Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective

A new measure of authentic auditory emotion recognition: Application to patients with schizophrenia

BACKGROUND

Many social processes such as emotion recognition are severely impaired in patients with schizophrenia. While basic auditory processing seems to play a key role in identifying emotions, research in this field is limited due to the lack of proper assessment batteries. Many of the widely accepted tests utilize actors to portray certain emotions-these batteries are less ecologically and face valid.

METHODS

This study utilized a newly developed auditory emotion recognition test that contained natural stimuli from spontaneous displays of emotions to assess 28 patients with schizophrenia and 16 healthy controls.

RESULTS

The results indicate that the newly developed test, referred to as the INTONATION Test, is more sensitive to the emotion recognition deficits in patients with schizophrenia than previously used measures. The correlations of the INTONATION Test measures with basic auditory processes were similar to established tests of auditory emotion. Particular emotion sub scores from the INTONTATION test, such as happiness, demonstrated the strongest correlations with specific auditory processing skills, such as formant discrimination and sinusoidal amplitude modulation detection (SAM60).

CONCLUSIONS

The results from this study indicate that auditory emotion recognition impairments are more pronounced in patients with schizophrenia when perceiving authentic displays of emotion. Understanding these deficits could help specify the nature of auditory emotion recognition deficits in patients with schizophrenia and those at risk.

Emotion Recognition and Adverse Childhood Experiences in Individuals at Clinical High Risk of Psychosis

OBJECTIVE

To investigate the association between facial affect recognition (FAR) and type of adverse childhood experiences (ACEs) in a sample of clinical high risk (CHR) individuals and a matched sample of healthy controls (HCs).

METHODS

In total, 309 CHR individuals and 51 HC were recruited as part of an European Union-funded multicenter study (EU-GEI) and included in this work. During a 2-year follow-up period, 65 CHR participants made a transition to psychosis (CHR-T) and 279 did not (CHR-NT). FAR ability was measured using a computerized version of the Degraded Facial Affect Recognition (DFAR) task. ACEs were measured using the Childhood Experience of Care and Abuse Questionnaire, the Childhood Trauma Questionnaire, and the Bullying Questionnaire. Generalized regression models were used to investigate the relationship between ACE and FAR. Logistic regressions were used to investigate the relationship between FAR and psychotic transition.

RESULTS

In CHR individuals, having experienced emotional abuse was associated with decreased total and neutral DFAR scores. CHR individuals who had experienced bullying performed better in the total DFAR and in the frightened condition. In HC and CHR, having experienced the death of a parent during childhood was associated with lower DFAR total score and lower neutral DFAR score, respectively. Analyses revealed a modest increase of transition risk with increasing mistakes from happy to angry faces.

CONCLUSIONS

Adverse experiences in childhood seem to have a significant impact on emotional processing in adult life. This information could be helpful in a therapeutic setting where both difficulties in social interactions and adverse experiences are often addressed.

Models Predicting Psychosis in Patients With High Clinical Risk: A Systematic Review

OBJECTIVE

The present study reviews predictive models used to improve prediction of psychosis onset in individuals at clinical high risk for psychosis (CHR), using clinical, biological, neurocognitive, environmental, and combinations of predictors.

METHODS

A systematic literature search on PubMed was carried out (from 1998 through 2019) to find all studies that developed or validated a model predicting the transition to psychosis in CHR subjects.

RESULTS

We found 1,406 records. Thirty-eight of them met the inclusion criteria; 11 studies using clinical predictive models, seven studies using biological models, five studies using neurocognitive models, five studies using environmental models, and 18 studies using combinations of predictive models across different domains. While the highest positive predictive value (PPV) in clinical, biological, neurocognitive, and combined predictive models were relatively high (all above 83), the highest PPV across environmental predictive models was modest (63%). Moreover, none of the combined models showed a superiority when compared with more parsimonious models (using only neurocognitive, clinical, biological, or environmental factors).

CONCLUSIONS

The use of predictive models may allow high prognostic accuracy for psychosis prediction in CHR individuals. However, only ten studies had performed an internal validation of their models. Among the models with the highest PPVs, only the biological and neurocognitive but not the combined models underwent validation. Further validation of predicted models is needed to ensure external validity.

Clinical Validity of DSM-5 Attenuated Psychosis Syndrome: Advances in Diagnosis, Prognosis, and Treatment

IMPORTANCE

Since the release of the DSM-5 diagnosis of attenuated psychosis syndrome (DSM-5-APS) in 2013, several research studies have investigated its clinical validity. Although critical and narrative reviews have reviewed these progresses, no systematic review has comprehensively summarized the available evidence regarding the clinical validity of DSM-5-APS.

OBJECTIVE

To provide current evidence on the clinical validity of DSM-5-APS, focusing on recent advances in diagnosis, prognosis, and treatment.

EVIDENCE REVIEW

A multistep literature search using the Web of Science database, Cochrane Central Register of Reviews, Ovid/PsychINFO, conference proceedings, and trial registries from database inception to June 16, 2019, was conducted following PRISMA and MOOSE guidelines and PROSPERO protocol. Studies with original data investigating individuals diagnosed using DSM-5-APS or meeting comparable criteria were included. The results of the systematic review were summarized in tables and narratively synthesized against established evidence-based antecedent, concurrent, and prognostic validators. A quantitative meta-analysis was conducted to explore the cumulative risk of psychosis onset at 6, 12, 24, and 36 months in individuals diagnosed using DSM-5-APS criteria.

FINDINGS

The systematic review included 56 articles, which reported on 124 validators, including 15 antecedent, 55 concurrent, and 54 prognostic validators. The epidemiological prevalence of the general non-help-seeking young population meeting DSM-5-APS criteria was 0.3%; the prevalence of individuals meeting DSM-5-APS criteria was variable in clinical samples. The interrater reliability for DSM-5-APS criteria was comparable with that of other DSM-5 mental disorders and can be optimized by the use of specific psychometric instruments. DSM-5-APS criteria were associated with frequent depressive comorbid disorders, distress, suicidality, and functional impairment. The meta-analysis included 23 prospective cohort studies, including 2376 individuals. The meta-analytical risk of psychosis onset was 11% at 6 months, 15% at 12 months, 20% at 24 months, and 23% at 36 months. Research into predisposing and precipitating epidemiological factors, neurobiological correlates, and effective treatments for DSM-5-APS criteria has been limited.

CONCLUSIONS AND RELEVANCE

Over recent years, DSM-5-APS criteria have received substantial concurrent and prognostic validation, mostly driven by research into the clinical high-risk state for psychosis. Precipitating and predisposing factors, neurobiological correlates, and effective treatments are undetermined to date.

Relationship between aberrant salience and positive emotion misrecognition in acute relapse of schizophrenia

INTRODUCTION

Aberrant salience is the incorrect assignment of salience or significance to innocuous stimuli, and been hypothesized to be a central mechanism in the development of psychosis. In addition to aberrant salience, social-cognitive models of psychosis suggest that the way people process information about the self is important in all stages of psychosis. The aim of the present study is to explore the relationship between aberrant salience and emotion processing in schizophrenia patients with psychotic relapse.

METHODS

A sample of 42 patients with relapse was recruited. Aberrant salience was measured with the Aberrant Salience Inventory (ASI). Assessment of social cognition was carried out using the Facial Emotion Identification Test (FEIT). Partial correlations were controlled for possible confounding variables.

RESULTS

The ASI factors "increase in meaning" and "heightened cognition" positively correlated with impaired recognition of positive emotions, and ASI total score inversely correlated to time to response to task. Most of incorrect answers corresponded to misclassification of positive emotions.

