title: Associations between social cognition, skills, and function and subclinical negative and positive symptoms in 22q11.2 deletion syndrome.
abstract: BACKGROUND
  Identification of the early signs of schizophrenia would be a major achievement for the early intervention and prevention strategies in psychiatry. Social impairments are defining features of schizophrenia. Impairments of individual layers of social competencies are frequently described in individuals with 22q11.2 deletion syndrome (22q11.2DS), who have high risk of schizophrenia. It is unclear whether and to what extent social impairments associate with subclinical negative and positive symptoms in 22q11.2DS, and which layer of social impairments are more correlated with schizophrenia-related symptoms. The aims of this study were to conduct a comprehensive investigation of social impairments at three different levels (function, skill, and cognition) and their interrelationship and to determine to what degree the social impairments correlate to subclinical levels of negative and positive symptoms, respectively, in a young cohort of 22q11.2DS not diagnosed with schizophrenia.
  
  
  METHODS
  The level of social impairment was addressed using questionnaires and objective measures of social functioning (The Adaptive Behavior Assessment System), skills (Social Responsiveness Scale), and cognition (The Awareness of Social Inference Test and CANTAB Emotional Recognition Task), and the presence of subclinical symptoms of schizophrenia were evaluated using the Structured Interview for Prodromal Syndromes in a cross-sectional case-control study of 29 cases and 29 controls, aged 12 to 25 years. Association between social impairment and negative and positive symptoms levels was examined in cases only.
  
  
  RESULTS
  Subjects with 22q11.2DS were highly impaired in social function, social skills, and social cognition (p≤ 6.2 × 10-9) relative to control peers and presented with more negative (p= 5.8 × 10-11) and positive (p= 7.5 × 10-4) symptoms. In particular, social functional and skill levels were highly associated with notably subclinical negative symptoms levels.
  
  
  CONCLUSIONS
  This study shows strong correlations between levels of social impairments and subclinical negative and positive symptoms. However, longitudinal studies are required to show if social impairments represent early disease manifestations. If parental or self-reporting suggests severe social impairment, it should advocate for clinical awareness not only to social deficits per se but also of potential subclinical psychosis symptoms.
authors.affiliation: Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Boserupvej 2, 4000 Roskilde, Denmark ; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Copenhagen Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Vangkilde
authors.affiliation: Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Bispebjerg Bakke 30, 2400 Copenhagen NV, Denmark ; Lundbeck Foundation Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Ndr. Ringvej 29-67, 2600 Glostrup, Denmark.
authors.forename: J R M
authors.initials: JR
authors.lastname: Jepsen
authors.affiliation: Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Boserupvej 2, 4000 Roskilde, Denmark ; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Copenhagen Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Schmock
authors.affiliation: Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
authors.forename: C
authors.initials: C
authors.lastname: Olesen
authors.affiliation: Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Boserupvej 2, 4000 Roskilde, Denmark ; deCODE genetics, Amgen, Sturlugata 8, 101 Reykjavik, Iceland.
authors.forename: S
authors.initials: S
authors.lastname: Arnarsdóttir
authors.affiliation: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark.
authors.forename: W F C
authors.initials: WF
authors.lastname: Baaré
authors.affiliation: Child and Adolescent Mental Health Center, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Bispebjerg Bakke 30, 2400 Copenhagen NV, Denmark ; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Denmark.
authors.forename: K J
authors.initials: KJ
authors.lastname: Plessen
authors.affiliation: H. Lundbeck A/S, Ottiliavej 9, 2500 Valby, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Didriksen
authors.affiliation: Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark ; Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen NV, Denmark.
authors.forename: H R
authors.initials: HR
authors.lastname: Siebner
authors.affiliation: Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Boserupvej 2, 4000 Roskilde, Denmark ; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Copenhagen Denmark ; Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Werge
authors.affiliation: Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Mental Health Services, Capital Region of Denmark, Boserupvej 2, 4000 Roskilde, Denmark ; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Copenhagen Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Olsen
keywords: 22q11 deletion syndrome; Emotional recognition task; Negative symptoms; Positive symptoms; Schizophrenia; Social cognition; Social function; Social skills; Theory of mind