Facial emotion labeling deficits in children and adolescents at risk for bipolar disorder

OBJECTIVE: Research has revealed facial emotion labeling deficits in children and adolescents with bipolar disorder. To assess whether such impairments may be an endophenotype for bipolar disorder, the authors examined facial emotion identification proficiency in children who were at risk for bipolar disorder because they had a first-degree relative with the illness. METHOD: The facial expressions subtests of the Diagnostic Analysis of Nonverbal Accuracy scale were administered to 52 patients with bipolar disorder, 24 at-risk youths, and 78 control subjects, all 4-18 years of age. RESULTS: Compared with the control group, both the bipolar and at-risk groups made more errors identifying facial emotions. The number of errors did not differ significantly between the bipolar and at-risk groups. CONCLUSIONS: Deficits in facial emotion labeling may be a risk marker for bipolar disorder. Further study is needed to determine the neural mechanisms involved, as well as to explore other emotional processing impairments in youths at risk for bipolar disorder and to identify genetic associations.     

Increased Intrasubject Variability in Response Time in Youths With Bipolar Disorder and At-Risk Family Members

ObjectiveDeficits in sustained attention may represent an endophenotype for bipolar disorder (BD). One heritable measure of sustained attention is intrasubject variability in response time (ISV-RT). We tested the hypothesis that, compared with controls, both youths with BD and those at familial risk for the disorder would have increased ISV-RT.MethodSubjects were 28 patients with BD, 26 unaffected youths with a first-degree relative with BD, and 24 control youths without an affected relative, all aged 7 to 17 years. Subjects completed the Flanker Continuous Performance Test.ResultsBipolar disorder and at-risk youths had increased ISV-RT, compared with the controls. Differences were independent of comorbid psychopathology in youths with BD and present in psychiatrically healthy at-risk youths.ConclusionsIncreased ISV-RT may be a risk marker for BD. Further research is needed to investigate the neural and genetic underpinnings of this deficit, as well as the specificity of the finding to BD. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(6):628-635.     

Facial emotion recognition in euthymic patients with bipolar disorder and their unaffected first-degree relatives

BackgroundFacial emotion recognition (FER) is an important task associated with social cognition because facial expression is a significant source of non-verbal information that guides interpersonal relationships. Increasing evidence suggests that bipolar disorder (BD) patients present deficits in FER and these deficits may be present in individuals at high genetic risk for BD. The aim of this study was to evaluate the occurrence of FER deficits in euthymic BD patients, their first-degree relatives, and healthy controls (HC) and to consider if these deficits might be regarded as an endophenotype candidate for BD.MethodsWe studied 23 patients with DSM-IV BD type I, 22 first-degree relatives of these patients, and 27 HC. We used the Penn Emotion Recognition Tests to evaluate tasks of FER, emotion discrimination, and emotional acuity. Patients were recruited from outpatient facilities at the Institute of Psychiatry of the University of Sao Paulo Medical School, or from the community through media advertisements, had to be euthymic, with age above 18 years old and a diagnosis of DSM-IV BD type I.ResultsEuthymic BD patients presented significantly fewer correct responses for fear, and significantly increased time to response to recognize happy faces when compared with HC, but not when compared with first-degree relatives. First-degree relatives did not significantly differ from HC on any of the emotion recognition tasks.ConclusionOur results suggest that deficits in FER are present in euthymic patients, but not in subjects at high genetic risk for BD. Thus, we have not found evidence to consider FER as an endophenotype candidate for BD.     

Impaired fixation to eyes during facial emotion labelling in children with bipolar disorder or severe mood dysregulation

Background

Children with bipolar disorder (BD) or severe mood dysregulation (SMD) show behavioural and neural deficits during facial emotion processing. In those with other psychiatric disorders, such deficits have been associated with reduced attention to eye regions while looking at faces.

Methods

We examined gaze fixation patterns during a facial emotion labelling task among children with pediatric BD and SMD and among healthy controls. Participants viewed facial expressions with varying emotions (anger, fear, sadness, happiness, neutral) and emotional levels (60%, 80%, 100%) and labelled emotional expressions.

Results

Our study included 22 children with BD, 28 with SMD and 22 controls. Across all facial emotions, children with BD and SMD made more labelling errors than controls. Compared with controls, children with BD spent less time looking at eyes and made fewer eye fixations across emotional expressions. Gaze patterns in children with SMD tended to fall between those of children with BD and controls, although they did not differ significantly from either of these groups on most measures. Decreased fixations to eyes correlated with lower labelling accuracy in children with BD, but not in those with SMD or in controls.

