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Risperidone versus haloperidol for facial affect recognition in schizophrenia: Findings from a randomised study
Abstract
Patients with schizophrenia consistently fail to perform facial affect recognition tasks as accurately as healthy controls. So far, the effects of different antipsychotic drugs on this deficit, as well as the mechanisms through which these drugs may exert their influence on face processing models, remain poorly understood. Twenty-five hospitalised acute schizophrenic patients were randomised to either haloperidol or risperidone following their admission. Patients performed a facial affect discrimination task. In order to differentiate drug effects on perceptive versus semantic processing of faces, the evaluation also included two facial identity discrimination tasks (inverted and upright faces). All evaluations were performed before treatment initiation, after 2 weeks and after 4 weeks of treatment. Compared with patients receiving haloperidol, patients receiving risperidone showed better discrimination of facial affect and inverted faces, but not of upright faces. Differential drug effects were most prominent 2 weeks after treatment initiation. Performance on inverted faces accounted for only 1% of the variance in affect discrimination. Additionally, there was an inverse relationship between negative symptoms and performance on upright-face identification and affect discrimination, with the strongest and most significant correlation being for affect discrimination. Our findings suggest that the preferential effect of risperidone on affect discrimination is unlikely to be due to global effects on general face processing. Moreover, although risperidone appears to enhance the processing of individual salient facial features, this effect cannot explain the improvement in affect recognition. We conclude that risperidone may specifically act on the processing of emotion-laden information.
... One of these studies detected improvements on an emotional processing task at follow-up [61], the other study involved an attributional style task, and found no effects of the medication [49]. Studies that involved patients who had a prior drug-free period, mostly found improvements in emotion processing tasks [50,52,53,70], and one in a theory of mind task [56]. Some studies specified that participants were taking an antipsychotic at baseline prior to switching to another [51, 54, 55, 58-60, 62-65, 67, 68] and one did not describe the prior treatment status of participants [66]. ...
... Studies comparing different antipsychotics produced inconsistent results. Some found that patients treated with second-generation drugs did better than those taking first-generation antipsychotics [55,59,66,69,70], but there was no consistent pattern to the results. Others found no difference between different agents or types of agent [57,60,62,65,67,72]. ...
Introduction
Social cognition is an important area of mental functioning relevant to psychiatric disorders and social functioning, that may be affected by psychiatric drug treatments. The aim of this review was to investigate the effects of medications with sedative properties, on social cognition.
Method
This systematic review included experimental and neuroimaging studies investigating drug effects on social cognition. Data quality was assessed using a modified Downs and Black checklist (Trac et al. CMAJ 188: E120-E129, 2016). The review used narrative synthesis to analyse the data.
Results
40 papers were identified for inclusion, 11 papers investigating benzodiazepine effects, and 29 investigating antipsychotic effects, on social cognition.
Narrative synthesis showed that diazepam impairs healthy volunteer’s emotion recognition, with supporting neuroimaging studies showing benzodiazepines attenuate amygdala activity. Studies of antipsychotic effects on social cognition gave variable results. However, many of these studies were in patients already taking medication, and potential practice effects were identified due to short-term follow-ups.
Conclusion
Healthy volunteer studies suggest that diazepam reduces emotional processing ability. The effects of benzodiazepines on other aspects of social cognition, as well as the effects of antipsychotics, remain unclear. Interpretations of the papers in this review were limited by variability in measures, small sample sizes, and lack of randomisation. More robust studies are necessary to evaluate the impact of these medications on social cognition.
... recognition of emotions and their expression (Fakra et al., 2008(Fakra et al., , 2009(Fakra et al., , 2015. ...
Background
Evaluating emotional experiences in the life of people with Schizophrenia Spectrum Disorder (SSD) is fundamental for developing interventions aimed at promoting well‐being in specific times and contexts. However, little is known about emotional variability in this population. In DiAPAson project, we evaluated between‐ and within‐person differences in emotional intensity, variability, and instability between people with SSD and healthy controls, and the association with psychiatric severity and levels of functioning.
