Next Article in Journal
Hospitalizations for Suicidal Events: Reiteration Risk—The Experience in the Veneto Region, Italy
Previous Article in Journal
No Money, Poor Mental Health, and High Counterproductive Behavior: The Mediating Effect of Perceived Stress on Financial Threats and Job Performance
 
 
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Relationship between Semantic Memory and Social Cognition in Schizophrenia: A Preliminary Analysis

by
Javier Pérez-Flores
1,*,
Antonieta Nieto
1 and
Ofelia Delgado
2
1
School of Psychology, Department of Clinical Psychology, Psychobiology, and Methodology, University of La Laguna, 38204 Tenerife, Spain
2
University Hospital Nuestra Señora de Candelaria, 38010 Tenerife, Spain
*
Author to whom correspondence should be addressed.
Psychiatry Int. 2024, 5(3), 424-433; https://doi.org/10.3390/psychiatryint5030029
Submission received: 28 May 2024 / Revised: 30 June 2024 / Accepted: 30 July 2024 / Published: 2 August 2024

Abstract

:
This study investigates the relationship between semantic memory and social cognition in schizophrenia. The sample included 50 individuals with schizophrenia (mean age 42.54, SD 9.98; 14 women, 36 men) and 30 controls (mean age 42.06, SD 12.50; 6 women, 24 men). Semantic memory was assessed using verbal fluency and the Camel and Cactus Test, while social cognition was evaluated through the Face Test and the Hinting Task. The schizophrenia group showed significantly lower performance in both semantic memory (semantic fluency: t(78) = 7.77, p < 0.007, δ = 1.79; Camel and Cactus Test: t(78) = 5.37, p < 0.007, δ = 1.26) and social cognition (Face Test: t(78) = 5.94, p < 0.007, δ = 1.34; Hinting Task: t(78) = 7.79, p < 0.007, δ = 1.79). Strong correlations were observed between the Camel and Cactus Test and social cognition measures (Face Test: r = 0.63, p < 0.005; Hinting Task: r = 0.54, p < 0.005). Regression analyses indicated that the Camel and Cactus Test significantly predicted social cognition performance independent of symptomatology, explaining 53% of the variance in the Face Test and 54% in the Hinting Task. This study provides new insights into the cognitive underpinnings of schizophrenia, emphasizing the need for further research to explore these relationships and their implications for cognitive models and therapeutic interventions.

1. Introduction

Semantic memory contains general information about the world, including the meanings of words, concepts, and knowledge about objects and events. This knowledge is abstract, generalized, and not tied to a particular experience [1]. Traditionally, two main perspectives have sought to explain how information is stored in semantic memory. The first proposes that concepts are stored in hierarchical networks, exemplified by models like that of Collins and Quillian [2]. This approach has a fundamental limitation: its rigidity. Outside of laboratory tasks, category boundaries are not so clear, and the importance assigned to categories may vary depending on personal experience [3]. The second approach proposes that knowledge is distributed in networks but not organized hierarchically. In this model, nodes activate to varying degrees based on the relationship distance, which depends on how concepts co-occur in an individual’s experience. An example of this type of model is that of Collins and Loftus [4]. Although these models are less rigid [3], they overlook the impact of perceptual context on semantic memory and its relationship with episodic memory [5].
In the last decade, a new explanatory framework has emerged aiming to overcome the limitations described: grounded cognition. This approach posits that context plays a central role in conceptual activation. The term “context” not only refers to the perceptual features of the particular situation but also includes the interaction with the individual, their goals, expectations, and prior learning experiences. Therefore, semantic activation involves not only the activation of an abstract concept but also the activation of sensory and motor representations that guide experience by generating expectations about the future [6]. Thus, grounded cognition presents semantic memory as a set of conceptual frameworks in constant interaction with experience [6,7].
Parallels can be drawn between grounded cognition and the concept of social cognition. Social cognition encompasses several related processes that are essential for the development of social interaction, primarily involved in the perception, encoding, storage, retrieval, and regulation of information about others and oneself [8]. Social cognition relies on mentalization, a process that allows us to internalize our experiences by transforming bodily physical experience into a mental–verbal symbol [9]. Therefore, effective social cognition requires an interaction between current experience and previously abstracted conceptual frameworks, as proposed by grounded theory.
The study of social cognition in different psychiatric disorders has identified deficits in various populations, most notably in schizophrenia [10]. Individuals with schizophrenia display several social cognition deficits, such as difficulties in perceiving and recognizing emotions [11], challenges with Theory of Mind (the ability to represent and infer others’ mental states) [12], and problems with abstraction and the use of social knowledge, encompassing stored information about the rules, roles, expectations, and goals governing social interactions [13].
In the case of semantic memory, while alterations in semantic associations can be observed in the speech of individuals with schizophrenia [14], semantic memory has received less attention than other domains. Available studies indicate that individuals with schizophrenia showed lower performance than controls in several semantic memory tests, especially in semantic fluency and categorization. In the case of semantic association tasks, studies are scarce and results are contradictory [15,16].
Given the conceptual relationship between grounded cognition and social cognition, it is reasonable to think that the deficits in social cognition of people with schizophrenia could be linked to their performance on semantic memory tasks. Additionally, the study of the relationship between semantic memory and social cognition in schizophrenia can provide new insights into the involvement of top-down processes, such as access to semantic information, in the manifestations of the disorder. The relevance of these processes have been highlighted in relation to language and thought disorders [17], as well as cognitive functioning alterations [18]. Moreover, the involvement of top-down processes is a central component in cognitive models of schizophrenia. These models indicate that previously stored information is used as a guide for present behavior, serving as a fundamental tool for the processes that allow us to adapt our behavior [19]. Therefore, studying the relationship between semantic memory and social cognition could provide new empirical data to enrich this common framework.
The objective of this study is to examine the relationships between performance on semantic memory tasks and social cognition tasks in schizophrenia and to assess the predictive capacity of semantic memory for social cognition in individuals with schizophrenia.

