Social-Cognitive Deficits in Schizophrenia

  • Daniela MierEmail author
  • Peter Kirsch
Part of the Current Topics in Behavioral Neurosciences book series (CTBN, volume 30)


Patients with schizophrenia not only suffer from prototypical psychotic symptoms such as delusions and hallucinations and from cognitive deficits, but also from tremendous deficits in social functioning. However, little is known about the interplay between the cognitive and the social-cognitive deficits in schizophrenia. Our chapter gives an overview on behavioral, as well as functional imaging studies on social cognition in schizophrenia. Main findings on cognitive and motivational deficits in schizophrenia are reviewed and introduced within the context of the dopamine hypothesis of schizophrenia. The reviewed findings suggest that disturbed “social brain” functioning in schizophrenia, depending on the specific context, can either lead to a neglect of the emotions and intentions of others or to the false attribution of these emotions and intentions in an emotionally neutral social content. We integrate these findings with the current knowledge about aberrant dopaminergic firing in schizophrenia by presenting a comprehensive model explaining core symptoms of the disorder. The main implication of the presented model is that neither cognitive-motivational, nor social-cognitive deficits alone cause schizophrenia symptoms, but that symptoms only emerge by the interplay of disturbed social brain functioning with aberrant dopaminergic firing.


Schizophrenia Social cognition Social brain Amygdala Superior temporal sulcus Dopamine hypothesis Aberrant salience Ventral striatum Prefrontal cortex 


