Emotional Prosody Processing in Schizophrenic Patients: A Selective Review and Meta-Analysis

Relationships Between Immune-Inflammatory Features and Social Cognitive Impairments in Patients With Schizophrenia Spectrum Disorders: A Systematic Review

INTRODUCTION

Patients with schizophrenia spectrum disorders (SSD), particularly patients with schizophrenia, have social cognitive impairments characterized by difficulties in emotion recognition, the ability to attribute mental states, explaining the causes of events, and identifying and utilizing social cues. These impairments appear from early life and are associated with poor functional and social prognosis. The origin of these impairments is not fully understood. The inflammatory hypothesis is one of the pathophysiological hypotheses of schizophrenia. Inflammatory marker abnormalities are also present in the early stages of schizophrenia and are associated with neuronal degeneration. Following our main hypothesis, the aim of this work was to conduct a review to explore the relationship between social cognition and inflammatory markers in SSD.

METHODS

The review included original studies reporting measures of social cognition and plasma levels of inflammatory markers in patients with SSD using the Pubmed, PsycINFO, and Embase databases. The PRISMA methodology was followed.

RESULTS

Eleven studies were selected and analyzed. They showed significant correlations between plasma cytokine levels and theory of mind and facial emotion recognition abilities.

CONCLUSION

The correlations do not seem to be specific to social cognitive impairments, but our results support the hypothesis of a link between pro- and anti-inflammatory markers and cognition in SSD. In the future, other studies should be conducted to clarify this link from a diagnostic and therapeutic perspective: identification of inflammatory trait factors and patient subgroups and personalized anti-inflammatory therapies.

Can artificial intelligence be the future solution to the enormous challenges and suffering caused by Schizophrenia?

This study evaluated the potential of artificial intelligence (AI) in the diagnosis, treatment, and prognostic assessment of schizophrenia (SZ) and explored collaborative directions for AI applications in future medical innovations. SZ is a severe mental disorder that causes significant suffering and imposes challenges on patients. With the rapid advancement of machine learning and deep learning technologies, AI has demonstrated notable advantages in the early diagnosis of high-risk populations. By integrating multidimensional biomarkers and linguistic behavior data of patients, AI can provide further objective and precise diagnostic criteria. Moreover, it aids in formulating personalized treatment plans, enhancing therapeutic outcomes, and offering new therapeutic strategies for patients with treatment-resistant SZ. Furthermore, AI excels in developing individualized prognostic plans, which enables the rapid identification of disease progression, accurate prediction of disease trajectory, and timely adjustment of treatment strategies, thereby improving prognosis and facilitating recovery. Despite the immense potential of AI in SZ management, its role as an auxiliary tool must be emphasized, with clinical judgment and compassionate care from healthcare professionals remaining crucial. Future research should focus on optimizing human-machine interactions to achieve efficient AI application in SZ management. The in-depth integration of AI technology into clinical practice will advance the field of SZ, ultimately improving the quality of life and treatment outcomes of patients.

The Mandarin Chinese auditory emotions stimulus database: A validated corpus of monosyllabic Chinese characters

Auditory emotional rhythm can be transmitted by simple syllables. This study aimed to establish and validate an auditory speech dataset containing Mandarin Chinese auditory emotional monosyllables (MCAE-Monosyllable), a resource that has not been previously available. A total of 422 Chinese monosyllables were recorded by six professional Mandarin actors, each expressing seven emotions: neutral, happy, angry, sad, fearful, disgusted, and surprised. Additionally, each neutral voice was recorded in four Chinese tones. After standardization and energy balance, the recordings were evaluated by 720 Chinese college students for emotional categories (forced to choose one out of seven emotions) and emotional intensity (rated on a scale of 1-9). The final dataset consists of 18,089 valid Chinese monosyllabic pronunciations (neutrality: 9425, sadness: 2453, anger: 2024; surprise: 1699, disgust: 1624, happiness: 590, fear: 274). On average, neutrality had the highest accuracy rate (79%), followed by anger (75%) and sadness (75%), surprise (74%), happiness (73%), disgust (72%), and finally fear (67%). We provided detailed validation results, acoustic information, and perceptual intensity rating values for each sound. The MCAE-Monosyllable database serves as a valuable resource for neural decoding of Chinese emotional speech, cross-cultural language research, and behavioral or clinical studies related to language and emotional disorders. The database can be obtained within the Open Science Framework ( https://osf.io/h3uem/?view_only=047dfd08dbb64ad0882410da340aa271 ).

