Is Theory of Mind in Schizophrenia More Strongly Associated with Clinical and Social Functioning than with Neurocognitive Deficits?
Abstract
This paper examines the correlations between 'Theory of Mind' (ToM) and neurocognitive performance, together with clinical and social functioning, in out-patients with schizophrenic disorders. It was hypothesised that, since the ability to make inferences about the environment and about other peoples' mental states is a key ingredient of social competence, the assessment of ToM would correlate more strongly with current social functioning than with more traditional neurocognitive measures. 'Independent raters' assessed Theory of Mind, neurocognitive and clinical variables as well as community functioning in 44 subjects with schizophrenia. The neuropsychological measures were more closely associated with community functioning than with psychiatric symptoms. These associations remained evident when the effects of intelligence were controlled. Patients with a higher level of competence in making social inferences had better overall community functioning than those who showed less ability in this aspect of social cognition. In a regression model, the capacity to comprehend other people's mental states (ToM-2) was among the best predictors of global social functioning, together with recent onset of illness, good verbal fluency and low levels of negative and positive symptoms. These results are consistent with other recent findings. ToM measures of social cognition may be a useful addition to neuropsychological assessment when developing programmes for reducing clinical impairments…
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Theory of mind (ToM) contributes to social functioning deficits in psychosis.
“Additionally, ToM, a component of social cognition (defined as an individual's ability to understand and interpret the beliefs, thoughts and intentions of others, allowing for the prediction and explanation of their behaviours, Premack and Woodruff 1978), has also been found to contribute to social functioning deficits (Roncone et al. 2002).”
From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Roncone et al. 2002
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“A correlation has also been reported between ToM behavioral deficits and functional outcome in patients with schizophrenia (Roncone et al., 2002; Bora et al., 2006).”
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“Impairments in ToM and self reflectivity have been found to be a significant predictor of social and work function, for instance, independent of concurrent assessments of neurocognition (Roncone et al, 2002; Bora et al., 2006; Brüne et al., 2007; Bell et al., 2009; Lysaker et al., 2009, 2010).”
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“This supports previous research suggesting that improvement in theory of mind may bene fi t more directly functional outcomes (Pollice et al., 2002).”
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“Roncone et al. (2002) found that ToM ability using tasks that consisted of false belief scenarios presented through cartoons correlated with global social functioning, while Brune (2005a) found that ToM defects were a predictor of social behavioral abnormalities using the social behavioral scale…”
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“…(see Couture et al., 2006 for a review) and that it explained incremental variance in observed social skill beyond that associated with elementary neurocognitive function is consistent with some reports (e.g., Pinkham and Penn, 2006; Roncone et al., 2002), but not others (e.g., Cohen et al., 2006).”
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“These deficits appear to be relatively stable over time and, although correlated with severity of psychopathology, cannot be explained simply as a reflection of symptoms or other features of schizophrenia (Abdel-Hamid et al., 2009; Bora, Yücel, & Pantelis, 2009; Langdon, Coltheart, Ward, & Catts, 2001; Roncone et al.,…”
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“The key score was the total for the complete scale and for a five-symptom cluster (Disorganisation, Negative Affect, Positive Symptoms, Elevated Affect, Negative Symptoms) (Roncone et al., 2002).”
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Lee, S. J., Kang, D. H., Kim, C.-W., Gu, B.-M., Park, J., Choi, C., Shin, N. Y., Lee, J., & Kwon, J. S. (2010) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2009.08.003 · Cited by 76 · see citing works
“Empathydeficitsmight play a role in social dysfunction in schizophrenia (Roncone et al., 2002;Mazza et al., 2003), as empathy is an essential part of social functioning that allows us to infer others' thoughts and feelings.”
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“Some evidence suggests that social cognition may be more strongly related to social functioning than is neurocognition (Pinkham and Penn, 2006; Pollice et al., 2002; Vauth, Rusch, Wirtz and Corrigan, 2004), while other research suggests that social cognition and neurocognition exert an interactive…”
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“There is a rich literature on social cognition that mainly focuses on schizophrenia and autism disorders (Roncone et al., 2002; Brüne, 2003; Mazza et al., 2003; Abdi and Sharma, 2004; Brüne, 2005a,b; Achim et al., 2011).”
