Facial expressivity during the clinical interview as a predictor functional disability in schizophrenia. a pilot study

Despite the central role of nonverbal behavior in regulating social interactions, its relationship to functional disability in schizophrenia has received little empirical attention. This study aimed at assessing the relationship of patients' spontaneous facial expressivity during the clinical interview to clinician-rated and self-reported measures of functional disability. The nonverbal behavior of 28 stabilized patients with schizophrenia was analyzed by using the Ethological Coding System for Interviews (ECSI). Functional disability was assessed using the Global Assessment of Functioning (GAF) scale and the Sheehan Disability Scale (DISS). Partial correlation analysis controlling for the confounding effects of neuroleptic treatment showed that facial expressivity was correlated with the GAF score (r=0.42, P=0.03) and the scores on the subscales of the DISS measuring work (r=-0.52, P=0.005) and social (r=-0.50, P=0.007) disability. In a multiple regression model, nonverbal behavior explained variation in patients' work and social disability better than negative symptoms. The results of this pilot study suggest that deficits in encoding affiliative signals may play a role in determining or aggravating functional disability in schizophrenia. One clinical implication of this finding is that remediation training programs designed to improve nonverbal communication could also serve as a useful adjunct for improving work and social functioning in patients with schizophrenia.