Parkinson's disease (PD) represents the second most prevalent neurodegenerative disorder. Despite notable advancements in the comprehension of its pathophysiology in recent years and the introduction of updated diagnostic criteria that reflect these developments, the comprehensive understanding of its intricate clinical presentation remains to be further investigated and more precisely delineated. A substantial body of evidence from existing literature has consistently demonstrated the presence of non-motor symptoms in patients with PD, including deficits in social cognition. Nevertheless, socio-cognitive dysfunctions in PD remain a relatively underexplored area, and the available tools for assessing these deficits are limited, particularly in the clinical setting. To address this gap in the existing literature, the present doctoral thesis is structured around three key objectives. The first aim is to improve the characterisation of socio-cognitive dysfunctions in PD in the clinical context. Secondly, the objective is to introduce and evaluate the clinical validity of a novel test designed to assess the ability to recognise complex mental states. Finally, the thesis aims to contribute to the elucidation of the neural correlates underlying deficits in mental state recognition in individuals with PD via magnetic resonance imaging. In order to achieve these aims, three behavioural studies (Study 1-3) and one neuroimaging study (Study 4) have been conducted. The results of this doctoral thesis posit that deficits in socio-cognitive processes can be observed in patients with PD from the early stages of the disease and are associated with structural and functional changes in brain areas involved in emotion understanding. Furthermore, this thesis suggests that a detailed characterisation of early socio-cognitive dysfunctions in PD may facilitate the definition of new cognitive phenotypes and potentially the development of new non-pharmacological interventions (Study 5) tailored to the individual's specific needs.

Previous constructivist research was integrated with a field study to investigate the hypothesis that the subjective perceptions of the current social, security and economic situation of the high and low-income groups in South Africa differ to the extent that they could be said to be living in totally different worlds of phenomenological experience. The data demonstrated clear differences when coded in terms of worldviews along an Optimism-Pessimism Continuum. A number of additional processing phenomena and social dynamics able to influence these perceptions were also identified from an interpretative analysis of the data. The results were explained in terms of the cueing and activation of specific schemata constructed from income-related prior experiences associated with each group and led to the conclusion that income and living conditions could well be factors contributing to the ongoing confrontations between government and impoverished communities. A number of recommendations to improve inter-group relations were included. / Psychology / M.A. (Psychology)

