Acceptability and suppression of negative emotion in anxiety and mood disorders.

The present study investigated perceived acceptability and suppression of negative emotion in participants with anxiety and mood disorders. Sixty participants with these disorders and 30 control participants watched an emotion-provoking film and completed self-report measures of their experience and regulation of emotions. The film elicited similar increases in negative emotion for clinical and nonclinical participants; however, clinical participants judged their resulting emotions as less acceptable and suppressed their emotions to a greater extent. The higher level of suppression in the clinical group was attributable to females in the clinical group suppressing their emotions more than females in the nonclinical group. For all participants, high levels of suppression were associated with increased negative emotion during the film and during a postfilm recovery period. Further analyses showed that appraising emotions as unacceptable mediated the relationship between negative emotion intensity and use of suppression in the clinical group. This study extends the literature on emotion regulation to a clinical sample and suggests that judging emotions as unacceptable and suppressing emotions may be important aspects of the phenomenology of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family study of schizophrenia and personality.

The purpose of this study was to determine whether the abnormal characteristics observed in relatives of schizophrenics represent variations in normal personality. Relatives (N?=?340) of patients with schizophrenia, affective disorder, and medical or surgical conditions were personally interviewed about psychiatric symptoms and completed the Multidimensional Personality Questionnaire. Relatives who were themselves ill had elevated scores on some scales. Relatives of schizophrenics had normal scores on all personality scales, but relatives of affectively ill probands differed from other relatives on Well-Being and measures of Negative Emotionality. When schizophrenic probands were subtyped by symptoms, relatives of emotionally blunted schizophrenics were found to have slightly lower scores on Social Closeness than did relatives of controls. Overall, these results suggest that schizophrenia is unrelated to normal personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

More evidence for generalized poor performance in facial emotion perception in schizophrenia.

Previous studies showing that schizophrenic patients have a deficit in the ability to perceive facial expressions of emotion in others often have not used a differential deficit design and standardized measures of emotion perception. Using standardized and cross-validated measures in a differential deficit design, S. L. Kerr and J. M. Neale (see record 1993-29687-001) found no evidence for a deficit specific to emotion perception among unmedicated schizophrenic patients. The present study replicated and extended the findings of Kerr and Neale in a sample of medicated schizophrenic patients. Results showed that medicated patients performed more poorly than controls overall; however, they performed no worse on facial emotion perception tasks than on a matched control task. These findings support Kerr and Neale's conclusion that schizophrenic patients do not have a differential deficit in facial emotion perception ability. Future research should examine the nature of schizophrenic patients generalized poor performance on tests of facial emotion perception. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective ratings and startle modulation in people with nonclinical depression.

This study tested predictions based on the emotion context insensitivity (ECI) hypothesis of Rottenberg, Gross, and Gotlib (2005) that a nonclinical sample of people with depressive symptoms would show reduced responses to both positive and negative stimuli relative to people without depression and would show an enhanced response to novelty. Seventy individuals completed diagnostic questionnaires, made ratings of 21 affectively valenced pictures, and then viewed the same 21 pictures and 21 novel pictures while startle blink responses were recorded from electromyographic activity of the orbicularis oculi. People with scores on the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) indicative of depression demonstrated a lack of affective startle modulation compared to the nondepression group. For all participants, the startle response was larger for novel pictures than for previously viewed pictures, but scores on the BDI were not related to response to novelty. Taken together, the results suggest that nonclinical depression is associated with a lack of affective modulation of startle, as has been shown for clinical depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotion perception in schizophrenia: Specific deficit or further evidence of generalized poor performance?

Several studies have investigated the ability of schizophrenics to perceive facial and vocal emotion in others. Although most suggest that schizophrenics have an emotion perception deficit, there is little agreement as to its specific nature. Much of the confusion may be attributed to the failure of investigators to use the differential deficit design and standardized measures of emotion perception. The present study reexamined the question of an emotion recognition deficit in a sample of 29 unmedicated schizophrenics and 23 normal controls, using facial and vocal emotion identification and discrimination tests that have been standardized and cross-validated plus 2 neuropsychological control tests. Results suggested that differences between schizophrenics and normals on such tasks reflect a generalized performance deficit, rather than a specific emotion recognition deficit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deficits in emotion-regulation skills predict alcohol use during and after cognitive–behavioral therapy for alcohol dependence.

