Imitation of facial expressions in schizophrenia

Visual Imagery Imitation Skills and Cognitive Functions in Patients with Schizophrenia

Background/Objectives

Visual demonstration by occupational therapists is very common in psychiatric treatment, however, some patients with schizophrenia could not imitate the actions despite the absence of any physical impairments. Therefore, the purpose of this study was to identify how cognitive functions such as attention and cognitive processes in the imitation process is necessary and how these processes were related to the ability to convert this into action (imitation) in patients with schizophrenia.

Method

The participants were patients with schizophrenia with mean age 59.2 (± 11.3) years, 23 were men and 10 were women. The participants were tested for imitation ability and cognitive function, working memory, and motor imagery.

Results

Three subjects achieved full scores in the visual imitation test. However, the median of the total score was 10.0, with many subjects failing to imitate multiple tasks. Imitation learning is associated with duration of illness(t = −4.09, p = .000), mental health(t = −2.30, p = .029), and cognitive function such as the ability to retain visual information(t = −2.97, p = .006), and that these factors are interrelated.

Conclusion

To effectively promote imitation learning in patients with schizophrenia, occupational therapists need to establish teaching methods that make it easier for learners to retain visual information from the early stages of their illness.

Computerized analysis of facial expressions in serious mental illness

Blunted facial affect is a transdiagnostic component of Serious Mental Illness (SMI) and is associated with a host of negative outcomes. However, blunted facial affect is a poorly understood phenomenon, with no known cures or treatments. A critical step in better understanding its phenotypic expression involves clarifying which facial expressions are altered in specific ways and under what contexts. The current literature suggests that individuals with SMI show decreased positive facial expressions, but typical, or even increased negative facial expressions during laboratory tasks. While this literature has coalesced around general trends, significantly more nuance is available regarding what components facial expressions are atypical and how those components are associated with increased severity of clinical ratings. The present project leveraged computerized facial analysis to test whether clinician-rated blunted affect is driven by decreases in duration, intensity, or frequency of positive versus other facial expressions during a structured clinical interview. Stable outpatients meeting criteria for SMI (N = 59) were examined. Facial expression did not generally vary as a function of clinical diagnosis. Overall, clinically-rated blunted affect was not associated with positive expressions, but was associated with decreased surprise and increased anger, sadness, and fear expressions. Blunted affect is not a monolithic lack of expressivity, and increased precision in operationally defining it is critical for uncovering its causes and maintaining factors. Our discussion focuses on this effort, and on advancing digital phenotyping of blunted facial affect more generally.

Facial and Vocal Markers of Schizophrenia Measured Using Remote Smartphone Assessments: Observational Study

Background

Machine learning–based facial and vocal measurements have demonstrated relationships with schizophrenia diagnosis and severity. Demonstrating utility and validity of remote and automated assessments conducted outside of controlled experimental or clinical settings can facilitate scaling such measurement tools to aid in risk assessment and tracking of treatment response in populations that are difficult to engage.

Objective

This study aimed to determine the accuracy of machine learning–based facial and vocal measurements acquired through automated assessments conducted remotely through smartphones.

Methods

Measurements of facial and vocal characteristics including facial expressivity, vocal acoustics, and speech prevalence were assessed in 20 patients with schizophrenia over the course of 2 weeks in response to two classes of prompts previously utilized in experimental laboratory assessments: evoked prompts, where subjects are guided to produce specific facial expressions and speech; and spontaneous prompts, where subjects are presented stimuli in the form of emotionally evocative imagery and asked to freely respond. Facial and vocal measurements were assessed in relation to schizophrenia symptom severity using the Positive and Negative Syndrome Scale.

Results

Vocal markers including speech prevalence, vocal jitter, fundamental frequency, and vocal intensity demonstrated specificity as markers of negative symptom severity, while measurement of facial expressivity demonstrated itself as a robust marker of overall schizophrenia symptom severity.

