Theory of Mind in Schizophrenia By : Victoria Mak, Cécile Delbouille, Cullen Conerly & Yvan Reynaud Introduction › In 1992, Frith voiced the hypothesis in which schizophrenia would be linked with a deficit in theory of mind. He explains it with cognitive, neuropsychological, speculative and heuristic hypothesis ›- Cognitive : anomaly of a part of information processing : the attribution of mental states to others like beliefs, thoughts, intentions. ›- Neuropsychological : this cognitive anomaly is due to morbid signs and cerebral functional anomalies. ›- Speculative : it could be tested experimentally ›- Heuristic : permit to reinterpret the troubles of schizophrenia in a clinical way, to explain a part of those troubles, and to open to new ideas of research. › What is Schizophrenia? ›Schizophrenia is a mental disorder with clinical signs ›including: ›- Positive symptoms: delusion, hallucinations,… ›- Negative symptoms: social retreat, alogia (loss of speaking capacity), apragmatism (loss of capacity to begin actions),… ›- Desorganization: language, behavior,… ›- Cognitive troubles: memory, attention,… › Biological basis of ToM performance in Schizophrenia By : Victoria Mak We will discuss the ………For the purpose of understanding special considerations in testing, the original basis in of ToM defecits and the biological basis of deficits STRUCTURAL › Mirror Neurons ✔ scientificamerican1106-54-I2-1.jpg (TMS-motor evoked potentials) –Enticott, Hoy, et al Mirror neurons, activating corresponding action areas of viewer as if they were participating, implicated in understanding intentions-empathy. Learned not as strong as instinctual activations. Mirror Neurons ✔ ›Superior Temporal Sulcus (STS)-biological motion ›Inferior Parietal Lobe-perception of emotions ›Inferior Frontal Gyrus- mirroring emotion/motion nrn2024-f1.jpg Indicates lower activation in mirror neuron system (TMS) –Enticott, Hoy, et al Frontal Cortex › ›Posterior Superior Temporal Sulcus (STS)initial sensing motion cues of animate objects ✔ ›Medial Prefrontal Cortex ✔ mentalizing, intentional stance ›Right prefrontal cortex ✗ metacognition › Screen Shot 2013-04-09 at 3.31.22 PM.png nrn0801_568a_f1.gif PETPosterior STS…functions in….shown in upper right-yellow. Leads to RPTJ (green) Medial Prefrontal Cortex-weak (middle area) shown bottom right Right Prefrontal Cortex , not activated also metacognition. In healthy, two foci in attribution of intentions PET(blood flow)- Brunet, Sarfati et al)-nonverbal TOM task Cognitive_Function_Brain_Diagram.jpg Basal Ganglia ✔ ›Distinguishing self from others ›Monitoring intention/consequences ›False-belief (self) › Also of note-in attribution intention, poster. Orbital gyrus and medial prefrontal gyrus not pres Instead middle occipital, L hippocampus (spatial mem) and cerebellum (secondary brain areas activate to compensate for damage) Basal Ganglia is also linked to metacognition ….distinguishing self/others, intention, and one’s own false beliefs Linked to “frontal function and dopaminergic system Limbic and motor systems Chemical (Genetic) › Stahl_BigFig_3.jpg Dopaminergic System oD4 receptor gene (DRD4) in ToM oD2 Schizophrenia o Dopamine Dopamine Hypothesis: disturbed and hyperactive dopaminergic signal transduction-high dopamine levels. Long range connectivity used to explain widespread abnormalities-dopamine may be involved in modulation Dopamine DA_rcpt_subtypes.png D2 receptors particularly disturbed in Schizophrenia. D4 not ruled out D4 polymorphism receptor gene (DRD4) “shorter alleles outperformed those with one or more longer alleles” in representational ToM Probably because of effects on frontal lobe development and functioning, Tests about ToM in Schizophrenia By Cécile Delbouille Aim of research: ›Understand… › ›How deficient ToM in schizophrenia is associated with other aspects of cognition › ›How the impairment fluctuates with acuity or chronicity of the schizophrenic disorder › ›How it affects the patients’ use of language and social behavior 1) Tasks involving the detection of irony (Mitchley 1998) ›9 brief written scenarios including irony ›18 schizophrenics › ›Results: -Schizophrenia didn’t understand irony in scenarios -More likely to interpret the stories literally -Lower IQ and negative (only negative) symptoms in schizophrenia. 