Mentalizing Skills Deficits in Schizophrenia as a Clue for Drug Choice: Clozapine Versus Other Antipsychotics on Keeping Outpatients Stable

Abstract

Objective: The study attempts to determine wether Theory of Mind (ToM) deficits are linked with resistance to antipsychotic treatment in patients with schizophrenia. Given that abnormalities on mentalizing are particularly severe in patients with poor premorbid adjustment, and poor premorbid adjustment is described as a factor of refractoriness to treatment, we expected to find a connection between ToM deficits and increased rates of antipsychotic drug resistance. Methods: Design: Descriptive and comparative study between fiftyseven schizophrenic patients and forty-eight patients with no psychiatric diagnosis, matched by sex, age and educational level. Assessment: Premorbid Adjustment Scale (PAS), Theory of Mind Tasks: First order "The cigarettes", "Sally and Anne". Second order: "The burglar", "The Ice Cream Van". Results: Ordinal regression analysis revealed a main association between deficits in first-order and second-order ToM tasks respectively and poor social premorbid adjustment (social isolation). Concerning first order ToM tasks, deficits also were related to a poor performance on the Trail Making Test B and males. In contrast, the test showed the highest significant association between second order ToM tasks with block design, males and clozapine treatment. R-square values amounted to 0.300 and 0.657, respectively. Conclusion: The ordinal regression showed that poor premorbid adjustment, males block design, and clozapine treatment (predictors of unfavourable response to treatment) were linked with deficits in second order ToM tasks in stabilized schizophrenic outpatients. Some refractory responses to drug treatment might derive from nuclear anomalies in social cognition.