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Recognition of affective prosody in bipolar and depressive conditions: A systematic review and meta-analysis
Abstract
Background:
Inconsistent results have been reported about the affective prosody recognition (APR) ability in patients with bipolar (BD) and depressive (DD) disorders. We aimed to (i) evaluate the magnitude of APR dysfunction in BD and DD patients, (ii) identify moderators for heterogeneous results, and (iii) highlight research trends in this field.
Methods:
A computerized literature search was conducted in five electronic databases from the inception to May 9th, 2022 to identify behavioural experiments that studied APR in BD or DD patients. Effect sizes were calculated using a random-effect model and recalculated after removing outliers and adjusting publication bias.
Results:
Twelve eligible articles totalling 16 studies were included in the meta-analysis, aggregating 612 patients and 809 healthy controls. Individual r2 ranged from 0.008 to 0.355, six of which reached a medium-to-large association strength. A medium-to-large pooled effect size (Hedges g = -0.58, 95 % CI -0.75 to -0.40, p < 0.001) for overall APR impairment in BD and DD patients was obtained. The Beck Depression Inventory score and answer option number were significant moderators. Neuropsychological mechanisms, multi-modal interaction and comorbidity effects have become primary research concerns.
Limitations:
Extant statistics were insufficient for disorder-specific analysis.
Conclusions:
Current findings demonstrate deficits of overall APR in BD and DD patients at a medium-to-large magnitude. APR can clinically serve for early screening and prognosis, but the depression severity, task complexity and confounding variables influence patients' APR performance. Future studies should incorporate neuroimaging approaches and investigate the effects of tonal language stimuli and clinical interventions.
... For one thing, fundamental research has extensively explored the hemispheric lateralization and neural networks of affective prosody (Durfee, Sheppard, Blake et al., 2021;Witteman et al., 2011). For another, clinical research either directly documented the outcomes of prosody-failure illnesses, such as aphasia and aprosodia (Benedetti et al., 2021), or revealed the functional deficits of affective prosody ability in patients with mental disorders, such as bipolar and depression disorders (Tang et al., 2022). Besides these two psychology-related disciplines, affective prosody also showed its presence in computer science and engineering. ...
... This contains a set of factors, such as demographic backgrounds and sociocultural beliefs, and also includes the psycho-therapeutic interventions among patients with mental disorders. In the former concern, for instance, it has been suggested that the recognition accuracy of affective prosody decreases in the elderly (Demenescu et al., 2015), but such an aging effect was not acknowledged in clinical patients (Tang et al., 2022;. As most research only included similarly aged participants, especially in patients-oriented studies, this factor has been under-investigated. ...
Affective prosody is an indispensable cognitive cue that moderates social activities, and has become a prevailing research topic in psychology-related disciplines. The present study conducts the first bibliometrics-based visualization analysis concerning affective prosody to evaluate the influential cases, including countries/regions, institutions, publication venues, academic articles, and disciplinary contributions, and the diachronic changes of publication trends and research hotspots. With the combination of statistical results and a qualitative literature inspection, limitations of extant studies and promising research directions were also proposed. The present study extracted the bibliographic data of 1,624 articles retrieved from the Web of Science Core Collection, which were published over the past 25 years (1997-2021). Statistical results revealed four leading powers (the U.S., Germany, England, and Canada) and four emerging fronts (China, France, Netherlands, and Switzerland), and identified three primary research themes in this field, including clinical implication, measurable index, and modality-specific issues. Literature inspection demonstrated current limitations in individual characteristics control and experiment-related influential factors, and proposed two prosperous research directions. Findings of the present study could facilitate academic retrieval of affective prosody research, help concerned researchers identify thematic hotspots and seek appropriate collaboration, and provide convenience for research policy and management in this field.
... In regard to the number of answer options and trials, no significance was found, though increases in the number of trials and answer options are more likely to result in greater task difficulty (Tang et al., 2022;. However, this result should be interpreted with caution since the failure in detecting significance may result from the limited number of eligible studies. ...
Purpose:
Pitch plays an important role in auditory perception of music and language. This study provides a systematic review with meta-analysis to investigate whether individuals with autism spectrum disorder (ASD) have enhanced pitch processing ability and to identify the potential factors associated with processing differences between ASD and neurotypicals.
Method:
We conducted a systematic search through six major electronic databases focusing on the studies that used nonspeech stimuli to provide a qualitative and quantitative assessment across existing studies on pitch perception in autism. We identified potential participant- and methodology-related moderators and conducted metaregression analyses using mixed-effects models.
Results:
On the basis of 22 studies with a total of 464 participants with ASD, we obtained a small-to-medium positive effect size ( g = 0.26) in support of enhanced pitch perception in ASD. Moreover, the mean age and nonverbal IQ of participants were found to significantly moderate the between-studies heterogeneity.
Conclusions:
Our study provides the first meta-analysis on auditory pitch perception in ASD and demonstrates the existence of different developmental trajectories between autistic individuals and neurotypicals. In addition to age, nonverbal ability is found to be a significant contributor to the lower level/local processing bias in ASD. We highlight the need for further investigation of pitch perception in ASD under challenging listening conditions. Future neurophysiological and brain imaging studies with a longitudinal design are also needed to better understand the underlying neural mechanisms of atypical pitch processing in ASD and to help guide auditory-based interventions for improving language and social functioning.
Supplemental Material
https://doi.org/10.23641/asha.21614271
... Only a handful of studies on emotional prosody recognition in bipolar and depressive disorders are available; however, a meta-analysis of 16 studies from 2004 to 2019 also showed that these patients demonstrated overall deficits at a medium to large magnitude (see Tang et al. 2022 for a review). It was reported that the behavioral impairments in the processing of emotional prosody for patients with bipolar disorders could be related to early sensory impairments (see Van prosody were related to their cognitive (Uekermann et al. 2008) or sensory-perceptual (Emerson et al. 1999) deficiencies. ...
In response to uncovering brain mechanisms underlying vocal communication and searching for biomarkers for mental illnesses, speech prosody has been increasingly studied in recent years in multiple disciplines, including psycholinguistics. In this article, we provide an up-to-date synthesis of the theoretical foundation and empirical evidence to profile linguistic and emotional prosody in the proper characterization of mental disorders, including schizophrenia, autism, Alzheimer's disease, and depression. Our review reveals a need to develop theoretically motivated and methodologically integrated approaches to the study of context-driven comprehension and expression of pragmatic-affective prosody, which will help elucidate the core features of socio-communicative problems in individuals with mental disorders. We propose that comprehensive models within and across the conventional cognition-emotion-language trichotomy need to be developed to integrate current findings and guide future research. In particular, there needs to be due emphasis on investigating multisensory and cross-modal effects in normal and pathological prosody research. Our review calls for multidisciplinary efforts to address the challenging issues to inform and inspire the advancement of linguistic theories and psychiatric diagnosis and treatment.
Expected final online publication date for the Annual Review of Linguistics, Volume 9 is January 2023. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... In regard to the number of answer options and trials, no significance was found, though increases in the number of trials and answer options are more likely to result in greater task difficulty (Tang et al., 2022;. However, this result should be interpreted with caution since the failure in detecting significance may result from the limited number of eligible studies. ...