Validation of behavioral measures of social cognition in individuals diagnosed with schizophrenia

Schizophrenia, a complex neuropsychiatric disorder, manifests severe impairments in social cognition, notably in Theory of Mind (ToM), empathy, and emotion recognition, which significantly influence social competence and overall functioning. These aspects are crucial for prognosis in individuals diagnosed with schizophrenia (SZ). This study validates a comics strip paradigm for ToM and empathy assessment, the Montreal Affective Voices (MAV) for measuring emotion recognition, and a Go-NoGo task for inhibition control estimation in individuals diagnosed with SZ, comparing their performance with healthy controls. SZ participants exhibited diminished abilities in the comics strip task, especially in ToM and empathy conditions, alongside challenges in identifying emotions from vocal cues in MAV. They responded slower and tended to be less accurate in the Go-NoGo task. The validated behavioral battery addresses the limitations of previous measures and emerges as a promising tool for future investigations into the neural systems underlying social cognition in schizophrenia. Such insights can lead to the development of long-needed treatment for negative symptoms and social dysfunctions in schizophrenia.

Pragmatic features in patients with schizophrenia

Schizophrenia is a heterogeneous disorder. Despite the fact that communication and language skills may be impaired in schizophrenia, only a few studies have examined specific aspects of pragmatic competence in these patients. Therefore, this study aimed to compare the pragmatic skills of schizophrenic patients and a control group. Forty-three schizophrenic patients with a Mean ± SD age of 40 ± 1.21 years old and a control group were assessed using the Adult Pragmatics Profile (APP), which is a validated tool consisting of three scales: verbal, nonverbal and paralinguistic. The participants in the schizophrenia group demonstrated significant impairments in pragmatic abilities compared to the participants in those the control group. The most remarkable difference was in the nonverbal scale (5.00 ± 1.09), while the lowest difference was seen in the verbal scale (18.30 ± 3.91). Within the nonverbal subscales, eye contact was the most impaired. Schizophrenic patients presented with impairments in their pragmatic skills (verbal, nonverbal and paralinguistic). As pragmatic skills play a paramount role in social communication, it is of great significance to address these impairments to enhance patients' quality of life.

Vocal emotion perception in schizophrenia and its diagnostic significance

BACKGROUND

Cognitive and emotional impairment are among the core features of schizophrenia; assessment of vocal emotion recognition may facilitate the detection of schizophrenia. We explored the differences between cognitive and social aspects of emotion using vocal emotion recognition and detailed clinical characterization.

METHODS

Clinical symptoms and social and cognitive functioning were assessed by trained clinical psychiatrists. A vocal emotion perception test, including an assessment of emotion recognition and emotional intensity, was conducted. One-hundred-six patients with schizophrenia (SCZ) and 230 healthy controls (HCs) were recruited.

RESULTS

Considering emotion recognition, scores for all emotion categories were significantly lower in SCZ compared to HC. Considering emotional intensity, scores for anger, calmness, sadness, and surprise were significantly lower in the SCZs. Vocal recognition patterns showed a trend of unification and simplification in SCZs. A direct correlation was confirmed between vocal recognition impairment and cognition. In diagnostic tests, only the total score of vocal emotion recognition was a reliable index for the presence of schizophrenia.

CONCLUSIONS

This study shows that patients with schizophrenia are characterized by impaired vocal emotion perception. Furthermore, explicit and implicit vocal emotion perception processing in individuals with schizophrenia are viewed as distinct entities. This study provides a voice recognition tool to facilitate and improve the diagnosis of schizophrenia.

