Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder

Ospina, Luz H.; Shanahan, M.; Perez‐Rodriguez, M. Mercedes; Chan, Chi Chuen; Clari, Rosarito; Burdick, Katherine E.

doi:10.1016/j.psychres.2019.01.033

Cited by 37 publications

(22 citation statements)

References 68 publications

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“…Poor emotion awareness has been found to be related to severity of hallucinations, but not delusions, in studies employing retrospective measures, with patients with a lifetime history of more psychotic symptoms displaying poorer emotion awareness 45 . In addition, poor emotion awareness has been found to be a major predictor of social functioning deficits in individuals with schizophrenia 15,46 and at-risk for psychosis 17 .…”

Section: Discussionmentioning

confidence: 99%

The impact of emotion awareness and regulation on psychotic symptoms during daily functioning

et al. 2020

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Emotion regulation (ER) difficulties are ubiquitous among individuals with schizophrenia and have been hypothesized to contribute to stress sensitivity and exacerbation of psychotic symptoms in this population. However, the evidence supporting this link is equivocal, potentially due to previous studies' reliance on retrospective assessments of ER and psychosis, as well as lack of consideration of putative moderators such as emotion awareness. To address these limitations, we employed experience sampling method using mobile electronic devices to investigate the links between momentary in vivo use of ER strategies (m ER), emotion awareness, and psychotic symptoms during daily functioning. Fifty-four individuals with schizophrenia completed assessment of m ER and psychotic symptoms, along with traditional retrospective measures of ER and symptoms. Use of m ER suppression predicted significant increases in momentary experiences of thought insertion, mind reading, auditory and visual hallucinations. Use of m ER reappraisal predicted significant increases in momentary experiences of suspiciousness, thought insertion, and mind reading. Emotion awareness, driven primarily by difficulties identifying feelings, moderated the impact of ER on psychotic symptoms. There were no associations between retrospective measures of ER and symptoms. Our results indicate that, among individuals with schizophrenia, emotion awareness significantly impacts the relationship between use of ER and exacerbations in psychotic symptoms during the course of daily functioning. Our results highlight the need to incorporate emotion awareness and regulation difficulties into the development of treatment models and interventions for psychosis. In addition, our results underscore the need to employ in vivo, high time-resolution assessment methods to study dynamic clinical phenomena such as ER and psychotic symptoms.

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Section: Discussionmentioning

confidence: 99%

The impact of emotion awareness and regulation on psychotic symptoms during daily functioning

et al. 2020

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“…The emotion recognition task (ERT) [ 38 ] is a 7-min test measuring participants’ ability to identify 6 basic facial emotion expressions along a continuum of expression magnitude. Participants fixate on a white “+” cross in the center of the screen for 1500 to 2500 ms, after which a face stimulus is displayed for 200 ms followed by a stimulus mask image for 250 ms.…”

Section: Methodsmentioning

confidence: 99%

Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study

Backx¹,

Skirrow²,

Dente³

et al. 2020

J Med Internet Res

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Background Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance. Objective This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments. Methods A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement. Results Intraclass correlation (ICC) coefficients ranged from ρ=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ρ≥0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ρ≥0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement. Conclusions Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings.

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“…Recent studies have identified a relationship between various symptoms of schizophrenia and alexithymia (the inability to identify the meaning and experience of emotion words) (Todarello et al, 2005; Fogley et al, 2014; Ospina et al, 2019) as well as with impaired facial emotion recognition (Tang et al, 2016). Yet, to the best of our knowledge studies examining facial emotion recognition in schizophrenia have rarely assessed the semantic understanding of emotion words prior to facial affect testing (Carra et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Impaired facial emotion perception of briefly presented double masked stimuli in violent offenders with schizophrenia spectrum disorders

Högman

Kristiansson

Fischer

et al. 2020

Schizophrenia Research: Cognition

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Social interactions require decoding of subtle rapidly changing emotional cues in others to facilitate socially appropriate behaviour. It is possible that impairments in the ability to detect and decode these signals may increase the risk for aggression. Therefore, we examined violent offenders with schizophrenia spectrum disorders (SSD) and compared these with healthy controls on a computerized paradigm of briefly presented double masked faces exhibiting 7 basic emotions. Our hypotheses were that impaired semantic understanding of emotion words and low cognitive ability would yield lowest emotion recognition. SSD exhibited lower accuracy of emotion perception than controls (46.1% compared with 64.5%, p = 0.026), even when considering the unbiased hit rate (22.4% compared with 43%, Z = 2.62, p < 0.01). Raw data showed uncommon but significant misclassifications of fear as sad, disgust as sad, sad as happy and angry as surprise. Once guessing and presentation frequencies were considered, only overall accuracy differed between SSD and healthy controls. There were significant correlations between cognitive ability, antipsychotic dose, speed and emotion accuracy in the SSD group. In conclusion, that there were no specific emotion biases in the SSD group compared to healthy controls, but particular individuals may have greater impairments in facial emotion perception, being influenced by intellectual ability, psychomotor speed and medication dosages, rather than specifically emotion word understanding. This implies that both state and trait factors influence emotion perception in the aggressive SSD group and may reveal one source of potential misunderstanding of social situations which may lead to boundary violations and aggression.

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Alexithymia predicts poorer social and everyday functioning in schizophrenia and bipolar disorder

Cited by 37 publications

References 68 publications

The impact of emotion awareness and regulation on psychotic symptoms during daily functioning

The impact of emotion awareness and regulation on psychotic symptoms during daily functioning

Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study

Impaired facial emotion perception of briefly presented double masked stimuli in violent offenders with schizophrenia spectrum disorders

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