Social functioning and facial emotional expression in neurological and psychiatric disorders

Three-dimensional video recordings: Accuracy, reliability, clinical and research guidelines - Reliability assessment of a 4D camera

OBJECTIVES

In addition to studying facial anatomy, stereophotogrammetry is an efficient diagnostic tool for assessing facial expressions through 3D video recordings. Current technology produces high-quality recordings but also generates extremely excessive data. Here, we compare various recording speeds for three standardized movements using the 3dMDface camera system, to assess its accuracy and reliability.

MATERIALS AND METHODS

A linear and two circular movements were performed using a 3D-printed cube mounted on a robotic arm. All movements were recorded initially at 60 fps (frames/second) and then at 30 and 15 fps. Recording accuracy was tested with best-fit superimpositions of consecutive frames of the 3D cube and calculation of the Mean Absolute Distance (MAD). The reliability of the recordings were tested with evaluation of the inter- and intra-examiner error.

RESULTS

The accuracy of movement recordings was excellent at all speeds (60, 30 and 15 fps), with variability in MAD values consistently being less than 1 mm. The reliability of the camera recordings was excellent at all recording speeds.

CONCLUSIONS

This study demonstrated that 3D recordings of facial expressions can be performed at 30 or even at 15 fps without significant loss of information. This considerably reduces the amount of produced data facilitating further processing and analyses.

Behavioral meaures of psychotic disorders: Using automatic facial coding to detect nonverbal expressions in video

Emotional deficits in psychosis are prevalent and difficult to treat. In particular, much remains unknown about facial expression abnormalities, and a key reason is that expressions are very labor-intensive to code. Automatic facial coding (AFC) can remove this barrier. The current study sought to both provide evidence for the utility of AFC in psychosis for research purposes and to provide evidence that AFC are valid measures of clinical constructs. Changes of facial expressions and head position of participants-39 with schizophrenia/schizoaffective disorder (SZ), 46 with other psychotic disorders (OP), and 108 never psychotic individuals (NP)-were assessed via FaceReader, a commercially available automated facial expression analysis software, using video recorded during a clinical interview. We first examined the behavioral measures of the psychotic disorder groups and tested if they can discriminate between the groups. Next, we evaluated links of behavioral measures with clinical symptoms, controlling for group membership. We found the SZ group was characterized by significantly less variation in neutral expressions, happy expressions, arousal, and head movements compared to NP. These measures discriminated SZ from NP well (AUC = 0.79, sensitivity = 0.79, specificity = 0.67) but discriminated SZ from OP less well (AUC = 0.66, sensitivity = 0.77, specificity = 0.46). We also found significant correlations between clinician-rated symptoms and most behavioral measures (particularly happy expressions, arousal, and head movements). Taken together, these results suggest that AFC can provide useful behavioral measures of psychosis, which could improve research on non-verbal expressions in psychosis and, ultimately, enhance treatment.

Optomyography-based sensing of facial expression derived arousal and valence in adults with depression

Background

Continuous assessment of affective behaviors could improve the diagnosis, assessment and monitoring of chronic mental health and neurological conditions such as depression. However, there are no technologies well suited to this, limiting potential clinical applications.

Aim

To test if we could replicate previous evidence of hypo reactivity to emotional salient material using an entirely new sensing technique called optomyography which is well suited to remote monitoring.

Methods

Thirty-eight depressed and 37 controls (≥18, ≤40 years) who met a research diagnosis of depression and an age-matched non-depressed control group. Changes in facial muscle activity over the brow (corrugator supercilli) and cheek (zygomaticus major) were measured whilst volunteers watched videos varying in emotional salience.

Results

Across all participants, videos rated as subjectively positive were associated with activation of muscles in the cheek relative to videos rated as neutral or negative. Videos rated as subjectively negative were associated with brow activation relative to videos judged as neutral or positive. Self-reported arousal was associated with a step increase in facial muscle activation across the brow and cheek. Group differences were significantly reduced activation in facial muscles during videos considered subjectively negative or rated as high arousal in depressed volunteers compared with controls.

