Theory of mind and context processing in individuals diagnosed with paranoid schizophrenia: a mixed-methods matched-control study

Background Theory of Mind (ToM) and contextual information processing are crucial for successful social functioning, yet individuals diagnosed with paranoid schizophrenia (PaSch) often experience problems in these domains.Methods The present mixed-methods study examined differences in ToM performance between 30 individuals diagnosed with PaSch and 30 matched healthy controls. Participants completed the Strange Stories Test to assess irony recognition and the Faux Pas Recognition Test to evaluate the ability to identify socially inappropriate statements and infer characters’ intentions.Results Quantitative analyses revealed that individuals diagnosed with PaSch performed significantly worse on tasks requiring recognition of irony and assessment of characters’ intentions, while comprehension of story content remained intact. Qualitative content analysis indicated that participants diagnosed with PaSch frequently focused on irrelevant or peripheral information and attributed malicious intent, reflecting impairments in contextual integration and perspective-taking.Discussion The study highlights the importance of examining both performance accuracy and response content to better understand socio-cognitive impairments in paranoid schizophrenia.