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June 2016

A Pathway to Understanding Emotional Dysfunction in Schizophrenia

Author Affiliations
  • 1Department of Psychiatry, Massachusetts General Hospital, Boston
  • 2Harvard Medical School, Boston, Massachusetts
  • 3The Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts
JAMA Psychiatry. 2016;73(6):555-556. doi:10.1001/jamapsychiatry.2016.0172

Abnormalities in emotional function are thought to play a central role in many of the core symptoms of schizophrenia. However, it has been unexpectedly difficult to pinpoint the changes in emotional processing that occur in the illness. Despite this, it has become increasingly important to make progress on this question. This is because, on the one hand, the well-characterized cognitive deficits associated with schizophrenia are not strongly linked to any of the major symptoms of the illness, and these deficits account for only a modest portion of the variance in the functional disability associated with schizophrenia. On the other hand, there is evidence that disruptions of emotional function underlie negative symptoms, particularly deficits in motivation, and psychotic symptoms, such as persecutory delusions. In fact, associations between the levels of psychotic symptoms and negative affect (eg, depression and anxiety) in prodromal, first-episode, and chronic patients and the high rates of comorbid depression in patients with schizophrenia1 suggest that psychosis and depression share some common underlying neurobiological mechanisms, further challenging the validity of the traditional Kraeplinean dichotomy between disorders of thought and affect.

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