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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 25  |  Issue : 1  |  Page : 31-38

Social cognition in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms: A comparative study


1 Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Department of Clinical Psychology, Post Graduate Institute of Behavioural and Medical Sciences, Raipur, Chhattisgarh, India
3 Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India

Date of Submission04-Feb-2020
Date of Decision08-Mar-2020
Date of Acceptance23-May-2020
Date of Web Publication7-Oct-2020

Correspondence Address:
Vikas Kumar
Department of Clinical Psychology, Central Institute of Psychiatry, Kanke, Ranchi - 834 006, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_6_20

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  Abstract 


Background: Non-affective psychosis refers to psychosis unrelated to mood or affect. Affective psychosis is a psychological disorder where people experience a loss of contact with reality and experience mood disturbances working as a primary cause. The focus has been shifted to the first-degree relatives of these populations to prevent the disorder at the earliest. So, the first-degree relatives are known to be a high-risk population with genetic vulnerability. These two disorders (schizophrenia and mania with psychotic symptoms) show various impairments in various field but these impairments are present to define these disorders, unaffected relatives of these two disorders for different areas like social, cognitive, neurocognitive and social functioning. Cognitive dysfunction and social cognition dysfunction as a trait marker nearly established in affective and non- affective populations. Aims and Objectives: Purpose of this study to assess social cognition, neurocognition and social functioning in FDRs of patients with schizophrenia and mania with psychotic symptoms. Methodology: The sample consisted of 30 FDRs of patients with schizophrenia and mania with psychotic symptoms and 15 normal healthy control. After the initial screening by the clinical assessments, based on their amenability for the interview, Social Cognition Rating Tools in Indian Setting (SOCRATIS) was applied to all three groups. Result and Conclusion: The study found that first degree relatives of patients with schizophrenia group found to be lower in externalized attribution bias on a measure of social cognition compared to FDRs of patients with mania with psychotic symptoms group and healthy controls. And the FDRs of patients with schizophrenia and mania with psychotic symptoms groups were found higher in reaction time in trail making on a measure of neurocognition compared to healthy controls.

Keywords: Affective and nonaffective psychosis, first-degree relatives, mania, schizophrenia, social cognition


How to cite this article:
Kumar V, Tikka DL, Das B. Social cognition in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms: A comparative study. J Mental Health Hum Behav 2020;25:31-8

How to cite this URL:
Kumar V, Tikka DL, Das B. Social cognition in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms: A comparative study. J Mental Health Hum Behav [serial online] 2020 [cited 2020 Nov 29];25:31-8. Available from: https://www.jmhhb.org/text.asp?2020/25/1/31/297422




  Introduction Top


Nonaffective psychosis refers to psychosis that is not related to emotions or mood. Schizophrenia and delusional disorders are examples of nonaffective psychosis, unlike bipolar disorder which is an affective psychosis involving emotional and mood abnormalities. Affect in the psychological sense refers to a person's emotional state. Affective psychosis is a psychological disorder where mood disturbances are the primary cause and the person may experience a loss of contact with reality. Over time, the focus has shifted to the first-degree relatives (FDRs) of these populations to prevent the disorder at the earliest. Hence, the FDRs are known to be a high-risk population with a genetic vulnerability and have been widely studied.

Schizophrenia is a disorder with variable phenotypic expression and poorly understood complex etiology. It involves a major genetic contribution, as well as environmental factors interacting with genetic susceptibility.[1] It is a complex and severe mental disorder, affecting the participant's actions, perceptions, emotions, and cognitive functions.[2],[3] Very often, this illness persists for a lifetime in the individual rendering patient dependent on the public health system. The onset of the disease is most common at the beginning of adulthood. The etiopathogenesis indicates that genetic predispositions and developmentally early hits such as social stress enhance the probability of developing schizophrenia.[4] Mania is characterized by a broad array of symptoms including grandiosity, mood lability, decreased need for sleep, and cognitive impairment.[5] A person may also experience psychotic symptoms, impaired functioning, substance abuse, and anxiety disorders.[6] During a manic episode, individuals usually may not perceive that they need treatment, although consequences of poor judgment, hyperactivity, and lack of insight are severe enough to profoundly impair their social and professional functioning. These two psychotic disorders show impairments in various fields of functioning.

