Video analysis of interaction in schizophrenia reveals functionally relevant abnormalities

Deficits of dyadic social interaction seem to diminish social functioning in schizophrenia. However, most previous studies are of a limited ecological validity due to decontextualized experimental conditions far off from real-world interaction. In this pilot study, we thus exposed participants to a more real-world-like situation to generate new hypotheses for research and therapeutic interventions.

Dyads of either participants with schizophrenia (n = 21) or control participants without mental disorder (n = 21) were presented with a 5-min emotionally engaging movie. The subsequent uninstructed dyadic interaction was videotaped and analyzed by means of a semi-quantitative, software-supported behavioral analysis.

The patients with schizophrenia showed significant abnormalities regarding their social interaction, such as more negative verbalizations, a more open display of negative affect and gaze abnormalities. Their interaction behavior was mostly characterized by neutral affect, silence and avoidance of direct eye contact. Neutral affect was associated with poorer psychosocial performance. Verbal intelligence and empathy were associated with positive interaction variables, which were also not impaired by psychotic symptom severity.

In this real-world-like dyadic interaction, participants with schizophrenia show distinct abnormalities that are relevant to psychosocial performance and consistent with a hypothesized lack of attunement to interaffective situations.