Kristin M. Healey

Facial Emotion Perception in Schizophrenia: A Meta-analytic Review

OBJECTIVES A considerable body of literature has reported on emotion perception deficits and the relevance to clinical symptoms and social functioning in schizophrenia. Studies published between 1970-2007 were examined regarding emotion perception abilities between patient and control groups and potential methodological, demographic, and clinical moderators. DATA SOURCES AND REVIEW: Eighty-six studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. A quality of reporting of meta-analysis standard was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics, and antipsychotic medication status were compiled and analyzed using Comprehensive Meta-analysis Version 2.0 (Borenstein M, Hedges L, Higgins J and Rothstein H. Comprehensive Meta-analysis. 2. Englewood, NJ: Biostat; 2005). RESULTS The meta-analysis revealed a large deficit in emotion perception in schizophrenia, irrespective of task type, and several factors that moderated the observed impairment. Illness-related factors included current hospitalization and--in part--clinical symptoms and antipsychotic treatment. Demographic factors included patient age and gender in controls but not race. CONCLUSION Emotion perception impairment in schizophrenia represents a robust finding in schizophrenia that appears to be moderated by certain clinical and demographic factors. Future directions for research on emotion perception are discussed.

The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel

BACKGROUND In schizophrenia, social cognition is strongly linked to functional outcome and is increasingly seen as a viable treatment target. The goal of the Social Cognition Psychometric Evaluation (SCOPE) study is to identify and improve the best existing measures of social cognition so they can be suitably applied in large-scale treatment studies. Initial phases of this project sought to (1) develop consensus on critical domains of social cognition and (2) identify the best existing measures of social cognition for use in treatment studies. METHODS Experts in social cognition were invited to nominate key domains of social cognition and the best measures of those domains. Nominations for measures were reduced according to set criteria, and all available psychometric information about these measures was summarized and provided to RAND panelists. Panelists rated the quality of each measure on multiple criteria, and diverging ratings were discussed at the in-person meeting to obtain consensus. RESULTS Expert surveys identified 4 core domains of social cognition-emotion processing, social perception, theory of mind/mental state attribution, and attributional style/bias. Using RAND panel consensus ratings, the following measures were selected for further evaluation: Ambiguous Intentions Hostility Questionnaire, Bell Lysaker Emotion Recognition Task, Penn Emotion Recognition Test, Relationships Across Domains, Reading the Mind in the Eyes Test, The Awareness of Social Inferences Test, Hinting Task, and Trustworthiness Task. DISCUSSION While it was possible to establish consensus, only a limited amount of psychometric information is currently available for the candidate measures, which underscores the need for well-validated and standardized measures in this area.

Facial emotion perception in depression and bipolar disorder: A quantitative review

A considerable body of literature has reported on emotion perception deficits and the relevance of these impairments in persons with depression and bipolar disorder. Fifty-one studies published between 1981-February 2009 were examined regarding emotion perception abilities between patient and control groups, and potential methodological, demographic and clinical moderators. Studies were identified through a computerized literature search of the MEDLINE, PsychINFO, and PubMed databases. The Meta-analysis Of Observational Studies in Epidemiology (MOOSE) standard (Stroup et al., 2000) was followed in the extraction of relevant studies and data. Data on emotion perception, methodology, demographic and clinical characteristics were compiled and analyzed using Comprehensive Meta-Analysis version 2.0 (Biostat, 2005). The meta-analysis revealed a moderate deficit in emotion perception in both bipolar disorder and major depressive disorder, irrespective of task type, diagnosis, age of onset/duration of illness, sex, and hospitalization status. Several factors that moderated the observed impairment include self-reported depression, age at time of testing, and years of education. Emotion perception impairment in bipolar disorder and major depressive disorder represents a moderate and stable deficit that appears to be moderated by a limited number of demographic and clinical factors.

Theory of mind and social judgments in people at clinical high risk of psychosis.

