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Social cognition

What is social cognition in schizophrenia? 

Social cognition describes the ability to understand the actions and intentions of other people. Aspects of social cognition may be altered in people with schizophrenia, including processes such as Theory of Mind, social perception, and emotion processing. Theory of Mind refers to the ability to infer the mental states of other people. Social perception is an awareness of social cues and norms that dictate social interactions. Emotion processing is the ability to perceive emotional cues. Social cognition is crucial for effective communication, and may relate to social competence and predict work functioning.

What is the evidence for social cognition?

Moderate to high quality evidence finds large effects of impaired social perception, emotion perception, and emotion processing, and medium-sized effects of impaired social knowledge, biological motion processing, and empathetic abilities in people with schizophrenia. In general, those with predominately negative symptoms show poorer social cognition than those with predominately positive symptoms. Facial emotion perception can be adversely affected by more severe negative symptoms, and non-emotional recognition may be adversely affected by more severe positive symptoms. High quality evidence shows a very small improvement in facial affect processing with antipsychotic medication, particularly second-generation antipsychotics.

High quality evidence shows a large theory of mind impairment in people with schizophrenia across multiple tasks, and regardless of sex or age. People with disorganised symptoms were particularly impaired on theory of mind tasks. Moderate quality evidence finds patients in an acute phase of the illness performed worse on theory of mind tasks than outpatients or patients soon to be discharged from hospital. Overall, poorer cognition was related to poorer theory of mind.

High quality evidence finds a small to medium-sized theory of mind impairment in relatives of people with schizophrenia, with lower education contributing to lower theory of mind scores. Moderate to high quality evidence also finds medium-sized theory of mind and overall social cognition impairments in people at ultra-high risk of psychosis.

Moderate to high quality evidence finds associations between better theory of mind and emotion processing, and better social functioning, community functioning and insight. There were also associations between poorer facial recognition, emotion processing, emotion perception, social perception, and theory of mind, and poorer performance on cognitive measures and more severe symptoms.

Moderate to high quality evidence finds a medium-sized effect of poorer social cognition in people with schizophrenia than in people with bipolar disorder on theory of mind and negative facial emotion recognition tasks, particularly in males. There were no differences on positive (happy) facial emotion recognition tasks. There were also no differences between people with schizophrenia and people with autism on theory of mind and emotion processing tasks.

March 2022

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Last updated at: 11:47 am, 21st March 2022
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