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Schizophrenia Research
journal homepage: www.elsevier.com/locate/schres
Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea
Department of Psychiatry, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, South Korea
c
Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
d
Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, South Korea
e
Department of Psychiatry, Seoul National Hospital, Seoul, South Korea
f
Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea
b
a r t i c l e
i n f o
Article history:
Received 10 January 2015
Received in revised form 17 March 2015
Accepted 22 March 2015
Available online 10 April 2015
Keywords:
Facial emotions recognition
Schizotypy
Ultra-high risk for psychosis
First-episode
Schizophrenia
Decit
Neurocognition
a b s t r a c t
Objective: This study aims to quantify facial emotion recognition abnormalities and their relation to
neurocognitive dysfunction and schizotypy in individuals at ultra-high risk (UHR) for psychosis and patients
with rst-episode schizophrenia (FES).
Methods: Forty individuals at UHR for psychosis, 24 patients with FES and 46 normal controls performed a facial
emotion recognition task that presented facial photographs encompassing all basic emotions. The perceptual
aberration scale and revised social anhedonia scale were employed for self-reported assessment of schizotypy.
An intellectual functioning (IQ) test and a broad battery of neurocognitive tests were conducted. Emotional
task performance indexed by accuracy rate of specic emotion was compared among three groups. The correlation of accuracy rate with neurocognitive tests and schizotypy scales were analyzed within each clinical group.
Results: A recognition decit of facial emotions was present in both clinical groups, even after adjusting for IQ and
gender as covariates. This emotional decit showed few signicant relationships with broad range of individual
neurocognitive measures. Meanwhile, this decit demonstrated signicant relationships with schizotypy,
especially perceptual aberration in each clinical group.
Conclusions: Facial emotion recognition decit may not only be present in FES patients, but may already have
evolved prior to the onset of overt psychotic symptoms. This emotion recognition decit may be linked to a
perceptual aberration and largely independent of broad range of neurocognitive dysfunction.
2015 Elsevier B.V. All rights reserved.
1. Introduction
Facial emotion recognition, or the ability to infer others' emotional
states, is essential for adaptive social interaction. Decit in facial
emotion recognition is a widely replicated nding in patients with
schizophrenia, including rst-episode patients (Edwards et al., 2001,
2002; Green et al., 2005; Addington et al., 2006; Kohler et al., 2010;
Savla et al., 2013). This decit is considered as a unique feature of
schizophrenia, going beyond neurocognitive impairment (Edwards
http://dx.doi.org/10.1016/j.schres.2015.03.026
0920-9964/ 2015 Elsevier B.V. All rights reserved.
et al., 2001; An et al., 2003; Kohler et al., 2003, 2010), although there
have been some contentions that emotional decit may be secondary
to general neurocognitive impairment (Kohler et al., 2000; Addington
et al., 2006).
In recent years, facial emotion recognition decit has been investigated in the putative prodromal, ultra-high-risk (UHR) phase of schizophrenia. Individuals at UHR, presenting attenuated but clinically
meaningful psychotic symptoms have elevated risk of transition into
frank psychosis (Yung and McGorry, 1996), while they are relatively
less contaminated by secondary morbidity with chronic illness accompanied by marked neurocognitive decline (Fusar-Poli et al., 2012a).
Impaired facial emotion recognition in individuals at UHR have been
demonstrated in a number of investigations (Addington et al., 2008;
van Rijn et al., 2011; Amminger et al., 2012a, 2012b; Green et al.,
2012; Thompson et al., 2012; Wolwer et al., 2012) including a metaanalysis (Fusar-Poli et al., 2012b). Furthermore, impairment in facial
61
62
Table 1
Demographic and clinical proles of normal controls, individuals at ultra-high-risk (UHR) for psychosis, and rst-episode schizophrenia (FES) patients.
