The emotional face of anorexia nervosa: The neural correlates of emotional processing.

Social-emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social-emotional processing in a large sample of individuals with AN.

Emotion Recognition in Face and Body Motion in Bulimia Nervosa.

Social cognition has been studied extensively in anorexia nervosa (AN), but there are few studies in bulimia nervosa (BN). This study investigated the ability of people with BN to recognise emotions in ambiguous facial expressions and in body movement. Participants were 26 women with BN, who were compared with 35 with AN, and 42 healthy controls. Participants completed an emotion recognition task by using faces portraying blended emotions, along with a body emotion recognition task by using videos of point-light walkers. The results indicated that BN participants exhibited difficulties recognising disgust in less-ambiguous facial expressions, and a tendency to interpret non-angry faces as anger, compared with healthy controls. These difficulties were similar to those found in AN. There were no significant differences amongst the groups in body motion emotion recognition. The findings suggest that difficulties with disgust and anger recognition in facial expressions may be shared transdiagnostically in people with eating disorders. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Dissociable brain correlates for depression, anxiety, dissociation, and somatization in depersonalization-derealization disorder.

OBJECTIVE: The cerebral mechanisms of traits associated with depersonalization-derealization disorder (DPRD) remain poorly understood. METHOD: Happy and sad emotion expressions were presented to DPRD and non-referred control (NC) subjects in an implicit event-related functional magnetic resonance imaging (fMRI) design, and correlated with self report scales reflecting typical co-morbidities of DPRD: depression, dissociation, anxiety, somatization. RESULTS: Significant differences between the slopes of the two groups were observed for somatization in the right temporal operculum (happy) and ventral striatum, bilaterally (sad). Discriminative regions for symptoms of depression were the right pulvinar (happy) and left amygdala (sad). For dissociation, discriminative regions were the left mesial inferior temporal gyrus (happy) and left supramarginal gyrus (sad). For state anxiety, discriminative regions were the left inferior frontal gyrus (happy) and parahippocampal gyrus (sad). For trait anxiety, discriminative regions were the right caudate head (happy) and left superior temporal gyrus (sad). Discussion The ascertained brain regions are in line with previous findings for the respective traits. The findings suggest separate brain systems for each trait. CONCLUSION: Our results do not justify any bias for a certain nosological category in DPRD.

Emotion Recognition in Blended Facial Expressions in Women with Anorexia Nervosa.

People with anorexia nervosa (AN) have difficulties in the social domain, and problems in the ability to recognise emotions in people's faces may contribute to these difficulties. This study aimed to investigate emotion recognition in women with AN and healthy controls (HC), using pictures of faces portraying blended emotions at different levels of ambiguity, which resemble real-life expressions more closely than prototypical expressions used in past studies. Seventy-seven participants (35 AN; 42 HC) completed the emotion recognition task. Results indicated that participants with AN were less accurate than HC recognising expressions of disgust, when shown less ambiguously. There were no differences in the recognition of other emotions. Participants with AN also showed response bias towards anger. These findings suggest a generally preserved ability to recognise emotions in women with AN, with the exception of disgust recognition. They also support previous findings of bias towards anger in AN patients.

Exploring emotion recognition in adults and adolescents with anorexia nervosa using a body motion paradigm.

OBJECTIVE: There is consistent evidence of difficulties in social cognition in adults with anorexia nervosa (AN), but less is known about adolescents. The aim of this study was to investigate the ability to recognise emotion expressed in body movement in adults and adolescents with AN. METHOD: One hundred and ninety-three females participated in the study (AN = 97: 61 adults and 36 adolescents). The performance of participants with AN on a body emotion recognition task was compared to age-matched healthy controls (HC = 96). RESULTS: AN participants were significantly worse than HC recognising sadness, with adolescent AN participants showing worse performance overall. There were no difficulties in the recognition of other emotions. DISCUSSION: The results partially support previous studies and the literature on facial emotion recognition, showing poorer recognition of sadness in AN. The results also suggest that difficulties in emotion recognition through body movements may be more subtle than other socio-emotional difficulties observed in AN.

Self-evaluation in schizophrenia: an fMRI study with implications for the understanding of insight.

