Improvement of Theory of Mind in Schizophrenia: A 15-Year Follow-Up Study

Abstract

Neurocognitive and social cognitive deficits are a hallmark of schizophrenia. The purpose of the present study was to investigate long-term changes in theory of mind (ToM), executive functions, lexical retrieval, and speed of information processing/attention in schizophrenia. We followed-up 31 outpatients with schizophrenia and 31 healthy control subjects for 15 years. ToM was assessed with the Reading the Mind from the Eyes Test (RMET), whereas neurocognitive functions were measured with the verbal fluency (VF) task (executive functions and lexical retrieval) and with the Digit-Symbol Substitution Test (DSST) (speed of information processing/attention). Clinical symptoms and general functioning were rated with the Positive and Negative Syndrome Scale (PANSS) and with the Global Assessment of Functioning (GAF) scale, respectively. At baseline assessment, patients with schizophrenia exhibited significant and generalized impairments on all measures. At follow-up, relative to the baseline, we observed marked improvements in ToM (RMET), stability in executive functions and lexical retrieval (VF), and a significant decline in psychomotor speed/attention (DSST) in schizophrenia. Clinical symptoms and psychosocial functions did not differ at baseline and at follow-up examinations (mild-to-moderate symptoms on the PANSS and moderate difficulty in social and occupational functions on the GAF). These results indicate that patients with schizophrenia with mild-to-moderate symptoms and functional deficits are characterized by improved ToM during over a decade.

Efficacy of metacognitive training on symptom severity, neurocognition and social cognition in patients with schizophrenia: A single‐blind randomized controlled trial

“…However, it is important to note that these differences were not detectable when comparing the two groups at any time points, and the mentioned results did not show up in the post‐training period. At the same time, our results can be of importance, as the trait‐like ToM impairment in schizophrenia is well known, it is present even in the remissive stages of the illness (Herold, Tényi, Lénárd & Trixler, 2002; Kelemen, 2019). Alterations in ToM functions play a marked role in the prevalence of delusional (Abu‐Akel, 1999; Frith & Corcoran, 2009), disorganized (Hardy‐Baylé et al ., 2003), hallucinatory (Frith & Corcoran, 2009), and negative symptoms (Shamay‐Tsoory, Shur, Barcai‐Goodman, Medlovich, Harari & Levkovitz, 2007).…”

“…We can see that at T0 the TAU + MCT group produced slightly more total errors. The reason behind it might be the following: the fact that we failed to find any relevant difference in the extent of changes between the groups at assessments T1 and T2 does not only mean there was no change in the quality of executive functions, but also reveals that intervention group members “caught up.” This is quite important, as ToM processing in schizophrenia is related to executive function deficits (Hardy‐Bayléas cited at Brüne, 2005), and ToM deficits contribute to the onset and prevalence of symptoms (e.g., Abu‐Akel, 1999; Frith, 2004; Kelemen, 2019). In addition, deficits in executive function may be related to symptoms of disorganization in schizophrenia (Hardy‐Baylé et al ., 2003).…”

“…Its subdomains are emotion recognition, theory of mind, attributional style, and social perception; and patients with schizophrenia show impairments in all of them (Green, Horan & Lee, 2015; Pinkham, Penn, Green, Buck, Healey & Harvey, 2014). The contribution of social cognitive deficits to the emergence and maintenance of schizophrenia symptoms is well established (e.g., Abu‐Akel, 1999; Brüne, 2005; Frith, 2004; Hardy‐Baylé, Sarfati & Passerieux, 2003; Kelemen, 2019). This body of evidence led to the development of supplementary treatments in this field (Vass, Fekete, Simon & Simon, 2018), where we can find treatments specifically targeting one of the subdomains of social cognition (e.g., Theory of Mind Intervention [ToMI], Bechi, Spangaro, Bosia et al ., 2013; Training of Affect Recognition [TAR], Wölwer & Frommann, 2011), or others that comprehensively target impairments in social cognition in schizophrenia (e.g., Social Cognition and Interaction Training [SCIT], Roberts & Penn, 2009).…”

Verbal manifestations of metacognitive and social cognitive operations in patients with schizophrenia who received metacognitive training

“…The ToM is one of the subdomains of social cognition (Pinkham et al, 2014); therefore, we considered these operations to be signs of social cognitive operations. The impairment of ToM in schizophrenia is well-documented (e.g., Abu-Akel, 1999;Firth & Corcoran, 1996;Herold et al, 2002;Kelemen et al, 2019). Our current study is not suited to detect errors in ToM operations, it only examines their manifestations.…”

6G Enabled Tactile Internet and Cognitive Internet of Healthcare Everything: Towards a Theoretical Framework

“…ToM is a psychological construct that displays the capacity for characteristic thoughts, feelings, and ideals toward others and the ability to apprehend different humans' intellectual states. ToM and intelligence are stimulated through domain-precise tasks, and overall performance is associated with numerous cognitive capacities [32].…”