Facial affect recognition in psychosis
Bordon, Natalie Sarah
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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.