Theoretical Background and Treatment of Social Cognitive Impairment in Schizophrenia- What is Known and What is Needed?

Abstract Background It is widely accepted that borderline personality disorder (BPD) is associated with significant impairments in mentalization and theory of mind (ToM) which are considered as closely related concepts by many authors particularly in psychoanalytical circles. However, for understanding interpersonal difficulties in personality disorders, it is important to distinguish neuro-social cognitive impairment from the abnormal meta-social-cognitive style of patients. Methods The current systematic review aimed to conduct separate meta-analyses of ‘mentalization’ [reflective functioning (RF] and different aspects of ToM in BPD. A literature search was conducted to locate relevant articles published between January 1990 to July 2021. Random-effect meta-analyses were conducted in 34 studies involving 1448 individuals with BPD and 2006 healthy controls. Results A very large impairment in RF was evident in BPD [d = 1.68, confidence interval (CI) = 1.17–2.19]. In contrast, ToM impairment was modest (d = 0.36, CI = 0.24–0.48). BPD patients underperformed healthy controls in ToM-reasoning (d = 0.44, CI = 0.32–0.56) but not ToM-decoding. Increased HyperToM (d = 0.60, CI = 0.41–0.79) and faux pas recognition (d = 0.62, CI = 0.35–0.90) errors in BPD compared to healthy controls were most robust ToM findings in this meta-analysis. Conclusions BPD is characterized by very severe deficits in RF and modest and selective abnormalities in ToM. Interpersonal problems and difficulties in processing social information in BPD can be best explained by patients' maldaptive meta-social cognitive style and top-down effects of these abnormalities rather than having a primary neuro-social cognitive deficit.

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Theory of Mind in Mild Cognitive Impairment – Relationship with Limbic Structures and Behavioural Change

Journal of the International Neuropsychological Society ◽

10.1017/s1355617719000870 ◽

2019 ◽

Vol 25 (10) ◽

pp. 1023-1034 ◽

Cited By ~ 1

Author(s):

Johannes C. Michaelian ◽

Loren Mowszowski ◽

Adam J. Guastella ◽

Julie D. Henry ◽

Shantel Duffy ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Theory Of Mind ◽

Social Cognitive ◽

Behavioural Change ◽

Hippocampal Volume ◽

Control Group ◽

Social Cognitive Deficits ◽

Magnetic Resonance Imaging Mri ◽

The Mind

AbstractObjectives:Older adults presenting with mild cognitive impairment (MCI) have a higher risk of developing dementia and also demonstrate impairments in social cognition. This study sought to establish whether in people with MCI, poorer theory of mind (ToM) was associated with volumetric changes in the amygdala and hippocampus, as well as early changes in behaviour.Methods:One hundred and fourteen people with MCI and fifty-two older adult controls completed the Reading the Mind in the Eyes Test (RMET), while close informants (e.g., spouse/family member/friend/carer) described any current behavioural changes using the Revised Cambridge Behavioural Inventory (CBI-R). A subsample of participants completed structural magnetic resonance imaging (MRI).Results:The MCI group showed poorer performance on all neuropsychological tests administered, and moderate reductions on the RMET compared to the control group (d = .44), with greater reduction observed in those with amnestic compared to non-amnestic MCI (p = .03). While a robust correlation was identified between poorer RMET performance and smaller hippocampal volume in the control group (ρ = .53, p = .01), this relationship was not apparent in the MCI group (ρ = .21, p = .11). In the MCI group, poorer RMET performance was associated with poorer everyday skills (ρ = −.26, p = .01) assessed by the CBI-R.Conclusions:Our findings cross-validate previous reports that social cognitive deficits in ToM are a feature of MCI and also suggest that disruptions to broader neural networks are likely to be implicated. Furthermore, ToM deficits in MCI are associated with a decline in everyday skills such as writing or paying bills.

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Effects of Social Cognitive Impairment on Speech Disorder in Schizophrenia

Schizophrenia Bulletin ◽

10.1093/schbul/sbs039 ◽

2012 ◽

Vol 39 (3) ◽

pp. 608-616 ◽

Cited By ~ 11

Author(s):

N. M. Docherty ◽

A. McCleery ◽

M. Divilbiss ◽

E. B. Schumann ◽

A. Moe ◽

...

