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Improvement in social cognition in patients with schizophrenia associated with treatment with olanzapine
Schizophrenia Research 66 (2004) 201 – 202 www.elsevier.com/locate/schres
Letter to the Editors
Improvement in social cognition in patients with schizophrenia associated with treatment with olanzapine
Dear Editors, Social cognition has been described as ‘‘the processes and functions that allow a person to understand, act on, and benefit from the interpersonal world’’ (Corrigan and Penn, 2001). It is the ability to accurately perceive and interpret social interactions, including both verbal and nonverbal information. Numerous studies have found that patients with schizophrenia have deficits in social cognition, including accurately recognizing nonverbal communication (Dougherty et al., 1974; Penn et al., 1997; Toomey et al., 2002). Previous work by Kee et al. (1998) suggests that treatment with risperidone enhances social cognition in schizophrenia patients. We examined the effects of olanzapine (OLZ) on social cognition in patients with schizophrenia. Fifty-two outpatients (31 men and 21 women) meeting the DSM-IV criteria for schizophrenia or schizoaffective disorder provided informed, written consent prior to study entry. All patients had received a conventional antipsychotic drug (CAD) for at least 3 months prior to study entry and were offered a 12month, open-label trial of olanzapine. Twenty-two individuals (14 men and 8 women) agreed to antipsychotic conversion. There were no significant differences between groups on any demographic variable. All 52 patients agreed to participate in baseline and endpoint testing using the Interpersonal Perception Task (IPT) (Archer and Costanzo, 1988, 1989). Additionally, the olanzapine group was also tested at 3 months. The IPT was developed to assess nonverbal communication and social perception (Archer and Cos0920-9964/$ - see front matter D 2003 Published by Elsevier B.V. doi:10.1016/S0920-9964(03)00185-3
tanzo, 1988, 1989). The IPT consists of 30 brief, naturalistic, videotaped scenes preceded by a multiple choice question and evaluates five domains of social cognition: status, intimacy, kinship, competition, and deception. Choosing the correct answer is based on the perception of non-verbal communication. While the IPT has not previously been used in schizophrenia research, it has a history of use in social psychology (Patterson et al., 2001; Schroeder and Ketrow, 1997; Zakahi and Gross, 1995). At baseline, patients were receiving a variety of conventional antipsychotics. The mean daily dose, in chlorpromazine equivalents, was 540.6 mg/day (S.D. 215.9). Concomitant medications included anticholinergic agents (80.8%), mood stabilizers (23.1%), and serotonin reuptake inhibitors (SSRIs) (19.2%). No patients were receiving benzodiazepines. At endpoint, a majority of the olanzapine-treated patients (77.3%) Table 1 CAD and OLZ groups: performance on IPT across time Baseline
Interim Endpoint p value* (12 weeks) (52 weeks)
Mean F S.D. Mean F S.D. Mean F S.D. CAD (n = 30) Lie 46.1 F 3.0 Kinship 52.2 F 4.6 Competition 55.0 F 4.5 Status 51.1 F 4.1 Intimacy 52.2 F 4.4 OLZ (n = 22) Lie 46.2 F 2.9 Kinship 49.2 F 4.5 Competition 46.2 F 3.3 Status 45.5 F 4.5 Intimacy 47.0 F 5.0
n/a
46.7 F 3.1 54.4 F 4.2 56.1 F 4.5 51.7 F 4.1 53.9 F 4.4
65.1 F 3.9 86.4 F 3.0 85.6 F 3.5 72.0 F 3.7 82.6 F 3.7
64.4 F 3.7 87.9 F 3.3 84.1 F 3.6 68.9 F 3.5 83.3 F 3.6
0.71** 0.10 0.33 0.77 0.18 0.0003*** < 0.0001 < 0.0001 < 0.0001 < 0.0001
S.D. = standard deviation; CAD = conventional antipsychotic drug; OLZ = olanzapine. * Differences significant at p < 0.05 for all tests. ** t-test for independent samples for all CAD tests. *** ANOVA for all OLZ tests.
202
Letter to the Editors
was on monotherapy, 22.7% was on a concomitant mood stabilizer and/or SSRI, and no patients were receiving anticholinergics. The mean olanzapine dose was stable at 15.3 mg/day. Results of the current study were as follows: (1) there were no significant differences between the conventional antipsychotic group (CAD) and the olanzapine (OLZ) group on IPT scores at baseline; however, there was significant difference at endpoint ( p < 0.0001); (2) no significant changes in IPT scores were found in the CAD group from baseline to endpoint; and (3) the OLZ group demonstrated statistically significant improvements in IPT scores over the study period (Table 1). It is important to note that significant improvements in IPT scores were observed after 12 weeks of olanzapine treatment and were maintained until the end of study. The present study is limited by its small sample size and lack of randomization. The possibility remains that the findings could be influenced by the discontinuation of conventional antipsychotics or anticholinergic agents. The use of additional measures of social cognition, as well as, inclusion of a psychopathology rating would strengthen the study. To our knowledge, this is the first study to compare the effects of olanzapine versus conventional antipsychotics on schizophrenia patients’ social cognition. While the olanzapine-treated patients’ experienced improvements in social cognition, no such effect was observed in the conventional antipsychotics group. The specific mechanism for this improvement is unknown at this time. Ameliorating deficits in social cognition, through medication or other means, may lead to improved outcomes for schizophrenia patients.
