Altered neural response to social awkwardness in schizophrenia spectrum disorders

Individuals with a schizophrenia spectrum disorder (SSD) have difficulties with social information processing, including mental state attribution, or "theory of mind" (ToM). Prior work has shown that these difficulties are related to disruption to the neural network subserving ToM. However, few such studies utilize naturalistic stimuli that are more representative of daily social interaction. Here, SSD and non-SSD individuals underwent fMRI while watching The Office to better understand how the ToM network responds to dynamic and complex social information, such as socially awkward moments. We find that medial prefrontal cortex tracks less with moment-to-moment awkwardness in SSD individuals. We also find a broad decrease in functional connectivity in the ToM network in SSD. Furthermore, neural response during awkward moments and functional connectivity was associated with psychotic experiences and social functioning. These results suggest that during naturalistic, socially awkward moments where mental state attribution is critical, individuals with SSD fail to recruit key regions of the ToM network, possibly contributing to decreased social understanding and impaired functioning.