CONCLUSION

Our findings show that there is evidence for a relationship between aberrant salience and emotion processing during a psychotic episode; we propose that aberrant salience and alterations in emotion processing trigger the loss of modulating feedback from the external world to produce a self-referential mental state.

Validation and extension of the Motivation and Pleasure Scale-Self Report (MAP-SR) across the schizophrenia spectrum in the Chinese context

BACKGROUND

Developed based on the Clinical Assessment Interview for Negative Symptoms (CAINS), the Motivation and Pleasure Scale-Self Report (MAP-SR) was designed to address the conceptual and psychometric limitations of other instruments assessing negative symptoms. We sought to validate and extend the applicability of the MAP-SR in the Chinese context across the schizophrenia spectrum.

METHODS

Three samples, including college students, individuals with social anhedonia and patients with schizophrenia, were recruited. Test-retest reliability, internal consistency, factor structure, and convergent/discriminant validity of the MAP-SR were examined. The group differences between the three participant groups were examined.

RESULTS

A four-factor structure of the MAP-SR was found consistently in all three groups of participants. The scale showed convergent/discriminant validity in patients with schizophrenia and individuals with social anhedonia, along with good reliability found in schizophrenia patients. The MAP-SR was also able to distinguish individuals with SocAnh and patients with SZ from matched controls.

CONCLUSIONS

The MAP-SR is a valid and reliable instrument in assessing negative symptoms in individuals along the schizophrenia spectrum.

The Attenuated Psychosis Syndrome and Facial Affect Processing in Adolescents With and Without Autism

BACKGROUND

Autism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. The attenuated psychosis syndrome (APS) is primarily defined by the presence of attenuated psychotic symptoms, which currently constitute the best and most-replicated clinical predictors of psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level.

MATERIALS AND METHOD

Fifty-three adolescents with APS and 81 typically developing controls (aged 12-18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition was assessed with the Amsterdam Neuropsychological Tasks using a cascade model of cognitive processing, in which disturbances in "lower-level" cognitive abilities (pattern recognition), affect "higher-level" cognitive processes (face recognition and facial affect recognition). For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication Questionnaire were used in a confirmatory item factor analysis framework.

RESULTS

Contrary to expectation, APS in adolescents was not associated with impairments in pattern, face, or facial affect recognition. However, the APS group with autism spectrum disorder showed a general latency in response time to social and non-social stimuli. Dimensionally assessed schizotypal and autistic-like traits did not predict the accuracy or the speed of face or facial affect recognition.

CONCLUSION

Facial affect processing performance was not associated with APS in adolescence and represents an unlikely early vulnerability marker for psychosis. APS individuals with a more autistic-like profile were characterized by slower responses to social- and non-social stimuli, suggesting that the combined effect of APS and autism spectrum disorder on cognition is larger than for APS alone.

Grant Report on d-Serine Augmentation of Neuroplasticity-Based Auditory Learning in Schizophrenia †

We report on the rationale and design of an ongoing NIMH sponsored R61-R33 project in schizophrenia/schizoaffective disorder. This project studies augmenting the efficacy of auditory neuroplasticity cognitive remediation (AudRem) with d-serine, an N-methyl-d-aspartate-type glutamate receptor (NMDAR) glycine-site agonist. We operationalize improved (smaller) thresholds in pitch (frequency) between successive auditory stimuli after AudRem as improved plasticity, and mismatch negativity (MMN) and auditory θ as measures of functional target engagement of both NMDAR agonism and plasticity. Previous studies showed that AudRem alone produces significant, but small cognitive improvements, while d-serine alone improves symptoms and MMN. However, the strongest results for plasticity outcomes (improved pitch thresholds, auditory MMN and θ) were found when combining d-serine and AudRem. AudRem improvements correlated with reading and other auditory cognitive tasks, suggesting plasticity improvements are predictive of functionally relevant outcomes. While d-serine appears to be efficacious for acute AudRem enhancement, the optimal dose remains an open question, as does the ability of combined d-serine + AudRem to produce sustained improvement. In the ongoing R61, 45 schizophrenia patients will be randomized to receive three placebo-controlled, double-blind d-serine + AudRem sessions across three separate 15 subject dose cohorts (80/100/120 mg/kg). Successful completion of the R61 is defined by ≥moderate effect size changes in target engagement and correlation with function, without safety issues. During the three-year R33, we will assess the sustained effects of d-serine + AudRem. In addition to testing a potentially viable treatment, this project will develop a methodology to assess the efficacy of novel NMDAR modulators, using d-serine as a "gold-standard".

Affective prosody and facial emotion recognition in first-episode schizophrenia: Associations with functioning & symptoms

Studies indicate that people with schizophrenia experience deficits in their ability to accurately detect emotions, both through facial expressions and voice intonation (i.e., prosody), and that functioning and symptoms are associated with these deficits. This study aimed to examine how facial emotion and affective prosody recognition are related to functioning and symptoms in a first-episode schizophrenia sample. Further, in light of research suggesting variable emotion-specific performance in people with schizophrenia, this study explored emotion-specific performance. Participants were 49 people with a recent first episode of schizophrenia taking part in a larger RCT. Results revealed that affective prosody recognition was significantly correlated with both role and social functioning. Regarding associations with psychiatric symptoms, facial emotion recognition was significantly, negatively associated with all three positive symptom scales, whereas affective prosody recognition was significantly, negatively associated with disorganization only. Emotion-specific analyses revealed that for affective prosody, participants were most accurate in recognizing anger and least accurate for disgust. For facial emotion recognition, participants were most accurate in recognizing happiness and least accurate for fear. Taken together, results suggest that affective prosody recognition is important for social and role functioning in people with first-episode schizophrenia. Results also suggest that this group may struggle more to identify negative emotions, though additional work is needed to clarify this pattern in affective prosody and determine real-world impact on social interactions.

Differential Patterns of Visual Sensory Alteration Underlying Face Emotion Recognition Impairment and Motion Perception Deficits in Schizophrenia and Autism Spectrum Disorder

BACKGROUND

Impaired face emotion recognition (FER) and abnormal motion processing are core features in schizophrenia (SZ) and autism spectrum disorder (ASD) that have been linked to atypical activity within the visual cortex. Despite overlaps, only a few studies have directly explored convergent versus divergent neural mechanisms of altered visual processing in ASD and SZ. We employed a multimodal imaging approach to evaluate FER and motion perception in relation to functioning of subcortical and cortical visual regions.

METHODS

Subjects were 20 high-functioning adults with ASD, 19 patients with SZ, and 17 control participants. Behavioral measures of coherent motion sensitivity and FER along with electrophysiological and functional magnetic resonance imaging measures of visual pattern and motion processing were obtained. Resting-state functional magnetic resonance imaging was used to assess the relationship between corticocortical and thalamocortical connectivity and atypical visual processing.

RESULTS

SZ and ASD participants had intercorrelated deficits in FER and motion sensitivity. In both groups, reduced motion sensitivity was associated with reduced functional magnetic resonance imaging activation in the occipitotemporal cortex and lower delta-band electroencephalogram power. In ASD, FER deficits correlated with hyperactivation of dorsal stream regions and increased evoked theta power. Activation of the pulvinar correlated with abnormal alpha-band modulation in SZ and ASD with under- and overmodulation, respectively, predicting increased clinical symptoms in both groups.

CONCLUSIONS

SZ and ASD participants showed equivalent deficits in FER and motion sensitivity but markedly different profiles of physiological dysfunction. The specific pattern of deficits observed in each group may help guide development of treatments designed to downregulate versus upregulate visual processing within the respective clinical groups.

