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Deficits in social cognition contribute to the severe difficulties in daily functioning of schizophrenic patients, although they have never been connected with suicidality. Theory of mind (ToM) tasks explore basic social abilities and have been found to be defective in schizophrenia. The relationship between ToM anomalies and suicidal history was studied in a sample of 57 stabilized outpatients. Logistic regression analysis showed an association between poor performance on second-order ToM tasks and a greater likelihood of suicidality in schizophrenic patients (OR = 4.02, 95% CI 1.18-13.62), which was independent of current clinical and neuropsychological status, with the exception of poor premorbid adjustment in infancy and adolescence. We caution against potential biases from mixing cross-sectional ToM scores with lifetime suicidal records and retrospective assessments of premorbid adjustment through repeated testing of patients and their relatives. Hence, the present findings suggest that ToM deficits may contribute to the high risk of suicide in schizophrenia.

The aim of this study was to investigate the influence of neurocognition in a false-belief/deception theory of mind (ToM) task in a sample of patients with schizophrenia. In a cross-sectional study of 43 remitted patients, the implication of neurocognition in first- and second-order ToM stories was analyzed, controlling for clinical symptoms and duration of illness. None of the cognitive factors were associated with the first-order ToM stories. A logistic regression model with high specificity (96.3%) and sensitivity (75%) was obtained in the second-order ToM story "The Burglar," the Information subtest (odds ratio [OR], 0.783; 95% confidence interval [CI], 0.62-0.99; p = 0.04) and the Block Design subtest (OR, 0.89; 95% CI, 0.79-1; p = 0.056) of the Wechsler Adult Intelligence Scale-III being the best predictive factors. Neurocognition was not related to first- or second-order ToM false-belief performance of the patients with schizophrenia. However, an influence of neuropsychological variables in the second-order ToM deception was observed. The clinical implications in the assessment of ToM are discussed.

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