Schizophrenia is associated with interpersonal difficulties related to impairments in the processing of facial emotional expressions. The aim of the present study was to identify brain regions associated with reality distortion syndrome reduction in a group of patients with schizophrenia during processing of emotionally salient stimuli. We used functional magnetic resonance imaging to measure cerebral blood oxygenation changes during an implicit emotional task in 11 patients with schizophrenia, who were scanned twice with an interval of 6–8weeks. We found that reality distortion syndrome reduction was associated with increases in the activation of the affective division of the anterior cingulate and lateral prefrontal cortices. Our findings may indicate that changes in the activation of these regions during processing of emotionally salient stimuli may represent neural markers of patients' symptomatic improvement.