title: Do we recognize facial expressions of emotions from persons with schizophrenia?
abstract: OBJECTIVE
  Impaired facial emotion expression is central to schizophrenia. Extensive work has quantified these differences, but it remains unclear how patient expressions are perceived by their healthy peers and other non-trained individuals. This study examined how static facial expressions of posed and evoked emotions of patients and controls are recognized by naïve observers.
  
  
  METHODS
  Facial photographs of 6 persons with stable schizophrenia and 6 matched healthy controls expressing five universal emotions (happy, sad, anger, fear, and disgust) and neutral were selected from a previous data set. Untrained raters (N=420) viewed each photo and identified the expressed emotion. Repeated measures ANOVAs were used to assess differences in accuracy and error patterns between patient and control expressions.
  
  
  RESULTS
  Expressions from healthy individuals were more accurately identified than those from schizophrenia patients across all conditions, except for posed sadness and evoked neutral faces, in which groups did not differ, and posed fear, in which patient expressions were more accurately identified than control expressions. Analysis of incorrect responses revealed misidentifications as neutral were most common across both groups but significantly more likely among patients.
  
  
  CONCLUSIONS
  Present findings demonstrate that patient expressions of emotion are poorly perceived by naïve observers and support the concept of affective flattening in schizophrenia. These results highlight the real world implications of impairments in emotion expression and may shed light on potential mechanisms of impaired social functioning in schizophrenia.
authors.affiliation: The Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. kh@upenn.edu
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Healey
authors.forename: Amy E
authors.initials: AE
authors.lastname: Pinkham
authors.forename: Jan A
authors.initials: JA
authors.lastname: Richard
authors.forename: Christian G
authors.initials: CG
authors.lastname: Kohler
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016022:Case-Control Studies; D004644:Emotions / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D010364:Pattern Recognition, Visual / Q000502:physiology*; D010468:Perceptual Disorders / Q000209:etiology*; D010775:Photic Stimulation / Q000379:methods; D011930:Reaction Time / Q000502:physiology; D012559:Schizophrenia / Q000150:complications*; D012565:Schizophrenic Psychology; D055815:Young Adult