Značenje anhedonije i poremećaja emocionalne percepcije za opće funkcioniranje u shizofreniji [The significance of anhedonia and deficits in emotion perception for global functioning in schizophrenia]

Grubišin, Jasmina (2011) Značenje anhedonije i poremećaja emocionalne percepcije za opće funkcioniranje u shizofreniji [The significance of anhedonia and deficits in emotion perception for global functioning in schizophrenia]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

The objectives of the present study were (1) to verify the relationships between anhedonia and emotion recognition deficits for global functioning in schizophrenic patients and (2) to explore possible correlations between anhedonia and emotion recognition deficits on one side and schizophrenic symptoms, duration of illness, age at onset of the illness and other sociodemographic characteristics on the other side. We recruited 65 female schizophrenic patients following DSM-IV and ICD-10 criteria treated with olanzapine or risperidone. The intensity of symptoms was assessed by PANSS and SANS and global functioning was assessed by GAF. Emotion recognition ability was assessed using the Penn Emotion Recognition Test - 40 Faces version (ER40), and anhedonia was assessed using self-rating scales for physical and social anhedonia: PAS – Physical Anhedonia Scale and RSAS - Revised Social Anhedonia Scale. ----- Results: Anhedonia reached significant levels only in a subgroup of patients, with social anhedonia (52.3%) being more frequent than physical anhedonia (43.1%). Overall anhedonia was present in 30.8% participants. Our findings demonstrated no relationship between anhedonia and age, illness duration and age of onset of the illness. Positive correlations were found between physical anhedonia and negative symptoms, and between social anhedonia and all domains of the illness. Participants with physical and social anhedonia had lower levels of global functioning and more severe negative symptoms and symptoms of general psychopathology. Overall emotion recognition accuracy (percentage of correct answers) was 66,9%. Patients were most accurate at recognizing happy expressions (92,5%), followed by sadness (79%) neutral expressions (61%), fear 51,2% and anger 50,8%. Negative correlations were found between global emotion recognition ability and PANSS negative dimension. Recognition of neutral expressions also showed negative correlation with PANSS negative dimension. Negative correlations were found between recognizing fear and age of onset of the illness, and between recognizing sadness and illness duration. Global emotion recognition depends on emotion category and emotion intensity but not on the poser’s gender. The analysis of emotion categories separately showed better recognition of high intensity anger on male and female faces; better recognition of moderate intensity fear on female face and better recognition of high intensity fear on male face; the effect of intensity on recognizing sadness is limited to male faces with no effect of intensity on recognizing sadness in female faces while happy faces are equally recognized regardless of intensity and poser’s gender. Happy, sad, fearful and angry expressions were most frequently misclassified as neutral, while neutral expressions were most frequently misclassified as sad. No difference in emotion recognition ability was found between anhedonic and non-anhedonic patients, between patients receiving treatment with different antipsychotics and those with different clinical features. Patients attributing sadness to neutral expressions had more severe symptoms; followed by those attribution anger and fear to neutral expressions. Patients attributing happiness to neutral expressions have more prominent social anhedonia. ----- Conclusion: Global anhedonia affects global functioning in female schizophrenic patients. The same was found for social anhedonia separately. We found no correlations between emotion recognition ability and global functioning in female schizophrenic patients.

