Role of visual integration in gaze perception and emotional intelligence in schizophrenia

Sensory and Multisensory Processing Changes and Their Contributions to Autism and Schizophrenia

Natural environments are typically multisensory, comprising information from multiple sensory modalities. It is in the integration of these incoming sensory signals that we form our perceptual gestalt that allows us to navigate through the world with relative ease. However, differences in multisensory integration (MSI) ability are found in a number of clinical conditions. Throughout this chapter, we discuss how MSI differences contribute to phenotypic characterization of autism and schizophrenia. Although these clinical populations are often described as opposite each other on a number of spectra, we describe similarities in behavioral performance and neural functions between the two conditions. Understanding the shared features of autism and schizophrenia through the lens of MSI research allows us to better understand the neural and behavioral underpinnings of both disorders. We provide potential avenues for remediation of MSI function in these populations.

Examining the joint and unique contributions of contour integration and visuospatial memory to altered eye gaze perception in schizophrenia

BACKGROUND

Eye gaze perception-a building block of social cognition-is altered in schizophrenia (SZ), manifesting as both reduced perceptual precision and stronger self-referential bias. Yet, the visual processing mechanisms influencing gaze precision and bias are unclear. This study examined the unique and joint contributions contour integration and visuospatial memory to altered eye gaze perception in SZ.

METHODS

A sample of 62 participants with SZ and 63 healthy controls completed a psychophysical gaze-perception task, which was used to measure perceptual precision and self-referential bias. Contour integration and visuospatial memory were measured using the Jittered Orientation Visual Integration (JOVI) task and the Brief Visuospatial Memory Test-Revised (BVMT-R), respectively. Hierarchical linear regressions were used to determine the unique contributions of these visual processes to perceptual precision and self-referential bias.

RESULTS

Contour integration, but not visuospatial memory, explained unique variance in perceptual precision during eye gaze perception across groups. Conversely, contour integration did not explain unique variance in self-referential bias of eye gaze perception; however, visuospatial memory was a significant predictor of self-referential bias even after accounting for the effect of contour integration.

CONCLUSIONS

Results indicate that perceptual precision and self-referential bias of eye gaze perception may be differentially influenced by different visual processes in SZ as well as HC. These findings can inform the development of more precise interventions for social cognition in SZ.

Aberrant Effective Connectivity During Eye Gaze Processing Is Linked to Social Functioning and Symptoms in Schizophrenia

BACKGROUND

Patients with schizophrenia show abnormal gaze processing, which is associated with social dysfunction. These abnormalities are related to aberrant connectivity among brain regions that are associated with visual processing, social cognition, and cognitive control. In this study, we investigated 1) how effective connectivity during gaze processing is disrupted in schizophrenia and 2) how this may contribute to social dysfunction and clinical symptoms.

METHODS

Thirty-nine patients with schizophrenia/schizoaffective disorder (SZ) and 33 healthy control participants completed an eye gaze processing task during functional magnetic resonance imaging. Participants viewed faces with different gaze angles and performed explicit and implicit gaze processing. Four brain regions-the secondary visual cortex, posterior superior temporal sulcus, inferior parietal lobule, and posterior medial frontal cortex-were identified as nodes for dynamic causal modeling analysis.

RESULTS

Both the SZ and healthy control groups showed similar model structures for general gaze processing. Explicit gaze discrimination led to changes in effective connectivity, including stronger excitatory, bottom-up connections from the secondary visual cortex to the posterior superior temporal sulcus and inferior parietal lobule and inhibitory, top-down connections from the posterior medial frontal cortex to the secondary visual cortex. Group differences in top-down modulation from the posterior medial frontal cortex to the posterior superior temporal sulcus and inferior parietal lobule were noted, such that these inhibitory connections were attenuated in the healthy control group but further strengthened in the SZ group. Connectivity was associated with social dysfunction and symptom severity.

CONCLUSIONS

The SZ group showed notably stronger top-down inhibition during explicit gaze discrimination, which was associated with more social dysfunction but less severe symptoms among patients. These findings help pinpoint neural mechanisms of aberrant gaze processing and may serve as future targets for interventions that combine neuromodulation with social cognitive training.