Age (years)
Education (years)
Gender (M/F)
SIPS-dened prodromal status (BIPS/APS/GRDS)
DSM-IV subtype
(paranoid/undifferentiated/residual)
Perceptual aberration1,2
Social anhedonia1,2,3
IQ2
Positive symptoms (SAPS, summary score)
Negative symptoms (SANS, summary score)
Antipsychotic medications
Naive/medicated3
Chlorpromazine equivalent dose (mg/day)a
Normal
controls
(n = 46)
First-episode schizophrenia
patients
(n = 24)
Statistical
analysis
p-Value
20.8 (3.5)
13.2 (1.9)
25/21
19.9 (3.6)
12.8 (2.0)
25/15
10/37/5
20.5 (3.3)
13.3 (2.3)
8/16
p = 0.427
p = 0.583
p = 0.074
29/2/2
3.9 (4.0)
10.1 (5.5)
9.0 (6.5)
23.3 (7.9)
7.7 (7.2)
16.7 (7.7)
p b 0.001
p b 0.001
105.8 (12.5)
104.1 (11.8)
3.5 (2.4)
7.0 (4.1)
96.0 (15.7)
6.0 (2.7)
9.4 (5.5)
37.55
F(2, 109) = 4.71
t = 3.88
t = 1.95
p = 0.011
p b 0.001
p = 0.056
24/16
138.2 (84.4)
1/23
454.7 (307.6)
2 = 19.64
t = 4.60
p b 0.001
p b 0.001
SIPS: Structured Interview for Prodromal Syndromes (McGlashan et al., 2003); BIPS: Brief Intermittent Psychotic Symptom Prodromal Syndrome; APS: Attenuated Positive Symptom
Prodromal Syndrome; GRDS: Genetic Risk and Deterioration Prodromal Syndrome; SAPS: Scale for Assessment of Positive Symptoms (Andreasen, 1984); SANS: Scale for Assessment
of Negative Symptoms (Andreasen, 1983); Perceptual aberration scale (Chapman et al., 1978) and Revised social anhedonia scale (Chapman et al., 1976) (2 UHR data were missing).
1
A signicant difference between normal controls and UHR individuals for psychosis (Bonferroni corrected p b 0.05).
2
A signicant difference between normal controls and FES patients (Bonferroni corrected p b 0.05).
3
A signicant difference between UHR individuals and FES patients (Bonferroni corrected p b 0.05).
a
Kroken et al. (2009).
false items that assess traits of subjective anhedonic experience to nonphysical situations including talking and exchanging expressions of
feelings (Chapman et al., 1976). The internal consistencies of both
schizotypy scales were 0.90 and 0.92 respectively.
Clinical interviews and psychopathology assessments were conducted using the SAPS (Andreasen, 1984; 020; total of four global subscale
scores), the Scale for Assessment of Negative Symptoms (SANS;
Andreasen, 1983; 025; total of ve global subscale scores). They
were administered by a psychiatrist (KKR) on the day of recruitment.
Each participant then received a packet of questionnaires including
the perceptual aberration scale (Chapman et al., 1978) and revised
social anhedonia scale (Chapman et al., 1976). The facial emotion
recognition task and the neurocognitive tests were conducted by a
masters-level psychologist (LMK) within a week of recruitment.
3. Results
3.1. Facial emotion recognition task performances
There was a signicant difference in accuracy rate in the facial
emotion recognition task between the three groups after adjusting for
IQ and gender [F(2, 105) = 10.3, p b 0.001; Table 2]. Post-hoc analyses
with Bonferroni correction revealed that the FES group (corrected
p b 0.001; Cohen's d = 1.23) and UHR group (corrected p = 0.023,
Cohen's d = 0.67) were worse than controls. There was no signicant
difference in facial emotion recognition performance between the two
clinical groups after adjusting for IQ and gender (corrected p = 0.132;
Cohen's d = 0.58).
Table 2
Accuracy rate (%) of emotions in normal controls, individuals at ultra-high-risk (UHR) for psychosis, and rst-episode schizophrenia (FES) patients.
