Facial emotion perception abnormality in patients with early schizophrenia Chi F. Tsui a , Jia Huang b , Simon S.Y. Lui a, b, c , Angie C.W. Au a , Meranda M.W. Leung a , Eric F.C. Cheung a , Raymond C.K. Chan b, ⁎ a Castle Peak Hospital, Hong Kong Special Administrative Region, China b Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China c University of Chinese Academy of Sciences, Beijing, China abstract article info Article history: Received 16 November 2012 Received in revised form 25 March 2013 Accepted 15 April 2013 Available online 10 May 2013 Keywords: Facial emotion perception Categorization Social context Schizophrenia Background: Deficit in facial emotion perception is an important social cognitive impairment in schizophrenic patients, and it is one of the key determinants of functional outcome in schizophrenia. However, the moderating effect of social context and the boundary of perceptual categories of facial emotion perception remain unclear. Method: A total of 36 schizophrenic outpatients in their early stage of illness and 43 healthy controls were recruited for evaluation of social and clinical characteristics, neurocognitive profiles, and facial emotion categorization (FEC) performance. FEC was assessed by a computer-based program with 120 trials, in which social context was presented in the form of a preceding question, in order to simulate the conditions of being praised (positive), blamed (nega- tive), or inquiry (neutral), while the participants were asked to judge a photograph derived from one of the five fa- cial images in a happy-angry emotion continuum. The FEC data was inserted into a logistic function model with subsequent analysis by repeated measures ANOVA and the shift point and slope as outcome measures. Results: Schizophrenic patients were significantly more likely to perceive ambiguous and subtle facial expres- sions as happy, rather than angry, in all three social contexts. However, the interaction effects between group and context for FEC performance was not significant. Conclusions: Schizophrenic patients, even in their early stage of illness, appear to have abnormal perceptions of facial emotion categories, which may explain some of their abnormal social interactions and disabilities. This study provides additional information in understanding social cognitive deficits among schizophrenic patients. © 2013 Elsevier B.V. All rights reserved. 1. Introduction Facial emotion perception is an important domain of social cognition (Green et al., 2005) and impairment in perceiving facial emotion contrib- utes to problems in interpersonal relationships, social isolation, the de- velopment of paranoid symptoms and violence, and a poor quality of life among patients with schizophrenia (Poole et al., 2000; Addington et al., 2006; Weiss et al., 2006). Previous studies have suggested that im- paired facial emotion perception exists in such individuals. A recent meta-analysis that pooled data from 86 studies (n = 3822; the mean duration of illness (DOI) = 10.3 years) concluded that schizophrenic patients have impaired facial emotion perceptions with a large overall ef- fect size (d = -0.91) (Kohler et al., 2010). However, previous research in this area is confounded by several methodological limitations. First, many previous studies ignored the effect of contextual information on fa- cial emotion perception. Second, many facial emotion perception para- digms used stimuli that expressed the full signal-strength of a discrete type of basic emotion, which differs markedly from the subtle and am- biguous signal-strength of facial expression that is encountered in real-life situations. Finally, many previous studies recruited chronic schizophrenic patients, even though it is known that a longer DOI is cor- related with more impairment in facial emotion perceptions (Chan et al., 2010). Contextual information is thought to be processed with the stim- ulus of facial emotion expression in two complementary social cogni- tive systems: lower-level bottom-up pathways that are dependent on limbic structures, and higher-level top-down pathways that are de- pendent on cortical structures which infer and contextualize repre- sentations that are derived from the lower levels (Green and Lee, 2012). Kring and Campellone (2012) suggested that patients with schizophrenia are unable to fully utilize contextual information when they process emotion perceptions. However, the impact of a so- cial context, in the form of a preceding question regarding facial emo- tion perceptions, has not been thoroughly studied. In addition, since neurocognitive functions are known to be prerequisites of social cog- nition (i.e., including emotion perceptions) (Green and Nuechterlein, 1999), their relationship with facial emotion perception and context processing in schizophrenic patients should also be investigated. It has been shown that an individual perceives facial expressions in a categorical, rather than a continuous, manner; for example, while using sets of facial drawings that differ according to constant physical changes in various emotion continua (Etcoff and Magee, 1992). When an Schizophrenia Research 147 (2013) 230–235 ⁎ Corresponding author at: Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China. Tel./fax: +86 10 64836274. E-mail address: rckchan@psych.ac.cn (R.C.K. Chan). 0920-9964/$ – see front matter © 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.schres.2013.04.019 Contents lists available at SciVerse ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres