Training of affect recognition in schizophrenia patients with violent offences: Behavioral treatment effects and electrophysiological correlates.

Violent offenders with schizophrenia have a particularly poor performance level in facial affect recognition. Nineteen male schizophrenia patients, who had been committed to psychiatric hospital detention because of violent offences and lack of criminal responsibility, were recruited to receive the Training of Affect Recognition (TAR). Performance in the Pictures of Facial Affect (PFA)-test and event-related potentials (ERPs) were registered in a pre-post-treatment design. TAR was feasible with a very high treatment effect (Cohen's d = 1.88), which persisted for 2 months post-treatment. ERPs remained unchanged post- vs. pre-treatment, while low resolution brain electromagnetic tomography (LORETA) revealed activation decreases in left-hemispheric parietal-temporal-occipital regions at 172 msec and activation increases in right dorsolateral prefrontal cortex and anterior cingulate at 250 msec. Possibly, violent offenders with schizophrenia are particularly amenable to TAR because of a high level of dysfunction at baseline. Post- vs. pre-treatment changes of neural activity (LORETA) may mirror a gain of efficiency in structural face decoding and a shift towards a more reflective mode of emotional face decoding, relying on increased frontal brain activity. Functional magnetic resonance imaging (BOLD-fMRI) -data from another study further supports this notion. TAR treatment might enable subjects with schizophrenia and a disposition to violence to reach a higher degree of deliberation of their reactive behavior to facial affect stimuli.
PMID: 23879268