Exploration de la reconnaissance des émotions en schizophrénie comorbide

Schizophrenia is a complex mental disorder that has multiple possible aetiologies that are rooted in both biology and environment. It is manifested through various negative and positive symptoms as well as many neurocognitive and sociocognitive deficits. To complicate matters, this disorder is highly comorbid with several others, with one of the most prevalent one being substance use disorder. Most research in the past has focused on either the neurobiology of this illness, identifying deficient brain structures and dysregulation in several neurotransmitter systems or on neurocognition trying to decipher the deficits in domains like attention, learning and memory through the use of modern technology such as functioning imaging. However, more recent studies have shown that what could very well be the hallmark of schizophrenia, is rather more linked to social functioning. Furthermore, social functioning can be more readily predicted when we examine sociocognitive domains rather than neurocognitive ones. More specifically, it has been shown that emotion recognition ability could have a very strong association with social functioning and outcomes. However, where emotion recognition is concerned, there is no clear consensus in the literature. Some argue the deficits are global while others suggest that it is emotion specific. Yet others have posited that perhaps, the heterogeneous findings in emotion recognition could be due not to the deficits themselves to rather to the methods used to measure emotion recognition. Also of importance, is the fact that most studies will solely focus on individuals that have schizophrenia alone when statistics show that around 50% of these individuals also suffer from substance use disorder. Therefore, trying to ascertain sociocognitive deficits in schizophrenia alone might not be optimal to generalize the findings.   As such, it was our first objective to assess emotion recognition both global and specific, in schizophrenia alone and in comorbid schizophrenia and substance use disorder, using virtual avatars as a more naturalistic measurement tool and also examining the impact of social functioning. Our results for the whole sample comprised of individuals with schizophrenia alone and schizophrenia and substance use disorder, showed good overall emotion recognition with sadness being the easiest to identify and fear the hardest. There were also specific misinterpretation patterns where fear tended to be misidentified as surprise while anger was perceived as neutrality. There was a positive correlation between identification sadness and frequency of positive interaction with family and a negative one between identification errors in neutrality and frequency of positive interaction with family. Importantly, individual with comorbid presentations were better at recognizing negative emotions like anger and fear leading to more interactions with others. Given those paradoxical results, we wanted in our second article, to better understand the impact of substance use disorder – more specifically for cannabis use which has been studied the most – on schizophrenia in order to make sense of the sociocognitive profiles we found, with the main objective of finding appropriate ways to remediate the deficits. We explored various explanatory models such as the neuroprotective hypothesis, the lower vulnerability hypothesis and finally the social hypothesis which is the one that holds the most promise. Finally, we examined the literature to see what was done the most often with regard to cognitive remediation in sociocognition. We can conclude that it would be preferable to create a hybrid remediation program that would include both practice learning – by creating a training program for emotion recognition tailor-fitted to individual deficits with virtual avatars – and strategy learning through group therapy to integrate social skills following retraining of emotion recognition.   To conclude, while our sample was small and did not allow us any predictive power or comparison with a control group, our results highlight the importance of targeted remediation and the impact of comorbid substance use disorder on sociocognitive profiles. We suggest that schizophrenia is rather a "social disorder" than it is a "brain" or "thought disorder". We explore the various social aetiologies such as traumatic childhood experiences, communication deviance and expressed emotion for the disorder while proposing that stigmatisation, social isolation and overall poor social interactions could be at the source of the many dysfunctions found in the disorder. Therefore, we suggest that the focus of future research should be on both comorbidities in schizophrenia, social cognition and social functioning outcomes.

Keyphrases: Schizophrenia, Substance use disorder, Comorbidity, Emotion recognition, Social functioning, Virtual avatars