Murray Alpert

Perception of facial emotion in schizophrenic and right brain-damaged patients

Deficits in the perception of facial emotion have been demonstrated in patients with rightsided brain damage (RBD) and schizophrenia (SZ). Furthermore, recent speculations have implicated right-hemisphere dysfunction in Type II schizophrenics, especially those with a preponderance of “negative symptoms” and flat affect. The performance of SZ, RBD, and normal control subjects was compared on measures assessing facial emotional perception. Both identification and discrimination paradigms were used, with positive/pleasant and negative/unpleasant emotions. To examine the effects of visuospatial and facial processing on facial emotion tasks, the Visual Matrices Test and the Benton Facial Recognition Test were administered. On both facial emotion tests, SZ and RBD patients were significantly impaired relative to normal subjects, but not different from each other. The SZ and RBD patients were also impaired on the matrices and facial recognition tests. When the effects of the matrices and neutral face recognition tests were statistically controlled, significant group differences remained for the identification task but not for the discrimination task. Thus, methodologies are presented for the neuropsychological study of facial emotional perception, and some support is provided for the notion that negative-symptom schizophrenia is associated with right hemisphere dysfunction.

Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and a battery of tests.

Components of emotional processing were examined in psychiatric and neurological populations: communication channel (face/voice), processing mode (expression/perception), and emotional valence (positive/negative). These were assessed with an experimental affect battery which was administered to schizophrenic, unipolar depressive, right-brain-damaged, Parkinsons disease, and normal control right-handed adults. For expression, subjects were taped while producing facial and vocal emotional expressions. Judges rated the expressions for accuracy and intensity. For perception, subjects were asked to identify and discriminate facial and vocal emotions. Using correlational techniques, relationships between facial and vocal channels and between expressive and perceptual modes were explored. The test battery has good psychometric properties and discriminates among diagnostic groups.

Reflections of depression in acoustic measures of the patient’s speech

BACKGROUND The literature on acoustic measures of voice in depression is reviewed. Authors have separated results derived from studies of automatic speech, such as counting or reading, from free speech. Free speech requires cognitive activity such as word finding and discourse planning in addition to the motor activity of automatic speech. Also, results have been less ambiguous if homogeneous groups of agitated or retarded depressed patients were examined. METHODS These distinctions are applied to the results of a 12-week double-blind treatment trial that compared response to nortriptyline (25-100 mg/day) with sertraline (50-150 mg/day). Twelve male and ten female elderly depressed patients and an age-matched normal control group (n=19) were studied. Patients were divided into retarded or agitated groups on the basis of ratings. Results from measures of fluency (speech productivity and pausing) and prosody (emphasis and inflection) are described. RESULTS Depressed patients showed less prosody than the normal subjects. Improvement in the retarded group was reflected in briefer pauses but not longer utterances. There was a trend in the agitated group for improvement to be reflected in the utterance but not the pause measure. CONCLUSIONS Clinical impressions are substantially related to acoustic parameters. Temporal changes associated with depression appear to reflect the depressed state whereas prosodic features seem to reflect a depressed trait. Acoustic measures of the patients speech may provide objective procedures to aid in the evaluation of depression. Limitations of the study are discussed.

Lateralization for the expression and perception of facial emotion as a function of age

In order to test the hypothesis of right hemisphere changes with age, this study examined lateralization for facial emotion in young, middle-aged, and older women (N = 90). For expression, subjects were photographed while posing positive and negative emotions. Composite photographs were created and rated for intensity. For perception, subjects were required to make intensity judgements about emotional chimeric faces. Overall, subjects demonstrated significant left-sided facial asymmetry for expression and significant left hemispace biases for perception. The findings for facial expression were not influenced by emotional valence or resting face asymmetries. There were no changes in lateralization as a function of age for either expression or perception. Taken together, these findings lend support to the notion that the right hemisphere mediates emotional processing across the adult life span.

Facial asymmetry while posing positive and negative emotions: support for the right hemisphere hypothesis

The purpose of this report was to examine facial asymmetry during the expression of positive and negative emotions. In addition, methodological factors in the study of facial asymmetry were considered. Subjects were 16 neurologically-healthy right-handed adult males, videotaped while posing eight facial expressions (positive and negative) under two conditions (verbal command and visual imitation). Separate asymmetry ratings of the two sides of the face were made by judges viewing normal or mirror-reversed versions of the videotape. There were no effects of valence, condition, or videotape orientation on the asymmetry ratings, and, in general, expressions were produced significantly more intensely on the left than the right side of the face. This finding is consistent with the hypothesis that the right cerebral hemisphere is dominant for the expression of facial emotion of both valences.

