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Accurately recognizing facial emotional expressions is important in psychiatrist-versus-patient interactions. This might be difficult when the physician and patients are from different cultures. More than two decades of research on facial expressions have documented the universality of the emotions of anger, contempt, disgust, fear, happiness, sadness, and surprise. In contrast, some research data supported the concept that there are significant cultural differences in the judgment of emotion. In this pilot study, the recognition of emotional facial expressions in 123 Japanese subjects was evaluated using the Japanese and Caucasian Facial Expression of Emotion (JACFEE) photos. The results indicated that Japanese subjects experienced difficulties in recognizing some emotional facial expressions and misunderstood others as depicted by the posers, when compared to previous studies using American subjects. Interestingly, the sex and cultural background of the poser did not appear to influence the accuracy of recognition. The data suggest that in this young Japanese sample, judgment of certain emotional facial expressions was significantly different from the Americans. Further exploration in this area is warranted due to its importance in cross-cultural clinician-patient interactions.

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Long-COVID refers to the lingering or protracted illness long after the acute illness. Depression, anxiety, fatigue, concentration and cognitive impairment appeared to be reported often in long COVID, psychosis seemed uncommon. Neuropsychiatric disorders in long COVID could be a consequence of direct viral insult on the central nervous system (CNS), continuous neuroinflammation, or neurodegeneration and metabolic impairment following the cerebral vascular accidents, or hypoxia from pulmonary damages and fibrotic changes. It is important to know how patients with various disorders, not only neuropsychiatric disorders, thrive under long COVID. How much the neuropsychiatric disorders reported in long COVID are stress related in nature, due to prolonged quarantine and social isolation, would also be important to study. Patients with diabetes are already known to have a higher risk of mortality and morbidity in COVID-19. How brain glucose metabolism may contribute to the neuropsychiatric symptoms in long COVID is an important area for COVID-19 research. Patients on psychotropics often asked their clinicians about potential conflicts of their medications with anti-COVID 19 vaccinations, or whether it would increase their vulnerability to COVID-19 viral infection. Thus, early reports of protective effects of psychotropics against COVID-19 need to be validated. Some antidepressant and antipsychotic agents indeed possess significant affinities for the sigma-1 and histamine receptors. This, with the earlier reports of reduced number of sigma-1 receptors in post- mortem schizophrenic brains and the reported roles of sigma and histamine receptors in neuroinflammation and viral infections, may point to an important and novel direction for drug discovery against COVID-19. Literature and data in all these areas are accumulating at a fast rate. We reviewed and discussed the relevant and important literature.

This may have clinic application in preventing hippocampal damage after glucocorticoid treatment.

INTRODUCTIONRecently, the study of faces has become popular. These studies range from the investigation of beauty and attraction, 1 to the psychiatrically relevant topics of percentage changes of emotional expressions in depression and schizophrenia. 2 Cross-cultural issues have been addressed extensively, 3-6 while high technological approaches include the identification of brain structures responsible for registering fear or aggression. 7,8 In order to identify the most suitable paradigm for investigating psychopathology and perceptual changes in Japanese psychiatric subjects, we tested the Japanese and Caucasian Facial Expressions of Emotion (JACFEE) in a sample of young Japanese subjects. 6 The JACFEE photo set 9 was developed by American workers and has been used by many investigators in the field of facial research. Some crosscultural results have been reported 3,4 and these analyses indicated a significant rater culture and emotion factor interaction. Our data showed even more dramatic ethnic differences, 6 which encouraged us to further examine the still photo paradigm for testing emotional expressions. It also alerted us to the fact that much work is needed before one embarks upon studying the emotionally compromised psychiatric patient.We were interested by the degree of incorrectness in the identification of facial emotional expressions by our Japanese raters under the Matsumoto-Ekman still photo paradigm. Our previous data show that out of the seven emotions posed, the Japanese raters did very poorly (45-56% correct) in recognizing anger, contempt, and fear. They did poorly in recognizing disgust and sadness (64-67% correct), and only scored well for recognition of surprise and happiness (89-95% correct). This poor performance of Japanese normal control raters prompted us to further examine their Psychiatry and Clinical Neurosciences (1999) AbstractUsing the Japanese and Caucasian Facial Expressions of Emotion (JACFEE) photo set, the relationship between recognition and intensity ratings of universal facial expressions of emotions in 123 Japanese undergraduate students was examined and compared with data reported by American raters. In Japanese raters, although the intensity was rated as high for some of the poses, their correctness scores were poor, suggesting a serious misjudgment of the intended emotions as defined in the JACFEE photo set. Only in Japanese raters were significant relationships between the intensity scores and the percentage correctness scores for sadness detected (r = 0.97, P < 0.0001), but no significant relationship was observed for other emotions. The robust correlation suggests the possibility that Japanese raters might be more responsive to certain emotional expressions when they are fully or intensely expressed. It is proposed that the facial emotional expression paradigm cannot be applied to the psychiatric setting without first refining for cultural differences.

Judging facial expressions of emotions has important clinical value in the assessment of psychiatric patients. Judging facial emotional expressions in foreign patients however, is not always easy. Controversy has existed in previous reports on cultural differences in identifying static facial expressions of emotions. While it has been argued that emotional expressions on the face are universally recognized, experimental data obtained were not necessarily totally supportive. Using the data reported in the literature, our previous pilot study showed that the Japanese interpreted many emotional expressions differently from USA viewers of the same emotions. In order to explore such discrepancies further, we conducted the same experiments on Chinese subjects residing in Beijing. The data showed that, similar to the Japanese viewers, Chinese viewers also judged many static facial emotional expressions differently from USA viewers. The combined results of the Chinese and the Japanese experiments suggest a major cross-cultural difference between American and Asian viewers in identifying some static facial emotional expressions, particularly when the posed emotion has negative connotations. The results have important implications for cross-cultural communications when facial emotional expressions are presented as static images.