Abstract
Background: Functional recovery is now a recognized treatment goal for schizophrenia. It is therefore important to better understand the cognitive and psychological factors that influence functioning and their interrelations. Among these factors, social cognition deficits and comorbid social anxiety are common in schizophrenia and have been separately linked to greater impairments in functioning. In a previous study, we observed that theory of mind (ToM) was the aspect of social cognition that showed the greatest association with functioning in recent-onset schizophrenia. Contrary to our expectations, patients with or without social anxiety showed similar ToM performance and similar levels of functioning as assessed with the Social and Occupational Functioning Scale (SOFAS). Since the SOFAS provides a single, global score, we aimed to refine our previous results by exploring the relationships with distinct areas of functioning rated with the Schizophrenia Objective Functioning Instrument (SOFI).
Methods: Fifty-six outpatients with recent-onset schizophrenia (mean illness duration = 21.2 months) had undergone a detailed interview that covered several aspects of their functioning. The records from these interviews were used to rate the 4 SOFI subscales, including (1) living situation, (2) instrumental activities of daily living, (3) productive activities and role functioning, and (4) social/recreational functioning. These ratings were compared between patients with (N = 27) or without (N = 29) a comorbid social anxiety disorder, and we also examined the link with ToM performance assessed with the Combined Stories Task.
Results: No group difference emerged between patients with or without social anxiety on the 4 SOFI subscales (all Ps >. 30). As for the link with ToM, a significant correlation was observed with productive activities and role functioning (r = .31, P = .02). The other correlations did not reach significance (P values between .08 and .72).
Conclusion: Previous studies reported poorer functioning in schizophrenia patients who also present with social anxiety, and the failure to replicate these results triggers questions regarding the factors at play. Here, we show that it was not our global measure of functioning that prevented us from observing an effect in our initial study. Another possibility is that differences in functioning are more specifically observed in more chronic patients or that some measures of functioning are more sensitive to the negative self-perception often linked with social anxiety. As for the link with ToM, the significant association only with productive activities and role functioning suggests that certain types of social interactions may be particularly affected by ToM deficits. We recently observed that ToM is linked to facilitation of social interactions when performing a collaborative task with another person, which could be particularly important in a work context.