Abstract
Background: There is a recognized need to understand the determinants of social functioning in people with schizophrenia. While several factors such as cognitive or social cognitive deficits or negative symptoms are linked to social functioning, we know little about the impact of these symptoms during real social interactions.
Methods: We developed new social collaboration tasks based on the social communication paradigm. Participants were asked to collaborate with another person to reorder sequences of images. For each trial of the task, participants were presented with a series of 6 images forming a story and were asked to tell the story to a confederate, who had the same 6 images in a random order. The confederate was asked to place her set of images in order based on the narrative produced by the participant. She was trained to provide feedback to signal eventual misunderstandings. A first study included 25 patients with schizophrenia and 22 healthy controls who presented 6 sequences of images from different movie scenes. A second study included 21 patients with schizophrenia and 22 healthy controls who presented 9 sequences of cartoon images. Patients also completed a theory of mind task and an evaluation of their symptoms with the PANSS (5-factor version). Naive research assistants then rated the audio recordings regarding how easy it was to place the card in order from the produced stories, how interesting each story was, and how expressive the voice was.
Results: In both studies, patients were judged to make the collaborative task more difficult than healthy controls (Study 1: t(45) = 2.5, P = .015; Study 2 t(41) = 2.0, P = .05). Patients’ stories were perceived as less interesting (Study 1: t(45) = 3.0, P = .004; Study 2: t(41) = 3.1, P = .003) and their voices were perceived as less expressive (Study 1: t(45) = 4.0, P < .001; Study 2 t(41) = 3.1, P = .004). In patients, the perceived difficulty was correlated with theory of mind abilities in both studies (Study 1: r = .49, P = .01; Study 2: r = .63 P = .002). In contrast, the expressiveness and the interest of the story were strongly linked together (Study 1: r = .80, P < .001; Study 2: r = .90 P < .001) and both significantly correlated with patient’s negative symptoms as assessed with the PANSS (study 1: r = −.42, P = .04 for expressiveness and r = .44, P = .03 for interest; Study 2: r = −.62, P = .003 for expressiveness and r =−.60, P = .004 for interest).
Conclusion: These results suggest that during the same social interaction, theory of mind deficits and negative symptoms can affect distinct aspects of the interaction. Theory of mind deficits seem to hinder the success of collaborative interactions whereas the lack of expressiveness (and more globally negative symptoms) seem to impact how interesting patients are perceived during social interactions.