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Cited by 16Action Observation and SynchronizationSchizophrenia research and treatmentMental Health and Psychiatry

Enhanced Automatic Action Imitation and Intact Imitation-Inhibition in Schizophrenia

Open access
Simonsen, Arndis, Fusaroli, Riccardo, Skewes, Joshua Charles, Roepstorff, Andreas, Campbell-Meiklejohn, Daniel, Mors, Ole, Bliksted, Vibeke·2019·Schizophrenia Bulletin
DOI 10.1093/schbul/sby006PMC PMC6293210
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Abstract

Imitation plays a key role in social learning and in facilitating social interactions and likely constitutes a basic building block of social cognition that supports higher-level social abilities. Recent findings suggest that patients with schizophrenia have imitation impairments that could contribute to the social impairments associated with the disorder. However, extant studies have specifically assessed voluntary imitation or automatic imitation of emotional stimuli without controlling for potential confounders. The imitation impairments seen might therefore be secondary to other cognitive, motoric, or emotional deficits associated with the disorder. To overcome this issue, we used an automatic imitation paradigm with nonemotional stimuli to assess automatic imitation and the top-down modulation of imitation where participants were required to lift one of 2 fingers according to a number shown on the screen while observing the same or the other finger movement. In addition, we used a control task with a visual cue in place of a moving finger, to isolate the effect of observing finger movement from other visual cueing effects. Data from 33 patients (31 medicated) and 40 matched healthy controls were analyzed. Patients displayed enhanced imitation and intact top-down modulation of imitation. The enhanced imitation seen in patients may have been medication induced as larger effects were seen in patients receiving higher antipsychotic doses. In sum, we did not find an imitation impairment in schizophrenia. The results suggest that previous findings of impaired imitation in schizophrenia might have been due to other cognitive, motoric, and/or emotional deficits.

AI snapshot

Written from the paper’s full text.

TL;DR

In an automatic imitation task with nonemotional hand stimuli, patients with schizophrenia showed enhanced automatic imitation and intact imitation-inhibition relative to matched healthy controls. The enhanced imitation was associated with higher antipsychotic medication dose, suggesting it may be medication-induced rather than a primary imitation deficit.

Key findings

  • Patients made more errors than controls (8.79% vs 5.27%) and had slower overall reaction times (592 ms vs 534.91 ms per trial; β = 0.37, SE = 0.14, t = 2.73, P = .01).
  • Patients showed enhanced automatic imitation: a significant task × group interaction on congruent trials (β = −0.11, SE = 0.05, t = −2.32, P = .021), with patients showing a larger RT difference between imitation and control trials than controls.
  • Imitation-inhibition was intact: no significant task × group interaction on incongruent trials (β = −0.07, SE = 0.05, t = −1.29, P = .195; BF = 0.07).
  • Higher antipsychotic dose was associated with a larger imitation effect on congruent trials (task × CPZ: β = −0.13, SE = 0.05, t = −2.47, P = .015), with no significant dose effect on incongruent trials (BF = 0.22).

Methods

  • Case-control study using a modified automatic imitation and effector priming control task with nonemotional hand videos; 2 × 2 design (task: imitation/control; congruency: congruent/incongruent), 120 trials total, 30 per condition. Participants lifted index or middle finger according to a number while observing same/other finger movement or a mask control.
  • Data from 33 patients with ICD-10 schizophrenia or schizoaffective disorder and 40 matched healthy controls were analyzed; 31 of 33 patients were medicated. Diagnosis was confirmed with SCAN; antipsychotic doses were converted to chlorpromazine equivalents.
  • Reaction times under 150 ms and over 2000 ms were excluded, as were error trials. Mixed effects regression models tested group × task and medication dose × task effects, with random intercepts for matched pairs and random slopes for group, task, and finger; Bayes factors assessed null results.

Limitations

  • The paper states that 31 of 33 patients were medicated, so it is unclear whether unmedicated patients would show similar behavior to controls.
  • The paper states that patients were not randomized to different antipsychotic types or doses, so unmeasured individual differences accompanying medication dose cannot be excluded.
  • Evident from the text: six patients were excluded because hand tremor prevented stable task performance, which may limit generalizability to more motorically impaired patients.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/schbul/sby006

Cites

76 of 76 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

26 of 43 cited sources checked · 18 supported · 1 flagged · accuracy not yet measured

  • Premisereasoning

    Earlier studies failed to account for general cognitive, motor, or emotional impairments linked to schizophrenia.

