Theory Of Mind Impairment Research Articles

A conceptual framework of cognitive-affective theory of mind: towards a precision identification of mental disorders

To explore the minds of others, which is traditionally referred to as Theory of Mind (ToM), is perhaps the most fundamental ability of humans as social beings. Impairments in ToM could lead to difficulties or even deficits in social interaction. The present study focuses on two core components of ToM, the ability to infer others’ beliefs and the ability to infer others’ emotions, which we refer to as cognitive and affective ToM respectively. Charting both typical and atypical trajectories underlying the cognitive-affective ToM promises to shed light on the precision identification of mental disorders, such as depressive disorders (DD) and autism spectrum disorder (ASD). However, most prior studies failed to capture the underlying processes involved in the cognitive-affective ToM in a fine-grained manner. To address this problem, we propose an innovative conceptual framework, referred to as visual theory of mind (V-ToM), by constructing visual scenes with emotional and cognitive meanings and by depicting explicitly a four-stage process of how humans make inferences about the beliefs and emotions of others. Through recording individuals’ eye movements while looking at the visual scenes, our model enables us to accurately measure each stage involved in the computation of cognitive-affective ToM, thereby allowing us to infer about potential difficulties that might occur in each stage. Our model is based on a large sample size (n > 700) and a novel audio-visual paradigm using visual scenes containing cognitive-emotional meanings. Here we report the obtained differential features among healthy controls, DD and ASD individuals that overcome the subjectivity of conventional questionnaire-based assessment, and therefore could serve as valuable references for mental health applications based on AI-aided digital medicine.

The effect of reading literary fiction on the theory of mind skills among persons with schizophrenia and normal controls.

Recent research data suggest that theory of mind (ToM) skills may improve after reading literary fiction. However, beside this short term favorable effect, regular long-term reading of literary fiction may also support ToM development or may improve ToM performance. The presence of impaired ToM abilities is well-documented in schizophrenia; however, the role of reading in these deficits is unknown. In the present study our aim was to assess the effect of prior reading experiences on theory of mind performance in patients with schizophrenia, and in healthy controls. ToM assessment was done with the Short Story Task, which is based on the interpretation of a Hemingway short story. After reading the short story, questions were asked in an interview format regarding comprehension, explicit and implicit ToM skills, then comparative analysis of schizophrenia patients was performed (n = 47) and matched to a normal control (n = 48) group concerning deficits of ToM abilities. Participants were also stratified according to their prior reading experiences. Previous reading experience was associated with better comprehension and explicit ToM performance both in patients with schizophrenia, and in healthy controls. However, the explicit ToM performance of patients with prior reading was still weaker compared to healthy controls with reading experiences. Path model analysis revealed that reading had a direct positive effect on ToM, and an indirect effect through improving comprehension. Prior reading experience is associated with better ToM performance not just in healthy controls but also in patients living with schizophrenia. Previous reading experience also improves comprehension, which in turn has a favorable impact on ToM. Our results support the idea that literary fiction reading may have a therapeutic potential in the rehabilitation of schizophrenia.

Performance in emotion recognition and theory of mind tasks in social anxiety and generalized anxiety disorders: a systematic review and meta-analysis.

Social cognition impairments may be associated with poor functional outcomes, symptoms, and disability in social anxiety disorder (SAD) and generalized anxiety disorder (GAD). This meta-analysis aims to determine if emotion recognition and theory of mind (ToM) are impaired in SAD or GAD compared to healthy controls. A systematic review was conducted in electronic databases (PubMed, PsycNet, and Web of Science) to retrieve studies assessing emotion recognition and/or ToM in patients with SAD or GAD, compared to healthy controls, up to March 2022. Meta-analyses using random-effects models were conducted. We identified 21 eligible studies: 13 reported emotion recognition and 10 ToM outcomes, with 585 SAD patients, 178 GAD patients, and 753 controls. Compared to controls, patients with SAD exhibited impairments in emotion recognition (SMD = -0.32, CI = -0.47 - -0.16, z = -3.97, p < 0.0001) and ToM (SMD = -0.44, CI = -0.83 -0.04, z = -2.18, p < 0.01). Results for GAD were inconclusive due to the limited number of studies meeting the inclusion criteria (two for each domain). Relevant demographic and clinical variables (age, sex, education level, and anxiety scores) were not significantly correlated with emotion recognition or ToM impairments in SAD and GAD. Further studies employing ecological measures with larger and homogenous samples are needed to better delineate the factors influencing social cognition outcomes in both SAD and GAD.

