title: Dynamic evoked facial expressions of emotions in schizophrenia.
abstract: OBJECTIVE
  Impaired facial expressions of emotions have been described as characteristic symptoms of schizophrenia. Previous investigations of dynamic facial expressions have reported on global assessment of positive and negative emotion expressions. In this study, we examined facial expression differences based on duration and frequencies of emotion expressions.
  
  
  METHODS
  12 persons with stable schizophrenia and matched healthy controls underwent a standardized procedure for evoked facial expressions of five universal emotions, including happy, sad, anger, fear, and disgust expressions. Subjects completed self-ratings of their emotion experience. Reliable raters coded evoked facial expressions according to the Facial Expression Coding System. For each emotion, facial expressions were coded as target, non-target or neutral expressions. Logistic regression analyses examined group differences in duration and frequencies of facial expressions.
  
  
  RESULTS
  Comparing overall duration of and frequencies of emotion expressions revealed affective flattening and inappropriate affect in patients, as evidenced by neutral and non-target expressions. Separated by emotion, impaired emotion expression was found in happy, sad and anger expression, but not for fear and disgust in which expressions were not well recognized.
  
  
  CONCLUSIONS
  In matched groups of participants, we found evidence for altered expressions in schizophrenia but equal subjective experience. Both affective flattening and inappropriate affect comprise abnormal facial expressions but may differ with respect to interpersonal communication and engagement. Future directions may include automated measurement, remediation of expressions and early detection of schizophrenia.
authors.affiliation: Neuropsychiatry Division, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, United States. kohler@upenn.edu
authors.forename: Christian G
authors.initials: CG
authors.lastname: Kohler
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Martin
authors.forename: Marina
authors.initials: M
authors.lastname: Milonova
authors.forename: Peng
authors.initials: P
authors.lastname: Wang
authors.forename: Ragini
authors.initials: R
authors.lastname: Verma
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Brensinger
authors.forename: Warren
authors.initials: W
authors.lastname: Bilker
authors.forename: Raquel E
authors.initials: RE
authors.lastname: Gur
authors.forename: Ruben C
authors.initials: RC
authors.lastname: Gur
mesh_terms: D000328:Adult; D000339:Affect; D000342:Affective Symptoms / Q000175:diagnosis / Q000503:physiopathology; D000553:Ambulatory Care; D035061:Control Groups; D004644:Emotions / Q000502:physiology; D005145:Face / Q000502:physiology*; D005149:Facial Expression; D005152:Facial Muscles / Q000502:physiology; D005239:Fear; D005260:Female; D006240:Happiness; D006801:Humans; D008297:Male; D033262:Narration; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis* / Q000503:physiopathology; D012565:Schizophrenic Psychology; D014705:Verbal Behavior / Q000502:physiology; D014743:Videotape Recording
references.citation: Psychiatry Res. 2003 Aug 1;119(3):261-70
references.pmid: 12914897
references.citation: Acta Psychiatr Scand. 2002 Jun;105(6):431-9
references.pmid: 12059847
references.citation: Arch Gen Psychiatry. 1976 May;33(5):565-8
references.pmid: 1267572
references.citation: J Nerv Ment Dis. 2007 Sep;195(9):758-64
references.pmid: 17984776
references.citation: Psychophysiology. 1999 Jan;36(1):35-43
references.pmid: 10098378
references.citation: Arch Gen Psychiatry. 1970 May;22(5):439-44
references.pmid: 5436868
references.citation: Am J Psychiatry. 1993 Nov;150(11):1654-60
references.pmid: 8214173
references.citation: Schizophr Res. 1992 Sep;7(3):225-31
references.pmid: 1390401
references.citation: Am J Psychiatry. 2007 May;164(5):813-9
references.pmid: 17475741
references.citation: Pharmacopsychiatry. 1992 Sep;25(5):233-9
references.pmid: 1357682
references.citation: J Commun Disord. 1990 Aug-Oct;23(4-5):287-301
references.pmid: 2246384
references.citation: J Neurosci Methods. 2002 Apr 15;115(2):137-43
references.pmid: 11992665
references.citation: Biol Psychiatry. 2005 May 1;57(9):1011-9
references.pmid: 15860342
references.citation: Psychol Med. 1992 Nov;22(4):929-37
references.pmid: 1362618
references.citation: Psychiatry Res. 2003 Mar 25;117(3):281-4
references.pmid: 12686371
references.citation: Psychiatry. 1990 Aug;53(3):209-28
references.pmid: 2217648
references.citation: J Abnorm Psychol. 1996 May;105(2):249-57
references.pmid: 8723006
references.citation: Psychol Assess. 2007 Jun;19(2):210-24
references.pmid: 17563202
references.citation: Br J Psychiatry. 1986 Nov;149:661-2
references.pmid: 3545358
references.citation: Eur Arch Psychiatry Clin Neurosci. 2004 Oct;254(5):335-42
references.pmid: 15365710
references.citation: Arch Gen Psychiatry. 1994 Nov;51(11):849-59; discussion 863-4
references.pmid: 7944874
references.citation: Schizophr Res. 2004 Apr 1;67(2-3):185-94
references.pmid: 14984877
references.citation: Schizophr Res. 2004 Dec 1;71(2-3):227-37
references.pmid: 15474894
references.citation: Schizophr Res. 1999 Nov 30;40(2):147-58
references.pmid: 10593454
references.citation: J Neurosci Methods. 2008 Feb 15;168(1):224-38
references.pmid: 18045693
references.citation: Biol Psychiatry. 1996 Sep 15;40(6):556-8
references.pmid: 8879480
references.citation: J Neurosci Methods. 2007 Jul 30;163(2):350-61
references.pmid: 17442398
references.citation: Eur Arch Psychiatry Clin Neurosci. 1990;240(2):67-76
references.pmid: 2149651
references.citation: Psychol Bull. 1994 Mar;115(2):288-99
references.pmid: 8165273
references.citation: Am J Psychiatry. 2005 Jan;162(1):92-101
references.pmid: 15625206
references.citation: J Abnorm Psychol. 1993 Nov;102(4):507-17
references.pmid: 8282918
references.citation: Psychiatry Res. 2006 Dec 7;145(2-3):87-94
references.pmid: 17074400
references.citation: Biol Psychiatry. 1998 Feb 1;43(3):165-72
references.pmid: 9494697
references.citation: Schizophr Res. 2008 Oct;105(1-3):49-60
references.pmid: 18789845
references.citation: Am J Psychiatry. 1998 Sep;155(9):1196-201
references.pmid: 9734542
references.citation: Psychophysiology. 1999 Mar;36(2):253-63
references.pmid: 10194972
references.citation: Psychophysiology. 1999 Mar;36(2):186-92
references.pmid: 10194965
references.citation: Psychiatry Res. 2004 Oct 30;128(3):235-44
references.pmid: 15541780
references.citation: Am J Psychiatry. 2003 Oct;160(10):1768-74
references.pmid: 14514489
references.citation: J Neurosci Methods. 2005 Jan 30;141(1):61-73
references.pmid: 15585289
references.citation: Compr Psychiatry. 2003 Jul-Aug;44(4):303-10
references.pmid: 12923708
references.citation: Psychiatry Res. 2007 May 30;151(1-2):67-76
references.pmid: 17368792
references.citation: J Abnorm Psychol. 1992 Feb;101(1):37-44
references.pmid: 1537971