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Article

Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients

by
Yuchen Li
1,
Ruichenxi Luo
1,
Dongmei Wang
2,3 and
Xiangyang Zhang
1,2,3,*
1
School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China
2
Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China
3
Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
*
Author to whom correspondence should be addressed.
Brain Sci. 2023, 13(7), 1075; https://doi.org/10.3390/brainsci13071075
Submission received: 15 June 2023 / Revised: 10 July 2023 / Accepted: 13 July 2023 / Published: 15 July 2023
(This article belongs to the Section Neuropsychology)
Versions Notes

Abstract

:
Patients with schizophrenia are afflicted by severe clinical symptoms and serious cognitive dysfunction. The aim of this study is to investigate the potential relationships between clinical symptoms and empathy and their variations between overweight and non-overweight schizophrenia patients. To address this problem, a group of 776 inpatients diagnosed with chronic schizophrenia (504 overweight patients and 272 non-overweight patients) was recruited. The Positive and Negative Syndrome Scale (PANSS) and its five-factor model were employed to assess clinical symptoms, while empathy levels were measured using the Interpersonal Reactivity Index (IRI). The overweight patients had lower education levels but higher positive symptoms than the non-overweight patients (all p < 0.05). In addition, the overweight patients performed significantly better with respect to empathy (FDR-corrected p < 0.05). Additional multiple regression analyses indicated significant associations between the total score of the IRI and PANSS negative symptoms, gender, and family history of psychiatric disorders among the overweight group; among non-overweight patients, there was a significant correlation between suicide and the total score of the IRI. This study provides evidence suggesting that chronic schizophrenia patients who are overweight may have distinct clinical characteristics, particularly with respect to their empathy, compared with non-overweight patients. Moreover, different variables are associated with empathy in different groups.

1. Introduction

Schizophrenia is one of the most common serious mental illnesses and numbers among the most serious disabling diseases [1]. With the discovery of antipsychotic drugs, the symptoms of schizophrenia have been effectively improved, especially hallucinations and delusions, among other positive symptoms. Although the use of antipsychotic drugs has greatly mitigated the clinical symptoms of schizophrenia patients, most patients experience weight gain and even an increased risk of developing metabolic syndrome [2,3,4]. Epidemiological studies have shown that the rate of overweight and obesity among Chinese schizophrenia patients is 44.8% [5], which is significantly higher than that among healthy control group [6]. In addition, numerous studies have consistently found that individuals with schizophrenia are 2–4 times more likely to develop metabolic syndrome than the general population [7,8].
There are various causes of weight gain among schizophrenic patients; for example, second-generation antipsychotics can lead to increased food intake, binge eating, and energy expenditure, which interfere with a patient’s eating behavior [9,10]. This may be related to a patient’s leptin levels [11] and affinity for histamine H1 receptors [12,13], D2 receptors, and 5-HT2C receptors [14]. Experimental evidence suggests that olanzapine increases an individual’s preference for high-fat/high-sugar diets [15,16]. In addition, a large number of factors are related to the enhanced risk of obesity among schizophrenic patients, such as being female, older, less educated, sedentary, lacking with respect to exercise [17], and having poor dietary choices [18]. Also, studies have shown that increased weight among patients leads to higher rates of metabolic diseases, for instance, cardiovascular disease and diabetes [19,20], which increase mortality [21,22]. Consequently, patients with schizophrenia have a life expectancy of 10 to 15 years less than their peers without psychiatric disorders [23,24]. Various studies have reported that individuals who are obese tend to exhibit lower self-esteem [25], higher rates of depression, and an elevated risk of suicide [26,27]. Therefore, weight gain is a key issue for patients with schizophrenia and needs to be taken seriously.
A large number of studies have demonstrated an association between increased weight and clinical symptoms among individuals with schizophrenia [5,28,29,30]. A study involving Chinese patients with chronic schizophrenia found a positive association between improvement in psychopathological symptoms (like negative symptoms) and obesity [29]. In another study of first-episode schizophrenia patients, it was shown that increases in PANSS positive symptoms, general psychopathological symptoms, and total scores were significantly associated with weight gain [5]. One of the major characteristics of schizophrenia, neurocognitive impairment, has been highlighted by numerous researchers [31,32]. According to numerous studies, schizophrenia patients exhibit cognitive impairments across multiple domains, such as information-processing speed, attention/alertness, working memory, verbal learning, and social cognition [33,34,35,36], suggesting that neurocognitive function remains a major focus of studies on schizophrenia. In comparison, less attention is paid to social cognition, which is important for the prognosis of patients’ social and personal daily functioning. Several studies have indicated that schizophrenic patients also present social cognitive impairments, mainly in the form of difficulties with emotion recognition and understanding the thoughts of others as well as treating others emotionally [37,38]. A meta-analysis showed that social cognitive functioning was more strongly associated with outcomes of functioning among schizophrenia patients compared to neurocognition [39].
Empathy, as an important social cognitive function, involves sharing, understanding, and responding to the emotional experiences of others and usually includes both cognitive and affective components, suggesting that cognitive empathy refers to the cognitive process of comprehending and recognizing the emotions of others, while affective empathy relates to the emotional experience of sharing in the feelings of others [40]. However, research has found inconsistent results regarding cognitive and affective empathy among schizophrenia patients. Many reports have found deficits in cognitive empathy among patients with schizophrenia, but there has been controversy regarding affective empathy. For example, according to a meta-analysis, people with schizophrenia have severe impairments in emotional empathy [41], suggesting that schizophrenic patients have a reduced ability to experience emotions. Nonetheless, some studies have indicated that patients with schizophrenia do not exhibit significant differences in affective empathy when compared with that of healthy individuals [42,43]. Several studies even suggest that people with schizophrenia can exhibit a greater degree of affective empathy [44,45]. Thus, there is no consensus on the research regarding empathy among schizophrenia patients. In addition, it is unclear whether obese schizophrenics have impairments in empathy. A recent study found that Theory of Mind (TOM) may correlate with metabolic dysfunction among males suffering from schizophrenia, showing that BMI has an impact on both affective and cognitive theory of mind among male patients [46]. However, a study with inconsistent findings on the association between GNAS (guanine nucleotide binding protein, alpha stimulating) gene polymorphisms and cognitive empathy in healthy female populations reported that C393C allele carriers had higher Interpersonal Reactivity Index (IRI) perspective-taking (PT) scores in comparison to T allele carriers. Furthermore, it is noteworthy that individuals with the C393C allele have been found to have an elevated risk of metabolic disorders, including hypertension, obesity, and diabetes [47].
Many studies have confirmed the connection between clinical symptoms and empathy, which suggests that clinical symptoms are predictors of empathy among schizophrenia patients. For instance, one study discovered statistically significant relationships between empathy and negative symptoms and general psychopathology among chronic schizophrenic patients [48]. In addition, numerous previous reports revealed that empathy was markedly related to negative symptoms among schizophrenia patients in both subjective reports and based on behavioral assessments [49,50,51]. However, the link between positive symptoms and empathy is uncertain, as some studies have shown no relationship between them [52], whereas several studies have found a weak correlation between positive symptoms and empathy [48]. Furthermore, there is a significant association between anxiety, depression, cognitive impairment, and empathy among patients with schizophrenia [48,53,54]. Thus, no definite conclusions have been drawn regarding this issue.
Based on our current understanding, there is no existing research that has focused on exploring the correlation between empathy and overweight status among patients who have been diagnosed with schizophrenia. Therefore, this relationship deserves to be investigated intensively in the Chinese population. Such an investigation may help to improve our understanding of the treatment of specific patient groups. The main purpose of the current study is to investigate the potential differences in empathy and clinical presentation between patients with schizophrenia who are overweight and those who are not by using a cross-sectional design. This study had two main objectives: (1) to determine empathic ability assessed via IRI among Chinese overweight versus non-overweight schizophrenic patients and (2) to reveal the association between empathy and clinical symptoms in both patient groups. We proposed the following hypotheses. (1) Empathic abilities will be better in the overweight group than in the non-overweight group. (2) Clinical symptoms, especially negative symptoms, will correlate significantly with empathic ability.