Conclusions

Established facial and vocal measurements, collected remotely in schizophrenia patients via smartphones in response to automated task prompts, demonstrated accuracy as markers of schizophrenia symptom severity. Clinical implications are discussed.

Interpersonal Coordination in Schizophrenia: A Scoping Review of the Literature

Interpersonal coordination forms the natural bridge between the self and others. It arises from the dynamic and complex set of embodied processes that involve nonverbal behaviors, perceptions, movement, and emotions that support adaptive interactions. Disembodiment has been implicated in a myriad of core clinical phenomena that manifest in a "praecox feeling" in persons with schizophrenia during interpersonal interactions. To further understand mechanisms underlying aberrant interpersonal interactions in schizophrenia, recent research has focused on mimicry, imitation, and interactional synchrony. In this study, we conducted a Pubmed, Web of Science, and PsycInfo database review of the literature on interpersonal coordination in schizophrenia to evaluate the body of work in mimicry, imitation, and interactional synchrony in relation to schizophrenia-spectrum conditions. The results of the review suggest that the sensory-motor processes underlying interpersonal coordination may result in impaired abilities to mimic and synchronize nonverbal behavior during interactions. Opportunities for future progress lie in studies of interpersonal coordination at different developmental stages of psychosis, potential use of interpersonal coordination to improve treatment adherence and reduce stigma, as well as interventions to improve social functioning in people with a serious mental illness.

Simulation and social behavior: an fMRI study of neural processing during simulation in individuals with and without risk for psychosis

Social dysfunction is a risk indicator for schizophrenia spectrum disorders, with at-risk individuals demonstrating a range of social behavior impairments. Variability in social ability may be explained by individual differences in the psychological processes of social behavior. In particular, mental simulation, the process by which an individual generates an internal representation of the thoughts or feelings of another, may explain variation in social behavior. This study investigates the neural process of simulation in healthy individuals and individuals at risk for psychosis. Using a novel fMRI pain paradigm, individuals watch videos of another person’s hand or foot experiencing pain. After each video, individuals are asked to simulate the observed painful situation on their own hand or foot. Neural activity during simulation in the somatosensory cortex was associated with real-world self-reported social behavior, such that a stronger neural response in the somatosensory cortex was associated with greater rates of positive social experiences and affective empathy across all participants. These findings suggest that the neural mechanisms that underlie simulation are important for social behavior, and may explain individual variability in social functioning in healthy and at-risk populations.

Decoupling of spontaneous facial mimicry from emotion recognition in schizophrenia

Past research indicates that spontaneous mimicry facilitates the decoding of others' emotions, leading to enhanced social perception and interpersonal rapport. Individuals with schizophrenia (SZ) show consistent deficits in emotion recognition and expression associated with poor social functioning. Given the prominence of blunted affect in schizophrenia, it is possible that spontaneous facial mimicry may also be impaired. However, studies assessing automatic facial mimicry in schizophrenia have yielded mixed results. It is therefore unknown whether emotion recognition deficits and impaired automatic facial mimicry are related in schizophrenia. SZ and demographically matched controls (CO) participated in a dynamic emotion recognition task. Electromyographic activity in muscles responsible for producing facial expressions was recorded during the task to assess spontaneous facial mimicry. SZ showed deficits in emotion identification compared to CO, but there was no group difference in the predictive power of spontaneous facial mimicry for avatar's expressed emotion. In CO, facial mimicry supported accurate emotion recognition, but it was decoupled in SZ. The finding of intact facial mimicry in SZ bears important clinical implications. For instance, clinicians might be able to improve the social functioning of patients by teaching them to pair specific patterns of facial muscle activation with distinct emotion words.

