Loneliness is associated with mentalizing and emotion recognition abilities in schizophrenia, but only in a cluster of patients with social cognitive deficits.

OBJECTIVE: Loneliness is a concern for patients with schizophrenia. However, the correlates of loneliness in patients with schizophrenia are unclear; thus, the aim of the study is to investigate neuro- and social cognitive mechanisms associated with loneliness in individuals with schizophrenia. METHOD: Data from clinical, neurocognitive, and social cognitive assessments were pooled from two cross-national samples (Poland/USA) to examine potential predictors of loneliness in 147 patients with schizophrenia and 103 healthy controls overall. Furthermore, the relationship between social cognition and loneliness was explored in clusters of patients with schizophrenia differing in social cognitive capacity. RESULTS: Patients reported higher levels of loneliness than healthy controls. Loneliness was linked to increased negative and affective symptoms in patients. A negative association between loneliness and mentalizing and emotion recognition abilities was found in the patients with social-cognitive impairments, but not in those who performed at normative levels. CONCLUSIONS: We have elucidated a novel mechanism which may explain previous inconsistent findings regarding the correlates of loneliness in individuals with schizophrenia.

Social cognitive bias increases loneliness both directly and by decreasing social connection in patients with schizophrenia.

While considerable emphasis has been put on investigating the mechanisms that drive reduced social connection in patients with schizophrenia (SCZ), recent studies have increasingly focused on the issue of loneliness in SCZ. As both social cognitive bias and self-reported empathy predict loneliness in non-clinical populations, the current study aims to examine the relationship between loneliness, reduced social connection and social cognitive biases, and self-reported empathy in SCZ. Ninety-three adult SCZ and sixty-six matched healthy individuals completed a battery of questionnaires measuring loneliness and social connection (Revised-UCLA Loneliness Scale, Lubben-Social Network Scale, Social Disconnectedness Scale), cognitive biases (Ambiguous Intentions Hostility Questionnaire, Davos Assessment of Cognitive Biases Scale, Cognitive Biases Questionnaire for psychosis) and self-reported empathy (Interpersonal Reactivity Index). Significant predictors of loneliness in SCZ were entered into two latent variables ("Social Threat Bias", "Social Connection"), and structural equation modeling was used to explore the direct and indirect relationships between Social Threat Bias, symptoms. and loneliness in SCZ. Patients reported higher levels of loneliness, cognitive biases and personal distress compared to controls. Furthermore, SCZ reported less social connection and perspective taking compared to controls. Structural equation modeling revealed that Social Threat Bias was linked to increased loneliness in SCZ both directly and indirectly via decreased social connection. Negative symptoms were directly linked with loneliness, while the association between affective symptoms and loneliness was mediated via Social Threat Bias. The results of the current study suggest that social threat bias should be considered while planning the interventions aimed to reduce loneliness in schizophrenia.

Mentalizing abilities mediate the impact of the basic social perception on negative symptoms in patients with schizophrenia.

Social cognitive deficits are currently considered as one of the main predictors of clinical symptoms and functional outcome in patients with schizophrenia. Multiple studies have suggested that a two-factor solution (low-level vs. high-level) best describes the structure of social cognitive processes in patients. While higher-order processes have been repeatedly linked to negative symptoms, no such association was found for lower-level processes. Thus, the aim of the current study is to examine whether the association between basic social perception processes and symptoms in patients with schizophrenia is mediated by mentalizing abilities. One hundred thirty-nine patients have completed basic social perception (Communicative Interactions Database task CID-12) and mentalizing (Reading the Mind in the Eyes task) tasks. In line with our hypothesis, we have observed full mediation of the effects of basic social perception abilities on negative symptoms via mentalizing abilities in patients. This effect suggests that, similarly as in the case of positive symptoms, a hierarchical nature of social cognitive processes should be considered while investigating negative symptoms of schizophrenia.

Using ERPs to explore the impact of affective distraction on working memory stages in schizophrenia.