2. Materials and Methods

2.1. Participants

From January to April 2019, 776 inpatients (male/female = 514/262) were recruited from four psychiatric hospitals located in Wuhan and Guangzhou. Trained investigators obtained general information, sociodemographic data, medical history, and the results of physical examinations and laboratory tests for all participants using a self-designed questionnaire.
The inclusion criteria and steps through which they were enforced were as follows: (1) patients had to be Han Chinese, aged between 18 and 70 years; (2) to ensure the accuracy of the diagnosis of schizophrenia, two trained psychiatrists independently utilized the Structured Clinical Interview of the DSM-IV (SCID) for diagnostic purposes; (3) patients’ duration of illness had to be at least one year; and (4) all patients had to have been receiving a consistent dose of antipsychotic medication for a minimum of 6 months prior to enrollment in the study. In addition, exclusion criteria were as follows: (1) comorbid serious physical illness (e.g., cardiovascular disease, infectious disease, cancer, and immune system disorders); (2) combination of severe neurological disorders or intellectual disability; (3) significant psychiatric symptom fluctuations in the last 2 weeks; and (4) pregnant or lactating women.
We obtained approval for the study protocol from the Institutional Review Board of the Institute of Psychology, Chinese Academy of Sciences. Prior to participation in this study, all participants or their legal guardians provided written informed consent.

2.2. Clinical Assessment

Six psychiatrists with more than 5 years of experience in clinical practice used the Positive and Negative Syndrome Scale (PANSS) to evaluate the psychopathological symptoms of the participants [55]. To ensure consistency and reliability, prior to initiating the study, the 6 psychiatrists attended a training course on using the PANSS. Thereafter, in a repeated assessment, they maintained an intra-rater correlation coefficient of 0.85 for the PANSS total score.
Traditionally, the PANSS is composed of positive, negative, and general psychopathology symptoms. However, we employed a novel five-factor model of the PANSS based on recent findings [56,57,58]. The five distinct components of the PANSS five-factor model are as follows: “Positive”, “Negative”, “Cognitive”, “Depressive”, and “Excitement”.

2.3. Empathy

In this study, the Interpersonal Reactivity Index (IRI), consisting of 28 items, was utilized to assess patient empathy [59]. The IRI has been frequently employed to gauge empathy among patients diagnosed with schizophrenia. It comprises four domains: Perspective Taking (PT), Fantasy (FS), Empathic Concern (EC), and Personal Distress (PD). The Cronbach’s α coefficient for the IRI was 0.775, and the Cronbach’s α coefficients for the factors ranged from 0.481 to 0.631. Although the Cronbach’s α coefficients for the factors were low, they were still at an acceptable level. This indicates that the scale has good internal consistency and good reliability. For the confirmatory factor analysis of scale, the four-factor model fit indices were χ2/df = 2.459, RMSEA = 0.043, GFI = 0.922, and AGFI = 0.906. The fit indices all reached a satisfactory level and had good validity.
PT is an individual’s tendency to spontaneously adopt the perspective of others and most clearly represents the cognitive aspect of empathy. FS is the ability to imagine and empathize with characters in virtual environments such as books, films, and television programs. EC most obviously corresponds to emotional empathy and refers to a tendency to empathize with and show concern for someone in a miserable situation. The PD scale measures an individual’s level of anxiety and discontent when they are in a stressful interpersonal environment. PT and FS are typically regarded as measures of cognitive empathy, while EC and PD are indicators of affective empathy. Previous studies conducted on Chinese populations have shown good clinical efficacy and test–repeat reliability of the Chinese version of the IRI [60].

2.4. Measurement of Anthropometric Variable

Standardized procedures were followed to measure weight and height of participants, and based on these measurements, we calculated the patients’ body mass index (BMI) values (kg/m2). The height of the participants was measured with an accuracy of one millimeter when standing upright and barefoot. Participants were instructed to wear light clothing and their weight was measured using an electronic scale with a precision of ±0.1 kg. We classified patients as either non-overweight (<23 kg/m2) or overweight (≥23 kg/m2) according to the standard BMI classification for Asians provided by the World Health Organization [61]. A BMI greater than or equal to 28 kg/m2 indicates that a person is obese [62].

2.5. Statistical Analysis

We used the χ2 test and the independent samples t-test to compare differences in demographic and clinical variables. Subsequently, correlations between clinical variables and empathy were analyzed using Pearson’s or Spearman’s correlation, as appropriate. Multivariate stepwise regression analysis, using the dependent variable of IRI total score, was further conducted to explore the variables related to empathy in the overweight and non-overweight groups.
We adjusted for multiple testing using the false discovery rate (FDR) method and conducted all statistical analyses using SPSS version 24.0. Statistical significance was determined as a two-tailed p-value < 0.05.

3. Results

3.1. Prevalence-Related, Clinical, and Demographic Characteristics of Overweight Patients

The demographic characteristics of all patients who were included in this study are presented in Table 1. The prevalence of overweight/obesity among patients with chronic schizophrenia was 64.9%, which was higher than that of the healthy southern Chinese population (33.7%) [6] and that reported in another epidemiological study of obesity in China (50.9%) [63] and similar to values reported in previous studies (40–70%) [5,64,65,66]. Also, the prevalence of obesity among patients with chronic schizophrenia was 18.9%, and there was no statistical difference in overweight/obesity rates between the male (62.8%) and female (69.1%) patient groups.
Compared to the non-overweight patients, overweight patients had fewer years of education (p = 0.001, FDR corrected p < 0.05), higher suicide rates (p = 0.015), and higher PANSS positive symptoms scores (p = 0.014; FDR corrected p = 0.056) but lower PANSS negative symptom scores (p = 0.025; FDR-corrected p = 0.061). (Table 2).

3.2. Comparison of IRI Scores between Non-Overweight and Overweight Patients

All patients completed the IRI. Table 3 shows the IRI scores of the participants. Compared to the non-overweight patients, the overweight patients performed better with respect to the IRI total score and PT and EC scores (all FDR-corrected p < 0.05).

