Objective: To explore the deficits of facial expression recognition, theory of mind and empathy in patients with schizophrenia and to examine the association of facial expression recognition with theory of mind and empathy. Methods: Totally 47 patients with schizophrenia who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and 35 normal participants were selected. The Facial Emotion Identification Test ( FEIT)，Yoni task, and the Questionnaire of Cognitive and Affective Empathy(QCAE) were used to measure expression recognition, theory of mind, and empathy. The main indicators were task accuracy and questionnaire scores. Results: Compared to normal controls, patient group showed significantly poorer performance on facial expression recognition accuracy and the Yoni task, and lower scores on cognitive empathy and peripheral responsivity subscale of the QCAE ( Ps<0.05).Regression analyses showed that performance on cognitive theory of mind(β=0. 33, P<0. 01) and affective theory of mind ((β=0.33, P<0. O1) of the Yoni task were positively associated with accuracy in recognizing happy expressions. Cognitive empathy scores of the QCAE were negatively associated with accuracy in recognizing neutral expressions (β=-0. 23, P<0.05 ). Patients had lower affective theory of mind accuracy (β=-0. 23, P<0. 05 ) and QCAE cognitive empathy scores (β3=-0. 34, P<0. 01). Conclusion: Patients with schizophrenia have deficits in expression recognition, theory of mind, and empathy, and that their abnormal expression recognition may be associated with deficits in theory of mind and empathy.

目的:探讨精神分裂症患者表情识别、心理推理能力和共情的缺损，并考察其表情识别能力与心理推理能力和共情的关系。方法:招募47例符合精神障碍诊断与统计手册第5版(DSM-5)诊断标准的精神分裂症患者和35例正常对照。采用表情识别任务(FEIT)评估表情识别，Yoni任务评估认知与情感心理推理能力，认知与情感共情问卷(QCAE)评估共情，主要指标为任务正确率和问卷得分。结果:精神分裂症患者组6种表情识别正确率、心理推理任务表现以及QCAE认知共情得分和情感共情远端反应得分均低于对照组(均P<0.05);回归分析显示Yoni任务认知条件正确率(β=0.33,P<0.01)和情感条件正确率(β=0.33,P<0.01)均与高兴表情识别正确率存在正向关联；QCAE认知共情得分与中性表情识别正确率呈负向关联(β=-0.23,P<0.05);精神分裂症患者Yoni任务情感条件正确率(β=-0.23,P<0.05)和QCAE认知共情得分(β=-0.34,P<0.01)更低。结论:精神分裂症患者表情识别、心理推理能力和共情存在缺损，并且患者表情识别的异常与其心理推理能力和共情的缺损相关。

教育部人文社会科学研究规划基金项目(19YJA190006);; 山东省自然科学基金(ZR2021MC103);; 国家自然科学基金(31871114)