Processing emotional expression and facial identity in schizophrenia

Processing of facial configuration in individuals at ultra-high risk for schizophrenia

BACKGROUND

Discrepancies in the ability to recognize faces constitute an important aspect of the impaired social cognitive abilities of patients with schizophrenia. Previous studies have suggested that specific problems with the processing of facial configuration affect the face-recognition deficit in patients with schizophrenia. However, little is known about whether these deficits in face recognition are present before the onset of schizophrenia.

METHOD

This study compared performances on a face processing task among three groups: individuals at ultra-high risk for schizophrenia (n=20), patients with schizophrenia (n=18), and normal controls (n=20) using a face-discrimination task involving pairs of photographs depicting upright and inverted images with changing features and configurations. Chair stimuli were used as the control task.

RESULTS

The individuals at ultra-high risk for schizophrenia performed more poorly than did normal controls with regard to the processing of facial configuration but not the facial feature and did not differ significantly from the patients with schizophrenia with regard to the processing of facial configuration and upright facial features.

CONCLUSION

This study suggests that a specific dysfunction in the processing of facial configuration, which has an impact on face recognition, might be present before and deteriorate in patients with schizophrenia. Deficits in face recognition among individuals at risk for psychosis might contribute significantly to the social dysfunction associated with schizophrenia.

Risperidone versus haloperidol for facial affect recognition in schizophrenia: findings from a randomised study

Patients with schizophrenia consistently fail to perform facial affect recognition tasks as accurately as healthy controls. So far, the effects of different antipsychotic drugs on this deficit, as well as the mechanisms through which these drugs may exert their influence on face processing models, remain poorly understood. Twenty-five hospitalised acute schizophrenic patients were randomised to either haloperidol or risperidone following their admission. Patients performed a facial affect discrimination task. In order to differentiate drug effects on perceptive versus semantic processing of faces, the evaluation also included two facial identity discrimination tasks (inverted and upright faces). All evaluations were performed before treatment initiation, after 2 weeks and after 4 weeks of treatment. Compared with patients receiving haloperidol, patients receiving risperidone showed better discrimination of facial affect and inverted faces, but not of upright faces. Differential drug effects were most prominent 2 weeks after treatment initiation. Performance on inverted faces accounted for only 1% of the variance in affect discrimination. Additionally, there was an inverse relationship between negative symptoms and performance on upright-face identification and affect discrimination, with the strongest and most significant correlation being for affect discrimination. Our findings suggest that the preferential effect of risperidone on affect discrimination is unlikely to be due to global effects on general face processing. Moreover, although risperidone appears to enhance the processing of individual salient facial features, this effect cannot explain the improvement in affect recognition. We conclude that risperidone may specifically act on the processing of emotion-laden information.

Facial emotion perception in Chinese patients with schizophrenia and non-psychotic first-degree relatives

Although there is a consensus that patients with schizophrenia have certain deficits in perceiving and expressing facial emotions, previous studies of facial emotion perception in schizophrenia do not present consistent results. The objective of this study was to explore facial emotion perception deficits in Chinese patients with schizophrenia and their non-psychotic first-degree relatives. Sixty-nine patients with schizophrenia, 56 of their first-degree relatives (33 parents and 23 siblings), and 92 healthy controls (67 younger healthy controls matched to the patients and siblings, and 25 older healthy controls matched to the parents) completed a set of facial emotion perception tasks, including facial emotion discrimination, identification, intensity, valence, and corresponding face identification tasks. The results demonstrated that patients with schizophrenia performed significantly worse than their siblings and younger healthy controls in accuracy in a variety of facial emotion perception tasks, whereas the siblings of the patients performed as well as the corresponding younger healthy controls in all of the facial emotion perception tasks. Patients with schizophrenia also showed significantly reduced speed than younger healthy controls, while siblings of patients did not demonstrate significant differences with both patients and younger healthy controls in speed. Meanwhile, we also found that parents of the schizophrenia patients performed significantly worse than the corresponding older healthy controls in accuracy in terms of facial emotion identification, valence, and the composite index of the facial discrimination, identification, intensity and valence tasks. Moreover, no significant differences were found between the parents of patients and older healthy controls in speed after controlling the years of education and IQ. Taken together, the results suggest that facial emotion perception deficits may serve as potential endophenotypes for schizophrenia.

