What aspects of emotional functioning are impaired in schizophrenia?

Quantifying abnormal emotion processing: A novel computational assessment method and application in schizophrenia

Abnormal emotion processing is a core feature of schizophrenia spectrum disorders (SSDs) that encompasses multiple operations. While deficits in some areas have been well-characterized, we understand less about abnormalities in the emotion processing that happens through language, which is highly relevant for social life. Here, we introduce a novel method using deep learning to estimate emotion processing rapidly from spoken language, testing this approach in male-identified patients with SSDs (n = 37) and healthy controls (n = 51). Using free responses to evocative stimuli, we derived a measure of appropriateness, or "emotional alignment" (EA). We examined psychometric characteristics of EA and its sensitivity to a single-dose challenge of oxytocin, a neuropeptide shown to enhance the salience of socioemotional information in SSDs. Patients showed impaired EA relative to controls, and impairment correlated with poorer social cognitive skill and more severe motivation and pleasure deficits. Adding EA to a logistic regression model with language-based measures of formal thought disorder (FTD) improved classification of patients versus controls. Lastly, oxytocin administration improved EA but not FTD among patients. While additional validation work is needed, these initial results suggest that an automated assay using spoken language may be a promising approach to assess emotion processing in SSDs.

Differential deficits in social versus monetary reinforcement learning in schizophrenia: Associations with facial emotion recognition

Despite evidence that individuals with schizophrenia (SZ) have an intact desire for social relationships, they have small social networks and report high levels of loneliness. Difficulty with reinforcement learning (RL), the ability to update behavior based on feedback, may inhibit the formation and maintenance of social relationships in SZ. However, impaired RL in SZ has largely been demonstrated via monetary tasks. Thus, it remains unclear whether SZ are similarly impaired in social and monetary RL, or whether social-specific factors may further inhibit their ability to learn from social feedback. Thirty-one individuals with SZ and 31 healthy controls (HCs) participated in a RL paradigm to test hypotheses about social versus monetary RL. SZ exhibited impaired RL compared to HCs in both social and monetary tasks. Further, a Group × Task interaction demonstrated that SZ was more impaired when learning from social than monetary reinforcement, F(1, 59) = 5.99, p = .017. This differential deficit to social RL was not accounted for by reported pleasure from social feedback, which did not differ between groups. Instead, SZ had poorer emotion recognition than HCs, t(1, 60) = 4.80, p < .001, particularly for negative emotions, and controlling for this eliminated the differential social RL impairment. These results suggest the possibility that difficulty recognizing social cues, especially those indicating negative feedback, may relate to a reduced ability to learn from others' feedback. Thus, future research could elucidate whether targeting these emotion recognition difficulties in treatment could serve as a potential mechanism for improving social functioning in SZ. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Social cognition and apathy between two cognitive subtypes of schizophrenia: Are there the same or different profiles?

Objective

Cognitive impairment is an essential feature of schizophrenia, and it involves a broad array of nonsocial and social cognitive domains. This study aimed to examine whether there are the same or different social cognition profiles between two cognitive subtypes of schizophrenia.

Method

There were one hundred and two chronic and institutionalized patients with schizophrenia from two referral tracks. One group is "Cognitively Normal Range" (CNR) (N = 52), and another group is "Below Normal Range" (BNR) (N = 50). We assessed or collected their apathy, emotional perception judgment, facial expression judgment, and empathy by the Apathy Evaluation Scale, the International Affective Picture System, the Japanese and Caucasian Facial Expression of Emotion, and the Interpersonal Reactivity Index, respectively.

Results

We found different impairment profiles depending on the cognitive subtypes of the patient with schizophrenia. Surprisingly, the CNR presented impairments in apathy, emotional perception judgment, facial expression judgment, and empathy and feature impairment in empathy and affective apathy. In contrast, even though the BNR had significant neurocognition impairments, they had almost intact empathy with significantly impaired cognitive apathy. Both groups' global deficit scores (GDSs) were comparable, and all reached at least a mild impairment level.

Conclusions

The CNR and the BNR had similar abilities in emotional perception judgment and facial emotion recognition. They also had differentiable deficits in apathy and empathy. Our findings provide important clinical implications for neuropsychological pathology and treatment in schizophrenia.

Schizophrenia decreases guilt and increases self-disgust: Potential role of altered executive function

Our knowledge of how the more complex self-conscious emotions (SCEs) are affected in schizophrenia is sparse. SCEs, unlike basic emotions, involve sophisticated frontal-lobe-related cognition, impairment of which characterizes the neurocognitive profile of schizophrenia. We investigated, in a cross-sectional study, whether SCEs (shame, guilt and self-disgust) are affected in schizophrenia, and the relationship between changes in SCEs and executive (dys)function. Twenty-nine Greek and thirty Arabic patients with schizophrenia were recruited alongside twenty-two Greek and thirty Arabic matched controls. Participants were administered the Self-Disgust Scale (TOSCA for shame and guilt was also administered to the Greek sample), and the Trail Making and Verbal Fluency Tests to measure executive function (EF). Trait levels of self-disgust and guilt were found to be higher and lower, respectively, in patients with schizophrenia relative to control participants; and poorer EF was related with higher trait levels of SD, but lower trait levels of guilt. The pattern of findings was largely unaffected when controlling for anxiety and depression. Given that altered levels of SCEs are closely related to poorer EF, we suggest that the link between EF and emotion regulation, widely established in basic emotions but under-studied in SCEs, may explain the current findings.

Negative and depressive symptoms differentially relate to real-world anticipatory and consummatory pleasure in schizophrenia

It has been suggested that schizophrenia is associated with deficits in anticipatory but not consummatory pleasure, though there is mixed support for this hypothesis. As individuals with schizophrenia can experience both negative and depressive symptoms, symptom heterogeneity in this population could contribute to these mixed hedonic findings. Specifically, while some research suggests that negative symptoms of schizophrenia are related to reduced anticipatory but not consummatory pleasure, research on major depressive disorder suggests that depressive symptoms are associated with both decreased anticipatory and consummatory pleasure. Still, it is unclear whether depressive symptoms are associated with experiences of pleasure in schizophrenia as they are in major depressive disorder. Thus, the present study used Ecological Momentary Assessment (four prompts per day over one week) to investigate the unique relationships of negative and depressive symptoms with daily reports of real-world anticipatory and consummatory pleasure in 63 individuals with schizophrenia. Higher negative symptoms related to reduced anticipatory but not consummatory pleasure. On the other hand, higher depressive symptoms related to reductions in both anticipatory and consummatory pleasure. Overall, these results indicate that negative and depressive symptoms are differentially associated with hedonic experience in schizophrenia, and suggest the need to account for the severity of both these symptom types when examining pleasure in this population. Elucidating the nature of these symptom contributions to hedonic impairments could increase causal understanding of these deficits and contribute to the development of more targeted treatments to enhance motivation and pleasure in schizophrenia.