Syntactic and affective prosody recognition: Schizophrenia vs. Autism spectrum disorders

Patients with a recent diagnosis of schizophrenia and individuals receiving a diagnosis of autism spectrum disorder without accompanying intellectual impairment (ASD w/o intellectual impairment) during their adulthood share several clinical characteristics. Exploring under-investigated aspects of these two clinical conditions may shed light on their possible connection and facilitate differential diagnosis at very early stages. To this end, we explored the ability of 15 adults with a recent diagnosis of schizophrenia, 15 individuals diagnosed with ASD w/o intellectual impairment as adults, and 15 healthy adults to resolve sentence ambiguities with the use of syntactic prosody, and to decode happiness, anger, sadness, surprise, fear, and neutrality based on affective prosody. Results revealed intact perception of syntactic prosody in adults with schizophrenia, but impaired affective prosody recognition, which could be attributed, however, to emotion processing difficulties overall. On the other hand, individuals with ASD w/o intellectual impairment were impaired on prosody comprehension per se, as evidenced in the most challenging conditions, namely the subject-reading condition and the emotion of surprise. The differences in prosody comprehension ability between the two clinical conditions may serve as an indicator, among other signs, during the diagnostic evaluation.

Impaired emotion perception in schizophrenia shows sex differences with channel- and category-specific effects: A pilot study

Individuals with schizophrenia reportedly demonstrate deficits in emotion perception. Relevant studies on the effects of decoder's sex, communication channels and emotion categories have produced mixed findings and seldom explored the interactions among these three key factors. The present pilot study examined how male and female individuals with schizophrenia and healthy controls perceived emotional (e.g., angry, happy, and sad) and neutral expressions from verbal semantic and nonverbal prosodic and facial channels. Twenty-eight (11 females) individuals with schizophrenia and 30 healthy controls (13 females) were asked to recognize emotional facial expressions, emotional prosody, and emotional semantics. Both accuracy and response time showed subpar performance for all communication channels and emotional categories in the schizophrenia group. More severe emotion perception deficits were found with the nonverbal (not the verbal) materials. There was also a reduced level of impairment with anger perception, especially in the female individuals with schizophrenia while biased perception towards emotional semantics was more pronounced in male individuals with schizophrenia. These findings, although preliminary, indicate the channel- and category-specific nature of emotion perception with potential sex differences among people with schizophrenia, which has important theoretical and practical implications.

The Mandarin Chinese auditory emotions stimulus database: A validated set of Chinese pseudo-sentences

Emotional prosody is fully embedded in language and can be influenced by the linguistic properties of a specific language. Considering the limitations of existing Chinese auditory stimulus database studies, we developed and validated an emotional auditory stimuli database composed of Chinese pseudo-sentences, recorded by six professional actors in Mandarin Chinese. Emotional expressions included happiness, sadness, anger, fear, disgust, pleasant surprise, and neutrality. All emotional categories were vocalized into two types of sentence patterns, declarative and interrogative. In addition, all emotional pseudo-sentences, except for neutral, were vocalized at two levels of emotional intensity: normal and strong. Each recording was validated with 40 native Chinese listeners in terms of the recognition accuracy of the intended emotion portrayal; finally, 4361 pseudo-sentence stimuli were included in the database. Validation of the database using a forced-choice recognition paradigm revealed high rates of emotional recognition accuracy. The detailed acoustic attributes of vocalization were provided and connected to the emotion recognition rates. This corpus could be a valuable resource for researchers and clinicians to explore the behavioral and neural mechanisms underlying emotion processing of the general population and emotional disturbances in neurological, psychiatric, and developmental disorders. The Mandarin Chinese auditory emotion stimulus database is available at the Open Science Framework ( https://osf.io/sfbm6/?view_only=e22a521e2a7d44c6b3343e11b88f39e3 ).

Neurocognitive Dynamics of Prosodic Salience over Semantics during Explicit and Implicit Processing of Basic Emotions in Spoken Words

How language mediates emotional perception and experience is poorly understood. The present event-related potential (ERP) study examined the explicit and implicit processing of emotional speech to differentiate the relative influences of communication channel, emotion category and task type in the prosodic salience effect. Thirty participants (15 women) were presented with spoken words denoting happiness, sadness and neutrality in either the prosodic or semantic channel. They were asked to judge the emotional content (explicit task) and speakers' gender (implicit task) of the stimuli. Results indicated that emotional prosody (relative to semantics) triggered larger N100, P200 and N400 amplitudes with greater delta, theta and alpha inter-trial phase coherence (ITPC) and event-related spectral perturbation (ERSP) values in the corresponding early time windows, and continued to produce larger LPC amplitudes and faster responses during late stages of higher-order cognitive processing. The relative salience of prosodic and semantics was modulated by emotion and task, though such modulatory effects varied across different processing stages. The prosodic salience effect was reduced for sadness processing and in the implicit task during early auditory processing and decision-making but reduced for happiness processing in the explicit task during conscious emotion processing. Additionally, across-trial synchronization of delta, theta and alpha bands predicted the ERP components with higher ITPC and ERSP values significantly associated with stronger N100, P200, N400 and LPC enhancement. These findings reveal the neurocognitive dynamics of emotional speech processing with prosodic salience tied to stage-dependent emotion- and task-specific effects, which can reveal insights into understanding language and emotion processing from cross-linguistic/cultural and clinical perspectives.

