Processing of facial emotion expression in major depression: a review

The effect of emotion recognition and mindfulness on depression symptoms: A case-control study

Abnormalities in emotion recognition (ER) are frequently reported in depression, with lower recognition accuracy in patients with major depressive disorder (MDD) when compared to healthy individuals. Mindfulness was found to directly impact the severity of depressive symptoms, by recognizing negative cognitions and dysfunctional reactions. The aims of this study were to compare ER and mindfulness levels between MDD patients and healthy controls (HCs), as well as to examine whether ER and mindfulness are related to symptom severity in MDD patients. Sixty-eight patients with MDD and 93 HCs participated in the study. A sociodemographic form, reading the mind in the eyes test (RMET), five facet mindfulness questionnaire-short form (FFMQ-S) and the Montgomery-Asberg depression scale (MADRS) were administered. Group comparison in ER and mindfulness was performed using the multivariate analysis of covariance (MANCOVA). Bivariate correlations and hierarchical linear regression analyses were performed to assess the associations between depression severity, ER and mindfulness in the patient group. Higher level of mindfulness was found in HCs relative to MDD group, however, no ER difference was present between the groups. A positive association between depression severity and the non-reactivity facet of mindfulness was found. On the other hand, ER was not significantly associated with symptom severity among individuals with MDD. Non-reactivity, unlike other dimensions of mindfulness, seems to increase with the severity of depressive symptoms among MDD patients. A particular focus on this subdimension in mindfulness techniques may yield better outcomes in alleviation of depressive symptoms.

Neural responses to facial emotions and subsequent clinical outcomes in difficult-to-treat depression

BACKGROUND

Amygdala and dorsal anterior cingulate cortex responses to facial emotions have shown promise in predicting treatment response in medication-free major depressive disorder (MDD). Here, we examined their role in the pathophysiology of clinical outcomes in more chronic, difficult-to-treat forms of MDD.

METHODS

Forty-five people with current MDD who had not responded to ⩾2 serotonergic antidepressants (n = 42, meeting pre-defined fMRI minimum quality thresholds) were enrolled and followed up over four months of standard primary care. Prior to medication review, subliminal facial emotion fMRI was used to extract blood-oxygen level-dependent effects for sad v. happy faces from two pre-registered a priori defined regions: bilateral amygdala and dorsal/pregenual anterior cingulate cortex. Clinical outcome was the percentage change on the self-reported Quick Inventory of Depressive Symptomatology (16-item).

RESULTS

We corroborated our pre-registered hypothesis (NCT04342299) that lower bilateral amygdala activation for sad v. happy faces predicted favorable clinical outcomes (rs[38] = 0.40, p = 0.01). In contrast, there was no effect for dorsal/pregenual anterior cingulate cortex activation (rs[38] = 0.18, p = 0.29), nor when using voxel-based whole-brain analyses (voxel-based Family-Wise Error-corrected p < 0.05). Predictive effects were mainly driven by the right amygdala whose response to happy faces was reduced in patients with higher anxiety levels.

CONCLUSIONS

We confirmed the prediction that a lower amygdala response to negative v. positive facial expressions might be an adaptive neural signature, which predicts subsequent symptom improvement also in difficult-to-treat MDD. Anxiety reduced adaptive amygdala responses.

Superior facial emotion recognition in adolescents with anorexia nervosa - A replication study

OBJECTIVE

Anorexia nervosa (AN) has been associated with alterations in the processing of socio-emotional information, including impairments in the recognition of emotions in other people's faces. However, adolescents with AN might not show the impairments found in adult patients. The present study investigated facial emotion recognition in adolescents with AN, aiming to replicate our previous results of superior emotion recognition abilities in adolescents with AN compared to adolescents without mental disorders.

METHOD

Adolescent girls (12-18 years) with AN (n = 33) were compared to girls without mental disorders (n = 41). Participants completed one task requiring identification of emotions (happy, sad, afraid, angry, neutral) in faces and one control task.

RESULTS

As expected, adolescents with AN showed superior emotion recognition, with higher accuracy rates specifically for afraid faces.

CONCLUSION

This is the first study replicating previous results on basic emotion recognition in adolescents with AN using (almost) the same methodology. The results suggest that, in contrast to adults, adolescents with AN do not show impairments in facial emotion recognition. The impairments may arise in the longer course of the illness, however, longitudinal studies are necessary to confirm this assumption.

Attention modulates facial expression processing in subsyndromal depression: A behavioral and ERP study

Impaired facial expression perception is a core element in depression, but the underlying mechanism remains controversial. This event-related potential study investigated how attention modulates facial expression perception in depression using a nonclinical sample. A group of healthy controls (HC, N = 39) and a group of individuals with subsyndromal depression (SD, N = 39) categorized faces based on either facial expression (happy vs. sad) or gender (male vs. female). Behaviorally, the SD group was less sensitive to the emotional valence of facial expression than the HC group when their attention was directed to facial expression, as revealed by comparable subjective ratings and accuracy rates in response to facial expressions. When attention was directed towards facial gender, the SD group versus the HC group showed a negative bias, as revealed by a faster N170 for sad faces than happy faces. Together, our findings suggest that attention plays a role in understanding the relationship between depression and facial expression perception.

Higher Intersubject Variability in Neural Response to Narrative Social Stimuli Among Youth With Higher Social Anxiety

OBJECTIVE

Social anxiety is associated with alterations in socioemotional processing, but the pathophysiology remains poorly understood. Movies present an opportunity to examine more naturalistic socioemotional processing by providing narrative and sensory context to emotion cues. This study aimed to characterize associations between neural response to contextualized social cues and social anxiety symptoms in children.

METHOD

Data from the Healthy Brain Network (final N = 740; age range 5-15 years) were split into discovery and replication samples to maximize generalizability of findings. Associations of parent- and self-reported social anxiety (Screen for Child Anxiety-related Emotional Disorders) with mean differences and person-to-person variability in functional magnetic resonance imaging-measured activation to 2 emotionally dynamic movies were characterized.

RESULTS

Though no evidence was found to indicate social anxiety symptoms were associated with mean differences in neural activity to emotional content (fit Spearman rs < 0.09), children with high social anxiety symptoms had higher intersubject activation variability in the posterior cingulate, supramarginal gyrus, and inferior frontal gyrus (Bonferroni familywise error-corrected ps < .05)-regions associated with attention, alertness, and emotion cue processing. Identified regions varied by age group and informant. Across ages, these effects were enhanced for scenes containing greater sensory intensity (brighter, louder, more motion, more vibrance).

CONCLUSION

These results provide evidence that children with high social anxiety symptoms show high person-to-person variability in the neural processing of sensory aspects of emotional content. These data indicate that children with high social anxiety may require personalized interventions for sensory and emotional difficulties, as the underlying neurology differs from child to child.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list.

Altered functional brain activity in first-episode major depressive disorder treated with electro-acupuncture: A resting-state functional magnetic resonance imaging study

Background

Previous studies have found electroacupuncture could improve the clinical symptoms of first-episode major depressive disorder (MDD), but the exact neural mechanism of action needs to be further elucidated.

Methods

Twenty-eight first-episode MDD patients were randomly divided into 14 electro-acupuncture stimulation (EAS) groups and 14 sham-acupuncture stimulation (SAS) groups, and clinical symptoms were assessed and functional magnetic resonance imaging (fMRI) scans were done in both groups. Amplitude of low-frequency fluctuations (ALFF) was used to observe the changes between the pre-treatment and post-treatment in the two groups, and the altered brain areas were selected as region of interest (ROI) to observe the FC changes. Meanwhile, the correlation between the altered clinical symptoms and the altered ALFF and FC of brain regions in the two groups was analyzed.

Results

The EAS significantly decreased the HAMD-24 and HAMA-14 scores of MDD than SAS group. The imaging results revealed that both groups were able to increase the ALFF of the left middle temporal gyrus and the left cerebellar posterior lobe. When using the left middle temporal gyrus and the left posterior cerebellar lobe as ROIs, EAS group increased the FC between the left middle temporal gyrus with the left superior frontal gyrus, the left middle frontal gyrus, and the left hippocampus, and decreased the FC between the left posterior cerebellar lobe and the left calcarine gyrus, while SAS group only increased the FC between the left middle temporal gyrus with the left superior frontal gyrus. The alternations in clinical symptoms after EAS treatment were positively correlated with the altered ALFF values in the left middle temporal gyrus and the altered FC values in the left middle temporal gyrus and the left middle frontal gyrus.

