Impaired processing of emotion in music, faces and voices supports a generalized emotional decoding deficit in alcoholism

WOMEN'S USE OF ALCOHOL: NEUROBIOBEHAVIORAL CONCOMITANTS AND CONSEQUENCES

In this narrative review, we draw from historical and contemporary literature to explore the impact of alcohol consumption on brain and behavior among women. We examine three domains: 1) the impact of alcohol use disorder (AUD) on neurobiobehavioral outcomes, 2) its impact on social cognition/emotion processing, and 3) alcohol's acute effects in older women. There is compelling evidence of alcohol-related compromise in neuropsychological function, neural activation, and brain structure. Investigations of social cognition and alcohol effects in older women represent emerging areas of study. Initial analyses suggest that women with AUD show significant deficits in emotion processing, a finding also observed in older women who have consumed a moderate dose of alcohol. Critically, despite the long-recognized need for programmatic interrogation of alcohol's effect in women, studies with sufficient numbers of women for meaningful analysis represent a small proportion of the literature, constraining interpretation and generalization.

Decoding Emotion in Drug Abusers: Evidence for Face and Body Emotion Recognition and for Disgust Emotion

Background: Different drugs damage the frontal cortices, particularly the prefrontal areas involved in both emotional and cognitive functions, with a consequence of decoding emotion deficits for people with substance abuse. The present study aimed to explore the cognitive impairments in drug abusers through facial, body and disgust emotion recognition, expanding the investigation of emotions processing, measuring accuracy and response velocity. Methods: We enrolled 13 addicted to cocaine and 12 alcohol patients attending treatment services in Italy, comparing them with 33 matched controls. Facial emotion and body posture recognition tasks, a disgust rating task and the Barrat Impulsivity Scale were included in the experimental assessment. Results: We found that emotional processes are differently influenced by cocaine and alcohol, suggesting that these substances impact diverse cerebral systems. Conclusions: Drug abusers seem to be less accurate on elaboration of facial, body and disgust emotions. Considering that the participants were not cognitively impaired, our data support the hypothesis that emotional impairments emerge independently from the damage of cognitive functions.

Impaired sequence generation: a preliminary comparison between high functioning autistic and neurotypical adults

Earlier research demonstrated robust cerebellar involvement in sequencing, including high-level social information sequencing that requires mental state attributions, termed mentalizing. Earlier research also found cerebellar deficiencies in autism spectrum disorders (ASD) which are characterized by social difficulties. However, studies on high-level social sequencing functionality by persons with ASD are almost non-existent. In this study, we, therefore, perform a comparison between behavioral performances of high-functioning ASD and neurotypical participants on the Picture and Verbal Sequencing Tasks. In these tasks, participants are requested to put separate events (depicted in cartoon-like pictures or behavioral sentences, respectively) in their correct chronological order. To do so, some of these events require understanding of high-level social beliefs, of social routines (i.e., scripts), or nonsocial mechanical functionality. As expected, on the Picture Sequencing task, we observed longer response times for persons with ASD (in comparison with neurotypical controls) when ordering sequences requiring an understanding of social beliefs and social scripts, but not when ordering nonsocial mechanical events. This confirms our hypotheses that social sequence processing is impaired in ASD. The verbal version of this task did not reveal differences between groups. Our results are the first step toward new theoretical insights for social impairments of persons with ASD. They highlight the importance of taking into account sequence processing, and indirectly the cerebellum when investigating ASD difficulties.

Association between empathy and drinking among a community sample of heavy drinkers: Sex differences and neural correlates

Alcohol use disorder (AUD) is a major health problem, yet most individuals with AUD do not perceive a need for formal treatment and do not receive treatment. The lack of treatment seeking among individuals with AUD may suggest a lack of self-awareness and insight into the seriousness of AUD related problems, as well as lack of empathy for the impact of one's drinking on others. Recent work has suggested that empathy may be impaired among individuals seeking treatment for AUD. Further these impairments may differ by sex such that males with lower empathy reported more drinking consequences and greater drinking intensity, but there was no association between empathy and drinking among females. The current study used regression analyses (alpha = 0.05) to examine the association between empathy (as measured by the four scales of the Interpersonal Reactivity Index), independent components of gray matter volume in regions associated with empathy, and drinking variables among non-treatment seeking drinkers with AUD (N = 136) and also examined these effects by sex. Results showed greater perspective taking was associated with less temporoparietal and frontotemporal gray matter volume (B(SE) = -0.912 (0.043), p = 0.034). An interaction between perspective taking and sex was associated with craving, such that higher perspective taking was associated with less craving for males only (B(SE) = -0.48 (0.243), p = 0.049; R2 = 0.087). Empathic concern was related to lower percent heavy drinking days for both males and females (B(SE) = -1.57 (0.743), p = 0.035; R2 = 0.11). The current study found empathy may be an important predictor of craving for males and frequency of heavy drinking for males and females. Future work should investigate whether empathy predicts treatment seeking.

Neural mechanisms underlying empathy during alcohol abstinence: evidence from connectome-based predictive modeling

Empathy impairments have been linked to alcohol dependence even during abstinent periods. Nonetheless, the neural underpinnings of abstinence-induced empathy deficits remain unclear. In this study, we employed connectome-based predictive modeling (CPM) by using whole brain resting-state functional connectivity (rs-FC) to predict empathy capability of abstinent alcoholics (n = 47) versus healthy controls (n = 59). In addition, the generalizability of the predictive model (i.e., one group treated as a training dataset and another one treated as a test dataset) was performed to determine whether healthy controls and abstinent alcoholics share common neural fingerprints of empathy. Our results showed that abstinent alcoholics relative to healthy controls had decreased empathy capacity. Although no predictive models were observed in the abstinence group, we found that individual empathy scores in the healthy group can be reliably predicted by functional connectivity from the default mode network (DMN) to the sensorimotor network (SMN), occipital network, and cingulo-opercular network (CON). Moreover, the identified connectivity fingerprints of healthy controls could be generalized to predict empathy in the abstinence group. These findings indicate that neural circuits accounting for empathy may be disrupted by alcohol use and the impaired degree varies greatly among abstinent individuals. The large inter-individual variation may impede identification of the predictive model of empathy in alcohol abstainers.

