Facial expression in male and female schizophrenia patients

This study investigated gender differences in facial expression as a reaction to various emotional stimuli in two groups of schizophrenia patients. The first group consisted of hospitalized patients (22 men and 13 women) who were tested at three points in time. The second group consisted of outpatients (21 men, 8 women) who were tested at two points in time. In addition, the facial behaviour of two control groups was investigated (17 men and 12 women; 18 men and 14 women, respectively). Facial activity was videotaped, whilst participants watched emotion-eliciting video clips and participated in an emotion-inducing interview, and measured using the Facial Action Coding System. In agreement with our expectations, schizophrenia patients showed significantly less facial activity overall than healthy control participants. Contrary to expectations, however, female patients did not display more facial activity compared to male schizophrenia patients. This finding contrasts with those of healthy participants in previous studies where women tended to show more facial activity than men. It was further expected that in non-psychotic patients (i.e. outpatients), gender differences would be more clearly apparent and female schizophrenia patients would show considerably more facial activity than male patients, with findings more or less comparable to the gender differences found in healthy controls. However, no significant interaction was found between patient group (in- vs. outpatients) and gender. The different explanations for these findings are considered in this study.     

Expressed emotion and airway conductance in children with bronchial asthma

Fourteen asthmatic children (ages 9–11) and their controls were exposed to a stress inducing competitive achievement situation. Facial expression of emotions were systematically analyzed from video-recordings, and peak expiratory flow rate (PEFR) reduction was measured from pre-stress to post-stress. The asthmatic children showed a significantly lower frequency and duration of overall emotional expression than their controls. Specifically, the frequency and duration of expressed anger/rage, enjoyment/joy, and surprise/startle were lower in the asthmatic children. Moreover, duration of overall expressed emotion showed a significant negative correlation with PEFR reduction in the asthmatic group, indicating a relevant relationship between facial expression of emotions and breathing function.     

Expression of emotion in asthmatic children and their mothers

The present study assessed how general asthmatic children's deficit in the facial expression of emotion is that we found in previous studies. Furthermore, the emotional behavior of the patients' mothers was explored. Eighteen children with bronchial asthma (ages 7.6 to 12.6), and eighteen control children were subjected to two frustrating achievement situations. They had to solve a difficult puzzle under time pressure by themselves, and with the verbal assistance of their healthy mothers. Facial expressions of emotion and heart rate were recorded from children and mothers. No deficit in emotion expression was observed in the asthmatic group. To the contrary, asthmatic children showed more expressions of anger/aggression and emotion expressions in total during the last phase of the 'child alone' condition. Moreover, in both experimental conditions they showed more unspecified facial movements than control children. Mothers of asthmatic children expressed more happiness than their controls. Heart rate data did not differentiate between target and control groups during any phase of the experiment. These findings counter psychodynamically based assumptions on emotional behavior of asthmatics and their mothers.     

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders

OBJECTIVE: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. METHOD: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures--the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory--were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. RESULTS: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p < .05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p < .05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p < .05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r = 0.49, p < .001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r = 0.51, p < .001; anxiety disorder: r = 0.57, p < .001). CONCLUSION: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.     

fMRI during affect discrimination in bipolar affective disorder

Objective: It has been hypothesized that disturbances in affect may represent distinct etiologic factors for bipolar affective disorder. The neural mechanisms mediating affective processes and their relationship to brain development and the pathophysiology of bipolar affective disorder remain to be clarified. Recent advances in neuroimaging techniques have made possible the non-invasive examination of specific brain regions during cortical challenge paradigms. This study reports findings based on fMRI data acquired during fearful and happy affect recognition paradigms in patients with bipolar affective disorder and in healthy adult subjects.

Methods: Prior to the scan, subjects were instructed to view the stimuli and to identify the type of facial expression presented. Echo planar scanning was performed on a 1.5 Tesla scanner which had been retrofitted with a whole body echo planar coil, using a head coil.