2. Materials and Methods

2.1. Participants

The study included two groups of participants: a group of individuals with schizophrenia and a control group. The Schizophrenia group consisted of 50 participants (14 women and 36 men). All of them were recruited from psychosocial rehabilitation centers (CRPS) of Tenerife. They were outpatients who voluntarily attended services aimed at their functional recovery. All participants were under psychopharmacological treatment, and their symptomatology was predominantly negative, with few positive or disorganized symptoms.
The control group comprised 30 participants without psychiatric or neurological diagnoses (6 women and 24 men).
All participants were volunteers and were provided with informed consent in advance, clearly stating the procedures that would be followed in the research. This work was conducted in accordance with the Declaration of Helsinki for human research and was previously reviewed by the ethics committee of the University Hospital Nuestra Señora de Candelaria de Candelaria (Tenerife, Spain).

2.2. Materials

The vocabulary subtest of the Wechsler Adult Intelligence Scale (WAIS-IV) was used as an estimator of general intellectual functioning [20].
Schizophrenia symptomatology was assessed using the Scale for the Assessment of Negative Symptoms (SANS) [21] and the Scale for the Assessment of Positive Symptoms (SAPS) [22]. These scales are clinical assessment tools used to measure negative and positive symptoms in individuals with psychotic disorders, primarily schizophrenia. SANS evaluates negative symptoms such as alogia, affective flattening, avolition, anhedonia, and diminished attention. In contrast, SAPS measures positive symptoms like hallucinations, delusions, bizarre behavior, and formal thought disorders. Both scales were designed to be administered by a clinician and are widely used in research and psychiatric diagnosis.
Semantic memory was evaluated using two approaches: a verbal fluency task and a semantic association task.
Verbal Fluency. The semantic fluency task was used. This task involves generating words that fall into a given category within one minute. In this study, we used the category “animals”.
Semantic Association. The Camel and Cactus Test was used [23]. This is a neuropsychological assessment designed to evaluate non-categorical semantic associations between concepts. Instead of grouping items by traditional categories (such as animals or plants), this task focuses on associations based on other types of semantic relationships, such as context of use, function, or shared characteristics. For example, the participant might be asked to associate a camel with a cactus due to their contextual relationship in a desert environment, rather than belonging to the same taxonomic category. A computerized version of the task was employed. In each trial, a word appeared at the top of the screen (e.g., Camel), while four words were displayed at the bottom (e.g., Tree; Sunflower; Cactus; Rose). The participant’s task was to select the word at the bottom most related to the word at the top.
Social cognition was assessed through two indicators: emotion perception and recognition, and Theory of Mind.
Emotion Perception and Recognition. The Face Test was used [24]. In this task, participants were shown an image of a person’s face displaying a specific emotional state. In each trial, they had to choose between two words shown at the bottom of the image to best match the facial expression.
Theory of Mind. The Hinting Task was used [25]. In each trial, participants were presented with a short story involving two people. This story was read aloud, and a copy was placed in front of the participants so they could reread it if necessary. In each story, one character hinted at something to their interlocutor. After hearing and reading the story, participants had to infer what the hinting character wanted to achieve. If the participant could not infer it at first, they were given a second chance after a continuation of the story, which added information and made the inference easier. Scoring was 0 if the participant could not identify the character’s intentions, 1 if they made the inference correctly after more information was provided, and 2 if they made the inference correctly after the first reading.

2.3. Procedure

Symptom assessment was conducted by the clinical psychologists and psychiatrists who develop, coordinate, and monitor treatment plans for the functional recovery of the participants.
The assessment of semantic memory and social cognition was carried out by an experienced neuropsychologist. The assessment was organized into separate sessions. Verbal fluency and emotion perception and recognition were evaluated first. In another session, the Hinting Task was administered, and in a final session, semantic association was evaluated. This distribution aimed to avoid bias due to participant fatigue or task interference.