Purpose: Pitch plays an important role in auditory perception of music and language. This study provides a systematic review with meta-analysis to investigate whether individuals with autism spectrum disorder (ASD) have enhanced pitch processing ability and identify the potential factors associated with processing differences between ASD and neurotypicals. Method: We conducted a systematic search through six major electronic databases focusing on the studies that used nonspeech stimuli to provide a qualitative and quantitative assessment across existing studies on pitch perception in autism. We identified potential participant- and methodology-related moderators and conducted meta-regression analyses using mixed-effects models. Results: On the basis of 22 studies with a total of 464 participants with ASD, we obtained a small-to-medium positive effect size (0.26) in support of enhanced pitch perception in ASD.Moreover, the mean age and non-verbal IQ of participants were found to significantly moderate the between-studies heterogeneity. Conclusion: Our study provides the first meta-analysis on auditory pitch perception in ASD and demonstrates the existence of different developmental trajectories between individuals with ASD and neurotypicals. Non-verbal ability can be a significant contributor to the lower-level/ local processing bias in ASD. We highlight the need for further investigation of pitch perception in ASD under challenging listening conditions. Future neurophysiological and brain imaging research studies with a longitudinal design are also needed to better understand the nature of the atypical processing in ASD to obtain new insights into the underlying neural mechanisms and to help guide auditory-based interventions for improving language and social functioning.
Lay abstract:
Differences in understanding others' emotions and attitudes through features in speech (e.g. intonation) have been observed in individuals with autism spectrum conditions, which contribute greatly to their social communication challenges. However, some studies reported that individuals with autism spectrum condition performed comparably to typically developing individuals on affective prosody recognition. Here, we provide a comprehensive review with statistical analysis of 23 existing studies on this topic to examine potential factors that could explain the discrepancies. Compared with typically developing individuals, autism spectrum condition participants generally appeared to encounter more difficulties in affective prosody recognition. But this finding was likely due to the tendency of the existing research to overly focus on deficits in autism. The affective prosody recognition performance in individuals with autism spectrum condition was closely related to the number of answer options offered to them. Moreover, the degree of difficulty in affective prosody recognition encountered by individuals with autism spectrum condition varied across emotions. The findings of this systematic review highlighted the need for further research on affective prosody recognition in autism (e.g. studies that include tonal language speakers and autism spectrum condition individuals with lower cognitive or verbal abilities).
Background
Abnormal neural activities during emotional processing have been found in both adults and youths with major depressive disorder. However, findings were inconsistent in each group and cannot be compared to each other.Methods
We first identified neuroimaging experiments that revealed abnormal neural activities during emotional processing in patients with major depressive disorder published from January 1997 to January 2019. Then we conducted voxel-wise meta-analyses on adult and youth patients separately and compared the two age groups using direct meta-comparison.ResultsFifty-four studies comprising 1141 patients and 1242 healthy controls were identified. Both adult and youth patients showed abnormal neural activities in anterior cingulate cortex, insula, superior and middle temporal gyrus, and occipital cortex compared to healthy controls. However, hyperactivities in the superior and middle frontal gyrus, amygdala, and hippocampus were only observed in adult patients, while hyperactivity in the striatum was only found in youth patients compared to controls. In addition, compared with youths, adult patients exhibited significantly greater abnormal activities in insula, middle frontal gyrus, and hippocampus, and significantly lower abnormal activities in middle temporal gyrus, middle occipital gyrus, lingual gyrus, and striatum.Conclusions
The common alterations confirmed the negative processing bias in major depressive disorder. Both adult and youth patients were suggested to have disturbed emotional perception, appraisal, and reactivity. However, adult patients might be more subject to the impaired appraisal and reactivity processes, while youth patients were more subject to the impaired perception process. These findings help us understand the progressive pathophysiology of major depressive disorder.
Objective
To conduct a meta-analysis of Theory of Mind studies exclusively in euthymic patients with bipolar disorder.
Method
After the exclusion of studies evaluating symptomatic patients during acute episodes, we performed a meta-analysis including a total of 30 studies, comparing 1294 euthymic bipolar disorder patients and 1116 healthy controls.
Results
Patients with bipolar disorder presented a significant impairment in Theory of Mind performance when compared to controls (Hedge’s g = −0.589, 95% confidence interval: −0.764 to −0.414, Z = −6.594, p < 0.001). When compared to controls, Theory of Mind was impaired in patients with both bipolar disorder I (Hedge’s g = −0.663, 95% confidence interval: −0.954 to −0.372, Z = −4.462, p < 0.001) and bipolar disorder II (Hedge’s g = −1.165, 95% confidence interval: −1.915 to −0.415, Z = −3.044, p = 0.002). Theory of Mind impairments were also significantly more severe in verbal tasks (Hedge’s g = −1.077, 95% confidence interval: −1.610 to −0.544, Z = −3.961 p < 0.001) than visual tasks (Hedge’s g =−0.614, 95% confidence interval: −0.844 to −0.384, Z = −5.231, p < 0.001) when compared to controls.
Conclusion
The results obtained confirm that Theory of Mind is impaired in remitted bipolar disorder patients, being a potential endophenotype for bipolar disorder. Moreover, we found higher deficits in verbal Theory of Mind, compared with visual Theory of Mind. Since most studies were cross-sectional, there is a need for longitudinal studies to evaluate whether the deficits detected in Theory of Mind are progressive over the course of the illness.
Background:
Biological motion, namely the movement of others, conveys information that allows the identification of affective states and intentions. This makes it an important avenue of research in autism spectrum disorder where social functioning is one of the main areas of difficulty. We aimed to create a quantitative summary of previous findings and investigate potential factors, which could explain the variable results found in the literature investigating biological motion perception in autism.
Methods:
A search from five electronic databases yielded 52 papers eligible for a quantitative summarisation, including behavioural, eye-tracking, electroencephalography and functional magnetic resonance imaging studies.
Results:
Using a three-level random effects meta-analytic approach, we found that individuals with autism generally showed decreased performance in perception and interpretation of biological motion. Results additionally suggest decreased performance when higher order information, such as emotion, is required. Moreover, with the increase of age, the difference between autistic and neurotypical individuals decreases, with children showing the largest effect size overall.
Conclusion:
We highlight the need for methodological standards and clear distinctions between the age groups and paradigms utilised when trying to interpret differences between the two populations.
This book serves as an accessible introduction into how meta-analyses can be conducted in R. Essential steps for meta-analysis are covered, including pooling of outcome measures, forest plots, heterogeneity diagnostics, subgroup analyses, meta-regression, methods to control for publication bias, risk of bias assessments and plotting tools.
Advanced, but highly relevant topics such as network meta-analysis, multi-/three-level meta-analyses, Bayesian meta-analysis approaches, SEM meta-analysis are also covered.
The programming and statistical background covered in the book are kept at a non-expert level. A print version of this book has been published with Chapman & Hall/CRC Press (Taylor & Francis). The complete book can be accessed online: https://bookdown.org/MathiasHarrer/Doing_Meta_Analysis_in_R/.
Emotional prosody (EP) has been increasingly recognized as an important area of schizophrenic patients’ dysfunctions in their language use and social communication. The present review aims to provide an updated synopsis on emotional prosody processing (EPP) in schizophrenic disorders, with a specific focus on performance characteristics, the influential factors and underlying neural mechanisms. A literature search up to 2018 was conducted with online databases, and final selections were limited to empirical studies which investigated the prosodic processing of at least one of the six basic emotions in patients with a clear diagnosis of schizophrenia without co-morbid diseases. A narrative synthesis was performed, covering the range of research topics, task paradigms, stimulus presentation, study populations and statistical power with a quantitative meta-analytic approach in Comprehensive Meta-Analysis Version 2.0. Study outcomes indicated that schizophrenic patients’ EPP deficits were consistently observed across studies (d = −0.92, 95% CI = −1.06 < δ < −0.78), with identification tasks (d = −0.95, 95% CI = −1.11 < δ < −0.80) being more difficult to process than discrimination tasks (d = −0.74, 95% CI = −1.03 < δ < −0.44) and emotional stimuli being more difficult than neutral stimuli. Patients’ performance was influenced by both participant- and experiment-related factors. Their social cognitive deficits in EP could be further explained by right-lateralized impairments and abnormalities in primary auditory cortex, medial prefrontal cortex and auditory-insula connectivity. The data pointed to impaired pre-attentive and attentive processes, both of which played important roles in the abnormal EPP in the schizophrenic population. The current selective review and meta-analysis support the clinical advocacy of including EP in early diagnosis and rehabilitation in the general framework of social cognition and neurocognition deficits in schizophrenic disorders. Future cross-sectional and longitudinal studies are further suggested to investigate schizophrenic patients’ perception and production of EP in different languages and cultures, modality forms and neuro-cognitive domains.