BACKGROUND Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations. AIMS Longitudinally examine theory of mind (ToM) and social judgments in a CHR sample to investigate the stability of performance over time and potential ability to predict conversion to psychosis. METHOD 147 CHR individuals and 85 help seeking controls (HSC) were assessed for up to 2years; 28 participants developed psychosis across both groups. Generalized linear mixed models for repeated measures were used to examine change over time for ratings on the three social cognitive indices of ToM, trustworthiness, and approachability. Hierarchical regression was used to test whether social cognitive variables explain more variance in conversion than IQ. RESULTS CHR individuals showed a positive bias in approachability judgments over time compared to HSC. Baseline ToM performance significantly (p<.05) predicted later conversion beyond IQ scores. These results were attenuated when controlling for baseline symptom level. CONCLUSIONS Although ToM deficits might predate conversion to psychosis, one must consider initial symptoms as well. Social judgments were not associated with conversion to schizophrenia.

Social cognition in schizophrenia: factor structure, clinical and functional correlates

Abstract Background: Social cognition is consistently impaired in people with schizophrenia, separable from general neurocognition, predictive of real-world functioning and amenable to psychosocial treatment. Few studies have empirically examined its underlying factor structure. Aims: This study (1) examines the factor structure of social cognition in both a sample of individuals with schizophrenia-spectrum disorders and non-clinical controls and (2) explores relationships of factors to neurocognition, symptoms and functioning. Method: A factor analysis was conducted on social cognition measures in a sample of 65 individuals with schizophrenia or schizoaffective disorder, and 50 control participants. The resulting factors were examined for their relationships to symptoms and functioning. Results: Results suggested a two-factor structure in the schizophrenia sample (social cognition skill and hostile attributional style) and a three-factor structure in the non-clinical sample (hostile attributional style, higher-level inferential processing and lower-level cue detection). In the schizophrenia sample, the social cognition skill factor was significantly related to negative symptoms and social functioning, whereas hostile attributional style predicted positive and general psychopathology symptoms. Conclusions: The factor structure of social cognition in schizophrenia separates hostile attributional style and social cognition skill, and each show differential relationships to relevant clinical variables in schizophrenia.

Do we recognize facial expressions of emotions from persons with schizophrenia

OBJECTIVES Impaired facial emotion expression is central to schizophrenia. Extensive work has quantified these differences, but it remains unclear how patient expressions are perceived by their healthy peers and other non-trained individuals. This study examined how static facial expressions of posed and evoked emotions of patients and controls are recognized by naïve observers. METHODS Facial photographs of 6 persons with stable schizophrenia and 6 matched healthy controls expressing five universal emotions (happy, sad, anger, fear, and disgust) and neutral were selected from a previous data set. Untrained raters (N=420) viewed each photo and identified the expressed emotion. Repeated measures ANOVAs were used to assess differences in accuracy and error patterns between patient and control expressions. RESULTS Expressions from healthy individuals were more accurately identified than those from schizophrenia patients across all conditions, except for posed sadness and evoked neutral faces, in which groups did not differ, and posed fear, in which patient expressions were more accurately identified than control expressions. Analysis of incorrect responses revealed misidentifications as neutral were most common across both groups but significantly more likely among patients. CONCLUSION Present findings demonstrate that patient expressions of emotion are poorly perceived by naïve observers and support the concept of affective flattening in schizophrenia. These results highlight the real world implications of impairments in emotion expression and may shed light on potential mechanisms of impaired social functioning in schizophrenia.

Deficits in social cognition in first episode psychosis: A review of the literature

OBJECTIVE Individuals with chronic schizophrenia (SCZ) consistently show impairments in social cognition (SC) that are associated with functional decline, and work suggests that similar associations exist in first-episode psychosis (FEP). The goal of the current article is to review and synthesize the current body of work examining SC in FEP. Secondary aims are to examine the relationship between SC and symptoms, and change in SC over time in FEP. DESIGN Literature is reviewed from four key SC domains: emotion processing (EP), theory of mind (ToM), social perception (SP), and attributional style (AS). Targeted searches of PsycINFO and Google Scholar were conducted to identify relevant manuscripts. RESULTS Data from 48 relevant studies (6 longitudinal) were reviewed and integrated. CONCLUSIONS (1) FEP individuals show consistent deficits in SC compared to healthy controls, most consistently in EP (particularly, fear and sadness recognition) and ToM compared to SP and AS, (2) individuals with FEP and SCZ show comparable SC deficits, (3) some evidence indicates SC deficits in FEP are associated with negative and positive symptoms, and (4) SC appears to be stable over time in FEP.