Recognition of affective prosody in bipolar and depressive conditions: A systematic review and meta-analysis

BACKGROUND

Inconsistent results have been reported about the affective prosody recognition (APR) ability in patients with bipolar (BD) and depressive (DD) disorders. We aimed to (i) evaluate the magnitude of APR dysfunction in BD and DD patients, (ii) identify moderators for heterogeneous results, and (iii) highlight research trends in this field.

METHODS

A computerized literature search was conducted in five electronic databases from the inception to May 9th, 2022 to identify behavioural experiments that studied APR in BD or DD patients. Effect sizes were calculated using a random-effect model and recalculated after removing outliers and adjusting publication bias.

RESULTS

Twelve eligible articles totalling 16 studies were included in the meta-analysis, aggregating 612 patients and 809 healthy controls. Individual r² ranged from 0.008 to 0.355, six of which reached a medium-to-large association strength. A medium-to-large pooled effect size (Hedges g = -0.58, 95 % CI -0.75 to -0.40, p < 0.001) for overall APR impairment in BD and DD patients was obtained. The Beck Depression Inventory score and answer option number were significant moderators. Neuropsychological mechanisms, multi-modal interaction and comorbidity effects have become primary research concerns.

LIMITATIONS

Extant statistics were insufficient for disorder-specific analysis.

CONCLUSIONS

Current findings demonstrate deficits of overall APR in BD and DD patients at a medium-to-large magnitude. APR can clinically serve for early screening and prognosis, but the depression severity, task complexity and confounding variables influence patients' APR performance. Future studies should incorporate neuroimaging approaches and investigate the effects of tonal language stimuli and clinical interventions.

Emotion recognition through Spanish prosody in people with schizophrenia

People with schizophrenia have deficits in the ability to identify emotions. An area of important dysfunction is the understanding of affective prosody, which can limit communication and social functionality. The objective of this study is to compare emotional recognition through prosody between a group of people with schizophrenia versus a control group without pathology, through the Reading the Mind in the Voice - Spanish Version scale (RMV-SV).

Voices 2: Improving Prosodic Recognition in Schizophrenia With an Online Rehabilitation Program

Introduction: Emotion recognition of voices may play an important role in interpersonal communication and patients with schizophrenia present alterations in this regard. Several on-line rehabilitation tools have been developed for treatment in this area. Voices is an on-line prosodic recognition program consisting of identifying different emotional tones in neutral phrases, in different sessions of gradually increasing difficulty. This training tool has previously reported benefits, and a new version has been created called Voices 2. The main aim of this study is to test the capacity of the Voices 2 program to improve emotion recognition through prosody for adults with schizophrenia. Secondly, it seeks to observe durability effects 1 month after intervention.

Method: A randomized, single-blind, multicenter clinical trial was conducted with 44 outpatients diagnosed with schizophrenia or schizoaffective disorder. The intervention group (also called Voices) was treated with Voices 2, whereas the control group was treated with auditory training that was not related to emotions. Sociodemographic and clinical data, clinical state (PANSS), Intelligence Quotient and prosodic recognition (RMV-SV) were measured at baseline. After intervention, RMV-SV and PANSS were assessed. One month later, the RMV-SV measure was repeated.

Results: The control group (n = 19) and the Voices group (n = 22) did not differ on χ², t or U tests in sociodemographic, clinical and psychometric variables at baseline or post-intervention (all p-values > 0.05). In the Voices group, statistically significant differences were observed in the RMV-SV scale applied post-intervention vs. that applied pre-intervention (Z = 2.47, p = 0.013). Similar results were observed in the 1-month follow-up RMV-SV vs. the pre-intervention RMV-SV (Z = 1.97, p = 0.049). PANSS scale was also assessed with no significant differences between pre vs. post measures in both groups. Lastly, Voices 2 was rated relatively higher, based on its ease of understanding, entertainment value, usefulness and the appropriateness of use of its emotional glossary.

