Perception of socially relevant stimuli in schizophrenia

Implicit and explicit processing of bodily emotions in schizophrenia

INTRODUCTION

Disturbed emotion processing is well documented in schizophrenia, but the majority of studies evaluate processing of emotion only from facial expressions. Social cues are also communicated via body posture, and they are similarly relevant for successful social interactions. The aim of the current study was to thoroughly examine body perception abilities in individuals with schizophrenia.

METHODS

Fifty-nine patients with schizophrenia and 37 healthy controls completed two tasks of body processing. The first, which was based on the Affect Misattribution Procedure, evaluated implicit processing of bodily emotions, and the second utilised a traditional emotion identification paradigm to assess explicit emotion recognition.

RESULTS

Results revealed aberrant implicit processing, but more normative explicit processing, in individuals with schizophrenia. Moderate associations were found between processing of bodies and symptoms of paranoia. Performance on the tasks was not related to cognitive functioning but was associated with clinician-rated social functioning.

CONCLUSIONS

Collectively, these results provide information about disturbed processing of bodily emotions in schizophrenia and suggest that these disturbances are associated with the severity of positive symptoms and predict difficulties in everyday social activities and interpersonal relationships.

Intact prioritisation of unconscious face processing in schizophrenia

INTRODUCTION

Faces provide a rich source of social information, crucial for the successful navigation of daily social interactions. People with schizophrenia suffer a wide range of social-cognitive deficits, including abnormalities in face perception. However, to date, studies of face perception in schizophrenia have primarily employed tasks that require patients to make judgements about the faces. It is, thus, unclear whether the reported deficits reflect an impairment in encoding visual face information, or biased social-cognitive evaluative processes.

METHODS

We assess the integrity of early unconscious face processing in 21 out-patients diagnosed with Schizophrenia or Schizoaffective Disorder (15M/6F) and 21 healthy controls (14M/7F). In order to control for any direct influence of higher order cognitive processes, we use a behavioural paradigm known as breaking continuous flash suppression (b-CFS), where participants simply respond to the presence and location of a face. In healthy adults, this method has previously been used to show that upright faces gain rapid and privileged access to conscious awareness over inverted faces and other inanimate objects.

RESULTS

Here, we report similar effects in patients, suggesting that the early unconscious stages of face processing are intact in schizophrenia.

CONCLUSION

Our data indicate that face processing deficits reported in the literature must manifest at a conscious stage of processing, where the influence of mentalizing or attribution biases might play a role.

Improving emotion recognition in schizophrenia with "VOICES": An on-line prosodic self-training

Introduction

Emotion recognition (ER) deficits have been extensively demonstrated in schizophrenia. These deficiencies are not only restricted to facial emotion recognition but also include emotional prosody (tone of the voice) recognition deficits. They have been significantly associated with symptom severity and poor social functioning. The aim of this study was to test the efficacy, in real clinical conditions, of an online self-training prosodic game included in the Social Cognition rehabilitation program e-Motional Training.

Method

A randomized, single-blind multicenter clinical trial was conducted with 50 outpatients with schizophrenia or schizoaffective disorder. The control group was treated with Treatment-as-usual (TAU), based on drug therapy, case management and individual and group psychotherapy (not focused on Social Cognition). The intervention group was treated with TAU plus the employment of Voices, an online self-training program devised for prosodic rehabilitation.

Statistical analysis

Linear regression was used to evaluate the effectiveness of the intervention in emotion recognition measured with the Reading the Mind in the Voice–Spanish Version (RMV-SV).

Results

There were statistically significant differences between the intervention and control group measured with RMV-SV (β = 3,6[IC 95%], p<0.001), with a response variable in RMV post R² = 0,617.

Discussion

Voices, a prosodic rehabilitation game included in e-Motional Training, seems to be a promising tool for improving emotional voice recognition deficits in schizophrenia, filling the need for such interventions.

Structural and effective brain connectivity underlying biological motion detection

The perception of actions underwrites a wide range of socio-cognitive functions. Previous neuroimaging and lesion studies identified several components of the brain network for visual biological motion (BM) processing, but interactions among these components and their relationship to behavior remain little understood. Here, using a recently developed integrative analysis of structural and effective connectivity derived from high angular resolution diffusion imaging (HARDI) and functional magnetic resonance imaging (fMRI), we assess the cerebro-cerebellar network for processing of camouflaged point-light BM. Dynamic causal modeling (DCM) informed by probabilistic tractography indicates that the right superior temporal sulcus (STS) serves as an integrator within the temporal module. However, the STS does not appear to be a "gatekeeper" in the functional integration of the occipito-temporal and frontal regions: The fusiform gyrus (FFG) and middle temporal cortex (MTC) are also connected to the right inferior frontal gyrus (IFG) and insula, indicating multiple parallel pathways. BM-specific loops of effective connectivity are seen between the left lateral cerebellar lobule Crus I and right STS, as well as between the left Crus I and right insula. The prevalence of a structural pathway between the FFG and STS is associated with better BM detection. Moreover, a canonical variate analysis shows that the visual sensitivity to BM is best predicted by BM-specific effective connectivity from the FFG to STS and from the IFG, insula, and STS to the early visual cortex. Overall, the study characterizes the architecture of the cerebro-cerebellar network for BM processing and offers prospects for assessing the social brain.

Paranoia Symptoms Moderate the Impact of Emotional Context Processing on Community Functioning of Individuals with Schizophrenia

This study examined whether better emotional context processing is associated with better community functioning among persons with schizophrenia, and whether the relationship between the two variables is moderated by level of paranoid symptoms. The Brief Psychiatric Rating Scale-Expanded Version, Emotional Context Processing Scale, and Multnomah Community Ability Scale were administered to 39 community-dwelling participants with schizophrenia or schizoaffective disorder. Emotional context processing had a small-to-moderate association with community functioning. However, the association between emotional context processing and community functioning was moderated by level of paranoid symptoms. Emotional context processing in participants with mild paranoid symptoms was strongly associated with better community functioning, whereas emotional context processing in those with severe paranoid symptoms was not. Emotional context processing and the degree of paranoia should be considered in treatment plans designed to enhance the community functioning of individuals with schizophrenia to help them improve their understanding of social situations.