The Role of the Posterior Cerebellum in Dysfunctional Social Sequencing

Recent advances in social neuroscience have highlighted the critical role of the cerebellum in social cognition, and especially the posterior cerebellum. Studies have supported the view that the posterior cerebellum builds internal action models of our social interactions to predict how other people's actions will be executed and what our most likely responses are to these actions. This mechanism allows to better anticipate action sequences during social interactions in an automatic and intuitive way and to fine-tune these anticipations, making it easier to understand other's social behaviors and mental states (e.g., beliefs, intentions, traits). In this paper, we argue that the central role of the posterior cerebellum in identifying and automatizing social action sequencing provides a fruitful starting point for investigating social dysfunctions in a variety of clinical pathologies, such as autism, obsessive-compulsive and bipolar disorder, depression, and addiction. Our key hypothesis is that dysfunctions of the posterior cerebellum lead to under- or overuse of inflexible social routines and lack of plasticity for learning new, more adaptive, social automatisms. We briefly review past research supporting this view and propose a program of research to test our hypothesis. This approach might alleviate a variety of mental problems of individuals who suffer from inflexible automatizations that stand in the way of adjustable and intuitive social behavior, by increasing posterior cerebellar plasticity using noninvasive neurostimulation or neuro-guided training programs.

Higher-Order Language Dysfunctions in Individuals with Alcohol Use Disorder

Patients with alcohol use disorders (AUD) have difficulties with certain aspects of higher-order language functions (HOLF) but there is no data on a wide range of these functions in this group. Therefore, the aim of this study was to compare different aspects of HOLF in patients with AUD and healthy controls (HC). A total of 31 patients with AUD and 44 HC took part in the study. We assessed HOLF with the Right Hemisphere Language Battery (RHLB) and measured control variables: depression using the Patient Health Questionnaire (PHQ) as well as the speed of processing and executive functions with the Color Trails Test (CTT). Patients with AUD had lower results on nine RHLB tests. Moreover, AUD patients had higher scores on PHQ and longer reaction times on CTT. The differences in most RHLB results remained significant after co-varying the control variables. Patients with AUD have difficulties with making inferences from the text, understanding the meaning of individual words, metaphorical content, and prosody, which may impede the comprehension and production of discourse in which linguistic elements must be integrated with non-verbal cues and contextual information. These disturbances may impact various spheres of everyday life and negatively influence social, private, and professional functioning.

A biological framework for emotional dysregulation in alcohol misuse: from gut to brain

Alcohol use disorder (AUD) has been associated with impairments in social and emotional cognition that play a crucial role in the development and maintenance of addiction. Repeated alcohol intoxications trigger inflammatory processes and sensitise the immune system. In addition, emerging data point to perturbations in the gut microbiome as a key regulator of the inflammatory cascade in AUD. Inflammation and social cognition are potent modulators of one another. At the same time, accumulating evidence implicates the gut microbiome in shaping emotional and social cognition, suggesting the possibility of a common underlying loop of crucial importance for addiction. Here we propose an integrative microbiome neuro-immuno-affective framework of how emotional dysregulation and alcohol-related microbiome dysbiosis could accelerate the cycle of addiction. We outline the overlapping effects of chronic alcohol use, inflammation and microbiome alterations on the fronto-limbic circuitry as a convergence hub for emotional dysregulation. We discuss the interdependent relationship of social cognition, immunity and the microbiome in relation to alcohol misuse- from binge drinking to addiction. In addition, we emphasise adolescence as a sensitive period for the confluence of alcohol harmful effects and emotional dysregulation in the developing gut-brain axis.

Tackling heterogeneity: Individual variability of emotion decoding deficits in severe alcohol use disorder

BACKGROUND

Severe alcohol use disorder (SAUD) is associated with social cognition deficits. Patients with SAUD are impaired for the recognition of emotional facial expressions, particularly at early stages of abstinence. These deficits damage interpersonal relations and increase relapse risk. However, uncertainties still abound on their variation across emotions and on the heterogeneity of emotional impairments across patients. We addressed these questions by exploring how the deficit varies according to emotions' type/intensity and patients' heterogeneity.

METHODS

Sixty-five recently detoxified patients with SAUD and 65 matched healthy controls performed the Facial Emotion Recognition Test, assessing the ability to identify six emotions (anger, contempt, disgust, fear, happiness, sadness) displayed by morphed faces with various intensities. Accuracy scores and detection thresholds were collected for each emotion. Beyond group comparisons, multiple single-case analyses determined the percentage of patients presenting decoding deficits for each emotion.

RESULTS

When current depression and anxiety symptoms were controlled for, patients did not present a general emotion decoding deficit, but were rather characterized by specific deficits for disgust/contempt in accuracy, and for disgust in detection threshold scores. Single-case analyses showed that only a third of patients presented a clinically significant emotional deficit.

CONCLUSIONS

Patients with SAUD only present emotional decoding deficits for specific interpersonal emotions (disgust/contempt) when subclinical psychopathological states are controlled for, and show no general emotional impairment. This goes against the proposal of a generalized social cognition deficit in this population. This group effect moreover masks a massive heterogeneity across patients, which has implications at experimental and clinical levels.

Socio-affective processing biases in severe alcohol use disorders: Experimental and therapeutic perspectives

Previous literature has consistently reported socio-affective information processing impairments in patients with severe alcohol use disorder (SAUD). Some recent studies have also suggested that these patients might exhibit biases toward stimuli indicating social threat, such as angry or disgusted faces. Such biases have been largely documented in other psychopathological disorders like anxiety, where they play a critical role in the emergence and maintenance of the disorder. A comprehensive understanding of these biases in SAUD would thus deepen the understanding of interpersonal difficulties and relapse-related factors. However, to date, no study has directly explored these biases in SAUD. In order to initiate efforts to address this issue, we first review preliminary evidence supporting the hypothesis of biased processing of social threat in SAUD. Then, we identify possible pathways through which such biases might negatively impact the course of the disorder. Finally, we provide precise recommendations and available materials to develop research in this promising field, and underline the related theoretical and clinical perspectives.

Impact of polysubstance use on social and non-affective cognitive performance among treatment-seeking individuals with alcohol use disorders

BACKGROUND

Individuals with alcohol use disorder (AUD) display deficits across a range of cognitive processes. Decrements in social cognition may be particularly important for interpersonal functioning and post-treatment adaptation. Although social cognitive deficits are associated with chronic use of numerous substances, the role of polysubstance use in AUD-associated deficits remains largely unaddressed.

METHODS

Community volunteers (n = 49; 22 men) and inpatient treatment-seekers with AUD were administered neurocognitive tasks indexing emotion processing and non-affective cognitive functioning. Tasks included an emotion discrimination task, a working memory task with affective stimuli, a general face processing (control) task, two measures of executive function, and two measures of visual spatial function. AUD subgroups included individuals with no recent (6-month) polysubstance use (AUD-Only; n = 22; 15 men), and those with at least weekly use (Poly-SU; n = 22; 18 men).

RESULTS

Poly-SU individuals evinced disadvantaged performance relative to other groups on the emotion discrimination task [ps ≤ 0.001], affective working memory task [ps ≤ 0.050], and two executive function measures [ps ≤ 0.051]. No differences were observed for visual spatial functioning [ps ≥ 0.498] or general face processing [ps ≥ 0.190]. No performance differences between AUD-Only and community volunteers were noted.

