Emotion Recognition Related to Functional Outcomes in Those at Risk for Psychosis

Different images of women doing different emotions.
Overall, no significant relationships between task performance and gray matter volume were observed in the clinical high-risk group.

In individuals at clinical high risk for psychosis, difficulties recognizing negative emotions may play an important role in poor functional outcomes, according to case-control study results published in JAMA Psychiatry. However, the study reported no findings distinguishing the entire clinical high-risk group in terms of gray matter volume.

Gemma Modinos, PhD, of the department of psychosis studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom, and colleagues conducted a case-control study of 213 people (mean age, 22.9±4.7 years; 49.3% women) at clinical high risk for psychosis and 52 healthy controls (mean age 23.3±4.0 years; 48.1% women). Patients were considered at clinical high risk for psychosis based on assessment and help-seeking.

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Clinical data were obtained from 9 psychosis detection centers in Europe between July 2010 and August 2016. At 12-month follow-up, study patients were assessed for the development of psychosis using standard scales and the Global Assessment of Functioning scale was also administered. The researchers evaluated associations between changes in brain regions, emotional processing, and subsequent clinical outcomes, using statistical analyses, including binary logistic regression.

The investigators used the Degraded Facial Affect Recognition (DFAR) Task, in which patients view 4 photographs of differing emotional states and 3 T magnetic resonance imaging scans were performed to assess emotion recognition. Gray matter regions of interest included medial prefrontal cortex, amygdala, hippocampus, and insula.

At 12-month follow-up, the researchers found that 20.7% of participants at clinical high risk had developed psychosis and 70.0% had poor overall functioning. However, DFAR task accuracy at baseline did not differ significantly between healthy controls and the entire clinical high risk group.

Among subjects at clinical high risk for psychosis, improved anger recognition at baseline was associated with poorer functional outcome (odds ratio, 0.88; 95% CI, 0.78-0.99; P =.03) and abnormal anger recognition was observed in those at clinical high risk with poor functioning compared with their counterparts with decent functioning. The investigators also reported that the ability to recognize emotions at baseline was not significantly associated with the onset of psychosis (happy, P =.81; fear, P =.77; anger, P =.96; neutral, P =.37).

Overall, no significant relationships between task performance and gray matter volume were observed in the clinical high-risk group, although there were correlations between happiness and anger recognition with medial prefrontal cortex volume in healthy subjects. Of note, in clinical high risk individuals with good compared with poor functioning, anger recognition was positively associated with left hippocampal volume, as well as fear recognition and left medial prefrontal cortex volume (both P =.02). No significant relationships were observed regarding development of psychosis.

Key study limitations included the short duration of follow-up and pooling of neuroimaging data across study sites.

“These findings have potential implications for the stratification of individuals at [clinical high risk] according to subsequent outcomes and suggests that functional outcomes might be improved by interventions that target socioemotional processing,” the researchers wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Modinos G, Kempton MJ, Tognin S, et al. Association of adverse outcomes with emotion processing and its neural substrate in individuals at clinical high risk for psychosis [published online November 13, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.3501