Enhanced Automatic Action Imitation and Intact Imitation-Inhibition in Schizophrenia

Imitation plays a key role in social learning and in facilitating social interactions and likely constitutes a basic building block of social cognition that supports higher-level social abilities. Recent findings suggest that patients with schizophrenia have imitation impairments that could contribute to the social impairments associated with the disorder. However, extant studies have specifically assessed voluntary imitation or automatic imitation of emotional stimuli without controlling for potential confounders. The imitation impairments seen might therefore be secondary to other cognitive, motoric, or emotional deficits associated with the disorder. To overcome this issue, we used an automatic imitation paradigm with nonemotional stimuli to assess automatic imitation and the top-down modulation of imitation where participants were required to lift one of 2 fingers according to a number shown on the screen while observing the same or the other finger movement. In addition, we used a control task with a visual cue in place of a moving finger, to isolate the effect of observing finger movement from other visual cueing effects. Data from 33 patients (31 medicated) and 40 matched healthy controls were analyzed. Patients displayed enhanced imitation and intact top-down modulation of imitation. The enhanced imitation seen in patients may have been medication induced as larger effects were seen in patients receiving higher antipsychotic doses. In sum, we did not find an imitation impairment in schizophrenia. The results suggest that previous findings of impaired imitation in schizophrenia might have been due to other cognitive, motoric, and/or emotional deficits.

Effects of bilateral prefrontal rTMS on brain activation during social-emotional evaluation in schizophrenia: A double-blind, randomized, exploratory study

This exploratory study reports on the effects of Repetitive Transcranial Magnetic Stimulation (rTMS) on (prefrontal) brain activity changes during ambiguous emotional evaluation in patients with schizophrenia. Before and after randomly assigned treatment with active and sham rTMS, patients performed the Wall of Faces task during fMRI scanning. fMRI analysis showed that rTMS treatment resulted in reduced activation of striato-fronto-parietal brain areas, while activation increased compared to baseline after sham. Thus, prefrontal rTMS may normalize an increased brain response to ambiguous emotional stimuli, but future studies should confirm these findings.

Using mimicry of body movements by a virtual agent to increase synchronization behavior and rapport in individuals with schizophrenia

Synchronization of behavior such as gestures or postures is assumed to serve crucial functions in social interaction but has been poorly studied to date in schizophrenia. Using a virtual collaborative environment (VCS), we tested 1) whether synchronization of behavior, i.e., the spontaneous initiation of gestures that are congruent with those of an interaction partner, was impaired in individuals with schizophrenia compared with healthy participants; 2) whether mimicry of the patients' body movements by the virtual interaction partner was associated with increased behavioral synchronization and rapport. 19 patients and 19 matched controls interacted with a virtual agent who either mimicked their head and torso movements with a delay varying randomly between 0.5 s and 4 s or did not mimic, and rated feelings of rapport toward the virtual agent after each condition. Both groups exhibited a higher and similar synchronization behavior of the virtual agent forearm movements when they were in the Mimicry condition rather than in the No-mimicry condition. In addition, both groups felt more comfortable with a mimicking virtual agent rather than a virtual agent not mimicking them suggesting that mimicry is able to increase rapport in individuals with schizophrenia. Our results suggest that schizophrenia cannot be considered anymore as a disorder of imitation, particularly as regards behavioral synchronization processes in social interaction contexts.

Cinemotion, a Program of Cognitive Remediation to Improve the Recognition and Expression of Facial Emotions in Schizophrenia: A Pilot Study

Objective: Patients with schizophrenia exhibit impaired social cognition, especially in the recognition and expression of facial emotions, aspects of communication profoundly interlinked in an embodied approach of cognition. Nevertheless, many training programs have been developed that focus on either of these deficits but not both. We therefore designed a training program, Cinemotion, intended to remedy the 2 deficits and investigated its feasibility and effects in patients with schizophrenia. Design: Thirty-one patients undergoing treatment for schizophrenia and presenting deficit in emotion recognition were randomized to a group of 16 to undergo Cinemotion training, delivered in weekly group sessions, and to a control treatment group of 15. At the conclusion of training or after 10 weeks in controls, we reassessed and compared original and final results to determine improvement. Methods: Facial emotions recognition (TREF), empathy (Questionnaire of Cognitive and Affective Empathy, QCAE), and attributional style (Ambiguous Intentions Hostility Questionnaire, AIHQ) were assessed before (T0) and after (T1) the program. External evaluators also assessed ability and accuracy of Cinemotion participants to self-generate facial emotion expression in response to verbal instruction. Results: Between T0 and T1, Cinemotion participants significantly improved total TREF, sadness, disgust, and anger scores, compared to findings in control treatment group. They also improved their ability and accuracy to self-generate facial expressions, especially sadness and fear, with no significant improvement in other components of social recognition. Conclusions: Our findings show the apparent efficacy of training using the Cinemotion program to improve the recognition and expression of facial emotions in schizophrenia.

