David L. Penn

Purpose: Family involvement in Coordinated Specialty Care (CSC) can enhance engagement and improve outcomes for young people with First Episode Psychosis (FEP). Digital interventions can circumvent many of the access and resource barriers that prevent families from engaging. The purpose of the current study was to better understand the experiences and challenges faced by caregivers who support a young person with FEP in the United States, and to use this information to guide the adaptation and further development of a digital intervention to support caregiver health and well-being. Methods: Participants engaged in interviews and focus groups centered on their experiences supporting an adult child with FEP, connecting their relative to CSC, and their preferences for a digital intervention to support caregivers. This study used content analysis to develop themes and subthemes across interview and focus group data. Results: Eight participants participated in the interviews and focus groups. Our findings support prior research indicating caregivers of young people with psychosis need evidence-based information about psychosis and assistance in managing systemic, social, and intrapersonal challenges. Participants advocated for a program with multimedia that could be accessed anywhere and anytime, facilitated connections with other caregivers, and emphasized messages of hope and recovery. Conclusion: Interventions aiming to promote mental health and well-being for FEP caregivers in the United States should incorporate evidence-based information about psychosis specific to caregivers and their relative's recovery stage, guidance for navigating the healthcare system and privacy laws, and actionable skills related to illness management, effective communication, and self-care.

Black Americans are diagnosed with schizophrenia spectrum disorders at more than twice the rate of White individuals and experience significantly worse outcomes following diagnosis. Little research has examined specific factors that may contribute to worse functional outcomes among Black Americans diagnosed with schizophrenia. One approach to understanding why racial disparities emerge is to examine established predictors of functioning in this population: neurocognition, social cognition, and symptom severity. The present study aims to broaden existing literature on racial differences within these domains by (a) examining racial differences in functioning and these established predictors of functioning (i.e., neurocognition, social, and symptom severity) and (b) investigating whether cognition and symptom domains similarly predict functioning between Black and White Americans with schizophrenia. Sixty-six participants' baseline neurocognition, social cognition, symptom severity, and functioning were assessed. Black participants demonstrated lower neurocognition scores and higher levels of disorganized symptoms relative to White participants. No racial differences in functioning or social cognition were observed. Further, race did not moderate the relationship between any of these established predictors and functioning outcomes. The largely nonsignificant differences in known predictors of functioning highlight the need to explore further domains that may be more relevant for understanding racial disparities in schizophrenia. Considering that psychosocial treatments for schizophrenia spectrum disorders often focus on cognition, these results underscore the importance of identifying whether these domains or other treatment targets may be better in addressing racial disparities in functioning. Possible areas of exploration for future work (e.g., structural factors, racism-related stress) are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Autistic adults and those with schizophrenia (SCZ) demonstrate similar levels of reduced social cognitive performance at the group level, but it is unclear whether these patterns are relatively consistent or highly variable within and between the two conditions. Seventy‐two adults with SCZ (52 male, M_age = 28.2 years) and 94 with diagnoses on the autism spectrum (83 male, M_age = 24.2 years) without intellectual disability completed a comprehensive social cognitive battery. Latent profile analysis identified four homogeneous subgroups that were compared on their diagnosis, independent living skills, neurocognition, and symptomatology. Two groups showed normative performance across most social cognitive tasks but were differentiated by one having significantly higher hostility and blaming biases. Autistic participants were more likely to demonstrate fully normative performance (46.8%) than participants with SCZ, whereas normative performance in SCZ was more likely to co‐occur with increased hostility and blaming biases (36.1%). Approximately 43% of participants in the full sample were classified into the remaining two groups showing low or very low performance. These participants tended to perform worse on neurocognitive tests and have lower IQ and fewer independent living skills. The prevalence of low performance on social cognitive tasks was comparable across clinical groups. However, nearly half of autistic participants demonstrated normative social cognitive performance, challenging assumptions that reduced social cognitive performance is inherent to the condition. Subgrouping also revealed a meaningful distinction between the clinical groups: participants with SCZ were more likely to demonstrate hostility biases than autistic participants, even when social cognitive performance was otherwise in the typical range.Lay Summary: Social cognition refers to the perception and interpretation of social information. Previous research has shown that both autistic people and those with schizophrenia demonstrate reduced performance on traditional social cognitive tasks, which we replicate here at the group level. However, we also found that almost half of autistic participants performed in the normal range. Over a third of participants with schizophrenia did as well, but for them this performance was accompanied by a hostility bias not commonly found in the autistic sample. Taken together, findings challenge assumptions that difficulties in social cognition are a uniform characteristic of these clinical conditions in those without intellectual disability.

Background: Loneliness is a concern for patients with schizophrenia (SCZ). However, the correlates of loneliness in SCZ are unclear; thus, the aim of the study is to investigate neuro- and social cognitive (SC) mechanisms associated with loneliness in SCZ. Methods: Data for the study were pooled from two cross-national samples (Poland/USA) and included 147 SCZ and 103 healthy controls (HC) overall. Data from clinical, neurocognitive, and SC assessments were examined as potential predictors of loneliness in HC and SCZ samples pooled across two sites. Furthermore, Latent Class Analysis (LCA) was used to cluster patients based on SC capacity. Next, the relationship between SC and loneliness was explored in each cluster of SCZ. Results: SCZ reported higher levels of loneliness than HC. Loneliness was linked to increased negative and affective symptoms in patients. A negative association between loneliness and mentalizing and emotion recognition abilities was found in the patients with social-cognitive impairments, but not in those who performed at normative levels. Conclusions: We have elucidated a novel mechanism which may explain previous inconsistent findings regarding the correlates of loneliness in SCZ. As decreased SC capacity may be linked with loneliness only in patients with observable SC impairments, SC heterogeneity in SCZ needs to be recognized while planning psychosocial interventions targeting loneliness in this group.

