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Carol Lin1, Ariel Schvarcz2, & Carrie E. Bearden1,2,3Theory of Mind Deficits in Patients with Adolescent-Onset Psychosis May 16, 2015Stanford Undergraduate Psychology Conference

1Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA; 2Department of Psychology, UCLA, Los Angeles, CA; 3Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA.

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SZ causes impaired emotional and social abilities1, among other debilitating symptoms2The exact etiology is unknownAfflicts ~1% of the worlds population3Typically emerges in young adulthood, though gender differences exist4

Schizophrenia (SZ) Background1 Hfner, H. (1988). What is schizophrenia? European archives of psychiatry and neurological sciences, 238(2), 63-72.2 Ritsner, M., Ben-Avi, I., Ponizovsky, A., Timinsky, I., Bistrov, E., & Modai, I. (2003). Quality of life and coping with schizophrenia symptoms. Quality of Life Research, 12(1), 1-9.3 Millegan, J. (2014).What causes schizophrenia? Research.4Eranti, S.V., MacCabe, J.H., Bundy, H., & Murray, R.M. (2013). Gender differences in age of onset of schizophrenia: A meta-analysis. Psychological Medicine, 43, 155-167.

SZ is a severe neurodevelopmental disorder1 that causes impaired emotional and social abilities, among other debilitating symptoms such as hallucinations, delusions, paranoia, and deteriorating quality of life.2 The exact etiology is unknown to this day, but it afflicts approximately 1% of the worlds population today.3 On average, the age of SZ onset is 18 in men, and 25 in women4.2

Emerges prior to age 18Form of schizophrenia associated with:Poorer prognosis5Profound difficulties in behaving, thinking, and communicating6Greater deficits in cognition and functioning7 relative to adult-onset SZ

Adolescent-Onset Psychosis (AOP)5: Vyas, N.S., & Gogtay, N. (2012). Treatment of early onset schizophrenia: Recent trends, challenges and future considerations. Frontiers in Psychiatry, 3(29), 1-5.6: Malla, A., & Payne, J. (2005): First-episode psychosis: Psychopathology, quality of life, and functional outcome. Schizophrenia Bulletin, 31(3), 650-671. 7: Pauly, K., Seiferth, N.Y., Kellermann, T., Backes, V., Vloet, T., Shah, N.J., et al.(2008). Cerebral dysfunctions of emotion cognition interactions in adolescent-onset schizophrenia. Journal of the American Academy of Child & Adolescent Psychiatry, 47(11), 1299-1310.

Adolescent-onset psychosis, or AOP, is one subtype of SZ that is defined as emergence of over psychosis prior to age 18. AOP is a particularly virulent and chronic form of schizophrenia associated with poorer prognosis, more profound difficulties in behaving, thinking and communicating, and greater deficits in cognition and functioning relative to adult-onset SZ.

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Theory of Mind (ToM)8 Frangou, S. (2010). Cognitive function in early onset schizophrenia: A selective review. Frontiers in Human Neuroscience, 3(79), 1-6.9: Sprong, M., Schothorst, P., Vos, E., Hox, J., & Van Engeland, H. (2007). Theory of mind in schizophrenia: Meta-analysis. The British Journal of Psychiatry, 191(1), 5-13.10: Brne, M. (2005). Theory of mind in schizophrenia: A review of the literature. Schizophrenia bulletin, 31(1), 21-42.11: Harrington, L., Siegert, R., & McClure, J. (2005). Theory of mind in schizophrenia: A critical review. Cognitive neuropsychiatry, 10(4), 249-288.

One particular area of impairment in SZ is social cognition8Particularly, Theory of Mind (ToM) skillsAlthough ToM deficits are widely documented among adult-onset schizophrenia patients,9,10,11 little is known about such impairments in AOP

One particular area of impairment for patients with psychosis is social cognition, which is the ability to understand another individuals intentions, emotions, and perspectives. Theory of Mind is one aspect of social cognition that is defined as the ability to predict another persons behavior by associating emotions such as desires and beliefs. However, while ToM deficits are widely documented among adult-onset SZ patients, little is known about such impairments in AOP, warranting further examination.

