What does electrodermal activity tell us about prognosis in the schizophrenia spectrum?

Blunted pupil light reflex is associated with negative symptoms and working memory in individuals with schizophrenia

Two largely separate lines of research have documented altered pupillary dynamics in individuals diagnosed with schizophrenia. An older set of studies has demonstrated reductions in the pupillary light reflex (PLR) in individuals with schizophrenia; however, clinical and cognitive correlates of this blunted PLR have been relatively unexplored. More recently, a large body of work has demonstrated reductions in pupillary dilation in response to cognitive demands in individuals with schizophrenia, and the degree of this blunted pupil dilation has been related to more severe cognitive deficits and motivational negative symptoms. These clinically relevant alterations in the cognitive modulation of pupil size have been interpreted as reflecting insufficient information processing resources or inappropriate effort allocation. To begin to bridge these two lines of work, we investigated the PLR in 34 individuals with schizophrenia and 30 healthy controls and related the amplitude of the PLR to motivational negative symptoms and cognitive performance. Consistent with prior work, we found that the PLR was reduced in individuals with schizophrenia, and furthermore, that these measurements were highly reliable across individuals. Blunted constriction was associated with more severe motivational negative symptoms and poorer working memory among individuals with schizophrenia. These observed correlates provide a bridge between older literature documenting an altered PLR and more recent work reporting associations between negative symptoms, cognition, and blunted pupillary dilation in response to cognitive demands in individuals with schizophrenia. We provide possible mechanistic interpretations of our data and consider a parsimonious explanation for reduced cognitive- and light-related modulation of pupil size.

Current trends and opportunities in the methodology of electrodermal activity measurement

Electrodermal activity (EDA) has been measured in the laboratory since the late 1800s. Although the influence of sudomotor nerve activity and the sympathetic nervous system on EDA is well established, the mechanisms underlying EDA signal generation are not completely understood. Owing to simplicity of instrumentation and modern electronics, these measurements have recently seen a transfer from the laboratory to wearable devices, sparking numerous novel applications while bringing along both challenges and new opportunities. In addition to developments in electronics and miniaturization, current trends in material technology and manufacturing have sparked innovations in electrode technologies, and trends in data science such as machine learning and sensor fusion are expanding the ways that measurement data can be processed and utilized. Although challenges remain for the quality of wearable EDA measurement, ongoing research and developments may shorten the quality gap between wearable EDA and standardized recordings in the laboratory. In this topical review, we provide an overview of the basics of EDA measurement, discuss the challenges and opportunities of wearable EDA, and review recent developments in instrumentation, material technology, signal processing, modeling and data science tools that may advance the field of EDA research and applications over the coming years.

Development of Autonomic Nervous System Assays as Point-of-Care Tests to Supplement Clinical Judgment in Risk Assessment for Suicidal Behavior: A Review

PURPOSE OF REVIEW

A biomarker point-of-care (POC) test that supplements the psychiatric interview and improves detection of patients at risk for suicide would be of value, and assays of autonomic nervous system (ANS) activity would satisfy the logistical requirements for a POC test. We performed a selective review of the available literature of ANS assays related to risk for suicide.

RECENT FINDINGS

We searched PubMed and Web of Science with the strategy: "suicide OR suicidal" AND "electrodermal OR heart rate variability OR pupillometry OR pupillography." The search produced 119 items, 21 of which provided original data regarding ANS methods and suicide. These 21 studies included 6 for electrodermal activity, 14 for heart rate variability, and 1 for the pupillary light reflex. The 21 papers showed associations between ANS assays and suicide risk in a direction suggesting underlying hyperarousal in patients at risk for suicide. ANS assays show promise for future development as POC tests to supplement clinical decision making in estimating risk for suicide.

Electrodermal activity patient simulator

Electrodermal activity (EDA) is an electrical property of the human skin, correlated with person's psychological arousal. Nowadays, different types of EDA measuring devices are used in highly versatile fields-from research, health-care and education to entertainment industry. But despite their universal use the quality of their measuring function (their accuracy) is questioned or investigated very seldom. In this paper, we propose a concept of an EDA patient simulator-a device enabling metrological testing of EDA devices by means of a variable resistance. EDA simulator was designed based on a programmable light-controlled resistor with a wide resistance range, capable of simulating skin conductance levels (SCL) and responses (SCR) and was equipped with an artificial hand. The hand included electrically conductive fingers for attachment of EDA device electrodes. A minimal set of tests for evaluating an EDA device was identified, the simulator's functionality discussed and some testing results presented.

