Responses to facial emotion and psychopathology

Usability of a Psychotherapeutic Interactive Gaming Tool Used in Facial Emotion Recognition for People with Schizophrenia

The objective of the study was to test the usability of ‘Feeling Master’ as a psychotherapeutic interactive gaming tool with LEGO cartoon faces showing the five basic emotions, for the assessment of emotional recognition in people with schizophrenia in comparison with healthy controls, and the relationship between face affect recognition (FER), attributional style, and theory of mind (ToM), which is the ability to understand the potential mental states and intentions of others. Nineteen individuals with schizophrenia (SZ) and 17 healthy control (HC) subjects completed the ‘Feeling Master’ that includes five basic emotions. To assess social cognition, the group with schizophrenia was evaluated with the Personal and Situational Attribution Questionnaire (IPSAQ) for the assessment of attributional style and the Hinting Task (ToM). Patients with SZ showed significant impairments in emotion recognition and their response time appeared to be slower than the HC in the recognition of each emotion. Taking into account the impairment in the recognition of each emotion, we only found a trend toward significance in error rates on fear recognition. The correlations between correct response on the ‘Feeling Master’ and the hinting task appeared to be significant in the correlation of surprise and theory of mind. In conclusion, this study demonstrated that the ‘Feeling Master’ could be useful for the evaluation of FER in people with schizophrenia. These results sustain the notion that impairments in emotion recognition are more prevalent in people with schizophrenia and that these are related with impairment in ToM.

Deficits in Early Stages of Face Processing in Schizophrenia: A Systematic Review of the P100 Component

INTRODUCTION

Schizophrenia is associated with deficits in face and affect recognition, which contribute to broader social functioning deficits. The present aim was to conduct a meta-analysis of early face processing in schizophrenia, as indexed by the P100 event-related potential component.

METHODS

Twelve studies (n = 328 patients with schizophrenia, n = 330 healthy controls) of the P100 component during face processing were evaluated by calculating Cohen's d for each study and overall weighted mean effect size (ES). In additional exploratory analyses, moderating influences of method and design were investigated, and the P100 component during face processing was evaluated based on valence: 5 studies (n = 225 patients, n = 225 controls) included neutral stimuli, 5 studies (n = 225 patients, n = 225 controls) included happy stimuli, and 4 studies (n = 209 patients, n = 209 controls) included fearful stimuli.

RESULTS

The amplitude of the P100 to face stimuli was smaller in patients relative to controls (ES = .41, P < .01). Methodological or design differences did not account for heterogeneity in ES. When split by valence, results indicate smaller P100 in patients relative to control subjects in response to neutral (ES = .32, P < .001) and happy (ES = .21, P < .05) stimuli, whereas there was no difference in response to fearful faces (ES = .09, P > .05).

DISCUSSION

The results indicate that P100 amplitude in response to faces is smaller in patients with schizophrenia, showing that socially relevant visual processing deficits begin earlier in processing than previously suggested. Additionally, the exploratory analyses suggest emotional specificity in these deficits. Ramifications for our understanding of face processing deficits and treatment development are discussed.

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

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

Eye Movement during Facial Affect Recognition by Patients with Schizophrenia, Using Japanese Pictures of Facial Affect

A possible relationship between recognition of facial affect and aberrant eye movement was examined in patients with schizophrenia. A Japanese version of standard pictures of facial affect was prepared. These pictures of basic emotions (surprise, anger, happiness, disgust, fear, sadness) were shown to 19 schizophrenic patients and 20 healthy controls who identified emotions while their eye movements were measured. The proportion of correct identifications of ‘disgust’ was significantly lower for schizophrenic patients, their eye fixation time was significantly longer for all pictures of facial affect, and their eye movement speed was slower for some facial affects (surprise, fear, and sadness). One index, eye fixation time for “happiness,” showed a significant difference between the high- and low-dosage antipsychotic drug groups. Some expected facial affect recognition disorder was seen in schizophrenic patients responding to the Japanese version of affect pictures, but there was no correlation between facial affect recognition disorder and aberrant eye movement.