The effects of abnormal visual experience on neurodevelopmental disorders

Normal visual development is supported by intrinsic neurobiological mechanisms and by appropriate stimulation from the environment, both of which facilitate the maturation of visual functions. However, an offset of this balance can give rise to visual disorders. Therefore, understanding the factors that support normal vision during development and in the mature brain is important, as vision guides movement, enables social interaction, and allows children to recognize and understand their environment. In this paper, we review fundamental mechanisms that support the maturation of visual functions and discuss and draw links between the perceptual and neurobiological impairments in autism spectrum disorder (ASD) and schizophrenia. We aim to explore how this is evident in the case of ASD, and how perceptual and neurobiological deficits further degrade social ability. Furthermore, we describe the altered perceptual experience of those with schizophrenia and evaluate theories of the underlying neural deficits that alter perception.

Neurobehavioral indices of gaze perception are associated with social cognition across schizophrenia patients and healthy controls

BACKGROUND

Gaze perception is a basic building block of social cognition, which is impaired in schizophrenia (SZ) and contributes to functional outcomes. Few studies, however, have investigated neural underpinnings of gaze perception and their relation to social cognition. We address this gap.

METHOD

We recruited 77 SZ patients and 71 healthy controls, who completed various social-cognition tasks. During functional magnetic resonance imaging, participants (62 SZ, 54 controls) completed a gaze-perception task, where they judged whether faces with varying gaze angles were self-directed or averted; as a control condition, participants identified stimulus gender. Activation estimates were extracted based on (a) task versus baseline, (b) gaze-perception versus gender-identification, (c) parametric modulation by perception of stimuli as self-directed versus averted, and (d) parametric modulation by stimulus gaze angle. We used latent variable analysis to test associations among diagnostic group, brain activation, gaze perception, and social cognition.

RESULTS

Preferential activation to gaze perception was observed throughout dorsomedial prefrontal cortex, superior temporal sulcus, and insula. Activation was modulated by stimulus gaze angle and perception of stimuli as self-directed versus averted. More precise gaze perception and higher task-related activation were associated with better social cognition. Patients with SZ showed hyperactivation within left pre-/postcentral gyrus, which was associated with more precise gaze perception and fewer symptoms and thus may be a compensatory mechanism.

CONCLUSIONS

Neural and behavioral indices of gaze perception were related to social cognition, across patients and controls. This suggests gaze perception is an important perceptual building block for more complex social cognition. Results are discussed in the context of dimensional psychopathology and clinical heterogeneity. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Research on social attention in autism and the challenges of the research domain criteria (RDoC) framework

The fuzzy nature of categories of psychopathology, such as autism, leads to significant research challenges. Alternatively, focusing research on the study of a common set of important and well-defined psychological constructs across psychiatric conditions may make the fundamental etiological processes of psychopathology easier to discern and treat (Cuthbert, 2022). The development of the research domain criteria (RDoC) framework is designed to guide this new research approach (Insel et al., 2010). However, progress in research may be expected to continually refine and reorganize the understanding of the specifics of these mental processes (Cuthbert & Insel, 2013). Moreover, knowledge gleaned from the study of both normative and atypical development can be mutually informative in the evolution of our understanding of these fundamental processes. A case in point is the study of social attention. This Autism 101 commentary provides an educational summary of research over the last few decades indicates that social attention is major construct in the study of human social-cognitive development, autism and other forms of psychopathology. The commentary also describes how this research can inform the Social Process dimension of the RDoC framework.

Eye Direction Detection and Perception as Premises of a Social Brain: A Narrative Review of Behavioral and Neural Data

The eyes and the gaze are important stimuli for social interaction in humans. Impaired recognition of facial identity, facial emotions, and inference of the intentions of others may result from difficulties in extracting information relevant to the eye region, mainly the direction of gaze. Therefore, a review of these data is of interest. Behavioral data demonstrating the importance of the eye region and how humans respond to gaze direction are reviewed narratively, and several theoretical models on how visual information on gaze is processed are discussed to propose a unified hypothesis. Several issues that have not yet been investigated are identified. The authors tentatively suggest experiments that might help progress research in this area. The neural aspects are subsequently reviewed to best describe the low-level and higher-level visual information processing stages in the targeted subcortical and cortical areas. A specific neural network is proposed on the basis of the literature. Various gray areas, such as the temporality of the processing of visual information, the question of salience priority, and the coordination between the two hemispheres, remain unclear and require further investigations. Finally, disordered gaze direction detection mechanisms and their consequences on social cognition and behavior are discussed as key deficiencies in several conditions, such as autism spectrum disorder, 22q11.2 deletion, schizophrenia, and social anxiety disorder. This narrative review provides significant additional data showing that the detection and perception of someone's gaze is an essential part of the development of our social brain.

