title: Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective.
abstract: BACKGROUND
  Schizophrenia is characterized by profound and disabling deficits in the ability to recognize emotion in facial expression and tone of voice. Although these deficits are well documented in established schizophrenia using recently validated tasks, their predictive utility in at-risk populations has not been formally evaluated.
  
  
  METHODS
  The Penn Emotion Recognition and Discrimination tasks, and recently developed measures of auditory emotion recognition, were administered to 49 clinical high-risk subjects prospectively followed for 2 years for schizophrenia outcome, and 31 healthy controls, and a developmental cohort of 43 individuals aged 7-26 years. Deficit in emotion recognition in at-risk subjects was compared with deficit in established schizophrenia, and with normal neurocognitive growth curves from childhood to early adulthood.
  
  
  RESULTS
  Deficits in emotion recognition significantly distinguished at-risk patients who transitioned to schizophrenia. By contrast, more general neurocognitive measures, such as attention vigilance or processing speed, were non-predictive. The best classification model for schizophrenia onset included both face emotion processing and negative symptoms, with accuracy of 96%, and area under the receiver-operating characteristic curve of 0.99. In a parallel developmental study, emotion recognition abilities were found to reach maturity prior to traditional age of risk for schizophrenia, suggesting they may serve as objective markers of early developmental insult.
  
  
  CONCLUSIONS
  Profound deficits in emotion recognition exist in at-risk patients prior to schizophrenia onset. They may serve as an index of early developmental insult, and represent an effective target for early identification and remediation. Future studies investigating emotion recognition deficits at both mechanistic and predictive levels are strongly encouraged.
authors.affiliation: Department of Psychiatry,Columbia University,New York,NY,USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Corcoran
authors.affiliation: Department of Psychiatry,Columbia University,New York,NY,USA.
authors.forename: J G
authors.initials: JG
authors.lastname: Keilp
authors.affiliation: Department of Psychiatry,Columbia University,New York,NY,USA.
authors.forename: J
authors.initials: J
authors.lastname: Kayser
authors.affiliation: Department of Psychiatry,Columbia University,New York,NY,USA.
authors.forename: C
authors.initials: C
authors.lastname: Klim
authors.affiliation: Nathan Kline Institute for Psychiatric Research,Orangeburg,NY,USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Butler
authors.affiliation: Department of Psychiatry,Columbia University,New York,NY,USA.
authors.forename: G E
authors.initials: GE
authors.lastname: Bruder
authors.affiliation: Department of Psychiatry,University of Pennsylvania,Philadelphia,PA,USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Gur
authors.affiliation: Department of Psychiatry,Columbia University,New York,NY,USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Javitt
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D004192:Discrimination, Psychological; D004644:Emotions; D005149:Facial Expression; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D021641:Recognition, Psychology; D012559:Schizophrenia / Q000175:diagnosis*; D055815:Young Adult
keywords: Auditory processing; face processing; prodrome; psychosis