BACKGROUND: Lack of insight is a core feature of schizophrenia and is associated with structural brain abnormalities. The functional neuroanatomy of insight has only recently been investigated. When people evaluate their personality traits compared to those of another, activation is seen in central midline structures (CMS) of the brain. This study set out to compare cerebral activation in schizophrenia patients versus controls during a self-evaluation task which included positive and negative traits as well as mental and physical illness terms. METHODS: Eleven schizophrenia patients and 8 healthy controls, matched for age were studied. Insight was assessed using the Schedule for the Assessment of Insight-expanded version (SAI-E). FMRI data were obtained with a 1.5 Tesla GE system and interactions between participant group, self versus other, significant at the cluster level, were recorded. RESULTS: Significant hypoactivation in the medial superior frontal gyrus (dorsomedial prefrontal cortex) was observed in patients vs. controls during self-evaluation of all traits combined. A second cluster of hypoactivation in the posterior cingulate was also detected. When the response to individual traits was explored, underactivation in other frontal regions plus right inferior parietal lobule emerged and this tended to correlate, albeit weakly with lower insight scores. Further, there were areas of hyperactivation relative to controls in anterior cingulate, frontal and parietal regions (especially precuneus) which showed moderate inverse correlations with insight scores. CONCLUSIONS: We have demonstrated that the CMS, identified as a key system underpinning self-evaluation, is dysfunctional in patients with schizophrenia, particularly dorso-medial PFC. This may have implications for lack of insight in schizophrenia. Hypofunction within the dorsomedial prefrontal region seems to be particularly important although other posterior and lateral cortical regions play a part and may modulate self-evaluative responses depending on the type of trait under consideration.

Neural response to specific components of fearful faces in healthy and schizophrenic adults.

Perception of fearful faces is associated with functional activation of cortico-limbic structures, which has been found altered in individuals with psychiatric disorders such as schizophrenia, autism and major depression. The objective of this study was to isolate the brain response to the features of standardized fearful faces by incorporating principal component analysis (PCA) into the analysis of neuroimaging data of healthy volunteers and individuals with schizophrenia. At the first stage, the visual characteristics of morphed fearful facial expressions (FEEST, Young et al., 2002) were classified with PCA, which produced seven orthogonal factors, with some of them related to emotionally salient facial features (eyes, mouth, brows) and others reflecting non-salient facial features. Subsequently, these PCA-based factors were included into the functional magnetic resonance imaging (fMRI) analysis of 63 healthy volunteers and 32 individuals with schizophrenia performing a task that involved implicit processing of FEEST stimuli. In healthy volunteers, significant neural response was found to visual characteristics of eyes, mouth or brows. In individuals with schizophrenia, PCA-based analysis enabled us to identify several significant clusters of activation that were not detected by the standard approach. These clusters were implicated in processing of visual and emotional information and were attributable to the perception of eyes and brows. PCA-based analysis could be useful in isolating brain response to salient facial features in psychiatric populations.

Amygdala activation to masked happy facial expressions.

The amygdala has a key role in automatic non-conscious processing of emotions. Highly salient emotional stimuli elicit amygdala activity, and happy faces are among the most rapidly perceived facial expressions. In backward masking paradigms, an image is presented briefly and then masked by another stimulus. However, reports of amygdala responses to masked happy faces have been mixed. In the present study, we used functional magnetic resonance imaging (fMRI) to examine amygdala activation to masked happy, sad, and neutral facial expressions. Masked happy faces elicited greater amygdala activation bilaterally as compared to masked sad faces. Our findings indicate that the amygdala is highly responsive to non-consciously perceived happy facial expressions.

Visual processing, social cognition and functional outcome in schizophrenia.

Visual processing deficits are well recognised in schizophrenia and have potentially important clinical implications. First, the pattern of deficits for different visual tasks may help understand the underlying pathophysiology of the visual dysfunction. Second, several studies report deficits correlating with functional outcomes, suggesting that outcome improvement is possible through visual remediation strategies. We investigated these issues in a group of 64 schizophrenia patients and matched controls with a battery of visual tasks targeting different points along the visual pathways and by examining direct and indirect relationships (via a potential mediator) of such deficits to functional outcome. The schizophrenia group was significantly worse on the visual tasks overall, with the deficit constant for low- and high-level processing. Zero-order correlations suggested minimal association between vision and outcome, however, correlations between three visual tasks and 'social perceptual' ability were found which in turn correlated with functional outcome; path analysis confirmed a significant but small and indirect effect of 'biological motion' processing ability on functional outcome mediated by 'social perception'. In conclusion, the pathophysiology of visual dysfunction affects low- and high-level visual areas similarly and the relationship between deficits and outcome is small and indirect.