Conclusion

We demonstrate for the first time that it is possible to detect facial expression hypo-reactivity in adults with depression in response to emotional content using glasses-based optomyography sensing. It is hoped these results may encourage the use of optomyography-based sensing to track facial expressions in the real-world, outside of a specialized testing environment.

Manipulating facial musculature with functional electrical stimulation as an intervention for major depressive disorder: a focused search of literature for a proposal

BACKGROUND

Major Depressive Disorder (MDD) is associated with interoceptive deficits expressed throughout the body, particularly the facial musculature. According to the facial feedback hypothesis, afferent feedback from the facial muscles suffices to alter the emotional experience. Thus, manipulating the facial muscles could provide a new "mind-body" intervention for MDD. This article provides a conceptual overview of functional electrical stimulation (FES), a novel neuromodulation-based treatment modality that can be potentially used in the treatment of disorders of disrupted brain connectivity, such as MDD.

METHODS

A focused literature search was performed for clinical studies of FES as a modulatory treatment for mood symptoms. The literature is reviewed in a narrative format, integrating theories of emotion, facial expression, and MDD.

RESULTS

A rich body of literature on FES supports the notion that peripheral muscle manipulation in patients with stroke or spinal cord injury may enhance central neuroplasticity, restoring lost sensorimotor function. These neuroplastic effects suggest that FES may be a promising innovative intervention for psychiatric disorders of disrupted brain connectivity, such as MDD. Recent pilot data on repetitive FES applied to the facial muscles in healthy participants and patients with MDD show early promise, suggesting that FES may attenuate the negative interoceptive bias associated with MDD by enhancing positive facial feedback. Neurobiologically, the amygdala and nodes of the emotion-to-motor transformation loop may serve as potential neural targets for facial FES in MDD, as they integrate proprioceptive and interoceptive inputs from muscles of facial expression and fine-tune their motor output in line with socio-emotional context.

CONCLUSIONS

Manipulating facial muscles may represent a mechanistically novel treatment strategy for MDD and other disorders of disrupted brain connectivity that is worthy of investigation in phase II/III trials.

Bodies in the Novel Infinite Jest

This manuscript provides a literary analysis of the use of bodies in the novel Infinite Jest by David Foster Wallace. The novel describes a world where oversaturation of external stimulation leads to the perception of mind and body of self of an individual as prosthetic parts, malleable and deformed, wherein the mind fails to feel bodily sensations and characters experience a complete disconnectedness from the self and others. Indeed, the disembodiment of characters and sensations of disconnection leads them to a compulsive quest for connectedness through the use of masks, made-up feelings, mind-body hybrid pain, corporeal malleability, and prostheses. These portrayals of the disordered and disconnectedness between body and mind or self will be described and compared to clinical conditions characterized by a disconnection between mind and body and impaired body self-awareness. Through this exercise, we argue that the use of scientifically inspired pathologized bodies is a means of conveying the stance of Wallace on or criticism of the degradation of society through excessive entertainment.

Mood and emotional disorders associated with parkinsonism, Huntington disease, and other movement disorders

This chapter provides a review of mood, emotional disorders, and emotion processing deficits associated with diseases that cause movement disorders, including Parkinson's disease, Lewy body dementia, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, frontotemporal dementia with parkinsonism, Huntington's disease, essential tremor, dystonia, and tardive dyskinesia. For each disorder, a clinical description of the common signs and symptoms, disease progression, and epidemiology is provided. Then the mood and emotional disorders associated with each of these diseases are described and discussed in terms of clinical presentation, incidence, prevalence, and alterations in quality of life. Alterations of emotion communication, such as affective speech prosody and facial emotional expression, associated with these disorders are also discussed. In addition, if applicable, deficits in gestural and lexical/verbal emotion are reviewed. Throughout the chapter, the relationships among mood and emotional disorders, alterations of emotional experiences, social communication, and quality of life, as well as treatment, are emphasized.