Using Functional Analysis as a Framework to Guide Individualized Treatment for Negative Symptoms

Although numerous interventions are available for negative symptoms, outcomes have been unsatisfactory with pharmacological and psychological interventions producing changes of only limited clinical significance. Here, we argue that because negative symptoms occur as a complex syndrome caused and maintained by numerous factors that vary between individuals they are unlikely to be treated effectively by the present "one size fits all" approaches. Instead, a well-founded selection of those interventions relevant to each individual is needed to optimize both the efficiency and the efficacy of existing approaches. The concept of functional analysis (FA) can be used to structure existing knowledge so that it can guide individualized treatment planning. FA is based on stimulus-response learning mechanisms taking into account the characteristics of the organism that contribute to the responses, their consequences and the contingency with which consequences are tied to the response. FA can thus be flexibly applied to the level of individual patients to understand the factors causing and maintaining negative symptoms and derive suitable interventions. In this article we will briefly introduce the concept of FA and demonstrate-exemplarily-how known psychological and biological correlates of negative symptoms can be incorporated into its framework. We then outline the framework's implications for individual assessment and treatment. Following the logic of FA, we argue that a detailed assessment is needed to identify the key factors causing or maintaining negative symptoms for each individual patient. Interventions can then be selected according to their likelihood of changing these key factors and need to take interactions between different factors into account. Supplementary case vignettes exemplify the usefulness of functional analysis for individual treatment planning. Finally, we discuss and point to avenues for future research guided by this model.

Abnormal Brain Activation During Theory of Mind Tasks in Schizophrenia: A Meta-Analysis

Social cognition abilities are severely impaired in schizophrenia (SZ). The current meta-analysis used foci of 21 individual studies on functional abnormalities in the schizophrenic brain in order to identify regions that reveal convergent under- or over-activation during theory of mind (TOM) tasks. Studies were included in the analyses when contrasting tasks that require the processing of mental states with tasks which did not. Only studies that investigated patients with an ICD or DSM diagnosis were included. Quantitative voxel-based meta-analyses were done using Seed-based d Mapping software. Common TOM regions like medial-prefrontal cortex and temporo-parietal junction revealed abnormal activation in schizophrenic patients: Under-activation was identified in the medial prefrontal cortex, left orbito-frontal cortex, and in a small section of the left posterior temporo-parietal junction. Remarkably, robust over-activation was identified in a more dorsal, bilateral section of the temporo-parietal junction. Further abnormal activation was identified in medial occipito-parietal cortex, right premotor areas, left cingulate gyrus, and lingual gyrus. The findings of this study suggest that SZ patients simultaneously show over- and under-activation in TOM-related regions. Especially interesting, temporo-parietal junction reveals diverging activation patterns with an under-activating left posterior and an over-activating bilateral dorsal section. In conclusion, SZ patients show less specialized brain activation in regions linked to TOM and increased activation in attention-related networks suggesting compensatory effects.

Deliberately generated and imitated facial expressions of emotions in people with eating disorders

BACKGROUND

People with eating disorders have difficulties in socio emotional functioning that could contribute to maintaining the functional consequences of the disorder. This study aimed to explore the ability to deliberately generate (i.e., pose) and imitate facial expressions of emotions in women with anorexia (AN) and bulimia nervosa (BN), compared to healthy controls (HC).

METHODS

One hundred and three participants (36 AN, 25 BN, and 42 HC) were asked to pose and imitate facial expressions of anger, disgust, fear, happiness, and sadness. Their facial expressions were recorded and coded.