Conclusion

EA demonstrates modulation of functional activity in the default mode network (DMN), sensorimotor network (SMN), cognitive control network (CCN), limbic system, and visual network (VN) for the treatment of the first-episode MDD. Our findings contribute to the neuroimaging evidence for the efficacy of EAS.

Disrupted limbic-prefrontal effective connectivity in response to fearful faces in lifetime depression

BACKGROUND

Multiple brain imaging studies of negative emotional bias in major depressive disorder (MDD) have used images of fearful facial expressions and focused on the amygdala and the prefrontal cortex. The results have, however, been inconsistent, potentially due to small sample sizes (typically N<50). It remains unclear if any alterations are a characteristic of current depression or of past experience of depression, and whether there are MDD-related changes in effective connectivity between the two brain regions.

METHODS

Activations and effective connectivity between the amygdala and dorsolateral prefrontal cortex (DLPFC) in response to fearful face stimuli were studied in a large population-based sample from Generation Scotland. Participants either had no history of MDD (N=664 in activation analyses, N=474 in connectivity analyses) or had a diagnosis of MDD during their lifetime (LMDD, N=290 in activation analyses, N=214 in connectivity analyses). The within-scanner task involved implicit facial emotion processing of neutral and fearful faces.

RESULTS

Compared to controls, LMDD was associated with increased activations in left amygdala (PFWE=0.031,kE=4) and left DLPFC (PFWE=0.002,kE=33), increased mean bilateral amygdala activation (β=0.0715,P=0.0314), and increased inhibition from left amygdala to left DLPFC, all in response to fearful faces contrasted to baseline. Results did not appear to be attributable to depressive illness severity or antidepressant medication status at scan time.

LIMITATIONS

Most studied participants had past rather than current depression, average severity of ongoing depression symptoms was low, and a substantial proportion of participants were receiving medication. The study was not longitudinal and the participants were only assessed a single time.

CONCLUSIONS

LMDD is associated with hyperactivity of the amygdala and DLPFC, and with stronger amygdala to DLPFC inhibitory connectivity, all in response to fearful faces, unrelated to depression severity at scan time. These results help reduce inconsistency in past literature and suggest disruption of 'bottom-up' limbic-prefrontal effective connectivity in depression.

Change in brain activation after transcranial pulsed electromagnetic fields in treatment-resistant depression

BACKGROUND

Preliminary evidence suggests antidepressant effects of transcranial pulsed electromagnetic fields (tPEMF). However, the precise mechanism of action in the brain is still unknown. The aim of this study was to investigate the influence of tPEMF on brain activation in patients with treatment-resistant depression (TRD) by studying two processes that might be of particular interest in relation to the symptoms of depression: emotional processing and reward processing.

METHODS

Eligible participants (n = 50) with TRD in this sham-controlled double-blind multicenter trial [registered at the Dutch Trial Register ( http://www.trialregister.nl ), NTR3702] were randomly assigned to five weeks daily active or sham tPEMF. Pre- and post-treatment functional MR-scans were made during which participants performed a social-emotional task and a reward task.

RESULTS

Participants in the active treatment group showed a stronger decrease in activation post-treatment compared to sham during reward-outcome processing in the left inferior frontal gyrus and in a cluster comprising the right lingual gyrus and the posterior part of the middle temporal gyrus. No effect of tPEMF was found on activation during the social-emotional task. Neurostimulation with tPEMF did also not affect behavioral performance for both tasks.

CONCLUSIONS

We found a decrease in reward-related activation as a result of tPEMF stimulation, while no effect of tPEMF on social-emotional processing was found. The treatment-related reduction in activation of regulatory regions may reflect normalization and may have implications for anhedonia. These findings suggest that there is an effect of tPEMF on brain activation of relevant circuits, albeit in the absence of a clinical antidepressant effect.

Rodent tests of depression and anxiety: Construct validity and translational relevance

Behavioral testing constitutes the primary method to measure the emotional states of nonhuman animals in preclinical research. Emerging as the characteristic tool of the behaviorist school of psychology, behavioral testing of animals, particularly rodents, is employed to understand the complex cognitive and affective symptoms of neuropsychiatric disorders. Following the symptom-based diagnosis model of the DSM, rodent models and tests of depression and anxiety focus on behavioral patterns that resemble the superficial symptoms of these disorders. While these practices provided researchers with a platform to screen novel antidepressant and anxiolytic drug candidates, their construct validity-involving relevant underlying mechanisms-has been questioned. In this review, we present the laboratory procedures used to assess depressive- and anxiety-like behaviors in rats and mice. These include constructs that rely on stress-triggered responses, such as behavioral despair, and those that emerge with nonaversive training, such as cognitive bias. We describe the specific behavioral tests that are used to assess these constructs and discuss the criticisms on their theoretical background. We review specific concerns about the construct validity and translational relevance of individual behavioral tests, outline the limitations of the traditional, symptom-based interpretation, and introduce novel, ethologically relevant frameworks that emphasize simple behavioral patterns. Finally, we explore behavioral monitoring and morphological analysis methods that can be integrated into behavioral testing and discuss how they can enhance the construct validity of these tests.

The effects of electroencephalography functional connectivity during emotional recognition among patients with major depressive disorder and healthy controls

BACKGROUND

The brain of major depressive disorder (MDD) is associated with altered functional connectivity (FC) compared to that of healthy individuals when processing positive and negative visual stimuli. Building upon alterations in brain connectivity, some researchers have employed electroencephalography (EEG) to study FC in MDD, aiming to enhance both diagnosis and treatment; however, the results have been inconsistent and the studies involving FC during emotional recognition are limited. This study aims to 1) investigate the effects of MDD on EEG patterns during visual emotional processing, 2) explore the therapeutic effects of antidepressant treatment on brain FC within the first week, and assess whether these effects can be predictive of treatment outcomes four weeks later, and 3) study baseline FC parameter biomarkers that can be used to predict treatment responsiveness in MDD patients.

METHODS

This clinical observational study recruited 38 healthy controls (HC) and 48 MDD patients. Patients underwent an EEG exam while looking at validated images of happy and sad faces at week 0 and 1. MDD patients were categorized into treatment responders and non-responders after 4 weeks of treatment. We conducted the FC analysis (node strength (NS), global efficiency (GE), and cluster coefficient (CC)) on HC and MDD patients using graph theoretical analysis. Multivariable linear regression was used to evaluate the influence of MDD on FC compared to HC, while controlling for confounding variables including age, gender, and academic degrees.

RESULTS

At week 0 and week 1, MDD patients revealed to have significant reductions in FC parameters (NS, GE and CC) compared to HC. When comparing MDD patients at week 1 post-antidepressant treatment and pre-treatment, no significant differences in FC changes were observed. Multivariable regression revealed a significant negative effect on FC of MDD. Compared to the treatment non-responsive group, the responsive group revealed a significantly higher FC in delta band frequency at baseline.

CONCLUSIONS

MDD patient group showed impaired FC during visual emotion-processing and we observed baseline FC parameters to be associated with treatment response at week 4. While signs of FC changes were observed in the brain after a week of treatment, it is possible that one week may still be insufficient to demonstrate significant alterations in the brain. Our results suggest the potential utilization of EEG-based FC as an indicative measure for predicting treatment response and monitoring treatment progress in MDD patients.

Emotional state dynamics impacts temporal memory

Emotional fluctuations are ubiquitous in everyday life, but precisely how they sculpt the temporal organization of memories remains unclear. Here, we designed a novel task-the Emotion Boundary Task-wherein participants viewed sequences of negative and neutral images surrounded by a color border. We manipulated perceptual context (border color), emotional valence, as well as the direction of emotional-valence shifts (i.e., shifts from neutral-to-negative and negative-to-neutral events) to create encoding events comprised of image sequences with a shared perceptual and/or emotional context. We measured memory for temporal order and subjectively remembered temporal distances for images processed within and across events. Negative images processed within events were remembered as closer in time compared to neutral ones. In contrast, temporal distance was remembered as longer for images spanning neutral-to-negative shifts-suggesting temporal dilation in memory with the onset of a negative event following a previously-neutral state. The extent of this negative-picture induced temporal dilation in memory correlated with dispositional negativity across individuals. Lastly, temporal order memory was enhanced for recently presented negative (compared to neutral) images. These findings suggest that emotional-state dynamics matters when considering emotion-temporal memory interactions: While persistent negative events may compress subjectively remembered time, dynamic shifts from neutral to negative events produce temporal dilation in memory, which may be relevant for adaptive emotional functioning.

