Eye gaze perception in bipolar disorder: Self-referential bias but intact perceptual sensitivity

The modulation effect of cognition on mentalization in late-life depression: a study of gaze perception-a potential screening tool for high-risk group of late-life depression

Introduction

Impairment in mentalization is implicated in the development and maintenance of depression. Major depressive disorders showed significant impairment in social cognition and such impairment appears to be positively associated with the severity of depression. Self-referential gaze perception (SRGP), a measurement of mentalization, was predominantly measured in patients with psychosis but rarely examined in late-life depression (LLD).

Methods

To assess the effect of cognition on the interpretation bias of mentalization, 29 LLD patients and 29 healthy controls were asked to judge if various gaze directions were directed to self in SRGP.

Results

Patients with better cognition showed less unambiguous-SRGP bias than those with worse cognitive scores; this difference was not found in healthy controls. Global cognition and executive function contributed to the SRGP rate in patients.

Conclusion

The current study is the first study to explore the relationship between cognition and SRGP in the LLD population. Our study findings suggested that the cognitive function of LLD patients may contribute to the modulation of interpretation bias, which in turn underlie the role of SRGP bias. Greater SRGP bias in patients may reflect social cognition deterioration, impairing the social interaction and functioning of LLD patients. This highlights the need for early intervention and cognitive decline identification to facilitate better prognosis and treatment effectiveness; thus, further studies could navigate the potential of SRGP task as a screening tool for high-risk group of LLD likely to develop dementia.

Aberrant Effective Connectivity During Eye Gaze Processing Is Linked to Social Functioning and Symptoms in Schizophrenia

BACKGROUND

Patients with schizophrenia show abnormal gaze processing, which is associated with social dysfunction. These abnormalities are related to aberrant connectivity among brain regions that are associated with visual processing, social cognition, and cognitive control. In this study, we investigated 1) how effective connectivity during gaze processing is disrupted in schizophrenia and 2) how this may contribute to social dysfunction and clinical symptoms.

METHODS

Thirty-nine patients with schizophrenia/schizoaffective disorder (SZ) and 33 healthy control participants completed an eye gaze processing task during functional magnetic resonance imaging. Participants viewed faces with different gaze angles and performed explicit and implicit gaze processing. Four brain regions-the secondary visual cortex, posterior superior temporal sulcus, inferior parietal lobule, and posterior medial frontal cortex-were identified as nodes for dynamic causal modeling analysis.

RESULTS

Both the SZ and healthy control groups showed similar model structures for general gaze processing. Explicit gaze discrimination led to changes in effective connectivity, including stronger excitatory, bottom-up connections from the secondary visual cortex to the posterior superior temporal sulcus and inferior parietal lobule and inhibitory, top-down connections from the posterior medial frontal cortex to the secondary visual cortex. Group differences in top-down modulation from the posterior medial frontal cortex to the posterior superior temporal sulcus and inferior parietal lobule were noted, such that these inhibitory connections were attenuated in the healthy control group but further strengthened in the SZ group. Connectivity was associated with social dysfunction and symptom severity.

CONCLUSIONS

The SZ group showed notably stronger top-down inhibition during explicit gaze discrimination, which was associated with more social dysfunction but less severe symptoms among patients. These findings help pinpoint neural mechanisms of aberrant gaze processing and may serve as future targets for interventions that combine neuromodulation with social cognitive training.

Neurobehavioral indices of gaze perception are associated with social cognition across schizophrenia patients and healthy controls

BACKGROUND

Gaze perception is a basic building block of social cognition, which is impaired in schizophrenia (SZ) and contributes to functional outcomes. Few studies, however, have investigated neural underpinnings of gaze perception and their relation to social cognition. We address this gap.

METHOD

We recruited 77 SZ patients and 71 healthy controls, who completed various social-cognition tasks. During functional magnetic resonance imaging, participants (62 SZ, 54 controls) completed a gaze-perception task, where they judged whether faces with varying gaze angles were self-directed or averted; as a control condition, participants identified stimulus gender. Activation estimates were extracted based on (a) task versus baseline, (b) gaze-perception versus gender-identification, (c) parametric modulation by perception of stimuli as self-directed versus averted, and (d) parametric modulation by stimulus gaze angle. We used latent variable analysis to test associations among diagnostic group, brain activation, gaze perception, and social cognition.