RESULTS

Participants with eating disorders (both AN and BN) were less accurate than HC when posing facial expressions of emotions. Participants with AN were less accurate compared to HC imitating facial expressions, whilst BN participants had a middle range performance. All results remained significant after controlling for anxiety, depression and autistic features.

LIMITATIONS

The relatively small number of BN participants recruited for this study.

CONCLUSIONS

The study findings suggest that people with eating disorders, particularly those with AN, have difficulties posing and imitating facial expressions of emotions. These difficulties could have an impact in social communication and social functioning. This is the first study to investigate the ability to pose and imitate facial expressions of emotions in people with eating disorders, and the findings suggest this area should be further explored in future studies.

Social cognition and psychopathology: a critical overview

The philosophical and interdisciplinary debate about the nature of social cognition, and the processes involved, has important implications for psychiatry. On one account, mindreading depends on making theoretical inferences about another person's mental states based on knowledge of folk psychology, the so-called "theory theory" (TT). On a different account, "simulation theory" (ST), mindreading depends on simulating the other's mental states within one's own mental or motor system. A third approach, "interaction theory" (IT), looks to embodied processes (involving movement, gesture, facial expression, vocal intonation, etc.) and the dynamics of intersubjective interactions (joint attention, joint action, and processes not confined to an individual system) in highly contextualized situations to explain social cognition, and disruptions of these processes in some psychopathological conditions. In this paper, we present a brief summary of these three theoretical frameworks (TT, ST, IT). We then focus on impaired social abilities in autism and schizophrenia from the perspective of the three approaches. We discuss the limitations of such approaches in the scientific studies of these and other pathologies, and we close with a short reflection on the future of the field. In this regard we argue that, to the extent that TT, ST and IT offer explanations that capture different (limited) aspects of social cognition, a pluralist approach might be best.

Altered brain activation during action imitation and observation in schizophrenia: a translational approach to investigating social dysfunction in schizophrenia

OBJECTIVE

Social impairments are a key feature of schizophrenia, but their underlying mechanisms are poorly understood. Imitation, a process through which we understand the minds of others, involves the so-called mirror neuron system, a network comprising the inferior parietal lobe, inferior frontal gyrus, and posterior superior temporal sulcus. The authors examined mirror neuron system function in schizophrenia.

METHOD

Sixteen medicated schizophrenia patients and 16 healthy comparison subjects performed an action imitation/observation task during functional MRI. Participants saw a video of a moving hand or spatial cue and were instructed to either execute finger movements associated with the stimulus or simply observe. Activation in the mirror neuron system was measured during imitative versus nonimitative actions and observation of a moving hand versus a moving spatial cue. These contrasts were compared across groups.

RESULTS

Activation in the mirror neuron system was less specific for imitation in schizophrenia. Relative to healthy subjects, patients had reduced activity in the posterior superior temporal sulcus during imitation and greater activity in the posterior superior temporal sulcus and inferior parietal lobe during nonimitative action. Patients also showed reduced activity in these regions during action observation. Mirror neuron system activation was related to symptom severity and social functioning in patients and to schizotypal syndrome in comparison subjects.

CONCLUSIONS

Given the role of the inferior parietal lobe and posterior superior temporal sulcus in imitation and social cognition, impaired imitative ability in schizophrenia may stem from faulty perception of biological motion and transformations from perception to action. These findings extend our understanding of social dysfunction in schizophrenia.

Dimensional information-theoretic measurement of facial emotion expressions in schizophrenia

Altered facial expressions of emotions are characteristic impairments in schizophrenia. Ratings of affect have traditionally been limited to clinical rating scales and facial muscle movement analysis, which require extensive training and have limitations based on methodology and ecological validity. To improve reliable assessment of dynamic facial expression changes, we have developed automated measurements of facial emotion expressions based on information-theoretic measures of expressivity of ambiguity and distinctiveness of facial expressions. These measures were examined in matched groups of persons with schizophrenia (n = 28) and healthy controls (n = 26) who underwent video acquisition to assess expressivity of basic emotions (happiness, sadness, anger, fear, and disgust) in evoked conditions. Persons with schizophrenia scored higher on ambiguity, the measure of conditional entropy within the expression of a single emotion, and they scored lower on distinctiveness, the measure of mutual information across expressions of different emotions. The automated measures compared favorably with observer-based ratings. This method can be applied for delineating dynamic emotional expressivity in healthy and clinical populations.

