This body of work is primarily based on behavioural results from a battery of tasks administered to

251 Pages·2010·2.75 MB·English

FACE PROCESSING IN SCHIZOPHRENIA:
AN INVESTIGATION OF CONFIGURAL PROCESSING AND
THE RELATIONSHIP WITH FACIAL EMOTION
PROCESSING AND NEUROCOGNITION

Nicole R. Joshua

Submitted in total fulfilment of the requirements of the degree of
Doctor of Philosophy

February 2010

The Mental Health Research Institute of Victoria and
The Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences
The University of Melbourne
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Abstract

Cognitive impairment is a key characteristic of schizophrenia and is a clear predictor of
functional outcome. This thesis explores the relationship between cognitive ability relating to
social and non-social processing. Schizophrenia patients demonstrate an impaired ability to
recognise, label and discriminate emotional expression within the face. The underlying
mechanisms behind this social cognitive impairment are not yet fully understood. This thesis
explores the notion that a basic perceptual impairment in processing facial information adversely
impacts on the perception of more complex information derived from faces, such as emotional
expression. Face perception relies on processing the featural characteristics of a face as well as
the relationship between these features. Information pertaining to the spatial distances between
features is referred to as configural information.
A group of schizophrenia patients and healthy control participants completed a battery of tasks
that assessed basic neurocognition, facial emotion processing and configural face processing. A
model of face processing was proposed and used to systematically pinpoint specific deficits that
may contribute to impaired face processing in schizophrenia. The results indicated that
schizophrenia patients show impairments on three broad constructs; basic neurocognition, facial
emotion processing, and most pertinently, deficits in configural processing. It was revealed that
although neurocognitive and face processing both explained a significant proportion of the
variance in facial emotion processing, the effect of neurocognition was indirect and mediated by
face processing.
To investigate the diagnostic specificity of these findings, a group of bipolar disorder patients
was also tested on the task battery. The results indicated that bipolar disorder patients also show
social and non-social cognitive impairments, however, not as severe as that demonstrated by the
schizophrenia patients. Furthermore, the effect of neurocognitive performance on facial
emotion processing appeared more direct for bipolar disorder patients compared to
schizophrenia patients. Although deficits in face processing were observable in bipolar, they
were not specific to configural processing. Thus, deficits in emotion processing were more
associated to neurocognitive ability in bipolar disorder patients, and more associated to
configural face processing in schizophrenia patients. The configural processing deficits in
schizophrenia are discussed as a lower-order perception problem. In conclusion, the results of
this thesis are discussed in terms of their implication for treatment.

ii
Declaration
This is to certify that:

a) This thesis comprises only my original work toward the PhD unless otherwise indicated

b) Due acknowledgment has been made in the text to all other material used

c) The thesis is less than 100,000 words in length, exclusive of tables, figures, bibliography and
appendices

___________________________

Nicole R. Joshua
September, 2009
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Acknowledgements

I would like to acknowledge a number of individuals who have helped me complete this
research. Some have assisted from the very beginning and others have been influential along the
way; many will be well into the future.

Firstly, I would like to acknowledge the contribution of my three supervisors; Susan Rossell,
Patrick Johnston and David Castle. I thank each of you for your practical assistance and for
sharing your expertise in many aspects of this research. You have helped me develop my ideas
and formulate methods to test these ideas. You have helped nurture my independence yet have
always been available to give advice and encouragement.

I would like to express my sincere gratitude to all the participants that took part in this research.
Thank you for sharing your experiences and contributing your valuable time. Without your
involvement this research would not have been possible.

I would like to acknowledge the Mental Health Research Institute for providing the resources
and technical support required for this research. Further acknowledgment goes to the University
of Melbourne, Department of Psychiatry, specifically Elizabeth Horton-Bell for administrative
support and to the Menzies Foundation who provided not only financial support but also a very
encouraging, friendly environment.

I would like to express my deep thanks and appreciation to Andrea Gogos and David O’Connor.
You have both helped me so much along this journey, providing advice and tolerance and most
of all friendship. I will always think back and laugh at our crazy centrifuge Friday antics. You
are both very talented scientists who will undoubtedly continue to make significant contributions
to your chosen areas of research. I am proud to have worked with you both.

