Several studies have found evidence that people with schizophrenia have difficulty recognizing emotion in facial expressions and tone of voice. These profound deficits in emotion recognition may even exist prior to the development of schizophrenia in high-risk individuals, according to a recent study conducted by Cheryl M. Corcoran, M.D., from the New York State Psychiatric Institute at Columbia University, and her colleagues.
Although significant improvements in the identification and treatment of schizophrenia have been made in recent years, discovering emotion recognition deficits early in people at risk of developing psychosis may be an important target for the early identification and treatment of the disorder.
Cognitive deficits in schizophrenia
Schizophrenia is a serious mental illness that affects a person’s ability to think clearly, make decisions, relate to others and manage emotions. The symptoms of schizophrenia are disabling and characterized by positive, negative and cognitive symptoms, which impact the person’s ability to function in daily life. These symptoms are categorized as follows.
disorganized speech and behavior
poor grooming and hygiene
limited eye contact
problems with attention
prioritizing and modulating social behavior symptoms
People who have schizophrenia often exhibit neurocognitive deficits and poor social functioning due to difficulty with emotional processing and social cognition — or the ability to perceive, recognize and understand social information. As a result, people with schizophrenia may have difficulty perceiving and identifying others’ emotions; feeling connected to others; drawing inferences about others’ thoughts, beliefs and intentions; managing their own emotions; and responding appropriately to others.
Social cognitive deficits are among the most disabling symptoms of schizophrenia, often marked by difficulty recognizing emotions based on social cues. These individuals have much difficulty “reading” others’ facial expressions. Normally, our social cognitive skills enable us to pick up on social cues, such as a person’s facial expression or tone of voice, that indicate how he or she is feeling. People who have difficulty picking up on these social cues may be more prone to social withdrawal and isolation.
Emotion recognition in high-risk patients
Corcoran and colleagues’ study evaluated the emotion recognition deficits by comparing 49 individuals at high clinical risk for schizophrenia and 31 healthy controls on a measure of face emotion recognition, called the Penn Emotion Recognition Test-40 faces (ER40). The ER40 uses 40 colored photographs of faces expressing four basic emotions (i.e., fear, anger, sadness and happiness) and can be used to differentiate the intensity of happiness or sadness.
The researchers found that seven of the patients in the high-risk group later developed schizophrenia within 2 ½ years. In support of their hypothesis, emotion recognition deficits in these individuals significantly predicted the development of schizophrenia.
The researchers also sought to determine whether impaired emotion recognition could better predict the development of psychosis than general neurocognitive deficits and other known predictors (e.g., negative symptoms and thought disorder) of schizophrenia. They also found that individuals at high clinical risk for developing schizophrenia were less able to accurately identify facial emotions, and the most significant predictors of the later development of schizophrenia were face emotion processing and negative symptoms, which were predictive of future schizophrenia with 96 percent accuracy.
In summary, this study found support for facial and auditory emotion recognition deficits as potential predictors of the disorder as well as support for the other known predictors of schizophrenia in the high-risk group, including subthreshold thought disorder, severity of negative symptoms and sensory processing deficits. The researchers also found that face emotion recognition deficits, or “face reading” deficits, were predictive of the development of schizophrenia and were evident even before the onset of schizophrenia. The early prediction of schizophrenia through emotion recognition deficits can be useful for identifying and providing early interventions to those at risk for developing the disorder.
Amanda Habermann is a writer for the Sovereign Health Group. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques. For more information and other inquiries about this article, contact the author at email@example.com.