Facial affect recognition and schizotypy

Aim: Deficits in facial affect recognition are well documented in schizophrenia, and have been associated with reduced social functioning and interpersonal difficulties. The aim of the present study was to test the possibility that facial affect recognition deficits represent an endophenotypic marker of schizophrenia liability by testing this capacity in individuals with the predisposition to symptoms of schizophrenia. Methods: Eight hundred and forty‐three psychologically healthy participants completed the Schizotypal Personality Questionnaire of which 28 scoring in the upper 15% (high‐schizotypy group) and 28 scoring in the lower 15% (low‐schizotypy group) completed measures of facial affect identification, facial affect discrimination, facial identity recognition, and a measure of negative affect. Results: After controlling for group differences in negative affect and facial identity recognition, negative (but not positive or disorganized) aspects of schizotypy were found to be significantly associated with reduced facial affect discrimination and facial affect recognition accuracy, and in particular, difficulties with the identification of negative emotions. Conclusions: These results provide limited support for the potential trait status of facial affect recognition deficits in schizophrenia and schizophrenia spectrum disorders, and suggest that these deficits may be particularly associated with the predisposition to negative symptoms of schizophrenia.     

Executive function and in-patient violence in forensic patients with schizophrenia

BACKGROUND: The literature on the association between neuropsychological deficits and in-patient violence in schizophrenia is limited and the findings inconsistent. AIMS: To examine the role of executive function deficits in inpatient violence using measures of dorsolateral (DLPFC) and ventrolateral prefrontal cortical (VLPFC) function. METHODS: Thirty-three violent and forty-nine non-violent male forensic in-patients with schizophrenia were assessed using neuropsychological tasks probing DLPFC and VLPFC function and on measures of symptoms and psychopathy. RESULTS: There were no significant group differences in neuropsychological task performance. Higher rates of violence were significantly associated with lower current IQ scores and higher excitement symptom scores. The 'violent' group had significantly higher interpersonal and antisocial domain psychopathy scores. In a logistic regression analysis, IQ and the interpersonal domain of psychopathy were significant discriminators of violent v. non-violent status. CONCLUSIONS: Personality factors rather than symptoms and neuropsychological function may be important in understanding in-patient violence in forensic patients with schizophrenia.     

Fearful faces in schizophrenia: the relationship between patient characteristics and facial affect recognition

Although schizophrenia has often been associated with deficits in facial affect recognition, it is debated whether the recognition of specific emotions is affected and if these facial affect-processing deficits are related to symptomatology or other patient characteristics. The purpose of the present study was to explore whether particular patient characteristics are associated with the recognition of specific facial expressions in patients with schizophrenia. Sixty-four patients with a DSM-IV diagnosis of schizophrenia were assessed with a computerized test of degraded facial affect recognition. Linear regression analysis showed that, in particular, negative symptoms and male sex were associated with worse recognition of fearful faces. Furthermore, diagnosis of nonparanoid schizophrenia and later age of onset were associated with worse recognition of neutral faces. Findings are explained in the light of a neuroanatomical dysfunction accounting for both negative symptoms, such as reduced emotional expression and social-emotional dysfunction, for which men seem more vulnerable than women.     

The McCollough effect and facial emotion discrimination in patients with schizophrenia and their unaffected relatives

Abnormalities in visual processing have been found consistently in schizophrenia patients, including deficits in early visual processing, perceptual organization, and facial emotion recognition. There is however no consensus as to whether these abnormalities represent heritable illness traits and what their contribution is to psychopathology. Fifty patients with schizophrenia, 61 of their first-degree healthy relatives, and 50 psychiatrically healthy volunteers were tested with regard to facial affect (FA) discrimination and susceptibility to develop the color-contingent illusion [the McCollough Effect (ME)]. Both patients and relatives demonstrated significantly lower accuracy in FA discrimination compared with controls. There was also a significant effect of familiality: Participants from the same families had more similar accuracy scores than those who belonged to different families. Experiments with the ME showed that schizophrenia patients required longer time to develop the illusion than relatives and controls, which indicated poor visual adaptation in schizophrenia. Relatives were marginally slower than controls. There was no significant association between the measures of FA discrimination accuracy and ME in any of the participant groups. Facial emotion discrimination was associated with the degree of interpersonal problems, as measured by the Schizotypal Personality Questionnaire in relatives and healthy volunteers, whereas the ME was associated with the perceptual-cognitive symptoms of schizotypy and positive symptoms of schizophrenia. Our results support the heritability of FA discrimination deficits as a trait and indicate visual adaptation abnormalities in schizophrenia, which are symptom related.     