Effect of acute exposure to radiofrequency electromagnetic fields emitted by a mobile phone (GSM 900 MHz) on electrodermal responsiveness in healthy human

PURPOSE

The present study aimed to determine the effect of acute exposure to electromagnetic fields (EMF) emitted by a mobile phone on electrodermal activity (EDA) in response to an auditory stimulus.

MATERIALS AND METHODS

The EDA of 28 young volunteers was recorded following 26 min of exposure to a GSM mobile phone (900 MHz). Palmar sensors enabled repeat recording of 2 min 45 s in the pre-exposure, exposure and post-exposure phases in response to sound stimuli.

RESULTS

The latency, amplitude of skin conductance responses (SCRs), integral of skin conductance response and number of SCRs in response to the auditory stimuli were not modified by exposure. Skin conductance and tonic activity decomposition of the recorded signal were significantly different between the two sessions (p < .0001), but the changes could not be attributed to EMF exposure. There was also a tendency toward a fast reduction in the amplitude and number of electrodermal responses after placement of the mobile phone. In response to successive stimuli, there was a significant difference between the first response and subsequent responses for all variables except latency.

CONCLUSIONS

Our results showed a decrease in the number of responses and their amplitude as a result of placement of the mobile device and whether it was turned 'on' or 'off', but there were no changes associated with exposure to GSM radiofrequency waves in this group of volunteers.

Clozapine-Induced Cardiovascular Side Effects and Autonomic Dysfunction: A Systematic Review

Background: Clozapine is the antipsychotic of choice for treatment-resistant schizophrenia and has minimal risk for extrapyramidal symptoms. Therapeutic benefits, however, are accompanied by a myriad of cardiometabolic side-effects. The specific reasons for clozapine's high propensity to cause adverse cardiometabolic events remain unknown, but it is believed that autonomic dysfunction may play a role in many of these.

Objective: This systematic review summarizes the literature on autonomic dysfunction and related cardiovascular side effects associated with clozapine treatment.

Method: A search of the EMBASE, MEDLINE, and EBM Cochrane databases was conducted using the search terms antipsychotic agents, antipsychotic drug^*, antipsychotic^*, schizophrenia, schizophren^*, psychos^*, psychotic^*, mental ill^*, mental disorder^*, neuroleptic^*, cardiovascular^*, cardiovascular diseases, clozapine^*, clozaril^*, autonomic^*, sympathetic^*, catecholamine^*, norepinephrine, noradrenaline, epinephrine, adrenaline.

Results: The search yielded 37 studies that were reviewed, of which only 16 studies have used interventions to manage cardiovascular side effects. Side effects reported in the studies include myocarditis, orthostatic hypotension and tachycardia. These were attributed to sympathetic hyperactivity, decreased vagal contribution, blockade of cholinergic and adrenergic receptors, reduced heart rate variability and elevated catecholamines with clozapine use. Autonomic neuropathy was identified by monitoring blood pressure and heart rate changes in response to stimuli and by spectral analysis of heart rate variability. Metoprolol, lorazepam, atenolol, propranolol, amlodipine, vasopressin and norepinephrine infusion were used to treat tachycardia and fluctuations in blood pressure, yet results were limited to case reports.

Conclusion: The results indicate there is a lack of clinical studies investigating autonomic dysfunction and a limited use of interventions to manage cardiovascular side effects associated with clozapine. As there is often no alternative treatment for refractory schizophrenia, the current review highlights the need for better designed studies, use of autonomic tests for prevention of cardiovascular disease and development of novel interventions for clozapine-induced side effects.

The association between electrodermal activity (EDA), depression and suicidal behaviour: A systematic review and narrative synthesis

BACKGROUND

Electrodermal activity (EDA) and other peripheral autonomic electrical parameters have been used as indicators of emotional states, including depressive states and suicidal state. We aimed to review EDA research systematically, focusing on EDA's usefulness as a biomarker for depression and suicidal behaviour.

METHODS

We searched MEDLINE, Scopus, Cochrane Library, and Web of Science databases, following PRISMA guidelines. The initial screening of articles was based on titles and abstracts; then the full text was reviewed. A preliminary synthesis of findings was developed using tables, thematic analysis and quality ratings.