Aberrant patterns of neural activity when perceiving emotion from biological motion in schizophrenia

Social perceptual deficits in schizophrenia are well established. Recent work suggests that the ability to extract social information from bodily cues is reduced in patients. However, little is known about the neurobiological mechanisms underlying this deficit. In the current study, 20 schizophrenia patients and 16 controls completed two tasks using point-light animations during fMRI: a basic biological motion task and an emotion in biological motion task. The basic biological motion task was used to localize activity in posterior superior temporal sulcus (pSTS), a critical region for biological motion perception. During the emotion in biological motion task, participants viewed brief videos depicting happiness, fear, anger, or neutral emotions and were asked to decide which emotion was portrayed. Activity in pSTS and amygdala was interrogated during this task. Results indicated that patients showed overall reduced activation compared to controls in pSTS and at a trend level in amygdala across emotions, despite similar task performance. Further, a functional connectivity analysis revealed that controls, but not patients, showed significant positive connectivity between pSTS and left frontal regions as well as bilateral angular gyrus during the emotion in biological motion task. These findings indicate that schizophrenia patients show aberrant neural activity and functional connectivity when extracting complex social information from simple motion stimuli, which may contribute to social perception deficits in this disorder.

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Perception of social information from bodily cues is impaired in schizophrenia.

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We examined neural correlates of perception of emotion from biological motion.

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Activity in amygdala and posterior superior temporal sulcus was reduced in patients.

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pSTS functional connectivity with frontal and parietal regions was reduced in patients.

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Aberrant neural responses may contribute to social perceptual deficits in schizophrenia.

It Is Not Just in Faces! Processing of Emotion and Intention from Biological Motion in Psychiatric Disorders

Social neuroscience offers a wide range of techniques that may be applied to study the social cognitive deficits that may underlie reduced social functioning—a common feature across many psychiatric disorders. At the same time, a significant proportion of research in this area has been conducted using paradigms that utilize static displays of faces or eyes. The use of point-light displays (PLDs) offers a viable alternative for studying recognition of emotion or intention inference while minimizing the amount of information presented to participants. This mini-review aims to summarize studies that have used PLD to study emotion and intention processing in schizophrenia (SCZ), affective disorders, anxiety and personality disorders, eating disorders and neurodegenerative disorders. Two main conclusions can be drawn from the reviewed studies: first, the social cognitive problems found in most of the psychiatric samples using PLD were of smaller magnitude than those found in studies presenting social information using faces or voices. Second, even though the information presented in PLDs is extremely limited, presentation of these types of stimuli is sufficient to elicit the disorder-specific, social cognitive biases (e.g., mood-congruent bias in depression, increased threat perception in anxious individuals, aberrant body size perception in eating disorders) documented using other methodologies. Taken together, these findings suggest that point-light stimuli may be a useful method of studying social information processing in psychiatry. At the same time, some limitations of using this methodology are also outlined.

Biological motion processing in schizophrenia - Systematic review and meta-analysis

CONTEXT

Patients with schizophrenia show impairments in processing of biological motion. This is especially important since deficits in domains of social cognition has been associated with functional outcome and everyday functioning in this population.

OBJECTIVES

We conducted a systematic review and meta-analysis of studies which have used point-light displays to present whole-body motion to patients with schizophrenia and healthy controls, to evaluate the magnitude of differences between these groups in biological motion processing.

METHOD

Firstly, relevant publications were identified by a systematic search of Google Scholar and PubMed databases. Secondly, we excluded non-relevant studies for the meta-analysis according to our exclusion criteria. Effect sizes were expressed as standardized mean difference (SMD).

RESULTS

15 papers reporting results of 14 different experiments with 571 patients and 482 controls were included in the meta-analysis. The results for the general biological motion perception analysis revealed that patients with schizophrenia (compared with healthy controls) present reduced biological motion processing capacity with the effect size (SMD) of 0.66 (95% CI, -0.79 to -0.54; p<0.001). The results for the specific biological motion-based tasks were also statistically significant with SMD of 0.72 for Basic Biological Motion task (95% CI: -0.94 to -0.51; p<0.001) and SMD of 0.61 for Emotion in Biological Motion task, (95% CI: -0.79 to -0.43; p<0.001) respectively.

CONCLUSION

The findings from our meta-analysis highlight abnormalities in general and specific domains of biological motion perception in schizophrenia patients as compared with healthy controls.

Facial decoding in schizophrenia is underpinned by basic visual processing impairments

Schizophrenia is associated with a strong deficit in the decoding of emotional facial expression (EFE). Nevertheless, it is still unclear whether this deficit is specific for emotions or due to a more general impairment for any type of facial processing. This study was designed to clarify this issue. Thirty patients suffering from schizophrenia and 30 matched healthy controls performed several tasks evaluating the recognition of both changeable (i.e. eyes orientation and emotions) and stable (i.e. gender, age) facial characteristics. Accuracy and reaction times were recorded. Schizophrenic patients presented a performance deficit (accuracy and reaction times) in the perception of both changeable and stable aspects of faces, without any specific deficit for emotional decoding. Our results demonstrate a generalized face recognition deficit in schizophrenic patients, probably caused by a perceptual deficit in basic visual processing. It seems that the deficit in the decoding of emotional facial expression (EFE) is not a specific deficit of emotion processing, but is at least partly related to a generalized perceptual deficit in lower-level perceptual processing, occurring before the stage of emotion processing, and underlying more complex cognitive dysfunctions. These findings should encourage future investigations to explore the neurophysiologic background of these generalized perceptual deficits, and stimulate a clinical approach focusing on more basic visual processing.

