Towards personalized medicine in psychosis: the roles of social cognition and metacognition
[eng] People with psychosis experience a range of symptoms and impairments that significantly impact their lives and often concur with disability. The best predictors of functional outcome are social cognition and metacognition, which are often impaired in psychosis. Interventions to improve both do...
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| Tipo de recurso: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2022 |
| País: | España |
| Institución: | Universidad de Barcelona |
| Repositorio: | Dipòsit Digital de la UB |
| OAI Identifier: | oai:diposit.ub.edu:2445/203131 |
| Acceso en línea: | https://hdl.handle.net/2445/203131 http://hdl.handle.net/10803/689211 |
| Access Level: | acceso abierto |
| Palabra clave: | Psicosi Diferències entre sexes (Psicologia) Medicina personalitzada Percepció social Metacognició Psychoses Sex differences (Psychology) Personalized medicine Social perception Metacognition |
| Sumario: | [eng] People with psychosis experience a range of symptoms and impairments that significantly impact their lives and often concur with disability. The best predictors of functional outcome are social cognition and metacognition, which are often impaired in psychosis. Interventions to improve both domains are effective, but this efficacy does not always translate into better functioning. Delivering early, and targeted social cognitive or metacognitive interventions to patients with psychosis could be instrumental in preventing poor functional outcome and preventing relapse, but the grounds on how to personalize these interventions are unknown. Although it has been suggested that the approach should take sex differences, the refining of measurement instruments and the use of sophisticated statistical models, these have not been explored yet. Under this rationale, the present doctoral dissertation aims to: 1) validate a test of facial emotion recognition (Baron Cohen’s Face Test) in healthy population, with the aim of detecting whether it is an appropriate tool to use in clinical research, 2) detect whether patients with first episode psychosis have different, clinically meaningful profiles of performance in social cognition and metacognition, 3) explore the sociodemographic, clinical, and neurocognitive characteristics of each profile, 4) examine if males and females with first episode psychosis are similar in their heterogeneity in social cognition and metacognition, 5) explore the role of social cognition and sex in functional outcome in people with established psychosis (schizophrenia). This broad aim yielded four research articles. The main findings of this doctoral dissertation are a) Baron Cohen’s Face Test is an adequate and reliable instrument to measure facial emotion recognition in Spanish population but it presents a ceiling effect, b) People with first-episode psychosis have distinct profiles of social cognition and metacognition that have specific clinical and neurocognitive correlates. Having worse social cognition is associated with worse clinical presentation, even if metacognition is preserved, c) Men and women with first-episode psychosis have similar configurations of social cognition and metacognition. However, there are sex- specific profiles that should be considered when delivering treatment. Sex-specific profiles seem to be associated with more severity of the disorder than the common profiles. These results suggest that people with psychosis can receive social cognitive or metacognitive targeted treatment as early as after the first episode, but these should be chosen considering the profile of each individual and their biological sex. Thus, patients with psychosis should always be carefully assessed for social cognitive and metacognitive performance. |
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