Facial affect processing deficits in schizophrenia: a meta-analysis of antipsychotic treatment effects

Emotional interference and attentional control in schizophrenia-spectrum disorders: The special case of neutral faces

BACKGROUND AND OBJECTIVES

Schizophrenia-spectrum disorders (SSD) are characterized by impaired emotion processing and attention. SSD patients are more sensitive to the presence of emotional distractors. But despite growing interest on the emotion-attention interplay, emotional interference in SSD is far from fully understood. Moreover, research to date has not established the link between emotional interference and attentional control in SSD. This study thus aimed to investigate the effects of facial expression and attentional control in SSD, by manipulating perceptual load.

METHODS

Twenty-two SSD patients and 22 healthy controls performed a target-letter discrimination task with task-irrelevant angry, happy, and neutral faces. Target-letter was presented among homogenous (low load) or heterogenous (high load) distractor-letters. Accuracy and RT were analysed using (generalized) linear mixed-effect models.

RESULTS

Accuracy was significantly lower in SSD patients than controls, regardless of perceptual load and facial expression. Concerning RT, SSD patients were significantly slower than controls in the presence of neutral faces, but only at high load. No group differences were observed for angry and happy faces.

LIMITATIONS

Heterogeneity of SSD, small sample size, lack of clinical control group, medication.

CONCLUSIONS

One possible explanation is that neutral faces captured exogenous attention to a greater extent in SSD, thus challenging attentional control in perceptually demanding conditions. This may reflect abnormal processing of neutral faces in SSD. If replicated, these findings will help to understand the interplay between exogenous attention, attentional control, and emotion processing in SSD, which may unravel the mechanism underlying socioemotional dysfunction in SSD.

Electrode montage for transcranial direct current stimulation governs its effect on symptoms and functionality in schizophrenia

Backgrounds

Patients with schizophrenia suffer from cognitive impairment that worsens real-world functional outcomes. We previously reported that multi-session transcranial direct current stimulation (tDCS) delivered to the left dorsolateral prefrontal cortex (DLPFC) improved daily living skills, while stimulation on the left superior temporal sulcus (STS) enhanced performance on a test of social cognition in these patients. To examine the region-dependent influence of tDCS on daily-living skills, neurocognition, and psychotic symptoms, this study compared effects of anodal stimulation targeting either of these two brain areas in patients with schizophrenia.

Methods

Data were collected from open-label, single-arm trials with anodal electrodes placed over the left DLPFC (N = 28) or STS (N = 15). Daily-living skills, neurocognition, and psychotic symptoms were measured with the UCSD performance-based skills assessment-brief (UPSA-B), Brief Assessment of Cognition in Schizophrenia (BACS), and Positive and Negative Syndrome Scale (PANSS), respectively. After baseline evaluation, tDCS (2 mA × 20 min) were delivered two times per day for 5 consecutive days. One month after the final stimulation, clinical assessments were repeated.

Results

Performance on the UPSA-B was significantly improved in patients who received anodal tDCS at the left DLPFC (d = 0.70, p < 0.001), while this effect was absent in patients with anodal electrodes placed on the left STS (d = 0.02, p = 0.939). Significant improvement was also observed for scores on the BACS with anodal tDCS delivered to the DLPFC (d = 0.49, p < 0.001); however, such neurocognitive enhancement was absent when the STS was stimulated (d = 0.05, p = 0.646). Both methods of anodal stimulation showed a significant improvement of General Psychopathology scores on the PANSS (DLPFC, d = 0.50, p = 0.027; STS, d = 0.44, p = 0.001).

Conclusion

These results indicate the importance of selecting brain regions as a target for tDCS according to clinical features of individual patients. Anodal stimulation of the left DLPFC may be advantageous in improving higher level functional outcomes in patients with schizophrenia.

Trial registration

These studies were registered within the University hospital Medical Information Network Clinical Trials Registry [(24), UMIN000015953], and the Japan Registry of Clinical Trials [(28), jRCTs032180026].

