The study of social cognition with neuroimaging methods as a means to explore future directions of deficit evaluation in schizophrenia?

doi:10.1016/j.psychres.2010.11.029

Psychiatry Research

Volume 190, Issue 1, 30 November 2011, Pages 23-31

https://doi.org/10.1016/j.psychres.2010.11.029 Get rights and content

Abstract

This article discusses the important advances in a recent field of science dealing with the brain processes implicated in understanding social situations and interacting with others. Many behavioral studies on schizophrenia have shown the impairment of these processes and their preferential relation with disorganization and negative syndromes. Brain imaging is a powerful method to identify brain systems participating in these processes in healthy subjects and will be used increasingly to study mental disorders such as schizophrenia. A few preliminary studies have opened this field of research and allowed for the drawing of some limited conclusions. We emphasize the importance of developing an integrated neurocognitive framework to account for the multifaceted nature of social cognition deficits in schizophrenia. Inspired by contemporary models of empathy and social cognition that identify different components such as shared representation, mentalizing, self/other distinction, we show how schizophrenia affects these components at the behavioral and functional levels. We also outline the interest of this model to understand putative abnormalities of contextual integration within the area of mentalization. Finally, we discuss how specialized measures of brain functions during the performance of these precisely defined mental processes might be used as outcome predictors.

Introduction

Schizophrenia is associated with a severe social handicap resulting in a drastic reduction of autonomy and of professional and personal achievements, and in the disruption of family and peer relations. Contrary to widespread intuition, several authors showed that these central aspects of prognosis are only weakly predicted by symptoms (Rosen and Garety, 2005, Wykes and Reeder, 2005, Brüne et al., 2007). The limited performance of clinical evaluations to discriminate the severity of the illness or to define therapeutic strategies has led to the proposal of new evaluation techniques and tools, many of them inspired by neuropsychological assessment. This was, for instance, the rationale for the initiative Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) of the National Institute of Mental Health (NIMH) that offered, from a consensus of experts, a neuropsychological battery to promote cognitive disorders as a target of pharmaceutical treatment (Marder et al., 2004). In addition, this proposal recognized explicitly the role of social cognition, among other domains such as attention, executive function, and working memory, to determine a patient's status beyond clinical evaluations. Given their objectives oriented at pharmaceutical research, MATRICS experts did not provide an integrated view of social cognition based on recent research in this domain. In the present article, we will take into account the emergence of a new field of research dealing with the neurocognitive processes involved in social behavior that recently offered both theoretical and experimental insights into the abnormal processes of schizophrenia. Importantly, social cognition appears promising to offer a convergent point of scattered research in several domains such as theory of mind, emotion perception, metacognition, cognitive remediation, and functional outcome evaluation.

This article provides an overview of research in the field, taking selectively into account results from behavioral research (section 2) to neuroimaging studies (4 Representing social information, 5 Self/other distinction mechanisms, and 6). We stress the relevance of models, coming from social and affective neurosciences, and propose a cognitive framework inspired by current models (section 3). In 7 Is there a link between mentalization deficits and disorder of contextual integration in schizophrenia?, 8 Memory engagement in social cognition, and 9, we outline three perspectives of research that would merit investigations using functional neuroimaging. We conclude by emphasizing the importance of this literature in assessing the illness course and outcome (section 10).

Section snippets

Insights from behavioral and clinical studies

As will be discussed in the following, social cognition does not constitute a unitary construct (Farrow, 2007) and is not even a function per se. Often classified as a hybrid between an emotional and a cognitive phenomenon, social cognition encompasses many aspects as follows: gesture social perception, eye-gaze detection, emotion perception, empathy, agency and self/other distinction, mentalizing (also known as theory of mind), recognition of intentional causality or intentionality, etc. Most

The needs for an integrative model of social cognition

Several conceptual frameworks have been proposed to guide experimentations on social cognition in schizophrenia research. Some psychopathological models such as the one described by Couture et al. (2010) aimed to explain the disorder in order to predict functional outcome. According to these authors, interpretations of social or emotional cues depend on the patient's attributional style (for instance, a personalizing bias), which in turn is influenced by theory of mind inferences. Although this

Representing social information

At the input of the information processing chain, new events come from the environment (external events such as others' gestures, facial expressions, speech utterances) or from ourselves (internal cognitive events such as thoughts and emotions, as well as our own actions, reactions, sensations). These events activate corresponding representations, which in turn can activate associated representations stored in memory (information stored in episodic memory about the specific context or person,

Self/other distinction mechanisms

The theory of shared representation implies the existence of a system that keeps track of the recipient to which the current representation is attached. As stressed by Decety and Jackson (2004), in the absence of such a system linked to regulation mechanisms, the activation of shared representations by other's imagined or observed action or emotion could lead to contagion and the inability to separate our feelings from those of others. In other words, this necessary system allows self/other

Mental state attribution through mentalizing

The model proposed in this article recognizes the importance of a mentalizing mechanism that can be conceptualized as an executive component managing the multiple aspects of representations that are concurrently activated by the inherently complex everyday social interactions (or by the different pieces of information provided in a mentalizing task). These activated representations can be either social or contextual and can be activated through perception or verbal descriptions or retrieved

Is there a link between mentalization deficits and disorder of contextual integration in schizophrenia?

The model of social cognition presented in this article describes the role of mentalization in generating an integrated representation of social percepts by evaluating and selecting hypotheses on the hidden mental states that give coherence to the observed behavior. Such an approach to theory of mind emphasizes the integrative role of mentalizing a manner analogous to the way that Dennett (1987) has described the “intentional stance” as an efficient means to give sense to the social world. As

Memory engagement in social cognition

Although the relationship between social cognition and memory has not often been addressed directly, there is an obvious and fundamental relationship between the mentioned systems of representation and different types of memory. Considering the tight relations between self-reflection and thinking about others, it is tentative to hypothesize a crucial influence of autobiographical memories on the capacity to understand others by recalling our own experiences in similar contexts (Dimaggio et al.,

Social cognition is under the influence of structural characteristics

As reported above, investigation of social-cognitive processes in schizophrenia led to incongruent findings in several brain regions. Taking into account recent research that benefited from advances in structural characterization of human grey and white matter, such findings deserve further explorations with special attention given to the correlations of abnormalities of brain structures with local functional measures. Concerning the correlates of cortical structure, Benedetti et al. (2009)

Mental handicap assessment as a perspective for neurocognitive research

In this article, we tried to integrate a large set of theoretical proposals and empirical evidence into a neurocognitive model of abnormal social cognition in schizophrenia. This selective review reveals the extreme difficulty to provide a unique conceptual framework that could account for the heterogeneous clinical and performance patterns found in this disorder. However, advances in social neuroscience based on healthy subjects allow a coherent investigation of the disorders within the scope

Acknowledgements

We would like to thank Nadine Bazin, Emilie Baup-Bobin and Amélia Lemoalle for their important contribution to the ideas and the results presented here.

DV received a PhD student grant from Neuropôle. AMA is supported by a postdoctoral research grant from the Canadian Institutes for Health Research (CIHR). PLJ received a salary grant from the CIHR (New Investigator). EB received funding from INSERM's “Contrat d'Interface pour hospitaliers” program. The authors would also like to acknowledge the

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