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Eur Arch Psychiatry Clin Neurosci. 2019 May 20. doi: 10.1007/s00406-019-01027-8. [Epub ahead of print]

Facial emotion recognition in people with schizophrenia and a history of violence: a mediation analysis.

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Psychiatric and Evaluation Unit, IRCCS Istituto Centro San Giovanni di Dio, Fatebenefratelli, Brescia, Italy.
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Department of Mental Health, ASST-Rhodense G.Salvini di Garbagnate, Milan, Italy.
Department of Mental Health, ASST Ovest Milanese, Milan, Italy.
Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy.
Department of Mental Health, ASST Spedali Civili of Brescia, Brescia, Italy.
St Magnus Hospital, Marley Lane, Haslemere, Surrey, UK.
GU and Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Division of Psychiatry, University College of London, London, UK.


Evidence for an association between impaired facial emotion recognition and violence in people with schizophrenia is inconclusive. In particular, the role of misidentification patterns involving specific emotions such as anger and the influence of clinical characteristics on this association remain unclear. In this study, we compared facial emotion recognition performance in age- and gender-matched schizophrenia spectrum disorders subjects with (N = 52) and without (N = 52) a history of violence. Data on current symptom severity, Cluster B personality status, past victimization, and alcohol and substance misuse were also collected. Compared to those without, subjects with a history of violence showed worse facial emotion recognition performances, involving anger, fear, disgust, sadness, and happiness. When formally testing the reporting of angry faces, evidence of enhanced sensitivity to anger was not supported. Finally, when the impact of current symptoms was assessed, higher severity of activation symptoms, including motor hyperactivity, elevated mood, excitement and distractibility, mediated the relationship between history of violence and poor facial emotion recognition performance. As a whole, our findings seem to support the role of perceptual deficits involving different emotions as well as of a mediation played by activation symptoms. Facial emotion recognition deficits associated with the propensity to violence, as well certain symptoms mediating their relationship, should be targeted by specific treatment approaches.


Facial emotion recognition; Mediation analysis; Schizophrenia; Violence


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