1
|
Haime Z, Watson AJ, Crellin N, Marston L, Joyce E, Moncrieff J. A systematic review of the effects of psychiatric medications on social cognition. BMC Psychiatry 2021; 21:597. [PMID: 34844572 PMCID: PMC8628466 DOI: 10.1186/s12888-021-03545-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/14/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social cognition is an important area of mental functioning relevant to psychiatric disorders and social functioning, that may be affected by psychiatric drug treatments. The aim of this review was to investigate the effects of medications with sedative properties, on social cognition. METHOD This systematic review included experimental and neuroimaging studies investigating drug effects on social cognition. Data quality was assessed using a modified Downs and Black checklist (Trac et al. CMAJ 188: E120-E129, 2016). The review used narrative synthesis to analyse the data. RESULTS 40 papers were identified for inclusion, 11 papers investigating benzodiazepine effects, and 29 investigating antipsychotic effects, on social cognition. Narrative synthesis showed that diazepam impairs healthy volunteer's emotion recognition, with supporting neuroimaging studies showing benzodiazepines attenuate amygdala activity. Studies of antipsychotic effects on social cognition gave variable results. However, many of these studies were in patients already taking medication, and potential practice effects were identified due to short-term follow-ups. CONCLUSION Healthy volunteer studies suggest that diazepam reduces emotional processing ability. The effects of benzodiazepines on other aspects of social cognition, as well as the effects of antipsychotics, remain unclear. Interpretations of the papers in this review were limited by variability in measures, small sample sizes, and lack of randomisation. More robust studies are necessary to evaluate the impact of these medications on social cognition.
Collapse
Affiliation(s)
- Zoë Haime
- Psychiatry Department, University College London, London, UK.
| | - Andrew J. Watson
- grid.83440.3b0000000121901201Institute of Neurology, UCL, London, UK
| | - Nadia Crellin
- grid.83440.3b0000000121901201Psychiatry Department, University College London, London, UK
| | - Louise Marston
- grid.83440.3b0000000121901201Department of Primary Care and Population Health, UCL, London, UK
| | - Eileen Joyce
- grid.83440.3b0000000121901201Institute of Neurology, UCL, London, UK
| | - Joanna Moncrieff
- grid.83440.3b0000000121901201Psychiatry Department, University College London, London, UK
| |
Collapse
|
2
|
Baldez DP, Biazus TB, Rabelo-da-Ponte FD, Nogaro GP, Martins DS, Kunz M, Czepielewski LS. The effect of antipsychotics on the cognitive performance of individuals with psychotic disorders: Network meta-analyses of randomized controlled trials. Neurosci Biobehav Rev 2021; 126:265-275. [PMID: 33812977 DOI: 10.1016/j.neubiorev.2021.03.028] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 12/12/2022]
Abstract
Cognitive deficits are a core aspect of psychotic disorders; however, it is not clear to which extent different pharmacological treatments could distinctly impact these outcomes. Hence, we conducted a systematic review and ten network meta-analyses of randomized controlled trials to compare the effect of antipsychotics on cognitive performance of individuals with psychotic disorders. Fifty-four trials were included in the analyses, enrolling 5866 patients. Compared to other antipsychotics, amisulpride performed better on verbal learning; quetiapine on composite score, attention and verbal learning; lurasidone on composite score; olanzapine on composite score and most cognitive domains; perphenazine on composite score, executive function, working memory, and verbal learning; risperidone on executive function and verbal learning; sertindole on processing speed; and ziprasidone on composite score, working memory, and verbal learning. Oppositely, haloperidol performed poorer on all cognitive domains, occupying the last positions in all rankings; and clozapine performed poorer on composite score, executive function, verbal learning, and visuoconstruction. We hope that these results should be taken into account when assessing and treating individuals with psychosis.
Collapse
Affiliation(s)
- Daniel Prates Baldez
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Tais Boeira Biazus
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil
| | - Francisco Diego Rabelo-da-Ponte
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Guilherme Pedro Nogaro
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil
| | - Dayane Santos Martins
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Maurício Kunz
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035-003, Brazil
| | - Letícia Sanguinetti Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Prédio Anexo, Porto Alegre, 90035-903, Brazil; Programa de Pós-Graduação em Psicologia, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600, Porto Alegre, 90035-003, Brazil.
| |
Collapse
|
3
|
Interaction of emotion and cognitive control along the psychosis continuum: A critical review. Int J Psychophysiol 2020; 147:156-175. [DOI: 10.1016/j.ijpsycho.2019.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 10/29/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022]
|
4
|
Statucka M, Walder DJ. Facial affect recognition and social functioning among individuals with varying degrees of schizotypy. Psychiatry Res 2017. [PMID: 28645078 DOI: 10.1016/j.psychres.2017.06.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Facial affect recognition (FAR) accuracy is impaired in schizophrenia and, to a lesser extent, in individuals at-risk for psychosis. Reduced reaction time and negative bias on FAR tasks are also evident in schizophrenia, though few studies have examined these measures in at-risk samples. Social dysfunction is associated with FAR deficits in schizophrenia and at-risk individuals. We aimed to elucidate the nature of FAR and social functioning among individuals from a non-clinical population reporting a range of schizotypal traits (i.e., risk for psychosis), and to examine whether FAR mediates the relationship between schizotypal traits and social functioning. Participants completed self-report measures assessing schizotypal traits and social functioning, and a computerized FAR task remotely via the Internet. High schizotypy individuals performed significantly worse than low schizotypy individuals on FAR total and neutral accuracy, demonstrated a negative bias, and reported significantly worse social functioning. Schizotypal traits were also negatively correlated with FAR performance and social functioning in the total sample. FAR accuracy did not mediate the direct relationship between schizotypal traits and social functioning. FAR may be an important social-cognitive endophenotype of psychosis risk with implications for understanding etiology of psychotic spectrum disorders, improving ways of identifying at-risk individuals, and developing preventive strategies.
Collapse
Affiliation(s)
- Marta Statucka
- Department of Psychology, The Graduate Center, Queens College, and Brooklyn College of The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, USA.
| | - Deborah J Walder
- Department of Psychology, The Graduate Center, Queens College, and Brooklyn College of The City University of New York, 2900 Bedford Avenue, Brooklyn, NY, USA.
| |
Collapse
|
5
|
The Change in Facial Emotion Recognition Ability in Inpatients with Treatment Resistant Schizophrenia After Electroconvulsive Therapy. Psychiatr Q 2017; 88:535-543. [PMID: 27663585 DOI: 10.1007/s11126-016-9466-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with schizophrenia have impairments in emotion recognition along with other social cognitive deficits. In the current study, we aimed to investigate the immediate benefits of ECT on facial emotion recognition ability. Thirty-two treatment resistant patients with schizophrenia who have been indicated for ECT enrolled in the study. Facial emotion stimuli were a set of 56 photographs that depicted seven basic emotions: sadness, anger, happiness, disgust, surprise, fear, and neutral faces. The average age of the participants was 33.4 ± 10.5 years. The rate of recognizing the disgusted facial expression increased significantly after ECT (p < 0.05) and no significant changes were found in the rest of the facial expressions (p > 0.05). After the ECT, the time period of responding to the fear and happy facial expressions were significantly shorter (p < 0.05). Facial emotion recognition ability is an important social cognitive skill for social harmony, proper relation and living independently. At least, the ECT sessions do not seem to affect facial emotion recognition ability negatively and seem to improve identifying disgusted facial emotion which is related with dopamine enriched regions in brain.
Collapse
|
6
|
Tsotsi S, Kosmidis MH, Bozikas VP. Improved facial affect recognition in schizophrenia following an emotion intervention, but not training attention-to-facial-features or treatment-as-usual. Psychiatry Res 2017; 254:135-142. [PMID: 28460284 DOI: 10.1016/j.psychres.2017.04.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 11/18/2022]
Abstract
In schizophrenia, impaired facial affect recognition (FAR) has been associated with patients' overall social functioning. Interventions targeting attention or FAR per se have invariably yielded improved FAR performance in these patients. Here, we compared the effects of two interventions, one targeting FAR and one targeting attention-to-facial-features, with treatment-as-usual on patients' FAR performance. Thirty-nine outpatients with schizophrenia were randomly assigned to one of three groups: FAR intervention (training to recognize emotional information, conveyed by changes in facial features), attention-to-facial-features intervention (training to detect changes in facial features), and treatment-as-usual. Also, 24 healthy controls, matched for age and education, were assigned to one of the two interventions. Two FAR measurements, baseline and post-intervention, were conducted using an original experimental procedure with alternative sets of stimuli. We found improved FAR performance following the intervention targeting FAR in comparison to the other patient groups, which in fact was comparable to the pre-intervention performance of healthy controls in the corresponding intervention group. This improvement was more pronounced in recognizing fear. Our findings suggest that compared to interventions targeting attention, and treatment-as-usual, training programs targeting FAR can be more effective in improving FAR in patients with schizophrenia, particularly assisting them in perceiving threat-related information more accurately.
