Impaired facial emotion perception in schizophrenia: a meta-analysis

Understanding and Taking Stock of Positive Emotion Disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.

Stria terminalis, amygdala, and temporoparietal junction networks facilitate efficient emotion processing under expectations

Rapid emotion processing is an ecologically essential ability for survival in social environments in which threatening or advantageous encounters dynamically and rapidly occur. Efficient emotion recognition is subserved by different processes, depending on one's expectations; however, the underlying functional and structural circuitry is still poorly understood. In this study, we delineate brain networks that subserve fast recognition of emotion in situations either congruent or incongruent with prior expectations. For this purpose, we used multimodal neuroimaging and investigated performance on a dynamic emotion perception task. We show that the extended amygdala structural and functional networks relate to speed of emotion processing under threatening conditions. Specifically, increased microstructure of the right stria terminalis, an amygdala white-matter pathway, was related to faster detection of emotion during actual presentation of anger or after cueing anger. Moreover, functional connectivity of right amygdala with limbic regions was related to faster detection of anger congruent with cue, suggesting selective attention to threat. On the contrary, we found that faster detection of anger incongruent with cue engaged the ventral attention "reorienting" network. Faster detection of happiness, in either expectancy context, engaged a widespread frontotemporal-subcortical functional network. These findings shed light on the functional and structural circuitries that facilitate speed of emotion recognition and, for the first time, elucidate a role for the stria terminalis in human emotion processing.

Emotion recognition in objects in patients with neurological disease

OBJECTIVE

Considerable research indicates that individuals with dementia have deficits in the ability to recognize emotion in other people. The present study examined ability to detect emotional qualities of objects.

METHOD

Fifty-two patients with frontotemporal dementia (FTD), 20 patients with Alzheimer's disease (AD), 18 patients awaiting surgery for intractable epilepsy, and 159 healthy controls completed a newly developed test of ability to recognize emotional qualities of art (music and paintings), and pleasantness in simple sensory stimuli (tactile, olfactory, auditory), and to make aesthetic judgments (geometric shapes, room décor). A subset of participants also completed a test of ability to recognize emotions in other people.

RESULTS

Patients with FTD showed a marked deficit in ability to recognize the emotions conveyed in art, compared with both healthy individuals and patients with AD (relative to controls, deficits in patients with AD only approached significance). This deficit remained robust after controlling for FTD patients' ability to recognize pleasantness in simple sensory stimuli, make aesthetic judgments, identify odors, and identify emotions in other people. Neither FTD nor AD patients showed deficits in recognizing pleasant sensory stimuli or making aesthetic judgments. Exploratory analysis of patients with epilepsy revealed no deficits in any of these domains.

CONCLUSION

Patients with FTD (but not AD) showed a significant, specific deficit in ability to interpret emotional messages in art, echoing FTD-related deficits in recognizing emotions in other people. This finding adds to our understanding of the impact these diseases have on the lives of patients and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social cognition in schizophrenia: A network-based approach to a Taiwanese version of the Reading the Mind in the Eyes test

BACKGROUND

This study aimed to examine social-cognitive impairments in patients with schizophrenia using the Eyes test. In contrast to previous methods using the correct answers, we developed the Taiwanese version of the Eyes test and constructed the response network to explore impairments in the emotional aspects of theory of mind in patients with schizophrenia.

METHODS

Eighteen patients with schizophrenia and 18 healthy controls were recruited to examine their performance of the Eyes test. To explore the internal structures of mental states, we used network analysis to construct the networks of choice patterns (i.e. participants' answers) by using two network indicators, including density (an index of structure diversity of a network) and centrality (an index of the choice patterns within a network). Moreover, we divided all the choices into negative, positive, and neutral item groups based on emotion polarity.

RESULTS

The patient group was slower and less accurate than the control group. Moreover, there was a negative correlation between accuracy and blunted affect, and there were positive correlations between reaction time and emotional withdrawal and apathetic social withdrawal. As compared to healthy controls, patients with schizophrenia showed larger density in the network structure and higher centrality than controls. Also, patients showed poorer performance on negative words than healthy controls.

CONCLUSION

Our results demonstrated more diversity to recognize negative emotions from patients' choice patterns as compared to those in the control group. These findings suggest that deficits on recognizing negative emotions might be associated with the dysfunctions of mental states in schizophrenia.

Polygenic Risk Score for Schizophrenia and Face-Processing Network in Young Adulthood

Development of schizophrenia relates to both genetic and environmental factors. Functional deficits in many cognitive domains, including the ability to communicate in social interactions and impaired recognition of facial expressions, are common for patients with schizophrenia and might also be present in individuals at risk of developing schizophrenia. Here we explore whether an individual's polygenic risk score (PRS) for schizophrenia is associated with the degree of interregional similarities in blood oxygen level-dependent (BOLD) signal and gray matter volume of the face-processing network and whether the exposure to early adversity moderates this association. A total of 90 individuals (mean age 22 years, both functional and structural data available) were used for discovery analyses, and 211 individuals (mean age 26 years, structural data available) were used for replication of the structural findings. Both samples were drawn from the Northern Finland Birth Cohort 1986. We found that the degree of interregional similarities in BOLD signal and gray matter volume vary as a function of PRS; lowest interregional correlation (both measures) was observed in individuals with high PRS. We also replicated the gray matter volume finding. We did not find evidence for an interaction between early adversity and PRS on the interregional correlation of BOLD signal and gray matter volume. We speculate that the observed group differences in PRS-related correlations in both modalities may result from differences in the concurrent functional engagement of the face-processing regions over time, eg, via differences in exposure to social interaction with other people.

Facial Emotion Recognition and Persecutory Ideation in Paranoid Schizophrenia

The recognition of facial signals has a crucial role in social interaction. It is well known that people suffering from paranoid schizophrenia have problems in the social domain, predominantly related to misinterpreting the intentions, emotions, and actions of others. The aim of this study was to examine whether there are differences in facial emotion recognition between people with paranoid schizophrenia and healthy controls. In addition, we examined the correlation between facial emotion recognition and the expression of persecutory ideation in people suffering from paranoid schizophrenia. The study involved 60 participants, 30 of whom suffered from paranoid schizophrenia and 30 healthy controls, equalized by gender, age, and education. The following instruments were used: Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces and the Persecutory Ideation Questionnaire. Compared with the controls, people suffering from paranoid schizophrenia were significantly less accurate in recognizing the following emotions: surprise, contempt, sadness, disgust, and emotionally neutral faces. Since the attribution of emotions to emotionally neutral faces is an important finding that could be linked with the social (dis)functionality of people suffering from paranoid schizophrenia, we analyzed and compared the wrong answers given by the two groups and found some differences between them. The results show that persecutory ideation has a statistically significant negative correlation with the successful recognition of emotionally neutral faces. All of the findings lead to the conclusion that paranoid schizophrenia, and within it the existence of persecutory ideation, leads to problems in recognizing the basic facial signals that form the foundation of everyday social interaction.

