title: Theory of mind functioning in mentally disordered offenders detained in high security psychiatric care: its relationship to clinical outcome, need and risk.
abstract: BACKGROUND
  Theory of mind (ToM) refers to the cognitive mechanisms that allow us to infer our own mental states and those of others. Whilst ToM deficits are frequently observed among individuals with schizophrenia, little is known about their relationship to functional outcome.
  
  
  OBJECTIVE
  Among patients with schizophrenia in a high security hospital, to test whether ToM performance, in relation to other cognitive and clinical variables, is related to measures of subsequent clinical outcome.
  
  
  METHODS
  ToM was assessed using the modified advanced test (MAT) and the revised eyes task (RET). Outcome, including ongoing need and risk, was assessed using the HoNOS secure, CANFOR and HCR-20 respectively three years post ToM assessment.
  
  
  RESULTS
  Performance on the RET was the only variable to be significantly correlated with the symptom ratings of the HoNOS secure and the HCR-20 total scores. Performance on the RET also accounted for approximately half of the variance in the CANFOR ratings and a third in the risk management item ratings of the HCR-20. Age, number of years diagnosed with schizophrenia and other aspects of cognition were also significantly correlated with the HoNOS security scale.
  
  
  CONCLUSIONS
  The results suggest that social perceptual ToM may be a useful prognostic indicator, but also that ToM impairments may represent an unmet need. Replication of the work with larger and more diverse samples of people with schizophrenia is necessary, as well as trials of therapeutic effort directed at improvement of ToM impairments.
authors.affiliation: Department of Psychology, Broadmoor Hospital, Crowthorne, Berkshire, UK. david.murphy@wlmht.nhs.uk
authors.forename: David
authors.initials: D
authors.lastname: Murphy
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D003134:Commitment of Persons with Psychiatric Disorders; D005555:Forensic Psychiatry / Q000379:methods*; D006801:Humans; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D008875:Middle Aged; D020380:Needs Assessment; D010364:Pattern Recognition, Visual; D011569:Psychiatric Status Rating Scales; D011582:Psychological Theory; D012044:Regression Analysis; D015203:Reproducibility of Results; D012308:Risk Management; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D012720:Severity of Illness Index