Facial expression and face orientation processing in schizophrenia

Schizophrenia patients exhibit deficits in recognition and identification of facial emotional expressions, but it is unclear whether these deficits result from abnormal affective processing or an impaired ability to process complex visual stimuli such as faces. Participants comprised 16 outpatients with schizophrenia and 22 matched healthy control subjects who performed two computerized visual matching tasks (facial emotional expression and orientation). Accuracy and reaction time were recorded. Clinical symptoms were assessed in the patients using the Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS), and Scale for the Assessment of Negative Symptoms (SANS). Social functioning as measured by the Zigler social competence scale was indexed in all participants. Patients with schizophrenia were less accurate than control participants on both facial emotion and orientation matching tasks, but there was no diagnosis-by-task interaction. Clinical symptoms of the patients were associated with deficits on emotion and orientation matching tasks. Worse social functioning was correlated with facial emotion matching errors across both groups. Patients with schizophrenia show general deficits in processing of faces, which is in turn associated with worse symptoms and reduced social functioning.

Exploring the role of face processing in facial emotion recognition in schizophrenia

OBJECTIVE

Impairment in emotion perception represents a fundamental feature of schizophrenia with important consequences in social functioning. A fundamental unresolved issue is the relationship between emotion perception and face perception. The aim of the present study was to examine whether facial identity recognition (Identity Discrimination) is a factor predicting facial emotion recognition in the context of the other factors, known as contributing to emotion perception, such as cognitive functions and symptoms.

METHODS

We enrolled 58 stable schizophrenic out-patients and 47 healthy subjects. Facial identity recognition and emotion perception were assessed with the Comprehensive Affect Testing System. Different multiple regression models with backward elimination were performed in order to discover the relation of each significant variable with emotion perception.

RESULTS

In a regression including the six significant variables (age, positive symptomatology, Identity Discrimination, attentive functions, verbal memory-learning, executive functions) versus emotion processing, only attentive functions (standardised β = 0.264, p = 0.038) and Identity Discrimination (standardised β = 0.279, p = 0.029) reached a significant level. Two partial regressions were performed including five variables, one excluding attentive functions and the other excluding Identity Discrimination. When we excluded attentive functions, the only significant variable was Identity Discrimination (standardised β = 0.278, p = 0.032). When we excluded Identity Discrimination, both verbal memory-learning (standardised β = 0.261, p = 0.042) and executive functions (standardised β = 0.253, p = 0.048) were significant.

CONCLUSIONS

Our results emphasised the role of face perception and attentional abilities on affect perception in schizophrenia. We additionally found a role of verbal memory-learning and executive functions on emotion perception. The relationship between those above-mentioned variables and emotion processing could have implications for cognitive rehabilitation.

Effect of risperidone on emotion recognition deficits in antipsychotic-naïve schizophrenia: a short-term follow-up study

BACKGROUND

Facial emotion recognition deficits [FERD] have been consistently demonstrated in treated schizophrenia patients. FERD in treatment-naïve patients and the effect of antipsychotics are yet to be explored.

AIMS

To examine for FERD in antipsychotic-naïve schizophrenia patients and the effect of short-term atypical antipsychotic treatment on FERD.

METHODS

Twenty-five antipsychotic-naïve schizophrenia [DSM-IV] patients and 30 age-, sex-, and education-matched healthy control subjects were assessed for FERD using the Tool for Recognition of Emotions in Neuropsychiatric DisorderS [TRENDS] - a culturally sensitive and valid tool. Psychopathology was assessed using SAPS and SANS. Performance of patients on TRENDS and psychopathology was re-assessed after short-term exposure to risperidone.

RESULTS

At baseline, the patients made significantly greater errors in recognition of negative emotions of fear and disgust which improved on follow-up. This improvement was influenced by severity of baseline negative symptoms.

CONCLUSION

Risperidone treatment can improve disgust recognition deficits in patients with schizophrenia.

Memory-prediction errors and their consequences in schizophrenia

Cognitive deficits play a central role in the onset of schizophrenia. Cognitive impairment precedes the onset of psychosis in at least a subgroup of patients, and accounts for considerable dysfunction. Yet cognitive deficits as currently measured are not significantly related to hallucinations and delusions. Part of this counterintuitive absence of a relationship may be caused by the lack of an organizing principle of cognitive impairment in schizophrenia research. We review literature suggesting that a system of memory-based prediction is central to human perception, thought and action , and forward the notion that many of the symptoms of schizophrenia are a result of a failure of this system.

