Michael Green - Social Cognition in Schizophrenia

Social Cognition and Social Neuroscience in Schizophrenia

Michael F. GreenWilliam P. Horan

Junghee Lee• Department of Psychiatry and Biobehavioral Sciences, UCLA

Geffen School of Medicine• UCLA Semel Institute for Neuroscience and Human Behavior• VA Desert Pacific Mental Illness, Research, Education and

Clinical Center (MIRECC)• VA Research Enhancement Award Program (REAP) on

Enhancing Community Integration for Homeless VeteransSchizophrenia Research

Forum Webinar Feb 2016

ConsultantAbbVie, ACADIA, DSP, FORUM, Lundbeck,

Luc (scientific board), Takeda

Past and Current Research SupportAmgen, Forum

Officer in non-profitMATRICS Assessment, Inc. – but receive no

financial compensation

Disclosures For M.F. Green(2 years)

Outline

• Pulling things apart: Systems of the Social Brain• Social cue perception• Experience sharing• Mentalizing • Experience and regulation of emotion

• Pulling things together: Integration & Implications• Which systems work and which don’t?• Integrating systems: e.g., empathy

Organizing findings from social cognition and social neuroscience in schizophrenia

• Work on social cognition in schizophrenia has exploded

• > 200 cites in PubMed every year from 2011-2015.

• Work on social neuroscience in schizophrenia is expanding

• Can only conduct an informative review in last couple of years.

Organizing findings from social cognition and social neuroscience in schizophrenia

What the review intended to do: • Provide a framework to organize the

findings.• Help to identify consistencies, failures to

replicate, or patterns across systems.• Identify what is intact versus impaired in

schizophrenia.

What the review did not intend to do:• Provide a mechanistic explanation of social

processing dysfunction in schizophrenia. • Identify new social processing systems.

Which social processing systems, among many, to consider?

1. Consensus among social neuroscientists that system is partly distinct from others (e.g. non-social) and important for social processing.

2. Sufficient clinical research of the system to allow inferences about social processing in schizophrenia.

Faces Voices

MentalizingSocial cue perception

Emotion regulation

Emotion experience

Experience and management of

emotion

Experience sharing

Motor resonance

Affect sharing

Impaired Intact Possibly intact

Subprocesses

Processes

Social processing systems in schizophrenia

For each system: - psychological processes- associated neural regions - findings from schizophrenia.Green, Horan, Lee, Nature Reviews Neuroscience 2015

Social Cue PerceptionThis system involves accurate identification of social information conveyed in cues from faces, voices, body movements / gestures, gait etc.For the review, we considered:

1. Face emotion perception2. Prosody (voice) perception

Schizophrenia patients show impairment on both types of tasks.

Superior temporal sulcus and Inferior frontal gyrus

Social Cue PerceptionKey regions: amygdala, fusiform gyrus,

superior temporal sulcus, inferior frontal gyrus

Fusiform gyrus

Amygdala

Facial Emotion Recognition in Schizophrenia (meta-analysis)

Between group differences:

Yellow: Controls > Patients- Amygdala / hippocampus- FusiformBlue: Patients > Controls

Taylor et al. Biological Psychiatry 2012

Experience SharingThe simple act of observing others’ behaviors leads us to experience neural activations that correspond to those that occur when we execute these behaviors1. Motor resonance -- while observing or executing

motor actions, input is compared with stored motor representations for actions.

2. Affect sharing -- shared processes are also engaged during the perception of emotional behaviors.

Inferior parietal lobule; Premotor cortex

Experience SharingMotor Resonance: inferior parietal; premotor cortex

Affect sharing: dorsal anterior cingulate cortex, anterior insula Affect Sharing

Dorsal ACC

Anterior insula

Motor Resonance

Lift Index

Lift Middle

2. Execute task

Lift Index

Lift Middle

Lift Index

Lift Middle

Lift Index

Lift Middle

3. Observe task

1. Imitate task

2.5 s

Imitation / Execution / Observation Task for Motor Resonance

• Patients

Finger Tasks- no group differences24 patients and 24 controls

1. Imitate task 3. Observe task2. Execute task• Controls

Horan,Iacoboni et al. NeuroImage Clinical 2014

Voxel threshold z=2.3, corrected cluster threshold p=0.05

MentalizingMentalizing (also called theory of mind or mental state attribution)

Understanding others requires one to take other people’s viewpoints into account and to make inferences about their mental states (including intentions, beliefs and emotions) based on available social cues.

