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Zhao X, Yao J, Lv Y, Zhang X, Han C, Chen L, Ren F, Zhou Q, Jin Z, Li Y, Du Y, Sui Y. Facial emotion perception abilities are related to grey matter volume in the culmen of cerebellum anterior lobe in drug-naïve patients with first-episode schizophrenia. Brain Imaging Behav 2022; 16:2072-2085. [PMID: 35751735 DOI: 10.1007/s11682-022-00677-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/02/2022]
Abstract
Impaired capability for understanding and interpreting the expressions on other people's faces manifests itself as a core feature of schizophrenia, contributing to social dysfunction. With the purpose of better understanding of the neurobiological basis of facial emotion perception deficits in schizophrenia, we investigated facial emotion perception abilities and regional structural brain abnormalities in drug-naïve patients with first-episode schizophrenia, and then examined the correlation between them. Fifty-two drug-naive patients with first-episode schizophrenia and 29 group-matched healthy controls were examined for facial emotion perception abilities assessed with the Facial Emotion Categorization and performed magnetic resonance imaging. The Facial Emotion Categorization data were inserted into a logistic function model so as to calculate shift point and slope as outcome measurements. Voxel-based morphometry was applied to investigate regional grey matter volume (GMV) alterations. The relationship between facial emotion perception and GMV was explored in patients using voxel-wise correlation analysis within brain regions that showed a significant GMV alterations in patients compared with controls. The schizophrenic patients performed differently on Facial Emotion Categorization tasks from the controls and presented a higher shift point and a steeper slope. Relative to the controls, patients showed GMV reductions in the superior temporal gyrus, middle occipital gyrus, parahippocampa gyrus, posterior cingulate, the culmen of cerebellum anterior lobe, cerebellar tonsil, and the declive of cerebellum posterior lobe. Importantly, abnormal performance on Facial Emotion Categorization was found correlated with GMV alterations in the culmen of cerebellum anterior lobe in schizophrenia. This study suggests that reduced GMV in the culmen of cerebellum anterior lobe occurs in first-episode schizophrenia, constituting a potential neuropathological basis for the impaired facial emotion perception in schizophrenia.
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Affiliation(s)
- Xiaoxin Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | | | - Yiding Lv
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | | | - Chongyang Han
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Lijun Chen
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Fangfang Ren
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Qun Zhou
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Zhuma Jin
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Yuan Li
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - Yasong Du
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Yuxiu Sui
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, 210029, China.
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Zierhut M, Böge K, Bergmann N, Hahne I, Braun A, Kraft J, Ta TMT, Ripke S, Bajbouj M, Hahn E. The Relationship Between the Recognition of Basic Emotions and Negative Symptoms in Individuals With Schizophrenia Spectrum Disorders - An Exploratory Study. Front Psychiatry 2022; 13:865226. [PMID: 35573376 PMCID: PMC9091587 DOI: 10.3389/fpsyt.2022.865226] [Citation(s) in RCA: 3] [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: 01/29/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Current research suggests that emotion recognition is impaired in individuals affected by schizophrenia spectrum disorders (SSD). However, the specific impact of negative symptoms on the ability to recognize single basic emotions has not yet been explored sufficiently and is the aim of the present study. A sample of N = 66 individuals diagnosed with SSD was recruited at the Charité - Universitätsmedizin Berlin. In a first step, correlation analyses were conducted between seven different negative symptom subdomains of the Positive and Negative Syndrome Scale (PANSS) and the accuracy and latency in recognizing the six basic emotions (anger, disgust, fear, happiness, sadness, surprise) using the Emotion Recognition Task (ERT) of the Cambridge Neuropsychological Test Automated Battery (CANTAB). The significant correlations were subjected to linear regression models that controlled for the significant covariates diagnoses, age, sex, and education. Results revealed that in individuals with SSD the negative symptom domain of blunted affect significantly predicted the accuracy of emotion recognition performance (p < 0.05), particularly, when recognizing happiness (p < 0.05). Additionally, we found that stereotyped thinking also predicted the performance of emotion recognition, especially the response latency (p < 0.05) and difficulty in abstract thinking predicted the recognition of fear (p < 0.05). However, the nominal significances did not withstand correction for multiple tests and therefore need to be followed up in further studies with a larger sample.
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Affiliation(s)
- Marco Zierhut
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charitè Junior Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Niklas Bergmann
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Inge Hahne
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alice Braun
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julia Kraft
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thi Minh Tam Ta
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Ripke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lu PY, Huang YL, Huang PC, Liu YC, Wei SY, Hsu WY, Chen KC, Chen PS, Wu WC, Yang YK, Tseng HH. Association of visual motor processing and social cognition in schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:21. [PMID: 33850147 PMCID: PMC8044174 DOI: 10.1038/s41537-021-00150-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/17/2021] [Indexed: 12/13/2022]
Abstract
Patients with schizophrenia have difficulties in social cognitive domains including emotion recognition and mentalization, and in sensorimotor processing and learning. The relationship between social cognitive deficits and sensorimotor function in patients with schizophrenia remains largely unexplored. With the hypothesis that impaired visual motor processing may decelerate information processing and subsequently affects various domains of social cognition, we examined the association of nonverbal emotion recognition, mentalization, and visual motor processing in schizophrenia. The study examined mentalization using the verbal subset of the Chinese version of Theory of Mind (CToM) Task, an equivalent task of the Faux Pas Test; emotion recognition using the Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW), and visual motor processing using a joystick tracking task controlled for basic motor function in 34 individuals with chronic schizophrenia in the community and 42 healthy controls. Patients with schizophrenia had significantly worse performance than healthy controls in social cognition, including facial, prosodic emotion recognition, and mentalization. Visual motor processing was also significantly worse in patients with schizophrenia. Only in patients with schizophrenia, both emotion recognition (mainly in prosodic modality, happy, and sad emotions) and mentalization were positively associated with their learning capacity of visual motor processing. These findings suggest a prospective role of sensorimotor function in their social cognitive deficits. Despite that the underlying neural mechanism needs further research, our findings may provide a new direction for restoration of social cognitive function in schizophrenia by enhancing visual motor processing ability.
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Affiliation(s)
- Pin-Yen Lu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
| | - Yu-Lien Huang
- Department of Psychology, Fo Guang University, Yilan, Taiwan
| | - Pai-Chuan Huang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Chia Liu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shyh-Yuh Wei
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Yun Hsu
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kao Chin Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po See Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin, Taiwan
| | - Wen-Chen Wu
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan.,School of Medicine and School of Law, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yen Kuang Yang
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Huai-Hsuan Tseng
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Khalil AH, El-Meguid MA, Bastawy M, Rabei S, Ali R, Abd Elmoneam MHE. Correlating cognitive functions to symptom domains and insight in Egyptian patients with schizophrenia. Int J Soc Psychiatry 2020; 66:240-248. [PMID: 31928181 DOI: 10.1177/0020764019897697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cognitive impairment is one of the fundamental features among patients with schizophrenia. The relationship between schizophrenia symptoms, insight and cognitive domains remains controversial. We aimed to study these relations in a sample of Egyptian patients with schizophrenia. METHODS A total of 109 patients with schizophrenia were assessed using Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders (4th ed.)) Axis I diagnosis (SCID-I), Positive and Negative Syndrome Scale (PANSS) and Scale to Assess Unawareness of Medical Disorder (SUMD). Cognitive functions were assessed using the Wechsler Adult Intelligence Scale (WAIS), the Wisconsin Card Sorting Test (WCST) and the Wechsler Memory Scale (WMS). The cognitive functions would be distributed to cover six cognitive domains: attention/vigilance speed of processing, verbal learning, visual learning, working memory and reasoning/problem solving. RESULTS There was a significant correlation between all cognitive domains (except attention) and PANSS subscales. PANSS negative and general psychopathology subscales were significantly correlated with five cognitive domains: speed of processing, verbal learning, visual learning, working memory and reasoning/problem solving. PANSS negative subscale was significantly correlated with verbal learning (verbal paired association 1) and visual learning (visual paired association 1). There was a significant correlation between all cognitive domains and SUMD, except verbal and visual learning domains assessed by verbal and visual paired association 1 subtests, as well as attention assessed by failure to maintain set subtest. Only visual learning (trials administered), working memory (percentage error), and processing speed (perseverative responses, and trials to complete first category) were significantly negatively correlated to SUMD. CONCLUSION Cognitive impairment in patients with schizophrenia is most likely to underlie negative symptoms, general psychopathology symptoms and poor insight, suggesting that treatment strategies minimizing these symptoms would improve cognitive impairment.
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Affiliation(s)
| | | | | | - Samah Rabei
- Neuropsychiatry Department, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ramy Ali
- Institute of Psychiatry, Ain Shams University, Cairo, Egypt
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Thibaudeau É, Achim AM, Parent C, Turcotte M, Cellard C. A meta-analysis of the associations between theory of mind and neurocognition in schizophrenia. Schizophr Res 2020; 216:118-128. [PMID: 31899095 DOI: 10.1016/j.schres.2019.12.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/27/2022]
Abstract
Theory of mind (ToM) refers to the ability to infer the mental states of others. ToM is impaired in schizophrenia and these deficits seem to hinder functional recovery. ToM is thus an important, but complex treatment target, supported by several processes. A large number of studies report significant associations between ToM and neurocognition (e.g. memory, attention), but the neurocognitive domains that are most closely linked to ToM remain to be identified. A meta-analysis was conducted to estimate the magnitude of the associations between ToM and neurocognition in people with schizophrenia. Correlations were extracted from the relevant literature, transformed into effect sizes Zr and pooled as weighted means. Focused-tests were employed to test for differences between neurocognitive domains and for differences linked to the characteristics of ToM tasks. Ninety-one studies (N = 5462) were included. Moderate associations emerged between ToM and each neurocognitive domain (Zrs 0.27-0.43), with no significant difference between domains (χ2(8) = 11.89, p = 0.156). Within the domain of executive functions, abstraction showed a stronger association with ToM (χ2(4) = 18.93, p = 0.001). Several ToM tasks characteristics (e.g. modality of stimuli, type of mental state), were significantly related to the magnitude of the associations between ToM and executive functions, visuospatial/problem solving, attention and episodic memory. These results suggest that ToM is linked to a wide range of neurocognitive abilities in schizophrenia, and that ToM tasks are a significant moderator of these associations. The assessment and treatment of ToM should consider the neurocognitive profile of each patient to understand his difficulties and to tailor interventions.