3.3. Relationship between Overweight and Empathy

Among all participants, the IRI total score showed negative correlations with age, age at first hospitalization, PANSS negative symptoms, general psychopathology, and total score but positive relations to education (all FDR-corrected; p < 0.05). Further multiple regression analysis using BMI as the dependent variable showed that IRI-based perspective taking (β = −0.071, t = 1.977, p = 0.048, and R2 change = 0.005), PANSS positive symptoms (β = 0.130, t = 3.591, p < 0.001, and R2 change = 0.016), PANSS negative symptoms (β = −0.077, t = −2.174, p = 0.040, and R2 change = 0.009), education years (β = −0.125, t = −3.469, p = 0.001, and R2 change = 0.10), and age (β = −0.077, t = −2.174, p = 0.030, and R2 change = 0.006) were associated with BMI.
Table 4 and Table 5 present the correlation coefficient matrices for empathy and clinical symptoms among the non-overweight and overweight patients, respectively. In the overweight group, PT, EC, and IRI total scores were negatively related to PANSS negative symptoms, general psychopathology, and total scores (FDR-corrected; all p < 0.05). However, no remarkable relationships between IRI total score and PANSS scores were observed among the non-overweight patients. In addition, PD was positively correlated with PANSS negative symptoms, general psychopathology, and total scores among the non-overweight patients (FDR-corrected; all p < 0.05).
After conducting an additional regression analysis on the overweight patients, we found an independent association between the IRI total score and PANSS negative symptoms (β = −0.202, t = −4.617, p < 0.001, and R2 change = 0.38), gender (β = 0.094, t = 2.136, p = 0.033, and R2 change = 0.009), and family history (β = 0.105, t = 2.386, p = 0.017, and R2 change = 0.013). In addition, among non-overweight patients, suicide was only associated with IRI total score (β = 0.171, t = 2.834, p = 0.005, and R2 change = 0.029).

4. Discussion

To the best of our knowledge, our study appears to be the first study conducted in China that investigates potential associations between overweight status, empathy, and clinical symptoms among schizophrenia patients. Some of the principal discoveries of this study were as follows: (1) The overweight group showed greater empathy than the non-overweight group. (2) Among the overweight patients, PANSS negative symptoms, gender, and family history were independently associated with the total score of the IRI. (3) Among the non-overweight patients, suicide was only associated with IRI total score.
This study revealed that overweight patients exhibited higher levels of empathy compared to non-overweight patients. Although there is a paucity of literature on the empathic capacity of overweight patients, our finding is consistent with that of a previous study reporting that a metabolic-dysfunction-related gene was associated with higher cognitive empathy among female participants [47]. Moreover, another study found that among females with schizophrenia, those with higher BMI scores possessed a greater capacity for empathy [67]. We hypothesized that there are several explanations for these findings. First, our study observed that overweight patients scored lower in terms of negative symptoms but higher in terms of depressive symptoms according to the PANSS five-factor model. One study investigated the link between negative symptoms and empathy among individuals diagnosed with schizophrenia; the authors consistently found associations between them [48], suggesting that the fewer negative symptoms a patient has, the greater their overall ability to empathize. Furthermore, studies have shown that greater depressive symptoms are associated with greater emotional empathy [48,68], which might explain the greater empathy among overweight patients with greater depressive symptoms. Second, oxytocin (OXT) has been extensively studied in terms of its being a key factor linking social signals to cognition, behavior, and reward [69]. OXT is central to the regulation of many social–behavioral domains, like emotion perception and empathy [70], and it also promotes the neuronal growth of specific brain regions related to social behavior and positive emotion induction [71]. Also, this study found that the obese group had significantly higher OXT levels than the healthy group, and these levels were associated with BMI and body fat levels [72]. Furthermore, the higher the serum OXT level, the higher the risk of metabolic syndrome [73]. Studies have demonstrated the use of OXT as a novel drug to treat social–behavioral deficits, such as emotion recognition and empathy, among patients with psychiatric disorders [70,74,75,76], with the results showing significant improvements in these symptoms after treatment. Also, one study revealed that men with schizophrenia who had a significantly lower BMI were worse at recognizing joyful emotions, and it found a significant positive correlation between the recognition of joyful emotions and IRI perspective taking [67]. In one large cohort study, there was an association between a common oxytocin receptor (OXTR) gene polymorphism (rs53576) and emotional empathy [77]. OXT requires the activation of G proteins in order to signal, and a healthy cohort study found a significant correlation between cognitive empathy and the GNAS C393T gene polymorphism involved in the encoding of G proteins. Minoretti et al. [78] hypothesized a possible association between the TT genotype and the schizophrenia deficiency syndrome subtype, for which affected patients typically present poor empathy [79]. However, C393C allele carriers have been shown to have more empathic tendencies, with higher IRI PT scores compared to C393T allele carriers, and the C393C allele has been recognized as a risk factor for several metabolic disorders, including obesity [47]. Third, our study observed a higher suicide rate in the overweight group, and related studies confirm that suicide relates to greater levels of empathy [80]. One study reported that schizophrenics who committed suicide had a higher intensity of von Economo neurons (VEN) located anterior to the cingulate gyrus (which has been widely shown to be strongly associated with empathy) compared to patients with other causes of death [81,82]. Notably, there were more female patients in our overweight group, and an increasing number of studies have shown that females perform better than males in terms of empathy [67,83,84]. However, the empathic difference found in this paper has not been definitively found in healthy populations or among other psychiatric patients, so it would be interesting to validate this result with respect to different people to verify whether this difference is unique to schizophrenics. Overall, the findings of our study suggest that overweight patients with schizophrenia may exhibit better empathy compared to non-overweight patients. As this study is an initial investigation of the association between overweight/obesity and empathy among individuals with schizophrenia, it is necessary to confirm this relationship in further research.
Notably, our results showed that PANSS negative symptoms were lower among the overweight participants, and this result is consistent with previous studies that reported a negative association between BMI and PANSS negative symptoms among chronic schizophrenia patients [29,30]. More interestingly, our study only showed a significant and independent association between negative symptoms and the empathy total score in the overweight group, thus corroborating previous research findings. This strongly suggests that there is a significant link between empathy and negative symptoms among individuals with schizophrenia [48,79]. One study found that lower levels of amygdala activation might be related to negative symptoms and empathy deficits, which could be the underlying mechanisms [85]. In addition, some studies utilizing different empathy assessment tools supported these results based on findings that negative symptoms predicted empathy test results [50,51]. However, some studies did not find an effect of negative symptoms on empathy [86]. Conflicts between previous reports regarding the effect of negative symptoms on empathy likely reflect the influence of schizophrenia subtype groups. In addition, we found a significant contribution of gender to the IRI total score, which is consistent with the previously found significant gender differences regarding empathy [47,67,84]. More interestingly, as in the prior findings, we found a significant association between suicide and IRI total scores among overweight patients [80]. Notably, the lower rate of suicide in the non-overweight group may be explained by the higher levels of negative symptoms, which constitute a protective factor against patient suicide [80,87,88]; additionally, patients with higher negative symptoms have lower suicide rates and are less empathic.
The several limitations of this study should be acknowledged. First, it should be noted that this study’s cross-sectional design restricted our ability to draw conclusions regarding whether clinical symptoms and empathy are directly correlated among patients with both overweight and schizophrenia. Therefore, our findings are only preliminary explorations. Second, our study did not include healthy controls and could neither determine whether schizophrenia patients have impaired empathy nor confirm the degree of impaired empathy among overweight and non-overweight patients. Third, patients with schizophrenia often have a severe cognitive impairment, and the use of the IRI, a self-rated scale widely used to assess empathy, may have the potential to produce relatively inaccurate results. Therefore, in the future, it is advisable to measure empathy in conjunction with other objective assessment tools or measurements in order to arrive at an accurate final result. Fourth, this study did not measure and compare neurocognitive function among overweight and non-overweight schizophrenia patients. Patients with schizophrenia usually suffered from poor neurocognitive function, and it is not known whether being overweight/obese affects cognitive function [89]. Several studies have found a strong link between neurocognitive function, clinical symptoms [90,91], and empathy [79,92]. However, the relationship between them is still inconclusive. Therefore, in further studies, it is necessary to measure and control neurocognitive functions among schizophrenia patients. Finally, the patients recruited for this paper comprised chronic patients with long hospital stays and a concentration of middle-aged patients on long-term medication, all of which contributed to the increased BMI. Therefore, future comparisons incorporating first-episode drug-naïve patients or other different populations are needed to confirm the findings.

