A comparison of facial emotion processing in neurological and psychiatric conditions

The Emotion Authenticity Recognition (EAR) test: normative data of an innovative test using dynamic emotional stimuli to evaluate the ability to recognize the authenticity of emotions expressed by faces

Despite research has massively focused on how emotions conveyed by faces are perceived, the perception of emotions' authenticity is a topic that has been surprisingly overlooked. Here, we present the Emotion Authenticity Recognition (EAR) test, a test specifically developed using dynamic stimuli depicting authentic and posed emotions to evaluate the ability of individuals to correctly identify an emotion (emotion recognition index, ER Index) and classify its authenticity (authenticity recognition index (EA Index). The EAR test has been validated on 522 healthy participants and normative values are provided. Correlations with demographic characteristics, empathy and general cognitive status have been obtained revealing that both indices are negatively correlated with age, and positively with education, cognitive status and different facets of empathy. The EAR test offers a new ecological test to assess the ability to detect emotion authenticity that allow to explore the eventual social cognitive deficit even in patients otherwise cognitively intact.

Recognition of emotional face expressions in patients with restless legs syndrome

OBJECTIVE

Restless legs syndrome (RLS) is one of the commonest neurologic diseases. Along with sensory and motor symptoms, cognitive impairment and psychiatric features can be seen with RLS. The present study, was planned to look for evidence of cognitive impairment by evaluating facial emotion recognition (FER) in patients with RLS.

METHODS

In this study, 80 patients with RLS and 50 healthy controls (HCs) were included. Demographic data were recorded. All patients with RLS and HCs were tested with Beck anxiety inventory (BAI), Beck depression inventory (BDI) and with Ekman's test for recognition of facial emotions.

RESULTS

Sixty-three of the patients with RLS and 37 of the HCs were female. The mean age of the patients was 45.41 ± 8.24, and the mean age of HCs was 43.12 ± 10.35. The patients and HCs were similar regarding sex, age, educational status, and marital status. Patients with RLS had FER difficulties comparing HCs. There was a negative correlation between Ekman's test scores and BDI (r = -0.311, p < 0.001) and BAI scores (r = -0.379, p < 0.001).

CONCLUSION

FER is an invaluable research topic regarding cognitive function in RLS, which may help us develop different perspectives in terms of revealing the pathophysiology and is very important for the well-being of the patients' social interactions.

Associative learning and facial expression recognition in schizophrenic patients: Effects of social presence

Schizophrenia (SCZ) is a psychiatric disorder that alters both general and social cognition. However, the exact mechanisms that are altered remain to be elucidated. In this study, we investigated associative learning (AL) and facial expression recognition (FER) in the same patients, using emotional expressions and abstract images. Our main aim was to investigate how these cognitive abilities are affected by SCZ and to assess the role of mere social presence, a factor that has not been considered before. The study compared the behavioral performance of 60 treated outpatients with SCZ and 103 demographically matched healthy volunteers. In the AL task, participants had to associate abstract images or facial expressions with key presses, guided by feedback on each trial. In the FER task, they had to report whether two successively presented facial expressions were the same or different. All participants performed the two tasks under two social context conditions: alone or in the presence of a passive but attentive audience. The results showed a severe learning impairment in patients compared to controls, with a slight advantage for facial expressions compared to abstract images, and a gender-dependent effect of social presence. In contrast, facial expression recognition was partially spared in patients and facilitated by social presence. We conclude that cognitive abilities are impaired in patients with SCZ, but their investigation needs to take into account the social context in which they are assessed.

The role of the differential outcomes procedure and schizotypy in the recognition of dynamic facial expressions of emotions

Emotional facial expression recognition is a key ability for adequate social functioning. The current study aims to test if the differential outcomes procedure (DOP) may improve the recognition of dynamic facial expressions of emotions and to further explore whether schizotypal personality traits may have any effect on performance. 183 undergraduate students completed a task where a face morphed from a neutral expression to one of the six basic emotions at full intensity over 10 s. Participants had to press spacebar as soon as they identified the emotion and choose which had appeared. In the first block, participants received no outcomes. In the second block, a group received specific outcomes associated to each emotion (DOP group), while another group received non-differential outcomes after correctly responding (NOP group). Employing generalized linear models (GLMs) and Bayesian inference we estimated different parameters to answer our research goals. Schizotypal personality traits did not seem to affect dynamic emotional facial expression recognition. Participants of the DOP group were less likely to respond incorrectly to faces showing Fear and Surprise at fewer intensity levels. This may suggest that the DOP could lead to better identification of the main features that differentiate each facial expression of emotion.

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.

Emotion recognition and processing in patients with mild cognitive impairment: A systematic review

The purpose of this study was to investigate emotion recognition and processing in patients with mild cognitive impairment (MCI) in order to update the state of current literature on this important but undervalued topic. We identified 15 papers published between 2012 and 2022 that meet the inclusion criteria. Paper search, selection, and extraction followed the PRISMA guidelines. We used a narrative synthesis approach in order to report a summary of the main findings taken from all papers. The results collected are still ambiguous: some studies did not find any differences between MCI and healthy controls (HC) groups in emotion recognition and processing, and other results reported emotion-specific deficits in emotion recognition regarding MCI patients (both regarding negative and neutral emotions). It is essential to underline that these findings could not be generalized to the whole MCI population due to the heterogeneous use of measures and composition of the sample. This does not allow us to make a comprehensive comparison between the results. Our suggestion for future research is to align the results using the same type of tests and emotion recognition assessment.