Results: The data indicate that in adult subjects with bipolar affective disorder, there is a reduction in dorsolateral prefrontal cortex activation and an increase in amygdalar activation in response to fearful facial affect. In a healthy comparison group, signal intensity changes were not found in these regions. In addition, although the patients with bipolar affective disorder completed the task demands, they demonstrated an impaired ability to correctly identify fearful facial affect but not the happy facial affect displayed.

Conclusion: These findings are consistent with the hypothesis that in some patients with bipolar affective disorder, there may be a reduction of frontal cortical function which may be associated with affective as well as attentional processing deficits.     

Impaired recognition of facial expressions of anger in Parkinson's disease patients acutely withdrawn from dopamine replacement therapy

We have previously reported that acute dopaminergic blockade in healthy volunteers results in a transient disruption of the recognition of facial expressions of anger, whilst leaving intact the recognition of other facial expressions (including fear and disgust) and facial identity processing. Parkinson's disease (PD) is characterised by cell loss in dopaminergic neuronal populations, and hence we predicted that PD would be associated with impaired anger recognition. We reasoned that treatment with dopamine replacement therapy (DRT) could mask any deficit present in PD, and therefore studied facial expression recognition in a group of PD patients transiently withdrawn from DRT. Seventeen PD patients were compared to 21 age- and IQ-matched controls on the Ekman 60 task, which required the forced-choice labelling of 10 exemplars of each of six facial expressions (anger, disgust, fear, sadness, happiness, surprise). In line with our predictions, PD patients showed a selective impairment in the recognition of facial expressions of anger. This deficit was not related to the PD patients' performance on the Benton unfamiliar-face matching task, which was normal, nor was the deficit related to overall disease severity, or to depression symptoms. However, as predicted by simulation theories, impaired anger recognition in PD was related to reduced levels of the anger-linked temperament trait, exploratory excitability. The results extend our previous findings of a role for dopamine in the processing of facial expressions of anger, and demonstrate the power of adopting a phylogenetic, comparative perspective on emotions.     

Humor and Laughter in Patients with Cerebellar Degeneration

Humor is a complex behavior which includes cognitive, affective and motor responses. Based on observations of affective changes in patients with cerebellar lesions, the cerebellum may support cerebral and brainstem areas involved in understanding and appreciation of humorous stimuli and expression of laughter. The aim of the present study was to examine if humor appreciation, perception of humorous stimuli, and the succeeding facial reaction differ between patients with cerebellar degeneration and healthy controls. Twenty-three adults with pure cerebellar degeneration were compared with 23 age-, gender-, and education-matched healthy control subjects. No significant difference in humor appreciation and perception of humorous stimuli could be found between groups using the 3 Witz-Dimensionen Test, a validated test asking for funniness and aversiveness of jokes and cartoons. Furthermore, while observing jokes, humorous cartoons, and video sketches, facial expressions of subjects were videotaped and afterwards analysed using the Facial Action Coding System. Using depression as a covariate, the number, and to a lesser degree, the duration of facial expressions during laughter were reduced in cerebellar patients compared to healthy controls. In sum, appreciation of humor appears to be largely preserved in patients with chronic cerebellar degeneration. Cerebellar circuits may contribute to the expression of laughter. Findings add to the literature that non-motor disorders in patients with chronic cerebellar disease are generally mild, but do not exclude that more marked disorders may show up in acute cerebellar disease and/or in more specific tests of humor appreciation.     

Are there differential deficits in facial emotion recognition between paranoid and non-paranoid schizophrenia? A signal detection analysis

This study assessed facial emotion recognition abilities in subjects with paranoid and non-paranoid schizophrenia (NPS) using signal detection theory. We explore the differential deficits in facial emotion recognition in 44 paranoid patients with schizophrenia (PS) and 30 non-paranoid patients with schizophrenia (NPS), compared to 80 healthy controls. We used morphed faces with different intensities of emotion and computed the sensitivity index (d′) of each emotion. The results showed that performance differed between the schizophrenia and healthy controls groups in the recognition of both negative and positive affects. The PS group performed worse than the healthy controls group but better than the NPS group in overall performance. Performance differed between the NPS and healthy controls groups in the recognition of all basic emotions and neutral faces; between the PS and healthy controls groups in the recognition of angry faces; and between the PS and NPS groups in the recognition of happiness, anger, sadness, disgust, and neutral affects. The facial emotion recognition impairment in schizophrenia may reflect a generalized deficit rather than a negative-emotion specific deficit. The PS group performed worse than the control group, but better than the NPS group in facial expression recognition, with differential deficits between PS and NPS patients.     