Responses to positive affect and unique resting-state connectivity in individuals at clinical high-risk for psychosis

Individuals at clinical high-risk for psychosis (CHR) report dampened positive affect, while this deficit appears to be an important clinical marker, our current understanding of underlying causes is limited. Dysfunctional regulatory strategies (i.e., abnormal use of dampening, self-focused, or emotion-focused strategies) may account for dampening affect but has not yet been examined. Participants (57 CHR and 56 healthy controls) completed the Response to Positive Affect Scale, clinical interviews, and resting-state scan examining nucleus accumbens (NAcc) connectivity. Individuals at CHR for psychosis showed greater dampening (but no differences in self/emotion-focus) in self-reported response to positive affect compared to healthy controls. In individuals at CHR, higher levels of dampening and lower levels of self-focus were associated with higher positive and lower negative symptoms. Dampening responses were related to decreased dorsal and rostral anterior cingulate cortex-NAcc resting-state connectivity in the CHR group but increased dorsal and rostral anterior cingulate cortex-NAcc resting-state connectivity in the healthy control group. Self-focused responses were related to increased dorsolateral prefrontal cortex-NAcc resting-state connectivity in the CHR group but decreased resting-state connectivity in the healthy control group. Self-reported dampening of positive affect was elevated in individuals at CHR for psychosis. Dampening and self-focused responses were associated with distinct resting-state connectivity compared to peers, suggesting unique mechanisms underlying these emotion regulation strategies. Responses to positive affect may be a useful target for cognitive treatment, but individuals at CHR show distinct neurocorrelates and may require a tailored approach.

Facial Emotion Recognition in Schizophrenia

Deficits in facial emotion recognition are one of the most common cognitive impairments, and they have been extensively studied in various psychiatric disorders, especially in schizophrenia. However, there is still a lack of conclusive evidence about the factors associated with schizophrenia and impairment at each stage of the disease, which poses a challenge to the clinical management of patients. Based on this, we summarize facial emotion cognition among patients with schizophrenia, introduce the internationally recognized Bruce-Young face recognition model, and review the behavioral and event-related potential studies on the recognition of emotions at each stage of the face recognition process, including suggestions for the future direction of clinical research to explore the underlying mechanisms of schizophrenia.

Heterogeneity of emotional experience in schizophrenia: Trait affect profiles predict clinical presentation and functional outcome

The current study examined whether subgroups of individuals with schizophrenia could be identified based on their profiles of trait positive and negative emotional experience, and whether those subgroups differed in their symptom presentation and functional outcome. Participants included 192 outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ) and 149 demographically matched healthy controls who completed the trait version of the Positive and Negative Affect Scale, as well as symptom and functional outcome assessments. Cluster analysis determined whether patients could be separated into meaningful subgroups based on their trait emotional experience profiles, and discriminant function analysis determined whether these groups were valid and adequately separated. Forty-two percent of the patients fell into an affectively normal cluster, whereas 28% and 30% fell into low positive affect (PA) and high negative affect (NA) clusters, respectively. These subgroups differed significantly on positive symptoms, negative symptoms, Diagnostic and Statistical Manual of Mental Disorders diagnoses, and functional outcomes. Trait emotional experience is heterogeneous in outpatients with psychotic disorders, and meaningful subgroups of patients with different profiles of PA and NA can be identified. These subgroups show meaningful differences in clinical presentation, which may necessitate different treatment approaches. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Revisiting anticipatory hedonic processing in patients with schizophrenia: An examination between representation activation and maintenance

BACKGROUND

Anticipatory anhedonia is one of the key deficits found in patients with schizophrenia (SCZ). However, the underlying mechanism of this deficit remains unclear. The present study examined whether representation activation and maintenance capacity influenced anticipatory experiences in SCZ patients.

METHODS

We recruited 46 SCZ patients (26 males) and 45 matched healthy controls (24 males). The Reward Representation Activation and Maintenance (RRAM) Task was administrated to assess anticipatory experience and representation activation and maintenance capacity.

RESULTS

SCZ patients exhibited lower subjective arousal than controls in anticipation of rewards with high probability when representation activation and maintenance were difficult to accomplish. SCZ patients also tended to reduce their button presses more than HC when they were required to maintain reward representation.

CONCLUSIONS

Our findings suggest that representation activation and maintenance may partially account for anticipatory anhedonia observed in SCZ patients.

The Fragile Brain: Stress Vulnerability, Negative Affect and GABAergic Neurocircuits in Psychosis

Persons with schizophrenia exhibit sensitivity to stress and negative affect (NA), both strongly correlated with poor functional outcome. This theoretical review suggests that NA reflects a "fragile brain," ie, vulnerable to stress, including events not experienced as stressful by healthy individuals. Based on postmortem evidence of altered gamma-aminobutyric acid (GABA) function in parvalbumin positive interneurons (PVI), animal models of PVI abnormalities and neuroimaging data with GABAergic challenge, it is suggested that GABAergic disruptions weaken cortical regions, which leads to stress vulnerability and excessive NA. Neurocircuits that respond to stressful and salient environmental stimuli, such as the hypothalamic-pituitary-adrenal axis and the amygdala, are highly dysregulated in schizophrenia, exhibiting hypo- and hyper-activity. PVI abnormalities in lateral prefrontal cortex and hippocampus have been hypothesized to affect cognitive function and positive symptoms, respectively; in the medial frontal cortex (dorsal anterior cingulate cortex and dorsal medial prefrontal cortex), these abnormalities may lead to vulnerability to stress, NA and dysregulation of stress responsive systems. Given that postmortem PVI disruptions have been identified in other conditions, such as bipolar disorder and autism, stress vulnerability may reflect a transdiagnostic dimension of psychopathology.

Trait emotional experience in individuals with schizophrenia and youth at clinical high risk for psychosis

BACKGROUND

Disturbances in trait emotions are a predominant feature in schizophrenia. However, less is known about (a) differences in trait emotion across phases of the illness such as the clinical high-risk (CHR) phase and (b) whether abnormalities in trait emotion that are associated with negative symptoms are driven by primary (i.e. idiopathic) or secondary (e.g. depression, anxiety) factors.

AIMS

To examine profiles of trait affective disturbance and their clinical correlates in individuals with schizophrenia and individuals at CHR for psychosis.

METHOD

In two studies (sample 1: 56 out-patients diagnosed with schizophrenia and 34 demographically matched individuals without schizophrenia (controls); sample 2: 50 individuals at CHR and 56 individuals not at CHR (controls)), participants completed self-report trait positive affect and negative affect questionnaires, clinical symptom interviews (positive, negative, disorganised, depression, anxiety) and community-based functional outcome measures.

RESULTS

Both clinical groups reported lower levels of positive affect (specific to joy among individuals with schizophrenia) and higher levels of negative affect compared with controls. For individuals with schizophrenia, links were found between positive affect and negative symptoms (which remained after controlling for secondary factors) and between negative affect and positive symptoms. For individuals at CHR, links were found between both affect dimensions and both types of symptom (which were largely accounted for by secondary factors).