Subthreshold social cognitive deficits may be a key to distinguish 22q11.2DS from schizophrenia

AIM

Social cognitive impairments are core features in 22q11.2 deletion syndrome (22q11.2DS) and schizophrenia (SCZ). Indeed, adults with 22q.11.2 DS often have poorer social competence as well as poorer performance on measures of social cognitive skills (emotion recognition and theory of mind, ToM) compared with typically developing people. However, studies comparing specific social cognitive components in 22q11.2DS and SCZ have not yet been widely conducted.

METHODS

In this study we compared performances of 22q11.2DS and SCZ on both facial emotion recognition and ToM. Patients with 22q11.2DS (n = 18) and matched SCZ patients were recruited. After neuropsychological testing, the facial emotion recognition test assessed the patients' ability to recognize six basic, universal emotions (joy, anger, sadness, fear, disgust, and contempt). The Versailles-situational intentional reading evaluated ToM with six scenes from movies showing characters in complex interactions (involving hints, lies, and indirect speech).

RESULTS

We show that 22q11.2DS exhibited significantly lower performance in emotion recognition than SCZ patients did, especially for disgust, contempt, and fear. This impairment seems to be a core cognitive phenotype in 22q11.2DS, regardless of the presence of SCZ symptoms. Concerning ToM, our results may highlight the same impairment level in 22q11.2DS and SCZ but require to be replicated in a larger cohort.

CONCLUSION

Our results document the existence of threshold social cognitive deficits distinguishing 22q11.2DS from SCZ.

Shared multisensory experience affects Others' boundary: The enfacement illusion in schizophrenia

Schizophrenia has been described as a psychiatric condition characterized by deficits in one's own and others' face recognition, as well as by a disturbed sense of body-ownership. To date, no study has integrated these two lines of research with the aim of investigating Enfacement Illusion (EI) proneness in schizophrenia. To accomplish this goal, the classic EI protocol was adapted to test the potential plasticity of both Self-Other and Other-Other boundaries. Results showed that EI induced the expected malleability of Self-Other boundary among both controls and patients. Interestingly, for the first time, the present study demonstrates that also the Other-Other boundary was influenced by EI. Furthermore, comparing the two groups, the malleability of the Other-Other boundary showed an opposite modulation. These results suggest that, instead of greater Self-Other boundary plasticity, a qualitative difference can be detected between schizophrenia patients and controls in the malleability of the Other-Other boundary. The present study points out a totally new aspect about body-illusions and schizophrenia disorder, demonstrating that EI is not only confined to self-sphere but it also affects the way we discriminate others, representing a potential crucial aspect in the social domain.

Differences in Facial Emotional Recognition Between Patients With the First-Episode Psychosis, Multi-episode Schizophrenia, and Healthy Controls

OBJECTIVES

The aim of our study was to assess the differences in facial emotional recognition (FER) between patients with first-episode psychosis (FEP), patients with multi-episode schizophrenia (SCH), and healthy controls (HC) and to find possible correlations of FER with psychopathology in the two patient groups.

METHODS

We performed a cross-sectional study enrolling 160 patients from two psychiatric hospitals in Croatia (80 FEP and 80 SCH) and 80 HC during the period from October 2015 until October 2017. Patients were assessed once during their hospital treatment, using the Penn Emotion Recognition Task for assessment of FER, rating scales for psychopathology and depression and self-reporting questionnaires for impulsiveness, aggression, and quality of life.

RESULTS

The number of correctly identified emotions significantly decreased from HC to FEP [Δ -7%; 95% confidence interval (CI) [-12% to -3%], effect size r = 0.30] and more markedly in SCH (Δ -15%; 95% CI [-25% to -10%], effect size r = 0.59) after the adjustment for age and gender and correction for multiple testing. Correct FER for negative emotions, but not for happiness and neutral emotions, had a statistically significant negative correlation with some features on the scales of psychopathology, impulsivity and aggression in both patient groups.

CONCLUSIONS

Impairment of FER is present from the first episode of schizophrenia and increases further with multiple psychotic episodes, but it may depend on or contribute to clinical symptoms. Therefore, assessment of FER should be included in the clinical assessment and integrated in the plan of treatment from the beginning of the illness. (JINS, 2019, 25, 165-173).

Neural correlates of dynamic emotion perception in schizophrenia and the influence of prior expectations

Impaired emotion perception is a well-established and stable deficit in schizophrenia; however, there is limited knowledge about the underlying aberrant cognitive and brain processes that result in emotion perception deficits. Recent influential work has shown that perceptual deficits in schizophrenia may result from aberrant precision in prior expectations, associated with disrupted activity in frontal regions. In the present study, we investigated the perception of dynamic, multisensory emotion, the influence of prior expectations and the underlying aberrant brain processes in schizophrenia. During a functional Magnetic Resonance Imaging scan, participants completed the Dynamic Emotion Perception task, which induces prior expectations with emotion instruction cues. We delineated neural responses and functional connectivity in whole-brain large-scale networks underlying emotion perception. Compared to healthy individuals, schizophrenia patients had lower accuracy specifically for emotions that were congruent with prior expectations. At the neural level, schizophrenia patients had less engagement of right inferior frontal and parietal regions, as well as right amygdala dysconnectivity during discrimination of emotions congruent with prior expectations. The results indicate that individuals with schizophrenia may have aberrant prior expectations about emotional expressions, associated with under-activity in inferior frontoparietal regions and right amygdala dysconnectivity, which results in impaired perception of emotion.

From "under" to "over" social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms?

Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning.

The valuation of social rewards in schizophrenia

Social impairment in schizophrenia is often thought to reflect poor social cognition. Here we examine responses to social rewards, an aspect of social functioning that is not featured prominently in the literature. The goal of this experiment was to explore whether people with schizophrenia (a) undervalue social rewards, and (b) whether the undervaluation of social rewards was related to motivation and pleasure deficits in schizophrenia and decreased social functioning. People with schizophrenia and healthy participants completed a game (Shore & Heerey, 2011) to explore preferences for different types of social (polite and genuine smiles) and nonsocial (monetary) rewards from computerized opponents. Preferences for reward types were quantified for each participant based on choice behavior during the game. Participants also completed a smile discrimination task to assess their ability to discriminate these types of smiles. Analyses revealed that people with schizophrenia (N = 41) treated genuine smiles as significantly less rewarding than did healthy participants (N = 29), despite showing a similar preference for monetary rewards. The undervaluation of social rewards was not related to the ability to discriminate between the smiles. The current findings provide preliminary evidence of reduced social reward valuation among individuals with schizophrenia, which may have implications for behavior in face-to-face social interactions. (PsycINFO Database Record

Impairments of emotional face processing in schizophrenia patients: Evidence from P100, N170 and P300 ERP components in a sample of auditory hallucinators

Patients with schizophrenia show impaired face and emotional expression processing that may be due to early perceptual deficits or late impairments in higher-order emotional facial recognition. This study examined event-related potentials (ERPs) in 23 patients with schizophrenia who experience auditory hallucinations and 19 healthy controls. EEG activity was recorded from 32 scalp sites positioned according to the 10-10 placement system. Linked left and right electrodes at the mastoids served as the reference. The P100, N170 and P300 were measured during an emotional facial identification task, which included neutral, joyful, sad, angry and fearful facial expressions and non-face stimuli (chairs). P100 was measured at O_1/2 and P_7/8. N170 was measured at P_7/8. P300 was measured at P_z. Patients with schizophrenia were slower at identifying all facial expressions, including neutral ones. They also showed less positive P100 amplitude to sad, angry and fearful facial expressions. N170 amplitudes were smaller in patients in response to neutral, joyful, sad, angry, and fearful facial expression. Patients showed less positive P300 mean amplitudes to all facial expressions, including neutral ones. Within-group comparisons showed that patients exhibited a different pattern of ERP modulation across facial expressions than controls for P100 and N170, but not for P300. Our findings are compatible with the idea that behavioural and electrophysiological face-processing deficits in schizophrenia arise from early-stage deficits in visual processing.