RESULTS

1287 articles were screened and 77 relevant studies were identified and included in the systematic review. The studies were fairly consistent in maintaining that hypoactive electrodermal response is an established feature of patients affected by depression. There is also preliminary evidence that monitoring EDA may help to differentiate the phases of mood disorders. A few studies provided evidence that EDA can be used to differentiate acutely suicidal subjects from depressed patients who are not severely suicidal. Although EDA has been shown to be a valid, sensitive marker of suicidal ideation, suicide attempts and violent suicidal behaviour, it also seems to be influenced to some extent by antidepressant treatment.

CONCLUSIONS

Most of the studies summarised in this review are quite outdated and employed a variety of designs and methods to evaluate EDA. This limits the generalisability of the results and makes it difficult to draw clear conclusions about the role of EDA in real-world settings. Electrodermal hypoactivity seems to be a reliable feature of depression and a valid marker of suicidal risk. Nevertheless, the potential utility of EDA in diagnosis, prevention, and treatment planning for depression and suicidal behaviour, should be thoroughly studied.

Cognition and autonomic function in schizophrenia: inferior cognitive test performance in electrodermal and niacin skin flush non-responders

BACKGROUND

Patients with schizophrenia suffer from a broad range of cognitive disturbances. The impact in terms of functional outcome is significant. There are also several reports of disturbed autonomic regulation in the disease. The present study examined cognitive function as well as psychophysiological parameters in patients with schizophrenia and healthy controls.

METHODS

Twenty-five patients and 14 controls were investigated with electrodermal activity (EDA), an oral niacin skin flush test and a comprehensive neurocognitive test program including the Wechsler battery (WAIS-R), Fingertapping Test, Trail Making Test, Verbal Fluency, Benton Visual Retention Test, Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test.

RESULTS

The patients generally had inferior test results compared to controls. Further analysis revealed that the EDA non-responding patient group explained this variation with significant lower test results than controls. On executive tests, EDA non-responders also performed significantly worse than EDA responding patients. The small group of niacin non-responding patients exhibited an even lower overall test performance. Delayed niacin flush also correlated inversely with psychomotor function and IQ in the patients.

CONCLUSION

The findings support the hypothesis of a neurodevelopment disturbance affecting both autonomic function and higher cortical function in schizophrenia.

A developmental increase in allostatic load from ages 3 to 11 years is associated with increased schizotypal personality at age 23 years

Although allostatic load has been investigated in mood and anxiety disorders, no prior study has investigated developmental change in allostatic load as a precursor to schizotypal personality. This study employed a multilevel developmental framework to examine whether the development of increased allostatic load, as indicated by impaired sympathetic nervous system habituation from ages 3 to 11 years, predisposes to schizotypal personality at age 23 years. Electrodermal activity to six aversive tones was recorded in 995 subjects at age 3 years and again at 11 years. Habituation slopes at both ages were used to create groups who showed a developmental increase in habituation (decreased allostatic load), and those who showed a developmental decrease in habituation (increased allostatic load). Children who showed a developmental increase in allostatic load from ages 3 to 11 years had higher levels of schizotypal personality at 23 years. A breakdown of total schizotypy scores demonstrated specificity of findings to cognitive-perceptual features of schizotypy. Findings are the first to document a developmental abnormality in allostasis in relation to adult schizotypal personality. The relative failure to develop normal habituation to repeated stressors throughout childhood is hypothesized to result in an accumulation of allostatic load and consequently increased positive symptom schizotypy in adulthood.

Physiological reactivity and facial expression to emotion-inducing films in patients with schizophrenia

The present study aimed to investigate the physiological reactivity and recognition to emotional stimuli in outpatients with schizophrenia and in healthy controls. Skin conductance response, skin conductance level, heart rate, respiration, corrugator muscle, and orbicularis muscle were all measured using five emotion-eliciting film clips. The patients reported lower intensity of experienced anger and disgust than controls. The patient and control groups did not differ in accuracy to recognize emotions except anger. Anger, fear, amusement, and sadness had a discriminative effect on physiological responses in the two groups. These findings provide helpful physiological evidence influenced by harmful or favorable emotional stimuli. Future directions may include to clarify how physiological reactivity and subject experience to emotion are related to their functioning.

