The Influence of Premorbid Adjustment and Autistic Traits on Social Cognitive Dysfunction in Schizophrenia

Abstract

Objectives:Premorbid dysfunction during childhood and adolescence is well documented in patients with schizophrenia. Literature pointed out multiple premorbid trajectories leading to different patients’ cognitive status, symptomatology, and global functioning after disease onset. This study aimed at identifying groups of premorbid trajectories and disentangling between group differences in clinical and cognitive measures, focusing on theory of mind (ToM) and autistic traits (ATs).Methods:Ninety-seven patients with schizophrenia were recruited and assessed for cognitive and ToM abilities, psychopathology, and ATs. A two-step cluster analysis identified three different groups of patients based on premorbid adjustment during childhood, adolescence, and late adolescence (i.e., stable-good, stable-poor, and “deteriorating”).Results:Compared to 66 healthy controls, results showed a widespread impairment in cognitive and ToM abilities among all groups of patients, except for affective ToM and executive functions in the stable-good group. Moreover, the stable-poor group exhibited more pronounced ATs and a more severe ToM impairment, compared to the other two groups of patients.Conclusions:Our findings highlight the existence of a group of patients with poor premorbid adjustment since childhood, more pronounced ATs and a severe ToM impairment affecting those basic mentalizing skills that are usually preserved in schizophrenia. Results might have intriguing implications in identifying underpinning endophenotypes and implementing cutting-edge rehabilitation programs.

Communicative-pragmatic abilities mediate the relationship between cognition and daily functioning in schizophrenia.

“…Relative to the second aim, we tested the effects of cognitive abilities, sequentially mediated by sociocognitive and pragmatic skills, on different domains of functioning. In line with a large body of literature highlighting the heterogeneity that characterizes neuropsychological predictors of functioning in schizophrenia (Bambini et al, 2016; Bechi et al, 2018; Bechi, Agostoni, Buonocore, Bosinelli, et al, 2020; Bechi, Spangaro, Agostoni, et al, 2019; Vaskinn et al, 2014), we expected different functional domains to be associated with specific neuropsychological predictors.…”

Theory of mind and stereotypic behavior promote daily functioning in patients with schizophrenia

“…Second, cognitive abilities, and especially attention and executive functions (Kurtz et al, 2016), and sociocognitive skills, and especially Theory of Mind and empathic abilities (Mucci et al, 2021), are considered major predictors of daily functioning in patients with schizophrenia, accounting for 20-30% of the variance (Best et al, 2014). Third, and in light of accumulating evidence suggesting that autistic symptoms can co-occur in individuals with schizophrenia, a number of studies have shown that co-occurring autistic symptoms in schizophrenia are significantly associated with lower quality of life and functioning (Bechi et al, 2019(Bechi et al, , 2020b, although this seems to be specific to symptomatically severe patients (Bechi et al, 2021).…”

Get up! Functional mobility and metabolic syndrome in chronic schizophrenia: Effects on cognition and quality of life

“…This appears particularly relevant in light of the chronic course of the disease, in which over time there is a greater prevalence of both Mets and FM, as a consequence of the physiological increase in age-related risk as well as of the increased risk related specifically to the disease (i.e., lifestyle, pharmacological treatment). Therefore, FM, as well as MetS, may represent a factor that can help explain the heterogeneity of the longitudinal trajectories of cognitive deficit in schizophrenia ( Carruthers et al, 2019 ; Bechi et al, 2020 ; Spangaro et al, 2021 ).…”