Mediating role of cognition and social cognition on creativity among patients with schizophrenia and healthy controls: Revisiting the Shared Vulnerability Model

Abstract

Aim As suggested by the Shared Vulnerability Model, impairment in executive functions could lead to worse creative performance among individuals with schizophrenia. Another impaired function in schizophrenia, previously related to creativity in healthy people, is theory of mind. However, little is known about the effect of theory of mind in creativity in schizophrenia. Therefore, the aim of this study was to analyze differences in creativity among patients with schizophrenia compared to healthy controls (HC) and to explore the potential role of executive functions and theory of mind as mediators of this relation. Methods Forty‐five patients with schizophrenia and 45 HC underwent a neuropsychological assessment, including executive functions (cognitive flexibility and working memory), theory of mind, and verbal and figural creativity. Results As expected, patients with schizophrenia obtained lower scores in creativity, cognitive flexibility, working memory, and theory of mind compared to HC. Path analysis showed that theory of mind mediated the relation between group (schizophrenia or HC) and both figural (Z = 2.075, P = 0.037) and verbal creativity (Z = 2.570, P = 0.010). Working memory mediated the relation between group and figural creativity (Z = 2.034, P = 0.041) and was marginally significant for verbal creativity (Z = 1.930, P = 0.053). Finally, cognitive flexibility mediated between group and figural creativity (Z = 2.454, P = 0.014). Conclusion Results suggest that the lower performance in creativity among patients with schizophrenia was partly due to an impairment in executive functions and theory of mind. The involvement of theory of mind opens up a new field of research as a possible risk factor in the Shared Vulnerability Model.

The impact of creativity on functional outcome in schizophrenia: a mediational model

“…As expected, creativity was related to neurocognition and social cognition, and mediated the relationship between neurocognition and functional outcome. The association between neurocognition and social cognition with creativity is consistent with previous research carried out in this pathology [38][39][40][41] . Similar to this study, another capacity that is related to creativity 43,44 , metacognition capacity, has also been shown to mediate the relationship between neurocognition and functional outcome in schizophrenia 47 .…”

“…A model with path analysis was estimated based on previous literature 1, 22,24,40 and including only paths between the predictors and the mediating or outcome variables that had correlated significantly in the previous analyses. Therefore, positive symptoms, excitement, depression, figural strengths, and verbal creativity were not included in the model.…”

“…Although creativity has been defined as a complex multidimensional construct, it is not a completely independent variable in schizophrenia. Previous literature suggests that creativity is closely related to neurocognition and social cognition in schizophrenia [38][39][40][41][42] . Specifically, both social cognition and neurocognition have been shown to play a mediatory role in the relationship between creativity and schizophrenia 40 .…”

“…Previous literature suggests that creativity is closely related to neurocognition and social cognition in schizophrenia [38][39][40][41][42] . Specifically, both social cognition and neurocognition have been shown to play a mediatory role in the relationship between creativity and schizophrenia 40 . Additional evidence comes from studies that have found the metacognitive ability (which is related to creative thinking) 43,44 to be associated with functional outcome in schizophrenia 45,46 as well as to mediate the relationship between neurocognition and functional outcome in this disease 47 .…”

Brain White Matter Correlates of Creativity in Schizophrenia: A Diffusion Tensor Imaging Study

“…Medication was transformed to chlorpromazine through the defined daily dose method (Leucht et al, 2016;Rothe et al, 2018). Standardized mean creativity scores of patients with schizophrenia based on a sample of healthy adults (obtained from Sampedro et al, 2019)…”