Context Effects on Facial Affect Recognition in Schizophrenia and Autism: Behavioral and Eye-Tracking Evidence

Although Schizophrenia (SCZ) and Autism Spectrum Disorder (ASD) share impairments in emotion recognition, the mechanisms underlying these impairments may differ. The current study used the novel "Emotions in Context" task to examine how the interpretation and visual inspection of facial affect is modulated by congruent and incongruent emotional contexts in SCZ and ASD. Both adults with SCZ (n= 44) and those with ASD (n= 21) exhibited reduced affect recognition relative to typically-developing (TD) controls (n= 39) when faces were integrated within broader emotional scenes but not when they were presented in isolation, underscoring the importance of using stimuli that better approximate real-world contexts. Additionally, viewing faces within congruent emotional scenes improved accuracy and visual attention to the face for controls more so than the clinical groups, suggesting that individuals with SCZ and ASD may not benefit from the presence of complementary emotional information as readily as controls. Despite these similarities, important distinctions between SCZ and ASD were found. In every condition, IQ was related to emotion-recognition accuracy for the SCZ group but not for the ASD or TD groups. Further, only the ASD group failed to increase their visual attention to faces in incongruent emotional scenes, suggesting a lower reliance on facial information within ambiguous emotional contexts relative to congruent ones. Collectively, these findings highlight both shared and distinct social cognitive processes in SCZ and ASD that may contribute to their characteristic social disabilities.

e-Motional Training®: Pilot study on a novel online training program on social cognition for patients with schizophrenia

Background

Patients with schizophrenia have deficits in social cognition (SC), a construct that includes emotion perception (EP), social perception (SP), theory of mind (ToM) and attributive style (AS). The aim of our study was to assess the applicability, identify potential problems and obtain preliminary data on the efficacy of a new online training program on SC called e-Motional Training (ET®), which can be remotely administered and remotely supervised by a clinician.

Materials and methods

A pre/post intervention pilot study was conducted with 21 patients with schizophrenia in the healthcare area of Ourense, Spain (12 patients were assigned to the intervention group and 9 in the control group). The control group received standard treatment (TAU) (occupational therapy and leisure group). The intervention group received TAU plus 12 sessions (1 hour per week) with ET® (including training modules on emotional perception and a short animated cartoon for ToM and AS training, including automated metacognitive feedback).

Endpoints: EP (Ekman 60 Faces Test), ToM (Hinting Task, Faux Pas, Happé), AS (Ambiguous Intentions Hostility Questionnaire).

Results

ET® was shown to be an understandable, viable and pleasant program for the participants. After the intervention, statistically significant data (p < 0.05) were obtained for the EP, ToM and AS variables.

Conclusion

ET® enables self-training in SC and online follow-up by the therapist, thereby covering the lack of online intervention instruments validated for patients with SC deficits. Our preliminary results demonstrate the feasibility of ET® and its possible efficacy in improving emotion recognition, ToM and AS.

Face recognition in schizophrenia disorder: A comprehensive review of behavioral, neuroimaging and neurophysiological studies

Facial emotion processing has been extensively studied in schizophrenia patients while general face processing has received less attention. The already published reviews do not address the current scientific literature in a complete manner. Therefore, here we tried to answer some questions that remain to be clarified, particularly: are the non-emotional aspects of facial processing in fact impaired in schizophrenia patients? At the behavioral level, our key conclusions are that visual perception deficit in schizophrenia patients: are not specific to faces; are most often present when the cognitive (e.g. attention) and perceptual demands of the tasks are important; and seems to worsen with the illness chronification. Although, currently evidence suggests impaired second order configural processing, more studies are necessary to determine whether or not holistic processing is impaired in schizophrenia patients. Neural and neurophysiological evidence suggests impaired earlier levels of visual processing, which might involve the deficits in interaction of the magnocellular and parvocellular pathways impacting on further processing. These deficits seem to be present even before the disorder out-set. Although evidence suggests that this deficit may be not specific to faces, further evidence on this question is necessary, in particularly more ecological studies including context and body processing.

Social trait judgment and affect recognition from static faces and video vignettes in schizophrenia

Social impairment is a core feature of schizophrenia, present from the pre-morbid stage and predictive of outcome, but the etiology of this deficit remains poorly understood. Successful and adaptive social interactions depend on one's ability to make rapid and accurate judgments about others in real time. Our surprising ability to form accurate first impressions from brief exposures, known as "thin slices" of behavior has been studied very extensively in healthy participants. We sought to examine affect and social trait judgment from thin slices of static or video stimuli in order to investigate the ability of schizophrenic individuals to form reliable social impressions of others. 21 individuals with schizophrenia (SZ) and 20 matched healthy participants (HC) were asked to identify emotions and social traits for actors in standardized face stimuli as well as brief video clips. Sound was removed from videos to remove all verbal cues. Clinical symptoms in SZ and delusional ideation in both groups were measured. Results showed a general impairment in affect recognition for both types of stimuli in SZ. However, the two groups did not differ in the judgments of trustworthiness, approachability, attractiveness, and intelligence. Interestingly, in SZ, the severity of positive symptoms was correlated with higher ratings of attractiveness, trustworthiness, and approachability. Finally, increased delusional ideation in SZ was associated with a tendency to rate others as more trustworthy, while the opposite was true for HC. These findings suggest that complex social judgments in SZ are affected by symptomatology.

The impact of social content and negative symptoms on affective ratings in schizophrenia

The anhedonia paradox has been a topic of ongoing study in schizophrenia. Previous research has found that schizophrenia patients report less enjoyment from various activities when compared to their healthy counterparts; however, the two groups appear to have similar in-the-moment emotional ratings of these events (Gard et al., 2007; Herbener et al., 2007; Horan et al., 2006). This study examined these in-the-moment experiences further, by assessing whether they differed between social and non-social experiences. The data were collected from 38 individuals with schizophrenia and 53 matched healthy controls in the greater Chicago area. In-the-moment emotional experience was measured by self-reported arousal and valence ratings for social and non-social stimuli taken from the International Affective Picture System (IAPS). Clinical ratings for patients were gathered by the Positive and Negative Syndrome Scale. A series of ANOVAs revealed that controls were more aroused by the social than nonsocial unpleasant stimuli, whereas patients did not show this distinction. Further, regression analyses revealed that negative symptom severity uniquely predicted lower arousal responses to unpleasant social, but not nonsocial, stimuli. Our results indicate that both subject and stimulus factors appear to contribute to differences in emotional responses in individuals with schizophrenia.

Unseen Affective Faces Influence Person Perception Judgments in Schizophrenia

To demonstrate the influence of unconscious affective processing on consciously processed information among people with and without schizophrenia, we used a continuous flash suppression (CFS) paradigm to examine whether early and rapid processing of affective information influences first impressions of structurally neutral faces. People with and without schizophrenia rated visible neutral faces as more or less trustworthy, warm, and competent when paired with unseen smiling or scowling faces compared to when paired with unseen neutral faces. Yet, people with schizophrenia also exhibited a deficit in explicit affect perception. These findings indicate that early processing of affective information is intact in schizophrenia but the integration of this information with semantic contexts is problematic. Furthermore, people with schizophrenia who were more influenced by smiling faces presented outside awareness reported experiencing more anticipatory pleasure, suggesting that the ability to rapidly process affective information is important for anticipation of future pleasurable events.

