Theory of mind and neurocognition in early psychosis: a quasi-experimental study

BMC Psychiatry

Stanley Catts⁴  Philip B Ward¹  Megan Still²  Michael H Connors³  Robyn Langdon³ 

[1] School of Psychiatry, University of New South Wales and Schizophrenia Research Unit, South Western Sydney Local Health District, Liverpool, NSW, Australia;Rehabilitation Services, Division of Mental Health, Sydney & South Western Sydney Local Health Districts, Liverpool, NSW, Australia;ARC Centre of Excellence in Cognition and its Disorders, and Department of Cognitive Science, Macquarie University, Sydney, NSW, Australia;School of Psychiatry, University of Queensland, Brisbane, QLD, Australia

关键词: Theory of mind;    Social functioning;    Schizophrenia;    Quality of life;    Occupational functioning;    Neurocognition;    First episode psychosis;    Early psychosis;   

Others  :  1091624
DOI  :  10.1186/s12888-014-0316-6

 received in 2014-06-07, accepted in 2014-10-24,  发布年份 2014

【 摘 要 】

Background

People with chronic psychosis often display theory of mind impairments that are not fully accounted for by other, more general neurocognitive deficits. In these patients, both theory of mind and neurocognitive deficits contribute to poor functioning, independently of psychotic symptoms. In young people with recent-onset psychosis, however, it is unclear the extent to which theory of mind impairment is independent of neurocognitive deficits. The primary aim of this study was to examine the evidence for specific theory of mind impairments in early psychosis. A secondary aim was to explore the relations between theory of mind, neurocognition, symptom severity, and functional outcomes.

Methods

Twenty-three patients who were within two years of their first psychotic episode and 19 healthy controls completed theory of mind and neurocognitive batteries. Social functioning, quality of life, and symptom severity were also assessed in patients.

Results

Patients demonstrated deficits in tasks assessing theory of mind and neurocognition relative to controls. Patients’ deficits in theory of mind were evident even after adjusting for their deficits in neurocognition. Neither theory of mind nor neurocognition predicted social functioning or quality of life in this early psychosis sample. Severity of negative symptoms, however, was a significant predictor of both outcomes.

Conclusions

While a specific theory of mind impairment was evident in this early psychosis sample, severity of negative symptoms emerged as the best predictor of poor functional outcome. Further early psychosis research is needed to examine the longitudinal progression of theory of mind impairments – independent of neurocognitive deficits – and their impact on psychosocial function.

