Faculty Bibliography

Social attachment is a biological and affective need. When this need is not met, people experience loneliness. Loneliness is associated with impaired social cognition, and is a risk factor for broad based morbidity across the adult lifespan even after controlling for multiple factors. However, little is known about loneliness in schizophrenia. Eighty-seven non-depressed individuals with schizophrenia or schizoaffective disorder (including 51 inpatients) and 58 control subjects completed the revised UCLA Loneliness scale. Social cognition was assessed with a self-report questionnaire and a performance-based task. Social trait perception was assessed with a facial task. Comorbid medical diagnoses were available for all inpatients. Patients reported greater loneliness levels than controls, while in- and out-patients did not significantly differ. In patients, loneliness was associated with self-report measures of social cognition. Patients' loneliness scores predicted a diagnosis of drug abuse/dependence, number of drugs used, hypertension and abnormal hemoglobin A1c levels. Patients experienced higher levels of loneliness than controls, independently of their objective social isolation. Loneliness did not rely on the same psychological processes in patients than in controls. Loneliness in schizophrenia is a symptom that deserves more scrutiny, particularly as it relates to the high prevalence of metabolic syndrome in this population.

Although social cognition deficits have been associated with schizophrenia, social trait judgments - or first impressions - have rarely been studied. These first impressions, formed immediately after looking at a person's face, have significant social consequences. Eighty-one individuals with schizophrenia or schizoaffective disorder and 62 control subjects rated 30 neutral faces on 10 positive or negative traits: attractive, mean, trustworthy, intelligent, dominant, fun, sociable, aggressive, emotionally stable and weird. Compared to controls, patients gave higher ratings for positive traits as well as for negative traits. Patients also demonstrated more ambivalence in their ratings. Patients who were exhibiting paranoid symptoms assigned higher intensity ratings for positive social traits than non-paranoid patients. Social trait ratings were negatively correlated with everyday problem solving skills in patients. Although patients appeared to form impressions of others in a manner similar to controls, they tended to assign higher scores for both positive and negative traits. This may help explain the social deficits observed in schizophrenia: first impressions of higher degree are harder to correct, and ambivalent attitudes may impair the motivation to interact with others. Consistent with research on paranoia and self-esteem, actively-paranoid patients' positive social traits judgments were of higher intensity than non-paranoid patients'.

Explicit but not implicit facial emotion perception has been shown to be impaired in schizophrenia. In this study, we used newly developed technology in social neuroscience to examine implicit emotion processing. It has been shown that when people look at faces, they automatically infer social traits, and these trait judgments rely heavily on facial features and subtle emotion expressions even with neutral faces. Eighty-one individuals with schizophrenia or schizoaffective disorder and 62 control subjects completed a computer task with 30 well-characterized neutral faces. They rated each face on 10 trait judgments: attractive, mean, trustworthy, intelligent, dominant, fun, sociable, aggressive, emotionally stable and weird. The degree to which trait ratings were predicted by objectively-measured subtle emotion expressions served as a measure of implicit emotion processing. Explicit emotion recognition was also examined. Trait ratings were significantly predicted by subtle facial emotional expressions in controls and patients. However, impairment in the implicit emotion perception of fear, happiness, anger and surprise was found in patients. Moreover, these deficits were associated with poorer everyday problem-solving skills and were relatively independent of explicit emotion recognition. Implicit emotion processing is impaired in patients with schizophrenia or schizoaffective disorder. Deficits in implicit and explicit emotion perception independently contribute to the patients' poor daily life skills. More research is needed to fully understand the role of implicit and explicit processes in the functional deficits of patients, in order to develop targeted and useful remediation interventions.

Individuals form first impressions of others all the time, which affects their social functioning. Typical adults form threat impressions in faces with neutral expressions quickly, requiring less than 40ms. These impressions appear to be mediated by low spatial frequency (LSF) content in the images. Little is known, however, about mechanisms of first impression formation in schizophrenia. The current study investigated how quickly individuals with schizophrenia can form consistent impressions of threat compared with controls and explored the mechanisms involved. Patients and controls were presented intact, LSF- or high spatial frequency (HSF)-filtered faces with durations that varied from 39 to 1703ms and were asked to rate how threatening each face was on a scale from 1 to 5. In order to assess the speed of impression formation for intact faces, correlations were calculated for ratings made at each duration compared to a reference duration of 1703ms for each group. Controls demonstrated a significant relation for intact faces presented for 39ms, whereas patients required 390ms to demonstrate a significant relation with the reference duration. For controls, LSFs primarily contributed to the formation of consistent threat impressions at 39ms, whereas patients showed a trend for utilizing both LSF and HSF information to form consistent threat impressions at 390ms. Results indicate that individuals with schizophrenia require a greater integration time to form a stable "first impression" of threat, which may be related to the need to utilize compensatory mechanisms such as HSF, as well as LSF, information.

