The Neural Activities of Theory of Mind in Patients with Schizophrenia: A meta-analysis of fMRI studies

Pei Xie¹ChaoZheng Huang²QingQing Li^3*Hanbin Sang^4,5*

• ¹School of Psychology, Sichuan Normal University, Chengdu, Sichuan Province, China
• ²School of Judicial Police, Gansu University of Political Science and Law, Lanzhou, China
• ³School of Psychology, Northwest Normal University, Lanzhou, Gansu Province, China
• ⁴Key Laboratory Of Child Cognition & Behavior Development Of Hainan Province, Haikou, Hainan Province, China
• ⁵School of Teacher Education, Qiongtai Normal University, Haikou, Hainan Province, China

Impairments in Theory of Mind (ToM) capabilities among patients with schizophrenia adversely affect their recovery process and daily functioning. Previous research has identified abnormal brain activity associated with ToM processes in these individuals; however, consensus has not yet been reached regarding the specific brain regions involved. Additionally, comparative neural activation patterns between schizophrenia patients and individuals at risk for schizophrenia remain inconsistently demonstrated. This study conducted an Activation Likelihood Estimation (ALE) meta-analysis on 40 functional magnetic resonance imaging (fMRI) studies employing coordinate-based neuroimaging to examine ToM processes across three groups: schizophrenia patients, healthy controls, and at-risk populations. Brain activation regions were determined for each group, and differences between groups were further analyzed. Results indicated reduced activation within the mentalization network and mirror neuron system among schizophrenia patients. In contrast, heightened convergent activation in the right middle temporal gyrus and right superior temporal gyrus was observed, suggesting compensatory neural activity during ToM processes. These findings provide further insight into the neural mechanisms underpinning ToM impairments in schizophrenia.