# Exploring theory of mind abilities in Lebanese chronic patients with schizophrenia: A cross-sectional study

## TL;DR

This study found that Lebanese patients with schizophrenia have impaired theory of mind abilities, especially in understanding others' second-order beliefs.

## Contribution

The study explores TOM impairments in a Lebanese chronic schizophrenia population using the Arabic TOM-15 and identifies gender and depression effects.

## Key findings

- Schizophrenia patients scored lower on first- and second-order false belief tasks compared to healthy controls.
- Second-order false belief impairments were more severe than first-order in schizophrenia patients.
- Depression was negatively associated with second-order TOM performance, and females outperformed males.

## Abstract

In recent decades, social cognition has become a central focus in schizophrenia research. Multiple previous studies reported impairments in multiple social cognitive domains. One particular domain of social cognition affected in schizophrenia is “Theory of Mind (TOM). The objective of this study was to examine the heterogeneity of ToM impairments within the schizophrenia population and compare TOM performance between individuals diagnosed with schizophrenia and a matched healthy control group.

a cross-sectional study was conducted between June 2024 and September 2024 at the Psychiatric Hospital of the Cross (HPC) in Lebanon that explored TOM abilities in 146, chronic Lebanese schizophrenia inpatients and 50 healthy controls, using the Arabic translation of the “TOM-15,” a False Belief Task.

A significant difference between schizophrenia patients and healthy controls was found, with the patient group scoring poorer on both first-order, and second-order false belief and in the comprehension control task of the TOM-15. Furthermore, among the patient population, impairments in second-order false belief were more pronounced than first-order. Performance on the BACS scale for neuro-cognition showed moderate associations with performance on the TOM-15. Multivariable analysis revealed a negative association between depression and second-order tasks as well as females outperforming males in TOM-15, especially in the second-order task.

The results revealed significant TOM impairments in patients with schizophrenia as compared to healthy controls, with greater difficulties observed in second-order false belief tasks.

•Lebanese chronic inpatients exhibit moderate impairments in Theory of Mind•Higher depressive symptoms were associated with poorer Theory of Mind•Theory of Mind was found to be weakly correlated with neurocognitive functioning.•The clinical symptoms and theory of mind did not significantly correlate.

Lebanese chronic inpatients exhibit moderate impairments in Theory of Mind

Higher depressive symptoms were associated with poorer Theory of Mind

Theory of Mind was found to be weakly correlated with neurocognitive functioning.

The clinical symptoms and theory of mind did not significantly correlate.