I would like to thank all my friends of whom there are too many to list but you all know who
you are. You have provided essential support and understanding throughout. The many girls
nights, aquatic adventures and countless coffees have kept me grounded and happy.

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I would like to give special thanks to Peter Knott who has impacted my life in so many ways.
You have supported me through many times of quirk and eek, you have always listened and
provided practical, rational and emotional support. Your laid back, level-headed, caring nature
has been unquestionably valuable. I thank you for making me so happy and I look forward to
the rest of our lives together.

Finally, I would like to express the deepest of thanks to my Mum and Dad. You have supported
me in every challenge I have taken on with unconditional love and care. You have always been
there for me, providing words of wisdom; my candle may be slightly singed at each end but here
is my pudding. I hope you are as proud of me as I am to be your daughter. I love you, thank
you.
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Publications & Presentations During Candidature

Refereed journal articles
Joshua N., Rossell S., 2009. Configural face processing in schizophrenia. Schizophr Res. 112(1-3), 99-103.
Joshua N., Gogos A., Rossell S., 2009. Executive functioning in schizophrenia: A thorough examination of
performance on the Hayling Sentence Completion Test compared to psychiatric and non-psychiatric controls.
Schizophr Res. 114(1), 84-90.
Gogos A., Joshua N., Rossell S., 2009. Using the Repeatable Battery for the Assessment of Neuropsychological
Status (RBANS) to investigate group and gender differences in schizophrenia and bipolar disorder. Aust N Z J
Psychiatry. (Accepted for publication 21/09/2009 awaiting DOI).

Manuscripts in preparation
Joshua N., Rossell S.L., 2009. Contour integration in chronic Australian schizophrenia outpatients. In preparation.
Batty R.A., Joshua N., Rossell S., 2009. Does the N170 indicate phases of encoding in face perception? In
preparation.
Batty R.A., Rossell S.L., Innes-Brown H., Joshua N.R., Francis A.J.P., 2009. Neurophysiological correlates of face
processing in schizotypy: Impoverished visual input or an isolated configural processing deficit? In preparation.
Stefanovic A., Roiser J.P., Joshua N.R., Neill E., O'Regan A., Morgan C.J.A., Curran V., Rossell S.L., 2009.
Modulated prefrontal BOLD response during a semantic priming task is associated with delusions in
schizophrenia. Molecular Psychiatry. Under review.

Oral presentations
Configural Face Processing in Schizophrenia. North West Area Mental Health / Department of Psychiatry
Colloquium. Melbourne, Australia (July, 2009).
Configural Face Processing in Schizophrenia. Joint WPA/ASPR Scientific Meeting. Melbourne, Australia
(December, 2007).
Confirmation of Candidature Proposed Research Presentation. The University of Melbourne. Melbourne, Australia
(January, 2006).
Understanding Perceptual Organisation in Psychosis. Joint CINP/ASPR Scientific Meeting. Brisbane, Australia
(December, 2005).

Poster presentations
National
Joshua, N. & Rossell, S. Emotion Processing in Schizophrenia: What does the whole face tell us the eyes cannot?
ASPR Scientific Meeting. Newcastle, Australia (2008).
Joshua, N., O'Regan, A. & Rossell, S. Perceptual Organisation in Schizophrenia. Melbourne Health Research Week.
Melbourne, Australia (2007).
Joshua, N., O'Regan, A. & Rossell, S. Facial Emotion Processing in Psychosis. ASPR Scientific Meeting. Sydney,
Australia (2006).
O'Regan, A., Joshua, N., & Rossell, S. Are Affective Prosodic Deficits Evident in Bipolar Disorder? ASPR Scientific
Meeting. Sydney, Australia (2006).
McPhee, A., Joshua, N. & Rossell, S. Biased Perception Towards Fearful Words in Delusions. Joint CINP/ASPR
Scientific Meeting. Brisbane, Australia (2005).
Joshua, N. The Effects of 24 Hours of Sleep Deprivation on Task Performance. Australasian Society for
Psychophysiology Annual Meeting. Melbourne, Australia (2004).

