Profiling of experiential pleasure, emotional regulation and emotion expression in patients with schizophrenia

Emotional subtypes in patients with depression: A cluster analysis

Major depressive disorder (MDD) is associated with deficits in emotion experience, expression and regulation. Whilst emotion regulation deficits prolong MDD, emotion expression influences symptomatic presentations, and anticipatory pleasure deficits predict recurrence risk. Profiling MDD patients from an emotion componential perspective can characterize subtypes with different clinical and functional outcomes. This study aimed to investigate emotional subtypes of MDD. A two-stage cluster analysis applied to 150 MDD patients. Clustering variables included emotion experience measured by Temporal Experience of Pleasure Scale, emotion expression measured by Toronto Alexithymia Scale, and emotion regulation measured by Emotion Regulation Questionnaire. We validated the resultant clusters by comparing their symptoms and functioning with that of 50 controls. Cluster 1 (n = 50) exhibited intact emotion experience and expression yet adopted reappraisal rather than suppression strategy, whereas Cluster 2 (n = 66) exhibited generalized emotional deficits. Cluster 3 (n = 34) exhibited emotion expression deficits and adopted both reappraisal and suppression strategies. On validation, Cluster 2 exhibited the worst, but Cluster 1 exhibited the least symptoms and social functioning impairments. Cluster 3 was intermediate among the two other subtypes. Our findings support the existence of different emotional subtypes in MDD patients, and have clinical and theoretical implications for developing future specific treatments for MDD.

Emotion-behaviour decoupling and experiential pleasure deficits predict negative symptoms and functional outcome in first-episode schizophrenia patients

BACKGROUND

Emotion-behaviour decoupling refers to the failure to translate emotion into motivated behaviour, and is a putative marker for schizophrenia. The heterogeneity of experiential pleasure and emotion expressivity deficits has been reported in schizophrenia patients. These three constructs are believed to contribute to negative symptoms, but very few studies have examined their predictive ability for clinical and functional outcome of schizophrenia. This study aimed to clarify whether these three constructs influence clinical and functional outcome of schizophrenia.

METHOD

At baseline, 127 first-episode schizophrenia patients completed a behavioural paradigm for emotion-behaviour decoupling, and self-report scales for experiential pleasure and emotion expressivity deficits. Cluster-analysis was applied to characterize schizophrenia subgroups based on these three constructs. At end-point (mean follow-up = 5.37 years, SD = 1.03 years), 85 schizophrenia patients were reassessed using the Clinical Assessment Interview for Negative Symptoms (CAINS) and a clinician-rated social functioning scale.

RESULTS

Cluster 1 (n = 74) did not show emotion-behaviour decoupling, and had intact experiential pleasure and emotion expressivity. Cluster 2 (n = 29) showed emotion-behaviour decoupling and experiential pleasure deficits. Cluster 3 (n = 24) showed emotion expressivity deficits. At endpoint, the three clusters differed significantly in CAINS MAP factor (p = 0.016) and social functioning (p = 0.019), but not CAINS EXP factor. Specifically, Cluster 2 (n = 18) showed more severe negative symptoms of CAINS MAP factor (p = 0.046) and poorer social functioning (p = 0.022) than Cluster 1 (n = 49). Cluster 3 (n = 18) did not differ from Cluster 1 and Cluster 2 in negative symptoms and social functioning.

DISCUSSION

Emotion-behaviour decoupling and experiential pleasure deficits predicted clinical and functional outcome of schizophrenia.

