title: Facial emotion identification in early-onset and first-episode psychosis: a systematic review with meta-analysis.
abstract: OBJECTIVE
  Patients with chronic schizophrenia are characterized by deficits in identifying facial expressions of emotion, and these deficits relate to impaired social and occupational function. It is not yet known if these deficits are trait-like and present at the onset of psychosis, preceding a subsequent diagnosis of schizophrenia. Our objective was to systematically review and analyze the extant literature to assess if there is a consistent profile of emotion identification problems in early-onset and first-episode psychosis.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of 12 peer-reviewed studies of facial emotion identification in early-onset and first-episode psychosis, published between 1980 and March 2013. We examined the average mean difference between patients and controls on measures of facial emotion identification.
  
  
  RESULTS
  Findings suggest that patients with early-onset and first-episode psychosis have impairment in identifying facial expressions of biologically salient emotion. Across the 12 studies, the onset of psychosis was distinguished by a generalized effect of significantly poorer accuracy for identifying facial expressions of emotion than healthy controls, and this difference had a substantial effect size (d=-0.88, N=378, 95% CI=-1.42 to -0.32). Within this general effect some emotions were also harder for patients to identify than others, with the magnitude of impairment found to be (i) large for disgust, fear and surprise, and (ii) medium for sadness, and happiness. No between groups mean differences were found for anger or neutral facial expressions.
  
  
  CONCLUSIONS
  Deficits in facial emotion identification are evident at first onset of a psychotic episode. The findings suggest that, over and above a generalized deficit in identifying facial emotion, patients may find some emotions harder to identifying than others. This reflects findings with chronic schizophrenia populations and suggests that emotion identification impairment represents a trait susceptibility marker, rather than a sequeale of illness. They signal the urgent need to treat emotion identification deficits at the onset of illness, which could improve functional outcomes.
authors.affiliation: School of Psychology, University of Sydney, Sydney, NSW, Australia; The Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia.
authors.forename: Sophie J
authors.initials: SJ
authors.lastname: Barkl
authors.affiliation: School of Psychology, University of Sydney, Sydney, NSW, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia.
authors.forename: Suncica
authors.initials: S
authors.lastname: Lah
authors.affiliation: The Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Anthony W F
authors.initials: AW
authors.lastname: Harris
authors.affiliation: The Brain Dynamics Centre, Sydney Medical School and Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA. Electronic address: leawilliams@stanford.edu.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Williams
mesh_terms: D004644:Emotions; D005149:Facial Expression; D006801:Humans; D010364:Pattern Recognition, Visual; D011618:Psychotic Disorders / Q000523:psychology*; D021641:Recognition, Psychology
keywords: Early-onset; Emotion identification; First-episode; Meta-analysis; Schizophrenia