CONCLUSIONS

Results extend the emerging literature exploring emotion processing in AUD and add to the established literature regarding cognitive deficits in this population. The data suggest that among individuals with AUD, those with polysubstance use may be particularly vulnerable to deficits in decoding emotional face content. The current work highlights the need to incorporate more nuanced and careful considerations of polysubstance use in the design and analysis for future investigations of alcohol-associated deficits in emotion processing.

Selective visual and crossmodal impairment in the discrimination of anger and fear expressions in severe alcohol use disorder

BACKGROUND

Severe alcohol use disorder (SAUD) is associated with impaired discrimination of emotional expressions. This deficit appears increased in crossmodal settings, when simultaneous inputs from different sensory modalities are presented. However, so far, studies exploring emotional crossmodal processing in SAUD relied on static faces and unmatched face/voice pairs, thus offering limited ecological validity. Our aim was therefore to assess emotional processing using a validated and ecological paradigm relying on dynamic audio-visual stimuli, manipulating the amount of emotional information available.

METHOD

Thirty individuals with SAUD and 30 matched healthy controls performed an emotional discrimination task requiring to identify five emotions (anger, disgust, fear, happiness, sadness) expressed as visual, auditory, or auditory-visual segments of varying length. Sensitivity indices (d') were computed to get an unbiased measure of emotional discrimination and entered in a Generalized Linear Mixed Model. Incorrect emotional attributions were also scrutinized through confusion matrices.

RESULTS

Discrimination levels varied across sensory modalities and emotions, and increased with stimuli duration. Crucially, performances also improved from unimodal to crossmodal conditions in both groups, but discrimination for anger crossmodal stimuli and fear crossmodal/visual stimuli remained selectively impaired in SAUD. These deficits were not influenced by stimuli duration, suggesting that they were not modulated by the amount of emotional information available. Moreover, they were not associated with systematic emotional error patterns reflecting specific confusions between emotions.

CONCLUSIONS

These results clarify the nature and extent of crossmodal impairments in SAUD and converge with earlier findings to ascribe a specific role for anger and fear in this pathology.

Emotional Face Processing among Treatment-Seeking Individuals with Alcohol Use Disorders: Investigating Sex Differences and Relationships with Interpersonal Functioning

BACKGROUND

Individuals in treatment for alcohol use disorder (AUD) display deficits across a broad range of cognitive processes. Disruptions in affective processing are understudied, but may be particularly important for interpersonal functioning and post-treatment adaptation. In particular, the role of sex in AUD-associated emotion processing deficits remains largely unaddressed and was a focus of the current investigation.

METHODS

Fifty-six treatment seekers with AUD and 54 healthy community controls (N = 110) were administered an emotional face discrimination task. Non-affective tasks included a sex-discrimination task and two brief measures of executive functioning. Two measures of interpersonal function were included.

RESULTS

Emotion processing deficits were evident among women with AUD relative to other groups. This sex-contingent relationship was not observed in measures of executive function, sex-discrimination or interpersonal problems, although individuals with AUD performed more poorly on these measures.

CONCLUSIONS

Results were consistent with extant literatures examining cognitive, affective and interpersonal functioning among individuals with AUD, and provided novel evidence of vulnerability to alcohol-associated deficits in emotion processing among women. While similar sex-contingent effects were not apparent among other measures, results support modest interrelationships, specifically including the import of emotion processing to interpersonal functioning in AUD. These data offer guidance for further systematic investigation and highlight important considerations for future relapse-prevention and recovery-facilitation efforts.

Gambling and Social Cognition: a Systematic Review

Purpose of Review

The aim of this article was to review current research regarding social cognition (SC) in gambling disorder (GD), to (i) compile and synthetize the current state of existing literature on this topic, and (ii) propose cognitive remediation therapy approaches focused on SC for clinicians.

Recent Findings

It is well known that disordered gamblers show impairment regarding non-social cognitive functions such as inhibition, attention, and decision-making. Furthermore, patients with substance use disorders also present certain deficits regarding social information processing which are difficult to differentiate from the intrinsic toxic effects linked to drugs or alcohol consumption.

Summary

To date, relatively little research has been undertaken to explore SC in gambling disorder (GD) with neuropsychological tasks. Preliminary results suggest impaired non-verbal emotion processing, but only one study has directly measured SC in GD. As a consequence, future research on this framework should propose diverse measures of SC, while controlling for other factors such as personality traits and subtypes of disordered gamblers.

Emotional processing and social cognition in alcohol use disorder

OBJECTIVE

To review deficits in emotional processing and social cognition potentially contributing to the dysfunctional emotion regulation and difficulties with interpersonal relationships observed in individuals with alcohol use disorder (AUD) and to provide directions for future research.

METHOD

First is presented a review of emotional and social-cognitive impairments in recently detoxified AUD individuals that include alexithymia, difficulties in decoding others' emotions, and reduced theory of mind and empathy skills. Social cognition disorders in AUD pose different issues discussed, such as whether (1) these deficits are consequences of excessive alcohol consumption or premorbid risk factors for addiction, (2) emotional and social impairments impede positive treatment outcome, (3) recovery of social abilities is possible with sustained abstinence, and (4) AUD patients are unaware of their emotional and social dysfunctions. Finally, current knowledge on structural and functional brain correlates of these deficits in AUD are reviewed.

RESULTS

Emotional and social-cognitive functions affected in AUD can potentially compromise efforts to initiate and maintain abstinence by hampering efficacy of clinical treatment. Such dysfunction can obstruct efforts to enable or reinstate higher-order abilities such as emotional self-regulation, motivation to change, success in interpersonal/social interactions, and emotional insight and awareness of social dysfunctions (i.e., accurate metacognition).

CONCLUSIONS

The present review highlights the need to account for emotional processing and social cognition in the evaluation and rehabilitation of alcohol-related neurocognitive disorders and to consider psychotherapeutic treatment involving remediation of emotional and social skills as implemented in psychiatric and neurological disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Neurophysiological and Interpersonal Correlates of Emotional Face Processing in Alcohol Use Disorder

BACKGROUND

A growing literature suggests deficient emotional facial expression (EFE) processing among recently abstinent individuals with alcohol use disorders (AUDs). Further investigation is needed to clarify valence-related discrepancies and elucidate neural and psychosocial correlates. We examined neurobehavioral indices of EFE processing and interpersonal problems in treatment seekers with AUDs and healthy community controls (CCs).

METHODS

Thirty-four individuals with AUDs and 39 CCs completed an emotion judgment task (EJT), requiring discrimination between happy, angry, and sad EFEs. A second task requiring discrimination of male and female faces with neutral expressions served as the control task (i.e., sex judgment task, SJT). Neurophysiological (i.e., N170 and P3) and behavioral measures were analyzed using generalized linear mixed models (GLMM). Interpersonal problems were assessed with the Inventory of Interpersonal Problems-64 (IIP-64). The relationship of IIP-64 and EJT performance was investigated via within-group correlations.

