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Theory of the mind in schizophrenia


The term “theory of mind” was initially proposed by Premack and Woodruff (1978) and refers to the individual’s ability to infer mental states of others such as intentions, dispositions and beliefs.

Evaluation of the theory of the mind with schizophrenia

Ruiz, García and Fuentes (2006) point out that generally the tests aimed at measuring the theory of the mind are usually presented in the form of comic strips on which certain questions are subsequently asked. The purpose of these questions is to evaluate two types of false beliefs in relation to history.

Types of questions

1. First order questions

The first-order questions are intended to assess the extent to which the evaluated subject is able to predict the behavior of a character who acts guided by an erroneous belief, Sally and Anne (Baron-Cohen, Leslie and Frith, 1985) and Cigarretes (Happè, 1994) would be examples of stories that pose first-order questions.

2. Second Order Questions

Second order questions assess the extent to which the subject being evaluated is able to predict the false belief that one of the characters has about the belief of another character, Ice-Cream Van Store (Baron-Cohen, 1989) and Burglar Store (Happè and Frith, 1994) are tests created for asking second-order questions.

Hinting Task

One of the most widely used instruments in psychosis research is the Hinting Task (Corcoran, Mercer and Frith, 1995) which comprises ten short stories in which there is an interaction between two characters. All these stories end with a hint of one character to the other. The objective of the task is that, after the reading of the different stories by the evaluator, the subject tries to explain what the character that emits the indirect response tries to say.

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Faux Pas Task

The Faux Pas Task (Stone, Baron-Cohen, Calder and Keane, 1998) presents the subject with ten stories in which one of the characters makes a mistake by saying something that is socially embarrassing. After presenting each of the stories to the subject, the subject is asked to detect the socially embarrassing situation and assess how the other character may have felt.

The test requires the subject’s ability to detect false beliefs in the case of the person who makes the socially embarrassing mistake, and to infer emotional states depending on how the character who received the verbalization may have felt.

Eye- Task

Eye- Task (Baron-Cohen, Wheelwright, Hill, Raste and Plumb, 2001), consists of showing the participants several photographs in which only the eyes of a subject are shown, asking them to infer what the person may be feeling or thinking. To make this assessment, the participant can only choose one of the four words offered as options.

Mind Theory Deficits in Schizophrenia

The differences found in performance in this area by patients diagnosed with schizophrenia and control subjects is substantial, as highlighted by two meta-analyses finding effect sizes between medium (d=0.69) and large (d=1.25) for these differences (Bora, Yucel and Pantelis, 2009; Sprong, Schothorst, Vos, Hox and Van Engeland, 2007).

Research Hypotheses

Historically, an attempt has been made to study the extent to which the symptoms of schizophrenia determine the deficits that people diagnosed with this disease theoretically present in their minds.

Some research bets on the hypothesis that the subject has to present a theory of mind without deficits of any kind in order to develop delirious persecutory ideas (Drury, Robinson and Birchwood, 1998; Watson, Blenner-Hasset and Charlton, 2000).

Others point out that patients who show negative or disorganized symptomatology have never developed a theory of mind, an aspect that can be observed in the worst performance they show when faced with tasks that demand the use of this capacity (Garety and Freeman, 1999; Greig, Bryson and Bell, 2004).

Research Objectives

A current objective in the study of deficits in mind theory in schizophrenia is to identify whether these deficits resemble a trait or state of the disease, as it would help resolve the question of whether they are exclusively associated with the symptoms of the disease.

It should be noted that the bulk of the research that has been carried out in this sense indicates that these deficits would constitute a trait of the disease itself (Herold, Tenyi, Lenard and Trixler, 2002; Irani et al, 2006; Janssen, Krabbendam, Jolles and Van Os, 2003; Penn, Sanna and Roberts 2008).

Although studies such as that of Bora et al (2009) show that, although these deficits seem to remain present in any phase of the disease, it is not known to what extent neurocognitive problems in working memory and executive functions, or the residual symptomatology itself, would be the factors that really contribute to the maintenance of these.

It therefore seems necessary to continue investigating in this direction before being able to affirm that these deficits constitute a feature of the disease.

Neurological vision

At the neurological level, Rodríguez and Touriño (2010) point out that in neuroimaging studies with healthy subjects it has been observed that some cerebral areas such as the prefrontal area, the amygdala or the lower parietal lobe, are activated during the performance of tasks in which the theory of the mind has to be put into practice (Brunet, Sarfati, Hardy-Bayle and Decety, 2000; 2003). In the case of patients diagnosed with schizophrenia, a decrease in activation has been found in the right prefrontal cortex and in the left lower frontal gyrus during the performance of such tasks (Adolphs, 2002; Brunet et al., 2000).


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