Schizophrenia - Review of Research Papers

Schizophrenia - Review of Research Papers.

Carl Stuart

Stuart Medical Series

 Literature Review.

Addington, J., Penn, D., Woods, S., Addington D., & Perkins D. (2008). Social Functioning in Individuals at Clinical High Risk for Psychosis. Schizophrenia Research, 99 (1-3), 119-124.

The abovementioned research studied the degree of impairment in social functioning among individuals who have a CHR (clinical high risk) for psychosis. The sample population was made up of 244 subjects who were comprised of 86 CHR subjects, 50 FE (first-episode of psychosis) subjects, 53 ME (multi-episode schizophrenia) subjects, and 55 NPC (non-psychiatric controls) subjects. The assessment was done using three symptom rating scales: SFS (Social Functioning Scale), QLS-role (Role Functioning subscale of the Quality of Life Scale) and PFS (premorbid functioning scale). The results of the research showed that:

        i.            The performance of the CHR group on SFS did not differ considerably from that of the ME and FE groups; and that these three groups had more impairment as compared to the NPC group.

      ii.            The CHR group performed better than the ME group in the QLS-role, but the performance of both were worse than the NPC group.

    iii.            CHR performance was relatively equivalent to that of the other groups in PFS.

Thus, it can be concluded from the above findings that the young people who were assessed did demonstrate significant social functioning deficits even during the pre-psychotic phase of the condition. These findings do support the fact that social deficits are present during both the pre-psychotic and psychotic phases of the condition.

These findings are related to the topic of psychosis. The term psychosis refers to disordered thinking or thought processes whereby the affected individual cannot distinguish between fantasy and reality due to impairment of reality testing capacities. Psychotic individual do create a repository of virtual non-existent social relationships in their minds and thoughts; and then project it to real-life experiences as manifested by the way they act and express themselves in real-life social interactions. This causes a disconnection from reality which leads to impaired social functioning. To worsen matters, the affected individual is unable to challenge his/her bizarre perceptions about social interactions. The degree of social functioning impairment depends on the duration (whether the symptoms were transient or persistent), and intensity. There is prodromal phase of psychosis whereby the pre-psychotic symptoms predominate, and is usually characterized by mild impairment of social functioning. This study shows that the degree of such impaired social functioning is more severe than it was previously considered to be, as illustrated by the scores of the symptom rating scales.

The above study is useful to a psychologist as it confirms that mild to moderate impairment in social functioning can occur during the pre-psychotic phase of a mental disorder. This will enable the psychologist to formulate the appropriate management plan that will manage the specific mental disorder while concurrently averting psychosis.

For the expansive field of psychology, this research is useful because it shows that social deficits are present during both the pre-psychotic and psychotic phases of symptoms. Thus, psychosis should be considered as a differential diagnosis in a patient who presents with social deficits.

Aguirre, F., Sergi, M., & Levy,C. (2008). Emotional Intelligence and Social Functioning in Persons with Schizotypy. Schizophrenia Research, 104 (1), 255-264.

The abovementioned research is a novel study of emotional intelligence in individuals affected by schizotypy. The subjects were selected from an undergraduate population of 2100 using the Schizotypal Personality Questionnaire-Brief Version. 96 subjects were identified and selected. Of this number, 40 were diagnosed with high schizotypy while the rest were diagnosed with low schizotypy. The subjects were assessed using the following tests; Mayer-Salovey-Caruso Emotional Intelligence Test, California Verbal Learning Test, Wisconsin Card Sorting Test, and Social Adjustment Scale-Self Report. These tests assessed emotional intelligence, verbal episodic memory, executive functioning and social functioning respectively.

The results showed that individuals with high schizotypy registered impairment in emotional intelligence (especially the perception and management of emotions) and social functioning (in the areas of peer relationships, academic functioning and family relationships). Emotional intelligence impairment among individuals with low schizotypy was considerably less severe as compared to their high schizotypy counterparts. There was no significant difference in executive functioning and verbal episodic memory between the two groups.

It can be inferred from the above results that the inability to perceive and manage emotions as it occurs with high schizotypy causes the affected individuals to develop poor peer relationship functioning. Also, based on the results, emotional intelligence is related to verbal episodic memory, but it bears no relationship to executive functioning. Thus, this research shows that schizotypy causes impairment in emotional intelligence and social functioning.

