Social expectations in early-stage psychosis: Less stereotypical facial expression predictions

Psychosis is conceptualized as existing along a continuum, with schizotypal traits and psychotic-like experiences observed in the general population and schizophrenia at its extreme. Predictive processing has recently been applied to the understanding of psychotic experiences, suggesting that symptoms may arise from disruptions at different levels in the processing hierarchy. We studied facial expression expectations and their impact on social perception in a group of 34 individuals with early-stage psychosis (<5 years from a first psychotic episode) and 34 control individuals. Individuals with psychosis exhibited less stereotypical expectations about facial expressions. Similar results were observed in exploratory analyses considering dimensional schizotypy scores within nonclinical participants. These findings suggest that psychosis may involve the development of less stereotypical, more nuanced, individualized predictions, possibly as a result of an overly prioritization of prediction errors, leading to a world that is hard to predict and may seem uncertain, magical and/or too complex to extract general (possibly stereotyped) rules. These results also support the continuum hypothesis of psychosis by highlighting shared phenomena across early-stage psychosis and schizotypy. These insights into predictive processing and less stereotypical social evaluations offer valuable opportunities for improving early detection and developing targeted interventions for social functioning and mental health in psychosis.