RESULTS

Preferential activation to gaze perception was observed throughout dorsomedial prefrontal cortex, superior temporal sulcus, and insula. Activation was modulated by stimulus gaze angle and perception of stimuli as self-directed versus averted. More precise gaze perception and higher task-related activation were associated with better social cognition. Patients with SZ showed hyperactivation within left pre-/postcentral gyrus, which was associated with more precise gaze perception and fewer symptoms and thus may be a compensatory mechanism.

CONCLUSIONS

Neural and behavioral indices of gaze perception were related to social cognition, across patients and controls. This suggests gaze perception is an important perceptual building block for more complex social cognition. Results are discussed in the context of dimensional psychopathology and clinical heterogeneity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reductions in regional theta power and fronto-parietal theta-gamma phase-amplitude coupling during gaze processing in bipolar disorder

Impaired social cognition is common in bipolar disorder (BD) and predicts poor functional outcomes. A critical determinant of social cognition is the ability to discriminate others' gaze direction, and its alteration may contribute to functional impairment in BD. However, the neural mechanisms underlying gaze processing in BD are unclear. Because neural oscillations are crucial neurobiological mechanisms supporting cognition, we aimed to understand their role in gaze processing in BD. Using electroencephalography (EEG) data recorded during a gaze discrimination task for 38 BD and 34 controls (HC), we examined: theta and gamma power over bilateral posterior and midline anterior locations associated with early face processing and higher-level cognitive processing, and theta-gamma phase-amplitude coupling (PAC) between locations. Compared to HC, BD showed reduced midline-anterior and left-posterior theta power, and diminished bottom-up/top-down theta-gamma PAC between anterior/posterior sites. Reduced theta power and theta-gamma PAC related to slower response times. These findings suggest that altered theta oscillations and anterior-posterior cross-frequency coupling between areas associated with higher-level cognition and early face processing may underlie impaired gaze processing in BD. This is a crucial step towards translational research that may inform novel social cognitive interventions (e.g., neuromodulation to target specific oscillatory dynamics) to improve functioning in BD.

Research on social attention in autism and the challenges of the research domain criteria (RDoC) framework

The fuzzy nature of categories of psychopathology, such as autism, leads to significant research challenges. Alternatively, focusing research on the study of a common set of important and well-defined psychological constructs across psychiatric conditions may make the fundamental etiological processes of psychopathology easier to discern and treat (Cuthbert, 2022). The development of the research domain criteria (RDoC) framework is designed to guide this new research approach (Insel et al., 2010). However, progress in research may be expected to continually refine and reorganize the understanding of the specifics of these mental processes (Cuthbert & Insel, 2013). Moreover, knowledge gleaned from the study of both normative and atypical development can be mutually informative in the evolution of our understanding of these fundamental processes. A case in point is the study of social attention. This Autism 101 commentary provides an educational summary of research over the last few decades indicates that social attention is major construct in the study of human social-cognitive development, autism and other forms of psychopathology. The commentary also describes how this research can inform the Social Process dimension of the RDoC framework.

Perception of eye contact, self-referential thinking and age

Increased thinking about one's self has been proposed to widen the gaze cone, that is, the range of gaze deviations that an observer judges as looking directly at them (eye contact). This study investigated the effects of a self-referential thinking manipulation and demographic factors on the gaze cone. In a preregistered experiment (N = 200), the self-referential thinking manipulation, as compared to a control manipulation, did not influence the gaze cone, or the use of first-person pronouns in a manipulation check measuring self-referential processing. This may indicate a failure of the manipulation and participants' lack of effort. However, participants' age was significantly correlated with both measures: older people had wider gaze cones and used more self-referring pronouns. A second experiment (N = 300) further examined the effect of the manipulation and demographic factors on self-referential processing, and the results were replicated. These findings may reflect age-related self-reference and positivity effects.

Applying hierarchical bayesian modeling to experimental psychopathology data: An introduction and tutorial

Over the past 2 decades Bayesian methods have been gaining popularity in many scientific disciplines. However, to this date, they are rarely part of formal graduate statistical training in clinical science. Although Bayesian methods can be an attractive alternative to classical methods for answering certain research questions, they involve a heavy "overhead" (e.g., advanced mathematical methods, complex computations), which pose significant barriers to researchers interested in adding Bayesian methods to their statistical toolbox. To increase the accessibility of Bayesian methods for psychopathology researchers, this article presents a gentle introduction of the Bayesian inference framework and a tutorial on implementation. We first provide a primer on the key concepts of Bayesian inference and major implementation considerations related to Bayesian estimation. We then demonstrate how to apply hierarchical Bayesian modeling (HBM) to experimental psychopathology data. Using a real dataset collected from two clinical groups (schizophrenia and bipolar disorder) and a healthy comparison sample on a psychophysical gaze perception task, we illustrate how to model individual responses and group differences with probability functions respectful of the presumed underlying data-generating process and the hierarchical nature of the data. We provide the code with explanations and the data used to generate and visualize the results to facilitate learning. Finally, we discuss interpretation of the results in terms of posterior probabilities and compare the results with those obtained using a traditional method. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Aberrant activation of the mentalizing brain system during eye gaze discrimination in bipolar disorder

