Theory of mind in schizophrenia: A critical review

Abstract

There is considerable evidence that ToM is impaired in people with schizophrenia. However, this is perhaps the only unequivocal finding on the topic to date. Issues that demand further clarification include: Is the deficit a state or a trait? How to measure ToM in schizophrenia research, and whether certain symptoms or groups of symptoms are associated with the ToM deficit. These issues are considered and the evidence evaluated. Some priorities for future research are suggested.

Th.o.m.a.s.: An exploratory assessment of Theory of Mind in schizophrenic subjects

“…score of the schizophrenic subjects we examined was worse than control, as was their performance at each of the four scales (A, B, C and D), at each of the three subscales (Awareness, Relation, and Realization), and at each of the four types of mental state assessed (Beliefs, Desires, Positive emotions, and Negative emotions). Globally, our results are aligned with the literature, showing a ToM deficit in schizophrenia (for overviews see Casacchia, Mazza, & Roncone,2004;Harrington, Siegert, & McClure, 2005).…”

Exploratory Study of the Association Between Insight and Theory of Mind (Tom) in Stable Schizophrenia Patients

“…These results add weight to the state dependent view of ToM deficits in schizophrenia, but at the same time they do not contradict recent accumulated findings of ToM impairment in schizophrenia high risk groups, which support the assumption that ToM deficits represent a trait marker of the disorder (see reviews in Brüne et al, 2005, Harrington et al, 2005., Sprong et al, 2007. This is so because it is possible that the continuity regarding ToM deficits along the "at risk" groups may in fact derive from an association between the positive psychotic symptoms continuum and ToM impairment.…”

“…A number of studies over the last 20 years have shown that schizophrenics not only perform poorly on traditional ToM tests, but also on other verbal and pictorial experimental tasks requiring more complex mentalising abilities, such as the understanding of social hints and metaphors, irony, humour, and faux pas. Some studies have also shown that these deficits are specific rather than secondary to chronicity or general cognitive impairment (see review in Brü ne, 2005b;Harrington, Siegert, & McClure, 2005). Evidence from high risk studies on first degree relatives Wykes, Hamid, & Wagstaff, 2001) and subjects with schizotypal traits Pickup, 2006) has also shown that ToM impairment may be considered a trait in schizophrenia spectrum disorders.…”

Mentalizing in schizophrenia: A multivariate functional MRI study

“…Theory of mind (ToM), an aspect of social cognition, refers to the cognitive ability of inferring agency, intentions, and beliefs that oneself and others hold. Several converging lines of research have identified deficits in ToM in patients with schizophrenia (Brune, 2005;Harrington, Siegert, & McClure, 2005) and explored the underlying neural architecture of these deficits (Sugranyes, Kyriakopoulos, Corrigall, Taylor, & Frangou, 2011). While the relationship between ToM and other neurocognitive domains awaits full explanation (Carrington & Bailey, 2009), specific regional activation differences when performing ToM tasks (Adolphs, 2009), coupled with behavioural evidence for distinct cognitive processes (Mehta, et al, 2013), suggest an independent role for ToM in understanding the cognitive dysfunction observed in schizophrenia.…”