Characteristics of Social Perception and their Changes after Treatment in Patients with Schizophrenia Using the Idea of Reference Provoking Task

Seungjin Choi; Il-Ho Park; Seon-Koo Lee; Jae-Jin Kim

doi:10.16946/kjsr.2013.16.2.69

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Choi, Park, Lee, and Kim: Characteristics of Social Perception and their Changes after Treatment in Patients with Schizophrenia Using the Idea of Reference Provoking Task

Original Article

Korean J Schizophr Res 2013;16(2):69-79.

Published online: 17 January 2013

DOI: https://doi.org/10.16946/kjsr.2013.16.2.69

Characteristics of Social Perception and their Changes after Treatment in Patients with Schizophrenia Using the Idea of Reference Provoking Task

Seungjin Choi, MD¹, Il-Ho Park, MD², Seon-Koo Lee, MD^3,⁴, Jae-Jin Kim, MD^1,^4,

¹Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea

²Department of Psychiatry, Kwandong University College of Medicine, Gangreung, Korea

³Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Ilsan, Korea

⁴Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

Address for correspondence: Jae-Jin Kim, Department of Psychiatry, Yonsei University Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea Tel: 02-2019-3341, Fax: 02-3462-4304 E-mail: jaejkim@yonsei.ac.kr 본 연구는 보건복지부 보건의료개발사업의 지원에 의하여 이루어진 것임 (A090537).

Revised 21 May 20134 June 2013 Accepted 7 June 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Patients with schizophrenia often present idea of reference in social situations, but there has been a limitation in quantitatively measuring their reactions to the social stimuli. The aim of this study was to investigate behavioral characteristics of patients with schizophrenia in social situations in which idea of reference can be provoked.

Methods

Forty subjects with schizophrenia (21 males) and 26 healthy volunteers (17 males) performed the idea-of-reference-provoking task, which was composed of movie clips with scenes of two women sitting on a bench of 1 or 5 m away. The conditions consisted of “referential conversation”, “non-referential conversation” or “no conversation”. The reactions of the participants were rated by the questionnaires for self-referential perception, malevolent interpretation and anxiety reaction.

Results

There were significant group differences in the reactions on self-referential perception, malevolent interpretation and anxiety reaction. After the treatment, patients with schizophrenia showed improved scores of the reactions. In particular, score changes of malevolent interpretation and anxiety reaction in patients with schizophrenia were correlated with change of paranoia scale (rs=0.65, p＜0.05 and rs =0.73, p＜0.05, respectively).

Conclusion

Patients with schizophrenia revealed self-referential bias and paranoid responses to social situations, which were improved after psychiatric treatment. Self-referential perceptions and paranoid responses may be state dependent rather than trait of schizophrenia.

Keywords: Schizophrenia, Idea of reference, Social perception, Social cognition

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Fig. 1.

A schematic description of the task conditions.

Fig. 2.

Correlations between score change in paranoid scale and changes in mean scores of self-referential perception, malevolent interpretation and anxiety reaction.

Table 1.

Demographic and clinical characteristics of participants

	Control (n=26)	SPR (n=40)	p-value∗
Male/Female	17 (65.4%)/9 (34.6%)	21 (52.5%)/19 (47.5%)	＜0.301
Age	028.3±04.3	29.6±07.1	＜0.351
Education	014.9±01.8	12.9±02.1	＜0.010
K-WAIS	108.2±09.8	97.3±09.2	＜0.010
Paranoid scale score	039.2±10.1	53.1±19.5	＜0.010
PANSS
Total score		62.8±18.0
Positive score		13.6±09.1
Negative score		14.7±05.0
General score		34.4±09.5
Duration of illness (years)		05.9±04.8

Values are mean±SD.

^∗ : chi-square for categorical variables and independent t-test for continuous variables. K-WAIS : Korean Wechsler adult intelligence scale, PANSS : Positive and Negative syndrome scale

Table 2.

Task scores for self-referential perception, malevolent interpretation and anxiety reaction