Normal brain activation in schizophrenia patients during associative emotional learning

Emotional deficits are among the core features of schizophrenia and both associative emotional learning and the related ability to verbalize emotions can be reduced. We investigated whether schizophrenia patients demonstrated impaired function of limbic and prefrontal areas during associative emotional learning. Patients and controls filled out an alexithymia questionnaire and performed an associative emotional learning task with positive, negative and neutral picture-word pairs during fMRI scanning. After scanning, they indicated for each pair whether they remembered it. We conducted standard GLM analysis and Independent Component Analysis (ICA). Both the GLM results and task-related ICA components were compared between groups. The alexithymia questionnaire indicated more cognitive-emotional processing difficulties in patients than controls, but equal experienced intensity of affective states. Patients remembered less picture-word pairs, irrespective of valence. GLM analysis showed significant visual, temporal, amygdalar/hippocampal, and prefrontal activation in all subjects. ICA identified a network of brain areas similar to GLM, mainly in response to negative stimuli. Neither analysis showed differences between patients and controls during learning. Although in previous studies schizophrenia patients showed abnormalities in both memory and emotion processing, neural circuits involved in cross-modal associative emotional learning may remain intact to a certain degree, which may have potential consequences for treatment.

Recognition of emotion from body language among patients with unipolar depression

Major depression may be associated with abnormal perception of emotions and impairment in social adaptation. Emotion recognition from body language and its possible implications to social adjustment have not been examined in patients with depression. Three groups of participants (51 with depression; 68 with history of depression in remission; and 69 never depressed healthy volunteers) were compared on static and dynamic tasks of emotion recognition from body language. Psychosocial adjustment was assessed using the Social Adjustment Scale Self-Report (SAS-SR). Participants with current depression showed reduced recognition accuracy for happy stimuli across tasks relative to remission and comparison participants. Participants with depression tended to show poorer psychosocial adaptation relative to remission and comparison groups. Correlations between perception accuracy of happiness and scores on the SAS-SR were largely not significant. These results indicate that depression is associated with reduced ability to appraise positive stimuli of emotional body language but emotion recognition performance is not tied to social adjustment. These alterations do not appear to be present in participants in remission suggesting state-like qualities.

Contribution of coherent motion to the perception of biological motion among persons with Schizophrenia

People with schizophrenia (SCZ) are impaired in several domains of visual processing, including the discrimination and detection of biological motion. However, the mechanisms underlying SCZ-related biological motion processing deficits are unknown. Moreover, whether these impairments are specific to biological motion or represent a more widespread visual motion processing deficit is unclear. In the current study, three experiments were conducted to investigate the contribution of global coherent motion processing to biological motion perception among patients with SCZ. In Experiments 1 and 2, participants with SCZ (n = 33) and healthy controls (n = 33) were asked to discriminate the direction of motion from upright and inverted point-light walkers in the presence and absence of a noise mask. Additionally, participants discriminated the direction of non-biological global coherent motion. In Experiment 3, participants discriminated the direction of motion from upright scrambled walkers (which contained only local motion information) and upright random position walkers (which contained only global form information). Consistent with previous research, results from Experiment 1 and 2 showed that people with SCZ exhibited deficits in the direction discrimination of point-light walkers; however, this impairment was accounted for by decreased performance in the coherent motion control task. Furthermore, results from Experiment 3 demonstrated similar performance in the discrimination of scrambled and random position point-light walkers.

Can antipsychotics improve social cognition in patients with schizophrenia?

Social cognition is described as the higher mental processes that are engaged while people store, process, and use social information to make sense of themselves and others. Aspects of social cognition include emotion perception, social cue interpretation, attribution style, and theory of mind, all of which appear disordered in schizophrenia. Such social cognitive deficits are believed to be important predictors of functional outcome in schizophrenia, therefore they may represent a crucial treatment target. Few studies have evaluated the influence of antipsychotic treatment on these deficits. The purpose of this review is to examine the relationship between antipsychotic treatment and social cognition, whether antipsychotics improve social cognitive function, and if so to explore differential medication effects. Comprehensive searches of PsycINFO and MEDLINE/PUBMED were conducted to identify relevant published manuscripts. Fifteen relevant papers published in English were found, describing original studies. On the basis of this review, we have drawn the following conclusions: first, the results do not engender optimism for the possibility that antipsychotic drugs can specifically facilitate social recovery. Second, the actions of antipsychotics on social cognition are inconclusive, due to lack of standardization across research groups, leading to inconsistencies between study designs, methods used, and medication dosages. Third, large-scale longitudinal investigations are needed to explore the unclear relationships between social cognition, symptoms, and functional outcome. Other non-pharmacological treatments focusing on training patients in the social cognitive areas may hold more promise.

Contribution of NMDA receptor hypofunction in prefrontal and cortical excitatory neurons to schizophrenia-like phenotypes

Pharmacological and genetic studies support a role for NMDA receptor (NMDAR) hypofunction in the etiology of schizophrenia. We have previously demonstrated that NMDAR obligatory subunit 1 (GluN1) deletion in corticolimbic interneurons during early postnatal development is sufficient to confer schizophrenia-like phenotypes in mice. However, the consequence of NMDAR hypofunction in cortical excitatory neurons is not well delineated. Here, we characterize a conditional knockout mouse strain (CtxGluN1 KO mice), in which postnatal GluN1 deletion is largely confined to the excitatory neurons in layer II/III of the medial prefrontal cortex and sensory cortices, as evidenced by the lack of GluN1 mRNA expression in in situ hybridization immunocytochemistry as well as the lack of NMDA currents with in vitro recordings. Mutants were impaired in prepulse inhibition of the auditory startle reflex as well as object-based short-term memory. However, they did not exhibit impairments in additional hallmarks of schizophrenia-like phenotypes (e.g. spatial working memory, social behavior, saccharine preference, novelty and amphetamine-induced hyperlocomotion, and anxiety-related behavior). Furthermore, upon administration of the NMDA receptor antagonist, MK-801, there were no differences in locomotor activity versus controls. The mutant mice also showed negligible levels of reactive oxygen species production following chronic social isolation, and recording of miniature-EPSC/IPSCs from layer II/III excitatory neurons in medial prefrontal cortex suggested no alteration in GABAergic activity. All together, the mutant mice displayed cognitive deficits in the absence of additional behavioral or cellular phenotypes reflecting schizophrenia pathophysiology. Thus, NMDAR hypofunction in prefrontal and cortical excitatory neurons may recapitulate only a cognitive aspect of human schizophrenia symptoms.