BACKGROUND: Among the various cognitive and affective evaluations that contribute to decisions about whether to engage in a future activity, three affective evaluations are particularly relevant: 1) interest in the activity itself, 2) the pleasure anticipated from the activity and 3) the excitement experienced while looking forward to the activity. In addition to these pre-activity evaluations, affective evaluations that are done after the activity is completed impact people's motivation to repeat the same activity. Although extant research suggests that these affective processes may be impaired in schizophrenia, it is not clear whether these impairments are mostly secondary to cognitive deficits. METHOD: In three independent studies utilizing simple laboratory tasks with minimal cognitive demands, patients with schizophrenia or schizoaffective disorder and healthy control subjects evaluated their pleasure, interest, and excitement immediately before and after completing the tasks. RESULTS: Patients' anticipated pleasure and posttest evaluations of pleasure and interest were significantly greater than controls'. No group differences were found for excitement. In patients, there were significant negative correlations between anticipated pleasure, pretest excitement and depression scores, and between pretest interest and negative symptoms. CONCLUSIONS: In these experiments, immediate affective evaluations reported by participants with schizophrenia or schizoaffective disorder were greater or similar to controls'. This finding is consistent with recent affective research showing that experiences of pleasure are intact in schizophrenia. These results emphasize the need to disentangle affective from cognitive processes in order to better understand the complex impairments present in schizophrenia spectrum disorders.

The diagnosis of schizophrenia includes "positive" and "negative" symptoms. These titles were developed to respectively reflect if the symptoms are additions to normal experiences, such as delusions and hallucinations, or if they refer to the absence or the loss of normal emotional function or behavior. This paper describes the history of the negative symptom concept, from its origins up to the considerations for the DSM-5, including the steps that produced the current conceptualizations. The DSM-5 only includes deficits in emotional expression and avolition as negative symptoms, which can be assessed from interview information. Factor analyses show they encompass most other negative symptom items. In addition to using these negative symptoms in a categorical manner to make a diagnosis, the DSM-5 has quantitative severity ratings of the negative symptoms, along with ratings of delusions, cognitive symptoms, motor symptoms, disorganization, depression and mania. With this approach, the different symptom domains, including negative symptoms, can be measured and tracked over time. Another change in the DSM-5 is the dropping of the schizophrenia subtypes that have been included in earlier volumes, as they were not useful in treatment decisions or prognosis. An intended outcome of these changes in DSM-5 is for clinicians to directly treat the individual psychopathological domains of the disorder for optimizing individual outcomes. Finally, this paper includes descriptions of the negative symptom items from over a dozen different scales.

It is well established that individuals with schizophrenia are less active and engaged than healthy control subjects, and motivation deficits are considered a core symptom of the disease. However, it remains unclear if schizophrenia individuals perceive themselves as less motivated than others, and there is a scarcity in research examining the relationship between perceived motivation, psychopathology and personality traits. Eighty-six inpatients with schizophrenia and 45 non-patient control participants completed the Motivation and Energy Inventory, which consists of Global Motivation, Social Motivation and Situational Motivation (the motivation individuals experience when they are engaging in an activity). Participants also completed personality questionnaires and an affective evocative task. Compared to controls, schizophrenia participants reported lower situational motivation, and comparable global and social motivation. Situational motivation was negatively predicted by negative temperament, affective ambivalence and depression level. Our results are consistent with the idea that schizophrenia individuals are not impaired in their motivational disposition but lack energy during the implementation of their goals. This may reflect impairment in the prediction, maintenance and/or modulation of required effort and energy during goal-directed actions, and is predicted by some affective processes. Improving situational motivation may be an effective therapeutic approach in people with schizophrenia.

OBJECTIVE: Preferences or attitudes towards others are often shaped through implicit memory processes, and they serve a critical function in our social lives. Preferences driven by implicit familiarity (mere exposure effect) are particularly important when making judgments about others and forming attitudes of liking and social interaction. In schizophrenia, little is known about the effect of familiarity preference on judgments and attitudes toward others. METHODS: Subjects included 79 patients with a diagnosis of schizophrenia or schizoaffective disorder and 61 non-patient control subjects. Familiarity preference and trait judgments about others were assessed using a computer task in which neutral faces were rated on positive and negative character traits. "Attractiveness" was rated twice at the beginning and at the end, to measure familiarity preference. Clinical ratings were also obtained. RESULTS: Patients and controls both demonstrated a positive familiarity preference effect. However, the groups differed on the predictive value of familiarity preference for trait judgments. In both groups, the presence of a familiarity preference effect predicted greater positive trait judgments. In patients only, the presence of a familiarity preference effect also predicted, although the correlation was less significant, greater negative trait judgments. CONCLUSION: The findings are consistent with a preserved familiarity preference effect in individuals with schizophrenia and that the effect is primarily associated with changes in positive attitudes. However, in individuals with schizophrenia this effect is also linked with inferences about negative traits, resulting in ambivalence towards others. This finding may contribute to the impaired social functioning of people with schizophrenia.