Turning it upside down: areas of preserved cognitive function in schizophrenia

Patients with schizophrenia demonstrate marked impairments on most clinical neuropsychological tests. These findings suggest that patients suffer from a generalized form of cognitive impairment, with little evidence of spared performance documented in several large meta-analytic reviews of the clinical literature. In contrast, we review evidence for relative sparing of aspects of attention, procedural memory, and emotional processing observed in studies that have employed experimental approaches adapted from the cognitive and affective neuroscience literature. These islands of preserved performance suggest that the cognitive deficits in schizophrenia are not as general as they appear to be when assayed with clinical neuropsychological methods. The apparent contradiction in findings across methods may offer important clues about the nature of cognitive impairment in schizophrenia. The documentation of preserved cognitive function in schizophrenia may serve to sharpen hypotheses about the biological mechanisms that are implicated in the illness.

Deficits in implicit attention to social signals in schizophrenia and high risk groups: behavioural evidence from a new illusion

Background

An increasing body of evidence suggests that the apparent social impairments observed in schizophrenia may arise from deficits in social cognitive processing capacities. The ability to process basic social cues, such as gaze direction and biological motion, effortlessly and implicitly is thought to be a prerequisite for establishing successful social interactions and for construing a sense of “social intuition.” However, studies that address the ability to effortlessly process basic social cues in schizophrenia are lacking. Because social cognitive processing deficits may be part of the genetic vulnerability for schizophrenia, we also investigated two groups that have been shown to be at increased risk of developing schizophrenia-spectrum pathology: first-degree relatives of schizophrenia patients and men with Klinefelter syndrome (47,XXY).

Results

We compared 28 patients with schizophrenia, 29 siblings of patients with schizophrenia, and 29 individuals with Klinefelter syndrome with 46 matched healthy control subjects on a new paradigm. This paradigm measures one's susceptibility for a bias in distance estimation between two agents that is induced by the implicit processing of gaze direction and biological motion conveyed by these agents. Compared to control subjects, patients with schizophrenia, as well as siblings of patients and Klinefelter men, showed a lack of influence of social cues on their distance judgments.

Conclusions

We suggest that the insensitivity for social cues is a cognitive aspect of schizophrenia that may be seen as an endophenotype as it appears to be present both in relatives who are at increased genetic risk and in a genetic disorder at risk for schizophrenia-spectrum psychopathology. These social cue–processing deficits could contribute, in part, to the difficulties in higher order social cognitive tasks and, hence, to decreased social competence that has been observed in these groups.

Facial emotion perception in schizophrenia: a meta-analytic review

OBJECTIVES

A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005).

RESULTS

The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race.

CONCLUSION

Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.

Visual and cognitive processing of face information in schizophrenia: detection, discrimination and working memory

Face recognition involves several physiological and psychological processes, including those in visual, cognitive and affective domains. Studies have found that schizophrenia patients are deficient at recognizing facial emotions, yet visual and cognitive processing of facial information in this population has not been systematically examined. In this study, we examined visual detection, perceptual discrimination and working memory of faces as well as non-face visual objects in patients. Visual detection was measured by accuracy when detecting the presence of a briefly displayed face, image which contained only the basic configural information of a face. Perceptual discrimination was measured by discriminability scores for individual facial identity images, in which the degree of similarity between images was systematically varied via morphing. Working memory was measured by the discriminability scores when two comparison face images were separated by 3 or 10 s. All measurements were acquired using a psychophysical method (two-alternative forced choice). Relative to controls, patients showed significantly reduced accuracy in visual detection of faces (p=0.003), moderately degraded performance in perceptual discrimination of faces (p=0.065), and significantly impaired performance in working memory of faces (p<0.001 for both 3 and 10 sec conditions). Patients' performance on non-face versions of these tasks, while degraded, was not correlated with performance on face recognition. This pattern of results indicates that greater signal strength is required for visual and cognitive processing of facial information in schizophrenia.

Effects of sad mood on facial emotion recognition in Chinese people

This study examined the influence of sad mood on the judgment of ambiguous facial emotion expressions among 47 healthy volunteers who had been induced to feel sad (n=13), neutral (n=15), or happy (n=19) emotions by watching video clips. The findings suggest that when the targets were ambiguous, participants who were in a sad mood tended to classify them in the negative emotional categories rather than the positive emotional categories. Also, this observation indicates that emotion-specific negative bias in the judgment of facial expressions is associated with a sad mood. The finding argues against a general impairment in decoding facial expressions. Furthermore, the observed mood-congruent negative bias was best predicted by spatial perception. The findings of this study provide insights into the cognitive processes underlying the interpersonal difficulties experienced by people in a sad mood, which may be predisposing factors in the development of clinical depression.