Depression Severity Assessment for Adolescents at High Risk of Mental Disorders

Recent progress in artificial intelligence has led to the development of automatic behavioral marker recognition, such as facial and vocal expressions. Those automatic tools have enormous potential to support mental health assessment, clinical decision making, and treatment planning. In this paper, we investigate nonverbal behavioral markers of depression severity assessed during semi-structured medical interviews of adolescent patients. The main goal of our research is two-fold: studying a unique population of adolescents at high risk of mental disorders and differentiating mild depression from moderate or severe depression. We aim to explore computationally inferred facial and vocal behavioral responses elicited by three segments of the semi-structured medical interviews: Distress Assessment Questions, Ubiquitous Questions, and Concept Questions. Our experimental methodology reflects best practise used for analyzing small sample size and unbalanced datasets of unique patients. Our results show a very interesting trend with strongly discriminative behavioral markers from both acoustic and visual modalities. These promising results are likely due to the unique classification task (mild depression vs. moderate and severe depression) and three types of probing questions.

Emotion recognition depends on subjective emotional experience and not on facial expressivity: evidence from traumatic brain injury

BACKGROUND

Recognizing how others feel is paramount to social situations and commonly disrupted following traumatic brain injury (TBI). This study tested whether problems identifying emotion in others following TBI is related to problems expressing or feeling emotion in oneself, as theoretical models place emotion perception in the context of accurate encoding and/or shared emotional experiences.

METHODS

Individuals with TBI (n = 27; 20 males) and controls (n = 28; 16 males) were tested on an emotion recognition task, and asked to adopt facial expressions and relay emotional memories according to the presentation of stimuli (word and photos). After each trial, participants were asked to self-report their feelings of happiness, anger and sadness. Judges that were blind to the presentation of stimuli assessed emotional facial expressivity.

RESULTS

Emotional experience was a unique predictor of affect recognition across all emotions while facial expressivity did not contribute to any of the regression models. Furthermore, difficulties in recognizing emotion for individuals with TBI were no longer evident after cognitive ability and experience of emotion were entered into the analyses.

CONCLUSIONS

Emotion perceptual difficulties following TBI may stem from an inability to experience affective states and may tie in with alexythymia in clinical conditions.

Emotional cues from expressive behavior of women and men with Parkinson's disease

OBJECTIVE

Emotional experience of people with Parkinson's disease is prone to being misunderstood by observers and even healthcare practitioners, which affects treatment effectiveness and makes clients suffer distress in their social lives. This study was designed to identify reliable emotional cues from expressive behavior in women and men with Parkinson's disease.

METHOD

Videotaped expressive behavior of 96 participants during an interview of discussing enjoyable events was rated using the Interpersonal Communication Rating Protocol. Indices from emotional measures were represented in three components. Correlational analyses between expressive behavior domains and emotional components were conducted for the total sample and by gender separately.

RESULTS

More gross motor expressivity and smiling/laughing indicated more positive affect in the total sample. Less conversational engagement indicated more negative affect in women. However, women with more negative affect and depression appeared to smile and laugh more.

CONCLUSION

This study identified reliable cues from expressive behavior that could be used for assessment of emotional experience in people with Parkinson's disease. For women, because smiling/laughing may convey two possible meanings, that is, more positive and more negative affect, this cue needs to be interpreted cautiously and be used for detecting the intensity, not the type, of emotional experience. Healthcare practitioners should be sensitive to valid cues to make an accurate evaluation of emotion in people with Parkinson's disease.

Unaltered emotional experience in Parkinson's disease: Pupillometry and behavioral evidence

INTRODUCTION

Recognizing emotions in others is a pivotal part of socioemotional functioning and plays a central role in social interactions. It has been shown that individuals suffering from Parkinson's disease (PD) are less accurate at identifying basic emotions such as fear, sadness, and happiness; however, previous studies have predominantly assessed emotion processing using unimodal stimuli (e.g., pictures) that do not reflect the complexity of real-world processing demands. Dynamic, naturalistic stimuli (e.g., movies) have been shown to elicit stronger subjective emotional experiences than unimodal stimuli and can facilitate emotion recognition.