2.4. Data Analysis

Descriptive statistics were first obtained for each variable, and group performance was compared using Student’s t-tests. To avoid potential increases due to successive contrasts, Bonferroni correction was used for seven comparisons (α/7 = 0.05/7 = 0.007). Homogeneity of variances was assessed with Levene’s test, and Welch’s correction was applied for degrees of freedom when appropriate. Effect sizes of the differences were calculated using Cohen’s delta (δ).
Pearson correlations between the studied variables were subsequently analyzed. Significant relationships served as the basis for regression models aimed at predicting social cognition performance based on semantic memory performance. The stepwise procedure was used to avoid variance redundancy, and in all cases, tolerance indices and variance inflation factors were calculated. Tolerance indices were always above 0.7, and the variance inflation factors were below 5. Dominance analysis was employed to estimate the percentage of variance associated with each variable in the regression.
The correlation and regression analyses were conducted only for the group of individuals with schizophrenia.
The data analysis was performed using R software (version 4.4.0). For script management and execution, the integrated development environment R Studio (version 2024.4.0) was used [26,27].

3. Results

3.1. Descriptive Statistics of the Sample and Intergroup Contrasts

The groups were statistically equivalent in age, years of education, and vocabulary score (WAIS-IV). This information can be found in Table 1.
The analysis of symptomatology showed that negative symptoms were more prevalent, especially anhedonia/asociality. Descriptive statistics of the symptomatology are presented in Table 2.
The performance of the groups across different variables and potential differences between them were analyzed. In the case of semantic memory measures, the patients performed significantly worse than the control group in the two tasks. Similarly, their performance was lower in the two social cognition tasks. All effect sizes were large (δ > 0.80). This information can be found in Table 3.

3.2. Pearson Correlation between Measures

Pearson correlations between the measures were examined. All correlations were significant, although those involving the Camel and Cactus Test were larger and of greater magnitude. These results are shown in Table 4. Moreover, since the literature suggests that symptomatology can influence performance on semantic memory tasks [15], the correlation between these tasks and the disease’s symptomatology was determined. Semantic fluency showed significant negative correlations with bizarre behavior (r = −0.34, p < 0.05), alogia (r = −0.32, p < 0.05), affective flattening (r = −0.41, p < 0.01), and attentional difficulties (r = −0.42, p < 0.01). The Camel and Cactus Test showed no significant correlations with any of the symptom dimensions.

3.3. Linear Regression Analyses

Linear regression analyses were conducted with the semantic memory measures as predictors and the social cognition measures as criteria variables. Given that semantic fluency significantly correlated with symptomatology, the corresponding regression analyses were conducted including symptomatology and using a stepwise procedure. The first model included the Face Test as the dependent variable and, after the stepwise process, bizarre behavior, affective flattening, and Camel and Cactus Test were selected as predictors. This model was significant [F(3,46) = 17.35, p < 0.005] and explained 53% of the variance in the Face Test. Dominance analysis allowed estimation of the percentage of variance associated with each predictor. Bizarre behavior explained 6% of the variance, affective flattening 13%, and Camel and Cactus Test 35%.
The same process was conducted using the Hinting Task as the dependent variable. The predictors selected in the stepwise procedure were the same as in the Face Test case: bizarre behavior, affective flattening, and the Camel and Cactus Test. The model was significant [F(3,46) = 18.39, p < 0.005] and explained 54% of the variance in the Hinting Task. Dominance analysis showed that bizarre behavior explained 8% of the variance, affective flattening 23%, and the Camel and Cactus Test 23%.
The statistics of the linear regression analyses are found in Table 5.

