crimination, whereas impaired happiness discrimination was not
predicted by these two perceptual variables, but rather by IQ.
Most previous studies of facial emotion recognition in schizo-
phrenia have found that patients make poor judgments classify-
ing and labeling different emotional expressions (1,2). Extending
this work, the present study found that patients performed
poorly on a task where only one emotional expression was
presented at a time. This result suggests that patients have
difficulty detecting the presence of a given emotion. Classifica-
tion and detection of facial emotion are two distinct but closely
related processes (17). How the deficits in these two emotion
processes are related in schizophrenia remains to be explored.
The connection between affective processing systems (e.g.,
amygdala) and visual processing systems (e.g., striate and extra-
striate cortex) has been a topic of intense research. Damage to
the amygdala results in lower activity in the visual cortex during
emotion recognition (18). Presumably, changes in activity levels
within early visual areas also influence activity within the amyg-
dala. The current study found that schizophrenia patients’ per-
formance in contrast detection and nonaffective face recognition
predicted their fear discrimination performance, suggesting that
the known deficits in the visual and affective processing domains
are associated in schizophrenia. It is not clear whether deficient
visual processing leads to deficient affective processing in
schizophrenia or vice versa. Examining the effects of modulating
signals in one domain (e.g., physical attributes of the visual
stimulus) on performance in the other (e.g., affect discrimina-
tion) may help clarify this issue. Also, other aspects of social
cognitive dysfunction in schizophrenia, particularly those that
rely on abstract representations of other people, may not be
associated with basic perceptual processing abnormalities. This
possibility should be examined in future studies.
Impaired performance on both fear and happiness discrimi-
nation seems to suggest an emotion recognition problem that is
not confined to specific affect categories. However, further
analysis revealed that the impairment in fear discrimination was
predicted by visual and nonaffective face discrimination but not
other variables such as IQ or PANSS scores. In contrast, the
impairment in happiness discrimination was predicted by IQ but
not other variables, suggesting that dysfunctions of distinct brain
systems are implicated in these two domains of emotion discrim-
ination. The result of differential associations in patients is
consistent with previous findings that happiness discrimination
and fear discrimination rely on different facial features (mouth vs.
eyes) (19) and involve different brain mechanisms (20). The
selective association between performance in fear discrimination
and contrast detection in patients is also consistent with the
known connections between the magnocellular pathway (which
processes contrast information) and the amygdala (which pro-
cesses fear information) (6).
In sum, the results of this study, along with previous studies,
suggest that impairment in emotion recognition in schizophrenia
can no longer be viewed solely as a problem of affective
processing: basic perceptual processing deficits appear to play
an integral role. Therefore, novel therapeutic interventions that
aim to improve social cognition in schizophrenia patients should
account for the role of perceptual factors.
This work was supported in part by grants from the National
Institutes of Health (NIH) and Harvard University.
We thank Dr. Ken Nakayama for help during the initial phase
of the study, Dr. Jejoong Kim for his comments on an earlier
version of the article, and Dr. Caitlin Ravichandran for her help
with statistical analysis.
The authors report no biomedical financial interests or other
conflicts of interest.
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Figure 3. Summary of correlations between emotion recognition and per-
ceptual and clinical variables. Abscissa shows the nonemotion variables
with which the emotion performance was correlated. Ordinate represents
the correlation coefﬁcient: Pearson R for continuous variables (identity dis-
crimination and contrast detection) and Spearman Rho for the clinical
scales. An asterisk denotes a signiﬁcant correlation at p ⬍ .05. Two asterisks
denote a signiﬁcant correlation at p ⱕ .001. Gray bars are for correlations
with fear discrimination; white bars are for correlations with happiness
discrimination. BDI, Beck Depression Inventory; PANSS, Positive and Nega-
tive Syndrome Scale.
4 BIOL PSYCHIATRY 2009;xx:xxx D. Norton et al.
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