A systematic review of the effects of psychiatric medications on social cognition

Abstract

Introduction Social cognition is an important area of mental functioning relevant to psychiatric disorders and social functioning, that may be affected by psychiatric drug treatments. The aim of this review was to investigate the effects of medications with sedative properties, on social cognition. Method This systematic review included experimental and neuroimaging studies investigating drug effects on social cognition. Data quality was assessed using a modified Downs and Black checklist (Trac et al. CMAJ 188: E120-E129, 2016). The review used narrative synthesis to analyse the data. Results 40 papers were identified for inclusion, 11 papers investigating benzodiazepine effects, and 29 investigating antipsychotic effects, on social cognition. Narrative synthesis showed that diazepam impairs healthy volunteer’s emotion recognition, with supporting neuroimaging studies showing benzodiazepines attenuate amygdala activity. Studies of antipsychotic effects on social cognition gave variable results. However, many of these studies were in patients already taking medication, and potential practice effects were identified due to short-term follow-ups. Conclusion Healthy volunteer studies suggest that diazepam reduces emotional processing ability. The effects of benzodiazepines on other aspects of social cognition, as well as the effects of antipsychotics, remain unclear. Interpretations of the papers in this review were limited by variability in measures, small sample sizes, and lack of randomisation. More robust studies are necessary to evaluate the impact of these medications on social cognition.

European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia

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Transcranial Direct Current Stimulation on the Left Superior Temporal Sulcus Improves Social Cognition in Schizophrenia: An Open-Label Study

“…In a meta-analysis ( 15 ), the ability of tDCS on the prefrontal cortex, e.g., the dorsolateral prefrontal cortex (DLPFC), to improve working memory has been shown in patients with schizophrenia (Hedges' g = 0.49). Likewise, it is speculated that tDCS may partially alleviate social cognition impairments that are resistant to antipsychotic drugs ( 16 ).…”

Pharmacological interventions for social cognitive impairments in schizophrenia: A protocol for a systematic review and network meta-analysis

“…Results of meta-analyses indicate that intranasal oxytocin and atypical antipsychotic drugs may improve theory of mind ( Bürkner et al, 2017 ) and emotion recognition ( Gabay et al, 2015 ), respectively, while anti-dementia drugs (e.g., donepezil, galantamine, rivastigmine, and memantine) may elicit limited effects. On the other hand, emotional processing in healthy subjects becomes worse by diazepam, as indicated by meta-analysis ( Haime et al, 2021 ). Therefore, additional research to promote the rational selection of compounds is desirable for facilitating the development of novel therapeutics to alleviate social cognitive deficits.…”