Contextual social cognition impairments in schizophrenia and bipolar disorder

Background

The ability to integrate contextual information with social cues to generate social meaning is a key aspect of social cognition. It is widely accepted that patients with schizophrenia and bipolar disorders have deficits in social cognition; however, previous studies on these disorders did not use tasks that replicate everyday situations.

Methodology/Principal Findings

This study evaluates the performance of patients with schizophrenia and bipolar disorders on social cognition tasks (emotional processing, empathy, and social norms knowledge) that incorporate different levels of contextual dependence and involvement of real-life scenarios. Furthermore, we explored the association between social cognition measures, clinical symptoms and executive functions. Using a logistic regression analysis, we explored whether the involvement of more basic skills in emotional processing predicted performance on empathy tasks. The results showed that both patient groups exhibited deficits in social cognition tasks with greater context sensitivity and involvement of real-life scenarios. These deficits were more severe in schizophrenic than in bipolar patients. Patients did not differ from controls in tasks involving explicit knowledge. Moreover, schizophrenic patients’ depression levels were negatively correlated with performance on empathy tasks.

Conclusions/Significance

Overall performance on emotion recognition predicted performance on intentionality attribution during the more ambiguous situations of the empathy task. These results suggest that social cognition deficits could be related to a general impairment in the capacity to implicitly integrate contextual cues. Important implications for the assessment and treatment of individuals with schizophrenia and bipolar disorders, as well as for neurocognitive models of these pathologies are discussed.

Emotional memory modulation in schizophrenia: an overview

OBJECTIVE

In healthy controls, the emotional charge of stimuli influences how well stimuli are remembered. Although patients with schizophrenia (SCZ) have deficits in memory and in emotional processing, studies on emotional memory modulation (EMM) in SCZ report contradictory results. The aim of this review was to investigate whether methodological differences could explain these contradictory results.

METHOD

We reviewed the literature to investigate whether task differences could explain these differences. Due to the methodological differences, a meta-analysis was not possible.

RESULTS

Fourteen studies were identified that used a total of 22 tasks to study EMM in patients with SCZ. Two-thirds of the tasks showed no differences in EMM between patients with SCZ and healthy controls. Differences in EMM were found more often when long-term compared to short-term memory was measured, when memory instructions were implicit instead of explicit and when stronger emotional stimuli were used. An overall memory deficit or the mode of retrieval was not related to EMM.

CONCLUSION

Deficits in EMM in long-term compared to short-term memory point toward impaired emotional modulation of memory consolidation. Reduced EMM on implicit, but not explicit, tasks suggests a deficit in unconsciously using emotional content to modulate memory.

Differential effects of antipsychotics on lateral bias and social attention in female rats

RATIONALE

Prior research has demonstrated that individuals with schizophrenia may exhibit lateral biases in attention and deficits in social behavior. The use of a noninvasive animal model of attentional impairments in schizophrenia and antipsychotic drugs can help elucidate the biological underpinnings of attentional processes and facilitate the study of novel therapeutics.

OBJECTIVES

The purpose of this study was to compare the effects of three antipsychotic drugs on measures of lateral bias and social attention in healthy, unoperated female rats.

MATERIALS AND METHODS

Female Long-Evans rats selected for a preexisting lateral bias in attention, a right behavioral orientation preference (BOP), were administered clozapine, haloperidol, sulpiride, or vehicle. Lateral bias in attention was assessed by determining which forelimb rats removed a nuisance stimulus from first. Social attention was examined by comparing the latency to remove nuisance stimuli in the presence of a social (inaccessible female rat) versus non-social (blinking clock) distractor.

RESULTS

All antipsychotic drugs eliminated right lateral bias in attention, while control animals retained their initial bias. Clozapine eliminated right lateral bias more rapidly than the other drugs. Animals receiving clozapine also selectively displayed increased attention to another rat.

CONCLUSIONS

The results suggest that the antipsychotic medication clozapine rapidly alters attentional bias and uniquely influences attention to a social stimulus. The right BOP paradigm is a useful animal model for comparing antipsychotic drug effects on lateralized attentional bias and attention to social stimuli.

Social cognition and visual perception in schizophrenia inpatients treated with first-and second-generation antipsychotic drugs

PURPOSE

Social cognition captures affect recognition, social cue perception, "theory of mind," empathy, and attributional style. The aim of our study was to assess social cognition in schizophrenia inpatients being treated with first-generation antipsychotic drugs (FGAs), n=28 (perphenazine and haloperidol, FGAs) or with second-generation antipsychotic drugs (SGAs), n=56 (olanzapine and clozapine, SGAs).

SUBJECTS AND METHODS

Eighty-four patients completed the Facial Expression Recognition Test, the Voice Emotion Recognition Test, the Short Recognition Memory Test for Faces, and the Reading the Mind in the Eyes Test. Patients also completed the Visual Object and Space Perception Test (VOSP) as a control task, which would not engage social cognition. The patients were compared with fifty healthy controls matched for age and gender.

RESULTS

There were no significant differences on social cognitive performance between the FGA- and SGA-treatment groups. Nor was olanzapine superior to clozapine, FGAs or both. However, patients treated with FGAs performed significantly worse on VOSP compared to both groups treated with SGAs, a 10% difference.

CONCLUSIONS

We cannot conclude that SGAs were associated with better social cognition than FGAs. However, there were small but significant advantages for SGAs in non-social visual processing function, as evaluated with the VOSP.

