with clinical symptoms, nor age at onset of the disease. We conclude that ToM deficit arises early during the course of the illness (already present in young patients), increases in middle-aged patients, and relates only partially with EF. 10.1016/j.psychres.2017.10.041
    Schizophrenia patients are impaired in empathic accuracy. Lee J,Zaki J,Harvey P-O,Ochsner K,Green M F Psychological medicine BACKGROUND:Empathy is crucial for successful social relationships. Despite its importance for social interactions, little is known about empathy in schizophrenia. This study investigated the degree to which schizophrenia patients can accurately infer the affective state of another person (i.e. empathic accuracy). METHOD:A group of 30 schizophrenia patients and 22 healthy controls performed an empathic accuracy task on which they continuously rated the affective state of another person shown in a video (referred to as the 'target'). These ratings were compared with the target's own continuous self-rating of affective state; empathic accuracy was defined as the correlation between participants' ratings and the targets' self-ratings. A separate line-tracking task was administered to measure motoric/attentional factors that could account for group differences in performance. Participants' self-rated empathy was measured using the Interpersonal Reactivity Index, and targets' self-rated emotional expressivity was measured using the Berkeley Expressivity Questionnaire. RESULTS:Compared with controls, schizophrenia patients showed lower empathic accuracy although they performed the motoric tracking task at high accuracy. There was a significant group×target expressivity interaction such that patients showed a smaller increase in empathic accuracy with higher levels of emotional expressivity by the target, compared with controls. Patients' empathic accuracy was uncorrelated with self-reported empathy or clinical symptoms. CONCLUSIONS:Schizophrenia patients showed lower empathic accuracy than controls, and their empathic accuracy was less influenced by the emotional expressivity of the target. These findings suggest that schizophrenia patients benefit less from social cues of another person when making an empathic judgement. 10.1017/S0033291711000614
    Dissociation of cognitive from affective components of theory of mind in schizophrenia. Shamay-Tsoory Simone G,Shur Syvan,Barcai-Goodman Liat,Medlovich S,Harari Hagay,Levkovitz Yechiel Psychiatry research Patients suffering from schizophrenia show impaired emotional and social behavior, such as misinterpretation of social situations and lack of theory of mind. However, there is conflicting evidence regarding their ability to perform on theory of mind tasks. Based on previous findings with patients suffering from prefrontal damage, the present study suggests that the behavioral deficit of schizophrenic patients may be due to impaired 'affective theory of mind' abilities, rather than to a general impairment in theory of mind. To test this hypothesis we assessed the ability of 22 schizophrenic patients and 55 age-matched healthy controls, to judge first and second order affective vs. cognitive mental state attribution, based on eye gaze. The relationships between negative and positive symptoms of schizophrenia, and affective and cognitive theory of mind were also assessed. Results indicated that while healthy controls made fewer errors on affective as compared to cognitive theory of mind conditions, schizophrenic patients showed a less prominent trend. Although the pattern of reaction time did not differ significantly between groups, the patients made significantly more errors in the affective conditions, as compared to controls. Furthermore, correlation analysis indicated that impaired affective theory of mind in these patients correlated with their level of negative symptoms. These results indicate that individuals with high level of negative symptoms of schizophrenia may demonstrate selective impairment in their ability to attribute affective mental states. These findings offer new insight into the affective facets of social behavior that may underlie the profound behavioral disturbances observed in schizophrenia. 10.1016/j.psychres.2005.10.018