5. Conclusions

In summary, we revealed that overweight patients showed better empathy than non-overweight schizophrenic patients and that PANSS negative symptoms were found to have a significant independent correlation with IRI total scores among the overweight patients. Furthermore, this study has some methodological limitations, including the use of self-reported measures on the IRI self-reported measures, which might have introduced potential bias in our results; thus, we should interpret these findings with caution and investigate them further in future studies using a longitudinal design to identify additional factors that could explain empathic performance among the overweight schizophrenia patients. In future research, it should also be interesting to explore the differences in empathy across age, education years, race, and ethnicity and investigate whether similar results to this paper can be found in different populations, such as healthy populations and those with other mental illnesses such as depression.

Author Contributions

Conceptualization, Y.L., R.L., D.W. and X.Z.; formal analysis, Y.L. and R.L.; funding acquisition, X.Z.; investigation, Y.L. and R.L.; project administration, X.Z. and D.W.; resources, X.Z. and R.L.; supervision, X.Z. and D.W.; writing—original draft, Y.L.; writing—review and editing, X.Z. and D.W. All authors have read and agreed to the published version of the manuscript.

Funding

This study was funded by the National Key Research and Development Program of China (2017YFC1310405) and the CAS International Cooperation Research Program (153111KYSB20190004).

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Chinese Academy of Sciences’ Institute of Psychology (ID: H18031).

Informed Consent Statement

Informed consent was obtained from all participants involved in this study.

Data Availability Statement

The data presented in this study are available from the corresponding author on reasonable request.

