Integration of emotional and cognitive aspects of theory of mind in schizophrenia and its relation to prefrontal neurocognitive performance

Introduction. There is substantial evidence that patients with schizophrenia present with impaired Theory of Mind (ToM). Whereas previous studies have focused on general ToM abilities, the present study is aimed at testing the underlying behavioural and neurocognitive mechanisms of the impaired integration of affective and cognitive aspects of ToM (the integration of emotional information with mentalising) in patients with schizophrenia. Methods. Twenty-six patients with schizophrenia and 35 healthy controls were tested on two ToM tasks involving the integration of affective and cognitive ToM abilities: "Faux Pas" and "reading the mind in the eyes" tasks. To assess the neurocognitive bases of impaired ToM, the ID/ED test (intradimensional/extradimensional shifting test from the CANTAB) was administered. Results. Patients performed poorly on both the cognitive-affective integration ToM tasks and the ID/ED task as compared to controls. Furthermore, patients' ToM scores were selectively correlated with the reversal trials, which are believed to be associated with orbitofrontal functioning. In addition, more than 50% of the variance in recognising and understanding Faux Pas could be explained by patients' symptomatology. Performance on orbitofrontal related tasks was correlated with subjects' Faux Pas scores in the patients group, but not in the healthy control group. Conclusions. Schizophrenic patients appear to have considerable impairment in affective and cognitive ToM integration, which may be related to orbitofrontal dysfunction. These results are in line with previous findings regarding empathy and the importance of the orbitofrontal area in the integration of cognition and affect.