Cognitive predictors of stress-induced mood malleability in depression

BACKGROUND & OBJECTIVES

Basic attentional control, negative biases in attention and interpretation, and rumination are all cognitive processes associated with depression; however, less is known about their predictive role in depressive mood reactivity and -recovery in response to stress, and their relation to severity of depression.

DESIGN & METHODS

We experimentally induced stress based on an autobiographical imagery script in a sample of 92 participants with Major Depressive Disorder with or without comorbid anxiety disorders. We used simple regression analysis for investigating the roles of state- and trait rumination, attentional networks, and attentional and interpretation biases for predicting stress-induced depressive mood reactivity and -recovery, respectively, and whether they in parallel mediated the association between cognitive processes and depression severity.

RESULTS

Stress-induced depressive mood reactivity was predicted by better orienting ability and more state rumination. Better recovery was predicted by better orienting efficiency and lower negative interpretation bias. Furthermore, the relation between state rumination and depression severity was partially mediated by depressive mood reactivity, however limited by the lack of temporal precedence in the analysis.

CONCLUSIONS

We characterized the relation between cognitive processes and mood malleability in response to stress. Findings could refine theoretical models of depression if causality is established.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04137367.

Behavioral and neuroanatomical correlates of facial emotion processing in post-stroke depression

BACKGROUND

Emotion processing deficits are known to accompany depressive symptoms and are often seen in stroke patients. Little is known about the influence of post-stroke depressive (PSD) symptoms and specific brain lesions on altered emotion processing abilities and how these phenomena develop over time. This potential relationship may impact post-stroke rehabilitation of neurological and psychosocial function. To address this scientific gap, we investigated the relationship between PSD symptoms and emotion processing abilities in a longitudinal study design from the first days post-stroke into the early chronic phase.

METHODS

Twenty-six ischemic stroke patients performed an emotion processing task on videos with emotional faces ('happy,' 'sad,' 'anger,' 'fear,' and 'neutral') at different intensity levels (20%, 40%, 60%, 80%, 100%). Recognition accuracies and response times were measured, as well as scores of depressive symptoms (Montgomery-Åsberg Depression Rating Scale). Twenty-eight healthy participants matched in age and sex were included as a control group. Whole-brain support-vector regression lesion-symptom mapping (SVR-LSM) analyses were performed to investigate whether specific lesion locations were associated with the recognition accuracy of specific emotion categories.

RESULTS

Stroke patients performed worse in overall recognition accuracy compared to controls, specifically in the recognition of happy, sad, and fearful faces. Notably, more depressed stroke patients showed an increased processing towards specific negative emotions, as they responded significantly faster to angry faces and recognized sad faces of low intensities significantly more accurately. These effects obtained for the first days after stroke partly persisted to follow-up assessment several months later. SVR-LSM analyses revealed that inferior and middle frontal regions (IFG/MFG) and insula and putamen were associated with emotion-recognition deficits in stroke. Specifically, recognizing happy facial expressions was influenced by lesions affecting the anterior insula, putamen, IFG, MFG, orbitofrontal cortex, and rolandic operculum. Lesions in the posterior insula, rolandic operculum, and MFG were also related to reduced recognition accuracy of fearful facial expressions, whereas recognition deficits of sad faces were associated with frontal pole, IFG, and MFG damage.

CONCLUSION

PSD symptoms facilitate processing negative emotional stimuli, specifically angry and sad facial expressions. The recognition accuracy of different emotional categories was linked to brain lesions in emotion-related processing circuits, including insula, basal ganglia, IFG, and MFG. In summary, our study provides support for psychosocial and neural factors underlying emotional processing after stroke, contributing to the pathophysiology of PSD.

Perceptual Observer Modeling Reveals Likely Mechanisms of Face Expression Recognition Deficits in Depression

BACKGROUND

Deficits in face emotion recognition are well documented in depression, but the underlying mechanisms are poorly understood. Psychophysical observer models provide a way to precisely characterize such mechanisms. Using model-based analyses, we tested 2 hypotheses about how depression may reduce sensitivity to detect face emotion: 1) via a change in selectivity for visual information diagnostic of emotion or 2) via a change in signal-to-noise ratio in the system performing emotion detection.

METHODS

Sixty adults, one half meeting criteria for major depressive disorder and the other half healthy control participants, identified sadness and happiness in noisy face stimuli, and their responses were used to estimate templates encoding the visual information used for emotion identification. We analyzed these templates using traditional and model-based analyses; in the latter, the match between templates and stimuli, representing sensory evidence for the information encoded in the template, was compared against behavioral data.

RESULTS

Estimated happiness templates produced sensory evidence that was less strongly correlated with response times in participants with depression than in control participants, suggesting that depression was associated with a reduced signal-to-noise ratio in the detection of happiness. The opposite results were found for the detection of sadness. We found little evidence that depression was accompanied by changes in selectivity (i.e., information used to detect emotion), but depression was associated with a stronger influence of face identity on selectivity.

CONCLUSIONS

Depression is more strongly associated with changes in signal-to-noise ratio during emotion recognition, suggesting that deficits in emotion detection are driven primarily by deprecated signal quality rather than suboptimal sampling of information used to detect emotion.

The Story behind the Mask: A Narrative Review on Hypomimia in Parkinson's Disease

Facial movements are crucial for social and emotional interaction and well-being. Reduced facial expressions (i.e., hypomimia) is a common feature in patients with Parkinson's disease (PD) and previous studies linked this manifestation to both motor symptoms of the disease and altered emotion recognition and processing. Nevertheless, research on facial motor impairment in PD has been rather scarce and only a limited number of clinical evaluation tools are available, often suffering from poor validation processes and high inter- and intra-rater variability. In recent years, the availability of technology-enhanced quantification methods of facial movements, such as automated video analysis and machine learning application, led to increasing interest in studying hypomimia in PD. In this narrative review, we summarize the current knowledge on pathophysiological hypotheses at the basis of hypomimia in PD, with particular focus on the association between reduced facial expressions and emotional processing and analyze the current evaluation tools and management strategies for this symptom, as well as future research perspectives.

Cross-cultural adaptation and clinical application of the Perth Empathy Scale

OBJECTIVE

Alterations of empathy have been observed in patients with various mental disorders. The Perth Empathy Scale (PES) was recently developed to measure a multidimensional construct of empathy across positive and negative emotions. However, its psychometric properties and clinical applications have not been examined in the Chinese context.

METHODS

The Chinese version of the PES was developed and administered to a large Chinese sample (n = 1090). Factor structure, internal consistency, test-retest reliability, and convergent, discriminant, as well as concurrent validity were examined. Moreover, 50 patients with major depressive disorder (MDD) and 50 healthy controls were recruited to explore the clinical utility of the PES.

RESULTS

Confirmatory factor analyses supported a theoretically congruent three-factor structure of empathy, namely Cognitive Empathy, Negative Affective Empathy and Positive Affective Empathy. The PES showed good to excellent internal consistency reliability, good convergent and discriminant validity, acceptable concurrent validity, and moderate to high test-retest reliability. Patients with MDD had significantly lower PES scores compared to healthy controls. Linear discriminant function comprised of the three factors correctly differentiated 71% of participants, which further verified the clinical utility of the PES.

CONCLUSIONS

Our findings indicated that the Chinese version of the PES is a reliable and valid instrument to measure cognitive and affective empathy across negative and positive emotions, and could therefore be used in both research and clinical practice.

