Emotion recognition deficits as predictors of transition in individuals at clinical high risk for schizophrenia: a neurodevelopmental perspective

Abstract

Background Schizophrenia is characterized by profound and disabling deficits in the ability to recognize emotion in facial expression and tone of voice. Although these deficits are well documented in established schizophrenia using recently validated tasks, their predictive utility in at-risk populations has not been formally evaluated. Method The Penn Emotion Recognition and Discrimination tasks, and recently developed measures of auditory emotion recognition, were administered to 49 clinical high-risk subjects prospectively followed for 2 years for schizophrenia outcome, and 31 healthy controls, and a developmental cohort of 43 individuals aged 7–26 years. Deficit in emotion recognition in at-risk subjects was compared with deficit in established schizophrenia, and with normal neurocognitive growth curves from childhood to early adulthood. Results Deficits in emotion recognition significantly distinguished at-risk patients who transitioned to schizophrenia. By contrast, more general neurocognitive measures, such as attention vigilance or processing speed, were non-predictive. The best classification model for schizophrenia onset included both face emotion processing and negative symptoms, with accuracy of 96%, and area under the receiver-operating characteristic curve of 0.99. In a parallel developmental study, emotion recognition abilities were found to reach maturity prior to traditional age of risk for schizophrenia, suggesting they may serve as objective markers of early developmental insult. Conclusions Profound deficits in emotion recognition exist in at-risk patients prior to schizophrenia onset. They may serve as an index of early developmental insult, and represent an effective target for early identification and remediation. Future studies investigating emotion recognition deficits at both mechanistic and predictive levels are strongly encouraged.

Neural Substrates of Auditory Emotion Recognition Deficits in Schizophrenia

“…In healthy volunteers, we observed bitemporal MMN responses to FM deviant tones suggesting potential activation of both medial temporal and auditory structures (Leitman et al, 2011a). In addition, functional dysconnectivity has been shown to contribute to cognitive dysfunction in schizophrenia, across frontal, limbic, and parietal networks (Deserno et al, 2012;Mukherjee et al, 2012;Hoptman et al, 2014). In the present report, rsfMRI "seeds" were placed in bilateral auditory and anterior insula cortex based on MMN source localization, and contributions of sensory-insular dysconnectivity to impaired AER function were assessed.…”

“…AER deficits have been observed in individuals at high symptomatic risk for schizophrenia even before illness onset (Amminger et al, 2012;Corcoran et al, 2015), suggesting that such deficits are likely present early in the course of the disorder and are independent from subsequent treatment. Finally, not all subjects participated in all components of the study.…”

Auditory dysfunction in schizophrenia: integrating clinical and basic features

“…Furthermore, in individuals showing potential early (prodromal) symptoms of schizophrenia and therefore deemed to be at high risk of developing this disorder, deficits in MMN generation 35,36 and auditory sensory measures 37 precede illness onset and predict which individuals will progress to psychosis. Once present, deficits in MMN persist despite treatment with antipsychotic medications, highlighting the utility of neurophysiological markers for both clinical and translational research approaches.…”

Basic self‐disturbance, neurocognition and metacognition: A pilot study among help‐seeking adolescents with and without attenuated psychosis syndrome

“…Over the past 2 decades, 2 lines of research have established that basic self-disturbance (SD) (Comparelli et al, 2016;Koren, Lacoua, Rothschild-Yakar, & Parnas, 2016;Koren et al, 2013;Nelson, Thompson, & Yung, 2012;Nelson, Thompson, & Yung, 2013;Parnas et al, 2011;Parnas, Handest, Jansson, & Saebye, 2005;Raballo et al, 2016) and impaired neurocognition (Addington & Heinssen, 2012;Bora & Murray, 2014;Brewer et al, 2006;Carrión et al, 2015;Corcoran et al, 2015;Corigliano et al, 2014;Eastvold, Heaton, & Cadenhead, 2007;Fusar-Poli et al, 2012;Giuliano et al, 2012;Hawkins et al, 2004;Lee, Hong, Shin, & Kwon, 2015;Pukrop & Klosterkotter, 2010;Pukrop et al, 2006;Seidman et al, 2010;Seidman et al, 2016) are important trait-like features of schizophrenia and risk for psychosis. Disturbance of basic or minima self refers to instability in the tacit (pre-reflective) sense of being a self-coinciding and self-present subject of experience and action (Huber & Gross, 1989;Nelson, Yung, Bechdolf, & McGorry, 2008;Parnas & Handest, 2003).…”