2008 relationship between theory of mind and executive function in schizophrenia-a systematic review

8/13/2019 2008 Relationship Between Theory of Mind and Executive Function in Schizophrenia-A Systematic Review

1/8

Fax +41 61 306 12 34

E-Mail [email protected]

Review

Psychopathology 2008;41:206213

DOI: 10.1159/000125554

Relationship between Theory of Mindand Executive Function in Schizophrenia:A Systematic Review

Graham J. Pickup

Sub-Department of Clinical Health Psychology, University College London, London, UK

Introduction

In his cognitive neuropsychological model of schizo-phrenia, Frith [1, 2] suggested that particular symptomsof the disorder are associated with impairments in The-ory of Mind (ToM), or mentalizing, the ability to cor-rectly attribute mental states such as intentions, thoughtsand beliefs to other people. By drawing parallels with au-tistic individuals who have empirically well-establishedmentalizing difficulties [3], Frith proposed that ToM im-

pairments in schizophrenia are particularly pronouncedin patients with positive or negative behavioural signs ofthe disorder, such as inappropriate behaviour, speech oraffect (positive signs) or reduced behaviour, poverty ofspeech or flat affect (negative signs). He further suggestedthat schizophrenia patients with paranoid symptoms(such as delusions of reference or persecution) have moresubtle ToM impairments, as they continue to mentalize,but make errors when they infer other peoples intentionsand beliefs. He proposed that patients with only passivitysymptoms (e.g. delusions of control) or those withoutcurrent symptoms (in remission) have intact ToM. Two

recent reviews of more than 30 empirical studies in thisfield [4, 5] concluded that there is considerable evidencefor impaired ToM in schizophrenia, with patients per-forming worse than control groups on a wide range ofverbal and non-verbal ToM tasks. However, further workis needed to clarify the relation between ToM impair-ments, symptomatology and other cognitive domains inthe disorder.

Key Words

Theory of mind Mentalizing Social cognition Executive

functions Schizophrenia

Abstract

Background:There is good agreement that Theory of Mind

(ToM) and executive function are impaired to some degree

in many patients with schizophrenia. However, few studies

have set out to investigate as a primary aim the relationship

between these 2 cognitive domains in the disorder. Meth-ods:A systematic review was carried out to identify all pub-

lished studies in which tests of ToM and executive function

were administered to individuals with schizophrenia, and in

which the relation between scores was reported. Results:

The review revealed 17 relevant studies, of which 8 reported

the relation between ToM and executive function using mul-

tivariate statistics. These all concurred in showing that ToM

ability continued to predict an individual having schizophre-

nia (rather than being a control participant) once executive

function was controlled for. Conclusions: There is very good

agreement that ToM and executive function impairments in

schizophrenia are independent of one another. Implicationsare discussed for the putative brain systems involved in the

disorder and for its cognitive rehabilitation.

Copyright 2008 S. Karger AG, Basel

Received: January 8, 2007

Accepted after revision: July 10, 2007

Published online: April 11, 2008

Dr. G.J. PickupSub-Department of Clinical Health PsychologyUniversity College London, Gower Street

London WC1E 6BT (UK)Tel. +44 207 679 1844, Fax +44 207 916 1989, E-Mail [email protected]

2008 S. Ka rger AG, Basel02544962/08/04140206$24.50/0

Accessible online at:www.karger.com/psp
http://dx.doi.org/10.1159%2F000125554http://dx.doi.org/10.1159%2F000125554


2/8

ToM and Executive Function inSchizophrenia

Psychopathology 2008;41:206213 207

Some researchers have argued that a domain-specificcognitive module [6] and dedicated neural system un-derlie mentalizing abilities in humans, and indeed neu-roimaging studies show that a particular set of brain re-gions are reliably activated when healthy subjects per-form ToM tasks [7]. Recent studies have suggested that

different processes (e.g. seeing the world from anothersperspective in cognitive or emotional terms, applyingknowledge of the world, thinking about others who aresimilar to or different from oneself, perceiving commu-nicative intent) are involved in ToM, and that specificbrain areas may subserve each of these processes [8]. Bythis account, ToM impairments in schizophrenia may re-flect particular problems with the ToM module, over andabove other cognitive deficits characteristic of the disor-der, and studies showing that patients poor performanceon ToM tasks cannot simply be explained by lower IQ [9,10] are compatible with this notion.