4. Discussion

As expected, individuals with schizophrenia have shown significantly lower performance in semantic fluency. This test is one of the most commonly used to assess semantic memory in schizophrenia, and the presence of impairment in this task is a robust finding [15,16]. On the contrary, performance on Camel and Cactus has been scarcely studied. Our results indicate a poor performance in this task. In general, semantic association tasks have been less used than other semantics tests, and results are mixed. Thus, for example, Barrera et al. [28] observed a deterioration in the Camel and Cactus task only in patients with a Formal Thought Disorder ranging from moderate to severe. Lawrence et al. [29], in contrast, observed impaired performance on two semantic association tasks in an unselected sample of patients with schizophrenia, while Stirling et al. [30] obtained no evidence of impaired performance on the Pyramids and Palm Trees Test and no differences between patients with and without thought disorder. Interestingly, our results indicate an impaired performance in the conceptual association task with greater effect size than found in the meta-analysis by Doughty and Done [15], even though no significant correlation was found between the Camel and Cactus Test and symptomatology, including formal thought disorders. This highlights the importance of studying these semantic association tasks further in schizophrenia and to clarify their relationship with the disorder’s characteristics.
Our results also clearly support the impairment of social cognition in schizophrenia. Participants with schizophrenia show significantly lower performance in the emotional recognition task, with an effect size similar to that found by Kohler et al. in their meta-analysis [31]. The impairment of perception and recognition of faces with emotional expressions is a widely replicated finding in the scientific literature [32]. In the case of Theory of Mind, we obtained similar results. Participants with schizophrenia showed significantly lower scores than controls on the Hinting Task, with a large effect size. This result is consistent with the previous literature [33].
Both the fluency test and the Camel and Cactus Test showed significant correlations with the Face Test and Hinting Task. Curiously, although intergroup differences were greater for semantic fluency, the strength of correlations with social cognition tasks was higher for the Camel and Cactus Test. To assess the predictive capacity of semantic memory for social cognition, regression models were constructed considering symptomatology. As a result, semantic fluency was excluded from the models through stepwise selection because it showed significant relationships with symptomatology. However, the Camel and Cactus Test remained in the models and was found to account for most of the explained variance in the Face Test, with an equivalent proportion to affective flattening in the Hinting Task. This suggests that the predictive capacity of semantic memory depends on the indicators used for its measurement. Additionally, it is important to consider that the processes underlying each of the tasks used to assess semantic memory are different. Verbal fluency tasks involve a greater degree of self-regulation, as the search process requires a higher involvement of executive functioning [34]. In contrast, the Camel and Cactus Test relies on spontaneous associations in response to a stimulus and not on a self-directed search process, restricted to a specific instruction. Schizophrenia symptoms, particularly negative symptomatology, have been associated with difficulties in executive functioning, and it has been suggested that these difficulties can partially explain the behavioral manifestations of patients [35]. Therefore, it is expected that the verbal fluency task, which shows greater involvement of executive functioning in its execution, also has a stronger relationship with schizophrenia symptomatology. This could explain why verbal fluency was eliminated from the regression models by the stepwise procedure, as it has a higher shared variance with the symptomatology of the disease. Furthermore, this could also explain why the effect sizes of the differences between groups are larger for the verbal fluency task compared to the semantic association task. It has been suggested that activities involving a greater degree of top-down processing will be more challenging for individuals with schizophrenia [36]. Thus, verbal fluency tasks may be more discriminative in group comparisons.
A paradoxical result in our analysis is that bizarre behavior is positively associated with social cognition measures. In fact, social cognition measures are positively (though not significantly) associated with bizarre behavior and delusional ideas. Conversely, they are negatively associated with the other symptoms. This differential behavior of symptomatology in relation to social cognition has been previously identified in the scientific literature. While negative symptomatology shows negative and consistent associations with social cognition, positive symptomatology exhibits more complex and variable relationships [37,38]. It has even been documented that errors in social cognition tasks differ in individuals with a higher prevalence of positive symptomatology, as they make more errors due to excessive use of inferences (hyper-ToM) [39]. Although the relationship between symptomatology and social cognition is a topic of great interest for schizophrenia research, we cannot draw conclusions in this regard, as it exceeds the objective of our work and the methodology planned for its achievement.
To the best of our knowledge, there are currently no studies in the literature that relate semantic memory with social cognition in schizophrenia. One possible interpretation of the predictive capacity of semantic memory difficulties for impairments of social cognition may be that both have common causes. A common cause could be a central difficulty in using semantic information related to contextual associations. This information is more related to the uses, functions, and shared characteristics between objects and/or concepts than to traditional semantic categories. It is precisely the use of this information that is necessary to perform the Camel and Cactus task. This deficit in the use of information related to contextual associations is part of the conceptualization of both grounded cognition [6,7] and social cognition [8]. Moreover, it represents a common link with the cognitive model of schizophrenia proposed by Gray et al. and Hemsley [19,40,41]. From the perspective of these theoretical models, the utilization of prior information about associations between stimuli, and between stimuli and actions, is fundamental for appropriately guiding behavior in various situations. This implies an effect of previously stored information on experience, which allows for the selection of relevant information and the generation of a coherent action plan suited to the situation. A fundamental defect in the activation of previously stored associations, as indicated by our results, would hinder the identification of contextual cues and the adaptation of behavior. Consequently, this difficulty would negatively impact performance in social situations, making it harder to identify social cues, apply implicit and explicit rules, and generate mental representations about the intentions of others. Therefore, although our results are novel because they explore a relationship between constructs that has not been previously examined, they are integrated within a broader theoretical framework with numerous empirical findings. For example, a role for semantic processing in perception [42], language [17], and attention [43] has been postulated. The association between semantic memory and social cognition found in our study provides new empirical evidence to this line of research. Additionally, there are treatment proposals aimed at improving access to and utilization of previously stored information to alleviate manifestations of schizophrenia. An example is therapies based on metacognitive training [42]. These approaches encourage patients to question their conclusions, actively seek information, and better integrate their internal representations to generate more accurate interpretations and adapt their behavior. These treatment approaches have shown significant improvements in various aspects of schizophrenia, particularly in social cognition and social functioning [43]. Our results are consistent with these approaches and provide empirical evidence that social cognition is related to processes of semantic information association.
This study has some limitations. First, and as the main limitation, we must consider that the sample size allows for obtaining preliminary results, but achieving results with greater reliability and generalizability would require the use of larger samples. Secondly, both semantic memory and social cognition are constructs encompassing many different domains. Future research should increase the number of indicators to gain a broader picture of participants’ difficulties and relationships between variables. Additionally, schizophrenia exhibits high heterogeneity based on the disease stage. In our study, the sample consisted of individuals with schizophrenia in the chronic phase. This phase is characterized by a higher prevalence of negative symptomatology, which has been suggested as a potential influence on performance in semantic memory tasks [15]. Additionally, although deficits in social cognition have shown some stability across the phases of the disorder [44], they exhibit a stronger association with negative symptomatology [45,46]. Therefore, it is expected that, in different phases of the disorder, the relationships between semantic memory and social cognition may differ, as well as the possible influence of symptomatology. It would be interesting to conduct longitudinal studies or, alternatively, include patient groups at different stages to evaluate how the interactions between semantic memory and social cognition vary over time. Finally, it should be noted that the sex distribution differs between groups, with a higher proportion of females in the schizophrenia group. Given that women with schizophrenia tend to perform better on tasks involving verbal content and social cognition compared to men with schizophrenia [47,48], this distribution should not affect the significant differences found. However, it is important to consider that a more balanced sex distribution in the sample would yield more reliable results and should be addressed in future research.
In conclusion, our work supports evidence that semantic memory is impaired in individuals with schizophrenia. It also indicates a significant relationship between semantic memory and social cognition, particularly when using non-categorical semantic association tasks. This opens new lines of research and provides a common link with cognitive models of schizophrenia.

