Facial emotion linked cooperation in patients with paranoid schizophrenia: A test on the Interpersonal Communication Model

Background: Patients with schizophrenia consistently show deficits in facial affect perception and social behaviours. It is illusive to suggest that these deficits in facial affect perception cause poor social behaviours. Aim: The present research aims to study how facial affects influence ingratiation, cooperation and punishment behaviours of the patients. Methods: Forty outpatients with paranoid schizophrenia, 26 matched depressed patients and 46 healthy volunteers were recruited. After measurement of clinical symptoms and depression, their facial emotion recognition, neurocognitive functioning and the facial affects dependent cooperative behaviour were measured using a modified version of Mixed-Motive Game. Results: The depressed control group showed demographic characteristics, depression levels and neurocognitive functioning similar to the schizophrenic group. Patients with schizophrenia committed significantly more errors in neutral face identification than the other two groups. They were significantly more punitive on the Mixed-Motive Game in the neutral face condition. Conclusion: Neutral face misidentification was a unique emotion-processing deficit in the schizophrenic group. Their increase in punitive behaviours in the neutral face condition might confuse their family members and trigger more expressed emotion from them, thus increasing the risk of relapse. Family members might display more happy faces to promote positive relationships with patients.