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Social cognition across the schizophrenia–bipolar disorder spectrum

Nature Reviews Psychology volume 3, pages 91–107 (2024)Cite this article

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Abstract

Impaired social cognition is a key symptom dimension in schizophrenia-spectrum disorders and — to a lesser extent — in bipolar disorder, and is highly predictive of poor community functioning. However, careful characterization of social cognitive domains (including emotion processing, mentalizing, social perception and/or knowledge, and attributional style) is lacking, which hampers transdiagnostic comparison, obscures areas requiring further research and development, and limits development of targeted interventions. In this Review, we first describe the evidence for impaired social cognition on the schizophrenia–bipolar spectrum across social cognitive domains and illness phases. Next, we discuss the links between impairments in specific social cognitive domains (particularly mentalizing and emotion processing) and impaired community functioning and reduced quality of life. We then critically examine how domains are assessed and whether available assessment batteries are sensitive to social cognitive impairments in schizophrenia-spectrum disorders and in bipolar disorder. Finally, we review interventions that target social cognition in schizophrenia–bipolar spectrum disorders and identify areas where systematic evaluation and widespread implementation into clinical practice are needed. Based on this information, we make recommendations for increased mechanistic understanding and intervention development to improve social cognition and quality of life for people diagnosed with schizophrenia-spectrum disorders and bipolar disorder.

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Fig. 1: Domains of social cognition impairments across diagnoses and illness stages.

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Acknowledgements

T.E.V.R. acknowledges the financial support of an Al and Val Rosenstrauss Fellowship from the Rebecca L. Cooper Medical Research Foundation and a Dame Kate Campbell Fellowship from the University of Melbourne.

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Authors and Affiliations

  1. Schizophrenia and Bipolar Disorder Program, Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA

    Kathryn E. Lewandowski

  2. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Kathryn E. Lewandowski

  3. Department of Psychology, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, TX, USA

    Amy E. Pinkham

  4. Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia

    Tamsyn E. Van Rheenen

  5. Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University, Melbourne, Victoria, Australia

    Tamsyn E. Van Rheenen

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Lewandowski, K.E., Pinkham, A.E. & Van Rheenen, T.E. Social cognition across the schizophrenia–bipolar disorder spectrum. Nat Rev Psychol 3, 91–107 (2024). https://doi.org/10.1038/s44159-023-00269-7

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