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Iliuta FP, Manea MC, Teodorescu A, Lacau RM, Manea M, Mares AM, Varlam CI, Ciobanu CA, Ciobanu AM. Predictive factors and symptom severity spectrum in adult schizophrenia: Potential insights for improved management and adequate care. Biomed Rep 2024; 21:132. [PMID: 39114301 PMCID: PMC11304515 DOI: 10.3892/br.2024.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 07/04/2024] [Indexed: 08/10/2024] Open
Abstract
Schizophrenia is one of the most disabling psychiatric disorders characterized by positive (hallucinations, delusions, formal thinking disorder) and negative symptoms (anhedonia, lack of speech and motivation). The present study aimed to identify the predictive factors of schizophrenia in adults, and potential differences in the environment of origin, sex, levels of occupational stress, intellectual level, marital status and age of onset of the disease depending on the severity of symptoms using analysis of data collected from 120 patients with a diagnosis of schizophrenia. The study was conducted at the 'Prof. Dr. Alexandru Obregia' Clinical Psychiatric Hospital in Bucharest and included adult patients hospitalized between March 2018 and January 2021 diagnosed with schizophrenia and evaluated by general clinical examination, psychiatric, neurological and psychological evaluation. Results revealed that robust predictors of mild and moderate symptoms were affective symptoms, heredo-collateral history of schizophrenia, late onset, the presence of positive and negative symptoms, substance abuse, stress and marital status, unmarried, lower IQ and mental deficiency. For moderate-severe and severe symptoms, predictors were affective symptoms, heredo-collateral history of schizophrenia and affective disorders, substance abuse, stress, borderline IQ and mild mental deficiency. The present results can be used for further development of psychopharmacological management of schizophrenia.
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Affiliation(s)
- Floris Petru Iliuta
- Department of Psychiatry and Psychology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 010221, Romania
| | - Mihnea Costin Manea
- Department of Psychiatry and Psychology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 010221, Romania
| | - Andreea Teodorescu
- Faculty of Medicine, Transilvania University of Brasov, Brasov 500019, Romania
| | - Radu-Mihail Lacau
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Mirela Manea
- Department of Psychiatry and Psychology, Faculty of Dental Medicine, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 010221, Romania
| | - Aliss Madalina Mares
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | - Corina Ioana Varlam
- Department of Psychiatry, ‘Prof. Dr. Alexandru Obregia’ Clinical Hospital of Psychiatry, Bucharest 041914, Romania
| | | | - Adela Magdalena Ciobanu
- Department of Neurosciences, Discipline of Psychiatry, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest 050474, Romania
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Tsui HKH, Luk SL, Hsiao J, Chan SKW. Facial emotion perception in individuals with clinical high risk for psychosis compared with healthy controls, first-episode psychosis, and in predicting psychosis transition: A systematic review and meta-analysis. Psychiatry Res 2024; 340:116143. [PMID: 39167864 DOI: 10.1016/j.psychres.2024.116143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/10/2024] [Accepted: 08/11/2024] [Indexed: 08/23/2024]
Abstract
Facial emotion perception deficits, a possible indicator of illness progression and transdiagnostic phenotype, were examined in high-risk psychosis (CHR) patients through a systematic review and meta-analysis of 35 studies (2567 CHR individuals, 1103 non-transitioned [CHR-NT], 212 transitioned [CHR-T], 512 first-episode psychosis [FEP], and 1936 healthy controls [HC]). CHR showed overall (g = -0.369 [95 % CI, -0.485 to -0.253]) and specific impairments in detecting anger, disgust, fear, happiness, neutrality, and sadness compared to HC, except for surprise. FEP revealed a general deficit than CHR (g = -0.378 [95 % CI, -0.509 to -0.247]), and CHR-T displayed more pronounced baseline impairments than CHR-NT (g = -0.217 [95 % CI, -0.365 to -0.068]). FEP only exhibited a poorer ability to perceive fear, but not other individual emotions, compared to CHR. Similar performances in perceiving individual emotions were observed regardless of transition status (CHR-NT and CHR-T). However, literature comparing the perception of individual emotions among FEP, CHR-T, and CHR is limited. This study primarily characterized the general and overall impairments of facial emotion perception in CHR which could predict transition risk, emphasizing the need for future research on multimodal parameters of emotion perception and associations with other psychiatric outcomes.
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Affiliation(s)
- Harry Kam Hung Tsui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Siu Lee Luk
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR
| | - Janet Hsiao
- Division of Social Science, Hong Kong University of Science & Technology, Hong Kong SAR, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR.
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Grave J, Cordeiro S, de Sá Teixeira N, Korb S, Soares SC. Emotional anticipation for dynamic emotional faces is not modulated by schizotypal traits: A Representational Momentum study. Q J Exp Psychol (Hove) 2024:17470218241253703. [PMID: 38679800 DOI: 10.1177/17470218241253703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Schizotypy, a personality structure that resembles schizophrenia symptoms, is often associated with abnormal facial emotion perception. Based on the prevailing sense of threat in psychotic experiences, and the immediate perceptual history of seeing others' facial expressions, individuals with high schizotypal traits may exhibit a heightened tendency to anticipate anger. To test this, we used insights from Representational Momentum (RM), a perceptual phenomenon in which the endpoint of a dynamic event is systematically displaced forward, into the immediate future. Angry-to-ambiguous and happy-to-ambiguous avatar faces were presented, each followed by a probe with the same (ambiguous) expression as the endpoint, or one slightly changed to express greater happiness/anger. Participants judged if the probe was "equal" to the endpoint and rated how confident they were. The sample was divided into high (N = 46) and low (N = 49) schizotypal traits using the Schizotypal Personality Questionnaire (SPQ). First, a forward bias was found in happy-to-ambiguous faces, suggesting emotional anticipation solely for dynamic faces changing towards a potential threat (anger). This may reflect an adaptative mechanism, as it is safer to anticipate any hostility from a conspecific than the opposite. Second, contrary to our hypothesis, high schizotypal traits did not heighten RM for happy-to-ambiguous faces, nor did they lead to overconfidence in biased judgements. This may suggest a typical pattern of emotional anticipation in non-clinical schizotypy, but caution is needed due to the use of self-report questionnaires, university students, and a modest sample size. Future studies should also investigate if the same holds for clinical manifestations of schizophrenia.
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Affiliation(s)
- Joana Grave
- William James Center for Research (WJCR-Aveiro), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS@RISE), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Sara Cordeiro
- Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Nuno de Sá Teixeira
- William James Center for Research (WJCR-Aveiro), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Sebastian Korb
- Department of Psychology, University of Essex, Colchester, UK
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
| | - Sandra Cristina Soares
- William James Center for Research (WJCR-Aveiro), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
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Bae M, Cho J, Won S. Facial emotion-recognition deficits in patients with schizophrenia and unaffected first-degree relatives. Front Psychiatry 2024; 15:1373288. [PMID: 38680783 PMCID: PMC11046458 DOI: 10.3389/fpsyt.2024.1373288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction This study aimed to determine trait- and state-dependent markers of schizophrenia by investigating facial emotion-recognition (FER) deficits in remitted patients with schizophrenia and their first-degree relatives (FR). Methods Three groups were included: the Schizophrenia group (n=66), their unaffected FR group (n=40), and healthy controls (n=50) who were matched for age, sex, and years of education. A facial-labeling task was used to examine FER deficits using the following eight standardized expressions: happy, fearful, disgusted, angry, sad, contemptuous, surprised, and neutral. Results There was a poorer accuracy in the recognition of sadness and anger in the Schizophrenia group as well as in contempt in both the Schizophrenia and FR groups compared with healthy controls. The response times for the recognition of contempt, sadness, and neutral emotion were delayed in the Schizophrenia group and those for fear were delayed in the Schizophrenia and FR groups compared with healthy controls. Conclusion Concerning the accuracy in FER, sadness and anger can be considered state-dependent markers of remitted schizophrenia, and contempt is a trait-dependent marker of schizophrenia. Similarly, for response times in FER, contempt, sadness, and neutral emotion can be considered state-dependent markers of remitted schizophrenia, while fear is considered a trait-dependent marker of schizophrenia. These findings may contribute to the early diagnosis of schizophrenia and the development of relevant therapeutic interventions.
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Affiliation(s)
- Minjae Bae
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Gyeongsan Joongang Hospital, Gyeongsan, Gyeongbuk, Republic of Korea
| | - Jihyun Cho
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seunghee Won
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
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Stevens M, Ní Mhurchú S, Corley E, Egan C, Hallahan B, McDonald C, Donohoe G, Burke T. Uncinate fasciculus microstructural organisation and emotion recognition in schizophrenia: controlling for hit rate bias. Front Behav Neurosci 2024; 18:1302916. [PMID: 38566859 PMCID: PMC10985192 DOI: 10.3389/fnbeh.2024.1302916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/02/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Schizophrenia (SCZ) is a complex neurodevelopmental disorder characterised by functional and structural brain dysconnectivity and disturbances in perception, cognition, emotion, and social functioning. In the present study, we investigated whether the microstructural organisation of the uncinate fasciculus (UF) was associated with emotion recognition (ER) performance. Additionally, we investigated the usefulness of an unbiased hit rate (UHR) score to control for response biases (i.e., participant guessing) during an emotion recognition task (ERT). Methods Fifty-eight individuals diagnosed with SCZ were included. The CANTAB ERT was used to measure social cognition. Specific ROI manual tract segmentation was completed using ExploreDTI and followed the protocol previously outlined by Coad et al. (2020). Results We found that the microstructural organisation of the UF was significantly correlated with physical neglect and ER outcomes. Furthermore, we found that the UHR score was more sensitive to ERT subscale emotion items than the standard HR score. Finally, given the association between childhood trauma (in particular childhood neglect) and social cognition in SCZ, a mediation analysis found evidence that microstructural alterations of the UF mediated an association between childhood trauma and social cognitive performance. Discussion The mediating role of microstructural alterations in the UF on the association between childhood trauma and social cognitive performance suggests that early life adversity impacts both brain development and social cognitive outcomes for people with SCZ. Limitations of the present study include the restricted ability of the tensor model to correctly assess multi-directionality at regions where fibre populations intersect.
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Affiliation(s)
- Matthew Stevens
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Neuroimaging Cognition and Genomics (NICOG), University of Galway, Galway, Ireland
| | - Síle Ní Mhurchú
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Neuroimaging Cognition and Genomics (NICOG), University of Galway, Galway, Ireland
| | - Emma Corley
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Neuroimaging Cognition and Genomics (NICOG), University of Galway, Galway, Ireland
| | - Ciara Egan
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Neuroimaging Cognition and Genomics (NICOG), University of Galway, Galway, Ireland
| | - Brian Hallahan
- Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Colm McDonald
- Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Gary Donohoe
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Neuroimaging Cognition and Genomics (NICOG), University of Galway, Galway, Ireland
| | - Tom Burke
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Neuroimaging Cognition and Genomics (NICOG), University of Galway, Galway, Ireland
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Williams TF, Conley RE, Mittal VA. The relevance of social anxiety for understanding social functioning and facial emotion recognition in individuals at clinical high-risk for psychosis. Early Interv Psychiatry 2023; 17:1021-1027. [PMID: 36641807 PMCID: PMC10349169 DOI: 10.1111/eip.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/07/2022] [Accepted: 01/01/2023] [Indexed: 01/16/2023]
Abstract
AIM Individuals at clinical high risk (CHR) for psychosis often experience poor social functioning and impaired facial emotion recognition (FER); however, the impact of frequently comorbid symptoms upon these processes is underexplored. In particular, social anxiety is characteristic of this population and also related to poor social functioning and FER biases, such as misinterpreting neutral faces as negative or threatening; however, little is known about how social anxiety relates to these processes in CHR individuals. The present study examined the overlap of social anxiety, social functioning, and FER accuracy and bias. METHOD Participants (CHR N = 62, healthy controls N = 52) completed the self-report Social Interaction Anxiety Scale (SIAS), Penn Emotion Recognition-40 (ER-40) behavioural task, and interviewer-rated Global Functioning Scale-Social (GFS-S). The ER-40 was used to assess both FER accuracy (e.g., overall number of correct responses) and bias (e.g., mislabelling neutral faces as angry). RESULTS Consistent with previous research, relative to controls, CHR participants had more social anxiety (d = -1.07), poorer social functioning (d = -1.62), and performed more poorly on the FER task (e.g., d = -.37). Within CHR participants, social anxiety was related to an anger detection bias (r = .28), above and beyond positive symptom severity, which in turn was related to FER accuracy (r = .26) and social functioning (r = -.28). CONCLUSION These findings suggest that ongoing work examining social processes within CHR individuals needs to account for social anxiety and that social anxiety may be a useful preventive intervention target.
