Eye Movement Abnormalities During the Gaze Perception Task in Individuals With Clinical High Risk for Psychosis: A Discriminant Analysis With Hidden Markov Models

Objectives Social cognitive impairments were well-documented in schizophrenia and individuals with clinical high risk for psychosis (CHR). While eye movement abnormalities during gaze perception in schizophrenia have been suggested, such understanding in individuals with CHR is limited. Design, Settings and Participants This study recruited 36 CHR individuals and 50 healthy controls (HC) to perform a gaze perception task with eye-tracking techniques analyzed with hidden Markov models for predictability and pattern recognition. Eye movement variables and behavioral responses, self-referential gaze perception (SRGP) rates, were compared between groups and examined with discriminant analyses. Associations between eye movements and SRGP rates with multiple symptom dimensions and social functioning were examined. Results Results indicated that CHR group displayed nose-focused (vs eye-focused) and erratic eye movement patterns compared to HC. The combination of behavioral and eye movement variables exhibited a discriminatory ability of 0.893 area under the curve (AUC) in classifying CHR and HC, significantly outperforming models using either SRGP rates (AUC = 0.824) or eye movement variables (AUC = 0.781) alone. The combined model achieved high sensitivity (0.861) and specificity (0.820), with eyes-nose scale, fixation duration, and ambiguous SRGP rate emerging as the most discriminative features. Self-referential gaze perception rates were primarily associated with schizotypy and social anxiety, while eye movement patterns were mainly associated with delusional ideations and social functioning. Conclusions and Relevance This study comprehensively examined eye movement patterns during gaze perception in CHR and their associations with clinical manifestations, suggesting the potential of visual attention patterns as both diagnostic biomarkers and therapeutic targets in the CHR population.