Theory of mind and social judgments in people at clinical high risk of psychosis

Schizophr Res. 2013 Nov;150(2-3):498-504. doi: 10.1016/j.schres.2013.08.038. Epub 2013 Sep 20.


Background: Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations.

Aims: Longitudinally examine theory of mind (ToM) and social judgments in a CHR sample to investigate the stability of performance over time and potential ability to predict conversion to psychosis.

Method: 147 CHR individuals and 85 help seeking controls (HSC) were assessed for up to 2years; 28 participants developed psychosis across both groups. Generalized linear mixed models for repeated measures were used to examine change over time for ratings on the three social cognitive indices of ToM, trustworthiness, and approachability. Hierarchical regression was used to test whether social cognitive variables explain more variance in conversion than IQ.

Results: CHR individuals showed a positive bias in approachability judgments over time compared to HSC. Baseline ToM performance significantly (p<.05) predicted later conversion beyond IQ scores. These results were attenuated when controlling for baseline symptom level.

Conclusions: Although ToM deficits might predate conversion to psychosis, one must consider initial symptoms as well. Social judgments were not associated with conversion to schizophrenia.

Keywords: Clinical high risk; Longitudinal study; Schizophrenia; Social cognition; Social judgments; Theory of mind.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Cognition Disorders / diagnosis
  • Cognition Disorders / etiology*
  • Female
  • Humans
  • Judgment / physiology*
  • Linear Models
  • Longitudinal Studies
  • Male
  • Neuropsychological Tests
  • Psychiatric Status Rating Scales
  • Psychotic Disorders / complications*
  • Psychotic Disorders / psychology*
  • Social Behavior*
  • Theory of Mind / physiology*
  • Young Adult