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Affiliation(s)
- Élisabeth Thibaudeau
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
| | - Amélie M Achim
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 4873, G1V 0A6 Québec, Québec, Canada.
| | - Carolane Parent
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 4873, G1V 0A6 Québec, Québec, Canada.
| | - Mélissa Turcotte
- École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
| | - Caroline Cellard
- CERVO Brain Research Center, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), 2601 Chemin de la Canardière, G1J 2G3 Québec, Québec, Canada; École de psychologie, Université Laval, Pavillon Félix-Antoine-Savard, 2325 Allée des Bibliothèques, G1V 0A6 Québec, Québec, Canada.
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Lado-Codesido M, Méndez Pérez C, Mateos R, Olivares JM, García Caballero A. Improving emotion recognition in schizophrenia with "VOICES": An on-line prosodic self-training. PLoS One 2019; 14:e0210816. [PMID: 30682067 PMCID: PMC6347191 DOI: 10.1371/journal.pone.0210816] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/31/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Emotion recognition (ER) deficits have been extensively demonstrated in schizophrenia. These deficiencies are not only restricted to facial emotion recognition but also include emotional prosody (tone of the voice) recognition deficits. They have been significantly associated with symptom severity and poor social functioning. The aim of this study was to test the efficacy, in real clinical conditions, of an online self-training prosodic game included in the Social Cognition rehabilitation program e-Motional Training. Method A randomized, single-blind multicenter clinical trial was conducted with 50 outpatients with schizophrenia or schizoaffective disorder. The control group was treated with Treatment-as-usual (TAU), based on drug therapy, case management and individual and group psychotherapy (not focused on Social Cognition). The intervention group was treated with TAU plus the employment of Voices, an online self-training program devised for prosodic rehabilitation. Statistical analysis Linear regression was used to evaluate the effectiveness of the intervention in emotion recognition measured with the Reading the Mind in the Voice–Spanish Version (RMV-SV). Results There were statistically significant differences between the intervention and control group measured with RMV-SV (β = 3,6[IC 95%], p<0.001), with a response variable in RMV post R2 = 0,617. Discussion Voices, a prosodic rehabilitation game included in e-Motional Training, seems to be a promising tool for improving emotional voice recognition deficits in schizophrenia, filling the need for such interventions.
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Affiliation(s)
- María Lado-Codesido
- University of Santiago de Compostela, Santiago de Compostela, Spain, Donostia University Hospital, San Sebastián, Spain
| | | | - Raimundo Mateos
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Olivares
- Department of Psychiatry, Biomedical Institute of Galicia Sur, Biomedical Research Center in Mental Health Network (CIBERSAM), University Hospital Complex of Vigo, Pontevedra, Spain
| | - Alejandro García Caballero
- Department of Psychiatry, Biomedical Institute of Galicia Sur, Biomedical Research Center in Mental Health Network (CIBERSAM), University Hospital Complex of Ourense, Ourense, Spain
- Department of Psychiatry, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- * E-mail:
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Mothersill D, Dillon R, Hargreaves A, Castorina M, Furey E, Fagan AJ, Meaney JF, Fitzmaurice B, Hallahan B, McDonald C, Wykes T, Corvin A, Robertson IH, Donohoe G. Computerised working memory-based cognitive remediation therapy does not affect Reading the Mind in The Eyes test performance or neural activity during a Facial Emotion Recognition test in psychosis. Eur J Neurosci 2018; 48:1691-1705. [PMID: 29804303 DOI: 10.1111/ejn.13976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 04/18/2018] [Accepted: 05/18/2018] [Indexed: 01/24/2023]
Abstract
Working memory-based cognitive remediation therapy (CT) for psychosis has recently been associated with broad improvements in performance on untrained tasks measuring working memory, episodic memory and IQ, and changes in associated brain regions. However, it is unclear whether these improvements transfer to the domain of social cognition and neural activity related to performance on social cognitive tasks. We examined performance on the Reading the Mind in the Eyes test (Eyes test) in a large sample of participants with psychosis who underwent working memory-based CT (N = 43) compared to a control group of participants with psychosis (N = 35). In a subset of this sample, we used functional magnetic resonance imaging (fMRI) to examine changes in neural activity during a facial emotion recognition task in participants who underwent CT (N = 15) compared to a control group (N = 15). No significant effects of CT were observed on Eyes test performance or on neural activity during facial emotion recognition, either at p < 0.05 family-wise error or at a p < 0.001 uncorrected threshold, within a priori social cognitive regions of interest. This study suggests that working memory-based CT does not significantly impact an aspect of social cognition which was measured behaviourally and neurally. It provides further evidence that deficits in the ability to decode mental state from facial expressions are dissociable from working memory deficits, and suggests that future CT programmes should target social cognition in addition to working memory for the purposes of further enhancing social function.
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Affiliation(s)
- David Mothersill
- School of Psychology & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Rachael Dillon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - April Hargreaves
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Marco Castorina
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Emilia Furey
- School of Psychology & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
| | - Andrew J Fagan
- National Centre for Advanced Medical Imaging (CAMI), St. James's Hospital / School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - James F Meaney
- National Centre for Advanced Medical Imaging (CAMI), St. James's Hospital / School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Brian Hallahan
- Department of Psychiatry & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
| | - Colm McDonald
- Department of Psychiatry & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
| | - Til Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aiden Corvin
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Ian H Robertson
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Gary Donohoe
- School of Psychology & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
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Mueller DR, Khalesi Z, Benzing V, Castiglione CI, Roder V. Does Integrated Neurocognitive Therapy (INT) reduce severe negative symptoms in schizophrenia outpatients? Schizophr Res 2017; 188:92-97. [PMID: 28185784 DOI: 10.1016/j.schres.2017.01.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 12/16/2022]
Abstract
Negative symptoms often inhibit the social integration of people suffering from schizophrenia. Reducing severe negative symptoms (SNS) in a clinically relevant way is a major unmet need. The aim of this study was to investigate whether Integrated Neurocognitive Therapy (INT), a group cognitive remediation therapy (CRT), reduces SNS in schizophrenia outpatients. INT was compared with Treatment As Usual (TAU) in a randomized-controlled trial (RCT). A total of 61 SNS outpatients participated in the study, 28 were allocated to the INT group and 33 to the TAU group. A test-battery was used at baseline, post-treatment at 15weeks, and 1-year-follow-up. Remission rates of SNS after therapy were significantly higher for INT compared to TAU. A trend favoring INT was obtained at follow-up. Furthermore, INT showed significantly higher functional outcome during follow-up compared to TAU. Regarding cognition, the strongest significant effect was found in attention post-treatment. No effects between groups on more complex neurocognition and social cognition were evident. SNS outpatients seem to accept INT group intervention as suggested by the high attendance rate.
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Affiliation(s)
- Daniel R Mueller
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
| | - Zahra Khalesi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Valentin Benzing
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland; Institute of Sport Science, University of Bern, Switzerland
| | - Clelia I Castiglione
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Volker Roder
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland.
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Gülkesen KH, Isleyen F, Cinemre B, Samur MK, Sen Kaya S, Zayim N. A Web-based Game for Teaching Facial Expressions to Schizophrenic Patients. Appl Clin Inform 2017; 8:719-730. [PMID: 28696479 PMCID: PMC6220685 DOI: 10.4338/aci-2016-10-ra-0172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/27/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Recognizing facial expressions is an important social skill. In some psychological disorders such as schizophrenia, loss of this skill may complicate the patient's daily life. Prior research has shown that information technology may help to develop facial expression recognition skills through educational software and games. OBJECTIVES To examine if a computer game designed for teaching facial expressions would improve facial expression recognition skills of patients with schizophrenia. METHODS We developed a website composed of eight serious games. Thirty-two patients were given a pre-test composed of 21 facial expression photographs. Eighteen patients were in the study group while 14 were in the control group. Patients in the study group were asked to play the games on the website. After a period of one month, we performed a post-test for all patients. RESULTS The median score of the correct answers was 17.5 in the control group whereas it was 16.5 in the study group (of 21) in pretest. The median post-test score was 18 in the control group (p=0.052) whereas it was 20 in the study group (p<0.001). CONCLUSIONS Computer games may be used for the purpose of educating people who have difficulty in recognizing facial expressions.