Accuracy rate
Normal controls
(n = 46)
Post-hoc
Corrected
p-valuea
88.0 (9.4)
80.7 (12.4)
72.6 (15.5)
N vs. U
N vs. S
U vs. S
0.023
b0.001
0.132
Bonferroni-corrected p-value.
63
Fig. 1. Relationship between accuracy rate (%) of the facial emotion recognition and Chapman's schizotypy scales in (A) individuals at ultra-high risk (UHR) for psychosis and (B) rstepisode schizophrenia (FES) patients.
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References
Abbott, G.R., Green, M.J., 2013. Facial affect recognition and schizotypal personality
characteristics. Early Interv. Psychiatry 7 (1), 5863.
Addington, J., Saeedi, H., Addington, D., 2006. Facial affect recognition: a mediator
between cognitive and social functioning in psychosis? Schizophr. Res. 85 (13),
142150.
Addington, J., Penn, D., Woods, S.W., Addington, D., Perkins, D.O., 2008. Facial affect recognition in individuals at clinical high risk for psychosis. Br. J. Psychiatry 192 (1), 6768.
Adolphs, R., 2002. Recognizing emotion from facial expressions: psychological and neurological mechanisms. Behav. Cogn. Neurosci. Rev. 1 (1), 2162.
Amminger, G.P., Schafer, M.R., Klier, C.M., Schlogelhofer, M., Mossaheb, N., Thompson, A.,
Bechdolf, A., Allott, K., McGorry, P.D., Nelson, B., 2012a. Facial and vocal affect
perception in people at ultra-high risk of psychosis, rst-episode schizophrenia and
healthy controls. Early Interv. Psychiatry 6 (4), 450454.
Amminger, G.P., Schafer, M.R., Papageorgiou, K., Klier, C.M., Schlogelhofer, M., Mossaheb,
N., Werneck-Rohrer, S., Nelson, B., McGorry, P.D., 2012b. Emotion recognition in
individuals at clinical high-risk for schizophrenia. Schizophr. Bull. 38 (5), 10301039.
An, S.K., Lee, S.J., Lee, C.H., Cho, H.S., Lee, P.G., Lee, C.I., Lee, E., Roh, K.S., Namkoong, K.,
2003. Reduced P3 amplitudes by negative facial emotional photographs in
schizophrenia. Schizophr. Res. 64 (23), 125135.
An, S.K., Kang, J.I., Park, J.Y., Kim, K.R., Lee, S.Y., Lee, E., 2010. Attribution bias in ultra-high
risk for psychosis and rst-episode schizophrenia. Schizophr. Res. 118 (13), 5461.
Andreasen, N.C., 1983. Scale for the Assessment of Negative Symptoms. University of
Iowa, Iowa City.
Andreasen, N.C., 1984. Scale for the Assessment of Positive Symptons. University of Iowa,
Iowa City.
Bang, M., Kim, K.R., Song, Y.Y., Baek, S., Lee, E., An, S.K., 2015. Neurocognitive impairments
in individuals at ultra-high risk for psychosis: who will really convert? Aust. N. Z.
J. Psychiatry http://dx.doi.org/10.1177/0004867414561527 (in press).
Bliksted, V., Fagerlund, B., Weed, E., Frith, C., Videbech, P., 2014. Social cognition and
neurocognitive decits in rst-episode schizophrenia. Schizophr. Res. 153 (13),
917.
Buchanan, T.W., Bibas, D., Adolphs, R., 2010. Associations between feeling and judging the
emotions of happiness and fear: ndings from a large-scale eld experiment. PLoS
ONE 5 (5), e10640.
Chapman, L.J., Chapman, J.P., Raulin, M.L., 1976. Scales for physical and social anhedonia.
J. Abnorm. Psychol. 85 (4), 374382.
Chapman, L.J., Chapman, J.P., Raulin, M.L., 1978. Body-image aberration in schizophrenia.
J. Abnorm. Psychol. 87 (4), 399.
Chapman, L.J., Chapman, J.P., Kwapil, T.R., Eckblad, M., Zinser, M.C., 1994. Putatively
psychosis-prone subjects 10 years later. J. Abnorm. Psychol. 103 (2), 171183.