Contextualizing the neurobiology of conduct disorder in an emotion dysregulation framework

Conduct disorder (CD) represents the most common childhood psychiatric disorder found in community and mental health clinics. This paper provides a comprehensive review of the neurobiology of CD; specifically, neurological and neurochemical correlates. Converging evidence suggests that neurological profiles of individuals with CD, compared to peers, are characterized by reduced P300 brain wave amplitude, deactivation of the anterior cingulated cortex and reduced activation in the left amygdala in response to negative stimuli, and reduced right temporal lobe volume. The neurochemical profiles of individuals with CD are characterized by reduced serotonin and cortisol levels (i.e., decreased HPA axis function), as well as attenuated autonomic nervous system functioning. Popular theoretical frameworks cited within the CD literature are limited in their ability to explain and consolidate the neurological and neurochemical findings. We believe that emotion dysregulation theory, though not often used within CD research, may provide the most comprehensive and inclusive framework for understanding neurobiological aspects of this disorder. Limitations within the literature, future directions for research, and implications of the findings will be discussed.

Chaos in schizophrenia associations, reality or metaphor?

There is evidence that schizophrenic associations display "chaotic", random-like behavior and decreased predictability. The evidence suggests a hypothesis that the "chaotic" mental disorganization could be explained within the concept of nonlinear dynamics and complexity in the brain that may cause chaotic neural organization. Testing of the hypothesis in the present study was performed using nonlinear analysis of bilateral electrodermal activity (EDA) during resting state and an association test in 56 schizophrenic patients and 44 healthy participants. EDA is a suitable measure of brain and autonomic activity reflecting neurobiological changes in schizophrenia that may indicate changes in nonlinear neural dynamics related to associative process. The results show that quantitative indices of chaotic dynamics (the largest Lyapunov exponents) calculated from EDA signals recorded during rest and the association test are significantly higher in schizophrenia patients than in the control group and increase during the test in comparison to the resting state. The difference was confirmed by statistical methods and using surrogate data testing that rejected an explanation within the linear statistical framework. The results provide supportive evidence that pseudo-randomness of schizophrenic associations and less predictability could be linked to increased complexity of nonlinear neural dynamics, although certain limitations in data interpretation must be taken into account.

Fronto-limbic and autonomic disjunctions to negative emotion distinguish schizophrenia subtypes

Schizophrenia patients show a disconnection in amygdala-medial prefrontal cortex and autonomic arousal systems for processing fear. Concurrent functional magnetic resonance imaging [fMRI] and skin conductance recording were used to determine whether these disturbances are specific to fear, or present in response to other signals of danger. We also examined whether these disturbances distinguish a specific symptom profile. During scanning, 27 schizophrenia (13 paranoid, 14 nonparanoid) and 22 matched healthy control subjects viewed standardized facial expressions of fear, anger and disgust (versus neutral). Skin conductance responses [SCRs]were acquired simultaneously to assess phasic increases in arousal. 'With-arousal' versus 'without-arousal' responses were analysed using non-parametric methods. For controls, 'with-arousal' responses were associated with emotion-specific activity for fear (amygdala), disgust (insula) and anger (anterior cingulate), together with common medial prefrontal cortex [MPFC] engagement, as predicted. Schizophrenia patients displayed abnormally increased phasic arousal, with concomitant reductions in emotion-specific regions and MPFC. These findings may reflect a general disconnection between central and autonomic systems for processing signals of danger. This disjunction was most apparent in patients with a profile of paranoia, coupled with poor social function and insight. Heightened autonomic sensitivity to signals of fear, threat or contamination, without effective neural mechanisms for appraisal, may underlie paranoid delusions which concern threat and contamination, and associated social and interpersonal difficulties.

Niacin skin-flush response and electrodermal activity in patients with schizophrenia and healthy controls

Patients with schizophrenia have in different studies shown reduced niacin sensitivity and lower electrodermal activity (EDA) after auditory stimulation. Peripheral mediation of prostaglandins may have a physiological role in both responses. This motivates study of both niacin response and electrodermal responding in the same patients with schizophrenia. Thirty patients with schizophrenia and 17 controls were investigated with EDA and thereafter given 200mg niacin orally with continuous assessment of skin temperature. The patients showed a delayed temperature increase after niacin ingestion (P=0.002) and a higher frequency of electrodermal non-responding (P<0.05). Response/non-response for niacin correlated with EDA response/non-response in the patient group (P=0.009). The niacin test revealed a slower vasodilation reaction in the patients. The association between response patterns for the niacin test and EDA suggests that a common aberration in skin physiology may be of importance for both reactions in schizophrenia.