Characterizing emotion profiles in non‐clinical population: A cluster analytical study

Emotion processing and beliefs about pleasure can influence the development and severity of depressive symptoms. This cluster analysis study aimed to profile a large sample of college students using pleasure experience, emotion expression and regulation as well as beliefs about pleasure. We also aimed to validate the resultant clusters in terms of depressive symptoms. A set of checklists capturing beliefs about pleasure and the three facets of emotion processing was administered to 1028 college students. A two-stage cluster analysis was used to analyze the profile of these emotional aspects in these college students. Our results showed that a three-cluster solution best fit the data. Cluster 1 (n = 536) was characterized by moderate levels of beliefs about pleasure, pleasure experience, emotion expression, and regulation; Cluster 2 (n = 402) was characterized by generally high levels of beliefs about pleasure, pleasure experience, emotion expression, and regulation; Cluster 3 (n = 90) was characterized by relatively low levels of beliefs about pleasure, pleasure experience, emotion expression, and regulation. The three clusters differed significantly in the severity of depressive symptoms. Our findings suggest the existence of three emotional subtypes, which may be useful in early detection of youth at risk of developing depression.

Automatic Schizophrenia Detection Using Multimodality Media via a Text Reading Task

Schizophrenia is a crippling chronic mental disease that affects people worldwide. In this work, an automatic schizophrenia detection algorithm is proposed based on the reading deficit of schizophrenic patients. From speech and video modalities, the automatic schizophrenia detection algorithm illustrates abnormal speech, head movement, and reading fluency during the reading task. In the speech modality, an acoustic model of speech emotional flatness in schizophrenia is established to reflect the emotional expression flatness of schizophrenic speech from the perspective of speech production and perception. In the video modality, the head-movement-related features are proposed to illustrate the spontaneous head movement caused by repeated reading and unconscious movement, and the reading-fluency-related features are proposed to convey the damaged degree of schizophrenic patients' reading fluency. The experimental data of this work are 160 segments of speech and video data recorded by 40 participants (20 schizophrenic patients and 20 normal controls). Combined with support vector machines and random forest, the accuracy of the proposed acoustic model, the head-movement-related features, and the reading-fluency-related features range from 94.38 to 96.50%, 73.38 to 83.38%, and 79.50 to 83.63%, respectively. The average accuracy of the proposed automatic schizophrenia detection algorithm reaches 97.50%. The experimental results indicate the effectiveness of the proposed automatic detection algorithm as an auxiliary diagnostic method for schizophrenia.

Emotion Regulation and Depressive Symptoms Mediate the Association Between Schizotypal Personality Traits and Suicidality in Chinese College Students

OBJECTIVE

The psychological mechanisms underlying the relationship between schizotypal personality traits and suicidality are not understood. This study investigated the association of schizotypal personality traits with suicidality and explored the mediating role of cognitive appraisal and depression in the relationship between those two variables in a sample of Chinese college students.

METHOD

Participants (N = 2457) completed the Schizotypal Personality Questionnaire, the Emotional Regulation Questionnaire, the Zung Self-rating Depression Scale, and three questions related to suicidality.

RESULTS

The cognitive reappraisal score was lower in the students with suicidality than the students without suicidality, whereas scores for depression and schizotypal personality traits were higher in the students with suicidality than the students without suicidality. Schizotypal personality traits and depression were risk factors for suicidality. Depression mediated the association between schizotypal personality traits and suicidality. Cognitive reappraisal negatively affected symptoms of depression and had a significant mediating effect on the association between schizotypal personality traits and suicidality.

CONCLUSIONS

Schizotypal personality traits and depression are risk factors for suicidality. Cognitive reappraisal and depression mediate the association between schizotypal personality traits and suicidality.

A transdiagnostic meta-analysis of physical and social Anhedonia in major depressive disorder and schizophrenia spectrum disorders

INTRODUCTION

Anhedonia is a transdiagnostic construct conceptualized as physical or social, however, the extent to which these subtypes differ across psychotic and mood pathology remains poorly understood. We aimed to quantify the severity of physical and social anhedonia across Major Depressive Disorder (MDD) and Schizophrenia Spectrum Disorder (SSDs).

METHODS

We conducted meta-analyses of the Chapman Physical and Social Anhedonia Scales (PAS;SAS). We reviewed data from participants with MDD, and SSDs separately.