  1. Abi-Dargham A (2004) Do we still believe in the dopamine hypothesis? New data bring new evidence. Int J Neuropsychopharmacol 7(Suppl 1):S1–S5CrossRefPubMedGoogle Scholar
  2. Abi-Dargham A, Mawlawi O, Lombardo I, Gil R, Martinez D, Huang Y, Hwang DR, Keilp J, Kochan L, Van Heertum R, Gorman JM, Laruelle M (2002) Prefrontal dopamine D1 receptors and working memory in schizophrenia. J Neurosci Off J Soc Neurosci 22:3708–3719Google Scholar
  3. Amodio DM, Frith CD (2006) Meeting of minds: the medial frontal cortex and social cognition. Nat Rev Neurosci 7:268–277CrossRefPubMedGoogle Scholar
  4. Anticevic A, Van Snellenberg JX, Cohen RE, Repovs G, Dowd EC, Barch DM (2012) Amygdala recruitment in schizophrenia in response to aversive emotional material: a meta-analysis of neuroimaging studies. Schizophr Bull 38:608–621CrossRefPubMedGoogle Scholar
  5. Aylward E, Walker E, Bettes B (1984) Intelligence in schizophrenia: meta-analysis of the research. Schizophr Bull 10:430–459CrossRefPubMedGoogle Scholar
  6. Backasch B, Straube B, Pyka M, Klohn-Saghatolislam F, Muller MJ, Kircher TT, Leube DT (2013) Hyperintentionality during automatic perception of naturalistic cooperative behavior in patients with schizophrenia. Soc Neurosci 8:489–504CrossRefPubMedGoogle Scholar
  7. Barnett JH, Scoriels L, Munafo MR (2008) Meta-analysis of the cognitive effects of the catechol-O-methyltransferase gene Val158/108Met polymorphism. Biol Psychiatry 64:137–144CrossRefPubMedGoogle Scholar
  8. Brothers L (1990) The social brain: a project for integrating primate behavior and neurophysiology in a new domain. Concepts Neurosci 1:27–51Google Scholar
  9. Brune M, Schaub D (2012) Mental state attribution in schizophrenia: what distinguishes patients with “poor” from patients with “fair” mentalising skills? Eur Psychiatry J Assoc Eur Psychiatr 27:358–364CrossRefGoogle Scholar
  10. Burns JK (2004) An evolutionary theory of schizophrenia: cortical connectivity, metarepresentation, and the social brain. Behav Brain Sci 27:831–855; discussion 855–885Google Scholar
  11. Ciaramidaro A, Bolte S, Schlitt S, Hainz D, Poustka F, Weber B, Bara BG, Freitag C, Walter H (2015) Schizophrenia and autism as contrasting minds: neural evidence for the hypo-hyper-intentionality hypothesis. Schizophr Bull 41:171–179CrossRefPubMedGoogle Scholar
  12. Das P, Kemp AH, Flynn G, Harris AW, Liddell BJ, Whitford TJ, Peduto A, Gordon E, Williams LM (2007) Functional disconnections in the direct and indirect amygdala pathways for fear processing in schizophrenia. Schizophr Res 90:284–294CrossRefPubMedGoogle Scholar
  13. Derntl B, Habel U (2011) Deficits in social cognition: a marker for psychiatric disorders? Eur Arch Psychiatry Clin Neurosci 261(Suppl 2):S145–S149CrossRefPubMedGoogle Scholar
  14. Diaconescu AO, Jensen J, Wang H, Willeit M, Menon M, Kapur S, McIntosh AR (2011) Aberrant effective connectivity in schizophrenia patients during appetitive conditioning. Front Hum Neurosci 4:239CrossRefPubMedPubMedCentralGoogle Scholar
  15. Edwards J, Jackson HJ, Pattison PE (2002) Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review. Clin Psychol Rev 22:789–832CrossRefPubMedGoogle Scholar
  16. Frith CD, Corcoran R (1996) Exploring theory of mind in people with schizophrenia. Psychol Med 26:521–530CrossRefPubMedGoogle Scholar
  17. Grace AA (1991) Phasic versus tonic dopamine release and the modulation of dopamine system responsivity: a hypothesis for the etiology of schizophrenia. Neuroscience 41:1–24CrossRefPubMedGoogle Scholar
  18. Habel U, Chechko N, Pauly K, Koch K, Backes V, Seiferth N, Shah NJ, Stocker T, Schneider F, Kellermann T (2010) Neural correlates of emotion recognition in schizophrenia. Schizophr Res 122:113–123CrossRefPubMedGoogle Scholar
  19. Haralanova E, Haralanov S, Beraldi A, Moller HJ, Hennig-Fast K (2012) Subjective emotional over-arousal to neutral social scenes in paranoid schizophrenia. Eur Arch Psychiatry Clin Neurosci 262:59–68CrossRefPubMedGoogle Scholar
  20. Holt DJ, Kunkel L, Weiss AP, Goff DC, Wright CI, Shin LM, Rauch SL, Hootnick J, Heckers S (2006) Increased medial temporal lobe activation during the passive viewing of emotional and neutral facial expressions in schizophrenia. Schizophr Res 82:153–162CrossRefPubMedGoogle Scholar
  21. Hooker CI, Tully LM, Verosky SC, Fisher M, Holland C, Vinogradov S (2011) Can I trust you? Negative affective priming influences social judgments in schizophrenia. J Abnorm Psychol 120:98–107CrossRefPubMedPubMedCentralGoogle Scholar
  22. Hooker CI, Bruce L, Fisher M, Verosky SC, Miyakawa A, D’Esposito M, Vinogradov S (2013) The influence of combined cognitive plus social-cognitive training on amygdala response during face emotion recognition in schizophrenia. Psychiatry Res 213:99–107CrossRefPubMedGoogle Scholar
  23. Kapur S (2003) Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry 160:13–23CrossRefPubMedGoogle Scholar
  24. Kapur S, Mizrahi R, Li M (2005) From dopamine to salience to psychosis–linking biology, pharmacology and phenomenology of psychosis. Schizophr Res 79:59–68CrossRefPubMedGoogle Scholar
  25. Knable MB, Weinberger DR (1997) Dopamine, the prefrontal cortex and schizophrenia. J Psychopharmacol 11:123–131CrossRefPubMedGoogle Scholar
  26. Kohler CG, Turner TH, Bilker WB, Brensinger CM, Siegel SJ, Kanes SJ, Gur RE, Gur RC (2003) Facial emotion recognition in schizophrenia: intensity effects and error pattern. Am J Psychiatry 160:1768–1774CrossRefPubMedGoogle Scholar
  27. Krach S, Kamp-Becker I, Einhauser W, Sommer J, Frassle S, Jansen A, Rademacher L, Muller-Pinzler L, Gazzola V, Paulus FM (2015) Evidence from pupillometry and fMRI indicates reduced neural response during vicarious social pain but not physical pain in autism. Hum Brain Mapp 36(11):4730–4744Google Scholar