Emotion Perception in Schizophrenia: Context Matters

Research on emotion perception in schizophrenia has focused primarily on the perception of static faces displaying different emotion signals or expressions. However, perception of emotion in daily life relies on much more than just the face. In this article, we review the role of context in emotion perception among people with and without schizophrenia. We argue that not only is context central to the perception of emotion, it in fact helps to construct the perception. Implications for future research on emotion perception are discussed.

Mirror neuron function, psychosis, and empathy in schizophrenia

Processing of social and emotional information has been shown to be disturbed in schizophrenia. The biological underpinnings of these abnormalities may be explained by an abnormally functioning mirror neuron system. Yet the relationship between mirror neuron system activity in schizophrenia, as measured using an electroencephalography (EEG) paradigm, and socio-emotional functioning has not been assessed. The present research measured empathy and mirror neuron activity using an established EEG paradigm assessing the integrity of the Mu rhythm (8-13Hz) suppression over the sensorimotor cortex during observed and actual hand movement in 16 schizophrenia-spectrum disorder (SSD) participants (n=8 actively psychotic and n=8 in residual illness phase) and 16 age- and gender-matched healthy comparison participants. Actively psychotic SSD participants showed significantly greater mu suppression over the sensorimotor cortex of the left hemisphere than residual phase SSD and healthy comparison individuals. The latter two groups showed similar levels of mu suppression. Greater left-sided mu suppression was positively correlated with psychotic symptoms (i.e., greater mu suppression/mirror neuron activity was highest among subjects with the greater severity of psychotic symptoms). SSD subjects tended to have significantly higher levels of Personal Distress (as measured by the Interpersonal Reactivity Index) than healthy participants. The present study suggests that abnormal mirror neuron activity may exist among patients with schizophrenia during the active (psychotic) phase of the illness, and correlates with severity of psychosis.

Lower effective connectivity between amygdala and parietal regions in response to fearful faces in schizophrenia

Behavioral abnormalities related to processing negative emotions such as fear have been demonstrated in schizophrenia. The amygdala is strongly associated with fear processing, and alterations in amygdala function and structure have been demonstrated in schizophrenia. Further, functional disconnectivity has been attributed as key to the etiology of schizophrenia, with a number of lines of evidence supporting this theory. In the present study, we examine the effective connectivity corresponding to fear processing, from the amygdala to the whole brain, and compare this between patients with schizophrenia and control participants. An implicit facial emotion processing task was performed by 19 patients with schizophrenia and 24 matched controls during fMRI scanning. During the task, participants made gender judgments from facial images with either neutral or fearful emotion. Neural response to fearful images versus neutral was used as contrast of interest to estimate effective connectivity between the amygdala and the whole brain using the psycho-physiological interactions approach. This connectivity was compared between patients with schizophrenia and healthy controls. We show that when looking at fearful compared to neutral faces patients with schizophrenia show significantly reduced effective connectivity from the amygdala to a large cluster of regions including parts of the precuneus and parietal lobe, compared to healthy controls. These regions have been associated with emotion processing and high level social cognition tasks involving self related processing and mental representations about other people. The reduced amygdala connectivity in schizophrenia shown here further illuminates the neural basis for the behavioral abnormalities in emotional and social function found in the disorder.

Subjective emotional over-arousal to neutral social scenes in paranoid schizophrenia

From the clinical practice and some experimental studies, it is apparent that paranoid schizophrenia patients tend to assign emotional salience to neutral social stimuli. This aberrant cognitive bias has been conceptualized to result from increased emotional arousal, but direct empirical data are scarce. The aim of the present study was to quantify the subjective emotional arousal (SEA) evoked by emotionally non-salient (neutral) compared to emotionally salient (negative) social stimuli in schizophrenia patients and healthy controls. Thirty male inpatients with paranoid schizophrenia psychosis and 30 demographically matched healthy controls rated their level of SEA in response to neutral and negative social scenes from the International Affective Picture System and the Munich Affective Picture System. Schizophrenia patients compared to healthy controls had an increased overall SEA level. This relatively higher SEA was evoked only by the neutral but not by the negative social scenes. To our knowledge, the present study is the first designed to directly demonstrate subjective emotional over-arousal to neutral social scenes in paranoid schizophrenia. This finding might explain previous clinical and experimental data and could be viewed as the missing link between the primary neurobiological and secondary psychological mechanisms of paranoid psychotic-symptom formation. Furthermore, despite being very short and easy to perform, the task we used appeared to be sensitive enough to reveal emotional dysregulation, in terms of emotional disinhibition/hyperactivation in paranoid schizophrenia patients. Thus, it could have further research and clinical applications, including as a neurobehavioral probe for imaging studies.

Attentional and emotional functioning in schizophrenia patients treated with conventional and atypical antipsychotic drugs

BACKGROUND

Effectiveness of antipsychotics in treating emotional and cognitive deficits in schizophrenia still remains controversial. The aim of our study was to assess emotional and cognitive functioning in schizophrenic inpatients currently treated with typical antipsychotics (perphenazine, perazine, fluphenazine, and haloperidol) and in another group of schizophrenic inpatients currently on atypical antipsychotics (olanzapine, risperidone, amisulpride, and quetiapine).

MATERIAL/METHODS

One hundred patients with DSM-IV schizophrenia or schizoaffective disorders (39 treated using typical antipsychotics and 61 treated with atypical antipsychotics) under naturalistic treatment conditions, and 50 healthy controls were given the following: Test of Everyday Attention, Facial Emotion Recognition Test, Facial Memory Recognition Test, and "Reading the mind in the eyes" Test.

RESULTS

Patients with a diagnosis of schizophrenia revealed the following deficits: facial emotion perception, empathy /theory of mind, visual selective attention/speed, attentional switching, and auditory-verbal working memory. Our results show a significant difference between schizophrenic and healthy controls in all tasks, with schizophrenic patients performing worse than controls. Interestingly, our patients on atypical neuroleptics performed similarly compared to schizophrenic patients treated with conventional neuroleptics on all tasks provided. There were some significant relationships between emotional and cognitive deficits and clinical variables.

CONCLUSIONS

Our findings remain consistent with other recent studies in which atypical antipsychotics did not show a clear advantage over typical antipsychotics on both emotional and cognitive functioning.