These findings are related to the topic of Schizotypal Personality Disorder and schizophrenia. Schizotypy stipulates that personality characteristics have a range of continuum from normal states to schizophrenia. Schizotypal personality disorder is characterized by pervasive deficits in interpersonal and social functioning with significant impairment in the ability to form close relationships. It is also characterized by distortions in perception and cognition. The age of onset is early adulthood and this is why the sample population that was assessed was made up of undergraduates. The disorder usually presents with the following symptoms; ideas of reference, magical thinking, illusion, disordered thought processes, constricted affect, paranoid ideation, eccentric behavior, inability to form close friendships and excessive social anxiety. All these symptoms were assessed in this research using the various symptoms rating scale. An association between schizotypy and emotional intelligence has been theorized to exist, and this research confirms the existence of such an association.       

The above study is useful to a psychologist as it confirms an association between schizotypy and emotional intelligence. This will enable the psychologist to consider the degree of impairment in emotional intelligence when formulating the appropriate management plan for individuals affected by schizotypy.

This research is useful in psychology because it confirms the existence of an association between schizotypy and emotional intelligence. Thus, evaluation for schizotypy should be done in a patient who presents with deficits in emotional intelligence.

Green, M., Bearden, C., Cannon, T. Fiske, A., Hellemann, G. et al. (2012). Social Cognition in Schizophrenia, Part 1: Performance across Phases of Illness. Schizophrenia Bulletin, 38(4), 854-864.

This cross-sectional study assesses three aspects of impaired social cognition at different developmental phases of schizophrenia. The aspects assessed are social relationship perception, theory of mind (ToM), and emotion processing. The developmental phases were divided into three distinct periods: the prodromal phase, first episode and the chronic phase. The total number of subjects was 311, with 50 of them having psychotic prodromal risk syndrome alongside their demographic control of 34 participants, 81 first-episode schizophrenics alongside their demographic control of 46 participants; and 53 patients diagnosed with chronic schizophrenia alongside their demographic control of 47 participants. The assessment was done using Mayer-Salovey-Caruso Emotional Intelligence Test, Relationships across Domains Test; and The Awareness of Social Inference Test which assessed emotional processing, social relationship perception and emotional processing respectively. The results showed significant impairment of social cognitive performance across the three domains assessed in the clinical sample. Evaluation of group differences showed that the performance was comparable across the three phases of illness with the illness remaining consistently stable (that is, there was no improvement or deterioration of symptoms). Age was shown to have no significance in determining the outcome of the study. These results show that the three domains do fit into a stable pattern which influences treatment and prognosis.

These findings are related to the topic of schizophrenia. Research has shown that schizophrenia is associated with impairments in social and cognitive functions, and this in turn does determine the overall functional outcome. This research has shown that there is a degree of stability to these impairments within the development phases of the illness.

The above study is useful to a psychologist as it confirms that social cognition impairments are stable across the developmental phases of the illness. This will enable the psychologist to assess the degree of social impairment at presentation, and thereafter anchoring the management plan on this assessment. This study is also able to guide a psychologist on how to monitor for the outcome of treatment.

This research is useful in psychology because it confirms the stability of social cognition impairments across the developmental phases of the illness. Moreover, the research shows that social cognitive impairments can be used as vulnerability indicators. Thus, it provides groundwork for further research on longitudinal stability of impairment in social functioning in patients who are suffering from schizophrenia.

Horan, W. Green, M., DeGroot, M., Fiske, A., Hellemann, G. et al. (2012). Social Cognition in Schizophrenia, Part 2:12-Month Stability and Prediction of Functional Outcome in First-Episode Patients. Schizophrenia Bulletin, 38(4), 865-872.

This research assessed longitudinal stability alongside the functional correlates of impairments in social cognition among first-episode individuals (person newly diagnosed with schizophrenia). 55 subjects completed the baseline assessment and the subsequent follow-up assessments which occurred for a period of 12 months. The follow-up assessed the three main domains of social cognition (social relationship perception, theory of mind and emotion processing), clinical ratings of symptoms, and real-world functioning. The results of the study showed longitudinal stability across all the social cognitive tests, with a test-retest correlation of about 0.7. For the 12-month assessment, both 12-month and higher baseline social cognition results were strongly associated with improved social functioning, independent living and work functioning.  Moreover, multiple cross-lagged panel analysis demonstrated consistency with the causal model. The causal model used in the research stipulated that baseline social cognition determined the functional outcome in excess of the contribution made by symptoms. Therefore, it can be inferred that the symptoms of first-episode schizophrenia are longitudinally stable with the baseline score being a useful indicator of prognosis.

According to the research titled Social Cognition in Schizophrenia, Part 1: Performance across Phases of Illness, impairments in social cognition is a stable functional feature of schizophrenia; and as such the findings of this research do apply to its companion study, Social Cognition in Schizophrenia, Part 2:12-Month Stability and Prediction of Functional Outcome in First-Episode Patients as both studies do point towards use of social cognitive impairments as vulnerability indicators.

