Patterns of Emotion Attribution are Affected in Patients with Schizophrenia

A, Srivastava P. Empathic Accuracy Task: Indian Adaptation and Validation

Background

The Empathic Accuracy Task (EAT) is an objective measure to assess empathic accuracy. Due to the variability in the number and linked emotions of the narrated events, we adapted EAT for the Indian sociocultural setting as Indian EAT (I-EAT).

Methods

Eight videos were adapted in three languages (English, Hindi, and Kannada), narrating emotional events with a uniform representation of age groups, different emotions, and sex. The adapted I-EAT was then validated by cross-sectional comparison with different tests similar to EAT and those that assessed concepts different from or similar to empathy, in 29 healthy young adults, 23 healthy older adults (aged ≥60 years) along with clinical groups of 15 young people with depression, 15 older people with depression, and 15 young people with schizophrenia.

Results

We selected eight videos with good content validity and internal consistency (Cronbach's alpha = 0.73. We obtained satisfactory concurrent validity of the EAT scores with the self-reported empathic assessments using the Questionnaire of Cognitive and Affective Empathy (Cognitive empathy score = 0.29, p = .034; Total score = 0.29, p = .035) and Interpersonal Reactivity Index (Empathic concern score = 0.45, p = .001). Good divergent validity was revealed in the high inverse correlation recorded with the Apathy Evaluation Scale ( = -0.67, p < .001). I-EAT did not correlate significantly with measures of social cognition. Known-groups validity was adequate in young adults with the significantly lower EAT scores (Cohen's d: 0.77 to 1.15) in the Schizophrenia group and higher EAT-N scores (Cohen's d: 0.51) in the Depression group, compared to the Healthy group. The Healthy group of the geriatric population also achieved significantly higher EAT scores (Cohen's d: 0.71 to 0.85) than the Depression group.

Conclusion

With a good validity and internal consistency, I-EAT can be used in the Indian population to assess empathic accuracy without compromising performance of the original EAT.

Cognitive versus emotional modulation within a Stroop paradigm in patients with schizophrenia

BACKGROUND

Schizophrenia is a complex disorder involving deficits in both cognitive and emotional processes. Specifically, a marked deficit in cognitive control has been found, which seems to increase when dealing with emotional information.

AIMS

With the aim of exploring the possible common links behind cognitive and emotional deficits, two versions of the emotional Stroop task were administered.

METHOD

In the cognitive-emotional task, participants had to name the ink colour (while ignoring the meaning) of emotional words. In contrast, the emotional-emotional task consisted of emotional words superimposed on emotional faces, and the participants had to indicate the emotional valence of the faces. Fifty-eight participants (29 in-patients diagnosed with schizophrenia and 29 controls) took part in the study.

RESULTS

Patients and controls showed similar response times in the cognitive-emotional task; however, patients were significantly slower than controls in the emotional-emotional task. This result supports the idea that patients show a more pronounced impairment in conflict modulation with emotional content. Besides, no significant correlations between the tasks and positive or negative symptoms were found. This would indicate that deficits are relatively independent of the clinical status of patients. However, a significant correlation between the emotional-emotional task and cognitive symptoms was found.

CONCLUSIONS

These findings suggest a restricted capacity of patients with schizophrenia to deal with the attentional demands arising from emotional stimuli.

Masked ambiguity - Emotion identification in schizophrenia and major depressive disorder

Both patients with schizophrenia and with a major depressive disorder (MDD) display deficits in identifying facial expressions of emotion during acute phases of their illness. However, specific deficit patterns have not yet been reliably demonstrated. Tasks that employ emotionally ambiguous stimuli have recently shown distinct deficit patterns in patients with schizophrenia compared to other mental disorders as well as healthy controls. We here investigate whether a task which uses an ambiguous Japanese (Noh) mask and a corresponding human stimulus generates distinctive emotion attribution patterns in thirty-two Caucasian patients with schizophrenia, matched MDD patients and healthy controls. Results show that patients with schizophrenia displayed reaction time disadvantages compared to healthy controls while identifying sadness and anger. MDD patients were more likely to label stimuli with basic compared to subtle emotional expressions. Moreover, they showed more difficulties assigning emotions to the human stimulus than to the Noh mask. IQ, age and cognitive functioning did not modulate these results. Because overall group differences were not observed, this task is not suitable for diagnosing patients. However, the subtle differences that did emerge might give therapists handles that can be used in therapy.

Facial affect recognition in early and late-stage schizophrenia patients

Prior studies have shown deficits in social cognition and emotion perception in first-episode psychosis (FEP) and multi-episode schizophrenia (MES) patients. These studies compared patients at different stages of the illness with only a single control group which differed in age from at least one clinical group. The present study provides new evidence of a differential pattern of deficit in facial affect recognition in FEP and MES patients using a double age-matched control design. Compared to their controls, FEP patients only showed impaired recognition of fearful faces (p=.007). In contrast to this, the MES patients showed a more generalized deficit compared to their age-matched controls, with impaired recognition of angry, sad and fearful faces (ps<.01) and an increased misattribution of emotional meaning to neutral faces. PANSS scores of FEP patients on Depressed factor correlated positively with the accuracy to recognize fearful expressions (r=.473). For the MES group fear recognition correlated positively with negative PANSS factor (r=.498) and recognition of sad and neutral expressions was inversely correlated with disorganized PANSS factor (r=-.461 and r=-.541, respectively). These results provide evidence that a generalized impairment of affect recognition is observed in advanced-stage patients and is not characteristic of the early stages of schizophrenia. Moreover, the finding that anomalous attribution of emotional meaning to neutral faces is observed only in MES patients suggests that an increased attribution of salience to social stimuli is a characteristic of social cognition in advanced stages of the disorder.