    Neurocognitive basis of impaired empathy in schizophrenia. Shamay-Tsoory Simone G,Shur Syvan,Harari Hagai,Levkovitz Yechiel Neuropsychology Patients with schizophrenia show impaired emotional and social behavior, such as lack of theory of mind and misinterpretation of social situations. However, there is a paucity of work focusing on the empathic abilities of these patients. The present study was designed to examine the degree of impairment in cognitive and affective empathy in schizophrenia and to evaluate the contribution of executive prefrontal functions to empathy in these patients. To explore the neurocognitive processes that underlie the empathic ability in schizophrenic patients, the relationship between empathy scores and the performance on a cognitive flexibility task that assesses dorsolateral and orbitofrontal functioning (set shifting and reversal, respectively) was examined in 26 patients with schizophrenia and 31 healthy control subjects. Results indicated that patients with schizophrenia were significantly impaired in both cognitive and affective empathy compared with healthy control subjects. The degree of impaired empathy related to the severity of negative symptoms. In addition, patients showed impaired performance on measures of both shifting and reversal. However, while cognitive empathy was particularly related to measurements of orbitofrontal (rather than dorsolateral) functioning, affective empathy was related to measures of social functioning. 10.1037/0894-4105.21.4.431
    Neural correlates of the core facets of empathy in schizophrenia. Derntl Birgit,Finkelmeyer Andreas,Voss Bianca,Eickhoff Simon B,Kellermann Thilo,Schneider Frank,Habel Ute Schizophrenia research Empathy is a multidimensional construct composed of several components such as emotion recognition, emotional perspective taking and affective responsiveness. Even though patients with schizophrenia demonstrate deficits in all core components of this basic social ability, the neural underpinnings of these dysfunctions are less clear. Using fMRI, we analyzed data from 15 patients meeting the DSM-IV criteria for schizophrenia and 15 matched healthy volunteers performing three separate paradigms tapping the core components of empathy, i.e. emotion recognition, perspective taking and affective responsiveness. Behavioral data analysis indicated a significant empathic deficit in patients, reflected in worse performance in all three domains. Analysis of functional data revealed hypoactivation in a fronto-temporo-parietal network including the amygdala in patients. Moreover, amygdala activation correlated negatively with severity of negative symptoms. The results suggest that schizophrenia patients not only suffer from a broad range of emotional deficits but also show cortical and subcortical abnormalities, extending previous findings on fronto-temporal cortical dysfunctions. Since empathy is related to psychosocial functioning and hence of high clinical relevance in schizophrenia, a more detailed understanding of the exact nature of these impairments is mandatory. 10.1016/j.schres.2011.12.018
    Assessment of empathy in first-episode psychosis and meta-analytic comparison with previous studies in schizophrenia. Achim Amelie M,Ouellet Rosalie,Roy Marc-André,Jackson Philip L Psychiatry research Empathy is a multidimensional construct that relies on affective and cognitive component processes. A few studies have reported impairments of both cognitive and affective empathy components in patients with schizophrenia. It is, however, not known whether these difficulties are already present at psychosis onset. The affective and cognitive components of empathy were thus assessed in 31 patients with first-episode psychosis (FEP) and 31 matched healthy controls using the Interpersonal Reactivity Index (IRI). Our results were then compared to previous studies of empathy in patients with more chronic schizophrenia via a meta-analysis. In addition, we also assessed the relationship between empathy ratings, Mentalizing performance and clinical symptoms. Contrary to what has been reported in people with more chronic schizophrenia, the IRI ratings did not significantly differ between FEP and controls in our study, though a trend was observed for the Personal distress scale. For the Perspective taking scale, our meta-analysis revealed a significantly lower effect size in this study with FEP patients relative to previous schizophrenia studies. In the FEP group, the IRI ratings were not related to positive, negative or general psychopathology symptoms, but a significant relationship emerged between the Liebowitz Social Anxiety Scale and Perspective taking (negative correlation). In addition, a significant positive correlation was observed between the Empathic concern subscale and our theory of mind task. This study supports the idea that the cognitive component of empathy is less affected in patients with first-episode psychosis relative to patients with more chronic schizophrenia, and the impairments reported in previous reports with more chronic populations should be interpreted in light of a possible deterioration of this cognitive skill. The findings also provide some insight into the relationship between empathy and clinical symptoms such as social anxiety. 10.1016/j.psychres.2010.10.030
