Schizophrenia and processing of facial emotions: sex matters

Face and emotion recognition in individuals diagnosed with schizophrenia, ultra-high risk for psychosis, unaffected siblings, and healthy controls in a sample from Turkey

Face and emotion recognition are crucial components of social cognition. We aimed to compare them in patients diagnosed with schizophrenia (SCZ), ultra-high risk for psychosis (UHR), unaffected siblings of schizophrenia patients (SIB), and healthy controls (HC).

METHODS

One hundred sixty-six participants (45 SCZ, 14 UHR, 45 SIB, and 62 HC) were interviewed with the Structured Clinical Interview for DSM-5 (SCID-5). Positive and Negative syndrome scale (PANSS), PennCNB Facial Memory (CPF), and Emotion Recognition Task (ER40) were applied.

RESULTS

In CPF, SCZ performed significantly lower than SIB and HC. SIB was also significantly lower than HC for total correct responses. The sample size of the UHR group was small, and the statistical comparisons did not reach a significance, however, a trend towards decreased performance between the SCZ and SIB was found. In ER40, SCZ performed significantly lower than HC and SIB in all domains, except for the insignificant findings for angry ER between SIB and SCZ. SIB also performed significantly lower than HC for angry, negative, and total ER. UHR was similar to SCZ for happy and sad ER and performed significantly lower than HC for happy ER. The effect of SCZ diagnosis on the efficiency of CPF and ER40 was significant when corrected for age and education. For SCZ, PANSS also significantly affected the CPF and ER40.

CONCLUSION

Our findings suggest varying levels of face and emotion recognition deficits in individuals with SCZ, UHR, and SIB. Face and emotion recognition deficits are promising schizophrenia endophenotypes related to social cognition.

Designing a neuroclinical assessment of empathy deficits in psychopathy based on the Zipper Model of Empathy

Ho, M.H., Kemp, B.T., Eisenbarth, H. & Rijnders, R.J.P. Designing a neuroclinical assessment of empathy deficits in psychopathy based on the Zipper Model of Empathy. NEUROSCI BIOBEHAV REV YY(Y) XXX-XXX, 2023. The heterogeneity of the literature on empathy highlights its multidimensional and dynamic nature and affects unclear descriptions of empathy in the context of psychopathology. The Zipper Model of Empathy integrates current theories of empathy and proposes that empathy maturity is dependent on whether contextual and personal factors push affective and cognitive processes together or apart. This concept paper therefore proposes a comprehensive battery of physiological and behavioral measures to empirically assess empathy processing according to this model with an application for psychopathic personality. We propose using the following measures to assess each component of this model: (1) facial electromyography; (2) the Emotion Recognition Task; (3) the Empathy Accuracy task and physiological measures (e.g., heart rate); (4) a selection of Theory of Mind tasks and an adapted Dot Perspective Task, and; (5) an adjusted Charity Task. Ultimately, we hope this paper serves as a starting point for discussion and debate on defining and assessing empathy processing, to encourage research to falsify and update this model to improve our understanding of empathy.

Impaired emotion perception in schizophrenia shows sex differences with channel- and category-specific effects: A pilot study

Individuals with schizophrenia reportedly demonstrate deficits in emotion perception. Relevant studies on the effects of decoder's sex, communication channels and emotion categories have produced mixed findings and seldom explored the interactions among these three key factors. The present pilot study examined how male and female individuals with schizophrenia and healthy controls perceived emotional (e.g., angry, happy, and sad) and neutral expressions from verbal semantic and nonverbal prosodic and facial channels. Twenty-eight (11 females) individuals with schizophrenia and 30 healthy controls (13 females) were asked to recognize emotional facial expressions, emotional prosody, and emotional semantics. Both accuracy and response time showed subpar performance for all communication channels and emotional categories in the schizophrenia group. More severe emotion perception deficits were found with the nonverbal (not the verbal) materials. There was also a reduced level of impairment with anger perception, especially in the female individuals with schizophrenia while biased perception towards emotional semantics was more pronounced in male individuals with schizophrenia. These findings, although preliminary, indicate the channel- and category-specific nature of emotion perception with potential sex differences among people with schizophrenia, which has important theoretical and practical implications.

Gender differences in attentive bias during social information processing in schizophrenia: An eye-tracking study

Interpersonal communication is a specific scenario in which patients with psychiatric symptoms may manifest different behavioral patterns due to psychopathology. This was a pilot study by eye-tracking technology to investigate attentive bias during social information processing in schizophrenia. We enrolled 39 patients with schizophrenia from Shanghai Mental Health Center and 42 age-, gender- and education-matched healthy controls. The experiment was a free-viewing task, in which pictures with three types of degree of interpersonal communication were shown. We used two measures: 1) initial fixation duration, 2) total gaze duration. The Positive and Negative Syndrome Scale (PANSS) was used to determine symptom severity. The ratio of first fixation duration for pictures of communicating vs. non-communicating persons was significantly lower in patients than in controls (Mann-Whitney U = 512, p = 0.004). We found that male patients showed a significantly lower ratio of first fixation duration than male controls (Mann-Whitney U = 190, p = 0.028), while it was marginally lower in female patients than female controls (Mann-Whitney U = 77, p = 0.057). The ratio of first fixation duration for pictures of communicating persons vs. no persons was negatively correlated with PANSS negative symptoms in male patients (rho = -0.458, p = 0.024). In contrast, it was negatively correlated with PANSS positive symptoms in female patients (-0.701, p = 0.004). These findings suggest altered attentive bias during social information processing with a pattern of avoidance at first sight towards pictures of communicating persons in schizophrenia. It is worthwhile to note that social functioning impairment is associated with the severity of symptoms.

Negative symptoms in schizophrenia, assessed by the brief negative symptom scale, self-evaluation of negative symptom scale, and social cognition: a gender effect

OBJECTIVE

Negative symptoms of schizophrenia can be related to social cognition. The aim was to measure a relationship between the results on the new scales for the assessment of negative symptoms such as the Brief Negative Symptom Scale (BNSS) and Self-evaluation of Negative Symptoms (SNS), and the measures of social cognition.

METHODS

The study included 80 patients (40 men, 40 women) with schizophrenia, aged 19-63 (mean 38 years), during the improvement period. They were assessed using the BNSS, SNS, Personal and Social Performance (PSP) scales, and the tests for social cognition such as the Facial Emotion Identification Test, Reading the Mind in Eyes Test, Strange Stories and Faux Pas Test.

RESULTS

Male patients obtained higher scores than females when assessed by the BNSS. No gender differences were observed for the SNS scale. Female patients scored better in the PSP and both parts of the Faux Pas test and obtained a significant correlation between the results of the SNS scale, BNSS, PSP, and the affective part of the Faux-Pas test what was not the case in males.