Dynamic causal modeling of eye gaze processing in schizophrenia

BACKGROUND

Abnormal eye gaze perception is related to symptoms and social functioning in schizophrenia. However, little is known about the brain network mechanisms underlying these abnormalities. Here, we employed dynamic causal modeling (DCM) of fMRI data to discover aberrant effective connectivity within networks associated with eye gaze processing in schizophrenia.

METHODS

Twenty-seven patients (schizophrenia/schizoaffective disorder, SZ) and 22 healthy controls (HC) completed an eye gaze processing task during fMRI. Participants viewed faces with different gaze angles and performed explicit gaze discrimination (Gaze: "Looking at you?" yes/no) or implicit gaze processing (Gender: "male or female?"). Four brain regions, the secondary visual cortex (Vis), posterior superior temporal sulcus (pSTS), inferior parietal lobule (IPL), and posterior medial frontal cortex (pMFC) were identified as nodes for subsequent DCM analysis.

RESULTS

SZ and HC showed similar generative model structure, but SZ showed altered connectivity for specific self-connections, inter-regional connections during all gaze processing (reduced excitatory bottom-up and enhanced inhibitory top-down connections), and modulation by explicit gaze discrimination (increased frontal inhibition of visual cortex). Altered effective connectivity was significantly associated with poorer social cognition and functioning.

CONCLUSIONS

General gaze processing in SZ is associated with distributed cortical dysfunctions and bidirectional connectivity between regions, while explicit gaze discrimination involves predominantly top-down abnormalities in the visual system. These results suggest plausible neural mechanisms underpinning gaze processing deficits and may serve as bio-markers for intervention.

Neural Oscillatory Abnormalities During Gaze Processing in Schizophrenia: Evidence of Reduced Theta Phase Consistency and Inter-areal Theta-Gamma Coupling

BACKGROUND

Abnormal gaze discrimination in schizophrenia (SZ) is associated with impairment in social functioning, but the neural mechanisms remain unclear. Evidence suggests that local neural oscillations and inter-areal communication through neural synchronization are critical physiological mechanisms supporting basic and complex cognitive processes. The roles of these mechanisms in abnormal gaze processing in SZ have not been investigated. The present study examined local neural oscillations and connectivity between anterior and bilateral posterior brain areas during gaze processing.

METHODS

During electroencephalography recording, 28 participants with SZ and 34 healthy control participants completed a gaze discrimination task. Time-frequency decomposition of electroencephalography data was used to examine neural oscillatory power and intertrial phase consistency at bilateral posterior and midline anterior scalp sites. In addition, connectivity between these anterior and posterior sites, in terms of cross-frequency coupling between theta phase and gamma amplitude, was examined using the Kullback-Leibler Modulation Index.

RESULTS

Participants with SZ showed reduced total power of theta-band activity relative to healthy control participants at all sites examined. This group difference could be accounted for by reduced intertrial phase consistency of theta activity in SZ participants, which was related to reduced gaze discrimination accuracy in SZ. In addition, SZ participants exhibited reduced Kullback-Leibler indexing, both feedforward and feedback connectivity, between the posterior and anterior sites.

CONCLUSIONS

These findings suggest that abnormal theta phase consistency and dysconnection between posterior face processing and anterior areas may underlie gaze processing deficits in SZ.

Abnormal visual representations associated with confusion of perceived facial expression in schizophrenia with social anxiety disorder