    Negative Schema and Rumination as Mediators of the Relationship Between Childhood Trauma and Recent Suicidal Ideation in Patients With Early Psychosis. Cui Yin,Kim Sung-Wan,Lee Bong Ju,Kim Jung Jin,Yu Je-Chun,Lee Kyu Young,Won Seunghee,Lee Seung-Hwan,Kim Seung-Hyun,Kang Shi Hyun,Kim Euitae,Piao Yan Hong,Kang Nam-In,Chung Young-Chul The Journal of clinical psychiatry OBJECTIVE:High rates of childhood trauma and adult suicidality have been reported in patients who have schizophrenia. This study sought to explore mediators between childhood trauma and suicidality in adulthood to help determine therapeutic approaches. METHODS:This study included 314 adult patients with early psychosis who were participants in the Korean Early Psychosis Cohort Study, which was a prospective naturalistic observational cohort study started in December 2014. DSM-5 criteria were used to assign the diagnosis of schizophrenia spectrum and other psychotic disorders. Cross-sectional data obtained at baseline were used for analysis. The Early Trauma Inventory Self Report-Short Form and the Columbia Suicide Severity Rating Scale were employed to collect data on childhood trauma and suicidal ideation and attempts. Other measures were used to evaluate depression, empathy, psychopathology, and rumination. RESULTS:A total of 90.1% of the participants experienced at least 1 childhood traumatic event. The rates of significant` physical punishment, emotional abuse, and sexual events were 37.3%, 35.6%, and 6.4%, respectively. The rates of recent suicidal ideation and attempts were 32.0% and 10.0%, respectively. Independent predictors of recent suicidal ideation included depression, negative schema, and rumination. Furthermore, negative schema and rumination played partial or full mediating roles in the relationship between childhood trauma and recent suicidal ideation. CONCLUSIONS:These findings highlight the importance of performing careful evaluations of childhood trauma and suicidality and of developing effective strategies to reduce mediating factors that may be amenable to psychosocial approaches. 10.4088/JCP.17m12088
    Gender differences in 542 Chinese inpatients with schizophrenia. Tang Yi-Lang,Gillespie Charles F,Epstein Michael P,Mao Pei-Xian,Jiang Feng,Chen Qi,Cai Zhuo-Ji,Mitchell Philip B Schizophrenia research OBJECTIVE:To investigate gender differences in the onset and other clinical features of Han Chinese inpatients with schizophrenia. METHODS:Five-hundred-and-forty-two Han Chinese inpatients with DSM-IV schizophrenia were assessed with the Positive and Negative Symptoms Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Function scale (GAF) and locally-developed standardized data collection forms. Comparisons were made between male and female patients. RESULTS:This is the largest study of gender differences in schizophrenia to be conducted in a Chinese population. In our sample, we found that schizophrenia onset occurred at a significantly earlier age in male patients compared to female patients and that late-onset schizophrenia (as defined by onset> or =45 years) was significantly more common in female patients. The paranoid subtype of schizophrenia was less common in male patients, males received higher daily doses of antipsychotics and demonstrated a different pattern of antipsychotic usage, being less likely to be treated with SGAs. Further, cigarette smoking was more common in male patients and male patients were more likely to be single or never married. By contrast, female patients showed a different pattern of ongoing symptoms and severity, being more likely to have persistent positive symptoms, more severe positive and affective symptoms, and a greater number of suicide attempts whereas male patients were more likely to show severe deterioration over time. CONCLUSIONS:There are notable gender differences in the age at onset, treatment and a range of other clinical features in Han Chinese patients with schizophrenia. Such differences were largely consistent with those reported in Western studies. These gender differences need to be considered in the assessment and management of Chinese patients with schizophrenia. 10.1016/j.schres.2007.05.025