2) Metaphor, or ‘‘real intentions’’ behind indirect speech (Corcoran 1995) ›55 schizophrenics, 14 depressed and 30 controls ›10 short stories about a social interaction between 2 characters, read aloud to subjects (‘‘hinting task’’) › ›Results: -Schizophrenics with negative symptoms performed worst on ToM tasks -Schizophrenics with passivity symptoms performed equally to controls -Patients with incoherence and paranoid symptoms were in between - › This study suggests that performance on ToM tasks is a state rather than a trait variable 3) Short text passages illustrated by cartoons (Frith and Corcoran 1996; Pickup and Frith 2001) ›55 schizophrenics and 22 controls ›6 stories including a first or second order false belief with cartoon drawings › ›Results: › -Patients with behavioral and paranoid symptoms performed more poorly on tasks than others › -Easier tasks were successful!! 4) Visual jokes as depicted in cartoon drawings (Corcoran1997) ›44 schizophrenics, 7 depressed and 40 controls ›10 jokes could be understood in physical or behavioral terms ›10 jokes required mental state attribution › 7 involving false belief. ›Results: › -impaired in schizophrenic patients › -Patients with behavioral symptoms performed worst, particularly if mental state attribution was involved. › -Patients with passivity and paranoid symptoms also performed worse than controls › Main conclusion of the tests: ›It is their lack of understanding of the mental states of the story characters that makes them fail in such tests. (Langdon, Pickup, Frith, Brunet) Dispute: ›Clinical findings of Trognon, Sperber and Wilson › › impairment in social interaction › › reduced capacity to effectively engage in communication ›Frith’s think › › › ToM in schizophrenia is compromised › › › failure to monitor their own and other’s mental states and behavior Common findings: ›Many schizophrenics experience a significant loss of metacognitive capacity or previously held capacities : › ›Firstly, to create complex representations of the self and others › ›Secondly, to use that knowledge to respond to psychological challenges › Important notice: During experience, researchers noticed that patients are quite aware of their loss. Actually, They can describe it and so they fight to live with that conscious diminishment II/ Cognitive deficits in Schizophrenia By : Yvan Reynaud What is cognition? ›Cognition is the capacity to treat the information, ›acquire new knowledge and use it. › ›Mental processes : ›perception ›attention ›motors functions ›memory ›planning ›language ›learning … › The most severe cognitive functions touched are: ›Verbal memory and learning ›Semantic memory ›Attention ›Executive functions ›Motor speed › Patients with Schizophrenia ›Evidence has shown that patients with ›Schizophrenia show impaired Systematize ›ToM and cognitive abilities › The cognitive troubles in schizophrenia: ›appear early ›correspond to a general deficit but also specific ›are frequent and often severe ›have important functional consequences ›are not simply the result of prescribed treatment or other clinical symptoms ›require an assessment and specific management ›can’t be stopped by a treatment › A central position in Schizophrenia ›Cognitive difficulties are approved since a long time › ›For some scientists, Schizophrenia is a pathology of cognition. › ›But cognitive troubles are not a part of the diagnostic criteria of this trouble. › Zakzanis and Heinrichs (1998) ›In a meta - analysis of 204 studies, they showed that: ›- 61 to 78% of patients had scores below the median of control subjects on all cognitive tests ›- 75% of patients had an IQ score below the median of control subjects ›- A number of patients, however, retain performance "normal" › ›è This study shows the frequency and severity of cognitive impairments. › Research ›ToM impairments have been found in ›schizophrenia in : onatural communication situations otasks assessing first and second order false beliefs oirony comprehension ohinting comprehension