Performance and response time in emotion recognition and mentalizing measures in patients with schizophrenia

Schizophrenia is associated with marked impairments in social cognition, particularly in emotion recognition and mentalizing. Although these deficits have been extensively documented, most studies rely on static, highly controlled measures and focus primarily on accuracy-based outcomes, thereby limiting ecological validity. This study aimed to examine performance and response times across static and dynamic social-cognitive measures in patients with schizophrenia compared to healthy controls, and to investigate the effects of speed instructions on emotion recognition performance.

In a sample of patients with schizophrenia (n = 90) and matched healthy controls (n = 100), we evaluated social cognition through two validated measures: the Penn Emotion Recognition Test (ER-40) for emotion recognition and the Movie for the Assessment of Social Cognition (MASC) for mentalizing, respectively. Performance and response times were the main outcome variables.

Patients showed worse performance and longer response times than controls on the ER-40 and MASC measures. Across the entire sample, there was a statistically significant inverse association between response time and the rate of correct answers in both ER-40 and MASC measures. Speed instructions in the ER-40 did not influence performance or response times in either group. In the MASC, patients exhibited more mentalizing errors than controls. Additionally, patients identified anger more quickly than fear or sadness, a pattern not observed in the healthy control group.

Integrating accuracy and response time provides a comprehensive characterization of social-cognitive deficits in patients with schizophrenia. These findings highlight the importance of incorporating response time and dynamic measures to enhance the ecological validity of social-cognitive assessment and suggest that future rehabilitation programs may benefit from addressing both accuracy and response speed in emotion recognition and mentalizing domains.