METHOD

In this experiment, pupil measurements of PD patients and matched healthy controls (HC) were recorded while they watched short film clips. Participants' task was to identify the emotion elicited by each clip and rate the intensity of their emotional response. We explored (a) how PD affects subjective emotional experience in response to dynamic, ecologically valid film stimuli, and (b) whether there are PD-related changes in pupillary response, which may contribute to the differences in emotion processing reported in the literature.

RESULTS

Behavioral results showed that identification of the felt emotion as well as perceived intensity varies by emotion, but no significant group effect was found. Pupil measurements revealed differences in dilation depending on the emotion evoked by the film clips (happy, tender, sadness, fear, and neutral) for both groups.

CONCLUSIONS

Our results suggest that differences in emotional response may be negligible when PD patients and healthy controls are presented with dynamic, ecologically valid emotional stimuli. Given the limited data available on pupil response in PD, this study provides new evidence to suggest that the PD-related deficits in emotion processing reported in the literature may not translate to real-world differences in physiological or subjective emotion processing in early-stage PD patients.

Application of technology to social communication impairment in childhood and adolescence

Social communication impairment has been implicated in various mental health disorders. The primary aim of this review paper is to summarize the extant research on the development and application of technologies to address social communication deficits, conceptualized according to the four constructs outlined by the NIMH's Research Domain Criteria (RDoC), transdiagnostically in children and adolescents. An exhaustive and systematic search yielded 69 peer-reviewed articles meeting all inclusion criteria (i.e., used technology, applied the technology to target impairment in at least one of four constructs of social communication, included a child or adolescent samples). We found limited use of technology for exploration of impairment in reception of non-facial communication, compared to the other social communication constructs. In addition, there has been an overwhelming focus on social communication impairment in children and adolescents with Autism Spectrum Disorder (ASD), with relatively few studies evaluating technology application in other clinical populations. Implications for future directions for technological interventions to treat social communication impairments transdiagnostically are discussed.

Deficits in the Mimicry of Facial Expressions in Parkinson's Disease

Background: Humans spontaneously mimic the facial expressions of others, facilitating social interaction. This mimicking behavior may be impaired in individuals with Parkinson's disease, for whom the loss of facial movements is a clinical feature.

Objective: To assess the presence of facial mimicry in patients with Parkinson's disease.

Method: Twenty-seven non-depressed patients with idiopathic Parkinson's disease and 28 age-matched controls had their facial muscles recorded with electromyography while they observed presentations of calm, happy, sad, angry, and fearful emotions.

Results: Patients exhibited reduced amplitude and delayed onset in the zygomaticus major muscle region (smiling response) following happy presentations (patients M = 0.02, 95% confidence interval [CI] −0.15 to 0.18, controls M = 0.26, CI 0.14 to 0.37, ANOVA, effect size [ES] = 0.18, p < 0.001). Although patients exhibited activation of the corrugator supercilii and medial frontalis (frowning response) following sad and fearful presentations, the frontalis response to sad presentations was attenuated relative to controls (patients M = 0.05, CI −0.08 to 0.18, controls M = 0.21, CI 0.09 to 0.34, ANOVA, ES = 0.07, p = 0.017). The amplitude of patients' zygomaticus activity in response to positive emotions was found to be negatively correlated with response times for ratings of emotional identification, suggesting a motor-behavioral link (r = –0.45, p = 0.02, two-tailed).

Conclusions: Patients showed decreased mimicry overall, mimicking other peoples' frowns to some extent, but presenting with profoundly weakened and delayed smiles. These findings open a new avenue of inquiry into the “masked face” syndrome of PD.

Psychosocial difficulties from the perspective of persons with neuropsychiatric disorders

PURPOSE

The objective of this study is to determine whether persons with neuropsychiatric disorders experience a common set of psychosocial difficulties using qualitative data from focus groups and individual interviews.