Specific facial emotion recognition deficits across the course of psychosis: A comparison of individuals with low-risk, high-risk, first-episode psychosis and multi-episode schizophrenia-spectrum disorders

Our study aimed to explore the recognition of specific emotions across the course of psychosis. A visual task representing the six basic emotions was used to assess facial emotion recognition (FER) in 204 healthy controls classified into 152 low-risk (LR) and 52 high-risk for psychosis (HR), following a psychometric risk approach; and 100 patients: 44 with first-episode psychosis (FEP) and 56 with multi-episode schizophrenia-spectrum disorders (MES). First, we performed a MANCOVA to compare the four conditions. Next, we conducted a logistic regression to explore whether specific FER deficits predicted the presence of psychosis. Finally, we investigated the relationships of FER with psychosis-like experiences (PLEs) and psychotic symptoms. Global FER, anger and fear recognition were impaired in HR, FEP and MES. No differences between HR and FEP appeared. Moreover, fear and anger correctly classified 83% of individuals into LR or psychosis. FER was associated with PLEs and psychotic symptoms. Concluding, FER is early impaired in HR individuals and increases along the psychosis continuum. However, fear recognition is similarly impaired throughout the illness, suggesting a possible vulnerability marker. Furthermore, deficits in anger and fear recognition predicted the presence of psychosis. Therefore, we suggest that FER may be essential in detecting psychosis risk.

Pharmacological interventions for social cognitive impairments in schizophrenia: A protocol for a systematic review and network meta-analysis

Background

Social cognitive impairments adversely affect social functioning (e.g., employment status) in patients with schizophrenia. Although pharmacological interventions have been suggested to provide some benefits on social cognition, little information is available on the comparative efficacy of pharmacotherapy. Thus, the aim of this planned systematic review and network meta-analysis is to perform a quantitative comparison of the effects of various psychotropic drugs, including supplements, on social cognition disturbances of schizophrenia.

Methods

The literature search will be carried out using the PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, ClinicalTrials.gov, and International Clinical Trials Registry Platform databases from inception onward. Randomized controlled trials that examined the efficacy of drugs in social cognitive disturbances will be included, based on the most recent studies and the broader literature than previously searched. This protocol defines a priori the methods that will be used for study selection, data collection, quality assessment, and statistical syntheses.

Discussion

The findings this work are expected to help promote the development of better therapeutics of social cognitive impairments in schizophrenia and related psychiatric conditions.

Systematic Review Registration

[www.crd.york.ac.uk/prospero], identifier [CRD42021293224].

Neural Correlates of Facial Emotion Recognition in Non-help-seeking University Students With Ultra-High Risk for Psychosis

Background

Since the introduction of the neurodevelopmental perspective of schizophrenia research on individuals at ultra-high risk for psychosis (UHR) has gained increasing interest, aiming at early detection and intervention. Results from fMRI studies investigating behavioral and brain functional changes in UHR during facial emotion recognition, an essential component of social cognition, showed heterogenous results, probably due clinical diversity across these investigations. This fMRI study investigated emotion recognition in a sub-group of the UHR spectrum, namely non-help-seeking, drug-naïve UHR with high cognitive functioning to reveal the neurofunctional underpinnings of their social functioning in comparison to healthy controls.

Methods

Two large cohorts of students from an elite University (n 1 = 4,040, n 2 = 4,364) were screened firstly with the Prodromal Questionnaires and by surpassing predefined cut-offs then interviewed with the semi-structured Interview for Psychosis-Risk Syndromes to verify their UHR status. Twenty-one identified non-help-seeking UHR and 23 non-UHR control subjects were scanned with functional magnetic resonance imaging while classifying emotions (i.e., neutral, happy, disgust and fear) in a facial emotion recognition task.