Impaired decision making in suicide attempters

OBJECTIVE: The understanding of suicidal behavior is incomplete. The stress-diathesis model suggests that a deficit in serotonergic projections to the orbitofrontal cortex is involved in susceptibility to suicidal behavior. The orbitofrontal cortex has been implicated in decision making, a cognitive function dealing with complex choices that may be under serotonergic modulation. In this preliminary study, the authors assessed decision making in suicide attempters. METHOD: The authors used the Iowa Gambling Task to investigate patients with a history of violent (N=32) or nonviolent (N=37) suicidal behavior, patients suffering from affective disorders with no history of suicidal behavior (N=25), and healthy comparison subjects (N=82). Patients were assessed when they were not suffering from a current axis I disorder. The authors also assessed the correlation of Iowa Gambling Task performance with psychometric measures of impulsivity, hostility, anger, aggression, and emotional instability. RESULTS: Both groups of suicide attempters scored significantly lower than healthy comparison subjects, and violent suicide attempters performed significantly worse than affective comparison subjects. No significant differences were observed between the groups of suicide attempters or between the two comparison groups. The differences in performance could not be accounted for by age, intellectual ability, educational level, number of suicide attempts, age at first suicide attempt, history of axis I disorder, or medication use. Iowa Gambling Task performances were correlated positively with affective lability and with anger expression but not with impulsivity. CONCLUSIONS: Impaired decision making, possibly due to emotional dysfunction, may be a neuropsychological risk factor for suicidal behavior.     

Identifying differences in biased affective information processing in major depression

This study investigates the extent to which participants with major depression differ from healthy comparison participants in the irregularities in affective information processing, characterized by deficits in facial expression recognition, intensity categorization, and reaction time to identifying emotionally salient and neutral information. Data on diagnoses, symptom severity, and affective information processing using a facial recognition task were collected from 66 participants, male and female between ages 18 and 54 years, grouped by major depressive disorder (N = 37) or healthy non-psychiatric (N = 29) status. Findings from MANCOVAs revealed that major depression was associated with a significantly longer reaction time to sad facial expressions compared with healthy status. Also, depressed participants demonstrated a negative bias towards interpreting neutral facial expressions as sad significantly more often than healthy participants. In turn, healthy participants interpreted neutral faces as happy significantly more often than depressed participants. No group differences were observed for facial expression recognition and intensity categorization. The observed effects suggest that depression has significant effects on the perception of the intensity of negative affective stimuli, delayed speed of processing sad affective information, and biases towards interpreting neutral faces as sad.     

Dyadic facial affective indicators of severity of symptomatic burden in patients with panic disorder

BACKGROUND: Based on the results of research on facial affective behaviour in different psychological disorders, as well as on available findings on the specific behaviour of patients with panic disorder in interaction with their therapists, hypotheses about dyadic facial affective behaviour and its correlation with symptomatic burden of female panic patients are formulated. SAMPLING AND METHODS: The facial affective behaviour of 20 patients with panic disorder and their therapists, coded with the Emotional Facial Action Coding System, in the first treatment session is analyzed regarding interactive enmeshment, and for a subgroup of 15 dyads these data are correlated with those on symptomatic burden before treatment. RESULTS: A high degree of interactive enmeshment between patient and therapist correlates positively with the severity of symptomatic burden. All dyadic enmeshment indicators show highly significant positive correlations with body-related symptoms, but not with more general variables like global severity index of the SCL-90R or general anxiety (State Trait Anxiety Inventory). CONCLUSIONS: These results are discussed against the background of specific psychodynamics of panic patients and show that, on the one hand, therapists practise an interactive abstinence, but on the other hand, they tend to be pulled into a specific interactive enmeshment by patients with greater symptomatic burden. Limitations of the study arise from the small sample and the lack of a comparison group, therefore the question if the results are disorder specific or more general cannot be answered.     