Emotional Context Effects on the Rating of Ambiguous Facial Expressions in Depression and Schizophrenia Spectrum Disorders

ObjectiveTo investigate the influence of visual contextual information on emotion recognition of ambiguous facial expressions in depression and schizophrenia spectrum disorders. Method: Ambiguous facial expressions and emotional contexts representing anger, disgust, fear, joy, sadness and surprise were validated in a pre-test with healthy independent raters. Afterwards, 20 healthy participants (8 women, 12 men; mean age 24.35 ± 2.85 years), 20 participants with schizophrenia spectrum disorders (9 women, 11 men; mean age 40.25 ± 11.68 years) and 19 participants with depression (11 women, 8 men; mean age 43.74 ± 12.65 years) rated the emotional content of nine different faces in seven different emotion-suggesting contexts. The proportions of context-congruent answers and differences between emotion ratings in each context were analysed using non-parametric Kruskal-Wallis and explorative, paired Wilcoxon tests. Correlational analyses explored the influence of clinical symptoms assessed by clinician-administered scales. Results: The overall proportion of context-congruent answers did not differ between participants with depression and schizophrenia spectrum disorders compared to healthy participants. Participants with schizophrenia spectrum disorders were more susceptible to anger-suggesting contexts and participants with depression were more susceptible to fear-suggesting contexts. Differences in emotion recognition were associated with the severity of depressive, but not psychotic, symptoms. Conclusion: Despite increased susceptibility to anger-suggesting cues in schizophrenia and to fear-suggesting cues in depression, visual contextual influence remains largely consistent with healthy participants. Preserved emotional responsiveness suggests an efficacy of emotion training but emphasizes the need for additional research focusing on other factors contributing to social interaction deficits.

Normalized affective responsiveness following deep brain stimulation of the medial forebrain bundle in depression

Deep brain stimulation (DBS) of the supero-lateral medial forebrain bundle (slMFB) is associated with rapid and sustained antidepressant effects in treatment-resistant depression (TRD). Beyond that, improvements in social functioning have been reported. However, it is unclear whether social skills, the basis of successful social functioning, are systematically altered following slMFB DBS. Therefore, the current study investigated specific social skills (affective empathy, compassion, and theory of mind) in patients with TRD undergoing slMFB DBS in comparison to healthy subjects. 12 patients with TRD and 12 age- and gender-matched healthy subjects (5 females) performed the EmpaToM, a video-based naturalistic paradigm differentiating between affective empathy, compassion, and theory of mind. Patients were assessed before and three months after DBS onset and compared to an age- and gender-matched sample of healthy controls. All data were analyzed using non-parametric Mann-Whitney U tests. DBS treatment significantly affected patients' affective responsiveness towards emotional versus neutral situations (i.e. affective empathy): While their affective responsiveness was reduced compared to healthy subjects at baseline, they showed normalized affective responsiveness three months after slMFB DBS onset. No effects occurred in other domains with persisting deficits in compassion and intact socio-cognitive skills. Active slMFB DBS resulted in a normalized affective responsiveness in patients with TRD. This specific effect might represent one factor supporting the resumption of social activities after recovery from chronic depression. Considering the small size of this unique sample as well as the explorative nature of this study, future studies are needed to investigate the robustness of these effects.

Association Between Ego-Resilience and Social Isolation Among Urban Older People

Social isolation among older adults affects their physical and mental health. Ego-resilience is associated with flexible adaptation to various environments and acceptable behaviors. However, its association with social isolation among older people is unclear. Therefore, a health survey was conducted with 510 adults aged 65 years or older to assess social isolation, its associated factors, and ego resilience. The results showed that the social isolation group had a lower median ego-resiliency scale score (42.0) compared to the non-social isolation group (38.0). The social isolation group were mostly males without spouses, took time to move, had more depressive moods, and poorer subjective health status. The non-social isolated group had faster maximum walking speed. Low ego-resilience was newly identified as a factor associated with social isolation among older people, as were being male, having no spouse, and depressive symptoms. Mediation analysis revealed that ego-resilience affected social isolation and was partially mediated by depressive symptoms.

The Association Between Emotion Recognition and Internalizing Problems in Children and Adolescents: A Three-Level Meta-Analysis

Numerous studies have explored the link between how well youth recognize emotions and their internalizing problems, but a consensus remains elusive. This study used a three-level meta-analysis model to quantitatively synthesize the findings of existing studies to assess the relationship. A moderation analysis was also conducted to explore the sources of research heterogeneity. Through a systematic literature search, a total of 42 studies with 201 effect sizes were retrieved for the current meta-analysis, and 7579 participants were included. Emotion recognition was negatively correlated with internalizing problems. Children and adolescents with weaker emotion recognition skills were more likely to have internalizing problems. In addition, this meta-analysis found that publication year had a significant moderating effect. The correlation between emotion recognition and internalizing problems decreased over time. The degree of internalizing problems was also found to be a significant moderator. The correlation between emotion recognition and internalizing disorders was higher than the correlation between emotion recognition and internalizing symptoms. Deficits in emotion recognition might be relevant for the development and/or maintenance of internalizing problems in children and adolescents. The overall effect was small and future research should explore the clinical relevance of the association.

Differences in facial emotion recognition between bipolar disorder and other clinical populations: A systematic review and meta-analysis

Facial emotion (or expression) recognition (FER) is a domain of affective cognition impaired across various psychiatric conditions, including bipolar disorder (BD). We conducted a systematic review and meta-analysis searching for eligible articles published from inception to April 26, 2023, in PubMed/MEDLINE, Scopus, EMBASE, and PsycINFO to examine whether and to what extent FER would differ between people with BD and those with other mental disorders. Thirty-three studies comparing 1506 BD patients with 1973 clinical controls were included in the present systematic review, and twenty-six of them were analyzed in random-effects meta-analyses exploring the discrepancies in discriminating or identifying emotional stimuli at a general and specific level. Individuals with BD were more accurate in identifying each type of emotion during a FER task compared to individuals diagnosed with schizophrenia (SCZ) (SMD = 0.27; p-value = 0.006), with specific differences in the perception of anger (SMD = 0.46; p-value = 1.19e-06), fear (SMD = 0.38; p-value = 8.2e-04), and sadness (SMD = 0.33; p-value = 0.026). In contrast, BD patients were less accurate than individuals with major depressive disorder (MDD) in identifying each type of emotion (SMD = -0.24; p-value = 0.014), but these differences were more specific for sad emotional stimuli (SMD = -0.31; p-value = 0.009). No significant differences were observed when BD was compared with children and adolescents diagnosed with attention-deficit/hyperactivity disorder. FER emerges as a potential integrative instrument for guiding diagnosis by enabling discrimination between BD and SCZ or MDD. Enhancing the standardization of adopted tasks could further enhance the accuracy of this tool, leveraging FER potential as a therapeutic target.

Distinct physiological responses to social-evaluative stress in patients with major depressive disorder reporting a history of peer victimization

Peer victimization is a risk factor for the development of major depressive disorders, but little is known about the mechanisms. This study examined whether peer victimization alters physiological and affective responses to potentially threatening social stimuli. For this purpose, reactions to socially evaluative stimuli of depressive patients and healthy controls with varying histories of peer victimization were compared. In a social conditioning task, we studied heart rate responses to unconditioned socially negative and neutral evaluative video statements, followed by the heart rate reactions to conditioned stimuli, i.e. still images of the faces of the same actors. Diagnosis of depression and peer victimization were both associated with a more pronounced heart rate deceleration in response to unconditioned stimuli, irrespective of valence. The effect of peer victimization was stronger in depressive patients than in healthy controls. However, heart rate responses to the CSs were not related to depression or peer victimization. The results indicate a hypervigilant processing of social stimuli in depressive patients reporting histories of peer victimization. This distinct processing may be associated with inappropriate behavioral and emotional responses to social challenges, putting individuals at risk for depressive symptoms.

Interventions for deficits in recognition of emotions in facial expressions in major depressive disorder: An updated systematic review of clinical trials

The recognition of emotions in facial expressions (REFE) is a core construct of social cognition. In the last decades, studies have showed that REFE is altered in major depressive disorder (MDD), but the evidence is conflicting. Thus, we conducted a systematic review of clinical trials involving therapeutic interventions in MDD and any evaluation of REFE to update (2018-2023) and systematically evaluate the evidence derived from controlled clinical trials on the effects of therapeutic strategies to MDD on the REFE. Eleven studies were included in the final review. Some interventions, including drugs (ketamine, bupropion, psylocibin) and non-pharmacological strategies (psychotherapy) seem to be able to reduce pre-existing REFE biases in MDD patients. However, there was a high heterogeneity in the evaluated studies, in terms of sample, interventions, tasks and results. Further studies and more consistent evaluation tools are highly needed to better understand nuanced deficits and specific actions of different treatment options.