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Affiliation(s)
- Kemal Hakan Gülkesen
- Kemal Hakan Gülkesen, Department of Biostatistics and Medical Informatics, Faculty of Medicine, Akdeniz University, Antalya, Turkey,
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Zhao X, Sui Y, Yao J, Lv Y, Zhang X, Jin Z, Chen L, Zhang X. Reduced white matter integrity and facial emotion perception in never-medicated patients with first-episode schizophrenia: A diffusion tensor imaging study. Prog Neuropsychopharmacol Biol Psychiatry 2017; 77:57-64. [PMID: 28385492 DOI: 10.1016/j.pnpbp.2017.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/08/2017] [Accepted: 03/27/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Facial emotion perception is impaired in schizophrenia. Although the pathology of schizophrenia is thought to involve abnormality in white matter (WM), few studies have examined the correlation between facial emotion perception and WM abnormalities in never-medicated patients with first-episode schizophrenia. The present study tested associations between facial emotion perception and WM integrity in order to investigate the neural basis of impaired facial emotion perception in schizophrenia. METHODS Sixty-three schizophrenic patients and thirty control subjects underwent facial emotion categorization (FEC). The FEC data was inserted into a logistic function model with subsequent analysis by independent-samples T test and the shift point and slope as outcome measurements. Severity of symptoms was measured using a five-factor model of the Positive and Negative Syndrome Scale (PANSS). Voxelwise group comparison of WM fractional anisotropy (FA) was operated using tract-based spatial statistics (TBSS). The correlation between impaired facial emotion perception and FA reduction was examined in patients using simple regression analysis within brain areas that showed a significant FA reduction in patients compared with controls. The same correlation analysis was also performed for control subjects in the whole brain. RESULTS The patients with schizophrenia reported a higher shift point and a steeper slope than control subjects in FEC. The patients showed a significant FA reduction in left deep WM in the parietal, temporal and occipital lobes, a small portion of the corpus callosum (CC), and the corona radiata. In voxelwise correlation analysis, we found that facial emotion perception significantly correlated with reduced FA in various WM regions, including left forceps major (FM), inferior longitudinal fasciculus (ILF), inferior fronto-occipital fasciculus (IFOF), Left splenium of CC, and left ILF. The correlation analyses in healthy controls revealed no significant correlation of FA with FEC task. CONCLUSIONS These results showed disrupted WM integrity in these regions constitutes a potential neural basis for the facial emotion perception impairments in schizophrenia.
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Affiliation(s)
- Xiaoxin Zhao
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yuxiu Sui
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China..
| | - Jingjing Yao
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Yiding Lv
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xinyue Zhang
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Zhuma Jin
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Lijun Chen
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
| | - Xiangrong Zhang
- Department of Psychiatry, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China
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11
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Huang CLC, Hsiao S. The Functional Significance of Affect Recognition, Neurocognition, and Clinical Symptoms in Schizophrenia. PLoS One 2017; 12:e0170114. [PMID: 28099444 PMCID: PMC5242509 DOI: 10.1371/journal.pone.0170114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/29/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The complex relationship and exact extent of the contribution of plausible indictors to social functional outcome in schizophrenia remain unclear. The present study aimed to explore the functional significance of clinical symptoms, neurocognition, and affect recognition simultaneously in schizophrenia. METHODS The clinical symptoms, basic neurocognition, facial emotion recognition, and social functioning of 154 subjects, including 74 with schizophrenia and 80 nonclinical comparisons, were assessed. RESULTS We observed that various subdomains of social functioning were extensively related to general intelligence, basic neurocognition, facial emotion recognition, and clinical symptoms, with different association patterns. Multivariate regression analyses revealed that years of education, age, sustained attention, working memory, and facial emotion recognition were significantly associated with global social functioning in schizophrenia. CONCLUSION Our findings suggest that affect recognition combined with nonsocial neurocognition demonstrated a crucial role in predicting global social function in schizophrenia.
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Affiliation(s)
- Charles Lung-Cheng Huang
- Department of Psychiatry, Chi Mei Medical Hospital, Tainan, Taiwan
- Department of Social Work, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Sigmund Hsiao
- Department of Psychology, National Chung Cheng University, Chiayi, Taiwan
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12
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Tsotsi S, Bozikas VP, Kosmidis MH. The role of attention processes in facial affect recognition in schizophrenia. Cogn Neuropsychiatry 2016; 20:526-41. [PMID: 26572586 DOI: 10.1080/13546805.2015.1110517] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Studies investigating the involvement of attention processes in facial affect recognition (FAR) have been contradictory, with some suggesting a generalised cognitive deficit, whereas others a specialised deficit in affect recognition. Given the ubiquity of both attention and emotion perception deficits in schizophrenia, we examined whether specific attentional processes, in fact, mediate FAR. METHODS Patients with schizophrenia (n = 38) and healthy controls (n = 24) performed tests assessing FAR and attention processes, specifically, visual attention (Trail Making Test A), sustained attention/inhibition (Rapid Visual Processing subtest; Cambridge Automated Neuropsychological Test Battery), and attention to details in facial features (AFF). AFF and FAR were assessed with newly devised experimental procedures. RESULTS Hierarchical multiple regression analyses showed a similar pattern of association between attention processes and FAR in both participant groups with respect to all attention processes investigated, predicting FAR accuracy. Additionally, visual attention predicted accuracy in happiness, disgust and surprise, whereas AFF predicted accuracy in anger and fear. Regarding FAR processing speed, no attention process predicted participants' performance on correct responses; AFF response speed predicted participants' FAR response speed, but only on incorrect responses. DISCUSSION The present findings highlight the role of attentional processes in emotion recognition, as deficits in the former were predictive of impairments in the latter. Furthermore, AFF appears to be involved in the discrimination of negatively valenced facial expressions. The lack of association between attentional processes and FAR processing speed, particularly regarding correct responses, might reflect the differential pattern of activation of cortical and subcortical structures involved in these cognitive processes.
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Affiliation(s)
- Stella Tsotsi
- a Lab of Cognitive Neuroscience , School of Psychology, Aristotle University of Thessaloniki , Greece.,b 1st Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Greece
| | - Vassilis P Bozikas
- b 1st Department of Psychiatry , School of Medicine, Aristotle University of Thessaloniki , Greece
| | - Mary H Kosmidis
- a Lab of Cognitive Neuroscience , School of Psychology, Aristotle University of Thessaloniki , Greece
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13
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Chen YH, Stone-Howell B, Edgar JC, Huang M, Wootton C, Hunter MA, Lu BY, Sadek JR, Miller GA, Cañive JM. Frontal slow-wave activity as a predictor of negative symptoms, cognition and functional capacity in schizophrenia. Br J Psychiatry 2016; 208:160-7. [PMID: 26206861 PMCID: PMC4837382 DOI: 10.1192/bjp.bp.114.156075] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/04/2014] [Accepted: 11/08/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND Increased temporal and frontal slow-wave delta (1-4 Hz) and theta (4-7 Hz) activities are the most consistent resting-state neural abnormalities reported in schizophrenia. The frontal lobe is associated with negative symptoms and cognitive abilities such as attention, with negative symptoms and impaired attention associated with poor functional capacity. AIMS To establish whether frontal dysfunction, as indexed by slowing, would be associated with functional impairments. METHOD Eyes-closed magnetoencephalography data were collected in 41 participants with schizophrenia and 37 healthy controls, and frequency-domain source imaging localised delta and theta activity. RESULTS Elevated delta and theta activity in right frontal and right temporoparietal regions was observed in the schizophrenia v. CONTROL GROUP In schizophrenia, right-frontal delta activity was uniquely associated with negative but not positive symptoms. In the full sample, increased right-frontal delta activity predicted poorer attention and functional capacity. CONCLUSIONS Our findings suggest that treatment-associated decreases in slow-wave activity could be accompanied by improved functional outcome and thus better prognosis.
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Affiliation(s)
- Yu-Han Chen
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Breannan Stone-Howell
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - J Christopher Edgar
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Mingxiong Huang
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Cassandra Wootton
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Michael A Hunter
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Brett Y Lu
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Joseph R Sadek
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - Gregory A Miller
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
| | - José M Cañive
- Yu-Han Chen, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Breannan Stone-Howell, MS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; J. Christopher Edgar, PhD, The Children's Hospital of Philadelphia and University of Pennsylvania, Department of Radiology, Philadelphia; Mingxiong Huang, PhD, University of California, San Diego, Department of Radiology, and San Diego VA Healthcare System, Department of Radiology, San Diego, California; Cassandra Wootton, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico; Michael A. Hunter, BS, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, The University of New Mexico School of Medicine, Department of Psychiatry and Department of Psychology, Albuquerque, New Mexico; Brett Y. Lu, MD, PhD, The University of Hawaii at Manoa, Department of Psychiatry, Honolulu, Hawaii; Joseph R. Sadek, PhD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, New Mexico; Gregory A. Miller, PhD, University of California, Los Angeles, Department of Psychology, Los Angeles, California; José M. Canĩve, MD, New Mexico Raymond G. Murphy VA Healthcare System, Psychiatry Research, Albuquerque, and The University of New Mexico School of Medicine, Department of Psychiatry, Albuquerque, New Mexico, USA
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14
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Quintero C, García Valencia J, Muñoz C, Rangel A, Palacio C, Ospina-Duque J, Arango-Viana JC, Aguirre-Acevedo D, Ocampo MV, Valencia AV, Jaramillo L, Sánchez R, Rodríguez-Lozada J. Sensibilidad en el Reconocimiento de Emociones Faciales Como Endofenotipo de Esquizofrenia. REVISTA COLOMBIANA DE PSICOLOGÍA 2015. [DOI: 10.15446/rcp.v24n1.41738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p class="MsoNormal" style="line-height: 200%;">Los endofenotipos son rasgos presentes antes de la aparición de un trastorno y podrían ser útiles para identificar genes de susceptibilidad. Se determinó si personas con esquizofrenia y sus familiares de primer grado no afectados tenían un desempeño menor que los controles en la Tarea de Multitransformación de Expresión Emocional, que mide reconocimiento de emociones faciales. Las personas con esquizofrenia y sus familiares mostraron menor sensibilidad o requirieron más intensidad para identificar emociones que los controles. La exactitud para identificar emociones fue similar entre familiares y controles, pero menor en aquellos con esquizofrenia. Esto sugiere que la sensibilidad para el reconocimiento de emociones faciales es un endofenotipo de la esquizofrenia.</p>
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15
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Bahk YC, Jang SK, Lee JY, Choi KH. Korean facial emotion recognition tasks for schizophrenia research. Psychiatry Investig 2015; 12:235-41. [PMID: 25866525 PMCID: PMC4390595 DOI: 10.4306/pi.2015.12.2.235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Revised: 04/01/2014] [Accepted: 04/11/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite the fact that facial emotion recognition (FER) tasks using Western faces should be applied with caution to non-Western participants or patients, there are few psychometrically sound and validated FER tasks featuring Easterners' facial expressions for emotions. Thus, we aimed to develop and establish the psychometric properties of the Korean Facial Emotion Identification Task (K-FEIT) and the Korean Facial Emotion Discrimination Task (K-FEDT) for individuals with schizophrenia. METHODS The K-FEIT and K-FEDT were administered to 42 Korean individuals with schizophrenia to evaluate their psychometric properties. To test the convergent and divergent validities, the Social Behavior Sequencing Task (SBST) and hinting task were administered as social-cognitive measures, and the Trail Making Test (TMT)-A and -B were administered as neurocognitive measures. RESULTS Average accuracy on the K-FEIT and K-FEDT were 63% and 74%, respectively, and internal consistencies of the K-FEIT and K-FEDT were 0.82 and 0.95, respectively. The K-FEIT and K-FEDT were significantly correlated with SBST and Hinting Task, but not with TMT-A and B. CONCLUSION Following replication studies in a larger sample, the K-FEIT and K-FEDT are expected to facilitate future studies targeting facial emotion recognition in schizophrenia in Korea. Limitations and directions for future research are discussed.
