Uchino Takashi, Akiyama Hisashi, Okubo Ryo, Wada Izumi, Aoki Akiko, Nohara Mariko, Okano Hiroki, Kubota Ryotaro, Yamada Yuji, Toyomaki Atsuhito, Hashimoto Naoki, Ikezawa Satoru, Nemoto Takahiro
Department of Neuropsychiatry, Toho University Faculty of Medicine, Ota, Tokyo, Japan.
Department of Psychiatry and Implementation Science, Toho University Faculty of Medicine, Ota, Tokyo, Japan.
Schizophrenia (Heidelb). 2024 Oct 29;10(1):94. doi: 10.1038/s41537-024-00515-8.
Intervention for social cognition could be key to improving social functioning in patients with schizophrenia. A first step towards its clinical implementation involves interviewing patients about their subjective difficulties with social cognition as they experience them in the real world. The present study focused on the clinical subtypes classified by the discrepancies between the subjective difficulties in social cognition and actual cognitive impairment. A total of 131 outpatients with schizophrenia and 68 healthy controls were included. Objective measurement of social cognition was performed using a test battery covering four representative domains, and subjective difficulties were determined by a questionnaire covering the same domains. A two-step cluster analysis explored the potential classification of social cognition in patients with schizophrenia. There was little correlation between the objective performance on social cognition tasks and subjective difficulties in social cognition. The analysis yielded three clusters: the low-impact group (low objective impairment and low subjective difficulties), the unaware group (high objective impairment but low subjective difficulties), and the perceptive group (moderate objective impairment and high subjective difficulties). Positive, negative, and general symptoms were more severe in the two groups that showed impaired performance on the social cognition tasks (i.e., the unaware and perceptive groups) than those in the low-impact group. Neurocognition and functional capacity were the lowest in the unaware group, and social functioning was the lowest in the perceptive group. Awareness about the clinical subtypes of social cognition could serve as a guidepost for providing individualized, targeted interventions.
对社会认知进行干预可能是改善精神分裂症患者社会功能的关键。其临床实施的第一步是询问患者在现实世界中所经历的社会认知方面的主观困难。本研究聚焦于根据社会认知方面的主观困难与实际认知障碍之间的差异所划分的临床亚型。共纳入了131例精神分裂症门诊患者和68名健康对照者。使用涵盖四个代表性领域的测试组合对社会认知进行客观测量，并通过涵盖相同领域的问卷确定主观困难。采用两步聚类分析探索精神分裂症患者社会认知的潜在分类。社会认知任务的客观表现与社会认知方面的主观困难之间几乎没有相关性。分析得出三个类别：低影响组（客观损害低且主观困难低）、未察觉组（客观损害高但主观困难低）和感知组（客观损害中等且主观困难高）。在社会认知任务中表现受损的两组（即未察觉组和感知组）的阳性、阴性和一般症状比低影响组更严重。神经认知和功能能力在未察觉组中最低，社会功能在感知组中最低。了解社会认知的临床亚型可为提供个性化、有针对性的干预提供指导。
