Journal List > Korean J Schizophr Res > v.16(2) > 1057793

Korean J Schizophr Res. 2013 Oct;16(2):69-79. Korean.
Published online October 31, 2013.
Copyright © 2013 Korean Society for Schizophrenia
Characteristics of Social Perception and their Changes after Treatment in Patients with Schizophrenia Using the Idea of Reference Provoking Task
Seungjin Choi, MD,1 Il-Ho Park, MD,2 Seon-Koo Lee, MD,3,4 and Jae-Jin Kim, MD1,4
1Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.
2Department of Psychiatry, Kwandong University College of Medicine, Gangreung, Korea.
3Department of Psychiatry, Ilsan Hospital, National Health Insurance Corporation, Ilsan, Korea.
4Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Jae-Jin Kim, Department of Psychiatry, Yonsei University Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel: 02-2019-3341, Fax: 02-3462-4304, Email:
Received May 21, 2013; Revised June 04, 2013; Accepted June 07, 2013.



Patients with schizophrenia often present idea of reference in social situations, but there has been a limitation in quantitatively measuring their reactions to the social stimuli. The aim of this study was to investigate behavioral characteristics of patients with schizophrenia in social situations in which idea of reference can be provoked.


Forty subjects with schizophrenia (21 males) and 26 healthy volunteers (17 males) performed the idea-of-reference-provoking task, which was composed of movie clips with scenes of two women sitting on a bench of 1 or 5 m away. The conditions consisted of "referential conversation", "non-referential conversation" or "no conversation". The reactions of the participants were rated by the questionnaires for self-referential perception, malevolent interpretation and anxiety reaction.


There were significant group differences in the reactions on self-referential perception, malevolent interpretation and anxiety reaction. After the treatment, patients with schizophrenia showed improved scores of the reactions. In particular, score changes of malevolent interpretation and anxiety reaction in patients with schizophrenia were correlated with change of paranoia scale (rs=0.65, p<0.05 and rs =0.73, p<0.05, respectively).


Patients with schizophrenia revealed self-referential bias and paranoid responses to social situations, which were improved after psychiatric treatment. Self-referential perceptions and paranoid responses may be state dependent rather than trait of schizophrenia.

