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Date Presented 03/21/24 This scoping review identifies psychosocial factors experienced by adults with upper extremity conditions that impede occupational performance. A preliminary conceptual model for psychosocial evaluation is explored. Primary Author and Speaker: Karrianna L. Iseminger [ABSTRACT FROM AUTHOR]

Date Presented 03/23/24 OTs are well situated to work with clients and the public in fostering positive social functioning that supports the occupational performance of young adults. Four components of positive social functioning are operationalized to guide practice. Primary Author and Speaker: Consuelo Kreider Additional Authors and Speakers: Sharon Mburu Contributing Authors: Sharon Medina, Sharon M. DiFino, Anya Klumpp, Jane Morgan-Daniel [ABSTRACT FROM AUTHOR]

Background/Objectives: Differences in appearance are often stigmatized in society, and dermatologic disease can lead to psychological and social sequelae that significantly impact patient quality of life. However, discrepancy between patient‐reported and physician‐assessed psychological distress raises a question of how clinicians are prepared in recognizing and managing the psychosocial impact of a child's skin condition. We aim to identify current practices among healthcare providers toward properly addressing appearance‐related psychosocial distress in pediatric dermatology patients. Methods: Surveys assessing provider attitude and practices to appearance‐related distress were distributed to members of the Society of Pediatric Dermatology via the Pediatric Dermatology Research Alliance, and Florida Chapter of American Academy of Pediatrics. Results: Over half of respondents report encountering appearance‐related psychosocial distress on a daily basis and believe screening to be important. However, only 14% use a validated screening tool and 18% screen all patients. Major obstacles to generalized screening were limited time and staffing. Self‐reported knowledge and management of appearance‐related psychosocial distress includes direct counseling and referrals to local support groups, mental health providers, specialized summer camps, and school‐affiliated resources. Nevertheless, 86% expressed interest in learning more about appearance‐related psychosocial distress, particularly about patient education and resources. Conclusions: Although clinicians frequently encounter appearance‐related distress with pediatric dermatology patients, screening is selective and lacks standardization. Self‐reported knowledge and management is comprehensive, but there is a need for increased training in patient education and resources. [ABSTRACT FROM AUTHOR]

Background The case-control model in psychiatric research, most notably in schizophrenia, has not led to biomarker identification (recent retrospective mega-analyses notwithstanding) or therapeutic innovation. The Research Domain Criteria (RDoC) approach argues for using a dimensional strategy toward identification of brain-behavior subtypes, less-wedded to diagnostic categories, that may translate better toward therapeutic innovation. Here, a large, multi-center, prospectively designed study aiming to identify brain-behavior subtypes in the social processes RDoC domain will be described. Methods The prospective design of a large, multi-center study that aims to recruit 300 people with a schizophrenia spectrum disorder and 180 healthy controls (total n=480) with a full range of social functioning from highly impaired to high performing will be described. Inter-site harmonization for clinical, social cognitive, neurocognitive, social functioning, and most important, neuroimaging approaches will be described including a traveling human phantom study. Imaging tasks aiming to identify lower-level and higher-level social cognitive circuit brain function and social cognitive tasks out of the scanner aim to identify lower-level and higher-level constructs with the overall aim of relation connectivity within and among social brain circuits with social cognitive performance out of the scanner. In addition, more complex tasks are being used to disentangle the relationship among social cognitive circuits and their relationship to social cognitive performance and social function out of the scanner. Results We were able to successfully combine neuroimaging data across sites, bolstered by results from our traveling human phantom study, showing that T1-weighted, diffusion-weighted, and fMRI data, through a clustering algorithm successfully identified each individual's scan. Combining data across sites, we found significantly different neural strategies related to efficiency across the full range of social impairment, independent of diagnosis in lower-level social cognitive tasks in the MRI scanner. We also found that machine learning approaches incorporating both lower-level and higher-level social cognitive networks during the resting state fMRI condition successfully distinguished between poorer and better social function. Finally, we found that an fMRI task engaging both lower and higher level social cognitive networks added to the neural strategy