CONCLUSIONS

Gender differences were found in the assessment of negative symptoms by a clinical scale and the relationship between negative symptoms and social cognition.KEY POINTSFemale patients scored better in the BNSS, PSP and both parts of the Faux-Pas testGender differences were present in the assessment of negative symptoms by clinical (BNSS) but not the self-assessment (SNS) scale.Female patients obtained a significant correlation between the results of the SNS scale, BNSS, PSP, and the affective part of the Faux-Pas test what was not the case in male subjects.

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

BACKGROUND

Impairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences.

METHODS

120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions.

RESULTS

Both groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief.

LIMITATIONS

The cross-sectional design does not allow for causal inferences.

CONCLUSION

BD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.

Social cognition and its relationship with sociodemographic, clinical, and psychosocial variables in first-episode psychosis

People with first episode of psychosis (FEP) show deficits in social cognition, which have been linked to several sociodemographic, clinical, and psychosocial variables. The aim of the present research was to study social cognition as a whole measure in people with FEP comparing it with a healthy control sample, to study gender differences, and to examine the relationship between sociodemographic, clinical, and psychosocial variables and social cognition in the onset of psychosis. A descriptive, cross-sectional study was performed. The study sample consisted of 63 people (18 females; 45 males) with a diagnosis of FEP and a healthy control group (78 participants: 38 females; 40 males). All the participants were assessed with the social cognitive domain of the MATRICS Consensus Cognitive Battery (MCCB) and several questionnaires related to studied variables. Our results indicated that compared with healthy controls, people with FEP showed social cognition deficits. Furthermore, premorbid IQ was the most relevant variable in social cognition performance in FEP sample. The findings of the present research may be taken into account in clinical practice to improve the intervention with people with FEP.

Face perception predicts affective theory of mind in autism spectrum disorder but not schizophrenia or typical development

Autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SCZ) have overlapping symptomatology related to difficulties with social cognition. Yet, few studies have directly compared social cognition in ASD, SCZ, and typical development (TD). The current study examined individual differences in face recognition and its relation to affective theory of mind (ToM) in each diagnostic group. Adults with ASD (n = 31), SCZ (n = 43), and TD (n = 47) between the ages of 18 and 48 years-old with full scale IQ above 80 participated in this study. The Reading the Mind in the Eyes Test (RMET) measured affective ToM, and the Benton Facial Recognition Test (BFRT) measured face perception. Adults with ASD and SCZ did not differ in their affective ToM abilities, and both groups showed affective ToM difficulties compared with TD. However, better face recognition ability uniquely predicted better affective ToM ability in ASD. Results suggest that affective ToM difficulties may relate to face processing in ASD but not SCZ. By clarifying the complex nature of individual differences in affective ToM and face recognition difficulties in these disorders, the present study suggests there may be divergent mechanisms underlying pathways to social dysfunction in ASD compared with SCZ. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Gender Role, But Not Sex, Shapes Humans' Susceptibility to Emotion

It is unknown whether the famous sex-related difference in emotion processing is accounted for by biological sex, gender role, or their interaction. To clarify the issue, in Study 1 we recorded event-related potentials in response to negative and positive images of diverse intensities when 47 masculine (26 males) and 47 feminine (22 males) subjects performed a non-emotional task. The occipital P1 and N1 amplitudes were larger in women than in men, while feminine subjects showed larger N1 amplitudes than masculine subjects, regardless of sex. Moreover, feminine subjects showed enhanced frontocentral N2 (210-270 ms) amplitudes for highly and mildly negative than for neutral stimuli, while masculine subjects showed an emotion effect only for highly negative stimuli. The feminine-specific effect for mildly negative stimuli was positively correlated to the feminine score, and this correlation was located to the anterior cingulate and the superior and medial frontal gyri. Furthermore, feminine but not masculine subjects showed enhanced parietal P3 (330-560 ms) amplitudes for highly and mildly positive than for neutral stimuli, an effect positively related to the feminine score and localized to the precuneus, posterior cingulate, and superior temporal gyrus. Machine learning analyses verified that single-trial N2 and P3 amplitudes of feminine subjects reliably discriminated the intensity of negative and positive stimuli, respectively. For ecological considerations, in Study 2 we used an observational approach (n = 300) and confirmed that feminine gender role, rather than biological sex, predicted individual differences in daily experience of emotion-related psychopathological symptoms. These findings provide solid evidence for the critical impact of gender role rather than sex on emotional susceptibility.

Multicentric evidence of emotional impairments in hypertensive heart disease

The mechanisms underlying emotional alterations constitute a key research target in neuroscience. Emerging evidence indicates that these disruptions can be related to abnormal interoception (i.e., the sensing of visceral feelings), as observed in patients with cardiodynamic deficits. To directly assess these links, we performed the first multicenter study on emotion recognition and interoception in patients with hypertensive heart disease (HHD). Participants from two countries completed a facial emotion recognition test, and a subsample additionally underwent an interoception protocol based on a validated heartbeat detection task. HHD patients from both countries presented deficits in the recognition of overall and negative emotions. Moreover, interoceptive performance was impaired in the HHD group. In addition, a significant association between interoceptive performance and emotion recognition was observed in the control group, but this relation was abolished in the HHD group. All results survived after covariance with cognitive status measures, suggesting they were not biased by general cognitive deficits in the patients. Taken together, these findings suggest that emotional recognition alterations could represent a sui generis deficit in HHD, and that it may be partially explained by the disruption of mechanisms subserving the integration of neuro-visceral signals.

Face pareidolia in schizophrenia

BACKGROUND

Faces convey valuable daily life social signals. As in most psychiatric conditions, non-verbal social cognition or its components including face processing may be aberrant in schizophrenia (SZ). Social participation of individuals with SZ is vital for their quality of life, and remediation of social abilities in this population is of high relevance both for society and clinical care.

METHOD

Tuning to faces in non-face images such as shadows, grilled toasts, or ink blots is called face pareidolia. Humans possess high sensitivity to facial signals: even fetuses and infants are well tuned to coarse face cues. Here we assessed face tuning in individuals with SZ and person-by-person matched controls by using a new experimental tool, a set of food-plate images bordering on the Giuseppe Arcimboldo style. The key benefit of these images is that single components do not trigger face processing.

RESULTS AND CONCLUSIONS

The outcome indicates that individuals with SZ exhibit aberrant face tuning in face-like non-face images (χ²(1) = 17.44, p = 0.0001) that can hamper adaptive interaction with peers and social participation hindering, in turn, clinical remediation. Face response rate in SZ patients was related to the scores on the event arrangement task tapping social cognition (Pearson product-moment correlation, r = 0.602, p = 0.01) and on picture completion task assessing visual perceptual organization (Spearman's rho = 0.614, p = 0.009). Therefore, poor performance on the face tuning task is unlikely to be accounted for by deviant general cognitive abilities, but rather by impairments in perceptual integration and social cognition. Comparison of these findings with data in autism and other neuropsychiatric conditions provides novel insights on the origins of face tuning in SZ and triggers brain imaging research.

