Classification of schizophrenia into clinical subtypes based on objective and subjective social cognition

A research team led by Professor Takahiro Nemoto at Toho University, in collaboration with Associate Professor Naoki Hashimoto and Assistant Professor Ryo Okubo at Hokkaido University, and Dr. Satoru Ikezawa at the National Center of Neurology and Psychiatry explored the agreement or discrepancy between subjective social cognitive difficulties and actual cognitive impairment. The study aimed to identify clinical subtypes in patients with schizophrenia, the results of which were published in Springer-Nature’s journal Schizophrenia on October 29, 2024.

Key Points

1. In patients with schizophrenia, a decline in social cognition—a fundamental skill for interpersonal relationships—leads to increased difficulties in social life, and efforts to improve social cognition are gaining attention.
2. Although schizophrenia is characterized by the inability of patients to accurately self-evaluate symptoms and functional decline, the relationship between subjective difficulties and objective performance in social cognition remains unclear.
3. Patients with schizophrenia can be categorized into three clinical subtypes based on social cognition: the “low-impact group” (low levels of objective impairment and subjective difficulties), the “unaware group” (high levels of objective impairment with low levels of subjective difficulties), and the “perceptive group” (moderate levels of objective impairment and high levels of subjective difficulties). Among them, the “perceptive group” exhibited the lowest levels of social functioning.
4. The “low-impact group” accounted for approximately half of the patients examined, the "unaware group" for around 30%, and the “perceptive group” for roughly 20%.
5. Based on these findings, it is important for clinicians to recognize these clinical subtypes in schizophrenia and to tailor treatment for each patient through a careful consultation about their social cognition-related interpersonal difficulties.