Associations between social cognition, skills, and function and subclinical negative and positive symptoms in 22q11.2 deletion syndrome

Abstract

BackgroundIdentification of the early signs of schizophrenia would be a major achievement for the early intervention and prevention strategies in psychiatry. Social impairments are defining features of schizophrenia. Impairments of individual layers of social competencies are frequently described in individuals with 22q11.2 deletion syndrome (22q11.2DS), who have high risk of schizophrenia. It is unclear whether and to what extent social impairments associate with subclinical negative and positive symptoms in 22q11.2DS, and which layer of social impairments are more correlated with schizophrenia-related symptoms. The aims of this study were to conduct a comprehensive investigation of social impairments at three different levels (function, skill, and cognition) and their interrelationship and to determine to what degree the social impairments correlate to subclinical levels of negative and positive symptoms, respectively, in a young cohort of 22q11.2DS not diagnosed with schizophrenia.MethodsThe level of social impairment was addressed using questionnaires and objective measures of social functioning (The Adaptive Behavior Assessment System), skills (Social Responsiveness Scale), and cognition (The Awareness of Social Inference Test and CANTAB Emotional Recognition Task), and the presence of subclinical symptoms of schizophrenia were evaluated using the Structured Interview for Prodromal Syndromes in a cross-sectional case-control study of 29 cases and 29 controls, aged 12 to 25 years. Association between social impairment and negative and positive symptoms levels was examined in cases only.ResultsSubjects with 22q11.2DS were highly impaired in social function, social skills, and social cognition (p ≤ 6.2 × 10−9) relative to control peers and presented with more negative (p = 5.8 × 10−11) and positive (p = 7.5 × 10−4) symptoms. In particular, social functional and skill levels were highly associated with notably subclinical negative symptoms levels.ConclusionsThis study shows strong correlations between levels of social impairments and subclinical negative and positive symptoms. However, longitudinal studies are required to show if social impairments represent early disease manifestations. If parental or self-reporting suggests severe social impairment, it should advocate for clinical awareness not only to social deficits per se but also of potential subclinical psychosis symptoms.

Social Cognition in 22q11.2 Deletion Syndrome and Idiopathic Developmental Neuropsychiatric Disorders

“…One study on 22q11DS found a signi cant inverse association, indicating poorer performance on a ToM task (anthropomorphic animations) was associated with higher SRS scores (20). Speci c to the relationship between TASIT and SRS, a prior study did not nd a signi cant association between TASIT performance and SRS in 22q11DS (48) in line with our ndings. One study on adult CHR participants found a signi cant association between higher TASIT scores and lower self-reported SRS scores (50).…”

“…Despite this, we did not nd a signi cant relationship between social cognition performance and real-world social behavior for any clinical group, although the ndings were trending in the expected direction across all groups. While numerous studies have used ToM tasks and the SRS concurrently in order to broadly examine social outcomes in our speci ed clinical groups, few have directly assessed the relationship between the two types of measures (20,48,82). A recent study in ASD adolescents found that combined poor performance on several social cognition tasks (ToM tasks, emotion-recognition tasks, and anthropomorphic animations) was collectively associated with elevated SRS scores (83).…”

“…The original SRS administered to parents/caregivers of the FEP group was rescored using the updated norms for the revised version (SRS-2), both of which have the same items, so as to be consistent across all groups. The SRS was originally developed to quantify (dimensionally measured) social impairments within the context of the ASD phenotype, but has now been extended to many other clinical populations, including 22q11DS (20,48), CHR (21,49,50), and FEP (21,49). It has also been shown to index traits that are continuously distributed in the general population (51).…”

Subthreshold social cognitive deficits may be a key to distinguish 22q11.2DS from schizophrenia

“…It includes a wide range of skills such as difficulty identifying emotions, feeling connected to others, inferring people's thoughts, and reacting emotionally to others (Green, Horan, & Lee, 2015). Dysfunctional social cognition in schizophrenia and in 22q11.2DS is now well established and supported by replicated studies (Campbell et al, 2015;Green et al, 2005Green et al, , 2008Penn et al, 2008;Savla et al, 2013;Vangkilde et al, 2016).…”

“…In SCZ and 22q11.2DS, dysfunctional social cognition is now well established and attested by significant and consistent scientific body of literature (Campbell, McCabe, Melville, Strutt, & Schall, 2015;Green et al, 2008;Green, Olivier, Crawley, Penn, & Silverstein, 2005;Penn, Sanna, & Roberts, 2008;Savla, Vella, Armstrong, Penn, & Twamley, 2013;Vangkilde et al, 2016). Emotional processing has been widely studied, and deficits in facial and vocal emotion recognition are now well established (Chan, Li, Cheung, & Gong, 2010;Irani, Seligman, Kamath, Kohler, & Gur, 2012;Leleu et al, 2016;McCabe et al, 2016).…”