Elsevier

Schizophrenia Research

Volume 190, December 2017, Pages 136-143
Schizophrenia Research

Social cognition psychometric evaluation (SCOPE) in people with early psychosis: A preliminary study

https://doi.org/10.1016/j.schres.2017.03.001Get rights and content

Abstract

Social cognition is an important outcome in schizophrenia research. Unfortunately, there has been a lack of consensus regarding which measures of social cognition best capture this domain of functioning. The Social Cognition Psychometric Evaluation (SCOPE) study was developed to address the need for a battery of measures that have sound psychometric properties and can be implemented in clinical trials for individuals with chronic schizophrenia. The current study expands upon the SCOPE study by examining the psychometric properties of the eight candidate measures administered to individuals early in the course of psychosis. Thirty-eight stable outpatients with first episode psychosis and thirty-nine healthy controls completed the battery at baseline and one-month follow-up assessments. The SCOPE battery was evaluated on a collection of psychometric properties, including: (1) Reliability – including test-retest and internal consistency, (2) Between group differences, (3) Utility as a repeated measure, (4) Relationship to social and occupational functioning, (5) Incremental validity – variance in functioning beyond neurocognition, and (6) Feasibility – including practicality of administration and tolerability. Social cognition accounted for substantially more variance in functional outcome than neurocognition. Only one measure, the Hinting task, displayed adequate psychometric properties to be recommended for use in clinical research with first episode psychosis. The remaining candidate measures would require modifications before implementation or cannot be recommended for use in clinical research with first episode psychosis.

Introduction

Social cognition, defined as the mental processes underlying people's capacity to perceive, process and comprehend social information, is related to quality of life, daily living skills and occupational functioning in schizophrenia (Frith, 2008, Green et al., 2012, Kunda, 1999, Mancuso et al., 2011). Social cognition accounts for additional variance in functioning than various cognitive factors (Brϋne et al., 2007), and mediates the relationship between neurocognition and functioning in psychosis (Fett et al., 2011, Schmidt et al., 2011). Based on its relation to functional outcome, social cognition in schizophrenia has garnered considerable research interest over the past few decades and is increasingly considered a viable target for treatment (Couture et al., 2006, Fett et al., 2011, Green and Leitman, 2008, Penn et al., 1997).

Despite burgeoning interest in studying social cognition, studies investigating this construct vary greatly in the tasks employed, many of which may lack a strong empirical foundation and involve unknown or questionable psychometric properties (Couture and Penn, 2012, Fett et al., 2011, Savla et al., 2013, Thompson et al., 2011). The absence of a validated battery of social cognitive measures is problematic as inadequate and inconsistent measurement can jeopardize the validity, reproducibility, and comparability of findings, and may lead to effective treatments being discarded or ineffective treatments pursued (Drost, 2011).

To address this need, an ongoing NIMH project called the Social Cognition Psychometric Evaluation (SCOPE) study was initiated (Pinkham et al., 2014, Pinkham et al., 2015). SCOPE is a multiphase project that involves identifying the currently accepted domains of social cognition, selecting the best available measures to assess these domains, and administering tasks to a large sample of stable outpatients with schizophrenia and demographically-matched controls.

Findings from the initial validation study suggested the Bell-Lysaker Emotion Recognition Task (BLERT; Bell et al., 1997), Penn Emotion Recognition Task (ER-40; Kohler et al., 2003), Reading the Mind in the Eyes Test (Eyes; Baron-Cohen et al., 2001), The Awareness of Social Inferences Test (TASIT; McDonald et al., 2003), and Hinting Task (Hinting; Corcoran et al., 1995), displayed acceptable reliability and validity for implementation in clinical research. Remaining measures, including: Ambiguous Intentions Hostility Questionnaire (AIHQ; Combs et al., 2007), Relationships Across Domains (RAD; Sergi et al., 2009), and Trustworthiness Task (Trust; Adolphs et al., 1998), demonstrated weaker characteristics and were deemed inadequate for use in clinical trials targeting social cognition (Pinkham et al., 2015), although subsequent findings support continued development and use of the AIHQ Blame Score (Buck et al., 2017, in press).

Importantly, SCOPE included a predominantly middle-aged, chronic sample typical of many treatment studies. There is some debate as to whether first episode psychosis (FEP) and chronic schizophrenia patients should exhibit the same types and degree of social cognitive impairment (Savla et al., 2013, Thompson et al., 2011, Ventura et al., 2015). Some research suggests attenuated or unremarkable deficits earlier in the course of illness (An et al., 2010, Bora and Pantelis, 2013, Romero-Ferreiro et al., 2016, Sprong et al., 2007), though findings are mixed (Barkl et al., 2014, Green et al., 2012, Horan et al., 2011, Zaytseva et al., 2013). FEP samples may also be more heterogeneous than many chronic schizophrenia samples (Birchwood et al., 1998), and differences in social cognition across phase of illness may stem from variations in clinical stability (Bora and Pantelis, 2013, Green et al., 2012) and age-related changes in neurocognitive abilities (Hartshorne and Germine, 2015). Consequently, the results of SCOPE may not accurately represent younger individuals with FEP.