opicture-sequencing tasks › An affected way of living › ›10-20% of patients have a job, and only 30% of them work a significant number of hours. › ›They are often unable to live independently › ›Their have low self-esteem and quality of life › Functional field Cognitive deficit correspondent Social functioning Declarative memory Vigilance Professional functioning Declarative memory Vigilance Executive functions Work memory Independent life Declarative memory Executive functions Work memory › The procedure to show the deficit in theory of mind for schizophrenic people is based on the one used for autistics. They have for common frame, the cognitive neuropsychology. › Affective ToM in Schizophrenia By: Cullen Conerly Affective ToM › ›Affective ToM (or Affective empathy) is the sub-facet of ToM that involves implicit understanding of emotions in others (Shamay-Tsoory, Shur, Harari, & Levkovitz, 2007) Patients with Schizophrenia ›Evidence has shown that patients with Schizophrenia show impaired Affective ToM and empathizing abilities › ›Thus, they struggle with basic social engagement and functioning. Patients with Schizophrenia (continued) ›Ziv et al. (2011) describes the two main functions of executive functions associated with ToM that would be deficient in patients with Schizophrenia as the ability to inhibit salient information so that less salient information can be considered and the ability to think hypothetically using mental representations for appropriate reactions to stimuli. Empathy: Reading the Mind in the Eyes Task ›Empathy was assessed through the Reading the Mind in the Eyes Task by Shimansky, David, Rössler, and Haker (2010) › ›Those with schizophrenia performed poorly on the mentalizing task. Emotional Recognition ›A study by Sparks, McDonald, Lino, O’Donnell, and Green (2010), using the Facial Expressions of Emotions: Stimuli and Tests' (FEEST), found that patients with schizophrenia did significantly worse on emotional recognition than did the healthy control group. The study also found, using self-reports on empathy, that there were higher levels of personal distress in participants with schizophrenia. Also, lower levels of perspective taking and empathic concern in those with schizophrenia. › Social Inference and Sarcasm ›A study by Sparks et al.(2010) used The Awareness of Social Inference Test which assessed sarcasm recognition using a series of both sincere and sarcastic interactions ›It was found that participants diagnosed with schizophrenia scored significantly lower in recognizing both simple sarcasm and paradoxical sarcasm Links to Symptoms ›SANS (Sparks et al. 2010): ›Avolition/Apathy ›Alogia (language connection) ›Attention ›Affective Blunting › ›SAPS (Sparks et al. 2010): ›Delusions and Empathic Concern (positive relationship) › › Conclusion ›Schizophrenia is associated with a number of deficits in ToM and social cognitive functions that adversely affect the individual in his or her daily life. ›Work in understanding both the biological factors and social outcomes of these outcomes is necessary for both the caring for and helping manage the lives of those with schizophrenia. References : ›Heinrichs, R. W. & Zakzanis, K. K. (1998) Neurocognitive deficit in schizophrenia: A quantitative review of the evidence. Neuropsychology, 12,426–445. ›Frith, C. D. (1992). The Cognitive Neuropsychology of Schizophrenia. Hove, UK : Lawrence Erlbaum. ›Frith, C. D., & Cocoran, R. (1996). Exploring « theory of mind » in people with schizophrenia. Psychological medicine, 26, 521-530. ›Schimansky, J., David, N., Rössler, W., & Haker, H. (2010). Sense of agency and mentalizing: Dissociation of subdomains of social cognition in patients with schizophrenia. Psychiatry Research, 178(1), 39-45. doi:10.1016/j.psychres.2010.04.002 ›Shamay-Tsoory, S. G., Shur, S., Harari, H., & Levkovitz, Y. (2007). Neurocognitive basis of Impaired Empathy in Schizophrenia. Neuropsychology., 21(4), 431-438. doi: 10.1037/0894-4105.21.4.431 ›Sparks, A., McDonald, S., Lino, B., O'Donnell, M., & Green, M. J. (2010). Social cognition, empathy and functional outcome in schizophrenia. 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