Social cognitive deficits are common across many psychiatric conditions and contribute to broader social dysfunction. One hypothesized mechanism involves altered basic visual processing, which may disrupt the perception of low-level social cues and, in turn, compromise broader social cognitive processes. Here, we examined relations between basic visual processing and different levels of social cognition in a transdiagnostic youth sample.

A sample of 148 youth, ranging from healthy individuals to individuals with neuropsychiatric diagnoses and significant social dysfunction, completed two measures of basic visual processing (contrast sensitivity and visual integration) and a battery of social cognition tasks spanning lower-level (gaze perception) to mid-level (emotion recognition) to higher-level (theory of mind) social cognition. We used a four-level path model to test whether basic visual processing predicts gaze perception, which in turn predicts emotion recognition, which predicts theory of mind.

Poorer contrast sensitivity and visual integration were associated with less precise gaze perception, which was, in turn, associated with worse emotion recognition, which was associated with worse theory of mind. This four-level path model demonstrated good fit and showed superior fit compared to alternative models.

These findings suggest that basic visual processing influences the perception of basic social cues (e.g. gaze direction), which subsequently impairs more complex social perception and inference. Notably, this study extends prior observations from individuals with chronic schizophrenia to a transdiagnostic youth sample, indicating that altered basic visual processing may be a shared mechanism contributing to social cognitive deficits across psychiatric disorders and illness stages.

Social cognitive impairments are a fundamental aspect of schizophrenia, exerting a substantial influence on patients’ functional outcomes. However, to date, there have been no meta-analyses of comprehensive pharmacological interventions covering all domains of social cognition. The aim of the present study was to address this knowledge gap by conducting a network meta-analysis, a comprehensive approach that systematically compares the efficacy of pharmacological interventions across all domains of social cognition.

A literature search for randomized controlled trials (RCTs) was conducted using PubMed, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.

A total of 8,752 records were screened, and 60 RCTs involving 4,270 subjects were included in the systematic review. Thirty-six pharmacological interventions were extracted, but no compounds had a significant ameliorative effect on social cognition in comparison with placebo. In each domain of social cognition, the following compounds were identified as the most probable candidates for treatment selection: selective glycine uptake inhibitor (standardized mean difference [SMD], 0.46; 95% credible interval [CI], −0.52 to 1.44) and stimulant (SMD, 0.44; 95% CI, −0.57 to 1.45) for emotion perception in comparison with placebo. In the context of emotion processing, γ-aminobutyric acid (A) α2/α3 partial agonist (SMD, 0.33; 95% CI, −0.53 to 1.19) emerged as the top compound.

To date, no pharmacological interventions have demonstrated efficacy for social cognitive impairments in schizophrenia.

Impairments in mentalizing, or theory of mind, occur across psychiatric disorders. Static illustrations are widely used to assess mentalizing due to their simplicity, and they allow assessment of specific cognitive processes. However, systematic comparisons of impairments between psychiatric disorders, neurodevelopmental disorders, and at-risk groups in mentalizing tasks with static illustrations are currently lacking.

A systematic review with pairwise and network meta-analyses (NMA) was conducted to evaluate mentalizing impairments using tasks with static illustrations across psychiatric disorders compared to healthy controls (HCs) and between groups. Subgroup analyses examined specific mentalizing domains (false belief, humor, and intentionality), and meta-regression analyses explored potential moderators. The ceiling effects of specific tasks were also examined.

Eighty-nine studies were included, involving 9,038 participants and 11 psychiatric conditions. Significant mentalizing deficits were observed across all conditions versus HCs, except for the familial risk for bipolar disorder group. NMA demonstrated that schizophrenia (g = −0.960) and early schizophrenia (g = −0.785) exhibited the most pronounced impairments, followed by borderline personality disorder (g = −0.612) and obsessive-compulsive disorder (g = −0.613). Particularly, schizophrenia showed significantly greater deficits than autism, bipolar disorder, clinical and familial high risk for schizophrenia, and depression. Domain-specific analyses highlighted differential impairment patterns. The presence of prominent ceiling effects suggests major limitations of tasks with static illustrations.

This review provides detailed insights into transdiagnostic and disorder-specific patterns of mentalizing impairments with tasks using static illustrations. Findings highlight the importance of domain-specific approaches, examining interindividual variability, refining assessment tools, and implementing targeted interventions.