Discussion: Improvements were observed in prosodic recognition following intervention with Voices 2 in the Voices group. Although these results are similar to other clinical trial rehabilitation programs, specific research on the matter remains scarce. Certain aspects, such as the durability of effects or adherence should be thoroughly studied and clarified.

Clinical Trial Registration: [https://doi.org/10.17605/OSF.IO/G95C4].

Processing of Spoken Emotions in Schizophrenia: Forensic and Non-forensic Patients Differ in Emotional Identification and Integration but Not in Selective Attention

Patients with schizophrenia (PwS) typically demonstrate deficits in visual processing of emotions. Less is known about auditory processing of spoken-emotions, as conveyed by the prosodic (tone) and semantics (words) channels. In a previous study, forensic PwS (who committed violent offenses) identified spoken-emotions and integrated the emotional information from both channels similarly to controls. However, their performance indicated larger failures of selective-attention, and lower discrimination between spoken-emotions, than controls. Given that forensic schizophrenia represents a special subgroup, the current study compared forensic and non-forensic PwS. Forty-five PwS listened to sentences conveying four basic emotions presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Their performance was compared to that of 21 forensic PwS (previous study). The two groups did not differ in selective-attention. However, better emotional identification and discrimination, as well as better channel integration were found for the forensic PwS. Results have several clinical implications: difficulties in spoken-emotions processing might not necessarily relate to schizophrenia; attentional deficits might not be a risk factor for aggression in schizophrenia; and forensic schizophrenia might have unique characteristics as related to spoken-emotions processing (motivation, stimulation).

Prosodic deficits and interpersonal difficulties in patients with schizophrenia

The present study examines the use of receptive emotional and linguistic prosody in patients with schizophrenia; particularly, its aim was to evaluate the type and number of errors made when comprehending the emotions and modes implied by meaningless utterances. Seventy-eight participants were enrolled to the study, i.e. two groups (patients with schizophrenia and healthy controls) consisting of 39 subjects. The severity of illness was evaluated with the Positive and Negative Syndrome Scale; comprehension of emotional and linguistic prosody was assessed by the subtests of the Polish Version of the Right Hemisphere Language Battery. Neither emotional nor linguistic prosody comprehension both correlated with schizophrenia symptoms. The study group experienced more difficulties in distinguishing between happiness and anger, and were more likely to misunderstand imperative utterances, confusing them with interrogative or affirmative ones. Such impairments are significant as they may affect the ability to form and sustain relationships with other people, achieve success in the work environment, and integrate in the community. They may also be a trait mark of the illness independent of psychotic symptoms. Further research is needed to translate this knowledge into meaningful and therapeutic interventions to improve quality of life, both for affected individuals and for their communication partners.

Unisensory and Multisensory Stroop Effects Modulate Gender Differences in Verbal and Nonverbal Emotion Perception

Purpose This study aimed to examine the Stroop effects of verbal and nonverbal cues and their relative impacts on gender differences in unisensory and multisensory emotion perception. Method Experiment 1 investigated how well 88 normal Chinese adults (43 women and 45 men) could identify emotions conveyed through face, prosody and semantics as three independent channels. Experiments 2 and 3 further explored gender differences during multisensory integration of emotion through a cross-channel (prosody-semantics) and a cross-modal (face-prosody-semantics) Stroop task, respectively, in which 78 participants (41 women and 37 men) were asked to selectively attend to one of the two or three communication channels. Results The integration of accuracy and reaction time data indicated that paralinguistic cues (i.e., face and prosody) of emotions were consistently more salient than linguistic ones (i.e., semantics) throughout the study. Additionally, women demonstrated advantages in processing all three types of emotional signals in the unisensory task, but only preserved their strengths in paralinguistic processing and showed greater Stroop effects of nonverbal cues on verbal ones during multisensory perception. Conclusions These findings demonstrate clear gender differences in verbal and nonverbal emotion perception that are modulated by sensory channels, which have important theoretical and practical implications. Supplemental Material https://doi.org/10.23641/asha.16435599.