Limitations

Most children with BD were medicated, which precluded our ability to evaluate medication effects on gaze patterns.

Conclusion

Facial emotion labelling deficits in children with BD are associated with impaired attention to eyes. Future research should examine whether impaired attention to eyes is associated with neural dysfunction. Eye gaze deficits in children with BD during facial emotion labelling may also have treatment implications. Finally, children with SMD exhibited decreased attention to eyes to a lesser extent than those with BD, and these equivocal findings are worthy of further study.     

Callous-Unemotional Traits Are Related to Combined Deficits in Recognizing Afraid Faces and Body Poses

ObjectivesThe aim of the present study was to examine accuracy in labeling body poses conveying fear. Youths with callous-unemotional traits experience emotional processing deficits seemingly on par with deficits showed by patients with amygdala damage. That is, there is growing evidence that children with callous-unemotional traits have problems recognizing afraid emotional expressions. Although people with amygdala damage show deficits in labeling afraid faces, they have an intact ability to label afraid body poses.MethodBoys (N = 55; ages 8-16 years) from a community center were recruited to label emotional faces and static body poses and to complete the Inventory of Callous-Unemotional Traits and a measure of violence and antisocial behavior.ResultsCallous-unemotional traits were related to poorer accuracy when labeling afraid faces and afraid body postures. However, when response bias was taken into account, callous-unemotional traits were related to deficits in many facial expressions. Notably, the combination of poorly labeling afraid faces and body poses was linked to the highest levels of callous-unemotional traits and violence.ConclusionsFindings support a generalized deficit in processing displays of fear that are not specific to faces. The results support the argument that a general “fear-blindness” is related to a lack of empathy and to violence and antisocial behavior. Methodological issues with regard to deciding whether people are accurately labeling fear and other emotions are discussed. However, early identification of fear deficits that affect multiple modalities is argued to be important for clinical intervention.     

Neural correlates of cognitive flexibility in children at risk for bipolar disorder

BackgroundYouth with bipolar disorder (BD) show behavioral and neural deficits in cognitive flexibility; however, whether such deficits exist among youths at risk for BD has not been explored.MethodsThe current fMRI study examined the neural basis of cognitive flexibility in BD youth (n = 28), unaffected youth at risk for BD (AR; n = 13), and healthy volunteer youth (HV; n = 21) by comparing brain activation patterns while participants performed the change task. On change trials, subjects must inhibit a prepotent response and execute an alternate one.ResultsDuring successful change trials, both BD and AR youth had increased right ventrolateral prefrontal and inferior parietal activity, compared to HV youth. During failed change trials, both BD and AR youth exhibited increased caudate activation relative to HV youth, but BD youth showed increased activation in the subgenual anterior cingulate cortex (ACC) relative to the other two groups.ConclusionsAbnormal activity in ventrolateral prefrontal cortex, inferior parietal cortex, and striatum during a cognitive flexibility task may represent a potential BD endophenotype, but subgenual ACC dysfunction may represent a marker of BD illness itself.     

Diminished sensitivity and specificity at recognising facial emotional expressions of varying intensity underlie emotion-specific recognition deficits in autism spectrum disorders

BackgroundA plethora of research on facial emotion recognition in autism spectrum disorders (ASD) exists and reported deficits in ASD compared to controls, particularly for negative basic emotions. However, these studies have largely used static high intensity stimuli. The current study investigated facial emotion recognition across three levels of expression intensity from videos, looking at accuracy rates to investigate impairments in facial emotion recognition and error patterns (’confusions’) to explore potential underlying factors.MethodTwelve individuals with ASD (9 M/3F; M(age) = 17.3) and 12 matched controls (9 M/3F; M(age) = 16.9) completed a facial emotion recognition task including 9 emotion categories (anger, disgust, fear, sadness, surprise, happiness, contempt, embarrassment, pride) and neutral, each expressed by 12 encoders at low, intermediate, and high intensity.ResultsA facial emotion recognition deficit was found overall for the ASD group compared to controls, as well as deficits in recognising individual negative emotions at varying expression intensities. Compared to controls, the ASD group showed significantly more, albeit typical, confusions between emotion categories (at high intensity), and significantly more confusions of emotions as ‘neutral’ (at low intensity).ConclusionsThe facial emotion recognition deficits identified in ASD, particularly for negative emotions, are in line with previous studies using other types of stimuli. Error analysis showed that individuals with ASD had difficulties detecting emotional information in the face (sensitivity) at low intensity, and correctly identifying emotional information (specificity) at high intensity. These results suggest different underlying mechanisms for the facial emotion recognition deficits at low vs high expression intensity.     

