Abstract
Social cognition, including emotion processing, is a recognised deficit observed in patients with schizophrenia. It is one cognitive domain which has been emphasised as requiring further investigation, with the efficacy of antipsychotic treatment on this deficit remaining unclear. Nine studies met our criteria for entry into a meta-analysis of the effects of medication on facial affect processing, including data from 1162 patients and six antipsychotics. Overall we found a small, positive effect (Hedge’s g = 0.13, 95% CI 0.05 to 0.21, p = 0.002). In a subgroup analysis this was statistically significant for atypical, but not typical, antipsychotics. It should be noted that the pooled sample size of the typical subgroup was significantly lower than the atypical. Meta-regression analyses revealed that age, gender and changes in symptom severity were not moderating factors. For the small, positive effect on facial affect processing, the clinical significance is questionable in terms of treating deficits in emotion identification in schizophrenia. We show that antipsychotic medications are poor at improving facial affect processing compared to reducing symptoms. This highlights the need for further investigation into the neuropharmacological mechanisms associated with accurate emotion processing, to inform treatment options for these deficits in schizophrenia.
Highlights
Antipsychotic medication is used to treat positive symptoms in schizophrenia (National Institute for Health and Care Excellence, 2014)
Deficits in social cognition have been shown to be strongly associated with functional outcome (Green et al, 2004), and is one of eight domains identified by the initiative ‘Measurement and Treatment Research to Improve Cognition in Schizophrenia’ (MATRICS), which require further investigation and treatment strategies (Nuechterlein et al, 2004)
Changes in positive and negative symptoms were not moderators (p = 0.83 and p = 0.97, respectively). These studies did report an improvement in both positive and negative symptoms from baseline to follow-up, the analyses suggest that the observed change in overall effect size for facial affect processing is independent of this symptom change
Summary
Antipsychotic medication is used to treat positive symptoms in schizophrenia (National Institute for Health and Care Excellence, 2014). In a review of the literature, Kucharska-Pietura and Mortimer (2013) concluded that antipsychotics are unlikely to facilitate the recovery of social cognition deficits in schizophrenia based on a review of 15 articles. By far the most widely studied aspect of social cognition is emotion processing, which is typically assessed using tasks requiring participants to perceive, identify and discriminate between facial emotion expressions. In a review specific to the facial affect recognition literature, Hempel and colleagues concluded, based on eight studies, that antipsychotic medication does not successfully treat this aspect of schizophrenia (Hempel et al, 2010)
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