Social cognition in schizophrenia

Social cognition describes the mental processes by which individuals perceive, process, and utilize information in social interactions.1 It is a topic that has attracted significant interest, as it can account for differences in daily functioning and quality of life.2 Numerous studies investigating this construct, especially as it relates to individuals with schizophrenia, have emerged in the last decade. Social cognition encompasses various domains that include emotion perception, theory of mind, social knowledge, and attributional style.3 Emotion perception describes ability to recognize and identify emotions. Theory of mind refers to one’s ability to comprehend mental states and intentions. Social knowledge involves awareness of the roles, rules, and goals underlying social interactions. Attributional style is an individual’s manner of interpreting the cause of events, specifically, tendency to attribute behaviors or events to personal or external factors. Impairments in these domains have been observed in patients with schizophrenia, and may contribute to one of the defining features of this disorder, social dysfunction.4 Studies have demonstrated consistent relationships between deficits in performance on social cognitive measures and poor functional outcomes, particularly social problem solving, social behavior, and functioning in the community.5 Impaired social functioning, in turn, is a poor prognostic factor and is predictive of relapse.6 Research also suggests that race is a significant moderator of emotion identification and functional outcomes, with weaker associations identified in samples of primarily Caucasians.7 Charernboon et al.8 investigated social cognition in an Asian population with clinically stable schizophrenia. The results demonstrated significant deficits in performance on social cognitive tests and a significant correlation between emotion perception and negative symptoms of the disorder. Their work suggests that deficits in social cognition are a defining feature of schizophrenia, regardless of race or culture. Additional research across different patient populations will be important for further characterizing how race impacts the relationship between social cognition and social functioning. The aforementioned studies have potentially important implications in the clinical setting, as addressing these deficits may improve social outcomes. Recent studies have explored the effect of broad-based and targeted social cognitive interventions on improving social cognitive skills.9 Broad based interventions involve a combination of training in social cognition, social skills, and neurocognition, while targeted interventions focus solely on training in specific social cognitive domains. These interventions have been associated with positive outcomes in patients with schizophrenia, particularly in emotion processing and theory of mind.8 Additional studies employing a well-validated battery of tasks will be important for better characterizing interventions associated with improved social cognition and functioning, and for clarifying the role of social cognition as a target in the treatment of schizophrenia.