Comparison of Emotion Recognition in Young People, Healthy Older Adults, and Patients with Mild Cognitive Impairment

BACKGROUND

The basic discrete emotions, namely, happiness, disgust, anger, fear, surprise, and sadness, are present across different cultures and societies. Facial emotion recognition is crucial in social interactions, but normal and pathological aging seem to affect this ability. The present research aims to identify the differences in the capacity for recognition of the six basic discrete emotions between young and older healthy controls (HOC) and mildly cognitively impaired patients (MCI).

METHOD

The sample (N = 107) consisted of 47 young adults, 27 healthy older adults, and 33 MCI patients. Several neuropsychological scales were administered to assess the cognitive state of the participants, followed by the emotional labeling task on the Ekman 60 Faces test.

RESULTS

The MANOVA analysis was significant and revealed the presence of differences in the emotion recognition abilities of the groups. Compared to HOC, the MCI group obtained a significantly lower number of hits on fear, anger, disgust, sadness, and surprise. The happiness emotion recognition rate did not differ significantly among the three groups. Surprisingly, young people and HOC did not show significant differences.

CONCLUSIONS

Our results demonstrated that MCI was associated with facial emotion recognition impairment, whereas normal aging did not seem to affect this ability.

Impaired Facial Emotion Recognition and Gaze Direction Detection in Mild Alzheimer's Disease: Results from the PACO Study

BACKGROUND

Facial emotion recognition (FER) and gaze direction (GD) identification are core components of social cognition, possibly impaired in many psychiatric or neurological conditions. Regarding Alzheimer's disease (AD), current knowledge is controversial.

OBJECTIVE

The aim of this study was to explore FER and GD identification in mild AD compared to healthy controls.

METHODS

180 participants with mild AD drawn from the PACO study and 74 healthy elderly controls were enrolled. Participants were asked to complete three socio-cognitive tasks: face sex identification, recognition of facial emotions (fear, happiness, anger, disgust) expressed at different intensities, and GD discrimination. Multivariate analyses were conducted to compare AD participants and healthy controls.

RESULTS

Sex recognition was preserved. GD determination for subtle deviations was impaired in AD. Recognition of prototypically expressed facial emotions was preserved while recognition of degraded facial emotions was impacted in AD participants compared to controls. Use of multivariate analysis suggested significant alteration of low-expressed fear and disgust recognition in the AD group.

CONCLUSION

Our results showed emotion recognition and GD identification in patients with early-stage AD compared to elderly controls. These impairments could be the object of specific therapeutic interventions such as social cognition remediation or raising awareness of primary caregivers to improve the quality of life of patients with early AD.

The role of state and trait anxiety in the processing of facial expressions of emotion

State anxiety appears to influence facial emotion processing (Attwood et al. 2017 R. Soc. Open Sci. 4, 160855). We aimed to (i) replicate these findings and (ii) investigate the role of trait anxiety, in an experiment with healthy UK participants (N = 48, 50% male, 50% high trait anxiety). High and low state anxiety were induced via inhalations of 7.5% carbon dioxide enriched air and medical air, respectively. High state anxiety reduced global emotion recognition accuracy (p = 0.01, η p 2 = 0.14 ), but it did not affect interpretation bias towards perceiving anger in ambiguous angry-happy facial morphs (p = 0.18, η p 2 = 0.04 ). We found no clear evidence of a relationship between trait anxiety and global emotion recognition accuracy (p = 0.60, η p 2 = 0.01 ) or interpretation bias towards perceiving anger (p = 0.83, η p 2 = 0.01 ). However, there was greater interpretation bias towards perceiving anger (i.e. away from happiness) during heightened state anxiety, among individuals with high trait anxiety (p = 0.03, d z = 0.33). State anxiety appears to impair emotion recognition accuracy, and among individuals with high trait anxiety, it appears to increase biases towards perceiving anger (away from happiness). Trait anxiety alone does not appear to be associated with facial emotion processing.

Emotion Processing Dysfunction in Alzheimer's Disease: An Overview of Behavioral Findings, Systems Neural Correlates, and Underlying Neural Biology

We described behavioral studies to highlight emotional processing deficits in Alzheimer's disease (AD). The findings suggest prominent deficit in recognizing negative emotions, pronounced effect of positive emotion on enhancing memory, and a critical role of cognitive deficits in manifesting emotional processing dysfunction in AD. We reviewed imaging studies to highlight morphometric and functional markers of hippocampal circuit dysfunction in emotional processing deficits. Despite amygdala reactivity to emotional stimuli, hippocampal dysfunction conduces to deficits in emotional memory. Finally, the reviewed studies implicating major neurotransmitter systems in anxiety and depression in AD supported altered cholinergic and noradrenergic signaling in AD emotional disorders. Overall, the studies showed altered emotions early in the course of illness and suggest the need of multimodal imaging for further investigations. Particularly, longitudinal studies with multiple behavioral paradigms translatable between preclinical and clinical models would provide data to elucidate the time course and underlying neurobiology of emotion processing dysfunction in AD.

Examining transcranial random noise stimulation as an add-on treatment for persistent symptoms in schizophrenia (STIM'Zo): a study protocol for a multicentre, double-blind, randomized sham-controlled clinical trial

Background

One out of three patients with schizophrenia failed to respond adequately to antipsychotics and continue to experience debilitating symptoms such as auditory hallucinations and negative symptoms. The development of additional therapeutic approaches for these persistent symptoms constitutes a major goal for patients. Here, we develop a randomized-controlled trial testing the efficacy of high-frequency transcranial random noise stimulation (hf-tRNS) for the treatment of resistant/persistent symptoms of schizophrenia in patients with various profiles of symptoms, cognitive deficits and illness duration. We also aim to investigate the biological and cognitive effects of hf-tRNS and to identify the predictors of clinical response.

