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.
Similar content being viewed by others
References
Premack D, Woodruff P (1978) Does the chimpanzee have a ‘theory of mind’? Behav Brain Sci 1:515–526
Decety J, Jackson PL (2004) The functional architecture of human empathy. Behav Cogn Neurosci Rev 3:71–100
Corrigan PW, Green MF (1993) Schizophrenic patients’ sensitivity to social cues: the role of abstraction. Am J Psychiatry 150:589–594
Pinkham AE, Penn DL, Perkins DO, Lieberman J (2003) Implications for the neural basis of social cognition for the study of schizophrenia. Am J Psychiatry 160:815–824
Edwards J, Jackson HJ, Pattison PE (2002) Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review. Clin Psychol Rev 22:789–832
Frith CD (2004) Schizophrenia and theory of mind. Psychol Med 34:385–389
Brüne M, Abdel-Hamid M, Lehmkamper C, Sonntag C (2007) Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best? Schizophr Res 92:151–159
Moritz S, Woodward TS (2007) Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention. Curr Opin Psychiatry 20:619–625
Penn DL, Roberts DL, Combs D, Sterne A (2007) Best practices: the development of the social cognition and interaction training program for schizophrenia spectrum disorders. Psychiatr Serv 58:449–451
Frith CD (1992) The cognitive neuropsychology of schizophrenia. Erlbaum, Hillsdale
Bora E, Yücel M, Pantelis C (2009) Theory of mind impairment: a distinct trait-marker for schizophrenia spectrum disorders and bipolar disorder? Acta Psychiatr Scand 120:253–264
Faraone SV, Seidman LJ, Kremen WS, Pepple JR, Lyons MJ, Tsuang MT (1995) Neuropsychological functioning among the nonpsychotic relatives of schizophrenic patients: a diagnostic efficiency analysis. J Abnorm Psychol 104:286–304
Snitz BE, Macdonald AW III, Carter CS (2006) Cognitive deficits in unaffected first-degree relatives of schizophrenia patients: a meta-analytic review of putative endophenotypes. Schizophr Bull 32:179–194
Chen WJ, Liu SK, Chang CJ, Lien YJ, Chang YH, Hwu HG (1998) Sustained attention deficit and schizotypal personality features in nonpsychotic relatives of schizophrenic patients. Am J Psychiatry 155:1214–1220
Sitskoorn MM, Aleman A, Ebisch SJ, Appels MC, Kahn RS (2004) Cognitive deficits in relatives of patients with schizophrenia: a meta-analysis. Schizophr Res 71:285–295
Appels MC, Sitskoorn MM, Westers P, Lems E, Kahn RS (2003) Cognitive dysfunctions in parents of schizophrenic patients parallel the deficits found in patients. Schizophr Res 63:285–293
Hoff AL, Svetina C, Maurizio AM, Crow TJ, Spokes K, DeLisi LE (2005) Familial cognitive deficits in schizophrenia. Am J Med Genet B Neuropsychiatr Genet 133B:43–49
Gur RE, Calkins ME, Gur RC, Horan WP, Nuechterlein KH, Seidman LJ, Stone WS (2007) The Consortium on the Genetics of Schizophrenia: neurocognitive endophenotypes. Schizophr Bull 33:49–68
Schiffman J, Lam CW, Jiwatram T, Ekstrom M, Sorensen H, Mednick S (2004) Perspective-taking deficits in people with schizophrenia spectrum disorders: a prospective investigation. Psychol Med 34:1581–1586
Pilowsky T, Yirmiya N, Arbelle S, Mozes T (2000) Theory of mind abilities of children with schizophrenia, children with autism, and normally developing children. Schizophr Res 42:145–155
Chung YS, Kang DH, Shin NY, Yoo SY, Kwon JS (2008) Deficit of theory of mind in individuals at ultra-high-risk for schizophrenia. Schizophr Res 99:111–118
Langdon R, Coltheart M (2001) Visual perspective-taking and schizotypy: evidence for a simulation-based account of mentalizing in normal adults. Cognition 82:1–26
Pickup GJ (2006) Theory of mind and its relation to schizotypy. Cogn Neuropsychiatry 11:177–192