Rheumatoid arthritis (RA) is a chronic, progressive autoimmune disease causing inflammation of the synovium resulting in severe pain, joint disfigurement and disability as well as malaise, fatigue and a depressed immune system. Treatment consists of three broad phases; firstly, following diagnosis treatment is focussed on rapid reduction of pain and inflammation. Secondly, maintenance of quiescence is sought through medication. Finally, if disease activity remains high despite medication, escalation to anti-TNF α therapy is required to prevent permanent joint damage and disability. The primary course of treatment is prescription of disease modifying anti-rheumatic drugs (DMARDs) within 3 months of onset of symptoms. However, DMARDs can take 8-12 weeks to exhibit a noticeable benefit whereas unpleasant side effects can occur shortly after initiation. Also, DMARDs do not alleviate pain; therefore it is difficult for patients to attribute recovery to this medication. For these reasons, although it is imperative for future health and functioning to take DMARDs as prescribed, non-adherence is common at 30-50%. Non-adherence to treatment can be intentional, where a decision is made not to conform to the prescription, or unintentional which is often due to forgetting. To measure intentional non-adherence, a validated measure of adherence for rheumatoid arthritis was reduced through exploratory factor analysis from 19 items to 5 items by removing items that did not add to the explained variance of adherence. The CQR5 explained 53% of the variance in adherence and was shown to have a good fit to the data through confirmatory factor analysis. A discriminant function equation was generated that correctly identifies 88.5% of patients as high or low adherers and has high clinical utility due to the brevity for patients and unidimensionality for easy interpretation. The CQR5 was used throughout the programme of research to measure intentional non-adherence along with a separate measure of unintentional non-adherence. Four commonly used social cognition models of illness were measured in 227 RA patients to determine which had the best utility for predicting non-adherence to DMARDs. Patients were recruited to represent the three stages of illness including newly diagnosed, established on DMARD therapy and established with concurrent anti-TNF α therapy. Logistic regression analysis showed that the Self Regulatory Model best predicted intentional non-adherence as patients with perceptions of worse consequences of RA and longer disease duration were more likely to be highly adherent to DMARDs in cross-sectional analysis. In contrast, the Theory of Planned Behaviour better predicted patients who self-reported forgetting their DMARDs with patients with more confidence in being able to take their medications (Perceived Behavioural Control) being less likely to forget. 171 patients were successfully followed-up six months after baseline recruitment. The longitudinal results showed that the social cognition models differed for patients at different stages of the illness suggesting that their experience of living with rheumatoid arthritis influenced perceptions of their illness and medications. Newly diagnosed patients scored lower on factors measuring perceptions of disease chronicity and seriousness whereas patients that had escalated to anti-TNF α therapy scored higher on these factors. The newly diagnosed patients also showed more variability in the social cognition scores whereas the more established patients demonstrated stable models of illness. This supports Leventhal’s (1992) theory that illness representations will be regulated through integration of knowledge and experience of an illness. Structural equation modelling was used to establish the best predictors of intentional non-adherence at six month follow-up. In support of research in other chronic illnesses (Horne & Weinman, 2002; Niklas, Dunbar & Wild, 2010), the effect of perceptions of the consequences and chronicity of the illness on adherence are mediated by perceptions of the necessity of the medication. In addition, the impact of the emotional reaction to the illness on adherence to DMARDs is mediated by concerns about the medication. In addition, this study incorporated factors from the Theory of Planned Behaviour to explain medication adherence and found that the influence of friends and family impacts on the patient’s confidence to follow the prescription accurately which in turn as an effect on adherence to DMARDs. This large longitudinal study found that by combining factors from a number of social cognition models, it is possible to explain and predict intentional non-adherence and provides some evidence for best ways to intervene to improve adherence and prognosis. To provide a more comprehensive and clinically useful picture of non-adherence, a Cost of Illness study was carried which found that patients self-reporting low adherence to DMARDs also had significantly higher costs for this medication. This was caused by an increased incidence of Leflunamide prescribing for patients who often forget their medication and was maintained longitudinally. This association has not been previously reported in the literature and provides some evidence that non-adherence to DMARDs is having a concrete effect on the clinical management of patients. Finally, an SMS text message based reminder service designed to remind patients who self-report forgetting their medications was tested through a simulation study for the cost and likely benefit in health related quality of life using the health economic analysis of the longitudinal study and the results of a survey establishing the feasibility of implementing such a service in the rheumatology clinic. A sensitivity analysis testing the number of messages sent and the cost per message found that a reminder service for the sample of patients in this programme of research would cost between £1387.00 and £142.27 per year. This would equate to a cost per Quality Adjusted Life Year (QALY) gain of between £2889.58 and £296.40 by enabling patients to adhere more rigorously to their DMARD regimen. This programme of research is the first to test four commonly used social cognition models to predict adherence to DMARDs in a large, multi-centre longitudinal study of rheumatoid arthritis patients. Perceptions of the likely duration and consequences of the illness, as measured by the Illness Perceptions Questionnaire and the necessity of medications (measured by the Beliefs about Medications Questionnaire) along with self-efficacy (measured by the Theory of Planned Behaviour) explained 24% of the variance in intentional adherence over six months. The results show the importance of considering intentional and unintentional non-adherence separately as they appear to have different underlying mechanisms as well as patients in different phases of the illness as their experience influences their social cognition models of illness. A simple SMS based reminder service could act as a cue to action to reduce unintentional non-adherence whereas addressing issues surrounding maladaptive perceptions about the illness and the treatment could improve intentional non-adherence which has the potential to improve the prognosis and quality of life for patients as well as safe costs for the NHS.

Within this thesis the role of cognitive processes in irritable bowel syndrome (IBS) will be examined. A systematic review and meta-analysis of the rate of psychiatric comorbidity in IBS participants, relative to controls, was performed. Evidence supported heightened rates of psychiatric disorder. A novel hypothesis regarding overlapping cognitive vulnerability to IBS and psychiatric disorders was found to fit well with the pattern of comorbidity. Competing hypotheses and the potential moderators were examined. Overall, no single model of psychiatric morbidity in IBS could fully account for the results of the meta-analysis. The implications of this meta-analysis for a cognitive approach to IBS are discussed. Cognitive processes were directly investigated in two experiments. First, in a modified exogenous cueing task, which assessed attention to pain words, there was faster orienting towards, and engagement with pain words in IBS participants relative to controls. Next, participants completed a primed lexical decision task, which indexed interpretation biases by measuring response times to targets after ambiguous illness primes. Relative to controls, IBS participants’ responses were slower to target words presented after ambiguous illness primes, and demonstrated priming for targets related to the neutral meaning of the illness prime. In the second study, different IBS and healthy control participants completed an internet-based survey of autobiographical memory. Participants described and rated painful and emotional autobiographical events. IBS participants reported pain memories from a more observer perspective relative to controls, suggesting a possible coping strategy for pain content. Finally, three cognitive styles, alexithymia, rumination and self-blame, were evaluated using existing and novel self-report measures. Overall, when compared with healthy participants, IBS participants reported: less difficulty identifying feelings as indexed by the alexithymia measure; increased pain-focused rumination; and a general, negative self-blame. These results may imply a vigilance-avoidance model of cognitive processing in IBS.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

