What you see is what you get: visual scanning failures of naturalistic social scenes in schizophrenia

Impairments in social cognition contribute significantly to disability in schizophrenia patients (SzP). Perception of facial expressions is critical for social cognition. Intact perception requires an individual to visually scan a complex dynamic social scene for transiently moving facial expressions that may be relevant for understanding the scene. The relationship of visual scanning for these facial expressions and social cognition remains unknown. In 39 SzP and 27 healthy controls (HC), we used eye-tracking to examine the relationship between performance on The Awareness of Social Inference Test (TASIT), which tests social cognition using naturalistic video clips of social situations, and visual scanning, measuring each individual's relative to the mean of HC. We then examined the relationship of visual scanning to the specific visual features (motion, contrast, luminance, faces) within the video clips. TASIT performance was significantly impaired in SzP for trials involving sarcasm ( < 10 ). Visual scanning was significantly more variable in SzP than HC ( < 10 ), and predicted TASIT performance in HC ( = 0.02) but not SzP ( = 0.91), differing significantly between groups ( = 0.04). During the visual scanning, SzP were less likely to be viewing faces ( = 0.0001) and less likely to saccade to facial motion in peripheral vision ( = 0.008). SzP show highly significant deficits in the use of visual scanning of naturalistic social scenes to inform social cognition. Alterations in visual scanning patterns may originate from impaired processing of facial motion within peripheral vision. Overall, these results highlight the utility of naturalistic stimuli in the study of social cognition deficits in schizophrenia.