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Affiliation(s)
- Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Rachel E Conley
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
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Delavari F, Rafi H, Sandini C, Murray RJ, Latrèche C, Van De Ville D, Eliez S. Amygdala subdivisions exhibit aberrant whole-brain functional connectivity in relation to stress intolerance and psychotic symptoms in 22q11.2DS. Transl Psychiatry 2023; 13:145. [PMID: 37142582 PMCID: PMC10160125 DOI: 10.1038/s41398-023-02458-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
The amygdala is a key region in emotional regulation, which is often impaired in psychosis. However, it is unclear if amygdala dysfunction directly contributes to psychosis, or whether it contributes to psychosis through symptoms of emotional dysregulation. We studied the functional connectivity of amygdala subdivisions in patients with 22q11.2DS, a known genetic model for psychosis susceptibility. We investigated how dysmaturation of each subdivision's connectivity contributes to positive psychotic symptoms and impaired tolerance to stress in deletion carriers. Longitudinally-repeated MRI scans from 105 patients with 22q11.2DS (64 at high-risk for psychosis and 37 with impaired tolerance to stress) and 120 healthy controls between the ages of 5 to 30 years were included. We calculated seed-based whole-brain functional connectivity for amygdalar subdivisions and employed a longitudinal multivariate approach to evaluate the developmental trajectory of functional connectivity across groups. Patients with 22q11.2DS presented a multivariate pattern of decreased basolateral amygdala (BLA)-frontal connectivity alongside increased BLA-hippocampal connectivity. Moreover, associations between developmental drops in centro-medial amygdala (CMA)-frontal connectivity to both impaired tolerance to stress and positive psychotic symptoms in deletion carriers were detected. Superficial amygdala hyperconnectivity to the striatum was revealed as a specific pattern arising in patients who develop mild to moderate positive psychotic symptoms. Overall, CMA-frontal dysconnectivity was found as a mutual neurobiological substrate in both impaired tolerance to stress and psychosis, suggesting a role in prodromal dysregulation of emotions in psychosis. While BLA dysconnectivity was found to be an early finding in patients with 22q11.2DS, which contributes to impaired tolerance to stress.
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Affiliation(s)
- Farnaz Delavari
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland.
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland.
| | - Halima Rafi
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Corrado Sandini
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Ryan J Murray
- Psychiatry Department, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Campus Biotech, Geneva, Switzerland
| | - Caren Latrèche
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Dimitri Van De Ville
- Neuro-X Institute, École Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
- Department of Genetic Medicine and Development, University of Geneva School of Medicine, Geneva, Switzerland
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Ryan PC, Damme KSF, Kuhney FS, Mittal VA. Social network size in adolescents at clinical high risk for psychosis. Early Interv Psychiatry 2023; 17:462-469. [PMID: 37156496 PMCID: PMC10167376 DOI: 10.1111/eip.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/12/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022]
Abstract
AIMS Adolescents and young adults at clinical high risk (CHR) for psychosis report few close friends. Social support has been linked to conversion to psychosis and psychosis relapse in CHR individuals. Expanding earlier research on loneliness and friendships at a single timepoint, this study described composition and changes in social network and its association with clinical and cognitive symptoms among CHR adolescents. METHODS Ninety five individuals (46 CHR individuals, 49 healthy volunteers) completed baseline and 1-year follow-up Social Network Index (SNI) evaluations and clinical interviews. Analyses first examined SNI size and composition across 10 categories (e.g., family, close friends, coworkers, classmates) between groups. Then, the relationship between SNI size and baseline social symptoms (i.e., paranoia, social anhedonia, social anxiety, social cognition), social function, and changes in symptoms and social networks over 1-year were examined within the CHR group. RESULTS CHR individuals showed smaller social networks overall, driven by fewer friendships and family relationships. Social cognition and social anxiety significantly related to SNI size at baseline, but social anhedonia and paranoia did not. SNI size related to social function, but with a modest effect size (r's = .45 and .56). Surprisingly, an increase in positive symptom severity related to an increase in familial but a decrease in coworker social network size. CONCLUSIONS The social support deficits in the CHR group were specific to relatives and friendships, with social anxiety and social cognition as implicated symptoms. Social relationships may serve as a promising early intervention target in individuals at CHR for psychosis.
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Affiliation(s)
- Patrick C Ryan
- National Institute of Mental Health, Bethesda, Maryland, USA
| | - Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois, USA
| | - Franchesca S Kuhney
- Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston, Illinois, USA
- Department of Psychiatry, Northwestern University, Chicago, Illinois, USA
- Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
- Institute for Policy Research (IPR), Northwestern University, Chicago, Illinois, USA
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Zouraraki C, Karamaouna P, Giakoumaki SG. Facial emotion recognition and schizotypal traits: A systematic review of behavioural studies. Early Interv Psychiatry 2023; 17:121-140. [PMID: 35840128 DOI: 10.1111/eip.13328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 03/19/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
AIM Previous research has indicated that individuals expressing high schizotypal traits and patients with Schizotypal Personality Disorder (SPD), show deficits in facial emotion recognition, compared to low schizotypal or control groups. On the other hand, non-significant findings also exist and the association of facial emotion recognition deficits with the different schizotypal dimensions is not well defined, thus limiting any conclusive outcomes. Therefore, the aim of this systematic review was to further clarify this relationship. METHODS PsychInfo, Web of Science, Scopus and PubMed were systematically searched, and 23 papers with a cross-sectional design were selected. Nineteen studies examined individuals with high schizotypal traits and four studies evaluated SPD individuals with behavioural facial emotion recognition paradigms and self-report measures or clinical interviews for schizotypal traits. All selected studies were published between 1994 and August 2020. RESULTS According to the evidence of studies, high schizotypal individuals and SPD patients have poorer performance in facial emotion recognition tasks. Negative schizotypy was related to lower accuracy for positive and negative emotions and faster emotion labeling while positive schizotypy was associated with worse accuracy for positive, negative and neutral emotions and more biases. Disorganized schizotypy was associated with poorer accuracy for negative emotions and suspiciousness with higher accuracy for disgust faces but lower total accuracy. CONCLUSIONS These findings are consistent with the vulnerability for schizophrenia spectrum disorders and support the idea that emotion recognition deficits are trait markers for these conditions. Thus, the effectiveness of early-intervention programmes could increase by also targeting this class of deficits.
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Affiliation(s)
- Chrysoula Zouraraki
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
| | - Penny Karamaouna
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
| | - Stella G Giakoumaki
- Laboratory of Neuropsychology, Department of Psychology, Faculty of Social Sciences, University of Crete, Rethymno, Greece
- University of Crete Research Center for the Humanities, The Social and Educational Sciences (UCRC), University of Crete, Rethymno, Greece
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Vines L, Bridgwater M, Bachman P, Hayes R, Catalano S, Jalbrzikowski M. Elevated emotion reactivity and emotion regulation in individuals at clinical high risk for developing psychosis and those diagnosed with a psychotic disorder. Early Interv Psychiatry 2022; 16:724-735. [PMID: 34528404 DOI: 10.1111/eip.13212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 06/29/2021] [Accepted: 08/15/2021] [Indexed: 11/28/2022]
Abstract
AIMS Disrupted affective processes are core features of psychosis; yet emotion reactivity and emotion regulation impairments have not been fully characterized in individuals at clinical high-risk for developing psychosis (CHR) or adolescents diagnosed with a psychotic disorder (AOP). Characterizing these impairments may provide a fuller understanding of factors contributing to psychosis risk and psychosis onset. Using cross-sectional and longitudinal data, we evaluated (1) group-level effects of emotion reactivity and regulation, (2) stability of group-level effects over time and age, (3) relationships between emotion reactivity and regulation, and (4) associations between these measures and psychosocial functioning and clinical symptomatology. METHODS Eighty-seven participants (CHR = 32, TD = 42, AOP = 13; 12-25 years, 1-5 visits) completed the Emotion Reactivity Scale, Difficulties in Emotion Regulation Scale, and Emotion Regulation Questionnaire. We assessed psychotic symptoms with the Structured Interview for Prodromal Syndromes and measured real-world functioning with the Global Functioning: Social and Role Scales. We used analysis of variance to assess Aim 1 and linear mixed models to address Aims 2-4. RESULTS CHR and AOP endorsed experiencing heightened levels of emotion reactivity and greater difficulty utilizing emotion regulation strategies compared to TD. These impairments were stable across time and adolescent development. Greater levels of emotion reactivity were associated with greater emotion regulation impairments. Greater impairments in emotion regulation were associated with lower social functioning and greater negative symptom severity. CONCLUSION Therapeutic interventions designed to reduce emotion reactivity and improve one's ability to utilize emotion regulation strategies may be effective in reducing clinical symptomatology and improving real-world functioning in CHR and AOP.
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Affiliation(s)
- Leah Vines
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miranda Bridgwater
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA
| | - Peter Bachman
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Hayes
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sabrina Catalano
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria Jalbrzikowski
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hou J, Schmitt S, Zhao X, Wang J, Chen J, Mao Z, Qi A, Lu Z, Kircher T, Yang Y, Shi J. Neural Correlates of Facial Emotion Recognition in Non-help-seeking University Students With Ultra-High Risk for Psychosis. Front Psychol 2022; 13:812208. [PMID: 35756282 PMCID: PMC9226575 DOI: 10.3389/fpsyg.2022.812208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Since the introduction of the neurodevelopmental perspective of schizophrenia research on individuals at ultra-high risk for psychosis (UHR) has gained increasing interest, aiming at early detection and intervention. Results from fMRI studies investigating behavioral and brain functional changes in UHR during facial emotion recognition, an essential component of social cognition, showed heterogenous results, probably due clinical diversity across these investigations. This fMRI study investigated emotion recognition in a sub-group of the UHR spectrum, namely non-help-seeking, drug-naïve UHR with high cognitive functioning to reveal the neurofunctional underpinnings of their social functioning in comparison to healthy controls. Methods Two large cohorts of students from an elite University (n 1 = 4,040, n 2 = 4,364) were screened firstly with the Prodromal Questionnaires and by surpassing predefined cut-offs then interviewed with the semi-structured Interview for Psychosis-Risk Syndromes to verify their UHR status. Twenty-one identified non-help-seeking UHR and 23 non-UHR control subjects were scanned with functional magnetic resonance imaging while classifying emotions (i.e., neutral, happy, disgust and fear) in a facial emotion recognition task. Results Behaviorally, no group differences were found concerning accuracy, reaction times, sensitivity or specificity, except that non-help-seeking UHR showed higher specificity when recognizing neutral facial expressions. In comparison to healthy non-UHR controls, non-help-seeking UHR showed generally higher activation in the superior temporal and left Heschl's gyrus as well as in the somatosensory, insular and midcingulate cortex than the control subjects during the entire recognition task regardless of the emotion categories. In an exploratory analysis, in the non-help-seeking UHR group, functional activity in the left superior temporal gyrus was significantly correlated with deficits in the ability to experience emotions at uncorrected statistical thresholds. Conclusions Compared to healthy controls, non-help-seeking UHR show no behavioral deficits during facial emotion recognition, but functional hyperactivities in brain regions associated with this cognitive process. Our study may inspire future early intervention and provide loci for treatment using neural stimulation.