Age and Gender Differences in Emotion Recognition

Background

Existing literature suggests that age affects recognition of affective facial expressions. Eye-tracking studies highlighted that age-related differences in recognition of emotions could be explained by different face exploration patterns due to attentional impairment. Gender also seems to play a role in recognition of emotions. Unfortunately, little is known about the differences in emotion perception abilities across lifespans for men and women, even if females show more ability from infancy.

Objective

The present study aimed to examine the role of age and gender on facial emotion recognition in relation to neuropsychological functions and face exploration strategies. We also aimed to explore the associations between emotion recognition and quality of life.

Methods

60 healthy people were consecutively enrolled in the study and divided into two groups: Younger Adults and Older Adults. Participants were assessed for: emotion recognition, attention abilities, frontal functioning, memory functioning and quality of life satisfaction. During the execution of the emotion recognition test using the Pictures of Facial Affects (PoFA) and a modified version of PoFA (M-PoFA), subject’s eye movements were recorded with an Eye Tracker.

Results

Significant differences between younger and older adults were detected for fear recognition when adjusted for cognitive functioning and eye-gaze fixations characteristics. Adjusted means of fear recognition were significantly higher in the younger group than in the older group. With regard to gender’s effects, old females recognized identical pairs of emotions better than old males. Considering the Satisfaction Profile (SAT-P) we detected negative correlations between some dimensions (Physical functioning, Sleep/feeding/free time) and emotion recognition (i.e., sadness, and disgust).

Conclusion

The current study provided novel insights into the specific mechanisms that may explain differences in emotion recognition, examining how age and gender differences can be outlined by cognitive functioning and face exploration strategies.

Emotion recognition latency, but not accuracy, relates to real life functioning in individuals at ultra-high risk for psychosis

BACKGROUND

Emotion recognition deficits are essential features of psychotic disorders and the ultra-high risk state of psychosis (UHR), that are known to relate to functional outcome. The potential associations between aspects of emotion recognition deficits and functioning are, however, understudied in UHR individuals.

METHOD

Emotion recognition accuracy and latency were assessed in 132 UHR individuals and 60 healthy controls using the CANTAB emotion recognition task along with multiple measures of real life functioning. Multiple regression analyses assessed the potential relations between emotion recognition accuracy, latency, and measures of functioning.

RESULTS

A consistent finding was that emotion recognition latency, but not accuracy, was associated with the four observer-rated measures of functioning (β in the range -1.57 to -16.20), which remained significant on one measure after controlling for neurocognitive processing speed. Neither emotion recognition accuracy, nor latency related to real life functioning in healthy controls.

DISCUSSION

The results suggest that processing speed of social cognitive information is an important correlate to real-life functioning in UHR individuals which may be a relevant target in social cognitive remediation programs for patients at risk for psychosis.

Anticipatory pleasure for future rewards is attenuated in patients with schizophrenia but not in individuals with schizotypal traits

The anhedonia paradox is consistently observed in individuals with schizophrenia. However, the underlying mechanism of the dissociation between trait and state hedonic capacity remains unclear. In the present study, we aimed to re-examine anhedonia in patients with schizophrenia (SCZ) and individuals with high schizotypy (HS) using the Monetary Incentive Delay (MID) task to assess different dimensions of anticipatory and consummatory pleasure. We recruited 44 SCZ patients, 46 matched healthy controls (HC), 30 individuals with HS and 35 with low schizotypy (LS). The modified MID task was used to measure anticipatory and consummatory pleasure in terms of valence and arousal ratings. To measure the predictive value of anticipatory pleasure, participants were asked to predict their hedonic experience before the MID task. For SCZ patients, there was no significant Group main effect or Group × Prize interaction on consummatory pleasantness to reward received or loss avoidance. As expected, SCZ patients (particularly male patients) reported less pleasantness and arousal to future rewards in both the prediction and feeling dimensions compared with HC. Additionally, male patients reported less anticipatory and consummatory negativity than HC. Individuals with HS predicted more arousing experience to high-rewards than LS individuals. They also reported and predicted more negativity to in-the-moment and future monetary losses. Further, the negative dimension of schizotypy predicted low levels of pleasantness and arousal towards future rewards, but the positive dimension predicted increased arousing experience towards future rewards. In conclusion, the anhedonia paradox in schizophrenia could be partially accounted for by the dissociation between anticipatory and consummatory pleasure.

Sex differences in facial emotion recognition in health and psychotic disorders

BACKGROUND

Previous studies examining sex-differences in facial emotion recognition (FER) in psychosis yielded inconsistent results. Although females are considered to be superior in FER in health, it remains unclear whether the specific sex-difference is present in psychosis. We aimed to examine whether women and men differ in FER ability in health and in psychosis, and to explore potential sex differences in the illness' effects on FER.

METHODS

Remitted psychotic patients and controls were assessed using the CANTAB Emotion Recognition Task (ERT) examining accuracies/response latencies in identifying basic emotional expressions. General linear model was performed to assess the effects of group, sex and their interactions on ERT performance.

RESULTS

Healthy females showed FER advantage in comparison to healthy males, while the aforementioned sex-difference was not observed in remitted psychotic patients. Our results also demonstrated the existence of overall FER deficit in psychosis in comparison to healthy controls, as well as the differential illness' effects on the recognition accuracy of facial expression of anger in males and females-suggesting that females with psychotic disorders undergo more profound deterioration of FER ability than their male counterparts.

CONCLUSION

The assessment of sex-differences in FER and other important features of psychosis is important for better understanding of its neurobiological basis and for the development of targeted treatments for improved functioning.

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.

Social cognition and aggression in methamphetamine dependence with and without a history of psychosis

In substance use and psychotic disorders, socially problematic behaviours, such as high aggression may, in part, be explained by deficits in social cognition skills, like the detection of emotions or intentions in others. The aim of this study was to assess the magnitude of social cognition impairment and its association with aggression in individuals with methamphetamine (MA) dependence, methamphetamine-associated psychosis (MAP), and healthy controls (CTRL). A total of 20 MAP participants, 21 MA-dependent participants without psychosis, and 21 CTRL participants performed a facial morphing emotion recognition task (ERT) across four basic emotions (anger, fear, happiness and sadness) and the reading the mind in the eyes task (RMET), and completed the aggression questionnaire. Both MA-dependent groups showed impairment in social cognition in terms of lower RMET scores relative to CTRL participants (MA; p = .047; MAP: p < .001). Additionally, performance decrements were significantly greater in MAP (p = .040), compared to MA-dependent participants. While deficits in recognising emotional expressions were restricted to anger in the MA group (p = .020), a generalized impairment across all four emotions was observed in MAP (all p ≤ .001). Additionally, both patient groups demonstrated higher levels of aggression than CTRLs, yet no association was found with social cognition. This study supported the notion of deficits in recognising facial emotional expressions and inferring mental states of others in MA dependence, with additional impairments in MAP. Failure to detect an association between social cognitive impairment and aggressive behaviour may implicate independent disturbances of the two phenomena in MA dependence.

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.