Acknowledgments

We would like to express our gratitude to the researchers, study participants, doctors, and nurses who contributed to this study.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. Salomon, J.A.; Vos, T.; Hogan, D.R.; Gagnon, M.; Naghavi, M.; Mokdad, A.; Begum, N.; Shah, R.; Karyana, M.; Kosen, S.; et al. Common values in assessing health outcomes from disease and injury: Disability weights measurement study for the Global Burden of Disease Study 2010. Lancet 2012, 380, 2129–2143. [Google Scholar] [CrossRef] [PubMed]
  2. Hert, M.; Detraux, J.; Winkel, R.; Yu, W.; Correll, C. Metabolic and cardiovascular adverse effects associated with antipsychotic drugs. Nat. Rev. Endocrinol. 2012, 8, 114–126. [Google Scholar] [CrossRef] [PubMed]
  3. Lett, T.; Wallace, T.J.M.; Chowdhury, N.; Tiwari, A.; Kennedy, J.; Müller, D.J. Pharmacogenetics of antipsychotic-induced weight gain: Review and clinical implications. Mol. Psychiatry 2011, 17, 242–266. [Google Scholar] [CrossRef] [Green Version]
  4. Reynolds, G.; Kirk, S. Metabolic side effects of antipsychotic drug treatment—Pharmacological mechanisms. Pharmacol. Ther. 2009, 125, 169–179. [Google Scholar] [CrossRef] [PubMed]
  5. Tian, Y.; Wang, D.; Wei, G.; Wang, J.; Zhou, H.; Xu, H.; Dai, Q.; Xiu, M.; Chen, D.; Wang, L.; et al. Prevalence of obesity and clinical and metabolic correlates in first-episode schizophrenia relative to healthy controls. Psychopharmacology 2021, 238, 745–753. [Google Scholar] [CrossRef]
  6. Hu, L.; Huang, X.; You, C.; Li, J.; Hong, K.; Li, P.; Wu, Y.; Wu, Q.; Wang, Z.; Gao, R.; et al. Prevalence of overweight, obesity, abdominal obesity and obesity-related risk factors in southern China. PLoS ONE 2017, 12, e0183934. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  7. Smith, M.; Hopkins, D.; Peveler, R.C.; Holt, R.; Woodward, M.; Ismail, K. First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: Systematic review and meta-analysis. Br. J. Psychiatry 2008, 192, 406–411. [Google Scholar] [CrossRef] [Green Version]
  8. Rouillon, F.; Sorbara, F. Schizophrenia and diabetes: Epidemiological data. Eur. Psychiatry J. 2006, 20 (Suppl. 4), S345–S348. [Google Scholar] [CrossRef]
  9. Werneke, U.; Taylor, D.; Sanders, T. Behavioral Interventions for Antipsychotic Induced Appetite Changes. Curr. Psychiatry Rep. 2013, 15, 347–356. [Google Scholar] [CrossRef] [Green Version]
  10. Blouin, M.; Tremblay, A.; Jalbert, M.-E.; Venables, H.; Bouchard, R.-H.; Roy, M.-A.; Alméras, N. Adiposity and Eating Behaviors in Patients Under Second Generation Antipsychotics. Obesity 2008, 16, 1780–1787. [Google Scholar] [CrossRef]
  11. Nurjono, M.; Neelamekam, S.; Lee, J. Serum leptin and its relationship with psychopathology in schizophrenia. Psychoneuroendocrinology 2014, 50, 149–154. [Google Scholar] [CrossRef]
  12. Kroeze, W.; Hufeisen, S.; Popadak, B.; Renock, S.; Steinberg, S.; Ernsberger, P.; Jayathilake, K.; Meltzer, H.; Roth, B. H1-Histamine Receptor Affinity Predicts Short-Term Weight Gain for Typical and Atypical Antipsychotic Drugs. Neuropsychopharmacol. Off. Publ. Am. Coll. Neuropsychopharmacol. 2003, 28, 519–526. [Google Scholar] [CrossRef] [Green Version]
  13. He, M.; Zhang, Q.; Deng, C.; Wang, H.; Lian, J.; Huang, X.-F. Hypothalamic histamine HI receptor-AMPK signaling time-dependently mediates olanzapine-induced hyperphagia and weight gain in female rats. Psychoneuroendocrinology 2014, 42, 153–164. [Google Scholar] [CrossRef] [Green Version]
  14. Correll, C.U.; Lencz, T.; Malhotra, A.K. Antipsychotic drugs and obesity. Trends Mol. Med. 2011, 17, 97–107. [Google Scholar] [CrossRef] [Green Version]
  15. Coccurello, R.; Moles, A. Potential mechanisms of atypical antipsychotic-induced metabolic derangement: Clues for understanding obesity and novel drug design. Pharmacol. Ther. 2010, 127, 210–251. [Google Scholar] [CrossRef]
  16. Gothelf, D.; Falk, B.; Singer, P.; Kairi, M.; Phillip, M.; Zigel, L.; Poraz, I.; Frishman, S.; Constantini, N.; Zalsman, G.; et al. Weight Gain Associated With Increased Food Intake and Low Habitual Activity Levels in Male Adolescent Schizophrenic Inpatients Treated With Olanzapine. Am. J. Psychiatry 2002, 159, 1055–1057. [Google Scholar] [CrossRef]
  17. Stubbs, B.; Williams, J.; Gaughran, F.; Craig, T. How sedentary are people with psychosis? A systematic review and meta-analysis. Schizophr. Res. 2016, 171, 103–109. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  18. Teasdale, S.; Ward, P.; Samaras, K.; Firth, J.; Stubbs, B.; Tripodi, E.; Burrows, T. Dietary intake of people with severe mental illness: Systematic review and meta-analysis. Br. J. Psychiatry 2019, 214, 251–259. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  19. Koliaki, C.; Liatis, S.; Kokkinos, A. Obesity and cardiovascular disease: Revisiting an old relationship. Metabolism 2018, 92, 98–107. [Google Scholar] [CrossRef] [PubMed]
  20. Lavie, C.; De Schutter, A.; Parto, P.; Jahangir, E.; Kokkinos, P.; Ortega, F.; Arena, R.; Milani, R. Obesity and Prevalence of Cardiovascular Diseases and Prognosis-The Obesity Paradox Updated. Prog. Cardiovasc. Dis. 2016, 58, 537–547. [Google Scholar] [CrossRef] [Green Version]
  21. Azad, M.; Shoesmith, W.; Al-Mamun, M.; Faris, A.; Naing, D.K.; Phanindranath, M.; Turin, T. Cardiovascular Diseases among Patients with Schizophrenia. Asian J. Psychiatry 2015, 19, 28–36. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  22. Westman, J.; Eriksson, S.; Gissler, M.; Hällgren, J.; Prieto, M.; Bobo, W.; Frye, M.; Erlinge, D.; Alfredsson, L.; Osby, U. Increased cardiovascular mortality in people with schizophrenia: A 24-year national register study. Epidemiol. Psychiatr. Sci. 2017, 27, 519–527. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  23. Hjorthøj, C.; Stürup, A.E.; McGrath, J.J.; Nordentoft, M. Years of potential life lost and life expectancy in schizophrenia: A systematic review and meta-analysis. Lancet Psychiatry 2017, 4, 295–301. [Google Scholar] [CrossRef] [PubMed]
  24. Beary, M.; Hodgson, R.; Wildgust, H. A critical review of major mortality risk factors for all-cause mortality in first-episode schizophrenia: Clinical and research implications. J. Psychopharmacol. 2012, 26, 52–61. [Google Scholar] [CrossRef]
  25. Oh, E.; Song, E.; Shin, J. Individual Factors Affecting Self-esteem, and Relationships Among Self-esteem, Body Mass Index, and Body Image in Patients With Schizophrenia. Arch. Psychiatr. Nurs. 2017, 31, 588–595. [Google Scholar] [CrossRef]
  26. Chouinard, V.-A.; Pingali, S.; Chouinard, P.; Henderson, D.; Mallya, S.; Cypess, A.; Cohen, B.; Öngür, D. Factors associated with overweight and obesity in schizophrenia, schizoaffective and bipolar disorders. Psychiatry Res. 2016, 237, 304–310. [Google Scholar] [CrossRef]
  27. Malhotra, N.; Kulhara, P.; Chakrabarti, S.; Grover, S. Lifestyle related factors & impact of metabolic syndrome on quality of life, level of functioning & self-esteem in patients with bipolar disorder & schizophrenia. Indian. J. Med. Res. 2016, 143, 434–442. [Google Scholar]