RESULTS

Analysis of the SJT revealed no group differences in behavioral measures, N170 amplitude, or P3 latency. P3 amplitudes, however, were significantly lower in the AUD group. For the EJT, initial observations of group differences in P3 amplitude were accounted for by differences in the control task. Behavioral analyses indicated that the AUD group was significantly less accurate than the CC group. Hypothesis-driven analyses using GLMM-estimated group differences indicated that anger processing was affected to a greater degree than were other emotions. Significant EJT/IIP-64 correlations were observed for anger processing within the AUD group and were confined to IIP-64 subscales with relatively high ratings on the affiliation dimension.

CONCLUSIONS

Findings provide partial support for an emotion-specific processing deficit in persons with AUDs. Anger processing was more robustly affected than other emotions and was associated with interpersonal problems characterized by being overly needy, nonassertive, and overly accommodating. Results extend prior reports and reinforce the need for comprehensive study of emotion processing and its real-world implications.

Altered oscillatory brain dynamics of emotional processing in young binge drinkers

Heavy episodic drinking, also termed binge drinking, is commonly practiced by young adults. It is accompanied by a range of cognitive, affective, and social problems, but the neural dynamics underlying changes in emotional functions is poorly understood. To investigate the behavioral and brain indices of affective processing as a function of binge drinking, young, healthy participants (23.3 ± 3.3 years) were assigned to two groups (n = 32 each) based on their drinking habits. Binge drinking (BD) participants reported drinking heavily with at least five binge episodes in the last 6 months, whereas light drinkers (LD) reported no more than one binge episode in the last 6 months. Participants provided subjective ratings of emotionally evocative images with negative, positive, erotic, and neutral themes mostly selected from the International Affective Picture System (IAPS). Electroencephalography (EEG) signal was recorded with a 64-channel system and analyzed in theta frequency band (4-7 Hz) with Morlet wavelets. Subjective ratings of the IAPS pictures were equivalent across both groups. However, affective modulation of event-related theta power both during early appraisal and later integrative processing stages was attenuated in BD, particularly those engaging in high-intensity drinking. These findings suggest that binge drinking is associated with altered neurophysiological indices of affective functions that are reflected in lower theta responsivity to emotions. The blunted long-range cortico-cortical and corticolimbic integration is consistent with compromised affective functions in alcohol use disorder. These findings may have implications for diagnostic and intervention strategies in heavy alcohol users.

Alcohol use and personality trait change: pooled analysis of six cohort studies

BACKGROUND

Personality has been associated with alcohol use, but less is known about how alcohol use may influence long-term personality trait change.

METHODS

The present study examines associations between alcohol use and change in the five major personality traits across two measurement occasions (mean follow-up of 5.6 years). A total of 39 722 participants (54% women) were pooled from six cohort studies for an individual-participant meta-analysis. Alcohol use was measured as (1) average alcohol consumption, (2) frequency of binge drinking, (3) symptoms of alcohol use disorder, and (4) a global indicator of risky alcohol use. Changes in the five major personality traits (extraversion, emotional stability, agreeableness, conscientiousness, and openness to experience) were used as outcomes.

RESULTS

Risky alcohol use was associated with increasing extraversion [0.25 T-scores over the mean follow-up of 5.6 years; 95% confidence interval (CI) 0.07-0.44] and decreasing emotional stability (-0.28; 95% CI -0.48 to -0.08), agreeableness (-0.67; 95% CI -0.87 to -0.36), and conscientiousness (-0.58; 95% CI -0.79 to -0.38). Except the association between alcohol use and extraversion, these associations were consistent across cohort studies and across different measures of alcohol use.

CONCLUSIONS

These findings suggest that alcohol use is associated with personality trait changes in adulthood.

Automatic visual-spatial perspective taking in alcohol-dependence: A study with happy emotional faces

BACKGROUND

Understanding the world from another's perspective is an important and potentially automatic human process which is crucial for efficient social interactions. However, while deficits have repeatedly been described for various interpersonal abilities in alcohol-dependence (AD), only one previous study has investigated perspective taking in this pathology.

AIM

The current study aimed to explore further how AD affects visual-spatial perspective taking (VSPT) by examining the effect of positive emotional stimuli on VSPT in both an AD and non-AD sample.

METHODS

Reaction times (RT) for simple spatial judgments were measured. Participants made these judgments from their perspective, but judgments were either congruent or incongruent with the perspective of another agent. The emotion conveyed by that agent (happy or neutral) was manipulated across trials.

RESULTS

Compared to baseline, both AD and non-AD groups displayed delayed RTs for spatial judgments when these were incongruent with the perspective of a happy agent (the expected VSPT RT cost, indicating automatic VSPT). The AD, but not the non-AD group, further displayed a VSPT RT cost when the agent expressed a neutral emotion.

CONCLUSION

There was no evidence that AD compromised automatic VSPT. However, as in previous research, AD was associated with differences in the processing of emotional stimuli. Future research should explore which 'real-world' settings are likely to trigger social confusion and misunderstanding.

Why cognitive event-related potentials (ERPs) should have a role in the management of alcohol disorders

Alcohol dependence is currently one of the most serious public health problems. Indeed, 3-8% of all deaths worldwide are attributable to effects of alcohol consumption. Although the first step in alcohol dependence treatment is straightforward, the main problem for clinicians lies with the prevention of relapse, as 40-70% of patients who only undergo psychosocial therapy resume alcohol use within a year following treatment. This review of the literature regarding event-related potentials (ERPs) is focused on two major neurocognitive factors that partially account for the inability of many alcoholics to remain abstinent: attentional biases towards alcohol-related stimuli that increase the urge to drink, and impaired response inhibition towards these cues that makes it more difficult for alcoholics to resist the temptation to drink. On this basis, we propose new research avenues to better implement ERPs in the management of alcohol disorders, according to four main directions that relate to (1) the development of ERP serial recordings; (2) the promotion of a multi-component ERP approach; (3) the definition of multi-site guidelines; and (4) the use of more representative laboratory situations through the use of more compelling environments.

Aspects of alcohol use disorder affecting social cognition as assessed using the Mini Social and Emotional Assessment (mini-SEA)

BACKGROUND

Alcohol Use Disorder (AUD) is associated with problems with processing complex social scenarios. Little is known about the relationship between distinct AUD-related factors (e.g., years of problematic drinking), aspects of cognitive function and dysfunction in individuals diagnosed with AUD, and the relative impact these may have on social cognition.

AIMS

To explore differences in social cognition between a group of participants diagnosed with AUD and controls, using a clinical measure, the Mini Social and Emotional Assessment (mini-SEA). The mini-SEA was used to evaluate social and emotional understanding through a facial emotional recognition task and by utilising a series of social scenes some of which contain a faux pas (social error).

