Social Cognition and Empathy in Schizophrenia

Schizophrenia is characterised not only by hallucinations and delusions but also by profound disturbances in social cognition and empathy. Social cognition encompasses the mental operations required to perceive, interpret and generate responses to the intentions, dispositions and behaviours of others. Core components include theory of mind (the ability to infer others’ beliefs and intentions), emotion recognition and attributional style. Empathy, divided into cognitive and affective facets, enables an individual to understand another’s emotional state and to share in their feelings. In schizophrenia, deficits in these domains contribute to poor social functioning, reduced quality of life and impaired vocational and interpersonal outcomes. Neurobiological studies point to altered structure and function within a distributed “social brain” network, including the medial prefrontal cortex, temporoparietal junction, superior temporal sulcus and anterior cingulate cortex. Dysregulation of glutamatergic signalling, particularly via N-methyl-D-aspartate (NMDA) receptors, and aberrant connectivity between social-processing hubs have been implicated in these impairments. Behavioural interventions and targeted pharmacological approaches seek to remediate these deficits by enhancing basic social-cognitive skills, leveraging preserved empathic capacity and restoring network connectivity.

Research from Nature Portfolio

A randomised placebo-controlled study examined the effects of an NMDA-receptor antagonist on mentalising performance and its neural correlates in healthy volunteers. Administration of ketamine induced transient psychotomimetic symptoms alongside a marked increase in “no mentalising” errors on a dynamic social-cognition task. Functional imaging revealed heightened activation in the posterior superior temporal sulcus and increased connectivity between this region and the anterior precuneus under ketamine. These findings support the hypothesis that deficient glutamate transmission contributes to mentalising deficits in schizophrenia and highlight glutamatergic modulation as a potential avenue for novel therapeutic development.

Social Cognition and Empathy in Schizophrenia publication trend

The graph below shows the total number of articles in social cognition and empathy in schizophrenia across all publications each year (not limited to Nature Index journals).

Technical terms

Social cognition: Mental operations enabling perception, interpretation and response to social information.
Theory of mind: Capacity to attribute mental states—beliefs, intentions and desires—to oneself and others.
Empathic accuracy: Ability to precisely infer another person’s emotional experiences in real time.
NMDA receptor: A subtype of glutamate receptor essential for synaptic plasticity and higher-order cognition.
Intersubject correlation: A metric of similarity in neural responses across individuals performing the same task.

References

1. The social cognitive and neural mechanisms that underlie social functioning in individuals with schizophrenia – a review. Translational Psychiatry (2023).
2. Effects of NMDA-receptor blockade by ketamine on mentalizing and its neural correlates in humans: a randomized control trial. Scientific Reports (2023).
3. Negative Schizotypy Associated With Weaker Intersubject Correlation in Dynamic Functional Connectivity During Empathic Accuracy Task. Schizophrenia Bulletin (2025).
4. Factor Structure of Social Cognition in Schizophrenia: Is Empathy Preserved?. Schizophrenia Research and Treatment (2013).