Social cognition, neurocognition, symptomatology, functional competences and outcomes in people with schizophrenia - A network analysis perspective

Abstract

Background: Extensive difficulties in reaching functional milestones characterize schizophrenia and related psychotic disorders. These impairments are in part explained by lower social cognitive abilities, cognitive impairment, and current psychopathology. The present study aims to model dynamic associations among social cognition, neurocognition, psychopathology, social skills, functional capacity, and functional outcomes in schizophrenia using network analysis in order to identify those factors that are most central to functioning.

Methods: The sample consisted of 408 patients with schizophrenia spectrum disorders who were drawn from the SCOPE project. Participants completed a complex battery of state-of-the-art measures of social cognition, neurocognition, and functional outcomes. Gaussian Graphical Modeling was used for estimation of the network structure. Accuracy of the network was evaluated using the Bootstrap method.

Results: Data supported the importance of functional capacity and social skills, which are prerequisites to real - world outcomes. These variables were among the most central in the network. Social cognition was related to functional capacity, social skills, and real - world functioning. Negative symptoms were connected to functional capacity, social skills, and real - world functioning.

Conclusions: Predictors of functional outcomes are complexly associated with each other. Functional capacity, social - skills, working memory, negative symptoms, mentalizing, and emotion recognition were central nodes that support their importance as potential targets of personalized intervention.

Keywords: Cognition; Competence; Functional outcomes; Network analysis; Schizophrenia; Social cognition.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Figure 1.

Network Plot Footnote: BLERT – Bell - Lysaker Emotion Recognition Test, ER – PENN Emotion Recognition test ER – 40, Eyes – Reading the Mind in the Eye Test, TAS – The Awareness of Social Inferences Test, HT – Hinting Task, HVLT – Hopkins Verbal Learning Test, LNS – Letter Number Sequencing, AF – Animal Fluency, SC – Symbol coding, TMT – Trail Making Test, SSPA – Social Skills Performance Assessment, UPSA – UCSD Performance Based Assessment, NEG – PANSS Negative symptoms, GEN – PANSS General psychopathology, POS – PANSS Positive symptoms, WS – SLOF Work skills, ACT – SLOF Activities, IR – SLOF Interpersonal Relationships, SA – SLOF Social Appropriateness. Relationship between SC and TMT is negative. More symbols coded was associated with shorter time in TMT.

Figure 2

Centrality estimates Footnote: BLERT – Bell - Lysaker Emotion Recognition Test, ER – PENN Emotion Recognition test ER – 40, Eyes – Reading the Mind in the Eye Test, TAS – The Awareness of Social Inferences Test, HT – Hinting Task, HVLT – Hopkins Verbal Learning Test, LNS – Letter Number Sequencing, AF – Animal Fluency, SC – Symbol coding, TMT – Trail Making Test, SSPA – Social Skills Performance Assessment, UPSA – UCSD Performance Based Assessment, NEG – PANSS Negative symptoms, GEN – PANSS General psychopathology, POS – PANSS Positive symptoms, WS – SLOF Work skills, ACT – SLOF Activities, IR – SLOF Interpersonal Relationships, SA – SLOF Social Appropriateness. Relationships between SC and TMT is negative. More symbols coded was associated with a shorter time in TMT.

Figure 3

Network stability