METHODS

Eighty-five participants (individuals with AUD and controls) completed demographic questions and a general cognitive and social cognitive test battery over three consecutive days.

RESULTS

Between group analyses revealed that the participants with AUD performed less well on the faux pas test, and differences were also revealed in the emotional facial recognition task. Years of problematic alcohol consumption was the strongest predictor of poor ToM reasoning.

CONCLUSION

These results suggest a strong link between AUD chronicity and social cognition, though the direction of this relationship needs further elucidation. This may be of clinical relevance to abstinence and relapse management, as basic social cognition skills and ability to maintain interpersonal relationships are likely to be crucial to recovery.

Relationship between empathic processing and drinking behavior in project MATCH

INTRODUCTION

Family relationships, social connectedness and a greater network of supportive others each predict better drinking outcomes among individuals with alcohol use disorder (AUD). The association between social factors and drinking may be related to the ability of individuals to take the perspectives of others' mental and emotional states, defined as empathic processing (EP). As such, it may be the case that EP is associated with social support (SS) and drinking behavior among individuals with AUD, yet few prior studies have attempted to define EP in an AUD sample.

METHODS

The current study was a secondary data analysis of Project MATCH (N=1726) using structural equation modeling to model EP as a latent factor. The study also sought to test the baseline associations between EP, SS, and drinking behavior, as well as sex differences in the associations between EP, SS, and drinking. It was hypothesized that EP would be positively associated with SS and negatively associated with drinking behavior.

RESULTS

Results suggested adequate model fit of the EP construct. Structural equation models indicated significant associations between EP, SS, and both drinking consequences and percent drinking days, but only for males. Males reported significantly lower EP and SS from friends, but more SS from family, compared to females. EP was not related to drinking among females.

CONCLUSIONS

The current study validated a model of EP in a treatment-seeking sample of individuals with alcohol use disorder. Future work may consider EP as a treatment-modifiable risk factor for drinking frequency and consequences in males.

Addictive behaviors: Why and how impaired mental time matters?

Mental time travel (MTT) allows navigation into the past, the future, and the minds of others, and it subserves future-oriented decision-making. Impaired MTT has been associated with a tendency to over-rely on the present, which is a characteristic of addictive behaviors. We here discuss the possible relationship between impaired autographical memory, future-oriented MTT, shortened time horizons, suboptimal social cognition, and poor decision-making in individuals with drug and gambling use disorders. We elaborate on how impaired MTT could compromise the process of change in addiction recovery and the effectiveness of psychotherapy. We argue that facilitating MTT represents, for individuals with addictive behaviors, an important process to enhance readiness to change, and to improve the quality and the efficiency of psychosocial interventions that focus on "emotional correction."

Preserved Affective Sharing But Impaired Decoding of Contextual Complex Emotions in Alcohol Dependence

BACKGROUND

Prior research has repeatedly shown that alcohol dependence is associated with a large range of impairments in psychological processes, which could lead to interpersonal deficits. Specifically, it has been suggested that these interpersonal difficulties are underpinned by reduced recognition and sharing of others' emotional states. However, this pattern of deficits remains to be clarified. This study thus aimed to investigate whether alcohol dependence is associated with impaired abilities in decoding contextual complex emotions and with altered sharing of others' emotions.

METHODS

Forty-one alcohol-dependent individuals (ADI) and 37 matched healthy individuals completed the Multifaceted Empathy Test, in which they were instructed to identify complex emotional states expressed by individuals in contextual scenes and to state to what extent they shared them.

RESULTS

Compared to healthy individuals, ADI were impaired in identifying negative (Cohen's d = 0.75) and positive (Cohen's d = 0.46) emotional states but, conversely, presented preserved abilities in sharing others' emotional states.

CONCLUSIONS

This study shows that alcohol dependence is characterized by an impaired ability to decode complex emotional states (both positive and negative), despite the presence of complementary contextual cues, but by preserved emotion-sharing. Therefore, these results extend earlier data describing an impaired ability to decode noncontextualized emotions toward contextualized and ecologically valid emotional states. They also indicate that some essential emotional competences such as emotion-sharing are preserved in alcohol dependence, thereby offering potential therapeutic levers.

The effect of alcohol dependence on automatic visuo-spatial perspective taking

BACKGROUND

Alcoholism is associated with cognitive deficits that affect social functioning. Previous research has shown that alcoholism is associated with deficits in conscious, deliberate social processing. However, little is known about whether alcoholism also affects rapid, spontaneous processing. We therefore investigated the extent to which alcoholism affects the ability to spontaneously adopt the viewpoint of another in a visuo-spatial perspective taking (VSPT) task.

METHODS

VSPT was measured in participants responding to a dot probe presented for 35ms alongside neutral faces, fearful faces and baseline stimuli (rectangles).

RESULTS

Non alcohol dependent participants showed the standard reaction time cost to fearful faces, but not neutral faces relative to baseline. However, Alcohol dependent (AD) participants showed a reaction time cost to both fearful and neutral faces.

CONCLUSIONS

AD participants are not impaired in their ability to automatically adopt the perspective of another. However, unlike non-AD participants, they show automatic perspective taking to both neutral and fearful faces.

Impaired non-verbal emotion processing in Pathological Gamblers

Impaired perception of emotion in others has been described and confirmed in addictions with substances, but no such data exists regarding addictions without substances. As it has been hypothesized that toxic effect of substances on the brain was responsible for the impairments described, studying addictions without substances could be of interest to confirm this hypothesis. Twenty-two male pathological gamblers were compared to 22 male healthy controls matched for age and education level on non-verbal emotion perception tasks including faces, voices, and musical excerpts. Depression and anxiety levels were controlled for. Pathological gamblers significantly underestimated the intensity of peacefulness in music, and overall they were less accurate when reading emotion in voices and faces. They also overestimated emotional intensity in neutral voices and faces. Although anxiety levels did account for accuracy problems when detecting fear in voices and for overestimating emotions in neutral faces, anxiety levels did not explain the range of deficits observed. This is the first study showing non-verbal perception deficits in a purely behavioural addiction. These findings show that deficits in decoding non-verbal signals are associated with addictive behaviours per se, and are not due solely to toxic effects of substances on the brain.

Alteration of complex negative emotions induced by music in euthymic patients with bipolar disorder

BACKGROUND

Research has shown bipolar disorder to be characterized by dysregulation of emotion processing, including biases in facial expression recognition that is most prevalent during depressive and manic states. Very few studies have examined induced emotions when patients are in a euthymic phase, and there has been no research on complex emotions. We therefore set out to test emotional hyperreactivity in response to musical excerpts inducing complex emotions in bipolar disorder during euthymia.

