Emotion-cognition interactions in schizophrenia: Implicit and explicit effects of facial expression

Working memory (WM) and emotion classification are amongst the cognitive domains where specific deficits have been reported for patients with schizophrenia. In healthy individuals, the capacity of visual working memory is enhanced when the material to be retained is emotionally salient, particularly for angry faces. We investigated whether patients with schizophrenia also have an enhanced WM capacity for angry faces. We compared 34 inpatients with schizophrenia and 34 age-, handedness- and gender-matched control participants in three separate tasks. In the WM task, participants saw two faces with angry, happy or neutral emotional expressions for 2 s and had to decide whether a probe face presented after a 1 s delay was identical to one of them. In the emotion classification task, they had to assign these faces to the appropriate categorical emotion. They also rated faces for valence and arousal. Although patients performed generally worse on the working memory task, they showed the same benefit for angry faces as control participants. However, patients were specifically impaired for angry faces on the emotion classification task. These results indicate preserved implicit emotion processing in schizophrenia patients, which contrasts with their impairment in explicit emotion classification. With regard to clinical practice, our findings underline the importance of assessing responsiveness to emotions in patients with schizophrenia, with a view possibly to utilize preserved implicit emotion processing in cognitive remediation programs.