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. 2019 Mar 7;45(2):377-385.
doi: 10.1093/schbul/sby027.

Hyper- and Hypomentalizing in Patients with First-Episode Schizophrenia: fMRI and Behavioral Studies

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Hyper- and Hypomentalizing in Patients with First-Episode Schizophrenia: fMRI and Behavioral Studies

Vibeke Bliksted et al. Schizophr Bull. .

Abstract

Background: Historically, research investigating neural correlates of mentalizing deficits in schizophrenia has focused on patients who have been ill for several years with lengthy exposure to medication. Little is known about the neural and behavioral presentations of theory-of-mind deficits in schizophrenia, shortly after the first episode of psychosis.

Methods: We investigated social cognition in 17 recently diagnosed first-episode schizophrenia (FES) patients with little or no exposure to antipsychotic medication and 1:1 matched healthy controls. We recorded behavioral and neural responses to the Animated Triangles Task (ATT), which is a nonverbal validated mentalizing task that measures the ascription of intentionality to the movements of objects.

Results: FES patients under-interpreted social cues and over-interpreted nonsocial cues. These effects were influenced by current intelligence (IQ). Control group and FES neural responses replicated earlier findings in healthy adults. However, a region of anterior medial prefrontal cortex (amPFC) of FES patients showed a different response pattern to that of controls. Unlike healthy controls, patients increased activity in this social cognition region while studying "random" movements of shapes, as compared to the study of movements normally interpreted as "intentional".

Conclusions: Mentalizing deficits in FES consists of hypo- and hypermentalizing. The neural pattern of FES patients is consistent with deficits in the ability to switch off mentalizing processes in potentially social contexts, instead increasing them when intentionality is not forthcoming. Overall, results demonstrate complexities of theory of mind deficits in schizophrenia that should be considered when offering social cognitive training programs.

Keywords: fMRI; first-episode schizophrenia; hypermentalizing; hypomentalizing; social cognition; theory of mind.

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Figures

Fig. 1.
Fig. 1.
The Animated Triangles Task (ATT). The scanning paradigm consisted of 4 blocks. Each block contained a presentation of a random and aToM movement sequence. Each clip lasted from 38 to 41 s. In addition, each block contained a still picture of a triangle scene, for 5 s. After each animation, subjects were asked a yes/no question (lasting 4 s) to ensure subjects paid attention to the task (supplementary material). Subjects pressed a button on a response box to indicate their response. There were no more than 128 s between 2 stimuli of the same type and condition. Stimuli were back projected onto a screen that could be seen by the subject in the scanner by way of a mirror placed above their eyes.
Fig. 2.
Fig. 2.
Behavioral data from Animated Triangles Task. Ratings of subject reports on what occurred after watching videos of the ATT (moving shapes with apparent intentionality or random movement). All comparisons of FES patients and controls were significant (Ps < 0.04). Error bars are 95% CI.
Fig. 3.
Fig. 3.
(A) Activation in the medial prefrontal cortex corresponding to the interaction of patient group and movement condition (thresholded Z > 3.0, P <.05, cluster corrected). Activation overlaid on the MNI152 brain. (B) Within this region of MPFC, centered on the mean beta, the interaction is driven primarily by a greater activation in schizophrenia patients while viewing random movement, confirmed by pairwise T-test. Error bars are within-subject 95% CI.

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