Social cognitive functioning in prodromal psychosis: A meta-analysis
Introduction
Social cognition refers to the mental operations that underlie social interactions, including the processes involved in the perception, interpretation, and generation of responses to the intentions, dispositions, and behaviors of other individuals (Penn et al., 1997, Green et al., 2005). Social cognition, similar to other aspects of cognition, is a multifaceted concept that comprises several sub-domains and processes. The Social Cognition Psychometric Evaluation (SCOPE) initiative of the National Institute of Mental Health (NIMH) identified four relevant domains, namely, theory of mind (ToM), social perception (SP), attributional bias (AB), and emotion processing (EP) (Green et al., 2004, Green et al., 2008, Pinkham et al., 2014). Recent meta-analyses have indicated that social cognitive function in patients with schizophrenia was markedly impaired (Savla et al., 2013, Chung et al., 2014). Deficits in social cognition are associated with the functional outcome of schizophrenia and contribute to the functional outcome beyond neurocognition (Schmidt et al., 2011, Mehta et al., 2013a). Social cognitive deficits are relatively stable throughout the disease course (Addington et al., 2006, Horan et al., 2012) given that these deficits are observed during remission (Sprong et al., 2007, Mehta et al., 2013b), as well as in relatives (Lavoie et al., 2013). These findings suggest that social cognitive deficits represent a trait marker for schizophrenia that is related to a genetic vulnerability associated with the pathology rather than a state-related aspect; however, some inconsistencies exist in each domain (Fiszdon and Reddy, 2012, Pinkham, 2014).
The concepts of ‘clinical high risk’ (CHR) and ‘ultra-high risk’ have been developed over the previous two decades to identify subjects at imminent risk of psychosis (Miller et al., 2002, McGorry et al., 2003, Fusar-Poli et al., 2013). Similarly, the concept of ‘Basic Symptom’, which is considered to be an earlier state of psychosis, has also been developed complementary to and along with high risk concepts (Schultze-Lutter et al., 2012). The high-risk state for psychosis is also associated with significant and widespread impairments in social cognition and neurocognitive performances (Fusar-Poli et al., 2012a, Bora and Murray, 2014, Lee et al., 2014a). A recent study demonstrated that ToM was impaired in individuals at CHR, and the performance of this group was intermediate between patients with first-episode psychosis and healthy controls (Bora and Pantelis, 2013). Individuals at CHR who later developed psychosis performed worse in the ToM domain compared with those who did not transition to psychosis (Kim et al., 2011). These results suggest that the ToM performance in individuals at CHR is intermediate between those of the healthy population and patients with schizophrenia. Patients with schizophrenia consistently exhibit deficits in SP (Green et al., 2007, Couture et al., 2010), and EP (Gur et al., 2002, Fisher et al., 2008); however, individuals at CHR exhibit mixed findings regarding social cognitive deficits (Pinkham et al., 2007, Couture et al., 2008, Pauly et al., 2010, Devylder et al., 2013). Therefore, the domains of social cognition that are associated with the largest impairments in individuals at CHR are not clear. Savla et al. (2013) found no significant differences in AB in patients with schizophrenia compared with healthy controls but did demonstrate that performances in other domains were impaired in patients with schizophrenia. However, most studies in individuals at CHR exhibit higher AB compared with healthy controls (An et al., 2010, Hauser et al., 2011, Stowkowy and Addington, 2012, Thompson et al., 2013). These findings suggest that an abnormality of AB in CHR is the specific feature that distinguishes it from schizophrenia.
Previous meta-analyses only investigated a single domain or social cognition as a whole (Fusar-Poli et al., 2012b, Bora and Pantelis, 2013). However, a domain-by-domain quantitative analysis of social cognitive function in individuals at CHR has not been performed. The identification of the domains and the extent of social deficits in individuals at CHR will aid in the determination of specific impairments that are trait markers for schizophrenia, indicate an increased or decreased risk of the transition to psychosis, and identify more specific targets in the development of therapeutic regimens for the high-risk group. The goals of the current meta-analysis are (1) to examine the magnitude of the differences between individuals at CHR and healthy controls across all four domains of social cognition, (2) to evaluate the impact of different moderators on the performance of each domain, and (3) to determine if significant impairments in each component of social cognition are present in CHR individuals who later develop psychosis compared with CHR non-converters.
Section snippets
Literature search
A systematic search strategy identified relevant studies. Two independent researchers (T. Y. L. and S. B. H.) conducted a two-step literature search. First, a literature search using PubMed, PsycINFO, EMBASE, and CINAHLplus was performed to identify relevant articles from database inception to November 2014. The following keywords, including their synonyms and combinations, were used as search terms: “social cognition”, “theory of mind”, “mentalizing”, “emotional perception”, “emotional
Description of studies
The electronic database and manual searches yielded 317 studies, and 22 studies were included in the meta-analysis (see Fig. 1 for the flowchart). Some studies were excluded because they shared the same subjects (Seiferth et al., 2008, van Rijn et al., 2011a, Amminger et al., 2012) or shared some subjects and had a smaller sample size (Chung et al., 2008, Kim et al., 2011). The 22 included studies reported data for 1229 individuals at CHR and 825 healthy controls. Three studies reported data
Discussion
The present study examined the quantitative evidence of deficits in social cognition domains in individuals at CHR based on the SCOPE initiative of the NIMH on social cognition in schizophrenia. This study is the first meta-analysis to investigate the domain-by-domain performances of social cognition in individuals at CHR. The present study indicated that individuals at CHR exhibited significant impairments in all domains of social cognition compared with healthy controls, with the largest
Role of funding source
This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (Grant no. 2013R1A2A1A03071089).
Contributors
Authors Jun Soo Kwon and Tae Young Lee were responsible for the design of the whole study and wrote the protocol. Authors Tae Young Lee and Sang Bin Hong wrote the manuscript. Authors Jun Soo Kwon and Na Young Shin supported the analysis, interpretation and manuscript revision. All authors contributed to and approved the final manuscript.
Conflict of interest
All authors have declared that there are no conflicts of interest in relation to the subject of this article.
Acknowledgment
We give our special thanks to the Yu Sun Chung.
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