Psychiatry Investig.
2016 Jan;13(1):102-111. 10.4306/pi.2016.13.1.102.
Affective Flattening in Patients with Schizophrenia: Differential Association with Amygdala Response to Threat-Related Facial Expression under Automatic and Controlled Processing Conditions
- Affiliations
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- 1Department of Psychosomatic Medicine, University of Leipzig, Leipzig, Germany. Thomas.Suslow@medizin.uni-leipzig.de
- 2Department of Psychiatry, University of Munster, Munster, Germany.
- 3Department of Psychiatry, University of Marburg, Marburg, Germany.
- 4Institute of Psychology, University of Munster, Munster, Germany.
- 5Department of Clinical Radiology, University of Munster, Munster, Germany.
- KMID: 2316602
- DOI: http://doi.org/10.4306/pi.2016.13.1.102
Abstract
OBJECTIVE
Early neuroimaging studies have demonstrated amygdala hypoactivation in schizophrenia but more recent research based on paradigms with minimal cognitive loads or examining automatic processing has observed amygdala hyperactivation. Hyperactivation was found to be related to affective flattening. In this study, amygdala responsivity to threat-related facial expression was investigated in patients as a function of automatic versus controlled processing and patients' flat affect.
METHODS
Functional magnetic resonance imaging was used to measure amygdala activation in 36 patients with schizophrenia and 42 healthy controls. During scanning, a viewing task with masked and unmasked fearful and neutral faces was presented.
RESULTS
Patients exhibited increased amygdala response to unmasked fearful faces. With respect to masked fearful faces, no between-group differences emerged for the sample as a whole but a subsample of patients with flat affect showed heightened amygdala activation. The amygdala response to masked fearful faces was positively correlated with the degree of flat affect. Conversely, amygdala response to unmasked fearful faces was negatively correlated to the severity of affective flattening. In patients, amygdala responses to masked and unmasked fearful faces showed an inverse correlation.
CONCLUSION
Our findings suggest that amygdala hyperresponsivity to unmasked fearful faces might be a functional characteristic of schizophrenia. Amygdala hyperresponsivity to masked fearful faces might be a specific characteristic of patients with affective flattening. A model of flat affect as a response mechanism to emotional overload is proposed.
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