Author Contributions

Conceptualization, J.P.-F., A.N. and O.D.; methodology, J.P.-F. and A.N.; software, J.P.-F.; validation, J.P.-F. and A.N.; formal analysis, J.P.-F.; investigation, J.P.-F. and O.D.; resources, O.D.; data curation, J.P.-F. and O.D.; writing—original draft preparation, J.P.-F.; writing—review and editing, A.N.; visualization, J.P.-F.; supervision, A.N.; project administration, O.D. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of University Hospital Nuestra Señora de Candelaria (Tenerife, Spain) (PI-09/14; 24 June 2014).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The original contributions presented in the study are included in the article, and further inquiries can be directed to the corresponding author/s.

Acknowledgments

We would like to extend our deepest gratitude to all the participants who generously devoted their time and shared their experiences with us, contributing invaluable insights to this study. Their willingness to participate selflessly and share personal information has been fundamental to the success of this research. We are also immensely grateful to the professionals from the Canary Islands Health Service for their pivotal role throughout the study. Their expertise, dedication, and collaboration have not only facilitated the smooth conduct of this study but have also enriched its quality significantly. Their contributions have been indispensable in navigating the complexities of research within a healthcare setting.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Binder, J.R.; Desai, R.H. The neurobiology of semantic memory. Trends Cogn. Sci. 2011, 15, 527–536. [Google Scholar] [CrossRef] [PubMed]
  2. Collins, A.M.; Quillian, M.R. Retrieval time from semantic memory. J. Verbal Learn. Verbal Behav. 1969, 8, 240–247. [Google Scholar] [CrossRef]
  3. Kumar, A.A. Semantic memory: A review of methods, models, and current challenges. Psychon. Bull. Rev. 2021, 28, 40–80. [Google Scholar] [CrossRef]
  4. Collins, A.M.; Loftus, E.F. A spreading-activation theory of semantic processing. Psychol. Rev. 1975, 82, 407–428. [Google Scholar] [CrossRef]
  5. Yonelinas, A.P.; Ranganath, C.; Ekstrom, A.D.; Wiltgen, B.J. A contextual binding theory of episodic memory: Systems consolidation reconsidered. Nat. Rev. Neurosci. 2019, 20, 364–375. [Google Scholar] [CrossRef] [PubMed]
  6. Barsalou, L.W. Situated conceptualization: Theory and applications. In Foundations of Embodied Cognition: Perceptual and Emotional Embodiment; Coello, Y., Fischer, M.H., Eds.; Routledge: London, UK; Taylor and Francis Group: Abingdon, UK, 2016; pp. 11–37. [Google Scholar]
  7. Matheson, H.E.; Barsalou, L.W. Embodiment and Grounding in Cognitive Neuroscience. In Stevens’ Handbook of Experimental Psychology and Cognitive Neuroscience; Wixted, J.T., Ed.; Wiley: Hoboken, NJ, USA, 2023. [Google Scholar] [CrossRef]
  8. Green, M.F.; Penn, D.L.; Bentall, R.; Carpenter, W.T.; Gaebel, W.; Gur, R.C.; Kring, A.M.; Park, S.; Silverstein, S.M.; Heinssen, R. Social cognition in schizophrenia: An NIMH workshop on definitions, assessment, and research opportunities. Schizophr. Bull. 2008, 34, 1211–1220. [Google Scholar] [CrossRef] [PubMed]
  9. Freeman, C. What is mentalizing? An overview. Br. J. Psychother. 2016, 32, 189–201. [Google Scholar] [CrossRef]
  10. Csulak, T.; Hajnal, A.; Kiss, S.; Dembrovszky, F.; Varjú-Solymár, M.; Sipos, Z.; Kovács, M.A.; Herold, M.; Varga, E.; Hegyi, P.; et al. Implicit Mentalizing in Patients With Schizophrenia: A Systematic Review and Meta-Analysis. Front. Psychol. 2022, 13, 790494. [Google Scholar] [CrossRef]
