Social cognition deficits and violence in people with a diagnosis of schizophrenia

Abstract

Introduction It is widely reported that people with schizophrenia have social cognition deficits. In addition to their negative impact on functioning and quality of life, these deficits may also contribute to the use of violence. It has recently been established that social cognitive interventions (SCIs) can ameliorate deficits in facial affect recognition (FAR). This project aimed to systematically review whether SCIs can also improve theory of mind (ToM) abilities in people with schizophrenia. The empirical study aimed to explore whether the extent of the deficits in FAR and ToM in people with schizophrenia differed between those with and without a substantial history of violence. Method A systematic review was undertaken to identify studies where SCIs were provided to adults with schizophrenia or schizoaffective disorder. Key findings were highlighted with the quality of the studies’ methodology and reporting assessed. A quantitative research study was also undertaken involving 22 men aged 18-64 with a diagnosis of schizophrenia or schizoaffective disorder, comparing those with and without a substantial history of violence (SHV) on measures of FAR and ToM. Results The majority of the 13 studies included in the systematic review found that the provision of SCIs led to significant improvements in ToM. However, all studies demonstrated a potential for bias and were limited by inadequate sample size. In the empirical study, less than half of participants scored within the normal range for overall FAR ability, with no difference identified between the SHV and no-SHV group. However, the SHV group were poorer at recognising sadness and showed a tendency to perform better at the detection of faux pas, compared to the no-SHV group. Conclusions The systematic review identified that a wide range of SCIs can improve ToM abilities in people with schizophrenia. Its findings highlight that stringent, adequately powered studies should be undertaken, utilising standardised assessments of a range of levels of ToM ability, to enable identification of the most effective intervention. The findings of the empirical study are limited by a small and imbalanced sample size between groups and so must be interpreted with caution. However, patterns observed in the results highlight areas for further exploration. The strengths of this study’s design and recruitment challenges are discussed.