Acta Neuropsychiatrica 2009: 21: 292–300 All rights reserved DOI: 10.1111/j.1601-5215.2009.00421.x  2009 John Wiley & Sons A/S ACTA NEUROPSYCHIATRICA Exploring the role of face processing in facial emotion recognition in schizophrenia Rocca P, Castagna F, Mongini T, Montemagni C, Rasetti R, Rocca G, Bogetto F. 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. Paola Rocca, Filomena Castagna, Tullia Mongini, Cristiana Montemagni, Roberta Rasetti, Giuseppe Rocca, Filippo Bogetto Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy Keywords: cognition; emotion perception, face perception; schizophrenia; symptoms Corresponding author: Paola Rocca, MD, Department of Neuroscience, Psychiatric Section, University of Turin, Via Cherasco 11, 10126 Turin, Italy. Tel: 0039 011 6336780; Fax: 0039 011 673473; E-mail: paola.rocca@unito.it Introduction Emotion perception has largely been showed impaired in patients with schizophrenia, compared to healthy controls (1). These deficits are present at the onset of illness (2) in both medicated and unmedicated sub- jects with schizophrenia (3,4) and are significantly correlated to poor social functioning, low levels of social skills and worse vocational functioning (5). Despite this general consensus, there is controversy regarding the exact mechanism explaining the deficit of emotion processing. The unresolved question focusses upon whether this deficit is specific for facial emotion, or if it is secondary to an impairment in face perception. At the heart of the dominant models for face recognition in healthy subjects (6,7), there is the idea that facial identity and expressions are recognised by 292