Neural correlates of emotional recognition memory in schizophrenia: effects of valence and arousal

Schizophrenia patients are often impaired in their memory for emotional events compared with healthy subjects. Investigations of the neural correlates of emotional memory in schizophrenia patients are scarce in the literature. The present study aimed to compare cerebral activations in schizophrenia patients and healthy controls during memory retrieval of emotional images that varied in both valence and arousal. In a study with functional magnetic resonance imaging, 37 schizophrenia patients were compared with 37 healthy participants while performing a yes/no recognition paradigm with positive, negative (differing in arousal intensity) and neutral images. Schizophrenia patients performed worse than healthy controls in all experimental conditions. They showed less cerebral activation in limbic and prefrontal regions than controls during retrieval of negatively valenced stimuli, but had a similar pattern of brain activation compared with controls during retrieval of positively valenced stimuli (particularly in the high arousal condition) in the cerebellum, temporal lobe and prefrontal cortex. Both groups demonstrated increased brain activations in the high relative to low arousing conditions. Our results suggest atypical brain function during retrieval of negative pictures, but intact functional circuitry of positive affect during episodic memory retrieval in schizophrenia patients. The arousal data revealed that schizophrenia patients closely resemble the control group at both the behavioral and neurofunctional level.

Facial emotion recognition and facial affect display in schizotypal personality disorder

BACKGROUND

Patients with schizophrenia have deficits in facial affect expression and detection that hinder social interactions. The goal of this study was to examine whether or not epidemiologically-related antipsychotic-naïve schizotypal personality disorder (SPD) subjects would have similar deficits as patients with schizophrenia.

METHODS

Matched SPD and healthy comparison (HC) subjects were asked to identify the eight classic emotions (SPD N=55, HC N=67) and to discriminate gender. Subjects (SPD N=22, HC N=17) were also photographed while displaying the same emotional expressions. Raters scored the subjects' facial expressions along several dimensions.

RESULTS

SPD subjects compared with HC were slower and less accurate in identifying facial expressions. This may have been driven by deficits in identifying gender. Although raters were able to identify correctly SPD and HC subjects' expressions equally well, raters found SPD subjects' facial expressions to be more odd, more ambiguous, and the subjects less attractive in general compared with HC subjects. Raters were less confident in their ability to correctly interpret SPD subjects' facial expressions and raters were less comfortable with the idea of spending time with the SPD subjects compared with HC subjects.

CONCLUSIONS

SPD subjects face two hurdles in terms of daily social interactions. They have problems both in correctly interpreting others' facial expressions and in generating socially attractive and unambiguous facial expressions.

Do patients with schizophrenia have a general or specific deficit in the perception of social threat? A meta-analytic study

This study investigates whether social cognitive deficits found in patients with schizophrenia are specific to social threat stimuli, and whether the deficits increase across the delusion spectrum from a subclinical sample to clinical manifestation. The authors presented the meta-analytic review of the published literature on social threat perception performance in three kinds of group comparisons: a subclinical group and a healthy control group, a schizophrenia group and a healthy control group, and a schizophrenia with delusion symptoms group and a healthy control group. The meta-analysis of 20 studies yielded six weighted effect sizes. The largest differences were found between the schizophrenia with delusion group and the healthy controls in both the threat and non-threat conditions. No differences were found between the effect sizes in the threat-related condition and the non-threat condition in any of the three group comparisons. Age was found to be significantly correlated with the effect sizes. The performance differences in both the threat and non-threat conditions reflect a generalized performance deficit, rather than a specific deficit, in the perception of social threat stimuli among patients with schizophrenia.

The Empathy Quotient: a cross-cultural comparison of the Italian version

INTRODUCTION

The Empathy Quotient (EQ) is a self-report questionnaire that was developed to measure the cognitive, affective, and behavioural aspects of empathy. We evaluated its cross-cultural validity in an Italian sample.

METHODS

A sample of 18- to 30-year-old undergraduate students of both sexes (N=256, males=118) were invited to fill in the Italian version of the EQ, as well as other measures of emotional competence and psychological distress. Results. The EQ had an excellent reliability (Cronbach's alpha=.79; test-retest at 1 month: Pearson's r=.85), and was normally distributed. Females scored higher than males, and more males (n=14, 11.9%) than females (n=4, 2.9%) scored lower than 30, the cutoff score that best differentiates autism spectrum conditions from controls. EQ was negatively related to the Toronto Alexithymia Scale (TAS) and positively related to the Marlowe-Crowne Social Desirability Scale (SDS). Principal component analysis retrieved the three-factor structure of the EQ. Lower emotional reactivity correlated with higher scores in measures of risk in both the schizophrenia-like (Peters et al. Delusions Inventory) and the bipolar (Hypomanic Personality Scale) spectra.

CONCLUSIONS

The Italian version of the EQ has good validity, with an acceptable replication of the original three-factor solution, yielding three subscales with high internal and test-retest reliability.

Facial emotion perception in schizophrenia: a meta-analytic review

OBJECTIVES

A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005).

RESULTS

The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race.

CONCLUSION

Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.

Impaired facial emotion perception in schizophrenia: a meta-analysis

Research into facial emotion perception in schizophrenia has burgeoned over the past several decades. The evidence is mixed regarding whether patients with schizophrenia have a general facial emotion perception deficit (a deficit in facial emotion perception plus a more basic deficit in facial processing) or specific facial emotion perception deficits (deficits only in facial emotion perception tasks). A meta-analysis is conducted of 28 facial emotion perception studies that include control tasks. These studies use differential deficit designs to examine whether patients with schizophrenia demonstrate a general deficit or specific deficit in facial emotion perception. A significant mean effect size is found for total facial emotion perception (d=-0.85). Patients with schizophrenia demonstrate impaired ability to perform corresponding control tasks, and the mean effect size is -0.70. The current findings suggest that patients with schizophrenia have moderately to severely impaired perception of facial emotion.

Facial emotion processing in schizophrenia: a non-specific neuropsychological deficit?

BACKGROUND

Identification of facial emotions has been found to be impaired in schizophrenia but there are uncertainties about the neuropsychological specificity of the finding.

METHOD

Twenty-two patients with schizophrenia and 20 healthy controls were given tests requiring identification of facial emotion, judgement of the intensity of emotional expressions without identification, familiar face recognition and the Benton Facial Recognition Test (BFRT). The schizophrenia patients were selected to be relatively intellectually preserved.

