Behavioral empathy performance differs by psychiatric disorder, with the strongest impairment occurring in schizophrenia patients followed by bipolar patients, and with the strongest association between clinical characteristics and empathy performance occurring in patients with depression, according to findings from a case-control study.
The finding that impairments in emotional competencies are disorder specific could enable better characterization of patient groups and allow for more tailored psychotherapeutic interventions, reported Birgit Derntl, Ph.D., of the University of Vienna, and colleagues.
They compared 72 patients – 24 each with schizophrenia, bipolar disorder, and depression – with 24 healthy age-, gender-, and verbal intelligence–matched controls. All participants performed three tasks focused on emotion recognition, emotional perspective taking, and affective responsiveness.
Emotion recognition was significantly better among the controls, compared with those in the schizophrenia and bipolar groups, with a trend toward significance compared with those in the depression group (Schizophrenia Res. 2012;142:58-64 [doi:10.1016/j.schres.2012.09.020]).
"A significant effect of emotion, but no significant emotion-by-group interaction emerged. Post hoc analysis of the significant emotion effect showed highest accuracy for happy conditions followed by neutral, anger, fear, disgust, and sad conditions," they said.
Emotional perspective taking, after researchers controlled for emotion recognition and affective responsiveness performance, also was significantly increased among the controls, compared with the schizophrenia patients. The schizophrenia patients also performed significantly worse than did the bipolar group on this task. No differences were seen between controls and depression patients, controls and bipolar patients, or depression patients and bipolar patients.
As with emotion recognition, a significant main effect of emotion was seen with emotional perspective taking, but no significant emotion-by-group interaction emerged for this measure, and post hoc analysis of the significant emotion effects showed highest accuracy for happy conditions followed by neutral, anger, disgust, fear, and sad conditions.
Similarly, affective responsiveness was highly significantly better among controls than among the other three groups after researchers controlled for emotion recognition and perspective taking performance, and the schizophrenia patients performed significantly worse than did the bipolar and depression patients. The bipolar and depression groups did not differ.
A significant main effect of emotion and a significant group-by-emotion interaction was seen for this measure; a significant group effect was seen for all negative emotions and neutral conditions, but no group effect was seen for happiness.
"Comparing the overall accuracy across all tasks revealed a significant task effect, with lowest accuracy in affective responsiveness and highest in emotional perspective taking," the investigators said, noting that a significant group effect occurred, with controls outperforming the schizophrenia and bipolar groups, and trending toward outperforming the depression group. The schizophrenia group performed worse than did both the bipolar and depression groups, and the bipolar and depression groups did not differ. A similar and significant task-by-group interaction was observed.
No significant differences were seen when comparing actual behavioral performance and self-reported empathy in any of the groups. Notably, however, the bipolar patients had significantly lower self-reported empathy sum scores, compared with the controls and the depression patients.
As for the association between clinical characteristics and empathy performance, symptom severity scores correlated with accuracy in affective responsiveness only in the depression group. Scores in the bipolar group and schizophrenia group were not correlated with accuracy in any of the empathy tasks, the investigators said.
Furthermore, duration of illness in the depression group, but not the other groups, was significantly and negatively associated with affective responsiveness score, indicating worse performance with longer disease duration.
Study participants were adults with a mean age of 41 years who were recruited from academic medical centers. Empathy tasks to assess emotion recognition involved the use of pictures of faces depicting five basic emotions and neutral expressions, which participants were asked to identify. Emotional perspective taking was assessed by asking participants to identify basic emotions and neutral scenes depicted in pictures involving social interaction; the face of one person in each picture was masked, and the participants were asked to infer the corresponding emotional expression of the masked face based on which expression would fit the emotional situation.
Affective responsiveness was assessed by asking participants to describe how short written sentences describing real-life emotional and emotionally neutral situations would make them feel if they were experiencing those situations.
While the study is limited by small sample size and by incomplete data regarding history of psychotic episodes (which have been shown to worsen cognitive performance in bipolar patients), and also by the fact that some participants were chronic patients and most were medicated, it nonetheless highlights that schizophrenia patients are particularly characterized by severe impairment in emotional perspective taking and affective responsiveness, when compared with healthy controls and patients with affective disorders, the investigators said.