Emotion recognition in Chinese people with schizophrenia

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

Disordered emotional processing in schizophrenia and one-sided brain damage

The work concentrates on the problem of human emotions in healthy and pathologically changed brains, mainly in persons afflicted with schizophrenia or with organic impairments localized in one of the cerebral hemispheres. This chapter presents the state of current knowledge concerning the hemispheric lateralization of emotions among healthy people, psychiatric patients, and patients with one-sided brain lesion, on the basis of clinical observations, the results of experimental work, and the newest neuroimaging techniques. The numerous experiments and scientific methods used to assess the hemispheric lateralization of emotions and the discrepancies in their results point toward a lack of consistent theory in the field of hemispheric specialization in the regulation of emotional processes. Particular scientific interest was taken in the emotions of persons afflicted with schizophrenia, either in its early or late stages. This was inspired by the emotional behavior of schizophrenic patients on a psychiatric ward and their ability to perceive and express emotions during various stages of the schizophrenic process. In order to examine the cerebral manifestations of emotional deficits and the specialization of cerebral hemispheres for emotional processes, the author has described the emotional behavior of patients with unilateral cerebral stroke, i.e., patients with damage to the right or left cerebral hemisphere. Overall, the inferior performance of emotional tasks by right-hemisphere-damaged patients compared to other groups might support right-hemisphere superiority for affect perception despite variations in the stimuli used.

A special role of negative emotion in children and adolescents with schizophrenia and other psychoses

Emotional impairments are apparent at an early stage in schizophrenia. While emotion processing has been studied intensively in adult patients, investigations focusing on children and adolescents with psychoses are rare. Emotion probes for mood induction and emotion discrimination that have been standardized in healthy subjects and applied to adult schizophrenia patients were evaluated in young patients (11-20 years). Twenty children and adolescents with schizophrenia and other psychotic disorders as well as twenty healthy volunteers matched for age, gender and parental education were examined. Results reveal successful mood induction in both patients and healthy volunteers, but with more negative affect prominent in patients. While a reduced ability to discriminate negative emotional faces emerged in patients than in controls, this difference failed to reach statistical significance. The similarities between test results of children and adolescents compared with those of adults demonstrate that both tests proved to be useful when applied to younger ages. Negative affect seems to be differentially affected, a finding that which may be already evident in the early course of schizophrenia.

A reversal of the normal pattern of parahippocampal response to neutral and fearful faces is associated with reality distortion in schizophrenia

BACKGROUND

Individuals with schizophrenia demonstrate impaired recognition of facial expressions and may misattribute emotional salience to otherwise nonsalient stimuli. The neural mechanisms underlying this deficit and the relationship with different symptoms remain poorly understood.

METHODS

We used event-related functional magnetic resonance imaging to measure neural responses to neutral, mildly fearful, and prototypically fearful facial expressions. The sample included 15 medicated individuals with chronic schizophrenia (SZ) and 11 healthy control individuals (CON), matched for gender (all male), age, and years of education.

RESULTS

A repeated measures 3 x 2 analysis of variance (ANOVA) revealed a significant interaction between expression intensity and group in right parahippocampal gyrus (p < .01). Individuals with chronic schizophrenia demonstrated a decrease, whereas CON showed an increase, in right parahippocampal gyrus response to increasingly fearful expressions. Between-group comparison revealed greater activation in SZ than CON in right parahippocampal gyrus to neutral faces. The reality distortion dimension, but not neuroleptic medication dose, was positively associated with the right parahippocampal gyral and right amygdalar response to neutral faces in SZ.

CONCLUSIONS

An abnormally increased parahippocampal response to neutral faces was positively associated with reality distortion in SZ. This may underlie the previously reported finding of a misattribution of emotional salience to nonsalient social stimuli in schizophrenia.