Recognition of facial expressions in obsessive-compulsive disorder

Sprengelmeyer et al. [Sprengelmeyer, R., Young, A. W., Pundt, I., Sprengelmeyer, A., Calder, A. J., Berrios, G., et al. (1997). Disgust implicated in obsessive-compulsive disorder. Proceedings of the Royal Society of London, 264, 1767-1773] found that patients with OCD showed severely impaired recognition of facial expressions of disgust. This result has potential to provide a unique window into the psychopathology of OCD, but several published attempts to replicate this finding have failed. The current study compared OCD patients to normal controls and panic disorder patients on ability to recognize facial expressions of negative emotions. Overall, the OCD patients were impaired in their ability to recognize disgust expressions, but only 33% of patients showed this deficit. These deficits were related to OCD symptom severity and general functioning, factors that may account for the inconsistent findings observed in different laboratories.

Basic emotions and psychological distress: association between recognition of facial expressions and Symptom Checklist-90 subscales

OBJECTIVE

Cross-cultural studies have demonstrated universal similarity in the recognition and expression of basic emotions in facial expressions. The so-called mood congruency effect, observed primarily in clinical populations, implies that subjects with depressed mood tend to judge positive emotions as neutral and neutral faces as negative. The objective was to investigate whether a mood congruency effect can be detected in case of mild impairments among healthy subjects. First, it was hypothesized that subjects with mild psychiatric symptom distress have poorer performance in affective facial recognition in general. Second, it was also hypothesized that these subjects have poorer functioning in neutral face recognition and that they are prone to attribute negative emotions, for example, sadness and fear to neutral faces. Third, it was also assumed that people with mild psychiatric symptom distress have poor performance in recognizing positive emotions.

METHODS

Pictures representing the basic emotions were used to examine the recognition of facial emotions; the Symptom Checklist-90 was obtained to quantify overall psychological distress and the severity of psychiatric symptoms on 9 primary symptom dimensions, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. One hundred seventeen healthy volunteers were recruited for the purpose of the study.

RESULTS

Consistent with the first hypothesis, results indicated a significant negative association between the overall recognition rate of facial expressions and the level of psychiatric symptoms in a healthy population. Consistent with the second hypothesis, the level of psychiatric symptoms was related inversely with the neutral facial expression recognition and directly with the negative bias in neutral facial expressions. However, our data did not support the assumption that people with mild psychiatric symptom distress would have a poorer performance in recognizing positive emotions.

CONCLUSIONS

These findings support the notion that difficulties in emotion processing in general and in neutral face recognition, including a negative bias in particular, are strongly related to psychological distress and the severity of psychiatric symptoms in a healthy population.

Social cognition in schizophrenia: a review of face processing

BACKGROUND

People with schizophrenia have difficulties in interpreting social information. Much social information is gathered from faces, and face processing represents a well-characterized model to study the basis of social deficits in schizophrenia.

SOURCES OF DATA

A narrative review of selected literature.

AREAS OF AGREEMENT

Individuals with schizophrenia have impairments in recognizing basic emotions and making social judgements from facial stimuli. Areas of controversy The neural basis of these abnormalities is still being determined. However, initial evidence implicates dysfunction of frontal and temporal lobe brain regions. Hyper-activation of the amygdala, a brain region involved in fear, to facial stimuli may be an important underlying neural abnormality.

GROWING POINTS

The present article highlights the difficulties that people with schizophrenia have in interpreting social cues from faces.

AREAS TIMELY FOR DEVELOPING RESEARCH

Research is required to understand more about both the basis of social deficits in schizophrenia and their potential remediation.

Fearful faces in schizophrenia: the relationship between patient characteristics and facial affect recognition

Although schizophrenia has often been associated with deficits in facial affect recognition, it is debated whether the recognition of specific emotions is affected and if these facial affect-processing deficits are related to symptomatology or other patient characteristics. The purpose of the present study was to explore whether particular patient characteristics are associated with the recognition of specific facial expressions in patients with schizophrenia. Sixty-four patients with a DSM-IV diagnosis of schizophrenia were assessed with a computerized test of degraded facial affect recognition. Linear regression analysis showed that, in particular, negative symptoms and male sex were associated with worse recognition of fearful faces. Furthermore, diagnosis of nonparanoid schizophrenia and later age of onset were associated with worse recognition of neutral faces. Findings are explained in the light of a neuroanatomical dysfunction accounting for both negative symptoms, such as reduced emotional expression and social-emotional dysfunction, for which men seem more vulnerable than women.