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Affiliation(s)
- Jiaojiao Hou
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Simon Schmitt
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
- Hannover Medical School, Clinics for Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany
| | - Xudong Zhao
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, China
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Jiayi Wang
- Tongji University School of Medicine, Shanghai, China
| | - Jianxing Chen
- Tongji University School of Medicine, Shanghai, China
| | - Ziyu Mao
- Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ansi Qi
- Department of Medical Psychology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Lu
- Department of Psychiatry, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tilo Kircher
- Department of Psychiatry, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
| | - Yunbo Yang
- Department of Psychiatry, University of Marburg, Marburg, Germany
| | - Jingyu Shi
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Division of Medical Humanities and Behavioral Sciences, Tongji University School of Medicine, Shanghai, China
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12
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Mohn-Haugen CR, Mohn C, Larøi F, Teigset CM, Øie MG, Rund BR. A systematic review of premorbid cognitive functioning and its timing of onset in schizophrenia spectrum disorders. Schizophr Res Cogn 2022; 28:100246. [PMID: 35251943 PMCID: PMC8892142 DOI: 10.1016/j.scog.2022.100246] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/24/2022]
Abstract
Cognitive impairments are core features of established schizophrenia spectrum disorders (SSD). However, it remains unclear whether specific cognitive functions are differentially impaired pre-onset and at what age these impairments can be detected. The purpose of this review was to elucidate these issues through a systematic summary of results from longitudinal studies investigating impairment in specific cognitive domains as antecedents of SSD. Relevant studies were identified by electronic and manual literature searches and included any original study of cognitive domains any time pre-onset of SSDs that included a control group. Effect sizes were calculated by domain for studies comparing high-risk participants who developed SSD with those who did not. The strongest evidence for impairment pre-onset was for mental processing speed, verbal learning and memory, executive function, and social cognition. Some verbal impairments, like language abilities at age 3 and verbal learning and memory at age 7, may develop as static deficits. Conversely, some non-verbal impairments, like mental processing speed, visuospatial abilities, and visual working memory manifest as developmental lag and become significant later in life. Most effect sizes were small to moderate, except for verbal fluency (d′ = 0,85), implying this impairment as central in high-risk participants who develop SSD. The present review documents extensive cognitive impairments pre-onset of SSD, and that these impairments start early in life, in line with the neurodevelopmental hypothesis of schizophrenia. Increased knowledge about cognitive impairments preonset can provide a better basis for understanding the complex pathogenesis of SSD as well as informing cognitive remediation programs. Specific cognitive domains evidence differential impairment pre-onset. Most effect sizes were small to moderate. Some verbal impairments develop as static deficits from early childhood. Some non-verbal impairments present as developmental lag and become apparent later. Impairments start early in life, in line with the neurodevelopmental hypothesis.
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Affiliation(s)
- Caroline Ranem Mohn-Haugen
- Research Department, Vestre Viken Hospital Trust, 3004 Drammen, Norway.,Department of Psychology, P. O. box 1094, Blindern, University of Oslo, 0317 Oslo, Norway
| | - Christine Mohn
- Norment Centre, Institute of Clinical Medicine, University of Oslo, P.O. box 4956, Nydalen, 0424 Oslo, Norway
| | - Frank Larøi
- Department of Psychology, P. O. box 1094, Blindern, University of Oslo, 0317 Oslo, Norway.,Psychology and Neuroscience of Cognition Research Unit, University of Liège, B-4000, Belgium
| | | | - Merete Glenne Øie
- Department of Psychology, P. O. box 1094, Blindern, University of Oslo, 0317 Oslo, Norway
| | - Bjørn Rishovd Rund
- Research Department, Vestre Viken Hospital Trust, 3004 Drammen, Norway.,Department of Psychology, P. O. box 1094, Blindern, University of Oslo, 0317 Oslo, Norway
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13
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Amorim M, Roberto MS, Kotz SA, Pinheiro AP. The perceived salience of vocal emotions is dampened in non-clinical auditory verbal hallucinations. Cogn Neuropsychiatry 2022; 27:169-182. [PMID: 34261424 DOI: 10.1080/13546805.2021.1949972] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Introduction: Auditory verbal hallucinations (AVH) are a cardinal symptom of schizophrenia but are also reported in the general population without need for psychiatric care. Previous evidence suggests that AVH may reflect an imbalance of prior expectation and sensory information, and that altered salience processing is characteristic of both psychotic and non-clinical voice hearers. However, it remains to be shown how such an imbalance affects the categorisation of vocal emotions in perceptual ambiguity.Methods: Neutral and emotional nonverbal vocalisations were morphed along two continua differing in valence (anger; pleasure), each including 11 morphing steps at intervals of 10%. College students (N = 234) differing in AVH proneness (measured with the Launay-Slade Hallucination Scale) evaluated the emotional quality of the vocalisations.Results: Increased AVH proneness was associated with more frequent categorisation of ambiguous vocalisations as 'neutral', irrespective of valence. Similarly, the perceptual boundary for emotional classification was shifted by AVH proneness: participants needed more emotional information to categorise a voice as emotional.Conclusions: These findings suggest that emotional salience in vocalisations is dampened as a function of increased AVH proneness. This could be related to changes in the acoustic representations of emotions or reflect top-down expectations of less salient information in the social environment.
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Affiliation(s)
- Maria Amorim
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Magda S Roberto
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal
| | - Sonja A Kotz
- Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, The Netherlands.,Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Ana P Pinheiro
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Lisboa, Portugal.,Faculty of Psychology and Neuroscience, University of Maastricht, Maastricht, The Netherlands
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14
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Osborne KJ, Kraus B, Curran T, Earls H, Mittal VA. An Event-Related Potential Investigation of Early Visual Processing Deficits During Face Perception in Youth at Clinical High Risk for Psychosis. Schizophr Bull 2022; 48:90-99. [PMID: 34111294 PMCID: PMC8781328 DOI: 10.1093/schbul/sbab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Impairments in early visual face perception are well documented in patients with schizophrenia. Specifically, event-related potential (ERP) research in patients with schizophrenia has demonstrated deficits in early sensory processing of stimulus properties (P1 component) and the structural encoding of faces (N170 component). However, it is not well understood if similar impairments are present in individuals at clinical high risk (CHR) for psychosis (ie, those in the putative prodromal stage of the illness). Thus, it is unknown if face perception deficits are the result of illness onset or are present in the high-risk period for the illness. The present study used the ERP technique to examine neural activation when viewing facial emotion expressions and objects in 44 CHR and 47 control adolescents and young adults (N = 91). P1 amplitude was similar across groups, indicating that early sensory processing impairments did not substantially contribute to face perception deficits in CHR youth. CHR youth exhibited reduced N170 amplitude compared to controls when viewing faces but not objects, implicating a specific deficit in the structural encoding of faces rather than a general perceptual deficit. Further, whereas controls demonstrated the expected face-selective N170 effect (ie, larger amplitude for faces than objects), CHR youth did not, which suggests that facial emotion expressions do not elicit the expected preferential perceptual processing for critical social information in individuals at CHR for psychosis. Together, these findings provide valuable information regarding the specific impairments contributing to face perception deficits in the high-risk period where treatment stands to aid in preventing illness progression.
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Affiliation(s)
- K Juston Osborne
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Brian Kraus
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Tim Curran
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Boulder, CO, USA
| | - Holly Earls
- Department of Psychology and Neuroscience, University of Colorado, Boulder, Boulder, CO, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
- Department of Psychiatry, Northwestern University, Evanston, IL, USA
- Institute for Policy Research, Northwestern University, Evanston, IL, USA
- Department of Medical Social Sciences, Evanston, IL, USA
- Institute for Innovations in Developmental Sciences (DevSci), Evanston, Chicago, IL, USA
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15
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Lukow PB, Kiemes A, Kempton MJ, Turkheimer FE, McGuire P, Modinos G. Neural correlates of emotional processing in psychosis risk and onset - A systematic review and meta-analysis of fMRI studies. Neurosci Biobehav Rev 2021; 128:780-788. [PMID: 33722617 PMCID: PMC8345001 DOI: 10.1016/j.neubiorev.2021.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/17/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
The neural bases of altered emotion processing in psychosis are still unclear. Systematic review indicated widespread activation decreases to emotion in first-episode psychosis. Evidence in people at clinical high-risk for psychosis lacked convergence. These findings were corroborated by image-based meta-analyses.
Aberrant emotion processing is a well-established component of psychotic disorders and is already present at the first episode of psychosis (FEP). However, the role of emotion processing abnormalities in the emergence of psychosis and the underlying neurobiology remain unclear. Here, we systematically reviewed functional magnetic resonance studies that used emotion processing task paradigms in FEP patients, and in people at clinical high-risk for psychosis (CHRp). Image-based meta-analyses with Seed-based d Mapping on available studies (n = 6) were also performed. Compared to controls, FEP patients showed decreased neural responses to emotion, particularly in the amygdala and anterior cingulate cortex. There were no significant differences between CHRp subjects and controls, but a high degree of heterogeneity was identified across studies. The role of altered emotion processing in the early phase of psychosis may be clarified through more homogenous experimental designs, particularly in the CHRp population.
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Affiliation(s)
- P B Lukow
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
| | - A Kiemes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
| | - M J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
| | - F E Turkheimer
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
| | - P McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK.
| | - G Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK; MRC Centre for Neurodevelopmental Disorders, King's College London, new hunt's House, Guy's Campus, SE1 1UL, London, UK.
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16
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Pena-Garijo J, Monfort-Escrig C. The centrality of secure attachment within an interacting network of symptoms, cognition, and attachment dimensions in persons with schizophrenia-spectrum disorders: A preliminary study. J Psychiatr Res 2021; 135:60-67. [PMID: 33450466 DOI: 10.1016/j.jpsychires.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Research in the field of psychosis broadly suggests that symptoms, neurocognitive deficits, social cognition, cognitive biases, and attachment experiences influence each other. However, little is known if any of these constructions play a more central role than others as they interact. METHOD To clarify this issue, we conducted a "network" analysis to explore the interplay among a set of variables related to attachment, cognition domains, and psychotic symptoms in a small sample of outpatients with stabilised schizophrenia-spectrum disorders (n = 25). Eighteen participants (72%) were first-episode patients. We assessed psychotic symptoms, attachment dimensions, neurocognitive performance, "theory of mind", emotion recognition, and "jumping to conclusions" bias using standardised instruments. RESULTS The study provides preliminary evidence about a network structure in which the secure attachment (SA) is the most central "node" within the interacting network considering all centrality measures, followed by general psychopathology. SA was closely connected to self-sufficiency (avoidant attachment) and child traumatism, as well as with neurocognition. Emotion recognition impairment was the most robust connection to positive symptoms and mediated the influence of SA on psychotic symptoms. CONCLUSIONS Beyond the importance of symptoms, our results, although preliminary, suggest the need to assess attachment experiences and cognition domains to improve specific interventions that can promote recovery in outpatients with psychosis.