Cohen, J., 1988. Statistical Power Analysis for the Behavioral Sciences. L. Erlbaum
Associates.
Comparelli, A., Corigliano, V., De Carolis, A., Mancinelli, I., Trovini, G., Ottavi, G., Dehning, J.,
Tatarelli, R., Brugnoli, R., Girardi, P., 2013. Emotion recognition impairment is present
early and is stable throughout the course of schizophrenia. Schizophr. Res. 143 (1),
6569.
Eack, S.M., Mermon, D.E., Montrose, D.M., Miewald, J., Gur, R.E., Gur, R.C., Sweeney, J.A.,
Keshavan, M.S., 2010. Social cognition decits among individuals at familial high
risk for schizophrenia. Schizophr. Bull. 36 (6), 10811088.
Edwards, J., Pattison, P.E., Jackson, H.J., Wales, R.J., 2001. Facial affect and affective prosody
recognition in rst-episode schizophrenia. Schizophr. Res. 48 (23), 235253.
Edwards, J., Jackson, H.J., Pattison, P.E., 2002. Emotion recognition via facial expression
and affective prosody in schizophrenia: a methodological review. Clin. Psychol. Rev.
22 (6), 789832.
First, M.B., Gibbon, M., Spitzer, R.L., Williams, J.B.W., 1996a. Structured Clinical Interview
for DSM-IV Axis I Disorders: Non-patients Edition (SCID-I/PS), Version 2. New York
State Psychiatric Institute Biometric Research, New York.
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W., 1996b. Structured Clinical Interview
for DSM-IV Axis I Disorders: Patient Edition (SCID-I/P). Version 2. New York State
Psychiatric Institute Biometrics Research, New York.
Fusar-Poli, P., Bonoldi, I., Yung, A.R., Borgwardt, S., Kempton, M.J., Valmaggia, L., Barale, F.,
Caverzasi, E., McGuire, P., 2012a. Predicting psychosis: meta-analysis of transition
outcomes in individuals at high clinical risk. Arch. Gen. Psychiatry 69 (3), 220229.
Fusar-Poli, P., Deste, G., Smieskova, R., Barlati, S., Yung, A.R., Howes, O., Stieglitz, R.D., Vita,
A., McGuire, P., Borgwardt, S., 2012b. Cognitive functioning in prodromal psychosis: a
meta-analysis. Arch. Gen. Psychiatry 69 (6), 562571.
Germine, L.T., Hooker, C.I., 2011. Face emotion recognition is related to individual
differences in psychosis-proneness. Psychol. Med. 41 (5), 937947.
Germine, L.T., Garrido, L., Bruce, L., Hooker, C., 2011. Social anhedonia is associated with
neural abnormalities during face emotion processing. Neuroimage 58 (3), 935945.
Goldman, A.I., Sripada, C.S., 2005. Simulationist models of face-based emotion recognition. Cognition 94 (3), 193213.
Gooding, D.C., Tallent, K.A., Matts, C.W., 2005. Clinical status of at-risk individuals 5 years
later: further validation of the psychometric high-risk strategy. J. Abnorm. Psychol.
114 (1), 170175.
Green, M.F., Olivier, B., Crawley, J.N., Penn, D.L., Silverstein, S., 2005. Social cognition in
schizophrenia: recommendations from the measurement and treatment research to
improve cognition in schizophrenia new approaches conference. Schizophr. Bull. 31
(4), 882887.
Green, M.F., Penn, D.L., Bentall, R., Carpenter, W.T., Gaebel, W., Gur, R.C., Kring, A.M., Park,
S., Silverstein, S.M., Heinssen, R., 2008. Social cognition in schizophrenia: an NIMH
workshop on denitions, assessment, and research opportunities. Schizophr. Bull.
34 (6), 12111220.
