Facial Emotion Perception in Schizophrenia: A Meta-analytic Review
Christian G. Kohler1,2, Jeffrey B. Walker2, Elizabeth
A. Martin2, Kristin M. Healey2, and Paul J. Moberg2
2Schizophrenia Research Center, Department of Psychiatry;
University of Pennsylvania School of Medicine, Philadelphia, PA
Objectives: A considerable body of literature has reported
on emotion perception deficits and the relevance to clinical
symptoms and social functioning in schizophrenia. Studies
published between 1970–2007 were examined regarding
emotion perception abilities between patient and control
groups and potential methodological, demographic, and
clinical moderators. Data Sources and Review: Eighty-
six studies were identified through a computerized litera-
ture search of the MEDLINE, PsychINFO, and PubMed
was followed in the extraction of relevant studies and data.
Data on emotion perception, methodology, demographic
and clinical characteristics, and antipsychotic medication
status were compiled and analyzed using Comprehensive
Meta-analysis Version 2.0 (Borenstein M, Hedges L,
Higgins J and Rothstein H. Comprehensive Meta-
analysis. 2. Englewood, NJ: Biostat; 2005). Results: The
in schizophrenia, irrespective of task type, and several fac-
tors that moderated the observed impairment. Illness-
related factors included current hospitalization and—in
part—clinical symptoms and antipsychotic treatment.
Demographic factors included patient age and gender in
controls but not race. Conclusion: Emotion perception
impairment in schizophrenia represents a robust finding
in schizophrenia that appears to be moderated by certain
clinical and demographic factors. Future directions for
research on emotion perception are discussed.
Key words: schizophrenia/meta-analysis/emotion
Although most efforts to examine behavioral deficits in
schizophrenia have focused on neurocognition, the past
25 years have seen a growing literature on emotion per-
ception deficits in schizophrenia (reviews by Edwards
et al,1Mandal et al,2and Morrison et al3) and in the
larger domain of social cognition,4,5which is defined
as the ability to process and apply social information.
Recognition of facial expressions of emotions is instru-
mental constituent of nonverbal communication, and
several studies in schizophrenia have underscored that
emotion perception abilities are related to social compe-
tence6–10and predictlater workfunctioning and indepen-
dent living.11In addition, emotion perception is more
affected in schizophrenia compared with psychiatric
control groups, such as mood disorders.12–14
Reviews of early studies3showed that results were lim-
ited by small sample sizes consisting of mostly inpatients
with prolonged hospitalizations and the use of diverse
nonstandardizedstimuli. Studydesignsimproved consid-
erably in the 1990s1,2with employment of standardized
tasks, exclusion criteria, and inclusion of in- and outpa-
characteristics are more representative of schizophrenia.
The qualitative review by Edwards et al1of studies pub-
lished prior to 2000 details the need to attend to numer-
ous demographic, task, and illness-related variables that
can interfere with accurate emotion perception. Among
others, duration of illness, negative symptoms, medica-
tion levels, outpatient vs inpatient status, stage of illness,
and schizophrenia subtypes were identified as potential
and unexamined variables that contribute to emotion
perception impairment and warrant further attention.
In general, task designs within emotion perception
studies can be separated into those that focus on identi-
fication of specific emotions and those that differentiate
between intensities of emotion expressions. Identification
tasks rely on choosing a qualitative label, usually from
a limited number of choices, to the picture of a facial ex-
pression. Differentiation tasks require judgment regard-
ing differences in emotion expressions—typically of 2
visual stimuli—without necessary identification of the
emotion. Numerous studies have employed both identi-
ficationand differentiationtasks, based on the possibility
that the different tasks yield differential impairment.
