Social cognitive deficits and their relationship with clinical symptoms in schizophrenia

While individuals with schizophrenia (SZ) exhibit deficits in social cognition, the specific profile of these deficits across multiple domains and their relationship with clinical symptoms warrants further characterization. This study aimed to systematically assess key social-cognitive domains-theory of mind (ToM), emotion recognition, attributional style, and social perception-and examine their associations with psychopathology in SZ. Sixty-eight individuals with SZ and 68 matched healthy controls (HC) completed a comprehensive battery of social-cognitive measures, including the false-belief task (assessing first- and second-order ToM), the Faux Pas task, the emotional recognition task, the attributional style questionnaire, and the social perception scale. Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Compared to HC, individuals with SZ showed significant deficits across all social-cognitive measures. Specifically, the SZ group exhibited deficits in emotion recognition for all negative emotions (fear, anger, sadness, disgust) but not for happiness, and in attributional style for positive but not negative events. Correlation analyses identified a statistically significant inverse relationship between attributional stability for negative events (i.e., the tendency to attribute the causes of negative events to factors that are persistent over time) and PANSS general psychopathology scores (τ = -0.25, P < 0.043). Furthermore, no other social-cognitive domains (ToM, emotion recognition, social perception) showed significant correlations with any PANSS symptom dimensions. Network analysis further characterized second-order ToM as the core deficit, exhibiting the highest strength and centrality within the social-cognitive network, with mediation effects most pronounced for sadness and happiness recognition. These findings highlight second-order ToM as a core deficit in individuals with schizophrenia and suggest that a stable attributional style may be associated with a lower overall burden of general psychopathology. These social-cognitive domains may represent promising targets for future cognitive remediation interventions for people living with schizophrenia.