heuristic, regarding optimal network utilization based on lower vs. higher level task performance. In this work we found significant positive associations between corresponding putative circuits and social cognitive performance (e.g. higher-level circuit functional connectivity was associated with higher level task performance), and inverse association of the lower level circuit functional connectivity with higher level task performance. Conclusions Overall, our results support the value of prospectively designed multi-center research work using clinical neuroimaging approaches. Our results also support the value of the RDoC approach, such that brain-behavior subtypes related to brain network utilization and task demand can identify groups of people based on social cognitive performance and social function. The work also fulfills the RDoC mandate in that brain circuitry that is targetable and is associated with performance in a behavioral domain, can be carried forward into target engagement studies to test promising new interventions. [ABSTRACT FROM AUTHOR]

Background Cognitive behavior therapy for psychosis (CBTp) has been used with patients with schizophrenia for well over fifty years. Previous evaluations of CBTp have emphasized change in global scores of psychosis as the primary (if not the only) outcome, neglecting evaluation of change in patient distress and functioning. This method of practice is inconsistent with the theory and aims of the interventions used in CBTp, particularly from a recovery perspective. Methods Fifty-three patients with schizophrenia spectrum illnesses in an inpatient hospital were offered weekly, 60-minute group sessions of illness education using a CBTp framework. A retrospective review was completed, which examined participant attendance and average level of engagement across sessions. Primary outcomes were analyzed for subsets of patients and included change in distress secondary to symptoms (clinician derived rating scale and Clinical Global Impressions scale [CGI]), symptoms of depression (Calgary Depression Rating Scale [CDS]), global assessment of functioning (GAF), and severity of psychosis (Brief Psychiatric Rating Scale [BPRS]) from initiation of CBTp to discharge (or at time of data collection). Fourteen patients rated subjective distress and interference in functioning secondary to symptoms, satisfaction with CBTp group and utility of skills learned. Results On average, participants attended 32.0 (27.2) groups, or 70.6% of groups offered. Moderate to high engagement across sessions was observed in 84% of the sample. Analyses of change from initiation of CBTp to endpoint yielded significant reduction in distress secondary to symptoms on both clinician ratings (W=666, p<0.001) and the CGI (W=120, p<0.001), as well as significant improvement on the GAF scale (W=-666, p<0.001), with an average increase of over 25 points. Total BPRS scores decreased significantly (W= 255, p<0.001), with significant reductions also seen in the negative symptom subscale (p= 0.016), anxiety/depression (p= 0.002), hostility (p= 0.003) and thought disturbance (p= 0.002). Trends were noted for attendance and engagement relating to greater distress reductions, improvements in CDS, total BPRS scores, and GAF scores. On average patients indicated that they were satisfied to very satisfied with the group overall and reported that they agree to mostly agree that skills learned in group help them to feel better and function better. Discussion From a recovery perspective, psychosocial treatments should emphasize distress reduction and improvement in adaptive functioning. Outcome measure selection should be consistent with the aims of the interventions. These findings indicate that individuals who participate in group CBTp demonstrate significant reductions in objective and subjective distress secondary to symptoms and in improvement in overall functioning. Moreover, participants report satisfaction with the group and report that the skills learned in group help them to cope with distress secondary to symptoms of the illness. Though change in total BPRS scores should be of interest (and reductions were indeed observed), this outcome should not be the primary, and certainly not the only focus when discussing efficacy of CBTp. It is suggested that future research evaluate CBTp in a manner consistent with the goals of the interventions. [ABSTRACT FROM AUTHOR]

