A review of emotion deficits in schizophrenia

“The concept of anhedonia in schizophrenia was further developed by Myerson,58 Rado,59 and Meehl.60 Currently, anhedonia is considered to be a major symptom of depression and a relevant symptom in deficit schizophrenia.”

“” The most widely used scale to measure alexithymia has been the Toronto Alexithymia Scale.(43) Its 20-item revised version(44) comprises three factors: (i) difficulty identifying feelings; (ii) difficulty describing feelings; and (iii) externally oriented thinking.”

“However, three studies(94) found significant correlations with positive symptoms, and 10 studies found some moderate correlations with negative symptoms.(95) Emotion recognition deficits correlate with multiple cognitive tests.”

“Some tests have been standardized and used repeatedly, such as the Facial Emotion Identification Test (FEIT) and the Facial Emotion Discrimination Test (FEDT).(85) The procedures used in emotion recognition have not been named consistently across studies (such as “identification,”“recognition,”“labeling,”“discriminati…”

“But such impairments have also been found in disorders like autism, schizophrenia and social anxiety disorder (Gross, 2004; Singh et al. 1998; Tremeau, 2006; Easter et al. 2005).”

“Moreover, schizophrenia patients’ diminished facial and vocal expression distinguishes them from other patient groups, including individuals with depression, Parkinson disease, and right hemisphere brain damage.(26,42,52,56,58) Importantly, diminished expression is observed among individuals with schizophrenia both on…”

“…in reward processing and/or stimulus saliency observed in schizophrenia (Murray et al., 2008), and possibly to dulling of emotional expression in patients (Tremeau, 2006), although this would have to be addressed in a study in which both behavioralmeasures and resting statemeasures are obtained.”

“exchange [389-391], even when taking medication [388].”

“Furthermore, compassion activates the self-soothing system, increasing positive emotions such as hope, optimism, warmth, contentment, love, and kindness, and decreasing negative emotions such as shame, fear, and helplessness (Trémeau, 2006).”

“Impairment in social cognition is a cardinal feature of the clinical presentation of both ASD and SZ [4–8].”

“Surprisingly, patients with schizophrenia, including those with primary negative symptoms, report comparable levels of pleasure for positive/ pleasant stimuli as the non-patient controls (Trémeau, Antonius, Cacioppo, Ziwich, Jalbrzikowski et al., 2009; see reviews in Cohen & Minor, 2010; Kring & Moran, 2008; Trémeau,…”

“Participants are typically shown two facial expressions (at the same time or after a delay), and required to tell whether the pictures represent the same or different types of emotion (Trémeau, 2006).”

“Introduction Schizophrenia is a chronic illness with deficits in emotional processing (for a review, see e.g., Tremeau, 2006).”

“Studies consistently demonstrate alterations in outward emotional expression in schizophrenia patients.(3,4) Study findings on emotional experience, however, are more heterogeneous.”

“Empathic ‘core’ processes may remain functional despite converging evidence for disturbances in experience, recognition and expression of emotions in schizophrenia (Schneider et al., 2006; Tremeau, 2006).”

“(Carpenter & Trull, 2013); mood disorders (Hofmann, Sawyer, Fang, & Asnaani, 2012; Townsend & Altshuler, 2012); obsessive compulsive disorder (Calkins, Berman, & Wilhelm, 2013); PTSD (Frewen & Lanius, 2006); and schizophrenia (Horan, Kring, & Blanchard, 2006; Trémeau, 2006).”

“This is consistent with several previous studies which have shown that patients with schizophrenia (Edwards et al. 2002 ; Kohler et al. 2003 ; Bediou et al. 2005; Tremeau, 2006 ; Derntl et al. 2009) and their first-degree relatives (Bediou et al. 2007) have a deficit in identifying emotions.”

“Individuals with schizophrenia show significant abnormalities in the experience, expression and perception of emotion (Aleman and Kahn, 2005; Tremeau, 2006; Pinkham et al., 2007; Kring and Moran, 2008).”

“008 are associated with illness-related measures like duration of illness [33], symptomatology [34], symptom severity [18,19], and cognitive disturbances [34] but are not influenced by age or antipsychotic treatment [31,32].”

“Impaired social functioning (4), emotional deficits (5), and a reduced Theory of Mind (6) then later characterise schizophrenia patients over the course of the disease.”

“…considering (a) the bulk of studies on facial affect processing deficits in schizophrenia patients (Mandal et al. 1998 ; Aleman & Kahn, 2005 ; Trémeau, 2006), which have an impact on social skills (Hooker & Park, 2002 ; Pinkham & Penn, 2006 ; Ikebuchi, 2007), and (b) the range of studies…”

“Trémeau, F.”

