Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Campus Mitte, Germany.
Eur Arch Psychiatry Clin Neurosci. 2012 Apr;262(3):217-26. doi: 10.1007/s00406-011-0250-2. Epub 2011 Sep 4.
Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocognitive endophenotypes, the existence of a distinct, potentially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree relatives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the 'Movie for the Assessment of Social Cognition'-a video-based ToM test-and an empathy questionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) 'cognitive' versus 'emotional' ToM, (2) error counts representing 'undermentalizing' versus 'overmentalizing', (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives' group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for 'undermentalizing' but not for 'overmentalizing'. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale 'fantasy' was associated with measures of psychotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophrenia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia.
心理理论（ToM）和同理心的改变与精神病体验的形成有关，也与精神分裂症患者的社会心理功能缺陷有关。受神经认知内表型概念的启发，精神分裂症存在一种独特的、潜在的基于神经生物学的社会认知易感性标志物，这是一个持续争论的问题。以前关于处于风险中的个体的社会认知缺陷的研究得出了相互矛盾的结果，这可能部分是由于对 ToM 的定性方面的区分不够。34 名精神分裂症患者的一级亲属（21 名父母、8 名兄弟姐妹、5 名子女；f/m：30/4；平均年龄：48.1 ± 12.7 岁）和 34 名对照受试者（f/m：25/9；平均年龄：45.9 ± 10.9 岁）完成了“电影评估社会认知”-一项基于视频的 ToM 测试-和一份同理心问卷（人际反应指数，IRI）。结果参数包括（1）“认知”与“情感”ToM，（2）代表“过度心理化”与“心理化不足”的错误计数，（3）同理心能力和（4）非社会神经认知。当控制年龄、性别和神经认知时，协方差分析显示，亲属组的认知但不是情感 ToM 受损。亲属组的“过度心理化”错误计数没有增加，但“心理化不足”错误计数增加。同理心的自我评估维度没有改变。在所有的 ToM 和同理心测量中，只有 IRI 分量表“幻想”与精神病风险的测量有关，即亚临床妄想观念的历史。本研究证实了精神分裂症患者一级亲属的认知 ToM 但不是情感 ToM 存在细微缺陷，而这些缺陷不能用整体认知缺陷来解释。研究结果证实了作为精神分裂症中间表型的独特社会认知能力的假设。