Social cognition is usually defined as the ability to construct representation about oneself, others, and interpersonal relationships.[7] Social cognition refers to the psychological processes that are involved in the perception, encoding, storage, retrieval, and regulation of information about other people and ourselves. It is a multidimensional construct that includes identifying others' affect display, inferring others' mental states, attributing meaning to others' actions, reading others' social cues, applying a working knowledge of social rules to socially reciprocate in kind, and managing one's emotional responses to maintain interpersonal relationships.[8] Individuals with schizophrenia often display marked impairments in processing social information, which can result in misinterpretations of the social intent of others, social withdrawal, and impaired daily social functioning. Indeed, in such individuals, social cognitive impairment has a more negative effect on daily functioning than noncognitive social functions.[9],[10]

An FDR is a family member who shares about 50% of their genes with a particular individual in a family. FDRs include parents, offspring, and siblings. In other words, a person's FDR is a parent, sibling, or child, and they share about half of their genes with the person. Schizophrenia is a major psychiatric disorder with variable phenotypic expression, and still, it is not thoroughly understood by the mental health community; this disorder is marked by very complex etiology which involves myriad genetic contributions, as well as environmental factors interacting with the genetic susceptibility. Multiple genes and different combinations of their polymorphic variant provide the genetic background, with a proportion of the transmitted genotypes remaining clinically unexpressed.[11] People with schizophrenia experience and develop a wide and diverse array of psychological difficulties reaching beyond the symptoms of the disease. People often experience very recalcitrant symptoms, and the longer presence of those symptoms leads to a significant reduction in all spheres of their socio-occupational, personal, and intellectual skills. They develop marked impairment in myriad cognitive and intellectual skills and abilities, affect and emotions, interpersonal and social skills, and so on.[12],[13],[14]

Social cognition and first-degree relatives of patients with schizophrenia and mania with psychotic symptoms

The importance of social cognition, functioning, and difficulties in social integration are frequently found in patients with schizophrenia and may affect their quality of life, thus revealing that the underlying mechanisms of these differences appear to be of high importance. The impairment of social functioning has been reported in FDRs of schizophrenia patients and individuals at ultra-high risk for psychosis.[15] Meta-analyses and many studies were reviewed in which various theory of mind (ToM) tests were performed on FDRs of patients with schizophrenia showing both positive and negative results.[16] Social cognitive functions of FDRs were found to be affected, which suggests the role of social cognition as an endophenotypic marker of schizophrenia.[17] Ay et al. have identified the ToM defects in schizophrenia patients and their FDRs. The defect in schizophrenia patients was significantly higher than that in the families. ToM and emotion recognition were found to be areas of difficulty in schizophrenia patients and their FDRs. The performances on ToM and emotion recognition were ranked from the worst to the best in the schizophrenia FDRs' group and the control group. The schizophrenia group showed poor performance in all subcomponents except irony. In the FDRs' group, the empathy subcomponent showed similar performance with the control group, whereas the subcomponents of the second-order false belief, metaphor, and faux pas tests showed similar performance with the patient group.[18] Santos et al. studied the capacity for mentalization of patients with bipolar disorder and their FDRs and examined the implications of clinical variables and cognitive deficits. Patients and FDRs were found to have a ToM deficit when they were evaluated with the Movie for the Assessment of Social Cognition, which was found to be similar in case of their performance in neurocognitive domains. The evidence of ToM deficits in FDRs supports the hypothesis that these deficits could be an independent trait marker for the cognitive deficit.[19]

Need for the study

Social cognitive deficits have been demonstrated in first-episode psychosis and affective psychosis, but the degree of deficit in family members of these groups at high risk for developing psychosis is unclear. Similarly, the deficit in social cognition in the group of affective psychosis and their FDRs is found to be inconsistent. Exploring the extent of deficit in these two groups of FDRs as the high-risk population in social cognition might help in developing preventive strategies for affective and nonaffective psychosis. The degree of impairment will also help to understand the progression of these disorders by studying FDRs of patients with affective and nonaffective psychosis.

The present study aimed to assess social cognition, neurocognition, and social functioning in FDRs of patients with schizophrenia and mania with psychotic symptoms. The objectives of the study were as follows: (i) to compare social cognition, neurocognition, and social functioning in FDRs of patients with schizophrenia and mania with psychotic symptoms; (ii) to correlate social cognition, neurocognition, and social functioning in FDRs of patients with schizophrenia; (iii) to correlate social cognition, neurocognition, and social functioning in FDRs of patients with mania with psychotic symptoms.


