Facial emotion recognition deficits in different stages of schizophrenia: A comparative cross-sectional study

Background: The relationship of facial emotion recognition deficits (FERD) with the stage, severity, and treatment of schizophrenia is unclear. This study aimed to assess FERD across acute drug-free, chronic symptomatic, and asymptomatic stages of schizophrenia and its correlation with attention deficits, positive, and negative symptoms.MethodsThis was a cross-sectional study with 132 subjects. The patient group (n = 99) was divided into three groups: Group A: drug-free symptomatic acute schizophrenia (n = 33), Group B: chronic symptomatic schizophrenia (n = 33), Group C: chronic asymptomatic schizophrenia (n = 33), and compared with Group D: healthy controls (n = 33). FERD was assessed using The Tool for Recognition of Emotions in Neuropsychiatric Disorders using the TRENDS Accuracy score (TRACS). Additional assessments included Psychotic Symptom Rating Scales (PSYRATS), Negative Symptom Assessment (NSA-16), and Digit Vigilance Test (DVT).ResultsA significant difference was noted in TRACS among the groups (H (3) = 17.36; p = 0.001). The acute group did worse in TRACS than chronic asymptomatic group and healthy control group (A<C, D). Worse TRACS was noted in acute group (A) than chronic groups B & C (U= 671; p = 0.002; r = 0.31). Symptomatic patients (Groups A & B) did significantly worse than the asymptomatic patients in Group C (U= 763.5; p = 0.01; r = 0.24). TRACS showed significant negative correlations with PSYRATS delusion score, total BPRS, DVT total time, and DVT omission errors.ConclusionThe acute drug-free stage of illness had highest FERD and chronic asymptomatic medicated patients had FERD comparable to the general population. Symptom remission was helpful, suggesting a state association instead of a trait.