Background. Deficits in a patient's ‘theory of mind’ (TOM) have been proposed to lead to psychosis. However, it remains unclear whether TOM deficits constitute a trait- or a state-related deficit and whether they respond to antipsychotic treatment, and also whether the change in TOM and change in psychosis are associated.

Method. In the cross-sectional component of this study, 71 patients with psychotic disorders were included and TOM ability was measured using a hinting task in which subjects had to infer real intentions behind indirect speech. In the longitudinal study, a different cohort of 17 drug-free patients were included wherein they received antipsychotic treatment for 6 weeks and the effect on psychotic symptoms and TOM was measured every 2 weeks. Associations between TOM and psychopathology were assessed and a mixed effects model was used to investigate the rate of change over time.

Results. Positive and Negative Syndrome Scale (PANSS) total scores were significantly associated with TOM scores. The hinting task was not associated with positive symptoms but was significantly associated with negative and general symptoms. The longitudinal arm of the study showed that both PANSS positive scores and TOM improved after medication was started, particularly during the first 2 weeks of antipsychotic treatment, but these changes were not associated. The TOM response at 2 weeks of antipsychotic treatment reached similar values to those obtained in the cross-sectional sample.

Conclusions. Although TOM and psychotic symptoms are related to each other, antipsychotic treatment impacts each independently, suggesting a dissimilar cognitive or neurobiological substrate for the two.

Disturbances in processing simple acoustic changes in a stream of stimuli have been widely reported in patients with schizophrenia, but little is know about auditory feature conjunction in these individuals. This study was designed to examine the extent to which patients with schizophrenia automatically process changes in conjunction of auditory features by using event-related brain potentials. Seventeen patients and 17 age-matched controls were presented with frequent low pitch tones at 45° to the left of center and frequent high pitch tones at 45° to the right of center while performing a continuous visual serial-choice reaction time task. The sequence of auditory stimuli included rare conjunction-deviants comprised of a different combination of features (e.g., low pitch tone at 45° right) and double-deviant tones that differed from the standard tones in both pitch and location (i.e., middle pitch at 0° azimuth). Conjunction-deviant stimuli elicited an MMN wave that was maximum at frontocentral sites. Compared with controls, the MMN to conjunction-deviant was reduced in patients and was more centrally distributed. Double-deviant sounds generated a biphasic MMN followed by a P3a wave at central sites. Both MMN and P3a were reduced in patients compared with controls. These results show that patients with schizophrenia have difficulty in automatically detecting changes in a combination of auditory features as well as orienting to what “normally” would be considered salient by healthy individuals.

Background A growing interest in first-episode schizophrenia reflects the belief that this line of investigation will lead to further developments regarding schizophrenia's aetiology, course and outcome.

Method Evidence from more recent clinical trials involving first-episode schizophrenia is integrated with neuroimaging data, specifically positron emission tomography, to provide direction regarding pharmacotherapy.

Results Individuals with a first episode of schizophrenia appear particularly responsive to pharmacotherapy, as well as quite sensitive to side-effects. At the same time, current clinical and receptor-binding data support the efficacy of low-dose neuroleptic treatment.

Conclusions Early and effective treatment of schizophrenia has been associated with better long-term outcome. Low-dose neuroleptic therapy is an effective treatment strategy and the diminished risk of side-effects with this approach may further enhance compliance and outcome.