Facial emotion recognition and its association with symptom severity, functionality, and cognitive impairment in schizophrenia: preliminary results

Johanna Vanessa Suárez-Salazar, Ana Fresán-Orellana, Ricardo Arturo Saracco-Álvarez

DOI: https://doi.org/10.17711/SM.0185-3325.2020.015

Abstract


Introduction. There is evidence to suggest that individuals with schizophrenia have greater difficulty in recognizing facial emotions, which has been related to cognitive impairment and higher symptom severity in this disease and seems to lead to a worse functional prognosis.

Objective. To determine the association between facial emotion recognition and symptom severity, functionality, and cognitive impairment in a sample of schizophrenic patients.

Method. This is an observational, cross-sectional, and correlational study conducted on 72 patients. The following scales: PANSS, MOCA, ERI, and FACT-Sz were used to assess symptom severity in schizophrenia, cognitive functioning, facial emotion recognition, and functionality, respectively. The Pearson Correlation Coefficient was used to measure the linear association between all variables.

Results. Overall, moderate symptom severity and mild cognitive and functional disability were found. The most frequently recognized emotion was joy (70%) and the least frequently recognized one was anger. A positive association was also found between anger recognition and severity of the PANSS cognitive subscale (r = - .24, p = .03), sadness recognition and severity of the PANSS negative subscale (r = - .24, p = .03), and the FACT-Sz score and fear recognition (r = .31, p = .008).

Discussion and conclusion. The present study yields preliminary results that provide a broader perspective on facial emotion recognition and, indirectly, social interaction and functionality in people with schizophrenia.

Keywords


Schizophrenia; facial recognition; cognitive dysfunction; emotions

Full Text:

HTML PDF EPUB

References


Addington, J., & Addington, D. (1993). Premorbid functioning, cognitive functioning, symptoms and outcome in schizophrenia. Journal of Psychiatry and Neuroscience, 18(1), 18-23.

Aguilar-Navarro, S. G., Mimenza-Alvarado, A. J., Palacios-García, A. A., Samudio-Cruz, A., Gutiérrez-Gutiérrez, L. A., & Ávila-Funes, J. A. (2018). Validez y confiabilidad del MoCA (Montreal Cognitive Assessment) para el tamizaje del deterioro cognoscitivo en México. Revista Colombiana de Psiquiatría, 47(4), 237-243. doi: 10.1016/j.rcp.2017.05.003

Barkl, S. J., Lah, S., Harris, A. W., & Williams, L. M. (2014). Facial emotion identification in early-onset and first-episode psychosis: A systematic review with meta-analysis. Schizophrenia Research, 159(1), 62-69. doi: 10.1016/j.schres.2014.07.049

Bora, E., Yalincetin, B., Akdede, B. B., & Alptekin, K. (2018). Duration of untreated psychosis and neurocognition in first-episode psychosis: A meta-analysis. Schizophrenia Research, 193, 3-10. doi: 10.1016/j.schres.2017.06.021

Chan, R. C., Li, H., Cheung, E. F., & Gong, Q. (2010). Impaired facial emotion perception in schizophrenia: A meta-analysis. Psychiatry Research, 178(2), 381-390. doi: 10.1016/j.psychres.2009.03.035

Cohen, J. (2013). Statistical power analysis for the behavioral sciences (Second Edition). New York: Lawrence Erlbaum Associates, Publishers. ISBN 0-8058-0283-5

Corigliano, V., De Carolis, A., Trovini, G., Dehning, J., Di Pietro, S., Curto, M., Donato, N., De Pisa, E., Girardi, P., & Comparelli, A. (2014). Neurocognition in schizophrenia: From prodrome to multi-episode illness. Psychiatry Research, 220(1-2), 129-134. doi: 10.1016/j.psychres.2014.07.067

Corredor Rozo, Z. L., Sánchez Espinosa, M. P., Rondón Lagos, M., Páez Rojas, P. L., Cortés Duque C. I., & Forero Castro, R. M. (2013). Estudio descriptivo de una muestra de pacientes con esquizofrenia residentes en el departamento de Boyacá, Colombia. Iatreia, 26(3), 245-256.

Daltio, C. S., Attux, C., & Ferraz, M. B. (2015). Knowledge in schizophrenia: The Portuguese version of KAST (Knowledge About Schizophrenia Test) and analysis of social-demographic and clinical factors’ influence. Schizophrenia Research, 168(1-2), 168-173. doi: 10.1016/j.schres.2015.07.009

Demirbuga, S., Sahin, E., Ozver, I., Aliustaoglu, S., Kandemir, E., Varkal, M. D., ... Ince, H. (2013). Facial emotion recognition in patients with violent schizophrenia. Schizophrenia Research, 144(1-3), 142-145. doi: 10.1016/j.schres.2012.12.015

Ekman, P. (1992). An argument for basic emotions. Cognition and Emotion, 6(3-4), 169-200. doi: 10.1080/02699939208411068

Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists Press.