Methods
102 individuals diagnosed with SSD (57 residential patients, 46 outpatients) and 112 healthy controls were thoroughly evaluated. Daily emotions were prospectively assessed with Experience Sampling Method eight times a day for a week. Statistical analyses included ANOVA, correlations, and generalized linear models.
Results
Participants with SSD, and especially residential patients, had a higher intensity of negative emotions when compared to controls. Moreover, all people with SSD reported a greater between‐person‐variability of both positive and negative emotions and greater intra‐variability of negative emotions than healthy controls. In addition, the emotion variability in people with SSD does not follow a linear or quadratic trend but is more “chaotic” if compared to controls.
Conclusions
Adequate assessments of positive and negative emotional experiences and their time course in people with SSD can assist mental health professionals with well‐being assessment, implementing targeted interventions through the identification of patterns, triggers, and potential predictors of emotional states.
... In contrast to the previous results however, Fakra et al. found risperidone to be superior in a facial affect discrimination task in comparison with an FGA, haloperidol, after 4 weeks (46). Animal studies also reported similar results; clozapine was able to attenuate reduction of social behavior in mice whereas haloperidol failed to do so (47). ...
Social dysfunction is one of the most debilitating aspects of schizophrenia. Treatment of this complex phenomenon, constituted by negative, cognitive, and affective symptoms, has been difficult with the available pharmacological agents, hence it represents an unmet medical need. Cariprazine, a novel, third-generation antipsychotic with a unique mechanism of action has been proven to sufficiently alleviate negative, cognitive, and affective symptoms of schizophrenia. These characteristics make this compound a valid candidate for addressing social dysfunction too. In this perspective, we argue that cariprazine can be viewed as a “socializing drug” that has the ability to improve the patient's functionality and ultimately their quality of life. Data from animal research, clinical trials, an observational study, and patient cases are provided.
... One of these studies detected improvements on an emotional processing task at follow-up [55], the other study involved an attributional style task, and found no effects of the medication [54]. Studies that involved patients who had a prior drug-free period, mostly found improvements in emotion processing tasks [56, 58, 59,70], and one in a theory of mind task [61]. Some studies speci ed that participants were taking an antipsychotic at baseline prior to switching to another [57, 60, 62, 63, 66, 67, 69, 71-75] and one did not describe the prior treatment status of participants [68]. ...
Introduction
Social cognition is an important area of mental functioning relevant to psychiatric disorders and social functioning, that may be affected by psychiatric drug treatments. The aim of this review was to investigate the effects of medications with sedative properties, on social cognition.
Method
This systematic review included experimental and neuroimaging studies investigating drug effects on social cognition. Data quality was assessed using a modified Downs and Black checklist [40]. The review used narrative synthesis to analyse the data.
Results
40 papers were identified for inclusion, 11 papers investigating benzodiazepine effects, and 29 investigating antipsychotic effects, on social cognition.
Narrative synthesis showed that diazepam impairs healthy volunteer’s emotion recognition, with supporting neuroimaging studies showing benzodiazepines attenuate amygdala activity. Studies of antipsychotic effects on social cognition gave variable results. However, many of these studies were in patients already taking medication, and potential practice effects were identified due to short-term follow-ups.
Conclusion
Healthy volunteer studies suggest that diazepam reduces emotional processing ability. The effects of benzodiazepines on other aspects of social cognition, as well as the effects of antipsychotics, remain unclear. Interpretations of the papers in this review were limited by variability in measures, small sample sizes, and lack of randomisation. More robust studies are necessary to evaluate the impact of these medications on social cognition.