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Schizophrenia Bulletin vol. 36 no. 5 pp. 1009–1019, 2010
Advance Access publication on March 27, 2009
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While early investigations included nonstandardized
emotional stimuli, many subsequent studies employed
face stimuli developed by Ekman and Friesen15or
Gur et al.16The black and white stimuli created by
Ekman and Friesen15consist of posed facial expressions
of universally recognized emotions, including happiness,
sadness, anger, fear, disgust, and surprise. Pictures are of
mostly middle-aged Caucasian posers, with more recent
inclusion of Asian but not African American or Hispanic
posers. The stimuli of Gur et al16include color faces
expressing happy, sad, angry, fearful, and disgusted emo-
tions in posed and evoked conditions, across adult age
groups and different ethnicities. Very few studies have
failed to elucidate emotion impairment in schizophrenia,
and the argument has been made that methodology and
account for group differences seen.17
Most9,18–22, but not all,17,23cross-sectional studies
have shown an association between illness severity, pos-
itive and negative symptoms of schizophrenia, and emo-
tion perceptionabilities that maybe furthermedicated by
chronicity of illness.8Potentially, the issue between clin-
ical parameters and perception abilities can be more
decisively investigated in a longitudinal design. Several
studies12,24–26with short-term follow-up in acutely ill
patients have revealed that standard treatment, including
improve performance on emotion perception suggesting
a trait-like deficit. On the other hand, specific application
ofemotionremediation hasbeen foundtobebeneficial.27
While the vast majority of studies on facial emotion
perception establish the existence of impairment in
schizophrenia, potential factors related to task design
and sample characteristics that may influence published
findings remain to be better understood. We conducted
a comprehensive meta-analysis of the existing studies on
emotion perception in schizophrenia with the aim to
quantify the magnitude of deficit seen in facial emotion
perception and to identify variables that may moderate
the impairment in schizophrenia. Specifically, the selec-
tion of variables was based on (1) the majority of facial
emotion perception studies being based on tasks of emo-
tion identification or differentiation, (2) findings in the
existing literature that implicate certain clinical variables,
ie, symptoms, hospitalization status, and illness duration
ing literature that implicate certain demographic varia-
bles, ie, age, gender, ethnicity, with emotion perception
abilities, and (4) adequate representation of the potential
variables within the extant literature to allow for mean-
emotion identification or differentiation reported on
a differential effect related to task. The lack of test design
affecting performance may indicate that although the
task types may overlap with different aspects of cognition,
We examined relatedness for clinical factors, in partic-
ular diagnosis of schizophrenia vs inclusion of schizoaf-
fective disorder, hospitalization status, duration of
illness, and clinical symptoms, and we anticipated that
emotion perception deficits in schizophrenia show asso-
ciation with characteristic clinical symptoms but are not
clearly related to diagnosis, stabilization of psychosis, or
to deterioration with prolonged duration of illness. Sim-
ilarly, based on the limited effect of antipsychotics on
cognition, we did not expect the meta-analysis to reveal
clear effects associated with antipsychotic treatment, ie,
related to being on antipsychotic and type and dosage.
Studies that have described demographic factors associ-
ple sizes. In healthy controls, subtle effects of age, gender,
and race have been associated with perception ability.28–31
Considering group characteristics that commonly included
age ranges between 18 and 65 years, male predominance,
and limited inclusion of participants with different ethnic-
ities, we were not confident to find a clear association be-
tween emotion perception and demographics between and
within groups. Nevertheless, investigation of demographic
characteristics may prove informative in elucidating that
the effect of the clinical condition on emotion perception
outweighs demographic influences.
Materials and Methods
Studies were identified through a computerized literature
search of the MEDLINE, PsychINFO, and PubMed
databases from 1970 through August 2007 using the
keywords ‘‘emotion, affect -perception, -recognition, --
identification, -differentiation, -discrimination, social
cognition, - perception, and schizophrenia and schizoaf-
fective disorder.’’ In addition, a thorough manual search
and reviews. The search was limited to English language
publications and studies of humans only. For further con-
sideration, articles included information about perfor-
mance measures and relevant statistical information
that permitted application of meta-analytical procedures.
Eligible studies focused on formal tests of facial emotion
identification and emotion differentiation in patients
with schizophrenia and healthy participants. Facial emo-
tion identification tasks were defined as tests that
required ascribing a qualitative label, usually from a
limited number of choices, to the picture of a facial ex-
pression. Facial emotion differentiation tasks required
judgment regarding differences in emotion expressions
without necessary identification of the emotion. A quality
C. G. Kohler et al.
of reporting of meta-analysis standard32was followed in
were initially reviewed for possible inclusion by 3 authors
teria. Relevant data for meta-analytic analysis, including
statistical values on differences in emotion perception,
ferentiation), clinical characteristics (diagnosis, inpatient
status, age at onset, duration, number of hospitalizations,
clinical symptoms), antipsychotics (medication status and
type and dosage), and demographic characteristics (age,
gender, education, race of participant) were subsequently
extracted and tabulated independently by 2 authors
(J.B.W. and P.J.M.). Disagreements were resolved by dis-
cussion and consensus.
