Communicative-Pragmatic Abilities Mediate the Relationship Between Cognition and Daily Functioning in Schizophrenia

Objective: Pragmatics refers to the capacity to understand the speaker's meaning and thus to appropriately engage in a conversation. This study aims at establishing the role of communicative-pragmatic abilities in functioning, defined as a set of daily activities, in schizophrenia. This would contribute to enrich current models of the neurocognitive predictors of functioning, which have so far neglected pragmatics. Method: One hundred people with schizophrenia underwent a comprehensive assessment including functioning, cognition, theory of mind (ToM), and pragmatics. We tested the effects of cognition as a predictor of functioning, first mediated by ToM, then sequentially mediated by ToM and pragmatics. Next, we explored the predictive effect of cognition, sequentially mediated by ToM and pragmatics, on different functional domains (i.e., interpersonal relations, instrumental role, and personal autonomy). Results: The first model confirmed that ToM acts as a mediator between cognition and functioning. Importantly, the second model highlighted also the main mediating role of pragmatics. The mediation models on different functional domains showed that, when considered together, both pragmatics and ToM significantly influenced all aspects of functioning. When considered separately, pragmatics was significantly related to interpersonal functioning, while ToM to personal autonomy. Conclusions: Innovatively, our findings highlight that pragmatics has a main role, both direct and indirect, in affecting functioning. Of particular interest is that the impact of pragmatics encompasses different functional domains, and especially interpersonal functioning. Key Points Question: Does pragmatics, defined as the ability to interpret language in the context of use, have a role in the complex interplay of daily functioning and neuropsychological aspects in schizophrenia? Findings: Our findings innovatively show the significant effect of communicative-pragmatic abilities on daily functioning. Importance: These findings are relevant because: (a) they extend the theoretical models of functional disruption in schizophrenia; (b) they offer noteworthy knowledge for the development of rehabilitative interventions aiming at functional recovery. Next Steps: Future research should focus on the implementation of rehabilitative interventions targeting communicative-pragmatic abilities.