As discussed by Langdon et al. [11], other models pro-pose that poor performance on ToM tasks in healthy andclinical populations reflects executive dysfunction. Execu-tive function refers to a constellation of higher-level cogni-tive abilities that enable an individual to plan and executegoal-directed operations [12], and it is well established thatindividuals with schizophrenia perform poorly on execu-tive tasks [13], with mounting evidence that impairmentsare particularly associated with the presence of positive ornegative behavioural signs [14]. Langdon et al. [11] notedthat if an executive dysfunction account of impaired ToMin schizophrenia is correct, it is likely that failure in 1 or

both of 2 specific executive functions is to blame: (1) theability to disengage from and inhibit salient information,such as the current state of affairs, so that less salient in-formation (e.g. another persons belief) can be considered,and (2) the ability to manipulate representations of hypo-thetical situations in order to reason consequentially, pre-dicting, for example, another persons belief about the cur-rent state of affairs based on knowledge about their expo-sure to a situation. The first of these abilities can be testedby attentional set-shifting tasks such as the WisconsinCard Sorting Test (WCST) [15] and the second by strategicplanning tasks such as the Tower of London (ToL) [16]. The

performance of schizophrenia patients is known to be im-paired on both of these tasks [17, 18], so it is possible thatthese executive difficulties could explain patients poorperformance on ToM tasks, without needing to invoke im-pairments in a ToM module.

Langdon et al. [11] investigated these competing ac-counts by administering a battery of ToM, disengagementand planning tasks to groups of schizophrenia patients

and healthy controls. They used a picture-sequencing testof ToM requiring understanding of false belief (FB), and adisengagement task involving capture picture-sequenc-ing stories in which correct responding required subjectsto disengage from a salient and misleading cue. Their plan-ning task was the ToL. Consistent with previous studies,

individuals with schizophrenia were impaired on bothToM and executive tasks relative to controls. Correlationaldata showed a strong association between patients perfor-mance on the ToM and capture tasks, but evidence wasfound for the modular account of impaired mentalizingfrom logistic regression, which showed that ToM perfor-mance continued to predict the likelihood of being a pa-tient when executive function was controlled for.

No other studies have had a primary aim of exploringthe relation between ToM and executive function inschizophrenia, although a number of researchers havetested both cognitive domains as part of other experi-

ments. For this paper, a literature review was planned toidentify al l of these other studies in order that the relationbetween ToM and executive function in schizophreniacould be systematically explored.

Methods

A literature review using the PsycINFO and MEDLINE data-bases was carried out in May 2007 to identify all published, Eng-lish language studies in which both ToM and executive functiontasks were given to adults with schizophrenia, and in which therelationship between scores was reported. All abstracts were read

in which the search terms theory of mind, mentali?ing, socialcognition, social perception or perspective taking appearedwith either schizo* or psycho?i? in any of the key search do-mains. All papers in which it was possible that executive functiontasks had been administered, were then read closely. The refer-ence lists from all relevant papers were searched to identify fur-ther papers for review.

Results

Seventeen relevant studies including Langdon et al. [11]were identified (see table 1). These used a wide range of

ToM tasks, including both non-verbal (e.g. FB picture-se-quencing, visual jokes [33], the Reading the Mind in theEyes test [46]) and verbal (e.g. FB and deception [20], hint-ing [30] and irony) tasks. The latter involved sets of storiesthat required subjects to correctly attribute first-order(e.g. He thinks that) and/or second-order (e.g. Hethinks that he thinks that) mental states to story char-acters. All of the 12 studies that used a control group found


3/8


4/8


5/8

Pickup


their schizophrenia patients to be significantly impairedrelative to controls on most or all of the ToM tasks.