CONCLUSIONS

Both clinical groups showed some evidence of reduced trait positive affect and elevated trait negative affect, suggesting that increasing trait positive affect and reducing trait negative affect is an important treatment goal across both populations. Clinical correlates of these emotional abnormalities were more integrally linked to clinical symptoms in individuals with schizophrenia and more closely linked to secondary influences such as depression and anxiety in individuals at CHR.

DECLARATION OF INTEREST

None.

Effect of emotional cues on prospective memory performance in patients with schizophrenia and major depressive disorder

Prospective memory (PM) is the ability to remember to carry out future intentions when prompted by a cue, and previous studies have suggested that emotional PM cues may enhance PM performance. This study examined the influence of emotional cues on PM performance in patients with schizophrenia and major depressive disorder. All participants were required to respond to emotional or neutral PM cues while completing a working memory task. Healthy participants showed improved PM performance with positive and negative cues. Patients with major depressive disorder were not impaired in PM performance and showed significant improvement in PM performance when cued by negative but not positive cues. Patients with schizophrenia had impaired PM performance irrespective of cue emotionality. In addition, the majority of patients with schizophrenia failed to show an emotional enhancement effect, and only those who had normal arousal ratings for negative PM cues showed emotional enhancement effect. These findings show for the first time that patients with schizophrenia exhibit PM impairments even with emotional cues, and suggest that arousal may be a critical factor for schizophrenia patients to utilize emotional cues to facilitate execution of future actions. In patients with major depressive disorder, our findings suggest that the negative bias in attention and retrospective memory may also extend to memory for future actions. These novel findings have both theoretical and clinical implications.

The Time Course of Dorsal and Rostral-Ventral Anterior Cingulate Cortex Activity in the Emotional Stroop Experiment Reveals Valence and Arousal Aberrant Modulation in Patients with Schizophrenia

This paper aims to investigate the temporal dynamics within the dorsal anterior cingulate cortex (dACC) and the rostral-ventral (rv) ACC during the interaction of emotional valence and arousal with cognitive control in patients with Schizophrenia (SZ). Although cognitive deficits in SZ are highly relevant and emotional disturbances are common, the temporal relationship of brain regions involved in the interaction of emotional and cognitive processing in SZ is yet to be determined. To address this issue, the reaction time (RT), event-related potential (ERP) and temporal dynamics of the dACC and rvACC activity were compared between SZ subjects and healthy controls (HC), using a modified emotional Stroop experiment (with factors namely congruence, arousal and valence). EEG was recorded with 64 channels and source localisation was performed using the sLORETA software package. We observed slower initial increase and lower peaks of time course activity within the dACC and rvACC in the SZ group. In this particular group, the dACC activity during late negativity was negatively correlated with a significantly higher RT in the high arousal conflict condition. In contrast to HC subjects, at the N450 window, there was no significant valence (ERP and rvACC ROI) modulation effect in the SZ subjects. Using high density EEG and source localisation, it was possible to distinguish various disturbances within the dACC and rvACC in patients with SZ, during emotion–cognition processing.

Aberrant Tendency of Noncurrent Emotional Experiences in Individuals at Ultra-High Risk for Psychosis

OBJECTIVE

This study aimed to investigate whether aberrant tendency of noncurrent emotion was present in individuals at ultra-high risk (UHR) for psychosis and to explore its associations with various clinical profiles.

METHODS

Fifty-seven individuals at UHR and 49 normal controls were enrolled. The tendency of experiencing noncurrent emotion was assessed using various noncurrent emotional self-reported formats, including trait [Neuroticism and Extraversion of the Eysenck Personality Questionnaire], hypothetical (Chapman's Revised Physical and Social Anhedonia Scales), and retrospective [AnhedoniaAsociality Subscale of the Scale for the Assessment of Negative Symptoms (SANS)] measures. Self-related beliefs (Self-Perception Scale), clinical positive and negative symptoms (SA Positive Symptoms and SANS), psychosocial function (Global Functioning Scale: Role Function and Global Functioning Scale: Social Function) were also examined.

RESULTS

Subjects at UHR for psychosis reported more trait unpleasant and less trait pleasant emotions, more hypothetical physical and social anhedonia, and more retrospective anhedonia than normal controls. In UHR, self-perception was correlated to trait unpleasant emotion and hypothetical physical and social anhedonia. Negative symptoms in UHR were associated with hypothetical physical anhedonia and retrospective anhedonia. Global social functioning was related to trait pleasant emotion, hypothetical physical and social anhedonia, and retrospective anhedonia. Neurocognitive function, positive symptoms, and global role functioning were not related with any noncurrent emotional experience measures in UHR.

CONCLUSION

These findings suggest that the aberrant tendency of noncurrent emotional experience may be present at the 'putative' prodromal phase and are grossly associated with self-related beliefs and psychosocial functioning but not neurocognitive functioning.

Anticipatory Emotion in Schizophrenia

While people with schizophrenia report experiencing as much emotion in the presence of emotionally evocative stimuli as do people without schizophrenia, evidence suggests that they have deficits in the anticipation of positive emotion. However, little is known about the anticipation of negative emotion in schizophrenia, thus leaving open whether anticipation deficits are more general. We sought to assess anticipation of positive and negative stimuli across multiple methods of measurement. We measured reported experience and emotion modulated startle response in people with (n = 27) and without (n = 27) schizophrenia as they anticipated and subsequently viewed evocative pictures. People with schizophrenia showed an overall dampened response during the anticipation of positive and negative stimuli, suggesting a more general deficit in anticipatory emotional responses. Moreover, anticipatory responses were related to symptoms and functioning in people with schizophrenia. Together, these findings point to important new directions for understanding emotion deficits in schizophrenia.

Reward processing and mood-related symptoms: An RDoC and translational neuroscience perspective

BACKGROUND

Two objectives of the NIMH Research Domain Criteria (RDoC) initiative are to identify (a) mechanisms that are common to multiple psychiatric disorders, and (b) mechanisms that are unique to specific psychiatric symptoms, and that reflect markers of differential risk for these symptoms. With respect to these objectives, a brain-behavior dimension that has received considerable attention and that is directly relevant to the Positive Valence Systems domain of the RDoC initiative involves reward processing.

METHODS

The present review paper first examines the relationship between reward processing and mood-related symptoms from an RDoC perspective. We then place this work in a larger context by examining the relationship between reward processing abnormalities and psychiatric symptoms defined broadly, including mood-related symptoms, schizophrenia, and addiction.

RESULTS

Our review suggests that reward hyposensitivity relates to a subtype of anhedonia characterized by motivational deficits in unipolar depression, and reward hypersensitivity relates to a cluster of hypo/manic symptoms characterized by excessive approach motivation in the context of bipolar disorder. Integrating this perspective with research on reward processing abnormalities in schizophrenia and addiction, we further argue that the principles of equifinality and multifinality may be preferable to a transdiagnostic perspective for conceptualizing the relationship between reward processing and psychiatric symptoms defined broadly.