Collapse
Affiliation(s)
- Stella Tsotsi
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece; 1st Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Vasilis P Bozikas
- 1st Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece.
| |
Collapse
|
7
|
Restricted attention to social cues in schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 2016; 266:649-61. [PMID: 27305925 DOI: 10.1007/s00406-016-0705-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
Deficits of psychosocial functioning are a robust finding in schizophrenia. Research on social cognition may open a new avenue for the development of effective interventions. As a correlate of social perceptive information processing deficits, schizophrenia patients (SZP) show deviant gaze behavior (GB) while viewing emotional faces. As understanding of a social environment requires gathering complex social information, our study aimed at investigating the gaze behavior of SZP related to social interactions and its impact on the level of social and role functioning. GB of 32 SZP and 37 healthy control individuals (HCI) was investigated with a high-resolution eye tracker during an unguided viewing of 12 complex pictures of social interaction scenes. Regarding whole pictures, SZP showed a shorter scanpath length, fewer fixations and a shorter mean distance between fixations. Furthermore, SZP exhibited fewer and shorter fixations on faces, but not on the socially informative bodies nor on the background, suggesting a cue-specific abnormality. Logistic regression with bootstrapping yielded a model including two GB parameters; a subsequent ROC curve analysis indicated an excellent ability of group discrimination (AUC .85). Face-related GB aberrations correlated with lower social and role functioning and with delusional thinking, but not with negative symptoms. Training of spontaneous integration of face-related social information seems promising to enable a holistic perception of social information, which may in turn improve social and role functioning. The observed ability to discriminate SZP from HCI warrants further research on the predictive validity of GB in psychosis risk prediction.
Collapse
|
8
|
Dondaine T, Robert G, Péron J, Grandjean D, Vérin M, Drapier D, Millet B. Biases in facial and vocal emotion recognition in chronic schizophrenia. Front Psychol 2014; 5:900. [PMID: 25202287 PMCID: PMC4141280 DOI: 10.3389/fpsyg.2014.00900] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/29/2014] [Indexed: 01/26/2023] Open
Abstract
There has been extensive research on impaired emotion recognition in schizophrenia in the facial and vocal modalities. The literature points to biases toward non-relevant emotions for emotional faces but few studies have examined biases in emotional recognition across different modalities (facial and vocal). In order to test emotion recognition biases, we exposed 23 patients with stabilized chronic schizophrenia and 23 healthy controls (HCs) to emotional facial and vocal tasks asking them to rate emotional intensity on visual analog scales. We showed that patients with schizophrenia provided higher intensity ratings on the non-target scales (e.g., surprise scale for fear stimuli) than HCs for the both tasks. Furthermore, with the exception of neutral vocal stimuli, they provided the same intensity ratings on the target scales as the HCs. These findings suggest that patients with chronic schizophrenia have emotional biases when judging emotional stimuli in the visual and vocal modalities. These biases may stem from a basic sensorial deficit, a high-order cognitive dysfunction, or both. The respective roles of prefrontal-subcortical circuitry and the basal ganglia are discussed.
Collapse
Affiliation(s)
- Thibaut Dondaine
- EA 4712 'Behavior and Basal Ganglia' Laboratory, Université de Rennes 1 Rennes, France ; Psychiatry Unit, Guillaume Régnier Hospital Rennes, France
| | - Gabriel Robert
- EA 4712 'Behavior and Basal Ganglia' Laboratory, Université de Rennes 1 Rennes, France ; Psychiatry Unit, Guillaume Régnier Hospital Rennes, France
| | - Julie Péron
- 'Neuroscience of Emotion and Affective Dynamics' Laboratory, Department of Psychology, University of Geneva Switzerland ; Swiss Center for Affective Sciences, University of Geneva Switzerland
| | - Didier Grandjean
- 'Neuroscience of Emotion and Affective Dynamics' Laboratory, Department of Psychology, University of Geneva Switzerland ; Swiss Center for Affective Sciences, University of Geneva Switzerland
| | - Marc Vérin
- EA 4712 'Behavior and Basal Ganglia' Laboratory, Université de Rennes 1 Rennes, France ; Neurology Unit, University Hospital of Rennes France
| | - Dominique Drapier
- EA 4712 'Behavior and Basal Ganglia' Laboratory, Université de Rennes 1 Rennes, France ; Psychiatry Unit, Guillaume Régnier Hospital Rennes, France
| | - Bruno Millet
- EA 4712 'Behavior and Basal Ganglia' Laboratory, Université de Rennes 1 Rennes, France ; Psychiatry Unit, Guillaume Régnier Hospital Rennes, France
| |
Collapse
|
9
|
Bossong MG, Jansma JM, Bhattacharyya S, Ramsey NF. Role of the endocannabinoid system in brain functions relevant for schizophrenia: an overview of human challenge studies with cannabis or ∆9-tetrahydrocannabinol (THC). Prog Neuropsychopharmacol Biol Psychiatry 2014; 52:53-69. [PMID: 24380726 DOI: 10.1016/j.pnpbp.2013.11.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Revised: 10/16/2013] [Accepted: 11/25/2013] [Indexed: 12/30/2022]
Abstract
Accumulating evidence suggests involvement of the endocannabinoid system in the pathophysiology of schizophrenia, which signifies a potential application for this system in the treatment of this disorder. However, before new research can focus on potential treatments that work by manipulating the endocannabinoid system, it needs to be elucidated how this system is involved in symptoms of schizophrenia. Here we review human studies that investigated acute effects of cannabis or ∆9-tetrahydrocannabinol (THC) on brain functions that are implicated in schizophrenia. Results suggest that the impact of THC administration depends on the difficulty of the task performed. Impaired performance of cognitive paradigms is reported on more challenging tasks, which is associated with both activity deficits in temporal and prefrontal areas and a failure to deactivate regions of the default mode network. Comparable reductions in prefrontal activity and impairments in deactivation of the default mode network are seen in patients during performance of cognitive paradigms. Normal performance levels after THC administration demonstrated for less demanding tasks are shown to be related to either increased neural effort in task-specific regions ('neurophysiological inefficiency'), or recruitment of alternative brain areas, which suggests a change in strategy to meet cognitive demands. Particularly a pattern of performance and brain activity corresponding with an inefficient working memory system is consistently demonstrated in patients. These similarities in brain function between intoxicated healthy volunteers and schizophrenia patients provide an argument for a role of the endocannabinoid system in symptoms of schizophrenia, and further emphasize this system as a potential novel target for treatment of these symptoms.
Collapse
Affiliation(s)
- Matthijs G Bossong
- Institute of Psychiatry, Department of Psychosis Studies, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom.
| | - J Martijn Jansma
- Rudolf Magnus Institute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Sagnik Bhattacharyya
- Institute of Psychiatry, Department of Psychosis Studies, King's College London, 16 De Crespigny Park, London SE5 8AF, United Kingdom
| | - Nick F Ramsey
- Rudolf Magnus Institute of Neuroscience, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
10
|
Abstract
Social cognition is described as the higher mental processes that are engaged while people store, process, and use social information to make sense of themselves and others. Aspects of social cognition include emotion perception, social cue interpretation, attribution style, and theory of mind, all of which appear disordered in schizophrenia. Such social cognitive deficits are believed to be important predictors of functional outcome in schizophrenia, therefore they may represent a crucial treatment target. Few studies have evaluated the influence of antipsychotic treatment on these deficits. The purpose of this review is to examine the relationship between antipsychotic treatment and social cognition, whether antipsychotics improve social cognitive function, and if so to explore differential medication effects. Comprehensive searches of PsycINFO and MEDLINE/PUBMED were conducted to identify relevant published manuscripts. Fifteen relevant papers published in English were found, describing original studies. On the basis of this review, we have drawn the following conclusions: first, the results do not engender optimism for the possibility that antipsychotic drugs can specifically facilitate social recovery. Second, the actions of antipsychotics on social cognition are inconclusive, due to lack of standardization across research groups, leading to inconsistencies between study designs, methods used, and medication dosages. Third, large-scale longitudinal investigations are needed to explore the unclear relationships between social cognition, symptoms, and functional outcome. Other non-pharmacological treatments focusing on training patients in the social cognitive areas may hold more promise.
Collapse
Affiliation(s)
- Katarzyna Kucharska-Pietura
- NAViGO, Grimsby, UK
- Hull York Medical School, Hull, UK
- Rharian Fields, The Gardens, Diana Princess of Wales Hospital, Grimsby, DN33 2BA UK
| | | |
Collapse
|
11
|
Efficacy of social cognition remediation programs targeting facial affect recognition deficits in schizophrenia: a review and consideration of high-risk samples and sex differences. Psychiatry Res 2013; 206:125-39. [PMID: 23375627 DOI: 10.1016/j.psychres.2012.12.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/29/2012] [Accepted: 12/08/2012] [Indexed: 12/14/2022]
Abstract
Schizophrenia patients suffer from significant social functioning deficits. Social cognition, particularly facial affect recognition (FAR), is an important predictor of functional outcome. Recently, investigators developed numerous social cognition remediation programs targeting FAR deficits with the goal of improving social functioning and quality of life in schizophrenia patients. This article builds on Horan et al.'s (2008) comprehensive review and Kurtz and Richardson's (2012) meta-analysis of a broad range of social cognition remediations, by systematically reviewing efficacy of empirically based remediations in schizophrenia specifically targeting FAR (across 23 studies), and their potential functional benefits. We describe each FAR-based social cognition remediation program, which may aid clinical scientists and clinicians in selecting programs for further study and practice. We critically evaluate limitations of FAR remediation programs and applications. Our review concludes FAR remediation programs are strongly efficacious in improving FAR performance and functional status in schizophrenia. Importantly, we provide rationale for and recommend that future research consider (as yet underexplored) sexual dimorphisms in FAR remediation effects, and examine FAR remediation in clinical high-risk for psychosis populations. The goal is to mitigate deficits, perhaps hinder illness onset, and individually tailor treatments across the psychosis continuum in a way that maximally aids those in greatest need.
