Elsevier

Biological Psychiatry

Volume 60, Issue 5, 1 September 2006, Pages 423-431
Biological Psychiatry

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A Reversal of the Normal Pattern of Parahippocampal Response to Neutral and Fearful Faces Is Associated with Reality Distortion in Schizophrenia

https://doi.org/10.1016/j.biopsych.2005.11.021Get rights and content

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 × 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.

Section snippets

Participants

Fifteen male individuals with a DSM-IV diagnosis of schizophrenia were recruited from outpatient clinics of the South London and Maudsley Trust, United Kingdom. The diagnosis of schizophrenia was made by psychiatrists using the Structured Clinical Interview for DSM-IV (SCID) (First et al 1995). Eleven healthy male control individuals matched for age and years of education were recruited from ancillary staff at the Maudsley Hospital and the local population. Exclusion criteria for all

Results

The 3 × 2 ANOVA of the whole brain statistical data produced a difference map [interaction intensity by group; F(1.4,34.3) = 3.8; p < .05] comprising one cluster centered within the right parahippocampal gyrus, which extended into the right hippocampus (coordinates: x = 18/22, y = −18/−22, z = −18/−23). There were no other main effects or interactions. The significant interaction was driven by the greater BOLD response in the right parahippocampal gyrus to neutral faces in individuals with

Discussion

We aimed to examine neural responses to fearful and neutral facial expressions in individuals with schizophrenia and the relationship between specific symptom dimensions and patterns of neural response to these stimuli in this population. Our findings demonstrate for the first time that individuals with schizophrenia can be distinguished from healthy control subjects by their differential patterns of neural response to fearful and neutral faces. While individuals with schizophrenia demonstrated

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