Deficits in Analytic and Common-Sense Reasoning in Schizophrenia.

Human rationality has a dual nature including analytic and common-sense thinking. Symptoms of schizophrenia have been suggested to be related to deficits in these aspects of logical reasoning. However, empirical studies investigating logical reasoning errors in schizophrenia and their clinical and neurocognitive correlates are scarce. Formal thought disorder and theory of mind (ToM) might be particularly important for understanding logical reasoning errors in schizophrenia. The current study compared the performances of 80 patients with schizophrenia with those of 49 healthy controls on syllogistic and counterfactual reasoning tasks and investigated clinical, neuropsychological, and social cognitive correlates of logical reasoning in schizophrenia. Patients with schizophrenia were impaired in both analytic and common-sense thinking. ToM impairment was a significant predictor of analytic reasoning abilities in schizophrenia. Executive functions and verbal memory were also significantly associated with analytic reasoning in schizophrenia. Further studies investigating logical reasoning errors in the early phases of the illness are needed.

Social cognition and behavioral outcomes in congenital heart disease: profiles and neuropsychiatric comorbidities

ABSTRACT Autism spectrum disorders are more prevalent in children with congenital heart disease (CHD) than in the general population. Children with CHD without diagnosed autism are also at increased risk for neurodevelopmental and psychiatric impairments. We characterized social and behavioral outcomes in children with CHD and examined neurodevelopmental and psychiatric comorbidities. Children without diagnosed autism who underwent infant open-heart surgery were eligible. Parent-reports assessed social communication, unusual behaviors, self-regulation, anxiety, and executive function (EF). Neuropsychological tests assessing theory of mind (ToM), working memory, and verbal comprehension were administered. Outcomes were compared to normative data. Linear regressions were estimated with parent-reported scores and ToM abilities as outcomes. Predictors were anxiety symptoms, parent-reported EF, and working memory scores. Covariates were age, parental education, ADHD diagnosis, and verbal comprehension. Clinically relevant comorbidities were identified (N children scoring ≥1SD below the norm). Fifty-six children (10.8 ± 1.8 years) participated virtually. Compared to norms, children with CHD had impaired ToM, more unusual behaviors (p = .002), and less self-regulation (p = .018), but better social communication (p = .014). “Autism-like” traits were positively associated with anxiety symptoms (ß(95% CI) = 0.28(0.08–0.49), p = .008) and worse working memory (ß(95% CI) = -0.36(−0.59–0.13), p = .003). Twenty-one out of 22 children who displayed clinically relevant social and behavioral scores also showed anxiety symptoms (n = 4), impaired EF (n = 7), or both (n = 10). Children with CHD without diagnosed autism have elevated unusual behaviors, lower self-regulation, and impaired ToM. There is a high risk of co-existing anxiety and impaired EF which may increase disease burden. Targeted therapeutic interventions are needed to reduce long-term psychosocial risks in these children. Abbreviation Attention deficit/hyperactivity disorder (ADHD), Autism Spectrum Rating Scale (ASRS), Behavior Rating Inventory of Executive Functions for school-aged children, 2nd Edition (BRIEF-2), cardiopulmonary bypass (CPB), congenital heart disease (CHD), Empathy/Systematizing Quotient Child Version (ESQ-C), Multidimensional Anxiety Scale for Children, 2nd Edition (MASC-2), Social Responsiveness Scale (School-age form), 2nd Edition (SRS-2), theory of mind (ToM), Theory of Mind Task Battery (ToM-TB), Wechsler Intelligence Scale for Children, 5th edition (WISC-V)

Altered temporoparietal junction activity during reflected self-evaluation in sub-clinical depression.