Affective priming in schizophrenia with and without affective negative symptoms

Abstract. In the present study automatic perceptual sensitivity to facial affect information was examined in chronic schizophrenic patients. An affective priming task including subliminal and supraliminal presentations of sad and happy facial affect was administered to schizophrenia patients with a flat affect expression (n = 30), schizophrenia patients suffering from anhedonia (n = 30), schizophrenia patients not suffering from anhedonia or flat affect (n = 28), and a group of healthy controls (n = 30). Subjects had to judge valence of neutral Chinese ideographs. Anhedonic and flat affect patients but not patients without affect symptoms were found to be sensitive to negative facial affect on an automatic processing level. None of the schizophrenic patient groups but healthy controls showed a subliminal valence-congruent priming effect based on positive facial affect. Anhedonia as assessed by standardised psychiatric rating was related to a subliminal sensitivity to negative facial expression and a valence-inverted perception of positive facial expression. This pattern of results is largely consistent with predictions derived from Meehls model of anhedonia. The aversive automatic perception of positive facial expression primarily found in anhedonic patients but also in schizophrenic control patients could lie in structural disturbances concerning the regulation of intimacy and distance.     

Anger expression and suppression among patients with essential hypertension

Abstract

Objective. Hypertension (HTN) is among the seven psychosomatic diseases for which mental etiologies were proposed in 1950s. The objective of this study was to evaluate the rate of anger suppression and expression in individuals with hypertension referred to the heart clinic of “Fatemeh Zahra” Hospital, Sari, Iran. Methods. 200 patients with primary hypertension were categorized as the case group. One hundred healthy individuals older than 30 years without previous history of arterial hypertension and severe mental disorders were considered as the control group. Both groups were matched in terms of age, gender and level of education. The Spielberger questionnaire was used to assess the trait anger, anger in and anger out. The data were analyzed using SPSS software with statistical tests such as t-test, chi-square and regression. Results. The trait anger and anger suppression in patients with hypertension were significantly higher than the control group (P < 0.001); however, anger out was not significantly different between the two groups (P = 0.984). Conclusion. Considering the fact that trait anger and anger suppression is more prevalent among people with hypertension than healthy individuals, it seems suitable to provide education concerning anger management and emotional expression for these patients with regard to the anger issue which is a psychosomatic aspect of the disease.     

Time course of facial emotion processing in women with borderline personality disorder: an ERP study

BackgroundBorderline personality disorder (BPD) is characterized by a negative perception of others. Previous studies have revealed deficits and biases in facial emotion recognition. This study investigates the behavioural and electrophysiological correlates underlying facial emotion processing in individuals with BPD.MethodsThe present study was conducted between July 2012 and May 2014. In an emotion classification task, unmedicated female patients with BPD as well as healthy women had to classify faces displaying blends of anger and happiness while the electroencephalogram was recorded. We analyzed visual event-related potentials (ERPs) reflecting early (P100), structural (N170) and categorical (P300) facial processing in addition to behavioural responses.ResultsWe included 36 women with BPD and 29 controls in our analysis. Patients with BPD were more likely than controls to classify predominantly happy faces as angry. Independent of facial emotion, women with BPD showed enhanced early occipital P100 amplitudes. Additionally, temporo-occipital N170 amplitudes were reduced at right hemispherical electrode sites. Centroparietal P300 amplitudes were reduced particularly for predominantly happy faces and increased for highly angry faces in women with BPD, whereas in healthy volunteers this component was modulated by both angry and happy facial affect.LimitationsOur sample included only women, and no clinical control group was investigated.ConclusionOur findings suggest reduced thresholds for facial anger and deficits in the discrimination of facial happiness in individuals with BPD. This biased perception is associated with alterations in very early visual as well as deficient structural and categorical processing of faces. The current data could help to explain the negative perception of others that may be related to the patients’ impairments in interpersonal functioning.     

