Understanding of Faux Pas in patients with schizophrenia

Theory of Mind (ToM) refers to our ability to attribute mental states such as beliefs, intentions and desires to other, allowing us to explain, manipulate and predict others' behavior. ToM abilities of patients with schizophrenia were repeatedly found to be deficient. Our purpose in undertaking the present study was to explore ToM deficits in patients with schizophrenia, using a task of an affective aspect of ToM abilities, namely, "Faux Pas" Test (FPT). The FPT requires a "cognitive" ToM ability (i.e., knowing that the person who insults the other has not realized that she/he should not do that) and a more "affective" component (i.e., empathizing for the person who received the insulting utterance). We assessed 40 inpatients with schizophrenia (32 men) and 30 healthy participants (24 men), matching on age, level of education and sex ratio. All patients met DSM-IV criteria for schizophrenia. Four written scenarios containing a faux pas (unintentionally insulting or hurtful statements given a particular context) were presented to each examinee. The participants read each scenario and responded to a series of 4 questions: "Did anyone say something she/he should not have said?" (faux pas detection); "Why shouldn't she/he have said it?" (appreciation of potential negative impact on others); "Why do you think she/he said it?" (appreciation of speaker's lack of consideration); "How do you think the other person might have felt?" (awareness of other's emotional reaction). Patients with schizophrenia performed more poorly than healthy participants across all conditions: detection of FP [U=366.5, p=0.001], reasons should not have made FP [U=215.5, p<0.001], reasons for making FP [t(65)=4.294, p<0.001], and empathy [U=372, p=0.001]. Only the third condition (reasons for making FP) was significantly correlated with the age at first diagnosis (r=0.462, =0.004) and with ratings of positive symptoms (r=-0.391, p=0.017) and with symptoms of general psychopathology (r=-0.339, p=0.040). The present study further supports previous findings of patients with schizophrenia difficulties in theory of mind, as it was measured through a faux pas which also assess, apart from the understanding of a person' s mental state, the understanding of a person's emotional state, after having received an unintentional insult. The inability of patients with schizophrenia to empathize and therefore detect a faux pas may cause serious problems in their everyday communication with others. Appropriate cognitive interventions may help patients to avoid unintentionally hurting other people's emotions, thus improving their interpersonal relationships.