Negative self-schema is a core symptom of depression. According to social psychological theories, two types of self-evaluations play important roles in forming the negative self-view: direct self-evaluation (that is, evaluating the self directly through one's first-person perspective introspection) and reflected self-evaluation (which requires theory of mind (ToM) ability, and is evaluating the self through reflecting on a third person's perspective). Although many previous studies have investigated the processing of the direct self-evaluation in depression, few have extended research on the reflected self-evaluation. In the current study, functional magnetic resonance imaging scans were acquired in 26 dysphoric (individuals with elevated number of depressive symptoms) and 28 control participants during both direct and reflected self-evaluation tasks. Two regions of interest were defined within bilateral temporoparietal junctions (TPJs) because their significant role in ToM. Results showed that the dysphoric participants evaluated themselves more negatively than the control participants, regardless of whose perspective they were taking. More importantly, the enhanced TPJs' activations were observed in the control group during the reflected self-evaluation task versus the direct self-evaluation task, whereas no such difference was observed in the dysphoric participants. The results are interpreted in the framework of impaired ToM ability in sub-clinical depression. General Scientific Summary (GSS) Negative self-schema is one of the core symptoms of depression. This study suggests that the negative self-schema reflects not only in direct self-evaluation (i.e. evaluating the self via one's own introspection) but also in reflected self-evaluation (i.e. evaluating the self via others' perspective). Importantly, altered TPJ activity was found during a reflected self-evaluation task among individuals with depressive symptoms. These changes in brain function might be associated with impaired ToM ability in sub-clinical depression.

Theory of mind in adolescents with Attention-Deficit Hyperactivity Disorder: A cross-sectional study.

Attention-Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder that may be associated with impaired Theory of Mind (ToM) and social cognition. ToM is a domain in social cognition, referring to one's ability to attribute beliefs, intents, perspectives, and understandings to oneself or others and to understand others' mental states. The present study enrolled 52 ADHD of adolescents and 41 healthy age-matched controls in this study. This study applied The Reading the Mind in The Eyes Task (RMET) and Theory of Mind Assessment Scale (Th.o.m.a.s.) for all participants. The results of these tasks were compared between the two study groups. No significant differences were found between these two study groups regarding ToM abilities using mean scores in the Th.o.m.a.s. inventory and the RMET. Furthermore, no association was found between the mean score in the ToM (in both study groups) and this study's parameters of gender, mean age, birth rank, family structure, and income. This study did not support the hypothesis that adolescents with ADHD perform worse on ToM tasks.

Relationship between theory of mind and metabolic parameters and functioning in patients with bipolar I disorder

Purpose: We aimed to investigate the relationship theory of mind abilities with functionality and metabolic alteration in patients with bipolar disorder-1 (BD-1) during the remission period.&#x0D; Materials and Methods: This cross-sectional study is consisted of 68 patients with bipolar disorder-1 and 45 healthy controls. Sociodemographic form, Reading the Mind in the Eyes Test (RMET), Bipolar Disorder Functioning Questionnaire (BDFQ) were administered to the participants. Body mass index (BMI), waist circumference (WC), fasting plasma glucose (FG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), total cholesterol (TC), triglyceride (TG) levels were recorded. &#x0D; Results: There were significant differences between the patient group and healthy control group in terms of WC, BMI, HDL, LDL, TG. The results of independent samples t-test indicated a statistically significant difference in RMET score between the two groups with control group significantly higher than patient group. &#x0D; Conclusion: Patients with BD-1 during the remission period have lower performance on theory of mind abilities and more alteration in metabolic parameters than healthy controls. Metabolic alteration and theory of mind impairment should be potential treatment target for BD

Assessment of theory of mind in Tunisian verbal children with autism spectrum disorder.

