The primary goal of this work was to compare the performance of SC and BD patients on several social cognition domains, assessing the relevance of context processing. We included tasks with different levels of contextual dependence and involvement of real-life scenarios. Emotional morphing provides a more realistic and sensitive measure than static stimuli due to the inclusion of a dynamic method for the presentation of facial expressions. In contrast, the TASIT is a more ecological test of contextual inference of emotional states and requires the integration of cues from face, prosody, gesture and social context to identify the emotions 
. We also included an ecological task of empathy for pain in the context of intentional and accidental harms. This task requires the contextual appraisal to infer intentions and subsequently provide empathy responses. Finally, we employed the SNQ, a task that can be solved with social rules learned by explicit knowledge and does not involve social context processing.
Our results showed that both SC and BD patients showed impairments in negative emotion recognition (accentuated in SC with more contextual information present). Moreover, both patient groups exhibited deficits in distinguishing empathy for pain in neutral and accidental situations from intentional situations in settings with contextual information present. In addition, depression levels in SC patients were negatively correlated with performance in empathy. Finally, regardless of group differences, the overall performance on emotion recognition predicted the performance on neutral and accidental situations during the empathy task.
This is the first social cognition study that has compared SC and BD patients in terms of context-sensitive measures of social cognition. Our results suggest that both disorders show deficits in social cognition tasks with greater context sensitivity, while in tasks that can be solved by explicit knowledge they performed normally. Thus, the pattern of social cognition deficits in SC and BD patients may be partially explained by a general impairment of social context processing.
Deficits in Social Cognition and Contextual Effects
Both patient groups showed more severe impairments for negative emotions in the emotional morphing task. This result was consistent with previous studies 
. Specifically, both groups had difficulties in recognizing fear expressions. In addition, SC patients showed deficits in disgust and anger recognition, while BD patients had impairments in sadness recognition. This kind of task (dynamic presentation of facial expressions) provides a more realistic and sensitive measure than static stimuli 
because it closely resembles the moving and dynamic facial stimuli encountered in everyday life situations.
We also included a more ecological task of contextual inference of emotional states (TASIT). In this task, both SC and BD patients performed lower than controls. However, SC exhibited greater deficits than BD patients. These results are supported by previous studies comparing both disorders 
. These findings are also consistent with previous reports on impaired emotion perception in SC patients 
on tasks combining facial, gesture, prosodic and contextual information. Our data suggest that although both disorders have deficits in the contextual inference of emotional states, impairments in SC are more severe.
In summary, the results of the emotional processing tasks showed that both SC and BD patients had deficits in recognizing negative emotions. We also found that controls exhibited better performance in the TASIT than in the emotional morphing. However, implicit contextual cues provided in the TASIT did not improve emotion recognition in SC and BD patients. These results are in line with a previous study 
showing that contextual cues (tone of voice, gesture and dynamic expression) presented in the TASIT normally assist healthy individuals in more accurately identifying emotional expressions 
A recent study 
found intact context processing in SC patients asked to interpret ambiguous facial expressions. The discrepancy between these results and our findings may be explained by the explicit/implicit presentation of contextual information in each study. Lee and colleagues used a paradigm that presented a fear-inducing or surprise-inducing statement immediately followed by image of a face. In this paradigm, contextual cues were explicitly presented by means of a sentence, while our study used a method that requires the implicit appraisal and integration of contextual cues to accurately recognize emotions.
We also employed an ecological measure of empathy for pain in settings with contextual information. In this task, SC and BD patients showed subtle deficits in distinguishing neutral and accidental situations from intentional pain situations. This result is expected since contextual pain cues in accidental and neutral situations are less clear and explicit than in intentional situations. Our data are in line with previous studies in SC 
and BD patients 
that have reported deficits in inferring intentionality of others’ actions. These results are also consistent with studies in SC patients 
showing social context processing deficits.
Moreover, both patient groups exhibited higher ratings of discomfort and punishment for accidental situations compared to controls. SC patients also presented higher ratings of empathic concern, while BD patients showed higher ratings of intention to hurt for accidental pain situations. Through the contextual appraisal of a situation we can infer intentions of an action and determine the empathizer’s behavioral responses. Thus, these findings may reflect the effects of impairments in SC and BD patients on the contextual appraisal, and the inference of intentionality of pain situations.
Finally, BD patients showed longer RTs in judgments of discomfort, intention to hurt, correctness and punishment. Consistent with these findings, previous studies in BD patients have reported a general decrease in psychomotor speed 
and longer RTs in empathy tasks 
Our results revealed no differences between patient groups and controls on the SNQ. This finding indicates that explicit knowledge of social rules is preserved in both disorders. This is consistent with previous reports showing that SC patients are able to identify violations of social norms 
and BD patients exhibit appropriate knowledge of social norms 
. Furthermore, the SNQ can be solved using relatively abstract and universal rules about the world learned by explicit knowledge, and does not measure context processing.
Finally, the logistic regression model suggests that in all groups the emotional processing performance (emotional morphing and TASIT) accurately predicts the ability to infer intentionality in the EPT in more ambiguous scenarios (accidental and neutral situations where differences among patients and controls were observed). In accidental and neutral pain situations, contextual cues are less clear and explicit than in intentional ones, complicating the interpretation of action intentionality. Moreover, the correct appraisal of others’ intentions in situations with subtle contextual clues requires intact recognition ability of emotions. Our findings are supported by previous evidence 
describing the association between emotional processing and empathy. In addition, the model suggests that the use of basic social skills on emotion recognition is necessary to perform complex abilities such as empathy evaluation.