Greater impairment in negative emotion evaluation ability in patients with paranoid schizophrenia

To explore whether or not patients with schizophrenia display a more profound impairment of negative emotion processing, we assessed the implicit evaluation of positive and negative emotional stimuli. Twenty patients with schizophrenia (9 paranoid, 11 non-paranoid) and 22 normal controls were instructed to classify emotional pictures according to the intrinsic valence if the pictures were black and white. If the stimuli were color-filtered, participants were instructed to press the positive/negative response key according to the extrinsic valence (assigned valence of color). The error rates of the color-filtered stimuli were used as dependent measures. Normal controls made more errors on trials of the positive pictures when the correct response was the negative response key than when the correct response was the positive response key. The reverse was true on trials of the negative pictures. Patients with schizophrenia, especially paranoid schizophrenia, committed more errors in trials of the positive pictures when the correct response key was the negative response key. However, the reverse was not true on trials of the negative pictures. These findings suggest that patients with paranoid schizophrenia might suffer from an impaired ability to evaluate negative emotions and have a loosening of association within their negative emotional networks.

Emotional information processing in violent patients with schizophrenia: association with psychopathy and symptomatology

Schizophrenia and psychopathy have been independently shown to be associated with deficits in the recognition of facial expressions. These disorders are highly co-morbid in forensic settings, and both are associated with aggressive behaviour. This study examines the relative contribution of psychopathic traits and psychotic symptoms to reported deficits in facial affect recognition in forensic patients with schizophrenia. Fifty-four male patients with schizophrenia were recruited from medium and high security hospitals. Participants were categorised into groups with high (HP), medium (MP) and low (LP) scores on the Psychopathy Checklist: Screening Version and based on symptomatology assessed using the Positive and Negative Syndrome Scale. Participants completed an animated facial affect recognition task assessing accuracy across the six basic emotions over high and low intensities. The HP group was found to have impaired recognition of sadness at low intensity compared with the LP group. In the overall sample, facial affect recognition for negatively valenced emotions was not related to positive or negative symptom scores. However, recognition accuracy for disgust was found to be negatively related to the severity of cognitive symptoms. Patients with high psychopathy scores and schizophrenia showed similar deficits in emotional information processing to those reported in the literature in non-psychotic psychopathic samples.

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

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

Emotion recognition via facial expression and affective prosody in schizophrenia: a methodological review

Disturbances in affect recognition may be one of the most pervasive and serious aspects of the schizophrenic patient's interpersonal problems. Interest in the decoding of emotional information in schizophrenia has focused on facial affect recognition with 29 experimental papers on that topic published since 1987. A smaller literature exists on the topic of recognition of affect in speech and there are at least seven studies, which have examined both face and voice perception in the same individuals with schizophrenia. This paper includes a comprehensive analysis of the schizophrenia facial affect recognition research over the past decade and the schizophrenia literature on affective prosody, and provides the first review of the schizophrenia literature on multichannel emotion recognition research. The weight of evidence would suggest that individuals with schizophrenia experience problems in the perception of emotional material; however, the specificity, extent, and nature of the deficits are unclear. Emotion recognition research in schizophrenia should be informed by the general literature on emotion recognition with serious attention paid to methodological issues.

Visual scanpaths to positive and negative facial emotions in an outpatient schizophrenia sample

We used a psychophysiological marker of visual attention (visual scanpath) to investigate facial emotion processing in schizophrenia (n= 65) and healthy control (n = 61) groups. Visual scanpaths to 'happy', *sad' and 'neutral' faces (two exposures each) were recorded using video-oculography. Emotion recognition accuracy was assessed under both 'difficult' (exposure 1) and 'limited choice' (exposure 2) conditions. Compared to controls, schizophrenia subjects showed 'restricted' scanning and reduced attention to salient facial features (eyes, nose, mouth), that was particularly apparent for happy and neutral faces: accuracy was correspondingly reduced for the 'difficult' condition. The schizophrenia deficit in positive emotion perception may reflect a failure to integrate salient features due to dysfunctions in local processing of detailed, relevant information (fewer fixations, less attention to facial features), and in the networks that synchronise local and global processing of biologically-relevant face stimuli (generally restricted scanning style).

