Are there differential deficits in facial emotion recognition between paranoid and non-paranoid schizophrenia? A signal detection analysis

Effects of an Audiovisual Emotion Perception Training for Schizophrenia: A Preliminary Study

Individuals with schizophrenia show a reduced ability to integrate facial and vocal information in emotion perception. Although emotion perception has been a target for treatment, no study has yet examined the effect of multimodal training on emotion perception in schizophrenia. In the present study, we developed an audiovisual emotion perception training and test in which a voice and a face were simultaneously presented, and subjects were asked to judge whether the emotions of the voice and the face matched. The voices were either angry or happy, and the faces were morphed on a continuum ranging from angry to happy. Sixteen patients with schizophrenia participated in six training sessions and three test sessions (i.e., pre-training, post-training, and generalization). Eighteen healthy controls participated only in pre-training test session. Prior to training, the patients with schizophrenia performed significantly worse than did the controls in the recognition of anger; however, following the training, the patients showed a significant improvement in recognizing anger, which was maintained and generalized to a new set of stimuli. The patients also improved the recognition of happiness following the training, but this effect was not maintained or generalized. These results provide preliminary evidence that a multimodal, audiovisual training may yield improvements in anger perception for patients with schizophrenia.

Multisensory Integration of Emotion in Schizophrenic Patients

Multisensory integration (MSI) of emotion has been increasingly recognized as an essential element of schizophrenic patients' impairments, leading to the breakdown of their interpersonal functioning. The present review provides an updated synopsis of schizophrenics' MSI abilities in emotion processing by examining relevant behavioral and neurological research. Existing behavioral studies have adopted well-established experimental paradigms to investigate how participants understand multisensory emotion stimuli, and interpret their reciprocal interactions. Yet it remains controversial with regard to congruence-induced facilitation effects, modality dominance effects, and generalized vs specific impairment hypotheses. Such inconsistencies are likely due to differences and variations in experimental manipulations, participants' clinical symptomatology, and cognitive abilities. Recent electrophysiological and neuroimaging research has revealed aberrant indices in event-related potential (ERP) and brain activation patterns, further suggesting impaired temporal processing and dysfunctional brain regions, connectivity and circuities at different stages of MSI in emotion processing. The limitations of existing studies and implications for future MSI work are discussed in light of research designs and techniques, study samples and stimuli, and clinical applications.

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.

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.

Improving working memory in schizophrenia: Effects of 1 mA and 2 mA transcranial direct current stimulation to the left DLPFC

Deficits in various cognitive processes, such as working memory, are characteristic for schizophrenia, lowering patients' functioning and quality of life. Recent research suggests that transcranial direct stimulation (tDCS) applied to the dorsolateral prefrontal cortex (DLPFC) may be a potential therapeutic intervention for cognitive deficits in schizophrenia. Here, we examined the effects of online tDCS to the DLPFC on working memory (WM) performance in 40 schizophrenia patients in two separate experiments with a double blind, sham-controlled, cross-over design. Patients underwent single sessions of active and sham tDCS in a randomized order. Stimulation parameters were anode F3, cathode right deltoid muscle, 21 min tDCS duration, 1 mA tDCS in Experiment 1 (N = 20) and 2 mA tDCS in Experiment 2 (N = 20). Primary outcome was the change in WM performance as measured by a verbal n-back paradigm (1- to 3-back). Irrespective of the stimulation intensity, data analysis showed a significant higher WM accuracy during active tDCS than during sham tDCS (p = 0.019), but no main effect of stimulation intensity (p = 0.392). Subsequent separate analyses revealed a significantly improved WM performance only during 1 mA (p = 0.048). TDCS facilitated WM functioning in schizophrenia, with an advantage of 1 mA over 2 mA. Our results support the notion that tDCS may be a potential treatment for cognitive deficits in schizophrenia and emphasize the need for future research on the specific stimulation parameters.

Scanning to conclusions? Visual attention to neutral faces under stress in individuals with and without subclinical paranoia

BACKGROUND AND OBJECTIVES

A promising candidate for a vulnerability indicator for psychosis is the restricted scanpath. Restricted scanning of social stimuli, such as faces, might also contribute to misinterpretations of facial expressions and thus increase the likelihood of delusional interpretations. Moreover, similar to other vulnerability indicators of psychosis, scanpaths may be susceptible to stress. Thus, we hypothesized that scanpath restriction would increase as a function of delusion-proneness, stress and their interaction.