    Gender differences in correlates of cognition in first-episode psychosis. Li Adrienne W Y,Hui Christy L M,Lee Edwin H M,Chang W C,Chan Sherry K W,Chen Eric Y H Psychiatry research Studies of gender cognitive differences in schizophrenia have reported mixed results. This study examined cognitive correlates including demographics, symptoms and functioning in men and women in a large sample of first-episode adult-onset psychosis patients. Detailed demographic, clinical and functioning data were collected from 360 first-episode patients upon admission into an early intervention service for psychotic disorders. They were also administered a comprehensive neurocognitive battery. Correlation analyses showed that memory and working memory were more significantly associated with onset age, negative symptoms and side effects in women. Processing speed correlated with antipsychotic dosage in men and side effects in women. Selective attention correlated with reality distortion and negative symptoms in women, and onset age and education in men. Executive function correlated with onset age and reality distortion in women. All cognitive domains significantly correlated with educational level and functioning in both genders. Negative symptoms explained significant variability in cognition in both genders, while reality distortion, side effects and affective symptoms were significant factors that differentiated between genders. Although there are similarities in cognitive deficits, considerable heterogeneity exists in associations of symptoms and cognition in men and women. Results facilitate individualised tailoring of interventions, including cognitive remediation therapy. 10.1016/j.psychres.2018.12.011
    Alexithymia and personality disorder functioning styles in paranoid schizophrenia. Yu Shaohua,Li Huichun,Liu Weibo,Zheng Leilei,Ma Ying,Chen Qiaozhen,Chen Yiping,Yu Hualiang,Lu Yunrong,Pan Bing,Wang Wei Psychopathology OBJECTIVES:Personality disorder functioning styles might contribute to the inconclusive findings about alexithymic features in schizophrenia. We therefore studied the relationship between alexithymia and personality styles in paranoid schizophrenia. METHODS:We administered the Chinese versions of the Toronto Alexithymia Scale (TAS-20), the Parker Personality Measure (PERM), the Positive and Negative Syndrome Scale as well as the Hamilton Anxiety and Depression Scales to 60 paranoid schizophrenia patients and 60 healthy control subjects. RESULTS:Patients scored significantly higher on the Positive and Negative Syndrome Scale, TAS 'difficulty identifying feelings' and 'difficulty describing feelings', Hamilton Depression Scale and most PERM scales. In healthy subjects, difficulty identifying feelings predicted the PERM 'dependent' style, and the Hamilton Anxiety Scale predicted difficulty identifying feelings and difficulty describing feelings. In patients, difficulty identifying feelings nonspecifically predicted all the PERM scales; by contrast, the PERM 'antisocial' style predicted difficulty identifying feelings, the 'avoidant' style predicted difficulty describing feelings, and the 'histrionic' and 'paranoid (-)' styles predicted 'externally oriented thinking'. CONCLUSIONS:Personality disorder functioning styles - instead of anxiety, depression, psychotic symptoms or disease duration - were specifically associated with alexithymia scales in our patients, which sheds light on a cognitive-personological substrate in paranoid schizophrenia on the one hand, and calls for a longitudinal design to discover how premorbid or postacute residual personality styles contribute to the sluggish disorder on the other. 10.1159/000325168
    Facial emotion recognition and alexithymia in Chinese male patients with deficit schizophrenia. Tang Xiao Wei,Yu Miao,Duan Wei Wei,Zhang Xiang Rong,Sha Wei Wei,Wang Xiang,Zhang Xiao Bin Psychiatry research Deficit schizophrenia (DS) has been proposed as a pathophysiologically distinct schizophrenia subtype. This study investigated facial emotion recognition deficits and alexithymia in DS and non-deficit schizophrenia patients (NDS) and their relationships with other clinical variables. The Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and Scale for the Assessment of Positive Symptoms (SAPS) were employed to evaluate the psychiatric symptoms in patients with schizophrenia. Facial emotion recognition deficits and Alexithymia were assessed in DS, NDS, and control groups by The Chinese Facial Emotion Test (CFET) and the Toronto Alexithymia Scale-20 (TAS-20). Compared with control group, both DS and NDS patients exhibited more severe facial emotion recognition impairments, with the exception of "happy faces" in NDS patients, as well as higher alexithymia scores. In DS patients, correct frequency for fear recognition and total CFET score were negatively correlated with TAS-20 Factor 3 subscore for "externally oriented thinking". Total TAS-20 score was positively correlated with BPRS negative symptom and SANS score in DS patients. In contrast, there were no correlations between TAS-20 scores/subscores and psychiatric symptoms in NDS patients. These findings indicated distinct facial emotion recognition impairments in DS and NDS patients. Alexithymia might be specifically related to the negative symptom in DS patients, suggesting DS as a unique schizophrenic subtype. 10.1016/j.psychres.2016.09.055