Moderating Effects of Emotional Recognition Competency in Rejective Parenting and Adolescent Depression and Aggression

Rejective parenting is a major antecedent of emotional instability and aggressive behavioral problems. Previous studies have reported that emotional problems, such as depression, anxiety, aggression, and conduct problems in children and adolescents, improve through interventions that enhance emotional recognition competency. In this study, we explored whether the emotional recognition ability levels of individual adolescents moderated the pathway of negative parenting on aggression mediated by depression The moderated mediating effect of emotional recognition competency was investigated through examining 2265 first-year high school students using the 2021 data from the Korean Children and Youth Panel Survey 2018. There was no significant moderating effect on the direct pathway from rejective parenting to aggression. The moderating effect of emotional recognition competency on the indirect pathway leading to aggression through depression in rejective parenting was significant. These results suggest that the ability to correctly understand signals related to the emotions of others can play an important role in reducing depression and aggressive behavior by reducing conflict with people around them and experiencing more support.

Brain functional alterations in patients with anorexia nervosa: A meta-analysis of task-based functional MRI studies

The goal of this study was to discern the neural activation patterns associated with anorexia nervosa (AN) in response to tasks related to body-, food-, emotional-, cognitive-, and reward- processing. A meta-analysis was performed on task-based fMRI studies, revealing that patients with AN showed increased activity in the left superior temporal gyrus and bilaterally in the ACC during a reward-related task. During cognitive-related tasks, patients with AN also showed increased activity in the left superior parietal gyrus, right middle temporal gyrus, but decreased activity in the MCC. Additionally, patients with AN showed increased activity bilaterally in the cerebellum, MCC, and decreased activity bilaterally in the bilateral precuneus/PCC, right middle temporal gyrus, left ACC when they viewed food images. During emotion-related tasks, patients with AN showed increased activity in the left cerebellum, but decreased activity bilaterally in the striatum, right mPFC, and right superior parietal gyrus. Patients with AN also showed increased activity in the right striatum and decreased activity in the right inferior temporal gyrus and bilaterally in the mPFC during body-related tasks. The present meta-analysis provides a comprehensive overview of the patterns of brain activity evoked by task stimuli, thereby augmenting the current comprehension of the pathophysiology in AN.

Brain mechanisms underlying the emotion processing bias in treatment-resistant depression

Depression is associated with a cognitive bias towards negative information and away from positive information. This biased emotion processing may underlie core depression symptoms, including persistent feelings of sadness or low mood and a reduced capacity to experience pleasure. The neural mechanisms responsible for this biased emotion processing remain unknown. Here, we had a unique opportunity to record stereotactic electroencephalography (sEEG) signals in the amygdala and prefrontal cortex (PFC) from 5 treatment-resistant depression (TRD) patients and 12 epilepsy patients (as control) while they participated in an affective bias task in which happy and sad faces were rated. First, compared with the control group, patients with TRD showed increased amygdala responses to sad faces in the early stage (around 300 ms) and decreased amygdala responses to happy faces in the late stage (around 600 ms) following the onset of faces. Further, during the late stage of happy face processing, alpha-band activity in PFC as well as alpha-phase locking between the amygdala and PFC were significantly greater in TRD patients compared to the controls. Second, after deep brain stimulation (DBS) delivered to bilateral subcallosal cingulate (SCC) and ventral capsule/ventral striatum (VC/VS), atypical amygdala and PFC processing of happy faces in TRD patients remitted toward the normative pattern. The increased amygdala activation during the early stage of sad face processing suggests an overactive bottom-up processing system in TRD. Meanwhile, the reduced amygdala response during the late stage of happy face processing could be attributed to inhibition by PFC through alpha-band oscillation, which can be released by DBS in SCC and VC/VS.

Immediate and Differential Response to Emotional Stimuli Associated With Transcranial Direct Current Stimulation for Depression: A Visual-Search Task Pilot Study

OBJECTIVES

When administered in repeated daily doses, transcranial direct current stimulation (tDCS) directed to the prefrontal cortex has cumulative efficacy for the treatment of depression. Depression can be marked by altered processing of emotionally salient information. An acute marker of response to tDCS may be measured as an immediate change in emotional information processing. Using an easily administered web-based task, we tested immediate changes in emotional information processing in acute response to tDCS in participants with and without depression.

MATERIALS AND METHODS

We enrolled n = 21 women with mild-to-moderate depression and n = 20 controls without depression to complete a web-based visual search task before and after 30 minutes of tDCS directed to the prefrontal cortex. The timed task required participants to identify a target face among arrays showing sad, neutral, or mixed (distractor) expressions.

RESULTS

At baseline, as predicted, the participants with depression differed from those without in emotional processing speed (mean z score difference -0.66 ± 0.27, p = 0.022) and accuracy in identifying sad stimuli (error rate: 4.4% vs 1.8%, p = 0.039). In response to tDCS, the participants with depression became significantly faster on the distractor condition (pre- vs post-tDCS z scores: -0.45 ± 0.65 vs -0.85 ± 0.65, p = 0.009), suggesting a specific reduction in bias toward negative emotional information. In response to tDCS, the depressed group also had significant improvements in self-reported mood (increased happy, decreased sad and anxious mood).

CONCLUSIONS

Participants with depression vs those without were differentiated by their performance of the visual search task at baseline and in response to tDCS. Given that measurable effects on depression scales may require weeks of tDCS treatments, acute change in emotional information processing can serve as an easily obtainable marker of depression and its response to tDCS.

CLINICAL TRIAL REGISTRATION

The Clinicaltrials.gov registration number for the study is NCT05188248.

Avatar-Based Strategies for Breast Cancer Patients: A Systematic Review

There is a lack of studies to determine if avatar-based protocols could be considered an efficient and accurate strategy to improve psychological well-being in oncology patients, even though it represents a growing field of research. To the best of our knowledge, this is the first systematic review addressing the effectiveness of avatar-based treatments to enhance quality of life (QoL) and psychological well-being in breast cancer patients. The purpose of this study was to review the scientific literature of those studies involving avatar-based technology and breast cancer patients in order to answer the following questions. (1) Are avatar-based strategies useful to im-prove QoL and psychological well-being (anxiety and depression symptoms) in breast cancer patients? (2) Which is the best way to develop avatar-based protocols for breast cancer patients? We conducted a systematic review of the peer-reviewed literature from EBSCO, Ovid, PubMed, Scopus, and Web of Science (WOS), following the PRISMA statements and using "avatar + breast cancer" or "avatar + cancer" as keywords. Studies which were published in either English or Spanish and which addressed QoL and psychological well-being in breast cancer patients were reviewed. The results will contribute to developing innovative avatar-based strategies focused on breast cancer patients.

Hypoactive Visual Cortex, Prefrontal Cortex and Insula during Self-Face Recognition in Adults with First-Episode Major Depressive Disorder

Self-face recognition is a vital aspect of self-referential processing, which is closely related to affective states. However, neuroimaging research on self-face recognition in adults with major depressive disorder is lacking. This study aims to investigate the alteration of brain activation during self-face recognition in adults with first-episode major depressive disorder (FEMDD) via functional magnetic resonance imaging (fMRI); FEMDD (n = 59) and healthy controls (HC, n = 36) who performed a self-face-recognition task during the fMRI scan. The differences in brain activation signal values between the two groups were analyzed, and Pearson correlation analysis was used to evaluate the relationship between the brain activation of significant group differences and the severity of depressive symptoms and negative self-evaluation; FEMDD showed significantly decreased brain activation in the bilateral occipital cortex, bilateral fusiform gyrus, right inferior frontal gyrus, and right insula during the task compared with HC. No significant correlation was detected between brain activation with significant group differences and the severity of depression and negative self-evaluation in FEMDD or HC. The results suggest the involvement of the malfunctioning visual cortex, prefrontal cortex, and insula in the pathophysiology of self-face recognition in FEMDD, which may provide a novel therapeutic target for adults with FEMDD.

The impact of emotional stimuli on response inhibition in an inpatient and day-hospital patient psychosomatic cohort

Objectives

To correctly recognize and respond to your counterpart's emotion is essential for a successful get-together. To ensure this, emotional processes and inhibitory control are linked and interact with each other. However, this interaction can be altered in several mental disorders. In a group of psychosomatic patients, we investigated possible differences in the response inhibition between neutral and emotional stimuli and whether a psychosomatic inpatient and day-hospital patient treatment influences response inhibition profiles.

