S68. DIFFERENTIAL PATTERN OF SOCIAL COGNITION IMPAIRMENT BETWEEN RURAL AND URBAN DWELLING PATIENTS OF SCHIZOPHRENIA AND ITS FUNCTIONAL CORRELATES
Authors: Ibrahim Ferose , Mehta Urvakhsh M , Keshav Kumar J K , Nair Sreekanth , Gowda Swetha , Rakesh K R , Naveen Kumar C N , Thirthalli Jagadisha 
Published: May 2020

Abstract

Background
Cognitive deficits (both neuro & social Cognition) play a vital role in determining functional status in schizophrenia. It has been noted that functional outcomes are relatively better in Indian rural settings. This suggests that cognition might be better in rural patients. Considering the prevailing vast cultural differences there is paucity of research which delineates the differences in social cognition and its impact on the functional outcomes between rural and urban setups. Hence, we aim to explore differential impairment in social cognition in patients with schizophrenia residing in rural versus urban settings and their impact on real-world functioning.

Methods
122 patients diagnosed with either schizophrenia or schizoaffective disorder from the rural taluk of Thirthahalli and Turuvekere were compared with 97 patients with similar diagnosis visiting a teaching hospital with urban residence. All the 219 patients met the standardized criteria for remission from positive and disorganized symptoms and were compared on culturally validated tests of SC—Social Cognition Rating Tool in Indian Setting (SOCRATIS) & Tool for Recognition of Emotions in Neuropsychiatric Disorders (TRENDS) to assess theory of mind, social perception and emotion recognition and NC—(attention/vigilance, speed of processing, visual and verbal learning, working memory and executive functions). Groningen Social Disabilities Schedule (GSDS) was used for the assessment of social dysfunction of the patients. Based on past factor analytical studies on these tests, social cognition dimensions were grouped into inferential social cognition which comprised of 1st order theory of mind & 2nd order theory of mind Index & socio-emotional cognition which included faux pas recognition, emotional recognition & social perception indices. These were compared using analysis of covariance after controlling for neurocognitive composite performance and other confounders Correlation between social-cognition and functioning among the two groups was assessed using Pearson correlation.

Results
Patients from rural population had significantly better inferential social cognition whereas patients form urban population had significantly better socio-emotional cognition. ANCOVA showed that even after controlling for effects of age, gender, duration of illness, family history, number of hospitalization & neuro-cognition composite scores the differences were significant. Social cognition composite score was significantly (negatively) correlated with functional disability. The socio-emotional cognition component had a stronger association (proportion of variance explained) with functioning in both rural & urban samples (r= -0.411, r= -0.403 respectively). Inferential Social cognition from both rural & urban samples (r= -0.212, r= -0.238) also has significant association with functioning but of lesser magnitude as compared to the former

Discussion
The two distinct components of social cognition - inferential and socio-emotional- were differentially impaired among rural & urban patients. With respect to its relationship with functioning, the socio-emotional cognition had a stronger association with functioning in both the groups. The reasons for the difference need to be explored by studying the socio-cultural characteristics of rural & urban dwelling patients which can moderate their expression of social cognition. These observations are critical in understanding how our micro- and macro-level environments can influence cognitive performance