Comprehensive Meta-analysis Version 2.033was used for
reporting contrasts of schizophrenia patients and healthy
controls on measures of facial emotion identification or
differentiation was standardized by calculating Cohen d,
the difference between the 2 raw means divided by the
pooled SD. In order to control for study differences in
sample size when mean effect sizes were computed, studies
were weighted according to their inverse variance esti-
mates. Effect sizes are typically categorized as small
(d = 0.2), medium(d=0.5),orlarge(d?0.8)basedonthese
the effect size were used. The Cochran Q statistic was uti-
for each facial emotion domain.35The significance level of
models except when the Q statistic revealed significant
model was used. The pooled estimates by the random-
effects model did not differ significantly from those
obtained by the fixed-effects model. The presented results
are according to the latter. Possible effect size moderators
wereexamined inthose domains with significant heteroge-
neity, based on the Q statistic and meta-regression techni-
ques. Cohen d values are provided for categorical
d values are based on unit of measure comparisons (ie,
Scheduled Assessment of Positive Symptoms [SAPS]
scores, % gender, etc) and do not yield information that
Publication bias was assessed graphically using a funnel
test, according to the methods of Begg and Mazumdar36
and Egger et al.37Further analysis included comparison
of studies grouped by task design and those reporting on
relevantdemographicandclinical characteristics and anti-
Out of 91 articles examined in detail, 53 articles totaling
parative studies of facial emotion identification and
graphic images of emotion expressions. Thirty-eight
articles were excluded for reasons of lack of control
groups (N = 13),11,18,81–91lack of data or statistics that
precluded meta-analysis (N = 11),13,92–101and tests that
included ratings for friendliness/pleasantness or evalua-
tion of video scenes (N = 8)3,17,102–107because these tasks
did not necessarily focus on perception of facial emotions
and other reasons (N = 6).9,27,108–111
Overall Meta-analysis Results
Analysis of facial identification and differentiation im-
pairment collapsed across the entire sample revealed
a large overall effect size (N = 3822, d = ?0.91, 95%
CI = ?0.97 < d < ?0.84) that was significantly hetero-
geneous(QB = 295.7,P < .001). Evidenceof publica-
tion bias was observed, as indicated by an asymmetric
funnel plot and a significant Begg test (P = .005, 1 tailed)
and Egger test (P = .003, 1 tailed). In light of this finding,
we calculated a fail-safe N, which revealed that 9538
‘‘null’’ studies would have to be located and included
in order to nullify the observed effect. Effect sizes for
the individual studies included in the meta-analysis are
illustrated in figure 1. To further probe the variability
among effect sizes, we proceeded to analyze psychomet-
ric, clinical, and demographic variables that might
explain this heterogeneity.
Examination of experimental tasks used to probe facial
down into tests tapping the domains of facial emotion
identification or differentiation. Comparisons of effect
sizes for studies examining facial affect identification
(N = 59 studies, d = ?0.89, 95% CI = ?1.05 < d <
?0.75) and differentiation (N = 27 studies, d = ?1.09,
95% CI = ?1.29 < d < ?0.89) revealed large performance
deficits that did not differ significantly from each other
(QB = 2.46, P = .117) (figure 2). For the remainder of
the analyses, the 2 test domains were collapsed into a single
variable and are collectively referred to as ‘‘facial emotion
nosis of schizophrenia or a mix of patients with schizo-
phrenia and schizoaffective disorder. Effect sizes for the
Studies were either comprised of a sole diag-
Facial Emotion Perception in Schizophrenia
Fig. 1. Individual Effect Sizes (Cohen d and 95% CIs) for Emotion Perception Studies.
C. G. Kohler et al.
schizophrenia diagnosis (N = 71 studies, d = ?0.98,
95% CI = ?1.12 < d < ?0.85) and the mixed diagnoses
(N=15studies(d=?0.85,95%CI = ?1.09 < d<?0.61)
were very large and did not differ significantly from each
other (QB = 0.90, P = .34). Although of interest, there
were too few studies (N = 2)38,47examining first-episode
patients to allow for meaningful comparisons.
from inclusion of inpatients (N = 38 studies) and outpa-
tients (N = 26 studies) to mixed groups (N = 8 studies).