Methods

One hundred and one patients, diagnosed with different psychiatric diagnoses (77 women, 41.43 ± 13.13 years), completed an emotional stop-signal task (ESST) and an impulsive behavior scale upon admission in an inpatient and day-hospital patient treatment on a psychosomatic ward (T0) and at discharge (T1). Patients with depressive disorders completed the test again after 1 year (follow-up measurement T2, n = 22). Emotional stimuli were angry and neutral faces. Stop-signal reaction time (SSRT) and stop-signal delay (SSD) were calculated as the main behavioral parameters.

Results

We found a significantly higher SSRT for neutral than angry faces at both admission (8.538 ms, p < 0.001) and discharge (11.142 ms, p < 0.001), with a matching higher SSD for angry than neutral faces at both timepoints (T0: 8.360 ms, p < 0.001, T1: (6.950 ms, p < 0.001). The SSRT for angry faces significantly decreased after treatment (-8.485 ms, p = 0.0110). For neutral faces, the decrease failed to reach significance (-5.881 ms, p = 0.250). A significant decrease in SSRT for neutral faces in patients with depressive disorders was found 1 year after discharge compared with admission (-19.040 ms, p = 0.0380).

Conclusion

Our data demonstrate a decreased response inhibition for neutral compared with emotional stimuli and an improved response inhibition for angry faces after discharge in a psychosomatic inpatient and day-hospital patient cohort. Additionally, patients with depressive disorders displayed a significantly better response inhibition for neutral faces 1 year after discharge compared with the baseline measurement. With this study, we provide more evidence for altered emotional response inhibition in different mental disorders and a hint that psychosomatic inpatient and day-hospital patient treatment may help to normalize it, even if the effects remained small and it needs further research to prove causality.

The association between passive social network usage and depression/negative emotions with envy as a mediator

This study aimed to investigate the relationships between passive social network usage (PSNU) and depression/negative emotions over time with the mediating role of envy among Vietnamese adolescents. First, it revealed that PSNU had a simultaneous effect on depression/negative emotions as well as at different time points, indicating that social network site behaviors can predict psychological states over time (explained by the social comparison theory). Second, the autoregressive effect also confirmed a potential reciprocal relationship between PSNU and depression, whereas PSNU appeared to have an impact on negative emotions but not the other way around. Specifically, depression at Time 1 was positively associated with PSNU at Time 2, whereas negative emotions did not exhibit a similar pattern (explained by the cognitive dissonance theory). The different associations were interpreted as depression having cognitive elements, while negative emotions were thought to be purely emotional states. The results demonstrated that behavior may potentially have a long-lasting effect on mental health (both negative emotions and depression), while it was depression, rather than negative emotions, that had a long-term effect on behaviors. Third, envy played a mediating role that connected the changes of PSNU and depression/negative emotions. The implications and limitations of these findings are discussed.

Opposing and emotion-specific associations between frontal activation with depression and anxiety symptoms during facial emotion processing in generalized anxiety and depression

Major depression (MDD) and generalized anxiety disorder (GAD) have become one of the leading global causes of disability and both are characterized by marked interpersonal and social impairments. However, despite high comorbidity and overlapping social-emotional deficits, it remains unclear whether MDD and GAD share a common neural basis during interpersonal processing. In the present study, we combined an emotional face processing paradigm with fMRI and dimensional and categorical analyses in a sample of unmedicated MDD and GAD patients (N = 72) as well as healthy controls (N = 35). No group differences were found in categorical analyses. However, the dimensional analyses revealed that dorsolateral prefrontal cortex (dlPFC) reactivity to sad facial expressions was positively associated with depression symptom load, yet negatively associated with anxiety symptom load in the entire sample. On the network level depression symptom load was positively associated with functional connectivity between the bilateral amygdala and a widespread network including the anterior cingulate and insular cortex. Together, these findings suggest that the dlPFC - engaged in cognitive and emotional processing - exhibits symptom- and emotion-specific alteration during interpersonal processing. Dysregulated communication between the amygdala and core regions of the salience network may represent depression-specific neural dysregulations.

Pupillary motility responses to affectively salient stimuli in individuals with depression or elevated risk of depression: A systematic review and meta-analysis

Elaborative affective processing is observed in depression, and pupillary reactivity, a continuous, sensitive, and reliable indicator of physiological arousal and neurocognitive processing, is increasingly utilized in studies of depression-related characteristics. As a first attempt to quantitively summarize existing evidence on depression-related pupillary reactivity alterations, this review and meta-analysis evaluated the direction, magnitude, and specificity of pupillary indices of affective processing towards positively, negatively, and neutrally-valenced stimuli among individuals diagnosed with depression or with elevated risk of depression. Studies on pupillary responses to affective stimuli in the target groups were identified in PsycINFO and PubMed databases. Twenty-two articles met inclusion criteria for the qualitative review and 16 for the quantitative review. Three-level frequentist and Bayesian models were applied to summarize pooled effects from baseline-controlled stimuli-induced average changes in pupillary responses. In general, compared to non-depressed individuals, individuals with depression or elevated risk of depression exhibited higher pupillary reactivity (d =0.15) towards negatively-valenced stimuli during affective processing. Pupillary motility towards negatively-valenced stimuli may be a promising trait-like marker for depression vulnerability.

Reduced eye gaze during facial emotion recognition in chronic depression: Effects of intranasal oxytocin

Chronic depression disorders (CDD) are characterized by impaired social cognitive functioning. Visual attention during social perception is altered in clinical depression and is known to be sensitive to intranasal treatment with oxytocin (OT). The present study thus investigated potential alterations in gaze preferences during a standardized facial emotion recognition (FER) task using remote eye tracking in patients with CDD and the effect of a single dose of intranasal OT (compared to placebo). In emotion recognition, CDD patients were not more impaired than healthy controls, and there was no OT effect. However, CDD patients (with placebo) demonstrated less attentional preference for the eye region during FER than healthy controls, which was not apparent in the CDD group after OT treatment. Our results suggest that despite largely preserved basic facial emotions recognition, attention in social perception may be altered in CDD, and that this bias may be sensitive to OT treatment. These findings highlight OTs potential as a means of augmenting psychotherapy.

Differential effects of faces and words in cognitive control in older adults with and without major depressive disorder: An emotional Stroop task study

Aging and major depressive disorders have been associated with impaired cognitive control. These deficits are also influenced by the affective valence and by the type of stimulus processed. Using an emotional Stroop task, the current study aims to examine cognitive control deficits and their association with emotion regulation in depression and the influence of the type of stimulus (words and faces) in this association. A total of 26 older patients with a major depressive disorder (MDD) (19 women; age range: 65-84 years) and 26 older healthy controls (18 women; age range: 65-80 years) participated in the study. The results showed that MDD individuals presented greater Stroop effects than their healthy controls and an absence of the conflict adaptation effect defined as a reduction of the influence of irrelevant stimulus dimensions after incongruent trials. Additionally, our results also showed that the processing of emotional words in depressed participants is more automatic than the processing of emotional faces. These findings suggest that older depressed individuals have greater difficulty in recognizing affective facial expressions than older healthy controls, while the over-learned behavior of word reading greatly reduces differences in the performance of the emotional Stroop task between groups (MDD and healthy controls).

Sleep and Healthy Aging Research on Depression (SHARE-D) randomized controlled trial: Protocol overview of an experimental model of depression with insomnia, inflammation, and affect mechanisms in older adults

Depression, one of the most common diseases in older adults, carries significant risk for morbidity and mortality. Because of the burgeoning population of older adults, the enormous burden of late-life depression, and the limited efficacy of current antidepressants in older adults, biologically plausible models that translate into selective depression prevention strategies are needed. Insomnia predicts depression recurrence and is a modifiable target to prevent incident and recurrent depression in older adults. Yet, it is not known how insomnia gets converted into biological- and affective risk for depression, which is critical for identification of molecular targets for pharmacologic interventions, and for refinement of insomnia treatments that target affective responding to improve efficacy. Sleep disturbance activates inflammatory signaling and primes immune responses to subsequent inflammatory challenge. In turn, inflammatory challenge induces depressive symptoms, which correlate with activation of brain regions implicated in depression. This study hypothesizes that insomnia serves as a vulnerability factor for inflammation-related depression; older adults with insomnia will show heightened inflammatory- and affective responding to inflammatory challenge as compared to those without insomnia. To test this hypothesis, this protocol paper describes a placebo-controlled, randomized, double-blind study of low dose endotoxin in older adults (n = 160; 60-80 y) with insomnia vs. comparison controls without insomnia. The aims of this study are to examine differences in depressive symptoms, measures of negative affective responding, and measures of positive affective responding as a function of insomnia and inflammatory challenge. If the hypotheses are confirmed, older adults with two "hits", insomnia and inflammatory activation, would represent a high risk group to be prioritized for monitoring and for depression prevention efforts using treatments that target insomnia or inflammation. Moreover, this study will inform the development of mechanism-based treatments that target affect responses in addition to sleep behaviors, and which might also be coupled with efforts to reduce inflammation to optimize efficacy of depression prevention.