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Affiliation(s)
- Josep Pena-Garijo
- Jaume I University. Castellon de la Plana, Spain; Mental Health Service. University Hospital Doctor Peset. Valencia, Spain.
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17
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Tognin S, Catalan A, Modinos G, Kempton MJ, Bilbao A, Nelson B, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BPF, van Os J, de Haan L, van der Gaag M, McGuire P, Valmaggia LR. Emotion Recognition and Adverse Childhood Experiences in Individuals at Clinical High Risk of Psychosis. Schizophr Bull 2020; 46:823-833. [PMID: 32080743 PMCID: PMC7345818 DOI: 10.1093/schbul/sbz128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the association between facial affect recognition (FAR) and type of adverse childhood experiences (ACEs) in a sample of clinical high risk (CHR) individuals and a matched sample of healthy controls (HCs). METHODS In total, 309 CHR individuals and 51 HC were recruited as part of an European Union-funded multicenter study (EU-GEI) and included in this work. During a 2-year follow-up period, 65 CHR participants made a transition to psychosis (CHR-T) and 279 did not (CHR-NT). FAR ability was measured using a computerized version of the Degraded Facial Affect Recognition (DFAR) task. ACEs were measured using the Childhood Experience of Care and Abuse Questionnaire, the Childhood Trauma Questionnaire, and the Bullying Questionnaire. Generalized regression models were used to investigate the relationship between ACE and FAR. Logistic regressions were used to investigate the relationship between FAR and psychotic transition. RESULTS In CHR individuals, having experienced emotional abuse was associated with decreased total and neutral DFAR scores. CHR individuals who had experienced bullying performed better in the total DFAR and in the frightened condition. In HC and CHR, having experienced the death of a parent during childhood was associated with lower DFAR total score and lower neutral DFAR score, respectively. Analyses revealed a modest increase of transition risk with increasing mistakes from happy to angry faces. CONCLUSIONS Adverse experiences in childhood seem to have a significant impact on emotional processing in adult life. This information could be helpful in a therapeutic setting where both difficulties in social interactions and adverse experiences are often addressed.
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Affiliation(s)
- Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; tel: +44(0)2078480415, fax: +44 (0)20 7848 0287, e-mail:
| | - Ana Catalan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Psychiatry, Basurto University Hospital, Bilbao, Spain,Department of Neuroscience, University of the Basque Country, Leioa, Spain
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christos Pantelis
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Rodrigo Bressan
- LiNC – Lab Integrative Neuroscience, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Madrid, Spain
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France,Faculté de Médecine Paris Descartes, GHU Paris – Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Mental Health research institute, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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18
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Modinos G, Kempton MJ, Tognin S, Calem M, Porffy L, Antoniades M, Mason A, Azis M, Allen P, Nelson B, McGorry P, Pantelis C, Riecher-Rössler A, Borgwardt S, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Glenthøj B, Ruhrmann S, Sachs G, Rutten B, van Os J, de Haan L, Velthorst E, van der Gaag M, Valmaggia LR, McGuire P. Association of Adverse Outcomes With Emotion Processing and Its Neural Substrate in Individuals at Clinical High Risk for Psychosis. JAMA Psychiatry 2020; 77:190-200. [PMID: 31722018 PMCID: PMC6865249 DOI: 10.1001/jamapsychiatry.2019.3501] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE The development of adverse clinical outcomes in patients with psychosis has been associated with behavioral and neuroanatomical deficits related to emotion processing. However, the association between alterations in brain regions subserving emotion processing and clinical outcomes remains unclear. OBJECTIVE To examine the association between alterations in emotion processing and regional gray matter volumes in individuals at clinical high risk (CHR) for psychosis, and the association with subsequent clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This naturalistic case-control study with clinical follow-up at 12 months was conducted from July 1, 2010, to August 31, 2016, and collected data from 9 psychosis early detection centers (Amsterdam, Basel, Cologne, Copenhagen, London, Melbourne, Paris, The Hague, and Vienna). Participants (213 individuals at CHR and 52 healthy controls) were enrolled in the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI) project. Data were analyzed from October 1, 2018, to April 24, 2019. MAIN MEASURES AND OUTCOMES Emotion recognition was assessed with the Degraded Facial Affect Recognition Task. Three-Tesla magnetic resonance imaging scans were acquired from all participants, and gray matter volume was measured in regions of interest (medial prefrontal cortex, amygdala, hippocampus, and insula). Clinical outcomes at 12 months were evaluated for transition to psychosis using the Comprehensive Assessment of At-Risk Mental States criteria, and the level of overall functioning was measured through the Global Assessment of Functioning [GAF] scale. RESULTS A total of 213 individuals at CHR (105 women [49.3%]; mean [SD] age, 22.9 [4.7] years) and 52 healthy controls (25 women [48.1%]; mean [SD] age, 23.3 [4.0] years) were included in the study at baseline. At the follow-up within 2 years of baseline, 44 individuals at CHR (20.7%) had developed psychosis and 169 (79.3%) had not. Of the individuals at CHR reinterviewed with the GAF, 39 (30.0%) showed good overall functioning (GAF score, ≥65), whereas 91 (70.0%) had poor overall functioning (GAF score, <65). Within the CHR sample, better anger recognition at baseline was associated with worse functional outcome (odds ratio [OR], 0.88; 95% CI, 0.78-0.99; P = .03). In individuals at CHR with a good functional outcome, positive associations were found between anger recognition and hippocampal volume (ze = 3.91; familywise error [FWE] P = .02) and between fear recognition and medial prefrontal cortex volume (z = 3.60; FWE P = .02), compared with participants with a poor outcome. The onset of psychosis was not associated with baseline emotion recognition performance (neutral OR, 0.93; 95% CI, 0.79-1.09; P = .37; happy OR, 1.03; 95% CI, 0.84-1.25; P = .81; fear OR, 0.98; 95% CI, 0.85-1.13; P = .77; anger OR, 1.00; 95% CI, 0.89-1.12; P = .96). No difference was observed in the association between performance and regional gray matter volumes in individuals at CHR who developed or did not develop psychosis (FWE P < .05). CONCLUSIONS AND RELEVANCE In this study, poor functional outcome in individuals at CHR was found to be associated with baseline abnormalities in recognizing negative emotion. This finding has potential implications for the stratification of individuals at CHR and suggests that interventions that target socioemotional processing may improve functional outcomes.
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Affiliation(s)
- Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, London, United Kingdom
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Maria Calem
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Lilla Porffy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Mathilde Antoniades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ava Mason
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom,Department of Psychology, University of Roehampton, London, United Kingdom
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Center for Neuropsychiatric Schizophrenia Research, University of Copenhagen, Mental Health Centre Glostrup, Copenhagen, Denmark,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, University of Copenhagen, Mental Health Centre Glostrup, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Rodrigo Bressan
- LiNC—Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo—UNIFESP, São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver (Spain), Spanish Mental Health Research Network (CIBERSAM), Barcelona, Spain
| | - Marie-Odile Krebs
- University of Paris, GHU-Paris, Sainte-Anne, C’JAAD, Hospitalo-Universitaire Department SHU, Inserm U1266, Institut de Psychiatrie (CNRS 3557), Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research, University of Copenhagen, Mental Health Centre Glostrup, Copenhagen, Denmark,Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, University of Copenhagen, Mental Health Centre Glostrup, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart Rutten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom,University Medical Centre Utrecht Brain Center, Department of Psychiatry, Utrecht University Medical Centre, Utrecht, the Netherlands
| | - Lieuwe de Haan
- Early Psychosis Department, Amsterdam UMC, Amsterdam, the Netherlands
| | - Eva Velthorst
- Early Psychosis Department, Amsterdam UMC, Amsterdam, the Netherlands,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark van der Gaag
- Amsterdam Public Mental Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Parnassia Psychiatric Institute, Department of Psychosis Research, The Hague, the Netherlands
| | - Lucia R. Valmaggia
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom,National Institute for Health Research, Biomedical Research Centre, London, United Kingdom,South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
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19
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Haining K, Matrunola C, Mitchell L, Gajwani R, Gross J, Gumley AI, Lawrie SM, Schwannauer M, Schultze-Lutter F, Uhlhaas PJ. Neuropsychological deficits in participants at clinical high risk for psychosis recruited from the community: relationships to functioning and clinical symptoms. Psychol Med 2020; 50:77-85. [PMID: 30862319 PMCID: PMC6949121 DOI: 10.1017/s0033291718003975] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The current study examined the pattern of neurocognitive impairments in a community-recruited sample of clinical high-risk (CHR) participants and established relationships with psychosocial functioning. METHODS CHR-participants (n = 108), participants who did not fulfil CHR-criteria (CHR-negatives) (n = 42) as well as a group of healthy controls (HCs) (n = 55) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed. RESULTS CHR-participants were significantly impaired on the Symbol-Coding and Token-Motor task and showed a reduction in total BACS-scores. Moreover, CHR-participants were characterised by prolonged response times (RTs) in emotion recognition as well as by reductions in both social and role functioning, GAF and premorbid adjustments compared with HCs. Neurocognitive impairments in emotion recognition accuracy, emotion recognition RT, processing speed and motor speed were associated with several aspects of functioning explaining between 4% and 12% of the variance. CONCLUSION The current data obtained from a community sample of CHR-participants highlight the importance of dysfunctions in motor and processing speed and emotion recognition RT. Moreover, these deficits were found to be related to global, social and role functioning, suggesting that neurocognitive impairments are an important aspect of sub-threshold psychotic experiences and a possible target for therapeutic interventions.
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Affiliation(s)
- Kate Haining
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Claire Matrunola
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Lucy Mitchell
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
| | - Ruchika Gajwani
- Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Germany
| | - Joachim Gross
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
- Institute of Biomagnetism and Biosignalanalysis, Westphalian Wilhelms University Muenster, Germany
| | | | | | | | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Univ. of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Germany
| | - Peter J. Uhlhaas
- Institute for Neuroscience and Psychology, Univ. of Glasgow, U.K
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20
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Oliver D, Reilly TJ, Baccaredda Boy O, Petros N, Davies C, Borgwardt S, McGuire P, Fusar-Poli P. What Causes the Onset of Psychosis in Individuals at Clinical High Risk? A Meta-analysis of Risk and Protective Factors. Schizophr Bull 2020; 46:110-120. [PMID: 31219164 PMCID: PMC6942149 DOI: 10.1093/schbul/sbz039] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Twenty percent of individuals at clinical high risk for psychosis (CHR-P) develop the disorder within 2 years. Extensive research has explored the factors that differentiate those who develop psychosis and those who do not, but the results are conflicting. The current systematic review and meta-analysis comprehensively addresses the consistency and magnitude of evidence for non-purely genetic risk and protective factors associated with the risk of developing psychosis in CHR-P individuals. Random effects meta-analyses, standardized mean difference (SMD) and odds ratio (OR) were used, in combination with an established stratification of evidence that assesses the association of each factor and the onset of psychotic disorders (from class I, convincing evidence to class IV weak evidence), while controlling for several types of biases. A total of 128 original controlled studies relating to 26 factors were retrieved. No factors showed class I-convincing evidence. Two further factors were associated with class II-highly suggestive evidence: attenuated positive psychotic symptoms (SMD = 0.348, 95% CI: 0.280, 0.415) and global functioning (SMD = -0.291, 95% CI: -0.370, -0.211). There was class III-suggestive evidence for negative psychotic symptoms (SMD = 0.393, 95% CI: 0.317, 0.469). There was either class IV-weak or no evidence for all other factors. Our findings suggest that despite the large number of putative risk factors investigated in the literature, only attenuated positive psychotic symptoms, global functioning, and negative psychotic symptoms show suggestive evidence or greater for association with transition to psychosis. The current findings may inform the refinement of clinical prediction models and precision medicine in this field.