  28. Hermes, E.; Nasrallah, H.; Davis, V.; Meyer, J.; McEvoy, J.; Goff, D.; Davis, S.; Stroup, T.; Swartz, M.; Lieberman, J.; et al. The Association Between Weight Change And Symptom Reduction in the CATIE Schizophrenia Trial. Schizophr. Res. 2011, 128, 166–170. [Google Scholar] [CrossRef] [Green Version]
  29. Tian, Y.; Liu, D.; Wang, D.; Wang, J.; Xu, H.; Dai, Q.; Andriescue, E.C.; Wu, H.E.; Xiu, M.; Chen, D.; et al. Obesity in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates and relationship with cognitive deficits. Schizophr. Res. 2020, 215, 270–276. [Google Scholar] [CrossRef]
  30. Hui, L.; Ye, M.; Tang, W.; Chen, D.-C.; Tan, Y.; Zhang, F.; Liu, J.; Liu, L.; Chen, Y.; Yang, F.-D.; et al. Obesity correlates with fewer symptoms in schizophrenia treated with long-term clozapine: Gender difference. Psychiatry Res. 2014, 225, 741–742. [Google Scholar] [CrossRef]
  31. Kahn, R.; Keefe, R. Schizophrenia Is a Cognitive Illness Time for a Change in Focus. JAMA Psychiatry 2013, 70, 1107–1112. [Google Scholar] [CrossRef]
  32. Jauhar, S.; Johnstone, M.; McKenna, P.J. Schizophrenia. Lancet 2022, 399, 473–486. [Google Scholar] [CrossRef]
  33. Li, W.; Zhou, F.C.; Zhang, L.; Ng, C.H.; Ungvari, G.S.; Li, J.; Xiang, Y.T. Comparison of cognitive dysfunction between schizophrenia and bipolar disorder patients: A meta-analysis of comparative studies. J. Affect. Disord. 2020, 274, 652–661. [Google Scholar] [CrossRef] [PubMed]
  34. Luck, S.J.; Hahn, B.; Leonard, C.J.; Gold, J.M. The Hyperfocusing Hypothesis: A New Account of Cognitive Dysfunction in Schizophrenia. Schizophr. Bull. 2019, 45, 991–1000. [Google Scholar] [CrossRef]
  35. Penades, R.; Franck, N.; Gonzalez-Vallespi, L.; Dekerle, M. Neuroimaging Studies of Cognitive Function in Schizophrenia. Adv. Exp. Med. Biol. 2019, 1118, 117–134. [Google Scholar]
  36. Lencz, T.; Smith, C.; McLaughlin, D.; Auther, A.; Nakayama, E.; Hovey, L.; Cornblatt, B. Generalized and Specific Neurocognitive Deficits in Prodromal Schizophrenia. Biol. Psychiatry 2006, 59, 863–871. [Google Scholar] [CrossRef]
  37. Green, M.F.; Horan, W.P.; Lee, J. Social cognition in schizophrenia. Nat. Rev. Neurosci. 2015, 16, 620–631. [Google Scholar] [CrossRef] [PubMed]
  38. Charernboon, T.; Patumanond, J. Social Cognition in Schizophrenia. Ment. Illn. 2017, 9, 16–19. [Google Scholar] [CrossRef] [Green Version]
  39. Fett, A.-K.; Viechtbauer, W.; Dominguez, M.-d.-G.; Penn, D.; van Os, J.; Krabbendam, L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neurosci. Biobehav. Rev. 2011, 35, 573–588. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  40. Cuff, B.M.P.; Brown, S.J.; Taylor, L.; Howat, D.J. Empathy: A Review of the Concept. Emot. Rev. 2016, 8, 144–153. [Google Scholar] [CrossRef]
  41. Bonfils, K.A.; Lysaker, P.H.; Minor, K.S.; Salyers, M.P. Affective empathy in schizophrenia: A meta-analysis. Schizophr. Res. 2016, 175, 109–117. [Google Scholar] [CrossRef] [Green Version]
  42. Lehmann, A.; Bahcesular, K.; Brockmann, E.M.; Biederbick, S.E.; Dziobek, I.; Gallinat, J.; Montag, C. Subjective experience of emotions and emotional empathy in paranoid schizophrenia. Psychiatry Res. 2014, 220, 825–833. [Google Scholar] [CrossRef] [PubMed]
  43. Berger, P.; Bitsch, F.; Jakobi, B.; Nagels, A.; Straube, B.; Falkenberg, I. Cognitive and emotional empathy in patients with schizophrenia spectrum disorders: A replication and extension study. Psychiatry Res. 2019, 276, 56–59. [Google Scholar] [CrossRef] [PubMed]
  44. Horan, W.; Reise, S.; Kern, R.; Lee, J.; Penn, D.; Green, M. Structure and Correlates of Self-Reported Empathy in Schizophrenia. J. Psychiatr. Res. 2015, 66-67, 60–66. [Google Scholar] [CrossRef] [Green Version]
  45. Michaels, T.M.; Horan, W.P.; Ginger, E.J.; Martinovich, Z.; Pinkham, A.E.; Smith, M.J. Cognitive empathy contributes to poor social functioning in schizophrenia: Evidence from a new self-report measure of cognitive and affective empathy. Psychiatry Res. 2014, 220, 803–810. [Google Scholar] [CrossRef]
  46. Cigliobianco, M.; Paoli, R.A.; Caletti, E.; Mansur, R.; Zugno, E.; Prunas, C.; McIntyre, R.S. Possible association between social cognition and metabolic dysfunctions in Bipolar Disorder and Schizophrenia: Preliminary results. J. Affect. Disord. 2019, 246, 828–835. [Google Scholar] [CrossRef]
  47. Huetter, F.K.; Horn, P.A.; Siffert, W. Sex-specific association of a common GNAS polymorphism with self-reported cognitive empathy in healthy volunteers. PLoS ONE 2018, 13, e0206114. [Google Scholar] [CrossRef]
  48. Wang, W.; Zhou, Y.; Liu, R.; Wei, S.; Xu, H.; Wang, J.; Wang, L.; Trinh, T.H.; Wu, H.E.; Wang, D.; et al. Association between empathy and clinical symptoms in chronic schizophrenia: A large sample study based on Chinese Han population. J. Psychiatr. Res. 2021, 139, 106–112. [Google Scholar] [CrossRef]
  49. Lincoln, T.M.; Mehl, S.; Kesting, M.L.; Rief, W. Negative symptoms and social cognition: Identifying targets for psychological interventions. Schizophr. Bull. 2011, 37 (Suppl. 2), S23–S32. [Google Scholar] [CrossRef] [Green Version]
  50. Smith, M.J.; Horan, W.P.; Cobia, D.J.; Karpouzian, T.M.; Fox, J.M.; Reilly, J.L.; Breiter, H.C. Performance-based empathy mediates the influence of working memory on social competence in schizophrenia. Schizophr. Bull. 2014, 40, 824–834. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  51. Chuang, S.P.; Wu, J.Y.W.; Wang, C.S. Metacognitive Beliefs, Cognitive Functioning, Psychiatric Symptoms and Empathy in People with Schizophrenia. Neuropsychiatr. Dis. Treat. 2021, 17, 2209–2217. [Google Scholar] [CrossRef]
  52. Gonzalez-Liencres, C.; Brown, E.C.; Tas, C.; Breidenstein, A.; Brune, M. Alterations in event-related potential responses to empathy for pain in schizophrenia. Psychiatry Res. 2016, 241, 14–21. [Google Scholar] [CrossRef] [PubMed]
  53. Abramowitz, A.C.; Ginger, E.J.; Gollan, J.K.; Smith, M.J. Empathy, depressive symptoms, and social functioning among individuals with schizophrenia. Psychiatry Res. 2014, 216, 325–332. [Google Scholar] [CrossRef] [PubMed]
  54. Achim, A.M.; Ouellet, R.; Roy, M.A.; Jackson, P.L. Assessment of empathy in first-episode psychosis and meta-analytic comparison with previous studies in schizophrenia. Psychiatry Res. 2011, 190, 3–8. [Google Scholar] [CrossRef]
  55. Kay, S.; Fiszbein, A.; Opler, L. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr. Bull. 1987, 13, 261–276. [Google Scholar] [CrossRef] [PubMed]
  56. Citrome, L.; Meng, X.; Hochfeld, M. Efficacy of iloperidone in schizophrenia: A PANSS five-factor analysis. Schizophr. Res. 2011, 131, 75–81. [Google Scholar] [CrossRef]
  57. Wallwork, R.; Fortgang, R.; Hashimoto, R.; Weinberger, D.; Dickinson, D. Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophr. Res. 2012, 137, 246–250. [Google Scholar] [CrossRef] [Green Version]
  58. Rodriguez-Jimenez, R.; Bagney, A.; Mezquita, L.; Martínez-Gras, I.; Sánchez-Morla, E.; Mesa, N.; Ibáñez, M.; Diez-Martin, J.; Jimenez-Arriero, M.-A.; Lobo, A.; et al. Cognition and the five-factor model of the Positive and Negative Syndrome Scale in schizophrenia. Schizophr. Res. 2013, 143, 77–83. [Google Scholar] [CrossRef] [Green Version]
