Theory of mind and perceptual context‐processing in schizophrenia

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Abstract
Introduction. A series of studies have suggested that schizophrenia patients are deficient in theory of mind (ToM). However, the cognitive mechanisms underlying ToM deficits in schizophrenia are largely unknown. The present study examined the hypothesis that impaired ToM in schizophrenia can be understood as a deficit in context processing. Methods. Disorganised schizophrenia patients (N = 12), nondisorganised schizophrenia patients (N = 36), and nonpsychotic psychiatric patients (N = 26) were tested on three ToM tasks and a visual size perception task, a measure of perceptual context processing. In addition, statistical analyses were carried out which compared chronic, treatment‐refractory schizophrenia patients (N = 28) to those with an episodic course of illness (N = 20). Results. Overall, ToM performance was linked to deficits in context processing in schizophrenia patients. Statistical comparisons showed that disorganised as well as chronic schizophrenia patients were more impaired in ToM but more accurate in a visual size perception task where perceptual context is misleading. Conclusions. This pattern of results is interpreted as indicating a possible link between deficits in ToM and perceptual context processing, which together with deficits in perceptual grouping, are part of a broader dysfunction in cognitive coordination in schizophrenia.