Deficits in social functioning are especially severe amongst schizophrenia individuals with the prevalent comorbidity of social anxiety disorder (SZ&SAD). Yet, the mechanisms underlying the recognition of facial expression of emotions-a hallmark of social cognition-are practically unexplored in SZ&SAD. Here, we aim to reveal the visual representations SZ&SAD (n = 16) and controls (n = 14) rely on for facial expression recognition. We ran a total of 30,000 trials of a facial expression categorization task with Bubbles, a data-driven technique. Results showed that SZ&SAD's ability to categorize facial expression was impared compared to controls. More severe negative symptoms (flat affect, apathy, reduced social drive) was associated with more impaired emotion recognition ability, and with more biases in attributing neutral affect to faces. Higher social anxiety symptoms, on the other hand, was found to enhance the reaction speed to neutral and angry faces. Most importantly, Bubbles showed that these abnormalities could be explained by inefficient visual representations of emotions: compared to controls, SZ&SAD subjects relied less on fine facial cues (high spatial frequencies) and more on coarse facial cues (low spatial frequencies). SZ&SAD participants also never relied on the eye regions (only on the mouth) to categorize facial expressions. We discuss how possible interactions between early (low sensitivity to coarse information) and late stages of the visual system (overreliance on these coarse features) might disrupt SZ&SAD's recognition of facial expressions. Our findings offer perceptual mechanisms through which comorbid SZ&SAD impairs crucial aspects of social cognition, as well as functional psychopathology.

Deconstructing eye contact perception: Measuring perceptual precision and self-referential tendency using an online psychophysical eye contact detection task

Eye contact perception—the ability to accurately and efficiently discriminate others’ gaze directions—is critical to understanding others and functioning in a complex social world. Previous research shows that it is affected in multiple neuropsychiatric disorders accompanied by social dysfunction, and understanding the cognitive processes giving rise to eye contact perception would help advance mechanistic investigations of psychopathology. This study aims to validate an online, psychophysical eye contact detection task through which two constituent cognitive components of eye contact perception (perceptual precision and self-referential tendency) can be derived. Data collected from a large online sample showed excellent test-retest reliability for self-referential tendency and moderate reliability for perceptual precision. Convergence validity was supported by correlations with social cognitive measures tapping into different aspects of understanding others. Hierarchical regression analyses revealed that perceptual precision and self-referential tendency explained unique variance in social cognition, suggesting that they measure unique aspects of related constructs. Overall, this study provided support for the reliability and validity of the eye contact perception metrics derived using the online Eye Contact Detection Task. The value of the task for future psychopathology research was discussed.

Examining motion speed processing in schizophrenia using the flash lag illusion

Research on visual perception in schizophrenia suggests a deficit in motion processing. Specifically, difficulties with discriminating motion speed are commonly reported. However, speed discrimination tasks typically require participants to make judgments about the difference between two stimuli in a two-interval forced choice (2IFC) task. Such tasks not only tap into speed processing mechanisms, but also rely on higher executive functioning including working memory and attention which has been shown to be compromised in schizophrenia. We used the Flash Lag illusion to examine speed processing in patients with schizophrenia. Based on previous research showing a strong dependence between motion speed and the illusion magnitude, we expected a deficit in speed processing to alter this relationship. A motion processing deficit in patients would also predict overall reductions in perceived lag. We found the magnitude and speed dependence of the Flash Lag illusion to be similar in patients and controls. Together, the findings suggest no general abnormality in motion speed processing in schizophrenia.

Are Negative Symptoms Merely the "Real World" Consequences of Deficits in Social Cognition?

Many investigations have demonstrated that negative symptoms and social cognitive deficits in schizophrenia play a large role in determining functional outcomes and ultimately long-term prognosis. Given this, there is increasing interest in understanding the relationship between these two symptom domains, particularly since studies have consistently found moderate to large associations between them. This shared variance raises a key question: to what degree do these two categories of symptoms arise from overlapping or identical changes in brain function? In other words, do some or all negative symptoms represent merely the downstream effects of social cognition deficits on daily functioning? In this commentary, the evidence for and against this possibility, limitations of currently validated empirical measurements of these symptoms, and directions for further investigation of this hypothesis are discussed. Understanding the shared and distinct mechanisms of these disabling deficits will have important implications for the design of novel, personalized treatments for psychotic illness.

