ORIGINAL PAPER Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients Christiane Montag • Kathrin Neuhaus • Anja Lehmann • Katja Kru ¨ger • Isabel Dziobek • Hauke R. Heekeren • Andreas Heinz • Ju ¨ rgen Gallinat Received: 3 September 2010 / Accepted: 12 August 2011 / Published online: 4 September 2011 Ó Springer-Verlag 2011 Abstract Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocog- nitive endophenotypes, the existence of a distinct, poten- tially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree rela- tives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the ‘Movie for the Assessment of Social Cog- nition’—a video-based ToM test—and an empathy ques- tionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) ‘cognitive’ versus ‘emotional’ ToM, (2) error counts representing ‘undermentalizing’ versus ‘overmentalizing’, (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives’ group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for ‘undermentalizing’ but not for ‘overmentalizing’. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale ‘fantasy’ was associated with measures of psy- chotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophre- nia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia. Keywords Endophenotype Á Theory of mind Á Empathy Á Movie for the Assessment of Social Cognition (MASC) Á Interpersonal Reactivity Index Introduction Theory of mind (ToM) describes the capacity to attribute mental states like thoughts, beliefs, intentions and feelings to oneself and others [1], whereas empathy requires some degree of affective mental state matching between indi- viduals [2]. Amongst the spectrum of social-cognitive deficits implicated in schizophrenia, ToM has received particular attention [3–5]. A substantial body of literature illustrates the importance of ToM for the current under- standing of the disease [6], for its functional outcome [4, 7] and targeted therapy [8, 9]. Moreover, as ToM functioning Christiane Montag and Kathrin Neuhaus have equally contributed to this work. C. Montag Á K. Neuhaus Á A. Lehmann (&) Á K. Kru ¨ger Á A. Heinz Á J. Gallinat Department of Psychiatry and Psychotherapy, Charite ´ University Medicine Berlin (Charite ´ Universita ¨tsmedizin Berlin), Campus Mitte, Charite ´platz 1, 10117 Berlin, Germany e-mail: anja.lehmann@charite.de I. Dziobek Á H. R. Heekeren Max Planck Institute for Human Development (Max-Planck-Institut fu ¨r Bildungsforschung), Lentzeallee 94, 14195 Berlin, Germany I. Dziobek Á H. R. Heekeren Cluster of Excellence ‘‘Languages of Emotion’’, Freie Universita ¨t, Habelschwerdter Allee 45, 14195 Berlin, Germany 123 Eur Arch Psychiatry Clin Neurosci (2012) 262:217–226 DOI 10.1007/s00406-011-0250-2