    “However, previous studies assessed either voluntary imitation [7][8][9][10][25][26][27][28][29][30][31] or automatic imitation of emotional stimuli 12,13,32,33 while not controlling for the cognitive, motoric, and/or emotional deficits associated with the disorder.”
    Quote in the paperSubstantial claim3 of 5 sources checked
    • cites [7][8][9][10][25][26][27][28][29][30][31]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [12] Haker, 2009, Empathy in schizophrenia: impaired resonance, Eur Arch Psychiatry Clin Neurosci source

      The Contagion section describes a study of automatic yawning and laughing responses, and Group differences in contagion acknowledges that illness-related psychomotor constraints could help explain the findings. But the paper did assess executive function and use stimulus-incongruent responses to examine overall psychomotor activity, so it does not support the blanket claim that it failed to account for cognitive and motor impairments. Page numbers are unavailable in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [13] Thakkar, 2014, Altered brain activation during action imitation and observation in schizophrenia: a translational approach to investigating social dysfunction in schizophrenia, Am J Psychiatry source

      The paper’s Discussion (page not available in our copy) says its groups were matched on IQ and made the same number of movements, addressing gross cognitive differences and motor output. Its Method also compares imitation with nonimitative action. Thus, the claim that this study failed to control for those deficits conflicts with the source; the task did not use emotional stimuli. (LLM, conf=0.86)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
    • cites [32] Schaefer, 2013, The global cognitive impairment in schizophrenia: consistent over decades and around the world, Schizophr Res source

      The Introduction and Discussion report generalized cognitive impairment in schizophrenia, supporting the cognitive-deficit premise. They do not assess whether earlier imitation studies controlled for cognitive, motoric, or emotional deficits; searches for imitation and those potential confounds did not establish that methodological claim. No page numbers were supplied for the indexed passages. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [33] Gilbert, 2008, Executive function, Curr Biol source
  • Premisecitation

    Across prior studies, patients have repeatedly made more imitation errors than healthy people for facial and manual actions and for facial expressions.

    “This research has consistently shown that patients make more errors when asked to imitate facial and manual movements [8][9][10][25][26][27][28] and facial expressions 7,10,26,[29][30][31] compared to healthy individuals.”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [8] Walther, 2013, Impaired gesture performance in schizophrenia: particular vulnerability of meaningless pantomimes, Neuropsychologia source
    • cites [9] Matthews, 2013, Gesture imitation in schizophrenia, Schizophr Bull source
    • cites [10] Park, 2008, Imitation, simulation, and schizophrenia, Schizophr Bull source
  • Premisecitation

    Earlier work on imitation in schizophrenia used either voluntary imitation tasks or automatic imitation of emotional stimuli.

    “However, previous studies assessed either voluntary imitation [7][8][9][10][25][26][27][28][29][30][31] or automatic imitation of emotional stimuli 12,13,32,33 while not controlling for the cognitive, motoric, and/or emotional deficits associated with the disorder.”
    Quote in the paperSubstantial claim3 of 5 sources checked
    • cites [7][8][9][10][25][26][27][28][29][30][31]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [12] Haker, 2009, Empathy in schizophrenia: impaired resonance, Eur Arch Psychiatry Clin Neurosci source

      The Contagion section describes an automatic response to videos of laughing and yawning faces, supporting this paper as an example of earlier work on automatic imitation. But the sentence’s added claim that such studies did not control for associated deficits is too broad for this source: the Group differences in contagion section examines executive functioning, medication, and stimulus-incongruent responses as an indicator of psychomotor activity. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [13] Thakkar, 2014, Altered brain activation during action imitation and observation in schizophrenia: a translational approach to investigating social dysfunction in schizophrenia, Am J Psychiatry source

      The Method > Experimental Paradigm describes instructed finger movements, supporting this paper as an example of voluntary imitation. But Method > Data Analysis compares imitative with nonimitative actions, and Results checks movement completion and timing; the claim that this study did not control for motoric deficits is therefore not supported. No page numbers are available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [32] Schaefer, 2013, The global cognitive impairment in schizophrenia: consistent over decades and around the world, Schizophr Res source