	Control (n=26)	SPR (n=40)	p-value∗
1 m, Referential context
Perception	3.37±1.96	2.69±1.90	＜0.17
Interpretation	0.51±0.74	1.76±1.69	＜0.01
Anxiety	0.93±1.09	1.95±1.77	＜0.01
1 m, non-Referential context
Perception	0.19±0.52	1.24±1.57	＜0.01
Interpretation	0.18±0.50	1.17±1.44	＜0.01
Anxiety	0.21±0.55	1.42±1.70	＜0.01
1 m, no-Conversation context
Perception	0.15±0.47	1.37±1.55	＜0.01
Interpretation	0.19±0.51	1.43±1.60	＜0.01
Anxiety	0.21±0.51	1.71±1.71	＜0.01
5 m, Referential context
Perception	2.81±1.66	2.48±1.81	＜0.45
Interpretation	0.65±0.67	1.86±1.95	＜0.01
Anxiety	1.10±0.95	2.04±1.88	＜0.01
5 m, non-Referential context
Perception	0.35±0.54	1.51±1.76	＜0.01
Interpretation	0.33±0.56	1.54±1.79	＜0.01
Anxiety	0.38±0.79	1.71±1.85	＜0.01
5 m, no-Conversation context
Perception	0.25±0.52	1.48±1.53	＜0.01
Interpretation	0.23±0.50	1.34±1.54	＜0.01
Anxiety	0.24±0.53	1.51±1.69	＜0.01

Values are mean±SD of rating scores (0 to 6).

^∗ : by independent t-test. Perception : self-referential perception score, Interpretation : malevolent interpretation score, Anxiety : anxiety reaction score

Table 3.

Distance effect on self- referential perception, malevolent interpretation and anxiety reaction

	Control group (n=26)		p-value∗
	1 m	5 m	p-value∗
Referential context
Perception	3.37±1.96	2.81±1.66	＜0.05
Interpretation	0.51±0.74	0.65±0.67	0.15
Anxiety	0.93±1.09	1.10±0.95	0.31
Non-Referential context
Perception	0.19±0.52	0.35±0.54	0.05
Interpretation	0.18±0.50	0.33±0.56	0.12
Anxiety	0.21±0.55	0.38±0.79	0.13
No-Conversation context
Perception	0.15±0.47	0.25±0.52	0.08
Interpretation	0.19±0.51	0.23±0.50	0.40
Anxiety	0.21±0.51	0.24±0.53	0.50
	Schizophrenia group (n=40)		p-value∗
	1 m	5 m	p-value∗
Referential context
Perception	2.69±1.90	2.48±1.81	0.33
Interpretation	1.76±1.69	1.86±1.95	0.56
Anxiety	1.95±1.77	2.04±1.88	0.69
Non-Referential context
Perception	1.24±1.57	1.51±1.76	0.06
Interpretation	1.17±1.44	1.54±1.79	＜0.05
Anxiety	1.42±1.70	1.71±1.85	0.07
No-Conversation context
Perception	1.37±1.55	1.48±1.53	0.40
Interpretation	1.43±1.60	1.34±1.54	0.42
Anxiety	1.71±1.71	1.51±1.69	0.06

Values are mean±SD of rating scores (0 to 6).

^∗ : by paired t-test. Perception : self-referential perception score, Interpretation : malevolent interpretation score, Anxiety : anxiety reaction score

Table 4.

Context effect on self-referential perception, malevolent interpretation and anxiety reaction

		Referential (R)	Non-referential (NR)	No conversation (NC)	p-value∗
	Control
	Perception	3.37±1.96	0.19±0.52	0.15±0.47	R ＞NR^†, R ＞NC^†
	Interpretation	0.51±0.74	0.18±0.50	0.19±0.51	R ＞NR^†, R ＞NC^†
1 m	Anxiety	0.93±1.09	0.21±0.55	0.21±0.51	R ＞NR^† R ＞NC^†, NR ＞NC^†
1 m	Schizophrenia
	Perception	2.69±1.90	1.24±1.57	1.37±1.55	R ＞NR^†, R ＞NC^†
	Interpretation	1.76±1.69	1.17±1.44	1.43±1.60	R ＞NR^†
	Anxiety	1.95±1.77	1.42±1.70	1.71±1.71
	Control
	Perception	2.81±1.66	0.35±0.54	0.25±0.52	R ＞NR^†, R ＞NC^†
	Interpretation	0.65±0.67	0.33±0.56	0.23±0.50	R ＞NR^‡, R ＞NC^†
5 m	Anxiety	1.10±0.95	0.38±0.79	0.24±0.53	R ＞NR^†, R ＞NC^†
5 m	Schizophrenia
	Perception	2.48±1.81	1.51±1.76	1.48±1.53	R ＞NR^†, R ＞NC^†
	Interpretation	1.86±1.95	1.54±1.79	1.34±1.54	R ＞NC^‡
	Anxiety	2.04±1.88	1.71±1.85	1.51±1.69

Values are mean±SD of rating scores (0 to 6).

^∗ : by repeated measure ANOVA, post hoc paired t-test & Bonferroni-correction was done,

^† : p<0.01,

^‡ : P<0.05. Perception : self-referential perception score, Interpretation : malevolent interpretation score, Anxiety : anxiety reaction score

Table 5.