METHODS

We recruited 21 patients with bipolar disorder (BD) in a euthymic phase and 21 matched healthy controls. Participants first rated their emotional reactivity on two validated self-report scales (ERS and MAThyS). They then rated their music-induced emotions on nine continuous scales. The targeted emotions were wonder, power, melancholy and tension. We used a specific generalized linear mixed model to analyze the behavioral data.

RESULTS

We found that participants in the euthymic bipolar group experienced more intense complex negative emotions than controls when the musical excerpts induced wonder. Moreover, patients exhibited greater emotional reactivity in daily life (ERS). Finally, a greater experience of tension while listening to positive music seemed to be mediated by greater emotional reactivity and a deficit in executive functions.

LIMITATIONS

The heterogeneity of the BD group in terms of clinical characteristics may have influenced the results.

CONCLUSIONS

Euthymic patients with bipolar disorder exhibit more complex negative emotions than controls in response to positive music.

Cognitive, emotion control, and motor performance of adolescents in the NCANDA study: Contributions from alcohol consumption, age, sex, ethnicity, and family history of addiction

OBJECTIVE

To investigate development of cognitive and motor functions in healthy adolescents and to explore whether hazardous drinking affects the normal developmental course of those functions.

METHOD

Participants were 831 adolescents recruited across 5 United States sites of the National Consortium on Alcohol and NeuroDevelopment in Adolescence 692 met criteria for no/low alcohol exposure, and 139 exceeded drinking thresholds. Cross-sectional, baseline data were collected with computerized and traditional neuropsychological tests assessing 8 functional domains expressed as composite scores. General additive modeling evaluated factors potentially modulating performance (age, sex, ethnicity, socioeconomic status, and pubertal developmental stage).

RESULTS

Older no/low-drinking participants achieved better scores than younger ones on 5 accuracy composites (general ability, abstraction, attention, emotion, and balance). Speeded responses for attention, motor speed, and general ability were sensitive to age and pubertal development. The exceeds-threshold group (accounting for age, sex, and other demographic factors) performed significantly below the no/low-drinking group on balance accuracy and on general ability, attention, episodic memory, emotion, and motor speed scores and showed evidence for faster speed at the expense of accuracy. Delay Discounting performance was consistent with poor impulse control in the younger no/low drinkers and in exceeds-threshold drinkers regardless of age.

CONCLUSIONS

Higher achievement with older age and pubertal stage in general ability, abstraction, attention, emotion, and balance suggests continued functional development through adolescence, possibly supported by concurrently maturing frontal, limbic, and cerebellar brain systems. Determination of whether low scores by the exceeds-threshold group resulted from drinking or from other preexisting factors requires longitudinal study. (PsycINFO Database Record

Facial, vocal and musical emotion recognition is altered in paranoid schizophrenic patients

Disturbed processing of emotional faces and voices is typically observed in schizophrenia. This deficit leads to impaired social cognition and interactions. In this study, we investigated whether impaired processing of emotions also affects musical stimuli, which are widely present in daily life and known for their emotional impact. Thirty schizophrenic patients and 30 matched healthy controls evaluated the emotional content of musical, vocal and facial stimuli. Schizophrenic patients are less accurate than healthy controls in recognizing emotion in music, voices and faces. Our results confirm impaired recognition of emotion in voice and face stimuli in schizophrenic patients and extend this observation to the recognition of emotion in musical stimuli.

Social cognition deficits and associations with drinking history in alcoholic men and women

BACKGROUND

Previous studies have demonstrated the presence of a social cognition factor as an element of general cognition in healthy control and clinical populations. Recently developed measures of social cognition include the social perception and faces subtests of the Wechsler Advanced Clinical Solutions (ACS) Social Cognition module. While these measures have been validated on various clinical samples, they have not been studied in alcoholics. Alcoholism has been associated with emotional abnormalities and diminished social cognitive functioning as well as neuropathology of brain areas underlying social processing abilities. We used the ACS Social Perception and Faces subtests to assess alcoholism-related impairments in social cognition.

METHODS

Social cognitive functioning was assessed in 77 abstinent alcoholic individuals (37 women) and 59 nonalcoholic control participants (29 women), using measures of the ACS Social Cognition module and subtests of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) that contain a social cognition component (Picture Completion and Comprehension). Group and gender differences in ACS and WAIS-IV performance were assessed, as well as relationships between measures of alcoholism severity and social cognitive functioning.

RESULTS

Alcoholics performed significantly worse than nonalcoholics on the ACS measures of Affect Naming and Faces Content. Alcoholic men were impaired relative to alcoholic women on Prosody Face Matching and Faces Content scores. Among alcoholics, longer durations of heavy drinking were associated with poorer performance on Affect Naming, and a greater number of daily drinks were associated with lower Prosody Face Matching performance. For alcoholic women, a longer duration of abstinence was associated with better performance on Affect Naming.

CONCLUSIONS

Alcoholic men and women showed different patterns of associations between alcoholism indices and clinically validated social cognition assessments. These findings extend into the social cognition domain, previous literature demonstrating the presence of cognitive deficits in alcoholism, their association with alcoholism severity, and variability by gender. Moreover, because impairments in social cognition can persist despite extended abstinence, they have important implications for relapse prevention.

Cognitive and affective theory of mind abilities in alcohol-dependent patients: the role of autobiographical memory

BACKGROUND

Many studies of patients with alcohol dependence (AD) have highlighted their difficulty in identifying both their own emotional state and those of a social partner. We examined (1) the cognitive and affective theory of mind (ToM) abilities of AD patients and (2) how the efficiency of their autobiographical memory (AM) can affect the effectiveness of ToM ability.

METHOD

In a cross-sectional design, AD patients (N=50) and healthy controls (N=30) completed a ToM movie paradigm (Versailles-Situational Intention Reading, V-SIR) in which they inferred the intentions of characters in movies depicting social interactions, and the "Reading the Mind in the Eyes" Test (RMET), which assessed the emotional dimension of the ToM. AM was investigated using the "Autobiographical Memory Interview" (AMI) to assess both episodic and semantic components of AM.

RESULTS

Concerning ToM, patients with AD showed lower performance in the RMET than control participants, whereas no difference was observed on the V-SIR test. AD patients had lower scores than controls on the AMI, for both episodic and semantic components and for different periods of life. A multiple linear regression analysis also showed that AM deficits might predict lower ToM performance, especially for the RMET task.

CONCLUSIONS

Patients with AD have a specific affective ToM deficit. They used episodic memories to perceive the emotions of others, whereas controls used preferentially semantic memories to perform the task. Both these deficits could constitute a risk of relapse and should be a target for psychotherapeutic interventions.