Analysis of facial emotion perception deficits for the 3
status classifications revealed significant heterogeneity
of effect sizes (QB = 19.65, P < .001) (figure 3). Post
hoc analysis revealed that inpatients (d = ?1.20, 95%
CI = ?1.30 < d < ?1.10) were more impaired than
both outpatients (d = ?0.70, 95% CI = ?0.80 < d <
?0.60) (QB = 16.01, P < .001) and the mixed group
(d=?0.58,95%CI = ?0.76 < d<?0.39)(QB = 10.57,
P < .01) but did not indicate a difference between out-
patients and the mixed group (QB = 0.37, P = .55).
Patient samples ranged
Age of Onset/Duration.
throughout the sample with regard to their age at onset
andthedurationofillness.Theageofonset(N = 16stud-
ies, mean 6 SD = 23.3 6 1.68) was shown to significantly
moderate effect sizes, relating a later age of onset to
greater impairment (Z = ?2.79, P = .006). In contrast,
duration of illness (N = 43 studies, mean years 6 SD =
10.3 6 4.34) was not significantly associated with effect
size on tasks of emotion perception (Z = 0.42, P = .67).
Schizophrenia patients varied
hospitalizations of the patients (N = 26 studies) did not
appear to have a significant impact on obtained effect
sizes (Z = ?1.54, P = .12).
For clinical symptom assess-
ment, results were mixed and based on the instruments
The total number of past and present
employed. Studies that employed the Scheduled Assess-
ment of Negative Symptoms (SANS112) and SAPS113
analysis revealed significant relationships between facial
emotion perception effect sizes and SANS scores (N = 20
studies, Z = ?4.13, P < .001) as well as SAPS scores
(N = 18 studies, Z = ?4.48, P < .001), relating higher lev-
els of negative or positive symptoms to greater deficit in
the ability to perceive facial affect. However, heterogene-
ity could not be explained by positive (N = 16 studies,
Z = 1.03, P = .30), negative (N = 16 studies, Z = ?1.44,
P = .15), or overall symptom scores (N = 11 studies,
Z = ?1.27, P = .20), as measured by the Positive and Neg-
ative Syndrome Scale.114Finally, measurements of gen-
eral psychopathology obtained by the Brief Psychiatric
Rating Scale (BPRS115) revealed a significant relation-
ship with effect sizes (Z = ?3.08, P = .002), but the
latter finding is tentative due to limited BPRS data
(N = 6 studies).
of antipsychotics on the observed effect sizes, studies
were classified as including (1) medicated (N = 57 stud-
ies), (2) unmedicated (N = 2 studies), or (3) mixed (med-
icated and unmedicated) (N = 20 studies) samples.
Homogeneity analysis revealed significant variability
among effect sizes (QB = 11.76, P < .01); unmedicated
patients (d = ?0.141, 95% CI = ?0.9 < d < ?0.18)
were the most impaired, followed by medicated patients
(d = ?1.00, 95% CI = ?1.10 < d < ?0.86), and then the
mixed group (d = ?0.73, 95% CI = ?0.89 < d < ?0.58)
(figure 4). Post hoc contrasts revealed that medicated
patients did not differ from unmedicated patients
(QB = 3.02, P = .082). The mixed group was signifi-
cantly less impaired than both the medicated (QB =
6.17, P < .05) and the unmedicated patients (QB =
8.35, P < .01). It should be noted, however, that data for
ysis involving this moderator variable classification should
be considered tentative.
Fig. 3. Effect Sizes (Cohen d and 95% CI) for Facial Emotion
Perception Deficits in Schizophrenia Patients by Study Setting (ie,
Inpatients, Outpatients, and Mixed).
Fig. 2. Effect Sizes (Cohen d and 95% CI) for Facial Emotion
Identification and Differentiation Deficits.
Facial Emotion Perception in Schizophrenia
divided into those using first-generation antipsychotics
(FGAs) (N = 25 studies) or second-generation antipsy-
chotics (SGAs) (N = 7 studies) and mixed groups
(N = 22 studies). Effect sizes for these 3 groups were
found to be heterogeneous (QB = 9.35, P < .01).