The present study examined performance in Theory of Mind (ToM) in a group of 31 Arabic-speaking verbal children (7-12 years-old) with autism spectrum disorder (ASD), in comparison with neurotypical controls (NT) matched for age and for cognitive abilities. An innovative task in a digital format named "The Tunisian Social Situations Instrument" (TSSI) was used and allowed us to study four different subdomains of ToM: attribution of intention and epistemic ToM (cognitive ToM), affective ToM, and detection of faux pas (advanced ToM). Our study showed impairments in ToM in children with ASD, similar to those reported in the literature. Our findings additionally suggested that affective and advanced ToM, specifically the detection of faux pas, might be more challenging for ASD children than other components of ToM. Future studies with larger number of children may lead us to specify which subdomains are the most impaired in order to develop specific tools targeting these specific impairments.

Individual differences in theory of mind correlate with the occurrence of false memory: A study with the DRM task.

Although long-term memory and Theory of Mind (ToM) are closely related across the whole lifespan, little is known about the relationship between ToM and semantic memory. Clinical studies have documented the co-occurrence of ToM impairments and semantic memory abnormalities in individuals with autism or semantic dementia. However, to date, no study has directly investigated the existence of a relationship between ToM and semantic memory in the typical population. We addressed this gap on a sample of 103 healthy adults (M age = 22.96 years; age range = 19-35 years). Participants completed a classical false memory task tapping on semantic processes, the Deese-Roediger-McDermott (DRM) task, and two ToM tasks, the Triangles and the Reading the Mind in the Eyes task. They also completed the vocabulary scale from the Wechsler Adult Intelligence Scale. Results showed that participants' semantic performance in the DRM task was significantly related to that in the Triangles task. Specifically, the higher participants' ToM in the Triangles task, the higher participants' reliance on semantic memory while making false memories in the DRM task. Our findings are consistent with the Fuzzy Trace Theory and the Weak Central Coherence account and suggest that a (partially) common cognitive process responsible for global versus detailed-focus information processing could underlie these two abilities.

Impairment of social cognitive functions in the patients with acute ischemic stroke

BACKGROUND. Cognitive impairment is common after a stroke. However, the condition of social cognitive functions, in particular theory of mind, in this group of patients has been studied insufficiently.&#x0D; AIM. To study the frequency and predictors of the development of the social cognitive disorders based on theory of mind impairment in patients with acute ischemic stroke.&#x0D; MATERIAL AND METHODS. Theory of mind impairment was assessed using Reading the Mind in the Eyes test in the acute period of ischemic stroke. National Institutes of Health Stroke scale was used to assess the severity of neurological deficit, modified Rankin scale the degree of disability, Delirium Severity Rating Scale the symptoms of delirium, Buss Perry aggressiveness scale severity of aggressive behavior, Montreal Cognitive Assessment Scale cognitive deficit. The severity of cortical atrophy was evaluated by computed tomography of the brain. The study included 86 patients, 53 males and 33 females. The average age of patients was 64 years. Statistical analysis was performed using the IBM SPSS Statistics 21 software package. Nonparametric statistics methods were used. Binary data were compared using the chi-square parameter, categorical data were compared using the MannWhitney test.&#x0D; RESULTS. Seventy percent of patients suffered from the impairment of social cognitive functions. Independent predictors of the impairment of theory of mind according to linear regression analysis were cognitive dysfunction according to the Montreal Cognitive Assessment Scale (p=0.0001) and the severity of cortical atrophy on computed tomography of the brain (p=0.001).&#x0D; CONCLUSION. Social cognitive impairment is registered in a substantial number of patients in acute period of stroke; its predictors include general cognitive impairment and cortical atrophy of the brain.