  11. Barkhof, E.; de Sonneville, L.M.; Meijer, C.J.; de Haan, L. Processing of facial and nonsocial information is differentially associated with severity of symptoms in patients with multiepisode schizophrenia. J. Nerv. Ment. Dis. 2015, 203, 112–119. [Google Scholar] [CrossRef]
  12. van Neerven, T.; Bos, D.J.; van Haren, N.E. Deficiencies in Theory of Mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: A systematic review of secondary literature. Neurosci. Biobehav. Rev. 2021, 120, 249–261. [Google Scholar] [CrossRef]
  13. Savla, G.N.; Vella, L.; Armstrong, C.C.; Penn, D.L.; Twamley, E.W. Deficits in domains of social cognition in schizophrenia: A meta-analysis of the empirical evidence. Schizophr. Bull. 2013, 39, 979–992. [Google Scholar] [CrossRef]
  14. Çokal, D.; Sevilla, G.; Jones, W.S.; Zimmerer, V.; Deamer, F.; Douglas, M.; Spencer, H.; Turkington, D.; Ferrier, N.; Varley, R.; et al. The language profile of formal thought disorder. NPJ Schizophr. 2018, 4, 18. [Google Scholar] [CrossRef]
  15. Doughty, O.J.; Done, D.J. Is semantic memory impaired in schizophrenia? A systematic review and meta-analysis of 91 studies. Cogn. Neuropsychiatry 2009, 14, 473–509. [Google Scholar] [CrossRef]
  16. Tan, E.J.; Neill, E.; Tomlinson, K.; Rossell, S.L. Semantic memory impairment across the schizophrenia continuum: A meta-analysis of category fluency performance. Schizophr. Bull. Open 2020, 1, sgaa054. [Google Scholar] [CrossRef]
  17. Rabagliati, H.; Delaney-Busch, N.; Snedeker, J.; Kuperberg, G. Spared bottom-up but impaired top-down interactive effects during naturalistic language processing in schizophrenia: Evidence from the visual-world paradigm. Psychol. Med. 2019, 49, 1335–1345. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  18. Gold, J.M.; Hahn, B.; Strauss, G.P.; Waltz, J.A. Turning it upside down: Areas of preserved cognitive function in schizophrenia. Neuropsychol. Rev. 2009, 19, 294–311. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  19. Hemsley, D.R. The schizophrenic experience: Taken out of context? Schizophr. Bull. 2005, 31, 43–53. [Google Scholar] [CrossRef] [PubMed]
  20. Wechsler, D. WAIS-IV: Wechsler Adult Intelligence Scale, 4th ed.; Pearson: San Antonio, TX, USA, 2008. [Google Scholar]
  21. Andreasen, N.C. Scale for the Assessment of Negative Symptoms (SANS); University of Iowa: Iowa City, IA, USA, 1983. [Google Scholar]
  22. Andreasen, N.C. Scale for the Assessment of Positive Symptoms (SAPS); University of Iowa: Iowa City, IA, USA, 1984. [Google Scholar]
  23. Adlam, A.L.R.; Bozeat, S.; Arnold, R.; Watson, P.; Hodges, J.R. Semantic knowledge in mild cognitive impairment and mild Alzheimer’s disease. Cortex 2010, 46, 668–679. [Google Scholar] [CrossRef]
  24. Baron-Cohen, S.; Wheelwright, S.; Jolliffe, T. Is there a “language of the eyes”? Evidence from normal adults, and adults with autism or Asperger syndrome. Vis. Cogn. 1997, 4, 311–331. [Google Scholar] [CrossRef]
  25. Corcoran, R.; Mercer, G.; Frith, C.D. Schizophrenia, symptomatology and social inference: Investigating “theory of mind” in people with schizophrenia. Schizophr. Res. 1995, 17, 5–13. [Google Scholar] [CrossRef]
  26. R Core Team. R: A Language and Environment for Statistical Computing; R Foundation for Statistical Computing: Vienna, Austria, 2024; Available online: https://www.R-project.org/ (accessed on 10 March 2024).
  27. R Studio Team. RStudio: Integrated Development for R. RStudio; PBC: Boston, MA, USA, 2024; Available online: http://www.rstudio.com/ (accessed on 10 March 2024).
  28. Barrera, A.; McKenna, P.J.; Berrios, G.E. Formal thought disorder in schizophrenia: An executive or a semantic deficit? Psychol. Med. 2005, 35, 121–132. [Google Scholar] [CrossRef] [PubMed]
