Effects of oxytocin on empathy, introspective accuracy, and social symptoms in schizophrenia: A 12-week twice-daily randomized controlled trial
Introduction
A promising psychopharmacological intervention for schizophrenia is the neuropeptide oxytocin (Rosenfeld et al., 2011). Oxytocin modulates networks involved in social cognition and emotion regulation and is shown to play a key role in social behaviors (Lee et al., 2009; Meyer-Lindenberg et al., 2011; Rosenfeld et al., 2011). Several studies have investigated the effects of adjunctive intranasal oxytocin in schizophrenia with mixed findings (Bradley and Woolley, 2017; Burkner et al., 2017; Cacciotti-Saija et al., 2015; Feifel et al., 2016; Mercedes Perez-Rodriguez et al., 2015; Oya et al., 2016).
To address heterogeneity in findings and the file drawer effect (Rosenthal, 1979), especially as documented in oxytocin treatment research (Lane et al., 2016), the present study presents tertiary (i.e., self-report measures) and exploratory outcomes (i.e., introspective accuracy or IA) from Jarskog et al. (2017). Previously, Jarskog et al. (2017) found limited effects of oxytocin on the secondary outcomes of social functioning (i.e., improvements in social skills) and negative symptoms but not on the primary outcomes of social cognition (i.e., emotion perception, theory of mind, attributional style). Given mixed findings and no previous research of oxytocin effects on IA, investigation of self-report and IA outcomes in the present study are exploratory.
Section snippets
Study design, participants, and randomization
Individuals with a diagnosis of schizophrenia or schizoaffective disorder participated in a double blind, randomized treatment study between June 2011 and September 2014. Participants completed screening, baseline, and assessment visits at six and 12 weeks. Participants were randomized to twice-daily intranasal oxytocin or placebo stratified by sex and total PANSS score. The Institutional Review Board at the University of North Carolina at Chapel Hill approved all procedures. Participants were
Baseline characteristics, randomization, and treatment adherence
Fig. 1 provides a CONSORT flowchart of study screening and inclusion. Thirty individuals in the placebo group and 32 in the oxytocin group were included in the study.
Baseline demographic and clinical information are presented in Table 1. The placebo group had significantly higher levels of paranoia indicated by PANSS items assessing social functioning (i.e., suspiciousness/persecution, hostility, passive/apathetic social withdrawal, uncooperativeness, and active social avoidance) compared with
Discussion
Twice-daily administration of intranasal oxytocin showed limited evidence for improving self-reported symptoms, empathy, and IA in patients with schizophrenia. Individuals in the oxytocin group showed improvement on the Perspective Taking subscale of the IRI only but not on other self-reported outcomes and IA. Improvements in empathy in the oxytocin group extend findings from an oxytocin treatment study of a shorter duration (i.e., 6 weeks) where improvements on empathic perspective taking as
Conflict of interest
The authors report no conflicts of interest.
Role of funding source
This work was supported by a grant from NIMH (grant number R01MH093529 – PIs CAP, DLP).
Acknowledgements
Odum Institute (University of North Carolina at Chapel Hill).
Contributors
CAP, DLP and LFJ designed the study and wrote the protocol. TFH wrote the first draft of the manuscript. TFH performed statistical analyses with support from the Odum Institute and certifies the accuracy of the results. All authors contributed to the data interpretation, meaningful manuscript revision, and all authors have approved the final manuscript.
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