Are Brain Responses to Emotion a Reliable Endophenotype of Schizophrenia? An Image-Based Functional Magnetic Resonance Imaging Meta-analysis

BackgroundImpaired emotion processing constitutes a key dimension of schizophrenia and a possible endophenotype of this illness. Empirical studies consistently report poorer emotion recognition performance in patients with schizophrenia as well as in individuals at enhanced risk of schizophrenia. Functional magnetic resonance imaging studies also report consistent patterns of abnormal brain activation in response to emotional stimuli in patients, in particular, decreased amygdala activation. In contrast, brain-level abnormalities in at-risk individuals are more elusive. We address this gap using an image-based meta-analysis of the functional magnetic resonance imaging literature.MethodsFunctional magnetic resonance imaging studies investigating brain responses to negative emotional stimuli and reporting a comparison between at-risk individuals and healthy control subjects were identified. Frequentist and Bayesian voxelwise meta-analyses were performed separately, by implementing a random-effect model with unthresholded group-level T-maps from individual studies as input.ResultsIn total, 17 studies with a cumulative total of 677 at-risk individuals and 805 healthy control subjects were included. Frequentist analyses did not reveal significant differences between at-risk individuals and healthy control subjects. Similar results were observed with Bayesian analyses, which provided strong evidence for the absence of meaningful brain activation differences across the entire brain. Region of interest analyses specifically focusing on the amygdala confirmed the lack of group differences in this region.ConclusionsThese results suggest that brain activation patterns in response to emotional stimuli are unlikely to constitute a reliable endophenotype of schizophrenia. We suggest that future studies instead focus on impaired functional connectivity as an alternative and promising endophenotype.     

Neural response during explicit and implicit face processing varies developmentally in bipolar disorder

Both children and adults with bipolar disorder (BD) exhibit face emotion labeling deficits and neural circuitry dysfunction in response to emotional faces. However, few studies have compared these groups directly to distinguish effects of age and diagnosis. Such studies are important to begin to elucidate the developmental trajectory of BD and facilitate its diagnosis, prevention and treatment. This functional magnetic resonance imaging study compares 41 individuals with BD (19 children; 22 adults) and 44 age-matched healthy individuals (25 children; 19 adults) when making explicit or implicit judgments about angry or happy face morphs across a range of emotion intensity. Linear trend analyses revealed that BD patients, irrespective of age, failed to recruit the amygdala in response to increasing angry face. This finding was no longer significant when the group was restricted to euthymic youth or those without comorbid attention deficit hyperactivity disorder although this may reflect low statistical power. Deficits in subgenual anterior cingulate modulation were observed in both patient groups but were related to implicit processing for child patients and explicit processing for adult patients. Abnormalities in face emotion labeling and the circuitry mediating it may be biomarkers of BD that are present across development.     

A quantitative analysis of facial emotion recognition in obsessive–compulsive disorder

Obsessive–Compulsive Disorder (OCD) is characterized by persistent and unwanted obsessions generally accompanied by ritualistic behaviors or compulsions. Previous research proposed specific disgust facial emotion recognition deficits in patients with OCD. This research however, remains largely inconsistent. Therefore, the results of 10 studies contrasting facial emotion recognition accuracy in patients with OCD (n=221) and non-psychiatric controls (n=224) were quantitatively reviewed and synthesized using meta-analytic techniques. Patients with OCD were less accurate than controls in recognizing emotional facial expressions. Patients were also less accurate in recognizing negative emotions as a whole; however, this was largely due to significant differences in disgust and anger recognition specifically. The results of this study suggest that patients with OCD have difficulty recognizing specific negative emotions in faces and may misclassify emotional expressions due to symptom characteristics within the disorder. The contribution of state-related emotion perception biases to these findings requires further clarification.     