BackgroundSelf-citationMehl, S., Rief, W., Mink, K., Lüllmann, E., & Lincoln, T. M. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2009.10.004 · Cited by 73 · see citing works
Niendam, T. A., Jalbrzikowski, M., & Bearden, C. E. (2009) · Neuropsychology Review · doi:10.1007/s11065-009-9108-z · Cited by 64 · see citing works
“…measures of social cognition have been shown to be better predictors of community functioning (Pijnenborg et al. 2009), more closely associated with social functioning (Roncone et al. 2002), and stronger predictors of social behavioral problems in schizophrenia patients (Brune et al. 2007).”
BackgroundTordjman, S., Celume, M.-P., Denis, L., Motillon, T., & Keromnes, G. (2019) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2019.04.007 · Cited by 72 · see citing works
Baslet, G. C., Termini, L., & Herbener, E. S. (2009) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3181b3b20f · Cited by 65 · see citing works
“Most studies have supported a relationship between theory of mind abilities and social functioning in schizophrenia (Roncone et al., 2002; Mazza et al., 2003, but also see Bâ et al., 2008).”
BackgroundThaler, N. S., Allen, D. N., Sutton, G. P., Vertinski, M., & Ringdahl, E. N. (2013) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2013.09.010 · Cited by 67 · see citing works
Baas, D., Wout‐Frank, M. V. ‘., Aleman, A., & Kahn, R. S. (2007) · Psychological Medicine · doi:10.1017/s0033291707001729 · Cited by 63 · see citing works
“…the functional consequences of impaired trustworthiness evaluation in itself, there is substantial supportive evidence that demonstrates a relationship between social cognition and social functioning in schizophrenia (Ihnen et al. 1998 ; Hooker & Park, 2002 ; Roncone et al. 2002 ; Brune, 2005).”
BackgroundShur, S., Shamay‐Tsoory, S., & Levkovitz, Y. (2008) · Cognitive Neuropsychiatry · doi:10.1080/13546800802490034 · Cited by 57 · see citing works
“Patients with schizophrenia often exhibit social deterioration and flattened affect, misinterpret social situations, and fail to understand social cues (Allen, Frantom, Strauss, & van Kammen, 2005; Corrigan & Nelson, 1998; Frith & Corcoran, 1996; Roncone et al., 2002; Sperber & Wilson, 2002).”
BackgroundChildhood adversity and social functioning in psychosis: Exploring clinical and cognitive mediators
Palmier‐Claus, J. E., Berry, K., Darrell-Berry, H., Emsley, R., Parker, S., Drake, R., & Bucci, S. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.02.004 · Cited by 63 · see citing works
Sex differences in theory of mind: A male advantage on Happé's “cartoon” task
Russell, T. A., Tchanturia, K., Rahman, Q., & Schmidt, U. (2007) · Cognition & Emotion · doi:10.1080/02699930601117096 · Cited by 125 · see citing works
Zanello, A., Perrig, L., & Huguelet, P. (2006) · Psychiatry Research · doi:10.1016/j.psychres.2003.07.009 · Cited by 60 · see citing works
Charzyńska, K., Kucharska, K., & Mortimer, A. M. (2015) · International Journal of Occupational Medicine and Environmental Health · doi:10.13075/ijomeh.1896.00341 · Cited by 65 · see citing works
Assessing Perspective Taking in Schizophrenia Using Relational Frame Theory
Villatte, M., Monestès, J., McHugh, L., Baqué, E. F., & Loas, G. (2010) · The Psychological Record · doi:10.1007/bf03395719 · Cited by 61 · see citing works
“…which constitutes one of the most dramatic features of this illness (Bora, Eryavuz, Kayahan, Sungu, & Veznedaroglu, 2006; Brüne, 2005b, 2006; Roncone et al., 2002; Schenkel, Spaulding, & Silverstein, 2005). according to Hyronemus, Penn, Corrigan, and Martin (1998), inaccurate social…”
BackgroundSocial-Cognitive Deficits in Schizophrenia
Mier, D. U., & Kirsch, P. (2015) · Current topics in behavioral neurosciences · doi:10.1007/7854_2015_427 · Cited by 67 · see citing works
Addressing Metacognitive Capacity in the Psychotherapy for Schizophrenia: A Case Study
Buck, K., & Lysaker, P. (2009) · Clinical Case Studies · doi:10.1177/1534650109352005 · Cited by 59 · see citing works
“…to hereafter as metacognitive capacity (Semerari et al., 2003), is not reducible to the result of a single symptom or neurocognitive deficit and is a central source of dysfunction (Brüne, Abdel-Hamid, Lehmkämper, & Sonntag, 2007; Langdon, Coltheart, Ward, & Catts, 2002; Roncone et al., 2002).”