Collapse
|
12
|
Dickey CC, Vu MAT, Voglmaier MM, Niznikiewicz MA, McCarley RW, Panych LP. Prosodic abnormalities in schizotypal personality disorder. Schizophr Res 2012; 142:20-30. [PMID: 23068317 PMCID: PMC3502641 DOI: 10.1016/j.schres.2012.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/31/2012] [Accepted: 09/05/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with schizophrenia speak with blunted vocal affect but little is known regarding the prosody of persons with schizotypal personality disorder (SPD). This work examined expressive prosody in SPD, its relationship to brain structure, and outlined a framework for measuring elements of prosody in clinical populations. METHODS Twenty-eight antipsychotic-naïve SPD subjects were matched with 27 healthy comparison (HC) subjects. Subjects read aloud short sentences and responded to probes to record both predetermined and self-generated speech samples. Samples were analyzed acoustically (pause proportion, duration, attack, and pitch variability) and subjectively by raters (amount of pauses, degree of emotion portrayed, and how much they wanted to hear more from the subjects) on paragraph, sentence, word, word-fragment, and syllable levels. Alexithymia and ability to self-monitor behavior were compared between groups. The pars opercularis was manually traced on structural MRI data. RESULTS SPD subjects' speech had significantly more pauses, was slower, had less pitch variability, and expressed less emotion than HC subjects. Pitch variability correlated with socio-economic status achievement. There was no difference between groups in left or right pars opercularis volumes. A statistically significant correlation suggested that smaller left pars opercularis volumes in SPD subjects correlated with more pauses and less emotion. SPD subjects reported more alexithymia and difficulty self-monitoring their behavior compared with controls. In SPD subjects the high alexithymia correlated with raters not wanting to hear more from them and SPD subjects' inability to modulate their social behavior correlated with their having fewer friends. Thus, the SPD subjects exhibited insight. CONCLUSIONS SPD subjects displayed significant prosodic deficits that were measurable in speech samples as brief as a word-fragment. The determinants of these deficits are not known although these may include a dysfunctional pars opercularis. These data add to the nascent literature describing social cognition deficits in SPD.
Collapse
Affiliation(s)
- Chandlee C. Dickey
- VA Boston Healthcare System, Harvard Medical School Psychiatry 116A-7, 940 Belmont St., Brockton, MA 02301,Laboratory of Neuroscience, VA Boston Healthcare System, Harvard Medical School 940 Belmont St., Brockton, MA 02301,Corresponding Author: Chandlee Dickey, M.D. VA Boston Healthcare System, Psychiatry 116A-7, 940 Belmont St., Brockton, MA 02301 Phone: (774) 826-2457 Fax: (774) 826-1859
| | - Mai-Anh T Vu
- Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School 1249 Boylston St, Boston, MA 02215
| | - Martina M. Voglmaier
- Laboratory of Neuroscience, VA Boston Healthcare System, Harvard Medical School 940 Belmont St., Brockton, MA 02301
| | - Margaret A. Niznikiewicz
- Laboratory of Neuroscience, VA Boston Healthcare System, Harvard Medical School 940 Belmont St., Brockton, MA 02301,Psychiatry Neuroimaging Laboratory, Brigham & Women's Hospital, Harvard Medical School 1249 Boylston St, Boston, MA 02215
| | - Robert W. McCarley
- Laboratory of Neuroscience, VA Boston Healthcare System, Harvard Medical School 940 Belmont St., Brockton, MA 02301
| | - Lawrence P. Panych
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School 75 Francis St., Boston, MA 02216
| |
Collapse
|
13
|
Whitton AE, Henry JD. The relationship between sub-clinical obsessive-compulsive symptoms and social cognition in chronic schizophrenia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 52:115-28. [PMID: 24215143 DOI: 10.1111/bjc.12004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 07/10/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Comorbid obsessive-compulsive (OC) symptoms in individuals with a primary diagnosis of schizophrenia are related to poorer cognitive performance and functional outcomes, but no study to date has assessed whether this comorbidity might also have implications for social cognition. The aim of the present study was to provide the first test of this possibility. DESIGN AND METHODS Individuals with schizophrenia (n = 34) and demographically matched non-clinical controls (n = 44) were assessed on two of the most important aspects of social cognitive function (1) facial affect recognition and (2) theory of mind, alongside more standard measures of cognitive function. RESULTS The presence of OC symptoms was related to poorer performance on some of the cognitive measures, as well as one of the social cognitive measures (facial affect recognition). However, these relationships disappeared after controlling for scores on more general indices of schizophrenia psychopathology. CONCLUSIONS The presence of OC symptoms in schizophrenia is not only associated with increased cognitive impairment but also increased difficulties with at least some aspects of social cognitive function. However, these relationships appear to reflect the elevated levels of psychopathology seen in this cohort more generally, rather than being uniquely attributable to OC symptomatology.
Collapse
|
14
|
Pompili A, Arnone B, Gasbarri A. Estrogens and memory in physiological and neuropathological conditions. Psychoneuroendocrinology 2012; 37:1379-96. [PMID: 22309827 DOI: 10.1016/j.psyneuen.2012.01.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Revised: 01/13/2012] [Accepted: 01/13/2012] [Indexed: 12/22/2022]
Abstract
Ovarian hormones can influence brain regions crucial to higher cognitive functions, such as learning and memory, acting at structural, cellular and functional levels, and modulating neurotransmitter systems. Among the main effects of estrogens, the protective role that they may play against the deterioration of cognitive functions occurring with normal aging is of essential importance. In fact, during the last century, there has been a 30 years increase in female life expectancy, from 50 to 83 years; however, the mean age of spontaneous menopause remains stable, 50-51 years, with variability related to race and ethnicity. Therefore, women are now spending a greater fraction of their lives in a hypoestrogenic state. Although many cognitive functions seem to be unaffected by normal aging, age-related impairments are particularly evident in tasks involving working memory (WM), whose deficits are a recognized feature of Alzheimer's disease (AD). Many studies conducted over the past two decades showed that the female gonadal hormone estradiol can influence performance of learning and memory tasks, both in animal and humans. There is a great deal of evidence, mostly from animal models, that estrogens can facilitate or enhance performance on WM tasks; therefore, it is very important to clarify their role on this type of memory. To this aim, in this review we briefly describe the most relevant neurobiological bases of estrogens, that can explain their effects on cognitive functioning, and then we summarize the results of works conducted in our laboratory, both on animals and humans, utilizing the menstrual/estrous cycle as a useful noninvasive model. Finally, we review the possible role of estrogens in neuropathological conditions, such as AD and schizophrenia.
Collapse
Affiliation(s)
- Assunta Pompili
- Department of Biomedical Sciences and Technologies, University of L'Aquila, L'Aquila, Italy.
| | | | | |
Collapse
|
15
|
Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Thibaut F, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, part 1: update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry 2012; 13:318-78. [PMID: 22834451 DOI: 10.3109/15622975.2012.696143] [Citation(s) in RCA: 382] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
These updated guidelines are based on a first edition of the World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Schizophrenia published in 2005. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful and these guidelines are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A-F; Bandelow et al. 2008b, World J Biol Psychiatry 9:242). This first part of the updated guidelines covers the general descriptions of antipsychotics and their side effects, the biological treatment of acute schizophrenia and the management of treatment-resistant schizophrenia.
Collapse
Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University of Goettingen, Goettingen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Surguladze SA, Chu EM, Marshall N, Evans A, Anilkumar APP, Timehin C, McDonald C, Ecker C, Phillips ML, David AS. Emotion processing in schizophrenia: fMRI study of patients treated with risperidone long-acting injections or conventional depot medication. J Psychopharmacol 2011; 25:722-33. [PMID: 20360158 DOI: 10.1177/0269881110363316] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We employed two event-related functional magnetic resonance imaging tasks using the pictures of mild and intense facial emotions of fear or happiness. The sample comprised 16 chronic schizophrenia patients treated with risperidone long-acting injections (RLAI), 16 patients treated with conventional antipsychotic depots (CONV) and 16 healthy controls (HC). The HC and RLAI groups demonstrated greater activation in the left amygdala in response to intensively fearful faces, and in right cerebellum to intensively happy faces compared with CONV patients. The CONV group demonstrated under-activation in the right temporal pole in response to intensively happy faces (compared with HC) and over-activation in ventro-medial prefrontal cortex (VMPFC) in response to both intensively happy and fearful expressions, compared with HC and RLAI groups. Our results suggest that networks implicated in the allocation of attentional resources (VMPFC) and emotion processing (amygdala, cerebellum) are differentially affected in patients on CONV versus RLAI.