Results

Behaviorally, no group differences were found concerning accuracy, reaction times, sensitivity or specificity, except that non-help-seeking UHR showed higher specificity when recognizing neutral facial expressions. In comparison to healthy non-UHR controls, non-help-seeking UHR showed generally higher activation in the superior temporal and left Heschl's gyrus as well as in the somatosensory, insular and midcingulate cortex than the control subjects during the entire recognition task regardless of the emotion categories. In an exploratory analysis, in the non-help-seeking UHR group, functional activity in the left superior temporal gyrus was significantly correlated with deficits in the ability to experience emotions at uncorrected statistical thresholds.

Conclusions

Compared to healthy controls, non-help-seeking UHR show no behavioral deficits during facial emotion recognition, but functional hyperactivities in brain regions associated with this cognitive process. Our study may inspire future early intervention and provide loci for treatment using neural stimulation.

Facial emotion identification impairments in Chinese persons living with schizophrenia: A meta-analysis

BACKGROUND

Facial emotion identification (FEI) deficits are associated with impaired social functioning in persons living with schizophrenia (PLwS), but the research on emotion-specific FEI deficits remains inconclusive. Furthermore, existing studies on FEI deficits are limited by their small sample sizes. We performed a meta-analysis of studies comparing the FEI abilities between Chinese PLwS and healthy controls in terms of the six basic facial emotions (happiness, sadness, fear, disgust, anger, and surprise), as well as contempt, calmness, and neutral facial expressions.

METHODS

Major Chinese- and English-language databases were searched to retrieve case-control studies that compared the FEI task performance between Chinese PLwS and healthy controls (HCs) and reported the emotion-specific correct identification scores for PLwS and HCs. The Joanna Briggs Institute Critical Appraisal Checklist for Case-control Studies ("JBI checklist," hereafter) was used to assess the risk of bias (RoB) of the included studies. Statistical analysis was performed using the "meta" package of R 4.1.2.

RESULTS

Twenty-three studies with a total of 28 case-control cohorts and 1,894 PLwS and 1,267 HCs were included. The RoB scores of the included studies ranged from two to seven. PLwS had statistically significantly lower FEI scores than HCs and the corresponding emotion-specific pooled standard mean differences (95% confidence intervals) were -0.69 (-0.88, -0.50) for happiness, -0.88 (-1.12, -0.63) for sadness, -1.44 (-1.83, -1.06) for fear, -1.18 (-1.60, -0.76) for disgust, -0.91 (-1.24, -0.57) for anger, -1.09 (-1.39, -0.78) for surprise, -0.26 (-0.51, -0.01) for contempt, -0.31 (-0.52, -0.09) for calmness, and -0.42 (-0.65, -0.18) for neutral. In the analyses of sources of heterogeneity, drug-naïve status, clinical setting, positive and negative psychotic symptoms, and RoB were significant moderators of the magnitudes of FEI deficits.

CONCLUSIONS

Chinese PLwS have significant FEI impairments in terms of recognizing the six basic facial emotions, contempt, calmness, and neutral emotions, and the magnitude of impairment varies depending on the type of emotion, clinical characteristics, and the level of RoB of the study. It is necessary to consider the characteristics of FEI deficits and the clinical moderators in the FEI deficits to develop remediation strategies targeting FEI deficits in schizophrenia.

European Psychiatric Association guidance on treatment of cognitive impairment in schizophrenia

Background

Although cognitive impairment is a core symptom of schizophrenia related to poorer outcomes in different functional domains, it still remains a major therapeutic challenge. To date, no comprehensive treatment guidelines for cognitive impairment in schizophrenia are implemented.

Methods

The aim of the present guidance paper is to provide a comprehensive meta-review of the current available evidence-based treatments for cognitive impairment in schizophrenia. The guidance is structured into three sections: pharmacological treatment, psychosocial interventions, and somatic treatments.