RESULTS

The patients with schizophrenia showed no deficit in identifying facial emotion, although they were slower than the controls. They were, however, impaired on judging the intensity of emotional expression without identification. They showed impairment in recognizing familiar faces but not on the BFRT.

CONCLUSIONS

When steps are taken to reduce the effects of general intellectual impairment, there is no deficit in identifying facial emotions in schizophrenia. There may, however, be a deficit in judging emotional intensity. The impairment found in naming familiar faces is consistent with other evidence of semantic memory impairment in the disorder.

Neurocognition, social cognition, perceived social discomfort, and vocational outcomes in schizophrenia

Social cognition has been suggested to be an important mediating variable in the relationship between neurocognition and functional outcome. The present study tested this model in relation to work rehabilitation outcome and added self-reported social discomfort as a possible mediator. One hundred fifty-one participants with schizophrenia or schizoaffective disorder participated in a 26-week work therapy program. Neurocognition was constructed as a latent construct comprised of selected variables from our intake test battery representing executive functioning, verbal memory, attention and working memory, processing speed, and thought disorder. Social cognition at intake was the other latent construct comprised of variables representing affect recognition, theory of mind, self-reported egocentricity, and ratings of rapport. The 2 latent constructs received support from confirmatory factor analysis. Social discomfort on the job was based on their self-report on a weekly questionnaire. In addition, we constructed a composite rehabilitation outcome that was based on how many hours they worked, how well they worked, and how complex was the job that they were doing. Path analysis showed direct effects of neurocognition on rehabilitation outcome and indirect effects mediated by social cognition and social discomfort. This model proved to be a good fit to the data and far superior to another model where only social cognition was the mediating variable between neurocognition and rehabilitation outcome. Findings suggest that neurocognition affects social cognition and that poorer social cognition leads to social discomfort on the job, which in turn leads to poorer rehabilitation outcomes. Implications for rehabilitation interventions are discussed.

Facial emotion perception in schizophrenia: a meta-analytic review

OBJECTIVES

A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005).

RESULTS

The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race.

CONCLUSION

Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.

Criterion B (social dysfunction) in persons with schizophrenia: the puzzle

PURPOSE OF REVIEW

This review focuses on social dysfunction in persons with schizophrenia and addresses three main questions. What is the core ability that is disordered in social dysfunction according to mainstream paradigms? How is social dysfunction primarily assessed in current research? Which levels of personal experience, and which trans-personal and sub-personal factors, are assessed by mainstream empirical research?

RECENT FINDINGS

Empirical studies on social dysfunction include research on trans-personal factors (stigma, availability of social and psychiatric facilities, and family resources), sub-personal factors (neurocognition) and personal factors (social cognition, coping and noncognitive factors). The main recent findings of these approaches are described and commented upon. Inconsistencies between studies are identified.

SUMMARY

What is it like to be a person with schizophrenia in the social world? Building upon empirical research, we can finally address this question. We argue that more qualitative research is needed into the reasons that persons with schizophrenia have for adopting or embracing their given type of relatedness to the others.

Affect recognition deficits in schizophrenia: neural substrates and psychopharmacological implications

Impaired emotional functioning is a prominent feature of schizophrenia that includes significant deficits in the ability to accurately recognize facial expressions of emotion. Recent work demonstrates that deficits in affect perception are related to functional outcome and negative symptoms, suggesting that remediation of these deficits may contribute to symptomatic and functional improvements. Thus far, antipsychotic drug treatments appear to be relatively ineffective as a remedial tool. However, investigations into the neurobiology of affective dysfunction show abnormal amygdala activation in schizophrenia during affect recognition tasks. Such findings indicate that regulation of amygdala responses may aid in more accurate emotion processing. Both serotonergic and anxiolytic GABAergic agents that modulate activation of the limbic system offer promising avenues for remediation efforts.

Self-reported empathic abilities in schizophrenia

BACKGROUND

Increasing evidence indicates impairments of empathic abilities in schizophrenia that may impact outcome and course of the disease. While there is consensus on the presence of deficits in 'theory of mind' in this disorder, i.e. cognitive aspects of mental state attribution, the ability to infer emotional experiences of others, i.e. affective empathy, has not been investigated so far.

METHODS

We assessed multiple dimensions of empathy in 45 schizophrenic patients and 45 healthy controls, matched for age and gender, with a self-rating instrument, the Interpersonal Reactivity Index (IRI). To control for modulating effects of cognitive deficits, a neuropsychological test battery was employed.

RESULTS

Schizophrenic patients showed significantly lower scores in cognitive empathy ('perspective taking': F=12.176, df=1, p=0.001) but more self-related aversive feelings in response to the distress of others ('personal distress: F=16.477, df=1, p<0.001). Self-ratings of affective empathy, i.e. concern for others, did not differ between groups. Results in the domains of empathy were not explained by symptoms or neurocognition as revealed by regression analysis. However, lower scores in 'perspective taking' were found with advancing duration of illness (r=-0.453, p=0.002).

CONCLUSIONS

Results indicate reductions of cognitive empathy but relatively preserved emotional empathic abilities in schizophrenia. Although previous studies observed deficits in emotion perception and expression, our findings support the concept of differentially disturbed abilities in cognitive and emotional empathy in schizophrenia.

Emotional memory in schizophrenia

Emotionally arousing scenes are better remembered than neutral ones. The biological basis of this emotional memory effect has been studied in lesion and neuro-imaging studies and depends upon an interaction between the amygdala and medial temporal lobe memory systems including the hippocampus. This study sought to investigate whether patients with schizophrenia had performance deficits on emotional memory tasks consistent with abnormal amygdala function. Patients with schizophrenia and matched control subjects were shown scenes with negative, positive and neutral emotional content. Subjects rated the slides according to how emotionally arousing they found them and then performed surprise memory tests at 10 min (recall) and 3 weeks (recall and recognition). Subjects with schizophrenia did not differ from control subjects in their ratings of the slides. However, patients showed a significant loss of the emotional enhancement of recognition memory for both negative and positive scenes. In addition, patients showed an overall deficit in recall memory, with a selective impairment in recall of the most arousing negative slides. These findings are consistent with the view that medial temporal lobe and in particular amygdala function is abnormal in schizophrenia.