  Methodology Top


This study was carried out in out and inpatient of the institution, after due approval from the Institute Ethics Committee. All the participants were recruited after obtaining written informed consent. The study sample comprised three groups: Group I included 15 FDRs of patients with schizophrenia from clinical population diagnosed recent onset as per ICD-10 (DCR) criteria, Group II included 15 FDRs of patients with mania with psychotic symptoms from clinical population diagnosed recent onset as per ICD-10 (DCR) criteria, and Group III included 15 healthy controls. Participants in all the three groups were aged between 18 and 50 years, could read Hindi, and provide written informed consent/assent for the study. In addition, to be included, the FDRs of patients were required to have a sibling with the diagnosis of schizophrenia and mania with psychotic symptoms but themselves not diagnosed with schizophrenia, mania with psychotic symptoms, or any other diagnosable mental disorder. Participants in the healthy control group were required to be free from any mental disorder (as screened using the General Health Questionnaire [GHQ]-12); only those with scores <3 were included,[20] with no family history of any major mental disorder in the FDRs. In addition, all the participants required a minimum of 8 years of formal education, normal vision and hearing, and sufficient mastery in Hindi to undergo the task and in the age group of 18–50 years. Exclusion criteria were a history of neurological illness, significant head injury, substance dependence (excluding nicotine and caffeine), and other psychiatric disorders, disruptive behavior (suicidal or homicidal) that warranted immediate intervention. All the three study groups were matched for age, gender, and education, and the FDRs of patients with schizophrenia, FDRs of patients with mania with psychotic symptoms, and healthy controls were evaluated on the GHQ-12 to rule out any psychiatric morbidity. The FDR groups included one person from among the siblings or parents of the patients who were selected in the study.

The following tools were used in the study: consent form which was used to regard the consent for the participation of the sample in the current research. The sociodemographic and clinical data sheet was designed to collect all details regarding age, sex, education, occupation, marital status, religion, caste, domicile, family income, duration of illness of the patient, etc. Additional information about the patient will be taken with the help of the institute's case record file of the patient. The GHQ-12 was introduced by Goldberg and Williams in 1988. It is a screening device for identifying minor psychiatric disorders in the general population and within the community or nonpsychiatric clinical settings such as primary care or general medical outpatients. The self-administered questionnaire focuses on two major areas: (a) the inability to carry out normal functions and (b) the appearance of new and distressing phenomena. Social Cognition Rating Tools in Indian Setting (SOCRATIS)[21] is a test battery that includes tools for social cognition constructs. The ToM and attributional bias test were used for the study.

Procedure

FDRs of patients with schizophrenia and mania with psychotic symptoms have been identified for the study. Written informed consent was taken from all the FDRs of patients with schizophrenia and mania with psychotic symptoms. Only those fulfilling the inclusion criteria were selected for the study. Sociodemographic data were taken from selected participants, and assessment on these FDRs was done. Participants from all the groups were assessed on tasks of social cognition (tests from SOCRATIS). The control group (Group 3) was selected from the normal population and included those who were fulfilling inclusion criteria and provided written informed consent. The GHQ-12 was applied to normal participants, and only those participants were taken who scored less than 3. Subsequently, the tools of social cognition (SOCRATIS, ToM, and attributional bias) were administered.

Statistical analysis

Appropriate statistical methods were used for analyzing the data. The result obtained was analyzed using the computer software program Statistical Package for the Social Sciences version 22.0 for Windows, Manufactured by IBM, New York, USA). Descriptive statistics were used for percentage, means, and standard deviation (SD). Group differences for sample characteristics and experimental variables were examined with one-way ANOVA and Chi-square test wherever applicable, and the Bonferroni post hoc tests were used to confirm where the differences occurred between the groups. Pearson correlation was used to assess the relationship between the variables.


  Results Top


Sociodemographic variables

[Table 1] shows a comparison of age, family income, and education (continuous variables) across the three groups – FDRs of patients with schizophrenia, FDRs of patients with mania with psychotic symptoms, and healthy controls using one-way ANOVA. The three groups were comparable in these variables. There was no significant difference found between the three groups. In the FDRs of the schizophrenia group, the mean age was 38.40 years (SD = 3.54), and in the FDRs of mania with psychotic symptoms group, the mean age was 36.13 years (SD = 7.80). In the healthy control group, the mean age was 34.60 years (SD = 3.43). The mean family income for the schizophrenia group was 10000.00 (SD = 3316.62), and for FDRs of mania with psychotic symptoms, it was 9333.33 (SD = 3062.83). For the healthy control group, it was 12233.33 (SD = 4450.78) and gave comparative information about sociodemographic characteristics (discrete variables) of the experimental and healthy control groups. Discrete variables consisted of marital status, religion, occupation, and habitat. Pearson Chi-square or Fisher's exact test was used. No significant difference was seen in marital status. It was lower in FDRs of mania with psychotic symptoms, i.e., 13 (86.7%). In the FDRs of patients with schizophrenia group, the number of employed people was 3 (20.0%), and the in FDRs of mania with psychotic symptoms group, the number of employed people was the same, i.e., 4 (26.7%). It was 7 (46.7%) in the healthy control group. The finding suggests that there was no statistically significant difference among the three groups.
Table 1: Comparison of sociodemographic variables (continuous) between first-degree relatives of patients with schizophrenia and mania with psychotic symptoms and healthy control groups (n=45)

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Experimental variables

[Table 2] shows a comparison of attribution bias between the FDRs of patients with schizophrenia, FDRs of patients with mania with psychotic symptoms, and healthy controls. The FDRs of schizophrenia group were found to be lower in externalized attribution bias with the mean of −3.53 (SD = 3.04) compared to the FDRs of patients with mania with psychotic symptoms group with the mean of −0.73 (SD = 1.981) and healthy controls with the mean of −0.07 (SD = 2.37) and statistically significant at 0.001 levels. The Tukey's test used for post hoc analysis showed that the FDRs of schizophrenia group had lower scores than FDRs of patients with mania with psychotic symptoms; the FDRs of patients with schizophrenia group had lower scores than the control group, and the FDRs of patients with mania with psychotic symptoms group also had lower scores than the control group. The FDRs of patients with schizophrenia group were found to be higher in personalized attribution bias with the mean of 0.88 (SD = 0.11) compared to the FDRs of patients with mania with psychotic symptoms group with the mean of 0.82 (SD = 0.09) and healthy controls with the mean of 0.95 (SD = 0.10) and statistically significant at 0.005 levels. Post hoc analysis showed that the FDRs of patients with schizophrenia group and the FDRs of patients with mania with psychotic symptoms group had lower scores than the control group.
Table 2: Comparison of attribution bias in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms and healthy control groups (n=45)

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[Table 3] shows a comparison of the ToM indices between the three groups. In the first-order ToM task, the FDRs of patients with schizophrenia group were found to with the mean of 0.876 (SD = 0.162) and FDRs of patients with mania with psychotic symptoms 0.967 (SD = 0.088), respectively, compared to a healthy control group with a mean of 0.909 (SD = 0.195). No statistically significant difference was found across the three groups. On Second order Theory of Mind index (SOT), the FDRs of patients with schizophrenia group were found to with the mean of 0.851 (SD = 0.157) and FDRs of patients with mania with psychotic symptoms 0.867 (SD = 0.179) compared to the healthy control group with a mean of 0.917 (SD = 0.145). In faux pas recognition task, the FDRs of patients with schizophrenia group were found in the mean of 0.717 (SD = 0.148) and FDRs of patients with mania with psychotic symptoms group with a mean of 0.752 (SD = 0.199) compared to the healthy control group with a mean of 0.670 (SD = 0.234). In faux pas recognition task, the FDRs of patients with schizophrenia group were found in the mean of 0.717 (SD = 0.148) and FDRs of patients with mania with psychotic symptoms group with a mean of 0.752 (SD = 0.199) compared to the healthy control group with a mean of 0.670 (SD = 0.234). The difference was not statistically significant.
Table 3: Comparison of theory of mind indices in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms and healthy control groups (n=45)

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[Table 4] shows a correlation between sociodemographic variables and experimental variables in FDRs of schizophrenia. Pearson correlation was used. It was found that there are a significant negative correlation between age and education and a significant negative correlation between family income and the first-order ToM.
Table 4: Correlation between sociodemographic variables and experimental variables (social cognition) in first-degree relatives of patients with schizophrenia groups

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  Discussion Top


Sample characteristics and sociodemographic characteristics [Table 1]