Results

Based on the reviewed evidence, this European Psychiatric Association guidance recommends an appropriate pharmacological management as a fundamental starting point in the treatment of cognitive impairment in schizophrenia. In particular, second-generation antipsychotics are recommended for their favorable cognitive profile compared to first-generation antipsychotics, although no clear superiority of a single second-generation antipsychotic has currently been found. Anticholinergic and benzodiazepine burdens should be kept to a minimum, considering the negative impact on cognitive functioning. Among psychosocial interventions, cognitive remediation and physical exercise are recommended for the treatment of cognitive impairment in schizophrenia. Noninvasive brain stimulation techniques could be taken into account as add-on therapy.

Conclusions

Overall, there is definitive progress in the field, but further research is needed to develop specific treatments for cognitive impairment in schizophrenia. The dissemination of this guidance paper may promote the development of shared guidelines concerning the treatment of cognitive functions in schizophrenia, with the purpose to improve the quality of care and to achieve recovery in this population.

Transcranial Direct Current Stimulation on the Left Superior Temporal Sulcus Improves Social Cognition in Schizophrenia: An Open-Label Study

BACKGROUND

Patients with schizophrenia show impairments of social cognition, which cause poor real-world functional outcomes. Transcranial direct current stimulation (tDCS) delivered to frontal brain areas has been shown to partially alleviate disturbances of social cognition. In this study, we aimed to determine whether multisession tDCS targeting the superior temporal sulcus (STS), a brain region closely related to social cognition, would improve social cognitive performance in patients with schizophrenia.

METHODS

This was an open-label, single-arm trial to investigate the benefits and safety of multisession tDCS over the left STS. Fifteen patients received tDCS (2 mA × 20 min) two times per day for 5 consecutive days. Anodal and cathodal electrodes were placed over the left STS and right supraorbital regions, respectively. Assessments with the Social Cognition Screening Questionnaire (SCSQ), the Hinting Task (HT), the Brief Assessment of Cognition in Schizophrenia (BACS), and the Positive and Negative Syndrome Scale (PANSS) were conducted at baseline and 1 month after the final stimulation.

RESULTS

Significant improvements were found on theory of mind, as measured using the SCSQ (d = 0.53) and the HT (d = 0.49). These changes on social cognition were not correlated with those of neurocognition, as measured using the BACS or psychotic symptoms, as measured using the PANSS. There were no adverse events of serious/moderate levels attributable to tDCS.

CONCLUSION

These results suggest that administration of multisession tDCS with anode stimulation targeting the left STS provides a novel strategy to improve functional outcomes in patients with schizophrenia.

ETHICS STATEMENT

The National Center of Neurology and Psychiatry Clinical Research Review Board (CRB3180006) approved this study.

TRIAL REGISTRATION

This study was registered within the Japan Registry of Clinical Trials (jRCTs032180026).

Factors influencing the outcome of integrated therapy approach in schizophrenia: A narrative review of the literature

The integration of pharmacotherapy with psychosocial interventions has an important role to play in the improvement of functional outcome of subjects with schizophrenia (SCZ), in all stages of the disorder. It is essential for the adequate management of unmet therapeutic needs, such as negative symptoms and cognitive dysfunctions which account for most of the functional impairment of subjects with SCZ and do not respond to available antipsychotics. Enhancing the knowledge on factors involved in the effectiveness of integrated treatment plans is an important step forward for SCZ care. This review aims to identify factors that might influence the impact of integrated treatments on functional outcome. Most studies on the impact of psychosocial treatments on functional outcome of subjects with SCZ did not control for the effect of prescribed antipsychotics or concomitant medications. However, several factors relevant to ongoing pharmacological treatment might influence the outcome of integrated therapy, with an impact on the adherence to treatment (e.g., therapeutic alliance and polypharmacotherapy) or on illness-related factors addressed by the psychosocial interventions (e.g., cognitive dysfunctions or motivational deficits). Indirect evidence suggests that treatment integration should consider the possible detrimental effects of different antipsychotics or concomitant medications on cognitive functions, as well as on secondary negative symptoms. Cognitive dysfunctions can interfere with participation to an integrated treatment plan and can be worsened by extrapyramidal or metabolic side effects of antipsychotics, or concomitant treatment with anticholinergics or benzodiazepines. Secondary negative symptoms, due to positive symptoms, sedation, extrapyramidal side effects or untreated depression, might cause early drop-out and poor adherence to treatment. Researchers and clinicians should examine all the above-mentioned factors and implement appropriate and personalized integrated treatments to improve the outcome of SCZ.