Recognition of Facial Emotion Expressions in Patients with Depressive Disorders: A Functional MRI Study

BACKGROUND

The present study evaluated the cortical activation during emotional information recognition.

METHODS

The study group included 16 patients with depression, and 16 healthy subjects were enrolled as a control group. Patients received eight weeks of antidepressant therapy. Functional MRI evaluated the cortical activation twice in the patient group and once in the control group. The fMRI task processed the emotional information with face demonstration from the PennCNP test battery.

RESULTS

During the processing of emotional information, patients showed activation in the middle and the inferior frontal gyri, the fusiform gyrus, and the occipital cortex. After treatment, patients showed a significant decrease in the frontal cortex activation for negative face demonstration and no frontal activation for positive emotion recognition. The left superior temporal gyrus activation zone appeared in patients after treatment and in the control group. Healthy subjects showed more intense frontal cortex activation when processing neutral emotions and less when showing happy and sad faces. Activation zones in the amygdala and the insula and deactivation zones in the posterior cingulate cortex were revealed in the controls.

CONCLUSION

This study confirms the hypothesis that anomalies in the processing of emotional stimuli can be a sign of a depressive disorder.

Behavioural approach-avoidance tendencies among individuals with elevated blood pressure

Emotional dampening (blunted responses to affective stimuli or experiences) has been reported in individuals with clinical and subclinical levels of elevated blood pressure (BP). Our aim in the present study was to explore how the basic motivational systems of approach and avoidance to positively- and negatively-valenced stimuli are affected in elevated BP. High BP (n = 27) and Low BP (n = 29) participants completed an approach-avoidance task. In this task, participants pulled the joystick towards them when viewing a happy face (approach) and pushing it away when viewing an angry face (avoid) in the congruent condition, and reversed these action-to-emotion pairings in the incongruent condition. A mixed-design ANOVA revealed a significant main effect of condition, such that overall participants were faster across trials in the congruent than trials of the incongruent condition. There was also an emotion x BP interaction. Among the Low BP group, there were no RT differences to happy and angry expressions (across congruent and incongruent conditions) but those with High BP were quicker to respond to actions paired with angry than happy facial expressions (across conditions). Findings suggest that valence-specific motivational reactions are not dampened with an increase in BP, and are rather sensitized for the negative emotion of anger.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04337-2.

Emotional bias training as a treatment for anxiety and depression: evidence from experimental medicine studies in healthy and medicated samples

BACKGROUND

Anxiety and depression are leading causes of disability worldwide, yet individuals are often unable to access appropriate treatment. There is a need to develop effective interventions that can be delivered remotely. Previous research has suggested that emotional processing biases are a potential target for intervention, and these may be altered through brief training programs.

METHODS

We report two experimental medicine studies of emotional bias training in two samples: individuals from the general population (n = 522) and individuals currently taking antidepressants to treat anxiety or depression (n = 212). Participants, recruited online, completed four sessions of EBT from their own home. Mental health and cognitive functioning outcomes were assessed at baseline, immediately post-training, and at 2-week follow-up.

RESULTS

In both studies, our intervention successfully trained participants to perceive ambiguous social information more positively. This persisted at a 2-week follow-up. There was no clear evidence that this change in emotional processing transferred to improvements in symptoms in the primary analyses. However, in both studies, there was weak evidence for improved quality of life following EBT amongst individuals with more depressive symptoms at baseline. No clear evidence of transfer effects was observed for self-reported daily stress, anhedonia or depressive symptoms. Exploratory analyses suggested that younger participants reported greater treatment gains.

CONCLUSIONS

These studies demonstrate the effectiveness of delivering a multi-session online training program to promote lasting cognitive changes. Given the inconsistent evidence for transfer effects, EBT requires further development before it can be considered as a treatment for anxiety and depression.

Facial expression-based indicators of schizophrenia: Evidence from recent research

Impaired ability to recognize emotion in other's face (decoding) or to express emotion through the face (encoding) are considered critical in schizophrenia. The topic of research draws considerable attention since clinicians rely heavily on the patient's facial expressions for diagnosis and on the patient's ability to understand the clinician's communicative intent. While most researchers argue in favor of a generalized emotion deficit, others indicate an emotion-specific deficit in schizophrenia. An early review (Mandal et al., 1998) indicated a possible breakdown in perception-expression-experience link of emotion; later reviews (Kohler et al., 2010; Chan et al., 2010) pointed to a generalized emotion processing deficit due to perceptual deficits in schizophrenia. The present review (2010-2022) revisits this controversy with 47 published studies (37 decoding, 10 encoding) conducted on 2364 patients in 20 countries. Schizophrenia is characterized by reduced emotion processing ability, especially with negative symptoms and at an acute state of illness. It is however still unclear whether this dysfunction is independent of a generalized face perception deficit or of subjective experience of emotion in schizophrenia.

Role of serotonin in modulation of decision-making in Parkinson's disease

BACKGROUND

Dysfunction of dopaminergic pathways has been considered to play a pivotal role in Parkinson's disease (PD), affecting the processing of emotional and rewarding information, and potentially leading to symptoms of depression or apathy. However, some aspects of motivation in PD might be affected by non-dopaminergic mechanisms.

AIM AND METHOD

The objective of this experimental medicine study was to investigate the contribution of serotonergic modulation via administration of citalopram (20 mg) for 7 days on motivated decision-making in twenty PD patients, measured using several different computerised tasks and clinical questionnaires that probe different aspects of decision-making. Twenty healthy controls were additionally tested without medication to assess any baseline differences between the two groups.

RESULTS

Results indicated that PD patients were overall less motivated than controls on an effort- and reward-based decision-making task. Citalopram increased or decreased willingness to exert effort for reward, depending on whether baseline motivation was high or low, respectively. A task assessing decision-making under risk revealed higher levels of risk aversion for potential losses in PD patients, which neither serotonin nor the patient's regular dopaminergic medication seemed to restore. However, citalopram in PD was associated with more risk-seeking choices for gains, although patients and controls did not differ on this at baseline.

CONCLUSION

The results provide evidence for a role of the serotonergic system in influencing some aspects of motivated decision-making in PD processes.

FMRI study of implicit emotional face processing in patients with MDD with melancholic subtype

Introduction

The accurate perception of facial expressions plays a vital role in daily life, allowing us to select appropriate responses in social situations. Understanding the neuronal basis of altered emotional face processing in patients with major depressive disorder (MDD) may lead to the appropriate choice of individual interventions to help patients maintain social functioning during depressive episodes. Inconsistencies in neuroimaging studies of emotional face processing are caused by heterogeneity in neurovegetative symptoms of depressive subtypes. The aim of this study was to investigate brain activation differences during implicit perception of faces with negative and positive emotions between healthy participants and patients with melancholic subtype of MDD. The neurobiological correlates of sex differences of MDD patients were also examined.

Methods

Thirty patients diagnosed with MDD and 21 healthy volunteers were studied using fMRI while performing an emotional face perception task.

Results

Comparing general face activation irrespective of emotional content, the intensity of BOLD signal was significantly decreased in the left thalamus, right supramarginal gyrus, right and left superior frontal gyrus, right middle frontal gyrus, and left fusiform gyrus in patients with melancholic depression compared to healthy participants. We observed only limited mood-congruence in response to faces of differing emotional valence. Brain activation in the middle temporal gyrus was significantly increased in response to fearful faces in comparison to happy faces in MDD patients. Elevated activation was observed in the right cingulate for happy and fearful faces, in precuneus for happy faces, and left posterior cingulate cortex for all faces in depressed women compared to men. The Inventory for Depressive Symptomatology (IDS) score was inversely correlated with activation in the left subgenual gyrus/left rectal gyrus for sad, neutral, and fearful faces in women in the MDD group. Patients with melancholic features performed similarly to controls during implicit emotional processing but showed reduced activation.

