Facial emotional expression in schizophrenia adolescents during verbal interaction with a parent

Research on emotional expression in adult schizophrenia patients has indicated an impairment of the patients’ facial expressions during social interaction. However, it is unclear whether schizophrenia adolescent-onset patients show comparable disturbances in facial expression. Our aim was to analyze facial emotions in adolescents with schizophrenia spectrum psychoses compared with non-patient controls during a problem-solving discussion with their primary caregivers. We assessed facial expressions of emotions and speaker position (speaking vs. listening) in schizophrenia and non-patient adolescents matched for age and gender. The facial emotions were coded with the Emotional Facial Action Coding System. Schizophrenia adolescents showed significantly lower rates per minute of expressions indicating positive emotions compared with non-patient adolescents (β = −0.95, 95 % CI [−1.34, −0.57], t(37.92) = −5.00, p ≤ 0.001). In contrast, there was no lower rate of expressions indicating negative emotions of schizophrenia adolescents (β = 0.10, CI [−0.42, 0.61], t(35.03) = 0.38, p = 0.709). While the negative facial expressions of non-patient adolescents were related to speaking (β = 0.63, CI [0.34, 0.92], t(26) = 4.50, p = < 0.001), this relationship was not observed in schizophrenia adolescents. Our results indicated an emotion-specific impairment of positive facial expressions in schizophrenia adolescents early in the course of illness and a deviant relation between facial emotional expressions and speech.

[1]  J. Hooley,et al.  Expressed emotion and psychiatric relapse: a meta-analysis. , 1998, Archives of general psychiatry.

[2]  H. Häfner,et al.  Epidemiology of early-onset schizophrenia , 2005, European Archives of Psychiatry and Clinical Neuroscience.

[3]  Janet Beavin Bavelas,et al.  The psychology of facial expression: Faces in dialogue , 1997 .

[4]  Martin H. Schmidt,et al.  Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years , 2005, European Archives of Psychiatry and Clinical Neuroscience.

[5]  J. Wixted,et al.  An Analysis of Social Competence in Schizophrenia , 1990, British Journal of Psychiatry.

[6]  Emil Kraepelin,et al.  Dementia praecox and paraphrenia , 2002 .

[7]  H. Remschmidt,et al.  Long-term course of adolescent schizophrenia. , 2005, Schizophrenia bulletin.

[8]  S. Kay,et al.  The positive and negative syndrome scale (PANSS) for schizophrenia. , 1987, Schizophrenia bulletin.

[9]  W. Gaebel,et al.  Facial expressivity in the course of schizophrenia and depression , 2004, European Archives of Psychiatry and Clinical Neuroscience.

[10]  M. Jandl,et al.  Expressed and perceived emotion over time: does the patients’ view matter for the caregivers’ burden? , 2011, European Archives of Psychiatry and Clinical Neuroscience.

[11]  R. Knight,et al.  Affectivity in schizophrenia. , 1985 .

[12]  C. Hollis.  Child and Adolescent (Juvenile Onset) Schizophrenia , 1995, British Journal of Psychiatry.

[13]  L. Seidman,et al.  Emotion processing in persons at risk for schizophrenia. , 2008, Schizophrenia bulletin.

[14]  I. Gillberg,et al.  Psychotic disorders diagnosed in adolescence. Outcome at age 30 years. , 1993, Journal of child psychology and psychiatry, and allied disciplines.

[15]  Nancy C. Andreasen,et al.  Negative symptoms in schizophrenia , 1982 .

[16]  E. Bleuler,et al.  Dementia praecox oder Gruppe der Schizophrenien , 1911 .

[17]  J. Borod,et al.  Spontaneous expression of facial emotion in schizophrenic and right-brain-damaged patients. , 1990, Journal of communication disorders.

[18]  G. Weisfeld.  The adaptive value of humor and laughter , 1993 .

[19]  D. A. Smith,et al.  Flat affect in schizophrenia does not reflect diminished subjective experience of emotion. , 1993, Journal of abnormal psychology.

[20]  S. Sayers,et al.  Affectivity in the problem-solving interactions of schizophrenia patients and their family members , 2004, Schizophrenia Research.

[21]  J. Russell,et al.  The psychology of facial expression: Frontmatter , 1997 .

[22]  T. Spoerri.  Kompendium der Psychiatrie , 1963 .

[23]  A. Kring,et al.  Do schizophrenic patients show a disjunctive relationship among expressive, experiential, and psychophysiological components of emotion? , 1996, Journal of abnormal psychology.

[24]  R. Exline,et al.  Appropriate and background affect in facial displays of emotion. Comparison of normal and schizophrenic males. , 1976, Archives of general psychiatry.

[25]  L. Joseph,et al.  Developing a Risk-Model of Time to First-Relapse for Children and Adolescents With a Psychotic Disorder , 2009, The Journal of nervous and mental disease.

[26]  J. Doane,et al.  Emotional Attitudes and Direct Communication in the Families of Schizophrenics , 1986, British Journal of Psychiatry.

[27]  Sohee Park,et al.  Emotion processing and its relationship to social functioning in schizophrenia patients , 2002, Psychiatry Research.

[28]  R. Krause,et al.  Interaction regulations used by schizophrenic and psychosomatic patients: studies on facial behavior in dyadic interactions. , 1990, Psychiatry.