Negative Schizotypy and Altered Functional Connectivity During Facial Emotion Processing

BACKGROUND

Impairment in facial emotion perception is an important domain of social cognition deficits in schizophrenia. Although impaired facial emotion perception has been found in individuals with negative schizotypy (NS), little is known about the corresponding change in brain functional connectivity.

METHODS

Sixty-four participants were classified into a high NS group (n = 34) and a low NS group (n = 30) based on their total scores on the Chapman scales for physical and social anhedonia. All participants undertook a facial emotion discrimination functional imaging task that consisted of four emotional valences (angry, fear, happy, and neutral). For univariate analysis, the signal change at the bilateral amygdala was compared for each emotional contrast using SPSS (P < .05). For the functional connectivity analysis, we calculated the beta-series functional connectivity of the bilateral amygdala with the medial prefrontal cortex (mPFC) and compared the group differences in SPM12 (P < .05, small volume family-wise error correction).

RESULTS

No significant differences were found between the high and low NS groups in accuracy and reaction time in the facial emotion discrimination task. The high NS group showed reduced brain activations at the amygdala under fearful and neutral conditions. Reduced functional connectivity between the amygdala and the mPFC/dorsal anterior cingulate cortex under the happy and fearful conditions in the high NS group was also found.

CONCLUSIONS

Our findings suggest that the individuals with high NS showed altered brain activity and functional connectivity at the amygdala during facial emotion processing and provide new evidence for understanding social cognition deficits in at-risk individuals.

Gender Differences in Social Cognition: A Cross-Sectional Pilot Study of Recently Diagnosed Patients with Schizophrenia and Healthy Subjects

OBJECTIVES

This study had 2 objectives: First, to explore the gender-related differences in emotional processing (EP) and theory of mind-both cognitive (CToM) and affective (AToM)-in patients with schizophrenia and in a control group of healthy subjects; and, second, to examine, from a gender perspective, the possible association between EP and CToM in the AToM performance.

METHODS

Forty patients with schizophrenia/schizoaffective disorder were recruited and matched by gender, age and years of education with 40 healthy subjects. EP was measured by the pictures of facial affect (POFA) test. CToM was measured using first- and second-order false-belief (FB) stories. AToM was measured by the reading the mind in the eyes test (RMET). Group and gender differences in CToM were analysed using the X² test, whereas EP and AToM were analysed using the non-parametric Mann-Whitney U Test and a general linear model. Results were adjusted by intelligence quotient and negative symptomatology.

RESULTS

Patients with schizophrenia underperformed against healthy subjects in the POFA test, second-order FB, and RMET, but not in first-order FB. No significant gender differences were found. However, there was a trend showing that females outperformed males in the POFA ( P = 0.056). Group ( P < 0.001), POFA ( P < 0.001) and second-order FB ( P = 0.022) were the best factors predicting RMET performance (adjusted R² = 0.584).

CONCLUSIONS

Our results suggest that the illness is the main factor related to the deficit in social cognition, except for the basic aspects of the CToM that were unimpaired in most patients. Nevertheless, the influence of female gender in EP should not be neglected in any group. Finally, the hierarchal interaction between these domains is discussed.

Impaired regulation of emotional distractors during working memory load in schizophrenia

Schizophrenia (SZ) patients exhibit deficits in emotion regulation that affect their daily functioning. There is evidence that the prefrontal cortex plays an important role in emotion regulation. However, it remains unclear how this brain region is involved in emotion regulation deficits in SZ, and how such deficits impact performance on cognitively demanding tasks. We examined how happy and fearful emotional distractors impact performance on working memory (WM) tasks of varying difficulty (0-back, 2-back), and brain activity using fMRI. Participants were 20 patients with SZ and 20 healthy controls (HC) matched on age, sex, race, and IQ. A significant 3-way interaction showed that SZ patients had lower performance compared to HC when exposed to fearful and happy distractors, but only during the 2-back task. Second-level fMRI between-group analysis revealed that compared to SZ patients, HC showed significantly greater increase in brain activity with WM load in the left IFG (BA 45) when exposed to fearful distractors. Less brain activity in this region was also associated with reduction in SZ patients' performance during higher WM load and the presence of fearful distractors. SZ patients had difficulty in performing a WM task when regulating emotions, and they failed to show the emotion-specific modulation of the left IFG observed in HC. These results suggest that SZ patients have difficulty with emotion regulation demands during effortful cognitive tasks. This also provides us with potential insight on how emotion regulation could be rehabilitated in SZ using cognitive training.

Social cognition intervention in schizophrenia: Description of the training of affect recognition program - Indian version

Social cognition refers to mental operations involved in processing of social cues and includes the domains of emotion processing, Theory of Mind (ToM), social perception, social knowledge and attributional bias. Significant deficits in ToM, emotion perception and social perception have been demonstrated in schizophrenia which can have an impact on socio-occupational functioning. Intervention modules for social cognition have demonstrated moderate effect sizes for improving emotion identification and discrimination. We describe the Indian version of the Training of Affect Recognition (TAR) program and a pilot study to demonstrate the feasibility of administering this intervention program in the Indian population. We also discuss the cultural sensibilities in adopting an intervention program for the Indian setting. To the best of our knowledge this is the first intervention program for social cognition for use in persons with schizophrenia in India.

The Impact of Sex Differences on Odor Identification and Facial Affect Recognition in Patients with Schizophrenia Spectrum Disorders

BACKGROUND

Social interactive functions such as facial emotion recognition and smell identification have been shown to differ between women and men. However, little is known about how these differences are mirrored in patients with schizophrenia and how these abilities interact with each other and with other clinical variables in patients vs. healthy controls.

METHODS

Standardized instruments were used to assess facial emotion recognition [Facially Expressed Emotion Labelling (FEEL)] and smell identification [University of Pennsylvania Smell Identification Test (UPSIT)] in 51 patients with schizophrenia spectrum disorders and 79 healthy controls; furthermore, working memory functions and clinical variables were assessed.

RESULTS

In both the univariate and the multivariate results, illness showed a significant influence on UPSIT and FEEL. The inclusion of age and working memory in the MANOVA resulted in a differential effect with sex and working memory as remaining significant factors. Duration of illness was correlated with both emotion recognition and smell identification in men only, whereas immediate general psychopathology and negative symptoms were associated with emotion recognition only in women.

CONCLUSION

Being affected by schizophrenia spectrum disorder impacts one's ability to correctly recognize facial affects and identify odors. Converging evidence suggests a link between the investigated basic and social cognitive abilities in patients with schizophrenia spectrum disorders with a strong contribution of working memory and differential effects of modulators in women vs. men.