Disrupted Eye Gaze Perception as a Biobehavioral Marker of Social Dysfunction: An RDoC Investigation

Social dysfunction is an intractable problem in a wide spectrum of psychiatric illnesses, undermining patients' capacities for employment, independent living, and maintaining meaningful relationships. Identifying common markers of social impairment across disorders and understanding their mechanisms are prerequisites to developing targeted neurobiological treatments that can be applied productively across diagnoses and illness stages to improve functional outcome. This project focuses on eye gaze perception, the ability to accurately and efficiently discriminate others' gaze direction, as a potential biomarker of social functioning that cuts across psychiatric diagnoses. This premise builds on both the monkey and human literatures showing gaze perception as a basic building block supporting higher-level social communication and social development, and reports of abnormal gaze perception in multiple psychiatric conditions accompanied by prominent social dysfunction (e.g., psychosis-spectrum disorders, autism-spectrum disorders, social phobia). A large sample (n = 225) of adolescent and young adult (age 14-30) psychiatric patients (regardless of diagnosis) with various degrees of impaired social functioning, and demographically-matched healthy controls (n = 75) will be recruited for this study. Participant's psychiatric phenotypes, cognition, social cognition, and community functioning will be dimensionally characterized. Eye gaze perception will be assessed using a psychophysical task, and two metrics (precision, self-referential bias) that respectively tap into gaze perception disturbances at the visual perceptual and interpretation levels, independent of general deficits, will be derived using hierarchical Bayesian modeling. A subset of the participants (150 psychiatric patients, 75 controls) will additionally undergo multimodal fMRI to determine the functional and structural brain network features of altered gaze perception. The specific aims of this project are three-fold: (1) Determine the generality of gaze perception disturbances in psychiatric patients with prominent social dysfunction; (2) Map behavioral indices of gaze perception disturbances to dimensions of psychiatric phenotypes and core functional domains; and (3) Identify the neural correlates of altered gaze perception in psychiatric patients with social dysfunction. Successfully completing these specific aims will identify the specific basic deficits, clinical profile, and underlying neural circuits associated with social dysfunction that can be used to guide targeted, personalized treatments, thus advancing NIMH's Strategic Objective 1 (describe neural circuits associated with mental illnesses and map the connectomes for mental illnesses) and Objective 3 (develop new treatments based on discoveries in neuroscience and behavioral science).

Emotional intelligence and schizophrenia spectrum disorders: a critical review

Abstract Introduction Emotional intelligence (EI) is a theoretical construct postulated by Mayer and Salovey to designate the ability to perceive, understand, use and manage emotions. The study of EI in schizophrenia offers new insights into the disorder’s cognitive and functional impacts. Objectives To comprehensively review studies analyzing EI impairment in schizophrenia spectrum disorders using standardized instruments. Methods Searches were run on MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov and SciELO databases. The only validated instrument used was the Multifactor Emotional Intelligence Scale (MSCEIT). Articles that used all branches of the MSCEIT to assess EI in schizophrenia spectrum disorders and healthy controls were included in the review. Results We found 30 articles on this topic. The studies analyzed showed a significant impairment of MSCEIT total score in patients with schizophrenia spectrum disorders when compared to healthy controls. In relation to the MSCEIT branches, understanding of emotions and management of emotions are the most impaired branches. Conclusion Since most studies are cross-sectional, it is not possible to establish a cause and effect relationship between EI deficits and schizophrenia spectrum disorders. Therefore, longitudinal studies are needed to establish a clearer relationship between these variables. By so doing, we may be able to intervene for prevention and management of these disorders, aiming at better quality of life for patients.

Perceptual integration of head and eye cues to gaze direction in schizophrenia

The perceptual mechanisms that underlie social experience in schizophrenia are increasingly becoming a target of empirical research. In the context of low-level vision, there is evidence for a reduction in the integration of sensory features in schizophrenia (e.g. increased thresholds for contour detection and motion coherence). In the context of higher-level vision, comparable differences in the integration of sensory features of the face could in theory impair the recognition of important social cues. Here we examine how the sense of where other people are looking relies upon the integration of eye-region cues and head-region cues. Adults with schizophrenia viewed face images designed to elicit the 'Wollaston illusion', a perceptual phenomenon in which the perceived gaze direction associated with a given pair of eyes is modulated by the surrounding sensory context. We performed computational modelling of these psychophysical data to quantify individual differences in the use of facial cues to gaze direction. We find that adults with schizophrenia exhibit a robust perceptual effect whereby their sense of other people's direction of gaze is strongly biased by sensory cues relating to head orientation in addition to eye region information. These results indicate that the visual integration of facial cues to gaze direction in schizophrenia is intact, helping to constrain theories of reduced integrative processing in higher-level and lower-level vision. In addition, robust gaze processing was evident in the tested participants despite reduced performance on a theory of mind task designed to assess higher-level social cognition.

