Gaze-speech coordination during social interaction in Parkinson's disease.

BACKGROUND: Parkinson's disease (PD) can affect social interaction and communication as well as motor and cognitive processes. Speech is affected in PD, as is the control of voluntary eye movements which are thought to play an important role in 'turn taking' in conversation. AIMS: This study aimed to measure eye movements during spoken conversation in PD to assess whether differences in patterns of eye gaze are linked to disrupted turn taking and impaired communication efficiency. METHODS & PROCEDURE: Eleven participants with mild PD and 14 controls completed a two-player guessing game. During each 3 min game turn, one of the players had to guess the names of as many objects as possible based only on the other player's description. Eye movements were recorded simultaneously in both participants using mobile eye trackers along with speech onset and offset times. OUTCOMES & RESULTS: When people with PD played the role of describer, the other player guessed fewer objects compared to when controls described objects. When guessing objects, people with PD performed just as well as controls. Analysis of eye fixations showed that people with PD made longer periods of fixation on the other player's face relative to controls and a lower number of such 'gaze on face' periods. CONCLUSIONS & IMPLICATIONS: A combination of oculomotor, cognitive and speech abnormalities may disrupt communication in PD. Better public awareness of oculomotor, speech and other deficits in the condition could improve social connectedness in people with Parkinson's. WHAT THIS PAPER ADDS: What is already known on this subject? Parkinson's disease is known to affect the control of voluntary eye movements. Direction of eye gaze is important in spoken conversation as a cue to turn-taking, but no studies have examined whether eye movements are different during communication in people with Parkinson's. What this paper adds to existing knowledge? People with Parkinson's showed longer periods of eye fixation during conversations compared to controls. Delays and overlaps between speech turns were also affected in patients. What are the clinical implications of this work? Better knowledge of the effect of the disease on eye gaze control amongst clinicians may help improve communication and social connectedness for patients in the future.

Patient-reported symptoms and experience following Guillain-Barré syndrome and related conditions: Questionnaire development and validation.

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare inflammatory peripheral nerve disorder with variable recovery. Evidence is lacking on experiences of people with GBS and measurement of these experiences. OBJECTIVE: We aimed to develop and validate an instrument to measure experiences of people with GBS. DESIGN: We used a cross-sectional design and online self-administered questionnaire survey. Question domains, based on a previous systematic review and qualitative study, covered experiences of GBS, symptom severity at each stage, healthcare and factors supporting or hindering recovery. Descriptive, exploratory factor and reliability analyses and multivariable regression analysis were used to investigate the relationships between variables of interest, explore questionnaire reliability and validity and identify factors predicting recovery. SETTING AND PARTICIPANTS: People with a previous diagnosis of GBS were recruited through a social media advert. RESULTS: A total of 291 responders, of different sexes, and marital statuses, were included, with most diagnosed between 2015 and 2019. Factor analysis showed four scales: symptoms, information provided, factors affecting recovery and care received. Positive social interactions, physical activity including physiotherapy and movement, changes made at home and immunoglobulin treatment were important for recovery. Multivariable models showed that immunoglobulin and/or plasma exchange were significant predictors of recovery. Employment and recovery factors (positive interactions, work support and changes at work or home, physical activity and therapy), though associated with recovery, did not reach statistical significance. CONCLUSION: The questionnaire demonstrated good internal reliability of scales and subscales and construct validity for people following GBS. PATIENT CONTRIBUTION: Patients were involved in developing and piloting the questionnaire.

The effect of directional social cues on saccadic eye movements in Parkinson's disease.

There is growing interest in how social processes and behaviour might be affected in Parkinson's disease. A task which has been widely used to assess how people orient attention in response to social cues is the spatial cueing task. Socially relevant directional cues, such as a picture of someone gazing or pointing to the left or the right have been shown to cause orienting of visual attention in the cued direction. The basal ganglia may play a role in responding to such directional cues, but no studies to date have examined whether similar social cueing effects are seen in people with Parkinson's disease. In this study, patients and healthy controls completed a prosaccade (Experiment 1) and an antisaccade task (Experiment 2) in which the target was preceded by arrow, eye gaze or pointing finger cues. Patients showed increased errors and response times for antisaccades but not prosaccades. Healthy participants made most anticipatory errors on pointing finger cue trials, but Parkinson's patients were equally affected by arrow, eye gaze and pointing cues. It is concluded that Parkinson's patients have a reduced ability to suppress responding to directional cues, but this effect is not specific to social cues.

