title: Identifying at-risk states beyond positive symptoms: a brief task assessing how neurocognitive impairments impact on misrepresentation of the social world through blunted emotional appraisal.
abstract: OBJECTIVE
  Neurocognitive impairments observed in psychotic disorder may impact on emotion recognition and theory of mind, resulting in altered understanding of the social world. Early intervention efforts would be served by further elucidation of this mechanism.
  
  
  METHODS
  Patients with a psychotic disorder (n=30) and a reference control group (n=310) were asked to offer emotional appraisals of images of social situations (EASS task). The degree to which case-control differences in appraisals were mediated by neurocognitive alterations was analyzed.
  
  
  RESULTS
  The EASS task displayed convergent and discriminant validity. Compared to controls, patients displayed blunted emotional appraisal of social situations (B=0.52, 95% CI: 0.30, 0.74, P<0.001; adjusted for age, sex and number of years of education: B=0.44, 95% CI: 0.20, 0.68, P<0.001), a difference of 0.88 (adjusted: 0.75) standard deviation. After adjustment for neurocognitive variables, the case-control difference was reduced by nearly 75% and was non-significant (B=0.12, 95% CI: -0.14, 0.39, P=0.37).
  
  
  CONCLUSIONS
  Neurocognitive impairments observed in patients with psychotic disorder may underlie misrepresentation of the social world, mediated by altered emotion recognition. A task assessing the social impact of cognitive alterations in clinical practice may be useful in detecting key alterations very early in the course of psychotic illness.
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, The Netherlands.
authors.forename: Mariana
authors.initials: M
authors.lastname: Galdos
authors.forename: Claudia J P
authors.initials: CJ
authors.lastname: Simons
authors.forename: Marieke
authors.initials: M
authors.lastname: Wichers
authors.forename: Aranzazu
authors.initials: A
authors.lastname: Fernandez-Rivas
authors.forename: Oscar
authors.initials: O
authors.lastname: Martinez-Azumendi
authors.forename: Tineke
authors.initials: T
authors.lastname: Lataster
authors.forename: Guillermo
authors.initials: G
authors.lastname: Amer
authors.forename: Inez
authors.initials: I
authors.lastname: Myin-Germeys
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Gonzalez-Torres
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology*; D042241:Early Diagnosis; D004522:Educational Status; D004644:Emotions; D005149:Facial Expression; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology; D021641:Recognition, Psychology; D012565:Schizophrenic Psychology; D012919:Social Behavior; D055815:Young Adult