Emotion recognition latency, but not accuracy, relates to real life functioning in individuals at ultra-high risk for psychosis

BACKGROUND

Emotion recognition deficits are essential features of psychotic disorders and the ultra-high risk state of psychosis (UHR), that are known to relate to functional outcome. The potential associations between aspects of emotion recognition deficits and functioning are, however, understudied in UHR individuals.

METHOD

Emotion recognition accuracy and latency were assessed in 132 UHR individuals and 60 healthy controls using the CANTAB emotion recognition task along with multiple measures of real life functioning. Multiple regression analyses assessed the potential relations between emotion recognition accuracy, latency, and measures of functioning.

RESULTS

A consistent finding was that emotion recognition latency, but not accuracy, was associated with the four observer-rated measures of functioning (β in the range -1.57 to -16.20), which remained significant on one measure after controlling for neurocognitive processing speed. Neither emotion recognition accuracy, nor latency related to real life functioning in healthy controls.

DISCUSSION

The results suggest that processing speed of social cognitive information is an important correlate to real-life functioning in UHR individuals which may be a relevant target in social cognitive remediation programs for patients at risk for psychosis.

Adult-onset Huntington disease: An update

Appropriate nursing-care strategies depend on the early recognition of Huntington disease (HD) to prioritize a plan of care. This article offers perspective on the clinical presentation, prognosis, diagnosis, and management of adult-onset HD.

Predictors of Transition to Psychosis in Individuals at Clinical High Risk

PURPOSE OF REVIEW

Current research is examining predictors of the transition to psychosis in youth who are at clinical high risk based on attenuated psychotic symptoms (APS). Determining predictors of the development of psychosis is important for an improved understanding of mechanisms as well as the development of preventative strategies. The purpose is to review the most recent literature identifying predictors of the transition to psychosis in those who are already assessed as being at risk.

RECENT FINDINGS

Multidomain models, in particular, integrated models of symptoms, social functioning, and cognition variables, achieve better predictive performance than individual factors. There are many methodological issues; however, several solutions have now been described in the literature. For youth who already have APS, predicting who may go on to later develop psychosis is possible. Several studies are underway in large consortiums that may overcome some of the methodological concerns and develop improved means of prediction.

Alterations in facial expressivity in youth at clinical high-risk for psychosis

Negative symptoms, such as blunted facial affect, are core features of psychotic disorders that predict poor functional outcome. However, it is unknown whether these impairments occur prior to the onset of psychosis. Understanding this phenomenon in the psychosis risk period has significant relevance for elucidating pathogenic processes, as well as potential for informing a viable new behavioral marker for broader social dysfunction and clinical course. The current study sought to determine the nature of facial expression deficits among individuals at clinical high-risk (CHR) for developing psychosis using a comprehensive approach, incorporating clinical interview ratings and automated facial expression coding analysis. A total of 42 CHR and 42 control participants completed clinical interviews and digitally taped segments were submitted into an automated, computerized tool to assess for 7 facial expressions (joy, anger, surprise, fear, contempt, disgust, sadness). Furthermore, relationships between facial expressions and social functioning and available scores on a psychosis conversion risk calculator from a total of 78 participants (39 CHR and 39 controls) were examined. Relationships between measures were also investigated (data was available for the Prodromal Inventory of Negative Symptoms among 33 CHR and 25 controls). Findings from clinical interview indicated that the CHR group exhibited elevated blunting. Furthermore, automated analyses showed that the CHR group displayed blunting in expressions of joy but surprisingly, increased anger facial expressions. Lastly, irregularities in facial expressions were related to decreased social functioning and increased psychosis conversion risk calculator scores, signaling heightened likelihood of conversion to psychosis. These findings suggest that alterations in facial expressivity occur early in the pathogenesis of psychosis and provide evidence for the efficacy of higher resolution measures of facial expressivity in psychosis research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Young spontaneously hypertensive rats (SHRs) display prodromal schizophrenia-like behavioral abnormalities

The Spontaneously Hypertensive Rat (SHR) strain has been suggested as an animal model of schizophrenia, considering that adult SHRs display behavioral abnormalities that mimic the cognitive, psychotic and negative symptoms of the disease and are characteristic of its animal models. SHRs display: (I) deficits in fear conditioning and latent inhibition (modeling cognitive impairments), (II) deficit in prepulse inhibition of startle reflex (reflecting a deficit in sensorimotor gating, and associated with psychotic symptoms), (III) diminished social behavior (modeling negative symptoms) and (IV) hyperlocomotion (modeling the hyperactivity of the dopaminergic mesolimbic system/ psychotic symptoms). These behavioral abnormalities are reversed specifically by the administration of antipsychotic drugs. Here, we performed a behavioral characterization of young (27-50 days old) SHRs in order to investigate potential early behavioral abnormalities resembling the prodromal phase of schizophrenia. When compared to Wistar rats, young SHRs did not display hyperlocomotion or PPI deficit, but exhibited diminished social interaction and impaired fear conditioning and latent inhibition. These findings are in accordance with the clinical course of schizophrenia: manifestation of social and cognitive impairments and absence of full-blown psychotic symptoms in the prodromal phase. The present data reinforce the SHR strain as a model of schizophrenia, expanding its validity to the prodromal phase of the disorder.

Age-Associated Deviations of Amygdala Functional Connectivity in Youths With Psychosis Spectrum Disorders: Relevance to Psychotic Symptoms

OBJECTIVE

The authors created normative growth charts of amygdala functional connectivity in typically developing youths, assessed age-associated deviations of these trajectories in youths with psychosis spectrum disorders, and explored how these disruptions are related to clinical symptomatology.

METHODS

Resting-state functional neuroimaging data from four samples (three cross-sectional, one longitudinal) were collected for 1,062 participants 10-25 years of age (622 typically developing control youths, 194 youths with psychosis spectrum disorders, and 246 youths with other psychopathology). The authors assessed deviations in the psychosis spectrum and other psychopathology groups in age-related changes in resting-state functional MRI amygdala-to-whole brain connectivity from a normative range derived from the control youths. The authors explored relationships between age-associated deviations in amygdala connectivity and positive symptoms in the psychosis spectrum group.

RESULTS

Normative trajectories demonstrated significant age-related decreases in centromedial amygdala connectivity with distinct regions of the brain. In contrast, the psychosis spectrum group failed to exhibit any significant age-associated changes between the centromedial amygdala and the prefrontal cortices, striatum, occipital cortex, and thalamus (all q values <0.1). Age-associated deviations in centromedial amygdala-striatum and centromedial amygdala-occipital connectivity were unique to the psychosis spectrum group and were not observed in the other psychopathology group. Exploratory analyses revealed that greater age-related deviation in centromedial amygdala-thalamus connectivity was significantly associated with increased severity of positive symptoms (r=0.19; q=0.05) in the psychosis spectrum group.

CONCLUSIONS

Using neurodevelopmental growth charts to identify a lack of normative development of amygdala connectivity in youths with psychosis spectrum disorders may help us better understand the neural basis of affective impairments in psychosis, informing prediction models and interventions.

Differences in Facial Emotional Recognition Between Patients With the First-Episode Psychosis, Multi-episode Schizophrenia, and Healthy Controls

OBJECTIVES

The aim of our study was to assess the differences in facial emotional recognition (FER) between patients with first-episode psychosis (FEP), patients with multi-episode schizophrenia (SCH), and healthy controls (HC) and to find possible correlations of FER with psychopathology in the two patient groups.

