Neural correlates of the core facets of empathy in schizophrenia

Abstract

Empathy is a multidimensional construct composed of several components such as emotion recognition, emotional perspective taking and affective responsiveness. Even though patients with schizophrenia demonstrate deficits in all core components of this basic social ability, the neural underpinnings of these dysfunctions are less clear. Using fMRI, we analyzed data from 15 patients meeting the DSM-IV criteria for schizophrenia and 15 matched healthy volunteers performing three separate paradigms tapping the core components of empathy, i.e. emotion recognition, perspective taking and affective responsiveness. Behavioral data analysis indicated a significant empathic deficit in patients, reflected in worse performance in all three domains. Analysis of functional data revealed hypoactivation in a fronto-temporo-parietal network including the amygdala in patients. Moreover, amygdala activation correlated negatively with severity of negative symptoms. The results suggest that schizophrenia patients not only suffer from a broad range of emotional deficits but also show cortical and subcortical abnormalities, extending previous findings on fronto-temporal cortical dysfunctions. Since empathy is related to psychosocial functioning and hence of high clinical relevance in schizophrenia, a more detailed understanding of the exact nature of these impairments is mandatory.

Fig. 1.

Performance (% correct with a line indicating the group mean, a) and reaction times (seconds, a line indicating the group mean, b) in emotion recognition (ER), emotional perspective taking (EPT), and affective responsiveness (AR) in schizophrenia patients and healthy controls. Results of data analyses revealed a significant group effect (p=.037) in performance, with patients showing less accuracy, and a significant task-by-group interaction (p<.001) for reaction times, indicating faster response times in patients during EPT (p=.003). Note that equal performance of participants sometimes might be covered by only one data point.

Fig. 2.

(a) Illustration of the significant group effect (F=5.69, p<.05 HET corr.), depicting hypoactivation of the patients vs. healthy controls in several brain regions. (b) Illustration of the significant group-by-task interaction (F=7.21, p<.05 HET corr.) showing significant differences in activation of the right putamen (slice: z=−4) and the right middle cingulate (slice: y=−4). Note that equal activation of participants sometimes might be covered by only one data point.

Fig. 3.

Illustration of the conjunction analysis across all three tasks (p<.05 FEW corr.) in controls (left) and patients (middle), revealing significantly less activation in a wide-spread network including frontal, temporal, occipital, and subcortical regions in patients (right).

Fig. 4.

Result of ROI analysis for the amygdala revealed a significant group effect (p=.003) indicating stronger amygdala activation bilaterally in controls in each of the three paradigms (mean activation of each group is indicated with a line, a). Note that equal amygdala activation of different participants sometimes might be covered by only one data point. Moreover, a significant correlation between amygdala activation during emotion recognition (ER) and PANSS negative scores emerged (r=−0.453, p=.045).