Background: While severe irritability is a predictor of future depression according to recent meta-analytic evidence, other mechanisms for this developmental transition remain unclear. In this study, we test whether deficits in emotion recognition may partially explain this specific association in youth with severe irritability, defined as Disruptive Mood Dysregulation Disorder (DMDD).
Methods: Participants aged 8–20 years old (Mean=13.3, SD=2.8) included youth with DMDD, split by low (DMDD/LD; n = 52) and high (DMDD/HD; n = 25) depressive symptoms, and healthy controls (HC; n = 39). A standardized computer task assessed emotion recognition of faces and voices of adults and children expressing happiness, fear, sadness and anger. A Group (3) × Emotion (4) × Actor (2) × Modality (2) repeated measures ANCOVA examined the number of errors and misidentification of emotions. Linear regression was then used to assess whether deficits in emotion recognition were predictive of depressive symptoms at a one year follow-up.
Results: DMDD/HD youth were more likely to interpret happy stimuli as angry and fearful compared to DMDD/LD (happy as angry: p=0.018; happy as fearful: p=0.008) and HC (happy as angry: p=0.014; happy as fearful: p=0.024). In youth with DMDD, the misidentification of happy stimuli as fearful was associated with higher depressive symptoms at follow-up (β=0.43, p=0.017), independent of baseline depressive and irritability symptoms.
Conclusions: Deficits in emotion recognition are associated, cross-sectionally and longitudinally, with depressive symptoms in youth with severe irritability. Future studies should examine the neural correlates that contribute to these associations.
Background
No study has investigated the impact of the duration of untreated depression (DUD) on the severity of depression at the two-year follow-up point in patients with major depressive disorder (MDD) who discontinued pharmacotherapy. This study aimed to investigate this issue.
Methods
This study enrolled 155 subjects with MDD at baseline, and 101 subjects who had discontinued pharmacotherapy for 17.1 ± 5.8 months were assessed at the two-year follow-up point. DUD was defined as the interval between the onset of the index major depressive episode and the start of pharmacotherapy. The 17-item Hamilton Depression Rating Scale (HAMD) was used to evaluate depression. Multiple linear regressions were used to examine the impacts of DUD on the severity and improvement percentage (IP) of depression at follow-up.
Results
A longer DUD was significantly associated with a greater severity and a lower IP of depression at follow-up. After controlling for confounding factors, DUD was the most significant factor predicting the severity and IP of depression at follow-up. DUD was more strongly associated with the prognosis of depression at follow-up than depression and anxiety severities at baseline.
Conclusions
The DUD at baseline independently predicted the severity of depression at the two-year follow-up point. Although the patients had discontinued pharmacotherapy for nearly 1.5 years, the impact of the DUD on the severity of depression persisted at follow-up. The DUD was an important index that predicted the severity of depression at the two-year follow-up point.
When we speak about heterogeneity in a meta-analysis, our intent is usually to understand the substantive implications of the heterogeneity. If an intervention yields a mean effect size of 50 points, we want to know if the effect size in different populations varies from 40 to 60, or from 10 to 90, because this speaks to the potential utility of the intervention. While there is a common belief that the I(2) statistic provides this information, it actually does not. In this example, if we are told that I(2) is 50%, we have no way of knowing if the effects range from 40 to 60, or from 10 to 90, or across some other range. Rather, if we want to communicate the predicted range of effects, then we should simply report this range. This gives readers the information they think is being captured by I(2) and does so in a way that is concise and unambiguous. Copyright © 2017 John Wiley & Sons, Ltd.
Background:
Exposure to ambient air pollution is widespread and may be detrimental to human brain development and a potential risk factor for Autism Spectrum Disorder (ASD). We conducted a systematic review of the human evidence on the relationship between ASD and exposure to all airborne pollutants, including particulate matter air pollutants and others (e.g. pesticides and metals).
Objective:
To answer the question: "is developmental exposure to air pollution associated with ASD?"
Methods:
We conducted a comprehensive search of the literature, identified relevant studies using inclusion/exclusion criteria pre-specified in our protocol (registered in PROSPERO, CRD # 42015017890), evaluated the potential risk of bias for each included study and identified an appropriate subset of studies to combine in a meta-analysis. We then rated the overall quality and strength of the evidence collectively across all air pollutants.
Results:
Of 1,158 total references identified, 23 human studies met our inclusion criteria (17 case-control, 4 ecological, 2 cohort). Risk of bias was generally low across studies for most domains; study limitations were related to potential confounding and accuracy of exposure assessment methods. We rated the quality of the body of evidence across all air pollutants as "moderate." From our meta-analysis, we found statistically significant summary odds ratios (ORs) of 1.07 (95% CI: 1.06, 1.08) per 10-?g/m3 increase in PM10 exposure (n = 6 studies) and 2.32 (95% CI: 2.15, 2.51) per 10-?g/m3 increase in PM2.5 exposure (n = 3 studies). For pollutants not included in a meta-analysis, we collectively evaluated evidence from each study in rating the strength and quality of overall evidence considering factors such as inconsistency, imprecision, and evidence of dose-response. All included studies generally showed increased risk of ASD with increasing exposure to air pollution, although not consistently across all chemical components.
Conclusion:
After considering strengths and limitations of the body of research, we concluded that there is "limited evidence of toxicity" for the association between early life exposure to air pollution as a whole and diagnosis of ASD. The strongest evidence was between prenatal exposure to particulate matter and ASD. However, the small number of studies in the meta-analysis and unexplained statistical heterogeneity across the individual study estimates means that the effect could be larger or smaller (including not significant) than these studies estimate. Our research supports the need for health protective public policy to reduce exposures to harmful airborne contaminants among pregnant women and children and suggests opportunities for optimizing future research.
Most studies investigating the processing of emotions in depressed patients reported impairments in the decoding of negative emotions. However, these studies adopted static stimuli (mostly stereotypical facial expressions corresponding to basic emotions) which do not reflect the way people experience emotions in everyday life. For this reason, this work proposes to investigate the decoding of emotional expressions in patients affected by recurrent major depressive disorder (RMDD) using dynamic audio/video stimuli. RMDDs’ performance is compared with the performance of patients with adjustment disorder with depressed mood (ADs) and healthy (HCs) subjects. The experiments involve 27 RMDDs (16 with acute depression – RMDD-A and 11 in a compensation phase – RMDD-C), 16 Ads, and 16 HCs. The ability to decode emotional expressions is assessed through an emotion recognition task based on short audio (without video), video (without audio), and audio/video clips. The results show that AD patients are significantly less accurate than HCs in decoding fear, anger, happiness, surprise, and sadness. RMDD-As with acute depression are significantly less accurate than HCs in decoding happiness, sadness, and surprise. Finally, no significant differences were found between HCs and RMDD-Cs in a compensation phase. The different communication channels and the types of emotion play a significant role in limiting the decoding accuracy.
