Empathy and Theory of Mind in Ultra-High Risk for Psychosis: Relations With Schizotypy and Executive Function

Abstract

Objective While recent studies have found deficits in theory of mind (ToM) skills in individuals at ultra-high risk (UHR) for psychosis, empathic tendencies in these subjects remain unclear. The presence of high schizotypy and compromised executive functions, which are found in UHR individuals, would affect ToM skills and empathic tendencies. We investigated the ToM skills and empathic tendencies of UHR individuals and examined their relationship with schizotypy and executive function.Methods This study included 28 UHR individuals and 28 age- and sex-matched healthy controls. All participants completed a self-reported empathic scale (Interpersonal Reactivity Index) and the Wisconsin Schizotypy Scales. Additionally, the ToM Picture Stories Task and Wisconsin Card Sorting Test were conducted.Results UHR individuals showed a trend toward lower self-reported empathic tendencies; however, there were no differences in ToM skills between the two groups. Of the four subscales of the IRI, only empathic concern showed a significant difference between the two groups. Empathic concern was inversely associated with negative schizotypy.Conclusion Our findings suggest that UHR individuals show relatively preserved cognitive empathy but compromised emotional empathy. Furthermore, in UHR individuals, the empathic concern subscale of the IRI was associated with negative schizotypy, while ToM skills were related to positive schizotypy and executive function.

Cold executive function processes and their hot analogs in schizotypy

“…It seems, therefore, that the well-reported association of fluid reasoning abilities with emotional intelligence (Olderbak et al, 2019; Simonet et al, 2021) is dissociated in schizotypy irrespective of the prevailing schizotypal dimension; the only exception being cognitive-perceptual schizotypy. As emotional intelligence is a core component of social cognition (Salovey & Mayer, 1990), the finding also adds further evidence on the decline of this complex function observed in schizotypy (e.g., Bora, 2020; Kong et al, 2021; Pflum & Gooding, 2018; Buck et al, 2017; Nahal et al, 2021; Wang et al, 2015; Wastler & Lenzenweger, 2021; Morrison et al, 2013).…”

Mentalizing in individuals with state and trait risk for psychosis: a systematic review

“…Regarding the 6 studies on Theory of Mind, 2 investigate differences between healthy controls and CHR/UHR ( 33 , 34 ), 3 compare state risk (CHR/UHR/AMRS), people suffering with psychosis, and healthy controls ( 23 , 31 , 32 ), and the last one focuses on the differences between schizotypal, negative affect and healthy control groups ( 35 ).…”

“…Kong et al ( 34 ) compared healthy patients with UHR individuals for psychosis – condition assessed with SIPS ( 39 ). They investigated impaired ToM skills – evaluated using the ToM Picture Stories Task ( 46 ) – and their relationship with schizotypy and executive function in UHR subjects.…”

“…Individuals with CHR, however, take longer (a similar time that is taken by people suffering with psychosis) than healthy controls to attribute emotion to others – a measure of emotional ToM ( 31 ). Finally, low ToM abilities have been associated with a wide range of schizotypal manifestations ( 34 ); with evidence from one study suggesting that those reporting high schizotypal traits show a tendency towards committing more hypermentalizing errors ( 35 ).…”

“…It was observed that negative metacognitive beliefs and the “need for control” tended to be more pronounced in individuals at risk ( 28 , 36 ). In the context of Theory of Mind (ToM) tasks, some studies failed to identify significant distinctions between CHR patients and healthy controls ( 23 , 33 , 34 ), whereas others reported lower ToM performance levels among schizotypal ( 35 ) and CHR individuals ( 31 , 32 ).…”