1. Presenter Dr Salman KareemFinal Year ResidentDepartment of PsychiatryACME , Pariyaram

2. Defining social cognition in schizophrenia What domains of social cognition Neurobiology of social cognition What is social cognitions relationship with positivesymptoms (eg, paranoia), negative symptoms, anddisorganization? What is the functional significance of social cognition?Does it behave as a mediator? Social cognition and the course of schizophrenia: doesitpredate the illness or occur early in the illness? Are theimpairments trait like? Treatment interventions 3. The Measurement and Treatment Research to ImproveCognition in Schizophrenia (MATRICS) project understanding the nature and extent of cognitivedysfunction in schizophrenia facilitate the development of treatments that willhopefully improve this debilitating aspect ofschizophrenia (Barch, 2005). 4. seven cognitive domains speed of processing, working memory, attention/vigilance, verbal learning and memory, visual learning and memory, reasoning and problem solving, social cognition (Green and Nuechterlein, 2004). 5. Social cognition is defined asthe mental operations underlying socialinteractions, which include the human ability to perceivethe intentions and dispositions of others (Brothers,1990, p. 28). how people think about themselves and others in thesocial world. 6. primary domains (constructs) of social cognition: emotion perception, Theory of Mind (ToM), and Attributional style social perception, social knowledge (social schema) 7. Neuro Biology network of neural structures is critically involved inprocessing social stimuli (Adolphs, 2001; Brothers, 1990;Phillips et al., 2003). These models focus on regions of the occipital andtemporal cortices such as the Fusiform Gyrus (FG) andSuperior Temporal Sulcus (STS) which underlie faceprocessing (Haxby, Hoffmann and Gobbini, 2000; Winston,Henson, Fine-Goulden, and Dolan, 2004) amygdala which plays a critical role in detecting threat,recognizing emotions, and making complex socialjudgments (Adolphs et al., 1994; Adolphs et al., 1998; Amaral et al., 2003; Winston et al., 2002) 8. Emotional processing Identifying emotions Facilitating emotions Understanding emotions Managing emotions Affect perception a domain of emotion processingthat is frequently measured in schizophrenia research. 9. emotion perception In regard to emotion perception (eg, identifyingemotion displayed in various facial expressions or toneof voice), the following conclusions can be drawn First, individuals with schizophrenia display deficitscompared with nonclinical control participants. Second, these deficits are more severe relative toindividuals with other psychiatric disorders such asdepressive disorder (unless psychotic features arepresent). Edwards et al, Hellewell and Whittaker,Kohler and Brennan, and Mandalet al 10. Third, the greatest deficits are evident in theperception of negative emotions (compared withpositive emotions). Fourth, the deficit in emotion perception is stable overtime, although evidence suggests that individuals inremission may outperform individuals in an acutephase of the disorder. 11. Fifth, individuals with schizophrenia perform worsetrying to read between the lines (ie, identifying whata given individual is thinking or feeling) but are lessimpaired on more concrete social judgments (ie,identifying what a person is wearing or doing). Sixth, many individuals with schizophrenia displayrestricted visual scanning and spend less timeexamining salient facial features during emotionperception tasks. 12. Finally, impairments in emotion perception arepresent early in the course of illness. 13. Theory of Mind ToM is defined as the ability to attribute mental states(including beliefs, intentions, desires, and goals) to theself and others. includes understanding false beliefs, hints, intentions,deception, metaphor, irony, and faux pas. 14. Over 30 studies have been conducted on ToM inschizophrenia, leading to the following conclusions . In general, individuals with schizophrenia exhibitdeficits in ToM relative to non ill and psychiatriccontrols. The bulk of research supports the conclusion that thisimpairment in schizophrenia is a trait deficit.- Brune and Harrington et al 15. First-degree relatives of individuals with schizophreniawho also score high on schizotypy have impaired ToM,lending support for ToM as a potential endophenotypefor schizophrenia. ToM deficits are present in both IP and OP samples,are not accounted for by deficits in general cognitivefunctioning, and are not uniquely associated with anyspecific symptom type (eg, paranoia). The etiology of ToM deficits in schizophrenia remainsunclear, in part because the genesis of normal ToM isstill vague. 16. Attributional bias Attributional style refers to explanations peoplegenerate regarding the causes of positive and negativeevents in their lives. individuals with -paranoia or persecutory delusions. Such individuals tend to blame others rather thansituations for negative events, an attributional styleknown as a personalizing bias. persons with Scz tends to focus on hostileattributional biases or the tendency to attribute hostileintentions to others actions 17. Individuals with persecutory delusions may of coursehave other social cognitive biases such as the tendencyto jump to conclusions and to demonstrate aconfirmation bias (that is, seeking confirmatoryevidence for a belief rather than disconfirmatoryevidence). 18. 2 factors prevent individuals with persecutorydelusions from correcting their bias in the face ofdisconfirming situational information: a strong need for closure (ie, an intolerance ofambiguity) and impairments in ToM. Associationship seen between need for closure andpersecutory delusions and between deficits in ToMand personalizing attributions 19. Individuals with persecutory delusions may of coursehave other social cognitive biases such as the tendencyto jump to conclusions and to demonstrate aconfirmation bias (ie, seeking confirmatory evidencefor a belief rather than disconfirmatory evidence). 20. Social perception Definition: The ability to understand and appraise socialroles, rules, and context. Involves using verbal and nonverbal cues in order tomake inferences about a social situation May be central to functioning in a social context, ie,facilitating interactions with people in social settingsor establishing relationships Can involve making critical appraisals, such asjudgments of trustworthiness in other people 21. Social knowledge Definition: Refers to representational templates of socialsituations or awareness of the roles, rules, expectationsand goals that govern social situations. Can be declarative, comprising facts and abstractconcepts (eg, social scripts) or procedural (eg, rules,skills, and strategies) processes. 