Exploring the experiences of having Guillain-Barré Syndrome: A qualitative interview study.

BACKGROUND: Guillain-Barré syndrome (GBS) is a rare inflammatory disorder affecting the peripheral nerves. Although typically there is full neurological recovery, some people continue to experience residual physical, psychological or social problems longer term. Evidence describing the experiences of people with GBS is limited. OBJECTIVE: We aimed to explore the experiences of people with GBS in the UK. DESIGN: We used qualitative (face-to-face and telephone) interviews to explore experiences of people with GBS. Audio-recorded data were transcribed verbatim and analysed using the Framework Method supported by NVivo 11. SETTING AND PARTICIPANTS: We purposively recruited a sample of 16 volunteers with a prior diagnosis of GBS of varying age, sex, ethnicity, location, marital status, time since diagnosis and length of hospital stay to maximize differences in experience. Interviewees were required to have been discharged from hospital, able to give informed consent, able to speak and understand English and currently resident in the United Kingdom. RESULTS: The key themes arising from the analysis were as follows: the importance of early diagnosis; the experiences of inpatient care; the importance of active support for recovery; the need for communication throughout the course of the illness; the need for greater awareness, knowledge and provision of information by health-care staff; and path to achieving function. CONCLUSION: This is the first qualitative study exploring experiences of people with GBS in the UK through their whole illness journey from onset to recovery. The findings contribute to our understanding of the experiences and support needs of people recovering from GBS.

Eye Movements in the "Morris Maze" Spatial Working Memory Task Reveal Deficits in Strategic Planning.

Analysis of eye movements can provide insights into processes underlying performance of cognitive tasks. We recorded eye movements in healthy participants and people with idiopathic Parkinson disease during a token foraging task based on the spatial working memory component of the widely used Cambridge Neuropsychological Test Automated Battery. Participants selected boxes (using a mouse click) to reveal hidden tokens. Tokens were never hidden under a box where one had been found before, such that memory had to be used to guide box selections. A key measure of performance in the task is between search errors (BSEs) in which a box where a token has been found is selected again. Eye movements were found to be most commonly directed toward the next box to be clicked on, but fixations also occurred at rates higher than expected by chance on boxes farther ahead or back along the search path. Looking ahead and looking back in this way was found to correlate negatively with BSEs and was significantly reduced in patients with Parkinson disease. Refixating boxes where tokens had already been found correlated with BSEs and the severity of Parkinson disease symptoms. It is concluded that eye movements can provide an index of cognitive planning in the task. Refixations on locations where a token has been found may also provide a sensitive indicator of visuospatial memory integrity. Eye movement measures derived from the spatial working memory task may prove useful in the assessment of executive functions as well as neurological and psychiatric diseases in the future.

The developmental trajectory of attentional orienting to socio-biological cues.

It has been proposed that the orienting of attention in the same direction as another's point of gaze relies on innate brain mechanisms which are present from birth, but direct evidence relating to the influence of eye gaze cues on attentional orienting in young children is limited. In two experiments, 137 children aged 3-10 years old performed an adapted pro-saccade task with centrally presented uninformative eye gaze, finger pointing and arrow pre-cues which were either congruent or incongruent with the direction of target presentations. When the central cue overlapped with presentation of the peripheral target (Experiment 1), children up to 5 years old had difficulty disengaging fixation from central fixation in order to saccade to the target. This effect was found to be particularly marked for eye gaze cues. When central cues were extinguished simultaneously with peripheral target onset (Experiment 2), this effect was greatly reduced. In both experiments finger pointing cues (image of pointing index finger presented at fixation) exerted a strong influence on saccade reaction time to the peripheral stimulus for the youngest group of children (<5 years). Overall the results suggest that although young children are strongly engaged by centrally presented eye gaze cues, the directional influence of such cues on overt attentional orienting is only present in older children, meaning that the effect is unlikely to be dependent upon an innate brain module. Instead, the results are consistent with the existence of stimulus-response associations which develop with age and environmental experience.

Applying the British picture vocabulary scale to estimate premorbid cognitive ability in adults.