Collapse
Affiliation(s)
- Simon A Surguladze
- Division of Psychological Medicine and Psychiatry, King's College London Institute of Psychiatry, London, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Chan RCK, Li H, Cheung EFC, Gong QY. Impaired facial emotion perception in schizophrenia: a meta-analysis. Psychiatry Res 2010; 178:381-90. [PMID: 20483476 DOI: 10.1016/j.psychres.2009.03.035] [Citation(s) in RCA: 147] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 03/17/2009] [Accepted: 03/27/2009] [Indexed: 12/12/2022]
Abstract
Research into facial emotion perception in schizophrenia has burgeoned over the past several decades. The evidence is mixed regarding whether patients with schizophrenia have a general facial emotion perception deficit (a deficit in facial emotion perception plus a more basic deficit in facial processing) or specific facial emotion perception deficits (deficits only in facial emotion perception tasks). A meta-analysis is conducted of 28 facial emotion perception studies that include control tasks. These studies use differential deficit designs to examine whether patients with schizophrenia demonstrate a general deficit or specific deficit in facial emotion perception. A significant mean effect size is found for total facial emotion perception (d=-0.85). Patients with schizophrenia demonstrate impaired ability to perform corresponding control tasks, and the mean effect size is -0.70. The current findings suggest that patients with schizophrenia have moderately to severely impaired perception of facial emotion.
Collapse
Affiliation(s)
- Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Institute of Psychology, Chinese Academy of Sciences, Beijing, PR China.
| | | | | | | |
Collapse
|
18
|
Hempel RJ, Dekker JA, van Beveren NJM, Tulen JHM, Hengeveld MW. The effect of antipsychotic medication on facial affect recognition in schizophrenia: a review. Psychiatry Res 2010; 178:1-9. [PMID: 20452051 DOI: 10.1016/j.psychres.2008.07.025] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 07/23/2008] [Accepted: 07/31/2008] [Indexed: 11/18/2022]
Abstract
Patients with schizophrenia suffer from impairments in facial affect recognition and social functioning. Since antipsychotic medication affects different areas in the brain, they may also affect target areas involved in emotional processing mechanisms. In this article, we review the findings of the effect of antipsychotic medication on facial affect recognition in schizophrenia. We searched PubMed for articles in English with the keywords schizophrenia, facial, affect, emotion, antipsychotic and medication, published till January 2008. Eight relevant articles were found describing original studies. No substantial improvements in facial affect recognition were found after treatment with either typical or atypical antipsychotic drugs. Facial affect recognition was not related to neuropsychological functioning, and it was unclear whether improvement of symptom severity was related to performance on the facial affect recognition tasks. It is recommended that future research should focus on measuring social skills and social functioning more directly, and by investigating the effects of additional behavioural treatments on facial affect recognition and social functioning relative to treatment with antipsychotic medication alone.
Collapse
Affiliation(s)
- Roelie J Hempel
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|
19
|
Chan RCK, Gao XJ, Li XY, Li HH, Cui JF, Deng YY, Wang Y. The Social Cognition and Interaction Training (SCIT): an extension to individuals with schizotypal personality features. Psychiatry Res 2010; 178:208-10. [PMID: 20421136 DOI: 10.1016/j.psychres.2010.03.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 03/17/2010] [Accepted: 03/28/2010] [Indexed: 11/15/2022]
Abstract
The current study aimed to extend the clinical utility of the Social Cognition and Interaction Training (SCIT) to individuals with schizotypal personality features. It provided preliminary findings on the suitability and efficacy of the SCIT for these individuals in mainland China.
Collapse
Affiliation(s)
- Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.
| | | | | | | | | | | | | |
Collapse
|
20
|
Roberts DL, Penn DL, Corrigan P, Lipkovich I, Kinon B, Black RA. Antipsychotic medication and social cue recognition in chronic schizophrenia. Psychiatry Res 2010; 178:46-50. [PMID: 20452678 DOI: 10.1016/j.psychres.2010.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/01/2010] [Accepted: 04/04/2010] [Indexed: 10/19/2022]
Abstract
Social cognition has received increased attention in schizophrenia research because it is associated with functional outcomes. Psychosocial interventions are being developed to enhance social cognition, however less attention has been paid to the association between antipsychotic medication use and social cognition. This study evaluated whether individuals treated with olanzapine (n=117) or quetiapine (n=106) achieved improvements in social cognition. Participants were drawn from a larger 6-month, multi-site, randomized, double-blind clinical trial. Social cognition was assessed using signal detection analysis of performance on the Social Cue Recognition Test. Social functioning was measured with an interpersonal functioning index and a broader quality of life measure. Results revealed that participants in both medication groups improved significantly but modestly on three out of four social cognition subscales. The small observed effect in this trial is generally consistent with previous studies, and supports the need for ongoing research into the biological mechanisms of social cognitive dysfunction in schizophrenia.
Collapse
Affiliation(s)
- David Leland Roberts
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Cabral-Calderin Y, Mendoza-Quiñones R, Garcia A, Caballero A, Domínguez M, Reyes MM. Effect of quetiapine treatment on facial emotion recognition deficits in schizophrenia patients. Schizophr Res 2010; 119:275-6. [PMID: 20406719 DOI: 10.1016/j.schres.2010.03.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 03/24/2010] [Accepted: 03/26/2010] [Indexed: 11/15/2022]
|
22
|
Fakra E, Salgado-Pineda P, Besnier N, Azorin JM, Blin O. Risperidone versus haloperidol for facial affect recognition in schizophrenia: findings from a randomised study. World J Biol Psychiatry 2010; 10:719-28. [PMID: 17853271 DOI: 10.1080/15622970701432536] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with schizophrenia consistently fail to perform facial affect recognition tasks as accurately as healthy controls. So far, the effects of different antipsychotic drugs on this deficit, as well as the mechanisms through which these drugs may exert their influence on face processing models, remain poorly understood. Twenty-five hospitalised acute schizophrenic patients were randomised to either haloperidol or risperidone following their admission. Patients performed a facial affect discrimination task. In order to differentiate drug effects on perceptive versus semantic processing of faces, the evaluation also included two facial identity discrimination tasks (inverted and upright faces). All evaluations were performed before treatment initiation, after 2 weeks and after 4 weeks of treatment. Compared with patients receiving haloperidol, patients receiving risperidone showed better discrimination of facial affect and inverted faces, but not of upright faces. Differential drug effects were most prominent 2 weeks after treatment initiation. Performance on inverted faces accounted for only 1% of the variance in affect discrimination. Additionally, there was an inverse relationship between negative symptoms and performance on upright-face identification and affect discrimination, with the strongest and most significant correlation being for affect discrimination. Our findings suggest that the preferential effect of risperidone on affect discrimination is unlikely to be due to global effects on general face processing. Moreover, although risperidone appears to enhance the processing of individual salient facial features, this effect cannot explain the improvement in affect recognition. We conclude that risperidone may specifically act on the processing of emotion-laden information.
Collapse
Affiliation(s)
- Eric Fakra
- Department of Psychiatry, University of Marseille, Marseille, France.
| | | | | | | | | |
Collapse
|
23
|
Fiszdon JM, Bell MD. Effects of presentation modality and valence on affect recognition performance in schizophrenia and healthy controls. Psychiatry Res 2009; 170:114-8. [PMID: 19900721 DOI: 10.1016/j.psychres.2008.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 11/13/2008] [Accepted: 11/19/2008] [Indexed: 10/20/2022]
Abstract
The majority of affect recognition research has used visual stimuli, with only a minority of studies examining auditory affect recognition, and fewer still comparing affect recognition across presentation modalities. In the current study, we evaluated affect recognition between 45 outpatients with schizophrenia or schizoaffective disorder and 56 healthy community controls on an auditory-only affect recognition task, as compared to a multichannel (videotape) version of the same task. We further examined between-group performance differences on auditory versus multichannel presentation modalities for a subset of positive and negative valence items. Results indicated that: 1) in general, healthy controls performed better than schizophrenia patients on affect recognition; 2) schizophrenia patients benefited less from a multichannel task presentation than did healthy controls, and 3) schizophrenia patients did not significantly differ from healthy controls on positive-valenced items presented in the auditory modality. These findings suggest the importance of carefully considering presentation modality and affective valence when assessing affect recognition in schizophrenia.
Collapse
|
24
|
Penn DL, Keefe RSE, Davis SM, Meyer PS, Perkins DO, Losardo D, Lieberman JA. The effects of antipsychotic medications on emotion perception in patients with chronic schizophrenia in the CATIE trial. Schizophr Res 2009; 115:17-23. [PMID: 19766459 PMCID: PMC2765056 DOI: 10.1016/j.schres.2009.08.016] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 08/19/2009] [Accepted: 08/21/2009] [Indexed: 11/18/2022]
Abstract
Few pharmacological intervention studies have examined the impact of medication on social cognition, particularly emotion perception. The goal of this randomized, double-blind study is to compare the effects of several second generation antipsychotics and a first generation antipsychotic, perphenazine, on emotion perception in individuals with schizophrenia. Patients were assigned to receive treatment with olanzapine, queitapine fumarate, risperidone, ziprasidone or perphenazine for up to 18 months. Eight hundred and seventy three patients completed an emotion perception test immediately prior to randomization and after 2 months of treatment. We also examined baseline predictors of emotion perception change. Most treatments were associated with a small, non-statistically significant improvement in emotion perception at two months, although they did not differ from one another. Greater improvement in emotion perception at 2 months was significantly predicted by lower baseline emotion perception and higher baseline neurocognitive functioning, and marginally predicted by less time on an antipsychotic.
