The Relationship between Social Cognition, Communicative Behavior in Family and Social Functioning in Schizophrenia Patients

Main Article Content

Supaporn Phaiphut
Chanokruthai Choen-arom



Objective: To examine the relationship among social cognition, family communication behavior, and social functioning in schizophrenic patients

Method: The analytical study with predictive correlational design. Study samples were 62 schizophrenic patients who came to receive service at the inpatient and outpatient departments of two psychiatric hospitals in the northeastern region. Data collection tools include personal demographic record, Brief Psychiatric Rating Scale (BPRS), Social Cognition Screening Questionnaire (SCSQ), The Face Test, Family Communication Behaviour Assessment, and Living Skills Assessment (LSD 30). The data were analysed using descriptive statistics, Pearson correlation, Biserial correlation and multiple regression.  

Results: The majority of samples were male (69.4%) with average age of 42.2 years. Most of them demonstrated deficits in every aspect of social cognition. Schematic inference (b = 3.770, p < 0.01) and severity of psychiatric symptoms (b =-1.004, p < 0.01) were jointly predicted 37.2% variance of the psychiatric patients’ social functioning scores. This study, however, did not find the significant relationship between social cognition and family communication behaviour (r = .033, p = 0.796). The only demographic variable found to be significantly related to the social functioning was the occupation (r = 252, p < 0.05).   

Conclusion: Severity of symptoms and social cognition, schematic inference dimension of social cognition to be specific, together can predict the social functioning score of the psychiatric patients who have mild to moderate psychiatric symptoms. Also, the ability to engage in occupations is significantly related to the social functioning score.  The therapeutic care of this group of patients should focus on the training of symptom management and schematic inference skills in order to decrease the likelihood of disability and increase the chance of building social relationships and living the life as part of the community.      

Keywords: Social cognition, Family communication behavior, Social functioning

Article Details

How to Cite
Phaiphut, S. ., & Choen-arom, C. . (2022). The Relationship between Social Cognition, Communicative Behavior in Family and Social Functioning in Schizophrenia Patients. Journal of the Psychiatric Association of Thailand, 67(1), 45–58. Retrieved from
Original Articles


Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. The Lancet. 2013 Nov;382(9904):1575–86.

Lotrakul M, Sukanich P. Ramathibodi Essential Psychiatry. Fourth Edition. Bangkok. Department of Psychiatry Faculty of Medicine Ramathibodi Hospital; 2015.

Udomratn P, Vasiknanonte S. Textbook of schizophrenia. Bangkok. Psychiatric Associations; 2009.

Green MF, Penn DL, Bentall R, Carpenter WT, Gaebel W, Gur RC, et al. Social Cognition in Schizophrenia: An NIMH Workshop on Definitions, Assessment, and Research Opportunities. Schizophrenia Bulletin. 2008 Aug 20;34(6):1211–20.

Green MF, Horan WP. Social Cognition in Schizophrenia. Curr Dir Psychol Sci. 2010 Aug;19(4):243–8.

Barbato M, Liu L, Penn DL, Keefe RSE, Perkins DO, Woods SW, et al. Social cognition as a mediator between neurocognition and functional outcome in individuals at clinical high risk for psychosis. Schizophrenia Research. 2013 Nov;150(2–3):542–6.

Fett A-KJ, Viechtbauer W, Dominguez M-G, Penn DL, van Os J, Krabbendam L. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neuroscience & Biobehavioral Reviews. 2011 Jan;35(3):573–88.

Amminger GP, Schäfer MR, Klier CM, Schlögelhofer M, Mossaheb N, Thompson A, et al. Facial and vocal affect perception in people at ultra-high risk of psychosis, first-episode schizophrenia and healthy controls: Affect perception in early psychosis. Early Intervention in Psychiatry. 2012 Nov;6(4):450–4.

Savla GN, Vella L, Armstrong CC, Penn DL, Twamley EW. Deficits in Domains of Social Cognition in Schizophrenia: A Meta-Analysis of the Empirical Evidence. Schizophrenia Bulletin. 2013 Sep;39(5):979–92.

Brown EC, Tas C, Can H, Esen-Danaci A, Brüne M. A closer look at the relationship between the subdomains of social functioning, social cognition and symptomatology in clinically stable patients with schizophrenia. Comprehensive Psychiatry. 2014 Jan;55(1):25–32.

Chouvong C. The Factor Effecting Communication Behaviorof Schizophrenic Patient and Their Family Member in Out Patients Department of Suansaranrom Hospital. [dissertation]. Suansaranrom Hospital. Department of Mental Health, Ministry of Public Health; 2002.

Chuamor P. Family Communication behaviours as Perceived by Persons with Relapsed Schizophrenia in Suan Prung Psychiatric Hospital. [dissertation]. Chiang Mai University; 2005.

Kittirattanapaiboon P. Training Program Guidelines for interviewing and scoring BPRS in the format of T-PANSS. Assessment of psychiatric symptoms Suanprung Hospital .Chiang Mai: Suanprung Hospital.

Roberts DL, Fiszdon J, Tek C. Initial validity of the Social Cognition Screening Questionnaire (SCSQ). Schizophr.Bull. 2011; 37 (Suppl. 1): 280.

Charernboon T. social cognition in schizophrenia. doctor of philosophy (clinical epidemiology) division of clinical epidemiology faculty of medicine thammasat university; 2016.

Charernboon T. Validity and Reliability of the Thai Version of the Faces Test. 2017;100:4.

Chittarom C. The effect of effective communication skills training program on communication in families with adolescent children. The 8th International Mental Health Academic Conference 2002; Mental Health and Drugs.