[29]  H. Dilling,et al.  Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F), Klinisch-diagnostische Leitlinien, Weltgesundheitsorganisation , 1991 .

[30]  J. Lindenmayer,et al.  Assessing positive and negative symptoms in children and adolescents. , 1994, The American journal of psychiatry.

[31]  J. Campos,et al.  Emergent Themes in the Study of Emotional Development and Emotion Regulation. , 1989 .

[32]  John M. Neale,et al.  A multimethod, multichannel assessment of affective flattening in schizophrenia , 1994, Psychiatry Research.

[33]  R. Krause,et al.  Facial expression of schizophrenic patients and their interaction partners. , 1989, Psychiatry.

[34]  J. McClellan,et al.  Childhood and adolescent schizophrenic, bipolar, and schizoaffective disorders: a clinical and outcome study. , 1991, Journal of the American Academy of Child and Adolescent Psychiatry.

[35]  P. Ekman.  An argument for basic emotions , 1992 .

[36]  H. Berenbaum,et al.  Emotional experience and expression in schizophrenia and depression. , 1992, Journal of abnormal psychology.

[37]  M. Schmidt,et al.  The psychosocial outcome of adolescent-onset schizophrenia: a 12-year followup. , 2000, Schizophrenia bulletin.

[38]  K. Scherer,et al.  Multimodal expression of emotion: affect programs or componential appraisal patterns? , 2007, Emotion.

[39]  J. Macher,et al.  Facial expressiveness in patients with schizophrenia compared to depressed patients and nonpatient comparison subjects. , 2005, The American journal of psychiatry.

[40]  E. Torrey,et al.  Controversies in Schizophrenia: Changes and Constancies , 1986 .

[41]  J. O. Johannessen,et al.  A comparison of adolescent- and adult-onset first-episode, non-affective psychosis: 2-year follow-up , 2012, European Archives of Psychiatry and Clinical Neuroscience.

[42]  Murray Alpert.  Controversies in Schizophrenia: Changes and Constancies , 1985 .

[43]  B. Mesquita,et al.  The social roles and functions of emotions , 1994 .

[44]  Vladas Griskevicius,et al.  An Evolutionary Perspective on Humor: Sexual Selection or Interest Indication? , 2009 .

[45]  F. Trémeau.  A review of emotion deficits in schizophrenia , 2006, Dialogues in clinical neuroscience.

[46]  K. Mueser,et al.  Anhedonia, positive and negative affect, and social functioning in schizophrenia. , 1998, Schizophrenia bulletin.

[47]  Robert R. Provine.  The psychology of facial expression: Yawns, laughs, smiles, tickles, and talking: Naturalistic and laboratory studies of facial action and social communication , 1997 .

[48]  C. Gillberg.  Schizophrenia in children and adolescents: Epidemiology of early onset schizophrenia , 2000 .

[49]  L. J. Brunner,et al.  Smiles can be back channels. , 1979 .

[50]  N C Andreasen,et al.  Negative symptoms in schizophrenia , 1982 .

[51]  Rainer Krause,et al.  Allgemeine psychoanalytische Krankheitslehre , 1997 .

[52]  J. Rabinowitz,et al.  A population based elaboration of the role of age of onset on the course of schizophrenia , 2006, Schizophrenia Research.

[53]  N. Birbaumer,et al.  Reduced emotional response of schizophrenic patients in remission during social interaction , 1995, Schizophrenia Research.

[54]  Heiner EUgring.  Nonverbal Expression of Psychological States in Psychiatric Patients , 1986 .

[55]  Frank Schneider,et al.  Computer-based analysis of facial action in schizophrenic and depressed patients , 1990, European Archives of Psychiatry and Clinical Neuroscience.

[56]  B. Kolb,et al.  Ethological study of facial behavior in nonparanoid and paranoid schizophrenic patients. , 1987, The American journal of psychiatry.

[57]  A. Malla,et al.  Is adolescent-onset first-episode psychosis different from adult onset? , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[58]  A. Kring,et al.  Emotional responding in deficit and non-deficit schizophrenia , 1999, Psychiatry Research.

[59]  D. Miklowitz,et al.  Interactional Correlates of Expressed Emotion in the Families of Schizophrenics , 1984, British Journal of Psychiatry.

[60]  Wolfgang Gaebel,et al.  Facial expression in male and female schizophrenia patients , 2010, European Archives of Psychiatry and Clinical Neuroscience.

[61]  M. Alpert.  Controversies in schizophrenia : changes and constancies : proceedings on the 74th Annual Meeting of the American Psychopathological Association, New York City, March 1-3, 1984 , 1985 .

[62]  M. Mandal,et al.  Facial expressions of emotions and schizophrenia: a review. , 1998, Schizophrenia bulletin.

[63]  E. Walker,et al.  Childhood precursors of schizophrenia: facial expressions of emotion. , 1993, The American journal of psychiatry.

[64]  Affekt und Beziehung , 1993 .

[65]  E. Moran,et al.  Emotional response deficits in schizophrenia: insights from affective science. , 2008, Schizophrenia bulletin.

[66]  W. Horan,et al.  The expression and experience of emotion in schizophrenia: a study of social interactions , 2003, Psychiatry Research.