Automatic processing of emotional facial expressions as a function of social anhedonia.

Anhedonia is an important feature of major depression and schizophrenia-spectrum disorders. Few neuroimaging studies have investigated neural alterations in high anhedonia, isolated from other psychopathological variables, by including only participants without clinical diagnoses. The present study examined healthy individuals scoring high (N = 18) vs. low (N = 19) in social anhedonia, who were carefully selected from a sample of N = 282 participants. To examine differences in automatic brain responses to social-affective stimuli between high vs. low social anhedonia participants, we used functional magnetic resonance imaging. To assess early, automatic stages of emotion processing, we administered a paradigm presenting brief (33ms), backward-masked happy, sad, and neutral facial expressions. Individuals high in social anhedonia demonstrated increased activation in the bilateral thalamus and left red nucleus in response to masked sad faces relative to individuals low in social anhedonia. No significant group differences in brain activation emerged in other regions known to be involved in emotion and reward processing, including the amygdala and nucleus accumbens. Our results suggest that high social anhedonia in otherwise healthy individuals is associated with exaggerated automatic reactivity in the thalamus, which is a brain structure that has been implicated in the mediation of attentional processes.

Predicting symptoms in major depression after inpatient treatment: the role of alexithymia.

Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.

Effect of gender on processing threat-related stimuli in patients with panic disorder: sex does matter.

BACKGROUND: Several studies have shown that female and male subjects process emotions differently. As women appear to be especially sensitive and responsive to negative and threatening stimuli, gender-specific emotional processing might be an important factor contributing to the increased likelihood of women compared to men to develop anxiety disorders, e.g. panic disorder (PD). METHODS: In this study, gender-specific neural activation during facial emotion processing was investigated in 20 PD patients (12 women, 8 men) by functional magnetic resonance imaging. RESULTS: Overall, significantly stronger activation, encompassing the amygdala, prefrontal, temporal, and occipital cortical areas, basal ganglia, and thalamus, was observed in women than in men during the processing of angry, fearful, or neutral but not happy facial expressions. Additionally, functional connectivity between the amygdala and prefrontal cortical areas and thalamus during the processing of angry facial expressions was significantly stronger in women than in men. CONCLUSIONS: These results emphasize gender as an important variable in neural activation patterns of emotional processing and may help to further elucidate the biological substrate of gender-specific susceptibility for PD.

Neural activation underlying acute grief in women after the loss of an unborn child.

OBJECTIVE: The traumatic loss of an unborn child by induced termination of pregnancy because of fetal malformation is a major life event that causes intense maternal grief. Increasing evidence supports the hypothesis that the same neural structures involved in the experience of physical pain are involved in the experience of social pain and loss. METHOD: To investigate neural activation patterns related to acute grief, the authors conducted a functional MRI study of 12 post-termination women and 12 noninduced women who delivered a healthy child. Brain activation was measured while participants viewed pictures of happy baby, happy adult, and neutral adult faces. RESULTS: Relative to comparison women, post-termination women showed greater activation in the middle and posterior cingulate gyrus, the inferior frontal gyrus, the middle temporal gyrus, the thalamus, and the brainstem in response to viewing happy baby faces. Functional connectivity between the cingulate gyrus and the thalamus during the processing of happy baby faces was significantly stronger in post-termination women. CONCLUSIONS: Overall, acute grief after the loss of an unborn child was closely related to the activation of the physical pain network encompassing the cingulate gyrus, the inferior frontal gyrus, the thalamus, and the brainstem. To the authors' knowledge, the stronger functional thalamocingulate connectivity in post-termination women is the first in vivo demonstration of an involvement of the neural maternal attachment network in grief after the loss of an unborn child.

Cognitive impairment and in vivo metabolites in first-episode neuroleptic-naive and chronic medicated schizophrenic patients: a proton magnetic resonance spectroscopy study.

Involvement of the prefrontal cortex in schizophrenia has been implicated by neuropsychological, as well as neuropathological and imaging studies. Reductions of N-acetylaspartate (NAA), an in vivo marker of neuronal integrity, have repeatedly been detected in the frontal lobes of patients with schizophrenia by proton magnetic resonance spectroscopy (1H-MRS). In chronic medicated patients, a positive correlation between NAA levels of the prefrontal cortex and cognitive functioning has been observed, but to date, there have been no studies in first-episode neuroleptic-naive patients. In this study, single-voxel 1H-MRS was used to investigate neuronal function of the dorsolateral prefrontal cortex in 15 first-episode and 20 chronic schizophrenic patients. Outcomes were compared to 20 age-matched healthy controls to assess the relationship between prefrontal metabolism and neuropsychological performance. Patients with chronic schizophrenia had significant reductions of NAA, glutamate/glutamine, and choline levels compared to first-episode patients and healthy controls. Furthermore, creatine and phosphocreatine were significantly reduced in both patient groups compared to healthy controls. In the neuropsychological tests, chronic schizophrenic patients performed significantly poorer in the Auditory Verbal Learning Task (AVLT) compared to first-episode patients. In both patient groups, NAA levels of the left frontal lobe significantly correlated with performances in verbal learning and memory. These results corroborate data from recent structural and spectroscopic imaging studies of the frontal lobes in schizophrenia, in which cortical gray matter reductions after onset of symptoms as well as reduced levels of NAA in chronic, but not in first-episode schizophrenic patients have been reported.