Bipolar disorder (BD) is associated with a range of social cognitive deficits. This study investigated the functioning of the mentalizing brain system in BD probed by an eye gaze perception task during fMRI. Compared with healthy controls (n = 21), BD participants (n = 14) showed reduced preferential activation for self-directed gaze discrimination in the medial prefrontal cortex (mPFC) and temporo-parietal junction (TPJ), which was associated with poorer cognition/social cognition. Aberrant functions of the mentalizing system should be further investigated as marker of social dysfunction and treatment targets.

Dynamic causal modeling of eye gaze processing in schizophrenia

BACKGROUND

Abnormal eye gaze perception is related to symptoms and social functioning in schizophrenia. However, little is known about the brain network mechanisms underlying these abnormalities. Here, we employed dynamic causal modeling (DCM) of fMRI data to discover aberrant effective connectivity within networks associated with eye gaze processing in schizophrenia.

METHODS

Twenty-seven patients (schizophrenia/schizoaffective disorder, SZ) and 22 healthy controls (HC) completed an eye gaze processing task during fMRI. Participants viewed faces with different gaze angles and performed explicit gaze discrimination (Gaze: "Looking at you?" yes/no) or implicit gaze processing (Gender: "male or female?"). Four brain regions, the secondary visual cortex (Vis), posterior superior temporal sulcus (pSTS), inferior parietal lobule (IPL), and posterior medial frontal cortex (pMFC) were identified as nodes for subsequent DCM analysis.

RESULTS

SZ and HC showed similar generative model structure, but SZ showed altered connectivity for specific self-connections, inter-regional connections during all gaze processing (reduced excitatory bottom-up and enhanced inhibitory top-down connections), and modulation by explicit gaze discrimination (increased frontal inhibition of visual cortex). Altered effective connectivity was significantly associated with poorer social cognition and functioning.

CONCLUSIONS

General gaze processing in SZ is associated with distributed cortical dysfunctions and bidirectional connectivity between regions, while explicit gaze discrimination involves predominantly top-down abnormalities in the visual system. These results suggest plausible neural mechanisms underpinning gaze processing deficits and may serve as bio-markers for intervention.

Neural Oscillatory Abnormalities During Gaze Processing in Schizophrenia: Evidence of Reduced Theta Phase Consistency and Inter-areal Theta-Gamma Coupling

BACKGROUND

Abnormal gaze discrimination in schizophrenia (SZ) is associated with impairment in social functioning, but the neural mechanisms remain unclear. Evidence suggests that local neural oscillations and inter-areal communication through neural synchronization are critical physiological mechanisms supporting basic and complex cognitive processes. The roles of these mechanisms in abnormal gaze processing in SZ have not been investigated. The present study examined local neural oscillations and connectivity between anterior and bilateral posterior brain areas during gaze processing.

METHODS

During electroencephalography recording, 28 participants with SZ and 34 healthy control participants completed a gaze discrimination task. Time-frequency decomposition of electroencephalography data was used to examine neural oscillatory power and intertrial phase consistency at bilateral posterior and midline anterior scalp sites. In addition, connectivity between these anterior and posterior sites, in terms of cross-frequency coupling between theta phase and gamma amplitude, was examined using the Kullback-Leibler Modulation Index.

RESULTS

Participants with SZ showed reduced total power of theta-band activity relative to healthy control participants at all sites examined. This group difference could be accounted for by reduced intertrial phase consistency of theta activity in SZ participants, which was related to reduced gaze discrimination accuracy in SZ. In addition, SZ participants exhibited reduced Kullback-Leibler indexing, both feedforward and feedback connectivity, between the posterior and anterior sites.

CONCLUSIONS

These findings suggest that abnormal theta phase consistency and dysconnection between posterior face processing and anterior areas may underlie gaze processing deficits in SZ.