Usability of a Psychotherapeutic Interactive Gaming Tool Used in Facial Emotion Recognition for People with Schizophrenia

The objective of the study was to test the usability of ‘Feeling Master’ as a psychotherapeutic interactive gaming tool with LEGO cartoon faces showing the five basic emotions, for the assessment of emotional recognition in people with schizophrenia in comparison with healthy controls, and the relationship between face affect recognition (FER), attributional style, and theory of mind (ToM), which is the ability to understand the potential mental states and intentions of others. Nineteen individuals with schizophrenia (SZ) and 17 healthy control (HC) subjects completed the ‘Feeling Master’ that includes five basic emotions. To assess social cognition, the group with schizophrenia was evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) for the assessment of attributional style and the Hinting Task (ToM). Patients with SZ showed significant impairments in emotion recognition and their response time appeared to be slower than the HC in the recognition of each emotion. Taking into account the impairment in the recognition of each emotion, we only found a trend toward significance in error rates on fear recognition. The correlations between correct response on the ‘Feeling Master’ and the hinting task appeared to be significant in the correlation of surprise and theory of mind. In conclusion, this study demonstrated that the ‘Feeling Master’ could be useful for the evaluation of FER in people with schizophrenia. These results sustain the notion that impairments in emotion recognition are more prevalent in people with schizophrenia and that these are related with impairment in ToM.

"To co-operate or not?" Risky co-operative behavior in Schizophrenia and the effect of vasopressin

Risky co-operation is when an individual chooses to co-operate in a social situation despite the possibility of the partner refusing to co-operate. Although this is a deviation from rational behavior, it may have helped humans in societal adaptation. Risky co-operation holds significance in social functioning. However, the status of risky cooperative behavior in schizophrenia, a disorder with impaired social cognition, is yet to be investigated. Moreover, the underlying neurobiology is unexplored. 27 individuals with schizophrenia and 30 healthy volunteers performed an iterative stag hunt game, an ecologically valid, neuroeconomics game to measure risky cooperative behavior. The patients and healthy volunteers were matched on age and sex. An independent group of patients (n = 30) later performed the stag hunt game with intranasal vasopressin or saline in a counterbalanced crossover study design. Patients with schizophrenia, compared to healthy controls, switched from high-risk situations to a low-risk situation at lower payoff, suggesting impaired co-operation in a risky situation. Group differences were significant even after controlling for general risk- taking tendency and subjective mood state. In part-II of the study, there was no statistically significant difference in risky co-operative behavior with vasopressin. The results suggest impaired risky co-operative behavior in schizophrenia, which could influence the functional outcome. The study also provides a testable, ecologically valid paradigm for risky co-operative behavior in schizophrenia. Though single dose vasopressin did not influence the risky co-operative behavior, long term study with repeated administration is needed for a definitive conclusion.