Intact perception of coherent motion, dynamic rigid form, and biological motion in chronic schizophrenia

BACKGROUND

Prior studies have documented biological motion perception deficits in schizophrenia, but it remains unclear whether the impairments arise from poor social cognition, perceptual organization, basic motion processing, or sustained attention/motivation. To address the issue, we had 24 chronic schizophrenia patients and 27 healthy controls perform three tasks: coherent motion, where subjects indicated whether a cloud of dots drifted leftward or rightward; dynamic rigid form, where subjects determined the tilt direction of a translating, point-light rectangle; and biological motion, where subjects judged whether a human point-light figure walked leftward or rightward. Task difficulty was staircase controlled and depended on the directional variability of the background dot motion. Catch trials were added to verify task attentiveness and engagement.

RESULTS

Patients and controls demonstrated similar performance thresholds and near-ceiling catch trial accuracy for each task (uncorrected ps > 0.1; ds < 0.35). In all but the coherent motion task, higher IQ correlated with better performance (ps < 0.001).

CONCLUSION

Schizophrenia patients have intact perception of motion coherence, dynamic rigid form, and biological motion at least for our sample and set-up. We speculate that previously documented biological motion perception deficits arose from task or stimulus differences or from group differences in IQ, attention, or motivation.

A Bayesian model comparison approach to test the specificity of visual integration impairment in schizophrenia or psychosis

Impaired visual integration is well documented in schizophrenia and related to functional outcomes. However, it is unclear if this deficit is specific to schizophrenia, or characteristic of psychosis more broadly. To address this question, this study used a Bayesian model comparison approach to examine the evidence of three grouping models of visual integration performance in 116 individuals with schizophrenia (SZ), schizoaffective disorder (SA), bipolar disorder (BD) with or without a history of prominent psychosis (BDP+ and BDP-, respectively), or no psychiatric diagnosis (healthy controls; HC). We compared: (1) Psychosis Model (psychosis, non-psychosis), where the psychosis group included SZ, SA, and BDP+, and the non-psychosis group included BDP- and HC; (2) Schizophrenia Model (SZ, non-SZ); and (3) DSM Model (SZ, SA, BD, HC). The relationship between visual integration and general cognition was also explored. The Psychosis Model showed the strongest evidence, and visual integration was associated with general cognition in participants with psychosis. The results were consistent with the Research Domain Criteria (RDoC) framework, indicating that visual integration impairment is characteristic of psychosis and not specific to SZ or DSM categories, and may share similar disease pathways with observed neurocognitive deficits in psychotic disorders.

Are executive functions related to emotional intelligence? A correlational study in schizophrenia and borderline personality disorder

This research explored the relationship between executive functions (working memory and reasoning subtests of the Wechsler Adult Intelligence Scale, Trail Making and Stroop tests, fluency and planning tasks, and Wisconsin Card Sorting Test) and emotional intelligence measured by the Mayer-Salovey-Caruso Emotional Intelligence Test in patients with schizophrenia or borderline personality disorder compared to a control group. As expected, both clinical groups performed worse than the control group in executive functions and emotional intelligence, although the impairment was greater in the borderline personality disorder group. Executive functions significantly correlated with social functioning. Results are discussed in relation to the brain circuits that mediate executive functions and emotional intelligence and the findings obtained with other models of social cognition.

Altered attentional and perceptual processes as indexed by N170 during gaze perception in schizophrenia: Relationship with perceived threat and paranoid delusions

Using gaze information to orient attention and guide behavior is critical to social adaptation. Previous studies have suggested that abnormal gaze perception in schizophrenia (SCZ) may originate in abnormal early attentional and perceptual processes and may be related to paranoid symptoms. Using event-related brain potentials (ERPs), this study investigated altered early attentional and perceptual processes during gaze perception and their relationship to paranoid delusions in SCZ. Twenty-eight individuals with SCZ or schizoaffective disorder and 32 demographically matched healthy controls (HCs) completed a gaze-discrimination task with face stimuli varying in gaze direction (direct, averted), head orientation (forward, deviated), and emotion (neutral, fearful). ERPs were recorded during the task. Participants rated experienced threat from each face after the task. Participants with SCZ were as accurate as, though slower than, HCs on the task. Participants with SCZ displayed enlarged N170 responses over the left hemisphere to averted gaze presented in fearful relative to neutral faces, indicating a heightened encoding sensitivity to faces signaling external threat. This abnormality was correlated with increased perceived threat and paranoid delusions. Participants with SCZ also showed a reduction of N170 modulation by head orientation (normally increased amplitude to deviated faces relative to forward faces), suggesting less integration of contextual cues of head orientation in gaze perception. The psychophysiological deviations observed during gaze discrimination in SCZ underscore the role of early attentional and perceptual abnormalities in social information processing and paranoid symptoms of SCZ.

