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Fortschr Neurol Psychiatr 2008; 76(10): 573-582
DOI: 10.1055/s-2008-1038250
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Theory of Mind bei Schizophrenien: Klinische und wissenschaftliche Aspekte

Theory of Mind in Schizophrenia: Clinical Aspects and Empirical ResearchK.  Koelkebeck1 , M.  Abdel-Hamid2 , P.  Ohrmann1 , M.  Brüne2
  • 1Klinik und Poliklinik für Psychiatrie und Psychotherapie des Universitätsklinikums Münster (Prof. Dr. med. Volker Arolt), Münster
  • 2LWL Klinik Bochum, Psychiatrie, Psychotherapie, Psychosomatik und Präventivmedizin, Klinik der Ruhr-Universität (Prof. Dr. med. Georg Juckel), Bochum
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Publication History

Publication Date:
02 October 2008 (online)

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Zusammenfassung

Eine Vielzahl von Studien hat sich mit den Fähigkeiten der sozialen Kognition bei psychiatrischen Erkrankungen befasst. Dabei kommt dem Konzept der Theory of Mind (ToM), welches die Fähigkeit bezeichnet, sich die eigenen Gedanken, Gefühle und Intentionen sowie die anderer Personen zu vergegenwärtigen, eine herausragende Bedeutung zu. Zahlreiche Untersuchungen haben sich mit Beeinträchtigungen dieser Fähigkeit unter anderem bei der Schizophrenie befasst und Hinweise auf selektive Defizite gefunden. Psychotische Symptome, wie z. B. Beeinflussungserleben und Verfolgungswahn, könnten ihre Ursache in der reduzierten Fähigkeit haben, eigene Intentionen und die des Gegenübers korrekt einzuschätzen. Inwiefern verminderte ToM-Fähigkeiten bei Patienten mit einer schizophrenen Psychose mit akuten Krankheitsphasen verbunden sind und ob diese Defizite durch kognitives Training verbessert werden können, ist Gegenstand aktueller Diskussion. In rezenten Studien wird zunehmend von ursprünglichen Forschungsrichtungen, in denen lediglich Defizite erfasst wurden, abgewichen. Es werden sowohl Unterscheidungen zwischen verschiedenen Bereichen sozialer Kognition getroffen als auch deren Zusammenhänge mit Sprach- und anderen kognitiven Fertigkeiten untersucht. Ein weiterer Schwerpunkt wird auf die verschiedenen Aspekte defizitärer sozialer Kognition und ihre Verknüpfung mit schizophrenen Spektrumsstörungen gelegt. Ziel dieses Artikels ist eine Begriffsklärung der verschiedenen Bereiche der sozialen Kognition sowie die Darstellung klinischer Implikationen und neuester Ergebnisse und Forschungsmethoden.

Abstract

The term Theory of Mind (ToM) refers to the capacity to infer one’s own and other persons’ mental states. A substantial body of research has highlighted impaired ToM in a variety of neuropsychiatric disorders, including schizophrenia. There is good empirical evidence that ToM is specifically impaired in schizophrenia and that many psychotic symptoms – for instance, delusions of alien control and persecution – may best be understood in light of a disturbed capacity in patients to relate their own intentions to executing behavior, and to monitor others’ intentions. However, it is still under debate if impaired ToM in schizophrenia is a state- or trait marker and whether patients could benefit from cognitive training in this domain. Recently, research has not only emphasized social cognitive deficits in patients, but has also focussed on interactions between ToM with language and other cognitive functions. Furthermore, interest in subprocesses of social cognition in psychotic spectrum disorders (e. g. schizotypy) is growing. The aim of this article is to line out clinical aspects of disturbed social cognition, to clarify terms used in this context as well as to present the latest research approaches into social cognition deficits.

