Electroconvulsive Therapy Improves the Ability to Recognize Disgust in People With Schizophrenia

by Madelaine Morton

For most of us, reading other people’s emotions is an automatic and essential part of daily interaction. Knowing your partner had a bad day the moment they walk in the door or avoiding your dad when he looks grumpy is a skill that many don’t need to put conscious effort into. Emotion recognition is not a hard-wired ability for everyone though. For example, those with schizophrenia tend to have difficulties recognizing emotional facial expressions, especially those conveying disgust.

Mixed results have been reported in previous studies examining the effect of antipsychotic medication on people with schizophrenia’s ability to interpret facial expressions. In addition to medication, electroconvulsive therapy (ECT) is sometimes used to treat symptoms of schizophrenia. This somewhat controversial treatment involves inducing seizures in the patient by passing small electric currents through the brain while under careful medical supervision.

Dr. Mihriban Dalkıran and her team wondered what effect ECT might have on the accuracy of recognizing facial expressions in people with schizophrenia and designed a study to find out. They predicted that patients would be better at recognizing emotions, specifically disgust, after being treated and would be faster at identifying facial emotions.

Thirty individuals who were already diagnosed with schizophrenia and recommended ECT in addition to their previously prescribed medication participated in Dalkıran’s study. The day before the scheduled ECT, participants were asked to perform an exercise in reading facial expressions. The exercise, officially called the Facial Emotion Recognition Test, consisted of 56 mixed photos of four male and four female models displaying sad, happy, fearful, angry, surprised, disgusted, and neutral facial expressions. Participants were asked to identify the emotions being expressed and the time taken to respond was noted. The next day, subjects received ECT and, within a week, were asked to complete the exercise again. Results between the two instances were then compared.

The researchers discovered that the people with schizophrenia’s ability to recognize disgust rom the facial expressions improved after ECT, but this effect was not seen with other emotions. Additionally, they were faster at identifying happy and fearful expressions. The researchers believe that ECT may have an effect on the right insula, a certain part of the brain which has been implicated in facial recognition of disgust. These findings are important because they provide psychologists with clues as to why people with schizophrenia have difficulties reading emotions and what avenues may be explored to help them overcome such a socially crippling symptom of the illness. While this study was the first to examine these particular effects, future studies in this area would benefit from having half of the participants not undergo ECT to act as a comparison group. This would allow the researchers to be confident that it was the ECT itself that caused the change in the participants, not anxiety of going through a procedure or some other explanation. Future research could also look at how results might differ in a more realistic setting, such as in a conversation with another person; the laboratory setting may have influenced the participants to respond differently than they would in a day-to-day  situation.

References

Dalkıran, M., Tasdemir, A., Salihoglu, T., et al. (2016). The change in facial emotion recognition ability in inpatients with treatment resistant schizophrenia after electroconvulsive therapy. Psychiatric Quarterly. doi:10.1007/s11126-016-9466-7

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