  29. Lawrence, V.A.; Doughty, O.; Al-Mousawi, A.; Clegg, F.; Done, D.J. Do overinclusion and distorted semantic category boundaries in schizophrenia arise from executive dysfunction? Schizophr. Res. 2007, 94, 172–179. [Google Scholar] [CrossRef] [PubMed]
  30. Stirling, J.; Hellewell, J.; Blakey, A.; Deakin, W. Thought disorder in schizophrenia is associated with both executive dysfunction and circumscribed impairments in semantic function. Psychol. Med. 2006, 36, 475–484. [Google Scholar] [CrossRef] [PubMed]
  31. Kohler, C.G.; Walker, J.B.; Martin, E.A.; Healey, K.M.; Moberg, P.J. Facial emotion perception in schizophrenia: A meta-analytic review. Schizophr. Bull. 2010, 36, 1009–1019. [Google Scholar] [CrossRef] [PubMed]
  32. Gao, Z.; Zhao, W.; Liu, S.; Liu, Z.; Yang, C.; Xu, Y. Facial Emotion Recognition in Schizophrenia. Front. Psychiatry 2021, 12, 633717. [Google Scholar] [CrossRef] [PubMed]
  33. Bora, E.; Yucel, M.; Pantelis, C. Theory of mind impairment in schizophrenia: Meta-analysis. Schizophr. Res. 2009, 109, 1–9. [Google Scholar] [CrossRef] [PubMed]
  34. Amunts, J.; Camilleri, J.A.; Eickhoff, S.B.; Heim, S.; Weis, S. Executive functions predict verbal fluency scores in healthy participants. Sci. Rep. 2020, 10, 11141. [Google Scholar] [CrossRef] [PubMed]
  35. Orellana, G.; Slachevsky, A. Executive functioning in schizophrenia. Front. Psychiatry 2013, 4, 35. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  36. Gold, J.M.; Robinson, B.; Leonard, C.J.; Hahn, B.; Chen, S.; McMahon, R.P.; Luck, S.J. Selective Attention, Working Memory, and Executive Function as Potential Independent Sources of Cognitive Dysfunction in Schizophrenia. Schizophr. Bull. 2018, 44, 1227–1234. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  37. Shean, G.; Meyer, J. Symptoms of schizophrenia and social cognition. Psychiatry Res. 2009, 170, 157–160. [Google Scholar] [CrossRef] [PubMed]
  38. Bliksted, V.; Videbech, P.; Fagerlund, B.; Frith, C. The effect of positive symptoms on social cognition in first-episode schizophrenia is modified by the presence of negative symptoms. Neuropsychology 2017, 31, 209–219. [Google Scholar] [CrossRef] [PubMed]
  39. Peyroux, E.; Prost, Z.; Danset-Alexandre, C.; Brenugat-Herne, L.; Carteau-Martin, I.; Gaudelus, B.; Jantac, C.; Attali, D.; Amado, I.; Graux, J.; et al. From “under” to “over” social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms? Schizophr. Res. Cogn. 2018, 15, 21–29. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  40. Gray, J.A.; Feldon, J.; Rawlins, J.N.; Hemsley, D.R.; Smith, A.D. The neuropsychology of schizophrenia. Behav. Brain Sci. 1991, 14, 1–20. [Google Scholar] [CrossRef]
  41. Hemsley, D.R. The development of a cognitive model of schizophrenia: Placing it in context. Neurosci. Biobehav. Rev. 2005, 29, 977–988. [Google Scholar] [CrossRef]
  42. Adámek, P.; Langová, V.; Horáček, J. Early-stage visual perception impairment in schizophrenia, bottom-up and back again. Schizophrenia 2022, 8, 27. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  43. Nestor, P.G.; Han, S.D.; Niznikiewicz, M.; Salisbury, D.; Spencer, K.; Shenton, M.E.; McCarley, R.W. Semantic disturbance in schizophrenia and its relationship to the cognitive neuroscience of attention. Biol. Psychol. 2001, 57, 23–46. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  44. Guaiana, G.; Lucarini, V.; Ebuenyi, I.D.; Abbatecola, M.; Tarantino, F.; Santoro, A.; Ghiandi, G.; Cappiello, A.; Pinto, A. Meta-cognitive training for schizophrenia. Cochrane Database Syst. Rev. 2023, 2023, CD015490. [Google Scholar] [CrossRef] [PubMed Central]
  45. Melville, G.; Hoffman, M.; Pollock, A.; Kurtz, M.M. Do metacognitive therapies for schizophrenia-spectrum disorders work? A meta-analytic investigation. Psychol. Med. 2024, 54, 1510–1518. [Google Scholar] [CrossRef] [PubMed]