The perception of facial emotion across the adult life span

This study was designed to examine changes in the perception of facial emotion across the adult life span. Subjects were 30 young (ages 21 to 39 years), 30 middle‐aged (ages 40 to 59 years), and 30 older (ages 60 to 81 years) normal adult right‐handed females. The three groups of subjects were carefully screened for neurological and psychiatric disorders and for cognitive and visuoperceptual deficits; the groups were closely matched on demographic variables. Subjects were required to identify photographs of facial emotional expressions (Ekman & Friesen, 1976). There were no overall changes in accuracy of perception as a function of age. The ages of posers in the photographs did not influence the perceptual accuracy scores. This study contributes to the literature about the characteristics of normal emotional processing across the adult life span.

A preliminary comparison of flat affect schizophrenics and brain-damaged patients on meausres of affective processing☆

Flat affect is a major component of schizophrenia and is often also seen in neurological disorders. A preliminary set of comparisons were conducted to delineate neuropsychological mechanisms underlying flat affect in schizophrenia, and new measures are described for the assessment of affective deficits in clinical populations. Subjects were schizophrenic with flat affect (SZs), right brain-damaged (RBD), Parkinsons Disease (PDs), and normal control (NC) right-handed adults. Subjects were administered affective measures of expression and perception in both facial and vocal channels. For both perceptual and expressive tasks the SZs performed significantly less accurately than the NCs and the PDs but did not differ from the RBDs. This was the case for both face and voice. This finding lends support to the speculation that right hemisphere mechanisms, especially cortical ones, may be compromised among schizophrenics with flat affect.

Carbamazepine Use in Children and Adolescents with Features of Attention-Deficit Hyperactivity Disorder: A Meta-Analysis

OBJECTIVE In the United States approximately 750,000 children receive psychostimulants to treat attention-deficit hyperactivity disorder (ADHD); up to 25% may not respond. The purpose of this study was to evaluate the reports in the international literature concerning the efficacy of carbamazepine (CBZ) in children with ADHD features by means of meta-analysis. METHOD A review of the world literature located 29 reports that dealt with behavior problems, activity levels, and CBZ in children. Of these, only 10 reports provided sufficient or pertinent information for the meta-analysis. RESULTS In all seven open studies, therapeutic responses were significant (ranging from p = .05 to .0001, two-tailed t test). Meta-analysis using weighted variables revealed a significant positive correlation (r = .88; p < .02) between duration of treatment and positive outcome. In three double-blind placebo-controlled studies, treatment effects for CBZs superiority over placebo ranged from p = .07 to .0001. A meta-analysis of these three studies revealed that CBZ was significantly (p = .018) more effective than placebo at controlling target symptoms. CONCLUSIONS Despite the general lack of attention that CBZ has received for treating ADHD, there is preliminary evidence that CBZ may be an effective alternate treatment in children with features of ADHD.

A Multimethod, Multichannel Assessment of Affective Flattening in Schizophrenia

Flat affect was examined across multiple contexts (during interviews and emotional films), multiple channels of expression (facial and vocal), and different assessment techniques (clinical ratings, observational ratings of facial expression, and acoustic analyses) in 23 medication-free schizophrenic patients. Patients participated in three different interviews during which either clinical ratings were made or their voices were audiotaped for later acoustic analyses. Patients were also videotaped while they viewed positive and negative emotional films. The videotapes were then coded for the frequency, intensity, and duration of positive and negative facial expressions. Results indicated that general clinical ratings were related across different interviews. However, only those items specific to affective flattening bore significant relationships to vocal and facial expressiveness. Vocal expressiveness and negative facial expressiveness were related, but vocal expressiveness was not related to positive facial expressiveness.

A comparison of clinical ratings with vocal acoustic measures of flat affect and alogia

In this report we compare clinical ratings of flat affect and alogia with objective measures of the patients speech prosody and productivity. Thirty schizophrenic patients were evaluated with the Scale for the Assessment of Negative Symptoms (SANS) and the St. Hans Rating Scale for extra pyramidal side effects. Their speech was recorded and analyzed acoustically for measures of prosody and productivity. Correlations between pairs of SANS items and acoustic measures (e.g. Vocal Inflection and Fundamental Frequency Variance) were weak. The SANS item and global ratings were strongly related. Ratings of bradykinesia overlapped with the SANS ratings but not with the acoustic measures. The SANS ratings appear to be derived from global impressions, with diffuse confounding of flat affect with alogia, and with bradykinesia. Acoustic analysis has the potential to provide objective measures that may help develop operational definitions of these constructs and enhance clinical assessment.