Capacities for theory of mind, metacognition, and neurocognitive function are independently related to emotional recognition in schizophrenia Paul H. Lysaker a,b,n , Bethany L. Leonhardt a , Martin Brüne c , Kelly D. Buck a , Alison James d , Jenifer Vohs b,e , Michael Francis b,e , Jay A. Hamm f , Giampaolo Salvatore g , Jamie M. Ringer a , Giancarlo Dimaggio g a Roudebush VA Medical Center (116H),1481 West 10th Street, Indianapolis, IN, USA b Indiana University School of Medicine, Indianapolis, IN, USA c Research Department of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital, Bochum, Germany d Indiana State University, Department of Psychology, Terre Haute, IN, USA e Larue D. Carter Memorial Hospital, IU Psychotic Disorders Research Program, Indianapolis, IN, USA f Midtown Community Mental Health Center/Eskenazi Health, Indianapolis, IN, USA g Centro di Terapia Metacognitiva Interpersonale, Rome, Italy article info Article history: Received 4 January 2014 Received in revised form 28 April 2014 Accepted 4 May 2014 Keywords: Schizophrenia Metacognition Theory of mind Negative symptoms Social cognition Neurocognition Affect recognition abstract While many with schizophrenia spectrum disorders experience difficulties understanding the feelings of others, little is known about the psychological antecedents of these deficits. To explore these issues we examined whether deficits in mental state decoding, mental state reasoning and metacognitive capacity predict performance on an emotion recognition task. Participants were 115 adults with a schizophrenia spectrum disorder and 58 adults with substance use disorders but no history of a diagnosis of psychosis who completed the Eyes and Hinting Test. Metacognitive capacity was assessed using the Metacognitive Assessment Scale Abbreviated and emotion recognition was assessed using the Bell Lysaker Emotion Recognition Test. Results revealed that the schizophrenia patients performed more poorly than controls on tests of emotion recognition, mental state decoding, mental state reasoning and metacognition. Lesser capacities for mental state decoding, mental state reasoning and metacognition were all uniquely related emotion recognition within the schizophrenia group even after controlling for neurocognition and symptoms in a stepwise multiple regression. Results suggest that deficits in emotion recognition in schizophrenia may partly result from a combination of impairments in the ability to judge the cognitive and affective states of others and difficulties forming complex representations of self and others. Published by Elsevier Ireland Ltd. 1. Introduction Persons with schizophrenia spectrum disorders have been widely found to experience significant difficulties recognizing the emotions other people experience. This includes problems inferring emotions in others from any of a range of verbal and non- verbal cues (Bell et al., 1997; Brüne, 2005a; Derntl et al., 2009; Hofer et al., 2009; Fiszdon and Johannesen, 2010), especially as social interactions become more complex (Baslet et al., 2009). These deficits are of both of theoretical and clinical interest in that they, by definition, represent a fundamental barrier to intimacy and intersubjectivity (Salvatore et al., 2007, 2008) and have been found in a range of studies to uniquely predict social and vocational function above and beyond the effects of other aspects of illness, such as neurocognitive deficits (Bora et al., 2006; Bell et al., 2009). One issue which is of increasing interest concerns whether there are different factors which might create or sustain deficits in emotional recognition (Fiszdon and Johannesen, 2010). Research has demonstrated that thinking about other people and oneself may involve semi-independent components (Lin et al., 2012; Mancuso et al., 2012). Some evidence, for instance, suggests that certain brain regions (e.g., amygdala) are activated when forming first impressions about the mental states of other people, while other areas may be active when people revise those quick judg- ments (Schiller et al., 2009). A slightly different set of brain Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres Psychiatry Research http://dx.doi.org/10.1016/j.psychres.2014.05.004 0165-1781/Published by Elsevier Ireland Ltd. n Corresponding author at: Roudebush VA Medical Center (116H),1481 West 10th Street, Indianapolis, IN, USA. Please cite this article as: Lysaker, P.H., et al., Capacities for theory of mind, metacognition, and neurocognitive function are independently related to emotional recognition in.... Psychiatry Research (2014), http://dx.doi.org/10.1016/j.psychres.2014.05.004i Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