Mentalizing in first-episode psychosis

Abstract

Mentalizing deficits have often been observed in people with schizophrenia and a few recent studies suggest that such deficits are also present in patients with first episode psychosis (FEP). It is not clear, however, whether these mentalizing deficits in FEP can be accounted for by underlying processes such as social cue recognition, social knowledge and general reasoning. In this study, we assessed mentalizing abilities in 31 people with FEP and 31 matched controls using a novel, comprehensive mentalizing task validated through the present study. We also assessed social cue recognition, social knowledge and non-social (or general) reasoning performance in the same participants in order to determine if the mentalizing deficits in FEP can be at least partly explained by performance in these three underlying processes. Overall, the mentalizing task revealed the greatest impairment in FEP, an impairment that remained significant even after controlling for social cue recognition, social knowledge and non-social reasoning performance. Interestingly, non-social reasoning and social knowledge were both shown to contribute to mentalizing performance. In addition, social cognition measures were linked to social functioning in the FEP group, with the strongest correlation observed with mentalizing performance. Taken together, these results show that mentalizing is an aspect of social cognition that is particularly affected in FEP and might contribute to functional impairments in these patients. These deficits could be a prime target for cognitive remediation in FEP, and our results suggest that this could be done either directly or through improvement of related social and non-social cognitive skills such as social knowledge and general reasoning.

Adjustment of speaker’s referential expressions to an addressee’s likely knowledge and link with theory of mind abilities

“…We expected a relationship between adjustment of verbal productions to the addressee’s likely knowledge and both ToM and empathic perspective-taking. In contrast, we did not predict a strong relationship with our measures of social knowledge or emotion recognition as these tests assess lower-level aspects of social cognition that are less directly related to social functioning (Achim et al, 2012, 2013b). …”

“…Our social cognition assessment included measures of ToM, social knowledge and emotion recognition, measured with the tests from the Batterie Intégrée de Cognition Sociale (BICS; Achim et al, 2012) and empathic perspective-taking measured with the Interpersonal Reactivity Index (IRI; Davis, 1980). …”

“…Even once this ability has been acquired, inter-individual differences can be observed in how good adults are at identifying the mental states of others in given situations (ex: Achim et al, 2012, 2013a; Pinkham et al, 2014). In typical ToM tasks intended for adult populations, participants are presented with short stories and are then asked to answer questions about the characters’ likely mental states, including their beliefs, knowledge, intentions or emotions, in different situations.…”

Theory of Mind in the Early Course of Schizophrenia

“…Studying this population is particularly fruitful in understanding the precise illness process when ToM impairments occurs since there are fewer effects of long-term medication use and prolonged duration of psychosis. Achim and colleagues [67] investigated ToM using a combination of mentalizing stories (hinting task, false belief task, fauz-pas test and the strange stories test) in 31 first-episode psychosis patients and 31 matched controls. Compared with other tasks which measured social cue recognition and social knowledge, the greatest impairments in first-episode psychosis patients were reported in mentalizing tasks.…”

Metacognitive profiles in individuals with a first episode of psychosis and their relation to social functioning and perceived social support

“…In individuals with schizophrenia, poorer social cognition and metacognitive abilities are recognised as strong predictors of social functioning deficits (Brüne et al, 2011), with evidence of these impairments also present in individuals with a first episode of psychosis (FEP) (Achim et al, 2012). Social cognition is part of a large body of research which includes concepts relating to a person's ability to consider other's perspective, such as theory of mind (ToM), and other concepts such as insight and mentalization, representing the ability to reflect upon one's own mental life.…”