Risk or resilience? Empathic abilities in patients with bipolar disorders and their first-degree relatives

Endophenotypes are intermediate phenotypes which are considered a more promising marker of genetic risk than illness itself. While previous research mostly used cognitive deficits, emotional functions are of greater relevance for bipolar disorder regarding the characteristic emotional hyper-reactability and deficient social-emotional competence. Hence, the aim of the present study was to clarify whether empathic abilities can serve as a possible endophenotype of bipolar disorder by applying a newly developed task in bipolar patients and their first-degree relatives. Three components of empathy (emotion recognition, perspective taking and affective responsiveness) have been assessed in a sample of 21 bipolar patients, 21 first-degree relatives and 21 healthy controls. Data analysis indicated significant differences between controls and patients for emotion recognition and affective responsiveness but not for perspective taking. This shows that in addition to difficulties in recognizing facial emotional expressions, bipolar patients have difficulties in identifying emotions they would experience in a given situation. However, the ability to take the perspective of another person in an emotional situation was intact but decreased with increasing severity of residual hypomanic and depressive symptoms. Relatives performed comparably bad on emotion recognition but did not differ from controls or patients in affective responsiveness. This study is the first to show that deficient emotion recognition is the only component of empathy which forms a possible endophenotype of bipolar disorder. This has important implications for prevention strategies. Furthermore, changes in affective responsiveness in first-degree relatives show a potential resilience marker.     

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.     

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.     

Facial Emotion Recognition in Psychosis and Associations With Polygenic Risk for Schizophrenia: Findings From the Multi-Center EU-GEI Case–Control Study

Background and HypothesisFacial Emotion Recognition is a key domain of social cognition associated with psychotic disorders as a candidate intermediate phenotype. In this study, we set out to investigate global and specific facial emotion recognition deficits in first-episode psychosis, and whether polygenic liability to psychotic disorders is associated with facial emotion recognition.Study Design828 First Episode Psychosis (FEP) patients and 1308 population-based controls completed assessments of the Degraded Facial Affect Recognition Task (DFAR) and a subsample of 524 FEP and 899 controls provided blood or saliva samples from which we extracted DNA, performed genotyping and computed polygenic risk scores for schizophrenia (SZ), bipolar disorder (BD), and major depressive disorder (MD).Study ResultsA worse ability to globally recognize facial emotion expressions was found in patients compared with controls [B= −1.5 (0.6), 95% CI −2.7 to −0.3], with evidence for stronger effects on negative emotions (fear [B = −3.3 (1.1), 95% CI −5.3 to −1.2] and anger [B = −2.3 (1.1), 95% CI −4.6 to −0.1]) than on happiness [B = 0.3 (0.7), 95% CI −1 to 1.7]. Pooling all participants, and controlling for confounds including case/control status, facial anger recognition was associated significantly with Schizophrenia Polygenic Risk Score (SZ PRS) [B = −3.5 (1.7), 95% CI −6.9 to −0.2].ConclusionsPsychosis is associated with impaired recognition of fear and anger, and higher SZ PRS is associated with worse facial anger recognition. Our findings provide evidence that facial emotion recognition of anger might play a role as an intermediate phenotype for psychosis.     

Hippocampal amnesia

Abstract

A 35-year-old right-handed woman (CK) showed deficits in sorting and rating emotional facial expressions and experienced temporary emotional hyperarousal with panic attacks during a T2-signal enhancement of the reglon of the right amygdala. In a sorting task CK was able to match positive, but not negative, basic emotions. Furthermore CK rated most facial emotions as unpleasant and unaroused. In the further course, the neuroradiologically demonstrated lesion dlsappeared, as well as the Impaired Identification and judgement of emotional faclal expressions. The results suggest that a lesion of the right amygdala is sufficient to disturb the processing of emotional facial expressions.     

Facial emotion recognition deficits in abstinent cannabis dependent patients

BackgroundCannabis is clearly the most popular illicit drug in North America, Europe and in other parts of the world. Evidence is accumulating for the involvement of the endocannabinoid system in emotional processing. However, only few studies examined emotional processing in chronic, heavy cannabis users and these studies were performed in cannabis dependent patients who were abstinent for 12–48 hours. The aim of this study was to investigate facial emotion identification and discrimination abilities in patients with cannabis dependence who were abstinent for at least 1 month.MethodsThe study included 30 males with cannabis dependency according to DSM-IV criteria and who had been abstinent for at least 1 month and 30 healthy controls. All the subjects were evaluated with Facial Emotion Identification Test (FEIT) and Facial Emotion Discrimination Test (FEDT).ResultsThe main finding of this study was the presence of deficits in both identification and discrimination of facial emotions in cannabis dependent patients during abstinence. In addition, when we examined negative and positive emotions separately, we found out that abstinent cannabis dependent patients performed significantly worse than controls in the identification of negative emotions but not positive emotions.ConclusionsOur findings indicate that facial emotion recognition deficits which have previously been observed in current cannabis users are still detectable in abstinent cannabis dependent patients and do not improve quickly with abstinence (an average of 3.2 months).     