CONCLUSION

We propose that vulnerability to either motivational anhedonia or approach-related hypo/manic symptoms involve extreme and opposite profiles of reward processing. We further propose that an equifinality and multifinality perspective may serve as a useful framework for future research on reward processing abnormalities and psychiatric symptoms.

The relevance of goal-orientation for motivation in high versus low proneness to negative symptoms

BACKGROUND

The psychological mechanisms of why individuals with negative symptoms fail to initiate and perform goal-directed behavior are not well understood. Drawing on the reward-sensitivity and expectancy-value theories, we investigate whether negative symptom-like experiences (NSLE) are associated with generating less approach goals (aimed at reaching a positive outcome) and more avoidance goals (aimed at avoiding a negative outcome) and whether this type of goal-orientation explains motivational deficits (i.e., perceiving goals as less feasible and important and being less committed to them).

METHODS

Based on the continuum model of negative symptoms, we identified two parallelized extreme groups with high and low levels of NSLE (n = 37, respectively) in an ad-hoc online-sample of healthy individuals (N = 262) using the Community Assessment of Psychic Experiences. In an online study, these participants were instructed to generate approach and avoidance goals and to rate each goal in terms of feasibility, importance and goal-commitment.

RESULTS

Participants with low levels of NSLE generated more approach than avoidance goals. Participants with high levels of NSLE showed no such difference due to increased numbers of avoidance goals. Furthermore, avoidance goal-orientation predicted reduced subjective feasibility and importance of goals and less goal-commitment.

LIMITATIONS

Results are based on a healthy sample rather than people with psychosis. No longitudinal or behavioral data for goal-striving was collected.

CONCLUSION

People with NSLE generate more avoidance goals than controls. This is dysfunctional because it correlates with feeling less committed to reach one's goals. Optimizing goal-setting could be a promising starting-point for psychological interventions aimed at reducing negative symptoms.

Neural mechanisms of mood-induced modulation of reality monitoring in schizophrenia

Reality monitoring is the ability to accurately distinguish the source of self-generated information from externally-presented information. Although people with schizophrenia (SZ) show impaired reality monitoring, nothing is known about how mood state influences this higher-order cognitive process. Accordingly, we induced positive, neutral and negative mood states to test how different mood states modulate subsequent reality monitoring performance. Our findings indicate that mood affected reality monitoring performance in HC and SZ participants in both similar and dissociable ways. Only a positive mood facilitated task performance in Healthy Control (HC) subjects, whereas a negative mood facilitated task performance in SZ subjects. Yet, when both HC and SZ participants were in a positive mood, they recruited medial prefrontal cortex (mPFC) to bias better subsequent self-generated item identification, despite the fact that mPFC signal was reduced in SZ participants. Additionally, in SZ subjects, negative mood states also modulated left and right dorsal mPFC signal to bias better externally-presented item identification. Together our findings reveal that although the mPFC is hypoactive in SZ participants, mPFC signal plays a functional role in mood-cognition interactions during both positive and negative mood states to facilitate subsequent reality monitoring decision-making.

Emotional and cognitive dysregulation in schizophrenia and depression: understanding common and distinct behavioral and neural mechanisms

Emerging behavioral and neuroimaging studies in schizophrenia (SCZ) and major depressive disorder (MD) are mapping mechanisms of co-occurring and distinct affective disturbances across these disorders. This constitutes a critical goal towards developing rationally guided therapies for upstream neural pathways that contribute to comorbid symptoms across disorders. We highlight the current state of the art in our understanding of emotional dysregulation in SCZ versus MD by focusing on broad domains of behavioral function that can map onto underlying neural systems, namely deficits in hedonics, anticipatory behaviors, computations underlying value and effort, and effortful goal-directed behaviors needed to pursue rewarding outcomes. We highlight unique disturbances in each disorder that may involve dissociable neural systems, but also possible interactions between affect and cognition in MD versus SCZ. Finally, we review computational and translational approaches that offer mechanistic insight into how cellular-level disruptions can lead to complex affective disturbances, informing development of therapies across MD and SCZ.

Neural Basis of Anhedonia and Amotivation in Patients with Schizophrenia: The Role of Reward System

Anhedonia, the inability to feel pleasure, and amotivation, the lack of motivation, are two prominent negative symptoms of schizophrenia, which contribute to the poor social and occupational behaviors in the patients. Recently growing evidence shows that anhedonia and amotivation are tied together, but have distinct neural correlates. It is important to note that both of these symptoms may derive from deficient functioning of the reward network. A further analysis into the neuroimaging findings of schizophrenia shows that the neural correlates overlap in the reward network including the ventral striatum, anterior cingulate cortex and orbitofrontal cortex. Other neuroimaging studies have demonstrated the involvement of the default mode network in anhedonia. The identification of a specific deficit in hedonic and motivational capacity may help to elucidate the mechanisms behind social functioning deficits in schizophrenia, and may also lead to more targeted treatment of negative symptoms.

Altered amygdala-prefrontal connectivity during emotion perception in schizophrenia

Individuals with schizophrenia evidence impaired emotional functioning. Abnormal amygdala activity has been identified as an etiological factor underlying affective impairment in this population, but the exact nature remains unclear. The current study utilized psychophysiological interaction analyses to examine functional connectivity between the amygdala and medial prefrontal cortex (mPFC) during an emotion perception task. Participants with schizophrenia (SZ) and healthy controls (HC) viewed and rated positive, negative, and neutral images while undergoing functional neuroimaging. Results revealed a significant group difference in right amygdala-mPFC connectivity during perception of negative versus neutral images. Specifically, HC participants demonstrated positive functional coupling between the amygdala and mPFC, consistent with co-active processing of salient information. In contrast, SZ participants evidenced negative functional coupling, consistent with top-down inhibition of the amygdala by the mPFC. A significant positive correlation between connectivity strength during negative image perception and clinician-rated social functioning was also observed in SZ participants, such that weaker right amygdala-mPFC coupling during negative compared to neutral image perception was associated with poorer social functioning. Overall, results suggest that emotional dysfunction and associated deficits in functional outcome in schizophrenia may relate to abnormal interactions between the amygdala and mPFC during perception of emotional stimuli. This study adds to the growing literature on abnormal functional connections in schizophrenia and supports the functional disconnection hypothesis of schizophrenia.