To summarize, SC and BD patients showed impairments in emotional processing and empathy tasks. However, empathy deficits seem to be more subtle and dependent on emotional processing. The pattern of performance of both patient groups suggests that SC and BD patients exhibit deficits in those social cognition tasks with greater context sensitivity and involvement of real-life scenarios (TASIT and EPT). In the SNQ, an explicit knowledge task, performance of both patient groups mirrored controls. These findings are consistent with previous reports of social contexts processing deficits in SC patients 
. Moreover, our data provide preliminary evidence of impairments in social context processing in BD patients. Our results also indicate that deficits in emotional processing tasks using context cues are less severe in BD than in SC patients.
The Relationship between Clinical Symptoms, Executive Functions and Social Cognition Measures
Our results showed negative correlations between depression levels and empathy task performance in SC patients. These results are consistent with previous studies in SC 
that report an association between depressive symptoms severity and social functioning. Furthermore, in the EPT, although significant differences in RTs were preserved after covariation, we found that depressive symptoms had significant covariant effects on delayed RTs of BD patients in discomfort and correctness judgments. These findings are supported by previous studies in BD patients 
showing that depressive symptoms were associated with dysfunction in psychomotor speed.
Regarding EF, our results showed that both patient groups performed worse than controls, but SC exhibited greater deficits than BD patients. Nevertheless, the social cognitive performance was not associated with EF. This may be explained by the high threshold (.0008) used to adjust the α level for multiple correlations. Although the IFS is a useful instrument to detect executive dysfunction in diseases involving the prefrontal cortex 
, it cannot serve as the sole tool to assess EF. Future studies should employ a more exhaustive EF evaluation to explore the relationship between executive functioning and contextual social cognition.
Limitations and Future Directions
Some important limitations of this study should be acknowledged. First, every participant was taking psychoactive drugs at the time of this study, which can influence cognitive functioning. We cannot rule out the possibility that medications influenced the context processing and social cognition performance. The sample size was relatively small, and therefore more subtle differences may have been missed due to a lack of statistical power and multiple comparison adjustments. However, our sample size is enough for the type of analyses performed here 
and is similar to previous studies in neuropsychiatric populations 
. Further studies should assess the effect of context processing in social cognition domains in larger samples of SC and BD patients.
Moreover, not all BD patients were euthymic. A more homogenous sample could modify the results of social cognition tasks that are strongly modulated by emotional state. In addition, this study included BD II patients, possibly indicating that impairments in social cognition found in this study may not be exclusively related to psychotic forms of these disorders. Future investigations should take into account the subtypes of SC and BD. Larger subgroups of BD patients in euthymic, manic, hypomanic or depressed states should also be assessed.
Finally, in this study social norms knowledge was assessed by means of a self-report questionnaire that implies lower complexity than the other social cognition tasks. Further studies should evaluate social norms knowledge using more ecological measures with different levels of context processing requirements.
Our study documents social contexts processing impairments in SC patients and BD patients. The results showed that both patient groups exhibit deficits in ecological measures of social cognition with greater context sensitivity (TASIT and EPT), while in the SNQ, a task that can be solved by explicit knowledge, they performed normally. These deficits would be related to a general impairment in the capacity to implicitly integrate contextual cues.
SC and BD partially share genetic susceptibility 
and symptomatology 
; and also have similar ages of onset, sex distributions, and prevalence 
. Despite these similarities, there are relatively few social cognition studies comparing both disorders. To our knowledge, this is the first study that assesses the effects of contextual social cognition performance comparing SC and BD patients.
From a theoretical perspective, our results support a recently proposed social context network model (SCNM) 
that describes the contextual influence on social cognitive processing as dependent on a frontotemporal network which: 1) updates contextual cues and uses them to make predictions (frontal areas), and 2) consolidates context-social target associative learning (temporal regions). At the structural and functional level, the most affected brain areas in SC are the temporal and frontal areas 
. Following this model, our results suggests that the pattern of social cognition deficits in SC may be partially explained by a general impairment of social context processing which is the result of an abnormal fronto-temporal network.
Volumetric reductions and functional impairments are also present in prefrontal regions in BD, while involvement of temporal lobe structures seems to be a feature more common in SC 
. These differences in the degree of disruption in fronto-temporal structures may explain the more severe social context processing impairments observed in SC patients. Although our findings provide preliminary evidence supporting this hypothesis, future studies in neuropsychiatric populations should strictly control for the context dependency levels of social cognition tasks, including measures with context processing requirements and context-free tests or manipulation of experimentally contextual cues.
Several reports in SC 
show a general deficit in contextual processing of nonsocial information. Furthermore, it has been suggested 
that in individuals with SC, better processing of nonsocial contexts is associated with stronger influence of context on emotional processing tasks. Thus, it is possible that in SC patients, similar mechanisms may influence the contextual processing of both social and non-social information. Therefore, in SC, frontotemporal networks would also be involved in the processing of anticipatory predictions based on context update (frontal areas) and the learning of context-target associations (temporal regions) for non-social information. In BD, further studies should assess the relationship between context processing of social and nonsocial information.
From a clinical perspective, our findings may have important implications for the non-pharmacological treatment of SC and BD patients. Although social cognition deficits are not considered core symptoms of SC or BD, these should be taken into account for the patients’ cognitive evaluation and rehabilitation. In addition, our results suggest that ecological measures with context processing requirements are sensitive tools that should be applied in the social cognition assessment of these patients. Moreover, incorporating naturalistic environments into treatment may help SC and BD adults to generalize learned social skills. Despite the challenge of implementation, intervention programs, which would teach implicit rules for interpreting unpredictable social contexts, should be put into place. Learning to appraise contextual cues may improve social skills of SC and BD patients.