Individuals with Autism Spectrum Disorder (ASD) are characterized by severe deficits in social communication, whereby the nature of their impairments in emotional prosody processing have yet to be specified. Here, we investigated emotional prosody processing in individuals with ASD and controls with novel, lifelike behavioral and neuroimaging paradigms. Compared to controls, individuals with ASD showed reduced emotional prosody recognition accuracy on a behavioral task. On the neural level, individuals with ASD displayed reduced activity of the STS, insula and amygdala for complex vs. basic emotions compared to controls. Moreover, the coupling between the STS and amygdala for complex vs. basic emotions was reduced in the ASD group. Finally, groups differed with respect to the relationship between brain activity and behavioral performance. Brain activity during emotional prosody processing was more strongly related to prosody recognition accuracy in ASD participants. In contrast, the coupling between STS and anterior cingulate cortex (ACC) activity predicted behavioral task performance more strongly in the control group. These results provide evidence for aberrant emotional prosody processing of individuals with ASD. They suggest that the differences in the relationship between the neural and behavioral level of individuals with ASD may account for their observed deficits in social communication.
Objectives
Evaluating the variation in the strength of the effect across studies is a key feature of meta-analyses. This variability is reflected by measures like τ2 or I2, but their clinical interpretation is not straightforward. A prediction interval is less complicated: it presents the expected range of true effects in similar studies. We aimed to show the advantages of having the prediction interval routinely reported in meta-analyses.
Design
We show how the prediction interval can help understand the uncertainty about whether an intervention works or not. To evaluate the implications of using this interval to interpret the results, we selected the first meta-analysis per intervention review of the Cochrane Database of Systematic Reviews Issues 2009–2013 with a dichotomous (n=2009) or continuous (n=1254) outcome, and generated 95% prediction intervals for them.
Results
In 72.4% of 479 statistically significant (random-effects p<0.05) meta-analyses in the Cochrane Database 2009–2013 with heterogeneity (I2>0), the 95% prediction interval suggested that the intervention effect could be null or even be in the opposite direction. In 20.3% of those 479 meta-analyses, the prediction interval showed that the effect could be completely opposite to the point estimate of the meta-analysis. We demonstrate also how the prediction interval can be used to calculate the probability that a new trial will show a negative effect and to improve the calculations of the power of a new trial.
Conclusions
The prediction interval reflects the variation in treatment effects over different settings, including what effect is to be expected in future patients, such as the patients that a clinician is interested to treat. Prediction intervals should be routinely reported to allow more informative inferences in meta-analyses.
Studies investigating on the ability of depressed patients to decode emotional expressions have mostly exploited static stimuli (i.e., static facial expressions of basic emotions) showing that (even though this was not always the case) depressed patients are less accurate (in literature this is reported as a bias) in decoding negative emotions (fear, sadness and anger). However, static stimuli may not reflect the everyday situations and therefore this pilot study proposes to exploit dynamic stimuli involving both visual and auditory channels. We recruited 16 outpatients with Recurrent Major Depressive Disorder (MDD) matched with 16 healthy controls (HC). Their competence to decode emotional expressions was assessed through an emotion recognition task that included short audio (without video), video (without audio) and audio/video tracks. The results show that depressed patients are less accurate than controls, even though with no statistical significant difference, in decoding fear and anger, but not sadness, happiness and surprise where differences are significant. This is independent of the communication mode (either visual, auditory, or both, even though MDDs perform more worse than HCs in audio/video) and the severity of depressive symptoms, suggesting that the MDDs poorer decoding accuracy towards negative emotions is latent and emerges only during and after stressful events. The poorer decoding accuracy of happiness and (positive) surprise can be due to anhedonia.
Emerging behavioral and neuroimaging studies in schizophrenia (SCZ) and major depressive disorder (MD) are mapping mechanisms of co-occurring and distinct affective disturbances across these disorders. This constitutes a critical goal towards developing rationally guided therapies for upstream neural pathways that contribute to comorbid symptoms across disorders. We highlight the current state of the art in our understanding of emotional dysregulation in SCZ versus MD by focusing on broad domains of behavioral function that can map onto underlying neural systems, namely deficits in hedonics, anticipatory behaviors, computations underlying value and effort, and effortful goal-directed behaviors needed to pursue rewarding outcomes. We highlight unique disturbances in each disorder that may involve dissociable neural systems, but also possible interactions between affect and cognition in MD versus SCZ. Finally, we review computational and translational approaches that offer mechanistic insight into how cellular- level disruptions can lead to complex affective disturbances, informing development of therapies across MD and SCZ.
Objective:
To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/subsyndromal stage and first-episode phase, and strategies for their respective treatment.
Methods:
A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania.
Results:
As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase.
Conclusions:
Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.
Emotion recognition deficits emerge with increasing age, in particular, a decline in the identification of sadness. However, little is known about the age-related changes of emotion processing in sensory, affective, and executive brain areas. This functional magnetic resonance imaging (fMRI) study investigated neural correlates of auditory processing of prosody across adult lifespan. Unattended detection of emotional prosody changes was assessed in 21 young (age range: 18-35 years), 19 middle-aged (age range: 36-55 years), and 15 older (age range: 56-75 years) adults. Pseudo-words uttered with neutral prosody were standards in an oddball paradigm with angry, sad, happy, and gender deviants (total 20% deviants). Changes in emotional prosody and voice gender elicited bilateral superior temporal gyri (STG) responses reflecting automatic encoding of prosody. At the right STG, responses to sad deviants decreased linearly with age, whereas happy events exhibited a non-linear relationship. In contrast to behavioral data, no age by sex interaction emerged on the neural networks. The aging decline of emotion processing of prosodic cues emerges already at an early automatic stage of information processing at the level of the auditory cortex. However, top-down modulation may lead to an additional perceptional bias, e.g., towards positive stimuli and may depend on context factors such as the listener’s sex.
Cognitive theories of depression posit that perception is negatively biased in depressive disorder. Previous studies have provided empirical evidence for this notion, but left open the question whether the negative perceptual bias reflects a stable trait or the current depressive state. Here we investigated the stability of negatively biased perception over time. Emotion perception was examined in patients with major depressive disorder (MDD) and healthy control participants in two experiments. In the first experiment subjective biases in the recognition of facial emotional expressions were assessed. Participants were presented with faces that were morphed between sad and neutral and happy expressions and had to decide whether the face was sad or happy. The second experiment assessed automatic emotion processing by measuring the potency of emotional faces to gain access to awareness using interocular suppression. A follow-up investigation using the same tests was performed three months later. In the emotion recognition task, patients with major depression showed a shift in the criterion for the differentiation between sad and happy faces: In comparison to healthy controls, patients with MDD required a greater intensity of the happy expression to recognize a face as happy. After three months, this negative perceptual bias was reduced in comparison to the control group. The reduction in negative perceptual bias correlated with the reduction of depressive symptoms. In contrast to previous work, we found no evidence for preferential access to awareness of sad vs. happy faces. Taken together, our results indicate that MDD-related perceptual biases in emotion recognition reflect the current clinical state rather than a stable depressive trait.
