Facial emotion recognition impaired early in schizophrenia, stable across disease course

Deficits in facial emotion recognition are apparent early in the course of schizophrenia but remain stable throughout the course of the disease, findings from a cross-sectional study suggest.

In the study of 43 patients with putative prodromal syndrome, 50 patients with a first episode of schizophrenia with very recent onset, 44 patients with multi-episode schizophrenia, and 86 unaffected healthy control subjects, deficits in the recognition of sadness and disgust were apparent in prodromal individuals, and deficits in recognition of all negative emotions were apparent in both first- and multi-episode patients, Dr. Anna Comparelli of Sapienza University of Rome, and her colleagues reported online in Schizophrenia Research.

Specifically, the patients with putative prodromal syndrome (the ultra-high-risk group) performed significantly worse than did healthy control subjects on recognition of sadness and disgust; the first-episode patients performed worse than did healthy controls on recognition of sadness, disgust, anger, and fear; and the multi-episode patients performed worse than did healthy controls on sadness, disgust, anger, fear, and happiness.

After adjustment for sociodemographic and clinical variables that differed significantly between the groups, and after correction for age, sex, and Positive and Negative Syndrome Scale (PANSS) positive and total scores, the significant differences between the groups were confirmed (Schizophrenia Res. 2012 Dec. 6 [doi: 10.1016/j.schres.2012.11.005]).

Patients in the ultra-high-risk group did worse than did healthy controls in recognizing sadness and disgust (P < .001), and those with first-episode psychosis performed worse than did healthy control subjects for sadness, disgust, anger, and fear (all P < .001). Meanwhile, multi-episode patients did worse than did healthy control subjects on sadness, disgust, anger, fear (P < .001), and happiness (P < .05).

The findings support those from previous studies demonstrating that emotion recognition deficit is specific for negative emotions in both first- and multi-episode schizophrenia patients, and they are among the first to compare deficits in emotion recognition in ultra-high-risk and chronic patients, the investigators said.

"Importantly, we did not see any evidence of progression or improvement over the three phases of illness. In fact, a new finding of our study is that, in this cross-sectional cohort, the deficit in facial emotion recognition is stable over the course of illness, not differing between prodromal, [first-episode schizophrenia], and [multi-episode schizophrenia]," they added.

This fits the pattern of a vulnerability indicator, as opposed to an indicator of severity or chronicity, and suggests emotion processing dysfunction as a possible endophenotype related to genetic risk, they said.

"Further studies on social cognition addressing its trend to impair, improve, or remain stable across the course of illness and whether there is any relationship with the progression of other cognitive domains are needed," they added.

Though limited by the fact that a possible role of antipsychotic drugs in emotion recognition was not ruled out and by the cross-sectional study design, this study nonetheless represents "a step toward better elucidation of the possible role of emotion recognition impairment in schizophrenia following its prodromal manifestations," the investigators said.

"The understanding of the interactions between neurocognition, social cognition, and social functioning in schizophrenia should be a goal for future research in the field of early intervention in psychosis. In fact, complex neurofunctional and psychological mechanisms underlying social cognition and functioning may highlight correct strategies for prevention and intervention."

Dr. Comparelli reported having no disclosures.

Deficits in facial emotion recognition are apparent early in the course of schizophrenia but remain stable throughout the course of the disease, findings from a cross-sectional study suggest.

In the study of 43 patients with putative prodromal syndrome, 50 patients with a first episode of schizophrenia with very recent onset, 44 patients with multi-episode schizophrenia, and 86 unaffected healthy control subjects, deficits in the recognition of sadness and disgust were apparent in prodromal individuals, and deficits in recognition of all negative emotions were apparent in both first- and multi-episode patients, Dr. Anna Comparelli of Sapienza University of Rome, and her colleagues reported online in Schizophrenia Research.

Specifically, the patients with putative prodromal syndrome (the ultra-high-risk group) performed significantly worse than did healthy control subjects on recognition of sadness and disgust; the first-episode patients performed worse than did healthy controls on recognition of sadness, disgust, anger, and fear; and the multi-episode patients performed worse than did healthy controls on sadness, disgust, anger, fear, and happiness.

After adjustment for sociodemographic and clinical variables that differed significantly between the groups, and after correction for age, sex, and Positive and Negative Syndrome Scale (PANSS) positive and total scores, the significant differences between the groups were confirmed (Schizophrenia Res. 2012 Dec. 6 [doi: 10.1016/j.schres.2012.11.005]).

Patients in the ultra-high-risk group did worse than did healthy controls in recognizing sadness and disgust (P < .001), and those with first-episode psychosis performed worse than did healthy control subjects for sadness, disgust, anger, and fear (all P < .001). Meanwhile, multi-episode patients did worse than did healthy control subjects on sadness, disgust, anger, fear (P < .001), and happiness (P < .05).