Methods

In a randomized, double-blind, 2-arm parallel-group, controlled, multicentre study, 144 patients with schizophrenia and persistent symptoms despite the prescription of at least one antipsychotic treatment will be randomly allocated to receive either active (n = 72) or sham (n = 72) hf-tRNS. hf-tRNS (100–500 Hz) will be delivered for 20 min with a current intensity of 2 mA and a 1-mA offset twice a day on 5 consecutive weekdays. The anode will be placed over the left dorsolateral prefrontal cortex and the cathode over the left temporoparietal junction. Patients’ symptoms will be assessed prior to hf-tRNS (baseline), after the 10 sessions, and at 1-, 3- and 6-month follow-up. The primary outcome will be the number of responders defined as a reduction of at least 25% from the baseline scores on the Positive and Negative Syndrome Scale (PANSS) after the 10 sessions. Secondary outcomes will include brain activity and connectivity, source monitoring performances, social cognition, other clinical (including auditory hallucinations) and biological variables, and attitude toward treatment.

Discussion

The results of this trial will constitute a first step toward establishing the usefulness of hf-tRNS in schizophrenia whatever the stage of the illness and the level of treatment resistance. We hypothesize a long-lasting effect of active hf-tRNS on the severity of schizophrenia symptoms as compared to sham. This trial will also have implications for the use of hf-tRNS as a preventive intervention of relapse in patients with schizophrenia.

Trial registration

ClinicalTrials.gov NCT02744989. Prospectively registered on 20 April 2016

Measuring emotion recognition: Added value in diagnosing dementia of the Alzheimer's disease type

Neuropsychological tests, particularly for episodic memory, are used to classify patients in memory clinics. Still, the differential diagnosis between dementia of the Alzheimer’s disease type (Dementia‐AD), mild cognitive impairment (MCI), or major depressive disorder (MDD) is challenging. However, impairments in other domains, such as emotion recognition, an aspect of social cognition, might have additional value in distinguishing Dementia‐AD from MCI and MDD and hence signal progression of neurodegeneration. We evaluated this in patients visiting a memory clinic.

Sixty healthy controls (HC) and 143 first time attendants of an academic hospital memory clinic who were eventually classified as Dementia‐AD (n = 45), MCI (n = 47), MDD (n = 27), or No Impairment (NI, n = 24) were included. We assessed group differences in Emotion Recognition (Ekman 60 Faces Test (EFT)) and episodic memory (Dutch Rey Auditory Verbal Learning Test (RAVLT)). With multinomial and binomial regression analysis, we assessed whether EFT was added to RAVLT in distinguishing patient groups.

Dementia‐AD patients had significantly worse emotion recognition than HC, MCI, MDD, and NI groups, but no other between‐group differences were found. Episodic memory was impaired in Dementia‐AD and MCI patients. We found no memory impairments in the MDD and NI groups. Emotion recognition in addition to episodic memory was significantly better in predicting group membership than episodic memory alone.

In conclusion, emotion recognition measurement had added value for differentiation between patients first visiting memory clinics, in particular in distinguishing Dementia‐AD from MCI. We recommend the standard inclusion of emotion recognition testing in neuropsychological assessment in memory clinics.

Long-Term Severe Mental Disorders Preceding Behavioral Variant Frontotemporal Dementia: Frequency and Clinical Correlates in an Outpatient Sample

BACKGROUND

The behavioral variant frontotemporal dementia (bvFTD) shares some clinical features with severe mental disorders, such as bipolar affective disorder (BAD), schizophrenia (SCZ), and schizoaffective disorder (SZA), and at least for a small subgroup of patients, these conditions may share similar pathological genetic mutations.

OBJECTIVES

To investigate the frequency of a past medical history satisfying diagnostic criteria for BAD, SCZ, and SZA in a bvFTD outpatient sample, and to compare the clinical profile of patients with and without a positive history.

METHODS

Cross-sectional study in which participants were consecutively selected after receiving a diagnosis of probable bvFTD and had a caregiver interviewed with SCID-I. The sample was categorized into two groups: with (bvFTD+) or without (bvFTD-) prior medical history satisfying diagnostic criteria for BAD/SCZ/SZA. Subjects went through cognitive, functional, and neuropsychiatric evaluations.

RESULTS

Overall, 46 bvFTD patients were included; bvFTD+ patients accounted for 36.9% of the sample. The main nosology fulfilling criteria was BAD (76.5%). The groups differed in Neuropsychiatric Inventory scores (p = 0.01), use of antipsychotics (p = 0.01), family history of psychosis (p = 0.01), presence of primitive reflexes (p = 0.04), Frontal Assessment Battery performance (p = 0.01), Ekman's facial emotion recognition test (p = 0.03), frequency of apathy (p = 0.03), and stereotyped behavior (p = 0.01). All these parameters were more frequent/worse in the bvFTD+ group.

CONCLUSIONS

A prior medical history compatible with BAD/SCZ/SZA was found in more than 1/3 of this sample of bvFTD patients and was associated with subtle distinctive clinical features.

