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The deficits in metacognition have been observed in schizophrenia but developmental roots of impaired metacognition are not well understood. Accordingly, this study compared metacognitive abilities of patients with schizophrenia and healthy group and examined the relationship between childhood trauma, attachment style and caregiver attitudes with metacognitive capacity which might contribute to metacognitive deficits in patient group. 35 patients with schizophrenia and 35 healthy people were included in the study. Metacognitive capacity was measured using the Metacognition Assessment Scale Abbreviated (MAS-A). This scale comprises four domains: self-reflectivity, understanding other's mind, decentration and mastery. Group comparisons revealed that schizophrenia patients had greater deficits in metacognitive ability. We found that the report of childhood emotional abuse, a pattern of anxious attachment and over protection by caregivers were uniquely related to metacognitive capacity., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Early clinical descriptions of and research with people with schizophrenia described apparent difficulties in moral judgement and sensitivity. However, this research failed to take into account the effect of cognitive deficits and symptoms on task performance., Methods: We assessed people with schizophrenia on the Moral Judgement Interview, a task used in the earlier literature, alongside a battery of neuro- and social-cognitive tasks., Results: Whereas people with schizophrenia perform more poorly on this task than controls, this is mediated by memory and declarative theory of mind, and also impacted by negative symptoms., Conclusions: These results indicate that performance deficits on moral judgement tasks are not a universal feature of schizophrenia, but rather due to associated difficulties such as those in social cognition.

While deficits in metacognition have been observed in schizophrenia (SZ), it is less clear whether these are specific to the disorder. Accordingly, this study compared metacognitive abilities of patients with schizophrenia and bipolar disorder (BD) and examined the degree to which neurocognition contributed to metacognitive deficits in both groups. Participants were 30 patients with SZ and 30 with BD. Metacognitive capacity was measured using the Metacognition Assessment Scale Abbreviated (MAS-A). This scale comprises four domains: self-reflectivity, understanding others' minds, decentration and mastery. Verbal memory, executive functioning and symptoms were concurrently assessed. Group comparisons revealed that SZ patients had greater deficits in metacognitive self-reflectivity, which correctly classified 85.2% of patients with SZ in a logistic regression. Self-reflectivity and understanding others'minds were related to verbal memory and executive functioning in the SZ group, but not in the BD group. Furthermore, greater positive and general psychotic symptoms were associated with poorer metacognition in SZ. Results suggest SZ involves unique deficits in the ability to self-reflect and that these deficits may be uniquely linked with neurocognition., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Introduction: Disordered moral behaviour and understanding of moral rules were described early in the literature on schizophrenia; however, moral cognition has received scant attention in spite of a large literature focused on social cognitive impairments and violent behaviour in schizophrenia., Methods: We conducted a narrative synthesis of the literature on violence, moral judgement and schizophrenia., Results: Initial empirical research into moral cognition in schizophrenia did not fully account for the basic- and social-cognitive deficits now known to characterise schizophrenia. Importantly, research into moral cognition in autism and psychopathy, disorders in part characterised by social cognitive impairments indicates subtle patterns of difference to the moral cognition of control participants. Recent neuroeconomic studies of moral cognition in schizophrenia have indicated that individuals with schizophrenia display subtle dysfunction in their fairness-related behaviours, but not in their propensity to engage in altruistic punishment., Conclusions: Further research has the potential to broaden our understanding of what is intact and what is impaired in moral cognition in schizophrenia and also to inform our theories of the structures subserving moral judgement in the general population. Furthermore, a more thorough understanding of moral cognitive impairments in schizophrenia may have implications for both legal process and psychosocial rehabilitation.