Schlüsselwörter

Theory of Mind - Schizophrenie - Kognition - linguistische Fähigkeiten - Zustands-/Episodenmarker

Key words

Theory of Mind - schizophrenia - cognition - language abilities - state-/trait marker

Literatur

  • 1 Frith C D. The cognitive Neuropsychology of Schizophrenia. Hove, UK: Lawrence Erlbaum Associates 1992
    Google Scholar
  • 2 Premack D, Woodruff G. Does the chimpanzee have a “Theory of mind”?.  Behav Brain Sci. 1978;  4 515-526
    Google Scholar
  • 3 Brüne M. “Theory of mind” in schizophrenia: A review of the literature.  Schizophr Bull. 2005;  31(1) 21-42
    Google Scholar
  • 4 Langdon R, Coltheart M, Ward P B. Empathetic perspective-taking is impaired in schizophrenia: Evidence from a study of emotion attribution and theory of mind.  Cognit Neuropsychiatry. 2006;  11 (2) 133-155
    Google Scholar
  • 5 Jahshan C S, Sergi M J. Theory of mind, neurocognition, and functional status in schizotypy.  Schizophr Res. 2007;  89 (1 – 3) 278-286
    Google Scholar
  • 6 Scholl B J, Leslie A. Modularity, development and “Theory of mind”.  Mind Lang. 1999;  14 131-153
    Google Scholar
  • 7 Perner J. Understanding the representational Mind. Cambridge, MA: MIT Press 1991
    Google Scholar
  • 8 Davies M, Stone T. Mental Simulations: Evaluations and Applications. Oxford, UK: Blackwell 1995
    Google Scholar
  • 9 Stone V E, Gerrans P. Does the normal brain have a theory of mind?.  Trends Cogn Sci. 2006;  10 3-4
    Google Scholar
  • 10 Wimmer H, Perner J. Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children's understanding of deception.  Cognition. 1983;  13 (1) 103-128
    Google Scholar
  • 11 Bruning N, Konrad K, Herpertz-Dahlmann B. Bedeutung und Ergebnisse der Theory of Mind-Forschung für den Autismus und andere psychiatrische Erkrankungen.  Z Kinder Jugendpsychiatr Psychother. 2005;  33 (2) 77-88
    Google Scholar
  • 12 Brunet-Gouet E, Decety J. Social brain dysfunctions in schizophrenia: A review of neuroimaging studies.  Psychiatry Res. 2006;  148 (2 – 3) 75-92
    Google Scholar
  • 13 Brüne M. Theory of mind and the role of IQ in chronic disorganized schizophrenia.  Schizophr Res. 2003;  60 (1) 57-64
    Google Scholar
  • 14 Mazza M, De Risio A, Surian L. et al . Selective impairments of theory of mind in people with schizophrenia.  Schizophr Res. 2001;  47 (2 – 3) 299-308
    Google Scholar
  • 15 Castelli F, Happé F G, Frith U. et al . Movement and mind: A functional imaging study of perception and interpretation of complex intentional movement patterns.  Neuroimage. 2000;  12 (3) 314-325
    Google Scholar
  • 16 Brüne M. Emotion recognition, “Theory of mind” and social behavior in schizophrenia.  Psychiatry Res. 2005;  133 (2 – 3) 135-147
    Google Scholar
  • 17 Mazza M, De Risio A, Tozzini C. et al . Machiavellianism and theory of mind in people affected by schizophrenia.  Brain Cogn. 2003;  51 (3) 262-269
    Google Scholar
  • 18 Brüne M, Abdel-Hamid M, Lehmkämper C. et al . Mental state attribution, neurocognitive functioning, and psychopathology: What predicts poor social competence in schizophrenia best?.  Schizophr Res. 2007;  92 (1 – 3) 151-159
    Google Scholar
  • 19 Silver H, Goodman C, Knoll G. et al . Schizophrenia patients with a history of severe violence differ from nonviolent schizophrenia patients in perception of emotions but not cognitive function.  J Clin Psychiatry. 2005;  66 (3) 300-308
    Google Scholar
  • 20 Abu-Akel A, Abushua'leh K. “Theory of mind” in violent and non-violent patients with paranoid schizophrenia.  Schizophr Res. 2004;  69 (1) 45-53
    Google Scholar