Behavioral variant frontotemporal dementia in patients with previous severe mental illness: a systematic and critical review

ABSTRACT Objectives: To explore the relationship between severe/serious mental illness (SMI) and the behavioral variant of frontotemporal dementia (bvFTD), as the patterns of symptoms and cognitive performance that characterize both disorders share similarities. Methods: We performed a systematic review investigating what has already been published regarding the relationship between bvFTD and SMI. Studies were selected from PubMed and LILACS databases, including those published up to February 12, 2018. The search strategy included the following terms: “frontotemporal dementia” plus “bipolar”, OR “frontotemporal dementia” plus “schizophrenia”, OR “frontotemporal dementia” plus “schizoaffective”. Publications without abstracts, case reports with absent genetic or histopathological confirmation, reviews and non-English language papers were excluded across the search process. Results: The search on PubMed retrieved 186 articles, of which 42 met eligibility criteria. On the LILACS database, none met the requirements. Generally, three major research aims were identified: 1) to look for frontotemporal lobar degeneration-associated genetic abnormalities in patients with prior SMI; 2) to compare the cognitive profile between patients affected by neurodegenerative disorders and schizophrenic patients; 3) to highlight the association between bvFTD and preceding psychiatric conditions and/or distinguish them both. The investigated mutations were found infrequently in the studied SMI samples. Cross-sectional studies comparing cognitive performance between bvFTD and psychiatric disorders mostly found no remarkable differences. There were only a few case reports identifying definite frontotemporal lobar degeneration in patients with previous psychiatric diagnoses. Conclusions: The available evidence demonstrates how fragile the current understanding is regarding the association between bvFTD and prior SMI.

A Novel Dynamic Morphed Stimuli Set to Assess Sensitivity to Identity and Emotion Attributes in Faces

Face-based tasks are used ubiquitously in the study of human perception and cognition. Video-based (dynamic) face stimuli are increasingly utilized by researchers because they have higher ecological validity than static images. However, there are few ready-to-use dynamic stimulus sets currently available to researchers that include non-emotional and non-face control stimuli. This paper outlines the development of three original dynamic stimulus sets: a set of emotional faces (fear and disgust), a set of non-emotional faces, and a set of car animations. Morphing software was employed to vary the intensity of the expression shown and to vary the similarity between actors. Manipulating these dimensions permits us to create tasks of varying difficulty that can be optimized to detect more subtle differences in face-processing ability. Using these new stimuli, two preliminary experiments were conducted to evaluate different aspects of facial identity recognition, emotion recognition, and non-face object discrimination. Results suggest that these five different tasks successfully avoided floor and ceiling effects in a healthy sample. A second experiment found that dynamic versions of the emotional stimuli were recognized more accurately than static versions, both for labeling, and discrimination paradigms. This indicates that, like previous emotion-only stimuli sets, the use of dynamic stimuli confers an advantage over image-based stimuli. These stimuli therefore provide a useful resource for researchers looking to investigate both emotional and non-emotional face-processing using dynamic stimuli. Moreover, these stimuli vary across crucial dimensions (i.e., face similarity and intensity of emotion) which allows researchers to modify task difficulty as required.

Memory across a short-delay: Systematic biases in memory for faces

From geometric figures to human faces, many visual stimuli vary along a continuum in featural space, anchored at one end by a highly distinctive constellation of features, at the other by a neutral set. Here we used a continuum of morphed faces to test whether errors in visual short-term memory are symmetric in feature space around the target or systematically biased toward one or the other end of the continuum. Participants were shown a face for 1 s. After a brief delay, participants were asked to choose the face they had been shown among three face options, which consisted of the target face, one face that was slightly more distinctive, and one face that was slightly more neutral. Continuums of morphed faces ranged from an average, neutral face to different distinctive celebrity faces two experiments, or from neutral facial expressions to highly emotional expressions a third experiment. Results showed that when participants made an incorrect response, they were more likely to incorrectly identify the more distinctive face than the more neutral or average face as the target face. This bias toward more extreme faces, however, was not observed for unfamiliar (non-celebrity) faces that were emotionally neutral. These findings suggest that visual memory encodes distinctive features of stimuli that lead to biases in later recognition.

The representation and plasticity of body emotion expression

Emotions are expressed by the face, the voice and the whole body. Research on the face and the voice has not only demonstrated that emotions are perceived categorically, but that this perception can be manipulated. The purpose of this study was to investigate, via two separate experiments using adaptation and multisensory techniques, whether the perception of body emotion expressions also shows categorical effects and plasticity. We used an approach developed for studies investigating both face and voice emotion perception and created novel morphed affective body stimuli, which varied in small incremental steps between emotions. Participants were instructed to perform an emotion categorisation of these morphed bodies after adaptation to bodies conveying different expressions (Experiment 1), or while simultaneously hearing affective voices (Experiment 2). We show that not only is body expression perceived categorically, but that both adaptation to affective body expressions and concurrent presentation of vocal affective information can shift the categorical boundary between body expressions, specifically for the angry body expressions. Overall, our findings provide significant new insights into emotional body categorisation, which may prove important in gaining a deeper understanding of body expression perception in everyday social situations.

Facial decoding in schizophrenia is underpinned by basic visual processing impairments

Schizophrenia is associated with a strong deficit in the decoding of emotional facial expression (EFE). Nevertheless, it is still unclear whether this deficit is specific for emotions or due to a more general impairment for any type of facial processing. This study was designed to clarify this issue. Thirty patients suffering from schizophrenia and 30 matched healthy controls performed several tasks evaluating the recognition of both changeable (i.e. eyes orientation and emotions) and stable (i.e. gender, age) facial characteristics. Accuracy and reaction times were recorded. Schizophrenic patients presented a performance deficit (accuracy and reaction times) in the perception of both changeable and stable aspects of faces, without any specific deficit for emotional decoding. Our results demonstrate a generalized face recognition deficit in schizophrenic patients, probably caused by a perceptual deficit in basic visual processing. It seems that the deficit in the decoding of emotional facial expression (EFE) is not a specific deficit of emotion processing, but is at least partly related to a generalized perceptual deficit in lower-level perceptual processing, occurring before the stage of emotion processing, and underlying more complex cognitive dysfunctions. These findings should encourage future investigations to explore the neurophysiologic background of these generalized perceptual deficits, and stimulate a clinical approach focusing on more basic visual processing.

