The impact of psychopathy traits on facial expression processing among individuals with a psychotic disorder: associations with symptomatology, emotion regulation and cognitive functioning

Scope: Individuals with psychosis exhibit marked deficits in facial expression perception and processing. Similar impairments are observed among people with a history of psychopathy. While both groups display atypical scanning patterns and associated poorer social functioning, the relative contribution of psychosis and psychopathy traits to these deficits remains unclear. Purpose: This thesis aims to extend previous facial emotion processing research in psychosis by utilising visual scanning eye-tracking tasks to examine the impact of coexisting psychopathy traits, as well as considering the contribution of symptomatology, emotion regulation and cognitive functioning. Methodology: Sixty-three participants were recruited, including 37 diagnosed with psychosis (Schizophrenia or Schizoaffective disorder) and 24 healthy controls. The Psychopathy Checklist: Screening-Version (PCL: SV) was used to assess psychopathy traits, and to divide psychosis participants into low (N=18) and high psychopathy (N=19) groups. Three visual-cognitive eye-tracking tasks were utilised to examine emotion recognition, emotion induction, and face recognition and working memory. Results: Among the psychosis group, relative to the control group, emotion recognition accuracy (Study 1) was significantly poorer, and while some atypical visual scan-paths were apparent, visual scanning strategies were not associated with recognition accuracy. Emotion induction (Study 2) was not impaired, although recall accuracy for faces (Study 3) was reduced and significant neuropsychological deficits apparent, although, again no accompanying visual scanning deficits were observed. Overall performance accuracy was associated with better immediate memory and higher premorbid IQ. Coexisting elevated psychopathy traits in psychosis were not associated with increased socio-cognitive performance deficits in either emotion or face recognition or mood induction. Conclusions: An aggregate index based on key task performance indices revealed a trend level difference for psychosis status, reflective of poorer social-cognition performance across tasks. These findings indicate combined treatments targeting both social cognitive and neurocognitive impairments may provide optimal clinical benefit in improving emotion-processing strategies. Diagnostic complexity in psychosis, involving elevated psychopathy traits should not be a barrier to remediation aimed at improving social-cognition, given the observed lack of association between psychopathy traits and impaired visual-cognitive strategies across the three facial emotion-processing tasks.