Stefanie J Schmidt1,2, Frauke Schultze-Lutter3, Ana Cerne1, Benno G Schimmelmann1,4, Jochen Kindler1, Daniela Hubl5, Michael Kaess1,6, Chantal Michel1; 1University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland, 2Clinical Psychology for Children and Adolescents, University of Bern, Switzerland, 3Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany, 4University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland, 5University Hospital Hamburg-Eppendorf, Hamburg, Germany, 6Section for Translational Psychobiology in Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
Poor social functioning is highly prevalent in subjects at clinical high risk (CHR) for psychosis and predictive of conversion to manifest psychosis. Neuro-cognitive and social-cognitive domains have found to be important predictors of social functioning in patients with psychosis. Some evidence also suggests that the relationship between neurocognition and functioning is mediated by social-cognitive domains and negative symptoms. However, these relationships are still poorly understood in CHR-subjects. Therefore, the aim of this study was to use structural equation modeling to estimate the relationships between neurocognitive domains, empathy as a specific social-cognitive domain, social functioning and positive as well as negative CHR-symptoms. The sample comprised 96 individuals (9-35 years), who sought help at the “Early Recognition and Intervention Center for mental crisis” (FETZ) Bern. CHR-symptoms were assessed using the Structured Interview for Psychosis-Risk Syndromes; social functioning by the social and occupational functioning assessment scale (SOFAS) and neurocognition by a comprehensive assessment-battery. The German version of the Interpersonal Reactivity Index (IRI) was used to assess empathy. Both neurocognitive domains and empathy were significantly associated with social functioning. Moreover, these relationships were significantly mediated by negative symptoms. No evidence for a mediating role through empathy or positive CHR-symptoms could be detected. The model showed a good fit to the data (RMSEA=0.04, CFI=0.96, TLI=0.95). This suggests that deficits in empathy as well as negative symptoms should be monitored carefully and treated as early as possible to prevent a negative cascading effect and to optimize generalization effects of neurocognitive remediation on social functioning.