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Affiliation(s)
- Yong-Chun Bahk
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Seon-Keong Jang
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Jee Ye Lee
- Department of Psychology, Korea University, Seoul, Republic of Korea
| | - Kee-Hong Choi
- Department of Psychology, Korea University, Seoul, Republic of Korea
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16
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Mercedes Perez-Rodriguez M, Mahon K, Russo M, Ungar AK, Burdick KE. Oxytocin and social cognition in affective and psychotic disorders. Eur Neuropsychopharmacol 2015; 25:265-82. [PMID: 25153535 PMCID: PMC4443696 DOI: 10.1016/j.euroneuro.2014.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/10/2014] [Accepted: 07/19/2014] [Indexed: 12/22/2022]
Abstract
Impairments in social cognition are now recognized as core illness features in psychotic and affective disorders. Despite the significant disability caused by social cognitive abnormalities, treatments for this symptom dimension are lacking. Here, we describe the evidence demonstrating abnormalities in social cognition in schizophrenia, major depressive disorder, and bipolar disorder, as well as the neurobiology of social cognition including the role of oxytocin. We then review clinical trials of oxytocin administration in psychotic and affective disorders and the impact of this agent on social cognition. To date, several studies have demonstrated that oxytocin may improve social cognition in schizophrenia; too few studies have been conducted in affective disorders to determine the effect of oxytocin on social cognition in these disorders. Future work is needed to clarify which aspects of social cognition may be improved with oxytocin treatment in psychotic and affective disorders.
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Affiliation(s)
- M Mercedes Perez-Rodriguez
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA; The Mental Health Patient Care Center and the Mental Illness Research Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA; CIBERSAM, Autonoma University of Madrid, Fundacion Jimenez Diaz Hospital, Spain.
| | - Katie Mahon
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Manuela Russo
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Allison K Ungar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Katherine E Burdick
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Psychiatry Box # 1230 One Gustave L. Levy Place, New York, NY 10029, USA
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Processing of facial and nonsocial information is differentially associated with severity of symptoms in patients with multiepisode schizophrenia. J Nerv Ment Dis 2015; 203:112-9. [PMID: 25594793 DOI: 10.1097/nmd.0000000000000246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients with schizophrenia show impairments in social cognitive abilities, such as recognizing facial emotions. However, the relation to symptoms remains unclear. The goal of this study was to explore whether facial emotion recognition and face identity recognition are associated with severity of symptoms and to which extent associations with symptoms differ for processing of social versus nonsocial information. Facial emotion recognition, face recognition, and abstract pattern recognition were evaluated in 98 patients with multiepisode schizophrenia. Severity of symptoms was measured using a five-factor model of the Positive and Negative Syndrome Scale. Results show that facial emotion recognition and, to a lesser extent, face recognition were predominantly associated with severity of disorganization symptoms. In contrast, recognition of nonsocial patterns was associated with negative symptoms, excitement, and emotional distress. Reaction time rather than accuracy of social cognition explained variance in symptomatology. These results lead to the conclusion that facial emotion processing in schizophrenia appears to be associated with severity of symptoms, especially disorganization.
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Brazo P, Beaucousin V, Lecardeur L, Razafimandimby A, Dollfus S. Social cognition in schizophrenic patients: the effect of semantic content and emotional prosody in the comprehension of emotional discourse. Front Psychiatry 2014; 5:120. [PMID: 25309458 PMCID: PMC4159994 DOI: 10.3389/fpsyt.2014.00120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/16/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The recognition of the emotion expressed during conversation relies on the integration of both semantic processing and decoding of emotional prosody. The integration of both types of elements is necessary for social interaction. No study has investigated how these processes are impaired in patients with schizophrenia during the comprehension of an emotional speech. Since patients with schizophrenia have difficulty in daily interactions, it would be of great interest to investigate how these processes are impaired. We tested the hypothesis that patients present lesser performances regarding both semantic and emotional prosodic processes during emotional speech comprehension compared with healthy participants. METHODS The paradigm is based on sentences built with emotional (anger, happiness, or sadness) semantic content uttered with or without congruent emotional prosody. The study participants had to decide with which of the emotional categories each sentence corresponded. RESULTS Patients performed significantly worse than their matched controls, even in the presence of emotional prosody, showing that their ability to understand emotional semantic content was impaired. Although prosody improved performances in both groups, it benefited the patients more than the controls. CONCLUSION Patients exhibited both impaired semantic and emotional prosodic comprehensions. However, they took greater advantage of emotional prosody adjunction than healthy participants. Consequently, focusing on emotional prosody during carrying may improve social communication.
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Affiliation(s)
- Perrine Brazo
- Service de Psychiatrie, Centre Hospitalier Universitaire de Caen , Caen , France ; UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
| | - Virginie Beaucousin
- Laboratoire de Psychopathologie et Neuropsychologie, Université de Paris 8 , Saint Denis , France
| | - Laurent Lecardeur
- Service de Psychiatrie, Centre Hospitalier Universitaire de Caen , Caen , France ; UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
| | - Annick Razafimandimby
- UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
| | - Sonia Dollfus
- Service de Psychiatrie, Centre Hospitalier Universitaire de Caen , Caen , France ; UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
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Tseng HH, Chen SH, Liu CM, Howes O, Huang YL, Hsieh MH, Liu CC, Shan JC, Lin YT, Hwu HG. Facial and prosodic emotion recognition deficits associate with specific clusters of psychotic symptoms in schizophrenia. PLoS One 2013; 8:e66571. [PMID: 23818944 PMCID: PMC3688591 DOI: 10.1371/journal.pone.0066571] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/08/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with schizophrenia perform significantly worse on emotion recognition tasks than healthy participants across several sensory modalities. Emotion recognition abilities are correlated with the severity of clinical symptoms, particularly negative symptoms. However, the relationships between specific deficits of emotion recognition across sensory modalities and the presentation of psychotic symptoms remain unclear. The current study aims to explore how emotion recognition ability across modalities and neurocognitive function correlate with clusters of psychotic symptoms in patients with schizophrenia. METHODS 111 participants who met the DSM-IV diagnostic criteria for schizophrenia and 70 healthy participants performed on a dual-modality emotion recognition task, the Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version (DANVA-2-TW), and selected subscales of WAIS-III. Of all, 92 patients received neurocognitive evaluations, including CPT and WCST. These patients also received the PANSS for clinical evaluation of symptomatology. RESULTS The emotion recognition ability of patients with schizophrenia was significantly worse than healthy participants in both facial and vocal modalities, particularly fearful emotion. An inverse correlation was noted between PANSS total score and recognition accuracy for happy emotion. The difficulty of happy emotion recognition and earlier age of onset, together with the perseveration error in WCST predicted total PANSS score. Furthermore, accuracy of happy emotion and the age of onset were the only two significant predictors of delusion/hallucination. All the associations with happy emotion recognition primarily concerned happy prosody. DISCUSSION Deficits in emotional processing in specific categories, i.e. in happy emotion, together with deficit in executive function, may reflect dysfunction of brain systems underlying severity of psychotic symptoms, in particular the positive dimension.
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Affiliation(s)
- Huai-Hsuan Tseng
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, United Kingdom
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Chih-Min Liu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Yu-Lien Huang
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Ming H. Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Chung Liu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jia-Chi Shan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
| | - Yi-Ting Lin
- Department of Psychiatry, National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin, Taiwan
| | - Hai-Gwo Hwu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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The Social Attribution Task-Multiple Choice (SAT-MC): A Psychometric and Equivalence Study of an Alternate Form. ISRN PSYCHIATRY 2013; 2013:830825. [PMID: 23864984 PMCID: PMC3706019 DOI: 10.1155/2013/830825] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/04/2013] [Indexed: 11/18/2022]
Abstract
The Social Attribution Task-Multiple Choice (SAT-MC) uses a 64-second video of geometric shapes set in motion to portray themes of social relatedness and intentions. Considered a test of "Theory of Mind," the SAT-MC assesses implicit social attribution formation while reducing verbal and basic cognitive demands required of other common measures. We present a comparability analysis of the SAT-MC and the new SAT-MC-II, an alternate form created for repeat testing, in a university sample (n = 92). Score distributions and patterns of association with external validation measures were nearly identical between the two forms, with convergent and discriminant validity supported by association with affect recognition ability and lack of association with basic visual reasoning. Internal consistency of the SAT-MC-II was superior (alpha = .81) to the SAT-MC (alpha = .56). Results support the use of SAT-MC and new SAT-MC-II as equivalent test forms. Demonstrating relatively higher association to social cognitive than basic cognitive abilities, the SAT-MC may provide enhanced sensitivity as an outcome measure of social cognitive intervention trials.