Selective attention to facial emotion and identity in schizophrenia

The selective attention to facial emotion and identity was investigated in 12 patients with schizophrenia and 12 healthy participants. Both patients and controls were required to perform two classification tasks (according either to identity or emotion). Two separate values for identity (person A/person B) and for emotion (fear/anger) were used. When the classification task was on one dimension, the other dimension was either correlated, constant, or orthogonal (Garner WR. The Processing of Information and Structure. Potomac, MD: Erlbaum, 1974, Garner WR. Interaction of stimulus dimensions in concept and choice processes. Cognitive Psychology 1976;8:98-123). Results indicated that both patients and healthy participants had an asymmetrical pattern of performance: they were able to selectively attend to the identity of the face presented, regardless of the emotion expressed on the face, but variation in identity interfered with the classification of facial emotion. Moreover, a correlational study indicated that the identity interference on emotion classification for schizophrenic patients covaried with the severity of their negative symptoms. The selective attention competencies in schizophrenia and the independence hypothesis of emotion and face recognition are discussed in the framework of current face recognition models.

Nonverbal social perception and symptomatology in schizophrenia

This study examined the relationship between nonverbal social perception and symptomatology in schizophrenia. Schizophrenic patients (n=28) and normal controls (n=28) were given the profile of nonverbal sensitivity test (PONS). Patients' symptoms were rated with the brief psychiatric rating scale (BPRS). Schizophrenic subjects performed significantly more poorly than normal subjects in their ability to decode nonverbal cues. In addition, normal subjects improved their accuracy significantly more than patients when provided with additional cues per scene to decode. The patients' total PONS score was not significantly correlated with the BPRS summary scores for positive or negative symptoms, but was significantly correlated with the individual positive symptom of conceptual disorganization. Subjects classified as having paranoid schizophrenia (n=11) on the basis of chart diagnoses performed significantly better on the PONS than did undifferentiated schizophrenic subjects (n=13). The discussion reviews how these results contribute to our understanding of social deficits in schizophrenia.

EEG-correlates of facial affect recognition and categorisation of blurred faces in schizophrenic patients and healthy volunteers

The ability to recognise emotional expressions of faces and the ability to categorise blurred and non-blurred faces and complex objects was tested in 16 schizophrenic in-patients and 16 healthy volunteers. EEGs were recorded during performance of the tasks and event-related potentials were compared between groups. Patients performed worse than healthy volunteers in recognition of facial affect but not in categorisation of blurred faces. Furthermore, within a 180-250ms latency range patients showed reduced amplitudes during affect recognition compared with controls but not during categorisation of blurred faces. Amplitudes recorded at frontal electrode sites were associated with performance in facial affect recognition. These results provide a first clue to the neurophysiological basis of the widely reported facial affect recognition deficit in schizophrenic patients.

Effects of lesion variables and emotion type on the perception of facial emotion

The purpose of this study was to consider the effects of valence, motoric direction (i.e., approach/withdrawal), and arousal on the perception of facial emotion in patients with unilateral cortical lesions. We also examined the influence of lesion side, site, and size on emotional perception. Subjects were 30 right-hemisphere-damaged (RHD) and 30 left-hemisphere-damaged (LHD) male patients with focal lesions restricted primarily to the frontal, temporal, or parietal lobe. Patient groups were comparable on demographic and clinical neurological variables. Subjects were tested for their ability to match photographs of four facial emotional expressions: happiness, sadness, fear, and anger. Overall, RHD patients were significantly more impaired than LHD patients in perceiving facial emotion. Lesion side, but not site, was associated with motoric direction and valence dimensions. RHD patients had specific deficits relative to LHD patients in processing negative and withdrawal emotions; there were no group differences for positive/approach emotions. Lesion size was not significantly correlated with accuracy of emotional perception.