Collapse
Affiliation(s)
- David L Penn
- University of North Carolina-Chapel Hill, Department of Psychology, Davie Hall, Chapel Hill, NC 27599-3270, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
Noggle CA, Dean RS. Atypical and typical antipsychotics in the schools. PSYCHOLOGY IN THE SCHOOLS 2009. [DOI: 10.1002/pits.20427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Abstract
Although the effects of estrogen on sexual behavior in mammals are well known, its role on other types of behavior, including cognition, have only recently been recognized. This review summarizes work conducted in our laboratory and others with the aim of identifying the effects of estrogen on cognitive functions. The first section will briefly describe the neurobiology of estrogen. The second section will discuss the effects of estrogen on cognitive behaviors in mammals, as well as the physiological relevance of these effects and their applicability to human health and disease. The third section will detail the role of estrogen on working memory in humans and nonhuman primates, and in rodents. Finally, the concluding section will briefly describe the relationship between estrogen and the aging brain.
Collapse
Affiliation(s)
- Antonella Gasbarri
- a Department of Biomedical Sciences and Technologies, Faculty of Sciences of Education, University of L'Aquila, via Vetoio, 67100 L'Aquila, Italy.
| | - Assunta Pompili
- b Department of Biomedical Sciences and Technologies, Faculty of Sciences of Education, University of L'Aquila, via Vetoio, 67100 L'Aquila, Italy.
| | - Maria Clotilde Tavares
- c Department of Physiological Sciences, Laboratory of Neurosciences and Behavior, Center of Primatology, University of Brasília, Campus Asa Norte, CEP 70910-900 Brasília, DF, Brazil.
| | - Carlos Tomaz
- d Department of Physiological Sciences, Laboratory of Neurosciences and Behavior, Institute of Biology, University of Brasília, Campus Asa Norte, CEP 70910-900 Brasília, DF, Brazil.
| |
Collapse
|
27
|
Behere RV, Venkatasubramanian G, Arasappa R, Reddy N, Gangadhar BN. Effect of risperidone on emotion recognition deficits in antipsychotic-naïve schizophrenia: a short-term follow-up study. Schizophr Res 2009; 113:72-6. [PMID: 19545977 DOI: 10.1016/j.schres.2009.05.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 05/25/2009] [Accepted: 05/26/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Facial emotion recognition deficits [FERD] have been consistently demonstrated in treated schizophrenia patients. FERD in treatment-naïve patients and the effect of antipsychotics are yet to be explored. AIMS To examine for FERD in antipsychotic-naïve schizophrenia patients and the effect of short-term atypical antipsychotic treatment on FERD. METHODS Twenty-five antipsychotic-naïve schizophrenia [DSM-IV] patients and 30 age-, sex-, and education-matched healthy control subjects were assessed for FERD using the Tool for Recognition of Emotions in Neuropsychiatric DisorderS [TRENDS] - a culturally sensitive and valid tool. Psychopathology was assessed using SAPS and SANS. Performance of patients on TRENDS and psychopathology was re-assessed after short-term exposure to risperidone. RESULTS At baseline, the patients made significantly greater errors in recognition of negative emotions of fear and disgust which improved on follow-up. This improvement was influenced by severity of baseline negative symptoms. CONCLUSION Risperidone treatment can improve disgust recognition deficits in patients with schizophrenia.
Collapse
Affiliation(s)
- Rishikesh V Behere
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | | | | |
Collapse
|
28
|
Using the MATRICS to guide development of a preclinical cognitive test battery for research in schizophrenia. Pharmacol Ther 2009; 122:150-202. [PMID: 19269307 DOI: 10.1016/j.pharmthera.2009.02.004] [Citation(s) in RCA: 256] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 02/17/2009] [Indexed: 12/29/2022]
Abstract
Cognitive deficits in schizophrenia are among the core symptoms of the disease, correlate with functional outcome, and are not well treated with current antipsychotic therapies. In order to bring together academic, industrial, and governmental bodies to address this great 'unmet therapeutic need', the NIMH sponsored the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) initiative. Through careful factor analysis and consensus of expert opinion, MATRICS identified seven domains of cognition that are deficient in schizophrenia (attention/vigilance, working memory, reasoning and problem solving, processing speed, visual learning and memory, verbal learning and memory, and social cognition) and recommended a specific neuropsychological test battery to probe these domains. In order to move the field forward and outline an approach for translational research, there is a need for a "preclinical MATRICS" to develop a rodent test battery that is appropriate for drug development. In this review, we outline such an approach and review current rodent tasks that target these seven domains of cognition. The rodent tasks are discussed in terms of their validity for probing each cognitive domain as well as a brief overview of the pharmacology and manipulations relevant to schizophrenia for each task.
Collapse
|
29
|
Derntl B, Finkelmeyer A, Toygar TK, Hülsmann A, Schneider F, Falkenberg DI, Habel U. Generalized deficit in all core components of empathy in schizophrenia. Schizophr Res 2009; 108:197-206. [PMID: 19087898 DOI: 10.1016/j.schres.2008.11.009] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/08/2008] [Accepted: 11/06/2008] [Indexed: 11/25/2022]
Abstract
Empathy is a multidimensional construct composed of several components such as emotion recognition, emotional perspective taking and affective responsiveness. Patients with schizophrenia demonstrate deficits in several domains of emotion processing and perspective taking, thus suggesting a dysfunctional emotional competence. We assessed empathic abilities via three paradigms measuring emotion recognition, perspective taking and affective responsiveness as well as self-report empathy questionnaires in 24 (12 females, 12 males) schizophrenia patients meeting the DSM-IV criteria for schizophrenia and 24 matched healthy volunteers. Patients were recruited from the Department of Psychiatry and Psychotherapy, RWTH Aachen University and healthy volunteers were recruited via advertisement. Groups were matched for age, gender and parental education. Data analysis indicates a significant empathic deficit in patients, reflected in worse performance in all three domains. This deficit was only partly reflected in the self-report empathy questionnaires. Comparing the different tasks, emotional perspective taking was the most difficult task for all subjects and symptomatology worsened affective responsiveness. Schizophrenia patients not only struggle to correctly identify emotions, but also have difficulties in spontaneously simulating another person's subjective world (perspective taking) and might not be able to respond adequately in terms of their own emotional experience (affective responsiveness), which are not caused by emotion perception deficits. The results suggest that all domains of empathy are affected in schizophrenia and have to be addressed independently in behavioral therapies, thereby offering a possibility to improve socio-occupational life.
Collapse
Affiliation(s)
- Birgit Derntl
- Department of Psychiatry and Psychotherapy, RWTH Aachen University, Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
30
|
Walker MA. Treatment of autism spectrum disorders: neurotransmitter signaling pathways involved in motivation and reward as therapeutic targets. Expert Opin Ther Targets 2008; 12:949-67. [PMID: 18620518 DOI: 10.1517/14728222.12.8.949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is a growing body of literature describing the etiology of autism spectrum disorders (ASD). Some of the targets suggested belong to neurochemical transmitter pathways implicated in the behavior and motivation reward pathway. OBJECTIVE To examine data linking potential targets to ASD and the feasibility of developing drugs targeting these pathways. While the inhibitors are mostly being developed for other indications, it is beneficial to examine them to determine the responsiveness of the targets to small-molecule modulation. METHODS A search in Medline and Scifinder for articles concerning relevant targets in the context of ASD and their relation to the reward signaling pathway. RESULTS There is evidence suggesting that behaviors controlled by these targets are related to behaviors exhibited by individuals with ASD. The targets appear to be involved in neurotransmitter pathways controlling motivation and reward, further implicating this system in ASD. Sufficient research has been conducted to identify lead compounds for discovering agents for treatment of ASD.
Collapse
Affiliation(s)
- Michael A Walker
- Bristol-Myers Squibb Co., Medicinal Chemistry, Research and Development, Wallingford, CT, USA.
| |
Collapse
|
31
|
Pousa E, Duñó R, Brébion G, David AS, Ruiz AI, Obiols JE. Theory of mind deficits in chronic schizophrenia: evidence for state dependence. Psychiatry Res 2008; 158:1-10. [PMID: 18166230 DOI: 10.1016/j.psychres.2006.05.018] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 03/29/2006] [Accepted: 05/14/2006] [Indexed: 11/30/2022]
Abstract
There is evidence that people with schizophrenia show specific deficits in theory of mind (ToM). However, it is a matter of debate whether these are trait or state dependent, and the nature of the relationship between ToM deficits and particular symptoms is controversial. This study aimed to shed further light on these issues by (1) examining ToM abilities in 61 individuals with chronic schizophrenia during a stable phase as compared with 51 healthy controls matched by gender, age, educational level and current IQ, and (2) exploring the relationship between ToM and symptoms. Second order verbal stories and a non-verbal picture-sequencing task were used as ToM measures. Results showed no differences in ToM performance between patients and controls on either measure. Subsequent subgrouping of patients into remitted and non-remitted showed a worse performance of non-remitted patients only on second order ToM tasks. Specific ToM deficits were found associated with delusions. Association with negative symptoms was found to be less specific and accounted for by illness chronicity and general cognitive impairment. The results from the present study are in line with models which hypothesise that specific ToM deficits in schizophrenia are state dependent and associated with delusions. Such associations may also be task specific.
