Impaired recognition of happy, sad and neutral expressions in schizophrenia is emotion, but not valence, specific and context dependent

It is not clear whether the deficits in emotion perception in schizophrenia are distinct from cognitive impairments or affect some emotions more than others. We tested the hypothesis that the emotion perception deficit in schizophrenia is valence specific. Participants comprised 75 chronic schizophrenia patients and 77 healthy controls who were asked to identify happy, sad and neutral facial emotional expressions. A test of facial identity recognition was also performed. Processing of happy, sad and neutral expressions differed in accuracy, processing strategy and efficiency. Patients were impaired on all parameters, but the valence-related pattern of performance did not differ in the two groups. Compared with healthy individuals, schizophrenia patients were more impaired in the processing of facial emotions than identity. Processing of neutral expressions was context dependent. Emotion impairment in schizophrenia appears to be selective for the emotion domain but not specific emotions. Test context influences how neutral facial expressions are processed.