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Affiliation(s)
- Dominic Oliver
- Early Psychosis: Interventions and Clinical detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,To whom correspondence should be addressed; Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF, UK; tel: 02078-480-355, e-mail:
| | - Thomas J Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ottone Baccaredda Boy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Natalia Petros
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Cathy Davies
- Early Psychosis: Interventions and Clinical detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,OASIS Service, South London and the Maudsley NHS National Health Service Foundation Trust, London, UK,Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy,National Institute of Health Research, Mental Health, Translational Research Collaboration, Early Psychosis Workstream, UK
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21
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Maat A, Therman S, Swaab H, Ziermans T. The Attenuated Psychosis Syndrome and Facial Affect Processing in Adolescents With and Without Autism. Front Psychiatry 2020; 11:759. [PMID: 32848934 PMCID: PMC7416636 DOI: 10.3389/fpsyt.2020.00759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Autism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. The attenuated psychosis syndrome (APS) is primarily defined by the presence of attenuated psychotic symptoms, which currently constitute the best and most-replicated clinical predictors of psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level. MATERIALS AND METHOD Fifty-three adolescents with APS and 81 typically developing controls (aged 12-18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition was assessed with the Amsterdam Neuropsychological Tasks using a cascade model of cognitive processing, in which disturbances in "lower-level" cognitive abilities (pattern recognition), affect "higher-level" cognitive processes (face recognition and facial affect recognition). For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication Questionnaire were used in a confirmatory item factor analysis framework. RESULTS Contrary to expectation, APS in adolescents was not associated with impairments in pattern, face, or facial affect recognition. However, the APS group with autism spectrum disorder showed a general latency in response time to social and non-social stimuli. Dimensionally assessed schizotypal and autistic-like traits did not predict the accuracy or the speed of face or facial affect recognition. CONCLUSION Facial affect processing performance was not associated with APS in adolescence and represents an unlikely early vulnerability marker for psychosis. APS individuals with a more autistic-like profile were characterized by slower responses to social- and non-social stimuli, suggesting that the combined effect of APS and autism spectrum disorder on cognition is larger than for APS alone.
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Affiliation(s)
- Arija Maat
- Department of Psychiatry, UMC Utrecht, University of Utrecht, Utrecht, Netherlands
| | - Sebastian Therman
- Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Swaab
- Clinical Child & Adolescent Studies, Leiden University, Leiden, Netherlands
| | - Tim Ziermans
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
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22
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Kleineidam L, Frommann I, Ruhrmann S, Klosterkötter J, Brockhaus-Dumke A, Wölwer W, Gaebel W, Maier W, Wagner M, Ettinger U. Antisaccade and prosaccade eye movements in individuals clinically at risk for psychosis: comparison with first-episode schizophrenia and prediction of conversion. Eur Arch Psychiatry Clin Neurosci 2019; 269:921-930. [PMID: 30635714 DOI: 10.1007/s00406-018-0973-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/19/2018] [Indexed: 02/03/2023]
Abstract
Saccadic eye movements are well-described markers of cerebral function and have been widely studied in schizophrenia spectrum populations. However, less is known about saccades in individuals clinically at risk for schizophrenia. Therefore, we studied individuals in an at-risk mental state (ARMS) (N = 160), patients in their first episode of schizophrenia (N = 32) and healthy controls (N = 75). N = 88 ARMS participants showed an early at-risk mental state (E-ARMS), defined by cognitive-perceptive basic symptoms (COPER) or a combination of risk and loss of function, whereas N = 72 were in a late at-risk mental state (L-ARMS), defined by attenuated psychotic symptoms or brief limited intermittent psychotic symptoms. We examined prosaccades, reflecting overt attentional shifts, and antisaccades, measuring inhibitory control, as well as their relationship as an indicator of the interplay of bottom-up and top-down influences. L-ARMS but not E-ARMS participants had increased antisaccade latencies compared to controls. First-episode patients had higher antisaccade error rates compared to E-ARMS participants and controls, and increased latencies compared to all other groups. Prosaccade latencies did not differ between groups. We observed the expected negative correlation between prosaccade latency and antisaccade error rate, indicating that individuals with shorter prosaccade latencies made more antisaccade errors. The magnitude of the association did not differ between groups. No saccadic measure predicted conversion to psychosis within 2 years. These findings confirm the existence of antisaccade impairments in patients with schizophrenia and provide evidence that volitional response generation in the antisaccade task may be affected even before onset of clinically overt psychosis.
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Affiliation(s)
- Luca Kleineidam
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Ingo Frommann
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anke Brockhaus-Dumke
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Rheinhessen-Fachklinik Alzey, Dautenheimer Landstraße 66, 55232, Alzey, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany. .,Department for Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Ulrich Ettinger
- Department of Psychology, University of Bonn, Kaiser-Karl-Ring 9, 53111, Bonn, Germany
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23
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Romain K, Eriksson A, Onyon R, Kumar M. The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.LEARNING OBJECTIVES:After reading this article you will be able to:
•understanding the range of risk factors for development of psychotic symptoms in young people and adults•understand in particular the association between trauma/abuse and subsequent psychosis•appreciate current evidence for the nature and strength of the link between substance misuse and psychosis.DECLARATION OF INTEREST:None.
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24
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Jalbrzikowski M, Murty VP, Tervo-Clemmens B, Foran W, Luna B. Age-Associated Deviations of Amygdala Functional Connectivity in Youths With Psychosis Spectrum Disorders: Relevance to Psychotic Symptoms. Am J Psychiatry 2019; 176:196-207. [PMID: 30654642 PMCID: PMC6420321 DOI: 10.1176/appi.ajp.2018.18040443] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The authors created normative growth charts of amygdala functional connectivity in typically developing youths, assessed age-associated deviations of these trajectories in youths with psychosis spectrum disorders, and explored how these disruptions are related to clinical symptomatology. METHODS Resting-state functional neuroimaging data from four samples (three cross-sectional, one longitudinal) were collected for 1,062 participants 10-25 years of age (622 typically developing control youths, 194 youths with psychosis spectrum disorders, and 246 youths with other psychopathology). The authors assessed deviations in the psychosis spectrum and other psychopathology groups in age-related changes in resting-state functional MRI amygdala-to-whole brain connectivity from a normative range derived from the control youths. The authors explored relationships between age-associated deviations in amygdala connectivity and positive symptoms in the psychosis spectrum group. RESULTS Normative trajectories demonstrated significant age-related decreases in centromedial amygdala connectivity with distinct regions of the brain. In contrast, the psychosis spectrum group failed to exhibit any significant age-associated changes between the centromedial amygdala and the prefrontal cortices, striatum, occipital cortex, and thalamus (all q values <0.1). Age-associated deviations in centromedial amygdala-striatum and centromedial amygdala-occipital connectivity were unique to the psychosis spectrum group and were not observed in the other psychopathology group. Exploratory analyses revealed that greater age-related deviation in centromedial amygdala-thalamus connectivity was significantly associated with increased severity of positive symptoms (r=0.19; q=0.05) in the psychosis spectrum group. CONCLUSIONS Using neurodevelopmental growth charts to identify a lack of normative development of amygdala connectivity in youths with psychosis spectrum disorders may help us better understand the neural basis of affective impairments in psychosis, informing prediction models and interventions.
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Affiliation(s)
| | | | | | | | - Beatriz Luna
- University of Pittsburgh, Department of Psychiatry,University of Pittsburgh, Department of Psychology,University of Pittsburgh, Department of Pediatrics
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25
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Influence of emotional contexts on facial emotion attribution in schizophrenia. Psychiatry Res 2018; 270:554-559. [PMID: 30343241 DOI: 10.1016/j.psychres.2018.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 11/20/2022]
Abstract
Recent emotion recognition studies in schizophrenia have reported misattribution of emotional content to emotionally neutral faces. While in these studies faces are presented in the absence of any contextual reference, in daily life facial expressions are typically perceived within a specific situational context. However, there is no evidence on the possible modulatory role of contextual aids on emotion attribution to neutral faces. We address this issue in the present study. Thirty schizophrenia patients and thirty paired controls performed an emotion categorization task (by choosing one among six labels of emotions) with neutral target faces that were superimposed on affectively positive, negative or neutral scenes. In presence of positive contexts, patients categorized neutral faces as happy and fearful more frequently than controls. When negative contexts were present, patients also categorized neutral faces as fearful more frequently than controls. However, in the presence of neutral contexts patients and controls did not differ in their categorization pattern. These results suggest that explicit presence of a neutral context seems to compensate for the bias showed by patients. With the purpose of correcting emotion misattribution in schizophrenia, emotionally neutral contexts might be incorporated to treatments aimed at improving social cognition performance in this patient population.
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26
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Glenthøj LB, Fagerlund B, Bak N, Hjorthøj C, Gregersen M, Kristensen TD, Wenneberg C, Krakauer K, Ventura J, Jepsen JRM, Nordentoft M. Examining speed of processing of facial emotion recognition in individuals at ultra-high risk for psychosis: Associations with symptoms and cognition. Schizophr Res 2018; 195:562-563. [PMID: 29102222 DOI: 10.1016/j.schres.2017.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/17/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Louise Birkedal Glenthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark.
| | - Birgitte Fagerlund
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark
| | - Nikolaj Bak
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark
| | - Carsten Hjorthøj
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark
| | - Maja Gregersen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark
| | - Tina Dam Kristensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
| | - Christina Wenneberg
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Functional Imaging Unit, Dep. of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Kristine Krakauer
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Functional Imaging Unit, Dep. of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, CA, USA
| | - Jens Richardt Møllegaard Jepsen
- Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark; Centre for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, Copenhagen University Hospital, DK-2600 Glostrup, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, University of Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen University Hospital, DK-2900 Hellerup, Denmark; Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, DK-2600 Glostrup, Denmark
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27
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Ntouros E, Karanikas E, Floros G, Andreou C, Tsoura A, Garyfallos G, Bozikas VP. Social cognition in the course of psychosis and its correlation with biomarkers in a male cohort. Cogn Neuropsychiatry 2018; 23:103-115. [PMID: 29447074 DOI: 10.1080/13546805.2018.1440201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Patients diagnosed with schizophrenia display deficits in Theory of Mind (ToM) and Emotion Perception (EP) even before the appearance of full-blown symptomatology. METHODS We evaluated ToM and EP in a male cohort consisting of 25 First Episode Psychosis (FEP) and 16 relapsed schizophrenic patients (CHRON) compared to 12 subjects in Ultra-high Risk (UHR) and 23 healthy controls (CTR). Furthermore, we measured the levels of Cortisol, Insulin like Growth Factor (IGF-1), TNF-a, TNF-b and several interleukins as potential biomarkers. RESULTS Deficits in EP and ToM were found in FEP, CHRON patients and UHR subjects compared to CTR. The impairments in these two domains seem to follow different patterns in the course of psychosis. EP was more impaired in subjects with a longer history of symptomatology whereas there was no statistically significant difference regarding ToM. On the other hand IL-4 was the only biomarker correlated to ToM and EP scores in two different samples of our study. CONCLUSION Social Cognition (SC) domains are impaired in patients with psychosis as well as in UHR subjects compared to healthy controls. There are differences in the progress of ToM and EP deficits in the course of psychosis. Interleukins as IL-4 could correlate to SC.