Changes in event-related potentials in patients with first-episode schizophrenia and their siblings

BACKGROUND

This study aimed to explore the characteristics of event-related potentials induced by facial emotion recognition in patients with first-episode schizophrenia and in their siblings.

METHODS

In this case-control study, 30 first-episode schizophrenia patients, 26 siblings, and 30 healthy controls were enrolled. They completed facial emotion recognition tasks from the Ekman Standard Faces Database as an induction for evoked potentials. Evoked potential data were obtained using a 64-channel electroencephalography system. Average evoked potential waveforms were computed from epochs for each stimulus type. The amplitudes and latency of the event-related potentials for P100 (positive potential 100 ms after stimulus onset), N170 (negative potential 170 ms after stimulus onset), and N250 (fronto-central peak) were investigated at O1, O2, P7, and P8 electrode locations.

RESULTS

There were significant differences between the groups for P100 amplitude (F = 11.526, P < 0.001), electrode position (F = 450.592, P < 0.001), emotion (disgust vs. happiness vs. fear) (F = 1722.467, P < 0.001), and emotion intensity (low vs. moderate vs. high) (F = 1737.169, P < 0.001). Post hoc analysis showed significantly larger amplitudes in the schizophrenia group at the O1, O2, P7, and P8 electrode positions. There were no significant differences between the siblings of schizophrenia patients and the healthy controls.

CONCLUSIONS

Patients with schizophrenia showed abnormalities in P100 amplitude, but similar results were not observed in their siblings. These results provide evidence of dysfunctional event-related potential patterns underlying facial emotion processing in patients with schizophrenia. P100 may be a characteristic index of schizophrenia.

Lower Sensitivity to Happy and Angry Facial Emotions in Young Adults with Psychiatric Problems

Many psychiatric problem domains have been associated with emotion-specific biases or general deficiencies in facial emotion identification. However, both within and between psychiatric problem domains, large variability exists in the types of emotion identification problems that were reported. Moreover, since the domain-specificity of the findings was often not addressed, it remains unclear whether patterns found for specific problem domains can be better explained by co-occurrence of other psychiatric problems or by more generic characteristics of psychopathology, for example, problem severity. In this study, we aimed to investigate associations between emotion identification biases and five psychiatric problem domains, and to determine the domain-specificity of these biases. Data were collected as part of the ‘No Fun No Glory’ study and involved 2,577 young adults. The study participants completed a dynamic facial emotion identification task involving happy, sad, angry, and fearful faces, and filled in the Adult Self-Report Questionnaire, of which we used the scales depressive problems, anxiety problems, avoidance problems, Attention-Deficit Hyperactivity Disorder (ADHD) problems and antisocial problems. Our results suggest that participants with antisocial problems were significantly less sensitive to happy facial emotions, participants with ADHD problems were less sensitive to angry emotions, and participants with avoidance problems were less sensitive to both angry and happy emotions. These effects could not be fully explained by co-occurring psychiatric problems. Whereas this seems to indicate domain-specificity, inspection of the overall pattern of effect sizes regardless of statistical significance reveals generic patterns as well, in that for all psychiatric problem domains the effect sizes for happy and angry emotions were larger than the effect sizes for sad and fearful emotions. As happy and angry emotions are strongly associated with approach and avoidance mechanisms in social interaction, these mechanisms may hold the key to understanding the associations between facial emotion identification and a wide range of psychiatric problems.

[Reconciliating neurology and psychiatry: The prototypical case of frontotemporal dementia]

Frontotemporal degeneration (FTD) in its behavioral variant (bvFTD) is probably one of the conditions that best illustrates the links between psychiatry and neurology. It is indeed admitted that between a third and half of patients with this condition, especially in early-onset forms, receive an initial diagnosis of psychiatric disorder (depression, schizophrenia, bipolar disorder) and are then referred to a psychiatric ward. BvFTD can thus be considered a neurological disorder with a psychiatric presentation. Among psychiatric symptoms reported in this disease, psychotic symptoms (hallucinations, delusions, especially of persecution), which have long been underestimated in bvFTD and are not part of the current diagnostic criteria, are present in about 20% of cases and may be inaugural. They are particularly common in the genetic forms related to a mutation in the C9orf72 gene (up to 50%), and to a lesser extent in the GRN gene (up to 25%). C9orf72 gene mutation is often associated with a family history of dementia or motor neuron disease but also of psychiatric disorders. It has also been described in sporadic presentation forms. Sometimes, the moderate degree of brain atrophy on MRI described in patients carrying this mutation may complicate the differential diagnosis with late-onset psychiatric diseases. In the present article, we underline the importance of considering that psychiatric - especially psychotic - symptoms are not rare in bvFTD, which should lead to a revision of the diagnostic criteria of this disease by taking greater account of this fact. We also propose a diagnostic chart, based on concerted evaluation by neurologists and psychiatrists for cases of atypical psychiatric symptoms (late-onset or pharmacoresistant troubles) leading to consider the possibility of a neurological disorder, in order to shed a new light on these difficult clinical situations. In the field of research, bvFTD may constitute a model to explore the neural basis of certain psychiatric disorders, and a possible molecular link between bvFTD and psychoses, which could eventually lead to new therapeutic approaches, has been recently suggested. Thus, bvFTD illustrates how the links between neurology and psychiatry are close and tend to evolve with the progress of scientific knowledge. It is necessary to strengthen collaboration between the two disciplines both to improve the care - diagnosis and management of these patients - and to promote the emergence of innovative clinical research.