Background To achieve recovery among people with schizophrenia, not only psychopathological symptoms but also real-world functioning have to be improved, however their rates of employment and living by themselves are still quite low. Numerous studies have shown that reduced functional capacity (lower ability to perform general living behavior such as finances and communication) contributes to insufficient real-world functioning. Functional capacity, however, does not directly translate into real-world functioning. In clinical settings, some people with schizophrenia have higher real-world functioning than that predicted by their reduced functional capacity. Recently, the personality traits are remarked as endophenotypes of human beings which affect behavior in real-world settings. In the previous studies of people with schizophrenia, personality traits have proven to influence their cognition and social functioning. We hypothesized that the people with schizophrenia who have specific personality traits show high real-world functioning in spite of their reduced functional capacity. Methods Measures used in this study were TCI-R (Temperament and Character Inventory-Revised) for personality traits, UPSA-B (UCSD Performance-based Skills Assessment-Brief) for functional capacity, SFS (Social Functioning Scale) for real-world functioning, and PANSS (Positive and Negative Syndrome Scale) for psychopathological symptoms. A total of 89 stable outpatients with schizophrenia (40 males and 49 females, mean age 40.6) were recruited and 41 patients showed lower functional capacity than the median score. Furthermore 41 patients were divided into two groups by the median score of real-world functioning of the total. Of those 41 patients, 22 landed above and 19 landed below or equal to the median score. Then the groups' characters were compared using t-test and chi-square test. Results The group of individuals with high real-world functioning but low functional capacity showed significantly lower Harm Avoidance (HA) level and lower PANSS total score than the other group of individuals with low real-world functioning and functional capacity. Plus, the above-mentioned group has more females than the other group significantly (mean HA score: 59.7 vs 76.4, mean PANSS total score: 79.6 vs 93.0, males: female ratio: 6:16 vs 9:10). Discussion The findings for the associations between real-world functioning and psychopathological symptoms as well as between real-world functioning and gender differences were consistent with the previous studies. HA reflects the tendency to inhibit responses to aversive stimuli leading to avoidance of punishment or non-reward. Given the previous work, avoidant behavior can be associated with stress vulnerability and personal adjustment. The present result suggested that unworried and extroverted behavior based on low HA contributed to improve or maintain high real-world functioning. Furthermore, the influence of HA on real-world functioning is independent of their reduced functional capacity that is a strong predictor for insufficient real-world functioning. Although we should investigate the causality in a future longitudinal study, in the current study we can conclude that psychosocial treatments considering personality traits may be able to enhance real-world functioning, which has thus far been recognized as difficult to improve, meaningfully contributing to functional recovery. [ABSTRACT FROM AUTHOR]

Background Cognitive impairment is a major unmet need in the treatment of schizophrenia. Over the last decade, the MATRICS Consensus Cognitive Battery (MCCB) and the cognitive-neuroscience-based Cambridge Neuropsychological Test Automated Battery (CANTAB) have been used to assess the effects of novel treatments for cognitive impairment in schizophrenia. Although both batteries purport to assess cognitive function in psychosis (Lees et al. 2017a, Keefe et al. 2013), no previous study has attempted to examine their validity longitudinally and the potential overlap between the two batteries over time. The aim of the current study was to assess the relationship between the MCCB and the CANTAB in the longitudinal assessment of cognitive impairment in schizophrenia. Also, it was targeted to examine the predictive effect of each battery on the psychosocial functioning of subjects. Methods A sample of 39 stable schizophrenia outpatients (mean age= 35.79, SD=10.06; males=27, 69.2 %) and 18 controls (mean age=35.94, SD=8.14; males= 12, 66.7 %). completed the MCCB and the CANTAB battery at baseline, and at 2, 4 and 8-weeks follow-up. UCSD Performance-Based Skills Assessment- brief version (UPSA-B), including total score, financial skills and communication skills indices, and Work and Social Assessment Scale (WSAS) scale were administered at baseline to examine psychosocial functioning. Mixed-model repeated measures approach was used for the timepoints mean comparison of each battery independently and the time*battery interaction (including the subjects ID as random variable). Backwards-stepwise linear regressions were performed to determine the best set of cognitive tests/domains derived from the MCCB and/or the CANTAB that would explain the maximum variance for functional outcomes. All the analysis controlled for age including it as covariable. Results The present study detects practice effects from baseline to follow-up assessments in the CANTAB cognitive battery in visual memory (F3,146= 4.37, p=0.006), reasoning and problem-solving (F3,147= 4.58, p=0.004) and social cognition (F3,239= 2.96, p= 0.033) in patients, and social cognition in controls (F3,66= 10.92, p<0.001). In contrast it finds stability in the MCCB battery over time. In particular, a significant time*battery interaction was found for those cognitive domains emphasizing the main time effect on CANTAB. Furthermore, MCCB verbal learning predicted global