Gesture imitation in schizophrenia

Recent evidence suggests that individuals with schizophrenia (SZ) are impaired in their ability to imitate gestures and movements generated by others. This impairment in imitation may be linked to difficulties in generating and maintaining internal representations in working memory (WM). We used a novel quantitative technique to investigate the relationship between WM and imitation ability. SZ outpatients and demographically matched healthy control (HC) participants imitated hand gestures. In Experiment 1, participants imitated single gestures. In Experiment 2, they imitated sequences of 2 gestures, either while viewing the gesture online or after a short delay that forced the use of WM. In Experiment 1, imitation errors were increased in SZ compared with HC. Experiment 2 revealed a significant interaction between imitation ability and WM. SZ produced more errors and required more time to imitate when that imitation depended upon WM compared with HC. Moreover, impaired imitation from WM was significantly correlated with the severity of negative symptoms but not with positive symptoms. In sum, gesture imitation was impaired in schizophrenia, especially when the production of an imitation depended upon WM and when an imitation entailed multiple actions. Such a deficit may have downstream consequences for new skill learning.

Stability of facial affective expressions in schizophrenia

Thirty-two videorecorded interviews were conducted by two interviewers with eight patients diagnosed with schizophrenia. Each patient was interviewed four times: three weekly interviews by the first interviewer and one additional interview by the second interviewer. 64 selected sequences where the patients were speaking about psychotic experiences were scored for facial affective behaviour with Emotion Facial Action Coding System (EMFACS). In accordance with previous research, the results show that patients diagnosed with schizophrenia express negative facial affectivity. Facial affective behaviour seems not to be dependent on temporality, since within-subjects ANOVA revealed no substantial changes in the amount of affects displayed across the weekly interview occasions. Whereas previous findings found contempt to be the most frequent affect in patients, in the present material disgust was as common, but depended on the interviewer. The results suggest that facial affectivity in these patients is primarily dominated by the negative emotions of disgust and, to a lesser extent, contempt and implies that this seems to be a fairly stable feature.

Could schizophrenic subjects improve their social cognition abilities only with observation and imitation of social situations?

Schizophrenics display impairments in domains of social cognition such as theory of mind and emotion recognition. Recent studies, showing that the relationship of social cognition abilities with functional outcome is more significant than other neuro-cognitive functions, have considered these abilities as a target for intervention research. This article describes preliminary data from a new group-based study focused on Emotion and ToM Imitation Training (ETIT), an imitation treatment aimed at improving social cognition and social functioning in schizophrenia. In the present study, 16 outpatients with schizophrenia completed ETIT assessment and were compared with 17 outpatients who participated to a Problem Solving Training group. Participants were assessed at pre- and post-test on measures of emotion recognition, theory of mind, cognition, flexibility and social functioning. We compared the rehabilitation training effects on neuro-physiological activation through the event-related potentials (ERPs) method, which was recorded pre- and post-rehabilitation training. The results showed that when compared to the control group, ETIT participants improved on every social cognitive measure and showed better social functioning at post-test. Improvement in social cognition, in particular in emotion recognition, is also supported by ERP responses: we recorded an increase in electroactivity of medio-frontal areas only after ETIT treatment. Action observation and imitation could be regarded as a new frontier in rehabilitation.

Dynamic evoked facial expressions of emotions in schizophrenia

OBJECTIVE

Impaired facial expressions of emotions have been described as characteristic symptoms of schizophrenia. Previous investigations of dynamic facial expressions have reported on global assessment of positive and negative emotion expressions. In this study, we examined facial expression differences based on duration and frequencies of emotion expressions.

