Executive Function And Personality Bases Of Recognition Of Facial Expressions Of Emotion And Alexithymia In Patients With Paranoid Schizophrenia

Background:Schizophrenia is a severe mental disorder with obscure etiology, unclear mechanisms, and poor prognosis and has a devastated impact on the society. The lifetime prevalence of schizophrenia is about0.7%worldwide, and there are7.8million patients suffering from schizophrenia in China. Knowing the etiology and pathology of schizophrenia and improving its prognosis etc. are of great value to the scientific research and the society. Affect impairment is one of the core syndromes of schizophrenia, which influences social functioning and prognosis of these patients. Therefore, emotion process is one of the major research topics in the area. Emotion processes include three domains, i.e., expression, experience, and recognition. Recognition of facial expressions of emotion (RFEE) is one of the examples of the emotion recognition. Alexithymia however, belongs to disorders of emotion experience and expression. Thus, it would be interesting to explore further on the RFEE and alexithymia in schizophrenia. As a high cognition structure, executive function is involved in the process of RFEE on the recognition step; and personality disorder functioning styles might be an important explanation for the incongruence of the previous studies on alexithymia in schizophrenia. Hence, to research executive function and personality disorder functioning styles respectively as the bases for RFEE and alexithymia would be a new viewpoint to such studies in schizophrenia.Aims:1) To examine the relationships between RFEE and executive function in schizophrenia;2) To investigate the relationships between alexithymia and personality disorder functioning styles in schizophrenia;3) To explore the relationships between RFEE and alexithymia in schizophrenia.Methods:We administered the Japanese and Caucasian Facial Expressions of Emotion (JACFEE), and the Wisconsin Card Sorting Test (WCST), the Chinese versions of the Toronto Alexithymia Scale (TAS-20C), the Parker Personality Measure (PERM) tests in88paranoid schizophrenia patients and75healthy volunteers. We also administered the Positive and Negative Symptom Scale (PANSS) and the Hamilton Anxiety and Depression Scales in these participants.Results:1) Patients displayed lower JACFEE recognition accuracies and poorer WCST performances. In patients, JACFEE recognition accuracies of contempt and disgust were negatively correlated with PANSS negative symptom scale score, recognition accuracy of fear was positively with PANSS positive symptom scale score, and recognition accuracy of surprise was negatively with PANSS general psychopathology score. Moreover, WCST completed categories predicted the JACFEE recognition accuracies of contempt, disgust, and sadness in patients.2) Patients scored higher on TAS Difficulty Identifying Feelings and Difficulty Describing Feelings, and most PERM scales. In patients, Difficulty Identifying Feelings or Difficulty Describing Feelings nonspecifically predicted all the PERM scales; by contrast, PERM Antisocial style predicted Difficulty Identifying Feelings, Avoidant style the Difficulty Describing Feelings.3) In patients, recognition accuracy on anger was negatively correlated with Difficulty Identifying Feelings and Difficulty Describing Feelings, and recognition accuracy on surprise was negatively correlated with Difficulty Identifying Feelings.Conclusions:1) Executive function affected recognition accuracies of facial emotions in schizophrenia, which supports the specific impairment in cognitive step of RFEE in schizophrenia;2) Alexithymia is one of the personological substrates in schizophrenia;3) Recognition of facial expressions of emotion and alexithymia influence each other in schizophrenia.