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González-Ortega I, de Los Mozos V, Echeburúa E, Mezo M, Besga A, Ruiz de Azúa S, González-Pinto A, Gutierrez M, Zorrilla I, González-Pinto A. Working memory as a predictor of negative symptoms and functional outcome in first episode psychosis. Psychiatry Res 2013; 206:8-16. [PMID: 22985548 DOI: 10.1016/j.psychres.2012.08.025] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/26/2012] [Accepted: 08/25/2012] [Indexed: 12/15/2022]
Abstract
The relationship of neurocognitive course with clinical and functional outcomes in psychosis is not well known, especially in the long term. The aim of the study was to examine the clinical and neuropsychological course of first-episode psychosis patients at 5-year follow-up and analyze the relationship of cognitive performance with clinical and functional outcome. The 5-year follow-up was conducted with 26 first-episode psychosis patients. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale, manic and depressive symptoms by the Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by the Functioning Assessment Short Test. The cognitive domains were assessed by the Wechsler Adult Intelligence Scale, the Wisconsin Card Sorting Test, the Trail Making Test, the Verbal Fluency Test, the Stroop Colour-Word Test and the Wechsler Memory Scale. Patients showed symptomatic improvement in the follow-up except in negative psychotic symptoms. There was also improvement in most cognitive domains except in working memory and processing speed in the follow-up. Working memory impairment was associated to negative psychotic symptoms and poor functional outcomes. Negative symptoms mediated the relationship between working memory and outcome. Therefore, negative symptoms should be a primary target of treatment to improve functional outcomes.
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Affiliation(s)
- Itxaso González-Ortega
- Department of Psychiatry, Alava University Hospital-Santiago, Department of Neurosciences, University of the Basque Country, CIBERSAM, Vitoria, Spain.
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Castagna F, Montemagni C, Maria Milani A, Rocca G, Rocca P, Casacchia M, Bogetto F. Prosody recognition and audiovisual emotion matching in schizophrenia: the contribution of cognition and psychopathology. Psychiatry Res 2013; 205:192-8. [PMID: 22985542 DOI: 10.1016/j.psychres.2012.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 08/16/2012] [Accepted: 08/25/2012] [Indexed: 01/12/2023]
Abstract
This study aimed to evaluate the ability to decode emotion in the auditory and audiovisual modality in a group of patients with schizophrenia, and to explore the role of cognition and psychopathology in affecting these emotion recognition abilities. Ninety-four outpatients in a stable phase and 51 healthy subjects were recruited. Patients were assessed through a psychiatric evaluation and a wide neuropsychological battery. All subjects completed the comprehensive affect testing system (CATS), a group of computerized tests designed to evaluate emotion perception abilities. With respect to the controls, patients were not impaired in the CATS tasks involving discrimination of nonemotional prosody, naming of emotional stimuli expressed by voice and judging the emotional content of a sentence, whereas they showed a specific impairment in decoding emotion in a conflicting auditory condition and in the multichannel modality. Prosody impairment was affected by executive functions, attention and negative symptoms, while deficit in multisensory emotion recognition was affected by executive functions and negative symptoms. These emotion recognition deficits, rather than being associated purely with emotion perception disturbances in schizophrenia, are affected by core symptoms of the illness.
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Affiliation(s)
- Filomena Castagna
- Department of Neuroscience, Psychiatric Section, University of Turin, Via Cherasco, 11, 10126 Turin, Italy
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Efficacy of a Social Cognition Training Program for Schizophrenic Patients: A Pilot Study. SPANISH JOURNAL OF PSYCHOLOGY 2013; 12:184-91. [DOI: 10.1017/s1138741600001591] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Psychosocial functioning impairment is recognized as a core feature of schizophrenia. Numerous studies have assessed the process that may underlie this impairment. In the last years, one of these processes that has been studied more is social cognition, which has been proposed as a mediator variable between neurocognition and functional outcome. Social cognition includes the subdomains of emotion recognition and social perception, and in recent years several authors have developed diverse training programs in these areas.The purpose of the present article is to assess the efficacy of the Social Cognition Training Program, a program that includes emotion recognition training and social perception training. The sample was made up of 14 outpatients with a diagnosis of schizophrenia according to CIE-10 criteria, randomly divided into two groups: experimental and control. All patients were assessed before and after the training program. Cognitive and psychopathological variables, social functioning, emotion recognition and social perception performance were assessed. Results suggest improvement in social perception and interpretation in the experimental group, in comparison with the control group, but not in emotion recognition. No significant correlations were obtained between social cognition training and other variables tested.
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Kantrowitz JT, Leitman DI, Lehrfeld JM, Laukka P, Juslin PN, Butler PD, Silipo G, Javitt DC. Reduction in tonal discriminations predicts receptive emotion processing deficits in schizophrenia and schizoaffective disorder. Schizophr Bull 2013; 39:86-93. [PMID: 21725063 PMCID: PMC3523919 DOI: 10.1093/schbul/sbr060] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Schizophrenia patients show decreased ability to identify emotion based upon tone of voice (voice emotion recognition), along with deficits in basic auditory processing. Interrelationship among these measures is poorly understood. METHODS Forty-one patients with schizophrenia/schizoaffective disorder and 41 controls were asked to identify the emotional valence (happy, sad, angry, fear, or neutral) of 38 synthesized frequency-modulated (FM) tones designed to mimic key acoustic features of human vocal expressions. The mean (F0M) and variability (F0SD) of fundamental frequency (pitch) and absence or presence of high frequency energy (HF500) of the tones were independently manipulated to assess contributions on emotion identification. Forty patients and 39 controls also completed tone-matching and voice emotion recognition tasks. RESULTS Both groups showed a nonrandom response pattern (P < .0001). Stimuli with highest and lowest F0M/F0SD were preferentially identified as happy and sad, respectively. Stimuli with low F0M and midrange F0SD values were identified as angry. Addition of HF500 increased rates of angry and decreased rates of sad identifications. Patients showed less differentiation of response across frequency changes, leading to a highly significant between-group difference in response pattern to maximally identifiable stimuli (d = 1.4). The differential identification pattern for FM tones correlated with deficits in basic tone-matching ability (P = .01), voice emotion recognition (P < .001), and negative symptoms (P < .001). CONCLUSIONS Specific FM tones conveyed reliable emotional percepts in both patients and controls and correlated highly with deficits in ability to recognize information based upon tone of voice, suggesting significant bottom-up contributions to social cognition and negative symptom impairments in schizophrenia.
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Affiliation(s)
- Joshua T. Kantrowitz
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962,Department of Psychiatry, Columbia University, New York, NY,To whom correspondence should be addressed; tel: 845-398-5503, fax: 845-398-6545, e-mail:
| | - David I. Leitman
- Department of Neuropsychiatry, University of Pennsylvania, Philadelphia, PA
| | - Jonathan M. Lehrfeld
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962
| | - Petri Laukka
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Pamela D. Butler
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962,Department of Psychiatry, New York University, New York, NY
| | - Gail Silipo
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962
| | - Daniel C. Javitt
- Schizophrenia Research Center, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY 10962,Department of Psychiatry, New York University, New York, NY
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Fiszdon JM, Reddy LF. Review of social cognitive treatments for psychosis. Clin Psychol Rev 2012; 32:724-40. [DOI: 10.1016/j.cpr.2012.09.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 09/07/2012] [Accepted: 09/11/2012] [Indexed: 11/24/2022]
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Sex differences in facial, prosodic, and social context emotional recognition in early-onset schizophrenia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2012; 2012:584725. [PMID: 22970365 PMCID: PMC3420677 DOI: 10.1155/2012/584725] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 11/12/2011] [Accepted: 11/15/2011] [Indexed: 01/08/2023]
Abstract
The purpose of the present study was to determine sex differences in facial, prosodic, and social context emotional recognition in schizophrenia (SCH). Thirty-eight patients (SCH, 20 females) and 38 healthy controls (CON, 20 females) participated in the study. Clinical scales (BPRS and PANSS) and an Affective States Scale were applied, as well as tasks to evaluate facial, prosodic, and within a social context emotional recognition. SCH showed lower accuracy and longer response times than CON, but no significant sex differences were observed in either facial or prosody recognition. In social context emotions, however, females showed higher empathy than males with respect to happiness in both groups. SCH reported being more identified with sad films than CON and females more with fear than males. The results of this study confirm the deficits of emotional recognition in male and female patients with schizophrenia compared to healthy subjects. Sex differences were detected in relation to social context emotions and facial and prosodic recognition depending on age.
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Facial emotion recognition in Chinese with schizophrenia at early and chronic stages of illness. Psychiatry Res 2011; 190:172-6. [PMID: 21856020 DOI: 10.1016/j.psychres.2011.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Revised: 05/13/2011] [Accepted: 07/02/2011] [Indexed: 12/14/2022]
Abstract
Deficits in facial emotion recognition have been recognised in Chinese patients diagnosed with schizophrenia. This study examined the relationship between chronicity of illness and performance of facial emotion recognition in Chinese with schizophrenia. There were altogether four groups of subjects matched for age and gender composition. The first and second groups comprised medically stable outpatients with first-episode schizophrenia (n=50) and their healthy controls (n=26). The third and fourth groups were patients with chronic schizophrenic illness (n=51) and their controls (n=28). The ability to recognise the six prototypical facial emotions was examined using locally validated coloured photographs from the Japanese and Caucasian Facial Expressions of Emotion. Chinese patients with schizophrenia, in both the first-episode and chronic stages, performed significantly worse than their control counterparts on overall facial emotion recognition, (P<0.001), with specific impairment in identifying surprise, fear and disgust. The level of deficit was similar at the two stages of illness. Findings suggest that impaired recognition of facial emotion did not appear to have worsened over the course of disease progression, suggesting that recognition of facial emotion is a rather stable trait of the illness. The emotion-specific deficit may have implications for understanding the social difficulties in schizophrenia.
