Flat affect in schizophrenia: a test of neuropsychological models

This study evaluated the association between neuropsychological indices of frontal lobe and right hemisphere impairment and deficits in the expression of affect in schizophrenia. The advantages of the present study were that unmedicated schizophrenia patients were studied and relevant demographic characteristics were controlled. Furthermore, deficits in affective expression were assessed both in a clinical interview and in subjects' response to affect-eliciting films. Despite the fact that schizophrenia subjects demonstrated significantly higher clinical ratings of affective flattening and less facial expression while viewing films than demographically matched control subjects, neuropsychological performance was not consistently related to these expressive deficits. The results thus failed to support for the proposed neuropsychological models of affective deficits in schizophrenia. The characterization of flat affect as a purely emotional deficit is questioned, and limitations of current neuropsychological theories of emotional expression and neuropsychological methods to test these theories in the study of schizophrenia are discussed as relevant concerns for future research.