Facial emotion recognition in first-episode schizophrenia and bipolar disorder with psychosis

Patients with schizophrenia and bipolar disorder have difficulties recognizing facial expressions of emotion. Differences in deficits between these disorders and the effects of treating acute symptoms of illness with antipsychotic medication on these deficits are not well characterized. First-episode patients with schizophrenia (n=24) and psychotic bipolar I disorder (n=16) were compared to a healthy control group (n=32) on the Penn Emotional Acuity Test. Patients were studied during an acute psychotic episode and after seven weeks of treatment with antipsychotic medication. During acute psychosis, bipolar patients showed deficits recognizing subtle facial expressions of happiness and sadness, and this deficit did not resolve with treatment. Schizophrenia patients similarly had difficulty recognizing subtle happy faces during acute illness that also did not resolve with treatment. In addition, problems recognizing subtle expressions of sadness among schizophrenia patients were apparent after treatment. Poorer emotion recognition at follow-up was related to negative symptom severity for schizophrenia patients. These findings highlight the severity and persistence of emotion recognition deficits early in the course of psychotic bipolar disorder and schizophrenia, and demonstrate an association of emotion processing deficits to negative symptoms in schizophrenia during periods of relative clinical stability.