An intact threat superiority effect for nonsocial but not social stimuli in schizophrenia.

Studies examining the processing of threat-related information in schizophrenia suggest that patients may show intact abilities to detect nonsocial threats despite impaired processing of social threat. The present study examined potential differences between social and nonsocial threat detection abilities in schizophrenia via two analogous threat perception tasks: one that used nonsocial threat (i.e., snakes) and one that used social threat (i.e., angry faces). Both tasks have reliably demonstrated a threat superiority effect (TSE) among healthy individuals in which threat-related stimuli are detected more accurately and efficiently than non-threat-related stimuli. Results from 30 healthy controls and 35 individuals with schizophrenia indicated that control participants showed a normative TSE on both the nonsocial and social tasks. In contrast, patients showed a TSE on only the nonsocial task, demonstrating intact detection abilities for nonsocial threat but impaired detection of social threats. The discrepant performance across nonsocial and social threat detection tasks within the patient group is consistent with evidence indicating that social and nonsocial information processing can be differentially affected in schizophrenia.

Improving measurement of attributional style in schizophrenia; A psychometric evaluation of the Ambiguous Intentions Hostility Questionnaire (AIHQ)

While attributional style is regarded as a core domain of social cognition, questions persist about the psychometric characteristics of measures used to assess it. One widely used assessment of attributional style is the Ambiguous Intentions Hostility Questionnaire (AIHQ). Two limitations of the AIHQ include (1) a possible restricted range resulting from too few and too homogenous item scenarios, and (2) use of rater scores that are cumbersome and time-consuming to score and have unknown incremental validity. The present study evaluated the psychometric properties of the AIHQ while concurrently testing changes aiming to improve the scale, in particular expansion of the number of self-report items and removal of the rater-scored items. One hundred sixty individuals diagnosed with schizophrenia and 58 healthy controls completed the full AIHQ along with measures of symptoms, functioning, and verbal intelligence. The AIHQ - particularly the self-reported blame score - demonstrated adequate internal consistency, test-retest reliability, and distinguished patients from controls. It also was significantly related to clinically-rated hostility and suspiciousness symptoms, and correlated with functional capacity even after controlling for verbal intelligence. Incremental validity analyses suggested that a higher number of self-report items strengthens relationships to outcomes in a manner that justifies this expansion, while rater-scored items had mixed results in providing additional information beyond self-report in the AIHQ.

Observable Social Cognition - A Rating Scale: An interview-based assessment for schizophrenia

Introduction. Individuals with schizophrenia consistently show impairments in social cognition (SC). SC has become a potential treatment target due to its association with functional outcomes. An alternative method of assessment is to administer an observer-based scale incorporating an informants “first hand” impressions in ratings. Methods. The present study used the Observable Social Cognition: A Rating Scale (OSCARS) in 62 outpatients and 50 non-psychiatric controls (NPCs) to assess performance in domains of SC (e.g. emotion perception, theory of mind). Results. The OSCARS demonstrated sufficient internal consistency and test-retest reliability. Construct validity was assessed through an exploratory factor analysis. Patient OSCARS indices were not significantly correlated with measures of SC with the exception of aggressive attributional style. Individuals with less impairment in SC reacted more aggressively to ambiguous situations. NPC OSCARS were significantly correlated with measures of theory of mind and attributional style. In a combined sample of patients and controls, six of eight items were significantly correlated with the SC task assessing the same domain, providing modest evidence of convergent validity. In patients, the OSCARS was significantly correlated with measures of functional outcome and neurocognition. Last, the OSCARS was found to be significantly associated with functional outcome after the influence of objective measures of SC was statistically removed. Conclusions. The present study provides preliminary evidence that the OSCARS may be useful for clinicians in collecting data about patients’ potential real-world SC deficits, in turn increasing the degree to which these impairments may be targeted in treatment.