Objective: As emotion regulation is widely considered to be a primary motive in the misuse of alcohol, our aim in the study was to investigate whether deficits in adaptive emotion-regulation skills maintain alcohol dependence (AD). Method: A prospective study investigated whether emotion-regulation skills were associated with AD and whether these skills predicted alcohol use during and after treatment for AD. Participants were 116 individuals treated for AD with cognitive–behavioral therapy. Emotion regulation and severity of AD symptoms were assessed by self-report. Alcohol use during treatment was assessed by Breathalyzer and urine analysis for ethyl glucuronide; alcohol use during the 3-month follow-up interval was assessed by self-report. Results: Pretreatment emotion-regulation skills predicted alcohol use during treatment, and posttreatment emotion-regulation skills predicted alcohol use at follow-up, even when controlling for other predictors potentially related to emotion regulation. Among a broad range of specific emotion-regulation skills, the ability to tolerate negative emotions was the only skill that negatively predicted subsequent alcohol consumption when controlling for the other skills. Individuals in the AD sample reported significantly larger deficits in emotion-regulation skills than did those in a nonclinical control sample but significantly less than did those in a sample of individuals exclusively meeting criteria for major depressive disorder. Conclusions: Enhancement of general emotion-regulation skills, especially the ability to tolerate negative emotions, appears to be an important target in the treatment of AD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Emotion responsivity, social cognition, and functional outcome in schizophrenia.

Social functioning deficits have long been a defining feature in schizophrenia, but relatively little research has examined how emotion responsivity influences functional outcome in this disorder. The goal of the current study was to begin to elucidate the relationships between emotion responsivity, social cognition, and functional outcome in schizophrenia. Participants were 40 outpatients diagnosed with schizophrenia or schizoaffective disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) and 40 controls. Each participant completed measures of emotion responsivity, social cognition (both emotion and social perception), and functional outcome. Individuals with schizophrenia demonstrated somewhat reduced emotion responsivity for positive and negative stimuli, as well as deficits in both social cognition and functional outcome, in comparison with controls. Additionally, results indicated that both social perception and emotion responsivity were positively correlated with functional outcome. Importantly, the relationship of emotion responsivity to functional outcome was not mediated by social perception and showed a significant relationship to functional outcome independent of social cognition. This finding suggests that emotion responsivity is an important factor in understanding functional outcome in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of distress to mood disturbance in primary care and psychiatric populations.

Disagreement remains as how to interpret elevated scores on measures of self-reported distress. This study compared elevated scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) in 2 samples to mood disturbance as assessed in an interview. In a primary medical care sample, most distressed patients did not have a mood disturbance, and distress without mood disturbance was associated with little impairment. Primary care patients with elevated scores on the CES-D were less distressed and less likely to have mood disturbance, major depression, or impairment than distressed psychiatric patients. Few patients with mood disturbance in either sample failed to meet criteria for major depression. Implications are discussed for research on depression using self-report measures, for generalizations across clinical and nonclinical populations, and for screening for preventive interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of expressed emotion in relatives of those with schizophrenia and its relationship with burden of care and perception of patients' social functioning

BACKGROUND: There is evidence that high expressed emotion (EE) in relatives of patients with schizophrenia is associated with higher levels of burden of care, and with worse perception of patient's social functioning. However, it is not clear whether changes in EE levels over time are associated with changes in relatives' burden of care and their perception of patients' social functioning. METHODS: Fifty patients with a diagnosis of schizophrenia and 50 relatives were included in the study soon after patients' admission to hospital. Thirty-six relatives and 31 patients were re-assessed 9 months after patients' discharge. Both assessments included patients' symptomatology and relatives' EE levels, burden of care, and perception of patients' social functioning. RESULTS: Twenty-three relatives (64%) had the same EE level in both assessments, nine (25%) had changed from high to low EE, and four (11%) from low to high EE. Improvement in burden and perception of patients' social role performance were significantly more accentuated among relatives who changed from high to low EE than among relatives who had a stable EE level. Variables that best predicted changes in EE levels were changes in burden scores and number of hours of contact between patients and relatives at follow-up. CONCLUSIONS: Change in EE is associated with change in circumstances and burden. Findings support the idea that EE is better understood in an integrative model.     