Genetic modulation of facial emotion recognition in borderline personality disorder

Facial emotion recognition (FER) has been described to be impaired in borderline personality disorder (BPD), especially for neutral faces. Genetic modulation of FER has been studied in healthy individuals and some psychiatric conditions, but no genetic association studies have been conducted in BPD hitherto. The main objective of our study was to explore the influence of the serotonin-transporter-linked promoter region (5HTTLPR) and catechol-o-methyltransferase (COMT) Val158Met on facial emotion processing among BPD patients. To that end, seventy-six BPD outpatients were asked to complete a computer-based facial affect recognition task, representing four emotions (neutral, happy, fearful or angry). Accuracy of FER and perceptual biases were calculated. The 5HTTLPR and COMT Val158Met polymorphisms were genotyped using saliva samples. Individuals with the high-activity serotonin-transporter genotype and those with the low-activity COMT genotype had significantly more difficulties identifying neutral faces; the former showed stronger bias to perceive neutral faces as happy, and the latter, neutral faces as fearful. Interestingly, the perceptual biases observed in our patients are similar to previous reports in healthy individuals. The authors propose that the ability to accurately recognize neutral faces might be a possible endophenotype of BPD. Sex-genotype interactions were also observed in relation to angry faces and 5HTTLPR, and neutral faces and COMT Val158Met polymorphisms, in line with sex-related differences previously described for both polymorphisms in relation to FER and other cognitive and behavioral outcomes. The impact of inaccurate FER on psychosocial functioning and potential interventions are also discussed.

Improved facial affect recognition in patients with first-episode psychosis

AIM

The present study aimed at assessing whether impaired facial affect recognition (FAR) in patients with first-episode psychosis (FEP) would improve after a brief intervention targeting FAR specifically.

METHODS

Thirty-five outpatients and 38 healthy controls were administered an intervention which involved training to recognize emotional information, conveyed by changes in facial features. Using a pre- and post-intervention design, two measurements of FAR were conducted using an experimental procedure with alternative sets of stimuli.

RESULTS

We found improved overall FAR performance in both participant groups with marked effects in recognizing anger, disgust and fear. Patients' post-intervention performance was comparable to healthy participants' baseline performance.

CONCLUSIONS

The present improvement in facial affects recognition in FEP patients, despite only somewhat impaired, emphasizes the importance of early targeted interventions for FAR in psychosis. Further research is needed to assess whether this improvement will generalize to global social functioning.

Emotion recognition and theory of mind in schizophrenia: A meta-analysis of neuroimaging studies

OBJECTIVES

Patients with schizophrenia have difficulties processing the emotional and cognitive states of others. Neuroimaging studies show inconsistent findings.

METHODS

We used a Seed-based d Mapping meta-analytic method to explore brain activation during facial emotion recognition and theory of mind tasks in schizophrenia patients.

RESULTS

The patients showed lesser recruitment of the facial emotion processing network; behavioural performance was associated with the activation of the precentral gyrus. We found abnormal activation of the mentalising network in schizophrenia patients during reasoning about other people's mental states; patients with worse performances showed lesser activation in the right insula and superior temporal gyrus. Multimodal meta-analysis showed overlaps of brain-related abnormalities for both modalities in schizophrenia, with reduced recruitment of the right insula, anterior cingulate and medial prefrontal cortex and increased activation in the bilateral parietal cortex. Meta-regression results indicate that illness duration, medication and symptomatology might influence social-cognitive network disruptions in schizophrenia.

CONCLUSIONS

These findings suggest the complex impairment of social cognition, as demonstrated by neural-related circuit disruptions during facial emotion processing and theory of mind tasks in schizophrenia.

Visualizing mental representations in schizophrenia patients: A reverse correlation approach

Schizophrenia patients have difficulties recognizing emotional states from faces, in particular those with negative valence, with severe consequences for daily life. What do these patients see in their minds eye, when they think of a face expressing a particular emotion or trait? The content of such mental representations can shed light into the nature of their deficits, but are usually inaccessible. For the first time, we explored the applicability of reverse correlation, which has been successfully used to visualize mental representations in healthy populations, to visualize mental representations in schizophrenia patients.