Post hoc contrasts revealed that FGA groups (d =
?1.10,95%CI = ?1.30 < d<?0.91)showedgreaterim-
pairment in facial emotion perception relative to SGA
groups (d = ?0.63, 95% CI = ?0.87 < d < ?0.38)
(QB = 9.00, P < .01) and mixed groups (d = ?0.82,
95% CI = ?1.00 < d < ?0.62) (QB = 4.12, P <
.05). Contrasts between patients on SGA and mixed
groups, however, were not significant (QB = 2.64,
P = .10) (figure 5).
Medicated patients were further sub-
the relationship between effect sizes and chlorpromazine
equivalents (N = 47 studies) and found a marginal, but
nonsignificant, relationship between higher chlorproma-
zine dosage and greater degree of impairment on tests of
facial emotion perception (Z = ?1.67, P = .10).
To further probe the effect
and the average age of patients were examined (N = 84
studies). Analysis revealed a strong relationship between
greater age in both patients (Z = ?5.25, P < .001) and
healthy controls (Z = ?2.98, P < .01) and facial emotion
Both the average age of controls (N = 81 studies)
ing both the percentages of male controls (N = 80 stud-
ies) and male patients (N = 81 studies) to effect sizes.
The percentage of male controls showed a relationship
with effect sizes (Z = 3.53, P < .001), indicating that
samples with more male controls were related to less im-
pairment in facial emotion perception in schizophrenia.
However, the percentage of male patients did not
The effect of gender was analyzed by compar-
appear to moderate effect sizes in schizophrenia (Z =
1.58, P = .11).
had an impact on facial emotion perception. Analysis
showed that education levels of controls (N = 66 studies)
were not significantly related to effect sizes (Z = ?0.44,
P = .66). Similarly, analyses of education levels of the pa-
tient group (N = 66 studies) revealed no significant asso-
ciation between this moderator and effect size (Z = 1.62,
P = .10).
We then sought to determine if education
race, identified by the percentage of Caucasians within
control(N = 48studies)andpatientgroups(N = 53stud-
ies). Effect sizes were moderated by the percentage of
Caucasian controls at a trend level (Z = ?1.90, P =
.058). In contrast, no relationship between the percentage
of Caucasian patients and effect size was seen (Z = ?1.01,
P = .31).
The last demographic variable investigated was
Over the past 25 years, a considerable body of literature
has established the presence of emotion perception im-
pairment in schizophrenia that affects quality of life
and psychosocial functioning. Generalizability of the
findings has been limited by the diversity of tasks
employed and diversity in clinical and demographic char-
acteristics of patient groups. While emotion perception
impairment in schizophrenia has been well documented,
it is questionable whether a differential deficit116can be
demonstrated against the more general impairment in fa-
cial processing.9,19,23,39,47,53,69,117Among other reasons,
impaired emotion perception may be related to the ten-
dency of persons with schizophrenia to visually scan fea-
tures of the face that are not important in the expression
of a particular emotion, as has been shown with comput-
Fig. 5. Effect Sizes (Cohen d and 95% CI) for Facial Emotion
Perception Deficits in Schizophrenia Patients by Type of
Antipsychotic Medication (ie, First Generation, Second
Generation, and Mixed).
Fig. 4. Effect Sizes (Cohen d and 95% CI) for Facial Emotion
(ie, Medicated, Unmedicated, and Mixed).
C. G. Kohler et al.
As anticipated, the results of the current meta-analysis,
which spanned the literature from 1970–2007 and in-
cluded 86 studies, revealed a large deficit in emotion per-
ception in patients with schizophrenia relative to healthy
participants (ie, d = ?0.91, 95% CI = ?0.97 < d <
?0.84). The effect size of emotion perception impairment
was significantly heterogeneous indicating the presence
of methodological, illness-related, and demographic fac-
tors that moderate the severity of impairment seen in
schizophrenia groups, specifically including hospitaliza-
tion status, age at onset, negative and positive symptoms,
medication status, and current age. Results of this meta-
analysis can be grouped into findings that—given the
expected, indeterminate findings that did not clearly con-
firm our hypotheses, and unexpected findings that ran
counter to our hypotheses. Expected findings were those
related to overall impairment, methodology, diagnostic
status, and demographics of age, gender, race, and edu-
cation. On the basis of most studies reporting on emotion
perception impairment in schizophrenia, the overall ef-
fect size confirmed these results and was measured as
large. In general, emotion perception tasks can be sepa-
rated into those that rely on identification or differenti-
ation. Identification tasks are based on choosing
a qualitative label with greater reliance on language
and semantic skills, while differentiation tasks require
judgment regarding differences in emotion expressions
and may be more dependent on visual analysis and spa-
tial skills. Our results support that emotion identification
and differentiation are independent of ‘‘top-down’’
mechanisms and have limited relationship to neurocogni-
tive aspects of the tasks.