METHODS

We performed a cross-sectional study enrolling 160 patients from two psychiatric hospitals in Croatia (80 FEP and 80 SCH) and 80 HC during the period from October 2015 until October 2017. Patients were assessed once during their hospital treatment, using the Penn Emotion Recognition Task for assessment of FER, rating scales for psychopathology and depression and self-reporting questionnaires for impulsiveness, aggression, and quality of life.

RESULTS

The number of correctly identified emotions significantly decreased from HC to FEP [Δ -7%; 95% confidence interval (CI) [-12% to -3%], effect size r = 0.30] and more markedly in SCH (Δ -15%; 95% CI [-25% to -10%], effect size r = 0.59) after the adjustment for age and gender and correction for multiple testing. Correct FER for negative emotions, but not for happiness and neutral emotions, had a statistically significant negative correlation with some features on the scales of psychopathology, impulsivity and aggression in both patient groups.

CONCLUSIONS

Impairment of FER is present from the first episode of schizophrenia and increases further with multiple psychotic episodes, but it may depend on or contribute to clinical symptoms. Therefore, assessment of FER should be included in the clinical assessment and integrated in the plan of treatment from the beginning of the illness. (JINS, 2019, 25, 165-173).

Basic auditory processing deficits and their association with auditory emotion recognition in schizophrenia

BACKGROUND

Individuals with schizophrenia are impaired in their ability to recognize emotions based on vocal cues and these impairments are associated with poor global outcome. Basic perceptual processes, such as auditory pitch processing, are impaired in schizophrenia and contribute to difficulty identifying emotions. However, previous work has focused on a relatively narrow assessment of auditory deficits and their relation to emotion recognition impairment in schizophrenia.

METHODS

We have assessed 87 patients with schizophrenia and 73 healthy controls on a comprehensive battery of tasks spanning the five empirically derived domains of auditory function. We also explored the relationship between basic auditory processing and auditory emotion recognition within the patient group using correlational analysis.

RESULTS

Patients exhibited widespread auditory impairments across multiple domains of auditory function, with mostly medium effect sizes. Performance on all of the basic auditory tests correlated with auditory emotion recognition at the p < .01 level in the patient group, with 9 out of 13 tests correlating with emotion recognition at r = 0.40 or greater. After controlling for cognition, many of the largest correlations involved spectral processing within the phase-locking range and discrimination of vocally based stimuli.

CONCLUSIONS

While many auditory skills contribute to this impairment, deficient formant discrimination appears to be a key skill contributing to impaired emotion recognition as this was the only basic auditory skill to enter a step-wise multiple regression after first entering a measure of cognitive impairment, and formant discrimination accounted for significant unique variance in emotion recognition performance after accounting for deficits in pitch processing.

Social aversive conditioning in youth at clinical high risk for psychosis and with psychosis: An ERP study

BACKGROUND

Social cognition and emotion processing are compromised in schizophrenia. Disruptions in these domains may also be present during the psychosis-risk state. Aversive conditioning is an established translational research paradigm to investigate affective reactivity and learning. Using an aversive conditioning ERP paradigm with social cues, we examined whether psychosis patients and at-risk youths differentially respond to aversively conditioned faces.

METHODS

Participants (ages 10-30) were enrolled into three demographically-matched groups: clinical risk for psychosis (CR, n = 32), psychosis (PS, n = 26), and healthy control (HC, n = 33). EEGs were recorded during a delay aversive conditioning task in which three neutral faces were paired with an aversive tone at 100%, 50% and 0% contingencies. Analysis focused on group differences in ERP peaks representing visual processing (occipital P120), emotional valence (frontal VPP), and directed attention (parietal-occipital P300), for dimensions of aversiveness (100% vs. 0%) and unpredictability (50% vs. 100% + 0%).

RESULTS

HC, but not CR or PS, showed increased P300 amplitude to aversive vs. non-aversive conditioned stimuli. CR, but not PS or HC, showed increased VPP amplitude to unpredictable vs. predictable stimuli.

CONCLUSIONS

PS and CR both fail to allocate appropriate salience to social cues that are predictably aversive. CR, but not PS exhibit heightened emotional reactivity to social cues that are of uncertain salience. Clinical risk for schizophrenia may involve neural abnormalities distinct from both healthy and fully-established disease states.

Impaired Motion Processing in Schizophrenia and the Attenuated Psychosis Syndrome: Etiological and Clinical Implications

OBJECTIVE

The ability to perceive the motion of biological objects, such as faces, is a critical component of daily function and correlates with the ability to successfully navigate social situations (social cognition). Deficits in motion perception in schizophrenia were first demonstrated about 20 years ago but remain understudied, especially in the early, potentially prodromal, stages of the illness. The authors examined the neural bases of visual sensory processing impairments, including motion, in patients with schizophrenia (N=63) and attenuated psychosis (clinical high risk) (N=32) compared with age-matched healthy control subjects (N=67).

METHOD

Electrophysiological recordings during stimulus and motion processing were analyzed using oscillatory (time frequency) approaches that differentiated motion-onset-evoked activity from stimulus-onset sensory-evoked responses. These were compared with functional MRI (fMRI) measures of motion processing.

RESULTS

Significant deficits in motion processing were observed across the two patient groups, and these deficits predicted impairments in both face-emotion recognition and cognitive function. In contrast to motion processing, sensory-evoked stimulus-onset responses were intact in patients with attenuated psychosis, and, further, the relative deficit in motion-onset responses compared with stimulus-onset responses predicted transition to schizophrenia. In patients with schizophrenia, motion detection deficits mapped to impaired activation in motion-sensitive visual cortex during fMRI. Additional visual impairments in patients with schizophrenia, not present in patients with attenuated psychosis, implicated other visual regions, including the middle occipital gyrus and pulvinar thalamic nucleus.

CONCLUSIONS

The study findings emphasize the importance of sensory-level visual dysfunction in the etiology of schizophrenia and in the personal experience of individuals with the disorder and demonstrate that motion-processing deficits may predate illness onset and contribute to impaired function even in patients with attenuated psychosis.

Emotional Prosody Processing in Schizophrenic Patients: A Selective Review and Meta-Analysis

Emotional prosody (EP) has been increasingly recognized as an important area of schizophrenic patients’ dysfunctions in their language use and social communication. The present review aims to provide an updated synopsis on emotional prosody processing (EPP) in schizophrenic disorders, with a specific focus on performance characteristics, the influential factors and underlying neural mechanisms. A literature search up to 2018 was conducted with online databases, and final selections were limited to empirical studies which investigated the prosodic processing of at least one of the six basic emotions in patients with a clear diagnosis of schizophrenia without co-morbid diseases. A narrative synthesis was performed, covering the range of research topics, task paradigms, stimulus presentation, study populations and statistical power with a quantitative meta-analytic approach in Comprehensive Meta-Analysis Version 2.0. Study outcomes indicated that schizophrenic patients’ EPP deficits were consistently observed across studies (d = −0.92, 95% CI = −1.06 < δ < −0.78), with identification tasks (d = −0.95, 95% CI = −1.11 < δ < −0.80) being more difficult to process than discrimination tasks (d = −0.74, 95% CI = −1.03 < δ < −0.44) and emotional stimuli being more difficult than neutral stimuli. Patients’ performance was influenced by both participant- and experiment-related factors. Their social cognitive deficits in EP could be further explained by right-lateralized impairments and abnormalities in primary auditory cortex, medial prefrontal cortex and auditory-insula connectivity. The data pointed to impaired pre-attentive and attentive processes, both of which played important roles in the abnormal EPP in the schizophrenic population. The current selective review and meta-analysis support the clinical advocacy of including EP in early diagnosis and rehabilitation in the general framework of social cognition and neurocognition deficits in schizophrenic disorders. Future cross-sectional and longitudinal studies are further suggested to investigate schizophrenic patients’ perception and production of EP in different languages and cultures, modality forms and neuro-cognitive domains.