Virtual reality-based theory of mind intervention in schizophrenia: Preliminary efficacy results

BackgroundIn recent years, a growing body of literature has supported the core nature and functional significance of Theory of Mind (ToM) deficit in schizophrenia. These findings have made ToM impairment a promising treatment target. However, despite the encouraging results, its complexity makes it difficult to develop new interventions and even to understand the exact nature and scope of the deficit. Yet, further investigation has suggested that using modern technology and multilevel assessment may help solve the problem. MethodsVirtual Reality-based Theory of Mind Intervention (VR-ToMIS) is a recently developed structured method using the combination of cognitive and behavioral therapeutic techniques and the advantages of Virtual Reality (VR) technology. A controlled study with a three-month follow-up was conducted with 42 patients (suffering from schizophrenia or schizo-affective disorder) randomly assigned to either an experimental (VR-ToMIS) or control group (passive-VR). Repeated two-way factorial analysis of covariance was used to evaluate the effects of VR-ToMIS on symptoms, neuro- and social cognition, pragmatic skills, and quality of life when the effect of IQ was controlled. ResultsPatients participating in VR-ToMIS showed significant improvements in all types of ToM tasks (except for hyper-ToM task, based on the results of Cartoon test, Faux pas test and and Baron-Cohen Minds in the Eyes Test) compared to the control group with moderate to large effect sizes. In the case of negative and cognitive symptoms, significant between-group differences were also supported. Improvement was moderated by IQ in the case of higher-order ToM, manner, and relevance implicatures. Results were proved to be sustainable three months after the treatment. ConclusionAlthough the presented results are considered preliminary, they support the potential of the integration of modern technology and traditional methods for future interventions.

The impact of prefrontal transcranial direct current stimulation (tDCS) on theory of mind, emotion regulation and emotional-behavioral functions in children with autism disorder: A randomized, sham-controlled, and parallel-group study.

Advances in our knowledge about the neuropsychological mechanisms underlying core deficits in autism spectrum disorder (ASD) have produced several novel treatment modalities. One of these approaches is modulation of activity of the brain regions involved in ASD symptoms. This study examined the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) on autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functions in children with ASD. Thirty-two children (Mage =10.16, SD=1.93, range 7-12 years) diagnosed with ASD were randomly assigned to active (N=17) or sham stimulation (N=15) groups in a randomized, sham-controlled, parallel-group design. Participants underwent 10 sessions of active (1.5mA, 15 min, bilateral left anodal/right cathodal DLPFC, 2 sessions per week) or sham tDCS. Autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functioning of the patients were assessed at baseline, immediately after the intervention, and 1 month after the intervention. A significant improvement of autism symptom severity (i.e., communication), theory of mind (i.e., ToM 3), and emotion regulation strategies was observed for the active as compared to the sham stimulation group at the end of the intervention, and these effects were maintained at the one-month follow-up. The results suggest that repeated tDCS with anodal stimulation of left and cathodal stimulation of right DLPFC improves autism symptom severity as well as social cognition and emotion regulation in ASD. LAY SUMMARY: Previous research has suggested that targeting core mechanisms underlying cognitive-emotional and behavioral deficits of autistic children might improve symptoms of ASD. Deficient social and behavioral functioning, impaired theory of mind, and emotional regulation deficits have been identified as core treatment targets for this group. Specific subregions of the prefrontal cortex are involved in these deficits, including hypoactivity of the dorsolateral prefrontal cortex (DLPFC). Upregulation of this area with non-invasive brain stimulation, namely anodal transcranial direct current stimulation (tDCS), results in improved social and behavioral functioning in children with ASD. Very few studies have however examined the effects of this intervention on theory of mind, emotional regulation, and emotional-behavioral problems. We examined the effects of anodal tDCS over the left DLPFC (F3), combined with cathodal tDCS over the right DLPFC (F4) on autism symptom severity as well as theory of mind, emotional regulation, and emotional-behavioral problems of children with ASD. This intervention improved autism symptom severity, specific domains of theory of mind, and emotion regulation. These findings have clinical implications for the treatment of ASD and suggest that targeting core mechanisms underlying socio-cognitive-emotional deficits of autistic children using tDCS might improve symptoms of ASD.

