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Effects of Antipsychotic Treatment on Emotion Perception Deficits in First-Episode Schizophrenia
Ellen S. Herbener, Ph.D. S. Kristian Hill, Ph.D. Robert W. Marvin, M.D. John A. Sweeney, Ph.D.
Objective: The authors evaluated emotion perception in acutely ill patients experiencing a first episode of schizophrenia. They also investigated the effects of antipsychotic medication on emotion perception. Method: Tests of the ability to perceive and discriminate emotional expressions from the Penn Computerized Neuropsychological Battery were given to 13 patients experiencing their first episode of schizophrenia. Patients were also assessed with the Positive and Negative Syndrome Scale. The patients were tested while they were unmedicated and again following clinical stabilization. Healthy individuals were evaluated over a similar time interval. Results: Patients with first-episode schizophrenia demonstrated impairments in emotion perception before treatment and no significant improvement after treatment. Emotion perception deficits were correlated with negative symptoms after clinical stabilization. Conclusions: Deficits in emotion perception are present at illness onset in schizophrenia and show minimal response to effective antipsychotic treatment. (Am J Psychiatry 2005; 162:1746–1748)
ognitive deficits are typically present at the onset of schizophrenia and show limited responsiveness to treatment (1, 2). However, it remains to be established whether
emotional processing deficits are present at illness onset and whether antipsychotic treatment reduces such deficits. The current study addresses these issues by assessing
Am J Psychiatry 162:9, September 2005
Thirteen healthy subjects were recruited who did not meet criteria for any axis I disorder according to SCID results. p<0. There was no significant improvement on any of the emotion tasks after treatment (Figure 1). age.0 0. Results At the baseline assessment.63. When the analyses described here were repeated with IQ as a covariate. At the time of each testing. Although the severity of emotional processing deficits was minimally related to symptom presentation during acute illness. SD=0. negative symptom scores were highly correlated with performance impairments on the emotional acuity task in the patients with schizophrenia (r= –0. these deficits were strongly linked to negative symptom severity after clinical stabilization.73. df=12.0 z Score –0. or parental education. Method Subjects were recruited from the University of Illinois Medical Center.20). df=1.001. p<0. The emotional acuity task requires individuals to rate 40 black-and-white pictures of adult faces along a 7-point continuum of emotional intensity (happy to sad). The results of the current study indicate that individuals with schizophrenia demonstrate deficits in emotional processing even at their first psychotic episode.01). Potential subjects were excluded if there was a history of substantial head injury. symptoms were assessed by using the Positive and Negative Syndrome Scale (4). and two with haloperidol at a mean dose 4. p= 0.001. All subjects completed tests of the ability to perceive and discriminate emotional expressions from the Penn Computerized Neuropsychological Battery (5.001.35.187. After treatment. Four individuals who were not responsive to risperidone or suffered substantial side effects were stabilized with alternate medications (one with ziprasidone 140 mg. substance dependence. emotion differentiation task sad condition partial η2=0. September 2005 Discussion Deficits in emotional processing have long been considered a core deficit in schizophrenia (8). p<0.5 –2.001. Following baseline testing (described in the next two paragraphs). written informed consent was obtained from all participating subjects. negative symptoms: t= 3. Data were converted to z scores by using means and standard deviations from normative data collected by the University of Pennsylvania group (6). and sad condition: F=12. patients began treatment with risperidone (mean dose= 3. There was a robust decrease in symptom scores in the patient group from baseline to follow-up (positive symptoms: t=7.0 Acuity b Patients Happy Sad Differentiation Emotion Task with schizophrenia were medication free at baseline. However. Subjects completed a second testing session when they were clinically stable (mean=31.71).01). 24. follow-up testing was done when they were clinically stable with medication.5 –1. patients with schizophrenia performed more poorly than healthy subjects on both the emotional acuity task (F=24. These comparison subjects did not differ from the patient group in sex distribution. 6). N=13.01). unrelated to change in emotion task performance in the patients with schizophrenia (all p>0. p<0.70. Positive symptom severity was not significantly correlated with task performance at either testing. which reduced the power of the analyses.org 1747 .75) who had no knowledge of task performance.35). df=1.BRIEF REPORTS emotion recognition in patients with first-episode schizophrenia before and after treatment.01).5 0. Clinical improvement was Am J Psychiatry 162:9. emotion differentiation task happy condition partial η2=0. After description of the study. The emotion differentiation task requires individuals to identify which of two faces in 40 pairs of black-and-white photographs shows more intense emotion. The effect sizes for change in emotion task performance after treatment were very small (emotional acuity task partial η2=0. df=12. Furthermore. These patients had received 4 or fewer weeks of treatment with antipsychotic medication in their lifetime and had been unmedicated for at least 5 days before testing.002).5 mg. SD=2. FIGURE 1.3 days later. 24. df=1. The number of patients in the current study is limited.psychiatryonline.0 –1. SD=8. 24.001) and the emotional differentiation task (happy condition: F=20. or systemic or neurological disorders that might affect symptom presentation or cognitive performance. Performance of Patients With First-Episode Schizophrenia and Healthy Comparison Subjects on the Penn Computerized Neuropsychological Battery Emotional Acuity and Emotion Differentiation Tasks at Baseline and Follow-Upa Patients with first-episode schizophrenia (N=13): Baseline Follow-up Healthy comparison subjects (N=13): Baseline Follow-up 1. Because medication effectively reduced some aspects of negative symptoms. SCID and Positive and Negative Syndrome Scale ratings were completed by trained clinicians with established reliability (kappa ≥0. Thirteen patients experiencing their first episode of schizophrenia were diagnosed by using the Structured Clinical Interview for DSM-IV (SCID) (3).241. the same effects were observed. it may be that residual core persistent negative symptoms have a stronger linkage to emotional processing deficits.38 mg. effect http://ajp. p<0. Subjects also completed the two-subtest version of the Wechsler Abbreviated Scale of Intelligence (7) to evaluate general intellectual function. these deficits were not significantly reduced by effective treatment with antipsychotic medication. one with aripiprazole 30 mg.