METHOD

The study was performed in five European countries (Finland, Italy, Germany, Poland and Spain) using the focus groups and individual interviews with persons with nine neuropsychiatric disorders (dementia, depression, epilepsy, migraine, multiple sclerosis, Parkinson's disease, schizophrenia, stroke and substance dependence). Digitally recorded sessions were analysed using a step-by-step qualitative and quantitative methodology resulting in the compilation of a common set of psychosocial difficulties using the International Classification of Functioning, Disability and Health (ICF) as a framework.

RESULTS

Sixty-seven persons participated in the study. Most persons with neuropsychiatric disorders experience difficulties in emotional functions, sleeping, carrying out daily routine, working and interpersonal relationships in common. Sixteen out of 33 psychosocial difficulties made up the common set. This set includes mental functions, pain and issues addressing activities and participation and provides first evidence for the hypothesis of horizontal epidemiology of psychosocial difficulties in neuropsychiatric disorders.

CONCLUSIONS

This study provides information about psychosocial difficulties that should be covered in the treatment and rehabilitation of persons with neuropsychiatric disorders regardless of clinical diagnoses.

IMPLICATIONS FOR REHABILITATION

Emotional problems, work and sleep problems should be addressed in all the treatments of neuropsychiatric disorders regardless of their specific diagnosis, etiology and severity. Personality issues should be targeted in the treatment for neurological disorders, whereas communication skill training may also be useful for mental disorders. The effects of medication and social environment on patient's daily life should be considered in all the neuropsychiatric conditions.

Nonverbal Social Withdrawal in Depression: Evidence from manual and automatic analysis

The relationship between nonverbal behavior and severity of depression was investigated by following depressed participants over the course of treatment and video recording a series of clinical interviews. Facial expressions and head pose were analyzed from video using manual and automatic systems. Both systems were highly consistent for FACS action units (AUs) and showed similar effects for change over time in depression severity. When symptom severity was high, participants made fewer affiliative facial expressions (AUs 12 and 15) and more non-affiliative facial expressions (AU 14). Participants also exhibited diminished head motion (i.e., amplitude and velocity) when symptom severity was high. These results are consistent with the Social Withdrawal hypothesis: that depressed individuals use nonverbal behavior to maintain or increase interpersonal distance. As individuals recover, they send more signals indicating a willingness to affiliate. The finding that automatic facial expression analysis was both consistent with manual coding and revealed the same pattern of findings suggests that automatic facial expression analysis may be ready to relieve the burden of manual coding in behavioral and clinical science.

Effects of the Lee Silverman Voice Treatment (LSVT® LOUD) on hypomimia in Parkinson's disease

Given associations between facial movement and voice, the potential of the Lee Silverman Voice Treatment (LSVT) to alleviate decreased facial expressivity, termed hypomimia, in Parkinson's disease (PD) was examined. Fifty-six participants--16 PD participants who underwent LSVT, 12 PD participants who underwent articulation treatment (ARTIC), 17 untreated PD participants, and 11 controls without PD--produced monologues about happy emotional experiences at pre- and post-treatment timepoints ("T1" and "T2," respectively), 1 month apart. The groups of LSVT, ARTIC, and untreated PD participants were matched on demographic and health status variables. The frequency and variability of facial expressions (Frequency and Variability) observable on 1-min monologue videorecordings were measured using the Facial Action Coding System (FACS). At T1, the Frequency and Variability of participants with PD were significantly lower than those of controls. Frequency and Variability increases of LSVT participants from T1 to T2 were significantly greater than those of ARTIC or untreated participants. Whereas the Frequency and Variability of ARTIC participants at T2 were significantly lower than those of controls, LSVT participants did not significantly differ from controls on these variables at T2. The implications of these findings, which suggest that LSVT reduces parkinsonian hypomimia, for PD-related psychosocial problems are considered.