Comparison of scores for self-referential perception, malevolent interpretation and anxiety reaction between pre-treatment and posttreatment in followup patients

	Follow-up schizophrenia group (n=10)		p-value∗
	Pre-treatment	Post-treatment	p-value∗
Paranoia scale	52.00 (31.00-98.00)	38.00 (28.00-53.00)	＜0.05
1 m, Referential context
Perception	02.38 (0.00-6.00)	00.75 (0.00-5.25)	＜0.29
Interpretation	01.25 (0.00-6.00)	00.00 (0.00-1.50)	＜0.05
Anxiety	01.63 (0.00-6.00)	00.00 (0.00-1.50)	＜0.05
1 m, non-Referential context
Perception	00.88 (0.00-5.75)	00.00 (0.00-1.25)	＜0.05
Interpretation	00.38 (0.00-5.75)	00.00 (0.00-1.50)	＜0.07
Anxiety	00.38 (0.00-6.00)	00.00 (0.00-2.50)	＜0.08
1 m, no-Conversation context
Perception	01.38 (0.00-6.00)	00.00 (0.00-2.25)	＜0.16
Interpretation	01.38 (0.00-5.75)	00.00 (0.00-2.50)	＜0.05
Anxiety	01.00 (0.00-6.00)	00.00 (0.00-1.50)	＜0.07
5 m, Referential context
Perception	03.75 (0.50-6.00)	01.50 (0.00-5.50)	＜0.11
Interpretation	01.75 (0.00-6.00)	00.00 (0.00-1.00)	＜0.05
Anxiety	01.75 (0.00-4.50)	00.00 (0.00-3.50)	＜0.07
5 m, non-Referential context
Perception	01.25 (0.00-5.50)	00.00 (0.00-0.50)	＜0.05
Interpretation	01.25 (0.00-6.00)	00.00 (0.00-1.50)	＜0.05
Anxiety	01.25 (0.00-6.00)	00.00 (0.00-2.00)	＜0.05
5 m, no-Conversation context
Perception	01.63 (0.00-5.75)	00.00 (0.00-1.50)	＜0.05
Interpretation	01.63 (0.00-5.75)	00.00 (0.00-1.25)	＜0.05
Anxiety	01.75 (0.00-6.00)	00.00 (0.00-2.00)	＜0.05

Values are median, minimum and maximum ranges.

^∗ : by Wilcoxon matched-pairs signed-ranks test. Perception : self-referential perception score, Interpretation : malevolent interpretation score, Anxiety : anxiety reaction score

Table 6.

Comparison of self-referential perception, malevolent interpretation and anxiety reaction between the control and posttreatment schizophrenia groups

	Control (n=26)	Post-treatment schizophrenia (n=10)	p-value∗
1 m, referential context
Perception	3.13 (0.00-6.00)	0.75 (0.00-5.25)	0.17
Interpretation	0.00 (0.00-2.25)	0.00 (0.00-1.50)	0.48
Anxiety	0.63 (0.00-3.50)	0.00 (0.00-1.50)	0.27
1 m, non-Referential context
Perception	0.00 (0.00-2.00)	0.00 (0.00-1.25)	0.66
Interpretation	0.00 (0.00-2.00)	0.00 (0.00-1.50)	0.57
Anxiety	0.00 (0.00-2.00)	0.00 (0.00-2.50)	0.54
1 m, no-Conversation context
Perception	0.00 (0.00-2.00)	0.00 (0.00-2.25)	0.21
Interpretation	0.00 (0.00-2.00)	0.00 (0.00-2.50)	0.54
Anxiety	0.00 (0.00-2.00)	0.00 (0.00-1.50)	0.39
5 m, Referential context
Perception	3.00 (0.00-6.00)	1.50 (0.00-5.50)	0.09
Interpretation	0.50 (0.00-2.50)	0.00 (0.00-1.00)	0.17
Anxiety	1.00 (0.00-3.50)	0.00 (0.00-3.50)	0.09
5 m, non-Referential context
Perception	0.00 (0.00-2.00)	0.00 (0.00-0.50)	0.37
Interpretation	0.00 (0.00-3.00)	0.00 (0.00-1.50)	0.69
Anxiety	0.00 (0.00-2.50)	0.00 (0.00-2.00)	0.48
5 m, no-Conversation context
Perception	0.00 (0.00-2.00)	0.00 (0.00-1.50)	0.90
Interpretation	0.00 (0.00-2.00)	0.00 (0.00-1.25)	0.90
Anxiety	0.00 (0.00-2.00)	0.00 (0.00-2.00)	0.74

^∗ : by Mann-Whitney U test, Values are median, minimum and maximum ranges are shown. Perception : self-referential perception score, Interpretation : malevolent interpretation score, Anxiety : anxiety reaction score

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