Exploring the nature of facial affect processing deficits in schizophrenia

Schizophrenia has been associated with deficits in facial affect processing, especially negative emotions. However, the exact nature of the deficit remains unclear. The aim of the present study was to investigate whether schizophrenia patients have problems in automatic allocation of attention as well as in controlled evaluation of facial affect. Thirty-seven patients with schizophrenia were compared with 41 control subjects on incidental facial affect processing (gender decision of faces with a fearful, angry, happy, disgusted, and neutral expression) and degraded facial affect labeling (labeling of fearful, angry, happy, and neutral faces). The groups were matched on estimates of verbal and performance intelligence (National Adult Reading Test; Raven's Matrices), general face recognition ability (Benton Face Recognition), and other demographic variables. The results showed that patients with schizophrenia as well as control subjects demonstrate the normal threat-related interference during incidental facial affect processing. Conversely, on controlled evaluation patients were specifically worse in the labeling of fearful faces. In particular, patients with high levels of negative symptoms may be characterized by deficits in labeling fear. We suggest that patients with schizophrenia show no evidence of deficits in the automatic allocation of attention resources to fearful (threat-indicating) faces, but have a deficit in the controlled processing of facial emotions that may be specific for fearful faces.     

Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder

Patients with borderline personality disorder (BPD) exhibit impairment in labeling of facial emotional expressions. However, it is not clear whether these deficits affect the whole domain of basic emotions, are valence-specific, or specific to individual emotions. Whether BPD patients' errors in a facial emotion recognition task create a specific pattern also remains to be elucidated. Our study tested two hypotheses: first, we hypothesized, that the emotion perception impairment in borderline personality disorder is specific to the negative emotion domain. Second, we hypothesized, that BPD patients would show error patterns in a facial emotion recognition task more commonly and more systematically than healthy comparison subjects. Participants comprised 33 inpatients with BPD and 32 matched healthy control subjects who performed a computerized version of the Ekman 60 Faces test. The indices of emotion recognition and the direction of errors were processed in separate analyses. Clinical symptoms and personality functioning were assessed using the Symptom Checklist-90-Revised and the Young Schema Questionnaire Long Form. Results showed that patients with BPD were less accurate than control participants in emotion recognition, in particular, in the discrimination of negative emotions, while they were not impaired in the recognition of happy facial expressions. In addition, patients over-attributed disgust and surprise and under-attributed fear to the facial expressions relative to controls. These findings suggest the importance of carefully considering error patterns, besides measuring recognition accuracy, especially among emotions with negative affective valence, when assessing facial affect recognition in BPD.     

Deficits in facial emotion recognition in schizophrenia: a replication study with korean subjects

Objective

We investigated the deficit in the recognition of facial emotions in a sample of medicated, stable Korean patients with schizophrenia using Korean facial emotion pictures and examined whether the possible impairments would corroborate previous findings.

Methods

Fifty-five patients with schizophrenia and 62 healthy control subjects completed the Facial Affect Identification Test with a new set of 44 colored photographs of Korean faces including the six universal emotions as well as neutral faces.

Results

Korean patients with schizophrenia showed impairments in the recognition of sad, fearful, and angry faces [F(1,114)=6.26, p=0.014; F(1,114)=6.18, p=0.014; F(1,114)=9.28, p=0.003, respectively], but their accuracy was no different from that of controls in the recognition of happy emotions. Higher total and three subscale scores of the Positive and Negative Syndrome Scale (PANSS) correlated with worse performance on both angry and neutral faces. Correct responses on happy stimuli were negatively correlated with negative symptom scores of the PANSS. Patients with schizophrenia also exhibited different patterns of misidentification relative to normal controls.

Conclusion

These findings were consistent with previous studies carried out with different ethnic groups, suggesting cross-cultural similarities in facial recognition impairment in schizophrenia.     

Psychopathy and violent behavior among patients with schizophrenia or schizoaffective disorder.