Collapse
Affiliation(s)
- Esther Pousa
- Psychiatry Department, Parc Taulí Hospital, Parc Taulí S/N, 08208 Sabadell, Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
32
|
Lindström E, Eberhard J, Levander S. Five-year follow-up during antipsychotic treatment: efficacy, safety, functional and social outcome. Acta Psychiatr Scand 2007:5-16. [PMID: 17953521 DOI: 10.1111/j.1600-0447.2007.01083.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Explore the long-term course of schizophrenia and related disorders. METHOD Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. RESULTS Stable symptomatology and side effects were observed. Clinician GAF scores were 55-61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked full-time. One in four had no social contacts except with staff. Eight patients died during the 5 years. CONCLUSION The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment.
Collapse
Affiliation(s)
- E Lindström
- Department of Neuroscience-Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | | | | |
Collapse
|
33
|
Vaskinn A, Sundet K, Friis S, Simonsen C, Birkenaes AB, Engh JA, Jónsdóttir H, Ringen PA, Opjordsmoen S, Andreassen OA. The effect of gender on emotion perception in schizophrenia and bipolar disorder. Acta Psychiatr Scand 2007; 116:263-70. [PMID: 17803756 DOI: 10.1111/j.1600-0447.2007.00991.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Impaired emotion perception is documented for schizophrenia, but findings have been mixed for bipolar disorder. In healthy samples females perform better than males. This study compared emotion perception in schizophrenia and bipolar disorder and investigated the effects of gender. METHOD Visual (facial pictures) and auditory (sentences) emotional stimuli were presented for identification and discrimination in groups of participants with schizophrenia, bipolar disorder and healthy controls. RESULTS Visual emotion perception was unimpaired in both clinical groups, but the schizophrenia sample showed reduced auditory emotion perception. Healthy males and male schizophrenia subjects performed worse than their female counterparts, whereas there were no gender differences within the bipolar group. CONCLUSION A disease-specific auditory emotion processing deficit was confirmed in schizophrenia, especially for males. Participants with bipolar disorder performed unimpaired.
Collapse
Affiliation(s)
- A Vaskinn
- Institute of Psychiatry, University of Oslo, Norway.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Fearful faces in schizophrenia: the relationship between patient characteristics and facial affect recognition. J Nerv Ment Dis 2007; 195:758-64. [PMID: 17984776 DOI: 10.1097/nmd.0b013e318142cc31] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although schizophrenia has often been associated with deficits in facial affect recognition, it is debated whether the recognition of specific emotions is affected and if these facial affect-processing deficits are related to symptomatology or other patient characteristics. The purpose of the present study was to explore whether particular patient characteristics are associated with the recognition of specific facial expressions in patients with schizophrenia. Sixty-four patients with a DSM-IV diagnosis of schizophrenia were assessed with a computerized test of degraded facial affect recognition. Linear regression analysis showed that, in particular, negative symptoms and male sex were associated with worse recognition of fearful faces. Furthermore, diagnosis of nonparanoid schizophrenia and later age of onset were associated with worse recognition of neutral faces. Findings are explained in the light of a neuroanatomical dysfunction accounting for both negative symptoms, such as reduced emotional expression and social-emotional dysfunction, for which men seem more vulnerable than women.
Collapse
|
35
|
Schenkel LS, Pavuluri MN, Herbener ES, Harral EM, Sweeney JA. Facial emotion processing in acutely ill and euthymic patients with pediatric bipolar disorder. J Am Acad Child Adolesc Psychiatry 2007; 46:1070-1079. [PMID: 17667485 DOI: 10.1097/chi.0b013e3180600fd6] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Past investigations indicate facial emotion-processing abnormalities in pediatric bipolar disorder (PBD) subjects. However, the extent to which these deficits represent state- and trait-related factors is unclear. We investigated facial affect processing in acutely ill and clinically stabilized children with PBD and matched healthy subjects. METHOD Subjects (N = 86) consisted of unmedicated/acutely ill (n = 29) and medicated/clinically stabilized (n = 29) PBD youths and matched healthy subjects (n = 28) who completed tasks of facial affect identification and differentiation. RESULTS Subjects with PBD, regardless of clinical and treatment status, showed marked impairments in the ability to correctly identify emotionally intense happy and sad facial expressions, with both groups tending to misjudge extreme facial expressions as being moderate to mild in intensity. However, when differentiating subtle variations of happy or sad expressions, only unmedicated/acutely ill PBD patients performed more poorly than healthy subjects. Younger age at onset was associated with more impaired emotion processing only in the PBD sample. PBD subjects with comorbid attention-deficit/hyperactivity disorder (ADHD) performed more poorly than subjects without ADHD when processing sad facial expressions, but not happy ones. CONCLUSIONS This study found evidence of both state-of-illness and trait-related deficits in emotion processing in PBD. Treatments are needed to better reduce this impairment and to reduce its developmental impact on interpersonal functioning.
Collapse
Affiliation(s)
- Lindsay S Schenkel
- All of the authors are with the Department of Psychiatry, University of Illinois at Chicago; Dr. Pavuluri is also with the Pediatric Mood Disorders Clinic, Institute for Juvenile Research, Chicago; and Dr. Sweeney is also with the Center for Cognitive Medicine, Chicago..
| | - Mani N Pavuluri
- All of the authors are with the Department of Psychiatry, University of Illinois at Chicago; Dr. Pavuluri is also with the Pediatric Mood Disorders Clinic, Institute for Juvenile Research, Chicago; and Dr. Sweeney is also with the Center for Cognitive Medicine, Chicago
| | - Ellen S Herbener
- All of the authors are with the Department of Psychiatry, University of Illinois at Chicago; Dr. Pavuluri is also with the Pediatric Mood Disorders Clinic, Institute for Juvenile Research, Chicago; and Dr. Sweeney is also with the Center for Cognitive Medicine, Chicago
| | - Erin M Harral
- All of the authors are with the Department of Psychiatry, University of Illinois at Chicago; Dr. Pavuluri is also with the Pediatric Mood Disorders Clinic, Institute for Juvenile Research, Chicago; and Dr. Sweeney is also with the Center for Cognitive Medicine, Chicago
| | - John A Sweeney
- All of the authors are with the Department of Psychiatry, University of Illinois at Chicago; Dr. Pavuluri is also with the Pediatric Mood Disorders Clinic, Institute for Juvenile Research, Chicago; and Dr. Sweeney is also with the Center for Cognitive Medicine, Chicago
| |
Collapse
|
36
|
Savina I, Beninger RJ. Schizophrenic patients treated with clozapine or olanzapine perform better on theory of mind tasks than those treated with risperidone or typical antipsychotic medications. Schizophr Res 2007; 94:128-38. [PMID: 17560766 DOI: 10.1016/j.schres.2007.04.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 04/12/2007] [Accepted: 04/17/2007] [Indexed: 11/20/2022]
Abstract
Theory of mind (ToM), the ability to attribute mental states to others, is associated with medial prefrontal cortical (mPFC) activity and is impaired in schizophrenia. Olanzapine or clozapine but not typical antipsychotics or risperidone preferentially affect c-fos expression in mPFC in animals. We tested the hypothesis that schizophrenic patients treated with different antipsychotics would perform differently on ToM tasks. Groups receiving Typicals (n=23), Clozapine (n=18), Olanzapine (n=20) or Risperidone (n=23) and a Control group of healthy volunteers (n=24) were matched for age, gender, handedness and education. ToM functioning was assessed with picture sequence, second-order belief and faux-pas tests. Schizophrenic groups performed similarly to controls on non-ToM conditions. The Olanzapine and Clozapine groups performed similarly to Controls on ToM tasks. The Typicals and Risperidone groups performed worse than the other groups on ToM tasks. We concluded that ToM performance of schizophrenic patients is influenced by the antipsychotic they are taking. Our results suggest that olanzapine or clozapine but not typicals or risperidone may improve or protect ToM ability.
