Oxytocin, a hormone known to influence a variety of emotional responses including attachment and social engagement, appears to be helpful as an adjunct to social-cognition training for some patients with schizophrenia, said Stephen Marder, M.D., of the Semel Institute for Neuroscience at UCLA last month at the International Congress on Schizophrenia Research in Orlando, Fla.
Marder made his remarks during the symposium “Pharmacological Approaches for Facilitating Nonpharmacologic Treatments.” The symposium represents one of the major trends in schizophrenia research today—the effort to improve cognition, and especially social cognition, which has emerged in recent years as key to long-term outcome and “real-world” functioning of patients with schizophrenia. It was the focus of a daylong satellite meeting prior to the formal start of the congress.
During the congress symposium, Marder outlined long-established evidence for impairment in social cognition in schizophrenia and its relationship to poorer outcome, as well as studies indicating that targeted training can improve social cognition. He cited recent work showing the critical role of social cognition—the ability to accurately interpret facial expressions and social cues and to draw inferences—in improving functioning in the community; for instance, recent research has indicated that social cognition is more positively associated with functioning than is basic cognition.
He drew attention to an important finding: that social cognition consists of “lower-level” cognitive skills—such as recognition of facial cues—and “higher-order” skills such as the ability to make emotional inferences and recognize sarcasm, for instance.
“One of the problems with social-cognition training is that while it is effective for improving lower-level social skills, it appears to be less effective for the higher-order skills,” Marder said.
So the use of pharmacologic approaches for facilitating nonpharmacologic treatments represents a relatively new wrinkle in research on cognition—an effort, Marder said, to match a multimodal intervention to a disease that affects multiple brain systems.
He described studies at UCLA aimed at using oxytocin, a 9-amino acid peptide that functions as a hormone and a neurotransmitter. In addition to regulating uterine contractions and lactation, oxytocin is involved in multiple aspects of social behavior and related emotions including improved emotional perception. A few studies have even shown that chronic administration of oxytocin reduces psychosis symptoms, he said.
One of the UCLA studies, by Michael Davis, M.D., Ph.D., involved a single-dose pilot evaluation of the effects of oxytocin on social-cognition measures. That study found statistically significant effects on a composite score of higher-order social-cognition measures, such as the ability to detect lies and sarcasm.
In a second study, oxytocin was administered just prior to social-cognition training to find out whether by increasing the salience of social information, oxytocin could facilitate learning for schizophrenia patients during such training.
Patients were randomized to 12 sessions of social-cognition training over six weeks with placebo or oxytocin administered 30 minutes prior to each group treatment. A range of measures of social cognition and “empathic accuracy”—the ability to interpret emotional context and communication accurately—were used to assess patients once they were no longer taking oxytocin, at seven weeks after the training and again one month after that.
The findings were intriguing: both the placebo and oxytocin groups improved on the social-cognition composite measure, but while the training demonstrated effectiveness on lower-level measures of cognition, oxytocin appeared to facilitate learning of higher-level social-cognition abilities, particularly empathic accuracy.
Marder said the results offer the promise of a new tool that can be used for some patients in whom social cognition is an especially challenging roadblock to improved functioning. “We think if these findings are confirmed in larger trials, they have important significance for pharmacologically augmenting cognitive training and may be useful in the treatment and outcome of some patients,” he said.
Funding for the research Marder described was provided by the Brain and Behavior Research Foundation, formerly known as NARSAD. ■