Getting the cue: sensory contributions to auditory emotion recognition impairments in schizophrenia

Individuals with schizophrenia show reliable deficits in the ability to recognize emotions from vocal expressions. Here, we examined emotion recognition ability in 23 schizophrenia patients relative to 17 healthy controls using a stimulus battery with well-characterized acoustic features. We further evaluated performance deficits relative to ancillary assessments of underlying pitch perception abilities. As predicted, patients showed reduced emotion recognition ability across a range of emotions, which correlated with impaired basic tone matching abilities. Emotion identification deficits were strongly related to pitch-based acoustic cues such as mean and variability of fundamental frequency. Whereas healthy subjects' performance varied as a function of the relative presence or absence of these cues, with higher cue levels leading to enhanced performance, schizophrenia patients showed significantly less variation in performance as a function of cue level. In contrast to pitch-based cues, both groups showed equivalent variation in performance as a function of intensity-based cues. Finally, patients were less able than controls to differentiate between expressions with high and low emotion intensity, and this deficit was also correlated with impaired tone matching ability. Both emotion identification and intensity rating deficits were unrelated to valence of intended emotions. Deficits in both auditory emotion identification and more basic perceptual abilities correlated with impaired functional outcome. Overall, these findings support the concept that auditory emotion identification deficits in schizophrenia reflect, at least in part, a relative inability to process critical acoustic characteristics of prosodic stimuli and that such deficits contribute to poor global outcome.     

精神分裂症患者面部表情认知与执行功能的相关性研究

目的:探讨精神分裂症患者面部表情认知功能和执行功能障碍的关系.方法:采用中国人面部情绪测验(CFET)和威斯康星卡片分类测验(WCST)对56例未用药精神分裂症患者进行评估,与49名正常健康者进行比较.结果:患者组CFET的总分及6种基本情绪认知评分均显著低于对照组(P＜0.01).患者组WCST显著较对照组为差.控制阳性症状量表(SAPS)和阴性症状量表(SANS)总分的偏相关分析显示.患者组CFET的惊正确分与WCST的总应答数呈正相关(r=-0.31,P＜0.05),悲正确分与CFET的错误应答数(r=-0.37,P＜0.01)、选择错误率(r=-0.38,P＜0.01)、持续性应答数(r=-0.34,P＜0.05)、持续性错误数(r=-0.48,P＜0.01)和持续性错误率(r=-0.40,P＜0.01)呈负相关,而与完成分类数(r=0.25,P＜0.05)呈正相关.结论:精神分裂症患者存在广泛的面部表情认知缺陷和执行功能障碍,患者面部表情认知功能与执行功能有相关性.     

The effects of childhood trauma in patients with first-episode schizophrenia

OBJECTIVE: To evaluate the impact of childhood trauma on psychopathology in 57 patients with first-episode schizophrenia. METHOD: Psychopathology was assessed by Brief Psychiatric Research Scale (BPRS), Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS) at first admission. Childhood trauma was assessed by Childhood Abuse Questionnaire and Childhood Trauma Questionnaire (CTQ) after discharge. RESULTS: Frequencies of childhood sexual abuse (CSA), emotional abuse (CEA) and physical abuse (CPA) were reported by 29.8%, 40.9% and 13.6% of the patients respectively. Histories of childhood emotional neglect (CEN) and physical neglect were found in 29.5% and 20.5% of the patients respectively. The patients reporting CSA had higher SAPS scores at admission, and had more suicide attempts before admission. The patients with history of CEA had more hallucinations and delusions of mind reading at admission. CPA, CEA and mean scores of CTQ correlated with the number of siblings. CONCLUSION: Our findings suggest that childhood trauma may alter the presentation of schizophrenia in first admission.     