Keywords: Schizophrenia; Idea of reference; Social perception; Social cognition


Fig. 1
A schematic description of the task conditions.
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Fig. 2
Correlations between score change in paranoid scale and changes in mean scores of self-referential perception, malevolent interpretation and anxiety reaction.
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Table 1
Demographic and clinical characteristics of participants
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Table 2
Task scores for self-referential perception, malevolent interpretation and anxiety reaction
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Table 3
Distance effect on self-referential perception, malevolent interpretation and anxiety reaction
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Table 4
Context effect on self-referential perception, malevolent interpretation and anxiety reaction
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Table 5
Comparison of scores for self-referential perception, malevolent interpretation and anxiety reaction between pre-treatment and post-treatment in follow-up patients
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Table 6
Comparison of self-referential perception, malevolent interpretation and anxiety reaction between the control and post-treatment schizophrenia groups
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1. Freeman D. Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev 2007;27:425–457.
2. Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell'Olio M, et al. Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry 2005;39:964–971.
3. Birchwood M, Smith J, Macmillan F, Hogg B, Prasad R, Harvey C, et al. Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers, a preliminary investigation. Psychol Med 1989;19:649–656.
4. Carpenter WT Jr, Strauss JS, Bartko JJ. Flexible system for the diagnosis of schizophrenia: report from the WHO International Pilot Study of Schizophrenia. Science 1973;182:1275–1278.
5. Cesková E, Prikryl R, Kasparek T, Ondrusova M. Psychopathology and treatment responsiveness of patients with first-episode schizophrenia. Neuropsychiatr Dis Treat 2005;1:179–185.
6. Jager M, Riedel M, Messer T, Laux G, Pfeiffer H, Naber D, et al. Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders. Eur Arch Psychiatry Clin Neurosci 2007;257:47–53.
7. Couture SM, Penn DL, Roberts DL. The functional significance of social cognition in schizophrenia: a review. Schizophr Bull 2006;32 Suppl 1:S44–S63.
8. Brune M, Abdel-Hamid M, Lehmkamper C, Sonntag C. Mental state attribution, neurocognitive functioning, and psychopathology: what predicts poor social competence in schizophrenia best? Schizophr Res 2007;92:151–159.
9. Addington J, Saeedi H, Addington D. Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. Br J Psychiatry 2006;189:373–378.
10. Edwards J, Jackson HJ, Pattison PE. Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review. Clin Psychol Rev 2002;22:789–832.
11. Bora E, Eryavuz A, Kayahan B, Sungu G, Veznedaroglu B. Social functioning, theory of mind and neurocognition in outpatients with schizophrenia; mental state decoding may be a better predictor of social functioning than mental state reasoning. Psychiatry Res 2006;145:95–103.
12. Kucharska-Pietura K, David AS, Masiak M, Phillips ML. Perception of facial and vocal affect by people with schizophrenia in early and late stages of illness. Br J Psychiatry 2005;187:523–528.
13. Hooker C, Park S. You must be looking at me: the nature of gaze perception in schizophrenia patients. Cogn Neuropsychiatry 2005;10:327–345.
14. Harrington L, Siegert RJ, McClure J. Theory of mind in schizophre nia: a critical review. Cogn Neuropsychiatry 2005;10:249–286.
15. Greig TC, Bryson GJ, Bell MD. Theory of mind performance in schizophrenia: diagnostic, symptom, and neuropsychological correlates. J Nerv Ment Dis 2004;192:12–18.
16. Kaplan HI, Sadock BJ. In: Comprehensive textbook of psychiatry. 5th ed. Baltimiore: Williams & Wilkins; 1989.
17. Park IH, Ku J, Lee H, Kim SY, Kim SI, Yoon KJ, et al. Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia. Acta Psychiatr Scand 2011;123:43–54.
18. Pinkham AE, Brensinger C, Kohler C, Gur RE, Gur RC. Actively paranoid patients with schizophrenia over attribute anger to neutral faces. Schizophr Res 2011;125:174–178.
19. Hooker C, Park S. Emotion processing and its relationship to social functioning in schizophrenia patients. Psychiatry Res 2002;112:41–50.
20. Hoffman EA, Haxby JV. Distinct representations of eye gaze and identity in the distributed human neural system for face perception. Nat Neurosci 2000;3:80–84.
21. Baron-Cohen S, Ring HA, Wheelwright S, Bullmore ET, Brammer MJ, Simmons A, et al. Social intelligence in the normal and autistic brain: an fMRI study. Eur J Neurosci 1999;11:1891–1898.
22. Russell TA, Rubia K, Bullmore ET, Soni W, Suckling J, Brammer MJ, et al. Exploring the social brain in schizophrenia: left prefrontal underactivation during mental state attribution. Am J Psychiatry 2000;157:2040–2042.
23. Gallagher HL, Frith CD. Functional imaging of 'theory of mind'. Trends Cogn Sci 2003;7:77–83.
24. Hooker CI, Bruce L, Lincoln SH, Fisher M, Vinogradov S. Theory of mind skills are related to gray matter volume in the ventromedial prefrontal cortex in schizophrenia. Biol Psychiatry 2011;70:1169–1178.
25. Honea R, Crow TJ, Passingham D, Mackay CE. Regional deficits in brain volume in schizophrenia: a meta-analysis of voxel-based morphometry studies. Am J Psychiatry 2005;162:2233–2245.
26. Brunet E, Sarfati Y, Hardy-Bayle MC, Decety J. Abnormalities of brain function during a nonverbal theory of mind task in schizophrenia. Neuropsychologia 2003;41:1574–1582.
27. Wible CG. Schizophrenia as a disorder of social communication. Schizophr Res Treatment 2012;2012:920485.
28. Horowitz MJ. Spatial behavior and psychopathology. J Nerv Ment Dis 1968;146:24–35.
29. Green MJ, Phillips ML. Social threat perception and the evolution of paranoia. Neurosci Biobehav Rev 2004;28:333–342.
30. Freeman D, Garety PA, Bebbington P, Slater M, Kuipers E, Fowler D, et al. The psychology of persecutory ideation II: a virtual reality experimental study. J Nerv Ment Dis 2005;193:309–315.
31. Valmaggia LR, Freeman D, Green C, Garety P, Swapp D, Antley A, et al. Virtual reality and paranoid ideations in people with an 'at-risk mental state' for psychosis. Br J Psychiatry Suppl 2007;51:s63–s68.
32. Bora E, Gokcen S, Kayahan B, Veznedaroglu B. Deficits of social-cognitive and social-perceptual aspects of theory of mind in remitted patients with schizophrenia: effect of residual symptoms. J Nerv Ment Dis 2008;196:95–99.
33. Brüne M. "Theory of mind" in schizophrenia: a review of the literature. Schizophr Bull 2005;31:21–42.
34. Corcoran R, Mercer G, Frith CD. Schizophrenia, symptomatology and social inference: investigating "theory of mind" in people with schizophrenia. Schizophr Res 1995;17:5–13.
35. Drury VM, Robinson EJ, Birchwood M. 'Theory of mind' skills during an acute episode of psychosis and following recovery. Psychol Med 1998;28:1101–1112.