Social cognition and apathy between two cognitive subtypes of schizophrenia: Are there the same or different profiles?

Abstract

Objective: Cognitive impairment is an essential feature of schizophrenia, and it involves a broad array of nonsocial and social cognitive domains. This study aimed to examine whether there are the same or different social cognition profiles between two cognitive subtypes of schizophrenia.

Method: There were one hundred and two chronic and institutionalized patients with schizophrenia from two referral tracks. One group is "Cognitively Normal Range" (CNR) (N = 52), and another group is "Below Normal Range" (BNR) (N = 50). We assessed or collected their apathy, emotional perception judgment, facial expression judgment, and empathy by the Apathy Evaluation Scale, the International Affective Picture System, the Japanese and Caucasian Facial Expression of Emotion, and the Interpersonal Reactivity Index, respectively.

Results: We found different impairment profiles depending on the cognitive subtypes of the patient with schizophrenia. Surprisingly, the CNR presented impairments in apathy, emotional perception judgment, facial expression judgment, and empathy and feature impairment in empathy and affective apathy. In contrast, even though the BNR had significant neurocognition impairments, they had almost intact empathy with significantly impaired cognitive apathy. Both groups' global deficit scores (GDSs) were comparable, and all reached at least a mild impairment level.

Conclusions: The CNR and the BNR had similar abilities in emotional perception judgment and facial emotion recognition. They also had differentiable deficits in apathy and empathy. Our findings provide important clinical implications for neuropsychological pathology and treatment in schizophrenia.

Keywords: Apathy; Neurocognition; Schizophrenia; Social cognition; Subtypes.

Fig. 1

The profile of GDS of all cognitive indexes of the two groups. Note: GDS: Global Deficit Score; SAVFT: Semantic Association Verbal Fluency Test; INF: Information Subtest; BD: Block Design Subtest; DS: Digit Span Subtest; DSS: Digit Symbol Substitution Subtest; ARI: Arithmetic Subtest; WMI: Working Memory Index; FSIQ: Full-Scaled Intelligence Quotient; LGI: Logical Memory-Immediate; LGII: Logical Memory Delayed; VRI: Visual Reproduction Immediate; VRII: Visual Reproduction Delayed; MCST-C: Modified Card Sorting test-Category; MSCT-P: Modified Card Sorting test-Perseveration; TMTa: Trail Making test, A form.

Fig. 2

The profile of GDS of all social cognitive indexes and apathy of the two groups. Note: GDS: Global Deficit Score; Tot Em: Total Empathy; Aff Em: Affective Empathy; Cog Em: Cognitive Empathy; PD: Personal Distress; EC: Empathic Concerns; PT: Perspective Taking; FS: Fantasy; Neg Aro: Negative Arousal; Neg Val: Negative Valence; Pos Aro: Positive Arousal; Pos Val: Positive Valence; Tot Apa: Total Apathy; Beh Apa: Behavioral Apathy; Aff Apa: Affective Apathy; Cog Apa: Cognitive Apathy.