Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients

Abstract

Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocognitive endophenotypes, the existence of a distinct, potentially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree relatives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the 'Movie for the Assessment of Social Cognition'-a video-based ToM test-and an empathy questionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) 'cognitive' versus 'emotional' ToM, (2) error counts representing 'undermentalizing' versus 'overmentalizing', (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives' group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for 'undermentalizing' but not for 'overmentalizing'. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale 'fantasy' was associated with measures of psychotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophrenia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia.

Empathy in schizophrenia: A meta-analysis of the Interpersonal Reactivity Index

“…However, some research indicates that reading fiction is associated with increased empathy and prosocial behavior (Johnson, 2012). In addition, given some literature linking fantasy abilities to increased psychotic symptoms (Sparks et al, 2010) and psychosis risk (Montag et al, 2012b), future research may try to glean a better understanding of how fantasy abilities affect (or are affected by) illness course and symptoms.…”

“…There is less evidence linking abilities to relate to fantasy characters to empathic or functional outcomes, but some literature shows a significant association between greater fantasy abilities and increased hallucinations and delusions (Sparks et al, 2010), and heightened fantasy abilities in relatives of people with schizophrenia have been associated with measures of psychosis risk (Montag et al, 2012b). Further, although no research to our knowledge has investigated this, it seems plausible that deficits in the ability to relate to fantasy characters may add another layer of difficulty to interpersonal interaction, where conversations may center on popular television shows or movies.…”

Theory of Mind in the Early Course of Schizophrenia

“…Similarly, other studies have found genetic liability effects in first-degree relatives [84][85][86][87][88]. Montag and colleagues reported impairments in ToM reasoning in parents and siblings of schizophrenic patients (not explained by other aspects of neurocognitive measures) using the 'Movie for the Assessment of Social Cognition' video-based task [87]. de Achával and colleagues [89] found that unaffected first-degree relatives showed underperformance on the Faces Test, Reading the Mind in the Eyes Test and the detection of social Faux Pas.…”

“…A study by Anselmetti et al [83] assessed relatives of schizophrenia patients and healthy controls using the ToM picture sequencing task, and reported ToM deficits in parents (separate score for mother and father) of patients with schizophrenia. Similarly, other studies have found genetic liability effects in first-degree relatives [84][85][86][87][88]. Montag and colleagues reported impairments in ToM reasoning in parents and siblings of schizophrenic patients (not explained by other aspects of neurocognitive measures) using the 'Movie for the Assessment of Social Cognition' video-based task [87].…”

Critical Evaluation of Auditory Event-Related Potential Deficits in Schizophrenia: Evidence From Large-Scale Single-Subject Pattern Classification

“…39 Hence, new signal processing methods like single-trial classification and modeling of event-related brain dynamics using time-frequency or blind source separation analysis may be favorable for modeling complex pathophysiological network processes. [39][40][41] Next, new paradigms or the investigation of other cognitive domains, eg, theory of mind 42 or emotion recognition, 43 could prove highly beneficial for discriminating schizophrenia and control groups. Last, magnetic resonance imaging methods have shown to hold some promise for differentiating between schizophrenia and mentally healthy subjects.…”