Schizophrenia and Category-Selectivity in the Brain: Normal for Faces but Abnormal for Houses

Face processing is regularly found to be impaired in schizophrenia (SZ), thus suggesting that social malfunctioning might be caused by dysfunctional face processing. Most studies focused on emotional face processes, whereas non-emotional face processing received less attention. While current reports on abnormal face processing in SZ are mixed, examinations of non-emotional face processing compared to adequate control stimuli may clarify whether SZ is characterized by a face-processing deficit. Patients with SZ (n = 28) and healthy controls (n = 30) engaged in an fMRI scan where images of non-emotional faces and houses were presented. A simple inverted-picture detection task warranted the participants' attention. Region of interest (ROI) analyses were conducted on face-sensitive regions including the fusiform face area, the occipital face area, and the superior temporal sulcus. Scene-sensitivity was assessed in the parahippocampal place area (PPA) and served as control condition. Patients did not show aberrant face-related neural processes in face-sensitive regions. This finding was also evident when analyses were done on individually defined ROIs or on in-house-localizer ROIs. Patients revealed a decreased specificity toward house stimuli as reflected in decreased neural response toward houses in the PPA. Again, this result was supported by supplementary analyses. Neural activation toward neutral faces was not found to be impaired in SZ, therefore speaking against an overall face-processing deficit. Aberrant activation in scene-sensitive PPA is also found in assessments of memory processes in SZ. It is up to future studies to show how impairments in PPA relate to functional outcome in SZ.

Impaired facial and vocal emotion decoding in schizophrenia is underpinned by basic perceptivo-motor deficits

INTRODUCTION

Emotional decoding impairments have been largely demonstrated in schizophrenia for facial and prosodic stimuli, when presented separately. Nevertheless, the exploration of crossmodal integration has been far less considered, despite its omnipresence in daily social interactions. Moreover, the role played by basic visuo-motor impairments in unimodal and crossmodal decoding remains unexplored.

METHODS

Thirty-two patients were compared with 32 matched controls in an emotional decoding task including unimodal (visual and auditory) and crossmodal (congruent and incongruent) conditions. A control perceptive task was also conducted to take potential low-level perceptual deficits into account.

RESULTS

Schizoprenic patients presented lower performance and higher reaction times for both unimodal tasks (visual and auditory) and crossmodal conditions. Moreover, reaction times for the visuo-perceptive task were also significantly longer for patients compared to controls.

CONCLUSIONS

The consistency of the results across unimodal and crossmodal tasks suggests a globalised emotional impairment in schizophrenia, independent of the sensorial modality and crossmodal nature of the stimuli. Centrally, given the results in the visuo-perceptive task, the impairments observed for emotional recognition appears at least partly explained by primary cognitive deficits, namely reduced processing speed.

Facial affect recognition and social functioning among individuals with varying degrees of schizotypy

Facial affect recognition (FAR) accuracy is impaired in schizophrenia and, to a lesser extent, in individuals at-risk for psychosis. Reduced reaction time and negative bias on FAR tasks are also evident in schizophrenia, though few studies have examined these measures in at-risk samples. Social dysfunction is associated with FAR deficits in schizophrenia and at-risk individuals. We aimed to elucidate the nature of FAR and social functioning among individuals from a non-clinical population reporting a range of schizotypal traits (i.e., risk for psychosis), and to examine whether FAR mediates the relationship between schizotypal traits and social functioning. Participants completed self-report measures assessing schizotypal traits and social functioning, and a computerized FAR task remotely via the Internet. High schizotypy individuals performed significantly worse than low schizotypy individuals on FAR total and neutral accuracy, demonstrated a negative bias, and reported significantly worse social functioning. Schizotypal traits were also negatively correlated with FAR performance and social functioning in the total sample. FAR accuracy did not mediate the direct relationship between schizotypal traits and social functioning. FAR may be an important social-cognitive endophenotype of psychosis risk with implications for understanding etiology of psychotic spectrum disorders, improving ways of identifying at-risk individuals, and developing preventive strategies.

Task-Related Functional Connectivity Analysis of Emotion Discrimination in a Family Study of Schizophrenia

Poor emotion recognition is a core deficit in schizophrenia and is associated with poor functional outcome. Functional magnetic resonance imaging (fMRI) multivariate analysis methods were used to elucidate the neural underpinnings of face and emotion processing associated with both genetic liability and disease-specific effects. Schizophrenia patients, relatives, and controls completed a task that included 4 facial emotion discrimination conditions and an age discrimination condition during fMRI. Three functional networks were derived from the data: the first involved in visual attention and response generation, the second a default mode network (DMN), and a third involved in face and emotion processing. No differences in activation were found between groups for the visual attention and response generation network, suggesting that basic processes were intact. Both schizophrenia patients and relatives showed evidence for hyperdeactivation in the DMN compared to controls, with relatives being intermediate, suggesting a genetic liability effect. Both disease-specific and genetic liability effects were found for the face processing network, which included the amygdala. Patients exhibited lower coordinated network activity compared to controls and relatives across all facial discrimination conditions. Additionally, in relation to the other emotion discrimination conditions, a heightened coordinated response during fear and anger discrimination was observed in schizophrenia compared to other conditions, whereas relatives demonstrated heightened coordinated activity for anger discrimination only relative to other emotion conditions. With regards to brain functioning, this study found that schizophrenia is associated with abnormal processing of threat-related information, and that in part may be associated with the genetic risk for the disorder, suggesting that the facial and emotion processing network could be targeted for intervention.

The Change in Facial Emotion Recognition Ability in Inpatients with Treatment Resistant Schizophrenia After Electroconvulsive Therapy

People with schizophrenia have impairments in emotion recognition along with other social cognitive deficits. In the current study, we aimed to investigate the immediate benefits of ECT on facial emotion recognition ability. Thirty-two treatment resistant patients with schizophrenia who have been indicated for ECT enrolled in the study. Facial emotion stimuli were a set of 56 photographs that depicted seven basic emotions: sadness, anger, happiness, disgust, surprise, fear, and neutral faces. The average age of the participants was 33.4 ± 10.5 years. The rate of recognizing the disgusted facial expression increased significantly after ECT (p < 0.05) and no significant changes were found in the rest of the facial expressions (p > 0.05). After the ECT, the time period of responding to the fear and happy facial expressions were significantly shorter (p < 0.05). Facial emotion recognition ability is an important social cognitive skill for social harmony, proper relation and living independently. At least, the ECT sessions do not seem to affect facial emotion recognition ability negatively and seem to improve identifying disgusted facial emotion which is related with dopamine enriched regions in brain.