The thesis examines social cognition and object relations in patients with schizophrenia using Thematic Apperception Test evaluated by SCORS. The theoretical part of the thesis deals with schizophrenia, Thematic Apperception Test and its interpretation systems (especially Westen's SCORS). Attention is also paid to the theoretical background of social cognition and object relations in patients with schizophrenia. The aim of the study is to verify the assumption that patients with schizophrenia will reach pathological scores in SCORS. The study also explores the relationships between different dimensions of SCORS in this clinical population. The results indicate that patients with schizophrenia have numerous deficits in social cognition and object relations, as measured by SCORS. Significantly lower scores (that belong or are very close to pathology) were found in a total of five SCORS's dimensions. In the remaining three dimensions patients with schizophrenia achieved below-average results. Cross-correlations among SCORS's dimensions and factor analysis results which revealed a three component structure of SCORS in patients with schizophrenia are also discussed. Keywords: Schizophrenia, social cognition, object relations, SCORS, Thematic Apperception Test, correlation analysis, factor analysis.

Dans ce travail, nous nous proposons d'étudier la cognition sociale chez les sourds en distinguant les aspects perceptifs et cognitifs selon le modèle proposé par Tager-Flusberg et Sullivan (2000). La surdité nous permet d'aborder l'influence des facteurs environnementaux sur le développement des composantes socio-perceptive et socio-cognitive ; nous ciblons nos recherches sur les enfants sourds nés de parents entendants, éduqués dans des écoles ordinaires et portants des prothèses auditives. La première question à laquelle nous tenterons de répondre est la suivante : le manque de communication avec l'entourage familial pendant les premiers mois de vie, en lien avec le contexte particulier de la surdité dans un milieu entendant, a-t-il une influence sur le développement de la composante socio-perceptive ? Nous étudions cette question avec deux expériences impliquant la perception des visages et des émotions ; ces tests nous permettent de mettre en évidence les performances et les stratégies de traitement utilisées. Nous recherchons d'une part, l'utilisation du processus configural et l'effet de focalisation de l'attention sur la région des yeux au cours d'une tâche de jugement de similarité entre visages et d'autre part, l'effet de traitement automatique de la colère avec une tâche de recherche visuelle. La deuxième question soulevée est relative au développement de la composante socio-cognitive, et notamment aux capacités liées à la théorie de l'esprit. Les possibilités croissantes d'intégration du discours, notamment grâce aux prothèses auditives, permettraient-elles le développement des capacités nécessaires à la compréhension des états mentaux d'autrui ? / In this thesis, we aimed to study the socio-perceptive and the socio-cognitive components of social cognition (Tager-Flusberg et Sullivan, 2000) in deaf children. Deafness give us the possibility to assess environmental factors' influence on the development of these components. To do so, we focus our studies on deaf children born from hearing parents, equipped with auditory protheses, and educated in ordinary schools. First, one of the main issue of the current studies is to assess whether the lack of communication with family during the first months of life, in line with the particular context of deafness in a hearing environment, have a significant impact on the socio-perceptive component. Experiments 1 and 2 were designed to assess this issue. Participants had to respond with two experiences related to faces and emotion perceptions ; those tests allow us to show the performances and the strategies of the treatment used. On a side, we are looking for the inversion effect and the eyes area focus effect during a test of faces' similarities judgment, and another side the angry automatic effect with a visual search test. The second question studied is related to the development of the socio-cognitive component, and especially on capacities of theory of mind. Could the improvement of internalization of speech, using auditory protheses, permit the development of the capacities needed to understand the state of mind of another? Or in contrary, are the possibilities to exchange precociously about his own state of mind needed to develop socio-cognitive component?

This thesis examines the relationship of verbal intelligence and social cognition through verbal subtests of Wechsler intelligence scales for adults (3rd revision) and Differential Self and Complexity of representations of People and Understanding of Social Causality scales in Thematic Apercepčního Test. The theoretical part introduces the concepts of intelligence and social cognition, as well as psychological tests of intelligence tests and apperception techniques. The theoretical part also focuses on the social intelligence as an answer to the question of the relationship between intelligence and social cognition. In the empirical part of the thesis data collected from 30 probands is processed who underwent testing above mentioned psychological tests. The data are processed with correlation and factor analysis. The conclusions statistical processing are in the thesis further developed in the context of the theoretical base of scientific knowledge. The discussion points to limits of the testing and suggests options for the future researchs.