RESULTS

Our first meta-analysis (n = 8 studies, 409 participants) with MDD revealed elevated SAS and PAS in MDD compared to controls. Within-group differences were not significant. Depressive symptom severity moderated the between-group effect of PAS. Our second meta-analysis (n = 44 studies, 3352 participants) revealed elevated SAS and PAS in SSDs compared to controls. We detected a moderate difference between the SAS and PAS within the SSD group. Age moderated within-group differences of SAS and PAS.

DISCUSSION

People with SSD or MDD experience elevated SAS and PAS compared to controls. People with SSDs endorse greater challenges experiencing social rewards relative to physical rewards. People with MDD experience social and physical rewards similarly. The moderating role of depressive symptoms in MDD suggests that physical anhedonia is more state-like than social anhedonia.

Distinct clinical manifestations of obsessive-compulsive disorder are associated with cortical thickness alteration

BACKGROUND

Although brain structural changes have been reported in patients with obsessive-compulsive disorder (OCD), results from previous studies have been inconsistent. A growing number of studies have focused on obsessive beliefs and impulsivity which could be involved in the occurrence and maintenance of OCD symptoms. The present study aimed to examine whether there are distinct brain structural changes in patients with different OCD subgroups.

METHODS

Eighty-nine patients with OCD and 42 healthy controls were recruited to undergo structural magnetic resonance imaging brain scan. OCD patients were classified into subgroups according to scores of the Obsessive Belief Questionnaire (OBQ-44) and the Barratt Impulsiveness Scale (BIS-11) using cluster analysis. Group comparisons in cortical thickness and subcortical volumes between all OCD patients and healthy controls, as well as between subgroups of OCD patients and healthy controls, were carried out.

RESULTS

OCD patients with more obsessive beliefs and attentional impulsivity (OCD_OB_AT) had reduced cortical thickness at the inferior parietal gyrus, the superior and middle temporal gyrus and the insula compared with OCD patients with higher score on the non-planning impulsivity (OCD_NP, corrected p < 0.05). The whole group of OCD patients and both subgroups showed reduced cortical thickness at the superior parietal gyrus compared with controls (uncorrected p < 0.01, number of vertices > 100).

CONCLUSION

Our results suggest that apart from distinct phenomenology, there are distinct neural correlates of different OCD subgroups based on obsessive beliefs and impulsivity. These neural correlates may have clinical significance and should be considered in future research.

Hypothesis of subcortical visual pathway impairment in schizophrenia

Schizophrenia is a severe mental disease involving both neurological and psychiatric abnormalities. Previous studies mainly focus on damage to high-order cognitive dysfunction, which is related to high-level cortical regions such as the prefrontal and temporal lobes. Recent research reveals that impairment of low-level sensory processing occurs in the early stage of schizophrenia, which may be due to impairment of the subcortical magnocellular visual pathway. Moreover, the structure and function of some important nuclei in a subcortical visual pathway are reported to be abnormal in patients with schizophrenia. Inspired by the above evidence, we propose a hypothesis that impairment of the Superior Colliculus-Pulvinar-Amygdala subcortical visual pathway may be involved in the pathological mechanisms of early stages of schizophrenia. And we propose a possible method to detect dysfunction of this subcortical pathway through examining topological processing, which may help early diagnosis of schizophrenia.