Facial affect recognition in anorexia nervosa: is obsessionality a missing piece of the puzzle?

OBJECTIVE: Socio-emotional difficulties are thought to be important maintaining factors of eating disorders. Several studies point to deficits in facial affect recognition in anorexia nervosa (AN). However, the majority of these studies fail to control for comorbidity and its effect on emotional processing. This study aims to explore how patients with AN recognize happiness and sadness in human faces, controlling for different comorbidities, namely anxiety, depression, and obsessive-compulsive symptoms. METHODS: Thirty patients with AN, and 40 healthy participants completed a facial emotion recognition task. This task measured discrimination accuracy, response bias and response time towards sad and happy faces presented at different durations (500 ms, 2000 ms). The associations between facial affect recognition and clinical symptoms and intelligence quotient were explored. RESULTS: Regression analysis showed that discrimination accuracy of sad faces presented for 500 ms was significantly associated with AN diagnosis, body mass index, and Obsessive-compulsive symptoms. However, the level of Obsessive-compulsive symptoms was the strongest predictor of a poor discrimination of briefly presented sad faces. CONCLUSIONS: Our results support previous studies that report emotional processing deficits in AN with obsessionality playing a pivotal role in this deficit.

Functional atlas of emotional faces processing: a voxel-based meta-analysis of 105 functional magnetic resonance imaging studies.

BACKGROUND: Most of our social interactions involve perception of emotional information from the faces of other people. Furthermore, such emotional processes are thought to be aberrant in a range of clinical disorders, including psychosis and depression. However, the exact neurofunctional maps underlying emotional facial processing are not well defined. METHODS: Two independent researchers conducted separate comprehensive PubMed (1990 to May 2008) searches to find all functional magnetic resonance imaging (fMRI) studies using a variant of the emotional faces paradigm in healthy participants. The search terms were: "fMRI AND happy faces," "fMRI AND sad faces," "fMRI AND fearful faces," "fMRI AND angry faces," "fMRI AND disgusted faces" and "fMRI AND neutral faces." We extracted spatial coordinates and inserted them in an electronic database. We performed activation likelihood estimation analysis for voxel-based meta-analyses. RESULTS: Of the originally identified studies, 105 met our inclusion criteria. The overall database consisted of 1785 brain coordinates that yielded an overall sample of 1600 healthy participants. Quantitative voxel-based meta-analysis of brain activation provided neurofunctional maps for 1) main effect of human faces; 2) main effect of emotional valence; and 3) modulatory effect of age, sex, explicit versus implicit processing and magnetic field strength. Processing of emotional faces was associated with increased activation in a number of visual, limbic, temporoparietal and prefrontal areas; the putamen; and the cerebellum. Happy, fearful and sad faces specifically activated the amygdala, whereas angry or disgusted faces had no effect on this brain region. Furthermore, amygdala sensitivity was greater for fearful than for happy or sad faces. Insular activation was selectively reported during processing of disgusted and angry faces. However, insular sensitivity was greater for disgusted than for angry faces. Conversely, neural response in the visual cortex and cerebellum was observable across all emotional conditions. LIMITATIONS: Although the activation likelihood estimation approach is currently one of the most powerful and reliable meta-analytical methods in neuroimaging research, it is insensitive to effect sizes. CONCLUSION: Our study has detailed neurofunctional maps to use as normative references in future fMRI studies of emotional facial processing in psychiatric populations. We found selective differences between neural networks underlying the basic emotions in limbic and insular brain regions.

An event related functional magnetic resonance imaging study of facial emotion processing in Asperger syndrome.

BACKGROUND: People with Asperger syndrome (AS) have life-long deficits in social behavior. The biological basis of this is unknown, but most likely includes impaired processing of facial emotion. Human social communication involves processing different facial emotions, and at different intensities. However nobody has examined brain function in people with AS when implicitly (unconsciously) processing four primary emotions at varying emotional intensities. METHODS: We used event-related functional magnetic resonance imaging (MRI) to examine neural responses when people with AS and controls implicitly processed neutral expressions, and mild (25%) and intense (100%) expressions of fear, disgust, happiness, and sadness. We included 18 right-handed adults; 9 with AS and 9 healthy controls who did not differ significantly in IQ. RESULTS: Both groups significantly activated 'face perception' areas when viewing neutral faces, including fusiform and extrastriate cortices. Further, both groups had significantly increased activation of fusiform and other extrastriate regions to increasing intensities of fear and happiness. However, people with AS generally showed fusiform and extrastriate hyporesponsiveness compared to controls across emotion types and intensities. CONCLUSIONS: Fusiform and extrastriate cortices are activated by facial expressions of four primary emotions in people with AS, but generally to a lesser degree than controls. This may partly explain the social impairments of people with AS.

