title: Theory of mind in schizophrenia: error types and associations with symptoms.
abstract: BACKGROUND
  Social cognition is an important determinant of functioning in schizophrenia. However, how social cognition relates to the clinical symptoms of schizophrenia is still unclear. The aim of this study was to explore the relationship between a social cognition domain, Theory of Mind (ToM), and the clinical symptoms of schizophrenia. Specifically, we investigated the associations between three ToM error types; 1) "overmentalizing" 2) "reduced ToM and 3) "no ToM", and positive, negative and disorganized symptoms.
  
  
  METHODS
  Fifty-two participants with a diagnosis of schizophrenia or schizoaffective disorder were assessed with the Movie for the Assessment of Social Cognition (MASC), a video-based ToM measure. An empirically validated five-factor model of the Positive and Negative Syndrome Scale (PANSS) was used to assess clinical symptoms.
  
  
  RESULTS
  There was a significant, small-moderate association between overmentalizing and positive symptoms (rho=.28, p=.04). Disorganized symptoms correlated at a trend level with "reduced ToM" (rho=.27, p=.05). There were no other significant correlations between ToM impairments and symptom levels. Positive/disorganized symptoms did not contribute significantly in explaining total ToM performance, whereas IQ did (B=.37, p=.01). Within the undermentalizing domain, participants performed more "reduced ToM" errors than "no ToM" errors.
  
  
  CONCLUSIONS
  Overmentalizing was associated with positive symptoms. The undermentalizing error types were unrelated to symptoms, but "reduced ToM" was somewhat associated to disorganization. The higher number of "reduced ToM" responses suggests that schizophrenia is characterized by accuracy problems rather than a fundamental lack of mental state concept. The findings call for the use of more sensitive measures when investigating ToM in schizophrenia to avoid the "right/wrong ToM"-dichotomy.
authors.affiliation: Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway. Electronic address: r.a.fretland@medisin.uio.no.
authors.forename: Ragnhild A
authors.initials: RA
authors.lastname: Fretland
authors.affiliation: Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Andersson
authors.affiliation: Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway.
authors.forename: Kjetil
authors.initials: K
authors.lastname: Sundet
authors.affiliation: NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway.
authors.forename: Ole A
authors.initials: OA
authors.lastname: Andreassen
authors.affiliation: NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Postboks 1078, Blindern, 0316 Oslo, Norway.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Melle
authors.affiliation: Department of Psychology, University of Oslo, Harald Schjelderups hus, Forskningsveien 3A, 0373 Oslo, Norway; NORMENT KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Ullevål Sykehus, Bygg 49, Postboks 4956 Nydalen, 0424 Oslo, Norway.
authors.forename: Anja
authors.initials: A
authors.lastname: Vaskinn
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology*; D012559:Schizophrenia; D012565:Schizophrenic Psychology; D056345:Theory of Mind; D055815:Young Adult
keywords: Overmentalizing; Schizophrenia; Social cognition; Symptoms; Theory of Mind; Undermentalizing