【 授权许可】

   
2014 Langdon et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Couture SM, Penn DL, Roberts DL: The functional significance of social cognition in schizophrenia: a review. Schizophr Bull 2006, 32:S44-S63.
• [2]Green MF, Penn DL, Bentall R, Carpenter WT, Gaebel W, Gur RC, Kring AM, Park S, Silverstein SM, Heinssen R: Social cognition in schizophrenia: An NIMH workshop on definitions, assessment, and research opportunities. Schizophr Bull 2008, 34:1211-1220.
• [3]Hooley JM: Interpersonal functioning and schizophrenia. In Oxford Textbook of Psychopathology. 2nd edition. Edited by Millon T, Blaney P, Davis R. Oxford University Press, New York; 2008:333-360.
• [4]Marsh PJ, Langdon R, Harris A, Coltheart M: The case for social-cognitive remediation in schizophrenia: a life well lived is more than remission from psychosis. Aust N Z J Psychiatry 2013, 47:512-515.
• [5]Roberts DL, Velligan DI: Can social functioning in schizophrenia be improved through targeted social cognitive intervention? Rehabil Res Pract 2012, 2012:8.
• [6]Bora E, Pantelis C: Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: systematic review and meta-analysis. Schizophr Res 2013, 144:31-36.
• [7]Green MF, Bearden CE, Cannon TD, Fiske AP, Hellemann GS, Horan WP, Kee K, Kern RS, Lee J, Sergi MJ, Subotnik KL, Sugar CA, Ventura J, Yee CM, Nuechterlein KH: Social cognition in schizophrenia, part 1: performance across phase of illness. Schizophr Bull 2012, 38:854-864.
• [8]Horan WP, Green MF, DeGroot M, Fiske A, Hellemann G, Kee K, Kern RS, Lee J, Sergi MJ, Subotnik KL, Sugar CA, Ventura J, Nuechterlein KH: Social cognition in schizophrenia, part 2: 12-month stability and prediction of functional outcome in first-episode patients. Schizophr Bull 2012, 38:865-872.
• [9]Bowie CR, Harvey PD: Cognitive deficits and functional outcome in schizophrenia. Neuropsychiatr Dis Treat 2006, 2:531-536.
• [10]Brüne M, Schaub D, Juckel G, Langdon R: Social skills and behavioral problems in schizophrenia: the role of mental state attribution, neurocognition and clinical symptomatology. Psychiatry Res 2011, 190:9-17.
• [11]Fett A-KJ, Viechtbauer W, Dominguez M-d-G, Penn DL, van Os J, Krabbendam L: The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis. Neurosci Biobehav Rev 2011, 35:573-588.
• [12]Bora E, Yucel M, Pantelis C: Theory of mind impairment in schizophrenia: meta-analysis. Schizophr Res 2009, 109:1-9.
• [13]Sullivan S, Herzig D, Mohr C, Lewis G, Corcoran R, Drake R, Evans J: Theory of mind and social functioning in first episode psychosis. Cognit Neuropsychiatry 2012, 18:219-242.
• [14]Sullivan S, Lewis G, Mohr C, Herzig D, Corcoran R, Drake R, Evans J: The longitudinal association between social functioning and theory of mind in first-episode psychosis. Cognit Neuropsychiatry 2013, 19:58-80.
• [15]Castle DJ, Jablensky A, McGrath JJ, Carr V, Morgan V, Waterreus A, Valuri G, Stain H, McGuffin P, Farmer A: The diagnostic interview for psychoses (DIP): development, reliability and applications. Psychol Med 2006, 36:69-80.
• [16]ICD-10: International Statistical Classification of Diseases and Related Health Problems 10th Rev. edn. Author, New York; 2008.
• [17]Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J: Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treat 2012, 2012:1-9.
• [18]First MB, Spitzer RL, Gibbon M, Williams JBW: Structured Clinical Interview for DSM-IV Axis I Disorders - Patient edition (SCID-I P, Version 2.0). New York State Psychiatric Institute, Biometrics Research Department, New York; 1996.
• [19]Langdon R, Coltheart M: Mentalising, schizotypy, and schizophrenia. Cognition 1999, 71:43-71.
• [20]Langdon R, Ward PB, Coltheart M: Reasoning anomalies associated with delusions in schizophrenia. Schizophr Bull 2010, 36:321-330.
• [21]Langdon R, Still M, Connors MH, Ward PB, Catts SV: Theory of mind in early psychosis. Early Interv Psychiatry 2014, 8:286-290.
• [22]Happé F, Brownell H, Winner E: Acquired ‘theory of mind’ impairments following stroke. Cognition 1999, 70:211-240.
• [23]Nelson HE, Willison J: National Adult Reading Test (NART): Test manual. 2nd edition. NFER Nelson, Windsor; 1991.
• [24]Wechsler D: Manual of the Wechsler Adult Intelligence Scale. 3rd edition. The Psychological Corporation, San Antonio; 1997.
• [25]Langdon R, Coltheart M, Ward PB, Catts SV: Disturbed communication in schizophrenia: the role of poor pragmatics and poor mind-reading. Psychol Med 2002, 32:1273-1284.
• [26]Heaton RK: Wisconsin Card Sorting Test Manual. Psychological Assessment Resources Inc., Odessa; 1981.
• [27]Spreen O, Strauss E: A Compendium of Neuropsychological Tests: Administration, Norms and Commentary. Neuropsychological Press, Tucson; 1998.
• [28]Golden CJ: Stroop Color and Word Test: Manual for Clinical and Experimental Uses. Stoelting, Chicago; 1978.
• [29]Andreasen NC: Scale for the Assessment of Negative Symptoms (SANS). University of Iowa, Iowa City; 1983.
• [30]Andreasen NC: Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa, Iowa City; 1984.
• [31]American Psychiatric Association: Social and Occupational Functioning Assessment Scale (SOFAS). In Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington: Author; 1994.
• [32]Heinrichs DW, Hanlon TE, Carpenter WT: The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 1984, 10:388-398.
• [33]Sharp C, Pane H, Ha C, Venta A, Patel AB, Sturek J, Fonagy P: Theory of mind and emotion regulation difficulties in adolescents with borderline traits. J Am Acad Child Adolesc Psychiatry 2011, 50:563-573.e561.
• [34]Green MF, Horan WP, Mathis KI, Wynn JK: Neurocognition and functional outcome in schizophrenia: filling in the gap. In Cognitive Impairment in Schizophrenia. Edited by Harvey PD. Cambridge University Press, New York; 2013:85-97.