Social Risk and Depression: Evidence from Manual and Automatic Facial Expression Analysis

Investigated the relationship between change over time in severity of depression symptoms and facial expression. Depressed participants were followed over the course of treatment and video recorded during a series of clinical interviews. Facial expressions were analyzed from the video using both manual and automatic systems. Automatic and manual coding were highly consistent for FACS action units, and showed similar effects for change over time in depression severity. For both systems, when symptom severity was high, participants made more facial expressions associated with contempt, smiled less, and those smiles that occurred were more likely to be accompanied by facial actions associated with contempt. These results are consistent with the "social risk hypothesis" of depression. According to this hypothesis, when symptoms are severe, depressed participants withdraw from other people in order to protect themselves from anticipated rejection, scorn, and social exclusion. As their symptoms fade, participants send more signals indicating a willingness to affiliate. The finding that automatic facial expression analysis was both consistent with manual coding and produced the same pattern of depression effects suggests that automatic facial expression analysis may be ready for use in behavioral and clinical science.

[Emotion and basal ganglia (I): what can we learn from Parkinson's disease?]

Parkinson's disease provides a useful model for studying the neural substrates of emotional processing. The striato-thalamo-cortical circuits, like the mesolimbic dopamine system that modulates their function, are thought to be involved in emotional processing. As Parkinson's disease is histopathologically characterized by the selective, progressive and chronic degeneration of the nigrostriatal and mesocorticolimbic dopamine systems, it can therefore serve as a model for assessing the functional role of these circuits in humans. In the present review, after a definition of emotional processing from a multicomponential perspective, a synopsis of the emotional disturbances observed in Parkinson's disease is proposed. Note that the studies on the affective consequences of subthalamic nucleus deep brain stimulation in Parkinson's disease were excluded from this review because the subject of a companion paper in this issue. This review leads to the conclusion that several emotional components would be disrupted in Parkinson's disease: subjective feeling, neurophysiological activation, and motor expression. We then discuss the functional roles of the striato-thalamo-cortical and mesolimbic circuits, ending with the conclusion that both these pathways are indeed involved in emotional processing.

Emotional processing in Parkinson's disease: a systematic review

Parkinson's disease provides a useful model for studying the neural substrates of emotional processing. The striato-thalamo-cortical circuits, like the mesolimbic dopamine system that modulates their function, are thought to be involved in emotional processing. As Parkinson's disease is histopathologically characterized by the selective, progressive, and chronic degeneration of the nigrostriatal and mesocorticolimbic dopamine systems, it can therefore serve as a model for assessing the functional role of these circuits in humans. In the present review, we begin by providing a synopsis of the emotional disturbances observed in Parkinson's disease. We then discuss the functional roles of the striato-thalamo-cortical and mesolimbic circuits, ending with the conclusion that both these pathways are indeed involved in emotional processing.

Culture, gender and health care stigma: Practitioners' response to facial masking experienced by people with Parkinson's disease

Facial masking in Parkinson's disease is the reduction of automatic and controlled expressive movement of facial musculature, creating an appearance of apathy, social disengagement or compromised cognitive status. Research in western cultures demonstrates that practitioners form negatively biased impressions associated with patient masking. Socio-cultural norms about facial expressivity vary according to culture and gender, yet little research has studied the effect of these factors on practitioners' responses toward patients who vary in facial expressivity. This study evaluated the effect of masking, culture and gender on practitioners' impressions of patient psychological attributes. Practitioners (N = 284) in the United States and Taiwan judged 12 Caucasian American and 12 Asian Taiwanese women and men patients in video clips from interviews. Half of each patient group had a moderate degree of facial masking and the other half had near-normal expressivity. Practitioners in both countries judged patients with higher masking to be more depressed and less sociable, less socially supportive, and less cognitively competent than patients with lower masking. Practitioners were more biased by masking when judging the sociability of the American patients, and American practitioners' judgments of patient sociability were more negatively biased in response to masking than were those of Taiwanese practitioners. Practitioners were more biased by masking when judging the cognitive competence and social supportiveness of the Taiwanese patients, and Taiwanese practitioners' judgments of patient cognitive competence were more negatively biased in response to masking than were those of American practitioners. The negative response to higher masking was stronger in practitioner judgments of women than men patients, particularly American patients. The findings suggest local cultural values as well as ethnic and gender stereotypes operate on practitioners' use of facial expressivity in clinical impression formation.