  46. Pelletier-Baldelli, A.; Holt, D.J. Are Negative Symptoms Merely the “Real World” Consequences of Deficits in Social Cognition? Schizophr. Bull. 2020, 46, 236–241, Erratum in Schizophr. Bull. 2020, 46, 454. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  47. Green, M.F.; Bearden, C.E.; Cannon, T.D.; Fiske, A.P.; Hellemann, G.S.; Horan, W.P.; Kee, K.; Kern, R.S.; Lee, J.; Sergi, M.J.; et al. Social cognition in schizophrenia, Part 1: Performance across phase of illness. Schizophr. Bull. 2012, 38, 854–864. [Google Scholar] [CrossRef] [PubMed] [PubMed Central]
  48. Leger, M.; Neill, J.C. A systematic review comparing sex differences in cognitive function in schizophrenia and in rodent models for schizophrenia, implications for improved therapeutic strategies. Neurosci. Biobehav. Rev. 2016, 68, 979–1000. [Google Scholar] [CrossRef] [PubMed]
Table 1. Sample characteristics and intergroup contrasts.
Table 1. Sample characteristics and intergroup contrasts.
SG: Mean (sd)CG: Mean (sd)t(78)p
Age42.54 (9.98)42.06 (12.50)−0.19>0.05
Education10.28 (2.85)11.30 (2.69)1.57>0.05
Vocabulary subtest26.00 (13.54)31.43 (10.50)1.96>0.05
Table 2. Scores obtained for the evaluated symptoms.
Table 2. Scores obtained for the evaluated symptoms.
Mean (sd)Range
Alogia1.44 (1.15)0–4
Affective flattening1.13 (0.92)0–3
Avolition/apathy1.32 (0.86)0–3
Anhedonia/asociality1.92 (1.09)0–4
Attention1.17 (0.95)0–3
Hallucinations0.89 (0.69)0–2
Delusional ideas0.73 (0.64)0–2
Bizarre behavior0.69 (0.84)0–3
Formal thought disorders0.63 (0.89)0–4
Table 3. Descriptive statistics of the variables and intergroup contrasts.
Table 3. Descriptive statistics of the variables and intergroup contrasts.
SG: Mean (sd)CG: Mean (sd)t(78) *pδ
Semantic Memory
Semantic fluency15.62 (6.52)24.47 (3.66)7.77<0.0071.79
Camel and Cactus Test44.38 (9.43)52.60 (4.09)5.37<0.0071.26
Social Cognition
Face Test16.34 (2.23)19.03 (1.38)5.94<0.0071.34
Hinting Task11.08 (5.79)17.93 (1.76)7.79<0.0071.79
* It was necessary to apply Welch’s correction for semantic verbal fluency (df = 77.74), Camel and Cactus Test (df = 72.48) and Hinting Task (df = 62.75).
Table 4. Pearson correlations between the measures.
Table 4. Pearson correlations between the measures.
Face TestHinting Task
Semantic fluencyr = 0.39, p < 0.01r = 0.35, p < 0.01
Camel and Cactus Testr = 0.63, p < 0.005r = 0.54, p < 0.005
Table 5. Linear regression analyses.
Table 5. Linear regression analyses.
Criterion Variable: Face Test
βSEtpDW Test *
Bizarre behavior0.260.302.44<0.052.23, p > 0.05
Affective flattening−0.360.21−3.37<0.005
Camel and Cactus Test0.550.025.28<0.005
Criterion Variable: Hinting Task
βSEtpDW test *
Bizarre behavior0.340.763.21<0.0051.71, p > 0.05
Affective flattening−0.51−4.823.21<0.005
Camel and Cactus Test0.420.064.17<0.005
* Durbin–Watson Test: when its result is not significant (p > 0.05), it indicates that the assumptions of linear regression are met.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Pérez-Flores, J.; Nieto, A.; Delgado, O. Relationship between Semantic Memory and Social Cognition in Schizophrenia: A Preliminary Analysis. Psychiatry Int. 2024, 5, 424-433. https://doi.org/10.3390/psychiatryint5030029

AMA Style

Pérez-Flores J, Nieto A, Delgado O. Relationship between Semantic Memory and Social Cognition in Schizophrenia: A Preliminary Analysis. Psychiatry International. 2024; 5(3):424-433. https://doi.org/10.3390/psychiatryint5030029

Chicago/Turabian Style

Pérez-Flores, Javier, Antonieta Nieto, and Ofelia Delgado. 2024. "Relationship between Semantic Memory and Social Cognition in Schizophrenia: A Preliminary Analysis" Psychiatry International 5, no. 3: 424-433. https://doi.org/10.3390/psychiatryint5030029

Article Metrics

Back to TopTop