These findings are related to the topic of schizophrenia. Schizophrenia is associated with impairments in social and cognitive capacities, and such impairments do determine the probable functional outcome. This research has shown that there is longitudinal stability of social cognitive impairments in first-episode schizophrenia, and thus the severity of impairment can be used as a vulnerability indicator within clinical settings.

The above study is useful to a psychologist as it confirms that social cognition impairments associated with first-episode schizophrenia are longitudinally stable, and that the baseline score determines the possible outcome of treatment. This will enable the psychologist to appreciate the value of baseline assessment of social impairment, as the resulting score underlies the planned management of the patient.  Moreover, the study shows that a psychologist can use the scores of social cognitive impairments as vulnerability indicators.

This research is useful in psychology because it confirms the longitudinal stability of social cognition impairments in first-episode schizophrenia. Moreover, the research shows that social cognitive impairments can be used as vulnerability indicators. Thus, it provides more information that can be used to assess the severity of first-episode schizophrenia, and the prognosis after initiation of the appropriate treatment. Furthermore, it provides information that can be useful in planning the management of the patient.

McCormick, L., Brumm, M. Beadle, J., Paradiso, S., Yamada, T., et al (2012). Mirror Neuron Function, Psychosis, and Empathy in Schizophrenia. Psychiatry Research, 201(3), 233 - 239.

Schizophrenia causes a disruption in the processing of emotional, cognitive and social information. The underlying pathophysiology is an abnormal functioning of the mirror neuron system. However, the association between schizophrenia and the mirror neuron system has never been assessed. This research assessed mirror neuron activity and empathy using an established electroencephalograph (EEG) paradigm. The paradigm used assessed the Mu (8-13Hz) rhythm suppression in association with hand movements, with the electrodes placed over the sensorimotor cortex. The total number of participants was 32 of whom 16 had a schizophrenia-spectrum disorder with 8 being actively psychotic and the remaining patients having residual illness. The other 16 were an appropriately matched healthy demographic control. The results showed that the active psychotic patients did demonstrate significant mu suppression over the left sensorimotor cortex. The patients having residual illness and the healthy participants did demonstrate equal mu suppression over the sensorimotor cortex, but the extent of their mu suppression was considerably less than that shown by psychotic patients. Also, the results showed more personal distress among patients with schizophrenia-spectrum disorder as compared to the healthy subjects.

Thus it can be inferred from the results of the study that the degree of mu suppression over the left sensorimotor cortex is positively correlated to the symptoms of psychosis. This implies that the motor neuron activity is directly related to psychosis, with severe symptoms of psychosis leading to a proportionate increase in the activity of the mirror neuron system. This explains why such patients experienced the greatest suppression of mu activity in the study. It can therefore be deduced from the results that abnormal activity of the mirror neuron occurs in schizophrenia patients only during the psychotic phase of the ailment, and its severity is correlated to the severity of the psychosis.

These findings are related to the topic of schizophrenia. The pathophysiology of schizophrenia consists of neurochemical and neuroanatomical abnormalities which are induced by either the genes or the environment. These abnormalities do predispose the affected individual to heightened vulnerability to stressors. It can be inferred from this study that these abnormalities do interact with each other, as is shown by the fact that derangement in the chemical homeostasis of neurons do affect their physical capabilities to conduct electrical impulses (which are ultimately measured by the EEG). Moreover, it can be deduced from the study that schizophrenia patients are more amenable to electroconvulsive therapy during the psychotic phase of the disease.

The above study is useful to a psychologist as it confirms that schizophrenia-spectrum disorder predisposes the patient to severe personal distress. Moreover, it confirms that abnormal activity of the mirror neuron occurs in schizophrenia patients only during the psychotic phase of the ailment, and its severity is correlated to the severity of the psychosis. This shows that electroconvulsive therapy is more effective in managing schizophrenia only when the patient has psychotic episodes.

This research is useful in psychology because it confirms that there is more personal distress among patients with schizophrenia-spectrum disorder as compared to the healthy population; and that abnormal activity of the mirror neuron occurs in schizophrenia patients only during the psychotic phase of the ailment, and its severity is correlated to the severity of the psychosis.

Zhu, B., Chen, C., Loftus, E.F, He, Q., Chen, C., Lei, X., & Dong, Q.(2012). Brief Exposure to Misinformation Can Lead to Long-term False Memories. Applied Cognitive Psychology, 26, 301-307.

