Contextual Social Cognition Impairments in Schizophrenia and Bipolar Disorder

BackgroundThe ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations. Methodology/Principal FindingsThis study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks. Conclusions/SignificanceOverall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.背景：将情境信息与社交线索整合以生成社交意义的能力，是社交认知（social cognition）的核心特征之一。学界普遍认为，精神分裂症与双相障碍患者存在社交认知缺损，但既往针对此类疾病的研究未采用能够复刻日常真实场景的实验任务。 方法与主要结果：本研究评估了精神分裂症与双相障碍患者在三类社交认知任务中的表现，分别为情绪加工（emotional processing）、共情（empathy）与社会规范知识（social norms knowledge），上述任务均设置了不同程度的情境依赖性，并纳入真实生活场景元素。此外，本研究探讨了社交认知测评指标、临床症状与执行功能（executive functions）之间的关联；通过逻辑回归分析（logistic regression analysis），验证了情绪加工中的基础技能参与度是否能够预测共情任务的表现。结果显示，两组患者在情境敏感性更高、包含真实生活场景的社交认知任务中均存在缺损，且精神分裂症患者的缺损程度显著重于双相障碍患者；而在涉及显性知识（explicit knowledge）的任务中，患者组与健康对照组无显著差异。此外，精神分裂症患者的抑郁水平与共情任务表现呈负相关。 结论与意义：在共情任务中更为模糊的情境下，情绪识别的整体表现可预测意图归因（intentionality attribution）的表现。本研究结果提示，社交认知缺损可能与个体内隐整合情境线索的能力普遍受损相关。本文还讨论了该发现对精神分裂症与双相障碍患者的评估与治疗，以及此类疾病的神经认知模型构建的重要启示价值。