“Nevertheless, the publication of comprehensive reviews on the subject of negative symptoms [12,34,36] reflects a growing recognition of their clinical relevance.”

“One reason for this deficit is likely due not just to a neurophysiological abnormality (cf. Trémeau 2006) but additionally to the experiential distance many people with schizophrenia feel from their body as a lived through subject of experience and action (Krueger and Henriksen 2016).”

“More recently, abnormalities in emotional processing in psychosis have been suggested in different aspects: expression, perception and experience (Trémeau, 2006; Cohen andMinor, 2008; Kring and Moran, 2008).”

“, 2006b), and individualswith schizophrenia regularly scorehigher thancontrols on these questionnaires (Trémeau, 2006; Horan et al., 2006b).”

“This deficiency may lead to severely impaired social functioning and a reduction of EI [for reviews, see Couture et al., 2006; Eack et al., 2007; Kohler and Martin, 2006; Tremeau, 2006; van Honk and Schutter, 2006].”

“…occasions of showing congruent motor resonance with happy emotions could be consequently uncommon in patients suffering from schizophrenia (Kring and Earnst, 2003; Wolf et al., 2004, 2006; Trèmeau, 2006), hence the lack of specific and congruent responses of Zygomaticus muscle to positive stimuli.”

“All these characteristics yield an “emotionally flattened” speech (Tremeau, 2006).”

“Given the importance of face perception in social interactions, research exploring various aspects of face processing in the disorder has uncovered a range of pervasive deficits, involving judgments of facial attributes, familiarity and identity [40,41], and, most notably, emotion recognition [42-44].”

“Furthermore, research has also shown that individuals with schizophrenia have impairments in emotion perception across other expressive channels besides faces, such as tone of voice and body gestures.(13) More recently, researchers have examined the ability to use contextual information to modify emotion perception in…”

“Individuals with schizophrenia exhibit impaired emotional functioning, including difficulties in recognizing and discriminating facial affect.(1) During the past 2 decades, schizophrenia researchers have become increasingly”

“An extensive review by Tremeau (2006) specifically identified dysfunction in schizophrenia in the domains of emotion expression, emotion experience, and emotion recognition.”

“Recent research is suggesting that individuals with schizophrenia present high levels of emotional deregulation on the experiential, processing and expressive levels that could exacerbate their distress and their social impairments.(1) Emotional distress seems to be at its highest level at the onset of the illness and…”

“Indeed, the functional importance of deficits in face processing not only relates to social outcomes and global “real-world” performance (Kee et al., 2003; Edwards et al., 2001, 2002; Mandal et al., 1998; Trémeau, 2006), but might also contribute to symptom exacerbation.”

“In particular, the concept of anhedonia–the inability to experience pleasure from positive stimuli–has undergone recent revision (reviewed in Trémeau, 2006; Kring and Moran, 2008; Cohen and Minor, in press), with the increasing realization that patients experience a relatively normal intrapsychic…”

“FAR impairments in SCZ have mainly been described for processing of negative emotional facial expressions (for review see Tremeau, 2006). associated with reduced FG grey matter volume (Goghari et al., 2011), but also with reduced amygdala, fusiform and superior frontal gyrus activation and elevated…”

“, verbal, facial, and acoustic) (Trémeau, 2006).”

“Thus, contradictory data have been obtained on the nature and degree of the influence of clinical and cognitive features of patients for them to recognise facial expressions, and on the specifics of the deficit regarding different emotions (Mandal et al.,1998; Sachs, Steger-Wuchse, Crispin-Exner, Gur, & Katschnig, 200…”

“, 2002), which may be related to the impairments in social functioning, work functioning and independent living (Mueser et al., 1996; Hooker and Park, 2002; Kee et al., 2003; Addington et al., 2006; Couture et al., 2006; Trémeau, 2006).”

“Individuals with schizophrenia evidence impaired emotional functioning, including deficits in emotional expression, perception, and recognition (Kring and Elis, 2013; Mandal et al., 1998; Tremeau, 2006).”

“Most behavioral studies about blunted affect have used facial expressions, because the face is themost emotionally expressive part of the body (Tremeau, 2006).”

“While some studies report a relationship between impaired emotional prosody and positive symptoms, other studies report either a relationship with negative symptoms or no relationship at all (for reviews see Bozikas et al., 2004; Trémeau, 2006).”

“Processing facial expressions has been found to be impaired in schizophrenia (Mandal et al., 1998; Earnst and Kring, 1999; Phillips et al., 2003; Trémeau, 2006;Marwick and Hall, 2008 and Ochsner, 2008).”