OBJECTIVE: Although a strong association between violence and psychopathy has been demonstrated in nonpsychotic forensic populations, the relationship between psychopathy and violence among patients with schizophrenia has not been thoroughly explored. Patients with and without a history of persistent violent behavior were compared for comorbidity of psychopathy and schizophrenia or schizoaffective disorder. METHODS: Violent and nonviolent patients were identified through reviews of hospital charts and records of arrests and convictions. The Psychopathy Checklist: Screening Version was administered to 51 patients, 26 violent patients and 25 matched nonviolent patients. Analysis of variance was used as the principal statistical method for comparing violent and nonviolent groups. RESULTS: Mean psychopathy scores were higher for violent patients than nonviolent patients. Five of the violent patients (19 percent) had scores exceeding the cutoff for psychopathy, and 13 (50 percent) scored in the possible psychopathic range. All of the nonviolent patients scored below the cutoff for possible psychopathy. Higher psychopathy scores were associated with earlier age of onset of illness and more arrests for both violent and nonviolent offenses. CONCLUSIONS: The comorbidity of schizophrenia and psychopathy was found to be higher among violent patients than among nonviolent patients. Violent patients with schizophrenia who score high on measures of psychopathy may have a personality disorder that precedes the emergence of psychotic symptoms, or they may constitute a previously unclassified subtype of schizophrenia, characterized by early symptoms of conduct disorder symptoms and persistent violent behavior.     

Dissociation and social cognition in schizophrenia spectrum disorder

While there is emerging evidence that dissociation is linked with trauma history and possibly symptoms in schizophrenia, it remains unclear whether dissociation represents a symptom dimensions in its own right in schizophrenia and as such is uniquely related to other features of illness. To explore this issue the current study sought to find out whether dissociation was uniquely related to an index of social cognition closely linked to social functioning, namely affect recognition. We hypothesized that dissociation would be linked with affect recognition because symptoms of dissociation may uniquely disrupt processes which are expected to be needed for correctly recognizing emotions. The sample contained 49 participants diagnosed with a schizophrenia spectrum disorder who were in a non-acute phase of disorder. Participants were concurrently administered the Bell-Lysaker Emotion Recognition Task, the Dissociative Experiences Scale, the Post Traumatic Stress Disorder Checklist and the Positive and Negative Symptoms Scale. Stepwise linear regression analyses were performed in which dissociative symptoms were forced to enter after the other symptoms in order to predict deficits in affect recognition. These analyses revealed that greater levels of dissociative symptoms predicted poorer recognition of negative emotions over and above that of positive, negative, cognitive and PTSD symptoms. Results are consistent with the possibility that dissociation represents a unique dimension o f psychopathology in schizophrenia which may be linked to function.     

Accuracy and intensity of posed emotional expressions in unmedicated schizophrenia patients: vocal and facial channels

This study investigated the ability of schizophrenia patients to volitionally display various emotional expressions. Accuracy and intensity of facial and vocal emotional expression were rated in 26 unmedicated male schizophrenia patients and 20 non-patient male controls while posing emotional facial and vocal expressions. Results indicate that schizophrenia patients, compared to non-patient controls, had deficits in their ability to portray some, but not all, emotions. Accuracy and intensity of posed facial and vocal expressions were inversely correlated with negative symptoms in the patient group. We conclude that observable flattened affect in schizophrenia during posed expression is not evident across all emotions. Furthermore, substantial disruption in the ability to portray posed emotions may be largely driven by the presence of negative symptoms.     

Deficits in facial affect recognition in unaffected siblings of Xhosa schizophrenia patients: evidence for a neurocognitive endophenotype

The present study in an African Xhosa sample examined whether familial vulnerability to schizophrenia is associated with deficits in facial affect recognition. Healthy comparison subjects, unaffected siblings of schizophrenia patients, and schizophrenia patients were tested with a task requiring rapid recognition of matched positive (happy), negative (angry), and neutral facial expressions. Siblings and patients demonstrated impaired recognition of negative relative to positive facial expressions whereas comparison subjects recognized negative and positive expressions at an equal level of accuracy. These results suggest that deficits in the processing negative affect from social cues are transmitted in families and may represent a heritable endophenotype of schizophrenia.     

The relationship between affect expression and affect recognition in schizophrenia.

To examine the relationship between affect expression and affect recognition, we assessed 30 clinically stable, medicated schizophrenic inpatients. Affect expression was assessed using both a standard clinical rating scale (SANS) and a computerized acoustic voice analysis (VOXCOM). Affect recognition was assessed using the Florida Affect Battery (FAB). The schizophrenics' performance on the FAB was impaired, indicating broad deficits in affect recognition (p<0.05). There were no significant correlations between measures of affect expression and affect recognition, suggesting that the expressive impairment in schizophrenia is not related to their ability to discern emotions in others. SANS Inappropriate Affect, however, was negatively correlated with facial affect recognition (p = 0.001), suggesting that raters' impression of inappropriate affect may indicate a failure in the process of affect attunement.     