Neuropsychological, neuropsychiatric, and clinical correlates of affective and cognitive theory of mind in Parkinson's disease: A meta-analysis.

Theory of mind (ToM) is the ability to infer others' mental (Cognitive) and emotional (Affective) states, both being impaired in Parkinson's disease (PD). However, the clinical, neuropsychological, and neuropsychiatric features underlying Affective and Cognitive ToM deficits in PD are unclear. Therefore, we performed a meta-analytic study to test whether PD demographical, clinical, neuropsychological, or neuropsychiatric changes related differently to both ToM processes. A systematic literature search was performed up to January 2022, including a total of 31 studies following our search terms. Data from each study were obtained from demographic (age, education), clinical (disease duration, Hoehn & Yahr staging system, Unified Parkinson's Disease Rating Scale-III, levodopa equivalent daily dose), neuropsychological (global cognitive functioning, memory subdomains, executive functions subdomains, processing speed/complex attention/working memory, visuospatial and constructional abilities, and language), and neuropsychiatric (depression, apathy, anxiety) variables. Affective ToM impairment in PD was related to lower educational level and global cognition, deficits of generativity, decision making, attention/working memory, and language. Conversely, Cognitive ToM deficits were associated with advanced age, poorer global cognition, executive dysfunctions, and language impairments. Medication moderated the relationship between attention/working memory and Cognitive ToM, whereas age moderated the association of Affective ToM with language. No significant associations were found between ToM deficits and patients' neuropsychiatric or clinical states. These findings clarify the neuropsychological and clinical features that explain ToM deficits in PD. Possibly, our results suggest the need to explore the complex neural networks involving frontostriatal and temporoparietal circuits behind changes in social cognition in PD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The application of adapted dialectical behaviour therapy concepts and skills in the treatment of adults with autistic spectrum disorder who display challenging or offending behaviours

PurposeDespite some advances in the assessment and treatment of autism spectrum disorder (ASD), there remains a paucity of intervention and research literature in treating adults with ASD. There is growing evidence supporting a relationship between the core features of ASD and emotion dysregulation. There is an overlap between ASD and borderline personality disorder (BPD) characteristics such as emotional dysregulation, sensory issues and social skills deficits. This paper aims to explore the applications of dialectical behaviour therapy (DBT) concepts and skills in treating ASD individuals who display challenging or offending behaviours. The similarities in characteristics between ASD and BPD and the core issue of emotion dysregulation hold promise in the utility of DBT with ASD.Design/methodology/approachThis is a conceptual paper that includes a case vignette.FindingsA DBT-informed treatment approach using the adaptations and reconceptualization, i.e. risky mind–wise mind outlined in this paper, can be considered promising in addressing issues for ASD individuals, particularly those with challenging and/or offending behaviours. DBT incorporates different elements of applied behaviour analysis, cognitive behavioural therapy, mindfulness skills, sensory-based treatments, psychosocial interventions and emotion regulation skills, which makes it a more cohesive and integrated approach to treatment. The authors assert that DBT can be considered a more integrated, strengths-based, habilitative and trauma-informed approach which can be promising in its application to address challenging behaviours or offending in ASD individuals.Research limitations/implicationsIt is recommended that research be carried out to evaluate the effectiveness of adapted DBT programs in treating ASD individuals presenting with challenging and/or offending behaviours. Future research can focus on evaluating the effectiveness of the different DBT concepts and skills and the different DBT modules to determine which components of the program are particularly useful for this client group.Practical implicationsTreatment manuals have already been developed for clients with intellectual disability and developmental disabilities who exhibit challenging and/or offending behaviour; hence, it is recommended that modifications be made to make it more applicable and appropriate for ASD individuals. Modifications should address ASD-specific issues (e.g. black and white thinking, cognitive rigidity, sensory issues, impaired theory of mind, emotion dysregulation issues, social skills deficits and anxiety issues). The use of DBT has much wider implications regarding addressing comorbid mental health conditions and personality issues in this client group.Originality/valueThere are limited psychological interventions that prove to be useful for individuals with ASD with complex presentations and challenging or offending behaviours. This paper discusses the application of adapted DBT concepts and skills that appear to be promising in the treatment of this client group.