The present study was conducted on 15 FDRs of a patient with schizophrenia, 15 FDRs of a patient with mania with psychotic symptoms, and 15 normal controls, with a mean age of 18–50 years. Results show that there is no significant difference between the groups. In the present study, the three groups were compared on various sociodemographic and clinical variables such as sex, marital status, religion, socioeconomic status, habitat, education, occupation, history, and family history. There was no significant difference found in all of these variables among the groups included in the study. The result reveals that in FDRs of patients with schizophrenia, 15 (100.0%) were married, in FDRs of patients with mania with psychotic symptoms, 13 (86.7%) were married and 2 (13.3%) were unmarried, and in the normal controls, 14 (93.3%) were married and 1 (6.7%) individual was unmarried. In the FDRs of patients with schizophrenia group, the number of employed people was 3 (20.0%), and in the FDRs of patients with mania with psychotic symptoms group, the number of employed people was 4 (26.7%). In the healthy control group, it was 7 (46.7%). The finding suggests that there was no statistically significant difference among the three groups. Further, the result shows that 40% of the FDRs of patients with mania and schizophrenia are from rural backgrounds, whereas in the FDRs of patients with mania group, it is 60%, but in the healthy control group, it is 33.3%. This was also not statistically significant. Being a government tertiary hospital, majority of the patients attend the services belonging to families hailing from rural habitat; hence, the obtained finding of the study justifies it. A similar finding was observed by Srinivasan and Thara that 80% of the patients with schizophrenia come from rural backgrounds.[22] In the present study, there was no significant difference found between the three groups. The reason for not having any significant difference on sociodemographic variables could be that samples were well matched for the present study. Similarly, the finding suggests that there was no significant association of social cognition with demographic variables, age of onset, duration of illness, residual symptoms, and level of functioning. However, some well-matched studies also observed no significant differences between relatives and controls.[23],[24]

Attribution bias in first-degree relatives [Table 2]

In the present study, all the three groups were compared to the domain of attribution bias as part of social cognition. The difference was found to be statistically significant at 0.001 level of external bias across all the three groups. The result shows that FDRs of patients with schizophrenia group were found to be higher in personalized attributional bias as compared to the FDRs of patients with mania with psychotic symptoms group and healthy controls. This difference was found to be statistically significant at 0.005 levels. Unaffected relatives of people with schizophrenia are a population of interest to evaluate the potential endophenotypic, the role of social cognition in schizophrenia as they share genetic information with those affected by the disorder.[25] To date, studies investigating social cognition in unaffected relatives of patients with schizophrenia have shown inconsistent results. For instance, some studies[26],[27] have reported decreased performance on tests of social cognition in unaffected FDRs in comparison with healthy controls, whereas others have found similar levels of performance. Concerning social cognition, patients with schizophrenia performed the worst and the healthy controls performed the best, with siblings falling intermediate between the patients and healthy controls on all the subtests of social cognition except for externalizing bias and personalized bias.[28] This variability across studies could be explained at least in part by the characteristics of the study participants (relatives and/or control subjects) or by the experimental tasks used to measure social cognition.[29] Hence, our study also showed that the relatives of schizophrenia attribute using either personalized bias or by externalized bias more than relatives of mania with psychotic symptoms, but biases in attributing meaning are higher in both the groups than normal controls. Research has shown that social cognitive deficits are seen among FDRs and thus are considered to be trait related.[30] Furthermore, a variety of social cognitive deficits, especially biases, are thought to underlie various psychotic symptoms in later life, such as paranoia.

Theory of mind in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms [Table 3]

There were no significant differences in the task of a ToM across the three groups. In the faux pas recognition task, the FDRs of patients with schizophrenia group and FDRs of patients with mania with psychotic symptoms compared to the healthy control groups found that the difference was not statistically significant. The previous study by Lavoie et al. suggested that social cognition is affected in people with schizophrenia, but whether this is the case for healthy relatives or FDRs of these patients is less clear even though relatives did not display important clinical social cognition deficits.[31] The study by Wang et al. confirmed subtle deficits in cognitive but not emotional ToM in FDRs of schizophrenia patients, which were not explained by global cognitive deficits.[32] However, some of the previous studies suggest that social cognitive deficits, particularly ToM disturbances, are seen during the symptomatic affective episodes which remit or do not persist during remission/euthymic phase,[33] whereas other studies suggest persistence of subtle social cognitive deficits even during the euthymic phase,[34] more so in the domain of cognitive ToM than emotional ToM.[35] Similar findings support the existence of social cognitive deficits among patients with BD and provide a cross-cultural validation for most of the existing data.[36] The presence of the higher level of social cognition deficits among FRDs in comparison to healthy controls suggests that these are stable traits, which are more often present in the patients and at-risk individuals. This suggests that social cognition deficits can be considered as another important endophenotype for schizophrenia. The presence of a higher level of impairment in SC among the FDRs suggests that there is a need to include assessment and interventions to address the SC deficits.[37]

