Differences in implicit and spontaneous mentalization in schizophrenia

BACKGROUND The ability to mentalize is essential during social interactions. Mentalization can be divided into two separate systems: to an explicit part characterized by being conscious, reflective, verbal, and to an implicit part that is unconscious, automatic, non-verbal, intuitive. The term spontaneous mentalization is also used for the attribution of mental state that appears without explicit instruction. In schizophrenia, several studies have confirmed the deficit of explicit mentalization, but little data are available on non-explicit mentalization. Our aim is to provide a narrative review of the literature on this issue. METHODS Based on the methodology used in different publications, we examined implicit and spontaneous mentalization separately. To search for publications on the topic, we performed a PubMed database search. RESULTS A total of 26 studies, 9 studies examining implicit and 17 studies examining spontaneous mentalization were found. CONCLUSIONS Based on the results, implicit mentalization is relatively retained, but the effectiveness of implicit detec - tion of intentionality may be significantly influenced by other factors (e.g., neurocognitive deficits). In contrast, studies clearly report a deficit in spontaneous mentalization. Patients with schizophrenia are less sensitive to situations requiring spontaneous mentalizing activity. Interactions are less described by complex intentional mental states, and the descriptions often do not correspond to the particular interaction. Overall, in addition to the deficit of explicit mentalization, implicit or spontaneous mentalization performance is also affected in schizophrenia, if not to the same extent. These different deficits can also have potential therapeutic consequences.