Collapse
Affiliation(s)
- Ioulia Savina
- Department of Psychology, Queen's University, Kingston ON, Canada, K7L 3N6.
| | | |
Collapse
|
37
|
Bediou B, Asri F, Brunelin J, Krolak-Salmon P, D'Amato T, Saoud M, Tazi I. Emotion recognition and genetic vulnerability to schizophrenia. Br J Psychiatry 2007; 191:126-30. [PMID: 17666496 DOI: 10.1192/bjp.bp.106.028829] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epidemiological studies of schizophrenia suggest that this disorder has a substantial genetic component. Cognitive and social abilities, as well as the volumes of brain regions involved in emotion processing, have been found to be distributed along a continuum when comparing patients, siblings and controls, with siblings showing intermediate scores. AIMS To establish whether facial expression recognition is impaired in unaffected siblings of patients. METHOD Emotion and gender recognition were evaluated in a three-group pre-post study design in drug-naive patients with first-episode schizophrenia (n=40) and their unaffected siblings (n=30) compared with controls (n=26). RESULTS Patients and their healthy siblings showed impaired emotion recognition but normal gender recognition compared with controls. Patients'performance did not improve despite effective clinical stabilisation. CONCLUSIONS Impaired performance in healthy siblings and time stability in patients provides evidence of impairment of facial emotion recognition as an actual phenotype of schizophrenia.
Collapse
Affiliation(s)
- Benoit Bediou
- University of Lyon, Centre Hospitalier Le Vinatier, Bron, France.
| | | | | | | | | | | | | |
Collapse
|
38
|
Pinkham AE, Gur RE, Gur RC. Affect recognition deficits in schizophrenia: neural substrates and psychopharmacological implications. Expert Rev Neurother 2007; 7:807-16. [PMID: 17610388 DOI: 10.1586/14737175.7.7.807] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Impaired emotional functioning is a prominent feature of schizophrenia that includes significant deficits in the ability to accurately recognize facial expressions of emotion. Recent work demonstrates that deficits in affect perception are related to functional outcome and negative symptoms, suggesting that remediation of these deficits may contribute to symptomatic and functional improvements. Thus far, antipsychotic drug treatments appear to be relatively ineffective as a remedial tool. However, investigations into the neurobiology of affective dysfunction show abnormal amygdala activation in schizophrenia during affect recognition tasks. Such findings indicate that regulation of amygdala responses may aid in more accurate emotion processing. Both serotonergic and anxiolytic GABAergic agents that modulate activation of the limbic system offer promising avenues for remediation efforts.
Collapse
Affiliation(s)
- Amy E Pinkham
- University of Pennsylvania Medical Center, Department of Psychiatry, 10th Floor Gates Building, Philadelphia, PA 19104, USA.
| | | | | |
Collapse
|
39
|
Gur RE, Calkins ME, Gur RC, Horan WP, Nuechterlein KH, Seidman LJ, Stone WS. The Consortium on the Genetics of Schizophrenia: neurocognitive endophenotypes. Schizophr Bull 2007; 33:49-68. [PMID: 17101692 PMCID: PMC2632287 DOI: 10.1093/schbul/sbl055] [Citation(s) in RCA: 264] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The Consortium on the Genetics of Schizophrenia (COGS) is a 7-site collaboration that examines the genetic architecture of quantitative endophenotypes in families with schizophrenia. Here we review the background and rationale for selecting neurocognitive tasks as endophenotypic measures in genetic studies. Criteria are outlined for the potential of measures as endophenotypic vulnerability markers. These include association with illness, state independence (ie, adequate test-retest stability, adequate between-site reliability, impairments in patients not due to medications, impairments observed regardless of illness state), heritability, findings of higher rates in relatives of probands than in the general population, and cosegregation within families. The COGS required that, in addition, the measures be "neurocognitive" and thus linked to neurobiology and that they be feasible in multisite studies. The COGS neurocognitive assessment includes measures of attention, verbal memory, working memory, and a computerized neurocognitive battery that also includes facial processing tasks. Here we describe data demonstrating that these neurobehavioral measures meet criteria for endophenotypic candidacy. We conclude that quantitative neurocognitive endophenotypes need further evidence for efficacy in identifying genetic effects but have the potential of providing unprecedented insight into gene-environment interaction related to dimensions of brain and behavior in health and disease.
Collapse
Affiliation(s)
- Raquel E Gur
- Neuropsychiatry Section, Department of Psychiatry, University of Pennsylvania, 10 Gates, 3400 Spruce St., Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | |
Collapse
|
40
|
Abstract
Emotion deficits in schizophrenia have been described since the time of Kraepelin. However, no comprehensive review of clinical emotion studies has ever been conducted, in this work, studies that used diagnostic criteria and were published in English were selected from an extensive PubMed search. Fifty-five studies on emotion expression repeatedly showed that individuals with schizophrenia (IWSs) display fewer overt expressions than non patient comparison subjects (NCSs) in verbal, facial, and acoustic channels. No clear differences were found between IWSs and depressed subjects. Sixty-nine studies examined emotion experience in schizophrenia. IWSs report higher anhedonia, and they tend to show more negative emotions in real-life event studies. In evocative studies, they report a similar degree of pleasantness and a similar or higher degree of unpleasantness. From 110 studies, ii can be concluded that emotion recognition is impaired in schizophrenia in all channels. These deficits in social perception are correlated with neurocognitive deficits and some social skills. IWSs show dysfunction in the three domains of emotion expression, emotion experience, and emotion recognition, and these dysfunctions appear to be independent of each other across domains. These deficits in basic emotion processing may be linked to psychopathology and functional outcomes.
Collapse
Affiliation(s)
- Fabien Trémeau
- Nathan Kline Institute, 140 Old Orangeburg Road, Orangeburg, NY 10962, USA.
| |
Collapse
|
41
|
|
42
|
Salgado-Pineda P, Delaveau P, Blin O, Nieoullon A. Dopaminergic contribution to the regulation of emotional perception. Clin Neuropharmacol 2006; 28:228-37. [PMID: 16239763 DOI: 10.1097/01.wnf.0000185824.57690.f0] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dopamine (DA) acts as a key neurotransmitter in the brain. Numerous studies have shown its regulatory role in motor and cognitive function. However, the impairment of emotional processes in neurologic and psychiatric pathologies involving the dopaminergic system (Parkinson disease, schizophrenia, autism, Attention Deficit Hyperactivity Disorder, Huntington disease, frontal lobe lesions), as well as the influence that administration of dopaminergic agonists/antagonists exert on the processing of emotion, suggest a role for DA in emotional processes. Moreover, emotional processes are dependent upon a variety of structures, the majority of which form part of the limbic system and are subject to DA innervation. In reviewing the literature, the amygdala emerges as a brain structure critical for emotional processing. It may also be implicated in deficits in emotional recognition found in two major disorders where DA's implication is clear: Parkinson disease and schizophrenia. In addition, the amygdala's response to emotional tasks is likely to be altered by the administration of both agonist and antagonist dopaminergic drugs. Experimental studies reinforce the idea of a dopaminergic contribution to emotional response, as suggested by biochemical, pharmacologic, and lesion experiments. Although the implication of the dopaminergic system in emotional processing appears to be clearly documented, the contribution of specific DA receptor subtypes, or of the DA cotransmitters cholecystokinin and neurotensin, or even glutamate, is, however, still unclear. Altogether, these observations suggest that DA has, undoubtedly, a direct and/or indirect role in the full emotional process.
Collapse
Affiliation(s)
- Pilar Salgado-Pineda
- Institut des Neurosciences Cognitives de la Méditerranée, Faculté de Médecine, UMR 6193CNRS Université de la Méditerranée, France
| | | | | | | |
Collapse
|
43
|
Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, Möller HJ. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia, Part 1: acute treatment of schizophrenia. World J Biol Psychiatry 2005; 6:132-91. [PMID: 16173147 DOI: 10.1080/15622970510030090] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
These guide lines for the biological treatment of schizophrenia were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBO). The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of schizophrenia, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence. These guidelines are intended for use by all physicians seeing and treating people with schizophrenia. The data used for developing these guidelines have been extracted primarily from various national treatment guidelines and panels for schizophrenia, as well as from meta-analyses, reviews and randomised clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into four levels of evidence (A-D). This first part of the guidelines covers disease definition, classification, epidemiology and course of schizophrenia, as well as the management of the acute phase treatment. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication, other pharmacological treatment options, electroconvulsive therapy, adjunctive and novel therapeutic strategies) of adults suffering from schizophrenia.
Collapse
Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University of Saarland, Homburg/Saar, Germany
| | | | | | | | | | | |
Collapse
|
44
|
Wölwer W, Frommann N, Halfmann S, Piaszek A, Streit M, Gaebel W. Remediation of impairments in facial affect recognition in schizophrenia: efficacy and specificity of a new training program. Schizophr Res 2005; 80:295-303. [PMID: 16125367 DOI: 10.1016/j.schres.2005.07.018] [Citation(s) in RCA: 241] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 07/08/2005] [Accepted: 07/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Schizophrenia patients often exhibit impairments in facial affect recognition which contribute to their poor social functioning. These impairments are stable in the course of the disorder and seem not to be affected by conventional treatment. The present study investigates the efficacy and specificity of a new training program for the remediation of such impairments. METHOD A newly developed training program tackling affect recognition (TAR) was compared with a cognitive remediation training program (CRT) and treatment as usual (TAU) within a randomized three group pre-post design in n=77 post-acute schizophrenia patients. The TAR is a computer-aided 12-session program focussing on facial affect recognition, whereas the CRT aims to improve attention, memory and executive functioning. Facial affect recognition, face recognition, and neurocognitive performance were assessed before (T0) and after (T1) the six week training phase. During the training period all patients received antipsychotic medication. RESULTS Patients under TAR significantly improved in facial affect recognition, with recognition performance after training approaching the level of healthy controls from former studies. Patients under CRT and those without special training (TAU) did not improve in affect recognition, though patients under CRT improved in verbal memory functions. CONCLUSION According to these results, remediation of disturbed facial affect recognition in schizophrenia patients is possible, but not achievable with a traditional cognitive rehabilitation program such as the CRT. Instead, functional specialized remediation programs such as the newly developed TAR are a more suitable option.