The use of the Duchenne marker and symmetry of the expression in the judgment of smiles in schizophrenia

Research has recurrently shown that individuals with schizophrenia have impairments in emotional facial recognition and this deficit has been associated with aberrant visual scanning of the face. Because human beings have the ability to control the expression of emotion, the communication process becomes more complex. The goal of the current study was to conduct a systematic examination of the response pattern and perceptual-attentional processing in distinguishing smiles with the presence and absence of the Duchenne marker and symmetry and asymmetry of the activation in individuals with schizophrenia. Sixteen individuals diagnosed with schizophrenia and 16 control individuals were asked to judge whether the smiles were really happy or not. Individuals with schizophrenia produced fewer expected responses than controls in judging the symmetric non-Duchenne smile as not really happy. In addition, like their healthy counterparts, individuals with schizophrenia showed difficulty with the judgement of asymmetric Duchenne smiles. In addition to not being as sensitive to the cues, individuals with schizophrenia show differences in their viewing patterns. While the current study does not provide clear links between these viewing patterns and judgment responses, future research should explore other explanations, such as explicit knowledge, for the differences in results.

Emotion recognition and social skills in child and adolescent offspring of parents with schizophrenia

INTRODUCTION

Emotion recognition, a social cognition domain, is impaired in people with schizophrenia and contributes to social dysfunction. Whether impaired emotion recognition emerges as a manifestation of illness or predates symptoms is unclear. Findings from studies of emotion recognition impairments in first-degree relatives of people with schizophrenia are mixed and, to our knowledge, no studies have investigated the link between emotion recognition and social functioning in that population.

METHODS

This study examined facial affect recognition and social skills in 16 offspring of parents with schizophrenia (familial high-risk/FHR) compared to 34 age- and sex-matched healthy controls (HC), ages 7-19.

RESULTS

As hypothesised, FHR children exhibited impaired overall accuracy, accuracy in identifying fearful faces, and overall recognition speed relative to controls. Age-adjusted facial affect recognition accuracy scores predicted parent's overall rating of their child's social skills for both groups.

CONCLUSIONS

This study supports the presence of facial affect recognition deficits in FHR children. Importantly, as the first known study to suggest the presence of these deficits in young, asymptomatic FHR children, it extends findings to a developmental stage predating symptoms. Further, findings point to a relationship between early emotion recognition and social skills. Improved characterisation of deficits in FHR children could inform early intervention.

Facial emotion recognition in patients with focal and diffuse axonal injury

OBJECTIVE

Facial emotion recognition impairment has been well documented in patients with traumatic brain injury. Studies exploring the neural substrates involved in such deficits have implicated specific grey matter structures (e.g. orbitofrontal regions), as well as diffuse white matter damage. Our study aims to clarify whether different types of injuries (i.e. focal vs. diffuse) will lead to different types of impairments on facial emotion recognition tasks, as no study has directly compared these patients.

METHODS

The present study examined performance and response patterns on a facial emotion recognition task in 14 participants with diffuse axonal injury (DAI), 14 with focal injury (FI) and 22 healthy controls.

RESULTS

We found that, overall, participants with FI and DAI performed more poorly than controls on the facial emotion recognition task. Further, we observed comparable emotion recognition performance in participants with FI and DAI, despite differences in the nature and distribution of their lesions. However, the rating response pattern between the patient groups was different.

CONCLUSION

This is the first study to show that pure DAI, without gross focal lesions, can independently lead to facial emotion recognition deficits and that rating patterns differ depending on the type and location of trauma.

Approaching anger in schizophrenia: What an implicit task tells you that self-report does not

Motivational deficits are important determinants of impaired social functioning in schizophrenia, yet we know very little about their precise nature. One influential model of motivation distinguishes between approach and avoidance neurobiological systems that impact the tendency to approach rewarding and avoid threatening stimuli. The current study evaluated approach and avoidance motivational tendencies using both implicit and explicit measures. One-hundred and sixteen individuals with schizophrenia and 73 healthy controls completed the implicit Approach Avoidance Task (AAT) which provides a reaction time-based measure of approach and avoidance tendencies for happy and angry faces, and the Behavioral Inhibition/Behavioral Activation System Scale (BIS/BAS), a self-report measure of approach and avoidance tendencies. The patient sample was re-administered the AAT four weeks later to evaluate re-test reliability. At baseline, patients showed a significant tendency to approach (rather than avoid) angry faces on the AAT. This same pattern was replicated at the follow-up assessment. In contrast, on the BIS/BAS, patients reported significantly elevated BIS scores, reflecting increased avoidance of aversive, anxiety-inducing stimuli. Results suggest a discrepancy between patients' implicit behavioral tendency to approach angry faces and their self-reported avoidance of aversive stimuli.

Longitudinal stability of social cognition in schizophrenia: A 5-year follow-up of social perception and emotion processing

BACKGROUND

Individuals with schizophrenia exhibit marked and disproportional impairment in social cognition, which is associated with their level of community functioning. However, it is unclear whether social cognitive impairment is stable over time, or if impairment worsens as a function of illness chronicity. Moreover, little is known about the longitudinal associations between social cognition and community functioning.

METHOD

Forty-one outpatients with schizophrenia completed tests of emotion processing (Mayer-Salovey-Caruso Emotional Intelligence Test, MSCEIT) and social perception (Relationships Across Domains, RAD) at baseline and approximately five years later. Stability of performance was assessed using paired t-tests and correlations. Longitudinal associations between social cognition and community functioning (Role Functioning Scale, RFS) were assessed using cross-lagged panel correlation analysis.

RESULTS

Performance on the two social cognition tasks were stable over follow-up. There were no significant mean differences between assessment points [p's≥0.20, Cohen'sd's≤|0.20|], and baseline performance was highly correlated with performance at follow-up [ρ's≥0.70, ICC≥0.83, p's<0.001]. The contemporaneous association between social cognition and community functioning was moderately large at follow-up [ρ=0.49, p=0.002]. However, baseline social cognition did not show a significant longitudinal influence on follow-up community functioning [z=0.31, p=0.76].

CONCLUSIONS

These data support trait-like stability of selected areas of social cognition in schizophrenia. Cross-lagged correlations did not reveal a significant unidirectional influence of baseline social cognition on community functioning five years later. However, consistent with the larger literature, a moderately large cross-sectional association between social cognition and community functioning was observed. Based on stability and cross-sectional associations, these results suggest that social cognition might have short-term implications for functional outcome rather than long-term consequences.

Humanoid robots versus humans: How is emotional valence of facial expressions recognized by individuals with schizophrenia? An exploratory study

BACKGROUND

The use of humanoid robots to play a therapeutic role in helping individuals with social disorders such as autism is a newly emerging field, but remains unexplored in schizophrenia. As the ability for robots to convey emotion appear of fundamental importance for human-robot interactions, we aimed to evaluate how schizophrenia patients recognize positive and negative facial emotions displayed by a humanoid robot.

METHODS

We included 21 schizophrenia outpatients and 17 healthy participants. In a reaction time task, they were shown photographs of human faces and of a humanoid robot (iCub) expressing either positive or negative emotions, as well as a non-social stimulus. Patients' symptomatology, mind perception, reaction time and number of correct answers were evaluated.

RESULTS

Results indicated that patients and controls recognized better and faster the emotional valence of facial expressions expressed by humans than by the robot. Participants were faster when responding to positive compared to negative human faces and inversely were faster for negative compared to positive robot faces. Importantly, participants performed worse when they perceived iCub as being capable of experiencing things (experience subscale of the mind perception questionnaire). In schizophrenia patients, negative correlations emerged between negative symptoms and both robot's and human's negative face accuracy.