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van Rijn S, Aleman A, de Sonneville L, Sprong M, Ziermans T, Schothorst P, van Engeland H, Swaab H. Misattribution of facial expressions of emotion in adolescents at increased risk of psychosis: the role of inhibitory control. Psychol Med 2011; 41:499-508. [PMID: 20507669 DOI: 10.1017/s0033291710000929] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND By studying behavior, cognitive abilities and brain functioning in adolescents at high risk for psychosis, we can gain an insight into the vulnerability markers or protective factors in the development of psychotic symptoms. Although many high-risk studies have focused on impairments in neurocognitive functions, such as memory and attention, very few studies have investigated problems in processing social cues such as facial expressions as a possible vulnerability marker for psychosis. METHOD Thirty-six adolescents at ultra-high risk (UHR) for psychosis and 21 non-clinical controls completed a face recognition test, a facial affect labeling test and an inhibitory control test. Schizotypal traits and schizophrenia symptoms were assessed using a schizotypy questionnaire and the Positive and Negative Syndrome Scale (PANSS). RESULTS The UHR group showed impairments in labeling facial expressions of others, in addition to a spared ability to recognize facial identity. More specifically, the UHR group made more errors in labeling neutral expressions compared to the controls, and an analysis of error types indicated that neutral faces were misattributed as being angry. The degree of misattribution of neutral-as-angry faces correlated significantly with reduced inhibitory control. CONCLUSIONS Our findings suggest that misattributing social cues might contribute to vulnerability for psychosis. This social cognitive deficit may be related to problems in inhibitory control, which potentially plays an important role in the selection of appropriate social meaning. These findings may have relevance for understanding the mechanisms underlying prodromal social dysfunction, which should be targeted in future remediation interventions.
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Affiliation(s)
- S van Rijn
- Leiden University, Clinical Child and Adolescent Studies, Leiden, The Netherlands.
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Constant EL, Lancereau J, Gillain B, Delatte B, Ferauge M, Bruyer R. Deficit in negative emotional information processing in schizophrenia: does it occur in all patients? Psychiatry Res 2011; 185:315-20. [PMID: 20493558 DOI: 10.1016/j.psychres.2009.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 08/28/2009] [Accepted: 08/28/2009] [Indexed: 11/17/2022]
Abstract
The nature of the impairment in the processing of emotional information in schizophrenia is still being debated. Some authors reported that schizophrenia patients would show deficits in the treatment processing of negative emotional information without a negative bias, as observed in controls, when in a combined emotional situation including positive/negative information. Eighteen subjects with paranoid schizophrenia in remission with a low level of negative symptoms and 18 control subjects were exposed to 108 pairs of pictures (International Affective Picture System) depicting different emotions (N = negative, P = positive, n = neutral) from six different combinations: N/N, P/P, n/n, P/N, P/n, and N/n. The subjects responded by clicking on a right or left button in response to a negative or positive feeling toward the stimuli (forced choice task). They were also asked to classify each of the individual pictures as positive, negative, or neutral (emotion-recognition task). In this well-defined group of paranoid schizophrenia patients in remission, we observed the persistence of a negative bias when an ambiguous situation is displayed (P/N) with the absence of an impairment in negative emotional information recognition and the presence of a positive bias in the recognition of neutral stimuli, reflecting a tendency to keep arousal-provoking perceptual cues from entering into subjective awareness.
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Affiliation(s)
- Eric L Constant
- Department of Psychiatry, Université catholique de Louvain, UCL, 1200 Brussels, Belgium.
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Roux P, Christophe A, Passerieux C. The emotional paradox: Dissociation between explicit and implicit processing of emotional prosody in schizophrenia. Neuropsychologia 2010; 48:3642-9. [DOI: 10.1016/j.neuropsychologia.2010.08.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 08/13/2010] [Accepted: 08/22/2010] [Indexed: 11/27/2022]
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Abstract
It has been suggested that, relative to the other basic emotions, the perception of threat-related emotion is disproportionately impaired in schizophrenia-spectrum disorders. Yet research has not assessed how schizophrenia-spectrum disorders affect the ability to make direct appraisals of threat. In the present study, participants with schizophrenia spectrum disorders were compared with controls on two danger rating tasks that involved differentiating between faces and situations normatively judged to be either high or low in threat. It was also assessed whether danger ratings were related to clinical symptoms, as well as performance on an emotion recognition measure that depicted emotions in point-light animation (biological motion). While the two groups did not differ in their ability to differentiate high- from low-danger stimuli, or overall danger attributed to faces, overall danger attributed to situations was greater for the clinical group. The clinical group also showed a selective deficit recognizing fear on the bioemotion task, but only for the control group was recognition of threat-related emotions associated with danger ratings. These data are consistent with other evidence showing that there may be a disconnect between the usual processes used to make inferences regarding potential threat in schizophrenia spectrum disorders.
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Kohler CG, Walker JB, Martin EA, Healey KM, Moberg PJ. Facial emotion perception in schizophrenia: a meta-analytic review. Schizophr Bull 2010; 36:1009-19. [PMID: 19329561 PMCID: PMC2930336 DOI: 10.1093/schbul/sbn192] [Citation(s) in RCA: 655] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005). RESULTS The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race. CONCLUSION Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Factors in sensory processing of prosody in schizotypal personality disorder: an fMRI experiment. Schizophr Res 2010; 121:75-89. [PMID: 20362418 PMCID: PMC2905482 DOI: 10.1016/j.schres.2010.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 03/04/2010] [Accepted: 03/09/2010] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Persons diagnosed with schizophrenia demonstrate deficits in prosody recognition. To examine prosody along the schizophrenia spectrum, antipsychotic-naïve schizotypal personality disorder (SPD) subjects and healthy control subjects were compared. It was hypothesized that SPD subjects would perform more poorly; with cognitive and demographic factors contributing to the poor performance. The superior temporal gyrus (STG) was selected as the region-of-interest (ROI) given its known abnormalities in SPD and its important role in the processing of prosody. METHODS SPD and healthy comparison (HC) subjects were matched on age, IQ, and parental social-economic status (PSES). Cognitive measures included the Speech Sound Perception Test (SSPT) to examine phonological processing (SPD=68, HC=74) and the Verbal Fluency task to examine executive functioning (SPD=129, HC=138). The main experiment was a novel fMRI task of prosody identification using semantically neutral sentences spoken with emotional prosody (SPD=16, HC=13). Finally, volumetric measurement of the superior temporal sulcus (STS), a key region for processing prosody, and partially overlapping with the STG, was performed (SPD=30, HC=30). RESULTS Phonological processing and executive functioning were both impaired in SPD subjects compared with HC subjects. Contrary to the prediction, SPD subjects, as a group, were similar to HC subjects in terms of correctly indentifying the emotion conveyed and reaction time. Within the SPD group, prosody identification accuracy was influenced by executive functioning, IQ and perhaps PSES, relationships not found with HC subjects. Phonological perception aided prosody identification in both diagnostic groups. As expected, both groups activated the STG while performing the prosody identification task. However, SPD subjects may have been less "efficient" in their recruitment of STG neurons. Finally, SPD subjects demonstrated a trend toward smaller STS volumes on the left, particularly the lower bank. CONCLUSIONS These data suggest that subtle differences between SPD and controls in phonological processing, executive functioning, IQ, and possibly PSES, contributed to difficulty in processing prosody for some SPD subjects.
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Visual processing, social cognition and functional outcome in schizophrenia. Psychiatry Res 2010; 178:270-5. [PMID: 20494457 DOI: 10.1016/j.psychres.2009.09.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/08/2009] [Accepted: 09/22/2009] [Indexed: 11/22/2022]
Abstract
Visual processing deficits are well recognised in schizophrenia and have potentially important clinical implications. First, the pattern of deficits for different visual tasks may help understand the underlying pathophysiology of the visual dysfunction. Second, several studies report deficits correlating with functional outcomes, suggesting that outcome improvement is possible through visual remediation strategies. We investigated these issues in a group of 64 schizophrenia patients and matched controls with a battery of visual tasks targeting different points along the visual pathways and by examining direct and indirect relationships (via a potential mediator) of such deficits to functional outcome. The schizophrenia group was significantly worse on the visual tasks overall, with the deficit constant for low- and high-level processing. Zero-order correlations suggested minimal association between vision and outcome, however, correlations between three visual tasks and 'social perceptual' ability were found which in turn correlated with functional outcome; path analysis confirmed a significant but small and indirect effect of 'biological motion' processing ability on functional outcome mediated by 'social perception'. In conclusion, the pathophysiology of visual dysfunction affects low- and high-level visual areas similarly and the relationship between deficits and outcome is small and indirect.
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Hempel RJ, Dekker JA, van Beveren NJM, Tulen JHM, Hengeveld MW. The effect of antipsychotic medication on facial affect recognition in schizophrenia: a review. Psychiatry Res 2010; 178:1-9. [PMID: 20452051 DOI: 10.1016/j.psychres.2008.07.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 07/23/2008] [Accepted: 07/31/2008] [Indexed: 11/18/2022]
Abstract
Patients with schizophrenia suffer from impairments in facial affect recognition and social functioning. Since antipsychotic medication affects different areas in the brain, they may also affect target areas involved in emotional processing mechanisms. In this article, we review the findings of the effect of antipsychotic medication on facial affect recognition in schizophrenia. We searched PubMed for articles in English with the keywords schizophrenia, facial, affect, emotion, antipsychotic and medication, published till January 2008. Eight relevant articles were found describing original studies. No substantial improvements in facial affect recognition were found after treatment with either typical or atypical antipsychotic drugs. Facial affect recognition was not related to neuropsychological functioning, and it was unclear whether improvement of symptom severity was related to performance on the facial affect recognition tasks. It is recommended that future research should focus on measuring social skills and social functioning more directly, and by investigating the effects of additional behavioural treatments on facial affect recognition and social functioning relative to treatment with antipsychotic medication alone.