Estimating premorbid cognitive ability is an essential part of assessment as well as being an important consideration in research. The most widely used approach to premorbid assessment, The National Adult Reading Test (NART), relies on word reading ability. However, this can be problematic in patients where communication is impaired. This research assessed the effectiveness of a receptive vocabulary test, the British Picture Vocabulary Scale II (BPVS) as an alternative. Correlations were found between the BPVS, NART and the Weschler Abbreviated Scale of Intelligence (WASI) in 87 healthy participants. Regression equations were calculated relating NART and BPVS raw scores to IQ scores in the healthy sample. WASI, NART and BPVS scores were also obtained in 19 patients with varying neurological etiology as part of their routine assessment. Results showed that 18 out of 19 patients obtained BPVS derived IQ scores similar to or higher than their WASI IQ. Whereas mean BPVS derived IQ did not differ significantly between the standardization and clinical samples, WASI IQ scores were lower in the patient group. The findings suggest that the BPVS II 'holds' after acquired cognitive impairment and is a promising alternative method for estimating premorbid IQ in patients who have difficulties reading or verbalizing.

Act quickly, decide later: long-latency visual processing underlies perceptual decisions but not reflexive behavior.

Humans largely guide their behavior by their visual representation of the world. Recent studies have shown that visual information can trigger behavior within 150 msec, suggesting that visually guided responses to external events, in fact, precede conscious awareness of those events. However, is such a view correct? By using a texture discrimination task, we show that the brain relies on long-latency visual processing in order to guide perceptual decisions. Decreasing stimulus saliency leads to selective changes in long-latency visually evoked potential components reflecting scene segmentation. These latency changes are accompanied by almost equal changes in simple RTs and points of subjective simultaneity. Furthermore, we find a strong correlation between individual RTs and the latencies of scene segmentation related components in the visually evoked potentials, showing that the processes underlying these late brain potentials are critical in triggering a response. However, using the same texture stimuli in an antisaccade task, we found that reflexive, but erroneous, prosaccades, but not antisaccades, can be triggered by earlier visual processes. In other words: The brain can act quickly, but decides late. Differences between our study and earlier findings suggesting that action precedes conscious awareness can be explained by assuming that task demands determine whether a fast and unconscious, or a slower and conscious, representation is used to initiate a visually guided response.

Deficits in saccadic eye movements differ between subtypes of patients with mild cognitive impairment.

Introduction: Mild cognitive impairment (MCI) is known to be heterogeneous in its cognitive features and course of progression. Whilst memory impairment is characteristic of amnestic MCI (aMCI), cognitive deficits other than memory can occur in both aMCI and non-amnestic MCI (naMCI) and accurate assessment of the subtypes of MCI is difficult for clinicians without the application of extensive neuropsychological testing. In this study, we examine metrics derived from recording of reflexive and voluntary saccadic eye movements as a potential alternative method for discriminating between subtypes and assessing cognitive functions in MCI.Method: A total of 29 MCI patients and 29 age- and education-matched healthy controls (HCs) participated in the cross-sectional study. We recorded horizontal and vertical pro-saccades and anti-saccade responses. All the participants also completed a comprehensive neuropsychological tests battery.Results: Significant differences in saccadic eye movement were found between the subtypes of MCI and HCs. Patients with aMCI had a higher percentage of short latency "express" saccades than HCs. We found strong associations between saccadic reaction times and cognitive domains, including executive functions and attention. The mini-mental state examination (MMSE) was also found to correlate with uncorrected errors in the anti-saccade task.Conclusions: The increased proportion of saccades in the express latency range in aMCI may be indicative of problems with cognitive inhibitory control in these patients. A focus on this and other saccade metrics in the preclinical and prodromal stages of dementia may help to predict the clinical progression of the disease and direct interventions for the management of MCI. The clinical significance of saccadic eye movement impairments in MCI is not yet fully understood and should be investigated in further studies using larger samples.

Patients' experiences and perceptions of Guillain-Barré syndrome: A systematic review and meta-synthesis of qualitative research.