METHODS

12 persons with stable schizophrenia and matched healthy controls underwent a standardized procedure for evoked facial expressions of five universal emotions, including happy, sad, anger, fear, and disgust expressions. Subjects completed self-ratings of their emotion experience. Reliable raters coded evoked facial expressions according to the Facial Expression Coding System. For each emotion, facial expressions were coded as target, non-target or neutral expressions. Logistic regression analyses examined group differences in duration and frequencies of facial expressions.

RESULTS

Comparing overall duration of and frequencies of emotion expressions revealed affective flattening and inappropriate affect in patients, as evidenced by neutral and non-target expressions. Separated by emotion, impaired emotion expression was found in happy, sad and anger expression, but not for fear and disgust in which expressions were not well recognized.

CONCLUSION

In matched groups of participants, we found evidence for altered expressions in schizophrenia but equal subjective experience. Both affective flattening and inappropriate affect comprise abnormal facial expressions but may differ with respect to interpersonal communication and engagement. Future directions may include automated measurement, remediation of expressions and early detection of schizophrenia.

Static posed and evoked facial expressions of emotions in schizophrenia

OBJECTIVE

Impaired facial expressions of emotions have been described as characteristic symptoms of schizophrenia. Differences regarding individual facial muscle changes associated with specific emotions in posed and evoked expressions remain unclear. This study examined static facial expressions of emotions for evidence of flattened and inappropriate affect in persons with stable schizophrenia.

METHODS

12 persons with stable schizophrenia and matched healthy controls underwent a standardized procedure for posed and evoked facial expressions of five universal emotions, including happy, sad, anger, fear, and disgust expressions, at three intensity levels. Subjects completed self-ratings of their emotion experience. Certified raters coded images of facial expressions for presence of action units (AUs) according to the Facial Action Coding System. Logistic regression analyses were used to examine differences in the presence of AUs and emotion experience ratings by diagnosis, condition and intensity of expression.

RESULTS

Patient and control groups experienced similar intensities of emotions, however, the difference between posed and evoked emotions was less pronounced in patients. Differences in expression of frequent and infrequent AUs support clinical observations of flattened and inappropriate affect in schizophrenia. Specific differences involve the Duchenne smile for happy expressions and decreased furrowed brows in all negative emotion expressions in schizophrenia.

CONCLUSION

While patterns of facial expressions were similar between groups, general and emotion specific differences support the concept of impaired facial expressions in schizophrenia. Expression of emotions in schizophrenia could not be explained by impaired experience. Future directions may include automated measurement, remediation of expressions and early detection of schizophrenia.

Imitation, simulation, and schizophrenia

The social significance of imitation is that it provides internal tools for understanding the actions of others by simulating or forming internal representations of these actions. Imitation plays a central role in human social behavior by mediating diverse forms of social learning. However, imitation and simulation ability in schizophrenia has not been adequately addressed. The major aim of the present study was to investigate imitation ability in schizophrenia patients and healthy individuals by examining simple motor imitation that involved the replication of meaningless manual and oral gestures, and the imitation of emotional facial expressions, which has implications for mentalizing. A secondary aim of the present study was to investigate the relationships among imitation ability, social functioning, and working memory. Subjects were asked to mimic hand gestures, mouth movements, and facial expressions of others, online. Clinical symptoms, social competence, and working memory were also assessed. Patients with schizophrenia were significantly impaired on all imitation tasks. Imitation errors were significantly correlated with reduced social competence and increased negative symptoms. However, imitation ability was only weakly associated with working memory. To summarize, the present study examined the ability of patients with schizophrenia to imitate the behaviors demonstrated by others. The results indicate a fundamental impairment in imitation ability in schizophrenia and implicate a possible difficulty in simulation. Further research to determine the neural and developmental origins of this difficulty could be extremely helpful in elucidating the role of simulation in schizophrenia and to establish the complex relationships among mental representation, imitation, and social cognition.