We investigated mental representations of trustworthy faces, a primary dimension of social face evaluation that is highly correlated with valence. Patients (n = 23) and healthy controls (n = 34) classified images of noise-distorted faces as ‘trustworthy’, ‘untrustworthy’ or ‘neutral’. We visualized their mental representations of these concepts by averaging the noise patterns based on their classifications. These visualizations were then rated on trustworthiness by an independent sample of participants.

Patients were able to perform the reverse correlation task, with response times and biases similar to those of healthy controls, and the obtained images vividly reflected the respective constructs of interest. However, there were no significant differences between the ratings of the visualizations of patients and controls.

Conclusion: These novel findings provide a proof of principle that the reverse correlation technique can be applied to investigate mental representations in schizophrenia patients.

Masked ambiguity - Emotion identification in schizophrenia and major depressive disorder

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

MDMA Increases Cooperation and Recruitment of Social Brain Areas When Playing Trustworthy Players in an Iterated Prisoner's Dilemma

Social decision-making is fundamental for successful functioning and can be affected in psychiatric illness and by serotoninergic modulation. The Prisoner's Dilemma is the archetypal paradigm to model cooperation and trust. However, the effect of serotonergic enhancement is poorly characterized, and its influence on the effect of variations in opponent behavior unknown. To address this, we conducted a study investigating how the serotonergic enhancer 3,4-methylenedioxy-methamphetamine (MDMA) modulates behavior and its neural correlates during an iterated Prisoner's Dilemma with both trustworthy and untrustworthy opponents. We administered 100 mg MDMA or placebo to 20 male participants in a double-blind, placebo-controlled, crossover study. While being scanned, participants played repeated rounds with opponents who differed in levels of cooperation. On each round, participants chose to compete or cooperate and were asked to rate their trust in the other player. Cooperation with trustworthy, but not untrustworthy, opponents was enhanced following MDMA but not placebo (respectively: odds ratio = 2.01; 95% CI, 1.42-2.84, p < 0.001; odds ratio = 1.37; 95% CI, 0.78-2.30, not significant). Specifically, MDMA enhanced recovery from, but not the impact of, breaches in cooperation. During trial outcome, MDMA increased activation of four clusters incorporating precentral and supramarginal gyri, superior temporal cortex, central operculum/posterior insula, and supplementary motor area. There was a treatment × opponent interaction in right anterior insula and dorsal caudate. Trust ratings did not change across treatment sessions. MDMA increased cooperative behavior when playing trustworthy opponents. Underlying this was a change in brain activity of regions linked to social cognition. Our findings highlight the context-specific nature of MDMA's effect on social decision-making.SIGNIFICANCE STATEMENT We provide a detailed analysis of the effect of 3,4-methylenedioxy-methamphetamine (MDMA) on cooperative behavior during interpersonal interactions, as well as the neural correlates underlying these effects. We find that, following administration of MDMA, participants behave more cooperatively, but only when interacting with trustworthy partners. While breaches of trustworthy behavior have a similar impact following administration of MDMA compared with placebo, MDMA facilitates a greater recovery from these breaches of trust. Underlying this altered behavior are changes in brain activity during the viewing of opponents' behavior in regions whose involvement in social processing is well established. This work provides new insights into the impact of MDMA on social interactions, emphasizing the important role of the behavior of others toward us.

Comparing the effect of the subcategories of atypical antipsychotic medications on cognition in schizophrenia using a meta-analytic approach

OBJECTIVES

The aim of this study was to compare the two most commonly prescribed classes of atypical antipsychotic medications (i.e., -pines and -dones) with regard to their effects on cognition in patients with schizophrenia.

DATA SOURCES

Ovid Technologies web-based software was used to search the Medline and PsycINFO computerized databases to identify articles that met the inclusion criteria.

REVIEW METHODS

The search was limited to papers published after 1990, written in English, employing human subjects, using atypical antipsychotics, using a within-subjects design or control group of patients with schizophrenia for comparisons, using participants aged from 18-65, and employing standardized neuropsychological measures.

