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01.06.2014 | Original Paper | Ausgabe 4/2014

European Archives of Psychiatry and Clinical Neuroscience 4/2014

Limbic activity in antipsychotic naïve first-episode psychotic subjects during facial emotion discrimination

European Archives of Psychiatry and Clinical Neuroscience > Ausgabe 4/2014
Daniel Bergé, Susanna Carmona, Purificación Salgado, Mariana Rovira, Antoni Bulbena, Oscar Vilarroya
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Electronic supplementary material

The online version of this article (doi:10.​1007/​s00406-013-0465-5) contains supplementary material, which is available to authorized users.


The aim of this study was to determine brain activation during facial emotion discrimination in first-episode of psychosis. Eighteen patients underwent an fMRI while performing a facial emotion discrimination task during the acute episode, before starting antipsychotic drugs. A second fMRI and clinical evaluation were performed after evident clinical improvement. An equivalent control group underwent the same two fMRIs with a similar period of time between exams. The voxel-wise approach showed pre-treatment hypoactivation in ventro-limbic regions (cluster including right hippocampus and left amygdala; cluster size 528; p cluster <0.004) and facial perception involved in ventral–posterior regions (bilateral lingual gyrus, calcarine fissure and occipital superior gyrus, (k = 1,508, p < 0.001) and fronto–temporal regions. The region of interest approach also confirmed hypoactivation in right and left amygdala (cluster corrected p = 0.035 and 0.043, respectively). After treatment and clinical improvement, the voxel-wise approach showed a significant increase in activity in lingual gyrus and calcarine fissure in the group of patients. The regions of interest analysis showed an increase in amygdala activity during anger discrimination also in the group of patients. The results suggest a state-dependent model depicting a flattened and aberrant response of amygdala to emotion discrimination that could explain the seemingly contradictory previous findings of hypo- and hyper-amygdala activation.

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Supplementary material 1 ESM_1 Caption: Graphic representation of the emotion discrimination task. The active task is an emotion discrimination task where subjects are asked to discriminate the more expressive of a pair of simultaneously presented faces by pressing a button. On one side of the image the face may represent fear, anger, disgust or happiness. The other side represents a neutral face. The side of the emotional/neutral face was randomized counterbalancing. All emotional and neutral faces belong to the Ekman collection and were modified to show only the facial contour without other distracting features. Each block of active task is followed and preceded from a block of control task, where patients had to choose the vertical one of a pair of simultaneously and side to side rectangular figures. These figures presented a similar grey-intensity distribution to those of Ekman’s faces. Thus, the active task implies facial emotion discrimination whereas the control task only implies shape discrimination. Six blocks of control task were alternated with six blocks of facial emotion discrimination task which were separated by emotion (3 blocks of happiness, 1 block of anger, 1 of fear and 1 of disgust). Pictures inside each block were randomly ordered. Each active block consisted of 8 pairs of images, each one presented for 2,700 ms and followed by a cross image presented for 300 ms. (JPEG 111 kb)
Supplementary material 2 ESM_2 Caption: Top right: Design matrix of the statistical parametric design of second-level analysis where the first 43 columns represent the factor subjects, then two columns representing the factor group, two columns for the factor time, and 4 columns for the factor interaction group*time (group1-time1, group1-time2, group2-time1, group2-time2). Above the matrix, there is a representation of the contrast average effects. Top left and bottom: Statistical parametric map and the equivalent blobs of the average effects over a three-dimensional structural image. The statistical parametric map is corrected using family wise error at p < 0.05. This image was used to mask subsequent contrasts in the voxel-wise approach. (TIFF 2000 kb)
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