Development And The Clinical Application Of The Chinese Version Of The Movie For The Assessment Of Social Cognition

Objective Theory of mind(To M)refers to the ability of attributing thoughts,intentions,and emotions to oneself and others.Previous studies have suggested that social functioning impairment in schizophrenia is associated with social cognition deficits.Accordingly,the evidence that deficits in social skills play a role in the pathogenesis of many psychiatric disorders is growing.Schizophrenia,bipolar disorder and major depressive disorder display overlapping clinical symptoms,for example,in a minority of depressive individuals,psychotic symptoms may occur secondary to a depressive episode.However,they also each have characteristic symptom patterns and show a different clinical course.It remains unclear whether they are discrete entities with distinct etiology and pathogenesis,or whether there are similarities between affective and psychotic symptomatology.This study uses the Chinese version of the Movie for the Assessment of Social Cognition(MASC-C)to explore the theory of mind in schizophrenia,bipolar disorder and major depressive disorder and its relationship with clinical symptoms and social function.Methods Firstly,we recruited 42 patients with schizophrenia and 46 normal controls to test the reliability and validity for MASC-C.The MASC-C was developed according to the original version of the Movie for the Assessment of Social Cognition(MASC).Forty-two patients with schizophrenia and 46 normal controls were administered by the MASC-C,Eyes Task and Faux pas Task.Five patients with schizophrenia and 5 normal controls completed the retest of MASC-C.Next,we recruited 35 participants with schizophrenia,33 with bipolar disorder,30 with major depressive disorder,and 32 healthy controls.All participants were matched in age,gender and years of education.The MASC-C,Eyes Task and Faux pas Task both theverbal Fluency Test and Digit Span test was administered.The Positive and Negative Syndrome Scale(PANSS)was used for clinical evaluation of patients with schizophrenia.The Young Mania Rating Scale(YMRS)was used for patients with bipolar disorder.The Hamilton Rating Scale for Depression(HAMD)was used to evaluate the depression level of patients with major depressive disorder.All patients in the diagnosis group(schizophrenia group,bipolar disorder group and major depressive disorder group)were assessed by the Personal and Social Performance scale(PSP)to assess the level of social function.Results The internal consistency reliability of MASC-C was 0.816.The test-retest reliability was 0.822(95%CI=0.436-0.953).The scores of MASC-C were positively correlated with the scores on Eyes Task(rho=0.574,P<0.001)and Faux pas Task(rho=0.445,P<0.001).The receiver operating characteristic curve of MASC-C was0.904.Overall,To M impairments were observed in all patient groups compared with healthy controls,with patients with schizophrenia performing worse than those with bipolar disorder(P<0.001).In Faux pas task,patients with schizophrenia and bipolar disorder showed deficits,while patients with major depressive disorder only performed significantly poorer in Eyes Task(P<0.001).Patients with bipolar disorder had significantly higher scores in the hyper-To M error type(P<0.05).The less-To M and no-To M of the schizophrenia were significantly higher than those of the bipolar disorder and the healthy control(P<0.001).The DST score of the schizophrenia group was lower than the other three groups(P<0.001),and the VFT scores of the schizophrenia and the bipolar disorder were worse than the other groups(P<0.05).The total PSP score of the schizophrenia group was significantly lower than the other two groups(P<0.05).Conclusion MASC-C is an ecologically valid and useful tool for assessing social cognition in the Chinese population.The results suggest that To M deficits extent with the level of risk and severity of the disorders.The largest To M deficits are found inthe most severely impaired groups(patients with schizophrenia,bipolar disorder patients during a manic phase)and smaller deficits are present in groups with relatively fewer symptoms(patients with non-psychotic major depressive disorder).Patients with less-To M errors are mainly manifested as social cognitive dysfunction.The clinical symptoms are mainly negative symptoms,and their social dysfunction is more prominent.For example,for less-To M patients with schizophrenia,social cognitive training should focus on improving them Basic social cognition skills.Patients with hyper-To M errors are mainly manifested as deviations in social cognition,clinically with positive symptoms and manic episodes,such as schizophrenia patients with positive symptoms and mania with bipolar disorder.For patients with hyper-To M,social cognitive training should focus on correcting their social cognitive bias.