Facial emotion recognition and alexithymia in Chinese male patients with deficit schizophrenia

Deficit schizophrenia (DS) has been proposed as a pathophysiologically distinct schizophrenia subtype. This study investigated facial emotion recognition deficits and alexithymia in DS and non-deficit schizophrenia patients (NDS) and their relationships with other clinical variables. The Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS), and Scale for the Assessment of Positive Symptoms (SAPS) were employed to evaluate the psychiatric symptoms in patients with schizophrenia. Facial emotion recognition deficits and Alexithymia were assessed in DS, NDS, and control groups by The Chinese Facial Emotion Test (CFET) and the Toronto Alexithymia Scale-20 (TAS-20). Compared with control group, both DS and NDS patients exhibited more severe facial emotion recognition impairments, with the exception of "happy faces" in NDS patients, as well as higher alexithymia scores. In DS patients, correct frequency for fear recognition and total CFET score were negatively correlated with TAS-20 Factor 3 subscore for "externally oriented thinking". Total TAS-20 score was positively correlated with BPRS negative symptom and SANS score in DS patients. In contrast, there were no correlations between TAS-20 scores/subscores and psychiatric symptoms in NDS patients. These findings indicated distinct facial emotion recognition impairments in DS and NDS patients. Alexithymia might be specifically related to the negative symptom in DS patients, suggesting DS as a unique schizophrenic subtype.

Face perception in schizophrenia: a specific deficit

INTRODUCTION

Patients with schizophrenia have a large-scaled and severe cognitive impairment. This study examines whether a well-established deficit in face recognition in schizophrenia is a part of this general cognitive impairment or is specific to faces per se.

METHOD

The differential deficit in matching upright faces as compared with two psychometrically matched control tasks (matching inverted faces and matching none-face objects) was assessed in two well-matched samples of schizophrenics (n = 40) and controls (n = 40).

RESULTS

Indicating a generalised cognitive deficit, schizophrenics were impaired in all tasks. Importantly, however, the deficit in matching upright faces was stronger in magnitude (15.6%) than the deficits in matching inverted faces (10.1%) and non-face objects (10.2%). Consistently, schizophrenics showed weaker face inversion effects, indicating a configural processing dysfunction.

CONCLUSION

These results provide compelling evidence for a face-specific deficit in schizophrenia that may be associated with, but separable from, a generalised cognitive impairment.

Altered resting-state functional connectivity in emotion-processing brain regions in adults who were born very preterm

BACKGROUND

Very preterm birth (VPT; <32 weeks of gestation) has been associated with impairments in emotion regulation, social competence and communicative skills. However, the neuroanatomical mechanisms underlying such impairments have not been systematically studied. Here we investigated the functional integrity of the amygdala connectivity network in relation to the ability to recognize emotions from facial expressions in VPT adults.

METHOD

Thirty-six VPT-born adults and 38 age-matched controls were scanned at rest in a 3-T MRI scanner. Resting-state functional connectivity (rs-fc) was assessed with SPM8. A seed-based analysis focusing on three amygdalar subregions (centro-medial/latero-basal/superficial) was performed. Participants' ability to recognize emotions was assessed using dynamic stimuli of human faces expressing six emotions at different intensities with the Emotion Recognition Task (ERT).

RESULTS

VPT individuals compared to controls showed reduced rs-fc between the superficial subregion of the left amygdala, and the right posterior cingulate cortex (p = 0.017) and the left precuneus (p = 0.002). The VPT group further showed elevated rs-fc between the left superficial amygdala and the superior temporal sulcus (p = 0.008). Performance on the ERT showed that the VPT group was less able than controls to recognize anger at low levels of intensity. Anger scores were significantly associated with rs-fc between the superficial amygdala and the posterior cingulate cortex in controls but not in VPT individuals.

CONCLUSIONS

These findings suggest that alterations in rs-fc between the amygdala, parietal and temporal cortices could represent the mechanism linking VPT birth and deficits in emotion processing.

The role of attention processes in facial affect recognition in schizophrenia

INTRODUCTION

Studies investigating the involvement of attention processes in facial affect recognition (FAR) have been contradictory, with some suggesting a generalised cognitive deficit, whereas others a specialised deficit in affect recognition. Given the ubiquity of both attention and emotion perception deficits in schizophrenia, we examined whether specific attentional processes, in fact, mediate FAR.

METHODS

Patients with schizophrenia (n = 38) and healthy controls (n = 24) performed tests assessing FAR and attention processes, specifically, visual attention (Trail Making Test A), sustained attention/inhibition (Rapid Visual Processing subtest; Cambridge Automated Neuropsychological Test Battery), and attention to details in facial features (AFF). AFF and FAR were assessed with newly devised experimental procedures.

RESULTS

Hierarchical multiple regression analyses showed a similar pattern of association between attention processes and FAR in both participant groups with respect to all attention processes investigated, predicting FAR accuracy. Additionally, visual attention predicted accuracy in happiness, disgust and surprise, whereas AFF predicted accuracy in anger and fear. Regarding FAR processing speed, no attention process predicted participants' performance on correct responses; AFF response speed predicted participants' FAR response speed, but only on incorrect responses.

DISCUSSION

The present findings highlight the role of attentional processes in emotion recognition, as deficits in the former were predictive of impairments in the latter. Furthermore, AFF appears to be involved in the discrimination of negatively valenced facial expressions. The lack of association between attentional processes and FAR processing speed, particularly regarding correct responses, might reflect the differential pattern of activation of cortical and subcortical structures involved in these cognitive processes.

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.

Reading Emotions from Body Movement: A Generalized Impairment in Schizophrenia

Body language reading is a social cognitive process with importance for successful maneuvering of social situations. In this study, we investigated body language reading as assessed with human point-light displays in participants with a diagnosis of schizophrenia (n = 84) compared to healthy control participants (n = 84), aiming to answer three questions: (1) whether persons with a diagnosis of schizophrenia have poorer body language reading abilities than healthy persons; (2) whether some emotions are easier to read from body language than others, and if this is the same for individuals with schizophrenia and healthy individuals, and (3) whether there are sex differences in body language reading in participants with schizophrenia and healthy participants. A fourth research aim concerned associations of body language reading with symptoms and functioning in participants with schizophrenia. Scores on the body language reading measure was first standardized using a separate sample of healthy control participants (n = 101). Further results showed that persons with schizophrenia had impaired body language reading ability compared to healthy persons. A significant effect of emotion indicated that some emotions (happiness, neutral) were easier to recognize and this was so for both individuals with schizophrenia and healthy individuals. There were no sex differences for either diagnostic group. Body language reading ability was not associated with symptoms or functioning. In conclusion; schizophrenia was characterized by a global impairment in body language reading that was present for all emotions and across sex.

