Theory of Mind and Discourse Production in Schizotypy: An fMRI Study

Background Schizotypy (ST) reflects subclinical traits linked to schizophrenia spectrum disorders and associated cognitive and social impairments. Theory of Mind (ToM) and discourse production deficits are well-documented in schizophrenia (SZ), yet the neural basis of discourse-related ToM processes in ST remains unclear. This study investigated brain activation during narrative planning and production in individuals with schizotypal traits. Methods Thirty young adults (mean age = 18.8 years) completed standardized assessments, including the Schizotypal Personality Questionnaire–Brief Revised (SPQ-BR), adverse childhood experiences (ACEs), depression (PHQ-9), and dissociation (DES-B). Participants performed a discourse task in an fMRI scanner, describing nine-panel cartoons requiring inference of character intentions. Behavioral discourse metrics included total and inferred events. fMRI analyses examined activation during planning and production phases, with SPQ-BR positive, negative, and disorganized traits entered as regressors. Results Schizotypal traits correlated with multiple psychosocial risk factors, including elevated depression, ACEs, and dissociation (r = .48–.82, p < .01). During planning, canonical ToM/self-referential regions (vmPFC, precuneus, insula) were recruited. Positive traits correlated with increased activation in the right temporo-parietal junction, precuneus, and lingual gyrus, whereas disorganized traits were associated with reduced activation in the precuneus and lingual gyri. During production, networks spanning vmPFC, hippocampus, right TPJ, and basal ganglia were engaged. Negative traits correlated with increased motor/premotor activation, while disorganized traits correlated with reduced activation in lingual gyrus, SMA, and cerebellum. Conclusions Findings: demonstrate distinct neural correlates of schizotypal traits during discourse planning and production, supporting models of schizophrenia-spectrum risk emphasizing disrupted inference and integration processes.