Social cognition across the schizophrenia–bipolar disorder spectrum

Impaired social cognition is a key symptom dimension in schizophrenia-spectrum disorders and — to a lesser extent — in bipolar disorder, and is highly predictive of poor community functioning. However, careful characterization of social cognitive domains (including emotion processing, mentalizing, social perception and/or knowledge, and attributional style) is lacking, which hampers transdiagnostic comparison, obscures areas requiring further research and development, and limits development of targeted interventions. In this Review, we first describe the evidence for impaired social cognition on the schizophrenia–bipolar spectrum across social cognitive domains and illness phases. Next, we discuss the links between impairments in specific social cognitive domains (particularly mentalizing and emotion processing) and impaired community functioning and reduced quality of life. We then critically examine how domains are assessed and whether available assessment batteries are sensitive to social cognitive impairments in schizophrenia-spectrum disorders and in bipolar disorder. Finally, we review interventions that target social cognition in schizophrenia–bipolar spectrum disorders and identify areas where systematic evaluation and widespread implementation into clinical practice are needed. Based on this information, we make recommendations for increased mechanistic understanding and intervention development to improve social cognition and quality of life for people diagnosed with schizophrenia-spectrum disorders and bipolar disorder. Impairments in social cognition are typical in schizophrenia–bipolar spectrum disorders. In this Review, Lewandowski and colleagues characterize impairments across social cognitive domains and illness phases including links with community functioning, and make recommendations for assessment and intervention.