Associations between trait anhedonia and emotional memory deficits in females with schizophrenia versus major depression

Individuals with schizophrenia (SZ) and individuals with major depressive disorder (MDD) demonstrate impaired emotional memory and decreased enjoyment of pleasant experiences (e.g., anhedonia). However, it is unclear whether these impairments reflect similar or different processes in the two diagnostic groups. This study compared emotional memory performance in three groups of females - controls, MDD, and SZ. Given that physical and social trait anhedonia has been shown to differentiate course of illness and emotional functioning within each disorder, the present study also examined whether trait anhedonia related to emotional memory differently in the groups. Participants viewed emotional and neutral images and twenty-four hours later completed an incidental recognition test. SZ participants demonstrated a trend for the worst memory performance. Across all groups, high intensity and negative images were remembered most accurately, while groups were not differentially influenced by the valence of the stimuli. Physical anhedonia was predictive of reduced memory for negative stimuli across all diagnostic groups. Group specific findings indicated that higher levels of social anhedonia were predictive of poorer memory, but only in the SZ group. Effects remained significant when controlling for depressive symptoms. Results are considered in light of the differing role of anhedonia in SZ and MDD.

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.

Theory of mind in women with borderline personality disorder or schizophrenia: differences in overall ability and error patterns

Although borderline personality disorder (BPD) and schizophrenia (SZ) are notably different mental disorders, they share problems in social cognition-or understanding the feelings, intentions and thoughts of other people. To date no studies have directly compared the social cognitive abilities of individuals with these two disorders. In this study, the social cognitive subdomain theory of mind was investigated in women with BPD (n = 25), women with SZ (n = 25) and healthy women (n = 25). An ecologically valid video-based measure (Movie for the Assessment of Social Cognition) was used. For the overall score, women with SZ performed markedly below both healthy women and women with BPD, whereas women with BPD did not perform significantly different compared to the healthy control group. A statistically significant error type × group interaction effect indicated that the groups differed with respect to kind of errors. Whereas women with BPD made mostly overmentalizing errors, women with SZ in addition committed undermentalizing errors. Our study suggests different magnitude and pattern of social cognitive problems in BPD and SZ.

Face recognition in schizophrenia disorder: A comprehensive review of behavioral, neuroimaging and neurophysiological studies

Facial emotion processing has been extensively studied in schizophrenia patients while general face processing has received less attention. The already published reviews do not address the current scientific literature in a complete manner. Therefore, here we tried to answer some questions that remain to be clarified, particularly: are the non-emotional aspects of facial processing in fact impaired in schizophrenia patients? At the behavioral level, our key conclusions are that visual perception deficit in schizophrenia patients: are not specific to faces; are most often present when the cognitive (e.g. attention) and perceptual demands of the tasks are important; and seems to worsen with the illness chronification. Although, currently evidence suggests impaired second order configural processing, more studies are necessary to determine whether or not holistic processing is impaired in schizophrenia patients. Neural and neurophysiological evidence suggests impaired earlier levels of visual processing, which might involve the deficits in interaction of the magnocellular and parvocellular pathways impacting on further processing. These deficits seem to be present even before the disorder out-set. Although evidence suggests that this deficit may be not specific to faces, further evidence on this question is necessary, in particularly more ecological studies including context and body processing.

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.

Relationship between amygdala volume and emotion recognition in adolescents at ultra-high risk for psychosis

Amygdala volume has been proposed as a neural risk biomarker for psychotic illness, but findings in the ultra-high risk for psychosis (UHR) population have been somewhat inconsistent, which may be related to underlying social cognitive abilities. The current study investigated whether amygdala volumes were related to emotion-recognition impairments in UHR individuals, and whether volumes differed by sex. Secondary aims were to assess whether (a) emotion-recognition performance was associated with interhemispheric amygdala volume asymmetry and (b) amgydala volume and volume asymmetry acted as a mediator between emotion-recognition and outcome measures. The amygdala was manually delineated from magnetic resonance images for 39 UHR individuals who had also completed facial and prosody emotion-recognition tasks. Partial correlations were conducted to examine associations between amydgala volume/asymmetry and recognition of negative emotions. Mediation analyses were conducted using regression and bootstrapping techniques. Amygdala volume was positively correlated with sadness emotion recognition, in particular prosody, for females only. Left amygdala volume mediated the effect of sadness recognition on depressive symptoms, negative symptoms, overall psychopathology, and global functioning in females. Findings suggest a complex relationship between emotion recognition, the structure of the amygdala and illness outcome, where recognition of sadness appears to be the precipitator of this relationship in UHR females. Further research is needed to determine illness specificity and to confirm our sex- and emotion-specific results.

Facial emotion recognition deficits following moderate-severe Traumatic Brain Injury (TBI): re-examining the valence effect and the role of emotion intensity

Many individuals who sustain moderate-severe traumatic brain injuries (TBI) are poor at recognizing emotional expressions, with a greater impairment in recognizing negative (e.g., fear, disgust, sadness, and anger) than positive emotions (e.g., happiness and surprise). It has been questioned whether this "valence effect" might be an artifact of the wide use of static facial emotion stimuli (usually full-blown expressions) which differ in difficulty rather than a real consequence of brain impairment. This study aimed to investigate the valence effect in TBI, while examining emotion recognition across different intensities (low, medium, and high).

METHOD

Twenty-seven individuals with TBI and 28 matched control participants were tested on the Emotion Recognition Task (ERT). The TBI group was more impaired in overall emotion recognition, and less accurate recognizing negative emotions. However, examining the performance across the different intensities indicated that this difference was driven by some emotions (e.g., happiness) being much easier to recognize than others (e.g., fear and surprise). Our findings indicate that individuals with TBI have an overall deficit in facial emotion recognition, and that both people with TBI and control participants found some emotions more difficult than others. These results suggest that conventional measures of facial affect recognition that do not examine variance in the difficulty of emotions may produce erroneous conclusions about differential impairment. They also cast doubt on the notion that dissociable neural pathways underlie the recognition of positive and negative emotions, which are differentially affected by TBI and potentially other neurological or psychiatric disorders.

Sex differences in the ability to recognise non-verbal displays of emotion: a meta-analysis

The present study aimed to quantify the magnitude of sex differences in humans' ability to accurately recognise non-verbal emotional displays. Studies of relevance were those that required explicit labelling of discrete emotions presented in the visual and/or auditory modality. A final set of 551 effect sizes from 215 samples was included in a multilevel meta-analysis. The results showed a small overall advantage in favour of females on emotion recognition tasks (d=0.19). However, the magnitude of that sex difference was moderated by several factors, namely specific emotion, emotion type (negative, positive), sex of the actor, sensory modality (visual, audio, audio-visual) and age of the participants. Method of presentation (computer, slides, print, etc.), type of measurement (response time, accuracy) and year of publication did not significantly contribute to variance in effect sizes. These findings are discussed in the context of social and biological explanations of sex differences in emotion recognition.