Ekman, P., & Friesen, W. V. (1986). A new pan-cultural facial expression of emotion. Motivation and Emotion, 10(2), 159-168. doi: 10.1007/bf00992253

Fresán, A., De la Fuente-Sandoval, C., Loyzaga, C., Garcı́a-Anaya, M., Meyenberg, N., Nicolini, H., & Apiquian, R. (2005). A forced five-dimensional factor analysis and concurrent validity of the Positive and Negative Syndrome Scale in Mexican schizophrenic patients. Schizophrenia Research, 72(2-3), 123-129. doi: 10.1016/j.schres.2004.03.021

Garay, I. (2013). Estudio comparativo de los pacientes con esquizofrenia según su funcionalidad de acuerdo a las escalas FACT-Sz, CGI, GAF, PANSS y su asociación con la respuesta y resistencia a tratamiento (tesis para titulación del curso de posgrado de alta especialidad en medicina: manejo integral de los trastornos esquizofrénicos). Universidad Nacional Autónoma de México, México.

García, I., Fresán-Orellana, A., Medina-Mora, M. E., & Ruiz, G. M. (2008). Impact of Duration of Untreated Psychosis (DUP) in the course and outcome of schizophrenia. Salud Mental, 31(6), 479-485.

García, R. R., Aliste, F., & Soto, G. (2018). Cognición social en esquizofrenia: aspectos cognitivos y neurobiológicos. Revista Colombiana de Psiquiatría, 47(3), 170-176. doi: 10.1016/j.rcp.2017.03.004

Gómez, F., Zunzunegui, M. V., Lord, C., Alvarado, B., & García, A. (2013). Applicability of the MoCA‐S test in populations with little education in Colombia. International Journal of Geriatric Psychiatry, 28(8), 813-820. doi: 10.1002/gps.3885

Hernández, R., Fernández, C., & Baptista, P. (2014). Metodología de la Investigación (Sexta Edición). México D.F.: McGraw-Hill/Interamericana.

Hooker, C., & Park, S. (2002). Emotion processing and its relationship to social functioning in schizophrenia patients. Psychiatry Research, 112(1), 41-50. doi: 10.1016/s0165-1781(02)00177-4

Jetha, M. K., Zheng, X., Goldberg, J. O., Segalowitz, S. J., & Schmidt, L. A. (2013). Shyness and emotional face processing in schizophrenia: An ERP study. Biological Psychology, 94(3), 562-574. doi: 10.1016/j.biopsycho.2013.10.001

Julayanont, P., Tangwongchai, S., Hemrungrojn, S., Tunvirachaisakul, C., Phanthumchinda, K., Hongsawat, J., ... Nasreddine, Z. S. (2015). The Montreal Cognitive Assessment-Basic: A Screening Tool for Mild Cognitive Impairment in Illiterate and Low-Educated Elderly Adults. Journal of the American Geriatrics Society, 63(12), 2550-2554. doi: 10.1111/jgs.13820

Kee, K. S., Horan, W. P., Wynn, J. K., Mintz, J., & Green, M. F. (2006). An analysis of categorical perception of facial emotion in schizophrenia. Schizophrenia Research, 87(1-3), 228-237. doi: 10.1016/j.schres.2006.06.001

Li, H., Chan, R. C., Zhao, Q., Hong, X., & Gong, Q. (2010). Facial emotion perception in Chinese patients with schizophrenia and non-psychotic first-degree relatives. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 34(2), 393-400. doi: 10.1016/j.pnpbp.2010.01.007

Liu, T., Pinheiro, A. P., Zhao, Z., Nestor, P. G., McCarley, R. W., & Niznikiewicz, M. (2016). Simultaneous face and voice processing in schizophrenia. Behavioural Brain Research, 305, 76-86. doi: 10.1016/j.bbr.2016.01.039

Mendoza, R., Cabral-Calderin, Y., Domínguez, M., Garcia, A., Borrego, M., Caballero, A., ... Reyes, M. M. (2011). Impairment of emotional expression recognition in schizophrenia: A Cuban familial association study. Psychiatry Research, 185(1-2), 44-48. doi: 10.1016/j.psychres.2009.10.006

Namiki, C., Hirao, K., Yamada, M., Hanakawa, T., Fukuyama, H., Hayashi, T., & Murai, T. (2007). Impaired facial emotion recognition and reduced amygdalar volume in schizophrenia. Psychiatry Research: Neuroimaging, 156(1), 23-32. doi: 10.1016/j.pscychresns.2007.03.004

On, Z. X., Cotton, S., Farhall, J., Killackey, E., & Allott, K. (2016). Relationship between duration of untreated psychosis and neurocognition and social cognition in first-episode psychosis. Schizophrenia Research, 176(2-3), 529-532. doi: 10.1016/j.schres.2016.06.018

Pérez-Rincón, H. (1994). Imágenes del cuerpo (Segunda Edición). (pp. 230). México, D.F.: Fondo de Cultura Económica.

