Patient's Race May Affect Tests of Face, Emotion Recognition

The tendency of people to more easily remember faces—and to more easily recognize emotions in the faces—of people from their same race appears to exist as well in patients with schizophrenia, according to a study in the March 17 AJP in Advance.

This finding is important because it suggests that past studies of face memory and emotion recognition showing that African-American patients perform worse than Caucasians may be compromised by test bias if they use only Caucasian faces as the test stimuli.

It also tells researchers something important about the disease and underlying neuroanatomy involved in facial and emotion recognition—namely, that while that capacity is generally impaired in people with schizophrenia, the developmental influences that most likely shape recognition of faces (and the tendency to more easily remember faces of the same race) are shared by people with and without schizophrenia.

The study is scheduled for the print publication in May.

“The study has implications for research, but it also has clinical implications because of how it can affect the doctor-patient relationship,” said Robert Freedman, M.D., editor of the American Journal of Psychiatry.

“As psychiatrists we read our patients' faces, and we know that our faces are read by our patients,” Freedman told Psychiatric News. “And we know that patients with schizophrenia sometimes misinterpret what they read. This study points out that racial differences can further skew that misinterpretation.

The tendency of people to more easily recognize faces and facial emotions in the faces of others who share the same race is referred to by cognitive neuroscientists as the “other-race” effect. It has been documented that healthy individuals perform worse on face memory and emotion recognition when processing faces of people of a different race

According to the AJP study, Amy Pinkham, Ph.D., and colleagues in the Department of Neuropsychiatry at the University of Pennsylvania found this other-race effect in both schizophrenia patients and in nonpatients on immediate and delayed memory of faces and emotion recognition.

“These interactions demonstrate the presence of an intact other-race effect in schizophrenia that affects both face memory and emotion recognition,” they wrote.

At least two previous studies, by some of the same researchers at the University of Pennsylvania, had found that among patients with schizophrenia, Caucasians performed better on emotion recognition tasks than non-Caucasians. But those studies had used only Caucasian faces for the test stimuli.

One of those studies, “Cross-Ethnic Differences in Perception of Emotion in Schizophrenia,” was published in the September 2005 Schizophrenia Research. The other study, published in the March 2000 Schizophrenia Research, was titled “Emotional Processing in Schizophrenia Across Cultures: Standardized Measures of Discrimination and Experience.”

“Whereas these studies used only Caucasian stimuli, our tasks included stimuli with both Caucasian and African-American faces and failed to find a main effect of race in comparison subjects or patients,” Pinkham and colleagues wrote. “Notably, had we analyzed only responses to Caucasian stimuli, our results would have replicated those of the previous studies. Instead, our findings indicate that an other-race effect may account for the differences described in these earlier studies and highlight an important measurement issue in the extension of face processing and emotion research to clinical populations.”

The study encompassed 540 participants in four groups—african Americans with schizophrenia, Caucasians with schizophrenia, African-American community comparison subjects, and Caucasian community comparison subjects. Each group had 135 subjects.

All participants completed face-recognition and facial-emotion identification tasks that included both Caucasian and African-American faces as stimuli.

The researchers found that comparison participants performed better than individuals with schizophrenia across all tasks. However, both comparison participants and participants with schizophrenia exhibited a strong and significant other-race effect for face memory and emotion recognition. The magnitude of the other-race effect did not differ between these two groups.

In addition to methodological concerns with regard to neurocognitive testing, the results also suggest that the regions of the brain that influence face memory and emotion recognition, though impaired in people with schizophrenia, are subject to the same developmental influences as are experienced by people without schizophrenia.

Pinkham and colleagues stated that the fusiform face area of the brain located on the ventral surface of the temporal lobe on the fusiform gyrus is believed to be modulated by experience—such as disproportionate exposure to same-race faces relative to other-race faces during childhood—and has shown sensitivity to racial information in healthy individuals.

So, despite the deficits shown by patients in face and emotion recognition, the other-race effect exhibited by individuals with schizophrenia in the study by Pinkham and colleagues may reflect normative developmental experience with faces and normative development of the neural mechanisms of face processing.

“It would be informative, therefore, to compare individuals with schizophrenia with individuals with other neurodevelopmental disorders such as autism who similarly show face-processing deficits in adulthood but demonstrate qualitative and quantitative deficits with facial experience throughout childhood,” Pinkham and colleagues wrote.

“The Other-Race Effect in Face Processing Among African American and Caucasian Individuals With Schizophrenia” can be accessed at<http://ajp.psychiatryonline.org/pap.dtl>.“ Cross-Ethnic Differences in Perception of Emotion in Schizophrenia” and “Emotional Processing in Schizophrenia Across Cultures: Standardized Measures of Discrimination and Experience” can be accessed at<www.sciencedirect.com/science/journal>.▪