            The purpose of this study was to investigate whether brief exposure to experimentally-created false memories could lead to persistence of these memories for extended periods of time. The total number of participants was 342 and they were all subjected to the conventional three-stage misinformation process. The process involved viewing event slides, and thereafter reading narrations which contained the misinformation before finally completing several memory tests. This process was then repeated 18 months later.

The results of the initial tests demonstrated that effective misinformation do lead to the creation and persistence of false memories. After 18 months, the rate of persistence of the false memories was equivalent to those of true memories. These results therefore suggest that brief exposure to misinformation can lead to long-term false memories, with the strength of traces of these memories being equal to the strength of true memory traces.

These findings are related to the topic of psychopathology. The intensity of external perceptions does influence the process of formation, retention and recall of new memories. In this study, the three-stage procedure of misinformation did actively enhance the intensity of information absorbed. New memories due influence the thought process, and this could lead to thought disorders. Thought disorders disrupt the integrated and harmonious thinking process, and this adversely affects the thought content, communication capabilities and the thought process as expressed by the speech, behavior, writing and actions of the individual. Thus, misinformation can lead to changes in thinking, behavior and actions; and this procedure can be used maliciously for brainwashing and ideological indoctrination.

The above study is useful to a psychologist as it confirms that brief exposure to misinformation can lead to long-term false memories, with the strength of traces of these memories being equal to the strength of true memory traces. This information will enable the psychologists to restructure and re-orient the evaluation of a psychiatric patient who present with formal thought disorders in order to identify any instances of misinformation. This would enable the psychologist to shield the patient from such sources of misinformation, and this may alleviate the symptoms arising from the thought disorder.

This research is useful in psychology because it confirms that brief exposure to misinformation can lead to persistent false memories. This proves the fact that misinformation can be used to indoctrinate people to a particular point of view. Moreover, it can be inferred from the study that repeated cycles of misinformation have the potential to crystallize the false memories.

Elfenbein, H., & Ambady, N. (2003). When Familiarity Breeds Accuracy: Cultural Exposure and Facial Emotion Recognition. Journal of Consumer Psychology, 21(2), 115-125.

This study investigated for the role that cultural familiarity plays in recognition of facial expressions and the underlying emotions. Multiple ethnicities were investigated. These ethnicities are Chinese residing in china versus Chinese-Americans, non-Asian Americans versus Chinese-Americans; Tibetans in china and blacks residing in the US. The results of the study showed that Chinese, regardless of the place of residence, were able to accurately judge the expressions of other people, with the accuracy of their assessment being significantly greater than that of non-Asian Americans. Moreover, the accuracy of the judgment increased proportionately with greater participant exposure. The results also showed that Tibetans and African were able to accurately judge the expressions of other people, both non-host and host society members. The accuracy of judgments of various people did span generations without any evidence of biological or ethnic influences. In totality, the study shows that a universal affect system governs emotional expression, with subtle differences among cultures being accentuated with greater familiarization with such cultures.

These findings are related to the topic of cultural psychology. Culture does influence the psychological processes of a person, and a psychologist must understand that cultural differences can impede effective communication.

Cultural psychology is important to a psychologist because it enables him/her to appreciate how culture influences perceptions.

            Culture is important in the field of psychology, as it reveals the interactions between societal values and the psychological well-being of a person.

Hong, Y., Morris, M.W., Chiu, C., & Benet-Martinez, V. (2000). Multicultural Minds: A Dynamic Constructivist Approach to Culture and Cognition. American Psychologist, 55, 709-720.

This study sheds new light on the interaction between cognition and culture. The main focus of the study was the dynamics by which implicit theories are operationalized as a guidance principle in the creation of meanings of stimuli. The study utilized cognitive priming experiments which were arranged serially to simulate experiences of bicultural people. The simulation involved switching between either cultural settings in response to culturally-significant symbols. The study analyses how a dynamic constructivist approach sheds light on when and how cultural constructs drive behavior; and how a bicultural persons can control and manage a culture’s cognitive effects.  

These findings are related to the topic of cultural psychology. Culture is a major determinant in how an individual constructs and interprets a stimulus. The implications of such interpretations are illustrated by a bicultural person. Since a bicultural person has assimilated two different cultures, he/she can switch between either culture upon exposure to a significant cultural-laden symbol. Thus, a stimulus can be interpreted differently depending on the prevailing cultural framework.

Cultural psychology is important for a psychologist as it enables him/her to appreciate how culture influences perceptions.

            Culture is important in the field of psychology, as it reveals the interactions between cultural values and the psychological well-being of a person.