CONCLUSIONS

Individuals do not respond similarly to human facial emotion and to non-anthropomorphic emotional signals. Humanoid robots have the potential to convey emotions to patients with schizophrenia, but their appearance seems of major importance for human-robot interactions.

Integration of verbal and nonverbal emotional signals in patients with schizophrenia: Decreased nonverbal dominance

In day-to-day social interaction, emotions are usually expressed by verbal (e.g. spoken words) and nonverbal signals (e.g. facial expressions, prosody). In case of conflicting signals nonverbal signals are perceived as being the more reliable source of information. Deficits in interpreting nonverbal signals - as described for patients with schizophrenic disorders - might interfere with the ability to integrate verbal and nonverbal social cues into a meaningful whole. The aim of this study was to examine how schizophrenic disorders influence the integration of verbal and nonverbal signals. For this purpose short video sequences were presented to 21 patients with schizophrenia and 21 healthy controls. Each sequence showed an actor speaking a short sentence with independently varying emotional connotations at the verbal and the nonverbal level. The participants rated the valence of the speaker's emotional state on a four-point scale (from very negative to very positive). The relative impact of nonverbal cues as compared to verbal cues on these ratings was evaluated. Both groups base their decisions primarily on nonverbal information. However, this effect is significantly less prominent in the patient group. Patients tend to base their decisions less on nonverbal signals and more on verbal information than healthy controls.

Effects of cue modality and emotional category on recognition of nonverbal emotional signals in schizophrenia

BACKGROUND

Impaired interpretation of nonverbal emotional cues in patients with schizophrenia has been reported in several studies and a clinical relevance of these deficits for social functioning has been assumed. However, it is unclear to what extent the impairments depend on specific emotions or specific channels of nonverbal communication.

METHODS

Here, the effect of cue modality and emotional categories on accuracy of emotion recognition was evaluated in 21 patients with schizophrenia and compared to a healthy control group (n = 21). To this end, dynamic stimuli comprising speakers of both genders in three different sensory modalities (auditory, visual and audiovisual) and five emotional categories (happy, alluring, neutral, angry and disgusted) were used.

RESULTS

Patients with schizophrenia were found to be impaired in emotion recognition in comparison to the control group across all stimuli. Considering specific emotions more severe deficits were revealed in the recognition of alluring stimuli and less severe deficits in the recognition of disgusted stimuli as compared to all other emotions. Regarding cue modality the extent of the impairment in emotional recognition did not significantly differ between auditory and visual cues across all emotional categories. However, patients with schizophrenia showed significantly more severe disturbances for vocal as compared to facial cues when sexual interest is expressed (alluring stimuli), whereas more severe disturbances for facial as compared to vocal cues were observed when happiness or anger is expressed.

CONCLUSION

Our results confirmed that perceptual impairments can be observed for vocal as well as facial cues conveying various social and emotional connotations. The observed differences in severity of impairments with most severe deficits for alluring expressions might be related to specific difficulties in recognizing the complex social emotional information of interpersonal intentions as compared to "basic" emotional states. Therefore, future studies evaluating perception of nonverbal cues should consider a broader range of social and emotional signals beyond basic emotions including attitudes and interpersonal intentions. Identifying specific domains of social perception particularly prone for misunderstandings in patients with schizophrenia might allow for a refinement of interventions aiming at improving social functioning.

Enhancing Cognitive Training Through Aerobic Exercise After a First Schizophrenia Episode: Theoretical Conception and Pilot Study

Cognitive training (CT) and aerobic exercise have separately shown promise for improving cognitive deficits in schizophrenia. Aerobic exercise releases brain-derived neurotrophic factor, which promotes synaptic plasticity and neurogenesis. Thus, aerobic exercise provides a neurotrophic platform for neuroplasticity-based CT. The combination of aerobic exercise and CT may yield more robust effects than CT alone, particularly in the initial course of schizophrenia. In a pilot study, 7 patients with a recent onset of schizophrenia were assigned to Cognitive Training & Exercise (CT&E) and 9 to CT alone for a 10-week period. Posit Science programs were used for CT. Neurocognitive training focused on tuning neural circuits related to perceptual processing and verbal learning and memory. Social cognitive training used the same learning principles with social and affective stimuli. Both groups participated in these training sessions 2d/wk, 2h/d. The CT&E group also participated in an aerobic conditioning program for 30 minutes at our clinic 2d/wk and at home 2d/wk. The effect size for improvement in the MATRICS Consensus Cognitive Battery Overall Composite score for CT&E patients relative to CT patients was large. Functional outcome, particularly independent living skills, also tended to improve more in the CT&E than in the CT group. Muscular endurance, cardiovascular fitness, and diastolic blood pressure also showed relative improvement in the CT&E compared to the CT group. These encouraging pilot study findings support the promise of combining CT and aerobic exercise to improve the early course of schizophrenia.

Facial emotion perception in schizophrenia: Does sex matter?

AIM: To review the literature on sex differences in facial emotion perception (FEP) across the schizophrenia spectrum.

METHODS: We conducted a systematic review of empirical articles that were included in five separate meta-analyses of FEP across the schizophrenia spectrum, including meta-analyses that predominantly examined adults with chronic schizophrenia, people with early (onset prior to age 18) or recent-onset (experiencing their first or second psychotic episode or illness duration less than 2 years) schizophrenia, and unaffected first-degree relatives of people with schizophrenia. We also examined articles written in English (from November 2011 through June 2015) that were not included in the aforementioned meta-analyses through a literature search in the PubMed database. All relevant articles were accessed in full text. We examined all studies to determine the sample sizes, diagnostic characteristics, demographic information, methodologies, results, and whether each individual study reported on sex differences. The results from the meta-analyses themselves as well as the individual studies are reported in tables and text.

RESULTS: We retrieved 134 articles included in five separate meta-analyses and the PubMed database that examined FEP across the schizophrenia spectrum. Of these articles, 38 examined sex differences in FEP. Thirty of these studies did not find sex differences in FEP in either chronically ill adults with schizophrenia, early-onset or recently diagnosed people with schizophrenia, or first-degree relatives of people with schizophrenia. Of the eight studies that found sex differences in FEP, three found that chronically ill women outperformed men, one study found that girls with early-onset schizophrenia outperformed boys, and two studies found that women (including first-degree relatives, adults with schizophrenia, and the healthy control group) outperformed men on FEP tasks. In total, six of the eight studies that examined sex differences in FEP found that women outperformed men across the schizophrenia spectrum.

CONCLUSION: Evidence to date suggests few sex differences in FEP in schizophrenia; both men and women across the schizophrenia spectrum have deficits in FEP.

