Treating impaired social cognition

Our objectives have changed from simply dealing with symptoms to promoting recovery so that patients who have developed schizophrenia can return to a meaningful life. One thing that stands in the way is that, even when there is recovery from positive symptoms, diffuse cognitive impairment may remain.

There is also a more specific deficit – in social cognition, Armida Mucci (University of Naples, Italy) told the EPA. This deficit encompasses impairments in the perception and interpretation of facial and verbal expression, and also defects in the ability to identify and respond to the beliefs and intentions of others: ie, there is a problem with “the theory of mind”.

Social cognition and prognosis

Of course, a person needs general cognitive capacities such as attention and memory to be able to interact well with other people. But there is increasing evidence that deficits in social cognition are essentially independent of other aspects of cognitive function. And in some respects social cognition is a better predictor of a person’s capacity for independent life in the community and ability to perform everyday tasks.

Social cognition and neurocognition are separate cognitive domains.

In research undertaken by the 26-centre Italian Network for Research in Psychoses, which involved 922 stable patients who were living in the community and not suffering from depression, performance on standard measures of neurocognition and social cognition among those with schizophrenia was around 1.5 standard deviations below that of healthy controls.

Along with the continued presence of negative symptoms, both social cognition and neurocognition were important determinants of every functioning.

Sarcasm and lies

A further study by the Italian Network, presented by Paola Rocca (University of Turin, Italy), has identified the ability to detect sarcasm and understand a lie as particularly important in distinguishing between patient groups with different degrees of impaired social cognition.

Such findings reinforce the idea that social cognition should be a target of treatment using cognitive remediation techniques and suggest the possibility of tailored therapy.

Gabriele Sachs (Medical University of Vienna, Austria) is involved in a new study which will relate training in skills such as affect recognition and understanding the other’s perspective to functional outcome. The patients involved have all been stabilised on atypical antipsychotics.

The study also has a functional neuro-imaging element. Early data suggest that the combined approach of pharmacological treatment and social cognitive remediation is associated with increased activity in brain areas known to be involved in mentalization. Functional outcome data are awaited.