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.
Highlights
Theory of mind (ToM) refers to our ability to understand the internal states of other individuals, including the representation of intentions and complex social emotions
ToM dysfunctions, as characterized by laboratory tests, are thought to be a hallmark feature of schizophrenia [1,2,3,4,5], which is present before the onset of psychosis [6,7] and in the biological relatives of schizophrenia patients [8,9,10]
The three-way interaction among group, assessment, and test type indicated a significant difference between patients with schizophrenia and healthy controls, which exhibited a distinct pattern at baseline and follow-up assessment
Summary
Theory of mind (ToM) refers to our ability to understand the internal states of other individuals, including the representation of intentions and complex social emotions. ToM dysfunctions may be viewed as potential endophenotypes [11,12,13,14], the results are not equivocal and straightforward [15,16,17,18,19,20]. Several studies highlighted the relevance of ToM functions in clinical outcome, functional prognosis, and quality of life in schizophrenia [21,22]. Long-term follow-up studies are essential to better understand the prognosis and outcome of schizophrenia and to identify potential state-independent endophenotypes.
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