  28. Lee J, Quintana J, Nori P, Green MF (2011) Theory of mind in schizophrenia: exploring neural mechanisms of belief attribution. Soc Neurosci 6:569–581CrossRefPubMedPubMedCentralGoogle Scholar
  29. Lehmann A, Bahcesular K, Brockmann EM, Biederbick SE, Dziobek I, Gallinat J, Montag C (2014) Subjective experience of emotions and emotional empathy in paranoid schizophrenia. Psychiatry Res 220:825–833CrossRefPubMedGoogle Scholar
  30. Liakakis G, Nickel J, Seitz RJ (2011) Diversity of the inferior frontal gyrus–a meta-analysis of neuroimaging studies. Behav Brain Res 225:341–347CrossRefPubMedGoogle Scholar
  31. Liddle PF (1987) The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy. Br J Psychiatry J Ment Sci 151:145–151CrossRefGoogle Scholar
  32. Meyer-Lindenberg A, Weinberger DR (2006) Intermediate phenotypes and genetic mechanisms of psychiatric disorders. Nat Rev Neurosci 7:818–827CrossRefPubMedGoogle Scholar
  33. Mier D, Kirsch P, Meyer-Lindenberg A (2010a) Neural substrates of pleiotropic action of genetic variation in COMT: a meta-analysis. Mol Psychiatry 15:918–927CrossRefPubMedGoogle Scholar
  34. Mier D, Lis S, Neuthe K, Sauer C, Esslinger C, Gallhofer B, Kirsch P (2010b) The involvement of emotion recognition in affective theory of mind. Psychophysiology 47:1028–1039PubMedGoogle Scholar
  35. Mier D, Sauer C, Lis S, Esslinger C, Wilhelm J, Gallhofer B, Kirsch P (2010c) Neuronal correlates of affective theory of mind in schizophrenia out-patients: evidence for a baseline deficit. Psychol Med 40:1607–1617CrossRefPubMedGoogle Scholar
  36. Mier D, Lis S, Zygrodnik K, Sauer C, Ulferts J, Gallhofer B, Kirsch P (2014) Evidence for altered amygdala activation in schizophrenia in an adaptive emotion recognition task. Psychiatry Res 221:195–203CrossRefPubMedGoogle Scholar
  37. Moritz S, Kerstan A, Veckenstedt R, Randjbar S, Vitzthum F, Schmidt C, Heise M, Woodward TS (2011) Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behav Res Ther 49:151–157CrossRefPubMedGoogle Scholar
  38. Napal O, Ojeda N, Sanchez P, Elizagarate E, Pena J, Ezcurra J, Gutierrez M (2012) The course of the schizophrenia and its impact on cognition: a review of literature. Actas espanolas de psiquiatria 40:198–220PubMedGoogle Scholar
  39. Novic J, Luchins DJ, Perline R (1984) Facial affect recognition in schizophrenia. Is there a differential deficit? Br J Psychiatry J Ment Sci 144:533–537CrossRefGoogle Scholar
  40. Okochi T, Ikeda M, Kishi T, Kawashima K, Kinoshita Y, Kitajima T, Yamanouchi Y, Tomita M, Inada T, Ozaki N, Iwata N (2009) Meta-analysis of association between genetic variants in COMT and schizophrenia: an update. Schizophr Res 110:140–148CrossRefPubMedGoogle Scholar
  41. Paus T (2001) Primate anterior cingulate cortex: where motor control, drive and cognition interface. Nat Rev Neurosci 2:417–424CrossRefPubMedGoogle Scholar
  42. Pickup GJ (2008) Relationship between theory of mind and executive function in schizophrenia: a systematic review. Psychopathology 41:206–213CrossRefPubMedGoogle Scholar
  43. Pinkham AE, Hopfinger JB, Pelphrey KA, Piven J, Penn DL (2008) Neural bases for impaired social cognition in schizophrenia and autism spectrum disorders. Schizophr Res 99:164–175CrossRefPubMedGoogle Scholar
  44. Pinkham AE, Brensinger C, Kohler C, Gur RE, Gur RC (2011) Actively paranoid patients with schizophrenia over attribute anger to neutral faces. Schizophr Res 125:174–178CrossRefPubMedGoogle Scholar
  45. Premack D, Woodruff G (1978) Does the chimpanzee have a theory of mind? Behav Brain Sci 4:515–526CrossRefGoogle Scholar
  46. Quintana J, Wong T, Ortiz-Portillo E, Marder SR, Mazziotta JC (2003) Right lateral fusiform gyrus dysfunction during facial information processing in schizophrenia. Biol Psychiatry 53:1099–1112CrossRefPubMedGoogle Scholar
  47. Rausch F, Mier D, Eifler S, Esslinger C, Schilling C, Schirmbeck F, Englisch S, Meyer-Lindenberg A, Kirsch P, Zink M (2014) Reduced activation in ventral striatum and ventral tegmental area during probabilistic decision-making in schizophrenia. Schizophr Res 156:143–149CrossRefPubMedGoogle Scholar
  48. Roberts DL, Combs DR, Willoughby M, Mintz J, Gibson C, Rupp B, Penn DL (2014) A randomized, controlled trial of social cognition and interaction training (SCIT) for outpatients with schizophrenia spectrum disorders. Br J Clin Psychol Br Psychol Soc 53:281–298CrossRefGoogle Scholar
  49. Russell TA, Rubia K, Bullmore ET, Soni W, Suckling J, Brammer MJ, Simmons A, Williams SC, Sharma T (2000) Exploring the social brain in schizophrenia: left prefrontal underactivation during mental state attribution. Am J Psychiatry 157:2040–2042CrossRefPubMedGoogle Scholar
  50. Shenton ME, Dickey CC, Frumin M, McCarley RW (2001) A review of MRI findings in schizophrenia. Schizophr Res 49:1–52CrossRefPubMedPubMedCentralGoogle Scholar
  51. Tandon R, Keshavan MS, Nasrallah HA (2008) Schizophrenia, “just the facts” what we know in 2008. 2. Epidemiol Etiol Schizophr Res 102:1–18CrossRefGoogle Scholar
  52. Tandon R, Nasrallah HA, Keshavan MS (2009) Schizophrenia, “just the facts” 4. Clin Features Concept Schizophr Res 110:1–23CrossRefGoogle Scholar
  53. van Winkel R, Stefanis NC, Myin-Germeys I (2008) Psychosocial stress and psychosis: a review of the neurobiological mechanisms and the evidence for gene-stress interaction. Schizophr Bull 34:1095–1105CrossRefPubMedPubMedCentralGoogle Scholar
  54. Walter H, Ciaramidaro A, Adenzato M, Vasic N, Ardito RB, Erk S, Bara BG (2009) Dysfunction of the social brain in schizophrenia is modulated by intention type: an fMRI study. Soc Cogn Affect Neurosci 4:166–176CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Clinical PsychologyCentral Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheimGermany

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