Do better communication skills promote sheltered employment in schizophrenia?

Alongside various psychopathological symptoms and neurocognitive dysfunctions, communication skill impairments may be considered core feature of schizophrenia. Although many studies examined the relation between employment status and neurocognition in schizophrenia, we still know very little about the role of communication skills in vocational status among people with schizophrenia. The purpose of this study is to identify the most characteristic communication, neurocognitive and social cognition differences which separate the employed schizophrenia outpatients from those who do not work. The study included three groups: 33 schizophrenia outpatients employed in social firms, 29 unemployed schizophrenia outpatients participating in occupational therapy and sex & age matched 31 healthy controls. We assessed communication skills, global cognitive functioning, executive functions, memory, social cognition as well as severity of psychopathology. Our results indicate that the most characteristic differences between employed and unemployed schizophrenia outpatients are associated with selective language and communication skills, i.e. paralinguistic aspects of communication, understanding of discrete meaning of linguistic context and figurative meaning of language. We find no significant differences between both clinical groups with regard to neurocognition and social cognition. Moreover, unemployed group had more severe psychopathology than the employed group, so we re-analyzed results controlling for symptom severity. The only differences that endured were related to general communication skills and explanation of pictured metaphors, but only when controlling solely for positive or negative syndrome. In conclusion, the present study indicates that employment in schizophrenia is associated with better symptomatic remission and communication skills, but not with better neurocognition and social cognition.

Slow identification of facial happiness in early adolescence predicts onset of depression during 8 years of follow-up

Adolescent onset depression places a high burden on those who suffer from it, and is difficult to treat. An improved understanding of mechanisms underlying susceptibility to adolescent depression may be useful in early detection and as target in treatment. Facial emotion identification bias has been suggested as trait marker for depression, but results have been inconclusive. To explore whether facial emotion identification biases may be trait markers for depression, we tested whether the speed with which young adolescents identified happy, sad, angry and fearful facial emotions predicted the onset of depression during an eight-year follow-up period. We hypothesized that facial emotion identification speed predicts depression in a symptom-congruent way and differentially predicts symptoms of anhedonia and sadness. Data were collected as part of the TRacking Adolescents' Individual Lives Survey (TRAILS), and involved 1840 adolescents who participated in a facial emotion identification test at age 11 and were subjected to the World Health Organization Composite International Diagnostic Interview (CIDI) at age 19. In a multi-emotion model, slow identification of happy facial emotions tentatively predicted onset of depressive disorder within the follow-up period. Slow identification of happy emotions and fast identification of sad emotions predicted symptoms of anhedonia, but not symptoms of sadness. Our results suggest that the relative speed of identification of happiness in relation to the identification of sadness is a better predictor of depression than the identification of either facial emotion alone. A possible mechanism underlying the predictive role of facial emotion identification may be a less reactive reward system.

Emotional processing in Parkinson's disease and schizophrenia: evidence for response bias deficits in PD

Deficits in facial emotion recognition in Parkinson's disease (PD) patients has been well documented. Nevertheless, it is still not clear whether facial emotion recognition deficits are secondary to other cognitive impairments. The aim of this study was to answer the question of whether deficits in facial emotion recognition in PD result from impaired sensory processes, or from impaired decision processes. To address this question, we tested the ability to recognize a mixture of basic and complex emotions in 38 non-demented PD patients and 38 healthy controls matched on demographic characteristics. By using a task with an increased level of ambiguity, in conjunction with the signal detection theory, we were able to differentiate between sensitivity and response bias in facial emotion recognition. Sensitivity and response bias for facial emotion recognition were calculated using a d-prime value and a c index respectively. Our study is the first to employ the EIS-F scale for assessing facial emotion recognition among PD patients; to test its validity as an assessment tool, a group comprising schizophrenia patients and healthy controls were also tested. Patients with PD recognized emotions with less accuracy than healthy individuals (d-prime) and used a more liberal response criterion (c index). By contrast, patients with schizophrenia merely showed diminished sensitivity (d-prime). Our results suggest that an impaired ability to recognize facial emotions in PD patients may result from both decreased sensitivity and a significantly more liberal response criteria, whereas facial emotion recognition in schizophrenia may stem from a generalized sensory impairment only.

Face recognition in schizophrenia disorder: A comprehensive review of behavioral, neuroimaging and neurophysiological studies

Facial emotion processing has been extensively studied in schizophrenia patients while general face processing has received less attention. The already published reviews do not address the current scientific literature in a complete manner. Therefore, here we tried to answer some questions that remain to be clarified, particularly: are the non-emotional aspects of facial processing in fact impaired in schizophrenia patients? At the behavioral level, our key conclusions are that visual perception deficit in schizophrenia patients: are not specific to faces; are most often present when the cognitive (e.g. attention) and perceptual demands of the tasks are important; and seems to worsen with the illness chronification. Although, currently evidence suggests impaired second order configural processing, more studies are necessary to determine whether or not holistic processing is impaired in schizophrenia patients. Neural and neurophysiological evidence suggests impaired earlier levels of visual processing, which might involve the deficits in interaction of the magnocellular and parvocellular pathways impacting on further processing. These deficits seem to be present even before the disorder out-set. Although evidence suggests that this deficit may be not specific to faces, further evidence on this question is necessary, in particularly more ecological studies including context and body processing.