BACKGROUND: Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, with an incidence of 1-2/100,000 per year. Its severity is variable, ranging from very mild cases with brief weakness to severe paralysis, leading to inability to breathe independently, or even death. Currently there is limited evidence exploring the experiences of GBS patients. The aim of this study was to review patients' experiences and perceptions of GBS and its variants at diagnosis, discharge and during recovery, by conducting a systematic review and thematic meta-synthesis of qualitative studies of patients' experiences of GBS (and its variants). METHODS: We searched twelve electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review. RESULTS: Our search strategy identified a total of 5,282 citations and after removing duplicates and excluding citations based on title and abstract, and full-text screening, five studies were included in the review and meta-synthesis; all included studies were considered of acceptable quality. Through constant discussions and an iterative approach, we developed six analytical themes following a patient's journey from suspecting that they had a health problem, through to being hospitalised, experiencing ongoing difficulties, slowly recovering from GBS, adjusting to their new circumstances, and re-evaluating their lives. CONCLUSIONS: Despite the variety of experiences, it was evident from all included studies that being diagnosed with and surviving GBS was a life-changing experience for all participants. TRIAL REGISTRATION: Protocol was registered (CRD42019122199) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).

The neural basis of overall similarity and single-dimension sorting.

The ability to group stimuli into meaningful categories is fundamental to natural behavior. Raw perceptions would be useless without an ability to classify items as, for example, threat or food. Previous work suggests that people have a tendency to group stimuli either on the basis of a single dimension or by overall similarity (e.g., Milton, F.N., Longmore, C.A., and Wills, A.J. (2008). Processes of overall similarity sorting in free classification. J. Exp. Psychol. Hum. Percept. Perform, 34, 676-692.). It has recently been suggested that overall similarity sorting can engage similar rule-based processes to single-dimension sorting and, in addition, requires greater use of working memory (Milton, F.N., and Wills, A.J. (2004). The influences of stimulus properties on category construction. J. Exp. Psychol. Learn. Mem. Cogn, 30, 407-415.). These predictions were tested in an event-related fMRI study of spontaneous categorization. Results showed a striking overlap of activation between overall similarity and single-dimension sorting indicating engagement of common neural processes. Furthermore, overall similarity sorting recruited additional activity in bilateral precuneus, right cuneus, left cerebellum, left postcentral gyrus, right thalamus and right ventrolateral frontal cortex (VLFC). Our findings suggest that overall similarity sorting can be the result of rule-based processes and highlight a potential role for right VLFC in integrating multi-dimensional sensory information to form conceptual categories.

Covert face recognition relies on affective valence in congenital prosopagnosia.

Dominant accounts of covert recognition in prosopagnosia assume subthreshold activation of face representations created prior to onset of the disorder. Yet, such accounts cannot explain covert recognition in congenital prosopagnosia, where the impairment is present from birth. Alternatively, covert recognition may rely on affective valence, yet no study has explored this possibility. The current study addressed this issue in 3 individuals with congenital prosopagnosia, using measures of the scanpath to indicate recognition. Participants were asked to memorize 30 faces paired with descriptions of aggressive, nice, or neutral behaviours. In a later recognition test, eye movements were monitored while participants discriminated studied from novel faces. Sampling was reduced for studied--nice compared to studied--aggressive faces, and performance for studied--neutral and novel faces fell between these two conditions. This pattern of findings suggests that (a) positive emotion can facilitate processing in prosopagnosia, and (b) covert recognition may rely on emotional valence rather than familiarity.

Angry faces are special too: evidence from the visual scanpath.

Traditional models of face processing posit independent pathways for the processing of facial identity and facial expression (e.g., Bruce & Young, 1986). However, such models have been questioned by recent reports that suggest positive expressions may facilitate recognition (e.g., Baudouin et al., 2000), although little attention has been paid to the role of negative expressions. The current study used eye movement indicators to examine the influence of emotional expression (angry, happy, neutral) on the recognition of famous and novel faces. In line with previous research, the authors found some evidence that only happy expressions facilitate the processing of famous faces. However, the processing of novel faces was enhanced by the presence of an angry expression. Contrary to previous findings, this paper suggests that angry expressions also have an important role in the recognition process, and that the influence of emotional expression is modulated by face familiarity. The implications of this finding are discussed in relation to (1) current models of face processing, and (2) theories of oculomotor control in the viewing of facial stimuli.

Eye Movements in Neuropsychological Tasks.