Impaired Perception of Emotional Expression in Amyotrophic Lateral Sclerosis

MethodsTwenty-four patients with ALS and 24 age- and sex-matched healthy controls completed neuropsychological tests and facial emotion recognition tasks [ChaeLee Korean Facial Expressions of Emotions (ChaeLee-E)]. The ChaeLee-E test includes facial expressions for seven emotions: happiness, sadness, anger, disgust, fear, surprise, and neutral.ResultsThe ability to perceive facial emotions was significantly worse among ALS patients performed than among healthy controls [65.2±18.0% vs. 77.1±6.6% (mean±SD), p=0.009]. Eight of the 24 patients (33%) scored below the 5th percentile score of controls for recognizing facial emotions.ConclusionsEmotion perception deficits occur in Korean ALS patients, particularly regarding facial expressions of emotion. These findings expand the spectrum of cognitive and behavioral dysfunction associated with ALS into emotion processing dysfunction.     

Brain systems underlying response flexibility in healthy and bipolar adolescents: an event-related fMRI study

OBJECTIVES: Previous studies have indicated abnormalities in response flexibility in pediatric bipolar disorder (BD). Dysfunction in response flexibility may contribute to the pattern of behavioral and emotional dysregulation that is characteristic of BD, since depressed and manic patients respond inflexibly to emotional stimuli (i.e., anhedonia in the case of depression or inappropriate positive affect in the case of mania). The present study was undertaken to determine if neuronal responses differed between BD and control subjects on a simple motor response flexibility task. METHODS: To elucidate the neural substrates mediating response flexibility in pediatric BD, we studied 25 youth with BD and 17 age-, gender- and IQ-matched controls (CON) as they performed the change task while undergoing event-related functional magnetic resonance imaging (fMRI). The change task is a new fMRI task that requires subjects to both inhibit and replace a prepotent motor response with another motor response after the initial response has been cued. RESULTS: On correctly performed change trials relative to correctly performed go trials, BD patients generated significantly more activity in the left dorsolateral prefrontal cortex (DLPFC) and in the primary motor cortex than did healthy controls, even though performance levels did not differ across groups. CONCLUSIONS: These results indicate that functional deficits within the left DLPFC may mediate deficits in response flexibility in pediatric BD. This deficit may extend beyond the realm of motor control and also affect emotion regulation.     

Attention bias toward threat in pediatric anxiety disorders

ObjectiveTo examine attention bias toward threat faces in a large sample of anxiety-disordered youths using a well-established visual probe task.MethodStudy participants included 101 children and adolescents (ages 7–18 years) with generalized anxiety disorder, social phobia, and/or separation anxiety disorder enrolled in a multisite anxiety treatment study. Nonanxious youths (n = 51; ages 9–18 years) were recruited separately. Participants were administered a computerized visual probe task that presents pairs of faces portraying threat (angry), positive (happy), and neutral expressions. They pressed a response key to indicate the spatial location of a probe that replaced one of the faces on each trial. Attention bias scores were calculated from response times to probes for each emotional face type.ResultsCompared to healthy youths, anxious participants demonstrated a greater attention bias toward threat faces. This threat bias in anxious patients did not significantly vary across the anxiety disorders. There was no group difference in attention bias toward happy faces.ConclusionsThese results suggest that pediatric anxiety disorders are associated with an attention bias toward threat. Future research may examine the manner in which cognitive bias in anxious youths changes with treatment. J. Am. Acad. Child Adolesc. Psychiatry, 2008;47(10):1189–1196.     

Temporal stability of ADHD in the high-IQ population: results from the MGH Longitudinal Family Studies of ADHD

ObjectiveThe diagnosis of attention-deficit/hyperactivity disorder (ADHD) in high-IQ youths remains controversial.MethodTo further explore the diagnostic validity of ADHD in this population, we studied two cohorts of high-IQ youths, both with and without ADHD, across a 4.5-year period.ResultsCompared to those without ADHD, high-IQ youths with ADHD had significantly higher rates of mood, anxiety, and disruptive behavior disorders at follow-up. In addition, ADHD status was a significant predictor for higher impairments across most social, academic, and family functional domains. Associations between baseline and follow-up IQ scores did not differ between groups. Syndromal persistence rates of ADHD were similar between high-IQ and average-IQ youths with ADHD.ConclusionsThese results provide further support for the predictive validity of ADHD in high-IQ youths. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7): 817–825.