METHODS

Participants were asked to look at neutral faces and rate their trustworthiness under a stress and a non-stress condition, while the eye gaze was recorded. The non-clinical sample was classified into low- and high-paranoia scorers using a median split. Eye-tracking parameters of interest were number of fixations, fixations within emotion-relevant facial areas, scanpath length and duration of fixations.

RESULTS

In general, high-paranoia scorers had a significantly shorter scanpath compared to low-paranoia scorers (F(1, 48) = 2.831, p = 0.05, η_p² = 0.056) and there was a trend towards a further decrease of scanpath length under stress in high-paranoia scorers relative to low-paranoia scorers (interaction effect: F(1, 48) = 2.638, p = 0.056, η_p² = 0.052). However, no effects were found for the other eye-tracking parameters. Moreover, trustworthiness ratings remained unaffected by group or condition.

LIMITATIONS

The participants of this study had only slight elevations of delusion-proneness, which might explain the absence of differences in trustworthiness ratings.

CONCLUSIONS

Restricted scanpaths appear to be partly present in individuals with subclinical levels of paranoia and appear to be susceptible to stress in this group. Nevertheless, further research in high-risk groups is necessary before drawing more definite conclusions.

The relationship between childhood trauma, emotion recognition, and irritability in schizophrenia patients

This study investigated the relationship between childhood trauma, irritability, and emotion recognition, in schizophrenia patients during a psychotic break. Thirty-six schizophrenia inpatients and 36 healthy controls were assessed with the Irritability Questionnaire (IRQ) and two facial emotion recognition tasks, the Emotion Discrimination Test (EDT) and Emotion Identification Test (EIT). Patients were further assessed with the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II), the Positive and Negative Symptom Scale (PANSS), and the Childhood Trauma Questionnaire-28 (CTQ-28). EDT and EIT performance was significantly impaired in patients compared to healthy controls. Furthermore, patients tended to misidentify sad, surprised, or angry faces as showing fear, and this misidentification correlated with the patients' irritability. Childhood adversity increased irritability both directly and indirectly through emotion misidentification.

The relationship between facial emotion recognition and executive functions in first-episode patients with schizophrenia and their siblings

BACKGROUND

Although many studies have examined executive functions and facial emotion recognition in people with schizophrenia, few of them focused on the correlation between them. Furthermore, their relationship in the siblings of patients also remains unclear. The aim of the present study is to examine the correlation between executive functions and facial emotion recognition in patients with first-episode schizophrenia and their siblings.

METHODS

Thirty patients with first-episode schizophrenia, their twenty-six siblings, and thirty healthy controls were enrolled. They completed facial emotion recognition tasks using the Ekman Standard Faces Database, and executive functioning was measured by Wisconsin Card Sorting Test (WCST). Hierarchical regression analysis was applied to assess the correlation between executive functions and facial emotion recognition.

RESULTS

Our study found that in siblings, the accuracy in recognizing low degree 'disgust' emotion was negatively correlated with the total correct rate in WCST (r = -0.614, p = 0.023), but was positively correlated with the total error in WCST (r = 0.623, p = 0.020); the accuracy in recognizing 'neutral' emotion was positively correlated with the total error rate in WCST (r = 0.683, p = 0.014) while negatively correlated with the total correct rate in WCST (r = -0.677, p = 0.017). People with schizophrenia showed an impairment in facial emotion recognition when identifying moderate 'happy' facial emotion, the accuracy of which was significantly correlated with the number of completed categories of WCST (R(2) = 0.432, P < .05). There were no correlations between executive functions and facial emotion recognition in the healthy control group.

CONCLUSIONS

Our study demonstrated that facial emotion recognition impairment correlated with executive function impairment in people with schizophrenia and their unaffected siblings but not in healthy controls.

Emotional processing in Parkinson's disease and schizophrenia: evidence for response bias deficits in PD

Deficits in facial emotion recognition in Parkinson's disease (PD) patients has been well documented. Nevertheless, it is still not clear whether facial emotion recognition deficits are secondary to other cognitive impairments. The aim of this study was to answer the question of whether deficits in facial emotion recognition in PD result from impaired sensory processes, or from impaired decision processes. To address this question, we tested the ability to recognize a mixture of basic and complex emotions in 38 non-demented PD patients and 38 healthy controls matched on demographic characteristics. By using a task with an increased level of ambiguity, in conjunction with the signal detection theory, we were able to differentiate between sensitivity and response bias in facial emotion recognition. Sensitivity and response bias for facial emotion recognition were calculated using a d-prime value and a c index respectively. Our study is the first to employ the EIS-F scale for assessing facial emotion recognition among PD patients; to test its validity as an assessment tool, a group comprising schizophrenia patients and healthy controls were also tested. Patients with PD recognized emotions with less accuracy than healthy individuals (d-prime) and used a more liberal response criterion (c index). By contrast, patients with schizophrenia merely showed diminished sensitivity (d-prime). Our results suggest that an impaired ability to recognize facial emotions in PD patients may result from both decreased sensitivity and a significantly more liberal response criteria, whereas facial emotion recognition in schizophrenia may stem from a generalized sensory impairment only.