RESULTS

A total of 996 eligible studies were identified, and of these 19 were finally analyzed. Nine domains of cognitive functioning were assessed. The two groups of agents produced equivalent overall effects (-dones = .254 versus -pines = .202). The -pines were found to improve the domains of attention/working memory, executive functioning, fluency, nonverbal memory, processing speed, and verbal memory, each with a significant, small effect size. The -dones were found to improve attention/working memory, executive functioning, motor function, nonverbal memory, processing speed, and verbal memory, each with a significant, small effect size. Failsafe N was robust for all of the domains for the -pines, but only for the verbal memory domain for the -dones, suggesting that the significant findings for the other domains with the -dones are more tenuous.

CONCLUSION

The results indicate that the agents were largely equivalent and that there was no clear evidence that the pattern of cognitive effects differed as a result of the agent applied. The effects themselves, while statistically significant, were small, indicating that some or all of the differences may be attributable to practice effects on the instruments employed.

Social cognition in the course of psychosis and its correlation with biomarkers in a male cohort

INTRODUCTION

Patients diagnosed with schizophrenia display deficits in Theory of Mind (ToM) and Emotion Perception (EP) even before the appearance of full-blown symptomatology.

METHODS

We evaluated ToM and EP in a male cohort consisting of 25 First Episode Psychosis (FEP) and 16 relapsed schizophrenic patients (CHRON) compared to 12 subjects in Ultra-high Risk (UHR) and 23 healthy controls (CTR). Furthermore, we measured the levels of Cortisol, Insulin like Growth Factor (IGF-1), TNF-a, TNF-b and several interleukins as potential biomarkers.

RESULTS

Deficits in EP and ToM were found in FEP, CHRON patients and UHR subjects compared to CTR. The impairments in these two domains seem to follow different patterns in the course of psychosis. EP was more impaired in subjects with a longer history of symptomatology whereas there was no statistically significant difference regarding ToM. On the other hand IL-4 was the only biomarker correlated to ToM and EP scores in two different samples of our study.

CONCLUSION

Social Cognition (SC) domains are impaired in patients with psychosis as well as in UHR subjects compared to healthy controls. There are differences in the progress of ToM and EP deficits in the course of psychosis. Interleukins as IL-4 could correlate to SC.

Abnormal effective fronto-limbic connectivity during emotion processing in schizophrenia

BACKGROUND

Schizophrenia is associated with core emotional dysfunctions. At the neural level, functional neuro-imaging studies have highlighted fronto-limbic alterations during emotion processing in schizophrenia, as well as impaired connectivity between the amygdala and the prefrontal cortex. However, the direction of the impaired fronto-limbic connections remains largely unknown. To clarify this issue, we performed an effective connectivity study on emotion processing in schizophrenia.

METHODS

Forty-one healthy individuals and 39 schizophrenia patients (DSM-IV criteria) viewed negative, positive and neutral images during an fMRI session. Effective connectivity between significantly activated regions was examined using Granger causality and psychophysical interaction analyses.

RESULTS

Subjective ratings of emotionally neutral images were higher in schizophrenia patients than in controls. Across groups, significant activations were observed in the dorso-medial prefrontal cortex (dmPFC) and the bilateral amygdala. The Granger connectivity from the right amygdala to the dmPFC was significantly reduced in schizophrenia patients, relative to controls, during the negative and neutral conditions. The Granger connectivity from the left amygdala to the dmPFC was significantly reduced in schizophrenia patients, relative to controls, during the positive condition.

DISCUSSION

The finding of a reduced lagged connectivity from the bilateral amygdala to the dmPFC in schizophrenia suggests that the bottom-up mechanisms involved in the processing of highly arousing emotional stimuli are impaired in this disorder. The finding of an impaired lagged connectivity from the right amygdala to the dmPFC during the processing of emotionally neutral stimuli in schizophrenia is novel and may explain why these patients tend to confer emotional significance to irrelevant stimuli.