Background: Theory of Mind (ToM) is more affected than other cognitive and social cognitive abilities in patients with first-episode psychosis (FEP) and these deficits appear linked to these patients’ social functioning similarly to what is observed in chronic schizophrenia. Getting a better understanding of ToM deficits and how they impact functioning is thus of particular interest in the early stages of psychosis given the importance of this period for promoting recovery.
Aims: Our work aims to further understand the mechanisms leading to ToM deficits and their functional consequences in people with FEP.
Method: Using a complete social cognition test battery, we examined whether the scores of several social cognition measures were predictive of social and occupational functioning (measured with the SOFAS) in 59 patients from our first-episode clinic in Quebec City, Canada (70% with schizophrenia, 17% schizoaffective disorder, 13% other). The social cognition test battery included measures of ToM, social knowledge, and emotion recognition, as well as a control condition consisting of short stories with non-social (physical) reasoning questions. Given that social anxiety is also increasingly recognized as having a strong influence on functioning in schizophrenia, we assessed the direct effect of social anxiety on functioning and its moderating effect on the relationship between social cognition and functioning.
Results: Path analyses revealed that only ToM was a significant direct predictor of functioning in our FEP patients (unstandardized path coefficient (UPC)= 6.43, SE=2.15, p=.004), whereas social knowledge and general non-social reasoning had a significant indirect effect on functioning through their respective effects on ToM (CI=0.3-2.4 and CI=0.4-6.1, respectively). Interestingly, moderated mediation analyses revealed a significant mediation effect (UPC=-0.80, SE=0.33, p=.02) indicating that non-social reasoning was significantly affecting ToM performance and hence functioning in patients without social anxiety (CI=1.2-13.1) but not in patients with social anxiety (CI=-.08-4.0).
Conclusion: ToM was the best direct predictor of functioning in this sample of FEP patients. Social knowledge and general non-social reasoning also impacted functioning, but the effects were indirect because they went through ToM ability and/or were specific to patients without social anxiety. Patients with and without social anxiety might have different underpinnings to their ToM deficits and hence different treatment needs. Future work from our team will aim to further understand the neurocognitive causes and functional consequences of ToM deficits in FEP, and the implication of symptom profiles such as social anxiety.