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The Theory of Mind and Psychotic Symptoms Phenomenology in Substance-Induced Psychotic Disorder and Schizophrenia

Elif KÜÇÜK, Feride UYSAL, Özlem DEVRİM BALABAN, Başak TÜZÜN MUTLUER, Murat ERKIRAN
2024 35(4): 253-262
DOI: 10.5080/u27310
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Objective: The study aimed to determine clinical indicators that could
be used to differentiate between patients diagnosed with substanceinduced
psychotic disorder (SIPD) and patients diagnosed with
schizophrenia by comparing their psychotic symptoms and theory of
mind (ToM).
Methods: The study included 43 male patients diagnosed with
schizophrenia according to DSM-5 criteria and 43 male patients
diagnosed with SIPD. The patients were administered the
Sociodemographic and Clinical Data Form, Scale for the Assessment
of Positive Symptoms (SAPS), Scale for the Assessment of Negative
Symptoms (SANS), Psychotic Symptom Evaluation Scale (PSYRATS),
and Reading the Mind in the Eyes Test (RMET).
Results: In patients diagnosed with schizophrenia, the scores on SAPS
subscales for structural thought disorder and bizarre behavior, as well
as SANS total scores, were significantly higher compared to patients
diagnosed with SIPD (z=2.679, p=0.007; z=2.984, p=0.003; z=6.916,
p<0.001). The scores for recognizing negative and neutral expressions
on the RMET were significantly higher in patients with SIPD than in
patients with schizophrenia (z=3.540; p<0.001; z=4.404, p<0.001). It
was found that as the scores on the SANS total and Affect Blunting or
Flattening subscale, as well as the scores on the SAPS Bizarre Behavior
subscale decrease, the probability of having SIPD increases.
Conclusion: In patients diagnosed with SIPD, there are fewer
disorganized and negative symptoms compared to patients diagnosed
with schizophrenia. Patients with SIPD can recognize negative and
neutral expressions better than patients with schizophrenia. When
making a differential diagnosis between SIPD and schizophrenia, as
blunting in affect, total negative symptoms, and severity of bizarre
behavior decrease, the probability of being diagnosed with SIPD increases
relative to the probability of being diagnosed with schizophrenia.
Keywords: Schizophrenia, Substance-İnduced Psychosis, Theory of
Mind, Psychotic Symptoms