Schizophrenia Daily News Blog

Facial recognition and social function

Recent Schizophrenia Research Reviews, By Demian Rose, MD, PhD

Welcome to what I hope will become a regular presence at Schizophrenia.com, Recent Research Reviews. My intent with this column is to regularly summarize a new study that will help the casual reader attain a context for where the field of schizophrenia research is headed, and what the current data can tell us about this disease. To give you a little background about myself, I am finishing up a 4-year training program in psychiatry at the University of California at San Francisco, and have therefore had several years of experience working with people with schizophrenia in a variety of clinical settings. I have been interested in research for most of my academic career, and am currently piloting a study that aims to explore if social and emotional training can improve functioning in subjects with schizophrenia. My particular interest is exploring the boundaries between cognition (“thinking”) and emotion (“feeling”), as well as the ways in which the social functioning of people with schizophrenia might be affected by specific changes in the interplay between the brain systems underlying these phenomena.

“Facial Recognition and Social Cognition”, a summary review of:

Remediation of impairments in facial affect recognition in schizophrenia: Efficacy and specificity of a new training program.

Authored by: Wolwer W, Frommann N, Halfmann S, Piaszek A, Streit M, Gaebel W.
Published in: Schizophrenia Research, Aug 23, 2005

Who did the study:
This study was designed and carried out by researchers from the Department of Psychiatry and Psychotherapy at the University of Duesseldorf, Germany. Several of the authors had previously worked on a novel facial affect training program in 2003, which is used as one of the two experimental training programs in this study.

Why they did the study:
Impairments in facial affect recognition – the ability to accurately identify the emotional state of another person based upon their facial expression – have been well described in schizophrenia, and are thought to contribute to the poor overall social functioning seen in most people with the disease, who are often socially isolated with few close relationships.

Schizophrenics also tend to have specific deficits in non-social cognitive functioning, what the authors refer to as “cold cognition”. Cold cognition is the underpinning of what are called “executive tasks”, i.e. ones that require planning and flexibility to accomplish. Some examples would be keeping a budget or following a complicated conversation between several different people. Related deficits in the ability to sustain attention and certain types of memory are also commonly seen in people with schizophrenia.

What remains unclear to brain researchers is to what extent the cognitive and emotional deficits of schizophrenia are related, and to what extent they are separable. In other words: will improving one tend to improve the other, or will specific therapeutic interventions need to be established that specifically target the underlying brain domains of each? This study attempts to address this question by designing a training program that is specific to facial affect recognition and comparing it to a training program that is meant to specifically remediate cognitive deficits.

How they designed the study:
The authors recruited 77 subjects who had been diagnosed with schizophrenia and were stable on anti-psychotic medications. They then randomly assigned each subject to one of three treatment groups:

1) Those who would receive a 12-session (45 min each session, done twice per week for 6 weeks) facial affect recognition training program, called the TAR (“Training of Affect Recognition”).
2) Those who would receive a 12-session (45 min each session, done twice per week for 6 weeks) cold cognition training program, called the CRT (“cognitive remediation training”)
3) Those who would receive neither training program, but would receive the standard of care treatment (TAU; “treatment as usual”)

There were no significant differences in age, intelligence or severity of illness between the three groups. All subjects performed a number of tests both before and within one week of completing treatment.

What they found:
53 subjects completed the study, with roughly equal numbers dropping out from each of the three groups, usually due to lack of interest in continuing. When all of the testing data was compared, several differences were seen between the three treatment groups:

1) There was a trend towards subjects who received training (TAR or CRT) to perform better on most tests, as compared to those subjects who received treatment as usual (TAU). This was likely due to non-specific aspects that were shared by both training protocols, e.g. increased time spent with subjects.
2) Those subjects who received CRT performed significantly better on tasks of verbal memory – e.g., remembering words, recognizing words seen before – than both the TAR and TAU groups.
3) Those subjects who received TAR performed significantly better on facial affect recognition and social situational understanding than both the CRT and TAU groups.

The Take Home Message:
This study demonstrated that specific training of facial affect recognition can improve performance on facial recognition tasks in people with schizophrenia. Of equal importance, the improvements seen in TAR subjects were not seen in subjects who received more standard cognitive remediation. This suggests that facial affect recognition deficits in schizophrenia are likely not secondary to the other, more global deficits in attention and memory typically seen. These data support the growing belief among cognitive neuroscientists that “social cognition” – which describes aspects of social functioning that require processing information about the states and intentions of others – is a separable domain of brain functioning, one that is specifically affected in certain psychiatric disorders, including schizophrenia. If this is the case, it gives hope that we can design individually tailored treatment interventions that can specifically target social cognition, thereby leading to improvements in social functioning and overall quality of life in people with schizophrenia.