Deconstructing eye contact perception: Measuring perceptual precision and self-referential tendency using an online psychophysical eye contact detection task

Eye contact perception—the ability to accurately and efficiently discriminate others’ gaze directions—is critical to understanding others and functioning in a complex social world. Previous research shows that it is affected in multiple neuropsychiatric disorders accompanied by social dysfunction, and understanding the cognitive processes giving rise to eye contact perception would help advance mechanistic investigations of psychopathology. This study aims to validate an online, psychophysical eye contact detection task through which two constituent cognitive components of eye contact perception (perceptual precision and self-referential tendency) can be derived. Data collected from a large online sample showed excellent test-retest reliability for self-referential tendency and moderate reliability for perceptual precision. Convergence validity was supported by correlations with social cognitive measures tapping into different aspects of understanding others. Hierarchical regression analyses revealed that perceptual precision and self-referential tendency explained unique variance in social cognition, suggesting that they measure unique aspects of related constructs. Overall, this study provided support for the reliability and validity of the eye contact perception metrics derived using the online Eye Contact Detection Task. The value of the task for future psychopathology research was discussed.

Opposing sex-dependent effects of oxytocin on the perception of gaze direction

BACKGROUND

Gaze direction is an important cue of the eye region. Previous studies have revealed that oxytocin (OXT) increases orienting to the eye region of face. However, little has been known about the effect of OXT in men and women on the perception of gaze direction particularly when associated with different emotions.

OBJECTIVES

We investigated how oxytocin would affect gaze direction judgments for threatening, angry, and neutral facial expressions and whether this effect would be modulated by observers' sex.

METHODS

We used the cone of direct gaze (CoDG) task. Participants were required to judge the gaze direction of face between directed and averted gaze.

RESULTS

Results showed opposing sex-dependent effects of OXT such that OXT, as compared with placebo, tended to decrease the CoDG in men but increase it in women. The CoDG was marginally wider in men than in women in the placebo condition, and however, this difference was abolished following OXT treatment. We also found that the perception of gaze direction varied as a function of emotional expression such that the CoDG for angry and neutral faces was wider than that for fearful faces and the CoDG for angry faces was marginally wider than that for neutral ones. However, there was no significant interaction between treatment and facial expression.

CONCLUSIONS

Our findings provide the first evidence for sex-dependent effects of OXT on gaze direction perception, suggesting that OXT attenuates the self-referential judgment of gaze directions of others in men and enhances it in women despite differentiated emotions of faces.

Disrupted Eye Gaze Perception as a Biobehavioral Marker of Social Dysfunction: An RDoC Investigation

Social dysfunction is an intractable problem in a wide spectrum of psychiatric illnesses, undermining patients' capacities for employment, independent living, and maintaining meaningful relationships. Identifying common markers of social impairment across disorders and understanding their mechanisms are prerequisites to developing targeted neurobiological treatments that can be applied productively across diagnoses and illness stages to improve functional outcome. This project focuses on eye gaze perception, the ability to accurately and efficiently discriminate others' gaze direction, as a potential biomarker of social functioning that cuts across psychiatric diagnoses. This premise builds on both the monkey and human literatures showing gaze perception as a basic building block supporting higher-level social communication and social development, and reports of abnormal gaze perception in multiple psychiatric conditions accompanied by prominent social dysfunction (e.g., psychosis-spectrum disorders, autism-spectrum disorders, social phobia). A large sample (n = 225) of adolescent and young adult (age 14-30) psychiatric patients (regardless of diagnosis) with various degrees of impaired social functioning, and demographically-matched healthy controls (n = 75) will be recruited for this study. Participant's psychiatric phenotypes, cognition, social cognition, and community functioning will be dimensionally characterized. Eye gaze perception will be assessed using a psychophysical task, and two metrics (precision, self-referential bias) that respectively tap into gaze perception disturbances at the visual perceptual and interpretation levels, independent of general deficits, will be derived using hierarchical Bayesian modeling. A subset of the participants (150 psychiatric patients, 75 controls) will additionally undergo multimodal fMRI to determine the functional and structural brain network features of altered gaze perception. The specific aims of this project are three-fold: (1) Determine the generality of gaze perception disturbances in psychiatric patients with prominent social dysfunction; (2) Map behavioral indices of gaze perception disturbances to dimensions of psychiatric phenotypes and core functional domains; and (3) Identify the neural correlates of altered gaze perception in psychiatric patients with social dysfunction. Successfully completing these specific aims will identify the specific basic deficits, clinical profile, and underlying neural circuits associated with social dysfunction that can be used to guide targeted, personalized treatments, thus advancing NIMH's Strategic Objective 1 (describe neural circuits associated with mental illnesses and map the connectomes for mental illnesses) and Objective 3 (develop new treatments based on discoveries in neuroscience and behavioral science).