Emotion recognition and social competence in chronic schizophrenia.

This study evaluated (a) whether chronic, medicated schizophrenia patients show deficits in emotion recognition compared to nonpatients, and (b) whether deficits in emotion recognition are related to poorer social competence. Two emotion recognition tests developed by S. L. Kerr and J. M. Neale (1993) and Benton's Test of Facial Recognition (A. Benton, M. VanAllen, K. Hamsher, & H. Levin, 1978) were given to patients with chronic schizophrenia and nonpatient controls. Patients' social skills, social adjustment, and symptomatology were assessed. Like Kerr and Neale's unmedicated patients, these patients performed worse than controls on both emotion recognition tests and the control test. For patients, facial perception was related to the chronicity of illness and social competence. Chronicity of illness may contribute to face perception deficits in schizophrenia, which may affect social competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of focused and standard cognitive therapy for panic disorder

A set of measures assessing abilities related to legal standards for competence in the adjudicative process were administered to mentally-disordered criminal defendants with diagnoses of schizophrenia, affective disorder, other psychiatric disorders, and to criminal defendants without diagnosed mental disorder. Mentally-disordered defendants were recruited from two groups: those who had been committed for restoration of competence and those who had been identified by jail personnel as mentally ill. Significant impairments in competence-related abilities were found for approximately half of the defendants with schizophrenia. Defendants with schizophrenia scored lower on measures of understanding, reasoning, and appreciation related to the adjudication process. The association between symptoms and competence-related abilities was explored within diagnostic groups. Conceptual disorganization was found to be inversely correlated with performance on all measures in both defendants with schizophrenia and those with affective disorders. For other psychotic symptoms, differing patterns of correlations were found in the two major diagnostic groups. The implications for policy designed to safeguard the rights of defendants to be tried while competent are discussed.     

Rey-Osterrieth Complex Figure Test performance in acute, chronic, and remitted schizophrenia patients

To assess visual memory disturbance in different forms of schizophrenia, we compared Rey-Osterrieth Complex Figure Test (RCF) performance in acutely psychotic, chronically psychotic, and outpatient schizophrenia patients and in a control group of acutely psychotic patients with disorders other than schizophrenia. There were no group differences on the copy condition of the RCF. The chronic schizophrenia group utilized more abnormal copying strategies, however, than the outpatient or nonschizophrenia groups. Moreover, the chronic schizophrenia group demonstrated significantly poorer recall than the outpatient or nonschizophrenia groups, and a trend toward poorer performance than the acute schizophrenia group. Both groups of inpatient schizophrenia patients were characterized by a lack of relationship between copying strategies and recall accuracy. These data suggest that (a) chronic schizophrenia patients are characterized by more severe memory impairment than are nonchronic schizophrenia patients, and (b) visual memory disturbance in chronic schizophrenia is not solely a function of encoding difficulties.     

The backward masking red light effect in schizophrenia: Relationship to clinical features and neurocognitive performance.

The “backward masking red light effect” involves a change in visual backward masking performance with a red (compared with a green or gray) background that is in the opposite direction relative to nonpsychiatric controls. This effect has been previously reported in individuals with schizophrenia, their first-degree relatives, and a schizotypy sample. The current study provides the first examination of the relationship of this effect with clinical and neurocognitive measures in a new sample of higher functioning patients with schizophrenia. A location backward masking by pattern task was administered to 16 outpatients with schizophrenia and 21 nonpsychiatric controls. The task was presented on red, green, and gray backgrounds. There was a significant group by color interaction at the 60-ms stimulus onset asynchrony: Participants with schizophrenia tended to decrease accuracy with a red (compared with a gray) background, whereas controls tended to increase accuracy. This interaction remained significant after covarying for baseline (gray) backward masking accuracy. In the schizophrenia patients, a decrease in backward masking accuracy to the red background was correlated with more negative symptoms, lower estimated premorbid IQ, and greater color–word Stroop interference but was not related to positive or disorganized symptoms, age of onset, duration of illness, digit symbol coding performance, or baseline (gray) backward masking accuracy. In contrast, there was no relationship between the red light change score and any of the neurocognitive variables in the control group. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relationship between the five-factor model of personality and Axis I disorders in a nonclinical sample.