“Given the previously observed association between childhood trauma, structural brain alterations and poor social cognitive function in patients with SZ (Trémeau, 2006; Rokita et al., 2018, 2020; Cancel et al., 2019; Popovic et al., 2019), the lack of significantmediating effects in the patient group is surprising.”

“2007) and show difficulty verbalizing such experience (Trémeau 2006).”

“, 2019; Sprong, Schothorst, Vos, Hox, & Van Engeland, 2007), and to identify and describe one’s own and others’ emotional states (Kohler, Walker, Martin, Healy, & Moberg, 2010; O’Driscoll, Laing, & Mason, 2014; Trémeau, 2006).”

“The studies that compared VSZ with healthy controls (Silver et al., 2005; Wolfkuhler et al., 2012) support an emotion recognition deficit, as is seen generally in the schizophrenia literature (Trémeau, 2006).”

“…of auditory stimuli, patients with SZ have deficits in emotional expression and perception, including interpretation of emotional tones of voices (Hoekert et al., 2007; Kohler et al., 2004; Kohler and Martin, 2006; Kring and Moran, 2008; Mandal et al., 1998; Trémeau, 2006; Kantrowitz et al., 2015).”

“590 Married or cohabitating 5 (50) 8 (57) — — Divorced 0 1 (7) — — Never married 5 (50) 5 (36) — — Nicotine use (cigarettes/day) (n, %) 0.”

“Such deficits are associated with impairments in social interaction and predict functional outcome (Barkl et al., 2014; Trémeau, 2007).”

“This evidence is contrary to the longstanding reports of emotional abnormalities in SZ, which are largely based on the appearance of a lack of emotion in schizophrenia (e.g., flat affect and anhedonia, Bleuler, 1950; Kraeplin, 1919; Kring and Moran, 2008; Tremeau, 2006).”

“Difficulties in facial emotion perception are found in several diseases like epilepsy (Hlobil et al., 2008; Zhao et al., 2014) and schizophrenia (Kohler et al., 2000; Trémeau, 2006).”

“…studies investigating emotional experience in schizophrenia patients have not found significant differences between patients and controls in terms of subjective reports of negative emotions (Aghevli et al., 2003; Earnst & Kring, 1999; Kring et al., 1993; Salem & Kring, 1999; Trémeau, 2006).”

“In this context, sustained attention may be particularly relevant for the processing of complex social stimuli, such as eye gaze, head and body orientation, facial expression, and pointing gestures (Frischen et al., 2007; Kohler et al., 2000; Tremeau, 2006).”

“1 3 Patients with schizophrenia experience difficulties in dealing with emotions, which is evidenced by having lowered or disturbed emotional perception, emotional experience, emotional expression, and emotional identification [7].”

“Deficits in emotion expression associated with psychological disorders have been well-documented, particularly in patients with schizophrenia (see Trémeau, 2006 for review), although emotion expression deficits have also been identified in depression (Gehricke & Shapiro, 2000) and PTSD (Clapp…”

“Individuals with schizophrenia demonstrate consistent and pervasive difficulties in their ability to accurately perceive or decode universally recognized facial expressions of emotions(Morrison et al., 1988; Tremeau, 2006; Chan et al., 2008; Kohler et al., 2009).”

“…literature suggesting poor facial emotion recognition in schizophrenia (Addington and Addington, 1998; Baudouin et al., 2002; Russell et al., 2003; Tremeau, 2006; Fusar-Poli et al., 2009; Norton et al., 2009), the underlying mechanisms that lead to deficits of facial emotion recognition are not…”

“innovative emotional response task and a neuroleptic-free sample (Tremeau, 2006) there are several noteworthy limitations.”

“Relatedly, analyses of verbal and nonverbal expression among those with schizophrenia have demonstrated consistent results, independent of medication and internal states [24,25].”

“Emotion-evocative studies, which use emotional stimuli such as pictures of facial expressions or scenes, film clips, cartoons, odors, and flavors, have shown comparable degrees of experienced positive emotions and comparable-to-higher degrees of negative emotions in patients with schizophrenia than in normal controls…”

“Impairments in facial affect recognition are one of the most often replicated neuropsychological findings in schizophrenia (Trémeau, 2006; Morris et al., 2009; Kohler et al., 2010) and have been identified as a significant factor contributing to poor social and community functioning (Lee et al.”

“In schizophrenia, a deficit in facial affect recognition has often been reported.(2,3) However, the nature of this impairment is not clear.”

“We expected that these between-group effects would be greater when images were affectively salient due to the emotion processing deficits present in the schizophrenia population (Tremeau, 2006; Marwick and Hall, 2008).”

“In fact, all aspects of emotional behavior, such as emotion expression, experience, and recognition, are impaired in schizophrenia (Trémeau, 2006).”