Boonyamalik P, Suksawang S, Sawangwongsin S. Development of the living skills assessment for psychiatric rehabilitation (LSD 30). Journal of Srithanya Hospital. September 2012; 13: 1-12.

Buck BE, Healey KM, Gagen EC, Roberts DL, Penn DL. Social cognition in schizophrenia: factor structure, clinical and functional correlates. Journal of Mental Health. 2016 Jul 3;25(4):330–7.

Javed A, Charles A. The Importance of Social Cognition in Improving Functional Outcomes in Schizophrenia. Front Psychiatry. 2018 Apr 24;9:157.

Pinkham AE, Penn DL, Green MF, Harvey PD. Social Cognition Psychometric Evaluation: Results of the Initial Psychometric Study. SCHBUL. 2016 Mar;42(2):494–504.

Revheim N, & Medalia A, Verbal memory, problem-solving skills and community status in schizophrenia. Schizophrenia research. 2004; 68(2-3), 149–158.

Sergi M, Rassovsky Y, Widmark C, Reist C, Erhart S, Braff D, et al. Social cognition in schizophrenia: Relationships with neurocognition and negative symptoms. Schizophrenia Research. 2007 Feb;90(1–3):316–24.

Addington J, Saeedi H, Addington D. Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. Br J Psychiatry. 2006 Oct;189(4):373–8.

Mazza M, Pollice R, Pacitti F, Pino MC, Mariano M, Tripaldi S, et al. New evidence in theory of mind deficits in subjects with chronic schizophrenia and first episode: correlation with symptoms, neurocognition and social function. Rivista di psichiatria. 2012;10.

Okruszek Ł, Bala A, Wordecha M, Jarkiewicz M, Wysokiński A, Szczepocka E, et al. Social cognition in neuropsychiatric populations: a comparison of theory of mind in schizophrenia and mesial temporal lobe epilepsy. Sci Rep. 2017 Dec;7(1):484.

Roncone R, Falloon IRH, Mazza M, De Risio A, Pollice R, Necozione S, et al. Is Theory of Mind in Schizophrenia More Strongly Associated with Clinical and Social Functioning than with Neurocognitive Deficits? Psychopathology. 2002;35(5):280–8.

Couture SM. The Functional Significance of Social Cognition in Schizophrenia: A Review. Schizophrenia Bulletin. 2006 Aug 18;32(Supplement 1):S44–63.

Martin JA, Penn DL. Attributional Style in Schizophrenia: An Investigation in Outpatients With and Without Persecutory Delusions. Schizophrenia Bulletin. 2002 Jan 1;28(1):131–41.

Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, et al. The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Arch Gen Psychiatry 2009;66(3):236-47.

van Hooren S, Versmissen D, Janssen I, Myin-Germeys I, à Campo J, Mengelers R, et al. Social cognition and neurocognition as independent domains in psychosis. Schizophrenia Research. 2008 Aug;103(1–3):257–65.

Mancuso F, Horan WP, Kern RS, Green MF. Social cognition in psychosis: Multidimensional structure, clinical correlates, and relationship with functional outcome. Schizophrenia Research. 2011 Feb;125(2–3):143–51.

Andrzejewska M, Wójciak P, Domowicz K, Rybakowski J. Emotion recognition and theory of mind in chronicschizophrenia: association with negative symptoms. Arch Psych Psych. 2017 Dec 18;19(4):7–12.

Harvey PD, Strassnig MT, Silberstein J. Prediction of disability in schizophrenia: Symptoms, cognition, and self-assessment. Journal of Experimental Psychopathology. 2019 Jul;10(3):204380871986569.

Lindgren M, Holm M, Kieseppä T, Suvisaari J. Neurocognition and Social Cognition Predicting 1-Year Outcomes in First-Episode Psychosis. Front Psychiatry. 2020 Dec 4;11:603933.

Rajji TK, Miranda D, Mulsant BH. Cognition, function, and disability in patients with schizophrenia: a review of longitudinal studies. Can J Psychiatry. 2014; 59:13–7.

Ventura J, Hellemann GS, Thames AD, Koellner V, Nuechterlein KH. Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res. 2009; 113:189–99.

Arsova S, Bajraktarov S, Barbov I, Hadzihamza K. Patients with Schizophrenia and Self-Care. Open Access Maced J Med Sci. 2014 Jun 15;2(2):289–92.

Bae S-M, Lee S-H, Park Y-M, Hyun M-H, & Yoon H.. Predictive Factors of Social Functioning in Patients with Schizophrenia: Exploration for the Best Combination of Variables Using Data Mining. Psychiatry Investigation. 2010; 7(2), 93.

Mihwa H, Seong S-J. Effects of Psychotic Symptoms and Social Cognition on Job Retention in Patients with Schizophrenia in Korea. Int. J. Environ. Res. Public Health.2020;17, 2628

Weinberg D, Shahar G, Davidson L, McGlashan TH, Fennig S. Longitudinal Associations Between Negative Symptoms and Social Functioning in Schizophrenia: The Moderating Role of Employment Status and Setting. Psychiatry: Interpersonal and Biological Processes. 2009 Dec;72(4):370–81.

Bowie CR, Harvey PD. Communication abnormalities predict functional outcomes in chronic schizophrenia: Differential associations with social and adaptive functions. Schizophrenia Research. 2008 Aug;103(1–3):240–7.

Bowie CR, Gupta M, Holshausen K. Disconnected and underproductive speech in schizophrenia: Unique relationships across multiple indicators of social functioning. Schizophrenia Research. 2011 Sep;131(1–3):152–6.