MISATTRIBUTION OF EMOTIONAL OVER-AROUSAL TO NEUTRAL FACES IN ACUTE PARANOID SCHIZOPHRENIA PSYCHOSIS.

INTRODUCTION: Misattribution of motivational salience to non-salient (neutral) stimuli could be viewed as a hallmark of psychosis in schizophrenia. Studies have recently revealed increased subjective experience of emotional arousal (EA) to neutral social stimuli in paranoid schizophrenia psychosis, suggesting a misattribution of emotional salience to them. We examined this phenomenon directly by quantifying the level of EA subjectively attributed to low-arousal, neutral-valenced faces. SUBJECTS AND METHODS: A task for EA attribution to neutral (in the context of affective) facial expressions was applied to 44 actively psychotic paranoid schizophrenia inpatients and 44 well-matched healthy controls. RESULTS: Psychotic patients, compared with healthy controls, rated the neutral faces as more aroused (t (86) = 3.15, p =.001) thus misattributing emotional salience to them. DISCUSSION: This finding supports the hypothesis that over-assignment of EA to neutral faces could be viewed as a subclinical affective mechanism of the clinically manifested experience of delusional perception. CONCLUSION: The study provides the first direct empirical evidence for misattribution of emotional salience in terms of over-attribution of EA to neutral faces during acute paranoid schizophrenia psychosis.

Objective and quantitative equilibriometric evaluation of individual locomotor behaviour in schizophrenia: Translational and clinical implications.

Psychiatry is the only medical specialty that lacks clinically applicable biomarkers for objective evaluation of the existing pathology at a single-patient level. On the basis of an original translational equilibriometric method for evaluation of movement patterns, we have introduced in the everyday clinical practice of psychiatry an easy-to-perform computerized objective quantification of the individual locomotor behaviour during execution of the Unterberger stepping test. For the last 20 years, we have gradually collected a large database of more than 1000 schizophrenic patients, their relatives, and matched psychiatric, neurological, and healthy controls via cross-sectional and longitudinal investigations. Comparative analyses revealed transdiagnostic locomotor similarities among schizophrenic patients, high-risk schizotaxic individuals, and neurological patients with multiple sclerosis and cerebellar ataxia, thus suggesting common underlying brain mechanisms. In parallel, intradiagnostic dissimilarities were revealed, which allow to separate out subclinical locomotor subgroups within the diagnostic categories. Prototypical qualitative (dysmetric and ataxic) locomotor abnormalities in schizophrenic patients were differentiated from 2 atypical quantitative ones, manifested as either hypolocomotion or hyperlocomotion. Theoretical analyses suggested that these 3 subtypes of locomotor abnormalities could be conceived as objectively measurable biomarkers of 3 schizophrenic subgroups with dissimilar brain mechanisms, which require different treatment strategies. Analogies with the prominent role of locomotor measures in some well-known animal models of mental disorders advocate for a promising objective translational research in the so far over-subjective field of psychiatry. Distinctions among prototypical, atypical, and diagnostic biomarkers, as well as between neuromotor and psychomotor locomotor abnormalities, are discussed. Conclusions are drawn about the translational and clinical implications of the new approach and its future perspectives.

Latent Bipolarity In Unipolar Depression: Experimental Findings, Conceptual Analysis And Implications For Treatment Strategies.

INTRODUCTION: Previous studies have suggested that the two opposite poles of psychomotor disturbances in unipolar depression (UD) - retardation and agitation - require different treatment strategies as the psychomotor overactivation requires an augmentation of the antidepressant therapy with mood stabilizers and/or atypical antipsychotics. OBJECTIVE: The aim of the present study was to objectively identify and measure the psycho-motor disturbances in UD using differentiation between activity and reactivity. MATERIAL AND METHODS: An equilibriometric movement pattern analysis system that allows differentiation between psychomotor activity and reactivity was applied in 58 unipolar depressive patients and 76 healthy controls. RESULTS: Compared to controls, the patients as a group were significantly slower in their psychomotor reactivity. However, the subsequent subgrouping according to the direction of deviation of their objective psychomotor parameters revealed a disinhibition of psychomotor activity and/or reactivity in about one half of them. Such a contradictory combination of clinically manifested depressive mood and subclinically detected manic-like psychomotor overactivation might be regarded as belonging to the bipolar spectrum, since it was admitted that manic psychomotor disinhibition in unipolar depressive patients uncovers a latent bipolarity. CONCLUSION: Not only prototypical depressive inhibition, but also prototypical manic-like disinhibition may underlie clinically manifested UD. Since the combination between depressive mood and psychomotor overactivation multiplies the suicidal risk, we may presume that the timely detection of this combination at a subclinical level would contribute to an earlier and more effective suicidal prevention by an objectively-guided optimization of pharmacological treatment.