The relationship between the 5-factor model (FFM) of personality and Axis I disorders was evaluated in a nonclinical sample of 468 young adults. In general, scores on the 5 personality dimensions of neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness (assessed via the NEO Five-Factor Inventory) distinguished Ss with and without a variety of Axis I diagnoses from the Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R). In several instances, results indicate that scores on these dimensions were differentially sensitive to diagnosis. Furthermore, scores on these 5 personality dimensions accounted for unique variance in several Axis I diagnoses above and beyond that accounted for by a general measure of current psychopathological symptoms. These results support the utility of the FFM of personality in Axis I diagnostic assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cochlear implantation of children with minimal open-set speech recognition skills

OBJECTIVE: The purpose of this study was to evaluate the postoperative performance of 12 children who demonstrated some open-set speech recognition skills before receiving a Nucleus multichannel cochlear implant with a view toward expanding the selection criteria for cochlear implant candidacy to include children who derive minimal benefit from amplification. DESIGN: Pre- and postoperative performance of two groups of children were compared. Group 1 consisted of 12 children who demonstrated some open-set speech recognition skills before receiving a Nucleus multichannel cochlear implant (Borderline group). Group 2 consisted of 12 children who demonstrated no open-set speech recognition skills before implantation with a Nucleus device (Traditional group). In all children, candidacy was determined based on preimplant binaural aided performance. For most subjects, the poorer ear was selected for implantation. Mean pre- and postoperative speech recognition scores of the Borderline subjects were compared to determine the benefit provided by their cochlear implants. Secondly, matched-pair analyses were used to compare the mean speech recognition scores obtained by the Borderline and Traditional subjects. RESULTS: The scores of the Borderline group improved significantly on five of six speech recognition measures when 6 mo postoperative scores obtained with the implant were compared with preoperative test scores obtained with hearing aids. By the 12 mo postoperative interval, the scores of the Borderline group had improved significantly (p < 0.05) on all six measures. In contrast, scores obtained by the Traditional group had improved significantly on three of six measures at both the 6 and 12 mo postoperative intervals. Comparison of postoperative test scores revealed that the Borderline group scored significantly higher than the Traditional group on three of six measures at the 6 mo test interval and on six of six measures at the 12 mo test interval (p < 0.05). CONCLUSIONS: The findings of this study indicate that both groups derive significant benefit from their cochlear implants. Although the mean preoperative audiograms for the implanted ears did not differ significantly for the two groups of subjects, members of the Borderline group exhibited significantly better speech recognition skills than the Traditional group during the first year after implantation. These findings suggest that the increased auditory experience of the Borderline subjects positively influenced their performance with a cochlear implant. The authors advocate that the selection criteria used to determine pediatric cochlear implant candidacy be broadened to include consideration of children who demonstrate minimal open-set speech recognition skills.     

Neurocognitive basis of impaired empathy in schizophrenia.

Patients with schizophrenia show impaired emotional and social behavior, such as lack of theory of mind and misinterpretation of social situations. However, there is a paucity of work focusing on the empathic abilities of these patients. The present study was designed to examine the degree of impairment in cognitive and affective empathy in schizophrenia and to evaluate the contribution of executive prefrontal functions to empathy in these patients. To explore the neurocognitive processes that underlie the empathic ability in schizophrenic patients, the relationship between empathy scores and the performance on a cognitive flexibility task that assesses dorsolateral and orbitofrontal functioning (set shifting and reversal, respectively) was examined in 26 patients with schizophrenia and 31 healthy control subjects. Results indicated that patients with schizophrenia were significantly impaired in both cognitive and affective empathy compared with healthy control subjects. The degree of impaired empathy related to the severity of negative symptoms. In addition, patients showed impaired performance on measures of both shifting and reversal. However, while cognitive empathy was particularly related to measurements of orbitofrontal (rather than dorsolateral) functioning, affective empathy was related to measures of social functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotion–cognition interaction in people at familial high risk for schizophrenia: The impact of sex differences.