22. Relationships among social cognitive constructs andnegative symptoms are less clear. negative symptoms that involve reduced emotionalexperience (ie, anhedonia) or expression (ie, affectiveflattening) might be more associated with thedevelopment or maintenance of social cognitiondeficits. 23. Social cognitive deficits appear to be key determinantsof daily functioning in schizophrenia, includinginstrumental actions, interpersonal functioning, andvocational achievement. 24. social cognition involves the interface of emotional andcognitive processing, whereas neurocognitive processing isrelatively affect-neutral In contrast, negative symptoms could spring from a similaraffective processing dysfunction as social cognitiveimpairments.. failed empathy or mental simulation of others cognitive-affectstates (a putatively social cognitive phenomenon)may underlie ToM deficits and also foster the extinction ofsocial reinforcement, leading to increased negativesymptoms. . 25. Empirically, studies using statistical modelingtechniques and matched task designs have concludedthat social cognition is best understood as related to,but distinct from, neurocognition and negativesymptoms. This distinction is also observed at the neural levelbecause activation circuitry for social cognition vis--visneurocognition and negative symptoms arerelatively independent 26. Functional Outcome Impairments in daily functioning of schizophrenic patientsare related to both social and non-social cognitive domains(Couture et al., 2006, 2011). However, when social and non-social skills are analyzedtogether, they are better predictors of functional outcome(Couture et al., 2011). This means that social and non-social domains have anindependent influence on the everyday performance ofthese patients. Further, several studies show that social cognition has amediator effect between neuro-cognition and functionaloutcome (Couture et al., 2006; Bae et al., 2010;Schmidt etal., 2011b). 27. Social and non-social cognition are associated with functionaloutcome when they are studied separately, but when they areanalyzed together, non-social cognition reduces or loses itsassociation with functional outcome. That is, it is possible thatthe impact of non-social cognitive impairment in dailyfunctioning occurs through social cognitive impairments. Hence, it has been proposed that social cognition is a moreproximal factor in the causal mechanism leading to real worldperformance. For example, to develop interpersonal relationships, alterationsin theory of mind have stronger influence than memoryalterations. However, memory impairment can influence theoryof mind performance which in turn influences the ability todevelop interpersonal relationships. 28. Mediator/Trait life history stable trait that precedes, and even predicts, theillness onset. Using a videotape recording of a cohort of children having lunch,a study showed that alterations of social behavior were the mostsignificant predictors of those children who developedschizophrenia in adulthood, even more so than neuro-motordeficits (Schiffman et al., 2004). Moreover, individuals at ultra-high or family risk for psychosispresent social cognition alterations, especially in theory of mind(Chung et al., 2008;Anselmetti et al., 2009; Eack et al.,2010; Gibson et al., 2010; Kim et al., 2011a). These alterations can predict the psychotic conversion (Chung etal., 2008; Anselmetti et al., 2009; Eack et al., 2010;Gibson et al.,2010; Kim et al., 2011a 29. Consistent results were obtained in a study comparingsocial skills in prodromal, first episode, and chronicpatients, as well as in a longitudinal one of firstepisode patients (Green et al., 2012; Horan et al., 2012).Together, these studies show that social alterations area stable trait across the illness. 30. Treatment Implications Recent studies shows that it has a relationship withfunctional outcomes (eg, social skills, communityfunctioning). This, in turn, has inspired researchers to examinewhether social cognition can be improved becausesocial cognition may be an important target forpharmacological and psychosocial treatments. 31. Interestingly, there has been little support for atypicalmedications improving social cognition inschizophrenia because the one large adequatelypowered study found that neither quetiapine norrisperidone resulted in improved emotion perceptionamong 289 individuals with schizophrenia. 32. antipsychotic drugs of either class demonstrate littlereliable effect upon social cognition. There is amodicum of support for the use of oxytocin as anadjunct to antipsychotic drugs (Katarzyna Kucharska-Pietura AnnMortimer , CNS Drugs (2013) 27:335343) 33. Thus, there has been growing interest in psychosocialtreatments as a means of improving social cognition. Psychosocial treatment programs use a variety oftechniques to ameliorate social cognitive deficits, fromtargeted interventions that focus on a specific skill(eg, asking clients to imitate others facial expressionsto improve emotion perception) to those that targetintegrative social cognitive abilities via viewingvideotapes and role-playing. . 34. While there is growing evidence that social cognitioncan be improved, future research needs to determinewhether improvements in social cognition generalizeto other social cognitive domains as well as as tobehaviors 35. The Take Home Points Social cognition consists of multiple domains,including affect perception expression, theory ofmind, attributional styles, and social knowledge. Social cognition is not just a subset of neurocognition,it is a truly separable domain. Deficits in social cognition may explain the most or allof the relationship between neurocognition and socialoutcomes. Treating social cognitive deficits has the potential toimprove social outcomes, but these treatments are stillearly in their development stages. 36. We mortals cannot read other peoples mindsdirectly. But we make good guesses fromwhat they say, what we read between thelines, what they show in their faces and eyes,and what best explains their behavior.It is our species most remarkable talent.StevenPinkerSocial Cognition