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Affiliation(s)
- Evangelos Ntouros
- a Psychiatric Department , 424 General Military Hospital of Thessaloniki , Thessaloniki , Greece
| | - Evangelos Karanikas
- a Psychiatric Department , 424 General Military Hospital of Thessaloniki , Thessaloniki , Greece.,e The University of Queensland, Rural Clinical School, School of Medicine , Toowoomba , Australia
| | - Georgios Floros
- b 2nd Department of Psychiatry , Aristotle University of Thessaloniki, Psychiatric Hospital of Thessaloniki , Thessaloniki , Greece
| | - Christina Andreou
- c University Psychiatric Clinics, University of Basel , Basel , Switzerland
| | - Aikaterini Tsoura
- b 2nd Department of Psychiatry , Aristotle University of Thessaloniki, Psychiatric Hospital of Thessaloniki , Thessaloniki , Greece
| | - Georgios Garyfallos
- b 2nd Department of Psychiatry , Aristotle University of Thessaloniki, Psychiatric Hospital of Thessaloniki , Thessaloniki , Greece
| | - Vasilios P Bozikas
- d 1st Department of Psychiatry , Aristotle University of Thessaloniki, General Hospital "Papageorgiou" , Thessaloniki , Greece
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28
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A Developmental Perspective on Social-Cognition Difficulties in Youth at Clinical High Risk for Psychosis. Harv Rev Psychiatry 2018; 25:4-14. [PMID: 28059932 DOI: 10.1097/hrp.0000000000000125] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
After participating in this activity, learners should be better able to:• Evaluate the evolution of social cognitive abilities as a developmental process• Assess the evidence regarding social cognition difficulties in youth at clinical high risk for psychosisIndividuals at clinical high risk (CHR) for psychosis exhibit a broad range of difficulties, including impaired social cognition, which may represent a target for early identification and intervention. Several studies have examined various domains of social cognition in CHR individuals. Most focus on adolescent and young adult populations, but given the accumulating evidence that impairment exists before the onset of psychotic disorders, it is critically important to begin to look for these risk markers in younger children. The present article reviews 25 studies on CHR that examine any of the following four domains of social cognition: emotion processing, theory of mind, social perception, or attribution bias. Eligible studies were identified through a comprehensive literature search, conducted using electronic databases, including PubMed/MEDLINE and PsycINFO, and combinations of key social-cognition and CHR search terms. Despite some mixed results, the existing literature establishes that CHR individuals display social-cognitive impairment, though it remains unclear as to how and when that impairment develops. Thus, by using the literature on social cognition in typically developing children as a model and reference, and by looking at the evolution of social-cognitive abilities as a developmental process, our review presents a valuable new perspective that indicates the necessity of further investigation in younger, at-risk populations. Implications for treatment and future research are discussed.
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Sestito M, Parnas J, Maggini C, Gallese V. Sensing the Worst: Neurophenomenological Perspectives on Neutral Stimuli Misperception in Schizophrenia Spectrum. Front Hum Neurosci 2017; 11:269. [PMID: 28626392 PMCID: PMC5454073 DOI: 10.3389/fnhum.2017.00269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
While investigating social cognitive impairments in schizophrenia, prominent evidence has been found that patients with schizophrenia show a tendency to misclassify neutral stimuli as negatively valenced. Within this population, patients presenting delusions are more prone to this phenomenon. In a previous study, Schizophrenia spectrum (SzSp) patients rated positive, negative and neutral stimuli that were multimodally presented, while assessed with a checklist exploring anomalous subjective experiences and evaluated for positive and negative symptomatology. In the present work, we aimed to further explore the relationship between neutral stimuli misperception, anomalous experiences and positive/negative symptoms in SzSp patients. To this end, we adopted a dimensional approach by reconstructing from available data: (1) four a priori scales representing essential dimensions of SzSp experiential pathology following Parnas et al. (2005); and (2) five clinically meaningful factors to describe illness severity derived by Toomey et al. (1997). Results showed that although overall patients correctly recognized the target emotions, those who misinterpreted neutral auditory cues as negatively valenced also presented higher scores in Perplexity (PY), Bizarre Delusions (BD) and Disorganization (Di) dimensions. Moreover, a positive association between BD and both PY and Self-Disorder (SD) dimensions emerged, suggesting that psychotic symptoms may be directly linked to patients' subjectivity. In an attempt to comprehensively capture the multilayered neutral stimuli misperception phenomenon in SzSp, we aimed at bridging phenomenology and neurobiology by connecting the levels of molecular neurochemistry (i.e., altered dopaminergic neurotransmission), system neuroscience (aberrant salience of perceptual details) and psychopathology (the chain involving hyper-reflexivity, self-disorders and the emergence of delusions).
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Affiliation(s)
- Mariateresa Sestito
- Unit of Physiology, Department of Neuroscience, University of ParmaParma, Italy
- Department of Psychology, Wright State UniversityDayton, OH, United States
| | - Josef Parnas
- Psychiatric Center Hvidovre, University Hospital of CopenhagenCopenhagen, Denmark
- Center for Subjectivity Research, University of CopenhagenCopenhagen, Denmark
| | - Carlo Maggini
- Psychiatric Division, Department of Neuroscience, University of ParmaParma, Italy
| | - Vittorio Gallese
- Unit of Physiology, Department of Neuroscience, University of ParmaParma, Italy
- Institute of Philosophy, School of Advanced Study, University of LondonLondon, United Kingdom
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The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review. NPJ SCHIZOPHRENIA 2017; 3:20. [PMID: 28560266 PMCID: PMC5441569 DOI: 10.1038/s41537-017-0021-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/09/2017] [Accepted: 03/22/2017] [Indexed: 12/20/2022]
Abstract
Cognitive deficits are prominent features of the ultra-high risk state for psychosis that are known to impact functioning and course of illness. Cognitive remediation appears to be the most promising treatment approach to alleviate the cognitive deficits, which may translate into functional improvements. This study systematically reviewed the evidence on the effectiveness of cognitive remediation in the ultra-high risk population. The electronic databases MEDLINE, PsycINFO, and Embase were searched using keywords related to cognitive remediation and the UHR state. Studies were included if they were peer-reviewed, written in English, and included a population meeting standardized ultra-high risk criteria. Six original research articles were identified. All the studies provided computerized, bottom-up-based cognitive remediation, predominantly targeting neurocognitive function. Four out of five studies that reported a cognitive outcome found cognitive remediation to improve cognition in the domains of verbal memory, attention, and processing speed. Two out of four studies that reported on functional outcome found cognitive remediation to improve the functional outcome in the domains of social functioning and social adjustment. Zero out of the five studies that reported such an outcome found cognitive remediation to affect the magnitude of clinical symptoms. Research on the effect of cognitive remediation in the ultra-high risk state is still scarce. The current state of evidence indicates an effect of cognitive remediation on cognition and functioning in ultra-high risk individuals. More research on cognitive remediation in ultra-high risk is needed, notably in large-scale trials assessing the effect of neurocognitive and/or social cognitive remediation on multiple outcomes.
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Neuropsychology of subjects with ultra-high risk (UHR) of psychosis: A critical analysis of the literature. Encephale 2017; 43:241-253. [DOI: 10.1016/j.encep.2017.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/21/2016] [Accepted: 02/10/2017] [Indexed: 11/18/2022]
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Clark SR, Baune BT, Schubert KO, Lavoie S, Smesny S, Rice SM, Schäfer MR, Benninger F, Feucht M, Klier CM, McGorry PD, Amminger GP. Prediction of transition from ultra-high risk to first-episode psychosis using a probabilistic model combining history, clinical assessment and fatty-acid biomarkers. Transl Psychiatry 2016; 6:e897. [PMID: 27648919 PMCID: PMC5048208 DOI: 10.1038/tp.2016.170] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/29/2016] [Accepted: 07/20/2016] [Indexed: 11/08/2022] Open
Abstract
Current criteria identifying patients with ultra-high risk of psychosis (UHR) have low specificity, and less than one-third of UHR cases experience transition to psychosis within 3 years of initial assessment. We explored whether a Bayesian probabilistic multimodal model, combining baseline historical and clinical risk factors with biomarkers (oxidative stress, cell membrane fatty acids, resting quantitative electroencephalography (qEEG)), could improve this specificity. We analyzed data of a UHR cohort (n=40) with a 1-year transition rate of 28%. Positive and negative likelihood ratios were calculated for predictor variables with statistically significant receiver operating characteristic curves (ROCs), which excluded oxidative stress markers and qEEG parameters as significant predictors of transition. We clustered significant variables into historical (history of drug use), clinical (Positive and Negative Symptoms Scale positive, negative and general scores and Global Assessment of Function) and biomarker (total omega-3, nervonic acid) groups, and calculated the post-test probability of transition for each group and for group combinations using the odds ratio form of Bayes' rule. Combination of the three variable groups vastly improved the specificity of prediction (area under ROC=0.919, sensitivity=72.73%, specificity=96.43%). In this sample, our model identified over 70% of UHR patients who transitioned within 1 year, compared with 28% identified by standard UHR criteria. The model classified 77% of cases as very high or low risk (P>0.9, <0.1) based on history and clinical assessment, suggesting that a staged approach could be most efficient, reserving fatty-acid markers for 23% of cases remaining at intermediate probability following bedside interview.
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Affiliation(s)
- S R Clark
- Discipline of Psychiatry, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - B T Baune
- Discipline of Psychiatry, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - K O Schubert
- Discipline of Psychiatry, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - S Lavoie
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - S Smesny
- Department of Psychiatry, University Hospital Jena, Jena, Germany
| | - S M Rice
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - M R Schäfer
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - F Benninger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - M Feucht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - C M Klier
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - P D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - G P Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health and Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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Davis J, Eyre H, Jacka FN, Dodd S, Dean O, McEwen S, Debnath M, McGrath J, Maes M, Amminger P, McGorry PD, Pantelis C, Berk M. A review of vulnerability and risks for schizophrenia: Beyond the two hit hypothesis. Neurosci Biobehav Rev 2016; 65:185-94. [PMID: 27073049 PMCID: PMC4876729 DOI: 10.1016/j.neubiorev.2016.03.017] [Citation(s) in RCA: 201] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/25/2016] [Accepted: 03/25/2016] [Indexed: 01/15/2023]
Abstract
Schizophrenia risk has often been conceptualized using a model which requires two hits in order to generate the clinical phenotype-the first as an early priming in a genetically predisposed individual and the second a likely environmental insult. The aim of this paper was to review the literature and reformulate this binary risk-vulnerability model. We sourced the data for this narrative review from the electronic database PUBMED. Our search terms were not limited by language or date of publication. The development of schizophrenia may be driven by genetic vulnerability interacting with multiple vulnerability factors including lowered prenatal vitamin D exposure, viral infections, smoking intelligence quotient, social cognition cannabis use, social defeat, nutrition and childhood trauma. It is likely that these genetic risks, environmental risks and vulnerability factors are cumulative and interactive with each other and with critical periods of neurodevelopmental vulnerability. The development of schizophrenia is likely to be more complex and nuanced than the binary two hit model originally proposed nearly thirty years ago. Risk appears influenced by a more complex process involving genetic risk interfacing with multiple potentially interacting hits and vulnerability factors occurring at key periods of neurodevelopmental activity, which culminate in the expression of disease state. These risks are common across a number of neuropsychiatric and medical disorders, which might inform common preventive and intervention strategies across non-communicable disorders.