Green, M.F., Bearden, C.E., Cannon, T.D., Fiske, A.P., Hellemann, G.S., Horan, W.P., Kee, K.,
Kern, R.S., Lee, J., Sergi, M.J., Subotnik, K.L., Sugar, C.A., Ventura, J., Yee, C.M.,
Nuechterlein, K.H., 2012. Social cognition in schizophrenia, Part 1: performance
across phase of illness. Schizophr. Bull. 38 (4), 854864.
Ha, R.Y., Kang, J.I., Park, J.I., An, S.K., Cho, H.-S., 2011. Differences in the emotion recognition of Japanese and Caucasian facial expressions in Korea. J. Korean Soc. Depression
Bipolar Disord. 9, 1723.
Hempel, R.J., Dekker, J.A., van Beveren, N.J., Tulen, J.H., Hengeveld, M.W., 2010. The effect
of antipsychotic medication on facial affect recognition in schizophrenia: a review.
Psychiatry Res. 178 (1), 19.
Kang, J.I., Park, H.J., Kim, S.J., Kim, K.R., Lee, S.Y., Lee, E., An, S.K., Kwon, J.S., Lee, J.D., 2014.
Reduced binding potential of GABA-A/benzodiazepine receptors in individuals at
65
Sergi, M.J., Rassovsky, Y., Widmark, C., Reist, C., Erhart, S., Braff, D.L., Marder, S.R., Green,
M.F., 2007. Social cognition in schizophrenia: relationships with neurocognition and
negative symptoms. Schizophr. Res. 90 (13), 316324.
Shanton, K., Goldman, A., 2010. Simulation theory. Wires Cogn. Sci. 1 (4), 527538.
Shean, G., Bell, E., Cameron, C.D., 2007. Recognition of nonverbal affect and schizotypy.
J. Psychol. 141 (3), 281291.
Strauss, G.P., Gold, J.M., 2012. A new perspective on anhedonia in schizophrenia. Am.
J. Psychiatry 169 (4), 364373.
Thompson, A., Papas, A., Bartholomeusz, C., Allott, K., Amminger, G.P., Nelson, B., Wood, S.,
Yung, A., 2012. Social cognition in clinical "at risk" for psychosis and rst episode
psychosis populations. Schizophr. Res. 141 (23), 204209.
van Rijn, S., Aleman, A., de Sonneville, L., Sprong, M., Ziermans, T., Schothorst, P., van
Engeland, H., Swaab, H., 2011. Misattribution of facial expressions of emotion in
adolescents at increased risk of psychosis: the role of inhibitory control. Psychol.
Med. 41 (3), 499508.
Ventura, J., Wood, R.C., Hellemann, G.S., 2013. Symptom domains and neurocognitive
functioning can help differentiate social cognitive processes in schizophrenia: a
meta-analysis. Schizophr. Bull. 39 (1), 102111.
Wechsler, D., 1981. Manual for the Wechsler Adult Intelligence Scale-Revised (WAIS-R).
Psychological Corporation, New York.
Wickline, V.B., Nowicki, S., Bollini, A.M., Walker, E.F., 2012. Vocal and facial emotion
decoding difculties relating to social and thought problems: highlighting
schizotypal personality disorder. J. Nonverbal Behav. 36 (1), 5977.
Wolwer, W., Brinkmeyer, J., Stroth, S., Streit, M., Bechdolf, A., Ruhrmann, S., Wagner, M.,
Gaebel, W., 2012. Neurophysiological correlates of impaired facial affect recognition
in individuals at risk for schizophrenia. Schizophr. Bull. 38 (5), 10211029.
Yong, E., Barbato, M., Penn, D.L., Keefe, R.S., Woods, S.W., Perkins, D.O., Addington, J., 2014.
Exploratory analysis of social cognition and neurocognition in individuals at clinical
high risk for psychosis. Psychiatry Res. 218 (12), 3943.
Yung, A.R., McGorry, P.D., 1996. The prodromal phase of rst-episode psychosis: past and
current conceptualizations. Schizophr. Bull. 22 (2), 353370.