Emotion recognition in Chinese people with schizophrenia

This study examined whether people with paranoid or nonparanoid schizophrenia would show emotion-recognition deficits, both facial and prosodic. Furthermore, this study examined the neuropsychological predictors of emotion-recognition ability in people with schizophrenia. Participants comprised 86 people, of whom: 43 were people diagnosed with schizophrenia and 43 were controls. The 43 clinical participants were placed in either the paranoid group (n=19) or the nonparanoid group (n=24). Each participant was administered the Facial Emotion Recognition task and the Prosodic Recognition task, together with other neuropsychological measures of attention and visual perception. People suffering from nonparanoid schizophrenia were found to have deficits in both facial and prosodic emotion recognition, after correction for the differences in the intelligence and depression scores between the two groups. Furthermore, spatial perception was observed to be the best predictor of facial emotion identification in individuals with nonparanoid schizophrenia, whereas attentional processing control predicted both prosodic emotion identification and discrimination in nonparanoid schizophrenia patients. Our findings suggest that patients with schizophrenia in remission may still suffer from impairment of certain aspects of emotion recognition.     

The Change in Facial Emotion Recognition Ability in Inpatients with Treatment Resistant Schizophrenia After Electroconvulsive Therapy

People with schizophrenia have impairments in emotion recognition along with other social cognitive deficits. In the current study, we aimed to investigate the immediate benefits of ECT on facial emotion recognition ability. Thirty-two treatment resistant patients with schizophrenia who have been indicated for ECT enrolled in the study. Facial emotion stimuli were a set of 56 photographs that depicted seven basic emotions: sadness, anger, happiness, disgust, surprise, fear, and neutral faces. The average age of the participants was 33.4 ± 10.5 years. The rate of recognizing the disgusted facial expression increased significantly after ECT (p < 0.05) and no significant changes were found in the rest of the facial expressions (p > 0.05). After the ECT, the time period of responding to the fear and happy facial expressions were significantly shorter (p < 0.05). Facial emotion recognition ability is an important social cognitive skill for social harmony, proper relation and living independently. At least, the ECT sessions do not seem to affect facial emotion recognition ability negatively and seem to improve identifying disgusted facial emotion which is related with dopamine enriched regions in brain.     

The childhood-onset neuropsychiatric background to adulthood psychopathic traits and personality disorders

Childhood conduct disorder (CD) and adult psychopathic traits according to the Psychopathy Checklist Revised (PCL-R) were the closest psychiatric covariates to repeated violent crimes and aggression among offenders under forensic psychiatric investigation in Sweden. As psychopathy is not included in the present psychiatric diagnostic systems, we compared total and factor PCL-R scores to Axis I disorders, including childhood-onset neuropsychiatric disorders, and to Axis II personality disorders, to establish the convergence of psychopathic traits with other psychiatric diagnoses, and to identify possible unique features. Psychopathic traits were positively correlated with bipolar mood disorder and negatively with unipolar depression. The total PCL-R scores as well as the Factor 2 (unemotionality) and Factor 3 (behavioral dyscontrol) scores were significantly correlated with attention-deficit/hyperactivity disorder, Asperger's syndrome/high-functioning autistic traits, CD, substance abuse, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Cluster B personality disorders. The interpersonal Factor 1 showed none of these correlations and may capture features that are specific to psychopathy, distinguishing core psychopathy from other diagnostic definitions.     

Differential impairments of facial affect recognition in schizophrenia subtypes and major depression

The goal of this study was to assess facial affect recognition abilities in subjects with various schizophrenia subtypes and subjects with major depression. A total of six disorganized, 21 paranoid and 18 residual subjects with schizophrenia (DSM-IV criteria) were compared with 21 subjects with major depression (DSM-IV criteria) and 30 matched healthy control subjects. Two experimental tasks requiring the sorting and rating of emotional facial expressions were applied. Disorganized and paranoid subjects showed strong impairments in the sorting of emotional facial expressions. Depressive subjects displayed only minor deficits, and residual subjects were unimpaired. Subjects with disorganized schizophrenia rated emotional facial expressions as more aroused, and depressive subjects rated them as less aroused, than the other study groups. Our study demonstrates strong deficits in facial affect recognition in subjects with schizophrenia and pronounced disorganized or psychotic symptoms. Deficits in facial affect recognition are specific to schizophrenia. They may be considered as a state marker of schizophrenia.     