The studies similarly used a wide range of executivefunction measures. Those testing the ability to disengagefrom and inhibit salient information included the cap-ture picture-sequencing task discussed above, the classi-

cal Weigl [21], the WCST (e.g. number of categories cor-rect, total errors, perseverative errors) [15], the Haylingand Brixton tests [35], the interference score of the StroopColour-Word Test [31], Trails B time and errors [34] andthe interference score of the Concept Shifting Test, amodified version of Trails B. Where data were reported,patients with schizophrenia were generally significantlyimpaired on these tasks relative to controls. The mea-sures used to test strategic planning in the identifiedstudies were the ToL (e.g. initial planning time, averagetime for each subsequent move, proportion of ToL prob-lems solved in the minimum number of moves, number

of moves taken beyond the minimum to reach solution)[16], and the Key Search and Zoo Map subtests of the Be-havioural Assessment of Dysexecutive Syndrome [38].Again, patients with schizophrenia were impaired onthese tasks relative to controls (see table 1).

Fourteen of the studies reported correlational data re-garding the relation between ToM and executive func-tion, and with the exception of Mazza et al. [22], Schenkelet al. [40] and Pinkham and Penn [43] all found somesignificant correlations between the domains. Generally,whether the executive tasks measured disengagement orplanning, patients scores correlated with ToM perfor-

mance in about 65% of cases. Three studies reported sep-arate correlational data for healthy controls, and in allcases no associations were found. At first sight, the find-ings support the executive dysfunction account of im-paired ToM in schizophrenia. However, the correlationscould simply reflect shared task variance, and a betterway of testing the competing accounts is to explore inde-pendent effects using multivariate statistics. This wasdone in 8 of the reviewed studies [11, 2729, 37, 39, 41, 42]and all of these concurred in showing that ToM abilitycontinued to predict that an individual had schizophre-nia, rather than being a healthy control, once executive

function was controlled.

Discussion

This paper reviewed the 17 published studies in whichboth ToM and executive function tasks were adminis-tered to patients with schizophrenia. Despite the use ofSt

udy

Sample

Subjects

ToMmeasures

andresults

Executivefunctionmeasures

and

results

ToM/executiveco

rrelations

Multivariatestatistics

Asso

ciationswithsymptoms

Bora

etal.[47]

(2007)

Schizophrenia(5

8)

Nocontrolgroup

1st-and2nd-orderFB

stories,

ReadingtheMindintheEyes

testrevised;

nocontrolstocomparewith

WC

ST(cat,pers),

verbalfluency(K,A,S);

nocontrolstocomparewith

Patients:2nd-orderFB(but

not1st-orderFBorEyes

test)correlatedwithWCST

Notreported

2nd-

orderFBscores

associatedwithinsight

Brne

etal.[48]

(2007)

Schizophrenia(3

8)

Healthycontrols

(29)

Deceptionpicture-

sequencingandToM

questionnaire[37];

patientsimpairedrelativeto

controlsonalltasks

WC

ST(tot,pers),

BADSZooMaptest;

patientsimpairedrelativeto

controlsonalltasks

Patients:betterToMscores

onallmeasuresassociated

withbetterexecutive

scores;

controls:notrepo

rted

Notreported

Bette

rToMassociatedwith

lessn

egativesymptoms;

poor

ToMbestpredictorof

socia

lproblems

cat=Numberofcategori

escorrect;tot=totalerrors;pers=perseverativeerrors;sub=averagetimeforeachsubsequ

entmove;min=proportionofToLproblems

solvedintheminimum

numberofmoves;moves=n

umberofmovestakenbeyondtheminimum

toreachsolution.

Table

1

(continued)


6/8



many different tasks across studies, a highly consistentpicture emerged. All studies found that schizophreniapatients were impaired in both cognitive domains rela-tive to controls. Furthermore, all studies that exploredindependent effects concurred in showing that ToM andexecutive function impairments were independent. To-

gether, these data provide strong evidence that impairedToM in schizophrenia reflects dysfunction of a domain-specific cognitive system, rather than a domain-generalexecutive impairment.

