A comprehensive investigation of social cognition across different stages of psychosis: A staging model comparison including familial high-risk, ultra high-risk, first episode and chronic patients.

Background

Social cognition (SC) is central to functioning in schizophrenia spectrum disorders, yet most studies examine single disease stages or domains. It therefore remains unclear whether five SC domains (Theory of Mind [ToM], Social Perception [SP], Social Knowledge [SK], Emotion Recognition [ER], Attributional Bias [AB]) show homogenous impairments and follow a stage-like patterns across the psychosis spectrum.

Methods

A total of 359 participants (schizophrenia [SCH] = 59; first-episode psychosis [FEP] = 75; ultra-high risk [UHR-P] = 84; familial high-risk [FHR-P] = 55; healthy controls = 86) were administered a comprehensive SC battery and clinical scales. Group differences and linear trends (stage-ordered differences; stepwise gradients from FHR-P to SCH) were analyzed by ANCOVAs controlling for age and education. Associations with clinical variables were assessed using Spearman correlation.

Results

ANCOVA revealed a significant group difference only in ToM domain (p = .025), with lower performance in patients compared to asymptomatic FHRP. Linear trend analysis indicated small, but significant staging pattern in ToM (p = .023) and SK (p = .015). No significant staging was observed in SP, ER or AB. Better ToM and SK performance correlated with better functioning, fewer negative symptoms, and later age of onset.

Conclusions

SC impairment in psychosis is heterogeneous. ToM, and to a lesser extent SK, shows stage-ordered differences and significant clinical links, whereas SP, ER, and AB exhibit relatively flatter stage profiles across the psychosis spectrum. Given the cross-sectional design and modest effect sizes, conclusions about within-person change are not warranted.