Identifying at-risk states beyond positive symptoms: a brief task assessing how neurocognitive impairments impact on misrepresentation of the social world through blunted emotional appraisal

Mariana Galdos, Claudia J P Simons, Marieke Wichers, Aranzazu Fernandez-Rivas, Oscar Martinez-Azumendi, Tineke Lataster, Guillermo Amer, Inez Myin-Germeys, Miguel Angel Gonzalez-Torres, Jim van Os

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVE: Neurocognitive impairments observed in psychotic disorder may impact on emotion recognition and theory of mind, resulting in altered understanding of the social world. Early intervention efforts would be served by further elucidation of this mechanism.

METHOD: Patients with a psychotic disorder (n=30) and a reference control group (n=310) were asked to offer emotional appraisals of images of social situations (EASS task). The degree to which case-control differences in appraisals were mediated by neurocognitive alterations was analyzed.

RESULTS: The EASS task displayed convergent and discriminant validity. Compared to controls, patients displayed blunted emotional appraisal of social situations (B=0.52, 95% CI: 0.30, 0.74, P<0.001; adjusted for age, sex and number of years of education: B=0.44, 95% CI: 0.20, 0.68, P<0.001), a difference of 0.88 (adjusted: 0.75) standard deviation. After adjustment for neurocognitive variables, the case-control difference was reduced by nearly 75% and was non-significant (B=0.12, 95% CI: -0.14, 0.39, P=0.37).

CONCLUSIONS: Neurocognitive impairments observed in patients with psychotic disorder may underlie misrepresentation of the social world, mediated by altered emotion recognition. A task assessing the social impact of cognitive alterations in clinical practice may be useful in detecting key alterations very early in the course of psychotic illness.

Original languageEnglish
Pages (from-to)175-196
Number of pages22
JournalRevista Brasileira de Psiquiatria
Volume33 Suppl 2
Publication statusPublished - Oct 2011


  • Adolescent
  • Adult
  • Case-Control Studies
  • Cognition
  • Early Diagnosis
  • Educational Status
  • Emotions
  • Facial Expression
  • Female
  • Humans
  • Interpersonal Relations
  • Male
  • Psychiatric Status Rating Scales
  • Psychotic Disorders
  • Recognition (Psychology)
  • Schizophrenic Psychology
  • Social Behavior
  • Young Adult
  • Journal Article

Cite this