Social Cognition Deficits in Psychotic Disorders

Social cognition refers to the mental processes that underlie social interaction, including the perception, interpretation and response to others’ intentions, emotions and behaviours. In psychotic disorders—most prominently schizophrenia—deficits in social cognition are recognised as a core feature that contributes to poor social functioning, diminished quality of life and reduced vocational outcomes. These impairments encompass weakened theory of mind (the ability to attribute mental states to oneself and others), impaired emotion recognition, attributional biases that skew interpretations of social cues and, in some cases, hypermentalizing where neutral behaviours are over-interpreted as personally directed. Neurobiological studies implicate dysregulation of fronto-limbic circuits, aberrant amygdala connectivity and disrupted mirror-neuron system function. Deficits emerge early, often predating full-blown psychosis, persist across illness phases and show only partial dependence on general neurocognitive performance. Their global significance lies in the potential for targeted remediation—through specialised social cognitive training or integrated cognitive-behavioural approaches—to restore social engagement, improve clinical outcomes and reduce the societal burden of disability in psychotic populations.

Research from Nature Portfolio

A comparative investigation of mentalising performance in patients with schizophrenia and those with mesial temporal lobe epilepsy revealed that both groups exhibit similar impairments in reading subtle mental states from facial cues, as measured by a standard eyes-based task. Crucially, within the schizophrenia cohort, more severe deficits were linked to elevated positive symptomatology, suggesting a modulatory effect of active psychosis on social-cognitive processing. This work highlights a shared amygdala-network dysfunction across distinct clinical populations and underlines the role of symptom severity in shaping social cognition deficits.

Social Cognition Deficits in Psychotic Disorders publication trend

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

Technical terms

Theory of Mind: The capacity to infer and appreciate the beliefs, desires and intentions of others.

Mentalising: The process of interpreting one’s own and others’ actions in terms of underlying mental states.

Hypermentalizing bias: The tendency to over-attribute intentions or emotions to others, often leading to misinterpretation of neutral stimuli.

At-risk mental state (ARMS): A prodromal condition marked by attenuated psychotic symptoms and elevated risk of imminent psychosis.

First-episode psychosis (FES): The initial onset of a psychotic episode, offering a critical window for early intervention.

References

1. Social cognition in neuropsychiatric populations: a comparison of theory of mind in schizophrenia and mesial temporal lobe epilepsy. Scientific Reports (2017).
2. Assessing social cognition in patients with schizophrenia and healthy controls using the reading the mind in the eyes test (RMET): a systematic review and meta-regression.. Psychological Medicine (2024).
3. Mentalizing impairments and hypermentalizing bias in individuals with first-episode schizophrenia-spectrum disorder and at-risk mental state: the differential roles of neurocognition and social anxiety. European Archives of Psychiatry and Clinical Neuroscience (2024).
4. Characteristics of theory of mind impairment and its relationship with clinical symptoms and neurocognition in patients with schizophrenia. BMC Psychiatry (2023).