This chapter reviews how recording and analysis of eye movements have been applied to understanding cognitive functioning in patients with neurological disease. Measures derived from the performance of instructed eye movement tests such as the anti-saccade and memory-guided saccade tasks have been shown to be associated with cognitive test performance and the early stages of neurodegenerative disorders including Alzheimer's and Parkinson's disease. Other researchers have taken an ecological approach and recorded the uninstructed pattern of saccades made by patients during performance of established neuropsychological tasks. Studies that have analysed the eye movement strategies used in a number of widely used tests are reviewed, including the Corsi blocks, Tower of London, 'CANTAB' Spatial Working Memory and Brixton Spatial Anticipation test. The findings illustrate that eye movements are not purely in the service of vision, but support visuospatial working memory and forward action planning. Eye movement tests and measures also have potential for application in the assessment and diagnosis of neurological disease and cognitive impairment. Establishing large-scale normative data sets in healthy older adults and use of machine learning multivariate classifier algorithms may be key to further developing eye tracking applications in neuropsychological assessment.

Evidence of an eye movement-based memory effect in congenital prosopagnosia.

While extensive work has examined the role of covert recognition in acquired prosopagnosia, little attention has been directed to this process in the congenital form of the disorder. Indeed, evidence of covert recognition has only been demonstrated in one congenital case in which autonomic measures provided evidence of recognition (Jones and Tranel, 2001), whereas two investigations using behavioural indicators failed to demonstrate the effect (de Haan and Campbell, 1991; Bentin et al., 1999). In this paper, we use a behavioural indicator, an "eye movement-based memory effect" (Althoff and Cohen, 1999), to provide evidence of covert recognition in congenital prosopagnosia. In an initial experiment, we examined viewing strategies elicited to famous and novel faces in control participants, and found fewer fixations and reduced regional sampling for famous compared to novel faces. In a second experiment, we examined the same processes in a patient with congenital prosopagnosia (AA), and found some evidence of an eye movement-based memory effect regardless of his recognition accuracy. Finally, we examined whether a difference in scanning strategy was evident for those famous faces AA failed to explicitly recognise, and again found evidence of reduced sampling for famous faces. We use these findings to (a) provide evidence of intact structural representations in a case of congenital prosopagnosia, and (b) to suggest that covert recognition can be demonstrated using behavioural indicators in this disorder.

Role of the human supplementary eye field in the control of saccadic eye movements.

The precise function of the supplementary eye field (SEF) is poorly understood. Although electrophysiological and functional imaging studies are important for demonstrating when SEF neurones are active, lesion studies are critical to establish the functions for which the SEF is essential. Here we report a series of investigations performed on an extremely rare individual with a highly focal lesion of the medial frontal cortex. High-resolution structural imaging demonstrated that his lesion was confined to the region of the left paracentral sulcus, the anatomical locus of the SEF. Behavioural testing revealed that the patient was significantly impaired when required to switch between anti- and pro-saccades, when there were conflicting rules governing stimulus-response mappings for saccades. Similarly, the results of an arbitrary stimulus-response associative learning task demonstrated that he was impaired when required to select the appropriate saccade from conflicting eye movement responses, but not for limb movements on an analogous manual task. When making memory-guided saccadic sequences, the patient demonstrated hypometria, like patients with Parkinson's disease, but had no significant difficulties in reproducing the order of saccades correctly on a task that emphasized accuracy with a wide temporal segregation between responses. These findings are consistent with the hypothesis that the SEF plays a key role in implementing control when there is conflict between several, ongoing competing saccadic responses, but not when eye movements need to be made accurately in sequence.

Mind Your Step: the Effects of Mobile Phone Use on Gaze Behavior in Stair Climbing.

Stair walking is a hazardous activity and a common cause of fatal and non-fatal falls. Previous studies have assessed the role of eye movements in stair walking by asking people to repeatedly go up and down stairs in quiet and controlled conditions, while the role of peripheral vision was examined by giving participants specific fixation instructions or working memory tasks. We here extend this research to stair walking in a natural environment with other people present on the stairs and a now common secondary task: using one's mobile phone. Results show that using the mobile phone strongly draws one's attention away from the stairs, but that the distribution of gaze locations away from the phone is little influenced by using one's phone. Phone use also increased the time needed to walk the stairs, but handrail use remained low. These results indicate that limited foveal vision suffices for adequate stair walking in normal environments, but that mobile phone use has a strong influence on attention, which may pose problems when unexpected obstacles are encountered.