Emotion recognition in first-degree relatives [Table 5]
Table 5: Comparison of Emotion Recognition in First Degree Relatives of patients with schizophrenia and mania with psychotic symptoms and healthy control groups (n=45)

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Findings on the comparison of correct emotion recognition of FDRs of all the groups revealed that there was no significant difference in emotion recognition in FDRs of patients with schizophrenia and mania with psychotic symptoms, compared with normal healthy controls. FDRs of the schizophrenia group were found to have a higher compared to the FDRs of mania with psychotic symptoms group and the healthy control group. Dimensions of social cognition have received particular attention in the literature, namely emotion processing (EP) and ToM.[38] EP refers to aspects of perceiving and using emotion, and the empirical knowledge of this aspect of social cognition is usually based in studies of affect perception in faces and eyes, whereas sometimes, it has been considered an EP task. This field of research is still emerging, and available studies were not sufficient to provide an up-to-date portrait of social cognition performance in relatives of people with schizophrenia and mania with psychotic symptoms. However, the literature is currently limited to studies on emotional processing in FDRs and so additional studies will be required to evaluate the full mean of social cognition abilities, including social perception, social knowledge, and attributional biases.

Correlation between sociodemographic variable and experimental variables in first-degree relatives of patients with mania with psychotic symptoms and first-degree relatives of patients with schizophrenia groups [Table 4]

The present study also shows the relationship between social cognition with sociodemographic and clinical variables in FDRs of patients with mania with psychotic symptoms and FDRs of patients with schizophrenia. The present study showed the negative correlation between ToM and family income (P < 0.05), which indicates that FDRs' family background makes a strong contribution to the development of their social cognition, in particular, to their understanding of false belief. This study shows few significant relations between variables of social cognition across the three groups. This study shows that unaffected FDRs of patients with schizophrenia and FDRs of patients with mania with psychotic symptoms display patterns of social cognition, which are different from healthy controls. It is not clear whether differences in performance between their relatives represent different degrees of functional compromise, such that general cognitive deficits affect specific aspects of social cognition in these groups. The present results underscore the need to carefully consider how general cognitive abilities affect social cognition in FDRs of patients with schizophrenia[39] and mania with psychotic symptoms and normal healthy controls.


  Conclusion Top


The present study is an attempt to a better understanding of social cognition in FDRs of patients with schizophrenia and mania with psychotic symptoms. The sociodemographic variables were matched, and this study reveals that the FDRs of people with schizophrenia show moderate difficulties in social cognition and the overall results are thus consistent with the hypothesis of an endophenotypic role of social cognition impairments in FDRs of patients with schizophrenia and mania with psychotic symptoms. Accordingly, it can be said that social cognition deficits among FDRs of patients with schizophrenia and mania with psychotic symptoms can act as an important endophenotype for estimating the risk of schizophrenia as well as a mania with psychotic symptoms. Further, social cognition deficits must be considered as an important target for intervention among the siblings to improve their outcome.

Limitations

The present study has some limitations. The sample size was modest and small, which made it difficult to generalize the results. There was a gender difference; more male participants could have been included. There was a difference in occupational status in FDRs and normal controls. Most of the participants were from low socioeconomic status and rural habitat, where the normal control group was from urban and middle socioeconomic status.

Implications of the study

In this study, attempts were made to understand the social cognition functioning of FDRs of patients with schizophrenia, FDRs of mania with psychotic symptoms, and normal controls. As a result, it was found that social cognition has been found to be poor as compared to normal controls. This study can help clinicians to understand deterioration in the social cognition of FDRs of patients with mental illness. It can also help to conceptualize the issue and plan preventive measures. It would also help to formulate an effective treatment plan to improve the socio-occupational functioning and quality of life of the FDRs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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