Impaired facial emotion perception of briefly presented double masked stimuli in violent offenders with schizophrenia spectrum disorders

Abstract

Social interactions require decoding of subtle rapidly changing emotional cues in others to facilitate socially appropriate behaviour. It is possible that impairments in the ability to detect and decode these signals may increase the risk for aggression. Therefore, we examined violent offenders with schizophrenia spectrum disorders (SSD) and compared these with healthy controls on a computerized paradigm of briefly presented double masked faces exhibiting 7 basic emotions. Our hypotheses were that impaired semantic understanding of emotion words and low cognitive ability would yield lowest emotion recognition. SSD exhibited lower accuracy of emotion perception than controls (46.1% compared with 64.5%, p = 0.026), even when considering the unbiased hit rate (22.4% compared with 43%, Z = 2.62, p < 0.01). Raw data showed uncommon but significant misclassifications of fear as sad, disgust as sad, sad as happy and angry as surprise. Once guessing and presentation frequencies were considered, only overall accuracy differed between SSD and healthy controls. There were significant correlations between cognitive ability, antipsychotic dose, speed and emotion accuracy in the SSD group. In conclusion, that there were no specific emotion biases in the SSD group compared to healthy controls, but particular individuals may have greater impairments in facial emotion perception, being influenced by intellectual ability, psychomotor speed and medication dosages, rather than specifically emotion word understanding. This implies that both state and trait factors influence emotion perception in the aggressive SSD group and may reveal one source of potential misunderstanding of social situations which may lead to boundary violations and aggression.

Neurocognition and social cognition in patients with schizophrenia spectrum disorders with and without a history of violence: results of a multinational European study

“…Also in this case, indeed, we observed impaired performance only in non-forensic patients compared with both forensic patients and HCs, while the latter groups did not differ with each other. This pattern fits with previous evidence of impaired contempt recognition in different samples of patients with schizophrenia [ 70 , 71 ], but not in violent offenders with SSD [ 72 ]. As for anger, this pattern suggests that hypersensitivity to the facial expression of contempt differentiates these emotions, increasing the ability to recognize them despite a general pattern of impaired recognition of negative emotions.…”

Cognition, prior aggression, and psychopathic traits in relation to impaired multimodal emotion recognition in psychotic spectrum disorders

“…Our results are in line with the extensive literature on emotion recognition deficits in schizophrenia ( 2–4 , 9 , 20 , 22 , 37 , 52 ) and in bipolar disorder ( 2 ); in video paradigms of emotion portrayals ( 12 ), in audio paradigms ( 15–17 , 19 ) and in point-light display studies ( 48 , 49 , 53 , 54 ). Yet our results suggest more severe impairment, especially in those who had been aggressive (31% drop in accuracy for PSD+Agg, and 17% drop for PSD-Agg, compared to healthy individuals), where other studies report a 5–20% drop in accuracy compared with healthy controls.…”

“…Emotion recognition research has mainly examined the six basic emotions of fear, sadness, anger, disgust, surprise, and happiness in facial emotion recognition; it is unclear if emotion recognition is worse in individuals with PSD with respect to a history of aggression if more ecologically valid multimodal emotion portrayals are used. Given the associations between cognitive function and emotion recognition in bipolar disorder ( 2 , 22 ) and in PSD ( 37 ) it is paramount to take cognition into account to ascertain if psychopathic traits and/or a history of aggression is associated with greater impairments in emotion recognition in the PSD group. Furthermore, it is necessary to control for possible effects of impaired semantic understanding of emotion words and possible psychomotor slowing from antipsychotic medications.…”

Psychotically driven aggression is associated with greater mentalizing challenges in psychotic spectrum disorders

“…Eighty-one individuals with PSD were recruited from the Stockholm Forensic Psychiatric Project (SFPP), which was established to investigate potential links between epidemiologically based risk factors for aggression in those with PSD with psychological measures and biological parameters. Further information regarding the overarching SFPP is described elsewhere in detail [21]. This sub-study of the SFPP is a cross-sectional cohort study of persons sentenced to receive inpatient compulsory forensic psychiatric care because of aggressive acts or a history of aggressive acts.…”