Categorical emotion recognition from voice improves during childhood and adolescence

Converging evidence demonstrates that emotion processing from facial expressions continues to improve throughout childhood and part of adolescence. Here we investigated whether this is also the case for emotions conveyed by non-linguistic vocal expressions, another key aspect of social interactions. We tested 225 children and adolescents (age 5–17) and 30 adults in a forced-choice labeling task using vocal bursts expressing four basic emotions (anger, fear, happiness and sadness). Mixed-model logistic regressions revealed a small but highly significant change with age, mainly driven by changes in the ability to identify anger and fear. Adult-level of performance was reached between 14 and 15 years of age. Also, across ages, female participants obtained better scores than male participants, with no significant interaction between age and sex effects. These results expand the findings showing that affective prosody understanding improves during childhood; they document, for the first time, continued improvement in vocal affect recognition from early childhood to mid- adolescence, a pivotal period for social maturation.

Cross Cultural Validation and Extension of the Clinical Assessment Interview for Negative Symptoms (CAINS) in the Chinese Context: Evidence from a Spectrum Perspective

The Clinical Assessment Interview for Negative Symptoms (CAINS) was designed in accordance with the recent theory and research in social affective neuroscience and to address the psychometric and conceptual limitations of other instruments assessing negative symptoms. The present study aimed to provide a large-scale validation of the CAINS in China and examine its applicability and validity evidence across the schizophrenia spectrum. Using confirmatory factor analysis, our results replicated the original findings in the US development samples that the CAINS possesses a stable 2-factor structure, namely "motivation/pleasure" and "expression". We also found significant correlations between the CAINS and other negative symptom measures. The CAINS demonstrated good discriminant validity in differentiating negative symptoms in people with schizophrenia, nonpsychotic first-degree relatives and people with social anhedonia. People with schizophrenia exhibited significantly higher CAINS subscale scores than first-degree relatives and healthy controls. In addition, first-degree relatives had higher "motivation/pleasure" scores than healthy controls. The "motivation/pleasure" subscale scores of individuals with social anhedonia were also significantly higher than healthy controls.

Emotion-Related Consciousness Detection in Patients With Disorders of Consciousness Through an EEG-Based BCI System

For patients with disorders of consciousness (DOC), such as vegetative state (VS) and minimally conscious state (MCS), detecting and assessing the residual cognitive functions of the brain remain challenging. Emotion-related cognitive functions are difficult to detect in patients with DOC using motor response-based clinical assessment scales such as the Coma Recovery Scale-Revised (CRS-R) because DOC patients have motor impairments and are unable to provide sufficient motor responses for emotion-related communication. In this study, we proposed an EEG-based brain-computer interface (BCI) system for emotion recognition in patients with DOC. Eight patients with DOC (5 VS and 3 MCS) and eight healthy controls participated in the BCI-based experiment. During the experiment, two movie clips flashed (appearing and disappearing) eight times with a random interstimulus interval between flashes to evoke P300 potentials. The subjects were instructed to focus on the crying or laughing movie clip and to count the flashes of the corresponding movie clip cued by instruction. The BCI system performed online P300 detection to determine which movie clip the patients responsed to and presented the result as feedback. Three of the eight patients and all eight healthy controls achieved online accuracies based on P300 detection that were significantly greater than chance level. P300 potentials were observed in the EEG signals from the three patients. These results indicated the three patients had abilities of emotion recognition and command following. Through spectral analysis, common spatial pattern (CSP) and differential entropy (DE) features in the delta, theta, alpha, beta, and gamma frequency bands were employed to classify the EEG signals during the crying and laughing movie clips. Two patients and all eight healthy controls achieved offline accuracies significantly greater than chance levels in the spectral analysis. Furthermore, stable topographic distribution patterns of CSP and DE features were observed in both the healthy subjects and these two patients. Our results suggest that cognitive experiments may be conducted using BCI systems in patients with DOC despite the inability of such patients to provide sufficient behavioral responses.

Changes in correlation characteristics of time consumption and mind-reading performance in pre-onset and post-onset psychosis

There is a strong correlation between neurocognition and social cognition. However, none of these studies have examined the key role of time consumption during social cognition tasks. Participants included 84 individuals with clinical high risk of psychosis (CHR), 95 healthy controls (HC), and 66 case controls (schizophrenia patients, SZ), who were assessed through the Reading-Mind-in-Eyes Tasks (RMET) with computerized recording of the response time (RT). Neurocognitive tests were also performed for the HC and CHR groups. A comparison of RMET performance revealed significantly lower scores in the SZ group compared to the HC group, with CHR individuals scoring between these two. However, both CHR and SZ subjects spent almost twice as long of the time on RMET compared to the HC subjects. Significant positive correlation was found between RMET accuracy and RT, though only in SZ patients. Taking the RT into consideration, the RMET performances were impacted by different neurocognition domains. Our findings provide new evidence about how time consumption in mind-reading may impact the relationship between social cognition and neurocognition, and we discuss the potential importance of recording the response time during social cognition assessment in individuals with early psychosis.

A Developmental Perspective on Social-Cognition Difficulties in Youth at Clinical High Risk for Psychosis

After participating in this activity, learners should be better able to:• Evaluate the evolution of social cognitive abilities as a developmental process• Assess the evidence regarding social cognition difficulties in youth at clinical high risk for psychosisIndividuals at clinical high risk (CHR) for psychosis exhibit a broad range of difficulties, including impaired social cognition, which may represent a target for early identification and intervention. Several studies have examined various domains of social cognition in CHR individuals. Most focus on adolescent and young adult populations, but given the accumulating evidence that impairment exists before the onset of psychotic disorders, it is critically important to begin to look for these risk markers in younger children. The present article reviews 25 studies on CHR that examine any of the following four domains of social cognition: emotion processing, theory of mind, social perception, or attribution bias. Eligible studies were identified through a comprehensive literature search, conducted using electronic databases, including PubMed/MEDLINE and PsycINFO, and combinations of key social-cognition and CHR search terms. Despite some mixed results, the existing literature establishes that CHR individuals display social-cognitive impairment, though it remains unclear as to how and when that impairment develops. Thus, by using the literature on social cognition in typically developing children as a model and reference, and by looking at the evolution of social-cognitive abilities as a developmental process, our review presents a valuable new perspective that indicates the necessity of further investigation in younger, at-risk populations. Implications for treatment and future research are discussed.

Developmental trajectory of mismatch negativity and visual event-related potentials in healthy controls: Implications for neurodevelopmental vs. neurodegenerative models of schizophrenia

Sensory processing deficits are core features of schizophrenia, reflected in impaired generation of event-related potential (ERP) measures such as auditory mismatch negativity (MMN) and visual P1. To understand the potential time course of development of deficits in schizophrenia, we obtained MMN to unattended duration, intensity and frequency deviants, and visual P1 to attended LSF stimuli, in 43 healthy individuals ages 6 to 25years (mean 17), and compared results to data from 30 adult schizophrenia patients (mean age 38). We analyzed "time-domain" measures of amplitude and latency, and event-related spectral perturbation (ERSP, "time-frequency") to evaluate underlying neurophysiological mechanisms. Duration and intensity MMN amplitudes increased from childhood to late adolescence, while frequency MMN reached maximum amplitude during early development. As reported previously, in ERSP analyses, MMN activity corresponded primarily to theta-band (4-7Hz) activity, while responses to standards occurred primarily in alpha (8-12Hz) across age groups. Both deviant-induced theta and standard-induced alpha activity declined significantly with age for all deviant types. Likewise, visual P1 also showed an amplitude decline over development, reflecting a reduction in both evoked power and ITC. While MMN "difference" waveform ERP data suggest failure of maturation in schizophrenia, MMN ERSP analyses instead support a neurodegenerative process, as these isolate responses to deviants and standards, showing large low-frequency evoked power for both in children. Neurodegenerative processes are also supported by large visual P1 amplitudes and large low-frequency evoked power in children, in contrast with adult schizophrenia. Sensory processing deficits in schizophrenia may be related to accelerated synaptic pruning.

