Schizophrenia and Autism as Contrasting Minds: Neural Evidence for the Hypo-Hyper-Intentionality Hypothesis

Abstract

Both schizophrenia (SCZ) and autism spectrum disorder (ASD) are characterized by mentalizing problems and associated neural dysfunction of the social brain. However, the deficits in mental state attribution are somehow opposed: Whereas patients with SCZ tend to over-attribute intentions to agents and physical events ("hyper-intentionality"), patients with autism treat people as devoid of intentions ("hypo-intentionality"). Here we aimed to investigate whether this hypo-hyper-intentionality hypothesis can be supported by neural evidence during a mentalizing task. Using functional magnetic resonance imaging (fMRI), we investigated the neural responses and functional connectivity during reading others intention. Scanning was performed in 23 individuals with ASD, 18 with paranoid SCZ and 23 gender and IQ matched control subjects. Both clinical groups showed reduced brain activation compared to controls for the contrast intentional vs physical information processing in left posterior superior temporal sulcus (pSTS) and ventral medial prefrontal cortex (vMPFC) for SCZ, and right pSTS in ASD. As predicted, these effects were caused in a group specific way: Relative increased activation for physical information processing in SCZ that was also correlated with positive PANNS score and relative decreased activation for intentional information processing in ASD. Additionally, we could demonstrate opposed connectivity patterns between the right pSTS and vMPFC in the clinical groups, ie, increased for SCZ, decreased for ASD. These findings represent opposed neural signatures in key regions of the social brain as predicted by the hyper-hypointentionality hypothesis.

Social-cognitive brain function and connectivity during visual perspective-taking in autism and schizophrenia

“…Pinkham, Hopfinger, Pelphrey, Piven, and Penn (2007) found similarly reduced brain activity in the amygdala, fusiform gyrus and ventrolateral prefrontal cortex in 12 adults with ASD and 12 adults with paranoid schizophrenia during a trustworthiness task. Ciaramidaro et al (2015) also found comparable reductions in superior temporal sulcus and ventromedial prefrontal cortex activity during a mentalizing task relative to healthy volunteers among 23 individuals with ASD and 18 patients with paranoid schizophrenia. Furthermore, they extended this work to examine functional connectivity, and found that both autism and schizophrenia were characterized by reduced fronto-temporal (superior temporal sulcus to ventromedial prefrontal cortex) connectivity.…”

Impact on Cortical Function of Cocaine Abuse Co-Occurring with HIV

“…These differences in neural system activation patterns, consistent with the RDoC initiative, have led some authors to hypothesize that ASD and SCZ represent extremes on a continuum of mind-reading abilities ranging from a mechanistic hypo-intentional (to treat people as objects) to a mentalistic hyper-intentional (to treat objects as people) mode, respectively (Ciaramidaro et al, 2015). Minichino et al, (2016) report that both ASD and SCZ patients show impaired eventrelated desynchronization of mu waves (a proxy of MNS activity) in response to observation of biological motion, which is associated with negative symptoms and poor social adjustment.…”

“…When viewed in the context of cognitive impulsivity in the HIV/AIDS cocaine-abuse co-morbid condition, these channels may be pharmacological targets for promoting healthy decision-making, and, in so doing, reduce HIV transmission and disease progression. Mirror Neurons in Psychiatric Disorders: from Neuroception to Bio-behavioral System Dysregulation Impairments in mind-reading abilities (ie, mentalization, empathy) represent core psychopathological features and key therapeutic targets in patients with schizophrenia (SCZ) and autism spectrum disorders (ASD) (Ciaramidaro et al, 2015). A functional mirror neuron system (MNS) is considered a prerequisite of these abilities (see Dinstein et al, 2010 for alternative views).…”

“…Hyperactive states of the MNS may be responsible for over-attribution of intentions to agents and physical events (hyper-intentionality, aberrant salience), misperception of benign social cues as threats (paranoid delusions), and hallucinations in SCZ; hypoactive states may explain a key clinical feature of ASD, ie the tendency to treat people as devoid of intention (Ciaramidaro et al, 2015). These differences in neural system activation patterns, consistent with the RDoC initiative, have led some authors to hypothesize that ASD and SCZ represent extremes on a continuum of mind-reading abilities ranging from a mechanistic hypo-intentional (to treat people as objects) to a mentalistic hyper-intentional (to treat objects as people) mode, respectively (Ciaramidaro et al, 2015).…”

“…Although it is well-known that impaired social cognitive skills are strongly associated with poor social outcomes and high levels of distress (Ciaramidaro et al, 2015), what is new is the hypothesis that altered neuroception, related to dysfunctional MNS activity, may mediate this relationship (Friedrich et al, 2014). Multidimensional interventions for ASD and SCZ should ideally target both cortical and peripheral components of this vicious cycle, with interventions aimed at synchronizing MNS and ANS activity such as neurofeedback (Friedrich et al, 2014), mindfulness, or yoga practices.…”