Altered attentional and perceptual processes as indexed by N170 during gaze perception in schizophrenia: Relationship with perceived threat and paranoid delusions

Using gaze information to orient attention and guide behavior is critical to social adaptation. Previous studies have suggested that abnormal gaze perception in schizophrenia (SCZ) may originate in abnormal early attentional and perceptual processes and may be related to paranoid symptoms. Using event-related brain potentials (ERPs), this study investigated altered early attentional and perceptual processes during gaze perception and their relationship to paranoid delusions in SCZ. Twenty-eight individuals with SCZ or schizoaffective disorder and 32 demographically matched healthy controls (HCs) completed a gaze-discrimination task with face stimuli varying in gaze direction (direct, averted), head orientation (forward, deviated), and emotion (neutral, fearful). ERPs were recorded during the task. Participants rated experienced threat from each face after the task. Participants with SCZ were as accurate as, though slower than, HCs on the task. Participants with SCZ displayed enlarged N170 responses over the left hemisphere to averted gaze presented in fearful relative to neutral faces, indicating a heightened encoding sensitivity to faces signaling external threat. This abnormality was correlated with increased perceived threat and paranoid delusions. Participants with SCZ also showed a reduction of N170 modulation by head orientation (normally increased amplitude to deviated faces relative to forward faces), suggesting less integration of contextual cues of head orientation in gaze perception. The psychophysiological deviations observed during gaze discrimination in SCZ underscore the role of early attentional and perceptual abnormalities in social information processing and paranoid symptoms of SCZ.