Psychological Medicine

Original Articles

Misattribution of facial expressions of emotion in adolescents at increased risk of psychosis: the role of inhibitory control

S. van Rijna1 c1, A. Alemana2, L. de Sonnevillea1, M. Spronga3, T. Ziermansa3, P. Schothorsta3, H. van Engelanda3 and H. Swaaba1

a1 Leiden University, Clinical Child and Adolescent Studies, Leiden, The Netherlands

a2 University of Groningen, BCN NeuroImaging Center, Groningen, The Netherlands

a3 University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, Utrecht, The Netherlands


Background By studying behavior, cognitive abilities and brain functioning in adolescents at high risk for psychosis, we can gain an insight into the vulnerability markers or protective factors in the development of psychotic symptoms. Although many high-risk studies have focused on impairments in neurocognitive functions, such as memory and attention, very few studies have investigated problems in processing social cues such as facial expressions as a possible vulnerability marker for psychosis.

Method Thirty-six adolescents at ultra-high risk (UHR) for psychosis and 21 non-clinical controls completed a face recognition test, a facial affect labeling test and an inhibitory control test. Schizotypal traits and schizophrenia symptoms were assessed using a schizotypy questionnaire and the Positive and Negative Syndrome Scale (PANSS).

Results The UHR group showed impairments in labeling facial expressions of others, in addition to a spared ability to recognize facial identity. More specifically, the UHR group made more errors in labeling neutral expressions compared to the controls, and an analysis of error types indicated that neutral faces were misattributed as being angry. The degree of misattribution of neutral-as-angry faces correlated significantly with reduced inhibitory control.

Conclusions Our findings suggest that misattributing social cues might contribute to vulnerability for psychosis. This social cognitive deficit may be related to problems in inhibitory control, which potentially plays an important role in the selection of appropriate social meaning. These findings may have relevance for understanding the mechanisms underlying prodromal social dysfunction, which should be targeted in future remediation interventions.

(Received June 22 2009)

(Revised March 30 2010)

(Accepted March 31 2010)

(Online publication May 27 2010)


c1 Address for correspondence: Dr S. Van Rijn, Leiden University, Faculty of Social and Behavioral Sciences, Clinical Child and Adolescent Studies, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands. (Email: