Diagnostic and treatment hierarchical reductionisms have led to an oversight of anxiety syndromes in schizophrenia. Nevertheless, recent data have indicated that anxiety can be a significant source of morbidity in this patient group. This paper reviews current knowledge concerning anxiety comorbidity in schizophrenia, its epidemiology, course, and treatment. A computerized search of the literature published from 1966 to July 2012 was conducted on Medline. Comorbid anxiety disorders are present in 38.3% of subjects with schizophrenia spectrum disorders. The most common anxiety disorder is social phobia followed by post-traumatic stress disorder and obsessive compulsive disorder. The presence and severity of symptoms of anxiety are associated with more severe clinical features and poorer outcomes. Available literature on the treatment consists primarily of case reports and open trials. Fragments of data support the notion of treating these anxiety states and syndromes as co-occurring clinical conditions with adjunctive medications and psychosocial interventions. However, additional work remains to be done on this issue before firm conclusions can be drawn.

The main research objective was seeking for the predictive role of such personal resources as resilience, sense of coherence, and coping with stress in psychological well-being of schizophrenia patients and their treatment. The study group comprised 201 individuals with schizophrenia, aged between 18 and 62. The following instruments were used: The sense of coherence scale SOC-29, The resilience scale for adults, polish adaptation of the stress appraisal measure, semistructured clinical interview, the positive and negative syndrome scale, the mood scale, and the general health questionnaire. A stepwise regression analysis aimed at selecting a group of significant predictors for the verified factors of psychological well-being in patients suffering from schizophrenia was carried out. The results of the study demonstrated the following to be significant predictors of psychological well-being in patients with schizophrenia: Resilience (explaining significantly the level of schizophrenic symptomatology Beta = -0.30, negative symptoms Beta = -0.385, and cognitive disorders Beta = -0.303), sense of coherence, which significantly predicted mood (in the case of manageability, Beta = 0.580 for positive mood, and Beta = 0.534 for negative mood) and psychiatric symptomatology (comprehensibility, Beta = 0.311 for negative symptoms, Beta = 0.173 for excessive arousal, and Beta = 0.330 for cognitive disorganization). The level of perceived stress appraised as challenge predicted positive mood (Beta = 0.164), while stress appraisal in terms of threat served as a predictor for negative mood and depressiveness (Beta = 0.190). The study results can prove helpful in creating therapeutic and programs and psychiatric rehabilitation for patients with schizophrenia.

BACKGROUND:Suicide is a leading cause of premature death in people with a diagnosis of schizophrenia. Although exposure to stressors can play a part in the pathways to death by suicide, there is evidence that some people with a diagnosis of schizophrenia can be resilient to the impact of suicide triggers. AIMS:To investigate factors that contribute to psychological resilience to suicidal thoughts and behaviours from the perspectives of people with a diagnosis of schizophrenia. METHOD:A qualitative design was used, involving semi-structured, face-to-face interviews. Twenty individuals with non-affective psychosis or schizophrenia diagnoses who had experience of suicide thoughts and behaviours participated in the study. The interviews were audio-recorded, transcribed verbatim and examined using inductive thematic analysis. RESULTS:Participants reported that psychological resilience to suicidal thoughts and behaviours involved ongoing effort. This ongoing effort encompassed: (a) understanding experiences (including reconciliation to mental health experiences and seeking reasons to live), (b) active behaviours (including talking to people and keeping occupied), and (c) relationship dynamics (including feeling supported by significant others and mental health professionals). CONCLUSIONS:Psychological resilience was described as a dynamic process that developed over time through the experiences of psychosis and the concomitant suicidal experiences. Psychological resilience can be understood using a multicomponential, dynamic approach that integrates buffering, recovery and maintenance resilience models. In order to nurture psychological resilience, interventions should focus on supporting the understanding and management of psychosis symptoms and concomitant suicidal experiences. DECLARATION OF INTEREST:None.