psychosocial functioning in patients and MCCB verbal memory and CANTAB processing speed were the best predictors of financial skills. Moreover, performance in CANTAB processing speed, verbal memory, working memory and reasoning, and problem-solving best predicted UPSA communication skills in patients. Finally, MCCB verbal learning predicted SWAS working skills. Discussion These findings suggest there are specific differences across cognitive tests to assess cognitive impairments in schizophrenia and that measures derived from the CANTAB appear to be more prone to practice effects in these patients. However, these results should be interpreted cautiously. There are some variables such as the number of included subjects, the placebo effect and patient's clinical symptomatology that could be taken into consideration. As previously (Kumar et al. 2016), a strong association was displayed between both batteries and the psychosocial functioning of the patients. In particular, verbal learning as measured with MCCB and a composite of various domains as assessed by CANTAB were the most related to working, financial and communication skills. These results underline the importance of cognitive performance in the daily function of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Background Schizophrenia and bipolar disorder are profoundly disabling illnesses. Social cognitive deficits are associated with functional disability and have been found to be unique predictors of community and work role functioning. Given their strength as predictors of functioning, social cognitive abilities have become targets of intervention. This study examined a recently developed intervention, Social Cognition and Interaction Training (SCIT), on social cognitive abilities, attitudes toward others at work, community functioning, and interpersonal effectiveness. Impact of the intervention was assessed post-intervention, and durability of treatment effects was assessed with a 3-month follow up assessment. Methods In this pilot study, 16 individuals with schizophrenia, schizoaffective disorder, or bipolar disorder received SCIT, a 24-session, group-based, skills training intervention. In addition, participants were provided with 30 minutes of individual training weekly to promote skill application. All participants were outpatients who were working or engaged in a non-compensated role (student, volunteer). Impact of the intervention on social cognitive skills was assessed with the Face Emotion Identification Task (FEIT), the Bell-Lysaker Emotion Recognition Task (BLERT), the Ambiguous Intentions and Hostility Questionnaire (AIHQ), and the Awareness of Social Inference Test (TASIT). Social and work role functioning were assessed with the First Episode Social Functioning Scale (FESFS), the Social Skill Performance Assessment (SSPA), the Vocational Efficacy in Trauma Survivors Scale (VETSS), and the Mentoring and Communication Support Scale (MC). An individual blind to training content conducted all of the assessments. Results Post-intervention, emotion recognition performance improved significantly, FEIT Total score t(14) = 2.70, p <.05 and BLERT Total score t(14) = 2.03, p =.06. Unexpectedly, an increase in aggressive responses to ambiguous situations on the AIHQ was also found, likely indicating that very passive individuals were becoming more assertive, t(15) = 2.22, p <.05. Post-intervention, there was also significant improvement in relationship quality, with participants perceiving improved professional relationships with peers, MC Task Support t(14) = 1.84, p <.01. There were also trends for greater interpersonal comfort with peers at work, MC Colleague t(14) = 3.58, p =.09, greater confidence in their ability to handle workplace situations, VETSS Coping subscale, t(13) = 1.71, p =.11, and more comfort in sharing about their illness with colleagues, VETSS Disclosure subscale, t(13) = 1.82, p =.09. However, no change in role functioning was found. Three-month follow-up data has been collected and will also be presented. Discussion Findings suggest that individuals with serious mental illness benefitted from social cognitive skills training. Participants had improved emotion recognition skills and were more likely to assertively check into ambiguous social interactions post-intervention. Individuals also experienced improved relationship quality, perceiving more support from colleagues in social and professional relationships, suggesting that the skills learned in SCIT were having an impact on real-world functioning. Results suggest that pairing SCIT with vocational rehabilitation may improve work outcomes for individuals with serious mental illness. [ABSTRACT FROM AUTHOR]

