Inefficient integration during multiple facial processing in pre-morbid and early phases of psychosis.

Objectives We used eye-tracking to evaluate multiple facial context processing and event-related potential(ERP) to evaluate multiple facial recognition in individuals at clinical-high risk(CHR) for psychosis. Methods In total, 173 subjects(83 CHRs and 90 healthy controls[HCs]) were included and their emotion perception performances were accessed. A total of 40 CHRs and 40 well-matched HCs completed an eye-tracking task where they viewed pictures depicting a person in the foreground, presented as context-free, context-compatible, and context-incompatible. During the two-year follow up, 26 CHRs developed psychosis, including 17 individuals who developed first-episode schizophrenia(FES). Eighteen well-matched HCs were made to complete the face number detection ERP task with image stimuli of one, two, or three faces. Results Compared to the HC group, the CHR group showed reduced visual attention to contextual processing when viewing multiple faces. With increasing complexity of contextual faces, the differences in eye-tracking characteristics also increased. In the ERP task, the N170 amplitude decreased with higher face number in FES patients, while it increased with higher face number in HCs. Conclusions Individuals in the very early phase of psychosis showed facial processing deficits with supporting evidence of different scanpaths during context processing and disruption of N170 during multiple facial recognition.