The relationship between theory of mind and executive functions in major depressive disorders: A review.

Patients suffering from major depressive disorder (MDD) experience difficulties in multiple cognitive and affective abilities. A large body of literature has argued that MDD patients show impaired executive functions (EFs) and deficits in theory of mind (ToM), the ability to infer the mental states of others. However, the relationship between ToM and EFs has been poorly investigated. The aim of this review is to provide an overview of studies that evaluated the association between ToM and EFs in patients with MDD diagnosis. A literature review was conducted to identify all published studies in which ToM and EFs measures were administered to individuals with MDD and in which the relationship between these two domains was investigated. Eleven studies were included, and for each study, we discussed the findings related to ToM, EFs, and the nature of the link between these two aspects. Most of the studies reported that patients with MDD, compared with healthy controls, showed significant impairments in both ToM and EFs abilities. Moreover, this review indicates the presence of a significant association between these two domains in MDD patients, supporting the evidences that executive functioning is important to perform ToM tasks. Although the results that emerged are interesting, the relationship between ToM and EFs in MDD needs further investigation.

Theory of mind in schizophrenia: a comparison of subgroups with low and high IQ

Background Social cognitive impairment is common in schizophrenia, but it is unclear if it is present in individuals with high IQ. This study compared theory of mind (ToM) in schizophrenia participants with low or high IQ to healthy controls. Methods One hundred and nineteen participants (71 healthy controls, 17 high IQ (IQ ≥115), and 31 low IQ (IQ ≤95) schizophrenia participants) were assessed with the Movie for the Assessment of Social Cognition, providing scores for total, cognitive, and affective ToM, along with overmentalizing, undermentalizing, and no-mentalizing errors. IQ was measured with Wechsler Abbreviated Scale of Intelligence; clinical symptoms with the Positive and Negative Syndrome Scale. Results Healthy controls performed better than the low IQ schizophrenia group for all ToM scores, and better than the high IQ schizophrenia group for the total score and under- and no-mentalizing errors. The high IQ group made fewer overmentalizing errors and had better total and cognitive ToM than the low IQ group. Their number of overmentalizing errors was indistinguishable from healthy controls. Conclusion Global ToM impairment was present in the low IQ schizophrenia group. Overmentalizing was not present in the high IQ group and appears related to lower IQ. Intact higher-level reasoning may prevent the high IQ group from making overmentalizing errors, through self-monitoring or inhibition. We propose that high IQ patients are chiefly impaired in lower-level ToM, whereas low IQ patients also have impaired higher-level ToM. Conceivably, this specific impairment could help explain the lower functioning reported in persons with intact IQ.

Delving into the Genetic Causes of Language Impairment in a Case of Partial Deletion of NRXN1

