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Objective: In the literature, a deficit in facial emotion recognition in schizophrenia is usually reported, which may be considered in relation with impairments in social and work functioning and independent living. Interestingly, this deficit is mentioned in medicationfree patients with schizophrenia or in individuals at risk for developing a psychosis. Clozapine has been reported to have beneficial effects on attention, executive functions, and working memory and is recommended for the management of treatment-resistant schizophrenia. Here we investigated changes of facial emotion recognition ability after clozapine use in patients with treatment resistant schizophrenia.
Methods: Twelve inpatients with treatment-resistant schizophrenia (F=7, M=5) were included in the study who were of an average age of 33.25±9.17 years. The patients were evaluated in the basal state and 4-5 months later according to Facial Emotion Recognition Test of Ekman’s series and PANSS. Wilcoxon Signed Rank Test was used.
Results: The mean dose of clozapine was 287.50±77.23 mg/day. The mean positive score (21.50±6.23 vs 10.78±2.86), the mean general psychopathology score (38.83±7.50 vs 25.67±5.93) and the mean total score (82.50±18.47 vs 53.67±11.74) according to PANSS were significantly improved after clozapine treatment (p0.05 for each). There were no significant differences between basal state and after clozapine treatment according to required time to recognize facial emotion expressions (p>0.05 for each).
Conclusion: In one study, the accuracy rate of facial emotion recognition was not significantly different between healthy controls (n=15) and patients with treatment-resistant schizophrenia who were receiving a 470±173 mg/day dose of clozapine. However, the basal accuracy rates according to facial emotion recognition were lacking and the authors did not discuss the change of facial emotion recognition ability after clozapine use. Interestingly, in a study, no differences between first or second generation antipsychotic drugs or within each group (i.e., olanzapine vs clozapine) were revealed in patients with schizophrenia according to facial emotion recognition ability. The improvement in negative symptoms is suggested to have a positive impact on facial emotion recognition ability. Thus, we consider that either the clozapine does not affect facial emotion recognition ability, although there is a definite influence on positive and general psychopathology, or clozapine did not improve facial emotion recognition ability because of ineffectiveness with negative symptoms as in our study.