Effects of a Short Emotional Management Program on Inpatients with Schizophrenia: A Pilot Study

The prevalence of schizophrenia is gradually increasing worldwide. Many patients with schizophrenia have a diminished ability to empathize and to detect their own emotions or those of others, deteriorating their social functioning and their quality of life. Nonetheless, emotional management training may improve patients' emotion recognition, emotional expression, and negative symptoms. Developing and applying a short but effective program that reflects the current medical environment, in which hospital stays are ever-diminishing, is warranted. This one-group, pretest-posttest, quasi-experimental pilot study aimed to examine the effects of a short emotional management program (EMP-S) on 17 patients with chronic schizophrenia. Participants were patients hospitalized in the National Center for Mental Health in Korea. After the completion of a twice-a-week, eight-session, four-week long EMP-S, participants showed improvements in emotion recognition, emotional expression, and negative symptoms. Our results suggest the applicability and potential effectiveness of the EMP-S, which takes the length of psychiatric hospital stay and the inpatient environment into consideration. To minimize any barriers to social functioning in the post-discharge lives of inpatients with chronic schizophrenia and enhance their social cognition-by improving their emotion recognition, emotional expression, and negative symptoms-we suggest the periodical administration of this EMP-S to these inpatients.

Self-reported emotion regulation difficulties in people with psychosis compared with non-clinical controls: A systematic literature review

Emotions play a key role in the development and experience of psychosis, yet there are important gaps in our understanding of how individuals with psychosis understand and respond to their emotions. This systematic review investigated self-reported emotion regulation difficulties in individuals with psychosis compared with non-clinical controls. An electronic database search was conducted in Medline, PsychINFO, and Embase and supplemented by searches of reference lists and citations. Seventeen studies were included. A narrative synthesis was conducted because contextual diversity was present across the studies and outcomes. Individuals with psychosis reported greater difficulties in (i) emotional clarity (specifically with identifying, describing, and understanding their emotions), (ii) emotional acceptance, (iii) engaging in goal-directed behaviours when experiencing negative emotions, and (iv) willingness to experience emotional distress in the pursuit of meaningful activities in life. Evidence pertaining to other self-reported emotion regulation difficulties was less clear. Effect sizes were generally large in magnitude but there were few studies on some self-reported emotion regulation difficulties, and all studies were at moderate to high risk of bias. Further research is needed to clarify the nature of emotion regulation difficulties in individuals with psychosis to inform the provision of targeted clinical interventions.

Anticipatory pleasure for future experiences in schizophrenia spectrum disorders and major depression: A systematic review and meta-analysis

OBJECTIVES

Deficits in anticipating pleasure may be an important dimension of anhedonia and functioning in psychiatric disorders, particularly schizophrenia and depression; however, inconsistent findings have limited the conclusions that can be drawn. We conducted the first systemic review and meta-analysis of the extant literature for research comparing psychiatric groups to healthy control groups on anticipatory pleasure.

METHODS

Academic Search Complete, Science Direct, and CINAHL databases were systematically searched up to 9 June 2018 for relevant peer-reviewed articles, book chapters, and dissertations. Reference lists were also hand searched. A total of 36 studies were included in the review.

RESULTS

A moderate-sized deficit was observed in schizophrenia spectrum disorders (k = 32, 1,851 patients and 1,449 controls, g = -0.42 [95% CI = -0.53 to -0.31], p < .001), and a large deficit in major depression (k = 415 patients and 506 controls, g = -0.87 [95% CI = -1.23 to -0.51], p < .001), with this effect being significantly larger for depression (p < .05). Meta-regression showed that heterogeneity was partially explained in schizophrenia spectrum by longer duration of illness and lower cognitive functioning predicting larger deficits. In depression, some evidence was found that ruling out a history of psychiatric illness in controls may be related to larger effects. There was evidence for small study bias inflating estimates in schizophrenia spectrum disorders.

CONCLUSIONS

Deficits in anticipatory pleasure are manifest in these disorders, and significantly more so in major depression. These findings indicate a possible therapeutic target to link cognitive, affective, and behavioural factors that precipitate and maintain disorder.

PRACTITIONER POINTS

Anticipatory pleasure is impaired in schizophrenia spectrum and major depression. A particular focus on enhancing anticipatory pleasure may improve motivation for rewarding behaviour and psychosocial functioning. The review contained only a small number of studies for major depression. Given the heterogeneity in effects, there are likely to be more moderators of anticipatory pleasure that require examination.