Creating Live Interactions to Mitigate Barriers (CLIMB): A Mobile Intervention to Improve Social Functioning in People With Chronic Psychotic Disorders

BACKGROUND

Numerous psychosocial interventions for individuals with chronic psychotic disorders (CPD) have shown positive effects on social cognitive and functional outcome measures. However, access to and engagement with these interventions remains limited. This is partly because these interventions require specially trained therapists, are not available in all clinical settings, and have a high scheduling burden for participants, usually requiring a commitment of several weeks. Delivering interventions remotely via mobile devices may facilitate access, improve scheduling flexibility, and decrease participant burden, thus improving adherence to intervention requirements. To address these needs, we designed the Creating Live Interactions to Mitigate Barriers (CLIMB) digital intervention, which aims to enhance social functioning in people with CPD. CLIMB consists of two treatment components: a computerized social cognition training (SCT) program and optimized remote group therapy (ORGT). ORGT is an innovative treatment that combines remote group therapy with group texting (short message service, SMS).

OBJECTIVES

The objectives of this single-arm study were to investigate the feasibility of delivering 6 weeks of CLIMB to people with CPD and explore the initial effects on outcomes.

METHODS

Participants were recruited, screened and enrolled via the Internet, and delivered assessments and interventions remotely using provided tablets (iPads). Participants were asked to complete 18 hours of SCT and to attend 6 remote group therapy sessions. To assess feasibility, adherence to study procedures, attrition rates, engagement metrics, and acceptability of the intervention were evaluated. Changes on measures of social cognition, quality of life, and symptoms were also explored.

RESULTS

In total, 27 participants were enrolled over 12 months. Remote assessments were completed successfully on 96% (26/27) of the enrolled participants. Retention in the 6-week trial was 78% (21/27). Of all the iPads used, 95% (22/23) were returned undamaged at the end of the intervention. Participants on average attended 84% of the group therapy sessions, completed a median of 9.5 hours of SCT, and posted a median of 5.2 messages per week on the group text chat. Participants rated CLIMB in the medium range in usability, acceptability, enjoyment, and perceived benefit. Participants showed significant improvements in emotion identification abilities for prosodic happiness (P=.001), prosodic happiness intensity (P=.04), and facial anger (P=.04), with large within-group effect sizes (d=.60 to d=.86). Trend-level improvements were observed on aspects of quality of life (P values less than .09). No improvements were observed for symptoms.

CONCLUSIONS

It is feasible and acceptable to remotely deliver an intervention aimed at enhancing social functioning in people with CPD using mobile devices. This approach may represent a scalable method to increase treatment access and adherence. Our pilot data also demonstrate within-group gains in some aspects of social cognition after 6 weeks of CLIMB. Future randomized controlled studies in larger samples should evaluate the extent to which CLIMB significantly improves social cognition, symptoms, and quality of life in CPD.

Emotion recognition deficits among persons with schizophrenia: Beyond stimulus complexity level and presentation modality

Studies have shown that persons with schizophrenia have lower accuracy in emotion recognition compared to persons without schizophrenia. However, the impact of the complexity level of the stimuli or the modality of presentation has not been extensively addressed. Forty three persons with a diagnosis of schizophrenia and 43 healthy controls, matched for age and gender, were administered tests assessing emotion recognition from stimuli with low and high levels of complexity presented via visual, auditory and semantic channels. For both groups, recognition rates were higher for high-complexity stimuli compared to low-complexity stimuli. Additionally, both groups obtained higher recognition rates for visual and semantic stimuli than for auditory stimuli, but persons with schizophrenia obtained lower accuracy than persons in the control group for all presentation modalities. Persons diagnosed with schizophrenia did not present a level of complexity specific deficit or modality-specific deficit compared to healthy controls. Results suggest that emotion recognition deficits in schizophrenia are beyond level of complexity of stimuli and modality, and present a global difficulty in cognitive functioning.

