其他摘要 | Emotion deficits may play an important role in the development of negative symptoms of schizophrenia. However, inconsistent findings on emotion deficits in schizophrenia suggest that there might be subtypes of emotion deficits. Previous studies on the emotion deficits in schizophrenia have focused on experiential pleasure and emotion expression rather than emotion regulation. In this study, we aimed to propose a theoretical framework of experiential pleasure, expression and regulation to identify subtypes in schizophrenia and across different diagnostic groups.
In Study 1,we conducted two experiments to identify and validate the different subtypes of emotion deficits in patients with schizophrenia. In Experiment 1,we recruited 146 patients with schizophrenia and 132 demographically matched healthy controls. A set of checklists capturing experiential pleasure, emotion expression and regulation were administered to all participants. We also assessed the severity of negative symptoms in patients with schizophrenia. We used a two-stage cluster analysis to analyze the profile of experiential pleasure, emotion expression and regulation. We found that the best solution consisted of three-cluster, namely "experiential pleasure and emotion regulation deficits", "emotion expression deficits",and "experiential pleasure, emotion expression and regulation deficits". Group-level comparisons showed that patients with "experiential pleasure and emotion expression deficits" reported more severe depressive and anhedonia symptoms than the other two groups. Moreover, patients with "experiential pleasure and emotion expression deficits" had more affective flattening than patients with "emotion expression deficits". In Experiment 2, we randomly selected 59 schizophrenia patients and 36 healthy controls from Experiment 1 to complete an Affective Incentives Delay task.We found that on anticipating positive stimuli, patients with "experiential pleasure and emotion regulation deficits" and healthy controls scored significantly higher than participants with "emotional expression deficits" and "experiential pleasure, emotional expression and regulation deficits".
In Study 2, we examined the subtypes of emotion deficits in patients with schizophrenia, bipolar disorder and major depressive disorder. Two experiments were conducted. In Experiment 1,we recruited 433 patients (170 with schizophrenia, 137 with bipolar disorder and 126 with major depressive disorder patients) and 150 healthy controls. All participants completed a battery of tests measuring experiential pleasure, emotion regulation and expression. Two stage cluster analysis indicated a three-cluster solution, which included the following three clusters: "experiential pleasure and emotion regulation deficits", "experiential pleasure, emotional expression and regulation deficits", and "emotional expression and regulation deficits". The proportions of the three subtypes of emotion deficits in patients with schizophrenia, bipolar disorder and major depressive disorder were significantly different. Moreover, there were significant differences in the severity of affective flattening and asociality rated by the SANS. In Experiment 2, we selected 77 patients (21 with schizophrenia, 35 with bipolar disorder and 21 with major depressive disorder) and 55 healthy controls at random from Experiment 1.The Monetary Incentives Delay task, the Affective Incentives Delay task, the Effort Expenditure for Reward Task, and the Effort and Pleasure Experience Task were administered to all participants. The clibnical symptoms of the patients were also evaluated. We found that in the feedback phases of the Monetary Incentives Delay Task and the Affective Incentives Delay Task, patients with "experiential pleasure deficits" and "experiential pleasure and emotional expression deficits" scored significantly lower than healthy controls, and those with "emotional expression deficits" showed no significant difference from healthy controls. The three subtypes displayed comparably less willingness to obtain monetary rewards in high reward probability and high reward magnitude conditions in motivation-related tasks. There was no group difference in clinical symptoms.
Taken together, these findings suggest that schizophrenia patients may be classified into three subtypes in terms of experiential pleasure, emotion regulation and expression, which are characterized by distinct clinical characteristics and behavioural manifestations. Moreover, there appears to be three different profiles of experiential pleasure, emotion regulation and expression in patients with schizophrenia, bipolar disorder and major depressive disorder, and the proportion of these emotional subtypes among the various clinical samples were significantly different. |
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