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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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“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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“Moreover, they improve first-order Theory of Mind ability; a particularly important result both because of the difficulties that are often observed in other rehabilitative interventions, and because it is now generally accepted that an individual’s social functioning is related not only to the ability to solve every d…”
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“…between social cognition and functional outcome has been studied less often; however associations have been found between ToM and functional status (Roncone et al., 2002) as well as social cue perception and functional status (Corrigan and Toomey, 1995; Kee et al., 2003; Mueser et al., 1996; Penn…”
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“Roncone (2002) found that the ability of ToM was strongly correlated with communication function in subjects with schizophrenia when intelligence ability was controlled.”
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Peyroux, É., & Franck, N. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00066 · Cited by 41
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“In addition, some studies show that social cognition possesses a stronger relationship with functional outcomes thandoesneurocognition (Pennet al., 1996; Pinkham and Penn, 2006; Roncone et al., 2002).”
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“Schizophrenia patients also show large deficits in TOM (Bora et al., 2009), which predicts 15–50% of variation in social functioning (Roncone et al., 2002; Brüne et al., 2007), suggesting TOM is a particularly important target for new treatments in order to improve social function and…”
Intact prototype learning in schizophrenia
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“T Roncone et al., 2002), and emotional intelligence (Kee et al., 2009).”
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“Given that ToM has been associated with critical aspects of social functioning (e.g., Roncone et al., 2002; Fett et al., 2011), it is important to understand the underpinnings of ToM deficits in schizophrenia and identify associated vulnerabilities in nonpsychotic relatives.”
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CASACCHIA, M., Mazza, M., & Roncone, R. (2004) · Current Psychiatry Reports · doi:10.1007/s11920-004-0063-3 · Cited by 22
“Theory of Mind and social functioning and psychosocial rehabilitation Theory of Mind abilities also were investigated to explore if they would correlate more strongly with current social functioning than more traditional neurocognitive measures in outpatients with schizophrenia disorders [ 97 ].”
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“study assesses a more sophisticated interpersonal problem (Roncone et al., 2002).”
BackgroundTheory of Mind and Psychiatry: An Introduction
Ang, G., & PRIDMORE, S. A. (2009) · Australasian Psychiatry · doi:10.1080/10398560802375982 · Cited by 22
“It has been suggested that performance on ToM predicts the level of functioning in society.(45,54,55) A longitudinal fMRI study by Lee et al.”
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“The deficit in advanced ToM may limit patients’ social function (e.g., working performance) and living independence (Brune, 2005; Pinkham and Penn, 2006; Roncone et al., 2002).”
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“For ToM, ToM-1 abilities were not affected in the patient group whereas ToM-2 variables were impaired, which is in accordance with the literature (Roncone et al., 2002; Shamay-Tsoory et al., 2007).”
Factors Related to Passive Social Withdrawal and Active Social Avoidance in Schizophrenia
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“Similarly, theory of mind, or the ability to understand and form ideas about the mental states of oneself and others, is often impaired in the disorder and related to adverse social functioning (Green et al., 2012; Kosmidis et al., 2011; Roncone et al., 2002).”
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Self-citationTheory of Mind and social functioning among neuropsychiatric disorders: A transdiagnostic study
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“…together with SZ in investigations of social functioning (e.g., Corrigan and Toomey, 1995; Lysaker and Davis, 2004; Pinkham and Penn, 2006; Roncone et al., 2002); however, no studies have explicitly confirmed that patients with SZ and SZA experience the same degree of social dysfunction…”
BackgroundThe Impact of Impaired “Theory of Mind” on Social Interactions in Schizophrenia
Kosmidis, M. H., Γιαννάκου, Μ., Garyfallos, G., Kiosseoglou, G., & Bozikas, V. (2011) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617711000300 · Cited by 21
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“Impairment in ToM is a key characteristic in individuals with schizophrenia, and interferes with successful social integration (Roncone et al., 2002; Brüne, 2005).”
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“( 2002 ) for explicit theory of mind and social functioning, and the findings presented here corroborate theirs.”