Keyword(s):

Cognitive Impairment ◽

Social Cognitive ◽

Speech Disorder

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Social cognitive impairment in people with epilepsy

10.5353/th_b4819925 ◽

2012 ◽

Author(s):

Man-kiu Ma

Keyword(s):

Cognitive Impairment ◽

Social Cognitive

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Analysis of Cognitive and Social Cognitive Factors Affecting Social Participation in Patients With Mild Cognitive Impairment

The Journal of Korean Society of Occupational Therapy ◽

10.14519/jksot.2017.25.4.05 ◽

2017 ◽

Vol 25 (4) ◽

pp. 61-74 ◽

Cited By ~ 1

Author(s):

Eun-Hye Jun ◽

◽

Young-Nam Cho ◽

Jae-Hoon Jung ◽

Tae-Hyung Oh

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Social Participation ◽

Social Cognitive ◽

Cognitive Factors ◽

Factors Affecting

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Cognitive Enhancement Therapy in Schizophrenia

Jurnal Psikiatri Surabaya ◽

10.20473/jps.v9i1.17515 ◽

2020 ◽

Vol 9 (1) ◽

pp. 7

Author(s):

Zain Budi Syulthoni ◽

I Gusti Ngurah Gunadi

Keyword(s):

Cognitive Impairment ◽

Cognitive Function ◽

Social Cognitive ◽

Cognitive Enhancement ◽

Late Onset ◽

Rehabilitation Program ◽

The Impact ◽

Additional Therapy ◽

The Brain ◽

Back To Work

Schizophrenia is a chronic, severe, and debilitate mental disorder that causing disability. Factors that causing disability is cognitive impairment. Cognitive impairment caused by disturbance in neurodevelopmental process of the brain that related to Dopaminergic, GABA-ergic, and Acethylcholinergic pathway. Cognitive Enhancement Therapy is additional therapy to recovery the cognitive function. CET facilitated repairmenin socio and non-socio cognitive function, encourage patient behaviour related social condition, develop patient understanding of schizophrenia and the impact on cognitive impair- ment, and rehabilitation program that characterised of an experiential and exercise to repair the non-social cognitive function (attention, memmory, and problem solving). CET shows improvement in early or late onset of schizophrenia. Pa- tients who got CET can back to work. Now, CET is used for early intervention in cognitive impairment in Schizophrenia. CET was also developed in patients with Schizoaffective, Schizophrenia comorbid with drug abuse, and patientswith au- tism. Hopefully, the improvement onquality of life patient with schizophrenia can achieve with combination pharmacother- apy and Cognitive Enhancement Therapy.

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Effectiveness of Integrated Neurocognitive Therapy on Cognitive Impairment and Functional Outcome for Schizophrenia Outpatients

Schizophrenia Research and Treatment ◽

10.1155/2018/2360697 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Andreana De Mare ◽

Miriam Cantarella ◽

Giovanni Galeoto

Keyword(s):

Cognitive Impairment ◽

Functional Outcome ◽

Effect Size ◽

Negative Symptoms ◽

Social Cognitive ◽

Meta Analysis ◽

Positive Symptoms ◽

Global Functioning ◽

Cognitive Domains ◽

Treatment Research

Cognitive impairment is highly prevalent in patients with schizophrenia and schizoaffective disorder. Many interventions have been developed to treat cognitive deficit, since it has a strong impact on functional outcome; however, there are no integrated interventions targeting multiple neuro- and social-cognitive domains with a particular focus on the generalization of the effects of therapy on the functional outcome. Recently, a group of experts has developed a cognitive remediation group therapy approach called Integrated Neurocognitive Therapy (INT), which includes exercises to improve the MATRICS (Measurement and Treatment Research to Improve Cognition in Schizophrenia) neuro- and social-cognitive domains. This systematic review and meta-analysis aimed to assess the efficacy of this approach. We conducted a search of PubMed, Scopus, Web of Science, and PsycINFO to select primary studies evaluating INT in schizophrenic and schizoaffective patients. The primary outcomes of the meta-analysis included negative and positive symptoms and global functioning. Two randomized controlled trials met inclusion criteria. A total of 217 participants were included. Based on the results from the Positive and Negative Syndrome Scale (PANSS), a significant pooled effect size was observed for negative symptoms, which demonstrated not only an improvement in the patients treated immediately after therapy but also a permanence of positive results at a 9–12-month follow-up. On the other hand, no significant effect size was observed for positive symptoms. In addition, a significant pooled effect size was found for Global Assessment of Functioning (GAF), which shows how INT’s integrated approach has lasting positive implications on patients’ functional outcome. We concluded that INT might be an effective treatment for negative symptoms and global functioning in patients with schizophrenia, compared to treatment as usual (TAU).

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