  59. Davis, M. Measuring individual differences in empathy: Evidence for multidimensional approach. J. Pers. Soc. Psychol. 1983, 10, 85–104. [Google Scholar] [CrossRef]
  60. Rong, X.; Sun, B.; Huang, X.; Cai, M.; Li, W. Reliabilities and validities of chinese version of interpersonal reactivity index. Chin. J. Clin. Psychol. 2010, 2, 158–160. [Google Scholar]
  61. WHO Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004, 363, 157–163. [Google Scholar] [CrossRef] [PubMed]
  62. Ji, C.; Chen, T.-J. Empirical Changes in the Prevalence of Overweight and Obesity among Chinese Students from 1985 to 2010 and Corresponding Preventive Strategies. Biomed. Environ. Sci. BES 2013, 26, 1–12. [Google Scholar]
  63. Pan, X.; Wang, L.; Pan, A. Epidemiology and determinants of obesity in China. Lancet Diabetes Endocrinol. 2021, 9, 373–392. [Google Scholar] [CrossRef] [PubMed]
  64. Coodin, S. Body Mass Index in Persons with Schizophrenia. Can. J. Psychiatry Rev. Can. Psychiatr. 2001, 46, 549–555. [Google Scholar] [CrossRef] [Green Version]
  65. Manu, P.; Dima, L.; Shulman, M.; Vancampfort, D.; De Hert, M.; Correll, C.U. Weight gain and obesity in schizophrenia: Epidemiology, pathobiology, and management. Acta Psychiatr. Scand. 2015, 132, 97–108. [Google Scholar] [CrossRef] [PubMed]
  66. Catapano, L.; Castle, D. Obesity in schizophrenia: What can be done about it? Australas. Psychiatry 2004, 12, 23–25. [Google Scholar] [CrossRef]
  67. Li, Y.; Zhou, Y.; Li, Y.; Luo, R.C.; Pallavi, B.G.; Wu, H.E.; Liu, H.; Wang, D.; Zhang, X. Gender differences in empathy and clinical symptoms in chronic schizophrenia patients: A large sample study based on a Chinese Han population. Int. J. Psychiatry Clin. Pract. 2023, 1–8. [Google Scholar] [CrossRef]
  68. Bennik, E.C.; Jeronimus, B.F.; Aan Het Rot, M. The relation between empathy and depressive symptoms in a Dutch population sample. J. Affect. Disord. 2019, 242, 48–51. [Google Scholar] [CrossRef]
  69. Marazziti, D.; Diep, P.T.; Carter, S.; Carbone, M.G. Oxytocin: An Old Hormone, a Novel Psychotropic Drug and its Possible Use in Treating Psychiatric Disorders. Curr. Med. Chem. 2022, 29, 5615–5687. [Google Scholar]
  70. Hurlemann, R.; Patin, A.; Onur, O.A.; Cohen, M.X.; Baumgartner, T.; Metzler, S.; Dziobek, I.; Gallinat, J.; Wagner, M.; Maier, W.; et al. Oxytocin enhances amygdala-dependent, socially reinforced learning and emotional empathy in humans. J. Neurosci. 2010, 30, 4999–5007. [Google Scholar] [CrossRef] [Green Version]
  71. Sanchez-Vidana, D.I.; Chan, N.M.; Chan, A.H.; Hui, K.K.; Lee, S.; Chan, H.Y.; Law, Y.S.; Sze, M.Y.; Tsui, W.C.; Fung, T.K.; et al. treatment with oxytocin promotes hippocampal cell proliferation, dendritic maturation and affects socio-emotional behavior. Neuroscience 2016, 333, 65–77. [Google Scholar] [CrossRef]
  72. Schorr, M.; Marengi, D.A.; Pulumo, R.L.; Yu, E.; Eddy, K.T.; Klibanski, A.; Miller, K.K.; Lawson, E.A. Oxytocin and Its Relationship to Body Composition, Bone Mineral Density, and Hip Geometry Across the Weight Spectrum. J. Clin. Endocrinol. Metab. 2017, 102, 2814–2824. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  73. Szulc, P.; Amri, E.-Z.; Varennes, A.; Panaia-Ferrari, P.; Fontas, E.; Goudable, J.; Chapurlat, R.; Breuil, V. High serum oxytocin is associated with metabolic syndrome in older men—The MINOS study. Diabetes Res. Clin. Pract. 2016, 122, 17–27. [Google Scholar] [CrossRef]
  74. Gulliver, D.; Werry, E.; Reekie, T.A.; Katte, T.A.; Jorgensen, W.; Kassiou, M. Targeting the Oxytocin System: New Pharmacotherapeutic Approaches. Trends Pharmacol. Sci. 2019, 40, 22–37. [Google Scholar] [CrossRef]
  75. Shahrestani, S.; Kemp, A.H.; Guastella, A.J. The impact of a single administration of intranasal oxytocin on the recognition of basic emotions in humans: A meta-analysis. Neuropsychopharmacology 2013, 38, 1929–1936. [Google Scholar] [CrossRef]
  76. Leppanen, J.; Ng, K.W.; Tchanturia, K.; Treasure, J. Meta-analysis of the effects of intranasal oxytocin on interpretation and expression of emotions. Neurosci. Biobehav. Rev. 2017, 78, 125–144. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  77. Huetter, F.; Bachmann, H.; Reinders, A.; Siffert, D.; Stelmach, P.; Knop, D.; Horn, P.; Siffert, W. Association of a Common Oxytocin Receptor Gene Polymorphism with Self-Reported ‘Empathic Concern’ in a Large Population of Healthy Volunteers. PLoS ONE 2016, 11, e0160059. [Google Scholar] [CrossRef] [Green Version]
  78. Minoretti, P.; Politi, P.; Coen, E.; Di Vito, C.; Bertona, M.; Bianchi, M.; Emanuele, E. The T393C polymorphism of the GNAS1 gene is associated with deficit schizophrenia in an Italian population sample. Neurosci. Lett. 2006, 397, 159–163. [Google Scholar] [CrossRef] [PubMed]
  79. Liu, J.; Tian, Y.; Wei, S.; Wenjia, W.; Wang, D.; Zhou, H.; Zhang, X. Association of empathy with clinical symptoms and cognitive function in Chinese chronic schizophrenia patients with and without deficit syndrome. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2022, 119, 110592. [Google Scholar] [CrossRef]
  80. Wang, W.; Zhou, Y.; Wang, J.; Xu, H.; Wei, S.; Wang, D.; Wang, L.; Zhang, X.Y. Prevalence, clinical correlates of suicide attempt and its relationship with empathy in patients with schizophrenia. Prog. Neuropsychopharmacol. Biol. Psychiatry 2020, 99, 109863. [Google Scholar] [CrossRef]
  81. Brüne, M.; Schoebel, A.; Karau, R.; Faustmann, P.; Dermietzel, R.; Juckel, G.; Petrasch-Parwez, E. Neuroanatomical Correlates of Suicide in Psychosis: The Possible Role of von Economo Neurons. PLoS ONE 2011, 6, e20936. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  82. Völlm, B.; Taylor, A.; Richardson, P.; Corcoran, R.; Stirling, J.; McKie, S.; Deakin, J.; Elliott, R. Neuronal correlates of theory of mind and empathy: A functional magnetic resonance imaging study in a nonverbal task. NeuroImage 2006, 29, 90–98. [Google Scholar] [CrossRef]
  83. Ferrer-Quintero, M.; Green, M.; Horan, W.; Penn, D.; Kern, R.; Lee, J. The effect of sex on social cognition and functioning in schizophrenia. NPJ Schizophr. 2021, 7, 57. [Google Scholar] [CrossRef] [PubMed]
  84. Chapman, E.; Baron-Cohen, S.; Auyeung, B.; Knickmeyer, R.; Taylor, K.; Hackett, G. Fetal testosterone and empathy: Evidence from the empathy quotient (EQ) and the “reading the mind in the eyes” test. Soc. Neurosci. 2006, 1, 135–148. [Google Scholar] [CrossRef] [PubMed]
  85. Derntl, B.; Finkelmeyer, A.; Voss, B.; Eickhoff, S.; Kellermann, T.; Schneider, F.; Habel, U. Neural correlates of the core facets of empathy in schizophrenia. Schizophr. Res. 2012, 136, 70–81. [Google Scholar] [CrossRef]
  86. Brunet-Gouet, E.; Myszkowski, N.; Ehrminger, M.; Urbach, M.; Aouizerate, B.; Brunel, L.; Capdevielle, D.; Chereau, I.; Dubertret, C.; Dubreucq, J.; et al. Confirmation of a Two-Factor Solution to the Questionnaire of Cognitive and Affective Empathy in a French Population of Patients With Schizophrenia Spectrum Disorders. Front. Psychiatry 2019, 10, 751. [Google Scholar] [CrossRef] [Green Version]
