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      A review of emotion deficits in schizophrenia Translated title: Una revisión acerca de los déficits de las emociones en la esquizofrenia Translated title: Revue des déficits émotionnels dans la schizophrénie

      , MD *

      Dialogues in Clinical Neuroscience

      Les Laboratoires Servier

      emotion, affect, schizophrenia, deficit, expression, experience, recognition

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          Abstract

          Emotion deficits in schizophrenia have been described since the time of Kraepelin. However, no comprehensive review of clinical emotion studies has ever been conducted, in this work, studies that used diagnostic criteria and were published in English were selected from an extensive PubMed search. Fifty-five studies on emotion expression repeatedly showed that individuals with schizophrenia (IWSs) display fewer overt expressions than non patient comparison subjects (NCSs) in verbal, facial, and acoustic channels. No clear differences were found between IWSs and depressed subjects. Sixty-nine studies examined emotion experience in schizophrenia. IWSs report higher anhedonia, and they tend to show more negative emotions in real-life event studies. In evocative studies, they report a similar degree of pleasantness and a similar or higher degree of unpleasantness. From 110 studies, ii can be concluded that emotion recognition is impaired in schizophrenia in all channels. These deficits in social perception are correlated with neurocognitive deficits and some social skills. IWSs show dysfunction in the three domains of emotion expression, emotion experience, and emotion recognition, and these dysfunctions appear to be independent of each other across domains. These deficits in basic emotion processing may be linked to psychopathology and functional outcomes.

          Translated abstract

          Desde Ios tiempos de Kraepelin han sido descritos Ios déficits de las emoeiones en la esquizofrenia. Sin embargo, nunca se ha realizado una extensa révision acerca de estudios clfnicos sobre las emoeiones. En este trabajo se seleccionaron, a partir de una amplia bûsqueda en PubMed, estudios que utilizaran criterios diagnôsticos y fueran publicados en inglés. Cincuenta y cinco estudios sobre la expresiôn de emoeiones mostraron repeiidamente que individuos con esquizofrenia (ICE) presentaban menos expresiones évidentes que sujetos de comparaciôn no pacientes en canales verbales, faciales y acûsticos. No se encontraron claras diferencias entre ICE y sujetos depresivos. Sesenta y nueve estudios examinaron la experiencia emocional en la esquizofrenia. Los ICE refirieron una anhedonia mâs elevada y iendieron a mostrar mâs emoeiones negativas en estudios sobre acontecimientos de la vida real. En estudios de recuerdos, estos individuos refirieron un grado similar de emoeiones agradablés, y un grado similar o mayor de emoeiones desagradables. A partir de 110 estudios se puede conclut que el reconocimiento de las emoeiones esta deteriorado en la esquizofrenia en todos Ios canales. Estos déficits en la perception social estân correlacionados con déficits neurocoqnitivos y con alqunas destrezas sociales. Los ICE muestran disfunciôn en très propiedades de las emoeiones: expresión, experiencia y reconocimiento, y estas disfunciones parecen ser independientes unas de oiras. Estos déficits en el procesamiento básico de las emoeiones podrfan estar vinculados con la psicopatologia y la evolucién funcional.

          Translated abstract

          Les déficits émotionnels de la schizophrénie ont été décrits depuis l'époque de Kraepelin. Cependant aucune revue complète sur les études cliniques concernant les émotions n'a jamais été menée à bien. Pour ce faire, nous avons sélectionné des études publiées en anglais et utilisant des critères diagnostiques à partir d'une large recherche sur PubMed. Dans 55 études sur l'expression des émotions, les schizophrènes ont montré à plusieurs reprises, par rapport à des sujets témoins non malades, des expressions moins extériorisées au niveau verbal, facial et acoustique. Aucune différence manifeste n'a été retrouvée entre les sujets schizophrènes et les sujets déprimés. Le vécu émotionnel de la schizophrénie a été étudié dans 63 études. Les schizophrènes font état d'une anhédonie plus importante, et ont tendance au cours des études sur les événements de vie réelle à extérioriser davantage les émotions négatives. Au cours d'études de réminiscence, ils se montrent aimables dans une même proportion et désagréables dans une proportion identique ou plus élevée. Nous pouvons conclure, à partir de 110 études, que la reconnaissance de l'émotion est détériorée dans toutes ses composantes chez les schizophrènes. Ces déficits de perception sociale sont liés à des déficits neurocognitifs et à quelques compétences sociales. Les schizophrènes présentent une dysfonction dans les trois domaines que sont l'expression de l'émotion, le vécu émotionnel et la reconnaissance de l'émotion, altérations semblant être indépendantes les unes des autres. Ces déficits des processus émotionnels de base peuvent être liés à des évolutions psychopathologiques et fonctionnelles.

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          Most cited references 112

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          Contributions of anterior cingulate cortex to behaviour.

