The cognitive architecture of verbal humor in schizophrenia

Previous literature showed that people with schizophrenia have difficulties in humor comprehension and might differ from controls in the appreciation of humor, i.e., in perceived funniness. However, the cognitive architecture that underlies humor impairment in this population remains unclear, with humorous items sometimes assessed in the context of the communicative-pragmatic profiling and sometimes included in Theory of Mind (ToM) tasks. Here we enrolled 116 people with schizophrenia and 116 healthy controls, who were administered a task including jokes based on sound aspects and jokes based on mental aspects (Phonological and Mental Jokes task). Both comprehension accuracy (ability to select the funny ending of the joke) and appreciation (ratings of funniness) were evaluated, together with other linguistic, cognitive, and clinical measures. Results highlighted a diffuse impairment in humor comprehension in schizophrenia compared to controls, with mental jokes being more difficult for both groups. Humor comprehension was robustly associated with the patients' global pragmatic and linguistic profile, while the association with ToM was negligible. Another remarkable finding was the increased appreciation of humor in individuals with schizophrenia, who rated jokes (both correctly and incorrectly completed) as funnier than controls did. Funniness ratings were not predicted by any measure, pointing to a dimension untied from cognition or psychopathology. Overall, this study offers evidence - on a considerably large sample - of altered humor understanding and appreciation in schizophrenia, sketching a cognitive architecture where humor impairment stands together with communicative impairment, rather than with social cognition. This has implications not only for the assessment of humor, but also for how to treat it in patients to improve their ability to navigate the social world.