Facial affect recognition in psychosis
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Date
29/11/2016Author
Bordon, Natalie Sarah
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Abstract
While a correlation between suffering from psychosis and an increased risk of engaging in
aggressive behaviours has been established, many factors have been explored which may
contribute to increasing this risk. Patients with a diagnosis of psychosis have been shown to
have significant difficulties in facial affect recognition (FAR) and some authors have
proposed that this may contribute to increasing the risk of displaying aggressive or violent
behaviours. A systematic review of the current evidence regarding the links between facial
affect recognition and aggression was conducted. Results were varied with some studies
providing evidence of a link between emotion recognition difficulties and aggression, while
others were unable to establish such an association. Results should be interpreted with some
caution as the quality of included studies was poor due to small sample sizes, insufficient
power and limited reporting of results. Adequately powered, randomised controlled studies
using appropriate blinding procedures and validated measures are therefore required.
There is a substantial evidence base demonstrating difficulties in emotional perception in
patients with psychosis, with evidence suggesting a relationship with reduced social
functioning, increased aggression and more severe symptoms of psychosis. In this review we
aim to review this field to assess if there is a causal link between facial affect recognition
difficulties and psychosis. The Bradford Hill criteria for establishing a causal relationship
from observational data were used to generate key hypotheses, which were then tested against
existing evidence. Where a published meta-analysis was not already available, new meta-analyses
were conducted. A large effect of FAR difficulties in those with a diagnosis of
psychosis, with a small to moderate correlation between FAR problems and symptoms of
psychosis was found. Evidence was provided for the existence of FAR problems in those at
clinical high risk of psychosis, while remediation of psychosis symptoms did not appear to
impact FAR difficulties. There appears to be good evidence of the existence of facial affect
recognition difficulties in the causation of psychosis, though larger, longitudinal studies are
required to provide further evidence of this.
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