The independence of ToM and executive function inschizophrenia is consistent with a number of studiesshowing dissociations between these cognitive domainsin other disorders [49]. For example, a case study byLough et al. [50] of a patient with frontotemporal demen-tia found relatively intact executive function but extreme-ly poor performance on a wide range of ToM tasks. Sim-ilarly, in a study of 31 patients with unilateral frontal lobe

lesions, Rowe et al. [51] found that they were impairedrelative to healthy controls on both ToM and executivefunction tasks, and that these deficits were independent.These findings are consistent with suggestions that sepa-rate brain regions subserve ToM ability and executivefunction in adults. In a review of functional imagingstudies, Gallagher and Frith [7] concluded that 3 areas,the anterior paracingulate cortex, the superior temporalsulci and the temporal poles bilaterally, are reliably acti-vated in healthy adults during ToM tasks. In contrast,many tests of executive function (e.g. the WCST) arethought to rely upon intact dorsolateral prefrontal cortex

(DLPFC) [52]. There is mounting evidence that all ofthese brain regions show abnormalities in schizophrenia,and it is possible that impairments in these different re-gions underlie the independent deficits in ToM and ex-ecutive functions in the disorder. For example, a recentreview of neuroimaging studies in which schizophreniapatients performed ToM tasks, [53] found good evidencefor an abnormal haemodynamic response in medial pre-frontal cortex (MPFC) in patients relative to controls.Furthermore, Weinberger et al. [54] found DLPFC un-der-activation relative to healthy controls when individu-als with schizophrenia performed the WCST.

In future research, it would be helpful for a functionalimaging study to administer both ToM and executivefunction tasks to schizophrenia patients and controls, inorder to explore the brain regions subserving these func-tions within the same sample. We might expect that whileboth types of task will activate some of the same brainregions because of shared task demands, each will addi-tionally activate unique areas, such as the DLPFC (for

executive tasks involving disengagement or set-shifting)and the MPFC for ToM tasks. Notably, a recent longitu-dinal functional imaging study [55] investigated perfor-mance of schizophrenia patients and controls on a socialcognition paradigm requiring empathic and forgivabilityjudgements. Following recovery from an acute episode,

the patients showed greater activation in the left MPFCwhen performing the task, and this was correlated withimproved insight and social functioning. In contrast, im-proved WCST performance was not associated with thisincrease in MPFC activation.

The cognitive deficits associated with schizophreniahave a significant impact on patients community func-tioning, including social and occupational functioningand activities of daily living. In 2 reviews, Green [56] andGreen et al. [57] concluded that better verbal memory,vigilance and executive function are particularly associ-ated with better functional outcome in the disorder. How-

ever, as discussed by Pinkham et al. [58], the relation be-tween traditional neurocognitive measures and psycho-social function is quite modest, and there is a strongargument for examining specific aspects of social cogni-tion in schizophrenia in more detail, as they may be ableto independently account for variance in social function-ing. Pinkham et al. [58] reviewed a number of studiesshowing that aspects of social cognition such as facial af-fect and social cue perception are related to social func-tioning in schizophrenia, and that this relation is oftenindependent of other cognitive deficits. It is as yet unclearto what extent these different domains of social cognition

are related to ToM in schizophrenia [59], but the conclu-sion from the present review that executive function andToM are independent in the disorder suggests that futureresearch could usefully explore the relation between ToMand social function, as ToM may independently accountfor significant variance in functioning. Interestingly, sev-eral recent studies [37, 43, 60] found that when ToM tasksand standard neurocognitive batteries were administeredto individuals with schizophrenia, ToM scores were goodpredictors of social functioning. This may have importantimplications for psychosocial rehabilitation in the disor-der because specific improvements in patients ToM abil-

ity may have a substantial impact on their social function.Recent evidence suggests that, contrary to Friths originalhypothesis [1], ToM impairments in schizophrenia maybe both a trait and state deficit, present (to some degree)in remitted patients [61, 62] as well as in those with activesymptoms. This indicates the potential importance of fo-cusing on ToM in the rehabilitation of all schizophreniapatients, whether they are symptomatic or not.


