Tin Psychiatryrends and Psychotherapy Review Article Emotional intelligence and schizophrenia spectrum disorders: a critical review Inteligência emocional e transtornos do espectro da esquizofrenia: uma revisão crítica da literatura Fernanda de Marzio Pestana Martins, Keila Pereira Leite, Alisson Paulino Trevizol, Julio Ricardo de Souza Noto, Elisa Brietzke Abstract Resumo Introduction: Emotional intelligence (EI) is a theoretical Introdução: Inteligência emocional (IE) é um constructo construct postulated by Mayer and Salovey to designate the postulado por Mayer e Salovey para designar a habilidade de ability to perceive, understand, use and manage emotions. The perceber, entender, utilizar e gerenciar emoções. O estudo de study of EI in schizophrenia offers new insights into the disorder’s IE em esquizofrenia oferece novos insights quanto ao impacto cognitive and functional impacts. deste transtorno em funções cognitivas e funcionais. Objectives: To comprehensively review studies analyzing Objetivos: Conduzir revisão da literatura que analisa o prejuízo EI impairment in schizophrenia spectrum disorders using em IE nos transtornos do espectro da esquizofrenia utilizando standardized instruments. instrumentos padronizados. Methods: Searches were run on MEDLINE/PubMed, Google Métodos: Buscas foram realizadas nos bancos de dados Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov and MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, SciELO databases. The only validated instrument used was the ClinicalTrials.gov e SciELO. O único instrumento validado utilizado Multifactor Emotional Intelligence Scale (MSCEIT). Articles that foi a Multifactor Emotional Intelligence Scale (MSCEIT). Artigos used all branches of the MSCEIT to assess EI in schizophrenia que utilizaram todas as ramificações da MSCEIT para avaliar spectrum disorders and healthy controls were included in the IE em transtornos do espectro da esquizofrenia e em controles review. saudáveis foram incluídos na revisão. Results: We found 30 articles on this topic. The studies analyzed Resultados: Encontramos 30 artigos no tópico estudado. Os showed a significant impairment of MSCEIT total score in patients estudos analisados mostraram um prejuízo significativo da IE with schizophrenia spectrum disorders when compared to healthy pela MSCEIT em pacientes com transtornos do espectro da controls. In relation to the MSCEIT branches, understanding of esquizofrenia quando comparados com controles saudáveis. emotions and management of emotions are the most impaired Em relação às ramificações da MSCEIT, compreensão das branches. emoções e gerenciamento das emoções foram as ramificações Conclusion: Since most studies are cross-sectional, it is not com maior prejuízo. possible to establish a cause and effect relationship between Conclusão: Devido à maior parte dos estudos serem estudos EI deficits and schizophrenia spectrum disorders. Therefore, transversais, não é possível estabelecer uma relação de causa longitudinal studies are needed to establish a clearer relationship e efeito entre os déficits em IE e transtornos do espectro da between these variables. By so doing, we may be able to esquizofrenia. Portanto, estudos longitudinais são necessários intervene for prevention and management of these disorders, para se estabelecer uma relação mais clara entre essas variáveis. aiming at better quality of life for patients. Assim, talvez possamos intervir na prevenção e manejo desses Keywords: Emotional intelligence, schizophrenia, psychotic transtornos, para uma melhor qualidade de vida dos pacientes. disorders. Descritores: Inteligência emocional, esquizofrenia, transtornos psicóticos. Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Submitted Feb 01 2018, accepted for publication Jun 14 2018. Suggested citation: Martins FMP, Leite KP, Trevizol AP, Noto JRS, Brietzke E. Emotional intelligence and schizophrenia spectrum disorders: a critical review. Trends Psychiatry Psychother. 2019;41(1):94-102. http://dx.doi.org/10.1590/2237-6089-2018-0001 APRS | CC-BY Trends Psychiatry Psychother. 