تئوری ذهن و قضاوت اجتماعی در افراد در معرض خطر بالای روان پریشی بالینی

Background Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations. Aims Longitudinally examine theory of mind (ToM) and social judgments in a CHR sample to investigate the stability of performance over time and potential ability to predict conversion to psychosis. Method 147 CHR individuals and 85 help seeking controls (HSC) were assessed for up to 2 years; 28 participants developed psychosis across both groups. Generalized linear mixed models for repeated measures were used to examine change over time for ratings on the three social cognitive indices of ToM, trustworthiness, and approachability. Hierarchical regression was used to test whether social cognitive variables explain more variance in conversion than IQ. Results CHR individuals showed a positive bias in approachability judgments over time compared to HSC. Baseline ToM performance significantly (p < .05) predicted later conversion beyond IQ scores. These results were attenuated when controlling for baseline symptom level. Conclusions Although ToM deficits might predate conversion to psychosis, one must consider initial symptoms as well. Social judgments were not associated with conversion to schizophrenia.

Similar to preventative work targeting medical illness, many research groups have focused on improving models of risk prediction in schizophrenia (Cannon et al., 2008). A central goal of this work is to enhance the understanding of factors related to conversion to psychosis and illness progression. Preliminary evidence suggests that social cognition (SC) may be a viable target, as deficits in SC are both present during the active illness phase and in populations at clinical high risk (CHR) for developing psychosis (Green et al., 2008 and Thompson et al., 2011). Specifically, there is some support for deficits in emotion recognition and theory of mind (ToM) prior to illness onset. Thus, the assessment of SC deficits in individuals at clinical high risk (CHR) of developing schizophrenia warrants further exploration, as it may lead to the identification of a putative risk marker. The present study examines the SC domains of ToM and social judgments in a CHR population. Individuals with first episode and chronic schizophrenia show consistent impairments in theory of mind (ToM) (Sprong et al., 2007). ToM typically refers to the ability to infer others' mental states (Green et al., 2008). In CHR individuals, there is mixed support for deficits in ToM. These studies are largely cross-sectional in design and administer a heterogeneous group of ToM tasks. Couture et al. (2008) found no significant differences in higher order ToM performance (Eyes Task) between CHR and healthy control (HC) groups. Stanford et al. (2011) also found no significant differences between CHR and HC groups in Eyes Task performance, nor with other first- and second-order ToM tasks (False Belief, Strange Story Tasks). Effect sizes (Cohen's d) computed from mean differences between HC and CHR groups were small in both studies (d = .06 − .35) ( Cohen, 1988). Conversely, Chung et al. (2008) utilized higher order, verbal tasks of ToM (False Belief and Strange Story Task) and found significant differences between CHR individuals and HCs matched on age and IQ. Recent studies provide further evidence of significant deficits in higher order ToM performance in CHR groups, although they were unable to draw conclusions about deficits' association with later conversion ( Green et al., 2012, Thompson et al., 2012 and Hur et al., 2013). There is one prior study in CHR individuals that assessed ToM longitudinally to predict progression to psychosis. Kim at al. (2011) examined performance in four lower and higher order ToM tasks in 49 ultra-high risk (UHR) individuals over time (mean = 2.8 years). They found significant differences between converters (n = 13) and non-converters (n = 36) at baseline in both higher order verbal (False Belief task; d = .74) and lower order non-verbal (Cartoon Task; d = .59) tasks. Further, there was not a significant relationship between ToM and symptoms, consistent with previous work ( Couture et al., 2008 and Stanford et al., 2011). Findings support the predictive value of ToM deficits in later conversion to psychosis. Taken together, this suggests that due to inconsistent findings and cross sectional design, further longitudinal investigation of ToM deficits in clinical high-risk groups is warranted. There is a less extensive literature investigating social judgments in psychotic spectrum illnesses. Social judgments include trustworthiness and approachability ratings, which require usage of nuanced, subtle information conveyed in facial appearances. Social judgments require integration of various sources of information, such as facial expression and previous experiences with similar looking individuals (Couture et al., 2008). Such evaluations are antecedents in decision-making processes that directly influence social behaviors. In chronic schizophrenia, findings are mixed regarding social judgments assessed with the trustworthiness task (Adolphs, 1998), although individuals with non-paranoid schizophrenia tend to rate unfamiliar faces as more trustworthy and with greater variability than controls (Baas et al., 2008a, Baas et al., 2008b, Pinkham et al., 2008, Couture et al., 2010 and Haut and MacDonald, 2010). Comparatively little work has focused on social judgments in CHR populations. Baas et al. (2008b) found that individuals at genetic risk of developing psychosis (first degree family members) rated faces significantly trustworthier than healthy controls. Similarly, Couture et al. (2008) found that CHR individuals judged a subset of untrustworthy faces as significantly trustworthier than healthy controls. Positive biases in social judgments are consistent with a body of established social cognitive deficits in schizophrenia, whereby patients have difficulty recognizing and applying appropriate social information (Baas et al., 2008b). The aim of the present study is to longitudinally investigate ToM and social judgment performance in a group of CHR individuals compared to a group of help seeking control (HSC) individuals. Here, we assess whether ToM and social judgment performance (a) differentially changes over time as a function of risk status and (b) predicts conversion to psychosis at baseline.