Epistemological and methodological significance of quantitative studies of psychomotor activity for the explanation of clinical depression.

RATIONALE, AIMS AND OBJECTIVES: Psychomotor disturbances have been regarded as cardinal symptoms of depression for centuries and their objective assessment may have predictive value with respect to the severity of clinical depression, treatment outcome and prognosis of the affective disorder. METHODS: Montgomery-Åsberg Depression Rating Scale (MADRS) and Hamilton Rating Scale for Anxiety (HAM-A). Psychomotor indicators of activity and reactivity were objectively recorded and measured by means of computerized ultrasonographic craniocorpography. RESULTS: We found a statistically significant correlation between disturbances in psychomotor indicators and MADRS total score (r = 0.4; P < 0.0001). The severity of HAM-A total score had no statistically significant correlation with psychomotor indicators (P > 0.05). We found that different items of MADRS and HAM-A correlated with psychomotor disturbances of different strength and significance. Objectively, measured psychomotor retardation was associated with greater severity of depressive symptoms assessed at the clinical level. CONCLUSIONS: Integration between different methods is needed in order to improve understanding of the psychopathology and the neurobiology of a disputable diagnosis such as clinical depression.

Subjective emotional over-arousal to neutral social scenes in paranoid schizophrenia.

From the clinical practice and some experimental studies, it is apparent that paranoid schizophrenia patients tend to assign emotional salience to neutral social stimuli. This aberrant cognitive bias has been conceptualized to result from increased emotional arousal, but direct empirical data are scarce. The aim of the present study was to quantify the subjective emotional arousal (SEA) evoked by emotionally non-salient (neutral) compared to emotionally salient (negative) social stimuli in schizophrenia patients and healthy controls. Thirty male inpatients with paranoid schizophrenia psychosis and 30 demographically matched healthy controls rated their level of SEA in response to neutral and negative social scenes from the International Affective Picture System and the Munich Affective Picture System. Schizophrenia patients compared to healthy controls had an increased overall SEA level. This relatively higher SEA was evoked only by the neutral but not by the negative social scenes. To our knowledge, the present study is the first designed to directly demonstrate subjective emotional over-arousal to neutral social scenes in paranoid schizophrenia. This finding might explain previous clinical and experimental data and could be viewed as the missing link between the primary neurobiological and secondary psychological mechanisms of paranoid psychotic-symptom formation. Furthermore, despite being very short and easy to perform, the task we used appeared to be sensitive enough to reveal emotional dysregulation, in terms of emotional disinhibition/hyperactivation in paranoid schizophrenia patients. Thus, it could have further research and clinical applications, including as a neurobehavioral probe for imaging studies.

Computerized ultrasonographic craniocorpography and abnormal psychomotor activity in psychiatric patients.

A new version of craniocorpography (CCG), called computerized ultrasonographic CCG (Comp-USCCG), has been clinically applied for objective recording, documentation, and quantitative evaluation of abnormal psychomotor activity in psychiatric patients. Implications of this completely new approach to psychopathology are discussed. An original representation of Comp-USCCG data (introducing the time dimension as a new CCG parameter) is used to illustrate better the atypical abnormal stepping Comp-USCCG movement patterns in psychotic patients, some of which have not been described in neurootological patients to date. These atypical abnormal stepping Comp-USCCG movement patterns are prolonged longitudinal or shortened or backward longitudinal displacement; dysrhythmic longitudinal or lateral sway; and longitudinal or lateral directional changes. Reflecting the abnormal psychomotor activity, Comp-USCCG also provides for possible indirect evaluation of the underlying subjective psychotic experience. The contribution of the approach could be defined as an application of a known neurootological method into a new field of medicine (psychiatry) with a new purpose (to record and measure abnormal psychomotor activity). Our conclusion is that Comp-USCCG could become the first objective and quantitative method available for use in the field of clinical psychiatry.