Abstract in Croatian

Cilj rada je istražiti ulogu anhedonije i emocionalne percepcije u općem funkcioniranju shizofrenih bolesnica. Neposredni ciljevi su istražiti izraženost anhedonije i deficita u emocionalnoj percepciji ovisno o trajanju bolesti i dobi bolesnika kada je bolest počela, te povezanost s pozitivnim i negativnim simptomima i sociodemografskim karakteristikama ispitanica. U istraživanju je sudjelovalo 65 bolesnica s dijagnozom shizofrenije prema kriterijima DSM-IV i MKB-10 liječenih risperidonom ili olanzapinom. Ispitanice su procjenjivane ocjenskim ljestvicama PANSS, SANS i GAF. Sposobnost prepoznavanja emocionalnih stanja ispitivana je primjenom Penn Emotion Recognition Test - 40 Faces version (ER40), a anhedonija je procjenjivana samoocjenskim ljestvicama za fizičku i socijalnu anhedoniju Physical Anhedonia Scale and Revised Social Anhedonia Scale. Statističkom obradom odredili smo povezanost anhedonije i sposobnosti prepoznavanja emocija s općim funkcioniranjem i kliničkim pokazateljima.----- Rezultati: Fizička anhedonija prisutna je u 43.1% ispitanica, socijalna anhedonija u 52.3% ispitanica, a mjereno objema ljestvicama anhedonija je prisutna u 30.8% ispitanica. Ispitanice s izraženom fizičkom anhedonijom imaju i izraženije negativne simptome bolesti, ispitanice s izraženom socijalnom anhedonijom imaju izraženije sve domene simptoma i lošije opće funkcioniranje a ispitanice s izraženom i fizičkom i socijalnom anhedonijom imaju loše opće funkcioniranje i izraženije sve domene simptoma osim pozitivnih. Anhedonija nije povezana s trajanjem bolesti. Prosječna uspješnost prepoznavanja svih emocija je 66,9%. Pojedinačno gledano najuspješnije se prepoznaje sreća u (92,5% točnih prepoznavanja) i ujedno s najmanjom varijabilnosti. Zatim slijedi tuga s 79% uspješnosti, neutralna ekspresija 61%, strah 51,2% i ljutnja 50,8%. Ukupno prepoznavanje emocija i zasebno prepoznavanje neutralne ekspresije u negativnoj su korelaciji s negativnom dimenzijom PANSS ljestvice. Dob početka bolesti utječe na prepoznavanje emocije strah, a trajanje bolesti utječe na prepoznavanje emocije tuga. Na ukupno prepoznavanje emocija ne utječe spol promatrane osobe, ali utječe vrsta i intenzitet emocije. Analiza pojedninačnog prepoznavanja emocija pokazuje da se na muškom i ženskom licu bolje prepoznaje ljutnja jakog intenziteta od ljutnje srednjeg intenziteta; na ženskom licu se bolje prepoznaje strah srednjeg intenziteta od straha jakog intenziteta, dok se na muškom licu bolje prepoznaje strah jakog intenziteta od straha srednjeg intenziteta; intenzitet značajno utječe na prepoznavanje tuge na muškom licu, dok ne utječe na prepoznavanje tuge na ženskom licu a sreća se bez obzira na intenzitet jednako prepoznaje na muškom i ženskom licu. Pri krivom prepoznavanju emocija, svim se kategorijama emocija najčešće krivo pripisuje neutralna ekspresija. Nema razlike u prepoznavanju emocija između anhedoničnih i neanhedoničnih ispitanica, ispitanica na različitoj terapiji i različitih kliničkih slika. Analizirajući pojedine kategorije emocija pojedinačno pokazalo se da prepoznavanje emocija na licu s neutralnom ekspresijom statistički značajno ovisi o izraženosti socijalne anhedonije, ukupnoj vrijednosti na PANSS ljestvici i podljestvicama negativnih simptoma i opće psihopatologije, ukupnoj vrijednosti na SANS ljestvici i podljestvicama zaravnjen afekt i alogija. Ispitanice koje licu s neutralnom ekspresijom pripisuju emociju tuga ili ljutnja imaju više izražene simptome bolesti, osobito negativne simptome; ispitanice koje licu s neutralnom ekspresijom priprisuju emociju strah imaju općenito izraženije simptome bolesti dok one koje licu s neutralnom ekspresijom priprisuju pozitivnu emociju sreća imaju izraženiju socijalnu anhedoniju. Nije nađena povezanost prepoznavanja emocija i općeg funkcioniranja. ----- Zaključak: Ukupna izraženost anhedonije (fizičke i socijalne) te socijalna anhedonija zasebno utječe na opće funkcioniranje shizofrenih bolesnica. Nije nađena povezanost između sposobnosti prepoznavanja emocija i općeg funkcioniranja shizofrenih bolesnica.

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