Empathy and Its Relationship With Social Functioning in Individuals at Ultra-High Risk for Psychosis

Empathy deficit in male patients with schizophrenia and its relationships with impulsivity and premeditated violence

Objective

To explore the pattern of empathy characteristics in male patients with schizophrenia (SCH) and to examine whether empathy deficit is associated with impulsivity and premeditated violence.

Methods

One hundred and fourteen male SCH patients were enrolled in this study. The demographic data of all patients were collected and the subjects were divided into two groups, namely, the violent group, including 60 cases, and the non-violent group, comprising 54 cases, according to the Modified Overt Aggression Scale (MOAS). The Chinese version of the Interpersonal Reactivity Index-C (IRI-C) was used to evaluate empathy and the Impulsive/Predicted Aggression Scales (IPAS) was employed to assess the characteristics of aggression.

Results

Among the 60 patients in the violent group, 44 patients had impulsive aggression (IA) and 16 patients had premeditated aggression (PM) according to the IPAS scale. In the violent group, the scores of the four subfactors of the IRI-C, i.e., perspective taking (PT), fantasy (FS), personal distress (PD), and empathy concern (EC), were significantly lower than in the non-violent group. Stepwise logistic regression showed that PM was independent influencing factor for violent behaviors in SCH patients. Correlation analysis revealed that EC of affective empathy was positively correlated with PM but not with IA.

Conclusion

SCH patients with violent behavior had more extensive empathy deficits compared with non-violent SCH patients. EC, IA and PM are independent risk factors of violence in SCH patients. Empathy concern is an important index to predict PM in male patients with SCH.

Deconstructing Mechanisms of Abnormal Categorical Perception of Emotional Facial Expressions in Schizophrenia Patients

OBJECTIVE

The current study aims to find out the potential reasons why most schizophrenia patients have a relatively low sensitivity to the classification of emotional facial expressions.

METHODS

By using an emotional categorical perception task, eighty-three schizophrenia patients and seventy-one healthy adults are provided with morphed emotional continuums with two emotional facial expressions (a positive emotional valence: happy; a negative emotional valence: sad).

RESULTS

Through comparing the difference between schizophrenia patients and healthy adults in the processes of estimating facial expressions with ambiguous emotions, we find that the pattern of emotional categorical perception for schizophrenia patients is significantly different from that of healthy controls when they process signals on the local facial areas. Compared to healthy people, schizophrenia patients have a significantly separate classification pattern in processing emotional signals between the eyes and mouth regions. It indicates that compared to healthy adults, schizophrenia patients have larger conflicts in integrating emotional signals from different facial areas. To overcome conflicts, more cognitive resources are required. Unfortunately, the lack of cognitive resources leads to the failure of integration, which further increases the difficulty of estimating facial expressions with ambiguous emotions, and finally leads to the relatively low sensitivity of emotional facial expressions classification.

CONCLUSION

To sum up, the deficit of abnormal perceptions of emotional facial expressions in schizophrenia patients results from an integrated deficit of signals on facial areas.

Empathy, Emotion Recognition, and Paranoia in the General Population

Background

Paranoia is associated with a multitude of social cognitive deficits, observed in both clinical and subclinical populations. Empathy is significantly and broadly impaired in schizophrenia, yet its relationship with subclinical paranoia is poorly understood. Furthermore, deficits in emotion recognition - a very early component of empathic processing - are present in both clinical and subclinical paranoia. Deficits in emotion recognition may therefore underlie relationships between paranoia and empathic processing. The current investigation aims to add to the literature on social cognition and paranoia by: (1) characterizing the relationship between paranoia and empathy, and (2) testing whether there is an indirect effect of emotion recognition on the relationship between empathy and paranoia.

Methods

Paranoia, empathy, and emotion recognition were assessed in a non-clinical sample of adults (n = 226) from the Nathan Kline Institute-Rockland (NKI-Rockland) dataset. Paranoia was measured using the Peters Delusions Inventory-21 (PDI-21). Empathy was measured using the Interpersonal Reactivity Index (IRI), a self-report instrument designed to assess empathy using four subscales: Personal Distress, Empathic Concern, Perspective Taking, and Fantasy. Emotion recognition was assessed using the Penn Emotion Recognition Test (ER-40). Structural equation modeling (SEM) was used to estimate relationships between paranoia, the four measures of empathy and emotion recognition.

Results

Paranoia was associated with the Fantasy subscale of the IRI, such that higher Fantasy was associated with more severe paranoia (p < 0.001). No other empathy subscales were associated with paranoia. Fantasy was also associated with the emotion recognition of fear, such that higher Fantasy was correlated with better recognition of fear (p = 0.008). Paranoia and emotion recognition were not significantly associated. The Empathic Concern subscale was negatively associated with emotion recognition, with higher empathic concern related to worse overall emotion recognition (p = 0.002). All indirect paths through emotion recognition were non-significant.

Discussion

These results suggest that imaginative perspective-taking contributes to paranoia in the general population. These data do not, however, point to robust global relationships between empathy and paranoia or to emotion recognition as an underlying mechanism. Deficits in empathy and emotion recognition observed in schizophrenia may be associated with the broader pathology of schizophrenia, and therefore not detectable with subclinical populations.