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HypothesisAs compared to typically developing adolescents, individuals with AOP will demonstrate impaired ToM skills as evidenced by poorer performance on a ToM Task.

Therefore, the current study sought to examine ToM deficits in the AOP population as compared to typically developing adolescents. We hypothesized that individuals with AOP would demonstrate impaired ToM skills, as evidenced by poorer performance on a ToM Task.5

ParticipantsTypically Developing Controls (N=35)AOP Patients (N=22)p valueMean Age, in years (SD)15.37(2.84)16.47 (1.61)0.068Gender, N (% female)15(42.9)7(31.8)0.405

Mean Current IQ (SD)106.3(17.1)102.6(14.6)0.394

Mean Participant Education, in years (SD)8.89(2.81)9.77(2.84)0.172

Race/Ethnicity (%)0.132

Caucasian, Non- Hispanic21(60.0)16(65.4) African-American5(14.3)0(0) Asian-American/ Pacific Islander3(8.6)1(4.5) Other/Declined to State6(17.1)5(22.7)

Participants were selected from a larger, ongoing study at UCLA. Our final sample consisted of 22 patients and 35 controls, who were demographically matched on age, gender, current IQ, years of education, and ethnicity. Patients met criteria for a psychotic-spectrum disorder, while controls were free of any Axis I disorders and any psychosis among first-degree relatives. All participants were administered a battery of clinical and neuropsychological measures including a ToM Task.6

Participants viewed 8 silent video clips depicting interactions between triangles Two conditionsTheory of Mind (ToM)Random (Rd)

AdministrationMethods Animations Task

This ToM task is called Animations. Participants viewed 8 silent video clips (34-45s in length) that illustrated interactions between triangles moving around stationary rectangles.

The 8 clips comprised 2 conditions; 4 Theory of Mind scenarios, which were simulated human interactions, & 4 random scenarios, or triangles that aimlessly moved around the screen. Clips were presented in randomized order to each participant. After viewing each clip, the participants were asked to describe what happened without feedback from the examiner and without an imposed time limit.7

Methods Animations Task

ScoringScored on the dimensions of:Intentionality (0-5)Appropriateness (0-3)Average Intentionality and Appropriateness scores were then calculated for each person for each task condition

AnalysesGroup differences in Intentionality and Appropriateness scores were evaluated with 2 (Group: AOP vs. controls) x 2 (Condition: ToM vs. Random) repeated-measures ANOVA

Each clip was then scored on the dimensions of Intentionality, the degree to which the subject describes complex, intentional mental states and interactions as depicted by the animated triangles, & Appropriateness, which is the accuracy of the descriptive response.

Variables were scored on a scale from 0-5 for Intentionality, higher Intentionality scores meaning that more emotionally expressive verbs were used to describe interactions between multiple entities. Simple action verbs (e.g., floating, running) received scores of 0, while those suggesting intentions and motives received score of 5 (e.g., seducing, coaxing) Appropriateness was scored on a scale from 0-3, with higher scores meaning more accurate descriptions of the events in the clips.

Average Intentionality and Appropriateness scores were then calculated for each person from the 4 clips comprising the Dimension (e.g., the 4 ToM clips, and the 4 Random clips). Therefore, each individual was left with 4 scores (ToM_I, ToM_A, RD_I, and RD_A)

Group differences in Intentionality and Appropriateness scores were evaluated using a repeated measure ANOVA, with dimensions of 2 (Group: AOP vs. controls) x 2 (Condition: ToM vs. Random) on SPSS v. 2.08

Interaction ResultsSignificant group by condition interactions were found for both Intentionality (F(1,55)=87.212, p