Towards a cross-modal perspective of emotional perception in social anxiety: review and future directions

The excessive fear of being negatively evaluated constitutes a central component of social anxiety (SA). Models posit that selective attention to threat and biased interpretations of ambiguous stimuli contribute to the maintenance of this psychopathology. There is strong support for the existence of processing biases but most of the available evidence comes from face research. Emotions are, however, not only conveyed through facial cues, but also through other channels, such as vocal and postural cues. These non-facial cues have yet received much less attention. We therefore plead for a cross-modal investigation of biases in SA. We argue that the inclusion of new modalities may be an efficient research tool to (1) address the specificity or generalizability of these biases; (2) offer an insight into the potential influence of SA on cross-modal processes; (3) operationalize emotional ambiguity by manipulating cross-modal emotional congruency; (4) inform the debate about the role of top-down and bottom-up factors in biasing attention; and (5) probe the cross-modal generalizability of cognitive training. Theoretical and clinical implications as well as potential fruitful avenues for research are discussed.

Psychiatry and music

Vocal and/or instrumental sounds combined in such a way as to produce beauty of form, harmony and expression of emotion is music. Brain, mind and music are remarkably related to each other and music has got a strong impact on psychiatry. With the advent of music therapy, as an efficient form of alternative therapy in treating major psychiatric conditions, this impact has been further strengthened. In this review, we deliberate upon the historical aspects of the relationship between psychiatry and music, neural processing underlying music, music's relation to classical psychology and psychopathology and scientific evidence base for music therapy in major psychiatric disorders. We highlight the role of Indian forms of music and Indian contribution to music therapy.

Altered emotion perception in insomnia disorder

STUDY OBJECTIVES

Chronic insomnia is a prevalent sleep disorder that negatively affects daytime functioning and confers risk for the future development of psychiatric disorder. Patients with insomnia often report problems with emotion regulation and impaired social interactions. Moreover, experimental sleep loss in healthy adults is associated with altered reactivity to and interpretation of emotional information. In the current study, we investigated socioemotional processing in patients with chronic insomnia disorder relative to healthy good sleepers.

DESIGN

Between-groups comparison.

SETTING

Sleep Research Laboratory.

PARTICIPANTS

Patients with well-defined psychophysiological insomnia (PI; n = 16), free from psychiatric disorder, and an age- and sex-matched control group of good sleepers (GS; n = 15).

INTERVENTIONS

N/A.

MEASUREMENT AND RESULTS

All participants completed a facial expression recognition task, between 18:00 and 19:00, requiring participants to categorize and rate the intensity of four emotional expression categories: anger, fear, happiness, and sadness. People with PI did not differ from GS with respect to categorization of facial expressions. However, in terms of intensity judgements, across all emotion categories, patients tended to rate faces as less emotionally intense (Cohen's d = 0.70). Specifically, they rated expressions displaying sadness and fear as significantly less emotionally intense than healthy GS (both P < 0.05; Cohen's d = 0.77 and 0.89, respectively). Measures of sleepiness (Psychomotor Vigilance Test, Karolinska Sleepiness Scale) or self-reported sleep were not reliably associated with emotional intensity ratings. However, anxiety and depression were negatively related to intensity ratings.

CONCLUSION

For the first time we show that chronic insomnia is associated with reduced ratings of emotion intensity for face expressions displaying sadness and fear. Further work is required to elucidate possible mechanisms and pathways underlying insomnia-related emotional impairment.

Cognition, emotion, and attention

Deficits of attention, emotion, and cognition occur in individuals with alcohol abuse and addiction. This review elucidates the concepts of attention, emotion, and cognition and references research on the underlying neural networks and their compromise in alcohol use disorder. Neuroimaging research on adolescents with family history of alcoholism contributes to the understanding of pre-existing brain structural conditions and characterization of cognition and attention processes in high-risk individuals. Attention and cognition interact with other brain functions, including perceptual selection, salience, emotion, reward, and memory, through interconnected neural networks. Recent research reports compromised microstructural and functional network connectivity in alcoholism, which can have an effect on the dynamic tuning between brain systems, e.g., the frontally based executive control system, the limbic emotion system, and the midbrain-striatal reward system, thereby impeding cognitive flexibility and behavioral adaptation to changing environments. Finally, we introduce concepts of functional compensation, the capacity to generate attentional resources for performance enhancement, and brain structure recovery with abstinence. An understanding of the neural mechanisms of attention, emotion, and cognition will likely provide the basis for better treatment strategies for developing skills that enhance alcoholism therapy adherence and quality of life, and reduce the propensity for relapse.

Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism

Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychologic profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among subjects is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory; (2) executive functions; (3) emotion and psychosocial skills; (4) visuospatial cognition; and (5) psychomotor abilities. Although the entire brain might be vulnerable in uncomplicated alcoholism, the brain systems that are considered to be most at risk are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome.

Recognition of facial expressions by alcoholic patients: a systematic literature review

BACKGROUND

Alcohol abuse and dependence can cause a wide variety of cognitive, psychomotor, and visual-spatial deficits. It is questionable whether this condition is associated with impairments in the recognition of affective and/or emotional information. Such impairments may promote deficits in social cognition and, consequently, in the adaptation and interaction of alcohol abusers with their social environment. The aim of this systematic review was to systematize the literature on alcoholics' recognition of basic facial expressions in terms of the following outcome variables: accuracy, emotional intensity, and latency time.

METHODS

A systematic literature search in the PsycINFO, PubMed, and SciELO electronic databases, with no restrictions regarding publication year, was employed as the study methodology.

RESULTS

The findings of some studies indicate that alcoholics have greater impairment in facial expression recognition tasks, while others could not differentiate the clinical group from controls. However, there was a trend toward greater deficits in alcoholics. Alcoholics displayed less accuracy in recognition of sadness and disgust and required greater emotional intensity to judge facial expressions corresponding to fear and anger.

CONCLUSION

The current study was only able to identify trends in the chosen outcome variables. Future studies that aim to provide more precise evidence for the potential influence of alcohol on social cognition are needed.

Below and beyond the recognition of emotional facial expressions in alcohol dependence: from basic perception to social cognition

Studies that have carried out experimental evaluation of emotional skills in alcohol-dependence have, up to now, been mainly focused on the exploration of emotional facial expressions (EFE) decoding. In the present paper, we provide some complements to the recent systematic literature review published by Donadon and de Lima Osório on this crucial topic. We also suggest research avenues that must be, in our opinion, considered in the coming years. More precisely, we propose, first, that a battery integrating a set of emotional tasks relating to different processes should be developed to better systemize EFE decoding measures in alcohol-dependence. Second, we propose to go below EFE recognition deficits and to seek for the roots of those alterations, particularly by investigating the putative role played by early visual processing and vision-emotion interactions in the emotional impairment observed in alcohol-dependence. Third, we insist on the need to go beyond EFE recognition deficits by suggesting that they only constitute a part of wider emotional deficits in alcohol-dependence. Importantly, since the efficient decoding of emotions is a crucial ability for the development and maintenance of satisfactory interpersonal relationships, we suggest that disruption of this ability in alcohol-dependent individuals may have adverse consequences for their social integration. One way to achieve this research agenda would be to develop the field of affective and social neuroscience of alcohol-dependence, which could ultimately lead to major advances at both theoretical and therapeutic levels.