After the remission of psychotic symptoms in patients with chronic schizophrenia, a persistently high rate of disability suggests potential influences from socio-ecological factors. This study aimed to explore the complex relationships between socioecological factors, including sleep quality, psychological resilience, family resilience, and social support, and the severity of psychiatric disability in patients with chronic schizophrenia. Employing a cross-sectional design, the study involved 188 individuals with chronic schizophrenia. Disability was measured using the World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS 2.0), while social support, family resilience, psychological resilience, and sleep quality were assessed using the Social Support Rating Scale (SSRS), Family Hardiness Index (FHI), Connor-Davidson Resilience Scale (CD-RISC), and Pittsburgh Sleep Quality Index (PSQI), respectively. LASSO regression and structural equation modeling (SEM) analyses were conducted to identify predictive factors and their interrelationships. The mean WHO-DAS 2.0 score of 72.91 ± 14.04 indicated substantial difficulties in daily activities, necessitating comprehensive support among participants. LASSO regression identified frequent disease relapses, low education levels, and poor sleep quality as risk factors for disability, whereas strong social support, family resilience, and individual resilience emerged as protective factors against disability. SEM demonstrated that the enhancement of family and individual resilience by social support contributes to the mitigation of disability. The study underscores the critical roles of social support, family resilience, and individual psychological resilience in reducing disability in patients with chronic schizophrenia, suggesting that interventions targeting these factors may improve rehabilitation outcomes.

BACKGROUND:Major depressive depression (MDD) is often accompanied by suicidal behavior. Increasing evidence shows that MDD patients display psychotic symptoms. However, the relationship between psychotic symptoms and suicide attempt in MDD has not been reported. Therefore, this study was to identify the prevalence and associated factors of suicide attempts in first-episode and untreated Chinese Han outpatients comorbid with psychotic major depression (PMD). METHODS:1718 first-episode and untreated MDD outpatients were assessed with Positive Symptom Scale of Positive and Negative Syndrome Scale (PANSS), the 17-item Hamilton Depression Scale, Hamilton Anxiety Scale, and clinical global impression of severity scale (CGI-S). Some glycolipid metabolism and thyroid hormone parameters were measured. RESULTS:In MDD patients, the percentage of PMD was 10.0%. The incidence of attempted suicide in PMD patients was 51.5%, which was more than 3 times higher than that in non-PMD patients (16.7%). In PMD patients, compared to non-attempters, suicide attempters were older, had a longer course of disease, scored higher on all scales, as well as had higher levels of thyroid stimulating hormone (TSH), thyroid peroxidases antibody, anti-thyroglobulin and blood glucose. PANSS positive symptom, CGI, diastolic blood pressure and TSH were independently associated with suicide attempts of PMD. CONCLUSIONS:PMD patients have a higher prevalence of suicide attempt than non-PMD patients. Some demographic and clinical parameters are relevant factors for suicide attempt in PMD patients.

STUDY OBJECTIVES:Disrupted sleep is one of the prominent but often overlooked presenting symptoms in the clinical course of psychotic disorders. The aims of this study were to examine the prevalence of sleep disturbances, particularly insomnia and nightmares, and their prospective associations with the risk of suicide attempts in patients with schizophrenia-spectrum disorders. METHODS:A naturalistic longitudinal study was conducted in outpatients diagnosed with schizophrenia-spectrum disorders recruited from the psychiatric outpatient clinic of a regional university-affiliated public hospital in Hong Kong. A detailed sleep questionnaire was completed by 388 patients at baseline in May-June 2006. Relevant clinical information was extracted from clinical case notes from June 2007-October 2014. RESULTS:Prevalence of frequent insomnia and frequent nightmares was 19% and 9%, respectively. Baseline frequent insomnia was significantly associated with an increased incidence of suicide attempts during the follow-up period (adjusted hazard ratio = 4.63, 95% confidence interval 1.40-15.36, P < 0.05). Nightmare complaint alone did not predict the occurrence of suicide attempts, but the comorbidity of nightmares and insomnia was associated with the risk of suicide attempt over follow-up (adjusted HR = 11.10, 95% confidence interval: 1.68-73.43, P < 0.05). CONCLUSIONS:Sleep disturbances are common in patients with schizophrenia-spectrum disorders. The association between sleep disturbances and suicidal risk underscores the need for enhanced clinical attention and intervention on sleep disturbances in patients with schizophrenia.