Research on individuals with schizophrenia (SCZ) shows a variety of emotional and cognitive deficits. We examined the hypothesis that ineffective emotional interference control may impact working memory (WM) performance by disrupting information encoding, maintenance, or retrieval in SCZ. Twenty-eight SCZ and 28 matched healthy controls (HC) performed the visual and verbal delayed-matching-to-sample task (DMST) with trials preceded by negative and nonemotional visual distractors. Event-Related Potentials associated with affective stimuli processing (Late Positive Potential-LPP) and WM-encoding (target-P3), maintenance (Negative Slow Wave-NSW), and retrieval (probe-P3) were analyzed. Patients showed overall worse DMST accuracy than HC. Emotional distraction negatively impacted accuracy during the verbal DMST in both groups combined. Both groups also displayed similar LPP modulation during the presentation of emotional distractors. HC showed enhanced NSW after presentation of a negative distraction, whereas this did not occur in SCZ. Comparable effects of emotional distraction were found for WM-encoding and retrieval in both groups. While emotional and neutral stimuli differentially impacted WM-maintenance on the neural level in HC, we did not observe this effect in SCZ, even though both groups showed similar behavioral and neurophysiological reactions to affective stimuli. Deficits in inhibitory mechanisms in SCZ may be responsible for this effect and may have particular relevance for WM-maintenance difficulties.

Brain correlates of recognition of communicative interactions from biological motion in schizophrenia.

BACKGROUND: Recognition of communicative interactions is a complex social cognitive ability which is associated with a specific neural activity in healthy individuals. However, neural correlates of communicative interaction processing from whole-body motion have not been known in patients with schizophrenia (SCZ). Therefore, the current study aims to examine the neural activity associated with recognition of communicative interactions in SCZ by using displays of the dyadic interactions downgraded to minimalistic point-light presentations. METHODS: Twenty-six healthy controls (HC) and 25 SCZ were asked to judge whether two agents presented only by point-light displays were communicating or acting independently. Task-related activity and functional connectivity of brain structures were examined with General Linear Model and Generalized Psychophysiological Interaction approach, respectively. RESULTS: HC were significantly more efficient in recognizing each type of action than SCZ. At the neural level, the activity of the right posterior superior temporal sulcus (pSTS) was observed to be higher in HC compared with SCZ for communicative v. individual action processing. Importantly, increased connectivity of the right pSTS with structures associated with mentalizing (left pSTS) and mirroring networks (left frontal areas) was observed in HC, but not in SCZ, during the presentation of social interactions. CONCLUSION: Under-recruitment of the right pSTS, a structure known to have a pivotal role in social processing, may also be of importance for higher-order social cognitive deficits in SCZ. Furthermore, decreased task-related connectivity of the right pSTS may result in reduced use of additional sources of information (for instance motor resonance signals) during social cognitive processing in schizophrenia.

Social and nonsocial affective processing in schizophrenia - An ERP study.

BACKGROUND: Despite social cognitive dysfunction that may be observed in patients with schizophrenia, the knowledge about social and nonsocial affective processing in schizophrenia is scant. The aim of this study was to examine neurophysiological and behavioural responses to neutral and negative stimuli with (faces, people) and without (animals, objects) social content in schizophrenia. METHODS: Twenty-six patients with schizophrenia (SCZ) and 21 healthy controls (HC) completed a visual oddball paradigm with either negative or neutral pictures from the Nencki Affective Picture System (NAPS) as targets while EEG was recorded. Half of the stimuli within each category presented social content (faces, people). RESULTS: Negative stimuli with social content produced lower N2 amplitude and higher mean LPP than any other type of stimuli in both groups. Despite differences in behavioural ratings and alterations in ERP processing of affective stimuli (lack of EPN differentiation, decreased P3 to neutral stimuli) SCZ were still able to respond to specific categories of stimuli similarly to HC. CONCLUSIONS: The pattern of results suggests that with no additional emotion-related task demands patients with schizophrenia may present similar attentional engagement with negative social stimuli as healthy controls.

Low Risk for Switch to Mania during Treatment with Sleep Promoting Antidepressants.

INTRODUCTION: Sleep-promoting antidepressants are of interest because they are used not only as antidepressants, but also to promote sleep. METHODS: We reviewed case reports describing the switch to mania during treatment with trazodone, mirtazapine, or agomelatine. RESULTS: Trazodone, mirtazapine, and agomelatine may induce manic symptoms. However, the risk of switching is related, first of all, to doses recommended for antidepressant treatment, administered without mood-stabilizer co-therapy. Low doses of these antidepressants, used for their hypnotic or sedative effects, were observed to cause mania only in patients with other risk factors for switching. There is no evidence for trazodone or mirtazapine and only sparse evidence for agomelatine, claiming that treatment with these antidepressants is related to an increased risk of switching to mania when administered in combination with a mood stabilizer. DISCUSSION: These findings suggest that low doses of trazodone and mirtazapine are safe in bipolar disorder, and should still be considered important alternatives to hypnotics when long-term pharmacological treatment of insomnia is necessary. It seems that these antidepressants and agomelatine can also be used safely in antidepressant doses when combined with a mood stabilizer.