Difficulty recognising facial emotions is common to patients with psychosis and their close relatives, shows research.
The findings emerge from an analysis of patients and relatives in the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study.
“Overall, there was a consistent pattern indicating more pronounced emotion recognition deficits for probands receiving diagnoses characterized by comparatively less frequent mood disturbances and more persistent psychosis”, say lead study author Anthony Ruocco (University of Illinois at Chicago, USA) and co-workers.
They say this is consistent with previous research in this cohort supporting a continuum of psychosis symptoms. The 297 patients with schizophrenia had the most severe difficulties with emotion recognition, relative to 380 mentally healthy volunteers, followed by the 130 patients with schizoaffective disorder and the 248 with psychotic bipolar disorder.
“Facial emotion recognition deficits may reflect critical social-cognitive limitations that affect patients with psychotic disorders as well as their non-psychotic relatives”, the team comments in Schizophrenia Research.
Patients’ difficulties varied according to the specific emotion. Only schizophrenia patients had trouble recognising happy faces, but all patient groups had the most difficulty with neutral faces, most often misidentifying them as sad faces. Emotion recognition impairments were associated with more severe negative symptoms among schizophrenia patients and more severe manic symptoms among patients with psychotic bipolar disorder.
First-degree relatives of the patients also had impaired emotion recognition ability, although to a lesser extent than the patients. Like the patients, the relatives had particular difficulty in correctly classifying neutral faces, compared with the controls.
The impairment was most striking in relatives of patients with schizophrenia (n=332) or bipolar-type schizoaffective disorder (n=154), and as seen for the patients, relatives of schizophrenia patients tended to mistake neutral faces for sad faces. These groups also had difficulty identifying angry faces, and their difficulties with emotion recognition were present regardless of whether they had cluster A or B personality disorder traits or no psychotic tendencies.
“Importantly, difficulties for probands and most relatives in recognizing neutral faces suggested a possible negative attribution bias toward perceiving sadness in faces intended to convey no emotion”, say Ruocco et al.
“This suggests that social interaction difficulties may in part be related to misperceiving emotional cues, perhaps in ways reflecting inner mood states exerting a more robust impact on perceptual processes.”
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