Inoue Y, Yamada K, Hirano M, Shinohara M, Tamaoki T, Iguchi H, Tonooka Y, Kanba S (2006) Impairment of theory of mind in patients in remission following first episode of schizophrenia. Eur Arch Psychiatry Clin Neurosci 256:326–328
Janssen I, Krabbendam L, Jolles J, van Os J (2003) Alterations in theory of mind in patients with schizophrenia and non-psychotic relatives. Acta Psychiatr Scand 108:110–117
Herold R, Tenyi T, Lenard K, Trixler M (2002) Theory of mind deficit in people with schizophrenia during remission. Psychol Med 32:1125–1129
Pickup GJ, Frith CD (2001) Theory of mind impairments in schizophrenia: symptomatology, severity and specificity. Psychol Med 31:207–220
Pousa E, Duno R, Brebion G, David AS, Ruiz AI, Obiols JE (2008) Theory of mind deficits in chronic schizophrenia: evidence for state dependence. Psychiatry Res 158:1–10
Anselmetti S, Bechi M, Bosia M, Quarticelli C, Ermoli E, Smeraldi E, Cavallaro R (2009) ‘Theory’ of mind impairment in patients affected by schizophrenia and in their parents. Schizophr Res 115:278–285
de Achával D, Costanzo EY, Villarreal M, Jauregui IO, Chiodi A, Castro MN, Fahrer RD, Leiguarda RC, Chu EM, Guinjoan SM (2010) Emotion processing and theory of mind in schizophrenia patients and their unaffected first-degree relatives. Neuropsychologia 48:1209–1215
Irani F, Platek SM, Panyavin IS, Calkins ME, Kohler C, Siegel SJ, Schachter M, Gur RE, Gur RC (2006) Self-face recognition and theory of mind in patients with schizophrenia and first-degree relatives. Schizophr Res 88:151–160
Kelemen O, Kéri S, Must A, Benedek G, Janka Z (2004) No evidence for impaired ‘theory of mind’ in unaffected first-degree relatives of schizophrenia patients. Acta Psychiatr Scand 110:146–149
Pentaraki AD, Stefanis NK, Stahl D (2008) Theory of mind as a potential endophenotype of schizophrenia: understanding false beliefs in families with schizophrenia. Schizophr Res 98(suppl):103
Pentaraki AD, Stefanis NK, Stahl D (2008) Theory of mind in families with schizophrenia: understanding mental representation in schizophrenia. Schizophr Res 98(suppl):190–191
Bora E, Gokcen S, Kayahan B, Veznedaroglu B (2008) Deficits of social-cognitive and social-perceptual aspects of theory of mind in remitted patients with schizophrenia: effect of residual symptoms. J Nerv Ment Dis 196:95–99
Versmissen D, Janssen I, Myin-Germeys I, Mengelers R, Campo JA, van Os J, Krabbendam L (2008) Evidence for a relationship between mentalising deficits and paranoia over the psychosis continuum. Schizophr Res 99:103–110
Marjoram D, Miller P, McIntosh AM, Cunningham Owens DG, Johnstone EC, Lawrie S (2006) A neuropsychological investigation into ‘Theory of Mind’ and enhanced risk of schizophrenia. Psychiatry Res 144:29–37
Shamay-Tsoory SG, Shur S, Barcai-Goodman L, Medlovich S, Harari H, Levkovitz Y (2007) Dissociation of cognitive from affective components of theory of mind in schizophrenia. Psychiatry Res 149:11–23
Montag C, Dziobek I, Richter IS, Neuhaus K, Lehmann A, Sylla R, Heekeren HR, Heinz A, Gallinat J (2011) Different aspects of theory of mind in paranoid schizophrenia: evidence from a video-based assessment. Psychiatry Res 186:203–209
Fyfe S, Williams C, Mason OJ, Pickup GJ (2008) Apophenia, theory of mind and schizotypy: perceiving meaning and intentionality in randomness. Cortex 44:1316–1325
Pousa E, Ruiz AI, David AS (2008) Mentalising impairment as a trait marker of schizophrenia? Br J Psychiatry 192:312
Dziobek I, Fleck S, Kalbe E, Rogers K, Hassenstab J, Brand M, Kessler J, Woike JK, Wolf OT, Convit A (2006) Introducing MASC: a movie for the assessment of social cognition. J Autism Dev Disord 36:623–636