Humans are unique in their ability to flexibly and rapidly adapt their behaviour and select courses of action that lead to future reward. Several ‘component processes’ must be implemented by the human brain in order to facilitate this behaviour. This thesis examines two such components; (i) the neural substrates supporting action selection during value- guided choice using magnetoencephalography (MEG), and (ii) learning the value of environmental stimuli and other people’s actions using functional magnetic resonance imaging (fMRI). In both situations, it is helpful to formally model the underlying component process, as this generates predictions of trial-to-trial variability in the signal from a brain region involved in its implementation. In the case of value-guided action selection, a biophysically realistic implementation of a drift diffusion model is used. Using this model, it is predicted that there are specific times and frequency bands at which correlates of value are seen. Firstly, there are correlates of the overall value of the two presented options, and secondly the difference in value between the options. Both correlates should be observed in the local field potential, which is closely related to the signal measured using MEG. Importantly, the content of these predictions is quite distinct from the function of the model circuit, which is to transform inputs relating to the value of each option into a categorical decision. In the case of social learning, the same reinforcement learning model is used to track both the value of two stimuli that the subject can choose between, and the advice of a confederate who is playing alongside them. As the confederate advice is actually delivered by a computer, it is possible to keep prediction error and learning rate terms for stimuli and advice orthogonal to one another, and so look for neural correlates of both social and non-social learning in the same fMRI data. Correlates of intentional inference are found in a network of brain regions previously implicated in social cognition, notably the dorsomedial prefrontal cortex, the right temporoparietal junction, and the anterior cingulate gyrus.

Les difficultés à interagir dans le monde social et à s’y adapter sont une plainte centrale des personnes souffrant de troubles psychiatriques et notamment de schizophrénie ou de troubles apparentés. Ces difficultés, qui constituent un frein au processus de réhabilitation psychosociale, pourraient en partie être expliquées par un dysfonctionnement des processus regroupés sous le terme de cognition sociale. La cognition sociale est définie comme la capacité à construire des représentations sur soi-même et autrui, et sur les relations entre soi et les autres, ainsi qu’à utiliser ces représentations de manière flexible, afin de guider le comportement social ; et inclut des processus tels que le traitement des émotions, la théorie de l’esprit, le style attributionnel, la perception et les connaissances sociales. Des déficits concernant les différentes composantes de la cognition sociale ont été largement mis en évidence dans la schizophrénie et les troubles apparentés, et semblent par ailleurs avoir un lien fort avec les difficultés observées dans les domaines du fonctionnement social, mais également des relations privilégiées avec les processus neurocognitifs, même si ces deux composantes semblent relativement indépendantes. Afin de compenser ces troubles, de nombreuses prises en charge de remédiation cognitive ont été proposées ces dernières années. L’objectif de ce travail de thèse a été d’évaluer la possibilité d’améliorer les déficits touchant la sphère de la cognition sociale des personnes souffrant de troubles psychotiques à l’aide d’un outil de remédiation spécifiquement développé à cet effet, le programme RC2S. Etant donnée l’hétérogénéité des déficits touchant la sphère de la cognition sociale dans la schizophrénie, et l’importance fondamentale portée au transfert des compétences dans la vie quotidienne, RC2S a été développé comme une thérapie individualisée et flexible, qui permet aux patients de s’entraîner aux interactions sociales dans un environnement réaliste, et d’adapter la prise en charge aux difficultés spécifiques de la personne. Nous présenterons ici trois études basées sur la méthodologie du cas unique, mettant en évidence l’impact de cette thérapie sur les troubles de la cognition sociale de deux patients souffrant de schizophrénie et d’un patient présentant un trouble de la personnalité schizoïde. / In people with psychiatric disorders, particularly those suffering from schizophrenia and related illnesses, pronounced difficulties in social interactions and adaptation are a key manifestation. These disabilities, which are a serious impediment to psychosocial rehabilitation process, could be partly explained by impairments in processes grouped under the generic term of social cognition. Social cognition is defined as the ability to construct mental representations about others and oneself, and about one’s relationships to others, and to use these representations in a flexible way to guide social behavior. It includes abilities such as emotion processes, theory of mind (ToM), attributional style, and social perception and knowledge. In schizophrenia and related disorders, several components of social cognition are usually altered, and are strongly associated with functional outcome and independent but partly related to neurocognitive processes. The impact of several kinds of interventions and particularly of social cognitive remediation programs has been studied recently, and new strategies and programs in this line are currently being developed. The main objective of this doctoral thesis was to assess the feasibility of improving social cognition in people with psychotic disorders, using a cognitive remediation program specifically designed for this purpose, the RC2S program. Considering that the social cognitive deficits experienced by patients with schizophrenia are very diverse, and that the main objective of social cognitive remediation is to improve patient’s functioning in their social daily life, RC2S was developed as an individualized and flexible program, which allows patients to practice social interactions in a realistic environment, and to adapt therapy to the specificity of every patient’s profile. This manuscript present three single case studies, using specific methodology, to highlight the impact of this new therapy on social cognitive impairments of two people with schizophrenia and one patient with schizoid personality disorder.