A Systematic Review on Dysconnectivity in Face and Emotion Processing Networks in Schizophrenia

Introduction Schizophrenia is a complex psychiatric disorder which affects approximately 20 million people worldwide. Patients show face processing deficits which greatly affects their social interactions and social cognitive abilities (i.e. trouble empathizing with others). Face processing is an important skill that allows humans to recognize others, detect emotions, and use these abilities for effective social interactions. Although face processing has been extensively studied using functional magnetic resonance imaging (fMRI), there has not been a systematic review investigating links between social-cognitive dysfunction, face processing networks, and clinical symptoms. Here, we comprehensively review for the first time how dysconnectivity in social cognitive networks contribute to face processing deficits and how this is tied to positive and negative symptoms. MethodReviewed studies were a.) written in English, b.) focused on face and emotion processing in schizophrenia (not limited to first episode psychosis [FEP]), and c.) were resting or task-based fMRI studies looking at face/emotion processing neural networks utilizing functional connectivity or measured functional activity broadly. Studies were excluded if they were not related to face processing, focused on different disorders (i.e. depression), used effective connectivity, included combined fMRI-other modality studies , and included non-schizophrenia patient groups. We screened studies from 2020-2025. PubMed, PsycINFO, Web of Science and Google Scholar were utilized to pool results. Results Nine articles were reviewed. Resting state studies and task studies showed elevated Positive and Negative Syndrome Scale (PANSS) positive scores for FEP patients coupled with social cognition deficits. Increased suicidality in schizophrenia was tied to higher PANSS positive symptoms and impaired processing of angry faces. Increased default mode network (DMN) dysconnectivity was tied to disrupted fear recognition processing and subsequently elevated PANSS positive scores. Conclusions Social-cognitive deficits broadly stem around challenges recognizing and processing negative faces. Factors such as trauma, suicidality, and inflammation should be further examined.