Disordered emotional processing in schizophrenia and one-sided brain damage

The work concentrates on the problem of human emotions in healthy and pathologically changed brains, mainly in persons afflicted with schizophrenia or with organic impairments localized in one of the cerebral hemispheres. This chapter presents the state of current knowledge concerning the hemispheric lateralization of emotions among healthy people, psychiatric patients, and patients with one-sided brain lesion, on the basis of clinical observations, the results of experimental work, and the newest neuroimaging techniques. The numerous experiments and scientific methods used to assess the hemispheric lateralization of emotions and the discrepancies in their results point toward a lack of consistent theory in the field of hemispheric specialization in the regulation of emotional processes. Particular scientific interest was taken in the emotions of persons afflicted with schizophrenia, either in its early or late stages. This was inspired by the emotional behavior of schizophrenic patients on a psychiatric ward and their ability to perceive and express emotions during various stages of the schizophrenic process. In order to examine the cerebral manifestations of emotional deficits and the specialization of cerebral hemispheres for emotional processes, the author has described the emotional behavior of patients with unilateral cerebral stroke, i.e., patients with damage to the right or left cerebral hemisphere. Overall, the inferior performance of emotional tasks by right-hemisphere-damaged patients compared to other groups might support right-hemisphere superiority for affect perception despite variations in the stimuli used.

Use of the process dissociation procedure to study the contextual effects on face recognition in schizophrenia: familiarity, associative recollection and discriminative recollection

Contextual effects were explored in schizophrenia patients and paired comparison subjects during a long-term face recognition task. The objective was to investigate the contextual effects on face recognition by manipulating, in the same experiment, the perceptual context of the face (intrinsic vs. extrinsic) and the task context (inclusion vs. exclusion instructions). The situation was derived from the Jacoby's [Jacoby, L.L., 1991. A process dissociation framework: separating automatic from intentional uses of memory. Journal of Memory and Language 30, 513-541] process dissociation procedure. The results showed that schizophrenia patients (N=20) presented lower performances than healthy controls (N=20) in the inclusion but not in the exclusion task. This observation emphasizes the heterogeneity of recollection and suggests that the memory impairment in schizophrenia reflects an imbalance between two mechanisms. The first is a deficit in "associative recollection", i.e., the failure to use efficiently associative information. The other is an enhanced "discriminative recollection" that impedes their capacity to process information separately from its perceptual context. In addition, correlation with symptoms suggest that the former is expressed in the loosening of associations characteristic of disorganization symptoms, whereas the latter reflects the lack of flexibility or the contextualization bias related to psychotic symptoms, i.e., delusions and hallucinations.

Electromagnetic brain activity evoked by affective stimuli in schizophrenia

Schizophrenia is typically associated with cognitive deficits, but symptoms also point to alterations in the processing of affective material, with potential impact on behavioral performance. This impact may unfold on multiple time scales, but initial processing of rapidly unfolding social cues may be particularly important. MEG-assessed regional brain activity associated with the capacity to process the emotional content of rapid visual stimuli (3/s) was examined in 12 individuals with schizophrenia and 12 matched controls. Patients showed less differentiation of emotional versus neutral stimuli 90-300 ms following picture onset. Together with group differences in the lateral topography of valence effects, these results are discussed as evidence of deficient automatic processing of emotionally potent stimuli in schizophrenia.

The development of emotion-processing in children: effects of age, emotion, and intensity

BACKGROUND

This study examined the effects of age and two novel factors (intensity and emotion category) on healthy children's developing emotion-processing from 4 to 15 years using two matching paradigms.

METHODS

An explicit emotion-matching task was employed in which children matched the emotion of a target individual, and an implicit task whereby participants ignored the emotive facial stimulus and matched identity. Four intensities (25%, 50%, 75%, and 100%) for each of five emotion categories (sad, anger, happy, fear, and disgust) were included and provided a novel avenue of emotion-processing exploration.