Changes in social emotion recognition following traumatic frontal lobe injury

Changes in social and emotional behaviour have been consistently observed in patients with traumatic brain injury. These changes are associated with emotion recognition deficits which represent one of the major barriers to a successful familiar and social reintegration. In the present study, 32 patients with traumatic brain injury, involving the frontal lobe, and 41 ageand education-matched healthy controls were analyzed. A Go/No-Go task was designed, where each participant had to recognize faces representing three social emotions (arrogance, guilt and jealousy). Results suggested that ability to recognize two social emotions (arrogance and jealousy) was significantly reduced in patients with traumatic brain injury, indicating frontal lesion can reduce emotion recognition ability. In addition, the analysis of the results for hemispheric lesion location (right, left or bilateral) suggested the bilateral lesion sub-group showed a lower accuracy on all social emotions.     

Acquired self‐control of insula cortex modulates emotion recognition and brain network connectivity in schizophrenia

Real‐time functional magnetic resonance imaging (rtfMRI) is a novel technique that has allowed subjects to achieve self‐regulation of circumscribed brain regions. Despite its anticipated therapeutic benefits, there is no report on successful application of this technique in psychiatric populations. The objectives of the present study were to train schizophrenia patients to achieve volitional control of bilateral anterior insula cortex on multiple days, and to explore the effect of learned self‐regulation on face emotion recognition (an extensively studied deficit in schizophrenia) and on brain network connectivity. Nine patients with schizophrenia were trained to regulate the hemodynamic response in bilateral anterior insula with contingent rtfMRI neurofeedback, through a 2‐weeks training. At the end of the training stage, patients performed a face emotion recognition task to explore behavioral effects of learned self‐regulation. A learning effect in self‐regulation was found for bilateral anterior insula, which persisted through the training. Following successful self‐regulation, patients recognized disgust faces more accurately and happy faces less accurately. Improvements in disgust recognition were correlated with levels of self‐activation of right insula. RtfMRI training led to an increase in the number of the incoming and outgoing effective connections of the anterior insula. This study shows for the first time that patients with schizophrenia can learn volitional brain regulation by rtfMRI feedback training leading to changes in the perception of emotions and modulations of the brain network connectivity. These findings open the door for further studies of rtfMRI in severely ill psychiatric populations, and possible therapeutic applications. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.     

Flat affect in schizophrenia: relation to emotion processing and neurocognitive measures

Impaired emotional functioning in schizophrenia is a prominent clinical feature that manifests primarily as flat affect. Studies have examined the perception, experience, and expression of emotions in schizophrenia and reported normal ratings of experience but impaired affect identification. However, the relation between flat affect and performance on facial affect identification and cognitive tasks has not been systematically examined in relation to premorbid adjustment and clinical outcome. We report a prospective study of 63 patients with at least moderate severity of flat affect and 99 patients without flat affect, who were compared on functional domains, emotion processing tasks, and neurocognitive measures. Flat affect was more common in men and was associated with poorer premorbid adjustment, worse current quality of life, and worse outcome at 1-year follow-up. Patients overall performed more poorly on emotion processing tasks, one that required identification of happy and sad emotions and one that required differentiating among intensities within these emotions. They responded inaccurately yet faster than controls for the intensity differentiation task, suggesting a decomposition of the normal relation between accuracy and speed. Flat affect ratings, compared with other negative symptoms, uniquely predicted performance on emotion processing tasks. Patients with flat affect showed greater impairment in both emotion processing tasks, with the most pronounced impairment for the intensity differentiation task. However, the 2 patient groups did not differ in the neurocognitive profile except for verbal memory. We conclude that flat affect is an important clinical feature of schizophrenia that exacerbates the course of illness.     

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.     

Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications

OBJECTIVE: To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications. METHOD: Relevant studies and previous review papers were identified via computer literature searches. RESULTS: Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large-scale general population studies indicate the relationship is a causal one, with a dose-effect. CONCLUSION: Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified.     