Chronic cannabis use is associated with cognitive impairment and has been identified as a risk factor for schizophrenia. Patients with schizophrenia show profound deficits in social cognition such as the ability to attribute mental states to others, referred to as "theory of mind" (ToM). Aberrant activation of the ToM network has been demonstrated across different phases of schizophrenia, including at-risk stages. Accordingly, we aimed to investigate the ToM network in chronic cannabis users. Fifteen cannabis users received functional brain imaging during performance of a ToM cartoon story task. Findings were compared with 14 control subjects. Cannabis users showed less activation in the left parahippocampal gyrus, the right precuneus and cuneus, but greater activation in the left cuneus and the right anterior cingulate gyrus compared to healthy controls. These activation patterns resemble those found in at-risk populations, suggesting that cannabis use can affect the processing of social information similar to other risk factor constellations for psychosis., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Studies of psychiatric disorders have traditionally focused on emotional symptoms such as depression, anxiety and hallucinations. However, poorly controlled cognitive deficits are equally prominent and severely compromise quality of life, including social and professional integration. Consequently, intensive efforts are being made to characterize the cellular and cerebral circuits underpinning cognitive function, define the nature and causes of cognitive impairment in psychiatric disorders and identify more effective treatments. Successful development will depend on rigorous validation in animal models as well as in patients, including measures of real-world cognitive functioning. This article critically discusses these issues, highlighting the challenges and opportunities for improving cognition in individuals suffering from psychiatric disorders.

Poor social skills and abnormal behaviors are key features of schizophrenia and comprise important aspects of social functioning. Previous studies have shown that impairment of a social cognitive capacity for mental state attribution may be predictive of poor social skills. Poor social skills also seem to be related to the presence of negative symptoms, whereas the association with other symptom domains seems less clear. The contribution of nonsocial cognition, particularly executive functioning, to functional outcome in schizophrenia, and the relationships between social and nonsocial cognition, continue to be debated. To examine the relationships of mental state attribution with social skills, neurocognition and clinical symptomatology, we pooled data from two previous independent studies into one sample of 69 patients with schizophrenia. The sample was stratified for IQ, age range, and attention deficits. We also used a novel five-factor model of the Positive and Negative Syndrome Scale. A combined verbal and non-verbal score of mental state attribution was the best cognitive predictor of social skills, whereas neurocognition (i.e., executive planning skills) did not mediate this effect. When measures of psychopathology were included, levels of disorganized and negative symptoms predicted large proportions of variance in social functioning. Nevertheless, mental state attribution remained the sole, significant cognitive predictor variable in the equation. In conclusion, a capacity for mental state attribution is uniquely important for social skills in schizophrenia. As such, training to target social cognitive skills, including mental state attribution, may be particularly beneficial for patients' social functioning., (Copyright © 2010. Published by Elsevier Ireland Ltd.)

Background: Huntington's disease (HD) is an autosomal dominant degenerative brain disorder that is characterized by motor, cognitive, and affective symptoms. There is, to some, degree, phenomenological overlap with schizophrenia. Schizophrenia patients are frequently impaired in "theory of mind" (ToM), that is, the ability to reflect on the mental states of self and others, with mixed evidence for a ToM deficit in HD., Methods: We examined ToM and neurocognitive functioning in 25 patients diagnosed with HD. For comparison, 25 patients with schizophrenia and 25 healthy controls, matched for age and gender, were included., Results: Patients with HD were impaired in ToM relative to controls. The pattern of neurocognitive deficits including ToM strikingly resembled the one found in schizophrenia, suggesting a selectively impaired ToM. In contrast to previous schizophrenia research, ToM was not associated with functional measures on the Unified Huntington's Disease Rating Scale (UHDRS)., Conclusions: The present study shows that patients with HD have deficits in ToM similar to schizophrenia. The association of impaired ToM with function needs to be established in future studies using rating scales that more specifically address interpersonal problems., (Copyright © 2011 Movement Disorder Society.)

The study aimed to investigate the pattern of proverb comprehension impairment and its relationship to proverb familiarity and executive dysfunction in schizophrenia. To assess the specificity of the impairment pattern to schizophrenia, alcohol-dependent patients were included as a psychiatric comparison group, as deficits of executive function and theory of mind as well as dysfunction of the prefrontal cortex, which have been related to proverb comprehension difficulties, are common in both disorders. Twenty-four schizophrenia patients, 20 alcohol-dependent patients and 34 healthy controls were administered a multiple-choice proverb interpretation task incorporating ratings of subjective familiarity and measures of executive function. Schizophrenia patients chose the correct abstract and meaningful interpretations less frequently and instead chose the incorrect concrete (both meaningless and meaningful) proverb interpretations more often than alcohol-dependent patients and healthy controls. Relative to healthy controls, schizophrenia patients also chose more abstract-meaningless response alternatives and were impaired in all executive domains. Impaired divided attention was most consistently associated with proverb interpretation deficits in both patient groups. Taken together, schizophrenia patients showed a specific pattern of proverb comprehension impairments related to executive dysfunction and symptoms. The comparison with the alcohol-dependent subgroup suggests that a more comprehensive and severe impairment of complex higher-order cognitive functions including executive behavioural control and non-literal language comprehension might be associated with frontal dysfunction in schizophrenia as compared to alcohol use disorder.

