Visual exploration of emotional faces in schizophrenia using masks from the Japanese Noh theatre.

Studying eye movements during visual exploration is widely used to investigate visual information processing in schizophrenia. Here, we used masks from the Japanese Noh theatre to study visual exploration behavior during an emotional face recognition task and a brightness evaluation control task using the same stimuli. Eye movements were recorded in 25 patients with schizophrenia and 25 age-matched healthy controls while participants explored seven photos of Japanese Noh masks tilted to seven different angles. Additionally, participants were assessed on seven upright binary black and white pictures of these Noh masks (Mooney-like pictures), seven Upside-down pictures (180° upside-down turned Mooneys), and seven Neutral pictures. Participants either had to indicate whether they had recognized a face and its emotional expression, or they had to evaluate the brightness of the picture (total N = 56 trials). We observed a clear effect of inclination angle of Noh masks on emotional ratings (p < 0.001) and visual exploration behavior in both groups. Controls made larger saccades than patients when not being able to recognize a face in upside-down Mooney pictures (p < 0.01). Patients also made smaller saccades when exploring pictures for brightness (p < 0.05). Exploration behavior in patients was related to depressive symptom expression during emotional face recognition but not during brightness evaluation. Our findings suggest that visual exploration behavior in patients with schizophrenia is less flexible than in controls depending on the specific task requirements, specifically when exploring physical aspects of the environment.