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Affiliation(s)
- Roelie J Hempel
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Fiszdon JM, Johannesen JK. Functional significance of preserved affect recognition in schizophrenia. Psychiatry Res 2010; 176:120-5. [PMID: 20202689 PMCID: PMC2844467 DOI: 10.1016/j.psychres.2009.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2009] [Revised: 08/21/2009] [Accepted: 08/25/2009] [Indexed: 11/20/2022]
Abstract
Affect recognition (AR) is a core component of social information processing; thus, it may be critical to understanding social behavior and functioning in broader aspects of daily living. Deficits in AR are well documented in schizophrenia, but there is also evidence that many individuals with schizophrenia perform AR tasks at near-normal levels. In the current study, we sought to evaluate the functional significance of AR deficits in schizophrenia by comparing subgroups with normal-range and impaired AR performance on proxy and interviewer-rated measures of real-world functioning. Schizophrenia outpatients were classified as normal-range (N=17) and impaired (N=31) based on a logistic cut point in the sample distribution of Bell-Lysaker Emotion Recognition Task (BLERT) scores, referenced to a normative sample of healthy control subjects (N=56). The derived schizophrenia subgroups were then compared on proxy [University of California San Diego Performance-Based Skill Assessment (UPSA), Social Skills Performance Assessment (SSPA), Medication Management Ability Assessment (MMAA)] and interviewer-rated [Quality of Life Scale (QLS), Independent Living Skills Survey (ILSS)] measures of functioning, as well as a battery of neurocognitive tests. Initial analyses indicated superior MMAA and QLS performance in the near-normal AR subgroup. Covariate analyses indicated that group differences in neurocognition fully mediated the observed associations between AR and MMAA, and attenuated the observed relationships between AR classification and QLS. These results support three main conclusions. First, AR, like many other domains of psychopathology studied in schizophrenia, is preserved in select subgroups. Second, there is a positive relationship between AR performance and functional outcome measures. Third, neurocognition appears to mediate the relationship between AR and measures of functioning.
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Abstract
Socio-emotional competence is a key aspect of schizophrenia, both in terms of psychopathological vulnerability and outcome. In this respect, current research increasingly emphasizes the importance of deficits in facial expression recognition. The focus of the present study is the performance in recognizing 6 basic emotions (sadness, anger, happiness, fear, disgust, surprise) which play an essential role in shaping daily function and interpersonal interactions. A group of 20 patients diagnosed with DSM-IV schizophrenia were compared with a group of 20 matched controls on a facial expression recognition task, derived from the Karolinska Directed Emotional Faces (Lundqvist D, Flykt A, Ohmann A (1998) The Karolinska Directed Emotional Faces (KDEF). Stockholm (Sweden): Karolinska Institute), and were subsequently assessed with the Positive and Negative Syndrome Scale (PANSS). Facial expression recognition performance was significantly more impaired in patients, and was selectively correlated with the positive and cognitive dimensions of the positive and negative syndrome scale. Furthermore, significant group differences were found with respect to happiness and surprise.
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Rocca P, Castagna F, Mongini T, Montemagni C, Rasetti R, Rocca G, Bogetto F. Exploring the role of face processing in facial emotion recognition in schizophrenia. Acta Neuropsychiatr 2009; 21:292-300. [PMID: 25384735 DOI: 10.1111/j.1601-5215.2009.00421.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Impairment in emotion perception represents a fundamental feature of schizophrenia with important consequences in social functioning. A fundamental unresolved issue is the relationship between emotion perception and face perception. The aim of the present study was to examine whether facial identity recognition (Identity Discrimination) is a factor predicting facial emotion recognition in the context of the other factors, known as contributing to emotion perception, such as cognitive functions and symptoms. METHODS We enrolled 58 stable schizophrenic out-patients and 47 healthy subjects. Facial identity recognition and emotion perception were assessed with the Comprehensive Affect Testing System. Different multiple regression models with backward elimination were performed in order to discover the relation of each significant variable with emotion perception. RESULTS In a regression including the six significant variables (age, positive symptomatology, Identity Discrimination, attentive functions, verbal memory-learning, executive functions) versus emotion processing, only attentive functions (standardised β = 0.264, p = 0.038) and Identity Discrimination (standardised β = 0.279, p = 0.029) reached a significant level. Two partial regressions were performed including five variables, one excluding attentive functions and the other excluding Identity Discrimination. When we excluded attentive functions, the only significant variable was Identity Discrimination (standardised β = 0.278, p = 0.032). When we excluded Identity Discrimination, both verbal memory-learning (standardised β = 0.261, p = 0.042) and executive functions (standardised β = 0.253, p = 0.048) were significant. CONCLUSIONS Our results emphasised the role of face perception and attentional abilities on affect perception in schizophrenia. We additionally found a role of verbal memory-learning and executive functions on emotion perception. The relationship between those above-mentioned variables and emotion processing could have implications for cognitive rehabilitation.
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Affiliation(s)
- Paola Rocca
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
| | - Filomena Castagna
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
| | - Tullia Mongini
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
| | - Cristiana Montemagni
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
| | - Roberta Rasetti
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
| | - Giuseppe Rocca
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
| | - Filippo Bogetto
- 1Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
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Pan YJ, Chen SH, Chen WJ, Liu SK. Affect recognition as an independent social function determinant in schizophrenia. Compr Psychiatry 2009; 50:443-52. [PMID: 19683615 DOI: 10.1016/j.comppsych.2008.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Revised: 10/15/2008] [Accepted: 11/02/2008] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Facial affect recognition deficits may represent specific deficits and contribute to social dysfunction in patients with schizophrenia. Whether their impacts on social dysfunction are independent to those caused by deficits in basic neurocognition and clinical symptoms needs to be further delineated. METHOD Association patterns between affect recognition and basic neurocognitive abilities in 40 acute and 33 stable patients with schizophrenia were compared to explore whether their interrelationships changed across clinical stages. The independent contribution of affect recognition deficits to social dysfunction was explored by multivariate models controlling for general intellectual ability, basic neurocognition, and clinical symptoms. RESULTS Affect recognition deficits were associated with social role performances, self-care, and contributed independently to global social functioning in stable patients but not in acute patients. Conversely, affect recognition deficits were associated with impaired basic neurocognitions in acute patients but not in stable patients. CONCLUSION In stabilized community patients with schizophrenia, affect recognition deficits were relatively independent to basic neurocognition and had significant social functional consequences.
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Affiliation(s)
- Yi-Ju Pan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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Ventura J, Hellemann GS, Thames AD, Koellner V, Nuechterlein KH. Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res 2009; 113:189-99. [PMID: 19628375 PMCID: PMC2825750 DOI: 10.1016/j.schres.2009.03.035] [Citation(s) in RCA: 392] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 03/16/2009] [Accepted: 03/16/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neurocognitive functioning in schizophrenia has received considerable attention because of its robust prediction of functional outcome. Psychiatric symptoms, in particular negative symptoms, have also been shown to predict functional outcome, but have garnered much less attention. The high degree of intercorrelation among all of these variables leaves unclear whether neurocognition has a direct effect on functional outcome or whether that relationship to functional outcome is partially mediated by symptoms. METHODS A meta-analysis of 73 published English language studies (total n=6519) was conducted to determine the magnitude of the relationship between neurocognition and symptoms, and between symptoms and functional outcome. A model was tested in which symptoms mediate the relationship between neurocognition and functional outcome. Functional outcome involved measures of social relationships, school and work functioning, and laboratory assessments of social skill. RESULTS Although negative symptoms were found to be significantly related to neurocognitive functioning (p<.01) positive symptoms were not (p=.97). The relationship was moderate for negative symptoms (r=-.24, n=4757, 53 studies), but positive symptoms were not at all related to neurocogniton (r=.00, n=1297, 25 studies). Negative symptoms were significantly correlated with functional outcome (r=-.42, p<.01), and again the correlation was higher than for positive symptoms (r=-.03, p=.55). Furthermore, our findings support a model in which negative symptoms significantly mediate the relationship between neurocognition and functional outcome (Sobel test p<.01). CONCLUSIONS Although neurocognition and negative symptoms are both predictors of functional outcome, negative symptoms might at least partially mediate the relationship between neurocognition and outcome.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90095-6968, USA.
| | | | - April D. Thames
- Alliant International University, Alhambra, California, United States
| | | | - Keith H. Nuechterlein
- UCLA Department of Psychiatry and Biobehavioral Sciences, United States,UCLA Department of Psychology, United States
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Bach DR, Buxtorf K, Grandjean D, Strik WK. The influence of emotion clarity on emotional prosody identification in paranoid schizophrenia. Psychol Med 2009; 39:927-938. [PMID: 19000339 DOI: 10.1017/s0033291708004704] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identification of emotional facial expression and emotional prosody (i.e. speech melody) is often impaired in schizophrenia. For facial emotion identification, a recent study suggested that the relative deficit in schizophrenia is enhanced when the presented emotion is easier to recognize. It is unclear whether this effect is specific to face processing or part of a more general emotion recognition deficit. METHOD We used clarity-graded emotional prosodic stimuli without semantic content, and tested 25 in-patients with paranoid schizophrenia, 25 healthy control participants and 25 depressive in-patients on emotional prosody identification. Facial expression identification was used as a control task. RESULTS Patients with paranoid schizophrenia performed worse than both control groups in identifying emotional prosody, with no specific deficit in any individual emotion category. This deficit was present in high-clarity but not in low-clarity stimuli. Performance in facial control tasks was also impaired, with identification of emotional facial expression being a better predictor of emotional prosody identification than illness-related factors. Of those, negative symptoms emerged as the best predictor for emotional prosody identification. CONCLUSIONS This study suggests a general deficit in identifying high-clarity emotional cues. This finding is in line with the hypothesis that schizophrenia is characterized by high noise in internal representations and by increased fluctuations in cerebral networks.
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Affiliation(s)
- D R Bach
- University Hospital of Psychiatry, University of Bern, Bern 60, Switzerland.