BackgroundAllott, K., Cotton, S., Chinnery, G. L., Baksheev, G., Massey, J., Sun, P., Collins, Z., Barlow, E., Broussard, C., Wahid, T., et al. (2013) · Schizophrenia Research · doi:10.1016/j.schres.2013.07.047 · Cited by 57 · see citing works
Fearful Faces in Schizophrenia
Wout‐Frank, M. V. ‘., van Dijke, A., Aleman, A., Kessels, R. P. C., Pijpers, W., & Kahn, R. S. (2007) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318142cc31 · Cited by 51 · see citing works
“In addition, Pollice et al. (2002) demonstrated that comprehension of other people’s mental states, recent illness onset, good verbal fluency, and low levels of schizophrenia symptomatology were among the best predictors of global social functioning.”
BackgroundStanghellini, G., & Ballerini, M. (2011) · Psychopathology · doi:10.1159/000322637 · Cited by 48 · see citing works
Insight and theory of mind in schizophrenia
Ng, R., Fish, S. C., & Granholm, E. L. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.010 · Cited by 56 · see citing works
“ToM task performance and cognitive and clinical insight have all been found to be associated with neurocognitive impairment (Smith et al., 2000; Roncone et al., 2002; Drake and Lewis, 2003; Rossell et al., 2003; Sergi et al., 2007; Lepage et al., 2008; Bora et al., 2009; Nair et al., 2014),…”
BackgroundInfluentialThibaudeau, É., Cellard, C., Turcotte, M., & Achim, A. M. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaa182 · Cited by 51 · see citing works
Oxytocin and social cognition in affective and psychotic disorders
Pérez-Rodríguez, M. M., Mahon, K., Russo, M., Ungar, A. K., & Burdick, K. E. (2014) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2014.07.012 · Cited by 52 · see citing works
“Indeed, they are a critical obstacle to recovery and function (Brune et al., 2007) (Couture et al., 2006; Harvey and Bowie, 2012; Roncone et al., 2002), may cause more disability than http://dx.doi.org/10.1016/j.euroneuro.2014.07.012 0924-977X/& 2014 Elsevier B.V. and ECNP.”
BackgroundInfluentialMazza, M., Pollice, R., Pacitti, F., Pino, M., Mariano, M., Tripaldi, S., Casacchia, M., & Roncone, R. (2012) · Rivista di psichiatria · doi:10.1708/1139.12561 · Cited by 52 · see citing works
“We also obtained a correlation between ToM and social function in both groups: few studies have directly investigated the relationship between ToM deficits and social functioning (49) in schizophrenia (46, 50).”