Emotion recognition specialization and context-dependent risk of anxiety and depression in adolescents

BACKGROUND

Some adolescents function poorly in apparently benign environments, while others thrive despite hassles and difficulties. The aim of this study was to examine if adolescents with specialized skills in the recognition of either positive or negative emotions have a context-dependent risk of developing an anxiety or depressive disorder during adolescence, depending on exposure to positive or harsh parenting.

METHODS

Data came from a large prospective Dutch population study (N = 1539). At age 11, perceived parental rejection and emotional warmth were measured by questionnaire, and emotion recognition skills by means of a reaction-time task. Lifetime diagnoses of anxiety and depressive disorders were assessed at about age 19, using a standardized diagnostic interview.

RESULTS

Adolescents who were specialized in the recognition of positive emotions had a relatively high probability to develop an anxiety disorder when exposed to parental rejection (Bspecialization*rejection = 0.23, P < 0.01) and a relatively low probability in response to parental emotional warmth (Bspecialization*warmth = -0.24, P = 0.01), while the opposite pattern was found for specialists in negative emotions. The effect of parental emotional warmth on depression onset was likewise modified by emotion recognition specialization (B = -0.13, P = 0.03), but the effect of parental rejection was not (B = 0.02, P = 0.72). In general, the relative advantage of specialists in negative emotions was restricted to fairly uncommon negative conditions.

CONCLUSIONS

Our results suggest that there is no unequivocal relation between parenting behaviors and the probability to develop an anxiety or depressive disorder in adolescence, and that emotion recognition specialization may be a promising way to distinguish between various types of context-dependent reaction patterns.

The temporal unfolding of face processing in social anxiety disorder--a MEG study

The current study is the first to use magnetoencephalography (MEG) to examine how individuals with social anxiety disorder (SAD) process emotional facial expressions (EFEs). We expected that, compared to healthy controls (HCs), participants with SAD will show an early (<200 ms post-stimulus) over-activation in the insula and the fusiform gyrus (FG, associated with the N170/M170 component), and later (>200 ms post-stimulus) over-activation in the dorsolateral prefrontal cortex (DLPFC). Individuals with SAD (n = 12) and healthy controls (HCs, n = 12) were presented with photographs of facial displays during MEG recording. As compared to the HC group, the SAD group showed a reduced M170 (right FG under-activation around 130–200 ms); early reduced activation in the right insula, and lower insular sensitivity to the type of EFE displayed. In addition, the SAD group showed a late over-activation in the right DLPFC. This unique EFE processing pattern in SAD suggests an early under-activation of cortical areas, possibly related to reduced emphasis on high spatial frequency information and greater early emphasis on low spatial frequency information. The late DLPFC over-activation in the SAD group may correlate to failures of cognitive control in this disorder. The importance of a temporal perspective for the understanding of facial processing in psychopathology is underlined.

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This study is the first to use MEG to study social anxiety disorder (SAD).

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SADs and controls viewed emotional facial expressions during MEG.

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Compared to controls, SADs showed reduced M170 (early fusiform gyrus activity).

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SADs presented a late over-activation in the right dorsolateral prefrontal cortex.

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The late frontal over-activity may correlate to failures of cognitive control in SAD.

Personality, Alzheimer's disease and behavioural and cognitive symptoms of dementia: the PACO prospective cohort study protocol

Background

Alzheimer’s disease is characterised by a loss of cognitive function and behavioural problems as set out in the term “Behavioural and Psychological Symptoms of Dementia”. These behavioural symptoms have heavy consequences for the patients and their families.

A greater understanding of behavioural symptoms risk factors would allow better detection of those patients, a better understanding of crisis situations and better management of these patients. Some retrospective studies or simple observations suggested that personality could play a role in the occurrence of behavioural symptoms. Finally, performance in social cognition like facial recognition and perspective taking could be linked to certain personality traits and the subsequent risks of behavioural symptoms.

We propose to clarify this through a prospective, multicentre, multidisciplinary study.

Main Objective:

- To assess the effect of personality and life events on the risk of developing behavioural symptoms.

Secondary Objectives:

- To evaluate, at the time of inclusion, the connection between personality and performance in social cognition tests;

- To evaluate the correlation between performance in social cognition at inclusion and the risks of occurrence of behavioural symptoms;

- To evaluate the correlation between regional cerebral atrophy, using brain Magnetic Resonance Imaging at baseline, and the risk of behavioural symptoms.

Methods/Design

Study type and Population: Prospective multicentre cohort study with 252 patients with Alzheimer’s disease at prodromal or mild dementia stage.

The inclusion period will be of 18 months and the patients will be followed during 18 months. The initial evaluation will include: a clinical and neuropsychological examination, collection of behavioural symptoms data (Neuropsychiatric-Inventory scale) and their risk factors, a personality study using both a dimensional (personality traits) and categorical approach, an inventory of life events, social cognition tests and an Magnetic Resonance Imaging. Patients will be followed every 6 months (clinical examination and collection of behavioural symptoms data and risk factors) during 18 months.

Discussion

This study aims at better identifying the patients with Alzheimer’s disease at high risk of developing behavioural symptoms, to anticipate, detect and quickly treat these disorders and so, prevent serious consequences for the patient and his caregivers.

Trial registration

ClincalTrials.gov: NCT01297140

Discriminating facial expressions of emotion and its link with perceiving visual form in Parkinson's disease

We investigated the link between the ability to perceive facial expressions of emotion and the ability to perceive visual form in Parkinson's disease (PD). We assessed in individuals with PD and healthy controls the ability to discriminate graded intensities of facial expressions of anger from neutral expressions and the ability to discriminate radial frequency (RF) patterns with modulations in amplitude from a perfect circle. Those with PD were, as a group, impaired relative to controls in discriminating graded intensities of angry from neutral expressions and discriminating modulated amplitudes of RF patterns from perfect circles; these two abilities correlated positively and moderately to highly, even after removing the variance that was shared with disease progression and general cognitive functioning. The results indicate that the impaired ability to perceive visual form is likely to contribute to the impaired ability to perceive facial expressions of emotion in PD, and that both are related to the progression of the disease.