Introduction: Copy-number variations (CNVs) impacting on small DNA stretches and associated with language deficits provide a unique window to the role played by specific genes in language function. Methods: We report in detail on the cognitive, language, and genetic features of a girl bearing a small deletion (0.186 Mb) in the 2p16.3 region, arr[hg19] 2p16.3(50761778_50947729)×1, affecting exons 3–7 of NRXN1, a neurexin-coding gene previously related to schizophrenia, autism (ASD), attention deficit hyperactivity disorder (ADHD), mood disorder, and intellectual disability (ID). Results: The proband exhibits many of the features commonly found in subjects with deletions of NRXN1, like ASD-like traits (including ritualized behaviors, disordered sensory aspects, social disturbances, and impaired theory of mind), ADHD symptoms, moderate ID, and impaired speech and language. Regarding this latter aspect, we observed altered speech production, underdeveloped phonological awareness, minimal syntax, serious shortage of active vocabulary, impaired receptive language, and inappropriate pragmatic behavior (including lack of metapragmatic awareness and communicative use of gaze). Microarray analyses point to the dysregulation of several genes important for language function in the girl compared to her healthy parents. Discussion: Although some basic cognitive deficit – such as the impairment of executive function – might contribute to the language problems exhibited by the proband, molecular evidence suggests that they might result, to a great extent, from the abnormal expression of genes directly related to language.

A Phenomenological Approach to Understanding the Association Between Psychosis and Violence

AimsAlthough there is an established but complex relationship between violence and psychosis, the nature of this relationship remains unclear. To date, there has been a predominant focus within group-level quantitative studies on specific types of psychopathology such as threat/control-override and command hallucinations. However, the literature has not produced a consensus on the profile of psychopathological predictors of violence. Furthermore, there is an emerging literature suggesting the predictive paradigm has limited clinical utility in the management of harm-related behaviour. In the way that phenomenological analysis has produced a fuller understanding of psychosis (that can inform improved aetiological and interventional frameworks), the authors assert that such an approach (with its focus on subjectivity) has the potential to advance our understanding of the relationship between psychosis and violence in a way that has clinical applicability. To test this assertion, it is necessary to develop a model of assessment and analysis. The aim of this paper is to develop an evidence-based model to explore the phenomenological underpinnings of violence in psychosis.MethodsA two-stage method was followed. Firstly, drawing on existing phenomenological accounts of psychosis and approaches to understanding the subjectivity of violence perpetration, the authors developed a pilot evaluation model. This was tested and revised by applying the model to phenomenological case reports of psychosis and violence.ResultsThe findings so far demonstrate that as well as the role of circumscribed psychopathology on the likelihood of violence, other experiences within the psychotic spectrum such as operative hyperreflexivity and disturbances of ipseity play an important role. Additionally, feelings of disconnectedness and loss of recognising others as real combined with impaired theory of mind can lead to loss of normal inhibitory processes and violent behaviour. In keeping with a recent shift in focus from strict diagnostic criteria to individual psychotic phenomena, existential analysis can be applied to explore changes in self-identity and sense of belonging in the world to develop our understanding of the association between psychosis and violence.ConclusionThe phenomenological model developed produces a fuller picture of the association between psychosis and violence. As such it may generate insight into the association between psychosis and violence that has greater clinical utility than existing psychopathology-based theories do. This needs to be evaluated by field testing of the approach.

Self-perceived empathic abilities of people with autism towards living beings mostly differs for humans

Being phylogenetically close involves greater empathic perceptions towards other species. To explore this phenomenon, this study investigates the influence of neurocognitive predispositions to empathy on our perceptions of other organisms. Autistic spectrum disorders (ASD) are characterized, among others, by weakened empathic skills. Our online survey involved a group of 202 raters with ASD and a control group of 1100 raters, who had to make choices to assess their empathic perceptions toward an extended photographic sampling of organisms. Results highlight that both groups present overall similar trends in their empathic preferences, with empathy scores significantly decreasing with the phylogenetic distance relatively to humans. However, the empathy score attributed to Homo sapiens in the ASD group represents a striking outlier in the yet very sharp overall correlation between empathy scores and divergence time, scoring our species as low as cold-blooded vertebrates. These results are consistent with previous studies, which emphasized that (1) understanding human beings would be more difficult for people with ASD than decoding “animals” and (2) that Theory of Mind impairment would not represent a global deficit in people with ASD but may relate to the mindreading of specifically human agents.