Effects of early trauma on psychosis development in clinical high-risk individuals and stability of trauma assessment across studies: a review

Early trauma (ET), though broadly and inconsistently defined, has been repeatedly linked to numerous psychological disturbances, including various developmental stages of psychotic disorders. The prodromal phase of psychosis highlights a unique and relevant population that provides insight into the critical periods of psychosis development. As such, a relatively recent research focus on individuals at clinical high risk (CHR) for psychosis reveals robust associations of early life trauma exposures with prodromal symptoms and function in these cohorts. While prevalence rates of ET in CHR cohorts remain consistently high, methodological measures of traumatic experiences vary across studies, presenting potential problems for reliability and validity of results. This review aims to 1) highlight the existing evidence identifying associations of ET, of multiple forms, with both symptom severity and transition rates to psychosis in CHR individuals, 2) present data on the variability among trauma assessments and its implications for conclusions about its relationship with clinical variables, 3) describe cognitive deficits common in CHR cohorts, including perceptual and neurocognitive impairments, and their neural correlates, that may modify the relationship of ET to symptoms, and 4) propose future directions for standardization of trauma assessment in CHR cohorts to better understand its clinical and cognitive correlates.

[A role of interactions between N-methyl-D-aspartate and dopamine receptors in facial emotion recognition impairment in schizophrenia]

AIM

To search for genetic mechanisms of facial emotion recognition (FER) impairment, one of the features of schizophrenia that affects social adaptation of patients. Based on the view implicating the interplay between dopaminergic and glutamatergic systems into the pathogenesis of schizophrenia, authors explored the interaction effects of the C366G polymorphism in the GRIN2B gene encoding NMDA receptor subunit NR2B with ANKK1/DRD2 Taq1A and 48-VNTR DRD4 polymorphisms on FER.

MATERIAL AND METHODS

GRIN2B -DRD2 interaction effects were studied in a sample of 237 patients and 235 healthy controls, GRIN2B - DRD4 in 268 patients and 208 controls.

RESULTS AND CONCLUSION

Both effects were significant in combined samples of patients and controls (GRIN2B X DRD2, F=4.12, p=0.043; GRIN2B X DRD4, F=6.43, p=0.012). Further analysis confirmed the interaction effect of GRIN2B and DRD2 polymorphisms on FER in patients with schizophrenia. In patients with a less efficient allele of the DRD2 in the absence of the minor allele of the GRIN2B C366G polymorphism, the results were close to normal values while patients with minor alleles of both polymorphisms showed the worst results. This finding is in line with the conceptions on a possible role of NMDA-receptor hypofunction and D2-mediated regulation of NMDA-receptor activity in FER impairments in schizophrenia.

Social cognition and paranoia in forensic inpatients with schizophrenia: A cross-sectional study

BACKGROUND

People diagnosed with schizophrenia have difficulties in emotion recognition and theory of mind, and these may contribute to paranoia. The aim of this study was to determine whether this relationship is evident in patients residing in a secure forensic setting.

METHOD

Twenty-seven male participants with a diagnosis of schizophrenia and a history of offending behaviour were assessed using The Awareness of Social Inference Test (TASIT), The Ambiguous Intentions Hostility Questionnaire (AIHQ) and The Green et al. Paranoid Thought Scales (G-PTS). Individuals were recruited from two medium secure and one high secure forensic hospital in Scotland.

RESULTS

Correlation, logistic and multiple regression analyses did not find that emotion recognition and theory of mind were associated with indices of paranoid thinking.

CONCLUSION

Social cognition did not appear to be related to indices of paranoia in this forensic sample. Although participants reported low levels of paranoia overall, the results are consistent with recent conclusions that theory of mind impairments are not specifically linked to paranoia in people diagnosed with schizophrenia.

The effect of cognitive remediation in individuals at ultra-high risk for psychosis: a systematic review

Cognitive deficits are prominent features of the ultra-high risk state for psychosis that are known to impact functioning and course of illness. Cognitive remediation appears to be the most promising treatment approach to alleviate the cognitive deficits, which may translate into functional improvements. This study systematically reviewed the evidence on the effectiveness of cognitive remediation in the ultra-high risk population. The electronic databases MEDLINE, PsycINFO, and Embase were searched using keywords related to cognitive remediation and the UHR state. Studies were included if they were peer-reviewed, written in English, and included a population meeting standardized ultra-high risk criteria. Six original research articles were identified. All the studies provided computerized, bottom-up-based cognitive remediation, predominantly targeting neurocognitive function. Four out of five studies that reported a cognitive outcome found cognitive remediation to improve cognition in the domains of verbal memory, attention, and processing speed. Two out of four studies that reported on functional outcome found cognitive remediation to improve the functional outcome in the domains of social functioning and social adjustment. Zero out of the five studies that reported such an outcome found cognitive remediation to affect the magnitude of clinical symptoms. Research on the effect of cognitive remediation in the ultra-high risk state is still scarce. The current state of evidence indicates an effect of cognitive remediation on cognition and functioning in ultra-high risk individuals. More research on cognitive remediation in ultra-high risk is needed, notably in large-scale trials assessing the effect of neurocognitive and/or social cognitive remediation on multiple outcomes.

Emotion recognition and social skills in child and adolescent offspring of parents with schizophrenia

INTRODUCTION

Emotion recognition, a social cognition domain, is impaired in people with schizophrenia and contributes to social dysfunction. Whether impaired emotion recognition emerges as a manifestation of illness or predates symptoms is unclear. Findings from studies of emotion recognition impairments in first-degree relatives of people with schizophrenia are mixed and, to our knowledge, no studies have investigated the link between emotion recognition and social functioning in that population.

METHODS

This study examined facial affect recognition and social skills in 16 offspring of parents with schizophrenia (familial high-risk/FHR) compared to 34 age- and sex-matched healthy controls (HC), ages 7-19.

RESULTS

As hypothesised, FHR children exhibited impaired overall accuracy, accuracy in identifying fearful faces, and overall recognition speed relative to controls. Age-adjusted facial affect recognition accuracy scores predicted parent's overall rating of their child's social skills for both groups.

CONCLUSIONS

This study supports the presence of facial affect recognition deficits in FHR children. Importantly, as the first known study to suggest the presence of these deficits in young, asymptomatic FHR children, it extends findings to a developmental stage predating symptoms. Further, findings point to a relationship between early emotion recognition and social skills. Improved characterisation of deficits in FHR children could inform early intervention.

Face Processing Measures of Social Cognition: A Dimensional Approach to Developmental Psychopathology

BACKGROUND

Social cognition impairments in neurodevelopmental disorders impact functioning. Face processing is the most extensively studied aspect of social cognition, commonly indexing this construct in neuropsychiatric disorders compared with typically developing youths. Applying social cognition measures as a Research Domain Criteria concept in the clinical arena requires establishing cutoffs for intervention and identifying vulnerability for psychopathology across disorders. This can be accomplished by comparing extreme performers across multiple clinical symptom features.