Background Negative symptoms predict poor outcome in schizophrenia yet there is no recommended evidence-based treatment. Enhancing community functioning and promoting recovery in Veterans with schizophrenia is a VHA priority. Methods This presentation will review the sample, methods, and preliminary qualitative findings from an in-progress, VA-funded trial to evaluate a behavioral intervention to increase community engagement – Engaging in Community Roles and Experiences (EnCoRE) - in Veterans with schizophrenia who receive mental health services at three VA Medical Centers. EnCoRE includes motivational, cognitive, and behavioral skills training strategies aimed at increasing intrinsic motivation to engage in community activities, reduce negative expectancies, and perform skillfully in social situations. To date, 72 Veterans with schizophrenia have enrolled and 56 have completed study assessments. Participants completed post-assessment qualitative interviews about their experiences in EnCoRE, aspects of the program they perceived as more or less helpful, what they found challenging about becoming more active, and other reflections or suggestions about the intervention. Results Interviews were analyzed in 3 phases employing constant comparison of data units with others and data with emerging themes and examining meaning across interviews via focused cross-interview coding to organize themes, variations and interrelationships among the ideas, views, and experiences of the sample. We also examined relationships among using different components of the program and reports of engaging in community activities with intervention engagement and attendance. Participants who attended more frequently reported greater use of EnCoRE skills and strategies to increase participation in community/family activities. Participants reported benefits of specific components – especially detailed Action Planning - and offered suggestions for improvement. Participants reported that the group format, in which they felt that they were accountable to other Veterans, helped them feel more motivated to accomplish the goals they set in each group meeting. Conclusions Veterans with schizophrenia are receptive to a behavioral program to improve community functioning. Features such as focused content with in-depth planning for implementation, small group size, and having other Veterans to help and learn from can help Veterans with schizophrenia participate in new community activities. [Source of funding: VA RR&D (Bennett, PI)] [ABSTRACT FROM AUTHOR]

Background Negative symptoms represent an unmet need of schizophrenia treatment, occurring since the early phases of the disorder. Primary and persistent negative symptoms are associated with the worst outcome in terms of treatment response and psychosocial functioning. The prevalence of these symptoms in first episode patients, especially early after onset (within 2 years), has not been systematically studied. Methods In the present study we investigated the prevalence of negative symptoms of moderate severity, unconfounded by depression and extrapyramidal symptoms at baseline (U-NEG), and their persistence over the three phases of the OPTIMISE trial (i.e. after 4, 10 and 22 weeks of treatment). The impact on remission and psychosocial functioning of persistent negative symptoms (PNS) was also assessed. Results U-NEG were observed in 263/446 subjects (59% of the whole cohort of first-episode, recent-onset subjects). U-NEG were associated with worse psychosocial functioning and duration of psychosis at intake in the study. At the end of phase2 they were associated with poor psychosocial functioning (controlling for the severity of all other psychopathological dimensions and demographic variables). However, the attrition and remission rates did not differ with respect to subjects without negative symptoms of moderate severity. U-NEG persisted in 49 subjects (11% of the whole cohort and 18.6% of cases with U_NEG) at the end of phase1 (after 4 weeks of amisulpride treatment). The 49 early PNS subjects did not differ at baseline on measures of functioning and global severity of illness from non-persistent U-NEG subjects (NPNS), although the latter group had more severe depression and positive symptoms. At the end of phase1, PNS subjects had higher global severity of illness, were less frequently remitted and showed a worse psychosocial functioning than NPNS. During phase2 (6 weeks double-blind olanzapine vs amisulpride), 22/49 PNS subjects dropped (44.9%) vs 45/214 (21%) of NPNS. Among the 27 PNS who completed phase2, 13 (48.1%) were non-remitted and started phase3, representing 72% of all subjects entering phase3 (N=18). Only 10 subjects completed phase3 and 7 were non-remitted. These latter subjects had persistent negative symptoms across all treatment phases. Conclusions Unconfounded negative symptoms predicted poor psychosocial functioning. Persistent negative symptoms were associated with the worse psychosocial functioning at all phases and were the most resistant to antipsychotic treatment including clozapine. [ABSTRACT FROM AUTHOR]