No evidence for mirror system dysfunction in schizophrenia from a multimodal TMS/EEG study

Dysfunctional mirror neuron systems have been proposed to contribute to the social cognitive deficits observed in schizophrenia. A few studies have explored mirror systems in schizophrenia using various techniques such as TMS (levels of motor resonance) or EEG (levels of mu suppression), with mixed results. This study aimed to use a novel multimodal approach (i.e. concurrent TMS and EEG) to further investigate mirror systems and social cognition in schizophrenia. Nineteen individuals with schizophrenia or schizoaffective disorder and 19 healthy controls participated. Single-pulse TMS was applied to M1 during the observation of hand movements designed to elicit mirror system activity. Single EEG electrodes (C3, CZ, C4) recorded brain activity. Participants also completed facial affect recognition and theory of mind tasks. The schizophrenia group showed significant deficits in facial affect recognition and higher level theory of mind compared to healthy controls. A significant positive relationship was revealed between mu suppression and motor resonance for the overall sample, indicating concurrent validity of these measures. Levels of mu suppression and motor resonance were not significantly different between groups. These findings indicate that in stable outpatients with schizophrenia, mirror system functioning is intact, and therefore their social cognitive difficulties may be caused by alternative pathophysiology.

Emotion processing in schizophrenia is state and trait dependent

BACKGROUND

Substantial evidence exists about emotion processing (EP) impairments in schizophrenia patients. However, whether these deficits are present primarily during psychosis (i.e., state dependent) or an integral part of the disorder (i.e., trait dependent) remains unclear.

METHODS

EP was assessed with the degraded facial affect recognition task in schizophrenia patients (N=521) and healthy controls (N=312) at baseline (T1) and after a three year follow-up (T2). In schizophrenia patients symptomatic remission was assessed with the Positive and Negative Syndrome Scale (PANSS) remission tool. Patients were divided into four groups: remission T1 and remission T2 (RR); remission T1 and non-remission T2 (RN); non-remission T1 and non-remission T2 (NN) and non-remission T1 and remission T2 (NR). Factorial repeated measures ANCOVA was used to compare EP performance over time between groups. Age, gender and general cognition were included as covariates.

RESULTS

Schizophrenia patients performed worse than healthy controls on EP at T1 (p=0.001). The patients that were in symptomatic remission at both time points (the RR group) performed worse than the healthy controls at T2 (p<0.001). Significant group×time interactions were found between RR and RN (p=0.001), and between NR and RN (p=0.04), indicating a differential EP performance over time. No group×time interaction was found between NN and NR.

CONCLUSION

The results show relatively poor EP performance in schizophrenia patients compared to healthy controls. EP performance in schizophrenia patients was associated with symptomatic remission. The results provide support for the hypothesis that EP deficits in schizophrenia are both state and trait dependent.

Interpretation biases in paranoia

Information in the environment is frequently ambiguous in meaning. Emotional ambiguity, such as the stare of a stranger, or the scream of a child, encompasses possible good or bad emotional consequences. Those with elevated vulnerability to affective disorders tend to interpret such material more negatively than those without, a phenomenon known as "negative interpretation bias." In this study we examined the relationship between vulnerability to psychosis, measured by trait paranoia, and interpretation bias. One set of material permitted broadly positive/negative (valenced) interpretations, while another allowed more or less paranoid interpretations, allowing us to also investigate the content specificity of interpretation biases associated with paranoia. Regression analyses (n=70) revealed that trait paranoia, trait anxiety, and cognitive inflexibility predicted paranoid interpretation bias, whereas trait anxiety and cognitive inflexibility predicted negative interpretation bias. In a group comparison those with high levels of trait paranoia were negatively biased in their interpretations of ambiguous information relative to those with low trait paranoia, and this effect was most pronounced for material directly related to paranoid concerns. Together these data suggest that a negative interpretation bias occurs in those with elevated vulnerability to paranoia, and that this bias may be strongest for material matching paranoid beliefs. We conclude that content-specific biases may be important in the cause and maintenance of paranoid symptoms.