  • 21 Conrad K. Die beginnende Schizophrenie. Versuch einer Gestaltanalyse des Wahns. Stuttgart, DE: Thieme 1958
    Google Scholar
  • 22 Bertrand M C, Sutton H, Achim A M. Social cognitive impairments in first episode psychosis.  Schizophr Res. 2007;  95 (1 – 3) 124-133
    Google Scholar
  • 23 Inoue Y, Yamada K, Hirano M. et al . Impairment of theory of mind in patients in remission following first episode of schizophrenia.  Eur Arch Psychiatry Clin Neurosci. 2006;  256 (5) 326-328
    Google Scholar
  • 24 Kettle J W, O’Brien-Simpson L, Allen N B. Impaired theory of mind in first-episode schizophrenia: Comparison with community, university and depressed controls.  Schizophr Res. 2008;  99 (1 – 3) 96-102
    Google Scholar
  • 25 Holst E von, Mittelstaedt H. Das Reafferenzprinzip.  Naturwissenschaften. 1950;  37 (20) 464-476
    Google Scholar
  • 26 Langdon R, Michie P T, Ward P B. et al . Defective self and/or other mentalising in schizophrenia: A cognitive neuropsychological approach.  Cognit Neuropsychiatry. 1997;  2 167-193
    Google Scholar
  • 27 Hardy-Baylé M C. Organisation de l'action, phénomènes de conscience et représentation mentale de l'action chez des schizophrènes.  Actual Psychiatr. 1994;  20 393-400
    Google Scholar
  • 28 Hemsley D R. The schizophrenic experience: Taken out of context?.  Schizophr Bull. 2005;  31 (1) 43-53
    Google Scholar
  • 29 Schenkel L S, Spaulding W D, Silverstein S M. Poor premorbid social functioning and theory of mind deficit in schizophrenia: Evidence of reduced context processing?.  J Psychiatr Res. 2005;  39 (5) 499-508
    Google Scholar
  • 30 Sarfati Y, Hardy-Baylé M C, Brunet E. et al . Investigating theory of mind in schizophrenia: Influence of verbalization in disorganized and non-disorganized patients.  Schizophr Res. 1999;  37 (2) 183-190
    Google Scholar
  • 31 Abu-Akel A. Impaired theory of mind in schizophrenia.  Pragmat Cogn. 1999;  7 247-282
    Google Scholar
  • 32 Harrington L, Siegert R J, McClure J. Theory of mind in schizophrenia: A critical review.  Cognit Neuropsychiatry. 2005;  10 (4) 249-286
    Google Scholar
  • 33 Pickup G J, Frith C D. Theory of mind impairments in schizophrenia: Symptomatology, severity and specificity.  Psychol Med. 2001;  31 (2) 207-220
    Google Scholar
  • 34 Bömmer I, Brüne M. Neuropsychologische Aspekte wahnhafter Störungen: Charakteristischer Attribuierungsstil oder kognitives Defizit?.  Nervenarzt. 2007;  78 (7) 796-801
    Google Scholar
  • 35 Corcoran R, Frith C D. Autobiographical memory and theory of mind: Evidence of a relationship in schizophrenia.  Psychol Med. 2003;  33 (5) 897-905
    Google Scholar
  • 36 Sperber D, Wilson D. Pragmatics, modularity and mind-reading.  Mind Lang. 2002;  17 3-23
    Google Scholar
  • 37 Corcoran R, Frith C D. Conversational conduct and the symptoms of schizophrenia.  Cogn Neuropsychol. 1996;  1 305-318
    Google Scholar
  • 38 Abdi Z, Sharma T. Social cognition and its neural correlates in schizophrenia and autism.  CNS Spectr. 2004;  9 (5) 335-343
    Google Scholar
  • 39 Langdon R, Coltheart M, Ward P B. et al . Disturbed communication in schizophrenia: The role of poor pragmatics and poor mind-reading.  Psychol Med. 2002;  32 (7) 1273-1284
    Google Scholar
  • 40 Brüne M, Bodenstein L. Proverb comprehension reconsidered-“Theory of mind” and the pragmatic use of language in schizophrenia.  Schizophr Res. 2005;  75 (2 – 3) 233-239
    Google Scholar
  • 41 Burns J K. The social brain hypothesis of schizophrenia.  World Psychiatry. 2006;  5 (2) 77-81
    Google Scholar
