Alteration of visual scanpaths under emotional facial expression in schizophrenia patients has been described in recent years; however, it is not clear whether such results are different when they transfer to faces in natural social scenes. The present study was designed to investigate the effects of emotional faces in natural social scenes on the gaze patterns of patients with schizophrenia, compared to gaze at isolated faces. A novel theme identification task was used where participants selected a positive, neutral or negative word to describe an emotional picture. Participants were 29 patients with schizophrenia and 31 healthy controls. The Positive and Negative Syndrome Scale (PANSS) and the Scale of Social Function in Psychosis Inpatients (SSPI) were used to assess symptoms and social functioning. In total, patients with schizophrenia showed significantly fewer fixations, saccades numbers and decreased fixations in areas of interest. As expected, patients showed shorter scanpath length, but only in the pictures with social settings. Furthermore, the effect size of scanpaths parameters under social scene was all greater than isolated face. In addition, patients compared to controls showed more abnormal scanpath parameters processing negative and neutral faces than positive faces, especially in social scene. The present study suggests that scanpath length for social scene faces may be more sensitive than for isolated face pictures. Our findings further support restricted scanpath whilst recognizing emotional facial expressions in natural social scenes as a favorable topic for further investigation as a trait marker.

To investigate whether the eye movement pattern is different between facial emotion recognition and real social scene emotion recognition, and which can better reflect the social function and the clinical symptoms using a novel theme identification task. Total 29 patients with schizophrenia and 31 healthy controls completed the theme identification task, in which subjects selected which word, out of positive, neutral and negative, described the theme of a picture under facial emotion recognition and real social scene emotion recognition. Positive and negative syndrome scale (PANSS) and social function in psychosis inpatients (SSPI) were used to assess the symptom and social function. The schizophrenia’s eye movement paradigms under both facial emotion and social scene show decreased number of fixation (t=-3.49, P=0.00; t=-3.62, P=0.00), decreased number of saccades (t=-3.15, P=0.00; t=-3.72, P=0.00), decreased scan path length (t=-2.23, P=0.03; t=-4.18, P=0.03), decreased fixation number in interest area (t=3.01, P=0.00; t=-3.24, P=0.00). Different from facial emotion cognition, the eye movement under social scene cognition showed lower percentage of fixation number in interest area than that in healthy subjects (P=0.01), furthermore, the length of scan path under the negative social scene pictures was associated with the total score of SSPI (r=-0.38, P=0.04), the PANSS total score (r=-0.46, P=0.01), the positive symptoms score (r=-0.39, P=0.04), the general score (r=-0.50, P=0.01). The patients showed more abnormal eye tracking indicators under social scene than facial emotion. Under negative emotion social scene, the length of scan path related to social function and clinical symptoms, it may be a potential indicator to evaluate social function and degree of disease.