Suicidal ideation (SI) is common among people with schizophrenia. However, it has received less attention than suicide attempts (SA), especially in the Chinese population. Alexithymia is a well-established risk factor for SI across different populations. Nevertheless, very few studies evaluated their relationship in schizophrenia patients. We aimed to determine the prevalence and clinical correlates of SI and its relationship with alexithymia in 812 Chinese chronic schizophrenia inpatients. We assessed SI, clinical symptoms, and alexithymia by the Beck Scale for Suicidal Ideation, the Positive and Negative Syndrome Scale (PANSS), and the Toronto Alexithymia Scale, respectively. A multiple logistic regression model was conducted to identify independent correlates of SI. Receiver operating characteristic (ROC) curves and area under the curve (AUC) were performed to determine the ability of our model to distinguish between patients with and without SI. 10% (n = 84) reported current SI. Lifetime SA (OR, 4.68; 95% CI 2.76-7.94, p < 0.001), PANSS depressive factor (OR, 1.24; 95% CI 1.12-1.38, p < 0.001), PANSS positive subscale (OR, 1.055; 95% CI 1.004-1.108, p = 0.035), and difficulty identifying emotions (OR, 1.07; 95% CI 1.03-1.12, p = 0.002) were associated with SI. The AUC value was 0.80, indicating excellent distinguishing capabilities. Timely assessments of these factors may help identify schizophrenia patients who are at risk for SI.

Over the past century, the polypeptide oxytocin has played an important role in medicine with major highlights including the identification of its involvement in parturition and the milk let-down reflex. Oxytocin is now implicated in an extensive range of psychological phenomena including reward and memory processes and has been investigated as a treatment for several psychiatric disorders including addiction, anxiety, autism, and schizophrenia. In this review, we first provide an historical overview of oxytocin and describe key aspects of its physiological activity. We then outline some pharmacological limitations in this field of research before highlighting the role of oxytocin in a wide range of behavioral and neuronal processes. Finally, we review evidence for a modulatory role of oxytocin with regard to psychostimulant effects. Key findings suggest that oxytocin attenuates a broad number of cocaine and methamphetamine induced behaviors and associated neuronal activity in rodents. Evidence also outlines a role for oxytocin in the prosocial effects of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) in both rodents and humans. Clinical trials should now investigate the effectiveness of oxytocin as a novel intervention for psychostimulant addiction and should aim to determine its specific role in the therapeutic properties of MDMA that are currently being investigated.

Schizophrenia is a heterogeneous, debilitating disorder characterized by three distinct sets of clinical features: positive symptoms, negative symptoms, and cognitive deficits. Extant antipsychotic drugs have been most successful at treating the positive symptoms of patients with schizophrenia but have minimal therapeutic effects on negative symptoms and cognitive deficits, which are the symptoms that best predict the poor prognosis of these patients. Therefore, there has been a major effort towards identifying compounds that alleviate these symptoms. Oxytocin (OT) is a nonapeptide that regulates peripheral reproductive-relevant functions, and also acts as a neurotransmitter in the brain. Converging evidence from both preclinical and clinical research suggests that OT may have therapeutic efficacy for the positive symptoms, negative symptoms, and cognitive deficits of schizophrenia. In the majority of the small, randomized, placebo-controlled clinical trials conducted to date, OT has shown particular promise in its potential to treat the intractable negative symptoms and social cognitive deficits exhibited by most of the patients with this debilitating disorder. In this leading article, we summarize the clinical evidence relevant to (1) endogenous OT and schizophrenia, and (2) the putative therapeutic effects of OT on each of the three clinical domains.

Schizophrenia is a form of mental disorder that is behaviorally characterized by abnormal behavior, such as social function deficits or other behaviors that are disconnected from reality. Dysregulation of oxytocin may play a role in regulating the expression of schizophrenia. Given oxytocin's role in social cognition and behavior, a variety of studies have examined the potential clinical benefits of oxytocin in improving the psychopathology of patients with schizophrenia. In this review, we highlight the evidence for the role of endogenous oxytocin in schizophrenia, from animal models to human studies. We further discuss the potential of oxytocin as a therapeutic agent for schizophrenia and its implication in future treatment.