  • 42 Russell T A, Sharma T. Social Cognition and the neural Level: Investigations in Autism, Psychopathy and Schizophrenia. In: Brüne M, Ribbert H, Schiefenhövel W, Hrsg. The social Brain. Evolution and Pathology. Chichester, UK: Wiley and Sons 2003: 253-276
    Google Scholar
  • 43 Vogeley K, Kurthen M, Falkai P. et al . Essential functions of the human self model are implemented in the prefrontal cortex.  Conscious Cogn. 1999;  8(3) 343-363
    Google Scholar
  • 44 Sabbagh M A, Moulson M C, Harkness K L. Neural correlates of mental state decoding in human adults: An event-related potential study.  J Cogn Neurosci. 2004;  16(3) 415-426
    Google Scholar
  • 45 Gallagher H L, Frith C D. Functional imaging of “Theory of mind”.  Trends Cogn Sci. 2003;  7(2) 77-83
    Google Scholar
  • 46 Leube D, Pauly K, Kircher T. Schizophrenie und parietaler Kortex.  Nervenheilkunde. 2006;  6 442-444
    Google Scholar
  • 47 Russell T A, Rubia K, Bullmore E T. et al . Exploring the social brain in schizophrenia: Left prefrontal underactivation during mental state attribution.  Am J Psychiatry. 2000;  157 (12) 2040-2042
    Google Scholar
  • 48 Frith C D, Frith U. Interacting minds – a biological basis.  Science. 1999;  286 (5445) 1692-1695
    Google Scholar
  • 49 Frith U, Frith C D. The biological basis of social interaction.  Curr Dir Psychol Sci. 2001;  10 151-155
    Google Scholar
  • 50 Fujiwara H, Hirao K, Namiki C. et al . Anterior cingulate pathology and social cognition in schizophrenia: A study of gray matter, white matter and sulcal morphometry.  Neuroimage. 2007;  36 (4) 1236-1245
    Google Scholar
  • 51 Langdon R, Coltheart M. Recognition of metaphor and irony in young adults: The impact of schizotypal personality traits.  Psychiatry Res. 2004;  125 (1) 9-20
    Google Scholar
  • 52 Pickup G J. Theory of mind and its relation to schizotypy.  Cognit Neuropsychiatry. 2006;  11 (2) 177-192
    Google Scholar
  • 53 Platek S M, Critton S R, Myers T E. et al . Contagious yawning: The role of self-awareness and mental state attribution.  Brain Res Cogn Brain Res. 2003;  17 (2) 223-227
    Google Scholar
  • 54 Frith U. Autism: Explaining the Enigma. Oxford, UK: Blackwell Publishing 2003
    Google Scholar
  • 55 Inoue Y, Tonooka Y, Yamada K. et al . Deficiency of theory of mind in patients with remitted mood disorder.  J Affect Disord. 2004;  82(3) 403-409
    Google Scholar
  • 56 Bora E, Vahip S, Gonul A S. et al . Evidence for theory of mind deficits in euthymic patients with bipolar disorder.  Acta Psychiatr Scand. 2005;  112 (2) 110-116
    Google Scholar
  • 57 Uekermann J, Channon S, Winkel K. et al . Theory of mind, humour processing and executive functioning in alcoholism.  Addiction. 2007;  102 (2) 232-240
    Google Scholar
  • 58 Tchanturia K, Happé F G, Godley J. et al . “Theory of mind” in anorexia nervosa.  Eur Eat Dis Rev. 2004;  12 361-366
    Google Scholar
  • 59 Gregory C, Lough S, Stone V. et al . Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer’s disease: Theoretical and practical implications.  Brain. 2002;  125 (Pt 4) 752-764
    Google Scholar
  • 60 Langdon R, Coltheart M. Mentalising, schizotypy, and schizophrenia.  Cognition. 1999;  71 (1) 43-71
    Google Scholar
  • 61 David N, Bewernick B H, Cohen M X. et al . Neural representations of self versus other: Visual-spatial perspective taking and agency in a virtual ball-tossing game.  J Cogn Neurosci. 2006;  18 (6) 898-910
    Google Scholar
  • 62 Langdon R, Coltheart M. Visual perspective-taking and schizotypy: Evidence for a simulation-based account of mentalizing in normal adults.  Cognition. 2001;  82 (1) 1-26
    Google Scholar