Alterations in the processing of emotional stimuli (e.g., facial expressions, prosody, music) have repeatedly been reported in patients with major depression. Such impairments may result from the likewise prevalent executive deficits in these patients. However, studies investigating this relationship are rare. Moreover, most studies to date have only assessed impairments in unimodal emotional processing, whereas in real life, emotions are primarily conveyed through more than just one sensory channel. The current study therefore aimed at investigating multi-modal emotional processing in patients with depression and to assess the relationship between emotional and neurocognitive impairments. Fourty one patients suffering from major depression and 41 never-depressed healthy controls participated in an audiovisual (faces-sounds) emotional integration paradigm as well as a neurocognitive test battery. Our results showed that depressed patients were specifically impaired in the processing of positive auditory stimuli as they rated faces significantly more fearful when presented with happy than with neutral sounds. Such an effect was absent in controls. Findings in emotional processing in patients did not correlate with Beck's depression inventory score. Furthermore, neurocognitive findings revealed significant group differences for two of the tests. The effects found in audiovisual emotional processing, however, did not correlate with performance in the neurocognitive tests. In summary, our results underline the diversity of impairments going along with depression and indicate that deficits found for unimodal emotional processing cannot trivially be generalized to deficits in a multi-modal setting. The mechanisms of impairments therefore might be far more complex than previously thought. Our findings furthermore contradict the assumption that emotional processing deficits in major depression are associated with impaired attention or inhibitory functioning.
This study reports a finding about vocal expressions of emotion in Mandarin Chinese. Production and perception experiments used the same tone and mixed tone
sequences to test whether pitch variation is restricted due to the presence of lexical tones. Results showed that the restriction of pitch variation occurred in all high level tone
sequences
(tone 1 group) with the expression of happiness but did not happen for other dynamic tone groups. However, perception analysis revealed that all the emotions in every tone group received high identification rates; this indicates that listeners used other cues for encoding happiness in the tone 1 group. This study demonstrates that the restriction of pitch variation does not affect the perception of vocal emotions.
Background
Social cognition is impaired in patients with severe mental disorders. We aimed to investigate impairments in social cognition in youth with pediatric bipolar disorder (PBD) through a systematic review of the literature and the meta-analysis.
Method
Following the PRISMA guidelines, we searched in PubMed, Scopus, and Cochrane CENTRAL for studies reporting on the theory of mind (ToM) and emotion recognition (ER) abilities of patients with PBD compared to healthy controls (HC). We conducted a random-effects model meta-analysis for the contrast between PBD and HC. Subgroup and meta-regression analyses were conducted for demographic and clinical variables as appropriate.
Results
A total of thirteen studies involving 429 patients with PBD and 394 HC were included. Patients with PBD had significantly poorer social cognitive abilities (Hedges’ g for ER, g= -0.74, CI=-0.91, -0.57; and for ToM, g=-0.98, CI=-1.41 to -0.55). Subgroup analysis also revealed significant impairment in ER for patients in a euthymic state (g=-0.75). Age, gender, sample size, the severity of mood symptoms, estimated IQ, the frequencies of bipolar-I disorder, attention-deficit hyperactivity disorder, medications, study quality and euthymia did not moderate the difference in meta-regression. Heterogeneity was low in all analyses and there was no evidence for publication bias.
Conclusion
The results of this meta-analysis supported the notion that PBD is associated with a deficit in social cognitive abilities at a medium to a large level. Impairments in social cognition could be an illness-related trait of PBD. Meta-regression results did not find a moderator of the deficits in social cognition.
Purpose
The purpose was to examine and determine effect size distributions reported in published audiology and speech-language pathology research in order to provide researchers and clinicians with more relevant guidelines for the interpretation of potentially clinically meaningful findings.
Method
Cohen's d, Hedges' g, Pearson r, and sample sizes ( n = 1,387) were extracted from 32 meta-analyses in journals in speech-language pathology and audiology. Percentile ranks (25th, 50th, 75th) were calculated to determine estimates for small, medium, and large effect sizes, respectively. The median sample size was also used to explore statistical power for small, medium, and large effect sizes.
Results
For individual differences research, effect sizes of Pearson r = .24, .41, and .64 were found. For group differences, Cohen's d /Hedges' g = 0.25, 0.55, and 0.93. These values can be interpreted as small, medium, and large effect sizes in speech-language pathology and audiology. The majority of published research was inadequately powered to detect a medium effect size.
Conclusions
Effect size interpretations from published research in audiology and speech-language pathology were found to be underestimated based on Cohen's (1988, 1992) guidelines. Researchers in the field should consider using Pearson r = .25, .40, and .65 and Cohen's d /Hedges' g = 0.25, 0.55, and 0.95 as small, medium, and large effect sizes, respectively, and collect larger sample sizes to ensure that both significant and nonsignificant findings are robust and replicable.
Depression is characterized by increased levels of negative affect and decreased levels of positive affect. Prior research shows that individual differences in emotion regulation play an important role in understanding sustained negative affect within the disorder; yet, much less is known about the regulation of positive emotion in depression. The current paper utilizes emotion regulation models that synthesizes multiple emotion processes, including what people want to feel (emotion preferences) and the ways in which people typically respond to emotion (habitual use of emotion regulation strategies), to increase our understanding of positive emotion in depression. In doing so, we propose that depression is associated with relative reductions in the preference for positive emotion; these reductions may therefore increase the habitual use of emotion regulation strategies that serve to down-regulate positive emotion and decrease the use of strategies that serve to up-regulate positive emotion. Dysfunction in habitual emotion regulation strategy use may, in turn, contribute to the relatively low levels of positive emotion within the disorder. The paper also discusses important empirical gaps in the extant literature on emotion preferences and emotion regulation in depression and highlights novel treatment targets (e.g., emotion preferences) for interventions aimed at improving emotion dysfunction in depression.
Purpose
The aim of this study was to conduct a systematic review and meta-analysis to investigate whether preschool- and early school–age children with speech sound disorders (SSDs) have difficulties with speech perception.
Method
Systematic searching of 8 electronic databases identified 73 eligible studies across 71 articles examining the speech perception skills of children with SSDs. The findings and methodological characteristics of each study were reviewed, and the reporting of methodological information in each article was rated. A meta-analysis was conducted with studies that used the most common type of speech perception assessment task—lexical and/or phonetic judgment tasks.
Results
Across 60 of 73 studies, some or all children with SSDs were reported to have difficulties with speech perception. The meta-analysis showed a significant difference between children with SSDs and children with typically developing speech on lexical and/or phonetic judgment tasks.
Conclusion
Results from the meta-analysis demonstrate that children with SSDs have difficulties with speech perception. This appears to be the case for some but not all children with SSDs. The findings from this systematic review and meta-analysis also provide insight into the complex range of methodological issues involved in the study of speech perception in children with SSDs and the need for further research.
Supplemental Material
https://doi.org/10.23641/asha.9808361
Major Depressive Disorder (MDD) and bipolar disorder (BD) are still under recognized and undertreated, especially in primary care settings. One of the challenges faced by clinicians is the remarkable inter-individual variability among patients with these conditions. In addition, each patient with MDD and BD experiences a unique pattern of longitudinal changes across time, i.e., intra-individual variability can also be problematic. The immense amount of data generated and collected through the use of smartphones or personal devices offers an opportunity to obtain continuous and reliable information on each individual's behavior, a less burdensome way to capture both intra and inter-individual variability over time. Digital phenotypes (DP) are a promising strategy to be integrated with other "Omics" platforms for prediction of relevant outcomes in mood disorders, including but not restricted to, relapse, recurrence, cognitive decline and functional impairment. Despite existing limitations and some skepticism, digital phenotyping represents a field in great expansion and might eventually constitute a feasible strategy in biomarkers research for mood disorders.
Objectives:
Bipolar disorder (BD) is associated with impairments in facial emotion and emotional prosody perception during both mood episodes and periods of remission. To expand on previous research, the current study investigated cross-modal emotion perception, that is, matching of facial emotion and emotional prosody in remitted BD patients.
Methods:
Fifty-nine outpatients with BD and 45 healthy volunteers were included into a cross-sectional study. Cross-modal emotion perception was investigated by using two subtests out of the Comprehensive Affective Testing System (CATS).