Behavioral predispositions to approach or avoid emotional words in schizophrenia

Many data suggest a disjunction between decreased emotional expressions and relatively preserved experience of and ability to assess emotions in schizophrenia. Based in an embodied approach of cognition, several studies have highlighted affective stimulus-response congruency effect in healthy subjects that show a direct link between the perception of emotion and associated motor responses. This study investigated whether the categorization of emotional words involves an automatic sensorimotor simulation of approach and avoidance behaviors. We asked 28 subjects with schizophrenia and 28 controls to execute arm movements of approach or avoidance to categorize emotional words, according to their valence (positive or negative). Controls were faster to respond to a positive stimulus with a movement of approach and a negative stimulus with a movement of avoidance (congruent condition) than to perform the inverted response movements (incongruent condition). However, responses of patients with schizophrenia did not differ according to congruence condition. Our results support the apparent non-involvement of covert sensorimotor simulation of approach and avoidance in the categorization of emotional stimuli by patients with schizophrenia, despite their understanding of the emotional valence of words. This absence of affective stimulus-response compatibility effect would imply a decoupling between emotional and bodily states in patients with schizophrenia.

Design of a Virtual Reality System for Affect Analysis in Facial Expressions (VR-SAAFE); Application to Schizophrenia

Schizophrenia is a life-long, debilitating psychotic disorder with poor outcome that affects about 1% of the population. Although pharmacotherapy can alleviate some of the acute psychotic symptoms, residual social impairments present a significant barrier that prevents successful rehabilitation. With limited resources and access to social skills training opportunities, innovative technology has emerged as a potentially powerful tool for intervention. In this paper, we present a novel virtual reality (VR)-based system for understanding facial emotion processing impairments that may lead to poor social outcome in schizophrenia. We henceforth call it a VR System for Affect Analysis in Facial Expressions (VR-SAAFE). This system integrates a VR-based task presentation platform that can minutely control facial expressions of an avatar with or without accompanying verbal interaction, with an eye-tracker to quantitatively measure a participants real-time gaze and a set of physiological sensors to infer his/her affective states to allow in-depth understanding of the emotion recognition mechanism of patients with schizophrenia based on quantitative metrics. A usability study with 12 patients with schizophrenia and 12 healthy controls was conducted to examine processing of the emotional faces. Preliminary results indicated that there were significant differences in the way patients with schizophrenia processed and responded towards the emotional faces presented in the VR environment compared with healthy control participants. The preliminary results underscore the utility of such a VR-based system that enables precise and quantitative assessment of social skill deficits in patients with schizophrenia.

EMOTICOM: A Neuropsychological Test Battery to Evaluate Emotion, Motivation, Impulsivity, and Social Cognition

In mental health practice, both pharmacological and non-pharmacological treatments are aimed at improving neuropsychological symptoms, including cognitive and emotional impairments. However, at present there is no established neuropsychological test battery that comprehensively covers multiple affective domains relevant in a range of disorders. Our objective was to generate a standardized test battery, comprised of existing, adapted and novel tasks, to assess four core domains of affective cognition (emotion processing, motivation, impulsivity and social cognition) in order to facilitate and enhance treatment development and evaluation in a broad range of neuropsychiatric disorders. The battery was administered to 200 participants aged 18-50 years (50% female), 42 of whom were retested in order to assess reliability. An exploratory factor analysis identified 11 factors with eigenvalues greater than 1, which accounted for over 70% of the variance. Tasks showed moderate to excellent test-retest reliability and were not strongly correlated with demographic factors such as age or IQ. The EMOTICOM test battery is therefore a promising tool for the assessment of affective cognitive function in a range of contexts.

Schizophrenia symptom and functional correlates of anterior cingulate cortex activation to emotion stimuli: An fMRI investigation

Schizophrenia is a chronic mental illness characterized by distinct positive and negative symptoms and functional impairment. The anterior cingulate cortex (ACC) is a region of the brain's limbic system that is hypoactive during emotion processing in schizophrenia. Recent evidence suggests the hypoactive ACC in schizophrenia is due to negative (and not positive) symptoms. However, this finding has not been replicated and the functional significance of this relationship remains unclear. The present study examined the association between positive and negative symptoms, ACC activation to emotional images, and functional outcome in schizophrenia. Specifically, 16 schizophrenia/schizoaffective disorder (SZ/SZAF) and 15 control (CON) participants underwent an fMRI scan while completing an emotional picture-rating task. SZ/SZAF participants also completed clinician-rated measures of positive and negative symptoms and functional abilities. SZ/SZAF participants with high negative symptoms had reduced ACC activation to pleasant images relative to those with low negative symptoms and CON, who did not differ. Furthermore, amongst all SZ/SZAF participants poorer social functioning was associated with decreased ACC activation to pleasant images. Finally, ACC activation partially mediated the relationship between negative symptoms and social dysfunction. These results provide evidence of the functional significance of the relationship between negative symptoms and ACC dysfunction in schizophrenia.

Altered emotional modulation of associative memory in first episode schizophrenia: An fMRI study

Alterations of associative memory, resulting from perturbations within the medial temporal lobe, are well established in schizophrenia. So far, all the studies having examined associative memory in schizophrenia have limited ecological validity, as people experience various emotional stimuli in their life. As such, emotion must be taken into account in order to fully understand memory. Thus, we designed an fMRI study aimed at investigating neural correlates of the effects of emotions on associative memory in schizophrenia. Twenty-four first episode schizophrenia (FES) patients and 20 matched controls were instructed to memorize 90 pairs of standardized pictures during a scanned encoding phase. Each of the 90 pairs was composed of a scene and an unrelated object. Furthermore, trials were either neutral or emotional as a function of the emotional valence of the scene comprising each pair. FES patients exhibited lower performance for both conditions than controls, with greater deficits in regard to emotional versus neutral associations. fMRI analyses revealed that these deficits were related to lower activations in mnemonic and limbic regions. This study provides evidence of altered associative memory and emotional modulation in schizophrenia, resulting from dysfunctions in the cerebral networks underlying memory, emotion, and encoding strategies. Together, our results suggest that all these dysfunctions may be targets for new therapeutic interventions known to improve cognitive deficits in schizophrenia.

Associations between trait anhedonia and emotional memory deficits in females with schizophrenia versus major depression

Individuals with schizophrenia (SZ) and individuals with major depressive disorder (MDD) demonstrate impaired emotional memory and decreased enjoyment of pleasant experiences (e.g., anhedonia). However, it is unclear whether these impairments reflect similar or different processes in the two diagnostic groups. This study compared emotional memory performance in three groups of females - controls, MDD, and SZ. Given that physical and social trait anhedonia has been shown to differentiate course of illness and emotional functioning within each disorder, the present study also examined whether trait anhedonia related to emotional memory differently in the groups. Participants viewed emotional and neutral images and twenty-four hours later completed an incidental recognition test. SZ participants demonstrated a trend for the worst memory performance. Across all groups, high intensity and negative images were remembered most accurately, while groups were not differentially influenced by the valence of the stimuli. Physical anhedonia was predictive of reduced memory for negative stimuli across all diagnostic groups. Group specific findings indicated that higher levels of social anhedonia were predictive of poorer memory, but only in the SZ group. Effects remained significant when controlling for depressive symptoms. Results are considered in light of the differing role of anhedonia in SZ and MDD.