Impaired emotional facial expression recognition in alcoholics: are these deficits specific to emotional cues?

Previous studies have repeatedly linked alcoholism is to impairment in emotional facial expression decoding. The present study aimed at extending previous findings while controlling for exposure times of stimuli. Further, a control task was added on the decoding of non-emotional facial features. Twenty-five alcoholic participants were compared to 26 control participants matched for age, sex and educational level. Participants performed two computer tasks consisting of presentation of photographs of faces for either 250 or 1000 ms. The first task required "yes" or "no" responses as rapidly as possible to questions regarding non-emotional features of the face (gender, age range and cultural identity). The second task involved a different set of photographs implicating emotional facial expression decoding, with the same exposure times. Again, rapid "yes" or "no" responses to trials combining 32 emotional facial expressions by eight emotional labels (happiness, sadness, fear, anger, disgust, surprise, shame, and contempt) were required from participants. Reaction times were recorded for both tasks. Alcoholic and control participants showed similar results in both tasks in terms of response accuracy. Yet, in the emotional facial expression task, alcoholic participants' responses matched more negative emotional labels, especially sadness. Further, alcoholics were slower than control participants specifically to answer emotional questions on emotional facial expression. No differences appeared on reaction times in the control task. Contrary to expectations, no interaction of stimulus time exposure and group was observed. Overall, these findings replicate and extend previous results on emotional facial expression decoding ability: Alcoholics are specifically impaired on emotional non-verbal behavior information processing: They are slower to correctly identify an emotion.     

Fusiform gyrus volume reduction in first-episode schizophrenia: a magnetic resonance imaging study

BACKGROUND: The fusiform gyrus (occipitotemporal gyrus) is thought to be critical for face recognition and may possibly be associated with impaired facial recognition and interpretation of facial expression in schizophrenia. of postmortem studies have suggested that fusiform gyrus volume is reduced in schizophrenia, but there have been no in vivo structural studies of the fusiform gyrus in schizophrenia using magnetic resonance imaging. METHODS: High-spatial resolution magnetic resonance images were used to measure the gray matter volume of the fusiform gyrus in 22 patients with first-episode schizophrenia (first hospitalization), 20 with first-episode affective psychosis (mainly manic), and 24 control subjects. RESULTS: Patients with first-episode schizophrenia had overall smaller relative volumes (absolute volume/intracranial contents) of fusiform gyrus gray matter compared with controls (9%) and patients with affective psychosis (7%). For the left fusiform gyrus, patients with schizophrenia showed an 11% reduction compared with controls and patients with affective psychosis. Right fusiform gyrus volume differed in patients with schizophrenia only compared with controls (8%). CONCLUSION: Schizophrenia is associated with a bilateral reduction in fusiform gyrus gray matter volume that is evident at the time of first hospitalization and is different from the presentation of affective psychosis.     

Understanding deficits in empathy after traumatic brain injury: The role of affective responsivity

People with traumatic brain injury (TBI) often find social situations challenging because they can no longer respond to the emotional state of the people they are with. Many also lack emotional empathy in their social interactions. But are these problems related? The present study addressed this question by examining psychophysiological indices of emotional responding, including facial electromyography (EMG) and skin conductance during exposure to happy and angry facial expressions, in addition to self-rated emotional empathy in 21 adults with severe TBI and 22 control participants. In comparison to control participants, those in the TBI group displayed a reduction in the ability to empathize emotionally, and showed reduced physiological responding to the emotional expression of anger. By contrast, the control group spontaneously mimicked the emotional expressions they were exposed to, regardless of affective valence, and also demonstrated higher skin conductance responsivity to angry faces. The data further suggested that a loss of emotional empathy plays a role in the emotional response deficits to angry facial expressions following TBI. The results have implications for understanding the impaired social functioning and poor quality of interpersonal relationships commonly seen as a consequence of TBI.