Impairments of social cues recognition and social functioning in Chinese people with schizophrenia

Previous studies have suggested that social cognition deficits, and impaired social functioning, were associated with schizophrenia. However, specificity of the relationships between social cues recognition and social functioning remain largely undefined. The authors speculated that the two were related, and further that recognition of verbal and non-verbal social cues were impaired in people with schizophrenia. A total of 71 people (40 schizophrenia patients and 31 matched normal controls) voluntarily participated in this study. Social cues recognition abilities were measured by the eye gaze discrimination task and the faux pas recognition task. Social functioning was assessed using the Social Functioning Scale. Correlation analysis revealed a significant association between faux pas and, in particular, the social functioning subscales of the Social Functioning Scale (independence and employment) in patients with schizophrenia. Furthermore, the authors also observed that clinical participants performed significantly worse in both the eye gaze discrimination and faux pas recognition tasks than their healthy counterparts. These findings suggested that impaired social cues recognition in people with schizophrenia may be a possible explanation for their impaired social functioning.     

Functional MRI of facial emotion recognition deficits in schizophrenia and their electrophysiological correlates

Empirical evidence suggests impaired facial emotion recognition in schizophrenia. However, the nature of this deficit is the subject of ongoing research. The current study tested the hypothesis that a generalized deficit at an early stage of face-specific processing (i.e. putatively subserved by the fusiform gyrus) accounts for impaired facial emotion recognition in schizophrenia as opposed to the Negative Emotion-specific Deficit Model, which suggests impaired facial information processing at subsequent stages. Event-related potentials (ERPs) were recorded from 11 schizophrenia patients and 15 matched controls while performing a gender discrimination and a facial emotion recognition task. Significant reduction of the face-specific vertex positive potential (VPP) at a peak latency of 165 ms was confirmed in schizophrenia subjects whereas their early visual processing, as indexed by P1, was found to be intact. Attenuated VPP was found to correlate with subsequent P3 amplitude reduction and to predict accuracy when performing a facial emotion discrimination task. A subset of ten schizophrenia patients and ten matched healthy control subjects also performed similar tasks in the magnetic resonance imaging scanner. Patients showed reduced blood oxygenation level-dependent (BOLD) activation in the fusiform, inferior frontal, middle temporal and middle occipital gyrus as well as in the amygdala. Correlation analyses revealed that VPP and the subsequent P 3a ERP components predict fusiform gyrus BOLD activation. These results suggest that problems in facial affect recognition in schizophrenia may represent flow-on effects of a generalized deficit in early visual processing.     

Childhood trauma in patients with epileptic vs nonepileptic seizures

Objective

Childhood trauma has been implicated as a risk factor for the etiology of psychogenic nonepileptic seizures (PNES). Relatively little attention has been paid to whether profiles of specific trauma types differ between patients with epilepsy and PNES. Investigating childhood trauma profiles in these patient groups may identify psychological vulnerabilities that predispose to developing PNES, and aid early diagnoses, prevention, and treatment.

Methods

Data were collected from two cohorts (n_{Retrospective} = 203; n_Prospective = 209) admitted to video–electroencephalography (EEG) monitoring units in Melbourne Australia. The differences in Childhood Trauma Questionnaire domain score between patient groups were investigated using standardized effect sizes and general linear mixed-effects models (GLMMs). Receiver-operating characteristic curves were used to investigate classification accuracy.

Results

In the retrospective cohort, patients diagnosed with PNES reported greater childhood emotional abuse, emotional neglect, physical abuse, sexual abuse, and physical neglect relative to patients with epilepsy. These differences were replicated in the prospective cohort, except for physical abuse. GLMMs revealed significant main effects for group in both cohorts, but no evidence for any group by domain interactions. Reported sexual abuse showed the best screening performance of PNES, although no psychometric scores were adequate as isolated measures.

Significance

Patients with PNES report a greater frequency of childhood trauma than patients with epilepsy. This effect appears to hold across all trauma types, with no strong evidence emerging for a particular trauma type that is more prevalent in PNES. From a practical perspective, inquiry regarding a history of sexual abuse shows the most promise as a screening measure.     