2019;41(1) – 94-102 Emotional intelligence and schizophrenia - Martins et al. Introduction on the basis of their abstracts, the full texts were read by three authors, to ensure the best evaluation possible. According to Mayer and Salovey, emotional intelligence We searched for relevant original articles in English, (EI) is a set of interrelated abilities made up of four Portuguese or Spanish that used standardized methods dimensions: perception, understanding, management, to access Emotional Intelligence in the manner that this and use of emotions.1 Different explanatory concepts of construct was described by Mayer and Solomon. We EI have been translated into different instruments for were specifically searching for studies involving adult assessment of this construct. One example is the Mayer populations that compared EI between subjects with and Salovey four-dimensional model which Mayer et al.2 schizophrenia spectrum disorders and healthy controls used to generate the Multifactor Emotional Intelligence or subjects with different mental disorders. Scale (MEIS) and, more recently, Mayer et al.3 used to construct the MSCEIT. Deficiency of emotional intelligence has been Results considered a central feature in schizophrenia spectrum disorders and a crucial determinant of functional The first issue in this review was related to the outcomes according to Fett et al.4 This was considered instrument. The only instrument that appropriately so important that the Emotion Management branch of evaluated the EI as a construct was the MSCEIT. Because the MSCEIT was included in the National Institutes of of this, for the purpose of this study we focused only Mental Health Initiative, Measurement and Treatment on articles that used MSCEIT to evaluate EI. There are Research to Improve Cognition in Schizophrenia two main reasons for this choice: first, the Mayer and (MATRICS), as the representative test of social cognition Salovey model’s theoretical approach is more tenable to be evaluated in clinical trials, as reported by Green et than those of other models, in the researchers’ opinion. al.5 and Nuechterlein et al.6 Second, MSCEIT is currently the only ability test that The objective of this review was to comprehensively covers all four dimensions of EI. Third, as already assess the literature on EI in Schizophrenia spectrum explained, the MSCEIT has good validity, which has not disorders, aiming to describe and critically evaluate the been observed for other instruments.7 extent to which this concept could be clinically useful. The search returned 30 articles assessing associations between emotional abilities and schizophrenia spectrum disorders. After reading abstracts and full text articles, Methods 19 were selected because they reported using all four branches of the MSCEIT to evaluate EI scores. For this review, searches for relevant articles were Table 1 lists the studies, describing the populations run on the MEDLINE/PubMed, Google Scholar, Cochrane, studied and their study designs, main findings, and LILACS, Embase and SciELO databases. limitations. Searches were performed during October of 2017 for studies published from inception to 2017 and used Schizophrenia-spectrum disorders the following terms for MEDLINE/PubMed: (“Emotional Social cognition has been considered a core Intelligences” OR “Intelligence, Emotional” OR construct in the cognitive domain of schizophrenia “Intelligences, Emotional” OR “Social Intelligence” OR psychopathology and a crucial determinant of functional “Intelligence, Social” OR “Intelligences, Social” OR “Social outcomes.4 This was considered to be so important Intelligences”) AND (MSCEIT OR “Mayer-Salovey-Caruso that the Emotion Management branch of MSCEIT was Emotional Intelligence Test”) AND (“Schizophrenias” OR included by the National Institutes of Mental Health “Schizophrenic Disorders” OR “Disorder, Schizophrenic” OR Initiative, Measurement and Treatment Research to “Disorders, Schizophrenic” OR “Schizophrenic Disorder” Improve Cognition in Schizophrenia (MATRICS), as the OR “Schizophrenia” OR “Schizophrenia Spectrum and representative test for social cognition to be evaluated Other Psychotic Disorders” OR “Schizophrenia, Paranoid” in clinical trials.5,6 OR “Schizophrenia, Disorganized” OR “Schizophrenia, The studies reviewed found significant deficiencies Childhood” OR “Schizophrenia, Catatonic”). in the overall MSCEIT performance score and also in The reference lists of papers included were manually scores for each of its four components in patients with searched for additional pertinent references. The schizophrenia spectrum disorders, when compared to abstracts of all the articles identified were read by two healthy subjects. Kee et al.,19 Dawson et al.11 and Mao authors (KPL and FDMPM) to select those that would be et al.21 found that understanding and management included in our analysis. After we had selected articles of emotions were the most deficient. Furthermore, Trends Psychiatry Psychother. 2019;41(1) – 95 Emotional intelligence and schizophrenia - Martins et al. Table 1 - Findings of research investigating relationships between EI and schizophrenia spectrum disorders Disorder Study Study design Sample size Results Study limitations and bias Schizophrenia Albacet8 Cross-sectional 37 clinical subjects + 37 Impairment in MSCEIT score for - Small sample. first degree relatives + the clinical sample and for