Modulation of neural response to happy and sad faces by acute tryptophan depletion.

BACKGROUND: Central serotonin (5HT) plays a major role in emotional processing. We used functional neuroimaging (fMRI) to investigate the effects of experimental manipulation of central 5HT levels on the regional neural response to happy and sad facial expressions. METHODS: Ten healthy participants (eight men and two women) were scanned during an implicit emotional processing task after receiving a tryptophan-free (acute tryptophan depletion, ATD) or a balanced amino acid drink in a double-blind design. RESULTS: ATD lowered total plasma tryptophan concentration by 80%. There was no significant effect on subjective mood ratings, on response accuracy and on reaction times. Compared to sham depletion, ATD attenuated activation in the right medial/inferior frontal gyrus, the posterior cingulate cortex, the occipital and parietal cortex bilaterally, the right hippocampus, claustrum and insula. Conversely, ATD was associated with relatively increased activation in the left inferior frontal gyrus. ATD had differential effects on activation during the processing of happy and sad faces in the right putamen and in the left superior temporal gyrus. CONCLUSIONS: In both cortical and sub-cortical regions, the neural response associated with processing emotional faces is significantly modulated by 5HT manipulation resulting from ATD. Moreover, in certain areas, this effect of 5HT depends on the emotional valence of the stimulus.

Limbic and prefrontal responses to facial emotion expressions in depersonalization.

Depersonalization disorder, characterized by emotional detachment, has been associated with increased prefrontal cortical and decreased autonomic activity to emotional stimuli. Event-related fMRI with simultaneous measurements of skin conductance levels occurred in nine depersonalization disorder patients and 12 normal controls to neutral, mild and intense happy and sad facial expressions. Patients, but not controls, showed decreases in subcortical limbic activity to increasingly intense happy and sad facial expressions, respectively. For both happy and sad expressions, negative correlations between skin conductance measures in bilateral dorsal prefrontal cortices occurred only in depersonalization disorder patients. Abnormal decreases in limbic activity to increasingly intense emotional expressions, and increases in dorsal prefrontal cortical activity to emotionally arousing stimuli may underlie the emotional detachment of depersonalization disorder.

Sex-specific effects of COMT Val158Met polymorphism on corpus callosum structure: A whole-brain diffusion-weighted imaging study.

BACKGROUND: Genetic polymorphisms play a significant role in determining brain morphology, including white matter structure and may thus influence the development of brain functions. The main objective of this study was to examine the effect of Val158Met (rs4680) polymorphism of Catechol-O-Methyltransferase (COMT) gene on white matter connectivity in healthy adults. METHODS: We used a whole-brain diffusion-weighted imaging method with Tract-Based Spatial Statistics (TBSS) analysis to examine white matter structural integrity in intrinsic brain networks on a sample of healthy subjects (N = 82). RESULTS: Results revealed a sex-specific effect of COMT on corpus callosum (CC): in males only, Val homozygotes had significantly higher fractional anisotropy (FA) compared to Met-carriers. Volume-of-interest analysis showed a genotype by sex interaction on FA in genu and rostral midbody of CC, whereby Val males demonstrated higher FA than Met females. CONCLUSIONS: These results demonstrate the key effect of genes by sex interaction, rather than their individual contribution, on the corpus callosum anatomy.

A reversal of the normal pattern of parahippocampal response to neutral and fearful faces is associated with reality distortion in schizophrenia.