Results:
Compared to control subjects patients were impaired in matching sad (p < .001) and angry emotional prosody (p = .034) to one of five emotional faces exhibiting the corresponding emotion and significantly more frequently matched sad emotional prosody to happy faces (p < .001) and angry emotional prosody to neutral faces (p = .017). In addition, patients were impaired in matching neutral emotional faces to the emotional prosody of one of three sentences (p = .006) and significantly more often matched neutral faces to sad emotional prosody (p = .014).
Conclusions:
These findings demonstrate that, even during periods of symptomatic remission, patients suffering from BD are impaired in matching facial emotion and emotional prosody. As this type of emotion processing is relevant in everyday life, our results point to the necessity to provide specific training programs to improve psychosocial outcomes. (JINS, 2019, 25, 336-342).
Importance
Many studies have investigated impairments in cognitive domains in adults with autism spectrum disorder (ASD). Yet, to date, a comprehensive overview on the patterns of cognitive functioning is lacking.
Objective
To provide an overview of nonsocial and social cognitive functioning in various domains in adults with ASD, allowing for comparison of the severity of deficits between different domains.
Data Sources
A literature search performed in an academic medical setting was conducted using PubMed, PsycINFO, Embase, and Medline databases with the combination of the following free-text and Medical Subject Headings where applicable: [cogniti* OR neurocogniti* OR neuropsycholog* OR executive function* OR IQ OR intelligence quotient OR social cognition OR emotion perception OR affect perception OR emotion recognition OR attribution OR ToM OR mentalising OR mentalizing OR prosody OR social knowledge OR mind reading OR social cue OR social judgment] AND [autis* OR ASD OR Asperger OR Asperger’s OR PDD OR pervasive developmental disorder]. The search was further limited to studies published between 1980 (first inclusion of autism diagnosis in the DSM-III) and July 2018.
Study Selection
Studies included were published as a primary peer-reviewed research article in English, included individuals with ASD 16 years or older, and assessed at least 1 domain of neurocognitive functioning or social cognition using standard measures.
Data Extraction and Synthesis
Of 9892 articles identified and screened, 75 met the inclusion criteria for the systematic review and meta-analysis.
Main Outcomes and Measures
Hedges g effect sizes were computed, and random-effects models were used for all analyses. Moderators of between-study variability in effect sizes were assessed using meta-regressions.
Results
The systematic review and meta-analysis included 75 studies, with a combined sample of 3361 individuals with ASD (mean [SD] age, 32.0 [9.3] years; 75.9% male) and 5344 neurotypical adults (mean [SD] age, 32.3 [9.1] years; 70.1% male). Adults with ASD showed large impairments in theory of mind (g = −1.09; 95% CI, −1.25 to −0.92; number of studies = 39) and emotion perception and processing (g = −0.80; 95% CI, −1.04 to −0.55; n = 18), followed by medium impairments in processing speed (g = −0.61; 95% CI, −0.83 to −0.38; n = 21) and verbal learning and memory (g = −0.55; 95% CI, −0.86 to −0.25; n = 12). The least altered cognitive domains were attention and vigilance (g = −0.30; 95% CI, −0.81 to 0.21; n = 5) and working memory (g = −0.23; 95% CI, −0.47 to 0.01; n = 19). Meta-regressions confirmed robustness of the results.
Conclusions and Relevance
Results of this systematic review and meta-analysis suggest that adults with ASD show impairments in social cognitive domains and in specific nonsocial cognitive domains. These findings contribute to the understanding of the patterns of cognitive functioning in adults with ASD and may assist in the identification of targets for cognitive interventions.
Background:
Disruptions in affective processing characterize mood disorders, yet the neural mechanisms underlying internal state dependency in affective processes are not well understood. The present work presents a pilot investigation into state dependency among neural circuits known to be involved in processing affective information, by examining acute manic and depressive mood phases in adults with bipolar disorder and major depressive disorder.
Methods:
The present study probed affective processes with a well-validated passive picture-viewing task amongst acutely manic (n = 8) or acutely depressed (bipolar depression: n = 11; major depression: n = 15) mood-disordered adults during functional magnetic resonance imaging .
Results:
Beta-series correlation analyses seeded from the amygdala revealed distinct neural circuits distinguished across current mood state rather than diagnostic boundaries. We delineated an amygdala-striatum pathway that distinguished depressed from manic mood phase, rather than between diagnostic boundaries, in processing valenced information. Specifically, we found differences in this neural response to negative, but not positive, images across clinical mood states.
Limitations:
As a preliminary investigation of state-dependent affective processes, the current investigation is predominantly limited by the small sample size. While it provides direction and generates hypotheses for further work, future studies need to replicate and expand the reported effects with larger samples.
Conclusions:
These findings demonstrate the conditions under which mood state-dependent affective processes cut cross traditional diagnostic boundaries, speaking to recent advances in transdiagnostic disease mechanisms, and can guide future work examining the neural mechanisms driving symptomatology in affective disorders.
Major depressive disorder (MDD) is characterized by a biased emotion perception. In the auditory domain, MDD patients have been shown to exhibit attenuated processing of positive emotions expressed by speech melody (prosody). So far, no neuroimaging studies examining the neural basis of altered processing of emotional prosody in MDD are available. In this study, we addressed this issue by examining the emotion bias in MDD during evaluation of happy, neutral, and angry prosodic stimuli on a five‐point Likert scale during functional magnetic resonance imaging (fMRI). As expected, MDD patients rated happy prosody less intense than healthy controls (HC). At neural level, stronger activation in the middle superior temporal gyrus (STG) and the amygdala was found in all participants when processing emotional as compared to neutral prosody. MDD patients exhibited an increased activation of the amygdala during processing prosody irrespective of valence while no significant differences between groups were found for the STG, indicating that altered processing of prosodic emotions in MDD occurs rather within the amygdala than in auditory areas. Concurring with the valence‐specific behavioral effect of attenuated evaluation of positive prosodic stimuli, activation within the left amygdala of MDD patients correlated with ratings of happy, but not neutral or angry prosody. Our study provides first insights in the neural basis of reduced experience of positive information and an abnormally increased amygdala activity during prosody processing.
Background:
Deficits in emotional prosody processing have been observed in bipolar disorder (BD). While recent neural studies have explored impaired processing of facial expressions, little is known about deficits in emotional speech processing, or the specific stages of processing at which they occur. This study examined if pre-attentive detection and attention to emotional speech is impaired in BD, relative to healthy individuals.
Methods:
The EEG data was collected from 14 individuals with BD and 14 healthy control (HC) participants while the auditory stimuli was presented via a passive three-stimulus oddball sequence which included emotionally (neutral, happy, sad) spoken syllables and acoustically matched nonvocal tones. Event-related potentials (ERPs) were evaluated in terms of Mismatch Negativity (MMN) and P3a (event-related potentials signals).
Results:
Individuals with BD showed normal MMN amplitude, but significantly delayed MMN latency and reduced P3a amplitude in response to the emotional syllables compared to HC.
Limitations:
Small sample size, lack of control of psychopharmacological intervention and no inclusion of an affective prosody-labelling task.
Conclusions:
The finding that changes in emotional speech prosody in the pre-attentive stages of processing (MMN) were unimpaired in individuals with BD; while automatic orientation towards emotionally salient speech (P3a) was reduced compared to HC, suggests that vocal emotional cues may not be recognised as salient by individuals with BD, resulting in fewer attentional resources allocation to further processing. This may lead to poorer integration of auditory emotional cues and other sensory information and negatively impact interpersonal and psychosocial functions.
