Facial affect processing deficits in schizophrenia: A meta-analysis of antipsychotic treatment effects

Abstract

Social cognition, including emotion processing, is a recognised deficit observed in patients with schizophrenia. It is one cognitive domain which has been emphasised as requiring further investigation, with the efficacy of antipsychotic treatment on this deficit remaining unclear. Nine studies met our criteria for entry into a meta-analysis of the effects of medication on facial affect processing, including data from 1162 patients and six antipsychotics. Overall we found a small, positive effect (Hedge’s g = 0.13, 95% CI 0.05 to 0.21, p = 0.002). In a subgroup analysis this was statistically significant for atypical, but not typical, antipsychotics. It should be noted that the pooled sample size of the typical subgroup was significantly lower than the atypical. Meta-regression analyses revealed that age, gender and changes in symptom severity were not moderating factors. For the small, positive effect on facial affect processing, the clinical significance is questionable in terms of treating deficits in emotion identification in schizophrenia. We show that antipsychotic medications are poor at improving facial affect processing compared to reducing symptoms. This highlights the need for further investigation into the neuropharmacological mechanisms associated with accurate emotion processing, to inform treatment options for these deficits in schizophrenia.

Transcranial Direct Current Stimulation on the Left Superior Temporal Sulcus Improves Social Cognition in Schizophrenia: An Open-Label Study

“…First, the effect sizes obtained in this study are no less than those of cognitive rehabilitation that requires a greater constraint of time for patients and medical staffs (11). Second, effect sizes of tDCS on social cognition, reported here, are also greater than those of pharmacotherapy (37)(38)(39), while tDCS is only associated with local insults in most cases, unlike the case for medications that penetrate into the whole body. Therefore, tDCS may be useful in patients who cannot receive other modalities of treatment due to time constraints or intolerance caused by systemic side effects.…”

Masked ambiguity – Emotion identification in schizophrenia and major depressive disorder

“…It must be assumed that cognitive functioning of patients (with a neuroleptic) impacts the test results in emotion identification. However, recent studies on the impact of antipsychotic treatment on cognitive performance support the idea that negative effects on emotion identification are negligible (Gabay et al, 2015). Moreover, in this task we used emotion-labeling, which has been shown to be deficient in patients with affective disorders and schizophrenia (Feinberg et al, 1986).…”

Improved facial affect recognition in patients with first‐episode psychosis

“…These deficits may contribute to reduced occupational efficiency, independent living (Hamilton et al, 2014) and social functioning (Lee, Zaki, Harvey, Ochsner, & Green, 2011). Moreover, FAR deficits seem to be relatively resistant to antipsychotic medication (Gabay, Kempton, & Mehta, 2015).…”