Delusional disorders (DDs) are clinically rare syndromes characterized by false beliefs that are held with firm conviction despite counterevidence. The neuropsychology of DDs is poorly understood. Two partially opposing models--a cognitive bias model and a cognitive deficit model--have received mixed empiric support, partly because most research has been carried out in patients with paranoid schizophrenia, with which the nosologic association of DDs is unknown. Based on these models, we review empiric findings concerning the neuropsychology of DDs (narrowly defined). We conclude that DDs can best be seen as extreme variations of cognitive mechanisms involved in rapid threat detection and defensive harm avoidance. From this viewpoint, the two models seem to be complementary in explanatory power rather than contradictory. Future research may help to clarify the question of gene-environment interaction involvement in the formation of delusional beliefs.

Background: Research into mental state attribution has repeatedly shown that patients with schizophrenia are impaired in their capacity to reflect upon their own and others' beliefs, knowledge and intentions, with important confounds being executive functioning, intelligence, duration of illness, and medication. Furthermore, the extent to which impaired mental state attribution, neurocognition and psychopathology explain abnormal social behavior in schizophrenic patients has been a matter of debate. We sought to determine whether mental state attribution in schizophrenia predicts poor social competence better than "non-social" cognitive factors or psychopathology., Methods: Intelligence, executive functioning, mental state attribution, psychopathology and social behavior were assessed in 38 patients diagnosed with schizophrenia according to DSM-IV criteria and compared with 29 healthy controls paralleled for age and sex. All patients received antipsychotic treatment, and all participants had no history of substance abuse or traumatic brain injury., Results: In the entire schizophrenia group impaired mental state attribution alone accounted for about 50% of the variance of deviant social behavior, whereas the PANSS positive score and the duration of illness contributed an additional small amount of variance. This effect was even more pronounced in a subgroup of patients with at least normal intelligence, where neither the PANSS score nor the chronicity of the disorder remained significant predictors of poor social competence. Medication was not associated with any one of the neurocognitive measures including mental state attribution, psychopathology or social behavior., Conclusions: Impaired capacity to appreciate one's own and others' mental states is the single-best predictor of poor social competence in schizophrenia, and should perhaps be included in future definitions of the "core" symptomatology of schizophrenic disorders.

Background: For decades, impaired proverb comprehension has been regarded as typical of schizophrenic thought disorder. Testing patients' proverb understanding has widely been abandoned, however, due to poor reliability and validity of the assessment procedures. Since the underlying cognitive deficit of impaired proverb interpretation remained obscure, this study sought to determine the relation of proverb understanding with other cognitive domains, particularly 'theory of mind' or 'mindreading', in schizophrenia., Methods: 31 patients diagnosed with schizophrenia were assessed using a novel German Proverb Test [Barth, A., Küfferle, B., 2001. Die Entwicklung eines Sprichworttests zur Erfassung konkretistischer Denkstörungen bei schizophrenen Patienten. Nervenarzt 72, 853-858.], a 'theory of mind' test battery, a variety of executive functioning tests and verbal intelligence. Psychopathology was measured using the PANSS [Kay, S.R., Opler, L.A., Lindenmayer, J.P., 1989. The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. Br. J. Psychiatry 158 (suppl. 7), 59-67.]. Patients' task performance was compared to a group of healthy control persons., Results: 'Theory of mind', executive functioning and intelligence were strongly correlated with patients' ability to interpret proverbs correctly. In a regression analysis 'theory of mind' performance predicted, conservatively estimated, about 39% of the variance of proverb comprehension in the patient group., Conclusions: The ability to interpret such metaphorical speech that is typical of many proverbs crucially depends on schizophrenic patients' ability to infer mental states. Future studies may further address differences between schizophrenia subtypes or the relation to specific symptom clusters.