Impairments in social interaction are common symptoms of dementia and necessitate the use of validated neuropsychological instruments to measure social cognition. We aim to investigate the Hinting Task – Dutch version (HT-NL), which measures the ability to infer intentions behind indirect speech to assess Theory of Mind, in dementia.

Sixty-six patients with dementia, of whom 22 had behavioral variant frontotemporal dementia (bvFTD), 21 had primary progressive aphasia, and 23 had Alzheimer’s disease (AD), and 99 healthy control participants were included. We examined the HT-NL’s psychometric properties, including internal consistency, between-group differences using analyses of covariance with Bonferroni-adjusted post hoc comparisons, discriminative ability and concurrent validity using the area under the receiver operating characteristic curve (AUC), and construct validity using Spearman rank correlations with other cognitive tests.

Internal consistency was acceptable (Cronbach’s α = 0.74). All patient groups scored lower on the HT-NL than the control group. Patients with bvFTD scored lower than patients with AD dementia. The HT-NL showed excellent discriminative ability (AUC = 0.83), comparable to a test of emotion recognition (ΔAUC = 0.03, p = .67). The HT-NL correlated significantly with a test for emotion recognition (r = .45), and with measures of memory and language (r = [.31, .40]), but not with measures of information processing speed, executive functioning, or working memory (r = [.00, .17]). Preliminary normative data are provided.

The HT-NL is a psychometrically sound and valid instrument and is useful for identifying Theory of Mind impairments in patients with dementia.

Spontaneous mentalizing refers to the capacity to attribute mental states to oneself and others without explicit prompts or conscious deliberation. This process enables individuals to comprehend and anticipate social behaviors in a more intuitive manner. Individuals diagnosed with schizophrenia frequently demonstrate deficits in this domain, which contribute to impaired social functioning. The present meta-analysis aims to assess the extent of spontaneous mentalizing impairments in schizophrenia.

A comprehensive search was conducted in four prominent databases: MEDLINE, EMBASE, CENTRAL, and Web of Science. Following the review of the retrieved records and subsequent citation searching, a total of 15 studies were selected for inclusion in the quantitative synthesis. The data of 526 patients diagnosed with schizophrenia and 536 controls were subjected to analysis. Effect sizes for intentionality and appropriateness were computed utilizing weighted or standardized mean differences, and heterogeneity was evaluated.

Patients with schizophrenia exhibited substantial impairments in intentionality and appropriateness during mentalizing tasks, with large effect sizes. No significant differences were observed in random movement tasks, although patients also demonstrated deficits in interpreting goal-directed movements. Furthermore, high heterogeneity in some outcomes and variability in study methodologies were also noted.

This analysis corroborates substantial spontaneous mentalizing deficits in schizophrenia, underscoring their potential role in impaired social functioning. In conjunction with previous analyses, the present findings emphasize the pervasive nature of mentalizing deficits in schizophrenia, encompassing explicit, implicit, and spontaneous dimensions. These results hold significant implications for therapeutic strategies designed to augment social cognition in individuals with schizophrenia.

Mentalizing defines the set of social cognitive imaginative activities that enable interpretation of behaviors as arising from intentional mental states. Mentalization impairments have been related to childhood trauma (CT) and are widely present in people suffering from mental disorders. Nevertheless, the link between CT exposure, mentalization abilities, and related psychopathology remains unclear. This study aims to systematically review the evidence in this domain.

A Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic review of literature published until December 2022 was conducted through an Ovid search (Medline, Embase, and PsycINFO). The review was registered in the Prospective Register of Systematic Reviews (PROSPERO) (CRD42023455602).

Twenty-nine studies were included in the qualitative synthesis. Twenty studies (69%) showed a significant negative correlation between CT and mentalization. There was solid evidence for this association in patients with psychotic disorders, as almost half the studies focused on this population. The few studies focusing on unipolar depression, personality disorders, and opioid addiction also reported a negative impact of CT on mentalization. In contrast, evidence for post-traumatic stress disorder was inconsistent, and no evidence was found for bipolar disorder. When stratifying for subtypes of CT, there was solid evidence that neglect (physical and emotional) decreased mentalization capacity, while abuse (physical, emotional, or sexual) was not associated with mentalization impairments.

Although causality cannot be established, there was substantial evidence that CT negatively affects mentalization across various psychiatric disorders, particularly psychotic disorders. These findings highlight the potential of targeting mentalization impairments in prevention and treatment strategies aiming to reduce the incidence and the social functioning burden of mental illness.