BACKGROUND: Individuals with schizophrenia demonstrate impaired recognition of facial expressions and may misattribute emotional salience to otherwise nonsalient stimuli. The neural mechanisms underlying this deficit and the relationship with different symptoms remain poorly understood. METHODS: We used event-related functional magnetic resonance imaging to measure neural responses to neutral, mildly fearful, and prototypically fearful facial expressions. The sample included 15 medicated individuals with chronic schizophrenia (SZ) and 11 healthy control individuals (CON), matched for gender (all male), age, and years of education. RESULTS: A repeated measures 3 x 2 analysis of variance (ANOVA) revealed a significant interaction between expression intensity and group in right parahippocampal gyrus (p < .01). Individuals with chronic schizophrenia demonstrated a decrease, whereas CON showed an increase, in right parahippocampal gyrus response to increasingly fearful expressions. Between-group comparison revealed greater activation in SZ than CON in right parahippocampal gyrus to neutral faces. The reality distortion dimension, but not neuroleptic medication dose, was positively associated with the right parahippocampal gyral and right amygdalar response to neutral faces in SZ. CONCLUSIONS: An abnormally increased parahippocampal response to neutral faces was positively associated with reality distortion in SZ. This may underlie the previously reported finding of a misattribution of emotional salience to nonsalient social stimuli in schizophrenia.

A differential pattern of neural response toward sad versus happy facial expressions in major depressive disorder.

BACKGROUND: Accurate recognition of facial expressions is crucial for social functioning. In depressed individuals, implicit and explicit attentional biases away from happy and toward sad stimuli have been demonstrated. These may be associated with the negative cognitions in these individuals. METHODS: Using event-related functional magnetic resonance imaging (fMRI), neural responses to happy and sad facial expressions were measured in 14 healthy individuals and 16 individuals with major depressive disorder. RESULTS: Healthy but not depressed individuals demonstrated linear increases in response in bilateral fusiform gyri and right putamen to expressions of increasing happiness, while depressed individuals demonstrated linear increases in response in left putamen, left parahippocampal gyrus/amygdala, and right fusiform gyrus to expressions of increasing sadness. There was a negative correlation in depressed individuals between depression severity and magnitude of neural response within right fusiform gyrus to happy expressions. CONCLUSIONS: Our findings indicate preferential increases in neural response to sad but not happy facial expressions in neural regions involved in the processing of emotional stimuli in depressed individuals. These findings may be associated with the above pattern of implicit and explicit attentional biases in these individuals and suggest a potential neural basis for the negative cognitions and social dysfunction in major depression.

What are the effects of group cognitive behaviour therapy for voices? A randomised control trial.

BACKGROUND: Little evidence exists for the effects of psychological treatment on voices even though it is clear that CBT does affect delusions and symptoms overall. This study tested whether a group based on cognitive behavioural principles could produce beneficial effects on hallucinations. AIM: To test the effectiveness of group CBT on social functioning and severity of hallucinations. METHOD: Participants were included if they had a diagnosis of schizophrenia and experienced distressing auditory hallucinations (rated on the PANSS). They were randomly allocated to group CBT (N = 45) or a control group who received treatment as usual (N = 40). The two main outcomes were social functioning as measured by the Social Behaviour Schedule and the severity of hallucinations as measured by the total score on the Hallucinations Scale of PSYRATS. Assessments were carried out at baseline, 10 weeks (post therapy) and 36 weeks (six months following therapy). RESULTS: Mixed random effects models revealed significant improvement in social functioning (effect size 0.63 six months after the end of therapy). There was no general effect of group CBT on the severity of hallucinations. However, there was a large cluster effect of therapy group on the severity of hallucinations such that they were reduced in some but not all of the therapy groups. Improvement in hallucinations was associated with receiving therapy early in the trial and having very experienced therapists (extensive CBT training which included expert supervision for a series of individual cases for at least a year following initial training). CONCLUSION: Group CBT does improve social functioning but unless therapy is provided by experienced CBT therapists hallucinations are not reduced.

Cost analysis of treating schizophrenia with amisulpride: naturalistic mirror image study.

The aim of the study was to examine the costs of schizophrenia treatment using the atypical antipsychotic amisulpride relative to treatment with other antipsychotics. Service use data were collected for one year of amisulpride treatment. The patients were also assessed with the Global Assessment of Functioning (GAF) scale and scales of Quality of Life. These were compared with retrospectively collected data for the 1-year period prior to the patients commencing amisulpride. The findings indicate that, compared with the year before, the clinical and quality of life scores improved during the year of treatment with amisulpride. There was a numerical reduction of total costs, as well as costs of in- and out-patient service use per patient per year during the year on amisulpride compared with the year before the patients started amisulpride. Patients on amisulpride spent fewer days as acute in-patients, but stayed longer in rehabilitation wards. Amisulpride treatment may lead to a reduction in the cost of treating schizophrenia in comparison with treatment with other antipsychotic medications.