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Gold JM, Hahn B, Strauss GP, Waltz JA. Turning it upside down: areas of preserved cognitive function in schizophrenia. Neuropsychol Rev 2009; 19:294-311. [PMID: 19452280 DOI: 10.1007/s11065-009-9098-x] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/04/2009] [Indexed: 12/21/2022]
Abstract
Patients with schizophrenia demonstrate marked impairments on most clinical neuropsychological tests. These findings suggest that patients suffer from a generalized form of cognitive impairment, with little evidence of spared performance documented in several large meta-analytic reviews of the clinical literature. In contrast, we review evidence for relative sparing of aspects of attention, procedural memory, and emotional processing observed in studies that have employed experimental approaches adapted from the cognitive and affective neuroscience literature. These islands of preserved performance suggest that the cognitive deficits in schizophrenia are not as general as they appear to be when assayed with clinical neuropsychological methods. The apparent contradiction in findings across methods may offer important clues about the nature of cognitive impairment in schizophrenia. The documentation of preserved cognitive function in schizophrenia may serve to sharpen hypotheses about the biological mechanisms that are implicated in the illness.
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Affiliation(s)
- James M Gold
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, PO Box 21247, Baltimore, MD 21228, USA.
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Kohler CG, Walker JB, Martin EA, Healey KM, Moberg PJ. Facial emotion perception in schizophrenia: a meta-analytic review. Schizophr Bull 2009. [PMID: 19329561 DOI: 10.1093/schbul/sbn19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005). RESULTS The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race. CONCLUSION Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.
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Affiliation(s)
- Christian G Kohler
- Schizophrenia Research Center, Department of Psychiatry, University of Pennsylvania School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Suchy Y, Whittaker WJ, Strassberg DS, Eastvold A. Facial and prosodic affect recognition among pedophilic and nonpedophilic criminal child molesters. SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2009; 21:93-110. [PMID: 19218480 DOI: 10.1177/1079063208326930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The present study compared facial and prosodic affect recognition abilities among pedophilic and nonpedophilic child molesters and community-dwelling controls. Pedophilic child molesters are characterized by primary sexual interest in prepubescent children, whereas nonpedophilic child molesters are characterized by offending against children despite being primarily sexually attracted to adults. The results showed that nonpedophilic child molesters made more errors in recognizing both facial and prosodic affect, performing more poorly than both controls and pedophilic child molesters. These findings are consistent with greater psychopathic tendencies among nonpedophilic molesters as well as with prior findings of smaller amygdala volume among child molesters.
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Affiliation(s)
- Yana Suchy
- University of Utah, Department of Psychology, Salt Lake City, UT 84112-0251, USA.
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Kee KS, Horan WP, Salovey P, Kern RS, Sergi MJ, Fiske AP, Lee J, Subotnik KL, Nuechterlein K, Sugar CA, Green MF. Emotional intelligence in schizophrenia. Schizophr Res 2009; 107:61-8. [PMID: 18805674 DOI: 10.1016/j.schres.2008.08.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 07/30/2008] [Accepted: 08/01/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Deficits in emotion perception have been extensively documented in schizophrenia and are associated with poor psychosocial functioning. However, little is known about other aspects of emotion processing that are critical for adaptive functioning. The current study assessed schizophrenia patients' performance on a theoretically-based, well-validated, multidimensional measure of emotional intelligence, the Mayer-Salovey-Caruso Emotional Intelligence Test (Mayer, J.D., Salovey, P., Caruso, D.R., 2002. Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT): User's Manual. Multi-Health Systems, Inc., Toronto, Ontario). METHODS 50 schizophrenia outpatients and 39 non-psychiatric controls completed the MSCEIT, a performance measure comprised of subtests that assess four components (branches) of emotional intelligence: Identifying, Using, Understanding, and Managing Emotions. Among patients, associations between MSCEIT scores and measures of clinical symptoms as well as functional outcome were evaluated. RESULTS The MSCEIT demonstrated good psychometric properties in both groups. Schizophrenia patients performed significantly worse than controls on the total MSCEIT score, and on three of the four subtests: Identifying, Understanding, and Managing Emotions. Among patients, lower MSCEIT scores significantly correlated with higher negative and disorganized symptoms, as well as worse community functioning. CONCLUSIONS The MSCEIT is a useful tool for investigating emotion processing in schizophrenia. Individuals with schizophrenia demonstrate deficits across multiple domains of emotion processing. These deficits have significant links with clinical symptoms of schizophrenia and with how patients function in their daily lives. Further research is required to understand the links between emotional intelligence, clinical symptoms, and functional outcome in schizophrenia.
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Affiliation(s)
- Kimmy S Kee
- Psychology Program, California State University Channel Islands, USA.
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Abstract
Major depression is associated with impairments of executive functions and affect perception deficits, both being linked to dysfunction of fronto-subcortical networks. So far, little is known about the relationship between cognitive and affective deficits in major depression. In the present investigation, affect perception and executive functions were assessed in 29 patients with a diagnosis of major depression (Dep) and 29 healthy controls (HC). Both groups were comparable on IQ, age, and gender distribution. Depressed patients showed deficits of perception of affective prosody, which were significantly related to inhibition, set shifting, and working memory. Our findings suggest a significant association between cognitive deficits and affect perception impairments in major depression, which may be of considerable clinical relevance and might be addressed in treatment approaches. Future studies are desirable to investigate the nature of the association in more detail.
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Abstract
AIMS Alcoholism is associated with a range of cognitive deficits. These deficits might be explained by the 'frontal lobe hypothesis' which suggests a specific vulnerability of the prefrontal cortex (PFC) to the neurotoxic effects of alcohol. Social cognition is thought to be processed in the PFC, but so far only few studies have addressed the issue of social cognition deficits in alcoholism. This review aims to evaluate the deficits in social cognition in alcoholic patients. In addition an outline for future perspectives is given. METHODS Medline and Psyclit searches were performed for a 30-year period (1977-2007). RESULTS Alcoholism is associated clearly with social cognition impairments which include emotional face and prosody perception problems, theory of mind deficits and humour processing difficulties. CONCLUSIONS In summary, the social cognition impairments are consistent with the frontal lobe hypothesis of alcoholism. Future studies should focus on (i) the delineation of the basic cognitive processes which underlie social cognition deficits; and (ii) their relevance as predictors of treatment outcome in alcoholism.
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Affiliation(s)
- Jennifer Uekermann
- Institute of Cognitive Neuroscience, Ruhr-University of Bochum, Bochum, Germany.
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Csukly G, Czobor P, Simon L, Takács B. Basic emotions and psychological distress: association between recognition of facial expressions and Symptom Checklist-90 subscales. Compr Psychiatry 2008; 49:177-83. [PMID: 18243891 DOI: 10.1016/j.comppsych.2007.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Revised: 05/30/2007] [Accepted: 09/06/2007] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Cross-cultural studies have demonstrated universal similarity in the recognition and expression of basic emotions in facial expressions. The so-called mood congruency effect, observed primarily in clinical populations, implies that subjects with depressed mood tend to judge positive emotions as neutral and neutral faces as negative. The objective was to investigate whether a mood congruency effect can be detected in case of mild impairments among healthy subjects. First, it was hypothesized that subjects with mild psychiatric symptom distress have poorer performance in affective facial recognition in general. Second, it was also hypothesized that these subjects have poorer functioning in neutral face recognition and that they are prone to attribute negative emotions, for example, sadness and fear to neutral faces. Third, it was also assumed that people with mild psychiatric symptom distress have poor performance in recognizing positive emotions. METHODS Pictures representing the basic emotions were used to examine the recognition of facial emotions; the Symptom Checklist-90 was obtained to quantify overall psychological distress and the severity of psychiatric symptoms on 9 primary symptom dimensions, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. One hundred seventeen healthy volunteers were recruited for the purpose of the study. RESULTS Consistent with the first hypothesis, results indicated a significant negative association between the overall recognition rate of facial expressions and the level of psychiatric symptoms in a healthy population. Consistent with the second hypothesis, the level of psychiatric symptoms was related inversely with the neutral facial expression recognition and directly with the negative bias in neutral facial expressions. However, our data did not support the assumption that people with mild psychiatric symptom distress would have a poorer performance in recognizing positive emotions. CONCLUSIONS These findings support the notion that difficulties in emotion processing in general and in neutral face recognition, including a negative bias in particular, are strongly related to psychological distress and the severity of psychiatric symptoms in a healthy population.
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Affiliation(s)
- Gábor Csukly
- Department of Psychiatry and Psychotherapy, Faculty of General Medicine, Semmelweis University, 1083 Budapest, Hungary.
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Premkumar P, Cooke MA, Fannon D, Peters E, Michel TM, Aasen I, Murray RM, Kuipers E, Kumari V. Misattribution bias of threat-related facial expressions is related to a longer duration of illness and poor executive function in schizophrenia and schizoaffective disorder. Eur Psychiatry 2008; 23:14-9. [PMID: 18201874 PMCID: PMC3103823 DOI: 10.1016/j.eurpsy.2007.10.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 10/10/2007] [Accepted: 10/12/2007] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND While it is known that patients with schizophrenia recognize facial emotions, specifically negative emotions, less accurately, little is known about how they misattribute these emotions to other emotions and whether such misattribution biases are associated with symptoms, course of the disorder, or certain cognitive functions. METHOD Outpatients with schizophrenia or schizoaffective disorder (n=73) and healthy controls (n=30) performed a computerised Facial Emotion Attribution Test and Wisconsin Card Sorting Test (WCST). Patients were also rated on the Positive and Negative Syndrome Scale (PANSS). RESULTS Patients were poor at recognizing fearful and angry emotions and attributed fear to angry and angry to neutral expressions. Fear-as-anger misattributions were predicted independently by a longer duration of illness and WCST perseverative errors. CONCLUSION The findings show a bias towards misattributing fearful and angry facial emotions. The propensity for fear-as-anger misattribution biases increases as the length of time that the disorder is experienced increases and a more rigid style of information processing is used. This, at least in part, may be perpetuated by subtle fearfulness expressed by others while interacting with people with schizophrenia.
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Affiliation(s)
- Preethi Premkumar
- Department of Psychology, PO78, Institute of Psychiatry, King's College London, De Crespigny, Denmark Hill, London SE5 8AF, United Kingdom.
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