Facial expressions of emotions: recognition accuracy and affective reactions during late childhood

The present study examined the development of recognition ability and affective reactions to emotional facial expressions in a large sample of school-aged children (n = 504, ages 8-11 years of age). Specifically, the study aimed to investigate if changes in the emotion recognition ability and the affective reactions associated with the viewing of facial expressions occur during late childhood. Moreover, because small but robust gender differences during late-childhood have been proposed, the effects of gender on the development of emotion recognition and affective responses were examined. The results showed an overall increase in emotional face recognition ability from 8 to 11 years of age, particularly for neutral and sad expressions. However, the increase in sadness recognition was primarily due to the development of this recognition in boys. Moreover, our results indicate different developmental trends in males and females regarding the recognition of disgust. Last, developmental changes in affective reactions to emotional facial expressions were found. Whereas recognition ability increased over the developmental time period studied, affective reactions elicited by facial expressions were characterized by a decrease in arousal over the course of late childhood.

Are patients with schizophrenia impaired in processing non-emotional features of human faces?

It is known that individuals with schizophrenia exhibit signs of impaired face processing, however, the exact perceptual and cognitive mechanisms underlying these deficits are yet to be elucidated. One possible source of confusion in the current literature is the methodological and conceptual inconsistencies that can arise from the varied treatment of different aspects of face processing relating to emotional and non-emotional aspects of face perception. This review aims to disentangle the literature by focusing on the performance of patients with schizophrenia in a range of tasks that required processing of non-emotional features of face stimuli (e.g., identity or gender). We also consider the performance of patients on non-face stimuli that share common elements such as familiarity (e.g., cars) and social relevance (e.g., gait). We conclude by exploring whether observed deficits are best considered as “face-specific” and note that further investigation is required to properly assess the potential contribution of more generalized attentional or perceptual impairments.

Category Processing and the human likeness dimension of the Uncanny Valley Hypothesis: Eye-Tracking Data

The Uncanny Valley Hypothesis (Mori, 1970) predicts that perceptual difficulty distinguishing between a humanlike object (e.g., lifelike prosthetic hand, mannequin) and its human counterpart evokes negative affect. Research has focused on affect, with inconsistent results, but little is known about how objects along the hypothesis' dimension of human likeness (DHL) are actually perceived. This study used morph continua based on human and highly realistic computer-generated (avatar) faces to represent the DHL. Total number and dwell time of fixations to facial features were recorded while participants (N = 60) judged avatar versus human category membership of the faces in a forced choice categorization task. Fixation and dwell data confirmed the face feature hierarchy (eyes, nose, and mouth in this order of importance) across the DHL. There were no further findings for fixation. A change in the relative importance of these features was found for dwell time, with greater preferential processing of eyes and mouth of categorically ambiguous faces compared with unambiguous avatar faces. There were no significant differences between ambiguous and human faces. These findings applied for men and women, though women generally dwelled more on the eyes to the disadvantage of the nose. The mouth was unaffected by gender. In summary, the relative importance of facial features changed on the DHL's non-human side as a function of categorization ambiguity. This change was indicated by dwell time only, suggesting greater depth of perceptual processing of the eyes and mouth of ambiguous faces compared with these features in unambiguous avatar faces.

Facial emotion recognition in schizophrenia: the impact of gender

OBJECTIVE

Previous studies reported gender differences for facial emotion recognition in healthy people, with women performing better than men. Few studies that examined gender differences for facial emotion recognition in schizophrenia brought out inconsistent findings. The aim of this study is to investigate gender differences for facial emotion identification and discrimination abilities in patients with schizophrenia.

METHODS

35 female and 35 male patients with schizophrenia, along with 35 female and 35 male healthy controls were included in the study. All the subjects were evaluated with Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEDT), and Benton Facial Recognition Test (BFRT). Patients' psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Male patients performed significantly worse than female patients on FEIT total, and negative scores. Male controls performed significantly worse than female controls on FEIT total and negative scores. On all tasks, female patients performed comparable with controls. Male patients performed significantly worse than controls on FEIT, and FEDT.

CONCLUSION

Women with schizophrenia outperformed men for facial emotion recognition ability in a pattern that is similar with the healthy controls. It could be claimed that male patients with schizophrenia need special consideration for emotion perception deficits.

Assessment of perception of morphed facial expressions using the Emotion Recognition Task: normative data from healthy participants aged 8-75

The ability to recognize and label emotional facial expressions is an important aspect of social cognition. However, existing paradigms to examine this ability present only static facial expressions, suffer from ceiling effects or have limited or no norms. A computerized test, the Emotion Recognition Task (ERT), was developed to overcome these difficulties. In this study, we examined the effects of age, sex, and intellectual ability on emotion perception using the ERT. In this test, emotional facial expressions are presented as morphs gradually expressing one of the six basic emotions from neutral to four levels of intensity (40%, 60%, 80%, and 100%). The task was administered in 373 healthy participants aged 8-75. In children aged 8-17, only small developmental effects were found for the emotions anger and happiness, in contrast to adults who showed age-related decline on anger, fear, happiness, and sadness. Sex differences were present predominantly in the adult participants. IQ only minimally affected the perception of disgust in the children, while years of education were correlated with all emotions but surprise and disgust in the adult participants. A regression-based approach was adopted to present age- and education- or IQ-adjusted normative data for use in clinical practice. Previous studies using the ERT have demonstrated selective impairments on specific emotions in a variety of psychiatric, neurologic, or neurodegenerative patient groups, making the ERT a valuable addition to existing paradigms for the assessment of emotion perception.

Cognition-emotion dysinteraction in schizophrenia

Evolving theories of schizophrenia emphasize a "disconnection" in distributed fronto-striatal-limbic neural systems, which may give rise to breakdowns in cognition and emotional function. We discuss these diverse domains of function from the perspective of disrupted neural circuits involved in "cold" cognitive vs. "hot" affective operations and the interplay between these processes. We focus on three research areas that highlight cognition-emotion dysinteractions in schizophrenia: First, we discuss the role of cognitive deficits in the "maintenance" of emotional information. We review recent evidence suggesting that motivational abnormalities in schizophrenia may in part arise due to a disrupted ability to "maintain" affective information over time. Here, dysfunction in a prototypical "cold" cognitive operation may result in "affective" deficits in schizophrenia. Second, we discuss abnormalities in the detection and ascription of salience, manifest as excessive processing of non-emotional stimuli and inappropriate distractibility. We review emerging evidence suggesting deficits in some, but not other, specific emotional processes in schizophrenia - namely an intact ability to perceive emotion "in-the-moment" but poor prospective valuation of stimuli and heightened reactivity to stimuli that ought to be filtered. Third, we discuss abnormalities in learning mechanisms that may give rise to delusions, the fixed, false, and often emotionally charged beliefs that accompany psychosis. We highlight the role of affect in aberrant belief formation, mostly ignored by current theoretical models. Together, we attempt to provide a consilient overview for how breakdowns in neural systems underlying affect and cognition in psychosis interact across symptom domains. We conclude with a brief treatment of the neurobiology of schizophrenia and the need to close our explanatory gap between cellular-level hypotheses and complex behavioral symptoms observed in this illness.