Electrodermal predictors of functional outcome and negative symptoms in schizophrenia

The ability of electrodermal variables to predict negative symptoms and functional outcome over a 1-year period in schizophrenia was investigated in 78 young, recent-onset outpatients. Patients were stabilized on standardized medication and largely free of psychotic symptoms. Higher levels of both tonic (skin conductance level, nonspecific skin conductance response rate) and phasic (number of skin conductance orienting responses) activity were associated with more negative symptoms and with a combination of poorer social and occupational outcome at 1-year follow-up. This pattern was seen in both male and female patients, and in older and younger patients. Results are interpreted as suggesting that high levels of arousal and overreactivity to the environment may interfere with efficient cognitive processing in schizophrenia, contributing to poor outcome, and that negative symptoms might partially serve as a means of coping with overarousal.

Nonlinear complexity and spectral analyses of heart rate variability in medicated and unmedicated patients with schizophrenia

OBJECTIVE

Heart rate variability (HRV) reflects functioning of the autonomic nervous system and possibly also regulation by the neural limbic system, abnormalities of which have both figured prominently in various etiological models of schizophrenia, particularly those that address patients' vulnerability to stress in connection to psychosis onset and exacerbation. This study provides data on cardiac functioning in a sample of schizophrenia patients that were either medication free or on atypical antipsychotics, as well as cardiac data on matched healthy controls. We included a medication-free group to investigate whether abnormalities in HRV previously reported in the literature and associated with atypical antipsychotics were solely the effect of medications or whether they might be a feature of the illness (or psychosis) itself.

METHOD

We collected 24-hour ECGs on 19 patients and 24 controls. Of the patients, 9 were medication free and 10 were on atypical antipsychotics. All subject groups were matched for age and gender. Patient groups showed equivalent symptom severity and type, as well as duration of illness. We analyzed the data using nonlinear complexity (symbolic dynamic) HRV analyses as well as standard and relative spectral analyses.

RESULTS

For the medication-free patients as compared to the healthy controls, our data show decreased R-R intervals during sleep, and abnormal suppression of all frequency ranges, but particularly the low frequency range, which persisted even after adjusting the spectral data for the mean R-R interval. This effect was exacerbated for patients on atypical antipsychotics. Likewise, nonlinear complexity analysis showed significantly impaired HRV for medication-free patients that was exacerbated in the patients on atypical antipsychotics.

CONCLUSIONS

Altogether, the data suggest a pattern of significantly decreased cardiac vagal function of patients with schizophrenia as compared to healthy controls, apart from and beyond any differences due to medication side effects. The data additionally confirm earlier reports of a deleterious effect of atypical antipsychotics on HRV, which may exacerbate an underlying vulnerability in patients. These results support previous evidence that autonomic abnormalities may be a core feature of the illness (or psychosis), and that an even more conservative approach to cardiac risk in schizophrenia than previously thought may therefore be clinically appropriate.

Slow habituation of induced gamma and beta oscillations in association with unreality experiences in schizotypy

Highly schizotypal individuals exhibit deficits in attentional processing, in particular dysfunctional habituation. This has led to the suggestion that abnormal habituation may represent a trait marker of psychotic vulnerability. This study examined the difference between high- and low-schizotypal individuals' habituation of nonphase-locked gamma and beta-1 oscillations, with and without attention. Measures of schizotypy were obtained from 40 participants and habituation to different tones was examined over trials of three interval lengths, under conditions of attention and inattention. The data showed that all participants habituated over trials with long intervals when attending to the stimuli. However, those participants who scored high on the unreality subscale exhibited significantly less habituation relative to those with low unreality scores for the short-interval trials. Furthermore, there was no difference in the orienting response to the initial stimuli between these subgroups. These results are discussed in terms of a dysfunctional rehearsal process influencing habituation for those with high-unreality scores.

Schizophrenia and schizotypal personality: a tribute to Peter H. Venables

Peter Venables made multiple contributions to the field of schizophrenia and schizotypy, most notably in the areas of psychophysiology, neurocognition, and assessment. On the 50th anniversary of the start of his research career in 1951, a conference on schizophrenia and schizotypy was held in his honor in Tuscany, Italy. This special edition encapsulates many of the presentations given at that meeting, covering the areas of neurodevelopment, assessment, genetics, psychophysiology, neurocognition, brain imaging, psychopharmacology, intervention, and prevention. A key theme of this special edition concerns the integration of schizophrenia and schizotypy research in a manner that will allow for a more comprehensive understanding of both of these disorders.