Emotional processing deficits in chronic cannabis use: a replication and extension

Heavy cannabis use is associated with interpersonal problems that may arise in part from the inaccurate perception of emotional faces. Only one study reports impairments in emotional facial affect processing in heavy cannabis users; however, it is not clear whether these findings were attributable to differences between cannabis users and controls in schizotypy or gender, rather than from cannabis use itself. A total of 25 frequent cannabis users and 34 non-using controls completed an emotional processing task in an independent groups design. We asked participants to identify the emotions on faces morphed from neutral to 100% intensity, for six basic emotions. We measured percentage hit rate, sensitivity and response bias. Schizotypy was indexed using the Schizotypal Personality Questionnaire. Cannabis users showed lower accuracy and sensitivity on the emotional recognition task. Gender and schizotypy did not differ between the two groups. Men showed lower accuracy on the emotional processing task, but impairments in cannabis users remained when covarying for gender. Schizotypy negatively correlated with sensitivity scores, but this was unreliable when accounting for the groups. Chronic cannabis users showed generalised impairment in emotional processing. These results appeared as independent of the emotional processing deficits amongst men, and were not related to schizotypy.

Are patients with schizophrenia impaired in processing non-emotional features of human faces?

It is known that individuals with schizophrenia exhibit signs of impaired face processing, however, the exact perceptual and cognitive mechanisms underlying these deficits are yet to be elucidated. One possible source of confusion in the current literature is the methodological and conceptual inconsistencies that can arise from the varied treatment of different aspects of face processing relating to emotional and non-emotional aspects of face perception. This review aims to disentangle the literature by focusing on the performance of patients with schizophrenia in a range of tasks that required processing of non-emotional features of face stimuli (e.g., identity or gender). We also consider the performance of patients on non-face stimuli that share common elements such as familiarity (e.g., cars) and social relevance (e.g., gait). We conclude by exploring whether observed deficits are best considered as “face-specific” and note that further investigation is required to properly assess the potential contribution of more generalized attentional or perceptual impairments.

Schizophrenia patients experience substantial social cognition deficits across multiple domains in remission

Knowledge about SC (social cognition) during remission would inform us whether such deficits are trait- or state-markers of the disorder, as well as highlight its relevance for rehabilitation. We aimed to compare SC deficits and their relative independence from NC (neuro-cognition) deficits in remitted schizophrenia patients and matched health controls using comprehensive, culturally sensitive standardized tools. 60 schizophrenia patients meeting modified standardized criteria for remission and 60 age, gender and education matched healthy controls were compared on culturally validated tests of SC-Social Cognition Rating Tool in Indian Setting (SOCRATIS) & Tool for Recognition of Emotions in Neuropsychiatric Disorders (TRENDS) to assess theory of mind, attributional bias, social perception and emotion recognition and NC-(attention/vigilance, speed of processing, visual and verbal learning, working memory and executive functions). Patients had deficits in both SC and NC compared to healthy controls. Deficits in SC were largely independent of NC performance, and SC deficits persisted after adjusting for deficits in NC function. The effect sizes (Cohen's d) for SC deficits ranged from 0.37 to 2.23. All patients scored below a defined cut-off in at least one SC domain. SC deficits are likely to be state-independent in schizophrenia, as they are present in remission phase of the illness. This supports their status as a possible composite-endophenotype in schizophrenia.

Emotion recognition in the dementias: brain correlates and patient implications

SUMMARY Changes in behavior, personality and the ability to interact in social situations have been reported to varying extents across dementia syndromes. Deficits in the ability to recognize emotion in others probably contribute to these socioemotional changes. This article reviews the patterns of emotion recognition impairments and their underlying brain correlates in four dementia syndromes: Alzheimer’s disease; frontotemporal dementia; Huntington’s disease; and progressive supranuclear palsy. Despite emotion recognition deficits being observed in all these patient groups, a limited understanding exists on how these deficits translate into everyday behavior. The adoption of ecologically valid tasks is likely to improve our understanding of these deficits in everyday settings, and will help to provide guidance for management strategies for patients and their carers.

Emotion recognition impairment is present early and is stable throughout the course of schizophrenia

Individuals with schizophrenia experience problems in the perception of emotion throughout the course of the disorder. Few studies have addressed the progression of the deficit over time. The present investigation explores face emotion recognition (FER) performance throughout the course of schizophrenia. The aim of the study was to test the hypotheses that: 1) FER impairment was present in ultra high-risk (putatively prodromal) individuals, and that 2) impairment was stable across the course of the illness. Forty-three individuals with a putative prodromal syndrome, 50 patients with first episode of schizophrenia, 44 patients with multi-episode schizophrenia and 86 unaffected healthy control subjects were assessed to examine emotion recognition ability. ANCOVA analysis adjusted for possible confounder factors and subsequent planned contrasts with healthy controls was undertaken. The results revealed deficits in recognition of sadness and disgust in prodromal individuals, and of all negative emotions in both first-episode and multi-episode patients. Furthermore, there were no significant differences between clinical groups. Within the framework of the neurodevelopmental model of schizophrenia, our results suggest the presence of emotional recognition impairment before the onset of full-blown psychosis. Moreover, the deficit remains stable over the course of illness, fitting the pattern of a vulnerability indicator in contrast to an indicator of chronicity or severity.