This symposium will combine state-of-art findings from different complementary neuroimaging studies of social interactions and therapeutic interventions that aim to improve social functioning in psychosis. For the first time, we focus on the multi-dimensional concept of social functioning in which we combine pioneering findings on therapeutic interventions to refine prediction and optimization of therapeutic response using machine learning.Four different speakers with distinct expertise in complementary research will delineate precise methods of assaying neuroimaging-based assessments of social cognition, investigating how social cognition can be modulated by cognitive behavioral therapy and neuro-cognitive training in psychosis, to improve functional outcome. We will conclude the symposium by demonstrating how we can use machine learning to predict response to treatment at the individual level.Specifically, we will address four key-questions:1) How is the (in)sensitivity to social reward during social interactions expressed on the neural level? 3) Can social cognitive training increase activity within frontal-striatal circuits and improve reward processing?2) Does cognitive behavioral therapy that is particularly focused on social activation ameliorate negative symptoms and improve global functioning? Are the effects durable?4) Can machine learning help us predict the response to (social) cognitive training and optimize psychosocial interventions?First, Dr. Fett will present her recent research on the neural insensitivity to social reward in early psychosis. This group of patients has shown altered caudate and temporo-parietal junction activation as compared to healthy controls in two interactive fMRI trust games which they played against a pre-programmed cooperative and unfair partner. Second, Dr. Subramaniam will present her results on computerized social cognitive training in schizophrenia. She found that after social cognitive training, patients with psychosis showed increased activity within the medial prefrontal cortex, that was initially hypoactive, and significantly improved their ability to attain rewarding outcomes. Dr. Velthorst will present new data examining cognitive-behavioral therapy (CBT) focused on social activation and if this form of CBT could benefit patients recently diagnosed with a psychotic disorder. Her results show small positive effects on symptom severity post-treatment, particularly in the domain of global functioning.Finally, the study of Dr. Kambeitz-Ilankovic is one of the first using machine learning and structural neuroimaging in two independent samples to predict response to 40 hours of neuro-cognitive trainings. Her findings revealed balanced accuracy of 65-74% in both samples, predicting global functioning levels after the intervention. Furthermore, a significant pattern of neuroanatomical alterations in form of fronto-temporal-parietal volume reductions was associated with poor response to the training.Together, these exciting converging complementary findings from distinct studies indicate how we can target the points of neural circuit dysfunction with cognitive therapeutic interventions in psychosis, and use machine learning to personalize response to treatment for development of future precision medicine approaches. [ABSTRACT FROM AUTHOR]

Background Multicomponent programs for first-episode psychosis (FEP) offering coordinated specialty care (CSC) aim at maximizing opportunities for recovery by intervening early in the course of the illness. Two key components of recovery include social and occupational functioning. This study identified trajectories of social and occupational functioning in individuals enrolled in OnTrackNY, a statewide CSC program for treatment of early psychosis in community settings. Methods The sample in this naturalistic cohort design included 634 individuals between ages 16 and 30 with recent-onset, non-affective psychosis with at least one CSC follow-up assessment at 20 different sites across New York State. Clinicians collected demographic and clinical data at program entry and quarterly up to one year. Social and occupational functioning were assessed using the MIRECC Global Assessment of Functioning scales.3 Growth mixture models (GMM) were used to identify subgroups of clients with similar social and occupational functioning trajectories. The association between baseline demographic variables and trajectories were tested using chi-square tests and one-way ANOVAs. Results The GMM with four trajectory classes of social and occupational functioning best fit the data. The majority of the sample (59.1%) exhibited a greatly improving trajectory for occupational functioning from very low at baseline to moderate by 12 months with moderate and stable social functioning across the same period. A subgroup consisting of 14.9% of the sample had a similar moderate and stable trajectory for social functioning as the majority group, but were already exhibiting moderate occupational functioning at baseline and showed further improvement. Another subgroup (14.8%) entered the program high on both domains and remained stable or improved further. The most disabled group (11.4%) started low in both domains and improved across the year but remained at a dysfunctional occupational level. Female gender, higher education, adherence to antipsychotic medication and being employed or in school at enrollment were significantly associated with trajectories leading to more favorable social and occupational functioning. Discussion Four identified trajectories of FEP patients enrolled in CSC had improving or high-stable social and occupational functioning patterns. This is in contrast with the long-held view that most individuals with psychotic disorders have a deteriorating course of illness. Most variability in terms of trajectory patterns over 1-year follow-up is observed in occupational functioning, which suggests that this may be an important domain to target for intervention. [ABSTRACT FROM AUTHOR]

