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A dimensional approach in psychiatry strives to identify neurobiological signatures of core (dys)functions such as responses to emotional stimuli across nosological boundaries.
We compared responses to emotional stimuli between major psychiatric disorders and investigated whether there is a psychopathological correlate irrespective of diagnostic group.
We used functional magnetic resonance imaging (fMRI) to assess the functional correlates of responses to unexpected pleasant and aversive emotional pictures in n=175 subjects suffering from alcohol dependence (n=29), schizophrenia (n=37), major depressive disorder (MDD; n=25), bipolar disorder (acute manic episode; n=12), panic disorder (n=12) or attention deficit/hyperactivity disorder (ADHD; n=20) and in healthy controls (n=40). The level of anxiety was measured in all diagnostic groups with the State-Trait Anxiety Inventory, and severity of depressive mood was measured with Beck's depressions inventory in all diagnostic groups with the exception of bipolar patients.
Over all diagnostic groups, a significant activation of BA10 was observed during the presentation of unexpected pleasant pictures, whereas a significant activation of the left amygdala and left insula was found during the presentation of unexpected aversive pictures. We did not find significant effects of group, nor a correlation of neuronal activation with depressed mood or anxiety.
In spite of reported alterations in emotion processing in different psychiatric diseases, responses to emotional pictures did not differ across nosological boundaries in our study. However, a dimensional approach that targets e.g. personality traits or basic learning mechanisms and their neuropsychological correlates across traditional disease categories may be more promising.
According to cognitive theories of depression, negative biases affect most cognitive processes including perception. Such depressive perception may result not only from biased cognitive appraisal but also from automatic processing biases that influence the access of sensory information to awareness.
Twenty patients with major depressive disorder (MDD) and 20 healthy control participants underwent behavioural testing with a variant of binocular rivalry, continuous flash suppression (CFS), to investigate the potency of emotional visual stimuli to gain access to awareness. While a neutral, fearful, happy or sad emotional face was presented to one eye, high-contrast dynamic patterns were presented to the other eye, resulting in initial suppression of the face from awareness. Participants indicated the location of the face with a key press as soon as it became visible. The modulation of suppression time by emotional expression was taken as an index of unconscious emotion processing.
We found a significant difference in the emotional modulation of suppression time between MDD patients and controls. This difference was due to relatively shorter suppression of sad faces and, to a lesser degree, to longer suppression of happy faces in MDD. Suppression time modulation by sad expression correlated with change in self-reported severity of depression after 4 weeks.
Our finding of preferential access to awareness for mood-congruent stimuli supports the notion that depressive perception may be related to altered sensory information processing even at automatic processing stages. Such perceptual biases towards mood-congruent information may reinforce depressed mood and contribute to negative cognitive biases.
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