7/8

Pickup


References

1 Frith CD: The Cognitive Neuropsychologyof Schizophrenia. Hillsdale, Erlbaum Asso-ciates Ltd, 1992.

2 Frith CD: Schizophrenia and theory of mind:editorial. Psychol Med 2004; 34: 385389.

3 Baron-Cohen S, Tager-Flusberg H, Cohen

DJ: Understanding Other Minds. Perspec-tives from Developmental Cognitive Neuro-science. Oxford, Oxford University Press,2000.

4 Brne M: Theory of mind in schizophrenia:a review of the literature. Schizophr Bull2005; 31: 122.

5 Harring ton L, Siegert RJ, McClure J: Theoryof mind in schizophrenia: a critical review.Cognit Neuropsychiatry 2005; 10: 249286.

6 Scholl BJ, Leslie A: Modularity, developmentand theory of mind. Mind Lang 1999; 14:131153.

7 Gallagher HL, Frith CD: Functional imagingof theor y of mind. Trends Cogn Sci 2003; 7:7783.

8 Frith CD, Frith U: The neural basis of men-taliz ing. Neuron 2006; 50: 531534.

9 Doody GA, Gtz M, Johnstone EC, Frith CD,Cunningham-Owens DG: Theory of mindand psychoses. Psychol Med 1998; 28: 397405.

10 Pickup GJ, Frith CD: Theory of mind im-pairments in schizophrenia: symptomatol-ogy, severity and specificity. Psychol Med2001; 31: 207220.

11 Langdon R, Coltheart M, Ward PB, Catts SV:Mentalising, executive planning and disen-gagement in schizophrenia. Cognit Neuro-psychiatry 2001; 6: 81108.

12 Velligan DC, Bow-Thomas CC: Executivefunction in schizophrenia. Semin Clin Neu-

ropsychiatry 1999; 4: 2433.13 Chan RCK, Chen EYH, Cheung EFC, Cheung

HK: Executive dysfunctions in schizophre-nia: relationships to clinical manifestation.Eur Arch Psychiatry Clin Neurosci 2004;254: 256262.

14 Basso MR, Nasrallah HA, Olson SC, Born-stein RA: Neuropsychological correlates ofnegative, disorganized and psychotic symp-toms in schizophrenia. Schizophr Res 1998;31: 99111.

15 Heaton RK: A Manual for the WisconsinCard Sorting Test. Odessa, PsychologicalAssessment Resources, 1981.

16 Shallice T: Specific impairments of plan-ning. Phi los Trans R Soc Lond B 1982; 198:

199209.17 Gold JM, Carpenter C, Randolph C, Gold-

berg TE, Weinberger DR: Auditory workingmemory and Wisconsin Card Sorting Testperformance in schizophrenia. Arch GenPsychiatry 1997; 54: 159165.

18 Morris RG, Rushe T, Woodruf fe PWR, Mur-ray R: Problem-solving in schizophrenia: aspecif ic deficit in planning ability. SchizophrRes 1995; 14: 235246.

19 Murphy D: Theory of mind in a sample ofmen with schizophrenia detained in a spe-cial hospital: its relationship to symptomprofiles and neuropsychological tests. CrimBehav Ment Health 1998; 8: 1326.

20 Frith CD, Corcoran R: Exploring theory of

mind in people with schizophrenia. PsycholMed 1996; 26: 521530.

21 Weigl E: On the psychology of so-called pro-cesses of abstraction. J Norm Soc Psychol1941; 36: 333.

22 Mazza M, DeRisio A, Surian L, Roncone R,Casacchia M: Selective impairments of theo-ry of mind in people with schizophrenia.Schizophr Res 2001; 47: 299308.

23 Baron-Cohen S, Leslie A, Frith U: Does theautistic child have a Theory of Mind? Cog-nition 1985; 21: 3746.

24 Happ FGE: An advanced test of theory ofmind: understanding of story charactersthoughts and feelings by able autistics, men-tally handicapped and normal children and

adults. J Autism Dev Disord 1994; 24: 129154.

