Biased Recognition of Facial Affect in Patients with Major Depressive Disorder Reflects Clinical State

Cognitive theories of depression posit that perception is negatively biased in depressive disorder. Previous studies have provided empirical evidence for this notion, but left open the question whether the negative perceptual bias reflects a stable trait or the current depressive state. Here we investigated the stability of negatively biased perception over time. Emotion perception was examined in patients with major depressive disorder (MDD) and healthy control participants in two experiments. In the first experiment subjective biases in the recognition of facial emotional expressions were assessed. Participants were presented with faces that were morphed between sad and neutral and happy expressions and had to decide whether the face was sad or happy. The second experiment assessed automatic emotion processing by measuring the potency of emotional faces to gain access to awareness using interocular suppression. A follow-up investigation using the same tests was performed three months later. In the emotion recognition task, patients with major depression showed a shift in the criterion for the differentiation between sad and happy faces: In comparison to healthy controls, patients with MDD required a greater intensity of the happy expression to recognize a face as happy. After three months, this negative perceptual bias was reduced in comparison to the control group. The reduction in negative perceptual bias correlated with the reduction of depressive symptoms. In contrast to previous work, we found no evidence for preferential access to awareness of sad vs. happy faces. Taken together, our results indicate that MDD-related perceptual biases in emotion recognition reflect the current clinical state rather than a stable depressive trait

Ventricular tachycardia (VT) storm after cryoballoon-based pulmonary vein isolation

Objective: Unusual clinical course. Background: Following catheter ablation of atrial fibrillation, increased incidence of ventricular arrhythmia has been observed. We report a case of sustained ventricular arrhythmia in a patient who underwent cryoballoon-based pulmonary vein isolation for symptomatic persistent atrial fibrillation. Case Report: A 57-year-old patient with dilated cardiomyopathy underwent CB-based pulmonary vein isolation for symptomatic persistent AF. On the day following an uneventful procedure, the patient for the first time experienced a sustained ventricular tachycardia that exacerbated into VT storm. Each arrhythmia was terminated by the ICD that had been implanted for primary prevention. Antiarrhythmic treatment with amiodarone was initiated immediately. The patient remained free from sustained ventricular arrhythmia during follow-up. Conclusions: After pulmonary vein isolation, physicians should be vigilant for ventricular arrhythmia. The influence of atrial autonomic innervation on ventricular electrophysiology is largely unknown

Verzerrte Wahrnehmung von Gesichtausdrücken spiegelt bei Patienten mit unipolarer Depression den klinischen Zustand wider

