Social alienation in schizophrenia patients: association with insula responsiveness to facial expressions of disgust.
BACKGROUND
Among the functional neuroimaging studies on emotional face processing in schizophrenia, few have used paradigms with facial expressions of disgust. In this study, we investigated whether schizophrenia patients show less insula activation to macro-expressions (overt, clearly visible expressions) and micro-expressions (covert, very brief expressions) of disgust than healthy controls. Furthermore, departing from the assumption that disgust faces signal social rejection, we examined whether perceptual sensitivity to disgust is related to social alienation in patients and controls. We hypothesized that high insula responsiveness to facial disgust predicts social alienation.


METHODS
We used functional magnetic resonance imaging to measure insula activation in 36 schizophrenia patients and 40 healthy controls. During scanning, subjects passively viewed covert and overt presentations of disgust and neutral faces. To measure social alienation, a social loneliness scale and an agreeableness scale were administered.


RESULTS
Schizophrenia patients exhibited reduced insula activation in response to covert facial expressions of disgust. With respect to macro-expressions of disgust, no between-group differences emerged. In patients, insula responsiveness to covert faces of disgust was positively correlated with social loneliness. Furthermore, patients' insula responsiveness to covert and overt faces of disgust was negatively correlated with agreeableness. In controls, insula responsiveness to covert expressions of disgust correlated negatively with agreeableness.


CONCLUSIONS
Schizophrenia patients show reduced insula responsiveness to micro-expressions but not macro-expressions of disgust compared to healthy controls. In patients, low agreeableness was associated with stronger insula response to micro- and macro-expressions of disgust. Patients with a strong tendency to feel uncomfortable with social interactions appear to be characterized by a high sensitivity for facial expression signaling social rejection. Given the associations of insula responsiveness to covert disgust expression with low agreeableness in healthy individuals, insula responsiveness to expressions of disgust might be in general a neural marker of the personality trait of agreeableness.
Department of Psychiatry, University of Münster, Münster, Germany.
Christian
C
Lindner
Department of Psychiatry, University of Münster, Münster, Germany ; Department of Psychiatry, University of Marburg, Marburg, Germany.
Udo
U
Dannlowski
Department of Psychiatry, University of Münster, Münster, Germany.
Kirsten
K
Walhöfer
Department of Psychiatry, University of Münster, Münster, Germany.
Maike
M
Rödiger
Klinik am Schlossgarten, Dülmen, Germany.
Birgit
B
Maisch
Department of Psychiatry, University of Münster, Münster, Germany.
Jochen
J
Bauer
Department of Psychiatry, University of Münster, Münster, Germany.
Patricia
P
Ohrmann
Department of Psychiatry, University of Münster, Münster, Germany.
Rebekka
R
Lencer
Institute of Psychology, University of Münster, Münster, Germany.
Pienie
P
Zwitserlood
Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany.
Anette
A
Kersting
Department of Clinical Radiology, University of Münster, Münster, Germany.
Walter
W
Heindel
Department of Psychiatry, University of Münster, Münster, Germany.
Volker
V
Arolt
Department of Clinical Radiology, University of Münster, Münster, Germany.
Harald
H
Kugel
Department of Psychiatry, University of Münster, Münster, Germany ; Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany.
Thomas
T
Suslow
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001931:Brain Mapping; D004644:Emotions / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010364:Pattern Recognition, Visual / Q000502:physiology; D010775:Photic Stimulation; D011859:Radiography; D021641:Recognition, Psychology / Q000502:physiology; D012559:Schizophrenia / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012918:Social Alienation / Q000523:psychology*; D055815:Young Adult