International
Configural Face Processing in Schizophrenia. Schizophrenia International Research Society. Venice, Italy (June,
2008).
Joshua, N. & Rossell, S. Automatic and Controlled Emotion Processing: Preliminary Data. International Brain
Research Organisation. Melbourne, Australia (July, 2007).

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Foreword

I have been fascinated by the human brain since my first psychology class. The more I learnt
about cortical functioning the more I realised how such a complex system is vulnerable to fault.
Aberrant cognitive processing can lead to poor memory, planning, and attention for example.
To me however, the social implications of cognitive error are just as, if not more debilitating to
an individual. During many clinical interviews with schizophrenia patients this became
particularly apparent. During interviews I asked questions such as "do you have any regrets in
life?" and "what are your hopes for the future?". A recurring theme I observed was the need for
closer social contacts and the desire to make more friends. This led me to an interest in social
cognition in schizophrenia and a desire to understand not only why social skills are problematic
for patients but also how they can be improved. This body of work is a collection of studies
investigating social cognition in schizophrenia.
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Table of Contents
Abstract---------------------------------------------------------------------------------------------------ii
Declaration----------------------------------------------------------------------------------------------iii
Acknowledgements------------------------------------------------------------------------------------ iv
Publications & Presentations During Candidature---------------------------------------------- vi
Foreword ------------------------------------------------------------------------------------------------vii
Table of Contents-------------------------------------------------------------------------------------viii
List of Figures-----------------------------------------------------------------------------------------xiii
List of Tables------------------------------------------------------------------------------------------xiv
List of Abbreviations----------------------------------------------------------------------------------xv
Chapter 1 Introduction----------------------------------------------------------------------------- 1
1.1 Introduction to Schizophrenia--------------------------------------------------------------------1
1.2 The Costs of Schizophrenia-----------------------------------------------------------------------3
1.3 Cognition in Schizophrenia-----------------------------------------------------------------------3
1.4 Overall Aims & Hypotheses----------------------------------------------------------------------6
1.5 Study Questions-------------------------------------------------------------------------------------6
1.6 Significance of this Research----------------------------------------------------------------------7
1.7 Outline and Organisation of Thesis-------------------------------------------------------------7
Chapter 2 Methods---------------------------------------------------------------------------------- 9
2.1 Participant Information----------------------------------------------------------------------------9
2.1.1 Recruitment, Diagnosis & Inclusion Criteria---------------------------------------------9
2.1.2 Demographic Characteristics --------------------------------------------------------------10
2.1.3 Estimated Intelligence-----------------------------------------------------------------------10
2.1.4 Education-------------------------------------------------------------------------------------11
2.1.5 Employment----------------------------------------------------------------------------------11
2.1.6 Living Situation ------------------------------------------------------------------------------11
2.1.7 Mood Assessment ---------------------------------------------------------------------------11
2.1.8 Psychopathological Characteristics--------------------------------------------------------12
2.1.9 Global Assessment of Functioning-------------------------------------------------------13
2.1.10 Medication------------------------------------------------------------------------------------14
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2.2 Procedure, Testing Conditions and Apparatus -----------------------------------------------14
2.3 Task Battery ----------------------------------------------------------------------------------------15
2.4 Statistical Analysis ---------------------------------------------------------------------------------15
2.5 Summary--------------------------------------------------------------------------------------------18
Chapter 3 Neurocognition in Schizophrenia--------------------------------------------------19
3.1 Introduction----------------------------------------------------------------------------------------19
3.1.1 Background to Neurocognition in Schizophrenia--------------------------------------19
3.1.2 Memory----------------------------------------------------------------------------------------20
3.1.3 Visuospatial Ability--------------------------------------------------------------------------21
3.1.4 Language--------------------------------------------------------------------------------------22
3.1.5 Information Processing & Attention-----------------------------------------------------22