Davis MH (1983) Measuring individual differences in empathy: evidence for a multidimensional approach. J Person Soc Psychol 44:113–126
Montag C, Heinz A, Kunz D, Gallinat J (2007) Self-reported empathic abilities in schizophrenia. Schizophr Res 92:85–89
Wittchen HU, Fydrich T, Zaudig M (1997) SKID-I und SCID-II. Strukturiertes Klinisches Interview für DSM-IV. Hogrefe, Göttingen
Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Cannon T, Ventura J, McFarlane W, Perkins DO, Pearlson GD, Woods SW (2003) Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull 29:703–715
Yung AR, Phillips LJ, McGorry PD, McFarlane CA, Francey S, Harrigan S, Patton GC, Jackson HJ (1998) Prediction of psychosis. A step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl 172:14–20
Lehrl S, Triebig G, Fischer B (1995) Multiple choice vocabulary test MWT as a valid and short test to estimate premorbid intelligence. Acta Neurol Scand 91:335–345
Heubrock D (1992) Der Auditiv-Verbale Lerntest (AVLT) in der klinischen und experimentellen Neuropsychologie. Durchführung, Auswertung und Forschungsergebnisse. Zeitschrift für Differentielle und Diagnostische Psychologie 13:161–174
Paulus C (1992) Empathie, Kompetenz und Altruismus. http://www.uni-saarland.de/fak5/ezw/abteil/motiv/paper/empathie.htm
Raine A (1991) The SPQ: a scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophr Bull 17:555–564
Klein C, Andresen B, Jahn T (1997) Erfassung der schizotypen Persoenlichkeit nach DSM-III-R/Psychometrische Eigenschaften einer autorisierten deutschsprachigen Uebersetzung des ‘Schizotypal Personality Questionnaire’. (SPQ) von Raine. Diagnostica 43:347–369
Langdon R, Coltheart M (1999) Mentalising, schizotypy, and schizophrenia. Cognition 71:43–71
Calkins ME, Curtis CE, Grove WM, Iacono WG (2004) Multiple dimensions of schizotypy in first degree biological relatives of schizophrenia patients. Schizophr Bull 30:317–325
Peters ER, Joseph SA, Garety PA (1999) Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophr Bull 25:553–576
Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biometrical sciences. Behav Res Methods 39:175–191
Shaffer JP (1995) Multiple hypothesis testing. Annu Rev Psychol 46:561–584
Montag C, Ehrlich A, Neuhaus K, Dziobek I, Heekeren HR, Heinz A, Gallinat J (2010) Theory of mind impairments in euthymic bipolar patients. J Affect Disord 123:264–269
Mazza M, Di Michele V, Pollice R, Casacchia M, Roncone R (2008) Pragmatic language and theory of mind deficits in people with schizophrenia and their relatives. Psychopathology 41:254–263
Pinkham AE, Penn DL, Perkins DO, Graham KA, Siegel M (2007) Emotion perception and social skill over the course of psychosis: a comparison of individuals “at-risk” for psychosis and individuals with early and chronic schizophrenia spectrum illness. Cogn Neuropsychiatry 12:198–212
Toomey R, Seidman LJ, Lyons MJ, Faraone SV, Tsuang MT (1999) Poor perception of nonverbal social-emotional cues in relatives of schizophrenic patients. Schizophr Res 40:121–130
Bediou B, Asri F, Brunelin J, Krolak-Salmon P, d’Amato T, Saoud M, Tazi I (2007) Emotion recognition and genetic vulnerability to schizophrenia. Br J Psychiatry 191:126–130
Eack SM, Mermon E, Montrose DM, Miewald J, Gur RE, Gur RC, Sweeney JA, Keshavan MS (2010) Social cognition deficits among individuals at familial high risk for schizophrenia. Schizophr Bull 36:1081–1088
Leppänen JM, Niehaus DJ, Koen L, Du TE, Schoeman R, Emsley R (2008) Deficits in facial affect recognition in unaffected siblings of Xhosa schizophrenia patients: evidence for a neurocognitive endophenotype. Schizophr Res 99:270–273
Haker H, Rössler W (2009) Empathy in schizophrenia: impaired resonance. Eur Arch Psychiatry Clin Neurosci 259:352–361
Henry JD, Bailey PE, Rendell PG (2008) Empathy, social functioning and schizotypy. Psychiatry Res 160:15–22
Pickup GJ (2008) Relationship between theory of mind and executive function in schizophrenia: a systematic review. Psychopathology 41:206–213
Fernyhough C, Jones SR, Whittle C, Waterhouse J, Bentall RP (2008) Theory of mind, schizotypy, and persecutory ideation in young adults. Cogn Neuropsychiatry 13:233–249
Jahshan CS, Sergi MJ (2007) Theory of mind, neurocognition, and functional status in schizotypy. Schizophr Res 89:278–286
Langdon R, Coltheart M (2004) Recognition of metaphor and irony in young adults: the impact of schizotypal personality traits. Psychiatry Res 125:9–20
Meyer J, Shean G (2006) Social-cognitive functioning and schizotypal characteristics. J Psychol 140:199–207
Marjoram D, Job DE, Whalley HC, Gountouna VE, McIntosh AM, Simonotto E, Cunningham-Owens D, Johnstone EC, Lawrie S (2006) A visual joke fMRI investigation into theory of mind and enhanced risk of schizophrenia. Neuroimage 31:1850–1858
Sanchez-Bernardos ML, Avia MD (2006) The relationship between fantasy proneness and schizotypy in adolescents. J Nerv Ment Dis 194:411–414
Merritt RD, Waldo TG (2000) MMPI code types and the fantasy prone personality. Assessment 7:87–95
O’Connor K (2009) Cognitive and meta-cognitive dimensions of psychoses. Can J Psychiatry 54:152–159
Davis MH, Franzoi SL (1991) Stability and change in adolescent self-consciousness and empathy. J Res Person 25:70–87
Merckelbach H, Rassin E, Muris P (2000) Dissociation, schizotypy, and fantasy proneness in undergraduate students. J Nerv Ment Dis 188:428–431
Merckelbach H, van de Ven V (2001) Another White Christmas: fantasy proneness and reports of ‘hallucinatory experiences’ in undergraduate students. J Behav Ther Exp Psychiatry 32:137–144
Thalbourne M, Bartemucci L, Delin PS, Fox B (1997) Transliminality: its nature and correlates. J Am Soc Psych Res 91:305–331
Cohen J (1992) A power primer. Psychol Bull 112:155–159
Faraone SV, Seidman LJ, Kremen WS, Toomey R, Pepple JR, Tsuang MT (2000) Neuropsychologic functioning among the nonpsychotic relatives of schizophrenic patients: the effect of genetic loading. Biol Psychiatry 48:120–126
Derntl B, Finkelmeyer A, Eickhoff S, Kellermann T, Falkenberg DI, Schneider F, Habel U (2010) Multidimensional assessment of empathic abilities: neural correlates and gender differences. Psychoneuroendocrinology 35:67–82
Schulte-Rüther M, Markowitsch HJ, Shah NJ, Fink GR, Piefke M (2008) Gender differences in brain networks supporting empathy. Neuroimage 42:393–403
Baron-Cohen S, Wheelwright S, Hill J, Raste Y, Plumb I (2001) The “Reading the Mind in the Eyes” Test revised version: a study with normal adults, and adults with Asperger syndrome or high-functioning autism. J Child Psychol Psychiatry 42:241–251
Baron-Cohen S, Knickmeyer RC, Belmonte MK (2005) Sex differences in the brain: implications for explaining autism. Science 310:819–823
Schaub D, Brüne M, Jaspen E, Pajonk FG, Bierhoff HW, Juckel G (2011) The illness and everyday living: close interplay of psychopathological syndromes and psychosocial functioning in chronic schizophrenia. Eur Arch Psychiatry Clin Neurosci 261:85–93
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
Christiane Montag and Kathrin Neuhaus have equally contributed to this work.
Rights and permissions
About this article
Cite this article
Montag, C., Neuhaus, K., Lehmann, A. et al. Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 262, 217–226 (2012). https://doi.org/10.1007/s00406-011-0250-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00406-011-0250-2