The purpose of the current study was to extend Pinkham et al.'s (2015) psychometric investigation of the SCOPE battery with a younger FEP sample. Paralleling SCOPE, we report on: (1) Reliability: test-retest, internal consistency, (2) Between-group differences, (3) Utility as a repeated measure, (4) Relationship to social/occupational functioning, (5) Incremental validity: variance in functioning beyond neurocognition, and (6) Feasibility: practicality of administration, tolerability.

Section snippets

Participants

The study took place at the University of North Carolina at Chapel Hill. FEP patients were primarily recruited from the Outreach and Support Intervention Services (OASIS) clinic in Carrboro, NC. Patients required a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, or psychosis NOS, confirmed by the Structured Clinical Interview for DSM-IV Axis-I Disorders, Patient Edition (SCID-P; First et al., 2002). OASIS clinicians and/or a trained research assistant at UNC-CH

Participants

Thirty-eight patients and 39 controls completed the baseline assessment. Thirty-five patients and 36 controls returned to complete visit two. Average time between administrations was comparable for both groups (MFEP = 33.08 days, SD = 5.65; MHC = 31.61 days, SD = 4.81; t(70) =  1.190, P = 0.238). Groups did not differ in regard to gender, race, ethnicity, age, or estimated IQ (see Table 1). Patients completed significantly fewer years of education than controls, whereas patients' parents completed

Discussion

The current study evaluated the psychometric properties of the SCOPE battery for FEP. Our findings suggest one measure, the Hinting task, was considered Acceptable at Present, or appropriate for use with FEP patients. In addition to displaying adequate test-retest reliability and effectively distinguishing between patients/controls, Hinting also exhibited significant relationships with both performance-based measures of functioning.

The RAD was classified as Acceptable with Concerns and may be

Role of the funding source

This work was supported by the National Institute of Mental Health (R01 MH093432 awarded to Drs. Harvey, Penn and Pinkham).

Contributors

PH, DP and AP (Principal Investigators) designed the study and wrote the protocol for this project. KL wrote the first draft of the manuscript, conducted all statistical analyses, and certified the accuracy of the results. All authors provided edits and revisions to the manuscript, and are in agreement with the final version.

Conflicts of interest

Dr. Harvey serves as a consultant/advisory board member for Acadia Pharma, Boehringer Ingelheim, Lundbeck, Otsuka Digital Health, Roche, Sanofi, Sunovion, and Takeda. The remaining authors declare no conflicts of interest pertinent to this study.

Acknowledgments

We would like to thank all individuals who participated in this investigation, including all research subjects and research assistants at the participating sites for their significant effort and contribution to the SCOPE study.

References (49)

  • M.V. Romero-Ferreiro et al.

    Facial affect recognition in early and late-stage schizophrenia patients

    Schizophr. Res.

    (2016)
  • M.J. Sergi et al.

    Development of a measure of relationship perception in schizophrenia

    Psychiatry Res.

    (2009)
  • V.H. Srihari et al.

    Is early intervention for psychosis feasible and effective?

    Psychiatr. Clin. North Am.

    (2012)
  • E.L. Abner et al.

    Practice effects in a longitudinal, multi-center Alzheimer's disease prevention clinical trial

    Trials

    (2012)
  • R. Adolphs et al.

    The human amygdala in social judgment

    Nature

    (1998)
  • S. Baron-Cohen et al.

    The ‘reading the mind in the eyes’ test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism

    J. Child Psychol. Psychiatry

    (2001)
  • M. Birchwood et al.

    Early intervention in psychosis: the critical-period hypothesis

    Int. Clin. Psychopharmacol.

    (1998)
  • S.P. Broglio et al.

    Test-retest reliability of computerized concussion assessment programs

    J. Athl. Train.

    (2007)
  • M. Brϋne et al.

    Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best

    Schizophr. Res.

    (2007)
  • B. Buck et al.

    Improving measurement of attributional style in schizophrenia; a psychometric evaluation of the Ambiguous Intentions Hostility Questionnaire (AIHQ)

    J. Psychiatr. Res.

    (2017)
  • D.R. Combs et al.

    The ambiguous intentions hostility questionnaire (AIHQ): a new measure for evaluating hostile social-cognitive biases in paranoia

    Cogn. Neurodyn.

    (2007)
  • S.M. Couture et al.

    Introduction to social cognition in schizophrenia

  • S.M. Couture et al.

    The functional significance of social cognition in schizophrenia: a review

    Schizophr. Bull.

    (2006)
  • E.A. Drost

    Validity and reliability in social science research

    Educ. Res. Perspect.

    (2011)
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