Bohec A-L, Baltazar M, Tassin M, Rey R
Pole Est, centre expert schizophrénie, centre hospitalier Le Vinatier, 95, boulevard Pinel, BP 30039, 69678 Bron cedex, France; PsyR(2), Inserm U1028, CNRS, UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, Lyon-1 University, centre hospitalier Le Vinatier, Bron, France; Laboratoire de psychopathologie et neuropsychologie (EA 2027), université Paris 8, Saint-Denis, France.
Pôle pédopsychiatrie, Pole Est, centre hospitalier Le Vinatier, 95, boulevard Pinel, BP 30039, 69678 Bron cedex, France.
Encephale. 2021 Jun;47(3):254-262. doi: 10.1016/j.encep.2020.10.007. Epub 2021 Feb 26.
Schizophrenia spectrum disorders are associated with incapacitating social impairments, mostly due to Theory of Mind (ToM) deficits. Theory of mind difficulties often precede the beginning of schizophrenia spectrum disorders and contribute highly to the social withdrawal of patients. They also predict bad outcome for individuals suffering from this condition. The use of samples of individuals presenting subclinical forms of schizophrenia spectrum disorders constitute an opportunity to study theory of mind capacities. Notably, the study of theory of mind deficits in schizotypy allows a better understanding of predictive markers of schizophrenia spectrum disorders. They also contribute to the identification of primary processes involved in social difficulties associated with these disorders.
We searched PubMed, Science Direct and Google Scholar databases for peer-reviewed articles studying the association between theory of mind performance and schizotypal traits up to the 1 April 2020. The following syntax was used: schizotypy AND ("theory of mind" OR "social cognition" OR "irony" OR "false belief" OR "social inference" OR "hinting task"). We also checked the references from these articles for additional papers. Only English and French written articles were considered.
Twenty-three articles were included in the review. The majority of these studies (n=20) used behavioral measures of theory of mind (i.e. percentages of correct responses on a theory of mind task). Only a few (n=3) recent studies used brain imaging to study theory of mind in psychometric schizotypy. In those 23 studies, 18 report theory of mind difficulties in individuals with high schizotypal traits. Ten out of these 19 studies report an association between positive schizotypy and theory of mind deficits/hypomentalizing. The positive dimension was the most associated with theory of mind difficulties. The negative dimension was associated with theory of mind deficits in six studies out of 19 (33 %). The association between disorganization and theory of mind deficits was weak, mostly because of a lack of studies measuring this dimension (only one study out of 13 measured this particular trait). The association between hypermentalizing and schizotypy was poorly characterized, due to high heterogeneity in how this feature was conceptualized and measured. In summary, some authors consider good performance on a theory of mind task as a sign of hypermentalizing, while other authors consider that this feature relates to the production of erroneous interpretations of mental states. We advocate in favor of the second definition, and more studies using this framework should be conducted. Interestingly, the three studies using fMRI showed no significant behavioral differences between high and low schizotypal groups on theory of mind performance, while the patterns of brain activation differed. This shows that in individuals with schizotypy, theory of mind anomalies are not always captured just by behavioral performance. Brain imagery should be included in more studies to better understand theory of mind in schizotypy. In general, high heterogeneity in ways of assessing schizotypy, and in the tasks used to evaluate theory of mind, were found. Notably, some tasks require shallower theory of mind processing than others. It is a priority to design theory of mind tasks that allow for manipulating the difficulty of the items within one task, as well as the level of help that can be given, in order to allow for a better assessment of the impact of theory of mind difficulties and the ways to compensate for them.
The studies included in this review confirm the association between psychometric schizotypy and theory of mind. But the high heterogeneity in methods used in these studies, and notably the diversity in ways of assessing schizotypal traits and theory of mind, hinder a precise description of such an association. Additional studies are required. In particular, fMRI studies using tasks allowing for a precise description of altered and preserved theory of mind processes could be of great use in characterizing theory of mind difficulties associated with schizotypy.
精神分裂症谱系障碍与严重的社会功能损害相关，这主要归因于心理理论（ToM）缺陷。心理理论困难通常在精神分裂症谱系障碍发病之前就已出现，并在很大程度上导致患者社交退缩。它们还预示着患有这种疾病的个体预后不良。使用表现出精神分裂症谱系障碍亚临床形式的个体样本为研究心理理论能力提供了契机。值得注意的是，对分裂型人格障碍中心理理论缺陷的研究有助于更好地理解精神分裂症谱系障碍的预测指标。它们也有助于识别与这些障碍相关的社会困难中所涉及的基本过程。
我们在PubMed、Science Direct和谷歌学术数据库中搜索截至2020年4月1日研究心理理论表现与分裂型人格特质之间关联的同行评审文章。使用了以下检索式：分裂型人格障碍 AND（“心理理论”或“社会认知”或“反讽”或“错误信念”或“社会推理”或“暗示任务”）。我们还检查了这些文章的参考文献以获取其他论文。仅考虑英文和法文撰写的文章。
本综述纳入了23篇文章。这些研究中的大多数（n = 20）使用心理理论的行为测量方法（即心理理论任务上的正确反应百分比）。只有少数（n = 3）近期研究使用脑成像来研究心理测量的分裂型人格障碍中的心理理论。在这23项研究中，18项报告了具有高分裂型人格特质的个体存在心理理论困难。在这19项研究中的10项报告了阳性分裂型人格障碍与心理理论缺陷/心理化不足之间的关联。阳性维度与心理理论困难关联最为密切。在19项研究中的6项（33%）中，阴性维度与心理理论缺陷相关。紊乱与心理理论缺陷之间的关联较弱，主要是因为缺乏测量这一维度的研究（13项研究中只有1项测量了这一特定特质）。由于在该特征的概念化和测量方式上存在高度异质性，超心理化与分裂型人格障碍之间的关联特征尚不明确。总之，一些作者认为在心理理论任务上的良好表现是超心理化的标志，而其他作者则认为这一特征与对心理状态的错误解释的产生有关。我们支持第二种定义，并且应该开展更多使用该框架的研究。有趣的是，三项使用功能磁共振成像的研究表明，在心理理论表现上，高分裂型人格特质组和低分裂型人格特质组之间没有显著的行为差异，而脑激活模式不同。这表明在具有分裂型人格障碍的个体中，心理理论异常并不总是仅通过行为表现就能捕捉到。应该在更多研究中纳入脑成像，以更好地理解分裂型人格障碍中的心理理论。总体而言，发现评估分裂型人格障碍的方式以及用于评估心理理论的任务存在高度异质性。值得注意的是，一些任务所需的心理理论加工比其他任务浅。设计心理理论任务的一个优先事项是，要能够在一个任务中操纵项目的难度以及可以给予的帮助程度，以便更好地评估心理理论困难的影响以及弥补这些困难的方法。
本综述中纳入的研究证实了心理测量的分裂型人格障碍与心理理论之间的关联。但这些研究中使用的方法存在高度异质性，尤其是在评估分裂型人格特质和心理理论的方式上存在多样性，这妨碍了对这种关联的精确描述。需要更多的研究。特别是，使用能够精确描述心理理论过程改变和保留情况的任务的功能磁共振成像研究，对于刻画与分裂型人格障碍相关的心理理论困难可能会有很大帮助。
