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. 2024 Jan 31:15:1333711.
doi: 10.3389/fpsyt.2024.1333711. eCollection 2024.

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Giulia M Giordano  1 , Pasquale Pezzella  1 , Armida Mucci  1 , Stephen F Austin  2 , Andreas Erfurth  3 , Birte Glenthøj  4   5 , Alex Hofer  6 , Jan Hubenak  7 , Jan Libiger  7 , Ingrid Melle  8 , Mette Ø Nielsen  4   5 , Janusz K Rybakowski  9 , Pawel Wojciak  9 , Silvana Galderisi #  1 , Gabriele Sachs #  10
Affiliations

Negative symptoms and social cognition as mediators of the relationship between neurocognition and functional outcome in schizophrenia

Giulia M Giordano et al. Front Psychiatry. .

Abstract

Introduction: In this study we assessed the contribution of psychopathology, including the two domains of negative symptoms (motivational deficit and expressive deficit), processing speed as an index of neurocognition, and emotion recognition, as an index of social cognition, to poor functional outcomes in people with schizophrenia.

Methods: The Positive and Negative Syndrome Scale was used to evaluate positive symptoms and disorganization and the Brief Negative Symptom Scale to assess negative symptoms. The Symbol Coding and the Trail Making Test A and B were used to rate processing speed and the Facial Emotion Identification Test to assess emotion recognition. Functional outcome was assessed with the Personal and Social Performance Scale (PSP). Regression analyses were performed to identify predictors of functional outcome. Mediation analyses was used to investigate whether social cognition and negative symptom domains fully or partially mediated the impact of processing speed on functional outcome.

Results: One hundred and fifty subjects from 8 different European centers were recruited. Our data showed that the expressive deficit predicted global functioning and together with motivational deficit fully mediated the effects of neurocognition on it. Motivational deficit was a predictor of personal and social functioning and fully mediated neurocognitive impairment effects on the same outcome. Both motivational deficit and neurocognitive impairment predicted socially useful activities, and the emotion recognition domain of social cognition partially mediated the impact of neurocognitive deficits on this outcome.

Conclusions: Our results indicate that pathways to functional outcomes are specific for different domains of real-life functioning and that negative symptoms and social cognition mediate the impact of neurocognitive deficits on different domains of functioning. Our results suggest that both negative symptoms and social cognition should be targeted by psychosocial interventions to enhance the functional impact of neurocognitive remediation.

Keywords: emotion recognition; expressive deficit; mediation analysis; motivational deficit; negative symptoms; processing speed; schizophrenia.

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Conflict of interest statement

GG has been a consultant for Angelini. AM has been a consultant and/or advisor to or has received honoraria from Angelini, Gedeon. Richter Bulgaria, Janssen Pharmaceuticals, Lundbeck, Otsuka Pharmaceutical, Pfizer, Pierre Fabre, Rovi. Pharma and Boehringer Ingelheim. AE received consulting fees and/or honoraria for speeches within the last 3 years from Angelini, AOP Orphan, Germania, Janssen, Krka, Lundbeck, Mylan, Neuraxpharm, Recordati, and Sandoz. BG has been the leader of a Lundbeck Foundation Centre of Excellence for Clinical Intervention and Neuropsychiatric Schizophrenia Research CINS January 2009 – December 2021, which was partially financed by an independent grant from the Lundbeck Foundation based on international review and partially financed by the Mental Health Services in the Capital Region of Denmark, the University of Copenhagen, and other foundations. All grants are the property of the Mental Health Services in the Capital Region of Denmark and administrated by them. She has no other conflicts to disclose. AH has been a consultant for Recordati and Boehringer Ingelheim and Newron Pharmaceuticals and participated in educational conferences for Janssen and Lundbeck. JH received consulting fees and/or honoraria for speeches within the last 3 years from Angelini, Lundbeck, Janssen and Servier. SG has been a consultant and/or advisor to or has received honoraria from Angelini, Boehringer Ingelheim, Gedeon Richter-Recordati, Innova Pharma-Recordati Group, Janssen, Lundbeck, Otsuka, Recordati Pharmaceuticals, Rovi Pharma and Sunovion Pharmaceuticals. GS is president of the Austrian Society of Neuropsychopharmacology and Biological Psychiatry, which is partially financed by the support from pharmaceutical companies. GS received consulting fees and/or honoraria for speeches within the last 3 years from Janssen, Lundbeck, Mylan, Recordati, and Schwabe. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer CM declared a past co-authorship with the authors AM and SG to the handling editor. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Basic model of mediation analyses with (A) negative symptom domains and (B) social cognition domain of emotion recognition as mediators between neurocognition and measures of functional outcome.
Figure 2
Figure 2
Mediation analyses with negative symptoms as mediator between neurocognition and the Personal and social performance scale (PSP) total score and Personal and social relationships. The negative symptom domains were both full mediators of the impact of Processing speed on PSP total score (A) while the motivational deficit domain was a full mediator of the impact of Processing speed on PSP Personal and social relationships (B).
Figure 3
Figure 3
Mediation analyses with emotion recognition as mediator between neurocognition and the Personal and social performance scale (PSP) total score and Socially useful activities. The social cognition domain of emotion recognition partially mediates the impact of Processing speed on PSP total score (A) and of Processing speed on PSP Socially useful activities (B).
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