Several studies have demonstrated that patients with schizophrenia are impaired in recognizing emotions from facial expressions and in appreciating other people's mental states--the latter commonly referred to as 'theory of mind.' The question as to how social cognitive skills relate to patients' actual social behavior is, however, largely unanswered. This study examined emotion recognition, 'theory of mind,' and social behavior in schizophrenia. Emotion recognition, 'theory of mind,' executive functioning, 'crystallized' verbal intelligence, psychopathology, and social behavior were assessed in patients with schizophrenia compared with a healthy control group. Patients were significantly impaired on all tasks involving executive functioning, emotion recognition, and 'theory of mind.' Impaired executive functioning did, however, only partially account for the deficits in social perception and social cognition. Social perception and cognition in schizophrenia predicted the odds of being a patient significantly better than nonsocial cognition. Severe social behavioral abnormalities were linked to the duration of the illness, and even more so to 'theory of mind' deficits. Considering impaired social perception and social cognition significantly contributes to the understanding of social behavioral problems in schizophrenia.

The term theory of mind (ToM) refers to the capacity to infer one's own and other persons' mental states. A substantial body of research has highlighted the evolution of ToM in nonhuman primates, its emergence during human ontogeny, and impaired ToM in a variety of neuropsychiatric disorders, including schizophrenia. There is good empirical evidence that ToM is specifically impaired in schizophrenia and that many psychotic symptoms-for instance, delusions of alien control and persecution, the presence of thought and language disorganization, and other behavioral symptoms-may best be understood in light of a disturbed capacity in patients to relate their own intentions to executing behavior, and to monitor others' intentions. However, it is still under debate how an impaired ToM in schizophrenia is associated with other aspects of cognition, how the impairment fluctuates with acuity or chronicity of the schizophrenic disorder, and how this affects the patients' use of language and social behavior. In addition to these potential research areas, future studies may also address whether patients could benefit from cognitive training in this domain.

Background: Several studies have suggested a theory of mind (ToM) deficit in schizophrenic disorders. However, the role of interfering variables such as IQ, attention, memory, and severity of the disorder has remained ambiguous., Methods: A theory of mind picture story comprising a sequencing task, a first and a second order false belief test, and a tactical deception test was given to a group of 23 patients with chronic disorganized schizophrenia and to 12 healthy control persons. In addition, a nonsocial picture story had to be sequenced. Severity of the psychopathology was measured by using the brief psychiatric rating scale (BPRS), IQ was estimated using the 'Mehrfachwahlwortschatztest' (MWT, multiple choice verbal comprehension test)., Results: The schizophrenic group was impaired relative to controls on the theory of mind task, but not on the sequencing task of the nonsocial picture story. However, when controlled for IQ, no such difference was found. These findings were neither related to severity, duration, nor age at onset of the disorder., Conclusions: Theory of mind deficits in schizophrenia may be related to domain general impairments, e.g., intelligence and working memory load, rather than reflecting a 'genuine' compromised mental state attribution similar to autistic spectrum disorders. Schizophrenic patients may, however, rather be impaired in how and when to apply strategic social reasoning. Further studies to investigate the nature of social deficiency in schizophrenia are warranted.

Previous research on moral judgement in healthy adults suggests a complex interplay of automatic, emotional and deliberative processing. We aimed to advance understanding of these processes by examining moral judgement in individuals with schizophrenia, a population characterised by social-cognitive deficits and interpersonal difficulties. Forty-five patients with schizophrenia and 27 healthy controls judged high-conflict moral dilemmas in response to 3rd-person (i.e. “Is it morally okay to [perform X]?”) and 1st-person (i.e. “Would you [perform X]?”) probes. Controls were less utilitarian for 3rd-person than 1st-person probes, while this discrepancy did not hold for patients. Utilitarianism in patients correlated with higher levels of interpersonal conflict. Findings suggest that people with schizophrenia focus equally on outcomes across moral-judgement conditions that ought normally to elicit an outcome-action discrepancy, suggesting that they are less influenced by an automatic aversive response to harmful acts in dilemma scenarios, consistent with a dual-process model of moral judgement. [ABSTRACT FROM AUTHOR]

