Social cognitive impairments and negative symptoms in schizophrenia: are there subtypes with distinct functional correlates?

Abstract

Social cognitive impairments and negative symptoms are core features of schizophrenia closely associated with impaired community functioning. However, little is known about whether these are independent dimensions of illness and if so, whether individuals with schizophrenia can be meaningfully classified based on these dimensions (SANS) and potentially differentially treated. Five social cognitive measures plus Scale for the Assessment of Negative Symptoms (SANS) and Positive and Negative Syndrome Scale (PANSS) scores in a sample of 77 outpatients produced 2 distinct factors--a social cognitive factor and a negative symptom factor. Factor scores were used in a cluster analysis, which yielded 3 well-defined groupings--a high negative symptom group (HN) and 2 low negative symptom groups, 1 with higher social cognition (HSC) and 1 with low social cognition (LSC). To make these findings more practicable for research and clinical settings, a rule of thumb for categorizing using only the Mayer-Salovey-Caruso Emotional Intelligence Test and PANSS negative component was created and produced 84.4% agreement with the original cluster groups. An additional 63 subjects were added to cross validate the rule of thumb. When samples were combined (N = 140), the HSC group had significantly better quality of life and Global Assessment of Functioning (GAF) scores, higher rates of marriage and more hospitalizations. The LSC group had worse criminal and substance abuse histories. With 2 common assessment instruments, people with schizophrenia can be classified into 3 subgroups that have different barriers to community integration and could potentially benefit from different treatments.

Figures

Fig. 1.

Standardized social cognition and negative symptom measures by subgroups. Note: SAT-MC, Social Attribution Task-Multiple Choice; BLERT, Bell-Lysaker Emotion Recognition Task; Egocentricity, Egocentricity subscale from the Bell Object Relations Reality Testing Inventory (BORRTI); MSCEIT, Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT) from the MATRICS Consensus Cognitive Battery (MCCB); PANSS negative, Positive And Negative Syndrome Scale negative component; Flat Affect, Flat Affect and blunting subscale from the Schedule for the Assessment of Negative Symptoms (SANS); Alogia, Alogia subscale from the SANS; Avolition, Avolition and apathy subscale from the SANS; Anhedonia, Anhedonia and associality subscale from the SANS.