25 Baron-Cohen S: The autistic childs theory ofmind: a case of specif ic developmental delay.J Child Psychol Psychiatry 1989; 30: 285297.

26 Happ FGE, Frith U: Theory of mind in au-tism; in Schopler E, Mesibov G (eds): Learn-ing and Cognition in Autism. New York, Ple-num Press, 1994.

27 Langdon R, Coltheart M, Ward PB, Catts SV:Disturbed communication in schizophre-nia: the role of poor pragmatics and poormind-reading. Psychol Med 2002; 32: 12731284.

28 Langdon R, Davies M, Coltheart M: Under-

standing minds and understanding commu-nicated meanings in schizophrenia. MindLang 2002; 17: 68104.

29 Janssen I, Krabbendam L, Jolles J, van Os J:Alterations in theory of mind in patientswith schizophrenia and non-psychotic rela-tives. Acta Psychiatr Scand 2003; 108: 110117.

30 Corcoran R, Mercer G, Frith CD: Schizo-phrenia, symptomatology and social infer-ence: investigating theory of mind in peo-ple with schizophrenia. Schizophr Res 1995;17: 513.

31 Stroop JR: Studies of interference in serialverbal reactions. J Exp Psychol 1935; 18: 643662.

32 Drake RJ, Lewis SW: Insight and neurocog-nition in schizophrenia. Schizophr Res 2003;62: 165173.

33 Corcoran R, Cahill C, Frith CD: The appre-ciation of visual jokes in people with schizo-phrenia: a study of mentalizing ability.Schizophr Res 1997; 24: 319327.

34 Reitan C: The Trail Making Test. Manual forAdministration and Scoring. Tucson, ReitanNeuropsychological Laboratory, 1992.

35 Burgess PW, Shallice T: The Hayling andBrixton Tests. Bury St Edmunds, ThamesValley Test Company, 1997.

36 Greig TC, Bryson GJ, Bell MD: Theory ofmind performance in schizophrenia: diag-nostic, symptom and neuropsychologicalcorrelates. J Ner v Ment Dis 2004; 192: 1218.

37 Br ne M: Emotion recognition, theory ofmind, and social behaviour in schizophre-nia. Psychiatry Res 2005; 133: 135147.

38 Wilson BA, Alderman N, Burgess P, EmslieH, Evans JJ: Behavioural Assessment of theDysexecutive Syndrome (BADS). Bury StEdmunds, Thames Valley Test Company,1996.

39 Harrington L, Langdon R, Siegert RJ, Mc-Clure J: Schizophrenia, theory of mind andpersecutory delusions. Cognit Neuropsychi-atry 2005; 10: 87104.

40 Schenkel LS, Spaulding WD, Silverstein SM:Poor premorbid social functioning and the-ory of mind deficit in schizophrenia: evi-dence of reduced context processing? J Psy-chiatr Res 2005; 39: 499508.

41 Langdon R, Coltheart M, Ward PB: Empa-thetic perspective-taking is impaired inschizophrenia: evidence from a study ofemotion attribution and theory of mind.Cognit Neuropsychiatry 2006; 11: 133155.

42 Langdon R, Corner T, McLaren J, Ward PB,Coltheart M: Externalizing and personaliz-ing biases in persecutory delusions: the rela-tionship with poor insight and theory-of-mind. Behav Res Ther 2006; 44: 699713.

43 Pinkham AE, Penn DL: Neurocognitive and

social cognitive predictors of interpersonalskill in schizophrenia. Psychiatry Res 2006;143: 167178.

44 Corcoran R: Theory of mind and schizo-phrenia; in Corrigan PW, Penn DL (eds): So-cial Cognition and Schizophrenia. Washing-ton, American Psychological Association,2001.

45 Bora E, Eryavuz A, Kayahan B, Sungu G,Veznedaroglu B: Social functioning, theoryof mind and neurocognition in outpatientswith schizophrenia; mental state decodingmay be a better predictor of social function-ing than mental state reasoning. PsychiatryRes 2006; 145: 95103.