The effect of COMT Val158Met and DRD2 C957T polymorphisms on executive function and the impact of early life stress.

INTRODUCTION: Previous research has indicated that variation in genes encoding catechol-O-methyltransferase (COMT) and dopamine receptor D2 (DRD2) may influence cognitive function and that this may confer vulnerability to the development of mental health disorders such as schizophrenia. However, increasing evidence suggests environmental factors such as early life stress may interact with genetic variants in affecting these cognitive outcomes. This study investigated the effect of COMT Val158Met and DRD2 C957T polymorphisms on executive function and the impact of early life stress in healthy adults. METHODS: One hundred and twenty-two healthy adult males (mean age 35.2 years, range 21-63) were enrolled in the study. Cognitive function was assessed using Cambridge Neuropsychological Test Automated Battery and early life stress was assessed using the Childhood Traumatic Events Scale (Pennebaker & Susman, 1988). RESULTS: DRD2 C957T was significantly associated with executive function, with CC homozygotes having significantly reduced performance in spatial working memory and spatial planning. A significant genotype-trauma interaction was found in Rapid Visual Information Processing test, a measure of sustained attention, with CC carriers who had experienced early life stress exhibiting impaired performance compared to the CC carriers without early life stressful experiences. There were no significant findings for COMT Val158Met. CONCLUSIONS: This study supports previous findings that DRD2 C957T significantly affects performance on executive function related tasks in healthy individuals and shows for the first time that some of these effects may be mediated through the impact of childhood traumatic events. Future work should aim to clarify further the effect of stress on neuronal systems that are known to be vulnerable in mental health disorders and more specifically what the impact of this might be on cognitive function.

Multi-modal representation of effector modality in frontal cortex during rule switching.

We report a functional magnetic resonance imaging (fMRI) study which investigated whether brain areas involved in updating task rules within the frontal lobe of the cerebral cortex show activity related to the modality of motor response used in the task. Participants performed a rule switching task using different effector modalities. In some blocks participants responded with left/right button presses, whilst in other blocks left/right saccades were required. The color of a Cue event instructed a left or right response based upon a rule, followed by a Feedback which indicated whether the rule was to stay the same or "Flip" on the next trial. The findings revealed variation in the locus of activity within the ventrolateral frontal cortex dependent upon effector modality. Other frontal areas showed no significant difference in activity between response epochs but changed their pattern of connectivity with posterior cortical areas dependent upon response. Multivariate analysis revealed that the pattern of activity evoked by Flip rule Feedbacks within an apparently supra modal frontal region (dorsolateral frontal cortex) discriminated between response epochs. The results are consistent with the existence of multi-modal representations of stimulus-response (SR) rules within the frontal cerebral cortex.

Intranasal inhalation of oxytocin improves face processing in developmental prosopagnosia.

Developmental prosopagnosia (DP) is characterised by a severe lifelong impairment in face recognition. In recent years it has become clear that DP affects a substantial number of people, yet little work has attempted to improve face processing in these individuals. Intriguingly, recent evidence suggests that intranasal inhalation of the hormone oxytocin can improve face processing in unimpaired participants, and we investigated whether similar findings might be noted in DP. Ten adults with DP and 10 matched controls were tested using a randomized placebo-controlled double-blind within-subject experimental design (AB-BA). Each participant took part in two testing sessions separated by a 14-25 day interval. In each session, participants inhaled 24 IU of oxytocin or placebo spray, followed by a 45 min resting period to allow central oxytocin levels to plateau. Participants then completed two face processing tests: one assessing memory for a set of newly encoded faces, and one measuring the ability to match simultaneously presented faces according to identity. Participants completed the Multidimensional Mood Questionnaire (MMQ) at three points in each testing session to assess the possible mood-altering effects of oxytocin and to control for attention and wakefulness. Statistical comparisons revealed an improvement for DP but not control participants on both tests in the oxytocin condition, and analysis of scores on the MMQ indicated that the effect cannot be attributed to changes in mood, attention or wakefulness. This investigation provides the first evidence that oxytocin can improve face processing in DP, and the potential neural underpinnings of the findings are discussed alongside their implications for the treatment of face processing disorders.