Pérez-Rincón, H., Cortés, J., & Díaz-Martínez, A. (1999). El reconocimiento de la expresión facial de las emociones. Salud Mental, 22(1), 17-23.

Rodríguez-Bores Ramírez, L., Saracco-Álvarez, R., Escamilla-Orozco, R., & Fresán Orellana, A. (2014). Validez de la Escala de Evaluación Cognitiva de Montreal (MoCA) para determinar deterioro cognitivo en pacientes con esquizofrenia. Salud Mental, 37(6), 517-522.

Rodriguez-Jimenez, R., Dompablo, M., Bagney, A., Santabárbara, J., Aparicio, A. I., Torio, I., ... Palomo, T. (2015). The MCCB impairment profile in a Spanish sample of patients with schizophrenia: Effects of diagnosis, age, and gender on cognitive functioning. Schizophrenia Research, 169(1-3), 116-120. doi: 10.1016/j.schres.2015.09.013

Romero-Ferreiro, M. V., Aguado, L., Rodriguez-Torresano, J., Palomo, T., Rodriguez-Jimenez, R., & Pedreira-Massa, J. L. (2016). Facial affect recognition in early and late-stage schizophrenia patients. Schizophrenia Research, 172(1-3), 177-183. doi: 10.1016/j.schres.2016.02.010

Rund, B. R. (2018). The research evidence for schizophrenia as a neurodevelopmental disorder. Scandinavian Journal of Psychology, 59(1), 49-58. doi:10.1111/sjop.12414

Russell, J. A. (1994). Is there universal recognition of emotion from facial expression? A review of the cross-cultural studies. Psychological Bulletin, 115(1), 102-141. doi: 10.1037/0033-2909.115.1.102

Sachse, M., Schlitt, S., Hainz, D., Ciaramidaro, A., Walter, H., Poustka, F., ... Freitag, C. M. (2014). Facial emotion recognition in paranoid schizophrenia and autism spectrum disorder. Schizophrenia Research, 159(2-3), 509-514. doi: 10.1016/j.schres.2014.08.030

Saha, S., Chant, D., Welham, J., & McGrath, J. (2005). A Systematic Review of the Prevalence of Schizophrenia. PLoS Medicine, 2(5), e141. doi: 10.1371/journal.pmed.0020141

Saracco-Alvarez, R., Fresán, A., & Escamilla-Orozco, R. (2013). Facial emotion recognition in schizophrenia: A comparison with siblings and control subjects. Schizophrenia Research, 151(1-3), 291-292. doi: 10.1016/j.schres.2013.09.028

Scherer, K. R., & Scherer, U. (2011). Assessing the Ability to Recognize Facial and Vocal Expressions of Emotion: Construction and Validation of the Emotion Recognition Index. Journal of Nonverbal Behavior, 35(4), 305-326. doi: 10.1007/s10919-011-0115-4

Suzuki, T., Uchida, H., Nomura, K., Takeuchi, H., Nakajima, S., Tanabe, A., Yagi, G., Watanabe, K., & Kashima, H. (2008). Novel rating scales for schizophrenia — Targeted Inventory on Problems in Schizophrenia (TIP-Sz) and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz). Schizophrenia Research, 106(2-3), 328-336. doi: 10.1016/j.schres.2008.08.013

Tse, W. S., Lu, Y., Bond, A. J., Chan, R. C., & Tam, D. W. (2011). Facial emotion linked cooperation in patients with paranoid schizophrenia: A test on the Interpersonal Communication Model. International Journal of Social Psychiatry, 57(5), 509-517. doi: 10.1177/0020764010371276

Watanuki, T., Matsuo, K., Egashira, K., Nakashima, M., Harada, K., Nakano, M., ... Watanabe, Y. (2016). Precentral and inferior prefrontal hypoactivation during facial emotion recognition in patients with schizophrenia: A functional near-infrared spectroscopy study. Schizophrenia Research, 170(1), 109-114. doi: 10.1016/j.schres.2015.11.012

World Medical Association. (2013). Declaración de Helsinki - Principios éticos para las investigaciones médicas en seres humanos. 64ª Asamblea General. Fortaleza, Brasil.

Xu, Q., Yang, Y., Zhang, E., Qiao, F., Lin, W., & Liang, N. (2015). Emotional conflict in facial expression processing during scene viewing: An ERP study. Brain Research, 1608, 138-146. doi: 10.1016/j.brainres.2015.02.047