Introduction. Delusional disorders are characterised by monothematic, ‘encapsulated’ and incorrigible false beliefs and misinterpretations of social signals. Due to the rarity of cases with ‘pure’ delusional disorder (DD) in clinical settings most studies of social cognition in delusional patients have focused on patients with paranoid schizophrenia. In the present study we sought to examine emotion recognition, theory of mind abilities, and pragmatic language comprehension in patients with delusional disorder. Methods. Social cognition was assessed in 21 patients recruited over a 3-year period who were diagnosed with delusional disorder, paranoid, erotomanic, or jealous type. In addition to an emotion recognition and theory of mind test battery, we included a novel German Proverb Test, which has been found indicative of subtle theory of mind deficits in schizophrenic patients. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). Psychopathology was measured using the Positive and Negative Symptoms Scale (PANSS). Patients' task performance was compared to a group of 22 healthy control persons paralleled for verbal intelligence, education, and age. Results. Patients with DD made significantly more perseverative errors in the WCST, they performed more poorly on the theory of mind tasks and the proverb test, but were unimpaired in basic emotion recognition abilities relative to controls. When executive functioning was co-varied out, the group differences in theory of mind disappeared, whereas the greater propensity of patients with DD to interpret proverbs literally remained significant. Conclusions. In ‘pure’ DD the basic social cognitive abilities appear to be preserved. Difficulties in metaphorical speech comprehension and executive functioning could, however, indicate more subtle social cognitive deficits in these patients. [ABSTRACT FROM AUTHOR]

Abstract: Recent studies suggest that both the form and the content of persecutory delusional beliefs may reflect pathological exaggerations of evolved psychological mechanisms for dealing with social threat recognition. Here, we tested the hypothesis first put forward by Walston et al. [Evolution and Human Behavior 19 (1998) 257–260] that sex differences in the content of persecutory delusions reflect divergent ancestral hostile social threats, in a prospective study of two samples of German and Russian patients with delusions of persecution. Deluded men and women differed significantly in their attributions of perceived threats. The majority of men felt persecuted by groups of hostile strange males, whereas women projected their paranoid fears onto familiar people of their social environment, largely irrespective of psychiatric diagnosis or cultural background. In contrast to our predictions, however, both men and women with persecutory delusions were most frightened of physical violence. Fear of sexual coercion was only present in a small number of patients. In sum, this study is largely supportive of the hypothesis that the content of persecutory delusions reflects ancestral hostile threats. [Copyright &y& Elsevier]

Abstract: A wealth of studies has demonstrated that patients with schizophrenia are impaired in “theory of mind” (ToM). Here, we used a novel five-factor model of the Positive and Negative Syndrome Scale (PANSS) to test the hypothesis that selectivity of ToM deficits in schizophrenia depends on the predominating symptoms. We predicted that ToM impairments would be non-selective in patients with pronounced negative (NF) or disorganized symptoms (DF), whereas selective ToM impairment would occur in patients with predominant positive symptoms (PF). We recruited 50 patients diagnosed with schizophrenia or schizoaffective disorder and examined premorbid intelligence, executive functioning, ToM and psychopathology in comparison to a group of 29 healthy controls. Compared with healthy controls, patients performed more poorly on tasks involving executive functioning and ToM abilities. Using a novel PANSS five-factor model, we found a significant association of ToM deficits with the “disorganization” factor. Moreover, several individual PANSS items that were included within the disorganization factor correlated with impaired ToM, albeit the majority of correlations disappeared when controlled for executive functioning, and, to a lesser degree, when controlled for IQ. In addition, in the patient group we found interactions of poor ToM with symptoms belonging to the “emotional distress” factor of the PANSS. Contrary to expectations, associations of impaired ToM with positive symptoms were absent, and poor with regards to negative symptoms. This study lends further support to the assumption of differential associations of ToM deficits with individual symptoms and symptom clusters in schizophrenia. [Copyright &y& Elsevier]