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Clear indications of emotion depend on vivid stimuli
  1. J Zihl
  1. Max-Planck-Institute for Psychiatry, Munich, Germany

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    Implications for style of communication with depressed patients

    In this issue, recognition of emotion in depressed subjects is the focus of a paper by Kan et al (pp 1667–71).1 In contrast to others, these authors report that recognition of positive and negative visual and prosodic emotions is not impaired in depressed patients. Differences in methodological approaches most likely explain the discrepancy. Whereas earlier authors relied on presentation of static visual images, Kan and colleagues used moving facial stimuli, and it appears that the nature (clarity) of the latter stimulus helped depressed subjects to correctly assess facial emotions.

    Since the literature is abundant with reports on facial emotion recognition deficits in a variety of neurological conditions (e.g. stroke, temporal lobe epilepsy, Parkinson’s disease, Huntington’s disease), neuropsychiatric disorders (e.g. schizophrenia, frontotemporal dementia, dementia of the Alzheimer type, autism) and other disorders (e.g. adolescent mood and anxiety disorders, body dysmorphic disorder, social phobia), the results of the study by Kan et al has broad implications. It is, however, necessary to replicate their protocol and findings before drawing any firm conclusions on this issue. At the same time, it would also be important to seek possible differences in emotion recognition within the category “depression”. For example, impaired emotion recognition may not be a common finding in all depressed patients. Further, as has been shown for schizophrenic patients,2 the possibility that cognitive deficits may also contribute to difficulties in facial recognition should be considered, especially in depressives that have cognitive dysfunction.

    It is worthwhile noting that brain imaging studies on facial recognition in normal subjects also (mostly) depend on presentation of static faces. In studies where moving faces have been used, greater responses to dynamic versus static emotional expressions were found.3 Given that dynamic properties of an image increase attention to faces moving in the context of emotional expressions,4 it is not at all surprising that transmission of high quality facial emotion improves emotion recognition, thereby also enhancing face-to-face teleconferencing in virtual space.5 It is highly likely that similar principles hold true for all types of facial confrontation.

    The observations made by Kan and colleagues also have very practical implications. The main difficulty in discerning facial and, of course, prosodic emotion correctly may be as much due to the disposition of the “actor” (e.g. psychiatrist, neurologist, psychologist, family, friends) as to patients’ emotional perceptual difficulties. This interpretation takes on greater importance when one considers that facial and vocal expressions represent the main source of information in social perception and thus, social interaction. In this context, the work by Kan et al has far reaching implications for style of communication with depressed patients, as well as for the diagnostics and therapeutics of patients with neurological or psychiatric disorders.

    Implications for style of communication with depressed patients

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