Discussion and conclusion

This finding suggests that melancholic patients compensate for reduced brain activation when interpreting emotional content in order to perform similarly to controls. Overall, frontal hypoactivation in response to implicit emotional stimuli appeared to be the most robust feature of melancholic depression.

Psychopathic personality traits stress immunity and social potency moderate the relationship between emotional competence and cognitive functions in depression

Background

Psychopathic personality traits (PPT) and depression have both been shown to worsen emotional and cognitive functions. Moreover, PPT and depression share similar underlying neuronal circuits tapping into the emotional and cognitive domains. However, little is known about the influence of PPT on emotion and cognition in individuals with depression.

Objectives

This study aimed to examine the correlative relationships and moderating role of PPT in the association between emotional competence and cognitive functions in individuals with depression.

Methods

Data from 373 individuals diagnosed with depression (158 males, 215 females) were examined within a cohort study. Subjects filled out validated questionnaires surveying PPT and emotional competences. Furthermore, a comprehensive neuropsychological test battery was administered.

Results

Correlation analyses revealed a significant positive association between emotional competence and cognitive functions. Further, negative associations between emotional competence and the PPT "Blame Externalisation" and "Careless Nonplanfulness," as well as positive associations with psychopathic "Social Potency" and "Stress Immunity" were found. Moderation analyses indicated a significant positive influence of psychopathic "Stress Immunity" and "Social Influence" on the relationship between emotional competence and cognitive functions.

Conclusion

The findings highlight the importance of integrating PPT in depression research. Considering PPT in depression treatment could also facilitate the therapeutic process by identifying individual traits as resilience-strengthening or potentially harmful factors for depressive symptomatology. This study represents a stepping stone for further research regarding the role of personality traits in psychiatric disorders and their treatment.

Lack of speeded disengagement from facial expressions of disgust in remitted major depressive disorder: Evidence from an eye-movement study

Acute major depression is characterized by specific abnormalities in the way emotional material is attended to. In late stages of stimulus processing, clinically depressed and dysphoric individuals show difficulties to disengage attention from emotionally negative material. It is unclear, however, whether aberrant disengagement is a transitory attentional phenomenon tied to depressive symptoms, or whether it constitutes a more stable disposition that outlast the symptomatic episode. To address this issue, the current study examined 39 currently euthymic individuals previously affected by major depression (RMD) and 40 healthy control participants reporting no lifetime psychopathology (ND). We used a gaze-contingent eye tracking paradigm designed to separately assess the attentional components of engagement and disengagement when viewing facial expressions of sadness, disgust and happiness. Never-depressed healthy participants, but not remitted euthymic individuals, showed speeded disengagement from facial expressions of disgust. We propose that the lack of this distinct acceleration in previously depressed but fully remitted individuals might reflect an attentional disposition that carries over to euthymic phases of the disease. On the other hand, a tendency to disengage quickly from areas in the visual field that convey social disdain could potentially act as a protective, possibly mood-stabilizing bias in resilient individuals.

Longitudinal Pathways from Parent Internalizing Symptoms to Parent and Youth Emotion Functioning

The current study utilized mediation analyses to examine how parental symptoms of depression and anxiety impact child emotion regulation (ER) and emotion stability (ES) through parent emotion functioning, parenting, and the coparent relationship. 564 parents of children between 3 and 17 years (Mage = 9.47; 54.4% male) were recruited via Amazon's Mechanical Turk across three time points: baseline (Wave 1), 4 months (Wave 2), 8 months (Wave 3). Mediation results demonstrated that symptoms of parent depression at Wave 1 predicted worse coparent relationships and decreases in parents' ability to identify their own emotions at Wave 2. Symptoms of parental anxiety at Wave 1 predicted decreases in positive parenting and an increased tendency to have negative secondary emotional responses, impulse-control difficulties, and difficulty accessing emotion-regulation strategies at Wave 2. Additionally, symptoms of parental anxiety at Wave 1 directly predicted lower child ER and ES at Wave 3. However, no significant indirect pathways were identified between parent symptoms and child ER and ES. Sensitivity analyses examined the effects of three youth developmental stages (i.e., early and middle childhood and adolescence), as well as parent gender (i.e., mother and father), and found no significant differences across groups. Thus, even at non-clinical levels, parental symptoms of anxiety and depression may negatively impact parenting, parent regulation, and the coparent relationship, while parental anxiety symptoms may contribute to lower child ER and ES.

Altered recognition of fearful and angry facial expressions in women with fibromyalgia syndrome: an experimental case-control study

Evidence relative to facial emotion recognition and the role played by alexithymia in fibromyalgia syndrome is rare and heterogeneous. In this work, we investigated this ability in fibromyalgia investigating the implicit behaviour in the facial emotion recognition task, focusing on fear and anger. Twenty women with fibromyalgia and twenty healthy women as controls performed a facial emotion recognition of fearful and angry expressions. Their implicit behaviour was scored in accordance with the redundant target effect. The level of alexithymic traits through a standard psychological questionnaire and its effect on behavioral performance were also assessed. Participants affected by fibromyalgia reported a lower level of accuracy in recognizing fearful and angry expressions, in comparison with the controls. Crucially, such a difference was not explained by the different levels of alexithymic traits between groups. Our results agreed with some previous evidence suggesting an altered recognition of others' emotional facial expressions in fibromyalgia syndrome. Considering the role of emotion recognition on social cognition and psychological well-being in fibromyalgia, we underlined the crucial role of emotional difficulties in the onset and maintenance of the symptoms life-span.

Threat induction biases processing of emotional expressions

Threats can derive from our physical or social surroundings and bias the way we perceive and interpret a given situation. They can be signaled by peers through facial expressions, as expressed anger or fear can represent the source of perceived threat. The current study seeks to investigate enhanced attentional state and defensive reflexes associated with contextual threat induced through aversive sounds presented in an emotion recognition paradigm. In a sample of 120 healthy participants, response and gaze behavior revealed differences in perceiving emotional facial expressions between threat and safety conditions: Responses were slower under threat and less accurate. Happy and neutral facial expressions were classified correctly more often in a safety context and misclassified more often as fearful under threat. This unidirectional misclassification suggests that threat applies a negative filter to the perception of neutral and positive information. Eye movements were initiated later under threat, but fixation changes were more frequent and dwell times shorter compared to a safety context. These findings demonstrate that such experimental paradigms are capable of providing insight into how context alters emotion processing at cognitive, physiological, and behavioral levels. Such alterations may derive from evolutionary adaptations necessary for biasing cognitive processing to survive disadvantageous situations. This perspective sets up new testable hypotheses regarding how such levels of explanation may be dysfunctional in patient populations.

A Scoping Review on the Effects of Emotional Stimuli on Language Processing in People With Aphasia

PURPOSE

Emotional stimuli have been shown to influence language processing (both language comprehension and production) in people with aphasia (PWA); however, this finding is not universally reported. Effects of emotional stimuli on language performance in PWA could have clinical and theoretical implications, yet the sparsity of studies and variability among them make it difficult to appraise the significance of this effect. The purpose of this scoping review was to (a) determine the extent and range of research examining the effect of emotional stimuli on language processing in PWA, (b) summarize and evaluate research findings, and (c) identify gaps in the literature that may warrant future study.

METHOD

PsycINFO, PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched for articles that compared performance in response to emotional and nonemotional stimuli on at least one language measure in one or more adults with aphasia. Data related to methods and results were extracted from each article and charted in Excel.

RESULTS

Five hundred forty unique articles were found, and 18 articles, consisting of 19 studies, met inclusion/exclusion criteria for this review. Of the 19 studies included, 11 studies reported enhanced performance on a language task for emotional compared to nonemotional stimuli, seven reported no difference, and one reported worse performance for emotional compared to nonemotional stimuli. Possible modulating variables such as task type, measurement, stimulus characteristics, and sample characteristics are discussed along with gaps in the literature.

CONCLUSION

The extent of research in this area is sparse; however, there does appear to be some early evidence for better performance in response to emotional over nonemotional stimuli in PWA for some, but not all, language processes investigated.