          Assessments of anterior cingulate cortex in experimental animals and humans have led to unifying theories of its structural organization and contributions to mammalian behaviour. The anterior cingulate cortex forms a large region around the rostrum of the corpus callosum that is termed the anterior executive region. This region has numerous projections into motor systems, however, since these projections originate from different parts of anterior cingulate cortex and because functional studies have shown that it does not have a uniform contribution to brain functions, the anterior executive region is further subdivided into 'affect' and 'cognition' components. The affect division includes areas 25, 33 and rostral area 24, and has extensive connections with the amygdala and periaqueductal grey, and parts of it project to autonomic brainstem motor nuclei. In addition to regulating autonomic and endocrine functions, it is involved in conditioned emotional learning, vocalizations associated with expressing internal states, assessments of motivational content and assigning emotional valence to internal and external stimuli, and maternal-infant interactions. The cognition division includes caudal areas 24' and 32', the cingulate motor areas in the cingulate sulcus and nociceptive cortex. The cingulate motor areas project to the spinal cord and red nucleus and have premotor functions, while the nociceptive area is engaged in both response selection and cognitively demanding information processing. The cingulate epilepsy syndrome provides important support of experimental animal and human functional imaging studies for the role of anterior cingulate cortex in movement, affect and social behaviours. Excessive cingulate activity in cases with seizures confirmed in anterior cingulate cortex with subdural electrode recordings, can impair consciousness, alter affective state and expression, and influence skeletomotor and autonomic activity. Interictally, patients with anterior cingulate cortex epilepsy often display psychopathic or sociopathic behaviours. In other clinical examples of elevated anterior cingulate cortex activity it may contribute to tics, obsessive-compulsive behaviours, and aberrent social behaviour. Conversely, reduced cingulate activity following infarcts or surgery can contribute to behavioural disorders including akinetic mutism, diminished self-awareness and depression, motor neglect and impaired motor initiation, reduced responses to pain, and aberrent social behaviour. The role of anterior cingulate cortex in pain responsiveness is suggested by cingulumotomy results and functional imaging studies during noxious somatic stimulation. The affect division of anterior cingulate cortex modulates autonomic activity and internal emotional responses, while the cognition division is engaged in response selection associated with skeletomotor activity and responses to noxious stimuli. Overall, anterior cingulate cortex appears to play a crucial role in initiation, motivation, and goal-directed behaviours.(ABSTRACT TRUNCATED AT 400 WORDS)
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            Facial affect and affective prosody recognition in first-episode schizophrenia.

            Individuals with schizophrenia experience problems in the perception of emotional material; however, the specificity, extent, and nature of the deficits are unclear. Facial affect and affective prosody recognition were examined in representative samples of individuals with first-episode psychosis, assessed as outpatients during the early recovery phase of illness, and non-patients. Perception tasks were selected to allow examination of emotion category results across face and voice modalities. Facial tasks were computerised modifications of the Feinberg et al. procedure (Feinberg, T.E., Rifkin, A., Schaffer, C., Walker, E., 1986. Arch. Gen. Psychiatry 43, 276--279). Prosody tasks were developed using four professional actors, and item selections were based on responses of undergraduates. Participant groups did not differ in their understanding of the words used to describe emotions. Findings supported small but consistent deficits in recognition of fear and sadness across both communication channels for the combined schizophrenia (n=29) and other psychotic disorders (n=28) groups as compared to the affective psychoses (n=23) and non-patients (n=24). A diagnostic effect was evident that was independent of the contribution of intelligence. The detection of emotion recognition impairments in first-episode schizophrenia suggests a trait deficit. The pattern of results is consistent with amygdala dysfunction in schizophrenia and related psychoses.
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              Emotion perception in schizophrenia: specific deficit or further evidence of generalized poor performance?

              Several studies have investigated the ability of schizophrenics to perceive facial and vocal emotion in others. Although most suggest that schizophrenics have an emotion perception deficit, there is little agreement as to its specific nature. Much of the confusion may be attributed to the failure of investigators to use the differential deficit design and standardized measures of emotion perception. The present study reexamined the question of an emotion recognition deficit in a sample of 29 unmedicated schizophrenics and 23 normal controls, using facial and vocal emotion identification and discrimination tests that have been standardized and cross-validated plus two neuropsychological control tests. Results suggested that differences between schizophrenics and normals on such tasks reflect a generalized performance deficit, rather than a specific emotion recognition deficit.
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                Author and article information

                Contributors
                Nathan Kline Institute, Orangeburg, NY, USA
                Journal
                Dialogues Clin Neurosci
                Dialogues Clin Neurosci
                Dialogues in Clinical Neuroscience
                Les Laboratoires Servier (France )
                1294-8322
                1958-5969
                March 2006
                March 2006
                : 8
                : 1
                : 59-70
                Affiliations
                Nathan Kline Institute, Orangeburg, NY, USA
                Author notes
                Article
                3181757
                16640115
                Copyright: © 2006 LLS

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Clinical Research

                Neurosciences

                deficit, expression, affect, schizophrenia, recognition, experience, emotion

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