Psychopathic traits are associated with cortical and subcortical volume alterations in healthy individuals

Research suggests psychopathy is associated with structural brain alterations that may contribute to the affective and interpersonal deficits frequently observed in individuals with high psychopathic traits. However, the regional alterations related to different components of psychopathy are still unclear. We used voxel-based morphometry to characterize the structural correlates of psychopathy in a sample of 35 healthy adults assessed with the Triarchic Psychopathy Measure. Furthermore, we examined the regional grey matter alterations associated with the components described by the triarchic model. Our results showed that, after accounting for variation in total intracranial volume, age and IQ, overall psychopathy was negatively associated with grey matter volume in the left putamen and amygdala. Additional regression analysis with anatomical regions of interests revealed total triPM score was also associated with increased lateral orbitofrontal cortex (OFC) and caudate volume. Boldness was positively associated with volume in the right insula. Meanness was positively associated with lateral OFC and striatum volume, and negatively associated with amygdala volume. Finally, disinhibition was negatively associated with amygdala volume. Results highlight the contribution of both subcortical and cortical brain alterations for subclinical psychopathy and are discussed in light of prior research and theoretical accounts about the neurobiological bases of psychopathic traits.     

Categorization and evaluation of emotional faces in psychopathic women

Psychopathic individuals have been shown to respond less strongly than normal controls to emotional stimuli. Data about their ability to judge emotional facial expressions are inconsistent and limited to males. To measure categorical and dimensional evaluations of emotional facial expressions in psychopathic and non-psychopathic women, 13 female psychopathic forensic inpatients, 15 female non-psychopathic forensic inmates and 16 female healthy participants were tested in an emotion-categorizing task. Emotional facial expressions were presented briefly (33 ms) or until buttonpress. Participants were to classify emotional expressions, and to rate their valence and arousal. Group differences in categorization were observed at both presentation times. Psychopathic patients performed worst with briefly presented sad expressions. Moreover, their dimensional evaluation resulted in less positive ratings for happy expressions and less arousal for angry expressions compared with the responses of non-psychopathic and normal subjects. Results shed light on the mechanism possibly underlying the emotional deficits in psychopathic women.     

Facial affect recognition in the course of schizophrenia

Deficits in facial affect recognition have been shown repeatedly in schizophrenia. However, the stability of this deficit over time remains to be clarified. A total of 36 remitted, 32 acutely ill schizophrenic patients and 21 healthy volunteers participated in a cross-sectional and longitudinal study. All subjects were assessed twice within 4 weeks (acute schizophrenics and normal controls), or 12 weeks, respectively (remitted schizophrenics). Subjects had to identify six basic emotions from corresponding facial expressions shown as photographs on a video screen. Both acute and remitted schizophrenics demonstrated a stable deficit over time in facial affect recognition unrelated to psychopathology and medication. This suggests that deficits in facial affect recognition in schizophrenia reflect a trait-like, rather than a state-dependent, characteristic.     

Facial emotion recognition in patients with schizophrenia and their siblings

Background: Deficits in recognition of facial emotions have been widely reported in patients with schizophrenia. Previous studies that examined recognition of facial emotions in relatives of patients with schizophrenia brought out inconsistent results. Aims: In this study, we aimed to examine facial emotion identification and discrimination abilities in patients with schizophrenia and their healthy siblings to find out whether familial vulnerability to schizophrenia is associated with deficits in facial emotion recognition. Methods: Patients with schizophrenia (n=57), their unaffected biological siblings (n=58) and healthy controls (n=58) were included in the study. The three groups did not differ significantly for gender, age and education level. All the participants were evaluated with the Facial Emotion Identification Test (FEIT) and Facial Emotion Discrimination Test (FEDT). Results: Patients with schizophrenia performed significantly worse than controls on FEIT and FEDT. Siblings performed significantly better than patients and significantly worse than controls on FEIT and FEDT. Conclusions: Impaired performance of siblings on facial emotion identification and discrimination tasks provides evidence for the hypothesis that facial emotion recognition deficits are transmitted in families and may represent a heritable endophenotype of schizophrenia.