The therapeutic alliance has long been considered an essential part of treatment. Despite a large body of work examining the alliance-outcome relationship, very few studies have examined it within individuals with first episode psychosis (FEP). The present study examined the alliance at Session 3, 4, or 5 and its relationship to 2-year treatment outcomes and therapy participation in a sample of 144 FEP clients who received specialized FEP treatment at U.S. clinics. Furthermore, we examined between-therapist and within-therapist (client) effects of the alliance on outcomes. Results indicated that a better alliance was related to improved mental health recovery, psychological well-being, quality of life, total symptoms, negative symptoms, and disorganized symptoms at the end of treatment. In addition, the between-therapist effect of the alliance was significantly related to better mental health recovery whereas the within-therapist (client) effect of the alliance was related to better quality of life, total symptoms, and negative symptoms at the end of treatment. A stronger alliance was related to improved treatment outcomes in FEP. Future work should consider examining mediators of the alliance-outcome relationship as well as how changes in the alliance relate to changes in outcomes over time. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Negative symptoms and depression persist in one third of patients with schizophrenia. Previous studies suggested that depression has more impact on self-perceived compared to observer-rated social functions. Reduced emotional experience, a subdomain of negative symptoms, predicts social functioning deficits, although its role in self-assessment is unclear. We examined depression and reduced emotional experience and self-reports and informant ratings of social functioning and social cognitive abilities in 135 patients with schizophrenia. Discrepancies between sources were used to index the accuracy and bias in self-assessment. Less severe depression was associated with self-reports of reduced impairments in social functioning and better social cognitive abilities. Reduced emotional experience was related to informant ratings and self-reports of social functioning. Neither reduced emotional experience nor depression was correlated with discrepancies between sources, despite the bias of patients with lower depression to report that they were higher functioning and more competent. These findings suggest that patients with schizophrenia make global judgments about functioning based on current mood states. There was minimal association between the depression severity and the accuracy of self-assessment, despite positive biases associated with lower depression severity. The determinants of accuracy and bias in self-assessment requires more detailed examination and subdivision of patients based on their depression.

Previous research on attributions in schizophrenia has focused on whether individuals make hostile, intentional attributions for ambiguous negative events. It is unclear, however, whether individuals with schizophrenia differ from controls in their general judgments of intentionality judgments in nonconflict and emotionally neutral situations. Research in social psychology suggests that nonclinical individuals present with an automatic bias to see intentionality and that this bias is regulated by the operation of controlled processes. The present study examined whether this general intentionality bias distinguishes individuals with schizophrenia (n = 213) from nonpatient controls (n = 151). Indeed, individuals with schizophrenia were more likely to attribute intentional motives to others' actions relative to controls. This intentionality bias was related to hostility, role functioning, and independent living skills. These findings may provide one domain to examine in future approaches to social cognition in schizophrenia. (PsycINFO Database Record

The first section of the SCIT Clinician Guide includes six chapters that provide step-by-step instructions for implementing Phase I of SCIT. Phase I constitutes the first third of the intervention, lasting approximately two months, or seven weekly group sessions. The foci of Phase I are introducing clients to the intervention, providing psychoeducation about emotions, and providing training in recognizing emotions in oneself and others. This chapter describes Session 6, in which group members continue emotion perception training using more difficult stimuli consisting of faces that morph subtly between emotions. Clients continue to use skills learned in the previous session, and also practice assigning confidence estimates (0 to 100%) to emotion perception judgments. This technique is designed to increase social cognitive flexibility and metacognitive self-awareness, and to decrease bias against disconfirmatory evidence.

A converging body of clinical and empirical reports indicates that autism features elevated rates of paranoia comparable to those of individuals with paranoid schizophrenia. However, the distinct developmental courses and symptom manifestations of these two disorders suggest that the nature of paranoid ideation may differ between them in important and meaningful ways. To evaluate this hypothesis, we compared patterns of responses on the Paranoia Scale between actively paranoid individuals with schizophrenia (SCZP), individuals with schizophrenia who were not actively paranoid (SCZNP), adults with an Autism Spectrum Disorder (ASD), and healthy controls. Despite an overall similar level of heightened paranoia in the ASD and SCZP groups, discriminant correspondence analysis (DiCA) revealed that these groups were characterized by unique underlying factors. Paranoia in the SCZP group was defined by a factor based upon victimization, suspicion, and threat of harm. Whereas paranoia in the ASD group was partially characterized by this factor, it was distinguished from SCZP by an additional pattern of responses reflective of increased social cynicism. These findings indicate that paranoia in ASD is supported by qualitative factors distinct from schizophrenia and highlight mechanistic differences in the formation of paranoid ideation that may inform the development of disorder-specific treatments.