Background:
To date, research concerning Theory of Mind (ToM) in remitted bipolar disorder (rBD) has yielded inconclusive results. This may be a result of methodological shortcomings and the failure to consider relevant third variables. Furthermore, studies using ecologically valid stimuli are rare. This study examines ToM in rBD patients, using ecologically valid stimuli. Additionally, the effects of sad mood induction (MI) as well as of age and gender are considered.
Methods:
The sample comprises N = 44 rBD patients (rBDPs) and N = 40 healthy controls (HCs). ToM decoding is assessed using the Cambridge Mindreading Face-Voice-Battery (CAM) and ToM reasoning using the Movie for the Assessment of Social Cognition (MASC). Both tasks were divided into two parts to conduct one part with and one without MI.
Results:
While across the whole sample there was no evidence that rBDPs and HCs differed in ToM decoding or reasoning, in the younger subsample (age < 45) rBDPs performed worse than HCs in ToM decoding. While MI negatively influenced reasoning in both groups, gender had no effect.
Limitations:
Most patients in this study had a high level of social functioning, limiting the generalizability of the results.
Conclusion:
As important social steps have to be undertaken before middle-age, the decoding deficits in younger rBDPs might be of particular importance not only for social functioning but also for the course of illness. Furthermore, this age-related deficit may explain the inconclusive findings that have been reported so far.
Rationale and objectives:
The psychometric characteristics of image-based test items in radiological written examinations are not well known. In this study, we explored difficulty and discriminating power of these test items in postgraduate radiological digital examinations.
Materials and methods:
We reviewed test items of seven Dutch Radiology Progress Tests (DRPTs) that were taken from October 2013 to April 2017. The DRPT is a semiannual formative examination, required for all Dutch radiology residents. We assessed several stimulus and response characteristics of test items. The response format of test items included true or false, single right multiple choice with 2, 3, 4, or ≥5 answer options, pick-N multiple-choice, drag-and-drop, and long-list-menu formats. We calculated item P values and item-rest-correlation (Rir) values to assess difficulty and discriminating power. We performed linear regression analysis in image-based test items to investigate whether P and Rir values were significantly related to stimulus and response characteristics. Also, we compared psychometric indices between image-based test items and text-alone items.
Results:
P and Rir values of image-based items (n = 369) were significantly related to the type of response format (P < .001), and not to which of the seven DRPTs the item was obtained from, radiological subspecialty domain, nonvolumetric or volumetric character of images, or context-rich or context-free character of the stimulus. When accounted for type of response format, difficulty and discriminating power of image-based items did not differ significantly from text-alone items (n = 881). Test items with a relatively large number of answer options were generally more difficult, and discriminated better among high- and low-performing candidates.
Conclusion:
In postgraduate radiological written examinations, difficulty and discriminating power of image-based test items are related to the type of response format and are comparable to those of text-alone items. We recommend a response format with a relatively large number of answer options to optimize psychometric indices of radiological image-based test items.
The orbitofrontal cortex represents the reward or affective value of primary reinforcers including taste, touch, texture, and face expression. It learns to associate other stimuli with these to produce representations of the expected reward value for visual, auditory, and abstract stimuli including monetary reward value. The orbitofrontal cortex thus plays a key role in emotion, by representing the reward value of the goals for action. The learning process is stimulus-reinforcer association learning. Negative reward prediction error neurons are related to this affective learning. Activations in the orbitofrontal cortex correlate with the subjective emotional experience of affective stimuli, and damage to the orbitofrontal cortex impairs emotion-related learning, emotional behaviour, and subjective affective state. Top-down attention to affect modulates orbitofrontal cortex representations, and attention to intensity modulates representations in earlier cortical areas that represent the physical properties of stimuli. Top-down word-level cognitive inputs can bias affective representations in the orbitofrontal cortex, providing a mechanism for cognition to influence emotion. Whereas the orbitofrontal cortex provides a representation of reward or affective value on a continuous scale, areas beyond the orbitofrontal cortex such as the medial prefrontal cortex area 10 are involved in binary decision-making when a choice must be made. For this decision-making, the orbitofrontal cortex provides a representation of the value of each specific reward on the same scale, with no conversion to a common currency. Increased activity in a lateral orbitofrontal cortex non-reward area provides a new attractor-related approach to understanding and treating depression. Consistent with the theory, the lateral orbitofrontal cortex has increased functional connectivity in depression, and the medial orbitofrontal cortex, involved in reward, has decreased functional connectivity in depression.
Previous functional magnetic resonance imaging (fMRI) studies have reported that task-irrelevant, emotionally salient events can disrupt target discrimination, particularly when attentional demands are low, while others demonstrate alterations in the distracting effects of emotion in behavior and neural activation in the context of attention-demanding tasks. We used fMRI, in conjunction with an emotional oddball task, at different levels of target discrimination difficulty, to investigate the effects of emotional distractors on the detection of subsequent targets. In addition, we distinguished different behavioral components of target detection representing decisional, nondecisional, and response criterion processes. Results indicated that increasing target discrimination difficulty led to increased time required for both the decisional and nondecisional components of the detection response, as well as to increased target-related neural activation in frontoparietal regions. The emotional distractors were associated with activation in ventral occipital and frontal regions and dorsal frontal regions, but this activation was attenuated with increased difficulty. Emotional distraction did not alter the behavioral measures of target detection, but did lead to increased target-related frontoparietal activation for targets following emotional images as compared to those following neutral images. This latter effect varied with target discrimination difficulty, with an increased influence of the emotional distractors on subsequent target-related frontoparietal activation in the more difficult discrimination condition. This influence of emotional distraction was in addition associated specifically with the decisional component of target detection. These findings indicate that emotion-cognition interactions, in the emotional oddball task, vary depending on the difficulty of the target discrimination and the associated limitations on processing resources.
Editor's Note: PTJ's Editorial Board has adopted PRISMA to help PTJ better communicate research to physical therapists. For more, read Chris Maher's editorial starting on page 870.
Membership of the PRISMA Group is provided in the Acknowledgments.
This article has been reprinted with permission from the Annals of Internal Medicine from Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. Ann Intern Med. Available at: http://www.annals.org/cgi/content/full/151/4/264. The authors jointly hold copyright of this article. This article has also been published in PLoS Medicine, BMJ, Journal of Clinical Epidemiology, and Open Medicine.
Copyright © 2009 Moher et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Bipolar disorder and major depressive disorder have been shown to be associated with neurocognitive abnormalities during periods of clinical remission. However, at present, there is no consensus on whether these disorders have distinctive cognitive profiles. The aim of this study was to provide an updated systematic review of studies comparing neuropsychological functioning between bipolar disorder and major depressive disorder during remission. Main findings included the following: 1) no differences regarding performances in measures of attention and processing speed, executive functions and theory of mind were found between both patient groups and 2) regarding verbal memory, preliminary evidence points towards a more defective performance in patients with bipolar disorder than those with major depressive disorder. However, several variables with negative impact on cognition (medication status, age at onset, premorbid IQ, bipolar subtype, among others) were not adequately controlled in most studies. In conclusion, evidence from studies exploring neuropsychological profiles in bipolar disorder and major depressive disorder could not provide clues to differentiate these mood disorders. Larger studies with adequate control of confounding variables would be necessary to elucidate if the finding of more defective verbal memory performance in bipolar disorder is truly explained by distinct underlying mechanisms.
Background:
This study examined whether acutely (aMDD) and remitted depressed patients (rMDD) show deficits in the two aspects of social cognition - facial emotion recognition (FER) and reasoning - when using ecologically valid material. Furthermore, we examined whether reduced facial mimicry mediates the association between depressive symptoms and FER, and whether FER deficits and reasoning deficits are associated.