Event-related potentials (ERPs) and hemodynamic (functional near-infrared spectroscopy, fNIRS) as measures of schizophrenia deficits in emotional behavior

Recent research evidences supported the significant role of multimethodological neuroscientific approach for the diagnosis and the rehabilitative intervention in schizophrenia. Indeed both electrophysiological and neuroimaging measures in integration each other appear able to furnish a deep overview of the cognitive and affective behavior in schizophrenia patients (SPs). The aim of the present review is focused on the emotional dysfunctional response taking into account the multimeasures for emotional behavior, i.e., the event-related potentials (ERPs) and the hemodynamic profile functional near-infrared spectroscopy (fNIRS). These measures may be considered as predictive measures of the SPs' deficits in emotional behavior. The integration between ERP and fNIRS may support both the prefrontal cortical localization anomaly and the attentional bias toward some specific emotional conditions (mainly negative).

Investigating the empirical support for therapeutic targets proposed by the temporal experience of pleasure model in schizophrenia: A systematic review

BACKGROUND

Anhedonia and amotivation are substantial predictors of poor functional outcomes in people with schizophrenia and often present a formidable barrier to returning to work or building relationships. The Temporal Experience of Pleasure Model proposes constructs which should be considered therapeutic targets for these symptoms in schizophrenia e.g. anticipatory pleasure, memory, executive functions, motivation and behaviours related to the activity. Recent reviews have highlighted the need for a clear evidence base to drive the development of targeted interventions.

OBJECTIVE

To review systematically the empirical evidence for each TEP model component and propose evidence-based therapeutic targets for anhedonia and amotivation in schizophrenia.

METHOD

Following PRISMA guidelines, PubMed and PsycInfo were searched using the terms "schizophrenia" and "anhedonia". Studies were included if they measured anhedonia and participants had a diagnosis of schizophrenia. The methodology, measures and main findings from each study were extracted and critically summarised for each TEP model construct.

RESULTS

80 independent studies were reviewed and executive functions, emotional memory and the translation of motivation into actions are highlighted as key deficits with a strong evidence base in people with schizophrenia. However, there are many relationships that are unclear because the empirical work is limited by over-general tasks and measures.

CONCLUSIONS

Promising methods for research which have more ecological validity include experience sampling and behavioural tasks assessing motivation. Specific adaptations to Cognitive Remediation Therapy, Cognitive Behavioural Therapy and the utilisation of mobile technology to enhance representations and emotional memory are recommended for future development.

Neurobiological background of negative symptoms

Studies investigating neurobiological bases of negative symptoms of schizophrenia failed to provide consistent findings, possibly due to the heterogeneity of this psychopathological construct. We tried to review the findings published to date investigating neurobiological abnormalities after reducing the heterogeneity of the negative symptoms construct. The literature in electronic databases as well as citations and major articles are reviewed with respect to the phenomenology, pathology, genetics and neurobiology of schizophrenia. We searched PubMed with the keywords "negative symptoms," "deficit schizophrenia," "persistent negative symptoms," "neurotransmissions," "neuroimaging" and "genetic." Additional articles were identified by manually checking the reference lists of the relevant publications. Publications in English were considered, and unpublished studies, conference abstracts and poster presentations were not included. Structural and functional imaging studies addressed the issue of neurobiological background of negative symptoms from several perspectives (considering them as a unitary construct, focusing on primary and/or persistent negative symptoms and, more recently, clustering them into factors), but produced discrepant findings. The examined studies provided evidence suggesting that even primary and persistent negative symptoms include different psychopathological constructs, probably reflecting the dysfunction of different neurobiological substrates. Furthermore, they suggest that complex alterations in multiple neurotransmitter systems and genetic variants might influence the expression of negative symptoms in schizophrenia. On the whole, the reviewed findings, representing the distillation of a large body of disparate data, suggest that further deconstruction of negative symptomatology into more elementary components is needed to gain insight into underlying neurobiological mechanisms.

Neural signal during immediate reward anticipation in schizophrenia: Relationship to real-world motivation and function

Amotivation in schizophrenia is a central predictor of poor functioning, and is thought to occur due to deficits in anticipating future rewards, suggesting that impairments in anticipating pleasure can contribute to functional disability in schizophrenia. In healthy comparison (HC) participants, reward anticipation is associated with activity in frontal-striatal networks. By contrast, schizophrenia (SZ) participants show hypoactivation within these frontal-striatal networks during this motivated anticipatory brain state. Here, we examined neural activation in SZ and HC participants during the anticipatory phase of stimuli that predicted immediate upcoming reward and punishment, and during the feedback/outcome phase, in relation to trait measures of hedonic pleasure and real-world functional capacity. SZ patients showed hypoactivation in ventral striatum during reward anticipation. Additionally, we found distinct differences between HC and SZ groups in their association between reward-related immediate anticipatory neural activity and their reported experience of pleasure. HC participants recruited reward-related regions in striatum that significantly correlated with subjective consummatory pleasure, while SZ patients revealed activation in attention-related regions, such as the IPL, which correlated with consummatory pleasure and functional capacity. These findings may suggest that SZ patients activate compensatory attention processes during anticipation of immediate upcoming rewards, which likely contribute to their functional capacity in daily life.

Schizophrenia and Depression: A systematic Review of the Effectiveness and the Working Mechanisms Behind Acupuncture

OBJECTIVE

This systematic review assessed clinical evidence for the use of acupuncture as an add-on treatment in patients with depression and schizophrenia and for its underlying working mechanisms.

DATA SOURCES

Four databases (Medline, Scopus, ERIC, and the Cochrane Library) were searched with a cutoff date of March 31, 2014.

STUDY SELECTION

Systematic reviews and meta-analyses of acupuncture treatment for depression and schizophrenia were considered for inclusion. The scarcity of acupuncture research involving schizophrenia led to the inclusion of randomized controlled trials and case studies.

DATA EXTRACTION

The primary and secondary aims of this study were to evaluate the effects of acupuncture in treating patients with depression or schizophrenia and the possible working mechanisms underlying acupuncture through a systematic literature review.

DATA SYNTHESIS

The overall clinical results on using acupuncture to treat depression are promising, but only limited evidence for its effectiveness in treating schizophrenia was found. Acupuncture improves the quality of life, particularly that of sleep, in psychiatric patients. Brain research has revealed that acupuncture has a modulating and normalizing effect on the limbic-paralimbic-neocortical network (LPNN), including the default mode network. Because the LPNN is related to sleep and emotions, this might explain the improved qualities of life and sleep after acupuncture.

CONCLUSIONS

From the evidence found in this study, acupuncture seems to be an effective add-on treatment in patients with depression and, to a lesser degree, in patients with schizophrenia, but large well-designed studies are needed to confirm that evidence.