Abnormal GABAergic function and face processing in schizophrenia: A pharmacologic-fMRI study

The involvement of the gamma-aminobutyric acid (GABA) system in schizophrenia is suggested by postmortem studies and the common use of GABA receptor-potentiating agents in treatment. In a recent study, we used a benzodiazepine challenge to demonstrate abnormal GABAergic function during processing of negative visual stimuli in schizophrenia. This study extended this investigation by mapping GABAergic mechanisms associated with face processing and social appraisal in schizophrenia using a benzodiazepine challenge. Fourteen stable, medicated schizophrenia/schizoaffective patients (SZ) and 13 healthy controls (HC) underwent functional MRI using the blood oxygenation level-dependent (BOLD) technique while they performed the Socio-emotional Preference Task (SePT) on emotional face stimuli ("Do you like this face?"). Participants received single-blinded intravenous saline and lorazepam (LRZ) in two separate sessions separated by 1-3weeks. Both SZ and HC recruited medial prefrontal cortex/anterior cingulate during the SePT, relative to gender identification. A significant drug by group interaction was observed in the medial occipital cortex, such that SZ showed increased BOLD signal to LRZ challenge, while HC showed an expected decrease of signal; the interaction did not vary by task. The altered BOLD response to LRZ challenge in SZ was significantly correlated with increased negative affect across multiple measures. The altered response to LRZ challenge suggests that abnormal face processing and negative affect in SZ are associated with altered GABAergic function in the visual cortex, underscoring the role of impaired visual processing in socio-emotional deficits in schizophrenia.

Local and global limits on visual processing in schizophrenia

Schizophrenia has been linked to impaired performance on a range of visual processing tasks (e.g. detection of coherent motion and contour detection). It has been proposed that this is due to a general inability to integrate visual information at a global level. To test this theory, we assessed the performance of people with schizophrenia on a battery of tasks designed to probe voluntary averaging in different visual domains. Twenty-three outpatients with schizophrenia (mean age: 40±8 years; 3 female) and 20 age-matched control participants (mean age 39±9 years; 3 female) performed a motion coherence task and three equivalent noise (averaging) tasks, the latter allowing independent quantification of local and global limits on visual processing of motion, orientation and size. All performance measures were indistinguishable between the two groups (ps>0.05, one-way ANCOVAs), with one exception: participants with schizophrenia pooled fewer estimates of local orientation than controls when estimating average orientation (p = 0.01, one-way ANCOVA). These data do not support the notion of a generalised visual integration deficit in schizophrenia. Instead, they suggest that distinct visual dimensions are differentially affected in schizophrenia, with a specific impairment in the integration of visual orientation information.

A novel, online social cognitive training program for young adults with schizophrenia: A pilot study

BACKGROUND

Pervasive social cognition deficits are evident early in the course of schizophrenia and are directly linked to functional outcome, making them an important target for intervention. Here, we tested the feasibility of use, and initiated the evaluation of efficacy, of a novel, neuroplasticity-based online training program (SocialVille) in young adults with schizophrenia.

METHODS

Schizophrenia patients (n=17) completed 24 hours of online SocialVille game play either from home or at a clinic, over a 6-10 week period. We examined training feasibility, gains on the SocialVille exercises relative to matched healthy controls (n=17), and changes on measures of social cognition, social functioning, global functioning and motivation.

RESULTS

Subjects adhered to training requirements, and rated SocialVille in the medium to high range in satisfaction, enjoyment, and ease of use. Subjects demonstrated significant, large improvements on the speeded SocialVille tasks, and small to moderate improvements on the working memory tasks. Post-training performance on the SocialVille tasks were similar to initial performance of the healthy controls. Subjects also showed improvements on standard measures of social cognition, social functioning, and motivation. No improvements were recorded for emotion recognition indices on the MSCEIT, or on quality of life scales.

CONCLUSION

This study provides an initial proof of concept for online social cognition training in schizophrenia. This form of training demonstrated feasibility and resulted in within-subject gains in social functioning and motivation. This pilot study represents a first step towards validating this training approach; randomized controlled trials, now underway, are designed to confirm and extend these findings.