The influence of facial masking and sex on older adults' impressions of individuals with Parkinson's disease

Parkinson's disease (PD) involves facial masking, which may impair social interaction. Older adult observers who viewed segments of videotaped interviews of individuals with PD expressed less interest in relationships with women with higher masking and judged them as less supportive. Masking did not affect ratings of men in these domains, possibly because higher masking violates gender norms for expressivity in women but not in men. Observers formed less accurate ratings of the social supportiveness and social strain of women than men, and higher masking decreased accuracy for ratings of strain. Results suggest that some of the problems with social relationships in PD may be due to inaccurate impressions and reduced desire to interact with individuals with higher masking, especially women.

Schizophrenia: etiology and course

Decades of research on schizophrenia have not produced major breakthroughs, but gradual progress has been made in identifying risk factors and clarifying the nature of the etiologic process. This article provides an overview of trends in research findings as well as current assumptions about the interplay between environmental and genetic factors in the etiology of schizophrenia. Based on the cumulative findings, it appears that both genetic and prenatal factors can give rise to constitutional vulnerability. Subsequent neuromaturational processes, especially those that occur during adolescence, and exposure to stressful events can trigger the behavioral expression of this vulnerability.

Practitioners' impressions of patients with Parkinson's disease: the social ecology of the expressive mask

The expressive mask of Parkinson's disease, a reduced spontaneity, intensity, and fluidity of facial, bodily, and vocal expression, jeopardizes interpersonal interaction and quality of life. Observers have difficulty perceiving the "real" person behind the mask, leading to failed communication and misunderstanding. A social ecological explanation of this difficulty is that observers have learned in their daily social lives, and quite appropriately so, that expressive behavior reveals meaningful information about character. The premise of this study was that health practitioners, especially novices, would bring into the clinic their everyday perceptual tendencies related to deciphering character. The study examined novice and expert practitioners' impressions of the personality of patients with Parkinson's disease who were videotaped during a healthcare interview. It was found that practitioners, especially novices, appeared to be overly sensitive to expressive masking when forming impressions about patient extraversion. They incorrectly perceived patients with more masking to be less extraverted than patients with less masking. Novice practitioners were particularly inaccurate in their impressions of neuroticism compared to experts. Novices incorrectly perceived patients with more masking as being more neurotic, whereas experts tended to be sensitive to valid cues of neuroticism. Practitioners' impressions of patient conscientiousness were not sensitive to masking and were highly accurate.

A review of the cognitive and behavioral sequelae of Parkinson's disease: relationship to frontostriatal circuitry

BACKGROUND

Parkinson's disease is a neurodegenerative hypokinetic movement disorder presenting with subcortical pathology and characterized by motor deficits. However, as is frequently reported in the literature, patients with Parkinson's disease can also exhibit cognitive and behavioral impairments. These impairments may be attributed to dysfunction of multiple systems associated with the disease process in Parkinson's disease that are not necessarily related to motor symptoms. In recent years, considerable attention has addressed the circuits connecting the frontal cortical regions and the basal ganglia (i.e., frontostriatal circuits) and how they mediate cognition and behavior in humans. It has been suggested that these same circuits are disrupted in Parkinson's disease and may be responsible for the frontal/executive deficits predominantly reported in this patient population.

OBJECTIVE

The current survey of the literature provides a critique and analysis of the neuropsychological profile of Parkinson's disease, including cognitive impairments, behavioral alterations, and emotional processing deficits. A special feature of this paper is to ascertain how frontostriatal circuitry might provide the substrate for the neuropsychological impairments exhibited in Parkinson's disease. In so doing, studies involving nonhuman subjects, neurologically healthy adults, brain-lesioned individuals, and patients with Parkinson's disease are reviewed to provide a novel perspective in conceptualizing and categorizing the cognitive and behavioral sequelae concomitant to specific frontostriatal circuit dysfunction in Parkinson's disease.