Preserved emotional memory modulation in first episode psychosis

Although patients with schizophrenia have severe memory impairments and emotional deficits, studies investigating emotional memory modulation (EMM) in schizophrenia show contradictory results, possibly due to methodological differences and small group size. We investigated whether impaired EMM is already present in First Episode Psychosis (FEP) and whether impairments in EMM are task or stimulus dependent. Forty-five FEP and thirty-seven Healthy Control (HC) male participants matched for age performed visual and verbal short-term (immediate recall) and long-term (after 24h recognition) memory tasks with neutral, negative and positive stimuli. On all tasks overall memory performance for FEP was significantly below that of HC. Although EMM varied by task and type of stimulus, none of the tasks showed a difference in EMM between FEP and HC. There were no differences between FEP and HC in the way emotion modulates different memory domains. This could mean that EMM is spared in the early course of schizophrenia.

Complexities of emotional responses to social and non-social affective stimuli in schizophrenia

BACKGROUND

Adaptive emotional responses are important in interpersonal relationships. We investigated self-reported emotional experience, physiological reactivity, and micro-facial expressivity in relation to the social nature of stimuli in individuals with schizophrenia (SZ).

METHOD

Galvanic skin response (GSR) and facial electromyography (fEMG) were recorded in medicated outpatients with SZ and demographically matched healthy controls (CO) while they viewed social and non-social images from the International Affective Pictures System. Participants rated the valence and arousal, and selected a label for experienced emotions. Symptom severity in the SZ and psychometric schizotypy in CO were assessed.

RESULTS

The two groups did not differ in their labeling of the emotions evoked by the stimuli, but individuals with SZ were more positive in their valence ratings. Although self-reported arousal was similar in both groups, mean GSR was greater in SZ, suggesting differential awareness, or calibration of internal states. Both groups reported social images to be more arousing than non-social images but their physiological responses to non-social vs. social images were different. Self-reported arousal to neutral social images was correlated with positive symptoms in SZ. Negative symptoms in SZ and disorganized schizotypy in CO were associated with reduced mean fEMG. Greater corrugator mean fEMG activity for positive images in SZ indicates valence-incongruent facial expressions.

CONCLUSION

The patterns of emotional responses differed between the two groups. While both groups were in broad agreement in self-reported arousal and emotion labels, their mean GSR, and fEMG correlates of emotion diverged in relation to the social nature of the stimuli and clinical measures. Importantly, these results suggest disrupted self awareness of internal states in SZ and underscore the complexities of emotion processing in health and disease.

Influence of positive subliminal and supraliminal affective cues on goal pursuit in schizophrenia

Goal pursuit is known to be impaired in schizophrenia, but nothing much is known in these patients about unconscious affective processes underlying goal pursuit. Evidence suggests that in healthy individuals positive subliminal cues are taken as a signal that goal pursuit is easy and therefore reduce the effort that is mobilized for goal attainment. Patients with schizophrenia and healthy controls were instructed that a long run of successive correct responses in a visual attention task would entitle them to a reward (the goal to attain). Affective pictures were displayed supraliminally or subliminally during each run and electrophysiological activity was recorded. Patients self-assessed the emotional content of the pictures correctly. However, differences between patients and controls emerged during the goal pursuit task. Healthy controls mobilized less effort for the positive than the neutral subliminal pictures, as suggested by increased error rates and the weaker contingent negative variation (CNV). For the patients, no influence of positive subliminal pictures was found on performance and on the CNV. Similarly the influence of positive pictures was absent or abnormal on components which are usually impaired in patients (fronto-central P2 and N2). In contrast, positive pictures influenced normally the parieto-occipital N2, related to a component of visual attention which has been proposed to be preserved in schizophrenia. The present study indicates the difficulties of patients to modulate effort mobilization during goal pursuit in the presence of positive subliminal cues. The results question the role of cognitive deficits on affective influences.

Abnormal interactions between context, memory structure, and mood in schizophrenia: an ERP investigation

This study used event-related potentials to examine interactions between mood, sentence context, and semantic memory structure in schizophrenia. Seventeen male chronic schizophrenia and 15 healthy control subjects read sentence pairs after positive, negative, or neutral mood induction. Sentences ended with expected words (EW), within-category violations (WCV), or between-category violations (BCV). Across all moods, patients showed sensitivity to context indexed by reduced N400 to EW relative to both WCV and BCV. However, they did not show sensitivity to the semantic memory structure. N400 abnormalities were particularly enhanced under a negative mood in schizophrenia. These findings suggest abnormal interactions between mood, context processing, and connections within semantic memory in schizophrenia, and a specific role of negative mood in modulating semantic processes in this disease.

Affect modulated startle in schizophrenia: subjective experience matters

Data suggests that emotion reactivity as measured by the affect-modulated startle paradigm in those with schizophrenia (SZ) may be similar to healthy controls (HC). However, normative classification of the stimuli may not accurately reflect emotional experience, especially for those with SZ. To examine this possibility, the present study measured the affect-modulated startle response with images classified according to both normative and subjective ratings. Seventeen HC and 17 SZ completed an image viewing task during which startle probes were presented, followed by subjective valence and arousal ratings. Both groups exhibited inhibited startle responses to positive images, intermediate startle amplitudes to neutral images, and potentiated startle amplitudes to negative images. SZ rated the positive images as less positive than HC. When images were reclassified based on subjective valence ratings, both groups' startle magnitudes increased in response to subjectively rated positive images and decreased to subjectively rated neutral images. The number of trials classified into each valence condition suggested a tendency for SZ to classify neutral images as negative more often than HC. Overall, these findings suggest that affective stimuli modulate the startle response in HC and SZ in similar ways, but subjective emotional experience may differ in those with schizophrenia.

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.

Altered amygdala activation in schizophrenia patients during emotion processing

Dysfunctional emotion processing in patients suffering from schizophrenia is a prominent clinical feature of great importance for social functioning and subjective well-being. The neurobiological underpinnings are still poorly understood. Here we investigated a large sample of schizophrenia patients and matched healthy controls with an event-related fMRI task during emotion processing using emotional pictures from the International Affective Picture System (IAPS). Schizophrenia patients revealed stronger right amygdala activation during negative and attenuated response during positive affective picture processing compared to healthy controls. Further analysis indicated that medication status influences activation of the ventral anterior cingulate cortex during negative affective stimuli processing. These results might represent a correlate of altered emotional experience in schizophrenia patients who are known to report less positive and more negative affective states in daily life situations.

