Self-referential gaze perception of patients with schizophrenia and its relationship with symptomatology and cognitive functions

Self-referential gaze perception (SRGP)-the perception that others' gaze is towards oneself-is a core experience in patients with schizophrenia, and may be related to common delusional themes such as delusions of reference. Studies exploring SRGP bias in schizophrenia are limited and results have been inconsistent, particularly regarding its relationship with symptomatology and cognition. Seventy-five patients with schizophrenia-spectrum disorders (25 with high level of reference delusion, 25 with low reference delusion and 25 in clinical remission) and 25 matched healthy controls were compared in a gaze perception task to judge whether averted gaze with varied ambiguity was directed at them. All subjects were assessed with delusion and reference ideations and cognitive functions. Psychotic symptoms were assessed in patients. Gaze perception analysis adopted both behavioural and psychophysical approaches. Group differences and predictors of SRGP in ambiguous and unambiguous conditions were investigated. Both groups of symptomatic patients displayed higher ambiguous SRGP rate, and the group with high reference delusions showed more unambiguous SRGP bias. Cognitive functions were negatively associated with SRGP rate while positive and negative symptoms were positively associated. Cognitive function was the only significant predictor for ambiguous-SRGP rate. Patients with psychotic symptoms have hypermentalization of gaze perception as towards oneself, whereas patients with delusions of reference have more profound bias in gaze perception. General cognition is implicated in SRGP rate. Future studies could investigate interventions with targeted psychopathological profiles by improving non-social cognitive functions to test the hypothesis that cognitive functioning is related to SRGP bias and delusional beliefs.