CONCLUSIONS

The current review suggests that the neuropsychological profile of Parkinson's disease, which predominantly reflects frontal/executive dysfunction, may be attributed to disruption of the frontostriatal circuitry. The information generated from this review can serve as a guide in the assessment of frontal/executive dysfunction in Parkinson's disease with suggestions for a clinical neuropsychological test battery.

Acoustical analysis of posed prosodic expressions: effects of emotion and sex

Prosodic expression is an important channel of emotional communication and can be assessed through computerized acoustical analysis. Fundamental frequency (F0) is the most commonly studied acoustic measure and considered the best index of perceived pitch. In this study, we examined two factors that can influence prosodic expression, sex and emotion type. A special feature is the use of a neutral expression as a control measure. We also described procedures for eliciting posed prosodic expression via an experimental task from the New York Emotion Battery. Subjects were healthy men (n=10) and women (n=9), matched for age (M=29.2 yr.) and education (M=15.6 yr.). Subjects were asked to intone neutral-content sentences with happy, sad, and neutral prosody. F0 mean and standard deviation were measured using the Computerized Speech Lab program. Initial findings indicated that women produced significantly higher F0 values than did men and that happy sentences were produced with significantly higher F0 values than were sad sentences. When semitone conversions were applied and neutral prosody was subtracted out, differences remained for emotion type but not for sex. Findings are discussed in terms of implications for the assessment and treatment of prosody in clinical populations.

Emotional processing deficits in individuals with unilateral brain damage

This article presents a review of the neural mechanisms underlying emotional processing deficits (EPDs) in individuals with unilateral brain damage. First, key theoretical issues pertaining to the neuropsychology of emotion are presented. These include parameters of emotional processing, the componential approach, emotional domains, and hypotheses regarding hemispheric specialization for emotion. Second, the literature on hemispheric asymmetries for emotion is reviewed in terms of processing mode (perception and expression) and communication channel (facial, prosodic-intonational, and lexical-verbal). Studies involving normal adults and individuals with right- or left-sided brain damage are reviewed. Third, recent findings identifying the role of the right hemisphere in emotional processing are described. The article is concluded by aligning these new data with findings from the general literature, providing added support for the right-hemisphere emotion hypothesis.

Spontaneous facial expressivity in children with acquired brain injury

OBJECTIVES

To investigate spontaneous facial behavior during social interaction in children with acquired brain injury (ABI), and to explore possible links between ABI, facial expressivity, and caregiver-reported social competence.

DESIGN

Between-group comparisons using t tests, within-group comparisons using correlational analyses, correlational analyses of independent variables and outcome measures.

PARTICIPANTS

Sixteen school-aged children with ABI and 32 normally developing children of comparable age and gender.

MAIN OUTCOME MEASURE

Aspects of facial expressivity derived from coding scheme designed for this study.

RESULTS

Children with ABI were less expressive overall and tended to shift expressions less often than normally developing children. Several measures of expressivity were correlated with measures of social competence.

CONCLUSIONS

Brain injury inhibits production of some aspects of spontaneous facial expression. Results are suggestive of links between facial behavior and social skills.

Consequences of right cerebrovascular accident on emotional functioning: diagnostic and treatment implications

The relationship between lesion location and neuropsychiatric sequelae in stroke patients has been extensively studied. Emotional disorders associated with right hemisphere stroke include depression, anxiety, anger, and/or mania. Pharmacotherapy, electroconvulsive therapy, and/or psychotherapy are common treatments for these disorders. This article reviews the clinical presentations of seven right hemisphere stroke patients. The treatment rationale and course of treatment are described for two of these patients. The aims of this paper are to explore the appropriateness of various assessment tools and treatment modalities for stroke patients as well as to demonstrate the techniques of psychotherapy as applied to the two cases featured in this article. Specific factors that may significantly influence treatment outcome, such as lesion location and degree of cognitive impairment, are considered.