3.1.6 Executive Functioning----------------------------------------------------------------------23
3.2 Aims & Hypotheses-------------------------------------------------------------------------------24
3.3 Neurocognitive Tasks & Performance Results -----------------------------------------------25
3.3.1 Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)-26
3.3.2 Zoo Map --------------------------------------------------------------------------------------33
3.3.3 Hayling Sentence Completion Test (HSCT)---------------------------------------------35
3.3.4 The Brixton Spatial Anticipation Test (Brixton Test)----------------------------------38
3.4 Neurocognitive Strengths & Weaknesses in Schizophrenia --------------------------------40
3.5 Discussion ------------------------------------------------------------------------------------------43
3.5.1 Limitations------------------------------------------------------------------------------------44
3.5.2 Implications of Impaired Neurocognition in Schizophrenia--------------------------44
3.5.3 Neurocognition & Social Cognition------------------------------------------------------45
3.6 Summary--------------------------------------------------------------------------------------------47
Chapter 4 Emotion Processing in Schizophrenia --------------------------------------------49
4.1 Background to Social Cognition ----------------------------------------------------------------49
4.1.1 Social Cognition in Schizophrenia --------------------------------------------------------50
4.2 Background to Facial Emotion Processing----------------------------------------------------53
4.3 Facial Emotion Processing in Schizophrenia--------------------------------------------------55
4.3.1 Emotion Processing and Stage of Illness ------------------------------------------------56
4.3.2 Emotion Processing in At-Risk Populations--------------------------------------------56
4.3.3 Associations between Emotion Processing and Clinical Characteristics------------57
4.3.4 Emotion Processing and Neurocognition-----------------------------------------------58
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4.3.5 Emotion Processing and Functional Outcome-----------------------------------------58
4.3.6 Assessment Methods of Emotion Processing in Schizophrenia---------------------59
4.3.7 Generalized or Emotion Specific Deficit?-----------------------------------------------61
4.3.8 Limitations of Previous Literature--------------------------------------------------------63
4.4 Aims & Hypotheses-------------------------------------------------------------------------------64
4.5 Task Methodology---------------------------------------------------------------------------------65
4.5.1 Facial Emotion Discrimination Task-----------------------------------------------------65
4.5.2 Facial Emotion Labelling Task------------------------------------------------------------66
4.6 Results-----------------------------------------------------------------------------------------------66
4.6.1 Facial Emotion Discrimination------------------------------------------------------------67
4.6.2 Facial Emotion Labelling-------------------------------------------------------------------69
4.6.3 Between-Task Correlations-----------------------------------------------------------------72
4.7 Discussion ------------------------------------------------------------------------------------------72
4.7.1 Limitations------------------------------------------------------------------------------------76
4.7.2 Treatment Implications---------------------------------------------------------------------77
4.8 Summary--------------------------------------------------------------------------------------------78
Chapter 5 Face Processing in Schizophrenia--------------------------------------------------81
5.1 Background to Face Processing-----------------------------------------------------------------82
5.1.1 History of Face Processing Research-----------------------------------------------------83
5.1.2 Featural Face Processing--------------------------------------------------------------------84
5.1.3 The Face Inversion Effect------------------------------------------------------------------86
5.1.4 Configural Face Processing ----------------------------------------------------------------88
5.1.5 Development of Configural Face Processing -------------------------------------------90
5.1.6 Configural Processing and Expertise-----------------------------------------------------92
5.1.7 Neural Basis of Configural Face Processing---------------------------------------------93
5.1.8 Models of Configural Processing----------------------------------------------------------95
5.2 Face Processing in Schizophrenia---------------------------------------------------------------98
5.2.1 Differential Deficit Design-----------------------------------------------------------------99
5.2.2 Configural Face Processing in Schizophrenia-----------------------------------------101
5.3 Aims and Hypotheses---------------------------------------------------------------------------102
5.4 Face Processing Tasks – Methods & Results------------------------------------------------103
5.4.1 Scrambled Faces Task---------------------------------------------------------------------104
5.4.2 Featural-Spacing Manipulation Tasks---------------------------------------------------107
5.4.3 Fractured Face Task-----------------------------------------------------------------------119
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