METHODS

The Philadelphia Neurodevelopmental Cohort (N = 9498), a community sample of youths (8-21 years old), was assessed with a structured interview (Kiddie Schedule for Affective Disorders and Schizophrenia). The Penn Computerized Neurocognitive Battery was administered measuring accuracy and response time on Executive, Episodic Memory, Complex Cognition, and Social Cognition domains. We parsed participants by performance on social cognition into tertiles and examined their neurocognitive and clinical profiles.

RESULTS

The top social cognition group outperformed the bottom group in face memory and complex reasoning. Concerning symptoms, the top performing group did not differ from the middle group, but the bottom performing group had higher externalizing and psychosis symptoms. There were sex differences in social cognition and symptom profiles but no sex × performance or sex × diagnosis × domain interactions.

CONCLUSIONS

Social cognition is supported by strong face memory and complex reasoning skills. Poor performance portends more severe externalizing and psychosis symptoms. That average performance is sufficient for normative symptomatology suggests that interventions aimed at ameliorating social cognition deficits, as measured here, could be effective in normalizing level of symptoms.

Emotion processing deficits in the different dimensions of psychometric schizotypy

Schizotypy refers to a personality structure indicating "proneness" to schizophrenia. Around 10% of the general population has increased schizotypal traits, they also share other core features with schizophrenia and are thus at heightened risk for developing schizophrenia and spectrum disorders. A key aspect in schizophrenia-spectrum pathology is the impairment observed in emotion-related processes. This review summarizes findings on impairments related to central aspects of emotional processes, such as emotional disposition, alexithymia, facial affect recognition and speech prosody, in high schizotypal individuals in the general population. Although the studies in the field are not numerous, the current findings indicate that all these aspects of emotional processing are deficient in psychometric schizotypy, in accordance to the schizophrenia-spectrum literature. A disturbed frontotemporal neural network seems to be the critical link between these impairments, schizotypy and schizophrenia. The limitations of the current studies and suggestions for future research are discussed.

Psychosis prediction in secondary mental health services. A broad, comprehensive approach to the "at risk mental state" syndrome

BACKGROUND

Accuracy of risk algorithms for psychosis prediction in "at risk mental state" (ARMS) samples may differ according to the recruitment setting. Standardized criteria used to detect ARMS individuals may lack specificity if the recruitment setting is a secondary mental health service. The authors tested a modified strategy to predict psychosis conversion in this setting by using a systematic selection of trait-markers of the psychosis prodrome in a sample with a heterogeneous ARMS status.

METHODS

138 non-psychotic outpatients (aged 17-31) were consecutively recruited in secondary mental health services and followed-up for up to 3 years (mean follow-up time, 2.2 years; SD=0.9). Baseline ARMS status, clinical, demographic, cognitive, and neurological soft signs measures were collected. Cox regression was used to derive a risk index.

RESULTS

48% individuals met ARMS criteria (ARMS-Positive, ARMS+). Conversion rate to psychosis was 21% for the overall sample, 34% for ARMS+, and 9% for ARMS-Negative (ARMS-). The final predictor model with a positive predictive validity of 80% consisted of four variables: Disorder of Thought Content, visuospatial/constructional deficits, sensory-integration, and theory-of-mind abnormalities. Removing Disorder of Thought Content from the model only slightly modified the predictive accuracy (-6.2%), but increased the sensitivity (+9.5%).

CONCLUSIONS

These results suggest that in a secondary mental health setting the use of trait-markers of the psychosis prodrome may predict psychosis conversion with great accuracy despite the heterogeneity of the ARMS status. The use of the proposed predictive algorithm may enable a selective recruitment, potentially reducing duration of untreated psychosis and improving prognostic outcomes.

Contribution of oxytocin receptor polymorphisms to amygdala activation in schizophrenia spectrum disorders

BACKGROUND

Oxytocin has been proposed to mediate amygdala dysfunction associated with altered emotion processing in schizophrenia, but the contribution of oxytocin pathway genes is yet to be investigated.

AIMS

To identify potential different contributions of three oxytocin receptor polymorphisms (rs53576, rs237902 and rs2254298) between patients with schizophrenia spectrum disorders (SCZ), affective spectrum disorders (AD) and healthy controls (HC).

METHOD

In a total of 346 participants (104 with SCZ, 100 with AD, and 142 HC) underwent genotyping and functional magnetic resonance imaging (fMRI) during an emotional faces matching paradigm. Genetic association analyses were performed to test the possible effects on task-induced BOLD amygdala response to fearful/angry faces.

RESULTS

In participants with SCZ, the rs237902 G allele was associated with low amygdala activation (left hemisphere: b=-4.99, Bonferroni corrected P=0.04) and interaction analyses showed that this association was disorder specific (left hemisphere: Bonferroni corrected P=0.003; right hemisphere: Bonferroni corrected P=0.03). There were no associations between oxytocin polymorphisms and amygdala activation in the total sample, among AD patients or HC.

CONCLUSIONS

Rs237902 was associated with amygdala activation in response to fearful/angry faces only in patients with SCZ. Our findings indicate that the endogenous oxytocin system could serve as a contributing factor in biological underpinnings of emotion processing and that this contribution is disorder specific.

DECLARATION OF INTEREST

O.A.A. received speaker's honoraria from GSK, Otsuka, Lundbeck.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Neurocognitive profile in psychotic versus nonpsychotic individuals with 22q11.2 deletion syndrome

The 22q11.2 deletion syndrome (22q11DS) is associated with increased rates of psychotic disorders and cognitive deficits, but large scale studies are needed to elucidate their interaction. The objective of this two-center study was to identify the neurocognitive phenotype of individuals with 22q11DS and psychotic disorders. We hypothesized that psychotic 22q11DS individuals compared to nonpsychotic deleted individuals would have more severe neurocognitive deficits, especially in executive function and social cognition. These deficits would be present when compared to IQ- matched individuals with Williams Syndrome (WS). Three groups were ascertained from the Tel Aviv and Philadelphia centers: 22q11DS individuals with a psychotic disorder (n=31), nonpsychotic 22q11DS (n=86) and typically-developing controls (TD, n=828). In Tel Aviv a group of individuals with WS (n=18) matched in IQ to the 22q11DS psychotic group was also included. The Penn Computerized Neurocognitive Battery (CNB) was used to assess a wide-range of cognitive functions and all patients underwent structured psychiatric evaluations. 22q11DS individuals performed poorly on all CNB domains compared to TD. Participants with 22q11DS and psychosis, compared to nonpsychotic 22q11DS, had more severe deficits in global neurocognitive performance (GNP), executive function, social cognition and episodic memory domains. The primary deficits were also significant when comparing the Tel Aviv 22q11DS psychotic group to IQ-matched individuals with WS. In conclusion, 22q11DS individuals with a psychotic disorder have specific neurocognitive deficits that are reliably identified cross nationality using the CNB. These cognitive dysfunctions should be further studied as potential endophenotypes of psychosis in 22q11DS and as targets for intervention.

Emotional Experiences Predict the Conversion of Individuals with Attenuated Psychosis Syndrome to Psychosis: A 6-Month Follow up Study

The present study explored the conversion rate in individuals with Attenuated Psychosis Syndrome (APS) and potential predictor for transition in mainland China. Sixty-three participants identified as APS were followed up 6 months later. The results showed that 17% of individuals with APS converted to full-blown psychosis. The converters exhibited significantly poorer emotional experience and expression than the non-converters at baseline. A further binary logistic regression analysis showed that emotional experience could predict the transition (Wald = 4.18, p = 0.041, 95% CI = 1.04~6.82). The present study suggests an important role of emotional processing in the prediction of the development of full-blown psychosis.