Background Impairments in self-assessment in schizophrenia have been shown to have functional and clinical implications. Prior studies have suggested that overconfidence can be associated with poorer cognitive performance in people with schizophrenia, and that metacognitive awareness of performance may underlie other symptoms such as delusions and disability. However, overconfidence is common in healthy individuals as well. This study examines the correlations between performance on social cognitive tests, confidence in performance, effort allocated to the task, and other aspects of self-assessment in patients with schizophrenia and healthy controls. Methods Participants were stable outpatients with diagnoses of schizophrenia or schizoaffective disorder (n=218) and healthy controls (n=154). Measures included self-reported depression (BDI-2), interpersonal sensitivity (Persecution and Deservedness Scale; PADS), social cognitive ability (Observable Social Cognition Rating Scale; OSCARS), and social functioning (Specific Level of Functioning Scale; SLOF). A performance-based emotion recognition test (Bell Lysaker Emotion Recognition Test; BLERT) assessed social cognitive performance and provided the basis for confidence judgments. Results Confidence was higher when correct for both healthy controls t(150)=5.87, p<.001 and patients with schizophrenia, t(214)=5.44, p<.001. However, the effect size for controls was d=0.7 and d=0.3 for the patients. We found that healthy controls responded significantly more rapidly when correct than incorrect, t(150)=4.92, p<.001; d=0.37. Patients with schizophrenia, in contrast, did not significantly differ in their response times to items when they were correct or incorrect, t(214)=1.89, p=.06; d=.13. Schizophrenia patients reported more depression, more interpersonal sensitivity, poorer social cognitive ability, and poorer everyday functioning than the healthy controls (all p<.001). Interestingly, 28 schizophrenia patients (13%) provided confidence scores of 100% on every item, while only 3 healthy controls (1.4%) provided these 100% confidence scores. Healthy controls who were 100% confident did not perform differently from those who were not, M=76.8%, vs. M= 75.7%. However, the schizophrenia patients who were 100% confident performed significantly more poorly than those who were not, M=57.5 % (SD=21.5) vs. 67.2 % (SD=18.4) respectively, t(214)=2.56, p=.011. Those patients who believed that their performance was perfect also had significantly lower scores on the BDI than those who believed that they had made some errors, M=10.8 (SD=11.9) vs. M=15.8 (SD=12.5) respectively, t(214)=2.04, p=.048. Discussion Self-assessment of everyday social functioning in healthy people was associated with confidence and impressions of social cognitive competence and, to a lesser extent, depression. In contrast, the self-assessments of schizophrenia patients were correlated only with depression in a regression analysis. Confidence that one is correct when performing social cognitive tests was not associated with actual performance to a notable extent in either group, and confidence in healthy people was associated with a test-taking style that included more rapid responses both when correct and incorrect. These data are consistent with previous studies of confidence and self-assessment in both healthy people and people with schizophrenia, again suggesting that patients are largely relying on their current mood state as an index of their global everyday functioning. [ABSTRACT FROM AUTHOR]

Background Human beings are tuned for social stimuli. This tendency for individuals to prioritize processing social over nonsocial stimuli is referred to as social preference. Various lines of evidence emerging from basic science support the crucial role of social preference in the development of social cognitive skills and social functioning. It is plausible that disrupted social preference may play a role in social cognitive impairment and social dysfunction in schizophrenia. Hence, this study focused on one aspect of social preference, social cue orienting, and examined its neural correlates in schizophrenia using a functional magnetic resonance imaging (fMRI). Methods Method: Twenty-five outpatients with DSM-5 diagnosis of schizophrenia and 25 demographically matched community controls participated in this study. To assess sensitivity to orienting to social versus nonsocial cues, a gaze cuing task was administered in the 3T scanner at UCLA. At each trial, participants were asked to indicate the location of a target (i.e. the letter X in one of two peripheral boxes) following an uninformative central cue (either social or nonsocial). There were two stimulus onset asynchronies between the cue and the target (i.e. SOA of 150 or 750 ms). It