A negatively biased perception in patients with major depressive disorder (mdd) is postulated by cognitive theories of depression. Several previous behavioural studies endorse this concept with empirical data. So far, it has remained an open question whether the perceptual bias represents a stable trait in patients with depressive disorder or a transient feature reflecting the current clinical state. A stable trait might enable identification of persons at risk, whereas a transient marker could indicate changes in the clinical state of the depression. The present study focused on the temporal stability of a negative perceptual bias in mdd. In two experiments the perception of emotional stimuli by patients with mdd and healthy control participants was examined. The first experiment investigated the recognition of emotional facial expression. Participants were presented ambiguous facial expressions, artificially morphed from faces expressing a happy, sad or neutral emotion. They were asked to indicate whether they perceived the face presented as sad or happy in a two-alternative forced-choice task. In the second experiment, automatic processing of emotional stimuli was examined. The capacity of emotional expressions to breakinterocular suppression was assessed. The participants performed the same tests three months later in a follow-up experiment. At both timepoints, depressive symptoms were measured using standardized psychopathological questionnaires. During the depressive episode, patients required higher intensities of happiness in order to identify a facial expression as happy. The bias towards a perception of ambiguous faces as sad in patients with mdd was not to be replicated at the follow-up exam when depressive symptoms were reduced. The decrease in negative perceptual bias correlates with a decrease in depressive symptoms. On the level of automatic processing, no preferential access to awareness for negative facial expressions was found, contrasting with previous studies. Our findings indicate that a negative perceptual bias is confined to the depressive episode and can thus be conceived of as a state marker in major depressive disorder.Kognitive Theorien der Depression gehen davon aus, dass es bei depressiven Erkrankungen zu einer negativen Verzerrung der Wahrnehmung kommt. Frühere Untersuchungen unterstützten dieses Verständnis durch empirische Daten, ohne jedoch die Frage klären zu können, ob dieser negative Einfluss auf die Wahrnehmung eine stabile Eigenschaft ist oder den derzeitigen depressiven Zustand widerspiegelt. Die vorliegende Untersuchung ist der zeitlichen Stabilität einer negativ verzerrten Wahrnehmung von Gesichtsausdrücken bei Patienten mit depressiven Erkrankungen gewidmet. In zwei Experimenten wurde die Wahrnehmung von Emotionen durch Patienten mit unipolarer Depression und gesunde Probanden untersucht. Im ersten Experiment wurde die veränderte Wahrnehmung emotionaler Gesichtsausdrücke bestimmt. Den Studienteilnehmern wurden Bilder von gemorphten Gesichtsausdrücken vorgeführt, die jeweils einen Ausduck zwischen traurig und neutral oder fröhlich und neutral darstellten. Daraufhin sollten sie entscheiden, ob das jeweils gezeigte Gesicht einen traurigen oder fröhlichen Ausdruck aufwies. Im zweiten Experiment wurde die automatische Emotionsverarbeitung mittels der Eigenschaft emotionaler Gesichtsausdrücke, unter interokularer Suppression in die Wahrnehmung der Probanden durchzudringen, untersucht. Eine Folgeuntersuchung mit denselben Tests wurde drei Monate nach der ersten Messung durchgeführt. In der Aufgabe zur Erkennung des gezeigten Gefühlausdrucks zeigte sich in der Patientengruppe eine Verschiebung der Differenzierung zwischen traurigen und fröhlichen Gesichtsausdrücken: Im Vergleich zu gesunden Probanden benötigten Patienten mit mit unipolarer Depression zum ersten Messzeitpunkt eine gesteigerte Intensität des fröhlichen Gesichtsausdrucks, um diesen als fröhlich wahrzunehmen. Nach drei Monaten war der negative Einfluss in der Emotionswahrnehmung im Vergleich mit der Kontrollgruppe vermindert. Der Rückgang des negativen Einflusses auf die Wahrnehmung korrelierte mit der Verringerung depressiver Symptome. Im Gegensatz zur publizierten Datenlage konnten keine Hinweise auf die bevorzugte Wahrnehmung trauriger gegenüber fröhlichen Gesichtern gefunden werden. Zusammengefasst deuten die Ergebnisse der vorliegenden Untersuchung darauf hin, dass depressionsbedingte Veränderungen in der Wahrnehmung emotionaler Gesichtsausdrücke den aktuellen klinischen Zustand des Patienten widerspiegeln und kein stabiler Ausdruck einer generellen depressiven Eigenschaft sind

Examples of the morph steps for two face exemplars.

<p>Numbers indicate proportion of happiness expressed by the face: 0 corresponds to 100% sad, 1 to 100% happy, and 0.5 to 100% neutral. The middle position (0.56) is a slightly happy expression of 12% (see text).</p

Correlation between change of depressive symptoms and change of perceptual bias in patients with MDD.

<p>For patients diagnosed with depression, the change in the degree of severity of depressive symptoms between the two time points of testing correlated positively with the change of the perceptual biases between the two sessions. The severity of depressive symptoms is indexed by BDI scores. The perceptual bias is indicated by the PSE of the individual logistic functions.</p

Perceptual bias is reduced in patients with MDD with diminished depressive symptoms.

<p>MDD = major depressive disorder; HC = healthy controls. Bar plots depicting mean PSEs <b>(A)</b> and slopes <b>(B)</b> of the logistic functions for the two groups and two time points. A significant interaction of time and group was observed for the PSE, indicating the inflection point of the logistic functions (p < 0.001). For the slopes of the logistic functions, indicating the abruptness of the categorical shift from sad to happy, no main effects or interactions were found. *: interaction of time and group, p < 0.001. Error bars denote within-subject standard errors of mean [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129863#pone.0129863.ref053" target="_blank">53</a>].</p

Demographic data.

<p><i>IQ = intelligence quotient</i>, <i>assessed with WST (Wortschatztest); EHI = Edinburgh Handedness Inventory; BDI = Beck‘s Depression Inventory; HAMD = Hamilton Rating Scale for Depression; SE = standard error of the mean</i></p><p>Demographic data.</p