Eye-gaze processing in the broader bipolar phenotype revealed by electrical neuroimaging

Previous studies have documented atypical brain responses to faces in individuals with bipolar disorder (BD) and in their relatives. In view of previous findings of atypical face processing in youths at risk for BD, the aim of this study was to examine whether BD patients and offspring would show differential activation in networks of the social brain when processing eye-gaze. Data from 18 euthymic BD patients and 18 offspring, as well as 36 age-matched healthy controls, were collected using a delayed face-matching paradigm, event related potentials and electrical neuroimaging methods. The P200 component, which is implicated in facial cues decoding, differentiated the BD groups from their age-matched controls. P200 source reconstruction indicates impairments conveyed by eye-contact in a network involved in experiencing others' social intentions in BD patients (supplementary motor cortex, precentral gyrus, inferior parietal lobe), and the engagement of compensatory prefrontal mechanisms for modulating these functions in BD offspring. When viewing faces that had an averted gaze, BD patients and offspring showed a hypo-activation, compared to controls, particularly in regions involved in experiencing others' feelings (post-central gyrus in BD patients / ventral premotor cortex in offspring). Therefore, the neural mechanism for decoding shifts in eye-gaze may be a familial characteristic of BD.

A Bayesian model comparison approach to test the specificity of visual integration impairment in schizophrenia or psychosis

Impaired visual integration is well documented in schizophrenia and related to functional outcomes. However, it is unclear if this deficit is specific to schizophrenia, or characteristic of psychosis more broadly. To address this question, this study used a Bayesian model comparison approach to examine the evidence of three grouping models of visual integration performance in 116 individuals with schizophrenia (SZ), schizoaffective disorder (SA), bipolar disorder (BD) with or without a history of prominent psychosis (BDP+ and BDP-, respectively), or no psychiatric diagnosis (healthy controls; HC). We compared: (1) Psychosis Model (psychosis, non-psychosis), where the psychosis group included SZ, SA, and BDP+, and the non-psychosis group included BDP- and HC; (2) Schizophrenia Model (SZ, non-SZ); and (3) DSM Model (SZ, SA, BD, HC). The relationship between visual integration and general cognition was also explored. The Psychosis Model showed the strongest evidence, and visual integration was associated with general cognition in participants with psychosis. The results were consistent with the Research Domain Criteria (RDoC) framework, indicating that visual integration impairment is characteristic of psychosis and not specific to SZ or DSM categories, and may share similar disease pathways with observed neurocognitive deficits in psychotic disorders.

Maternal Diet, Metabolic State, and Inflammatory Response Exert Unique and Long-Lasting Influences on Offspring Behavior in Non-Human Primates

Nutritional status influences brain health and gestational exposure to metabolic disorders (e.g. obesity and diabetes) increases the risk of neuropsychiatric disorders. The aim of the present study was to further investigate the role of maternal Western-style diet (WSD), metabolic state, and inflammatory factors in the programming of Japanese macaque offspring behavior. Utilizing structural equation modeling, we investigated the relationships between maternal diet, prepregnancy adiposity, third trimester insulin response, and plasma cytokine levels on 11-month-old offspring behavior. Maternal WSD was associated with greater reactive and ritualized anxiety in offspring. Maternal adiposity and third trimester macrophage-derived chemokine (MDC) exerted opposing effects on offspring high-energy outbursts. Elevated levels of this behavior were associated with low maternal MDC and increased prepregnancy adiposity. This is the first study to show that maternal MDC levels influence offspring behavior. We found no evidence suggesting maternal peripheral inflammatory response mediated the effect of maternal diet and metabolic state on aberrant offspring behavior. Additionally, the extent of maternal metabolic impairment differentially influenced chemokine response. Elevated prepregnancy adiposity suppressed third trimester chemokines, while obesity-induced insulin resistance augmented peripheral chemokine levels. WSD also directly increased maternal interleukin-12. This is the first non-human primate study to delineate the effects of maternal diet and metabolic state on gestational inflammatory environment and subsequent offspring behavior. Our findings give insight to the complex mechanisms by which diet, metabolic state, and inflammation during pregnancy exert unique influences on offspring behavioral regulation.