is important to note that both social and nonsocial cues were uninformative, meaning that the direction of the cue was consistent with the target location on half of the trials and inconsistent on the other half. Results Based on previous studies, we focused on two regions of interest (ROIs), the superior temporal gyrus and the inferior frontal gyrus. In the superior temporal gyrus, we did not observe any significant effect. However, in the inferior frontal gyrus, we observed a significant cue type by SOA by group interaction. At SOA 150, two group showed comparable neural activation. At SOA750, controls showed greater neural activation for social cues than nonsocial cues, whereas patients showed the opposite pattern (i.e. greater activation for nonsocial cues than social cues). Discussion Conclusions: Our study found aberrant neural activation for social cue orienting in schizophrenia patients at a long SOA, but not at a short SOA, in the inferior frontal gyrus. We did not observe any group difference in the superior temporal gyrus. Neural processes related to social cue orienting in schizophrenia may become dysfunctional when social cue orienting is less reflexive. These findings suggest differential temporal processes of social cue detection in schizophrenia when communicating with others in everyday life. [ABSTRACT FROM AUTHOR]

Background Along with control of psychotic symptoms, improved functioning is an important treatment goal in schizophrenia, particularly from the patient perspective. Efficacy of aripiprazole once-monthly 400 mg (AOM 400) in the treatment of acute exacerbation of schizophrenia was demonstrated in a randomized, placebo-controlled study (Study 291, NCT01663532), in which AOM 400 significantly improved clinical symptoms and social functioning. In two randomized, controlled trials of AOM 400 as maintenance treatment in stable patients with schizophrenia, AOM 400 delayed time to, and reduced the rate of, impending relapse vs placebo or a subtherapeutic dose of AOM. In both of these relapse prevention studies, as well as a long-term, open-label extension study (Study 248; NCT00731549), stability in clinical symptoms and patient functioning was maintained with long-term AOM 400 treatment. Here we report post-hoc analyses of the effect of AOM 400 on personal and social functioning from the acute setting and open-label extension studies. Methods Post-hoc analyses were conducted on data from Study 291, a 12-week, randomized, double-blind, placebo-controlled trial of AOM 400 in patients experiencing an acute psychotic episode, and Study 248, a 52-week open-label extension of two randomized, controlled trials of AOM 400 as maintenance therapy. Assessment of functioning was made using the Personal and Social Performance (PSP) scale. For Study 291, results were also stratified by age (≤35 years or >35 years), and within-group difference in least squares mean (LSM) change from baseline for AOM 400 vs placebo was calculated in the efficacy sample to determine treatment effect using mixed-model repeated measures and analysis of covariance of observed case data. For Study 248, mean changes from baseline in PSP total score and across 4 domain subscales were tabulated by visit for the open-label AOM 400 maintenance phase and analyzed among observed cases in the efficacy sample. Results In Study 291, 340 patients were included in the analysis (AOM 400, n=168 [n=49 aged ≤35 years, n=119 aged >35 years]; placebo, n=172 [n=54 aged ≤35 years, n=118 aged >35 years]). LSM (SE) change from baseline in PSP total score was significantly greater with AOM 400 compared with placebo at week 12 (13.0 [1.2] vs 5.5 [1.2], respectively; P<0.001). Treatment effects in patients ≤35 years of age were larger (11.1 [95% CI, 4.8 to 17.5]; P=0.001) than those in patients >35 years of age (3.6 [95% CI, –0.6 to 7.9]; P=0.09). In Study 248, 1,081 patients entered the open-label maintenance phase and 858 completed the study. Mean (SD) PSP total score increased from 67.81 (11.79) at baseline to 68.62 (12.97) at the last study visit (week 52). Mean PSP domain scores at baseline were less than 2, indicating no greater than mild impairment. AOM 400 resulted in either small decreases or slight increases in scores for all PSP domain subscales, indicating maintenance of function over the course of the 52-week study. Discussion Results from two post-hoc analyses of data from studies in both the acute treatment and maintenance settings demonstrate the efficacy of AOM 400 in improving and maintaining personal and social functioning in patients with schizophrenia. In the acute setting, improvements in functioning were observed across age groups (≤35 years, >35 years). Notably, the magnitude of functional improvement was largest in patients aged ≤35 years on AOM 400 and smallest in patients aged ≤35 years on placebo, findings that suggest a greater sensitivity to improvements in social functioning in younger patients with schizophrenia treated with AOM 400. The results of the long-term study support the use of a long-acting injectable antipsychotic to preserve functioning in patients with schizophrenia. [ABSTRACT FROM AUTHOR]