Neural basis of cognitive-emotional processing and self-evaluation in schizophrenia

Schizophrenia is a grave mental illness that ranks very high among causes of
long term disability. As this disease usually manifests itself between the ages
of 16 and 30 years, it affects individuals at an often pivotal time in their
personal, professional and social development. It is characterized by deficits
in emotional processing and regulation (Aleman & Kahn, 2005).
Impairments in social functioning are a hallmark characteristic of
schizophrenia (DSM-IV), and have been shown to be most pronounced in persons
with schizophrenia, compared to other clinical disorders, such as bipolar
disorder (Corrigan & Penn 2001). The study of social cognition in schizophrenia
examines the processes responsible for social dysfunction (Corrigan & Penn,
2001; Pinkham et al. 2003). Social cognition has been defined as *the mental
operations underlying social interactions, which include the human ability to
perceive the intentions and dispositions of others* (Brothers 1990). These
processes thus refer to information processing in the brain, underlying social
interaction and they can be dissociated from nonsocial cognitive processes such
as memory and general problem solving (Pinkham et al. 2003). The importance of
social cognition is underscored by the fact that improvement in social
functioning is a major outcome variable in the treatment of schizophrenia. That
is, social cognition explains a larger portion of observed variance in every
day social functioning, than nonsocial cognitive functions do (Pinkham et al.
2003).
Brain circuits underlying social cognition include the ventral striatum, the
amygdala, the medial prefrontal and orbitofrontal cortex, anterior cingulate,
and insula (Phan et al. 2002; Pinkham et al. 2003). The importance of dopamine
pathways in neural processing in these circuits is well established (Grace
2000). There is neuroanatomical evidence of abnormalities in brain circuits
subserving social cognition in schizophrenia (Hulshoff Pol 2001; Gur et al.
2000; Chemerinski et al. 2002). These findings fit well with investigations of
social cognition in schizophrenia, employing affect recognition tasks, social
cue perception tasks, and theory-of-mind tasks, in which consistent impairments
were found (Corrigan & Penn 2001).

The aim of this study is to investigate the neural correlates of different
types of emotion regulation and emotional processing underlying social
cognition.

In this study patients and matched controls will undertake three fmri tasks, an
anatomy and a resting state with use of (f)MRI, three questionnaires and an
interview.
First the PANSS and possibly SCAN interview (for patients) will take place one
week before the scanning session maximally. Just before the scanning session
the participant has to fill in the PANAS, after this, instructions regarding
the fmri procedure and tasks will be given. The tasks will start at the
beginning of the experiment.
In the first task, the picture word task, the participant has to learn the
associations between positive, negative and neutral IAPS pictures and words
with the same valence. In the other task positive and negative words are
presented on the screen. In the following task, the metrical stress and emotion
task positive and negative words are presented on the screen. Participants have
to decide if, in one condition, the metrical stress is on the first or second
syllable, in the other condition participants have to judge if the word is
positive or negative. In the third task, the participant will be asked to make
decisions about themselves on specific statements requiring self-evaluation in
the domains of mood, social interactions, cognitive and physical abilities. In
the control condition, participants will be instructed to make decisions about
statements of factual knowledge.
After the scanning session, the Bermond Vorst Alexithymia Questionnaire and the
Birchwood Insight scale have to be completed.

Participants will be exposed to a 3 T magnetic field. No side effects have been
described so far. On rare occasions, a peripheral nerve (abdomen) is stimulated
by the changing magnet gradients. this will cause an itching feeling, but is
not harmful.