RESULTS

Increasing age significantly improved children's performance on both tasks, particularly for fear and disgust. Age was not associated with more subtle processing (i.e., lower intensity of expression). When explicitly matching emotion expressions, increasing intensity was associated with improved performance. When matching identities (implicit emotion-matching), emotion category and intensity influenced task performance. Sex effects were minimal.

CONCLUSIONS

In children, age, facial expression intensity and emotion category are important for predicting accuracy on emotion-processing tasks. Emotion category and expression intensity differentially affect performance on explicit and implicit emotion-processing tasks.

Temporal lobe gray matter in schizophrenia spectrum: a volumetric MRI study of the fusiform gyrus, parahippocampal gyrus, and middle and inferior temporal gyri

Although several brain morphologic studies have suggested abnormalities in the temporal regions to be a common indicator of vulnerability for the schizophrenia spectrum, less attention has been paid to temporal lobe structures other than the superior temporal gyrus or the medial temporal region. In this study, we investigated the volume of gray matter in the fusiform gyrus, the parahippocampal gyrus, the middle temporal gyrus, and the inferior temporal gyrus using magnetic resonance imaging in 39 schizotypal disorder patients, 65 schizophrenia patients, and 72 age and gender matched healthy control subjects. The anterior fusiform gyrus was significantly smaller in the schizophrenia patients than the control subjects but not in the schizotypal disorder patients, while the volume reduction of the posterior fusiform gyrus was common to both disorders. Volumes for the middle and inferior temporal gyri or the parahippocampal gyrus did not differ between groups. These findings suggest that abnormalities in the posterior region of the fusiform gyrus are, as have been suggested for the superior temporal gyrus or the amygdala/hippocampus, prominent among the temporal lobe structures as a common morphologic substrate for the schizophrenia spectrum, whereas more widespread alterations involving the anterior region might be associated with the development of full-blown schizophrenia.

The role of configural information in facial emotion recognition in schizophrenia

The schizophrenia deficit in facial emotion recognition could be accounted for by a deficit in processing the configural information of the face. The present experiment was designed to further test this hypothesis by studying the face-inversion effect in a facial emotion recognition task. The ability of 26 schizophrenic patients and 26 control participants to recognize facial emotions on upright and upside-down faces was assessed. Participants were told to state whether faces expressed one of six possible emotions (happiness, anger, disgust, fear, sadness, neutrality) in two sessions, one with upright faces and the other with upside-down faces. Discriminability and the decision criterion were computed. The results indicated that the schizophrenic patients were impaired in upright facial emotion discrimination by comparison with the controls. They also exhibited an inversion effect similar to the controls. However, whereas controls tended to adopt a more conservative criterion for all emotions and a liberal criterion for neutrality when the faces were upside-down, schizophrenic patients presented a decision criterion pattern that was similar for the two orientations and similar to controls in upside-down emotion recognition. The lack of a decision criterion shift was associated with positive symptoms such as delusions, hallucinations, and bizarre behavior. Moreover, positive and negative symptoms were associated with inversion effect on discriminability; the more severe the symptoms, the weaker the inversion effect. We conclude that individuals with schizophrenia do process the configural information of the face. However, further investigations are needed to assert whether this information is of good quality in schizophrenia.

Increased medial temporal lobe activation during the passive viewing of emotional and neutral facial expressions in schizophrenia

INTRODUCTION

Patients with schizophrenia show deficits in facial affect and facial identity recognition and exhibit structural and neurophysiological abnormalities in brain regions known to mediate these processes. Functional neuroimaging studies of neural responses to emotional facial expressions in schizophrenia have reported both increases and decreases in medial temporal lobe (MTL) activity in schizophrenia. Some of this variability may be related to the tasks performed and the baseline conditions used. Here we tested whether MTL responses to human faces in schizophrenia are abnormal when unconstrained by a cognitive task and measured relative to a low-level baseline (fixation) condition.

METHODS

15 patients with schizophrenia and 16 healthy control subjects underwent functional magnetic resonance imaging (fMRI) while passively viewing human faces displaying fearful, happy, and neutral emotional expressions.

RESULTS

Relative to control subjects, the patients demonstrated (1) significantly greater activation of the left hippocampus while viewing all three facial expressions and (2) increased right amygdala activation during the initial presentation of fearful and neutral facial expressions.

CONCLUSIONS

In schizophrenia, hippocampal and amygdala activity is elevated during the passive viewing of human faces.