Neuroimaging differences in spatial cognition between men and male-to-female transsexuals before and during hormone therapy.

INTRODUCTION: Neuropsychological abnormalities in transsexual patients have been reported in comparison with subjects without gender identity disorder (GID), suggesting differences in underlying neurobiological processes. However, these results have not consistently been confirmed. Furthermore, studies on cognitive effects of cross-sex hormone therapy also yield heterogeneous results. AIM: We hypothesized that untreated transsexual patients differ from men without GID in activation pattern associated with a mental rotation task and that these differences may further increase after commencing of hormonal treatment. METHOD: The present study investigated 11 male-to-female transsexual (MFTS) patients prior to cross-sex hormone therapy and 11 MFTS patients during hormone therapy in comparison with healthy men without GID. Using functional magnetic resonance imaging at 3-Tesla, a mental rotation paradigm with proven sexual dimorphism was applied to all subjects. Data were analyzed with SPM5. MAIN OUTCOME MEASURES: Patterns of brain activation associated with a mental rotation task. RESULTS: The classical mental rotation network was activated in all three groups, but significant differences within this network were observed. Men without GID exhibited significantly greater activation of the left parietal cortex (BA 40), a key region for mental rotation processes. Both transsexual groups revealed stronger activation of temporo-occipital regions in comparison with men without GID. CONCLUSIONS: Our results confirmed previously reported deviances of brain activation patterns in transsexual men from men without GID and also corroborated these findings in a group of transsexual patients receiving cross-sex hormone therapy. The present study indicates that there are a priori differences between men and transsexual patients caused by different neurobiological processes or task-solving strategies and that these differences remain stable over the course of hormonal treatment.

Automatic processing of facial emotion in schizophrenia with and without affective negative symptoms.

INTRODUCTION: It is assumed that people spontaneously evaluate any incoming stimulus as pleasant or unpleasant. The evaluative response appears to structure perception and to have direct links to emotional states. METHODS: To investigate the automatic processing of face valence a sequential priming task based on emotional face stimuli was administered to schizophrenia patients with a flat affect expression, schizophrenia patients suffering from anhedonia, schizophrenia patients not suffering from anhedonia or flat affect, and healthy controls. The Scale for the Assessment of Negative Symptoms (Andreasen, 1989) was applied to evaluate affective symptoms and categorize patients into groups. RESULTS: Schizophrenia patients without affective negative symptoms exhibited reversed priming effects similar to that of healthy subjects. In contrast, flat affect patients and anhedonic patients showed only a prime effect due to negative facial valence. In the flat affect patient group, negative prime faces facilitated the evaluation of target faces, whereas in the anhedonic patient group negative prime faces tended to inhibit the evaluation of subsequent target faces. CONCLUSIONS: The present findings support the idea that chronic schizophrenia patients extract automatically the valence of emotional facial expression but they also suggest processing differences between schizophrenia patients as a function of affective symptoms.

Detection of facial expressions of emotions in schizophrenia.

The aim of the present study was to examine spatial processing of facial emotion in schizophrenic patients suffering from affective symptoms. A face-in-the-crowd task using schematic stimuli was administered to schizophrenic patients with flat affect (n=30), schizophrenic patients suffering from anhedonia (n=30), schizophrenic patients not suffering from anhedonia or flat affect (n=28), and a group of healthy controls (n=30). Participants searched displays of neutral schematic faces for a face with a positive or negative mouth expression. Schizophrenic patients manifested a general slowing of response speed compared to normal subjects. All patient groups as well as normal subjects found negative faces more quickly than positive faces amongst neutral faces. Unexpectedly, with increasing anhedonia as assessed by psychiatric rating, a more efficient spatial detection of positive facial expression was observed. For flat-affect patients only, efficiency of search for negative facial expression did not differ from that in the neutral face control condition. This response pattern indicates that, in flat-affect schizophrenic patients, spatial search of negative facial expression might be slowed after the initial engagement of search processes. Potential explanations of the face processing effects found in anhedonia are discussed.

Automatic processing of verbal emotion stimuli in schizophrenia.

In the present study, automatic processing of verbal emotion stimuli was investigated as a function of affective symptoms, emotional state and trait characteristics of chronic schizophrenia patients. A sequential pronunciation priming task was administered to 30 schizophrenia patients with a flat affect expression, 30 schizophrenia patients suffering from anhedonia, 28 schizophrenia patients not suffering from anhedonia or flat affect, and 30 healthy subjects to assess affective and semantic priming effects. The Scale for the Assessment of Negative Symptoms (Andreasen, British Journal of Psychiatry, 1989, 155, 53-58) was applied to evaluate the flat affect and anhedonia, and to categorize patients into groups. Schizophrenia patients did not differ from healthy subjects in affective and semantic priming scores. However, affective priming based on positive primes was inversely correlated with negative state and trait affectivity, and positively correlated with trait joy in the patient sample. These results support the view that a decrement in automatic processing facilitation of positive valence might play a role in the development of negative emotions. The symptoms of flat affect and anhedonia do not appear to be associated with impairments in the automatic processing of verbal emotional material in schizophrenia.

The experience of basic emotions in schizophrenia with and without affective negative symptoms.

A diminished ability to experience emotion could be a key characteristic of the negative symptomatology in schizophrenia. We examined the frequency of basic emotions in everyday life as well as emotion control in various groups of chronic schizophrenic patients. Self-report questionnaires (Differential Emotions Scale [DES], Emotion Control Questionnaire [ECQ]) were provided to healthy controls and three groups of schizophrenia patients (n=88), i.e., affectively flat patients, anhedonic patients, and patients not suffering from affective negative symptoms. Patients with affective negative symptoms experienced the positive emotions interest and joy less frequently than healthy subjects or patients without affective negative symptoms. All schizophrenia patients felt fear more often and tended to feel disgust more frequently than healthy subjects. The frequency of guilt and anger experiences increased with the chronicity of the disease. Anhedonic patients manifested more emotion inhibition than healthy controls and exhibited an affectivity pattern consistent with Meehl's model of anhedonia.

Affective priming in schizophrenia with and without affective negative symptoms.

In the present study automatic perceptual sensitivity to facial affect information was examined in chronic schizophrenic patients. An affective priming task including subliminal and supraliminal presentations of sad and happy facial affect was administered to schizophrenia patients with a flat affect expression (n = 30), schizophrenia patients suffering from anhedonia (n = 30), schizophrenia patients not suffering from anhedonia or flat affect (n = 28), and a group of healthy controls (n = 30). Subjects had to judge valence of neutral Chinese ideographs. Anhedonic and flat affect patients but not patients without affect symptoms were found to be sensitive to negative facial affect on an automatic processing level. None of the schizophrenic patient groups but healthy controls showed a subliminal valence-congruent priming effect based on positive facial affect. Anhedonia as assessed by standardised psychiatric rating was related to a subliminal sensitivity to negative facial expression and a valence-inverted perception of positive facial expression. This pattern of results is largely consistent with predictions derived from Meehl's model of anhedonia. The aversive automatic perception of positive facial expression primarily found in anhedonic patients but also in schizophrenic control patients could lie in structural disturbances concerning the regulation of intimacy and distance.