The findings support those from previous studies demonstrating that emotion recognition deficit is specific for negative emotions in both first- and multi-episode schizophrenia patients, and they are among the first to compare deficits in emotion recognition in ultra-high-risk and chronic patients, the investigators said.

"Importantly, we did not see any evidence of progression or improvement over the three phases of illness. In fact, a new finding of our study is that, in this cross-sectional cohort, the deficit in facial emotion recognition is stable over the course of illness, not differing between prodromal, [first-episode schizophrenia], and [multi-episode schizophrenia]," they added.

This fits the pattern of a vulnerability indicator, as opposed to an indicator of severity or chronicity, and suggests emotion processing dysfunction as a possible endophenotype related to genetic risk, they said.

"Further studies on social cognition addressing its trend to impair, improve, or remain stable across the course of illness and whether there is any relationship with the progression of other cognitive domains are needed," they added.

Though limited by the fact that a possible role of antipsychotic drugs in emotion recognition was not ruled out and by the cross-sectional study design, this study nonetheless represents "a step toward better elucidation of the possible role of emotion recognition impairment in schizophrenia following its prodromal manifestations," the investigators said.

"The understanding of the interactions between neurocognition, social cognition, and social functioning in schizophrenia should be a goal for future research in the field of early intervention in psychosis. In fact, complex neurofunctional and psychological mechanisms underlying social cognition and functioning may highlight correct strategies for prevention and intervention."

Dr. Comparelli reported having no disclosures.

Deficits in facial emotion recognition are apparent early in the course of schizophrenia but remain stable throughout the course of the disease, findings from a cross-sectional study suggest.

In the study of 43 patients with putative prodromal syndrome, 50 patients with a first episode of schizophrenia with very recent onset, 44 patients with multi-episode schizophrenia, and 86 unaffected healthy control subjects, deficits in the recognition of sadness and disgust were apparent in prodromal individuals, and deficits in recognition of all negative emotions were apparent in both first- and multi-episode patients, Dr. Anna Comparelli of Sapienza University of Rome, and her colleagues reported online in Schizophrenia Research.

Specifically, the patients with putative prodromal syndrome (the ultra-high-risk group) performed significantly worse than did healthy control subjects on recognition of sadness and disgust; the first-episode patients performed worse than did healthy controls on recognition of sadness, disgust, anger, and fear; and the multi-episode patients performed worse than did healthy controls on sadness, disgust, anger, fear, and happiness.

After adjustment for sociodemographic and clinical variables that differed significantly between the groups, and after correction for age, sex, and Positive and Negative Syndrome Scale (PANSS) positive and total scores, the significant differences between the groups were confirmed (Schizophrenia Res. 2012 Dec. 6 [doi: 10.1016/j.schres.2012.11.005]).

Patients in the ultra-high-risk group did worse than did healthy controls in recognizing sadness and disgust (P < .001), and those with first-episode psychosis performed worse than did healthy control subjects for sadness, disgust, anger, and fear (all P < .001). Meanwhile, multi-episode patients did worse than did healthy control subjects on sadness, disgust, anger, fear (P < .001), and happiness (P < .05).

The findings support those from previous studies demonstrating that emotion recognition deficit is specific for negative emotions in both first- and multi-episode schizophrenia patients, and they are among the first to compare deficits in emotion recognition in ultra-high-risk and chronic patients, the investigators said.

"Importantly, we did not see any evidence of progression or improvement over the three phases of illness. In fact, a new finding of our study is that, in this cross-sectional cohort, the deficit in facial emotion recognition is stable over the course of illness, not differing between prodromal, [first-episode schizophrenia], and [multi-episode schizophrenia]," they added.

This fits the pattern of a vulnerability indicator, as opposed to an indicator of severity or chronicity, and suggests emotion processing dysfunction as a possible endophenotype related to genetic risk, they said.

"Further studies on social cognition addressing its trend to impair, improve, or remain stable across the course of illness and whether there is any relationship with the progression of other cognitive domains are needed," they added.

Though limited by the fact that a possible role of antipsychotic drugs in emotion recognition was not ruled out and by the cross-sectional study design, this study nonetheless represents "a step toward better elucidation of the possible role of emotion recognition impairment in schizophrenia following its prodromal manifestations," the investigators said.

"The understanding of the interactions between neurocognition, social cognition, and social functioning in schizophrenia should be a goal for future research in the field of early intervention in psychosis. In fact, complex neurofunctional and psychological mechanisms underlying social cognition and functioning may highlight correct strategies for prevention and intervention."

Dr. Comparelli reported having no disclosures.