Generality and specificity of emotion-recognition deficit in schizophrenic patients with positive and negative symptoms

Schizophrenic patients with positive and negative symptoms, as well as non-patient control subjects, were asked to recognize emotional stimuli of happy, sad, and neutral facial expressions. Dependent measures were the percentage of correct responses, and the incorrect use of an emotion category owing to false recognition. Schizophrenic patients with negative symptoms exhibited a generalized emotion-recognition deficit, and their use of emotion categories during false recognition was random. Schizophrenic patients with positive symptoms showed a deficit in their recognition of 'sad' emotion and were 'positively biased' to the category 'happy' as reflected by its most frequent usage during false recognition.

Positive and negative affect recognition in schizophrenia: a comparison with substance abuse and normal control subjects

This study had three aims: to compare a schizophrenia sample (n = 50) with a substance abuse (n = 25) and normal sample (n = 81) on affect recognition; to compare differences in their performance between positive and negative affect recognition; and to introduce a new videotape method of stimulus presentation. Subjects were asked to identify the predominant affect depicted in 21 5-10-s vignettes containing three trials of seven affect states. Results demonstrate significant group differences: normal subjects scored in the normal or mild range, substance abuse (s/a) subjects scored in the mild and moderate ranges, and the schizophrenia sample scored predominantly in the moderate to severe ranges. Accuracies were 92.3% for the normal sample, 77.2 for the s/a sample and 64.8 for the schizophrenia sample. Response dispersions were 97.6% for the schizophrenia group, 69% for the s/a sample and 38% in the normal sample. A repeated measures ANOVA revealed a group by type of affect interaction with schizophrenia subjects showing far greater differential impairment on negative affect recognition. Difficulty of item did not contribute to this difference. Test-retest reliability at 5 months for this new method was r = 0.76, and stability of categorization was very high over 5 months (weighted kappa = 0.93). These affect recognition deficits in schizophrenia are discussed as they relate to lateralization of brain function, high EE families, social skills impairment and implications for rehabilitation services.

Emotion-specific processing deficit in focal brain-damaged patients

Focal brain-damaged patients (left hemisphere damage, right hemisphere damage) and hospitalized general medical patients were asked to sort test photographs into target expressions of four facial emotions, happy, sad, fear and anger. In a second task, patients were asked to match neutral photographs with these target emotion expressions in a forced-choice format. Patients were also asked to rate their mood state on a two-dimensional affect grid. Right hemisphere-damaged patients were significantly inaccurate in matching the test-target expressions of facial emotions in comparison to left hemisphere-damaged or general medical patients. Analysis of error scores indicated a bias toward negative emotions by left hemisphere-damaged patients. Congruent to their mood state, left hemisphere-damaged patients also attributed "sadness" on neutral state of expression significantly more often than in right hemisphere-damaged patients.

Facial affect recognition in the course of schizophrenia

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

Proximal spacing to facial affect expressions in schizophrenia

Schizophrenics (N = 40), depressives (N = 36), anxiety neurotics (N = 35), and nonpatient controls (N = 60) were asked to walk forward from a distance of 10 feet to a distance comfortable for possible interaction with facial expressions of six affects and a neutral state, depicted in life-sized images. Schizophrenics demanded significantly greater proximal space than other groups to interact with facial affect expressions, especially the nonaroused ones (happy, sad, neutral state). Multiple discriminant analysis of the "comfortable interaction distance" data revealed that schizophrenic persons may be discriminated with moderate accuracy (52.5%) from other groups.

Paralinguistic characteristics of speech in schizophrenics and depressives

Schizophrenics, depressives, patients with anxiety neurosis and normal controls were asked to comment freely for 2 min on photographs depicting seven facial emotional expressions. Schizophrenics commented for the shortest duration of time with characteristic vocalization; depressives' speech was characterized by low initiative time latency, greater duration of utterance but fewer word-counts.