  87. Zhang, X.Y.; Du, X.; Yin, G.; Zhang, Y.; Chen, D.; Xiu, M.; Wang, C.; Zhang, R.; Cassidy, R.M.; Ning, Y.; et al. Prevalence and Clinical Correlates of and Cognitive Function at the Time of Suicide Attempts in First-Episode and Drug-Naive Patients With Schizophrenia. J. Clin. Psychiatry 2018, 79, 20361. [Google Scholar] [CrossRef]
  88. Castelein, S.; Liemburg, E.J.; de Lange, J.S.; van Es, F.D.; Visser, E.; Aleman, A.; Bruggeman, R.; Knegtering, H. Suicide in Recent Onset Psychosis Revisited: Significant Reduction of Suicide Rate over the Last Two Decades—A Replication Study of a Dutch Incidence Cohort. PLoS ONE 2015, 10, e0129263. [Google Scholar] [CrossRef]
  89. Hagi, K.; Nosaka, T.; Dickinson, D.; Lindenmayer, J.P.; Lee, J.; Friedman, J.; Boyer, L.; Han, M.; Abdul-Rashid, N.A.; Correll, C.U. Association Between Cardiovascular Risk Factors and Cognitive Impairment in People With Schizophrenia: A Systematic Review and Meta-analysis. JAMA Psychiatry 2021, 78, 510–518. [Google Scholar] [CrossRef]
  90. Lim, J.; Lee, S.A.; Lam, M.; Rapisarda, A.; Kraus, M.; Keefe, R.; Lee, J. The relationship between negative symptom subdomains and cognition. Psychol. Med. 2016, 46, 2169–2177. [Google Scholar] [CrossRef]
  91. Minor, K. Necessary, but not sufficient: Links between neurocognition, social cognition, and metacognition in schizophrenia are moderated by disorganized symptoms. Schizophr. Res. 2014, 159, 198–204. [Google Scholar] [CrossRef] [PubMed]
  92. Hoe, M.; Nakagami, E.; Green, M.; Brekke, J. The causal relationships between neurocognition, social cognition and functional outcome over time in schizophrenia: A latent difference score approach. Psychol. Med. 2012, 42, 2287–2299. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Table
Table 1. Demographic and clinical characteristics of schizophrenia patients with or without overweight, N (%) or M (SD).
Table 1. Demographic and clinical characteristics of schizophrenia patients with or without overweight, N (%) or M (SD).
IndexTotal Patients
(n = 776) 		Overweight
(n = 504)		Non-Overweight
(n = 272)		χ2/tdfp
Gender 2.97210.085
Male514 (66.2)323 (62.8)191 (37.2)
Female262 (33.8)181 (69.1)81 (30.9)
Marital status 8.20330.042 *
Single466 (60.1)287 (57.1)179 (66.1)
Married173 (22.3)122 (24.3)51 (18.8)
Divorced123 (15.9)88 (17.5)35 (12.9)
Widowed12 (1.5)6 (1.2)6 (2.2)
Diabetes 4.24910.039 *
Positive666 (85.8)81 (16.1)29 (10.7)
Negative110 (14.2)423 (83.9)243 (89.3)
Suicide history 5.92210.015 *
Positive680 (87.6)73 (14.5)23 (8.5)
Negative96 (12.4)431 (85.5)254 (91.5)
Smoking history 2.03120.362
Never smoker404 (52.1)265 (55.8)139 (53.7)
Former smoker109 (14.0)64 (13.5)45 (17.4)
Current smoker221 (28.5)146 (30.7)75 (29.0)
Family history of psychotic disorder 0.00610.940
Positive658 (84.8)77 (15.3)41 (15.1)
Negative118 (15.2)427 (84.7)231 (84.9)
Age (years)46.83 (12.28)46.51 (11.72)47.42 (13.25)0.9551,7740.340
Education (years)9.41 (3.11)9.13 (3.05)9.92 (3.17)3.3641,7740.001 **
Age at onset of schizophrenia25.37 (7.65)25.49 (7.60)25.21 (9.84)−0.4291,7740.668
Age of first hospitalization28.55 (9.96)28.49 (10.03)28.65(10.00)0.2071,7740.836
Ill course21.45 (11.76)21.05(11.26)22.21(12.61)1.2711,7740.204
Antipsychotic dose (mg/day)
(Chlorpromazine equivalents)		310.71 (230.20)311.24 (239.67)309.74 (212.08)−0.0861,7570.929
M: mean; SD: standard deviation. * Significant at p < 0.05; ** significant at p < 0.01.
Table
Table 2. Clinical characteristics of overweight patients and non-overweight patients, presented as M values (SD).
Table 2. Clinical characteristics of overweight patients and non-overweight patients, presented as M values (SD).
IndexOverweight
(n = 504)		Non-Overweight (n = 272)tdfp
PANSS scores
Positive symptoms16.41 (5.62)15.49 (4.64)−2.4531,7740.014 *
Negative symptoms20.70 (6.67)21.50 (6.42)1.6141,7740.107
General psychopathology39.50 (8.63)39.51 (8.00)0.0151,7740.988
Total76.61 (17.40)76.50 (15.70)−0.0911,7740.928
F1 Positive Symptoms9.25 (4.15)8.88 (3.59)−1.2871,7740.199
F2 Negative Symptoms16.93 (6.28)17.97 (5.89)2.2511,7710.025 *
F3 Cognitive Symptoms9.37 (3.11)9.21 (3.06)−0.6771,7740.498
F4 Depressive factor7.18 (2.60)6.77 (2.51)−2.0871,7720.037 *
F5 Excitement factor7.86 (2.99)7.33 (2.80)−2.3841,7740.017 *
M: mean; SD: standard deviation; PANSS = Positive and Negative Syndrome Scale. * Significant at p < 0.05.
Table
Table 3. The empathy of schizophrenia patients with or without deficit syndrome, presented as M values (SD).
Table 3. The empathy of schizophrenia patients with or without deficit syndrome, presented as M values (SD).
IndexOverweight
(n = 504)		Non-Overweight (n = 272)tdfp
Perspective Taking22.25 (5.13)21.32 (5.23)−2.4071,7740.016 *
Empathic Concern22.94 (5.02)22.07 (5.27)−2.2691,7740.024 *
Fantasy20.20 (5.63)19.39 (5.74)−1.9051,7740.057
Personal Distress20.94 (4.71)20.90 (4.85)−0.1101,7740.912
IRI total score86.33 (14.46)83.67 (15.20)−2.4021,7740.017 *
M: mean; SD: standard deviation; IRI = Interpersonal Reactivity Index. * Significant at p < 0.05.
Table
Table 4. Matrix of correlation coefficients between empathy and clinical symptoms among overweight patients.
Table 4. Matrix of correlation coefficients between empathy and clinical symptoms among overweight patients.
IndexPositive SymptomsNegative SymptomsGeneral
Psychopathology		PANSS Total
IRI
Perspective Taking−0.060−0.207 ***−0.186 ***−0.197 ***
Fantasy0.062−0.155 ***−0.079−0.071
Empathic Concern−0.023−0.147 **−0.116 **−0.121 **
Personal Distress0.0050.0120.0140.003
Total score−0.005−0.178 ***−0.137 **−0.140 **
** significant at p < 0.01; *** significant at p < 0.001.
Table
Table 5. Matrix of correlation coefficients between empathy and clinical symptoms among non-overweight patients.
Table 5. Matrix of correlation coefficients between empathy and clinical symptoms among non-overweight patients.
IndexPositive SymptomsNegative SymptomsGeneral
Psychopathology		PANSS Total
IRI
Perspective Taking−0.081−0.152 *−0.112−0.143 *
Fantasy0.033−0.069−0.015−0.026
Empathic Concern0.007−0.175 **−0.075−0.108
Personal Distress0.0060.157 **0.198 **0.167 **
Total score−0.011−0.089−0.007−0.043
* Significant at p < 0.05; ** significant at p < 0.01.
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Li, Y.; Luo, R.; Wang, D.; Zhang, X. Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients. Brain Sci. 2023, 13, 1075. https://doi.org/10.3390/brainsci13071075

AMA Style

Li Y, Luo R, Wang D, Zhang X. Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients. Brain Sciences. 2023; 13(7):1075. https://doi.org/10.3390/brainsci13071075

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Li, Yuchen, Ruichenxi Luo, Dongmei Wang, and Xiangyang Zhang. 2023. "Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients" Brain Sciences 13, no. 7: 1075. https://doi.org/10.3390/brainsci13071075

APA Style

Li, Y., Luo, R., Wang, D., & Zhang, X. (2023). Association between Empathy and Clinical Symptoms among Overweight and Non-Overweight Chinese Chronic Schizophrenia Patients. Brain Sciences, 13(7), 1075. https://doi.org/10.3390/brainsci13071075

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