Auditory emotion recognition deficits in schizophrenia: A systematic review and meta-analysis

BACKGROUND

Auditory emotion recognition (AER) deficits refer to the abnormal identification and interpretation of tonal or prosodic features that transmit emotional information in sounds or speech. Evidence suggests that AER deficits are related to the pathology of schizophrenia. However, the effect size of the deficit in specific emotional category recognition in schizophrenia and its association with psychotic symptoms have never been evaluated through a meta-analysis.

METHODS

A systematic search for literature published in English or Chinese until November 30, 2020 was conducted in PubMed, Embase, Web of Science, PsychINFO, and China National Knowledge Infrastructure (CNKI), WanFang and Weip Databases. AER differences between patients and healthy controls (HCs) were assessed by the standardized mean differences (SMDs). Subgroup analyses were conducted for the type of emotional stimuli and the diagnosis of schizophrenia or schizoaffective disorders (Sch/SchA). Meta-regression analyses were performed to assess the influence of patients' age, sex, illness duration, antipsychotic dose, positive and negative symptoms on the study SMDs.

RESULTS

Eighteen studies containing 615 psychosis (Sch/SchA) and 488 HCs were included in the meta-analysis. Patients exhibited moderate deficits in recognizing the neutral, happy, sad, angry, fear, disgust, and surprising emotion. Neither the semantic information in the auditory stimuli nor the diagnosis subtype affected AER deficits in schizophrenia. Sadness, anger, and disgust AER deficits were each positively associated with negative symptoms in schizophrenia.

CONCLUSIONS

Patients with schizophrenia have moderate AER deficits, which were associated with negative symptoms. Rehabilitation focusing on improving AER abilities may help improve negative symptoms and the long-term prognosis of schizophrenia.

Gender Differences in Identifying Facial, Prosodic, and Semantic Emotions Show Category- and Channel-Specific Effects Mediated by Encoder's Gender

Purpose The nature of gender differences in emotion processing has remained unclear due to the discrepancies in existing literature. This study examined the modulatory effects of emotion categories and communication channels on gender differences in verbal and nonverbal emotion perception. Method Eighty-eight participants (43 females and 45 males) were asked to identify three basic emotions (i.e., happiness, sadness, and anger) and neutrality encoded by female or male actors from verbal (i.e., semantic) or nonverbal (i.e., facial and prosodic) channels. Results While women showed an overall advantage in performance, their superiority was dependent on specific types of emotion and channel. Specifically, women outperformed men in regard to two basic emotions (happiness and sadness) in the nonverbal channels and only the anger category with verbal content. Conversely, men did better for the anger category in the nonverbal channels and for the other two emotions (happiness and sadness) in verbal content. There was an emotion- and channel-specific interaction effect between the two types of gender differences, with male subjects showing higher sensitivity to sad faces and prosody portrayed by the female encoders. Conclusion These findings reveal explicit emotion processing as a highly dynamic complex process with significant gender differences tied to specific emotion categories and communication channels. Supplemental Material https://doi.org/10.23641/asha.15032583.

Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience

The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.

Multimodal assessment of communicative-pragmatic features in schizophrenia: a machine learning approach

An impairment in pragmatic communication is a core feature of schizophrenia, often associated with difficulties in social interactions. The pragmatic deficits regard various pragmatic phenomena, e.g., direct and indirect communicative acts, deceit, irony, and include not only the use of language but also other expressive means such as non-verbal/extralinguistic modalities, e.g., gestures and body movements, and paralinguistic cues, e.g., prosody and tone of voice. The present paper focuses on the identification of those pragmatic features, i.e., communicative phenomena and expressive modalities, that more reliably discriminate between individuals with schizophrenia and healthy controls. We performed a multimodal assessment of communicative-pragmatic ability, and applied a machine learning approach, specifically a Decision Tree model, with the aim of identifying the pragmatic features that best separate the data into the two groups, i.e., individuals with schizophrenia and healthy controls, and represent their configuration. The results indicated good overall performance of the Decision Tree model, with mean Accuracy of 82%, Sensitivity of 76%, and Precision of 91%. Linguistic irony emerged as the most relevant pragmatic phenomenon in distinguishing between the two groups, followed by violation of the Gricean maxims, and then extralinguistic deceitful and sincere communicative acts. The results are discussed in light of the pragmatic theoretical literature, and their clinical relevance in terms of content and design of both assessment and rehabilitative training.