Self-citationVarga, E., Simon, M., Tényi, T., Schnell, Z., Hajnal, A. S., Orsi, G., Doczi, T. P., Komoly, S., Janszky, J., Füredi, R., et al. (2013) · Brain and Language · doi:10.1016/j.bandl.2013.05.017 · Cited by 55 · see citing works
“…to the poor overall community functioning (Brüne, 2005; Brüne, Abdel-Hamid, Lehmkämper, & Sonntag, 2007; Lysaker et al., 2005; Pinkham & Penn, 2006; Roncone et al., 2002; Sprong, Schothorst, Vos, Hox, & van Engeland, 2007); and they are superior to neurocognition or clinical symptoms in predicting…”
Ussorio, D., Giusti, L., Wittekind, C. E., Bianchini, V., Malavolta, M., Pollice, R., Casacchia, M., & Roncone, R. (2016) · Psychology and Psychotherapy: Theory, Research and Practice · doi:10.1111/papt.12059 · Cited by 51 · see citing works
Self-citationAdaptación al español de la prueba de teoría de la mente Hinting Task
Gil, D., Fernández-Modamio, M., Bengochea, R., & Arrieta, M. (2012) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2011.11.004 · Cited by 85 · see citing works
Adaptation of the Hinting Task theory of the mind test to Spanish
Gil, D., Fernández-Modamio, M., Bengochea, R., & Arrieta, M. (2012) · Revista de Psiquiatría y Salud Mental (English Edition) · doi:10.1016/j.rpsmen.2011.11.002 · Cited by 49 · see citing works
“18,19 Using a regression model, Roncone et al. 28 determined that the capacity to represent the mental states of other people was among the best predictors of good social functioning, together with recent onset of illness, good verbal fluency and low levels of positive or negative symptomatology Based on these results,…”
Tsoi, D. T.-Y., Lee, K.-H., Gee, K., Holden, K. L., Parks, R. W., & Woodruff, P. W. R. (2008) · Psychological Medicine · doi:10.1017/s0033291707002528 · Cited by 46 · see citing works
“Roncone et al. (2002) have reported that social cognition, in particular the capacity to make social inferences, has a significant contribution in the global social functioning in individuals with schizophrenia.”
BackgroundEmpathic accuracy and cognition in schizotypal personality disorder.
Ripoll, L. H., Zaki, J., Pérez-Rodríguez, M., Snyder, R., Strike, K., Boussi, A., Bartz, J. A., Ochsner, K., Siever, L., & New, A. (2013) · Psychiatry Research · doi:10.1016/j.psychres.2013.05.025 · Cited by 48 · see citing works
Subjective and Objective Cognitive Dysfunction in Schizophrenia – is there a Link?
Homayoun, S., Nadeau-Marcotte, F., Luck, D., & Stip, É. (2011) · Frontiers in Psychology · doi:10.3389/fpsyg.2011.00148 · Cited by 52 · see citing works
“However, the complexity of the situation is revealed in that although better metacognition is linked with improved treatment outcomes (Roncone et al., 2002), it is also linked with more depression as mentioned above, where Sands and Harrow (1999) found that having a co-morbid diagnosis of…”
Background
- Authors
- Roncone, R., Falloon, I. R. H., Mazza, M., De Risio, A., Pollice, R., Necozione, S., Morosini, P., & Casacchia, M.
- Affiliations
- University of L'Aquila (IT)
- University of Auckland (NZ)
- Venue
- Psychopathology
- Publisher
- S. Karger AG
- Published
- 2002
- Volume
- 35
- Issue
- 5
- Pages
- 280-288
- ISSN
- 0254-4962 (ISSN-L)
- 1423-033X
- OpenAlex
- W2049150789
- Cited by
- 255
- References
- 0
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 4 · 2021: 5 · 2020: 6 · 2019: 6 · 2018: 5 · 2017: 10 · 2016: 7 · 2015: 14 · 2014: 16 · 2013: 20 · 2012: 19
- FWCI
- 3.84
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi dell Aquila (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- theory of mind, schizophrenia, social cognition, social functioning, community functioning, neurocognitive impairment, social inference, negative symptoms, positive symptoms, verbal fluency, disease onset, psychosocial rehabilitation, neuropsychological assessment
- MeSH terms
- Adolescent, Adult, Brain, Cognition Disorders, Female, Humans, Male, Middle Aged, Neuropsychological Tests, Brief Psychiatric Rating Scale, Psychological Theory, Schizophrenia, Severity of Illness Index, Social Behavior, Social Perception, Diagnostic and Statistical Manual of Mental Disorders
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