Patients with schizophrenia are known to be impaired in several domains of emotional processing. These deficits have been associated with impaired social functioning. Since female patients show better social skills than male patients and healthy women outperform men in emotion recognition and empathic capacity, studying sex differences in emotional processing might contribute to a better understanding of the differences between men and women in the clinical manifestation of the illness. To this end, sex differences were studied in facial emotion recognition, emotion recognition in prosody and semantics of spoken language; empathy and perception of social interaction; working memory in simultaneous and sequential processing of language and emotion; long-term memory for visual information with positive, negative and neutral content; sensitivity to threat (inhibition) and reward (activation) in relationship to heartmeasures. The female advantage in emotion recognition, empathy and social perception was found to be preserved in schizophrenia. In addition, men but not women with schizophrenia were significantly impaired in performing a simultaneous language/emotion working memory task. These findings may explain in part the better course and outcome of female patients with schizophrenia. However, in more complex sequential or long-term processing of (emotional) stimuli, no female advantage was observed. Regarding inhibition, both male and female patients showed enhanced sensitivity to threat. Given the impaired performance in patients on all tasks involving emotional stimuli, our results confirm the accumulating evidence that schizophrenia is pre-eminently an emotional disorder
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