A bottom-up model of functional outcome in schizophrenia

Schizophrenia results in poor functional outcomes owing to numerous factors. This study provides the first test of a bottom-up causal model of functional outcome in schizophrenia, using neurocognition, vocal emotional cognition, alexithymia, and negative symptoms as predictors of functional outcome. We investigated a cross-sectional sample of 135 individuals with schizophrenia and 78 controls. Using a series of structural equation modelling analyses, a single pathway was generated among scores from the MATRICS Consensus Cognitive Battery (MCCB), vocal emotion recognition test, Toronto Alexithymia Scale (TAS), Brief Negative Symptom Scale, and the Personal and Social Performance Scale. The scores for each dimension of the MCCB in the schizophrenia group were significantly lower than that in the control group. The recognition accuracy for different emotions (anger, disgust, fear, sadness, surprise, and satire, but not calm was significantly lower in the schizophrenia group than in the control group. Moreover, the scores on the three dimensions of TAS were significantly higher in the schizophrenia group than in the control group. On path analysis modelling, the proposed bottom-up causal model showed a strong fit with the data and formed a single pathway, from neurocognition to vocal emotional cognition, to alexithymia, to negative symptoms, and to poor functional outcomes. The study results strongly support the proposed bottom-up causal model of functional outcome in schizophrenia. The model could be used to better understand the causal factors related to the functional outcome, as well as for the development of intervention strategies to improve functional outcomes in schizophrenia.

Recognition of affective prosody in autism spectrum conditions: A systematic review and meta-analysis

LAY ABSTRACT

Differences in understanding others' emotions and attitudes through features in speech (e.g. intonation) have been observed in individuals with autism spectrum conditions, which contribute greatly to their social communication challenges. However, some studies reported that individuals with autism spectrum condition performed comparably to typically developing individuals on affective prosody recognition. Here, we provide a comprehensive review with statistical analysis of 23 existing studies on this topic to examine potential factors that could explain the discrepancies. Compared with typically developing individuals, autism spectrum condition participants generally appeared to encounter more difficulties in affective prosody recognition. But this finding was likely due to the tendency of the existing research to overly focus on deficits in autism. The affective prosody recognition performance in individuals with autism spectrum condition was closely related to the number of answer options offered to them. Moreover, the degree of difficulty in affective prosody recognition encountered by individuals with autism spectrum condition varied across emotions. The findings of this systematic review highlighted the need for further research on affective prosody recognition in autism (e.g. studies that include tonal language speakers and autism spectrum condition individuals with lower cognitive or verbal abilities).

Language Dysfunction in Schizophrenia: Assessing Neural Tracking to Characterize the Underlying Disorder(s)?

Deficits in language production and comprehension are characteristic of schizophrenia. To date, it remains unclear whether these deficits arise from dysfunctional linguistic knowledge, or dysfunctional predictions derived from the linguistic context. Alternatively, the deficits could be a result of dysfunctional neural tracking of auditory information resulting in decreased auditory information fidelity and even distorted information. Here, we discuss possible ways for clinical neuroscientists to employ neural tracking methodology to independently characterize deficiencies on the auditory-sensory and abstract linguistic levels. This might lead to a mechanistic understanding of the deficits underlying language related disorder(s) in schizophrenia. We propose to combine naturalistic stimulation, measures of speech-brain synchronization, and computational modeling of abstract linguistic knowledge and predictions. These independent but likely interacting assessments may be exploited for an objective and differential diagnosis of schizophrenia, as well as a better understanding of the disorder on the functional level-illustrating the potential of neural tracking methodology as translational tool in a range of psychotic populations.

Effects of an Audiovisual Emotion Perception Training for Schizophrenia: A Preliminary Study

Individuals with schizophrenia show a reduced ability to integrate facial and vocal information in emotion perception. Although emotion perception has been a target for treatment, no study has yet examined the effect of multimodal training on emotion perception in schizophrenia. In the present study, we developed an audiovisual emotion perception training and test in which a voice and a face were simultaneously presented, and subjects were asked to judge whether the emotions of the voice and the face matched. The voices were either angry or happy, and the faces were morphed on a continuum ranging from angry to happy. Sixteen patients with schizophrenia participated in six training sessions and three test sessions (i.e., pre-training, post-training, and generalization). Eighteen healthy controls participated only in pre-training test session. Prior to training, the patients with schizophrenia performed significantly worse than did the controls in the recognition of anger; however, following the training, the patients showed a significant improvement in recognizing anger, which was maintained and generalized to a new set of stimuli. The patients also improved the recognition of happiness following the training, but this effect was not maintained or generalized. These results provide preliminary evidence that a multimodal, audiovisual training may yield improvements in anger perception for patients with schizophrenia.

