What aspects of emotional functioning are impaired in schizophrenia?

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Abstract

Disturbances in emotional functioning are a major cause of persistent functional disability in schizophrenia. However, it is not clear what specific aspects of emotional functioning are impaired. Some studies have indicated diminished experience of positive affect in individuals with schizophrenia, while others have not. The current study assessed emotional responses by 34 individuals with schizophrenia and 35 demographically matched healthy participants to 131 images sampling a wide range of emotional arousal and valence levels. Ratings of affective response elicited by individual images were highly correlated across the groups (r's > .90), indicating similar emotional experiences at the moment of stimulus exposure. However, the data did not indicate strong relationships between ratings of the emotional impact of the images and most measures of day-to-day emotional processing. These results demonstrate that individuals with schizophrenia report “normal” emotional responses to emotional stimuli, and thus suggests that deficits in emotional functioning associated with the disorder are likely to occur further downstream, and involve the effective integration of emotion and cognition for adaptive functioning in areas such as goal-setting, motivation, and memory.

Introduction

Disturbances in emotional processing in individuals with schizophrenia are related to persistent functional disability (cf. Blanchard et al., 1998, Herbener and Harrow, 2004, Hooker and Park, 2002), and may underlie negative and deficit symptoms such as avolition and anhedonia. However “emotional processing” is a broad term, encompassing multiple aspects of emotion that may or may not be impaired. Many studies of emotion processing in schizophrenia have focused on abnormalities in facial emotion perception (Kohler et al., 2000, Mueser et al., 1997) or affective expression (Aghevli et al., 2003, Berenbaum and Oltmanns, 1992, Herbener and Harrow, 2004, Kring and Neale, 1996). Findings generally indicate impairment in both aspects of emotional functioning, although data on their relationship is inconsistent.

Data is less clear on whether individuals with schizophrenia experience abnormalities in immediate emotional experience, as past studies have provided inconsistent results (Blanchard et al., 1994, Curtis et al., 1999, Hempel et al., 2005, Kring and Neale, 1996, Paradiso et al., 2003, Schlenker et al., 1995, Takahashi et al., 2004, Taylor et al., 2005). Several studies that assessed affective responses to emotional images “in the moment” found no differences in ratings of personal emotional experience between schizophrenia and healthy samples (Hempel et al., 2005, Schlenker et al., 1995, Takahashi et al., 2004). However, other studies using the same types of stimuli have found that subjects with schizophrenia report less positive emotional responses to positively valenced images (Paradiso et al., 2003, Taylor et al., 2005). This inconsistency could be due to a number of different aspects of the studies (methods differences, subject differences). Alternatively, individuals with schizophrenia may have difficulties in experiencing certain intensities of emotion, but not others, and thus differences in the characteristics of the stimuli used to elicit emotions across studies could account for the disparity in previous findings.

The current study tested whether individuals with schizophrenia differ from healthy individuals in their emotional responses to stimuli across a wide range of valence and arousal. This approach makes it possible to determine whether there are specific levels of valence or arousal that might be differentially affected by illness status (e.g., individuals with schizophrenia might be particularly unresponsive to very positive emotional stimuli, or to positive more than negative stimuli). A second aim of this study was to examine the relationship between reports of immediate emotional experience while viewing emotional images with self-reported level of anhedonia and other aspects of emotional functioning (e.g., emotional face perception, emotional expression). Differences between self-report of emotional experience “in the moment” and reports on aspects of past positive emotional experiences are particularly of interest given the inconsistencies found in past studies (cf. Aghevli et al., 2003, Berenbaum and Oltmanns, 1992, Berenbaum et al., 1987, Kring and Neale, 1996, Schlenker et al., 1995).

Section snippets

Subjects

Thirty-four participants meeting DSM-IV criteria for schizophrenia or schizoaffective disorder and 35 healthy participants were recruited into this study. Potential participants were excluded if they reported histories of head trauma with loss of consciousness for more than 15 minutes, substance dependence within the past 6 months, or neurological or systemic illness that might influence cognitive functioning. Diagnoses for all participants were established using the Structured Clinical

Differences between diagnostic groups on rankings of response to emotional stimuli during initial exposure

Self-reported responses to emotional stimuli were highly similar in schizophrenia and healthy participants across the full spectrum of valence and arousal levels. As shown in Fig. 1, rankings of both valence and arousal in response to the 131 images by the two groups were highly correlated (r = 0.98 for valence ratings; r = 0.95 for arousal ratings).

Differences between groups in ratings of stimuli

Repeated measures analyses were used to test for group differences (between-group factor) in ratings of the five valence levels and for the five

Discussion

The current data provide compelling evidence that schizophrenia patients and healthy individuals do not significantly differ in their immediate response to emotional stimuli, either in terms of intensity of perceived emotional valence or in the arousal that they elicit. These data, consistent with past reports indicating normative emotional experiences “in the moment” for individuals with schizophrenia, provide new evidence that this similarity in emotional experience is seen across a wide

Conclusion

The current data demonstrate that individuals with schizophrenia have similar emotional responses to visual emotional stimuli as healthy individuals, and that this similarity extends over a wide range of emotional stimuli. In addition to confirming the normal emotional experience of individuals with schizophrenia at the moment of exposure to stimuli, the present finding shows that clinical evidence of emotional dysfunction is apparently unrelated to any disturbance in immediate emotional

Acknowledgement

We thank Lindsay Termini, who has assisted with data collection in this study.

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