Social Cognition in Schizophrenia, Unaffected Relatives and Ultra-High Risk for Psychosis: What Do We Currently Know?

Introduction. Schizophrenia patients show impairments in social cognition (SC), which is a set of cognitive processes that underlie social interactions. The research about SC in schizophrenia has identified four main domains: Theory of mind (ToM), social perception, attributional style and emotional processing. The present review aims to summarize the most recent and consistent findings about SC in patients with schizophrenia, unaffected relatives and ultra-high risk for psychosis individuals (UHR), as well as its association with clinical variables and functional outcome. Methods. A systematic PsycINFO and Pubmed/Medline databases search was conducted. Results. ToM impairments have been observed in schizophrenia patients, unaffected relatives and UHR. Emotional processing disturbance has been consistently reported in schizophrenia patients and UHR. ToM and emotional processing have been correlated with symptomatology and functional outcome. However, inconsistencies have been found across studies that assess ToM and emotional processing as predictors of psychosis. Social perception and attributional style are affected in schizophrenia, but the research in at- risk populations is scarce, and their relationship with symptoms or functional outcome is not clear. Conclusions. All domains of SC are impaired in schizophrenia. Non affected relatives and UHR also display deficits of SC. More research must be conducted to assess the reliability of SC domains as endophenotypes or predictors of conversion to psychosis in at-risk populations.