Cognition-emotion dysinteraction in schizophrenia

Evolving theories of schizophrenia emphasize a "disconnection" in distributed fronto-striatal-limbic neural systems, which may give rise to breakdowns in cognition and emotional function. We discuss these diverse domains of function from the perspective of disrupted neural circuits involved in "cold" cognitive vs. "hot" affective operations and the interplay between these processes. We focus on three research areas that highlight cognition-emotion dysinteractions in schizophrenia: First, we discuss the role of cognitive deficits in the "maintenance" of emotional information. We review recent evidence suggesting that motivational abnormalities in schizophrenia may in part arise due to a disrupted ability to "maintain" affective information over time. Here, dysfunction in a prototypical "cold" cognitive operation may result in "affective" deficits in schizophrenia. Second, we discuss abnormalities in the detection and ascription of salience, manifest as excessive processing of non-emotional stimuli and inappropriate distractibility. We review emerging evidence suggesting deficits in some, but not other, specific emotional processes in schizophrenia - namely an intact ability to perceive emotion "in-the-moment" but poor prospective valuation of stimuli and heightened reactivity to stimuli that ought to be filtered. Third, we discuss abnormalities in learning mechanisms that may give rise to delusions, the fixed, false, and often emotionally charged beliefs that accompany psychosis. We highlight the role of affect in aberrant belief formation, mostly ignored by current theoretical models. Together, we attempt to provide a consilient overview for how breakdowns in neural systems underlying affect and cognition in psychosis interact across symptom domains. We conclude with a brief treatment of the neurobiology of schizophrenia and the need to close our explanatory gap between cellular-level hypotheses and complex behavioral symptoms observed in this illness.

Amygdala recruitment in schizophrenia in response to aversive emotional material: a meta-analysis of neuroimaging studies

Emotional dysfunction has long been established as a critical clinical feature of schizophrenia. In the past decade, there has been extensive work examining the potential contribution of abnormal amygdala activation to this dysfunction in patients with schizophrenia. A number of studies have demonstrated under-recruitment of the amygdala in response to emotional stimuli, while others have shown intact recruitment of this region. To date, there have been few attempts to synthesize this literature using quantitative criteria or to use a formal meta-analytic approach to examine which variables may moderate the magnitude of between-group differences in amygdala activation in response to aversive emotional stimuli. We conducted a meta-analysis of amygdala activation in patients with schizophrenia, using a bootstrapping approach to investigate: (a) evidence for amygdala under-recruitment in schizophrenia and (b) variables that may moderate the magnitude of between-group differences in amygdala activation. We demonstrate that patients with schizophrenia show statistically significant, but modest, under-recruitment of bilateral amygdala (mean effect size = -0.20 SD). However, present findings indicate that this under-recruitment is dependent on the use of a neutral vs emotion interaction contrast and is not apparent if amygdala activation by patients and controls is evaluated in a negative emotional condition only.

Reduced source activity of event-related potentials for affective facial pictures in schizophrenia patients

The ability to recognize facial affect is impaired in schizophrenia patients. This study compared source activities of the event-related potentials (ERPs) for affective facial pictures between schizophrenia patients and healthy controls. Twenty-three schizophrenia patients (11 females) and 24 healthy controls (12 females) were recruited. The standardized low-resolution brain electromagnetic tomography (sLORETA) source activities of four ERP components (P100, N170, N250, and P300) were compared between schizophrenia patients and healthy controls in response to fearful, happy, and neutral facial expressions. Group differences of sLORETA source activities were found only for the N170 component in response to the fearful face. Source activities in the middle frontal gyrus and inferior frontal gyrus were lower in schizophrenia patients compared to healthy controls. Source activity in the insula was lower in male schizophrenia patients compared to male healthy controls. Source activities in the superior temporal gyrus, middle temporal gyrus, insula and inferior frontal gyrus were lower in male compared to female schizophrenia patients. However, there was no gender difference on ERP source activities in the healthy controls. These results support the hypothesis that schizophrenia patients have reduced N170 current source density in response to fearful faces. The area exhibiting reduced current source density includes the frontal and temporal cortex. The present results suggest that there may be gender differences in facial affect processing in schizophrenia patients.

Sex differences in facial, prosodic, and social context emotional recognition in early-onset schizophrenia

The purpose of the present study was to determine sex differences in facial, prosodic, and social context emotional recognition in schizophrenia (SCH). Thirty-eight patients (SCH, 20 females) and 38 healthy controls (CON, 20 females) participated in the study. Clinical scales (BPRS and PANSS) and an Affective States Scale were applied, as well as tasks to evaluate facial, prosodic, and within a social context emotional recognition. SCH showed lower accuracy and longer response times than CON, but no significant sex differences were observed in either facial or prosody recognition. In social context emotions, however, females showed higher empathy than males with respect to happiness in both groups. SCH reported being more identified with sad films than CON and females more with fear than males. The results of this study confirm the deficits of emotional recognition in male and female patients with schizophrenia compared to healthy subjects. Sex differences were detected in relation to social context emotions and facial and prosodic recognition depending on age.

Sex-related memory recall and talkativeness for emotional stimuli

Recent studies have evidenced an increasing interest in sex-related brain mechanisms and cerebral lateralization subserving emotional memory, language processing, and conversational behavior. We used event-related-potentials (ERP) to examine the influence of sex and hemisphere on brain responses to emotional stimuli. Given that the P300 component of ERP is considered a cognitive neuroelectric phenomenon, we compared left and right hemisphere P300 responses to emotional stimuli in men and women. As indexed by both amplitude and latency measures, emotional stimuli elicited more robust P300 effects in the left hemisphere in women than in men, while a stronger P300 component was elicited in the right hemisphere in men compared to women. Our findings show that the variables of sex and hemisphere interacted significantly to influence the strength of the P300 component to the emotional stimuli. Emotional stimuli were also best recalled when given a long-term, incidental memory test, a fact potentially related to the differential P300 waves at encoding. Moreover, taking into account the sex-related differences in language processing and conversational behavior, in the present study we evaluated possible talkativeness differences between the two genders in the recollection of emotional stimuli. Our data showed that women used a higher number of words, compared to men, to describe both arousal and neutral stories. Moreover, the present results support the view that sex differences in lateralization may not be a general feature of language processing but may be related to the specific condition, such as the emotional content of stimuli.

Sex-specific associations between peripheral oxytocin and emotion perception in schizophrenia

BACKGROUND

We previously reported that higher levels of peripheral oxytocin are associated with lower levels of positive, general, and overall symptoms in women but not in men with schizophrenia. Here we investigate the influence of sex, sex steroid hormone fluctuations, and peripheral oxytocin levels on emotional processing in men and women with schizophrenia.

METHOD

Twenty-two women with schizophrenia and 31 female controls completed the Penn Emotion Acuity Test (PEAT), a facial emotion recognition and perception task, during two menstrual cycle phases: 1) early follicular (Days 2-4; low estrogen/progesterone) and 2) midluteal (Days 20-22; high estrogen/progesterone). Twenty-six males with schizophrenia and 26 male controls completed testing at comparable intervals. We obtained plasma hormone assays of estrogen, progesterone, testosterone, and oxytocin.