The high prevalence of metabolic syndrome in persons with schizophrenia has spurred investigational efforts to study the mechanism beneath its pathophysiology. Early psychosis dysfunction is present across multiple organ systems. On this account, schizophrenia may be a multisystem disorder in which one organ system is predominantly affected and where other organ systems are also concurrently involved. Growing evidence of the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, such as an association with cognitive dysfunction, altered autonomic nervous system regulation, desynchrony in the resting-state default mode network, and shared genetic liability, suggest that metabolic syndrome and schizophrenia are connected via common pathways that are central to schizophrenia pathogenesis, which may be underpinned by oxytocin system dysfunction. Oxytocin, a hormone that involves in the mechanisms of food intake and metabolic homeostasis, may partly explain this piece of the puzzle in the mechanism underlying this association. Given its prosocial and anorexigenic properties, oxytocin has been administered intranasally to investigate its therapeutic potential in schizophrenia and obesity. Although the pathophysiology and mechanisms of oxytocinergic dysfunction in metabolic syndrome and schizophrenia are both complex and it is still too early to draw a conclusion upon, oxytocinergic dysfunction may yield a new mechanistic insight into schizophrenia pathogenesis and treatment.

The aims of this study were to investigate experienced stigma and discrimination and their associated factors in people with schizophrenia who live in the community in Guangzhou, China. A total of 384 people with schizophrenia were randomly recruited from four districts of Guangzhou and completed the scales and questionnaires: Internalized Stigma of Mental Illness scale (ISMI), Self-Esteem Scale (SES), Discrimination and Stigma Scale (DISC-12), Brief Psychiatric Rating Scale (BPRS), PANSS negative scale (PANSS-N), Global Assessment of Functioning (GAF) and Schizophrenia Quality of Life Scale (SQLS). Insight and medication compliance were evaluated by psychiatrists. Data were analyzed by using descriptive statistics, Pearson correlation and multivariable linear regression. We found a significant positive correlation between BPRS score and PANSS-N score, GAF score was significantly negative correlated with SQLS score, Insight score was significantly negative correlated with medication compliance score, ISMI score was significantly positive correlated with SES score and experienced discrimination score. Multivariable linear regression found SQLS, SES and experienced discrimination were the main independent variables of ISMI and experienced discrimination was the most important factor of ISMI. Our findings suggest that people with schizophrenia often experienced stigma and discrimination in this Chinese population, and more anti-stigma interventions should be provided.

Background:The present study aimed to examine whether plasma oxidative stress is associated with cognitive impairment in long term hospitalized patients with chronic schizophrenia. Method:Ninety-six chronic schizophrenia patients and 94 healthy unaffected subjects were enrolled. Plasma markers of oxidative stress, including malondialdehyde (MDA), manganese superoxide dismutase (MnSOD), catalase (CAT), and glutathione peroxidase (GSH-Px), were measured. Psychiatric symptoms and cognitive function were assessed with the Positive and Negative Syndrome Scale (PANSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. Results:Plasma MDA levels and MnSOD and GSH-Px activities were significantly lower in schizophrenia patients than in healthy controls ( < 0.001), while plasma CAT activity was higher than in healthy controls ( < 0.005). Cognitive scores on the RBANS and all of its five subscales (all < 0.001) were significantly lower in schizophrenia patients than in healthy unaffected subjects. CAT and GSH-Px activities were positively correlated with the cognitive function scores corresponding to Visuospatial/Constructional abilities in the patient group ( = 0.298, 0.213, respectively, < 0.05). Also, the multiple regression analysis revealed that CAT and GSH-Px activities were independent and separate contributors to the Visuospatial/Constructional index of the RBANS. Meanwhile, CAT activity was negatively correlated with general pathological symptoms ( = -0.307, Bonferroni corrected = 0.008) and the total score of the PANSS domains ( = -0.299, Bonferroni corrected = 0.012). Conclusion:Our results that the reduced of MDA level and the increased CAT activity in plasma in male patients with chronic schizophrenia suggest that redox imbalance may be associated with the pathophysiology of schizophrenia, and it can induce impaired cognition and psychiatric symptoms.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.