Persecutory delusions and the perception of trustworthiness in unfamiliar faces in schizophrenia

Persecutory delusions, a common symptom of schizophrenia, involve a disruption in the way that patients determine the intentions of others and especially their trustworthiness. However, it is unclear to what extent general preference affects trustworthiness judgments in patients with schizophrenia and how that relates to paranoid symptomology. Patients with schizophrenia and control subjects rated unfamiliar faces for trustworthiness and attractiveness (as a proxy for preference). The results demonstrate that patients do not show an overall difference in their trustworthiness ratings of unfamiliar faces. However, they do show a significant reduction in the correlation between trustworthiness and other indicators of preference, in this case, attractiveness judgments. The level of persecutory delusions is associated with this effect, such that patients with low levels of delusions show correlations near that of normal controls and high levels of persecutory delusions are related to a reduced trust/attractiveness correlation. These results suggest that patients with schizophrenia suffering from persecutory delusions rely less on normative social cues when making interpersonal judgments. Such findings underscore the importance of examining symptom-specific information when studying trust in patients with schizophrenia.