... Moreover, secondgeneration antipsychotics have also been quite inefficient in improving FAR (Harvey et al., 2006;Herbener et al., 2005;Machado de Sousa and Hallak, 2008). Finally, direct comparisons between firstand secondgeneration antipsychotics have mostly yielded enhanced performance on FAR tasks in patients receiving second-generation antipsychotics (Fakra et al., 2009;Kee et al., 1998;Williams et al., 2003), but not all studies have replicated this association (Kucharska-Pietura et al., 2012). ...
In schizophrenia, impaired facial affect recognition (FAR) has been associated with patients' overall social functioning. Interventions targeting attention or FAR per se have invariably yielded improved FAR performance in these patients. Here, we compared the effects of two interventions, one targeting FAR and one targeting attention-to-facial-features, with treatment-as-usual on patients' FAR performance. Thirty-nine outpatients with schizophrenia were randomly assigned to one of three groups: FAR intervention (training to recognize emotional information, conveyed by changes in facial features), attention-to-facial-features intervention (training to detect changes in facial features), and treatment-as-usual. Also, 24 healthy controls, matched for age and education, were assigned to one of the two interventions. Two FAR measurements, baseline and post-intervention, were conducted using an original experimental procedure with alternative sets of stimuli. We found improved FAR performance following the intervention targeting FAR in comparison to the other patient groups, which in fact was comparable to the pre-intervention performance of healthy controls in the corresponding intervention group. This improvement was more pronounced in recognizing fear. Our findings suggest that compared to interventions targeting attention, and treatment-as-usual, training programs targeting FAR can be more effective in improving FAR in patients with schizophrenia, particularly assisting them in perceiving threat-related information more accurately.
Although the precise mechanisms and pathways of schizophrenia remain something of a mystery, there is little dispute that cognitive deficits present as some of the clearest and most debilitating symptoms of the disease. This book describes the characteristics of cognitive deficits in schizophrenia, functional implications, the course of impairments, the genetic and biological contributions and reviews management options, including neuropsychological, psychological and pharmacological techniques. Chapters are written by leading experts in the field, in an accessible and highly informative style, ensuring the content is clinically relevant. State-of-the-art information about new developments in the treatment of related features of the illness, such as disability, is provided. The wide ranging focus of this volume will appeal to clinicians and academic researchers working with patients impaired by severe mental illness.
Although the precise mechanisms and pathways of schizophrenia remain something of a mystery, there is little dispute that cognitive deficits present as some of the clearest and most debilitating symptoms of the disease. This book describes the characteristics of cognitive deficits in schizophrenia, functional implications, the course of impairments, the genetic and biological contributions and reviews management options, including neuropsychological, psychological and pharmacological techniques. Chapters are written by leading experts in the field, in an accessible and highly informative style, ensuring the content is clinically relevant. State-of-the-art information about new developments in the treatment of related features of the illness, such as disability, is provided. The wide ranging focus of this volume will appeal to clinicians and academic researchers working with patients impaired by severe mental illness.
Although the precise mechanisms and pathways of schizophrenia remain something of a mystery, there is little dispute that cognitive deficits present as some of the clearest and most debilitating symptoms of the disease. This book describes the characteristics of cognitive deficits in schizophrenia, functional implications, the course of impairments, the genetic and biological contributions and reviews management options, including neuropsychological, psychological and pharmacological techniques. Chapters are written by leading experts in the field, in an accessible and highly informative style, ensuring the content is clinically relevant. State-of-the-art information about new developments in the treatment of related features of the illness, such as disability, is provided. The wide ranging focus of this volume will appeal to clinicians and academic researchers working with patients impaired by severe mental illness.
Although the precise mechanisms and pathways of schizophrenia remain something of a mystery, there is little dispute that cognitive deficits present as some of the clearest and most debilitating symptoms of the disease. This book describes the characteristics of cognitive deficits in schizophrenia, functional implications, the course of impairments, the genetic and biological contributions and reviews management options, including neuropsychological, psychological and pharmacological techniques. Chapters are written by leading experts in the field, in an accessible and highly informative style, ensuring the content is clinically relevant. State-of-the-art information about new developments in the treatment of related features of the illness, such as disability, is provided. The wide ranging focus of this volume will appeal to clinicians and academic researchers working with patients impaired by severe mental illness.
Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other’s cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other’s thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional “lab” tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.
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) 2012 APA, all rights reserved)
Affect perception deficits have been extensively documented in schizophrenia and are associated with the social dysfunction that is characteristic of this disorder. The two previous studies examined facial affect perception in genetically at-risk samples and yielded mixed results. The current study was designed to provide a rigorous test of affect perception abilities among schizophrenia patients (n=58), their biological siblings without psychosis (n=51), and nonpsychiatric controls (n=49). Participants completed three measures of affect perception, including facial, vocal, and combined modality. Schizophrenia patients performed significantly worse than controls on two of the three affect perception tests as well as a composite index based on all three tests. The performance of the sibling group fell between the patient and control groups on each of the affect perception tests. However, group differences achieved statistical significance only for the composite index with the siblings performing significantly worse than controls and significantly better than the schizophrenia group. These findings demonstrate that subtle deficits in affect perception are detectable in the unaffected siblings of schizophrenia patients when multiple measures of different types of affect perception abilities are used in combination.
• Current research demonstrates that patients with schizophrenia display deficits in a broad range of interpersonal skills. To investigate the ability of patients with schizophrenia and major depression and normal controls to process facial stimuli, four tasks were constructed from 21 photographs of faces representing standardized poses of fundamental emotions. Two tasks were designed to investigate facial identity matching independent of emotion expressed, and two tasks were designed to test emotion recognition and emotion labeling, respectively. Results indicate that while depressed patients differed from controls only on the emotion-labeling task, those with schizophrenia showed deficits on all four tasks when compared with controls and did worse than patients with depression on the emotion tasks. The findings suggest that patients with schizophrenia are impaired on a broader range of facial perception skills than those with depression, when compared with controls.
The Structured Clinical Interview for DSM-III-R [Diagnostic and Statistical Manual, Revised] (SCID) is a semistructured interview for making the major Axis I and Axis II diagnoses. It is administered by a clinician or trained mental health professional who is familiar with the DSM-III-R classification and diagnostic criteria (1). The subjects may be either psychiatric or general medical patients or individuals who do not identify themselves as patients, such as subjects in a community survey of mental illness or family members of psychiatric patients. The language and diagnostic coverage make the SCID most appropriate for use with adults (age 18 or over), but with slight modification, it may be used with adolescents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Twenty-three acute schizophrenics, 21 acute major depressives (Research Diagnostic Criteria), and 15 normal controls participated in a study on facial expression and emotional face recognition. Under clinical conditions, spontaneous facial expression was assessed according to the affective flattening section of the Scale for the Assessment of Negative Symptoms. Under experimental laboratory conditions involuntary (emotion-eliciting interview) and voluntary facial expression (imitation and simulation of six basic emotions) were recorded on videotape, from which a raterbased analysis of intensity or correctness of facial activity was obtained. Emotional face recognition was also assessed under experimental conditions using the same stimulus material. All subjects were assessed twice (within 4 weeks), controlling for change of the psychopathological status in the patient groups. In schizophrenics, neuroleptic drug influence was controlled by random allocation to treatment with either haloperidol or perazine. The main findings were that schizophrenics and depressives are characterized by different quantitative, qualitative, and temporal patterns of affect-related dysfunctions. In particular, schizophrenics demonstrated a trait-like deficit in affect recognition and in their spontaneous and voluntary facial activity, irrespective of medication, drug type and dosage, or extrapyramidal side-effects. In depressives a stable deficit could be demonstrated only in their involuntary expression under emotion-eliciting interview conditions, whereas in the postacute phase a reduction in their voluntary expression became apparent. Differences in patterns of affect-related behavioral deficits may reflect dysfunctions in different underlying psychobiological systems.