disorder in line with current assumptions that the 2 dis-
orders are not viewed as distinct with respect to symp-
toms, outcome, and cognition. Several demographic
characteristics influenced the findings, including age in
patients and controls and race and gender in controls. In-
creased age of patients and controls was associated with
greater impairment in support of age-related decline in
emotion perception abilities.30Male gender in controls
lessened the impairment found in patient groups, but
male gender in patients did not moderate group differen-
ces. Evidence exists that men may have more difficulties
in emotion perception31compared with women. Within
the meta-analysis, the gender-related finding remained
isolated to controls, and the effect of illness in patients
may supersede any gender-related differences. The effect
of race on emotion perception abilities has received con-
siderable attention, and while it has been proposed that
universal emotions are equally recognized across ethnic
groups, recent studies support an own-race bias28that
race of participants was summarized as Caucasian and
non-Caucasian, and a potential moderating effect on
emotion perception was limited to a trend level of race
in controls. In the majority of studies, race of emotion
perception stimuli was not described or included Cauca-
sian subjects only, limiting statistical power to confirm
gated this issue in healthy persons found an advantage
for emotion perception in own-race faces28that is moder-
ated by familiarity,119and this finding has been extended
to schizophrenia.83,120,121Lastly, level of education failed
to significantlymoderateemotion perceptionfindings. Be-
tion and social cognition represent largely independent
Indeterminate findings included those involving meas-
ures of illness severity and antipsychotic treatment, while
thefinding forageat onset wasunexpected.Previous lon-
gitudinal studies that lasted between weeks to 1 year
showed lack of emotion perception improvement in
acutely ill patients12,25,26and indicated the potential
unrelatedness of emotion perception abilities and clinical
status in schizophrenia, similar to what has been shown
for neurocognition.122Within the meta-analysis, clinical
moderators that indicate illness severity, including being
hospitalizedatthetime oftestingandsomeclinical symp-
tom measurements, but not duration of illness, showed
adverse effects on emotion perception abilities. Clinical
symptoms were only characterized in about half of the
studies, and some, but not all, measurements of negative,
positive, and general symptoms were related to emotion
perception abilities. Recent investigations on schizophre-
nia subtypes reported on paranoid patients to be highly
accurate in recognition of genuine rather than posed
emotion expressions123or less impaired than other sub-
types.110Unfortunately, clinical descriptors within the
published studies on static images did not allow further
investigation of this relationship.
The results of examining effects of antipsychotics on
emotion perception were limited by the small sample
size of unmedicated patients who were most impaired.
However, the notion of untreated illness exerting effects
on emotion perception was not supported by comparison
of studies that included mixed samples and medicated
samples, where medicated samples performed worse.
Within the medicated sample, patients on FGA were
more impaired than patients on SGA. The literature
on possible effects of antipsychotics on cognition in per-
sons with acute and chronic schizophrenia remains in
evolution but may indicate a greater beneficial effect124
associated with SGAs compared with FGAs.
tween later age at onset and greater emotion perception
impairment, whichiscontrarytoour understandingabout
the association between onset of illness with clinical symp-
toms and cognition. It must be noted that limitations
Facial Emotion Perception in Schizophrenia
involving meta-analytic procedures include the descriptive
nature oftheanalysis andtheinability to more fullyexam-
ine directional mechanisms underlying results. It is there-
fore quite possible that studies reporting on groups with
later onset of illness differed in another measure that itself
related to worse emotion perception abilities. This mech-
anism may also play a role in the indeterminate findings
regarding clinical symptoms and antipsychotics.
In conclusion, to our knowledge, this is the first com-
prehensive meta-analysis examining facial emotion per-
ception in schizophrenia and the moderating effects of
illness-related and demographic factors. Further investi-
gations may clarify the association ofemotion perception
with clinical aspects of schizophrenia, including the rela-
tionship between specific illness-related characteristics,
such as first episode and subtype, on performance; emo-
risk125,126and emergence of psychosis.127
National Institute of Mental Health (MH01839 to
We have no financial or conflict of interest to disclose.
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