  • 63 Irani F, Platek S M, Panyavin I S. et al . Self-face recognition and theory of mind in patients with schizophrenia and first-degree relatives.  Schizophr Res. 2006;  88 (1 – 3) 151-160
    Google Scholar
  • 64 Russell T A, Reynaud E, Herba C. et al . Do you see what I see? Interpretations of intentional movement in schizophrenia.  Schizophr Res. 2006;  81 (1) 101-111
    Google Scholar
  • 65 Kircher T, Leube D. Selbst-Fremd-Repräsentation und ihre Störungen bei Schizophrenie. In: Förstl H, Hrsg. Theory of Mind. Neurobiologie und Psychologie sozialen Verhaltens. Heidelberg, DE: Springer Medizin Verlag 2007: 285-294
    Google Scholar
  • 66 Frith C D, Blakemore S, Wolpert D M. Explaining the symptoms of schizophrenia: Abnormalities in the awareness of action.  Brain Res Brain Res Rev. 2000;  31 (2 – 3) 357-363
    Google Scholar
  • 67 Blakemore S J, Smith J, Steel R. et al . The perception of self-produced sensory stimuli in patients with auditory hallucinations and passivity experiences: Evidence for a breakdown in self-monitoring.  Psychol Med. 2000;  30 (5) 1131-1139
    Google Scholar
  • 68 Gottesman I I, Gould T D. The endophenotype concept in psychiatry: Etymology and strategic intentions.  Am J Psychiatry. 2003;  160 (4) 636-645
    Google Scholar
  • 69 Canli T, Lesch K P. Long story short: The serotonin transporter in emotion regulation and social cognition.  Nat Neurosci. 2007;  10 (9) 1103-1109
    Google Scholar
  • 70 Bassett A S, Caluseriu O, Weksberg R. et al . Catechol-o-Methyl transferase and expression of schizophrenia in 73 adults with 22q11 deletion syndrome.  Biol Psychiatry. 2007;  61(10) 1135-1140
    Google Scholar
  • 71 Moritz S, Woodward T S, Burlon M. Metakognitives Training für schizophrene Patienten (MKT). Manual. Hamburg, DE: VanHam Campus Verlag 2005
    Google Scholar
  • 72 Combs D R, Adams S D, Penn D L. et al . Social cognition and interaction training (SCIT) for inpatients with schizophrenia spectrum disorders: Preliminary findings.  Schizophr Res. 2007;  91 (1 – 3) 112-116
    Google Scholar
  • 73 Kayser N, Sarfati Y, Besche C. et al . Elaboration of a rehabilitation method based on a pathogenetic hypothesis of “Theory of mind” impairment in schizophrenia.  Neuropsychol Rehabil. 2006;  16 (1) 83-95
    Google Scholar
  • 74 Mizrahi R, Kiang M, Mamo D C. et al . The selective effect of antipsychotics on the different dimensions of the experience of psychosis in schizophrenia spectrum disorders.  Schizophr Res. 2006;  88 (1 – 3) 111-118
    Google Scholar
  • 75 Knowles L, Sharma T. Identifying vulnerability markers in prodromal patients: A step in the right direction for schizophrenia prevention.  CNS Spectr. 2004;  9 (8) 595-602
    Google Scholar
  • 76 Bora E, Sehitoglu G, Aslier M. et al . Theory of mind and unawareness of illness in schizophrenia: Is poor insight a mentalizing deficit?.  Eur Arch Psychiatry Clin Neurosci. 2007;  257(2) 104-111
    Google Scholar
  • 77 Brüne M. Social Cognition and Behavior in Schizophrenia. In: Brüne M, Ribbert H, Schiefenhövel W, Hrsg. The social Brain. Evolution and Pathology. Chichester, UK: Wiley and Sons 2003: 227-313a
    Google Scholar
  • 78 Schiffman J, Lam C W, Jiwatram T. et al . Perspective-taking deficits in people with schizophrenia spectrum disorders: A prospective investigation.  Psychol Med. 2004;  34 (8) 1581-1586
    Google Scholar

Dr. med. Katja Koelkebeck

Klinik und Poliklinik für Psychiatrie und Psychotherapie Universitätsklinikum Münster

Albert-Schweitzer-Straße 11

48149 Münster

Email: katja.koelkebeck@ukmuenster.de

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