Perception. University of California, Extension Media Center, Berkeley. Archer, D., Costanzo, M., 1989. Interpreting the expressive behavior of others: the interpersonal perception task. J. Nonverbal Behav. 13, 225 – 246. Corrigan, P.W., Penn, D.L. (Eds.), 2001. Social Cognition and Schizophrenia. American Psychological Association, Washington, DC, p. 3. Dougherty, F.E., Bartlett, E.S., Izard, C.E., 1974. Responses of schizophrenics to expressions of the fundamental emotions. J. Clin. Psychol. 30, 236 – 243. Kee, K.S., Kern, R.S., Marshall, B.D., Green, M.F., 1998. Risperidone versus haloperidol for perception of emotion in treatmentresistant schizophrenia: preliminary findings. Schizophr. Res. 31, 159 – 165. Patterson, M.L., Foster, J.L., Bellmer, C.D., 2001. Another look at accuracy and confidence in social judgments. J. Nonverbal Behav. 25, 207 – 219. Penn, D.L., Corrigan, P.W., Bentall, R.P., Racenstein, J.M., Newman, L., 1997. Social cognition in schizophrenia. Psychol. Bull. 121, 114 – 132. Schroeder, J., Ketrow, S.M., 1997. Social anxiety and performance in an interpersonal perception task. Psychol. Rep. 81, 991 – 996. Toomey, R., Schuldberg, D., Corrigan, P., Green, M.F., 2002. Nonverbal social perception and symptomatology in schizophrenia. Schizophr. Res. 53, 83 – 91. Zakahi, W.R., Gross, B., 1995. Loneliness and interpersonal decoding skills. Commun. Q. 43, 75 – 85.
Kimberly H. Littrell * Richard G. Petty The Promedica Research Center, Tucker, GA, USA Georgia State University, Atlanta, GA, USA E-mail address: [email protected] Nicole M. Hilligoss Carol D. Kirshner Craig G. Johnson The Promedica Research Center, Tucker, GA, USA 13 February 2003
References Archer, D., Costanzo, M., 1988. The Interpersonal Perception Task: A New Video About Non-Verbal Communication and Social
* Corresponding author. The Promedica Research Center, Tucker, GA, USA.
Letter to the Editors
Improvement in social cognition in patients with schizophrenia associated with treatment with olanzapine
Dear Editors, Social cognition has been described as ‘‘the processes and functions that allow a person to understand, act on, and benefit from the interpersonal world’’ (Corrigan and Penn, 2001). It is the ability to accurately perceive and interpret social interactions, including both verbal and nonverbal information. Numerous studies have found that patients with schizophrenia have deficits in social cognition, including accurately recognizing nonverbal communication (Dougherty et al., 1974; Penn et al., 1997; Toomey et al., 2002). Previous work by Kee et al. (1998) suggests that treatment with risperidone enhances social cognition in schizophrenia patients. We examined the effects of olanzapine (OLZ) on social cognition in patients with schizophrenia. Fifty-two outpatients (31 men and 21 women) meeting the DSM-IV criteria for schizophrenia or schizoaffective disorder provided informed, written consent prior to study entry. All patients had received a conventional antipsychotic drug (CAD) for at least 3 months prior to study entry and were offered a 12month, open-label trial of olanzapine. Twenty-two individuals (14 men and 8 women) agreed to antipsychotic conversion. There were no significant differences between groups on any demographic variable. All 52 patients agreed to participate in baseline and endpoint testing using the Interpersonal Perception Task (IPT) (Archer and Costanzo, 1988, 1989). Additionally, the olanzapine group was also tested at 3 months. The IPT was developed to assess nonverbal communication and social perception (Archer and Cos0920-9964/$ - see front matter D 2003 Published by Elsevier B.V. doi:10.1016/S0920-9964(03)00185-3
tanzo, 1988, 1989). The IPT consists of 30 brief, naturalistic, videotaped scenes preceded by a multiple choice question and evaluates five domains of social cognition: status, intimacy, kinship, competition, and deception. Choosing the correct answer is based on the perception of non-verbal communication. While the IPT has not previously been used in schizophrenia research, it has a history of use in social psychology (Patterson et al., 2001; Schroeder and Ketrow, 1997; Zakahi and Gross, 1995). At baseline, patients were receiving a variety of conventional antipsychotics. The mean daily dose, in chlorpromazine equivalents, was 540.6 mg/day (S.D. 215.9). Concomitant medications included anticholinergic agents (80.8%), mood stabilizers (23.1%), and serotonin reuptake inhibitors (SSRIs) (19.2%). No patients were receiving benzodiazepines. At endpoint, a majority of the olanzapine-treated patients (77.3%) Table 1 CAD and OLZ groups: performance on IPT across time Baseline
Interim Endpoint p value* (12 weeks) (52 weeks)
Mean F S.D. Mean F S.D. Mean F S.D. CAD (n = 30) Lie 46.1 F 3.0 Kinship 52.2 F 4.6 Competition 55.0 F 4.5 Status 51.1 F 4.1 Intimacy 52.2 F 4.4 OLZ (n = 22) Lie 46.2 F 2.9 Kinship 49.2 F 4.5 Competition 46.2 F 3.3 Status 45.5 F 4.5 Intimacy 47.0 F 5.0
n/a
46.7 F 3.1 54.4 F 4.2 56.1 F 4.5 51.7 F 4.1 53.9 F 4.4
65.1 F 3.9 86.4 F 3.0 85.6 F 3.5 72.0 F 3.7 82.6 F 3.7
64.4 F 3.7 87.9 F 3.3 84.1 F 3.6 68.9 F 3.5 83.3 F 3.6
0.71** 0.10 0.33 0.77 0.18 0.0003*** < 0.0001 < 0.0001 < 0.0001 < 0.0001
S.D. = standard deviation; CAD = conventional antipsychotic drug; OLZ = olanzapine. * Differences significant at p < 0.05 for all tests. ** t-test for independent samples for all CAD tests. *** ANOVA for all OLZ tests.
