Social Cognition and Social Functioning in Schizophrenia

Schizophrenia patients have great difficulty navigating through the social
world and find it difficult to cope with this disability. Social dysfunction,
which is not only present in schizophrenia patients but also in those at-risk
to develop the disorder, may underlie many of the invalidating aspects in their
lives, e.g., social withdrawal, poor interpersonal relationships and impaired
occupational functioning,. In addition, poor social functioning has been shown
to predict conversion to schizophrenia in high-risk youth, and can thus serve
as a key point for early intervention. This indicates the urgency to
investigate the underlying mechanisms of social functioning in schizophrenia.

Recent research suggests that social cognition (usually defined as mental
processing of other people*s emotions, intentions, and behavior) plays a vital
role in social functioning, and schizophrenia researchers increasingly take
social cognition into consideration. One of the social cognitive processes that
is shown to be disturbed in individuals suffering from schizophrenia is the
understanding of intentions and emotions in others, also referred to as the
theory of mind. However, when closely examining schizophrenia patients*
impairments in theory of mind, they seem to result from difficulties in
self-other distinction rather than difficulties in representing other people*s
*minds*. As a consequence, patients may falsely project their own intentions or
emotions onto others, or experience others* intentions or emotions as being
their own.

Therefore, the proposed study will not only include measures of classic social
cognition (e.g. emotion perception, theory of mind, attributional style), but
also social cognition measures that tap into processes underlying self-other
distinction. Furthermore, we aim to enhance our understanding of the neural
substrates of self-other distinction processes during social interaction. By
comparing performance of schizophrenia patients and matched healthy controls on
these different measures, we aim to gain more insight in the underlying
mechanisms of (impaired) self-other distinction processes and relate social
cognitive performance to measures of social functioning.

We propose that difficulties with self-other distinction lie at the core of
schizophrenia, thus insight in these mechanisms will enhance our understanding
of the social issues patients struggle with the most, and as such crucially
extend current research on social cognition and social functioning in
schizophrenia that so far focused mainly on perceptual processes.

1.Social Cognitive
A.Do schizophrenia patients, compared to unaffected controls, show impaired
social cognition (perceiving, understanding, intentions and emotions of
others), especially when it comes to self-other distinction processes
(distinguishing intentions, action effects, and emotions of others from one*s
own intentions and emotions)?
B.Do impairments in self-other distinction processes impede social functioning
(as measured by self-report, social distancing, and life role plays) over and
above impairments in classic social cognition?

2.Biological - imaging (MRI) and genetics
a.Is fMRI activation in medial prefrontal cortex and cingulate cortex during
emotion processing and self referential task decreased in schizophrenia
patients compared to matched controls?
b.Are the brain areas that are involved in self-referential (medial frontal) or
emotion processing (amygdala and cingulate cortex), as measured with fMRI,
associated with performance on social cognitive measures of measures of social
functioning?
c.Is impaired social cognition and social functioning in schizophrenia
patients, relative to matched controls, associated with disruption of the white
matter tracts connecting frontal, parietal and temporal areas and a thinner
cortex in frontal, parietal and insular areas(as measured with DTI/sMRI)?

Patient-control design, comparing patients with schizophrenia and matched
controls.
This study is a follow-up of the protocol *Structural and functional neural
correlates of the experience of self-agency in health and
schizophrenia.* (protocol number 10-177), which was previously approved by the
METC.

A magnetic resonance imaging (MRI) scan session of approximately 60 minutes
will be performed: MRI is a non-invasive technique, so there is no need for
special preparation for the subject. There are no known risks associated with
the MRI acquisition and the data are solely used for research purposes.
However, structural cerebral pathology may be noticed. If medical treatment is
indicated, the subject will be notified.

During two different social-cognitive tasks the participant will be videotaped
to analyze emotions, physiological reactions and interpersonal skills.
Participants will not be informed about the goals of these measurements before
the start of the study, because this may interfere with the objectivity of the
measurements. Therefore, we will debrief them after completion of the task. If
a participant objects to the extraction and use of either emotional expressions
and/or heart rate, we will make a note of this objection and not extract the
respective data from the video material.

Subjects will experience no direct benefits from our study. In the long run,
increased understanding of the etiology and pathophysiology of schizophrenia,
may contribute to diagnosis, early detection and/or prediction of treatment
outcome.