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“Therefore the significant social functioning deficits of schizophrenic patients are based not merely on the misrepresentations of own and others’ minds (Roncone et al., 2002) but through this, communication difficulties also prevent proper adaptation and adjustment to the social world.”
BackgroundWhite Matter Correlates of Theory of Mind in Patients With First-Episode Psychosis
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“…psychotic disorders [Savla et al., 2013], social anxiety [Sloover et al., 2022], and autism spectrum disorders [Chung et al., 2014]) and is consistently associated with and predictive of functional (Fett et al., 2011; Hoogenhout & Malcolm-Smith, 2017; Roncone et al., 2002) and social outcomes.”
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“Deficits in SC in persons with SZ are well documented (Behere et al., 2008; Mehta et al., 2011; Penn, Addington, & Pinkham, 2006; Roncone et al., 2002).”
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“However, the performance of patients with schizophrenia in the study of the theory of mind clearly correlated with their level of social functioning [5], and appeared to be independent of the level of overall cognitive function [6].”
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“This impairment has been found to account for an estimated 15% to 40% of the variability in social functioning in individuals with schizophrenia, as indicated by several studies [26,33–37].”
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“These difficulties have been associated with symptom severity [40], level of para-noia [36] and functioning capacity [41] (for a review see [2]).”
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Managò, F., Huang, H., & Papaleo, F. (2015) · Handbook of behavioral neuroscience · doi:10.1016/b978-0-12-800981-9.00006-7 · Cited by 1
Disturbi della cognizione sociale e le loro conseguenze psicosociali
Roncone, R., Giusti, L., Mazza, M., & CASACCHIA, M. (2013) · Springer eBooks · doi:10.1007/978-88-470-2802-9_3 · Cited by 1
Self-citationLysaker, P. H., Erickson, M. A., Olesek, K. L., Grant, M. L. A., Ringer, J. M., Buck, K. D., Salvatore, G., Popolo, R., & Dimaggio, G. (2011) · Springer eBooks · doi:10.1007/978-94-007-0831-0_14
Lysaker, P. H., Davis, L. W., & Beattie, N. L. (2006) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-005-9003-8 · Cited by 10
Thought disorder as a dysexecutive phenomenon
McKenna, P. J., & Oh, T. M. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544057.007 · Cited by 2
The dyssemantic hypothesis of thought disorder
McKenna, P. J., & Oh, T. M. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544057.008
Thought disorder as a form of dysphasia
McKenna, P. J., & Oh, T. M. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544057.005
Thought disorder as a syndrome in schizophrenia
McKenna, P. J., & Oh, T. M. (2001) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544057.003 · Cited by 1
Saad, A., Montag, C., Gillespie, S. M., Hadad, B.-S., & Abu-Akel, A. (2026) · Schizophrenia Research · doi:10.1016/j.schres.2026.09.032
Gautier, M., Bertoux, M., Brevers, D., Vinsous, N., & Maurage, P. (2026) · Alcoholism Clinical and Experimental Research · doi:10.1111/acer.70410
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“For example, some studies reported that ToM is not associated with social functioning in people with psychosis [49,50], others have shown significant correlations between ToM and various measures of social functioning [51–53].”
Christensen, R., Velthorst, E., & Fett, A.-K. J. (2026) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2026.100419
“…of psychosis (Lindgren et al., 2018; Pennou et al., 2021; Sullivan et al., 2013; Ventura et al., 2015), as well as in more chronic phases (Brüne, 2005; Brüne et al., 2011; Cassetta and Goghari, 2014; Horton and Sil-verstein, 2008; Pijnenborg et al., 2009; Roncone et al., 2002; Zhu et al., 2007).”
Sozialpsychiatrie und Neurobiologie
Kawohl, W., Wyss, C., Roser, P., Brüne, M., Wulf Rössler, A., & Juckel, G. (2016) · Der Nervenarzt · doi:10.1007/s00115-016-0179-9 · Cited by 2
Metadata
- 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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