Facial affect recognition in early and late-stage schizophrenia patients

Prior studies have shown deficits in social cognition and emotion perception in first-episode psychosis (FEP) and multi-episode schizophrenia (MES) patients. These studies compared patients at different stages of the illness with only a single control group which differed in age from at least one clinical group. The present study provides new evidence of a differential pattern of deficit in facial affect recognition in FEP and MES patients using a double age-matched control design. Compared to their controls, FEP patients only showed impaired recognition of fearful faces (p=.007). In contrast to this, the MES patients showed a more generalized deficit compared to their age-matched controls, with impaired recognition of angry, sad and fearful faces (ps<.01) and an increased misattribution of emotional meaning to neutral faces. PANSS scores of FEP patients on Depressed factor correlated positively with the accuracy to recognize fearful expressions (r=.473). For the MES group fear recognition correlated positively with negative PANSS factor (r=.498) and recognition of sad and neutral expressions was inversely correlated with disorganized PANSS factor (r=-.461 and r=-.541, respectively). These results provide evidence that a generalized impairment of affect recognition is observed in advanced-stage patients and is not characteristic of the early stages of schizophrenia. Moreover, the finding that anomalous attribution of emotional meaning to neutral faces is observed only in MES patients suggests that an increased attribution of salience to social stimuli is a characteristic of social cognition in advanced stages of the disorder.

Neural Substrates of Auditory Emotion Recognition Deficits in Schizophrenia

Deficits in auditory emotion recognition (AER) are a core feature of schizophrenia and a key component of social cognitive impairment. AER deficits are tied behaviorally to impaired ability to interpret tonal ("prosodic") features of speech that normally convey emotion, such as modulations in base pitch (F0M) and pitch variability (F0SD). These modulations can be recreated using synthetic frequency modulated (FM) tones that mimic the prosodic contours of specific emotional stimuli. The present study investigates neural mechanisms underlying impaired AER using a combined event-related potential/resting-state functional connectivity (rsfMRI) approach in 84 schizophrenia/schizoaffective disorder patients and 66 healthy comparison subjects. Mismatch negativity (MMN) to FM tones was assessed in 43 patients/36 controls. rsfMRI between auditory cortex and medial temporal (insula) regions was assessed in 55 patients/51 controls. The relationship between AER, MMN to FM tones, and rsfMRI was assessed in the subset who performed all assessments (14 patients, 21 controls). As predicted, patients showed robust reductions in MMN across FM stimulus type (p = 0.005), particularly to modulations in F0M, along with impairments in AER and FM tone discrimination. MMN source analysis indicated dipoles in both auditory cortex and anterior insula, whereas rsfMRI analyses showed reduced auditory-insula connectivity. MMN to FM tones and functional connectivity together accounted for ∼50% of the variance in AER performance across individuals. These findings demonstrate that impaired preattentive processing of tonal information and reduced auditory-insula connectivity are critical determinants of social cognitive dysfunction in schizophrenia, and thus represent key targets for future research and clinical intervention.

SIGNIFICANCE STATEMENT

Schizophrenia patients show deficits in the ability to infer emotion based upon tone of voice [auditory emotion recognition (AER)] that drive impairments in social cognition and global functional outcome. This study evaluated neural substrates of impaired AER in schizophrenia using a combined event-related potential/resting-state fMRI approach. Patients showed impaired mismatch negativity response to emotionally relevant frequency modulated tones along with impaired functional connectivity between auditory and medial temporal (anterior insula) cortex. These deficits contributed in parallel to impaired AER and accounted for ∼50% of variance in AER performance. Overall, these findings demonstrate the importance of both auditory-level dysfunction and impaired auditory/insula connectivity in the pathophysiology of social cognitive dysfunction in schizophrenia.

Social cognition as an RDoC domain

While the bulk of research into neural substrates of behavior and psychopathology has focused on cognitive, memory and executive functions, there has been a recent surge of interest in emotion processing and social cognition, manifested in designating Social Cognition as a major RDoC domain. We describe the origins of this field's influence on cognitive neuroscience and highlight the most salient findings leading to the characterization of the "social brain" and the establishments of parameters that quantify normative and aberrant behaviors. Such parameters of behavior and neurobiology are required for a potentially successful RDoC construct, especially if heritability is established, because of the need to link with genomic systems. We proceed to illustrate how a social cognition measure can be used within the RDoC framework by presenting a task of facial emotion identification. We show that performance is sensitive to normative individual differences related to age and sex and to deficits associated with schizophrenia and other psychotic disorders. Neuroimaging studies with this task demonstrate that it recruits limbic and frontal regulatory activation in healthy samples as well as abnormalities in psychiatric populations. Evidence for its heritability was documented in genomic family studies and in patients with the 22q11.2 deletion syndrome. Measures that meet such criteria can help build translational bridges between cellular molecular mechanisms and behavior that elucidate aberrations related to psychopathology. Such links will transcend current diagnostic classifications and ultimately lead to a mechanistically based diagnostic nomenclature. Establishing such bridges will provide the elements necessary for early detection and scientifically grounded intervention.

Social Cognition in Individuals at Ultra-High Risk for Psychosis: A Meta-Analysis

Objective

Treatment in the ultra-high risk stage for a psychotic episode is critical to the course of symptoms. Markers for the development of psychosis have been studied, to optimize the detection of people at risk of psychosis. One possible marker for the transition to psychosis is social cognition. To estimate effect sizes for social cognition based on a quantitative integration of the published evidence, we conducted a meta-analysis of social cognitive performance in people at ultra high risk (UHR).

Methods

A literature search (1970-July 2015) was performed in PubMed, PsychINFO, Medline, Embase, and ISI Web of Science, using the search terms ‘social cognition’, ‘theory of mind’, ‘emotion recognition’, ‘attributional style’, ‘social knowledge’, ‘social perception’, ‘empathy’, ‘at risk mental state’, ‘clinical high risk’, ‘psychosis prodrome’, and ‘ultra high risk’. The pooled effect size (Cohen’s D) and the effect sizes for each domain of social cognition were calculated. A random effects model with 95% confidence intervals was used.

Results

Seventeen studies were included in the analysis. The overall significant effect was of medium magnitude (d = 0.52, 95% Cl = 0.38–0.65). No moderator effects were found for age, gender and sample size. Sub-analyses demonstrated that individuals in the UHR phase show significant moderate deficits in affect recognition and affect discrimination in faces as well as in voices and in verbal Theory of Mind (TOM). Due to an insufficient amount of studies, we did not calculate an effect size for attributional bias and social perception/ knowledge. A majority of studies did not find a correlation between social cognition deficits and transition to psychosis, which may suggest that social cognition in general is not a useful marker for the development of psychosis. However some studies suggest the possible predictive value of verbal TOM and the recognition of specific emotions in faces for the transition into psychosis. More research is needed on these subjects.

Conclusion

The published literature indicates consistent general impairments in social cognition in people in the UHR phase, but only very specific impairments seem to predict transition to psychosis.

Auditory dysfunction in schizophrenia: integrating clinical and basic features

Schizophrenia is a complex neuropsychiatric disorder that is associated with persistent psychosocial disability in affected individuals. Although studies of schizophrenia have traditionally focused on deficits in higher-order processes such as working memory and executive function, there is an increasing realization that, in this disorder, deficits can be found throughout the cortex and are manifest even at the level of early sensory processing. These deficits are highly amenable to translational investigation and represent potential novel targets for clinical intervention. Deficits, moreover, have been linked to specific structural abnormalities in post-mortem auditory cortex tissue from individuals with schizophrenia, providing unique insights into underlying pathophysiological mechanisms.