RESULTS

No sex differences were noted on the PEAT. Plasma oxytocin levels did not fluctuate across phases of the menstrual cycle. However, female patients and controls more accurately identified facial emotions during the early follicular versus midluteal phase (p<0.05). Higher oxytocin levels related to perceiving faces as happier in both female patients (r=-0.46, p=0.04) and controls (r=-0.40, p=0.04) but not in men.

CONCLUSION

Like healthy women, women with schizophrenia demonstrate menstrual-cycle dependent fluctuations in recognizing emotional cues. Like healthy women, female patients with higher levels of oxytocin perceived faces as happier. Future studies need to address whether this sex-specific relationship is associated with trust and other positive emotions, and whether exogenous oxytocin might enhance mood states and social interaction in female or all schizophrenia patients.

Sex-specific associations between peripheral oxytocin and emotion perception in schizophrenia

BACKGROUND

We previously reported that higher levels of peripheral oxytocin are associated with lower levels of positive, general, and overall symptoms in women but not in men with schizophrenia. Here we investigate the influence of sex, sex steroid hormone fluctuations, and peripheral oxytocin levels on emotional processing in men and women with schizophrenia.

METHOD

Twenty-two women with schizophrenia and 31 female controls completed the Penn Emotion Acuity Test (PEAT), a facial emotion recognition and perception task, during two menstrual cycle phases: 1) early follicular (Days 2-4; low estrogen/progesterone) and 2) midluteal (Days 20-22; high estrogen/progesterone). Twenty-six males with schizophrenia and 26 male controls completed testing at comparable intervals. We obtained plasma hormone assays of estrogen, progesterone, testosterone, and oxytocin.

RESULTS

No sex differences were noted on the PEAT. Plasma oxytocin levels did not fluctuate across phases of the menstrual cycle. However, female patients and controls more accurately identified facial emotions during the early follicular versus midluteal phase (p<0.05). Higher oxytocin levels related to perceiving faces as happier in both female patients (r=-0.46, p=0.04) and controls (r=-0.40, p=0.04) but not in men.

CONCLUSION

Like healthy women, women with schizophrenia demonstrate menstrual-cycle dependent fluctuations in recognizing emotional cues. Like healthy women, female patients with higher levels of oxytocin perceived faces as happier. Future studies need to address whether this sex-specific relationship is associated with trust and other positive emotions, and whether exogenous oxytocin might enhance mood states and social interaction in female or all schizophrenia patients.

Gender differences in patients presenting with first-episode psychosis in Hong Kong: a three-year follow up study

OBJECTIVE

The aim of the current study was to investigate gender differences with respect to pre-treatment characteristics, clinical presentation, service utilization and functional outcome in patients presenting with first-episode psychosis.

METHODS

A total of 700 participants (men, n = 360; women, n = 340) aged 15 to 25 years consecutively enrolled in a territory-wide first-episode psychosis treatment programme in Hong Kong from July 2001 to August 2003 were studied. Baseline and three-year follow up variables were collected via systematic medical file review.

RESULTS

At service entry, men had significantly lower educational attainment (p < 0.01), longer median duration of untreated psychosis (p < 0.001), fewer past suicidal attempts (p < 0.01), more severe negative symptoms (p < 0.05) and fewer affective symptoms (p < 0.01) than women. There was no significant gender difference in age of onset. In three-year follow up, men had more prominent negative symptoms (p < 0.001), fewer affective symptoms (p < 0.01), more violent behaviour and forensic records (p < 0.01), and higher rate of substance abuse (p < 0.01). Women achieved higher levels of functioning than men (Social Occupational Functioning Assessment Scale (SOFAS), p < 0.001) and a significantly higher proportion of women than men engaged in full-time employment or study for at least 12 consecutive months (p < 0.001) in the initial three years after psychiatric treatment.

CONCLUSION

Notable gender differences in clinical profiles, illness trajectory and functional outcome were demonstrated in Chinese young people suffering from first-episode psychosis. Differential needs between men and women and hence gender-specific therapeutic strategies should be considered in early intervention service.

Deficit in negative emotional information processing in schizophrenia: does it occur in all patients?

The nature of the impairment in the processing of emotional information in schizophrenia is still being debated. Some authors reported that schizophrenia patients would show deficits in the treatment processing of negative emotional information without a negative bias, as observed in controls, when in a combined emotional situation including positive/negative information. Eighteen subjects with paranoid schizophrenia in remission with a low level of negative symptoms and 18 control subjects were exposed to 108 pairs of pictures (International Affective Picture System) depicting different emotions (N = negative, P = positive, n = neutral) from six different combinations: N/N, P/P, n/n, P/N, P/n, and N/n. The subjects responded by clicking on a right or left button in response to a negative or positive feeling toward the stimuli (forced choice task). They were also asked to classify each of the individual pictures as positive, negative, or neutral (emotion-recognition task). In this well-defined group of paranoid schizophrenia patients in remission, we observed the persistence of a negative bias when an ambiguous situation is displayed (P/N) with the absence of an impairment in negative emotional information recognition and the presence of a positive bias in the recognition of neutral stimuli, reflecting a tendency to keep arousal-provoking perceptual cues from entering into subjective awareness.

Do patients with schizophrenia have a general or specific deficit in the perception of social threat? A meta-analytic study

This study investigates whether social cognitive deficits found in patients with schizophrenia are specific to social threat stimuli, and whether the deficits increase across the delusion spectrum from a subclinical sample to clinical manifestation. The authors presented the meta-analytic review of the published literature on social threat perception performance in three kinds of group comparisons: a subclinical group and a healthy control group, a schizophrenia group and a healthy control group, and a schizophrenia with delusion symptoms group and a healthy control group. The meta-analysis of 20 studies yielded six weighted effect sizes. The largest differences were found between the schizophrenia with delusion group and the healthy controls in both the threat and non-threat conditions. No differences were found between the effect sizes in the threat-related condition and the non-threat condition in any of the three group comparisons. Age was found to be significantly correlated with the effect sizes. The performance differences in both the threat and non-threat conditions reflect a generalized performance deficit, rather than a specific deficit, in the perception of social threat stimuli among patients with schizophrenia.

Differential roles of low and high spatial frequency content in abnormal facial emotion perception in schizophrenia

While schizophrenia patients are impaired at facial emotion perception, the role of basic visual processing in this deficit remains relatively unclear. We examined emotion perception when spatial frequency content of facial images was manipulated via high-pass and low-pass filtering. Unlike controls (n=29), patients (n=30) perceived images with low spatial frequencies as more fearful than those without this information, across emotional salience levels. Patients also perceived images with high spatial frequencies as happier. In controls, this effect was found only at low emotional salience. These results indicate that basic visual processing has an amplified modulatory effect on emotion perception in schizophrenia.