Collapse
Affiliation(s)
- Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, University of Duesseldorf, Rhineland State Clinics, Bergische Landstrasse 2, D-40629 Duesseldorf, Germany
| | | | | | | | | | | |
Collapse
|
45
|
Kucharska-Pietura K, David AS, Masiak M, Phillips ML. Perception of facial and vocal affect by people with schizophrenia in early and late stages of illness. Br J Psychiatry 2005; 187:523-8. [PMID: 16319404 DOI: 10.1192/bjp.187.6.523] [Citation(s) in RCA: 164] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Emotion recognition impairments have been demonstrated in schizophrenia, but few studies have examined whether these reflect generalised or specific perceptual deficits or are associated with illness course. AIMS To examine the nature of emotion recognition abnormalities in patients with schizophrenia at different stages of illness. METHOD We examined the performance of 50 in-patients with early-stage schizophrenia, 50 with chronic schizophrenia and 50 healthy controls on the Benton Facial Recognition Test, Facial Emotion Recognition Test and Voice Emotion Recognition Test. RESULTS Patients with chronic schizophrenia were significantly more impaired than other groups on the emotional tasks, even after controlling for impairments in non-emotional stimuli. Individual emotion recognition accuracy for the two sensory modalities was not significantly positively correlated for either group with schizophrenia. CONCLUSIONS Emotion recognition deficits in schizophrenia are trait features of the disorder and increase with illness duration.
Collapse
Affiliation(s)
- Katarzyna Kucharska-Pietura
- Department of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | | | | | | |
Collapse
|
46
|
Bozikas VP, Kosmidis MH, Anezoulaki D, Giannakou M, Karavatos A. Relationship of affect recognition with psychopathology and cognitive performance in schizophrenia. J Int Neuropsychol Soc 2004; 10:549-58. [PMID: 15327733 DOI: 10.1017/s1355617704104074] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2003] [Revised: 11/20/2003] [Indexed: 11/05/2022]
Abstract
The purpose of the present study was to explore the relationship between emotion perception and both psychopathology and cognitive functioning in a group of Greek patients with schizophrenia. Thirty-five patients with schizophrenia were assessed with computerized tests of emotion perception, using visual faces (Kinney's Affect Matching Test, KAMT), prosody (Affective Prosody Test, APT), and visual everyday scenarios (Fantie's Cartoon Test, FCT), as well as a facial recognition test (Kinney's Identity Matching Test, KIMT). The patients were also evaluated with the symptoms dimensions derived from the PANSS (positive, negative, cognitive, depression, and excitement) and a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and visual scanning/psychomotor speed. The three emotion perception and face recognition tests correlated significantly with each other. The KAMT was significantly related to the cognitive symptoms dimension of the PANSS and executive functions. The FCT was significantly related to level of education and attention. Finally, the APT was significantly related to the cognitive symptoms dimension, executive functions, and attention. Our findings regarding the significant relationships of affect perception, both facial and vocal, as well as in everyday scenarios, with several cognitive abilities support the notion that deficits in decoding affective information in schizophrenia could be attributed to impairment in more basic neurocognitive domains.
Collapse
Affiliation(s)
- Vasilis P Bozikas
- Department of Psychiatry, Aristotle University of Thessaloniki, Greece.
| | | | | | | | | |
Collapse
|
47
|
Littrell KH, Petty RG, Hilligoss NM, Kirshner CD, Johnson CG. Improvement in social cognition in patients with schizophrenia associated with treatment with olanzapine. Schizophr Res 2004; 66:201-2. [PMID: 15061258 DOI: 10.1016/s0920-9964(03)00185-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2003] [Revised: 05/15/2003] [Accepted: 05/29/2003] [Indexed: 10/27/2022]
|
48
|
Takeuchi Y, Fukunaga K. Different effects of five dopamine receptor subtypes on nuclear factor-kappaB activity in NG108-15 cells and mouse brain. J Neurochem 2004; 88:41-50. [PMID: 14675148 DOI: 10.1046/j.1471-4159.2003.02129.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We previously showed that dopamine receptors D1R and D2R expressed in NG108-15 cells activated protein kinase A and extracellular signal-regulated kinase (ERK) respectively, resulting in differential activation of nuclear factor (NF)-kappaB activity. To investigate whether other dopamine receptor subtypes regulate NF-kappaB, we established NG108-15 cells stably expressing D3R, D4R and D5R (NGD3R, NGD4R and NGD5R). D5R stimulation with SKF 38393 decreased NF-kappaB luciferase reporter activity in NGD5R cells, similar to D1R stimulation in NGD1R cells. However, D3R or D4R stimulation with quinpirole showed no change in NF-kappaB-Luci activity, although forskolin-induced cyclic AMP responsive element-Luci activation was attenuated by quinpirole treatment in NGD2LR, NGD3R and NGD4R cells. As expected, activation of ERK or serum responsive element-luciferase reporter not observed following stimulation with quinpirole in D3R- or D4R-expressing cells. We further examined the effects of haloperidol and risperidone, which are typical and atypical antipsychotic drugs respectively, on NF-kappaB activity by gel shift assay in mouse frontal cortex. Haloperidol treatment slightly attenuated basal NF-kappaB activity. By contrast, risperidone treatment enhanced NF-kappaB activity. Taken together, D2R and D1R/D5R had opposite effects on NF-kappaB activity in NG108-15 cells. Risperidone up-regulated and haloperidol down-regulated NF-kappaB activity in mouse brain. This effect may be related to the atypical antipsychotic properties of risperidone.
Collapse
Affiliation(s)
- Yusuke Takeuchi
- Department of Pharmacology, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan.
| | | |
Collapse
|
49
|
Abstract
Studies examining cognitive dysfunction in bipolar disorder have documented neuropsychologic impairment in some patients. Recollection memory, attention, and visual information processing may be particularly impaired in patients with bipolar illness. Cognitive impairment appears to worsen with illness progression, and may have a significant impact on function. Pharmacotherapy to treat bipolar disorder including lithium, anticonvulsants, antidepressants, and atypical antipsychotics may have varying effects on cognitive functioning. Treatment with atypical antipsychotics has been associated with improvement in various cognitive measures in patients with schizophrenia, and the little data available in patients with bipolar disorder suggest the potential for similar benefits. Studies to determine if current treatments for bipolar disorder can prevent, delay, or even improve cognitive dysfunction are needed.
Collapse
Affiliation(s)
- Glenda Macqueen
- St. Joseph's Center for Mental Health Services, D1, Mood Disorders Program, 100 West 5th St, Hamilton, ON, L9C 2E4, Canada.
| | | |
Collapse
|
50
|
Angelucci F, Mathé AA, Aloe L. Neurotrophic factors and CNS disorders: findings in rodent models of depression and schizophrenia. PROGRESS IN BRAIN RESEARCH 2004; 146:151-65. [PMID: 14699963 DOI: 10.1016/s0079-6123(03)46011-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are proteins involved in neuronal survival and plasticity of dopaminergic, cholinergic and serotonergic neurons in the central nervous system (CNS). Loss of neurons in specific brain regions has been found in depression and schizophrenia, and this chapter summarizes the findings of altered neurotrophins in animal models of those two disorders under baseline condition and following antidepressive and antipsychotic treatments. In a model of depression (Flinders sensitive line/Flinders resistant line; FSL/FRL rats), increased NGF and BDNF concentrations were found in frontal cortex of female, and in occipital cortex of male 'depressed' FSL compared to FRL control rats. Using the same model, the effects of electroconvulsive stimuli (ECS) and chronic lithium treatment on brain NGF, BDNF and glial cell line-derived neurotrophic factors were investigated. ECS and lithium altered the brain concentrations of neurotrophic factors in the hippocampus, frontal cortex, occipital cortex and striatum. ECS mimic the effects of electroconvulsive therapy (ECT) that is an effective treatment for depression and also schizophrenia. Since NGF and BDNF may also be changed in the CNS of animal models of schizophrenia, we investigated whether treatment with antipsychotic drugs (haloperidol, risperidone, and olanzapine) affects the constitutive levels of NGF and BDNF in the CNS. Both typical and atypical antipsychotic drugs altered the regional brain levels of NGF and BDNF. Other studies also demonstrated that these drugs differentially altered neurotrophin mRNAs. Overall, these studies indicate that alteration of brain level of NGF and BDNF could constitute part of the biochemical alterations induced by antipsychotic drugs.
Collapse
Affiliation(s)
- Francesco Angelucci
- Institute of Neurology, Catholic University, Largo Gemelli 8, I-00168, Rome, Italy.
| | | | | |
Collapse
|