Theory of mind and stereotypic behavior promote daily functioning in patients with schizophrenia

Margherita Bechi, Ahmad Abu-Akel, Giulia Agostoni, Mariachiara Buonocore, Marta Bosia, Francesca Martini, Roberto Cavallaro

Research output: Contribution to journalArticlepeer-review


Objectives: Functional disruption is a main feature of schizophrenia and still represents a major treatment challenge. A more in-depth identification of functional predictors is crucial for the creation of individualized rehabilitation treatments, which can translate into better functional outcomes. In this study, we aimed at pinpointing specific domains that affect different functional profiles, using a data-driven approach. Methods: We included a comprehensive evaluation of functional predictors, namely demographic, cognitive, sociocognitive and clinical variables, with a focus on constituent subdomains of autistic symptoms that have been associated with functioning in the recent literature. Results: In 123 schizophrenia patients, a two-step cluster analysis identified two groups of patients with different functional profiles (low vs high functioning). A backward stepwise logistic regression analysis showed that the odds of being a member of the high functioning group are significantly higher for individuals with (1) more years of education, (2) better Theory of Mind abilities, (3) higher levels of stereotypies/narrowed interests, (4) lower difficulties in social interaction, (5) lower communication difficulties and with (6) being male. Conclusion: Findings raise the intriguing possibility that stereotypic behaviors may have a beneficial effect on functioning in schizophrenia. While the underlying mechanism is currently unknown, we hypothesize that patients may benefit from contexts in which more predictive relationships between environmental entities can systematically be established. This study underscores the potential utility of routinely assessing autistic symptomatology in schizophrenia, which can be instrumental in identifying novel therapeutic targets that can be utilized to improve daily functioning.

Original languageEnglish
Pages (from-to)818-827
Number of pages10
JournalAustralian and New Zealand Journal of Psychiatry
Issue number7
StatePublished - Jul 2022
Externally publishedYes

Bibliographical note

Publisher Copyright:
© The Royal Australian and New Zealand College of Psychiatrists 2021.


  • Psychosis
  • autistic symptoms
  • psychopathology
  • recovery
  • rehabilitation
  • sociocognitive abilities

ASJC Scopus subject areas

  • Psychiatry and Mental health


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