Cognitive deficits are fundamental to schizophrenia, and research suggests that negative emotion abnormally interferes with certain cognitive processes in those with the illness. To a lesser extent, cognitive impairment is found in persons at risk for schizophrenia, but there is limited research on the impact of emotion on cognitive processing in at-risk groups. It is unknown whether interference of negative emotion precedes illness and contributes to vulnerability for the disorder. We studied the extent to which negative emotional information interferes with working memory in 21 adolescent and young adult first-degree relatives of people with schizophrenia and 22 community controls. Groups were comparable in age, sex, education, ethnicity, and socioeconomic status. Primary measures were n-back tasks varying in cognitive load (1-back, 2-back, 3-back) with emotional faces (neutral, happy, fearful) as stimuli. The control group's response times (RTs) and the women's RTs, regardless of group, differed depending on the emotion condition. In contrast, the RTs of the relatives and of the men, regardless of group, did not differ by emotion. This study is the first to examine emotion–cognition interactions in relatives of individuals with schizophrenia. Reduced efficiency in processing emotional information may contribute to a greater vulnerability for schizophrenia that may be heightened in men. Additional research with larger samples of men and women is needed to test these preliminary findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Anhedonia and the experience of emotion in individuals with schizophrenia.

Research shows that individuals with schizophrenia report symptoms of anhedonia when assessed by interview or questionnaire. However, when presented with emotional stimuli, they report emotional experiences that are similar to those of control participants. The authors hypothesized that deficits in working memory and episodic memory contribute to such discrepancies. They administered measures of working and episodic memory, self-report anhedonia questionnaires, and several types of emotional stimuli to 49 individuals with schizophrenia and 47 control participants. All participants reported experiencing similar amounts of pleasant-unpleasant emotion (valence) in response to stimuli, but individuals with schizophrenia reported experiencing less arousal for negative stimuli. Individuals with schizophrenia also reported greater social and physical anhedonia on a traditional anhedonia questionnaire. Disturbances in working memory moderated the relationship between physical anhedonia and participants' emotional experience of positive stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-monitoring dysfunction and the schizophrenic symptoms of alien control

BACKGROUND: Frith & Done (1988) have proposed that the experience of alien control symptoms in schizophrenia is related to a failure by such individuals to monitor effectively their own willed intentions, actions and thoughts. METHOD: To examine this hypothesis, a heterogeneous group of 35 patients, all carrying a DSM-III-R diagnosis of schizophrenia (or schizophreniform psychosis) and 24 non-patient controls, completed a battery of neuropsychological and cognitive tests, which inter alia, included four putative measures of self-monitoring. Patients took part in a detailed clinical interview to assess current levels of symptomatology. RESULTS: Patients generally performed at a lower level on most components of the test battery, including the four self-monitoring tests. Moreover, patients currently experiencing symptoms of alien control tended to experience greater difficulty with each of the self-monitoring tests; an effect that was relatively independent of neuropsychological or general cognitive function. CONCLUSIONS: The relationship between poor self-monitoring and the presence of alien control symptoms provides support for Frith & Done's account of the origins of these symptoms in schizophrenia.     

A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF)

BACKGROUND: The Global Assessment of Functioning (GAF) is a quick and simple measure of overall psychological disturbance. However, there is little research on the reliability and validity of this measure in severely mentally ill populations. METHOD: Multidisciplinary keyworkers assessed 103 patients at monthly intervals over a 6-month period. Overall GAF scores were obtained, with additional separate ratings for symptoms and disability. These were compared with changes in antipsychotic medication and support needs over the same period. RESULTS: Satisfactory reliability was obtained for total GAF score and for symptom and disability measures, in spite of raters having only one brief training session. All GAF scores were associated with current support needs of patients. Symptom and disability scores were associated with changes in antipsychotic medication in the previous month. Only symptom score was associated with increases in antipsychotic medication at time of rating. CONCLUSION: GAF proved to be a reliable and, within the limits of the indicators used, a valid measure of psychiatric disturbance in our sample of the severely mentally ill. Differences in relationships between the three GAF scores and medication/support needs indicate the usefulness of obtaining all three scores for monitoring levels and type of psychiatric disturbance in this population.