      The Methods section describes a review of cognition and neuropsychology in schizophrenia, not imitation studies. Searches for voluntary imitation, automatic imitation, emotional stimuli, and controls for motoric or emotional deficits found no passage addressing the attributed claim. (LLM, conf=0.75)

      Experimental — accuracy not yet measured
    • cites [33] Gilbert, 2008, Executive function, Curr Biol source
  • Study design and conductreasoning

    A control task was included so that imitation and imitation-inhibition could be distinguished from attentional or distractor-inhibition problems and from motor deficits.

    “We therefore included a control task 52 to be able to delineate imitation and imitation-inhibition from any attentional deficits or deficits in distractor-inhibition (for detailed task description, see Methods).This also allowed us to control for any motor deficits.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [52] Cook, 2011, Social attitudes differentially modulate imitation in adolescents and adults, Exp Brain Res source
  • Premisecitation

    Neuroimaging and TMS studies of the mirror neuron system in schizophrenia during action observation and execution disagree, reporting intact, reduced, altered, or increased activity.

    “Some imaging and transcranial magnetic stimulation (TMS) studies find intact activity [14][15][16][17] in the mirror neuron system (MNS)-which is thought to form the neural basis of imitation [18][19][20][21] -during action observation and execution; while others find this activity to be reduced, 22,23 altered, 13 or enhanced.14,24”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [14] McCormick, 2012, Mirror neuron function, psychosis, and empathy in schizophrenia, Psychiatry Res source
    • cites [15] Horan, 2014, Some markers of mirroring appear intact in schizophrenia: evidence from mu suppression, Cogn Affect Behav Neurosci source

      The Abstract and Conclusions report generally intact MNS-related activity in schizophrenia during action observation and execution, measured by EEG mu suppression. The Introduction describes mixed findings from other EEG studies, and the Conclusions report diminished activity in MEG/TMS studies and abnormalities in fMRI studies. The paper supports the broader point that findings differ, but its own intact finding comes from EEG, not imaging or TMS, and it does not establish every listed outcome for those methods. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [16] Horan, 2014, Self-reported empathy and neural activity during action imitation and observation in schizophrenia, Neuroimage Clin source
  • Classified as probably not a substantial claim. 10
  • May combine two claims. 7

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Because people with schizophrenia have varied emotion-processing difficulties, it is uncertain whether impaired imitation of emotional stimuli reflects imitation itself or other emotional processes.

    “Third, because patients display a variety of problems in processing of emotions, 46 it is unclear whether a deficit in voluntary or automatic imitation of emotional stimuli 11,12,47,48 would reflect a specific impairment in imitation, or other aspects of emotion processing”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [46] Tremeau, 2006, A review of emotion deficits in schizophrenia, Dialogues Clin Neurosci source
    • cites [11] Varcin, 2010, Empathic deficits in schizophrenia: the potential role of rapid facial mimicry, J Int Neuropsychol Soc source
    • cites [12] Haker, 2009, Empathy in schizophrenia: impaired resonance, Eur Arch Psychiatry Clin Neurosci source

  • Classified as probably not a substantial claim.

    Premisecitation

    The mechanisms that inhibit imitation are considered at least partly separate from general inhibitory control.

    “Imitation-inhibition and general inhibition processes are thus thought to be at least partially distinct.[36][37][38][39][40][41][42][43][44]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [36] Spengler, 2010, Hyperimitation of actions is related to reduced understanding of others’ minds in autism spectrum conditions, Biol Psychiatry source
    • cites [37] Brass, 2009, Inhibition of imitative behaviour and social cognition, Philos Trans R Soc Lond B Biol Sci source
    • cites [38] Brass, 2005, The inhibition of imitative and overlearned responses: a functional double dissociation, Neuropsychologia source

  • May combine two claims.

    Premisecitation

    Tasks requiring deliberate imitation place demands on general cognitive functions that are impaired in schizophrenia and are not unique to imitation.