Deficits in Degraded Facial Affect Labeling in Schizophrenia and Borderline Personality Disorder

Although deficits in facial affect processing have been reported in schizophrenia as well as in borderline personality disorder (BPD), these disorders have not yet been directly compared on facial affect labeling. Using degraded stimuli portraying neutral, angry, fearful and angry facial expressions, we hypothesized more errors in labeling negative facial expressions in patients with schizophrenia compared to healthy controls. Patients with BPD were expected to have difficulty in labeling neutral expressions and to display a bias towards a negative attribution when wrongly labeling neutral faces. Patients with schizophrenia (N = 57) and patients with BPD (N = 30) were compared to patients with somatoform disorder (SoD, a psychiatric control group; N = 25) and healthy control participants (N = 41) on facial affect labeling accuracy and type of misattributions. Patients with schizophrenia showed deficits in labeling angry and fearful expressions compared to the healthy control group and patients with BPD showed deficits in labeling neutral expressions compared to the healthy control group. Schizophrenia and BPD patients did not differ significantly from each other when labeling any of the facial expressions. Compared to SoD patients, schizophrenia patients showed deficits on fearful expressions, but BPD did not significantly differ from SoD patients on any of the facial expressions. With respect to the type of misattributions, BPD patients mistook neutral expressions more often for fearful expressions compared to schizophrenia patients and healthy controls, and less often for happy compared to schizophrenia patients. These findings suggest that although schizophrenia and BPD patients demonstrate different as well as similar facial affect labeling deficits, BPD may be associated with a tendency to detect negative affect in neutral expressions.

Colour influences perception of facial emotions but this effect is impaired in healthy ageing and schizophrenia

INTRODUCTION

Social cognition is commonly assessed by identification of emotions in facial expressions. Presence of colour, a salient feature of stimuli, might influence emotional face perception.

METHODS

We administered 2 tests of facial emotion recognition, the Emotion Recognition Test (ER40) using colour pictures and the Penn Emotional Acuity Test using monochromatic pictures, to 37 young healthy, 39 old healthy and 37 schizophrenic men.

RESULTS

Among young healthy individuals recognition of emotions was more accurate and faster in colour than in monochromatic pictures. Compared to the younger group, older healthy individuals revealed impairment in identification of sad expressions in colour but not monochromatic pictures. Schizophrenia patients showed greater impairment in colour than monochromatic pictures of neutral and sad expressions and overall total score compared to both healthy groups. Patients showed significant correlations between cognitive impairment and perception of emotion in colour but not monochromatic pictures.

CONCLUSIONS

Colour enhances perception of general emotional clues and this contextual effect is impaired in healthy ageing and schizophrenia. The effects of colour need to be considered in interpreting and comparing studies of emotion perception. Coloured face stimuli may be more sensitive to emotion processing impairments but less selective for emotion-specific information than monochromatic stimuli. This may impact on their utility in early detection of impairments and investigations of underlying mechanisms.

Efficacy of identifying neural components in the face and emotion processing system in schizophrenia using a dynamic functional localizer

Schizophrenia is associated with deficits in face perception and emotion recognition. Despite consistent behavioural results, the neural mechanisms underlying these cognitive abilities have been difficult to isolate, in part due to differences in neuroimaging methods used between studies for identifying regions in the face processing system. Given this problem, we aimed to validate a recently developed fMRI-based dynamic functional localizer task for use in studies of psychiatric populations and specifically schizophrenia. Previously, this functional localizer successfully identified each of the core face processing regions (i.e. fusiform face area, occipital face area, superior temporal sulcus), and regions within an extended system (e.g. amygdala) in healthy individuals. In this study, we tested the functional localizer success rate in 27 schizophrenia patients and in 24 community controls. Overall, the core face processing regions were localized equally between both the schizophrenia and control group. Additionally, the amygdala, a candidate brain region from the extended system, was identified in nearly half the participants from both groups. These results indicate the effectiveness of a dynamic functional localizer at identifying regions of interest associated with face perception and emotion recognition in schizophrenia. The use of dynamic functional localizers may help standardize the investigation of the facial and emotion processing system in this and other clinical populations.

Intact implicit processing of facial threat cues in schizophrenia

An emerging body of research suggests that people with schizophrenia retain the ability to implicitly perceive facial affect, despite well-documented difficulty explicitly identifying emotional expressions. It remains unclear, however, whether such functional implicit processing extends beyond emotion to other socially relevant facial cues. Here, we constructed two novel versions of the Affect Misattribution Procedure, a paradigm in which affective responses to primes are projected onto neutral targets. The first version included three face primes previously validated to elicit varying inferences of threat from healthy individuals via emotion-independent structural modification (e.g., nose and eye size). The second version included the threat-relevant emotional primes of angry, neutral, and happy faces. Data from 126 participants with schizophrenia and 84 healthy controls revealed that although performing more poorly on an assessment of explicit emotion recognition, patients showed normative implicit threat processing for both non-emotional and emotional facial cues. Collectively, these results support recent hypotheses postulating that the initial perception of salient facial information remains intact in schizophrenia, but that deficits arise at subsequent stages of contextual integration and appraisal. Such a breakdown in the stream of face processing has important implications for mechanistic models of social cognitive impairment in schizophrenia and treatment strategies aiming to improve functional outcome.

Precentral and inferior prefrontal hypoactivation during facial emotion recognition in patients with schizophrenia: A functional near-infrared spectroscopy study

Although patients with schizophrenia demonstrate abnormal processing of emotional face recognition, the neural substrates underlying this process remain unclear. We previously showed abnormal fronto-temporal function during facial expression of emotions, and cognitive inhibition in patients with schizophrenia using functional near-infrared spectroscopy (fNIRS). The aim of the current study was to use fNIRS to identify which brain regions involved in recognizing emotional faces are impaired in patients with schizophrenia, and to determine the neural substrates underlying the response to emotional facial expressions per se, and to facial expressions with cognitive inhibition. We recruited 19 patients with schizophrenia and 19 healthy controls, statistically matched on age, sex, and premorbid IQ. Brain function was measured by fNIRS during emotional face assessment and face identification tasks. Patients with schizophrenia showed lower activation of the right precentral and inferior frontal areas during the emotional face task compared to controls. Further, patients with schizophrenia were slower and less accurate in completing tasks compared to healthy participants. Decreasing performance was associated with increasing severity of the disease. Our present and prior studies suggest that the impaired behavioral performance in schizophrenia is associated with different mechanisms for processing emotional facial expressions versus facial expressions combined with cognitive inhibition.

Auditory processing deficits in bipolar disorder with and without a history of psychotic features

OBJECTIVES

Auditory perception deficits have been identified in schizophrenia (SZ) and linked to dysfunction in the auditory cortex. Given that psychotic symptoms, including auditory hallucinations, are also seen in bipolar disorder (BD), it may be that individuals with BD who also exhibit psychotic symptoms demonstrate a similar impairment in auditory perception.

METHODS

Fifty individuals with SZ, 30 individuals with bipolar I disorder with a history of psychosis (BD+), 28 individuals with bipolar I disorder with no history of psychotic features (BD-), and 29 normal controls (NC) were administered a tone discrimination task and an emotion recognition task.

RESULTS

Mixed-model analyses of covariance with planned comparisons indicated that individuals with BD+ performed at a level that was intermediate between those with BD- and those with SZ on the more difficult condition of the tone discrimination task and on the auditory condition of the emotion recognition task. There were no differences between the BD+ and BD- groups on the visual or auditory-visual affect recognition conditions. Regression analyses indicated that performance on the tone discrimination task predicted performance on all conditions of the emotion recognition task. Auditory hallucinations in BD+ were not related to performance on either task.