Prosody Dominates Over Semantics in Emotion Word Processing: Evidence From Cross-Channel and Cross-Modal Stroop Effects

Purpose Emotional speech communication involves multisensory integration of linguistic (e.g., semantic content) and paralinguistic (e.g., prosody and facial expressions) messages. Previous studies on linguistic versus paralinguistic salience effects in emotional speech processing have produced inconsistent findings. In this study, we investigated the relative perceptual saliency of emotion cues in cross-channel auditory alone task (i.e., semantics-prosody Stroop task) and cross-modal audiovisual task (i.e., semantics-prosody-face Stroop task). Method Thirty normal Chinese adults participated in two Stroop experiments with spoken emotion adjectives in Mandarin Chinese. Experiment 1 manipulated auditory pairing of emotional prosody (happy or sad) and lexical semantic content in congruent and incongruent conditions. Experiment 2 extended the protocol to cross-modal integration by introducing visual facial expression during auditory stimulus presentation. Participants were asked to judge emotional information for each test trial according to the instruction of selective attention. Results Accuracy and reaction time data indicated that, despite an increase in cognitive demand and task complexity in Experiment 2, prosody was consistently more salient than semantic content for emotion word processing and did not take precedence over facial expression. While congruent stimuli enhanced performance in both experiments, the facilitatory effect was smaller in Experiment 2. Conclusion Together, the results demonstrate the salient role of paralinguistic prosodic cues in emotion word processing and congruence facilitation effect in multisensory integration. Our study contributes tonal language data on how linguistic and paralinguistic messages converge in multisensory speech processing and lays a foundation for further exploring the brain mechanisms of cross-channel/modal emotion integration with potential clinical applications.

Processing of Emotions in Speech in Forensic Patients With Schizophrenia: Impairments in Identification, Selective Attention, and Integration of Speech Channels

Individuals with schizophrenia show deficits in recognition of emotions which may increase the risk of violence. This study explored how forensic patients with schizophrenia process spoken emotion by: (a) identifying emotions expressed in prosodic and semantic content separately, (b) selectively attending to one speech channel while ignoring the other, and (c) integrating the prosodic and the semantic channels, compared to non-clinical controls. Twenty-one forensic patients with schizophrenia and 21 matched controls listened to sentences conveying four emotions (anger, happiness, sadness, and neutrality) presented in semantic or prosodic channels, in different combinations. They were asked to rate how much they agreed that the sentences conveyed a predefined emotion, focusing on one channel or on the sentence as a whole. Forensic patients with schizophrenia performed with intact identification and integration of spoken emotions, but their ratings indicated reduced discrimination, larger failures of selective attention, and under-ratings of negative emotions, compared to controls. This finding doesn't support previous reports of an inclination to interpret social situations in a negative way among individuals with schizophrenia. Finally, current results may guide rehabilitation approaches matched to the pattern of auditory emotional processing presented by forensic patients with schizophrenia, improving social interactions and quality of life.

Speech Prosody as a Bridge Between Psychopathology and Linguistics: The Case of the Schizophrenia Spectrum

Patients with schizophrenia spectrum disorders experience severe difficulties in interpersonal communication, as described by traditional psychopathology and current research on social cognition. From a linguistic perspective, pragmatic abilities are crucial for successful communication. Empirical studies have shown that these abilities are significantly impaired in this group of patients. Prosody, the tone of voice with which words and sentences are pronounced, is one of the most important carriers of pragmatic meaning and can serve a range of functions from linguistic to emotional ones. Most of the existing literature on prosody of patients with schizophrenia spectrum disorders focuses on the expression of emotion, generally showing significant impairments. By contrast, the use of non-emotional prosody in these patients is scarcely investigated. In this paper, we first present a linguistic model to classify prosodic functions. Second, we discuss existing studies on the use of non-emotional prosody in these patients, providing an overview of the state of the art. Third, we delineate possible future lines of research in this field, also taking into account some classical psychopathological assumptions, for both diagnostic and therapeutic purposes.