Harris AW. html 7. Keshavan MS. Address correspondence and reprint requests to Dr. Schizophr Bull 1999. Mintz J: Does risperidone improve verbal working memory in treatment-resistant schizophrenia? Am J Psychiatry 1997. such as chronicity of illness. researchers have reported modest improvements in cognitive performance in select areas of functioning with atypical antipsychotic treatment. Herbener. Translated by Zinkin J. North Tonawanda. Keshavan MS. Gur RC: The Computerized Neuropsychological Battery (CNP) of the Brain Behavior Laboratory at the University of Pennsylvania. Herbener) and MH-62134 (Dr. Bleuler E: Dementia Praecox or the Group of Schizophrenias (1911). Gordon E: Emotion perception in schizophrenia: an eye movement study comparing the effectiveness of risperidone vs haloperidol. Received June 21. 1995 4. Williams LM. they may be another domain of deficit related to poorer functional outcome.upenn. IL 60612. 8. accepted Nov. Schizophr Res 2004. Thus. In the few studies comparing cognitive performance between unmedicated and medicated states in first-episode patients (1. From the Center for Cognitive Medicine.uic. NY. Kern RS. may also influence these relationships. Chicago. 156: 1336–1341 3. New York. Wechsler Abbreviated Scale of Intelligence. University of Illinois at Chicago. Sweeney JA: Negative symptom resolution and improvements in specific cognitive deficits after acute treatment in first-episode schizophrenia. Schuepbach D. Nonetheless. Psychiatry Res 2003. Kern RS. Marshall BD Jr.BRIEF REPORTS sizes of treatment on emotion task performance were so low that it is unlikely that statistical power considerations were responsible for the failure to identify improvement after treatment. Kay SR. Spitzer RL. Fiszbein A: Positive and Negative Syndrome Scale (PANSS). additional research with larger groups of subjects will be important to address this issue as well as whether other factors.med. Sakuma M. McGurk S. References 1.org Am J Psychiatry 162:9.psychiatryonline. 12). Psychiatry Res 1992. Department of Psychiatry. (13) found that a decrease in negative symptoms with treatment was correlated with cognitive improvement and that persistent negative symptoms were associated with ongoing cognitive deficits. 25:201–222 13. Herbener ES. 53:249–261 1748 http://ajp. Schuepbach et al.. Gibbon M.edu (e-mail). Marder SR. Gur RE. 154:799–804 12. 31: 159–165 10. Further. Kee KS. 1950 9. DeLisi LE: Longitudinal neuropsychological follow-up study of patients with first-episode schizophrenia. http://www. Schizophr Res 2002. Wieneke M. San Antonio. Hill SK. Am J Psychiatry 1999. 1986 5. University of Illinois at Chicago. Department of Psychiatry. 22. 120:13–27 11. 42:231–240 6. Tex. Erwin RJ. Kmiec JA. Gur RC. 2004. Multi-Health Systems. Previous studies assessing medication effects on emotion perception have typically compared performance during treatment with atypical and conventional antipsychotic medications and found better performance with atypical antipsychotics (9. Treatment studies assessing other aspects of cognitive performance in schizophrenia have also demonstrated somewhat better performance with atypical antipsychotics than conventional antipsychotic medications (11. The current data suggest that deficits in emotion perception are not significantly improved with effective atypical antipsychotic medication. Lieberman JA: The effects of atypical antipsychotic drugs on neurocognitive impairment in schizophrenia: a review and meta-analysis. New York. Marshall BD Jr. International Universities Press. 68:49–63 2. Loughland CM. Perkins DO. Ames D. they appear to represent an important target for clinical intervention. Green MF. eherbener@psych. 13). New York State Psychiatric Institute. Green MJ. Wood St. Psychological Corp (Harcourt).edu/bbl/pubs/downloads/nptasks. Opler LA. September 2005 . First MB: Structured Clinical Interview for DSM-IV (SCID). Keefe RSE. Cognitive Medicine. Herbener) and NIMH grants MH067223 (Dr. Schuepbach D. Smailis J. Wirshing WC. Skolnick B: Facial emotion discrimination. 912 S. Silva SG. Supported by a grant from the National Alliance for Research on Schizophrenia and Depression (Dr. Schizophr Res 1998. Hoff AL. Sweeney JA: Pretreatment and longitudinal studies of neuropsychological deficits in antipsychotic-naive patients with schizophrenia. Kushner M. 2004. 1: task construction and behavioral findings in normal subjects. 1999 8. revision received Sept. Horon R. Biometrics Research. 10). Green MF: Risperidone versus haloperidol for perception of emotion in treatment-resistant schizophrenia: preliminary findings. because emotion perception deficits were correlated after stabilization with negative symptoms. 2004. Williams JBW. Sweeney).