Schizophrenia patients misinterpret anger

A study shows that patients with schizophrenia struggle to recognize angry facial expressions, often mistaking them for fear.

The difficulty appears to be specific to emotion recognition, say the researchers, because schizophrenia patients performed as well as those with bipolar disorder and mentally healthy controls when it came to judging the age of people with angry facial expressions.

Vina Goghari (University of Calgary, Alberta, Canada) and Scott Sponheim (University of Minnesota, Minneapolis, USA) studied facial expression recognition in 27 patients with schizophrenia, 16 with bipolar I disorder, and 30 mentally healthy controls.

"A better understanding of facial emotional recognition deficits in the two severe mental disorders might assist with diagnostic clarification, as well as inform treatment development and selection," they comment in Comprehensive Psychiatry.

They report that schizophrenia patients correctly identified angry facial expressions just 60% of the time, most often interpreting these faces as frightened, followed by happy, sad, and then neutral. The bipolar disorder patients also tended to misidentify anger as fear, significantly more so than the controls. However, they were more accurate overall than schizophrenia patients, getting 75% of angry expressions correct, which was not significantly different from the controls, who got 78% correct.

"Greater facial emotion recognition deficits in schizophrenia patients compared to bipolar patients found in this study may be a reflection of greater degree of brain abnormalities in regions associated with facial emotion recognition, such as in the amygdala and hippocampus, in schizophrenia patients," suggests the team.

When identifying the other facial expressions - fear, sad, happy, and neutral - the two patient groups were as accurate as the controls. The three groups also had similar ability to identify the age of the faces. The only other difference to emerge was that bipolar disorder patients took significantly longer to classify emotional expressions than they did to determine age, whereas schizophrenia patients and controls took a similar length of time over both tasks.

"This finding may have clinical implications for treatment development in schizophrenia as it suggests that schizophrenia patients may have a different strategy when viewing faces compared to bipolar patients, which may result in lower accuracy," say the researchers.

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