Emotion regulation abnormalities in schizophrenia: cognitive change strategies fail to decrease the neural response to unpleasant stimuli

Contrary to early conceptualizations of emotional experience in schizophrenia (SZ), recent research indicates that patients do not self-report less in-the-moment pleasure than controls (CN). Rather, patients report experiencing elevated levels of negative emotionality in response to a range of evocative stimuli. In this study, we examined the possibility that elevations in negative emotionality in SZ may reflect an underlying emotion regulation abnormality. Event-related potentials (ERPs) were recorded from outpatients with SZ (n = 25) and demographically matched healthy controls (n = 21) during passive viewing of unpleasant and neutral photographs. Unpleasant images were preceded by an audio description that described the image as being either negative or neutral. Neutral images were preceded by neutral audio descriptions. The late positive potential (LPP), an ERP component sensitive to cognitive change strategies, was examined as an index of emotion regulation. Both CN and SZ showed an increased LPP to negatively described unpleasant images compared with neutral images. In addition, CN showed evidence of emotion regulation, as reflected by a smaller LPP for unpleasant images preceded by a neutral descriptor, relative to a negative descriptor. In contrast, SZ patients showed an inability to downregulate emotional response, as evidenced by no difference in the amplitude of the LPP for unpleasant images preceded by negative or neutral descriptors. Findings provide neurophysiological evidence for an emotion regulation abnormality in SZ and suggest that failures in cognitive change may underlie increased negative emotionality in SZ.

Impact of emotionality on memory and meta-memory in schizophrenia using video sequences

BACKGROUND AND OBJECTIVES

A vast amount of memory and meta-memory research in schizophrenia shows that these patients perform worse on memory accuracy and hold false information with strong conviction compared to healthy controls. So far, studies investigating these effects mainly used traditional static stimulus material like word lists or pictures. The question remains whether these memory and meta-memory effects are also present in (1) more near-life dynamic situations (i.e., using standardized videos) and (2) whether emotionality has an influence on memory and meta-memory deficits (i.e., response confidence) in schizophrenia compared to healthy controls.

METHOD

Twenty-seven schizophrenia patients and 24 healthy controls were administered a newly developed emotional video paradigm with five videos differing in emotionality (positive, two negative, neutral, and delusional related). After each video, a recognition task required participants to make old-new discriminations along with confidence ratings, investigating memory accuracy and meta-memory deficits in more dynamic settings.

RESULTS

For all but the positively valenced video, patients recognized fewer correct items compared to healthy controls, and did not differ with regard to the number of false memories for related items. In line with prior findings, schizophrenia patients showed more high-confident responses for misses and false memories for related items but displayed underconfidence for hits when compared to healthy controls, independent of emotionality.

LIMITATIONS

Limited sample size and control group; combined valence and arousal indicator for emotionality; general psychopathology indicator.

CONCLUSIONS

Emotionality differentially moderated memory accuracy, biases in schizophrenia patients compared to controls. Moreover, the meta-memory deficits identified in static paradigms also manifest in more dynamic settings near-life settings and seem to be independent of emotionality.

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.

Looking at the other side of the coin: a meta-analysis of self-reported emotional arousal in people with schizophrenia

Abnormalities in emotional experience have long been viewed as core features of schizophrenia. Numerous studies indicate that people with schizophrenia report less pleasure than controls when reporting non-current feelings using trait, hypothetical, prospective, and retrospective emotional self-report formats; however, current research has demonstrated that schizophrenia patients and controls do not differ in their subjective reactions to emotional stimuli in most laboratory studies. Although substantial attention has been paid to studies examining self-reported valence in schizophrenia, subjective reports of arousal in response to affective stimuli have been neglected. Understanding the role of arousal in schizophrenia is imperative given that valence and arousal are differentially associated with physiological and behavioral responses. To understand the role of self-reported arousal, a meta-analysis of 26 published studies employing laboratory emotion induction paradigms in patients with schizophrenia and healthy controls was conducted. Medline, PsycINFO, Web of Science, and PubMed electronic databases and reference lists from identified articles were used as data sources. Using a random effects model, analyses demonstrated that controls and people with schizophrenia reported similar levels of subjective arousal in response to pleasant and unpleasant stimuli; however, people with schizophrenia reported experiencing greater arousal than controls in response to neutral stimuli. Furthermore, moderator analyses suggested that gender and methodological factors, such as rating scale and stimulus type, may affect these patterns of results and play a key role in determining whether patients and controls differ in self-reported arousal.

Emotional episodes in the everyday lives of people with schizophrenia: the role of intrinsic motivation and negative symptoms

Research on emotional experience has indicated that subjects with schizophrenia experience less positive, and more negative emotional experience than non-psychiatric subjects in natural settings. Differences in the experience of emotion may result from differences in experiences such that everyday activities may evoke emotions. The purpose of this study was to identify if everyday experience of competence and autonomy were related to positive and negative emotion. Adults with schizophrenia spectrum disorders were recruited from day treatment programs (N=45). Data were collected using experience-sampling methods. A number of subjects failed to meet data adequacy (N=13) but did not differ from retained subjects (N=32) in symptoms or cognition. Positive and negative emotion models were analyzed using hierarchical linear modeling Everyday activities were characterized by those reported as easily accomplished and requiring at most moderate talents. Positive emotional experiences were stronger than negative emotional experiences. The majority of variance in positive and negative emotion existed between persons. Negative symptoms were significantly related to positive emotion, but not negative emotion. The perception that motivation for activity was external to subjects (e.g. wished they were doing something else) was related to decreased positive emotion and enhanced negative emotion. Activities that required more exertion for activities was related to enhanced positive emotion, whereas activities that subjects reported they wanted to do was associated with reduced negative emotion. The implications of this study are that everyday experiences of people with schizophrenia do affect emotional experience and that management of experience to enhance positive emotion may have therapeutic benefits.

Cognition-emotion dysinteraction in schizophrenia

Evolving theories of schizophrenia emphasize a "disconnection" in distributed fronto-striatal-limbic neural systems, which may give rise to breakdowns in cognition and emotional function. We discuss these diverse domains of function from the perspective of disrupted neural circuits involved in "cold" cognitive vs. "hot" affective operations and the interplay between these processes. We focus on three research areas that highlight cognition-emotion dysinteractions in schizophrenia: First, we discuss the role of cognitive deficits in the "maintenance" of emotional information. We review recent evidence suggesting that motivational abnormalities in schizophrenia may in part arise due to a disrupted ability to "maintain" affective information over time. Here, dysfunction in a prototypical "cold" cognitive operation may result in "affective" deficits in schizophrenia. Second, we discuss abnormalities in the detection and ascription of salience, manifest as excessive processing of non-emotional stimuli and inappropriate distractibility. We review emerging evidence suggesting deficits in some, but not other, specific emotional processes in schizophrenia - namely an intact ability to perceive emotion "in-the-moment" but poor prospective valuation of stimuli and heightened reactivity to stimuli that ought to be filtered. Third, we discuss abnormalities in learning mechanisms that may give rise to delusions, the fixed, false, and often emotionally charged beliefs that accompany psychosis. We highlight the role of affect in aberrant belief formation, mostly ignored by current theoretical models. Together, we attempt to provide a consilient overview for how breakdowns in neural systems underlying affect and cognition in psychosis interact across symptom domains. We conclude with a brief treatment of the neurobiology of schizophrenia and the need to close our explanatory gap between cellular-level hypotheses and complex behavioral symptoms observed in this illness.