Theory of mind and context processing in schizophrenia: the role of cognitive flexibility

The present study sought to identify whether cognitive flexibility and context processing may impact theory of mind (ToM) ability in schizophrenia. Thirty two patients with schizophrenia and 29 matched healthy participants were tested individually on their ToM ability using a task involving attribution and comprehension of a speaker's ironic intent. This task made it possible to determine whether the degree of incongruity between contextual information and a target sentence has an impact on the attribution of ironic intent to the protagonists of a story. Participants were also assessed on their cognitive flexibility and working memory. The main results revealed that participants with schizophrenia correctly perceived contextual information cueing attribution of ironic intent to the protagonist of the stimulus, but they showed difficulty to correctly integrate this information, performing significantly worse than healthy participants when they attributed mental states. However, some participants with schizophrenia performed like healthy control participants on the ToM task while others did not. A lack of flexibility seems to differentiate the two schizophrenia subgroups thereby obtained, suggesting that cognitive flexibility has an impact on ToM performances in schizophrenia. These difficulties were not associated with clinical symptoms. Such results will have an impact on cognitive remediation.