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Affiliation(s)
- Justin Davis
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia.
| | - Harris Eyre
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia
| | - Felice N Jacka
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Australia; Black Dog Institute, Sydney, Australia
| | - Seetal Dodd
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia
| | - Olivia Dean
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia
| | - Sarah McEwen
- Semel Institute for Neuroscience and Human Behavior, UCLA, United States
| | - Monojit Debnath
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - John McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Queensland, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland 4076, Australia
| | - Michael Maes
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia
| | - Paul Amminger
- Queensland Brain Institute, The University of Queensland, Brisbane, 4072, Queensland, Australia; Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, 35 Poplar Rd., Parkville, 3052, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, 35 Poplar Rd., Parkville, 3052, Australia; Centre of Youth Mental Health, University of Melbourne, 35 Poplar Rd., Parkville, 3052, Australia
| | - Christos Pantelis
- University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia; Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India; Melbourne Neuropsychiatry Centre, The University of Melbourne & Melbourne Health, Parkville, 3052, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052, Parkville, Australia
| | - Michael Berk
- Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, P.O. Box 291, Geelong, 3220, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, 3052, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland 4076, Australia; Orygen, The National Centre of Excellence in Youth Mental Health and Orygen Youth Health Research Centre, 35 Poplar Rd., Parkville, 3052, Australia; Centre of Youth Mental Health, University of Melbourne, 35 Poplar Rd., Parkville, 3052, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, 30 Royal Parade, 3052, Parkville, Australia
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Romero-Ferreiro MV, Aguado L, Rodriguez-Torresano J, Palomo T, Rodriguez-Jimenez R, Pedreira-Massa JL. Facial affect recognition in early and late-stage schizophrenia patients. Schizophr Res 2016; 172:177-83. [PMID: 26874869 DOI: 10.1016/j.schres.2016.02.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 02/03/2016] [Accepted: 02/03/2016] [Indexed: 01/14/2023]
Abstract
Prior studies have shown deficits in social cognition and emotion perception in first-episode psychosis (FEP) and multi-episode schizophrenia (MES) patients. These studies compared patients at different stages of the illness with only a single control group which differed in age from at least one clinical group. The present study provides new evidence of a differential pattern of deficit in facial affect recognition in FEP and MES patients using a double age-matched control design. Compared to their controls, FEP patients only showed impaired recognition of fearful faces (p=.007). In contrast to this, the MES patients showed a more generalized deficit compared to their age-matched controls, with impaired recognition of angry, sad and fearful faces (ps<.01) and an increased misattribution of emotional meaning to neutral faces. PANSS scores of FEP patients on Depressed factor correlated positively with the accuracy to recognize fearful expressions (r=.473). For the MES group fear recognition correlated positively with negative PANSS factor (r=.498) and recognition of sad and neutral expressions was inversely correlated with disorganized PANSS factor (r=-.461 and r=-.541, respectively). These results provide evidence that a generalized impairment of affect recognition is observed in advanced-stage patients and is not characteristic of the early stages of schizophrenia. Moreover, the finding that anomalous attribution of emotional meaning to neutral faces is observed only in MES patients suggests that an increased attribution of salience to social stimuli is a characteristic of social cognition in advanced stages of the disorder.
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Affiliation(s)
| | | | - Javier Rodriguez-Torresano
- Department of Psychiatry, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Avda. de Córdoba s/n, 28041 Madrid, Spain
| | - Tomás Palomo
- Complutense University of Madrid, Spain; Department of Psychiatry, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Avda. de Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - Roberto Rodriguez-Jimenez
- Complutense University of Madrid, Spain; Department of Psychiatry, Instituto de Investigación Hospital Universitario 12 de Octubre (i+12), Avda. de Córdoba s/n, 28041 Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - José Luis Pedreira-Massa
- Department of Psychiatry, Hospital Infantil Universitario Niño Jesús, Avda. Menéndez Pelayo, N° 65, 28009 Madrid, Spain; The National University of Distance Education, Spain
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Piskulic D, Liu L, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Bearden CE, Mathalon DH, Addington J. Social cognition over time in individuals at clinical high risk for psychosis: Findings from the NAPLS-2 cohort. Schizophr Res 2016; 171:176-81. [PMID: 26785807 PMCID: PMC5037438 DOI: 10.1016/j.schres.2016.01.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/07/2016] [Accepted: 01/10/2016] [Indexed: 11/17/2022]
Abstract
Deficits in social cognition are well established in schizophrenia and have been observed prior to the illness onset. Compared to healthy controls (HCs), individuals at clinical high risk of psychosis (CHR) are said to show deficits in social cognition similar to those observed in patients experiencing a first episode of psychosis. These deficits have been observed in several domains of social cognition, such as theory of mind (ToM), emotion perception and social perception. In the current study, the stability of three domains of social cognition (ToM, social perception and facial emotion perception) was assessed over time along and their association with both clinical symptoms and the later development of psychosis. Six hundred and seventy-five CHR individuals and 264 HC participants completed four tests of social cognition at baseline. Of those, 160 CHR and 155 HC participants completed assessments at all three time points (baseline, 1year and 2years) as part of their participation in the North American Prodrome Longitudinal Study. The CHR group performed poorer on all tests of social cognition across all time points compared to HCs. Social cognition was not associated with attenuated positive symptoms at any time point in the study. CHR individuals who developed a psychotic disorder during the course of the study did not differ in social cognition compared to those who did not develop psychosis. This longitudinal study demonstrated mild to moderate, but persistent ToM and social perception impairments in those at CHR for psychosis compared to HCs.
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Affiliation(s)
- Danijela Piskulic
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Kristin S. Cadenhead
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States
| | - Tyrone D. Cannon
- Department of Psychology, Yale University, New Haven, CT, United States
| | | | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States
| | - Ming T. Tsuang
- Department of Psychiatry, University of California San Diego, La Jolla, California, United States,Institute of Genomic Medicine, University of California, La Jolla, CA, United States
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, United States
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Carrie E. Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California, San Francisco, San Francisco, United States,Psychiatry Service, San Francisco, CA, United States
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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Can the Acoustic Analysis of Expressive Prosody Discriminate Schizophrenia? SPANISH JOURNAL OF PSYCHOLOGY 2015; 18:E86. [PMID: 26522128 DOI: 10.1017/sjp.2015.85] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Emotional states, attitudes and intentions are often conveyed by modulations in the tone of voice. Impaired recognition of emotions from a tone of voice (receptive prosody) has been described as characteristic symptoms of schizophrenia. However, the ability to express non-verbal information in speech (expressive prosody) has been understudied. This paper describes a useful technique for quantifying the degree of expressive prosody deficits in schizophrenia, using a semi-automatic method, and evaluates this method's ability to discriminate between patient and control groups. Forty-five medicated patients with a diagnosis of schizophrenia were matched with thirty-five healthy comparison subjects. Production of expressive prosodic speech was analyzed using variation in fundamental frequency (F0) measures on an emotionally neutral reading task. Results revealed that patients with schizophrenia exhibited significantly more pauses (p < .001), were slower (p < .001), and showed less pitch variability in speech (p < .05) and fewer variations in syllable timing (p < .001) than control subjects. These features have been associated with «flat» speech prosody. Signal processing algorithms applied to speech were shown to be capable of discriminating between patients and controls with an accuracy of 93.8%. These speech parameters may have a diagnostic and prognosis value and therefore could be used as a dependent measure in clinical trials.
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Social Cognition in Individuals at Ultra-High Risk for Psychosis: A Meta-Analysis. PLoS One 2015; 10:e0141075. [PMID: 26510175 PMCID: PMC4624797 DOI: 10.1371/journal.pone.0141075] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 10/05/2015] [Indexed: 11/29/2022] Open
Abstract
Objective Treatment in the ultra-high risk stage for a psychotic episode is critical to the course of symptoms. Markers for the development of psychosis have been studied, to optimize the detection of people at risk of psychosis. One possible marker for the transition to psychosis is social cognition. To estimate effect sizes for social cognition based on a quantitative integration of the published evidence, we conducted a meta-analysis of social cognitive performance in people at ultra high risk (UHR). Methods A literature search (1970-July 2015) was performed in PubMed, PsychINFO, Medline, Embase, and ISI Web of Science, using the search terms ‘social cognition’, ‘theory of mind’, ‘emotion recognition’, ‘attributional style’, ‘social knowledge’, ‘social perception’, ‘empathy’, ‘at risk mental state’, ‘clinical high risk’, ‘psychosis prodrome’, and ‘ultra high risk’. The pooled effect size (Cohen’s D) and the effect sizes for each domain of social cognition were calculated. A random effects model with 95% confidence intervals was used. Results Seventeen studies were included in the analysis. The overall significant effect was of medium magnitude (d = 0.52, 95% Cl = 0.38–0.65). No moderator effects were found for age, gender and sample size. Sub-analyses demonstrated that individuals in the UHR phase show significant moderate deficits in affect recognition and affect discrimination in faces as well as in voices and in verbal Theory of Mind (TOM). Due to an insufficient amount of studies, we did not calculate an effect size for attributional bias and social perception/ knowledge. A majority of studies did not find a correlation between social cognition deficits and transition to psychosis, which may suggest that social cognition in general is not a useful marker for the development of psychosis. However some studies suggest the possible predictive value of verbal TOM and the recognition of specific emotions in faces for the transition into psychosis. More research is needed on these subjects. Conclusion The published literature indicates consistent general impairments in social cognition in people in the UHR phase, but only very specific impairments seem to predict transition to psychosis.
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Corcoran CM, Keilp JG, Kayser J, Klim C, Butler PD, Bruder GE, Gur RC, Javitt DC. Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective. Psychol Med 2015; 45:2959-2973. [PMID: 26040537 PMCID: PMC5080982 DOI: 10.1017/s0033291715000902] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Schizophrenia is characterized by profound and disabling deficits in the ability to recognize emotion in facial expression and tone of voice. Although these deficits are well documented in established schizophrenia using recently validated tasks, their predictive utility in at-risk populations has not been formally evaluated. METHOD The Penn Emotion Recognition and Discrimination tasks, and recently developed measures of auditory emotion recognition, were administered to 49 clinical high-risk subjects prospectively followed for 2 years for schizophrenia outcome, and 31 healthy controls, and a developmental cohort of 43 individuals aged 7-26 years. Deficit in emotion recognition in at-risk subjects was compared with deficit in established schizophrenia, and with normal neurocognitive growth curves from childhood to early adulthood. RESULTS Deficits in emotion recognition significantly distinguished at-risk patients who transitioned to schizophrenia. By contrast, more general neurocognitive measures, such as attention vigilance or processing speed, were non-predictive. The best classification model for schizophrenia onset included both face emotion processing and negative symptoms, with accuracy of 96%, and area under the receiver-operating characteristic curve of 0.99. In a parallel developmental study, emotion recognition abilities were found to reach maturity prior to traditional age of risk for schizophrenia, suggesting they may serve as objective markers of early developmental insult. CONCLUSIONS Profound deficits in emotion recognition exist in at-risk patients prior to schizophrenia onset. They may serve as an index of early developmental insult, and represent an effective target for early identification and remediation. Future studies investigating emotion recognition deficits at both mechanistic and predictive levels are strongly encouraged.
