The emotional perception test is considered an effective tool in differentiating between schizophrenia and bipolar disorder. We hypothesized that schizophrenic patients would show decreased emotional perception ability compared with bipolar patients and that the disrupted emotional perception ability would be associated with the disrupted functional connectivity within the fronto-temporal-occipital circuit.
In total, 55 schizophrenic patients, 54 bipolar patients, and 50 healthy participants were evaluated using a computerized assessment tool for facial emotion recognition, resting-state magnetic resonance imaging, and Korean versions of the Positive and Negative Syndrome Scale (PANSS) and Young Mania Rating Scale (YMRS).
The emotional perception index (EPI) was higher in the schizophrenia group than in the bipolar and healthy control (lowest) groups. The PANSS total and YMRS scores positively correlated with the EPI in schizophrenia and bipolar patients. In healthy controls, EPI positively correlated with regional homogeneity (ReHo) within the left fusiform gyrus, left superior frontal gyrus, left inferior frontal gyrus, and right inferior temporal gyrus. In schizophrenic patients, EPI negatively correlated with ReHo within the frontal lobe and left fusiform gyrus. In bipolar patients, EPI positively correlated with ReHo within the left parietal lobe and negatively correlated with ReHo within both frontal lobes.
More specific definition of EPI should be suggested. Due to lack of cognitive function tests, cognitive functions might be biased throughout the analyses.
Schizophrenic patients showed decreased emotion recognition abilities compared with bipolar patients. Further, schizophrenic patients showed less frontal cortex usage, while bipolar patients used the parietal lobe to compensate for facial emotion recognition.

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