Identifying Other People’s Perspective and their Facial Emotions – A Comparison between Patients on Long-term Second-generation Antipsychotic Treatment for Schizophrenia and Neurotypical Controls

Abstract

Previous studies report that the inhibition of one’s own perspective in favour of acknowledging somebody else’s perspective relates to the neurotypical development of Theory of Mind (ToM) processes. ToM processing seems to be negatively affected in patients diagnosed with schizophrenia (PwS). Different tasks, using different populations, have been used to examine ToM (e.g. Hinting, facial emotion recognition, on-line perspective-taking), making generalizations problematic. We investigated ToM processing, using different paradigms, in one patient group on long-term second-generation antipsychotic treatment for schizophrenia and in neurotypical controls. Methods: Twenty-five patients on treatment with second-generation anti-psychotic medication for schizophrenia for more than ten years and neurotypical controls took part in a Hinting task, a facial emotion recognition task, and an on-line visual computational perspective-taking task. A battery of neuropsychological tests provided the input of a Principal Component Analysis (PCA). Results: Patients performed significantly less effectively than controls on the Hinting Task, and even patients in remittance struggled more with the task. No significant differences in facial emotion recognition between groups were found. The on-line perspective-taking task results revealed that controls, but not patients, presented an intrusion of the other perspective when judging their own perspective (altercentric behaviour). Reaction time results revealed that patients were significantly slower than controls when evaluating the “Other” perspective. The results of the perspective-taking task were examined further by relating them to components from the PCA. Errors in perspective-taking appeared correlated mostly to difficulties in mentalizing and cognitive control (neurotypical participants) and to hinting comprehension skills (patients). Conclusions: Results suggest that mentalizing and cognitive control are relevant functions for perspective-taking and that even after long-term treatment with second-generation antipsychotics, patients still have more difficulties in judging the Other perspective. The facial emotion recognition task suggested that facial emotion recognition is a separate interpretation skill not directly related to ToM