BACKGROUND: This study focused on the relationship between facial working memory and resting-state brain function abnormalities in patients with schizophrenia. METHODS: Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected from 28 first-episode schizophrenia (FSZ) patients and 33 healthy controls (HCs). Degree centrality (DC) and Granger causality analysis (GCA) were used to assess brain region connectivity. A delayed matching-to-sample task was used to examine visual working memory for faces and houses. Correlations between DC and facial working memory accuracy were analysed. Brain regions were selected as regions of interest (ROIs) and subjected to further GCA. MRI signals of the DC or GCA were extracted and analysed for correlation with clinical symptom scores. RESULT: The results revealed that FSZ patients presented facial working memory impairments at high loads (t = 2.21, P = 0.03). DC values of the right middle frontal gyrus (MFG) were linked to facial working memory accuracy (P <
0.05, false discovery rate (FDR) correction). GCA indicated inhibited connectivity from the right MFG to the right inferior frontal gyrus (IFG) and right thalamus and from the right postcentral gyrus to the right MFG in FSZ patients (P <
0.05, FDR correction). The DC values of the right thalamus were correlated with negative symptom scores (r = -0.44, P = 0.02) and affective symptom scores (r = -0.57, P <
0.01). CONCLUSIONS: Our findings suggest that FSZ patients may have impaired facial working memory ability, which may be associated with altered functions in multiple brain regions. Some of these functions are associated with clinical symptoms, which may provide insight into the underlying neural mechanisms of schizophrenia.