Temporoparietal junction; Temporal pole

MentalizingKey regions: Temporoparietal junction, temporal pole,

medial prefrontal cortex, precuneus

PrecuneusMedial Prefrontal cortex

Mentalizing and fMRI

John told Emily that he had a

Porsche. Actually, his car is a Ford.

Emily doesn’t know anything about

cars though, so she believed John.

When Emily sees John’s car, she

thinks it is:

Porsche Ford

False picture condition condition

Amy made a painting of a tree house three years ago when it was blue. That was before the storm. We built a new treehouse last summer, but we painted it red instead.

The treehouse in the painting is:

red blue

In both cases, a false representation leads to a correct answer.

Mentalizing / Theory of Mind: the mental capacity to represent one’s own mind and others’ mental state (i.e., belief, emotion, intention). Large pt-control effect sizes in performance (.96).False belief condition

Belief Attribution Task False belief vs. False photo / picture

Controls

Patients

z value > 1.96 with a corrected cluster probability of p=.05 using Gaussian random field theory.

Emotion Experience and Regulation

Emotion Experience in Schizophrenia is Intact:

Patients report diminished pleasure on interview and trait measures

However, patients report and show normal responses (self-report and physiological) when exposed to pleasant stimuli. But… might experience greater negative

responses to neutral stimuli.

Emotion Regulation• Emotion regulation -- processes by which

people influence which emotion is experienced, when it is experienced, and how it is experienced.

• The most extensively studied regulation strategy is cognitive reappraisal. That involves changing one’s interpretations or appraisals of stimuli to alter an emotional response.

Emotion RegulationKey regions: ventrolateral prefrontal cortex, dorsolateral

prefrontal cortex, amygdala

Ventrolateral and dorsolateral prefrontal cortex

Amygdala

Emotion Regulation in Schizophrenia and Bipolar Disorder

People with schizophrenia showed reduced activation in vlPFC during cognitive reappraisal; people with bipolar disorder showed increased activation.

Morris et al Transl. Psychiat 2012

Faces Voices

MentalizingSocial cue perception

Emotion regulation

Emotion experience

Experience and management of

emotion

Experience sharing

Motor resonance

Affect sharing

Impaired Intact Possibly intact

Subprocesses

Processes

Social processing systems in schizophrenia

Green, Horan, Lee, Nature Reviews Neuroscience 2015

When Systems Work Together: Empathy as an Emergent PhenomenonEmpathy-- sharing, understanding, and responding to the unique emotional experiences of another person. It depends on multiple components. • Experience sharing

• Affective empathy• Mentalizing

• Cognitive empathy• Other components:

• Emotion regulation (to be less empathic)• Prosocial motivation (takes resources)• Social cue perception• Empathic accuracy

Patterns of intact vs impaired activity across social processing systems

• Social cognition can be divided into reflective and reflexive social processes.

• Reflective require effortful controlled processing. These social processes are impaired in schizophrenia -- perception of face and voice social cues, mentalizing, emotion regulation.

• Reflexive require less mental effort than the other social processes. These social processes that are intact or partially intact in schizophrenia – motor resonance, affect sharing, and emotion experience.

Questions for Discussion• What are the shared and distinct contributions from social and

non-social processing systems? • What are the implications of this framework for self-other

processing?• What are the neural mechanisms for reflective versus reflexive

social processing?• What is the role of social context on patient – control

differences? • What is the role of negative emotion in social cognitive

impairment in schizophrenia?• Where does connectivity break down in schizophrenia: within

regions, between regions, between systems?• Does this framework apply to social cognitive impairment in

other neuropsychiatric disorders?• Can interventions be targeted for specific social processing

systems?