CONCLUSIONS

Our findings suggested that, although deficits in frequency discrimination and emotion recognition are more severe in SZ, these impairments extend to BD+. Although our results did not support the idea that auditory hallucinations may be related to these deficits, they indicated that basic auditory deficits may be a marker for psychosis, regardless of SZ or BD diagnosis.

Facial, vocal and cross-modal emotion processing in early-onset schizophrenia spectrum disorders

Recognition of emotional expressions plays an essential role in children's healthy development. Anomalies in these skills may result in empathy deficits, social interaction difficulties and premorbid emotional problems in children and adolescents with schizophrenia. Twenty-six subjects with early onset schizophrenia spectrum (EOSS) disorders and twenty-eight matched healthy controls (HC) were instructed to identify five basic emotions and a neutral expression. The assessment entailed presenting visual, auditory and congruent cross-modal stimuli. Using a generalized linear mixed model, we found no significant association for handedness, age or gender. However, significant associations emerged for emotion type, perception modality, and group. EOSS patients performed worse than HC in uni- and cross-modal emotional tasks with a specific negative emotion processing impairment pattern. There was no relationship between emotion identification scores and positive or negative symptoms, self-reported empathy traits or a positive history of developmental disorders. However, we found a significant association between emotional identification scores and nonverbal communication impairments. We conclude that cumulative dysfunctions in both nonverbal communication and emotion processing contribute to the social vulnerability and morbidity found in youths who display EOSS disorder.

Functional activation abnormalities during facial emotion perception in schizophrenia patients and nonpsychotic relatives

BACKGROUND

Deficits in facial emotion perception in schizophrenia may be a marker of disorder liability. Previous functional magnetic resonance imaging (fMRI) studies investigating these deficits have been limited by task demands that may recruit other impaired cognitive processes in schizophrenia.

METHODS

We used a family study design along with a passive viewing task during fMRI to investigate brain activation abnormalities underlying facial emotion perception in schizophrenia and examine whether such abnormalities are associated with the genetic liability to the disorder. Twenty-eight schizophrenia patients, 27 nonpsychotic relatives, and 27 community controls passively viewed images of facial emotions during an fMRI scan.

RESULTS

Analyses revealed hypoactivation in face processing areas for both patients and relatives compared to controls, and hyperactivation in relatives compared to both patients and controls for frontal regions implicated in emotion processing.

CONCLUSIONS

Results suggest that activation abnormalities during facial emotion perception are manifestations of the genetic liability to schizophrenia, and may be accompanied by compensatory mechanisms in relatives. Studying mechanisms in nonpsychotic relatives is a valuable way to examine effects of the unexpressed genetic liability to schizophrenia on the brain and behaviour.

Impairments in Negative Facial Emotion Recognition in Chinese Schizophrenia Patients Detected With a Newly Designed Task

Facial emotion recognition has been found to be impaired in schizophrenia, although overall results have been inconclusive. A new set of facial emotion stimuli with Chinese faces was developed, using static and dynamic avatars, the identification of which were subsequently validated in 562 healthy control subjects. This test was then used to identify facial emotion recognition accuracy in 44 patients with schizophrenia and 41 healthy controls. Overall, patients identified facial emotions significantly worse than healthy controls (p = 0.018) with a significant main effect for type of emotion (p = 0.016). Patients performed significantly worse in fear (p = 0.029) and sadness (p = 0.037), and marginally worse in anger (p = 0.052). No significant differences were evident in contempt (p = 0.254) or happiness (p = 0.943). Regarding error rates of misattribution, patients overidentified contempt (p = 0.035) and sadness (p = 0.01), but not anger, fear, or happiness. Conclusion, patients of Chinese ethnicity with schizophrenia may have significantly greater difficulties identifying negative, but not positive emotions.

Hostile attributions in bipolar disorder and schizophrenia contribute to poor social functioning

OBJECTIVE

To compare the profile of attributional style of a group of out-patients with bipolar disorder (BD) and schizophrenia (SZ), and a group of healthy controls - along with other social cognition domains - such as emotion recognition and theory of mind (ToM).

METHOD

A total of 46 out-patients diagnosed with BD, 49 with SZ, and 50 healthy controls were assessed in attributional style (Ambiguous Intentions Hostility Questionnaire), facial emotion recognition (FEIT, FEDT, ER-40), and ToM (Hinting Task). Symptomatology, clinical variables and global functioning were also collected.

RESULTS

Both groups with SZ and BD showed hostile social cognitive biases, compared with the control group. Patients with BD also showed a capacity for emotional recognition similar to those with SZ and worse than control subjects. In contrast, patients with SZ showed poorer ToM. Subthreshold depressive symptoms and an attributional style toward hostility appeared as the factors with a strongest association to global functioning in BD. In SZ, PANSS score and a tendency to aggressiveness were the most relevant factors.

CONCLUSION

Attributional style (along with other domains of social cognition) is altered in out-patients with BD and SZ. The presence of residual symptoms and a hostile social cognitive bias may contribute to the functional impairment of both groups.

Emotion recognition in frontotemporal dementia and Alzheimer's disease: A new film-based assessment

Deficits in recognizing others' emotions are reported in many psychiatric and neurological disorders, including autism, schizophrenia, behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD). Most previous emotion recognition studies have required participants to identify emotional expressions in photographs. This type of assessment differs from real-world emotion recognition in important ways: Images are static rather than dynamic, include only 1 modality of emotional information (i.e., visual information), and are presented absent a social context. Additionally, existing emotion recognition batteries typically include multiple negative emotions, but only 1 positive emotion (i.e., happiness) and no self-conscious emotions (e.g., embarrassment). We present initial results using a new task for assessing emotion recognition that was developed to address these limitations. In this task, respondents view a series of short film clips and are asked to identify the main characters' emotions. The task assesses multiple negative, positive, and self-conscious emotions based on information that is multimodal, dynamic, and socially embedded. We evaluate this approach in a sample of patients with bvFTD, AD, and normal controls. Results indicate that patients with bvFTD have emotion recognition deficits in all 3 categories of emotion compared to the other groups. These deficits were especially pronounced for negative and self-conscious emotions. Emotion recognition in this sample of patients with AD was indistinguishable from controls. These findings underscore the utility of this approach to assessing emotion recognition and suggest that previous findings that recognition of positive emotion was preserved in dementia patients may have resulted from the limited sampling of positive emotion in traditional tests.

Sensibilidad en el Reconocimiento de Emociones Faciales Como Endofenotipo de Esquizofrenia

<p class="MsoNormal" style="line-height: 200%;">Los endofenotipos son rasgos presentes antes de la aparición de un trastorno y podrían ser útiles para identificar genes de susceptibilidad. Se determinó si personas con esquizofrenia y sus familiares de primer grado no afectados tenían un desempeño menor que los controles en la Tarea de Multitransformación de Expresión Emocional, que mide reconocimiento de emociones faciales. Las personas con esquizofrenia y sus familiares mostraron menor sensibilidad o requirieron más intensidad para identificar emociones que los controles. La exactitud para identificar emociones fue similar entre familiares y controles, pero menor en aquellos con esquizofrenia. Esto sugiere que la sensibilidad para el reconocimiento de emociones faciales es un endofenotipo de la esquizofrenia.</p>