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Affiliation(s)
- C. M. Corcoran
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - J. G. Keilp
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - J. Kayser
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - C. Klim
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - P. D. Butler
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Department of Psychiatry, New York University, New York, NY, USA
| | - G. E. Bruder
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - R. C. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - D. C. Javitt
- Department of Psychiatry, Columbia University, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
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Modinos G, Tseng HH, Falkenberg I, Samson C, McGuire P, Allen P. Neural correlates of aberrant emotional salience predict psychotic symptoms and global functioning in high-risk and first-episode psychosis. Soc Cogn Affect Neurosci 2015; 10:1429-36. [PMID: 25809400 PMCID: PMC4590543 DOI: 10.1093/scan/nsv035] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/06/2015] [Accepted: 03/19/2015] [Indexed: 12/18/2022] Open
Abstract
Neurobiological and behavioral findings suggest that psychosis is associated with corticolimbic hyperactivity during the processing of emotional salience. This has not been widely studied in the early stages of psychosis, and the impact of these abnormalities on psychotic symptoms and global functioning is unknown. We sought to address this issue in 18 patients with first-episode psychosis (FEP), 18 individuals at ultra high risk of psychosis (UHR) and 22 healthy controls (HCs). Corticolimbic response and subjective ratings to emotional and neutral scenes were measured using functional magnetic resonance imaging. The clinical and functional impact of corticolimbic abnormalities was assessed with regression analyses. The FEP and UHR groups reported increased subjective emotional arousal to neutral scenes compared with HCs. Across groups, emotional vs neutral scenes elicited activation in the dorsomedial prefrontal cortex, inferior frontal gyrus/anterior insula and amygdala. Although FEP and UHR participants showed reduced activation in these regions when viewing emotional scenes compared with controls, this was driven by increased activation to neutral scenes. Corticolimbic hyperactivity to neutral scenes predicted higher levels of positive symptoms and poorer levels of functioning. These results indicate that disruption of emotional brain systems may represent an important biological substrate for the pathophysiology of early psychosis and UHR states.
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Affiliation(s)
- Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and
| | - Huai-Hsuan Tseng
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and
| | - Irina Falkenberg
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Carly Samson
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK and
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Pelletier-Baldelli A, Bernard JA, Mittal VA. Intrinsic Functional Connectivity in Salience and Default Mode Networks and Aberrant Social Processes in Youth at Ultra-High Risk for Psychosis. PLoS One 2015; 10:e0134936. [PMID: 26252525 PMCID: PMC4529226 DOI: 10.1371/journal.pone.0134936] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/15/2015] [Indexed: 12/19/2022] Open
Abstract
Social processes are key to navigating the world, and investigating their underlying mechanisms and cognitive architecture can aid in understanding disease states such as schizophrenia, where social processes are highly impacted. Evidence suggests that social processes are impaired in individuals at ultra high-risk for the development of psychosis (UHR). Understanding these phenomena in UHR youth may clarify disease etiology and social processes in a period that is characterized by significantly fewer confounds than schizophrenia. Furthermore, understanding social processing deficits in this population will help explain these processes in healthy individuals. The current study examined resting state connectivity of the salience (SN) and default mode networks (DMN) in association with facial emotion recognition (FER), an integral aspect of social processes, as well as broader social functioning (SF) in UHR individuals and healthy controls. Consistent with the existing literature, UHR youth were impaired in FER and SF when compared with controls. In the UHR group, we found increased connectivity between the SN and the medial prefrontal cortex, an area of the DMN relative to controls. In UHR youth, the DMN exhibited both positive and negative correlations with the somatosensory cortex/cerebellum and precuneus, respectively, which was linked with better FER performance. For SF, results showed that sensory processing links with the SN might be important in allowing for better SF for both groups, but especially in controls where sensory processing is likely to be unimpaired. These findings clarify how social processing deficits may manifest in psychosis, and underscore the importance of SN and DMN connectivity for social processing more generally.
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Affiliation(s)
- Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
- * E-mail:
| | - Jessica A. Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, United States of America
- Department of Psychology, Texas A&M University, College Station, Texas, United States of America
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, United States of America
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Negative symptoms in youths with psychosis spectrum features: complementary scales in relation to neurocognitive performance and function. Schizophr Res 2015; 166:322-7. [PMID: 26093946 PMCID: PMC4512843 DOI: 10.1016/j.schres.2015.05.037] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/20/2015] [Accepted: 05/22/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Negative symptoms in schizophrenia are related to impaired functioning. The presence of negative symptoms in early phases of psychosis in individuals at clinical risk is receiving increased attention. METHODS We evaluated comprehensively a sample of 92 young people (age range 15-25) applying the Clinical Assessment Interview for Negative Symptoms (CAINS), adapted for youth. Individuals at clinical high risk (CHR, n=29) were compared to individuals with schizophrenia (SZ, n=31) and normal controls (NC, n=32). In addition to the CAINS, participants were assessed with the Structured Interview for Prodromal Syndromes (SIPS), enabling examination of the relations among scales, as well as the Penn Computerized Neurocognitive Battery (CNB), to examine association with cognitive performance, and the Global Assessment of Function (GAF) to assess overall functioning. RESULTS The CHR group was intermediate to SZ and NC on nearly all clinical measures. Negative symptoms on the CAINS correlated better with negative than with other symptoms on the SIPS and were associated with neurocognitive deficits and poorer functioning. CONCLUSIONS This study illustrates the feasibility of in-depth evaluation of negative symptoms in youth and indicates that these symptoms are present already in the at-risk state and relate to impaired cognition and functioning.
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Barbato M, Liu L, Cadenhead KS, Cannon TD, Cornblatt BA, McGlashan TH, Perkins DO, Seidman LJ, Tsuang MT, Walker EF, Woods SW, Bearden CE, Mathalon DH, Heinssen R, Addington J. Theory of Mind, Emotion Recognition and Social Perception in Individuals at Clinical High Risk for Psychosis: findings from the NAPLS-2 cohort. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 2:133-139. [PMID: 27695675 PMCID: PMC5041592 DOI: 10.1016/j.scog.2015.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Social cognition, the mental operations that underlie social interactions, is a major construct to investigate in schizophrenia. Impairments in social cognition are present before the onset of psychosis, and even in unaffected first-degree relatives, suggesting that social cognition may be a trait marker of the illness. In a large cohort of individuals at clinical high risk for psychosis (CHR) and healthy controls, three domains of social cognition (theory of mind, facial emotion recognition and social perception) were assessed to clarify which domains are impaired in this population. Six-hundred and seventy-five CHR individuals and 264 controls, who were part of the multi-site North American Prodromal Longitudinal Study, completed The Awareness of Social Inference Test, the Penn Emotion Recognition task, the Penn Emotion Differentiation task, and the Relationship Across Domains, measures of theory of mind, facial emotion recognition, and social perception, respectively. Social cognition was not related to positive and negative symptom severity, but was associated with age and IQ. CHR individuals demonstrated poorer performance on all measures of social cognition. However, after controlling for age and IQ, the group differences remained significant for measures of theory of mind and social perception, but not for facial emotion recognition. Theory of mind and social perception are impaired in individuals at CHR for psychosis. Age and IQ seem to play an important role in the arising of deficits in facial affect recognition. Future studies should examine the stability of social cognition deficits over time and their role, if any, in the development of psychosis.
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Affiliation(s)
- Mariapaola Barbato
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Lu Liu
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, 140 Arbor Drive, San Diego, CA 92103, United States
| | - Tyrone D Cannon
- Department of Psychology, Yale University, Box 208205, New Haven, CT 06520-8205, United States
| | - Barbara A Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd St, Queens, NY 11004, United States
| | - Thomas H McGlashan
- Department of Psychiatry, Yale University, 300 George St., Suite 901, New Haven, CT 06511 United States
| | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, 101 Manning Dr, Chapel Hill, NC 27514, United States
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Landmark Building, 401 Park Drive, 2 East, Boston, MA 02215 United States
| | - Ming T Tsuang
- Department of Psychiatry, University of California San Diego, 140 Arbor Drive, San Diego, CA 92103, United States; Institute of Genomic Medicine, University of California, San Diego, 9500 Gilman Drive #0761, La Jolla, CA 92093-0761, United States
| | - Elaine F Walker
- Department of Psychology, Emory University, 487 Psychology Building, 36 Eagle Row, Atlanta, GA 30322, United States
| | - Scott W Woods
- Department of Psychiatry, Yale University, 300 George St., Suite 901, New Haven, CT 06511 United States
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, University of California, Los Angeles, 300 Building Medical Plaza, Suite 2265, Los Angeles, CA 90095, United States
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, 401 Parnassus Avenue, San Francisco, CA 94143, United States; Psychiatry Service, 116d, San Francisco VA Medical Center, 4150 Clement St. San Francisco, CA 94121 United States
| | - Robert Heinssen
- Division of Adult Translational Research and Treatment Development, National Institute of Mental Health, 6001 Executive Boulevard, Room 7141, Bethesda, MSC 9629, United States
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
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The prodromal phase of psychosis. Curr Opin Neurobiol 2015; 30:100-5. [DOI: 10.1016/j.conb.2014.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/10/2014] [Indexed: 11/18/2022]
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44
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Allott KA, Rice S, Bartholomeusz CF, Klier C, Schlögelhofer M, Schäfer MR, Amminger GP. Emotion recognition in unaffected first-degree relatives of individuals with first-episode schizophrenia. Schizophr Res 2015; 161:322-8. [PMID: 25533595 DOI: 10.1016/j.schres.2014.12.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/30/2014] [Accepted: 12/06/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Impairments in recognising negative emotions are found in individuals with first-episode and chronic schizophrenia and also in those at ultra-high risk for the illness. Whether these impairments are an endophenotype for schizophrenia is unclear. To examine the heritability of emotion recognition, the aim of this study was to examine whether facial and prosody emotion recognition deficits, particularly for negative emotions, are also present in unaffected first-degree relatives of people with schizophrenia. METHODS Face and prosody emotion recognition (ER) were examined in individuals with first-episode schizophrenia (n=30), their unaffected first-degree relatives (n=27) and healthy controls (n=30). Measures of psychopathology and IQ were also administered. RESULTS On the face ER task, first-episode schizophrenia participants performed significantly more poorly in recognising anger (p=.017), disgust (p=.033) and fear (p=.040) and first-degree relatives were significantly poorer at recognising fear (p=.003) than healthy controls. On the prosody ER task, first-episode schizophrenia participants made significantly more errors in recognising anger (p=.001) and surprise (p=.003) and first-degree relatives were significantly poorer at recognising anger (p=.005) than healthy controls. Effect sizes were medium to large. After controlling for age, IQ and symptoms, both unaffected first-degree relatives and first-episode schizophrenia patients displayed a significant deficit in facial fear recognition relative to healthy controls (p=.040 and p=.048, respectively). This deficit was not associated with current psychiatric symptoms. CONCLUSIONS These findings bolster evidence for emotion recognition (particularly for fear) as a heritable characteristic of schizophrenia. However, the diagnostic specificity of this finding requires further investigation.
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Affiliation(s)
- Kelly A Allott
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
| | - Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | | | - Claudia Klier
- Department of Child and Adolescent Psychiatry, Medical University, Vienna, Austria
| | - Monika Schlögelhofer
- Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Austria
| | - Miriam R Schäfer
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - G Paul Amminger
- Orygen, The National Centre of Excellence in Youth Mental Health, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; Department of Child and Adolescent Psychiatry, Medical University, Vienna, Austria
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Yu J, Zaroff CM, Bernardo AB. The hypervigilant misperception of Duchenne smiles in schizotypy. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2014. [DOI: 10.1080/17522439.2014.983960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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