Method:
In 42 aMDD, 43 rMDD, and 39 healthy controls (HC) FER was assessed using stimuli from the Amsterdam Dynamic Facial Expression Set, reasoning by the Movie for the Assessment of Social Cognition. Furthermore, the activity of Zygomaticus Major and Corrugator supercilii were recorded.
Results:
aMDD recognized happy faces less accurately, were less confident recognizing happiness and anger and found it more difficult to recognize happiness, anger and fear than HC. rMDD were less confident recognizing anger and found it more difficult to recognize happiness, anger and fear than HC. Reduced mimicry did not explain FER deficits. aMDD but not rMDD showed impaired reasoning.
Limitations:
The stimulus material was comparably easy to decode. Therefore, it is possible that the FER deficits of aMDD and rMDD patients are more pronounced than demonstrated in this study.
Conclusions:
aMDD show deficits in FER and reasoning, whereas rMDD only show mild impairments in the recognition of emotional expressions. There must be other processes - besides mimicry - that serve the accurate recognition of emotional facial expressions.
Background:
Depression severity is assessed in numerous research disciplines, ranging from the social sciences to genetics, and used as a dependent variable, predictor, covariate, or to enroll participants. The routine practice is to assess depression severity with one particular depression scale, and draw conclusions about depression in general, relying on the assumption that scales are interchangeable measures of depression. The present paper investigates to which degree 7 common depression scales differ in their item content and generalizability.
Methods:
A content analysis is carried out to determine symptom overlap among the 7 scales via the Jaccard index (0=no overlap, 1=full overlap). Per scale, rates of idiosyncratic symptoms, and rates of specific vs. compound symptoms, are computed.
Results:
The 7 instruments encompass 52 disparate symptoms. Mean overlap among all scales is low (0.36), mean overlap of each scale with all others ranges from 0.27 to 0.40, overlap among individual scales from 0.26 to 0.61. Symptoms feature across a mean of 3 scales, 40% of the symptoms appear in only a single scale, 12% across all instruments. Scales differ regarding their rates of idiosyncratic symptoms (0-33%) and compound symptoms (22-90%).
Limitations:
Future studies analyzing more and different scales will be required to obtain a better estimate of the number of depression symptoms; the present content analysis was carried out conservatively and likely underestimates heterogeneity across the 7 scales.
Conclusion:
The substantial heterogeneity of the depressive syndrome and low overlap among scales may lead to research results idiosyncratic to particular scales used, posing a threat to the replicability and generalizability of depression research. Implications and future research opportunities are discussed.
Background:
Comorbid depression is common in first-episode schizophrenia spectrum (FES) disorders. Both depression and FES are associated with significant deficits in facial and prosody emotion recognition performance. However, it remains unclear whether people with FES and comorbid depression, compared to those without comorbid depression, have overall poorer emotion recognition, or instead, a different pattern of emotion recognition deficits. The aim of this study was to compare facial and prosody emotion recognition performance between those with and without comorbid depression in FES.
Methods:
This study involved secondary analysis of baseline data from a randomized controlled trial of vocational intervention for young people with first-episode psychosis (N=82; age range: 15-25 years).
Results:
Those with comorbid depression (n=24) had more accurate recognition of sadness in faces compared to those without comorbid depression. Severity of depressive symptoms was also associated with more accurate recognition of sadness in faces. Such results did not recur for prosody emotion recognition.
Limitations:
In addition to the cross-sectional design, limitations of this study include the absence of facial and prosodic recognition of neutral emotions.
Conclusions:
Findings indicate a mood congruent negative bias in facial emotion recognition in those with comorbid depression and FES, and provide support for cognitive theories of depression that emphasise the role of such biases in the development and maintenance of depression. Longitudinal research is needed to determine whether mood-congruent negative biases are implicated in the development and maintenance of depression in FES, or whether such biases are simply markers of depressed state.
Talkers׳ regions of origin and native languages will significantly shape their speech production patterns. Previous results suggest that listeners are highly sensitive to whether a talker is a native or nonnative speaker of the language. Listeners also have some ability to categorize or classify talkers by regional dialect or nonnative accent. However, most previous studies have included variability in only one of these categories (many nonnative accents or many regional dialects). The present study simultaneously examined listeners’ perceptual organization of regional dialects and nonnative accents. Talkers representing six United States regional dialects, six international native dialects, and twelve nonnative accents were included in two tasks: an auditory free classification task—in which listeners grouped talkers based on perceived region of origin—and ladder task—in which listeners arranged talkers based on their perceived distance from standard American English. Listeners were sensitive to the distinction between native and nonnative accents, even when presented with a very wide range of dialects and accents. Further, subgroups within the native and nonnative clusters in the free classification task suggested several organizing factors, including perceived distance from the local standard, specific acoustic-phonetic talker characteristics, and speaking rate.
Objectives:
Auditory perception deficits have been identified in schizophrenia (SZ) and linked to dysfunction in the auditory cortex. Given that psychotic symptoms, including auditory hallucinations, are also seen in bipolar disorder (BD), it may be that individuals with BD who also exhibit psychotic symptoms demonstrate a similar impairment in auditory perception.
Methods:
Fifty individuals with SZ, 30 individuals with bipolar I disorder with a history of psychosis (BD+), 28 individuals with bipolar I disorder with no history of psychotic features (BD-), and 29 normal controls (NC) were administered a tone discrimination task and an emotion recognition task.
Results:
Mixed-model analyses of covariance with planned comparisons indicated that individuals with BD+ performed at a level that was intermediate between those with BD- and those with SZ on the more difficult condition of the tone discrimination task and on the auditory condition of the emotion recognition task. There were no differences between the BD+ and BD- groups on the visual or auditory-visual affect recognition conditions. Regression analyses indicated that performance on the tone discrimination task predicted performance on all conditions of the emotion recognition task. Auditory hallucinations in BD+ were not related to performance on either task.
Conclusions:
Our findings suggested that, although deficits in frequency discrimination and emotion recognition are more severe in SZ, these impairments extend to BD+. Although our results did not support the idea that auditory hallucinations may be related to these deficits, they indicated that basic auditory deficits may be a marker for psychosis, regardless of SZ or BD diagnosis.
Bipolar disorder is associated with impairments in emotion processing that are present during both mood episodes and periods of remission. In this context, most previous studies have investigated facial emotion recognition abilities. In contrast, the current study focused on the perception of prosodic and semantic affect.
The present study directly contrasted the perception of prosodic and semantic affect in 58 remitted patients meeting DSM-IV criteria for bipolar I disorder and 45 healthy volunteers by using 2 subtests of the Comprehensive Affective Testing System (CATS) and investigated the relationship of prosodic and semantic affect perception with patients' outcomes. Participants were investigated from June 2011 until May 2013.
Patients and controls did not differ regarding the recognition of the vocal emotion while ignoring the affective meaning of test trials (CATS 1), but patients significantly more often misinterpreted sad as happy prosody (P = .039). In addition, patients were impaired in recognizing the affective meaning of test trials while ignoring the vocal emotion (CATS 2; P = .052). Again, they significantly more often misinterpreted a sad affective meaning as a happy one (P = .025). However, the findings on misinterpretations did not withstand Bonferroni correction for multiple testing. CATS 1 test performance was negatively correlated with depression scores, whereas a positive association was found between performance on both tests and patients' functioning. Patients indicated a significantly lower quality of life (P < .001); however, multiple mediation analysis revealed that this finding was not mediated by differences in prosodic and/or semantic affect perception between the 2 groups.
Even during periods of remission, patients with bipolar disorder may be impaired in semantic but not prosodic affect perception. Notably, they may frequently misinterpret sadly expressed emotions as happy ones. Our findings underscore the relevance of these deficits in the psychosocial context.
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