精神分裂症首次发病患者额顶网络功能连接与面孔情绪识别能力的关系

目的:探讨首发精神分裂症患者在静息状态下额顶网络的功能连接特点,及其与面孔情绪识别能力的相关性。方法:对37例首发未用药的精神分裂症患者(患者组)和30名年龄、性别、利手、受教育程度与患者相匹配的健康者(正常对照组)进行静息态功能磁共振(f MRI)扫描,收集两组的一般临床特征,并采用面孔情绪测试评价被试的面孔情绪认知功能;以双侧背外侧前额叶(DLPFC)为种子点比较两组间额顶网络功能连接的差异,并分析与面孔情绪认知功能的相关性。结果:与正常对照组相比,患者组DLPFC与左顶下小叶(t=-3.243,Alphasim校正P0.05)、左额下回(t=-3.151,Alphasim校正P0.05)、左额中回(t=-3.151,Alphasim校正P0.05)、双侧尾状核(t=-4.325,Alphasim校正P0.05)、左颞中回(t=-3.120,Alphasim校正P0.05)的功能连接减低;与双侧扣带回中部(t=2.731,Alphasim校正P0.05)、右中央前回(t=3.991,Alphasim校正P0.05)、右岛叶(t=3.991,Alphasim校正P0.05)功能连接增强。患者组额-顶通路的功能连接与面孔情绪认知障碍呈正相关(r=0.501,P0.05)。结论:首发精神分裂症患者额顶网络的功能连接存在异常,其中DLPFC-顶下小叶通路的功能连接降低可能影响患者面孔情绪识别能力。     

Childhood trauma in obsessive-compulsive disorder, trichotillomania, and controls

There is relatively little data on the link between childhood trauma and obsessive-compulsive/putative obsessive-compulsive spectrum disorders. The revised Childhood Trauma Questionnaire (CTQ), which assesses physical, emotional, and sexual abuse as well as physical and emotional neglect, was administered to female patients with obsessive-compulsive disorder (OCD; n = 74; age: 36.1 plus minus 16.3), TTM (n = 36; age: 31.8 plus minus 12.3), and a group of normal controls (n = 31; age: 21.5 plus minus 1.0). The findings showed a significantly greater severity of childhood trauma in general, and emotional neglect specifically, in the patient groups compared to the controls. Although various factors may play a role in the etiology of both OCD and trichotillomania (TTM), this study is consistent with some evidence from previous studies suggesting that childhood trauma may play a role in the development of these disorders.     

Effect of yoga therapy on facial emotion recognition deficits,symptoms and functioning in patients with schizophrenia

Behere RV, Arasappa R, Jagannathan A, Varambally S, Venkatasubramanian G, Thirthalli J, Subbakrishna DK, Nagendra HR, Gangadhar BN. Effect of yoga therapy on facial emotion recognition deficits, symptoms and functioning in patients with schizophrenia. Objective: Facial emotion recognition deficits have been consistently demonstrated in schizophrenia and can impair socio‐occupational functioning in these patients. Treatments to improve these deficits in antipsychotic‐stabilized patients have not been well studied. Yoga therapy has been described to improve functioning in various domains in schizophrenia; however, its effect on FERD is not known. Method: Antipsychotic‐stabilized patients randomized to receive Yoga (n = 27), Exercise (n = 17) or Waitlist group (n = 22) were assessed at baseline, 2nd month, and 4th month of follow‐up by raters blind to group status. Assessments included Positive and Negative Syndrome Scale (PANSS), Socio‐Occupational Functioning Scale (SOFS), and Tool for Recognition of Emotions in Neuropsychiatric DisorderS (TRENDS). Results: There was a significant positive correlation between baseline FERD and socio‐occupational functioning (r = 0.3, P = 0.01). Paired samples t test showed significant improvement in positive and negative symptoms, socio‐occupational functioning and performance on TRENDS (P < 0.05) in the Yoga group, but not in the other two groups. Maximum improvement occurred at the end of 2 months, and improvement in positive and negative symptoms persisted at the end of 4 months. Conclusion: Yoga therapy can be a useful add‐on treatment to improve psychopathology, FERD, and socio‐occupational functioning in antipsychotic‐stabilized patients with schizophrenia.