46 Baron-Cohen S, Wheelwright S, Hill J, Raste

Y, Plumb I: The Reading the Mind in theEyes test revised version: a study with nor-mal adults, and adults with Asperger syn-drome or high-functioning autism. J ChildPsychol Psychiatry 2001; 42: 241251.

47 Bora E, Sehitoglu G, Aslier M, Atabay I,Veznedaroglu B: Theory of mind and un-awareness of illness in schizophrenia: is poorinsight a mentalizing deficit? Eur Arch Psy-chiatry Clin Neurosci 2007; 257: 104111.


8/8



48 Brne M, Abdel-Hamid M, Lehmkmper C,Sonntag C: Mental state attribution, neuro-cognitive functioning, and psychopatholo-gy: what predicts poor social competence inschizophrenia best? Schizophr Res 2007; 92:151159.

49 Lee K-H, Farrow TFD, Spence SA, WoodruffPWR: Social cognition, brain networks and

schizophrenia . Psychol Med 2004; 34: 391400.

50 Lough S, Gregory C, Hodges JR: Dissocia-tion of social cognition and executive func-tion in frontal variant frontotemporal de-mentia. Neurocase 2001; 7: 123130.

51 Rowe AD, Bullock PR, Polkey CE, MorrisRG: Theory of mind impairments and theirrelationship to executive functioning follow-ing frontal lobe excisions. Bra in 2001; 124:600616.

52 Fuster JM: The Prefrontal Cortex. Anatomy,Physiology and Neuropsychology of theFrontal Lobe. New York, Raven, 1989.

53 Brunet-Gouet E, Decety J: Social brain dys-functions in schizophrenia: a review of neu-roimaging studies. Psychiatry Res 2006; 148:7592.

54 Weinberger DR, Berman KF, Zec RF: Physi-ological dysfunction of dorsolateral prefron-tal cortex in schizophrenia. I. Regional cere-bral blood flow (rCBF) evidence. Arch Gen

Psychiatry 1986; 43: 114124.55 Lee K-H, Brown WH, Egleston PN, Green

RDJ, Farrow TFD, Hunter MD, Parks RW,Wilkinson ID, Spence SA, Woodruff PWR:A functional magnetic resonance imagingstudy of social cognition in schizophreniaduring an acute episode and after recovery.Am J Psychiatry 2006; 163: 19261933.

56 Green MF: What are the functional conse-quences of neurocognitive deficits in schizo-phrenia? Am J Psychiatry 1996; 153: 321330.

57 Green MF, Kern RS, Braff DL, Mintz J: Neu-rocognitive deficits and functional outcomein schizophrenia : are we measuring the rightstuff ? Schizophr Bull 2000; 26: 119136.

58 Pinkham AE, Penn DL, Perkins DO, Lieber-man J: Implications for the neural basis ofsocial cognition for the study of schizophre-nia. Am J Psychiatry 2003; 160: 815824.

59 Sergi MJ, Rassovsky Y, Widmark C, Reist C,Erhart S, Braff DL, Marder SR, Green MF:Social cognition in schizophrenia: relation-ships with neurocognition and negativesymptoms. Schizophr Res 2007; 90: 316324.

60 Roncone R, Falloon IRH, Mazza M, De RisioA, Pollice R, Necozione S, Morosini P, Ca-sacchia M: Is Theory of Mind in schizophre-

nia more strongly associated with clinicaland social functioning than with neurocog-nitive deficits? Psychopathology 2002; 35:280288.

61 Herold R, Tnyi T, Lnrd K, Trixler M: The-ory of mind deficit in people with schizo-phrenia during remission. Psychol Med2002; 32: 11251129.

62 Inoue Y, Yamada K, Hirano M, Shinohara M,Tamaoki T, Iguchi H, Tonooka Y, Kanba S:Impairment of theory of mind in patients inremission following first episode of schizo-phrenia. Eur Arch Psychiatry Clin Neurosci2006; 256: 326328.

2008 relationship between theory of mind and executive function in schizophrenia-a systematic review

Documents