Unfairness sensitivity and social decision-making in individuals with alcohol dependence: a preliminary study

BACKGROUND

Altruistic punishment is an evolutionary-based mechanism aimed at maximizing the probability of reciprocity in cooperative exchanges, through the deterrence of non-cooperators. In economic games, humans will often punish others for non-cooperation, even if this punishment is costly to the self. For instance, in the Ultimatum Game paradigm, people refuse offers considered as unfair even though they are disadvantaged financially by doing so. Here, we hypothesize that, due to an impulsive decision making style, individuals with alcoholism will display an heightened unfairness sensitivity that leads them to reject advantageous offers more frequently on the Ultimatum Game.

METHODS

Thirty recently detoxified alcohol-dependent individuals and 30 matched healthy control participants performed the Ultimatum Game task, in which participants had to respond to take-it-or-leave-it offers ranging from fair to unfair and made by a fictive proposer.

RESULTS

Alcohol-dependent participants decided to reject unfair offers more frequently during the Ultimatum Game, as compared to controls.

CONCLUSIONS

In situations of social frustration or irritation, such as unfair Ultimatum Game offers, alcohol-dependent individuals may have more difficulty than controls regulating their emotional impulses, and respond aggressively or retributively (i.e., by rejecting the unfair offer).

Polysubstance dependent patients display a more utilitarian profile in moral decision-making than alcohol-dependent patients, depressive patients and controls

BACKGROUND

Addiction has been shown to be associated with the endorsement of utilitarian moral judgments. Ventro-medial prefrontal cortex (VMPFC) dysfunction may explain these findings.

METHODS

100 subjects were recruited: 25 polysubstance dependent patients, 25 alcohol dependent patients, 25 patients with major depressive disorders, and 25 normal controls. Subjects were assessed with a battery of 24 moral dilemmas: 8 impersonal dilemmas (no physical contact involved); 8 personal pareto (direct action that does not make the harmed individual worse off) and 8 personal non-pareto (direct action that does make the harmed individual worse off). The Iowa Gambling Task was used to document a possible connection between VMPFC dysfunction and responses to the moral dilemmas.

RESULTS

Polysubstance dependent patients endorsed more utilitarian choices than controls on all types of dilemmas and more than depressed patients on impersonal and personal pareto dilemmas. Alcohol dependent patients had intermediate results between polysubstance dependent patients and controls but these differences were not significant. All patients showed significantly poorer performance compared to controls on the Iowa Gambling Task, but there was no significant association between Iowa Gambling Tasks scores and moral dilemma choices.

CONCLUSION

Polysubstance dependent patients made more utilitarian choices when responding to moral dilemmas than depressed patients and normal controls, while alcoholic patients showed intermediate results. The absence of correlation between performance on the Iowa Gambling Task and the number of more utilitarian choices indicates that moral dilemma and decision making under uncertainty tap into separate mechanisms.

Experimental and clinical usefulness of crossmodal paradigms in psychiatry: an illustration from emotional processing in alcohol-dependence

Crossmodal processing (i.e., the construction of a unified representation stemming from distinct sensorial modalities inputs) constitutes a crucial ability in humans' everyday life. It has been extensively explored at cognitive and cerebral levels during the last decade among healthy controls. Paradoxically however, and while difficulties to perform this integrative process have been suggested in a large range of psychopathological states (e.g., schizophrenia and autism), these crossmodal paradigms have been very rarely used in the exploration of psychiatric populations. The main aim of the present paper is thus to underline the experimental and clinical usefulness of exploring crossmodal processes in psychiatry. We will illustrate this proposal by means of the recent data obtained in the crossmodal exploration of emotional alterations in alcohol-dependence. Indeed, emotional decoding impairments might have a role in the development and maintenance of alcohol-dependence, and have been extensively investigated by means of experiments using separated visual or auditory stimulations. Besides these unimodal explorations, we have recently conducted several studies using audio-visual crossmodal paradigms, which has allowed us to improve the ecological validity of the unimodal experimental designs and to offer new insights on the emotional alterations among alcohol-dependent individuals. We will show how these preliminary results can be extended to develop a coherent and ambitious research program using crossmodal designs in various psychiatric populations and sensory modalities. We will finally end the paper by underlining the various potential clinical applications and the fundamental implications that can be raised by this emerging project.

Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism

It is widely accepted that autism is associated with disordered emotion processing and, in particular, with deficits of emotional reciprocity such as impaired emotion recognition and reduced empathy. However, a close examination of the literature reveals wide heterogeneity within the autistic population with respect to emotional competence. Here we argue that, where observed, emotional impairments are due to alexithymia-a condition that frequently co-occurs with autism-rather than a feature of autism per se. Alexithymia is a condition characterized by a reduced ability to identify and describe one's own emotion, but which results in reduced empathy and an impaired ability to recognize the emotions of others. We briefly review studies of emotion processing in alexithymia, and in autism, before describing a recent series of studies directly testing this 'alexithymia hypothesis'. If found to be correct, the alexithymia hypothesis has wide-reaching implications for the study of autism, and how we might best support subgroups of autistic individuals with, and without, accompanying alexithymia. Finally, we note the presence of elevated rates of alexithymia, and inconsistent reports of emotional impairments, in eating disorders, schizophrenia, substance abuse, Parkinson's Disease, multiple sclerosis and anxiety disorders. We speculate that examining the contribution of alexithymia to the emotional symptoms of these disorders may bear fruit in the same way that it is starting to do in autism.

Mental state decoding and mental state reasoning in recently detoxified alcohol-dependent individuals

Impaired social cognition has been associated with interpersonal problems and with the development of and relapse into alcohol abuse. In the present study, self-reported trait empathy, decoding of complex mental states and cognitive and affective mental state reasoning were assessed in alcohol-dependent participants, and the association with executive function and psychopathological characteristics was investigated. Twenty recently detoxified alcohol-dependent patients and 20 matched healthy controls were assessed with an abbreviated German version of the interpersonal reactivity index, the revised reading the mind in the eyes test, the faux pas story test, the trail making test and the letter-number-sequencing test. Patients were impaired relative to controls with regard to mental state decoding on the eyes test and showed reduced faux pas detection and impaired mental state reasoning reflected by lower faux pas understanding and faux pas empathy scores. There were no group differences regarding self-reported trait empathy. Performance on the sociocognitive measures was related to executive functioning and the severity of depressive symptoms. Although self-report measures might not always reliably detect impairments of social cognition, behavioural measures suggest pronounced impairments of mental state decoding and mental state reasoning in association with alcohol dependence. Findings ought to be incorporated into current treatment strategies.