Review articleThe effect of antipsychotic medication on facial affect recognition in schizophrenia: A review
Introduction
Three broad types of symptoms characterise schizophrenia: psychotic symptoms, cognitive impairment and negative symptoms (Mueser and McGurk, 2004). Negative symptoms are deficit states in which basic emotional and behavioural processes are diminished or absent. Negative symptoms (Fitzgerald et al., 2003) and cognitive impairment (Green et al., 2000) are strongly associated with functional impairment, including impairment in community living and work, as well as a limited quality of life. In addition, several investigators have found a deficit in facial affect recognition in schizophrenia (Walker et al., 1981, Feinberg et al., 1986, Heimberg et al., 1992, Mandal et al., 1998, Edwards et al., 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). However, it is still unclear whether the impairment in affect perception is a specific emotional deficit or whether it is related to a more generalised impairment in perception and attention (Bozikas et al., 2004).
It has previously been found that medication-free patients with schizophrenia and individuals at risk for developing a psychosis are impaired in their ability to recognise emotional facial expressions (Kerr and Neale, 1993, Addington et al., 2008). However, most patients with schizophrenia use antipsychotic medication. Therefore, it is important to investigate the effects of antipsychotic medication on facial affect recognition.
The main targets of most atypical antipsychotic agents are the dopaminergic and serotonergic systems, which are extensively distributed throughout the mesocorticolimbic regions (amygdala, hippocampus, thalamus and anterior cingulate) and the frontal cortical area, known to be implicated in emotional processing (Takahashi et al., 2005). Adolphs (2002) reviewed the neural systems necessary for recognising emotion in healthy individuals and distinguished two different processes: first, the perceptual processing (identifying) of facial features and second, the recognition of the emotional meaning. Adolphs (2002) discovered that the perceptual processing of emotional expressions involves visual cortical regions, and there is evidence that the fusiform gyrus is necessary to represent the static features of faces and identification, whereas the superior temporal gyrus is responsible for representing the dynamic features of faces. In schizophrenia, disturbances in neuronal activity during emotion recognition are found in the amygdala, the fusiform and the mid-occipital gyrus (Taylor et al., 2002, Johnston et al., 2005, Holt et al., 2006). In a review on abnormal brain functioning during emotional stimulation, Phillips et al. (2003) concluded that patients with schizophrenia showed impaired responses of the amygdala, anterior insula, and ventral striatum, regions that are part of the ventral system which is involved in the identification of the emotional significance of a stimulus, overt displays of emotions and autonomic responses to emotion-eliciting stimuli, that is, the more basic responses to these stimuli. Thus, the disturbances in these areas found in schizophrenia could contribute to difficulties in identifying emotional facial expressions. The aim of this review is to investigate whether antipsychotic medication is able to improve facial affect recognition in patients with schizophrenia.
Two previous reviews have been published regarding emotion perception and antipsychotic treatment. Mueser et al. (1997) reviewed three studies, all using the same outcome measures, with different sample characteristics in terms of chronicity of the illness and medication status (on/off medication). Unfortunately, Mueser et al. (1997) did not compare the different antipsychotics and their effects on facial affect recognition. Pinkham et al. (2007) only briefly described some studies that have investigated the effects of antipsychotic treatment of affect perception, but they do not give an extensive overview of these studies. The aim of the present review is to compare studies that investigated the effect of different antipsychotic agents on facial affect recognition in schizophrenia.
Section snippets
Methods
We searched PubMed for articles in English published till January 2008. The keywords we used were schizophrenia, facial, affect, emotion, antipsychotic and medication. We excluded editorials and letters, and studies that did not explicitly investigate the effects of antipsychotic medication on facial affect recognition.
We calculated effect sizes (Cohen's d; Cohen, 1992) where possible, either by using the reported means and standard deviations of the relevant tests, or by converting the
Results
Using the search terms ‘schizophrenia’, ‘facial’, ‘emotion’ and ‘antipsychotic’ resulted in a list of 29 articles, of which seven were useful for the present review (Lewis and Garver, 1995, Kee et al., 1998, Williams et al., 2003, Herbener et al., 2005, Harvey et al., 2006, Sergi et al., 2007, Fakra et al., in press). Using the search terms ‘schizophrenia’, ‘facial’, ‘emotion’ and ‘medication’ resulted in a list of 26 articles, of which five were useful (Gaebel and Wölwer, 1992, Kee et al., 1998
Discussion
This review was performed to compare studies that investigated the effects of antipsychotic medication on facial affect recognition in schizophrenia. Eight studies were eligible to be included in the present review.
Acknowledgements
The authors wish to thank the three anonymous reviewers for their constructive commentary during the preparation of this review article.
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