Can we grade social cognition defects in schizophrenia?

05 10 2016

Social cognition defect is  a core feature of schizophrenia.This include defects in emotion processing, social perception, theory of mind  (mental state attribution) and attributional style/biases. These defects are seen in prodromes, first episode,   while the disease is in remission and in first degree relatives . These are more associated with negative symptoms .Only few studies have looked at the relationship between social cognition defects and functioning. Understanding the social cognition status might help to tailor interventions to suit individual needs.This may improve functional outcomes.

Rocca and colleagues from Italy report the results of a cluster analysis  of 809 individuals with schizophrenia living in the community across Italy. A matched control group was also studied. Symptom severity ( using PANSS), negative symptoms ( using Brief Neg symptoms scale), social cognition ( Emotional intelligence Test, Facial emotion identification test, awareness of social interference test) and functional status ( Specific Level of functioning scale & Validation of real life outcomes) were measured.

Cluster analysis revealed three clusters :  unimpaired, impaired, and very impaired social cognition.Proportions were :unimpaired (42%), impaired (50.4%) and very impaired (7.5%). Functioning decreased parallel to decrease in social cognition. Theory of mind tests  ( to know how the individual understands others mental state) were important for cluster definition.

The awareness of social interference test ( checking sarcasm and lying) was good enough to help grade the three clusters. Patients who were able to detect sarcasm were more likely to be in the unimpaired group. Unimpaired group had higher grasp of sarcasm. Those in impaired group were better able to detect lies than very impaired.

Why does this happen? comprehension of lies/deceit is acquired before sarcasm/ irony. sarcasm involves more complex inferential chains. so if the individual can detect sarcasm , probably he/she has unimpaired social cognition. If they cannot detect deceit/lie, they may have very impaired social cognition.

How do we take this in to practice? The social interference test use video based vignettes. Clinicians need their  own culturally relevant vignettes ( may be movie clips might help ) to test this.

Authors agree that the natural stability of these clusters were not tested in this study- this being a cross sectional study. However, this is the first study using best available tools to measure the relevant constructs.


Once we classify the defects in social cognition what do we do? Would various social skills training help? Would training in virtual settings benefit ? Would improving these measures thorough interventions translate to real benefits in outcomes?… We don’t know…yet.

Summary of article : Social cognition in people with schizophrenia: a cluster-analytic approach.Rocca P, Galderisi S, Rossi A, Bertolino A, Rucci P, Gibertoni D, Montemagni C, Sigaudo M, Mucci A, Bucci P, Acciavatti T, Aguglia E, Amore M, Bellomo A, De Ronchi D, Dell’Osso L, Di Fabio F, Girardi P, Goracci A, Marchesi C, Monteleone P, Niolu C, Pinna F, Roncone R, Sacchetti E, Santonastaso P, Zeppegno P, Maj M; Italian Network for Research on Psychoses.

Psychol Med. 2016 Oct;46(13):2717-29. doi: 10.1017/S0033291716001100.PMID:27649341

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