202
Letter to the Editors
was on monotherapy, 22.7% was on a concomitant mood stabilizer and/or SSRI, and no patients were receiving anticholinergics. The mean olanzapine dose was stable at 15.3 mg/day. Results of the current study were as follows: (1) there were no significant differences between the conventional antipsychotic group (CAD) and the olanzapine (OLZ) group on IPT scores at baseline; however, there was significant difference at endpoint ( p < 0.0001); (2) no significant changes in IPT scores were found in the CAD group from baseline to endpoint; and (3) the OLZ group demonstrated statistically significant improvements in IPT scores over the study period (Table 1). It is important to note that significant improvements in IPT scores were observed after 12 weeks of olanzapine treatment and were maintained until the end of study. The present study is limited by its small sample size and lack of randomization. The possibility remains that the findings could be influenced by the discontinuation of conventional antipsychotics or anticholinergic agents. The use of additional measures of social cognition, as well as, inclusion of a psychopathology rating would strengthen the study. To our knowledge, this is the first study to compare the effects of olanzapine versus conventional antipsychotics on schizophrenia patients’ social cognition. While the olanzapine-treated patients’ experienced improvements in social cognition, no such effect was observed in the conventional antipsychotics group. The specific mechanism for this improvement is unknown at this time. Ameliorating deficits in social cognition, through medication or other means, may lead to improved outcomes for schizophrenia patients.
Perception. University of California, Extension Media Center, Berkeley. Archer, D., Costanzo, M., 1989. Interpreting the expressive behavior of others: the interpersonal perception task. J. Nonverbal Behav. 13, 225 – 246. Corrigan, P.W., Penn, D.L. (Eds.), 2001. Social Cognition and Schizophrenia. American Psychological Association, Washington, DC, p. 3. Dougherty, F.E., Bartlett, E.S., Izard, C.E., 1974. Responses of schizophrenics to expressions of the fundamental emotions. J. Clin. Psychol. 30, 236 – 243. Kee, K.S., Kern, R.S., Marshall, B.D., Green, M.F., 1998. Risperidone versus haloperidol for perception of emotion in treatmentresistant schizophrenia: preliminary findings. Schizophr. Res. 31, 159 – 165. Patterson, M.L., Foster, J.L., Bellmer, C.D., 2001. Another look at accuracy and confidence in social judgments. J. Nonverbal Behav. 25, 207 – 219. Penn, D.L., Corrigan, P.W., Bentall, R.P., Racenstein, J.M., Newman, L., 1997. Social cognition in schizophrenia. Psychol. Bull. 121, 114 – 132. Schroeder, J., Ketrow, S.M., 1997. Social anxiety and performance in an interpersonal perception task. Psychol. Rep. 81, 991 – 996. Toomey, R., Schuldberg, D., Corrigan, P., Green, M.F., 2002. Nonverbal social perception and symptomatology in schizophrenia. Schizophr. Res. 53, 83 – 91. Zakahi, W.R., Gross, B., 1995. Loneliness and interpersonal decoding skills. Commun. Q. 43, 75 – 85.
Kimberly H. Littrell * Richard G. Petty The Promedica Research Center, Tucker, GA, USA Georgia State University, Atlanta, GA, USA E-mail address: [email protected] Nicole M. Hilligoss Carol D. Kirshner Craig G. Johnson The Promedica Research Center, Tucker, GA, USA 13 February 2003
References Archer, D., Costanzo, M., 1988. The Interpersonal Perception Task: A New Video About Non-Verbal Communication and Social
* Corresponding author. The Promedica Research Center, Tucker, GA, USA.