    “voluntary tasks are (to varying degrees) taxing on a range of cognitive processes that are known to be impaired in schizophrenia, 32 but which are not specifically tied to imitation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [32] Schaefer, 2013, The global cognitive impairment in schizophrenia: consistent over decades and around the world, Schizophr Res source

  • May combine two claims.

    Premisecitation

    Weaker top-down control of imitation has been linked to poorer mentalizing and perspective taking, abilities that are impaired in schizophrenia.

    “Interestingly, reduced top-down modulation of imitation has also been associated with reduced mentalizing and perspective-taking ability, 36,40 abilities known to be impaired in schizophrenia.45”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [36] Spengler, 2010, Hyperimitation of actions is related to reduced understanding of others’ minds in autism spectrum conditions, Biol Psychiatry source
    • cites [40] Spengler, 2010, Resisting motor mimicry: control of imitation involves processes central to social cognition in patients with frontal and temporo-parietal lesions, Soc Neurosci source
    • cites [45] Chung, 2014, A meta-analysis of mentalizing impairments in adults with schizophrenia and autism spectrum disorder, Schizophr Bull source

  • Classified as probably not a substantial claim.

    Premisecitation

    Earlier behavioral work suggests that people with schizophrenia imitate others less accurately.

    “Behavioral studies on imitation in schizophrenia suggest that patients are impaired at imitating others [7][8][9][10][11][12]”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [7] Schwartz, 2006, Imitation of facial expressions in schizophrenia, Psychiatry Res source
    • cites [8] Walther, 2013, Impaired gesture performance in schizophrenia: particular vulnerability of meaningless pantomimes, Neuropsychologia source
    • cites [9] Matthews, 2013, Gesture imitation in schizophrenia, Schizophr Bull source

  • May combine two claims.

    Interpretationcitation

    The enhanced imitation result aligns with prior neuroimaging and TMS evidence of intact or increased mirror neuron system activity in patients, and with reports of preserved spontaneous social motor coordination in schizophrenia.

    “This finding is in line with imaging and TMS studies showing intact [14][15][16][17] or even enhanced 14,24 MNS activity in patients during action observation or imitation and with work done on social motor coordination in schizophrenia, where spontaneous coordination is preserved.62”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [14][15][16][17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [14] McCormick, 2012, Mirror neuron function, psychosis, and empathy in schizophrenia, Psychiatry Res source
    • cites [24] Lee, 2014, Involvement of the mirror neuron system in blunted affect in schizophrenia, Schizophr Res source
    • cites [62] Varlet, 2012, Impairments of social motor coordination in schizophrenia, PLoS One source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Schizophrenia sometimes involves overimitation, manifesting as echolalia or echopraxia.

    “Indeed, overimitation is sometimes seen in schizophrenia in the form of symptoms like echolalia or echopraxia.31,32”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [31] Gaebel, 1992, Facial expression and emotional face recognition in schizophrenia and depression, Eur Arch Psychiatry Clin Neurosci source
    • cites [32] Schaefer, 2013, The global cognitive impairment in schizophrenia: consistent over decades and around the world, Schizophr Res source

      The Introduction describes broad cognitive impairment and a variety of symptoms in schizophrenia, but does not address overimitation, echolalia, or echopraxia. Searches for those terms and for imitation or repetitive speech and actions found no passage supporting the specific claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Those earlier studies found that medication made neural activity resemble that of healthy controls, which was interpreted as therapeutic.

    “In these studies, medication was associated with activity more similar to that of the healthy controls, suggesting a therapeutic effect.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [13] Thakkar, 2014, Altered brain activation during action imitation and observation in schizophrenia: a translational approach to investigating social dysfunction in schizophrenia, Am J Psychiatry source
    • cites [22] Mehta, 2014, Reduced mirror neuron activity in schizophrenia and its association with theory of mind deficits: evidence from a transcranial magnetic stimulation study, Schizophr Bull source

  • May combine two claims.

    Interpretationown data

    Patients with schizophrenia showed intact top-down modulation of imitation (imitation-inhibition), as indicated by no significant group difference in the incongruent-trial task effect.

    “Patients displayed enhanced imitation and intact top-down modulation of imitation.”
    • Also stated in: § Imitation-Inhibition Effect: Inhibition of Imitation vs a Control Distractor Cue · plain
      “there was no significant interaction between task and group (BF = 0.07, table 2: incongruent trials)”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The SCAN interview was used to confirm each patient's diagnosis.

