Contributions of executive functions components to affective and cognitive theory of mind in outpatients diagnosed with schizophrenia

Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression

The reading the mind in the eyes test (RMET) - which assesses the theory of mind component of social cognition - is often used to compare social cognition between patients with schizophrenia and healthy controls. There is, however, no systematic review integrating the results of these studies. We identified 198 studies published before July 2020 that administered RMET to patients with schizophrenia or healthy controls from three English-language and two Chinese-language databases. These studies included 41 separate samples of patients with schizophrenia (total n = 1836) and 197 separate samples of healthy controls (total n = 23 675). The pooled RMET score was 19.76 (95% CI 18.91-20.60) in patients and 25.53 (95% CI 25.19-25.87) in controls (z = 12.41, p < 0.001). After excluding small-sample outlier studies, this difference in RMET performance was greater in studies using non-English v. English versions of RMET (Chi [Q] = 8.54, p < 0.001). Meta-regression analyses found a negative association of age with RMET score and a positive association of years of schooling with RMET score in both patients and controls. A secondary meta-analysis using a spline construction of 180 healthy control samples identified a non-monotonic relationship between age and RMET score - RMET scores increased with age before 31 and decreased with age after 31. These results indicate that patients with schizophrenia have substantial deficits in theory of mind compared with healthy controls, supporting the construct validity of RMET as a measure of social cognition. The different results for English versus non-English versions of RMET and the non-monotonic relationship between age and RMET score highlight the importance of the language of administration of RMET and the possibility that the relationship of aging with theory of mind is different from the relationship of aging with other types of cognitive functioning.

Mindfulness improves theory of mind in people experiencing psychosis: A pilot randomized clinical trial

Impaired Theory of Mind (ToM) ability is a core feature of psychotic disorders that challenges psychosis treatment. We aimed to explore the effect of a Mindfulness-Based Intervention (MBI) on ToM ability in a randomized clinical trial (RCT). A sample of 36 participants diagnosed with psychotic disorder were recruited from a community center and randomly allocated to Integrated Rehabilitation Treatment (IRT) or IRT+MBI. ToM skills were assessed through the Hinting Test and the Reading the Mind in the Eyes Test (RMET). IRT+MBI scored higher in RMET than IRT at posttreatment. MBI is a promising tool for improving ToM ability in psychosis.

Faux Pas Recognition and Executive Processes in Patients with Alcohol Use Disorder: Toward an Investigation of Interindividual Heterogeneity

OBJECTIVE

Impairment of executive functions (EF) has been documented for decades in patients with alcohol use disorders (AUD), while more recent studies have also reported impaired theory of mind. Both have been associated with negative outcomes, particularly a high risk of relapse. However, the interrelatedness of EF and theory of mind impairments remains subject to debate.

METHOD

About 19 AUD outpatients and 20 healthy controls (HC) were asked to complete measures of motor inhibition, mental flexibility, and updating to assess EF, and the faux pas test to assess theory of mind.

RESULTS

As expected, patients' mean performances on EF and faux pas measures were poorer than those of HC. Correlational analyses revealed that executive processes were differentially related to faux pas subscores. Additional single-case analyses corroborated the strong association between EF and faux pas interpretation, as patients with AUD mostly had congruent performances (i.e., both EF and faux pas impaired or both EF and faux pas preserved).

CONCLUSIONS

This study highlights the interrelatedness of EF and faux pas performances in AUD, but also emphasizes the incomplete overlap of the cognitive processes involved in these tasks, with heterogeneous patterns of association. Based on these findings, tailored cognitive rehabilitation programs that simultaneously target EF and faux pas recognition could be developed to favor patients' social inclusion and reduce the risk of relapse. Results also argue in favor of systematic screening for EF and theory of mind impairments among AUD patients.

Cognitive and Affective Theory of Mind in Positive Schizotypy: Relationship to Schizotypal Traits and Psychosocial Functioning

Theory of mind (ToM) impairments are well documented in schizophrenia, although it remains unclear whether these deficits exist among individuals with schizotypy. The current study sought to shed light on mixed findings in schizotypy by differentiating between various aspects of ToM, (cognitive/affective ToM and overmentalization/undermentalization). A three-group design (positive schizotypy, negative affect, and healthy control) was used to assess ToM performance on the Movie for Assessment of Social Cognition. Results indicated that the positive schizotypy group made greater intent overmentalization errors than both control groups. The schizotypy and negative affect groups made greater emotion overmentalization errors relative to healthy controls. In addition, the authors explored the relationship between ToM, schizotypal traits, and psychosocial functioning. Results demonstrated a significant positive relationship between cognitive-perceptual schizotypal traits and intent overmentalization as well as a significant positive relationship between interpersonal traits and emotion overmentalization. Finally, intent and emotion overmentalization were both related to poorer psychosocial functioning.

Social cognition and executive functioning in multiple sclerosis: A cluster-analytic approach

Multiple sclerosis (MS) is associated with deficits in social cognition, the process underlying social interaction and cognitive function. However, the relationships between executive impairment and social cognition remain unclear in MS. Previous studies exclusively focused on group comparisons between healthy controls and patients with MS, treating the latter as a homogeneous population. The variability of socio- and neurocognitive profiles in this pathology therefore remains underexplored. In the present study, we used a cluster analytic approach to explore the heterogeneity of executive and social cognition skills in MS. A total of 106 patients with MS were compared with 53 healthy matched controls on executive (e.g., working memory) and social cognition (facial emotion recognition and theory of mind) performances. A cluster analysis was then performed, focusing on the MS sample, to explore the presence of differential patterns of interaction between executive and social cognition difficulties and their links to sociodemographic, clinical and cognitive variables. We identified three distinct functional profiles: patients with no executive or social cognition deficits (Cluster 1); patients with difficulties in facial emotion recognition and theory of mind and, to a lesser extent, executive functioning (Cluster 2); and patients with executive functioning difficulties only (Cluster 3). Clinical characteristics (disease duration, disability, fatigue) did not differ between clusters. CONCLUSIONS: These results suggest that there are qualitative differences in the social cognition and executive difficulties that are commonly found among patients with MS. If replicated, the identification of these profiles in clinical practice could allow for more individualized rehabilitation.