Social Cognitive Impairments in Patients with Schizophrenia

Perception of social cues is one of the social cognitive impairments in schizophrenics that prompted research on how differently they perceive the world versus mentally stable individuals. Social cues are signals that people send to others by body movements, facial expressions or through vocal tone. In this case, individuals with schizophrenia may have difficulty creating an appropriate response to these social cues due to their illness.

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Green, Horan, and Lee (2015) stated, Face perception is the most-extensively studied aspect of social cue perception in schizophrenia (p. 621). Determining someone’s identity, sex or age is an example of non-affective face perception, and processing the emotional expressions on the faces of others is an example of affective face perception (621). According to their research, schizophrenic patients have less difficulty determining the sex of an individual but have more difficulty determining an individual’s identity (621). Another social cue that schizophrenics have some difficulty with is voice perception. Voice perception is the process in which someone’s language, pitch, intonation and rhythm (prosody) are heard, interpreted and understood by another person. Affective prosody perception includes tasks of implicit processing such as listening to sentences read with and without emotional intonation, and explicit processing such as making emotional judgements about a sentence read with and without emotional intonation (622). Green, Horan, and Lee summarize their findings and state that patients correctly perceive certain features of non-affective prosody (for example, intonation) but have difficulties with perceiving pitch and rhythm (622).

Moreover, schizophrenia patients from Lublin University Psychiatric Hospital were involved in a clinical study in which they had to take a Facial Emotion Recognition Test and a Voice Emotion Recognition Test. The Facial Emotion Recognition Test consisted of a set of photographs of human emotional faces that were presented on a screen for about 10 seconds each with an interval of 10 seconds between photographs, and participants were provided with a written list of nine emotions that they had to select for each photograph. (Kucharska-Pietura et al., 2005, para. 6). Results showed that patients with schizophrenia showed a greater impairment in their ability to recognize facial emotions compared to healthy controls (para. 14). The Voice Emotion Recognition Test consisted of a series of five sentences that were each spoken aloud and recorded by a professional male actor in a manner that conveyed one of six basic emotions, and participants then had to listen to each sentence and choose which emotion best described the speaker’s tone of voice (para. 8,9). According to the results, Patients with chronic schizophrenia were significantly more impaired than patients in the early stages of illness, and both patient groups were significantly more impaired than healthy controls (para. 22).

At times when someone is feeling a certain type of way, they tend to assume that they are the only ones feeling like that, but in reality there are plenty others experiencing the same thing. Experience sharing is the common first-hand and second-hand experiences that involve neural activity in the brain region that becomes activated when engaging in the same behavior as another person, and it can be separated into two different processes which are motor resonance and affect sharing (Green, Horan, and Lee, 2015, p. 622). According to their research, previous studies suggested that experience sharing might be diminished in patients with schizophrenia, but recent findings on these processes have emerged and are now conflicting (622). Motor resonance refers to a functional correspondence between the state in the motor system of an observer and that in the motor system of the person making the action (623). Put differently, people have the ability to connect with each other and understand each other’s actions and intentions through motor resonance. The view of someone’s actions and experiences produces brain activity similar to what would be observed in the event where someone else would play out similar actions and make similar experiences themselves. The findings for motor resonance in schizophrenics are mixed due to this area of research being relatively new (623). Green, Horan and Lee further state that affect sharing is also a component of experience sharing because it has to do with the correlation between the observation of an individual making an emotional expression and the activation of the parts of the individuals brain that are emotion-related (624). In this study, participants are imitating or executing facial expressions of emotion to see whether patients with schizophrenia imitate or execute those expressions differently. According to their findings, the patients scored similarly to the healthy individuals for personal traits associated with affect sharing, and some patients even showed more sensitivity to others’ feeling compared to the healthy individuals (624).

Mentalizing, or theory of mind, is the ability to make sense of our behaviours and the behaviours of others, as well as understanding our mental states (including beliefs, desires, intentions and emotions). According to Green et al. (2015), mentalizing is associated with certain regions of the brain that have been studied using tasks such as presenting participants with written stories about people interacting, cartoon panels illustrating people interacting, or images showing the eye region of the face only, then asking these participants to conclude their beliefs, intentions or emotions of the people that illustrated these stories, cartoons and images (p. 624). Their research states that patients with schizophrenia have difficulty understanding the intentions of others from a cartoon panel and inferring the beliefs of others from simple written stories (624). This is to say, schizophrenia patients showed decreased activity in the main regions of the brain used for mentalizing while performing this task. This finding may suggest that individuals with schizophrenia infer the mental states of others more slowly than healthy individuals, rather than that they have an overall impairment in mentalizing ability (625). Put it differently, it doesn’t necessarily mean that these patients have no mentalizing skills, rather that they may be more slow to comprehend due to the brain regions that are active during this task.

Another study by Mazza et al. (2008) revealed that patients with schizophrenia demonstrate pragmatic deficits in expressive language and in comprehension, i.e. poor understanding of non-literal speech (e.g. metaphor and irony), or poor understanding of proverbs (p. 255). This study explains how a deficiency in theory of mind competence is associated with the poor use of pragmatics in the communication aspect of human conversation in schizophrenics (255). In other words, these patients have difficulty with the meaning of what is being said due to the different ways that you can respond to these situations (for example, the word mouse can define an animal or a computer mouse). To summarize, people with schizophrenia may need a greater stimulation of action in the main regions of the brain involved in mentalizing in order to accomplish the same level of mentalizing skills of those in healthy individuals.

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