    “Diagnosis was confirmed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN).55,56”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [55] Wing, 1998 source
    • cites [56] 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Each control was matched to a patient on age, sex, childhood residence, education, and parental socioeconomic status where possible.

    “Controls were pairwise matched to the patients according to age, gender, childhood residence, as well as commenced educational level (or parents' educational attainment if higher than the patients') and parental socioeconomic status when possible (see table 1).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    A control task replaced the moving finger with a visual cue, so that the effect of seeing finger movement could be separated from other cueing effects.

    “In addition, we used a control task with a visual cue in place of a moving finger, to isolate the effect of observing finger movement from other visual cueing effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    In the task, imitation influences finger movements unintentionally, since participants are not told to imitate and imitating would hurt their performance.

    “Although the performed finger movements are voluntary, any effect of imitation on these is accidental since participants are not instructed to imitate, and general imitation results in poorer task performance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Pairwise matching was handled in the models by giving matched participants a shared identifier as a random intercept.

    “The analyses accounted for the pairwise matching of participants (when present), by assigning the matched individuals a common identifier and entering it as a random intercept.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationown data

    Whether patients not taking medication would behave like controls remains uncertain.

    “It is therefore unclear whether unmedicated patients would display similar behaviors as controls.”
    Quote in the paperNot a substantial claim
15 of 15

  • The paper relies on this without support.

    Antipsychotic medication dose is a valid proxy for medication-induced effects on automatic imitation, such that the observed dose association reflects a causal medication effect.

    “The enhanced imitation seen in patients may have been medication induced as larger effects were seen in patients receiving higher antipsychotic doses.”
    “Specifically, patients receiving a higher dose showed faster RTs during imitation vs control trials (see table 3: congruent trials).”
1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentz = 3.74reported p < .001 · recomputed p < .001

    “z = 3.74, p < .001”

  • Consistentz = 4.34reported p < .001 · recomputed p < .001

    “z = 4.34, p < .001”

  • Consistentz = 2.27reported p = .023 · recomputed p = .023

    “z = 2.27, p = .023”

3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Self-check results appear here once an independent check has confirmed them.

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Hurley, 2005, Perspectives on Imitation: Mechanisms of Imitation and Imitation in Animals
  2. 2005, Computer Assisted Personal Interviewing Application for the Schedules for Clinical Assessment in Neuropsychiatry Version 2.1 and Diagnostic Algorithms for WHO ICD 10 chapter V DCR and for Diagnostic and Statistical Manual of Mental Disorders, Version IV

Cited by

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Related

Authors
Simonsen, A., Fusaroli, R., Skewes, J. C., Roepstorff, A., Campbell-Meiklejohn, D., Mors, O., & Bliksted, V.
Affiliations
  • Aarhus University (DK)
  • University of Sussex (GB)
  • Aarhus University Hospital (DK)
Corresponding author
Simonsen, Arndis
ORCID
Venue
Schizophrenia Bulletin
Publisher
Oxford University Press (OUP)
Published
2018-02-21
Volume
45
Issue
1
Pages
87-95
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
DOI
10.1093/schbul/sby006
PMC
PMC6293210
OpenAlex
W2785101266
Semantic Scholar
37edf1c8b07618ea2b2f05d99984695685b5309a
Cited by
16
References
74
Citations by year
2025: 2 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 5 · 2018: 1
FWCI
2.56
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • PubMed (publishedVersion)
  • Sussex Research Online (University of Sussex) (submittedVersion)
  • Europe PMC (PubMed Central) (submittedVersion)
  • PubMed Central (submittedVersion)
  • Figshare (submittedVersion, cc-by)
Funders
Lundbeck Foundation, Denmark (R102-A9118, R155-2014-1724)
Topics
  • Social Sciences › Psychology › Social Psychology › Action Observation and Synchronization
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Keywords
schizophrenia, automatic imitation
MeSH terms
Adult, Female, Humans, Imitative Behavior, Inhibition, Psychological, Male, Middle Aged, Psychomotor Performance, Schizophrenia

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-08.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-08.

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