[01] Svetlozar Haralanov, E-Motion Center, Institute for Cognitive-Affective Neuroscience, Sofia, Bulgaria; Department of Psychiatry, Medical University, Sofia, Bulgaria; University Hospital of Neurology and Psychiatry “St. Naum”, Luben Russev Sofia, Bulgaria. [02] Evelina Haralanova, E-Motion Center, Institute for Cognitive-Affective Neuroscience, Sofia, Bulgaria; Department of Psychiatry, Medical University, Sofia, Bulgaria; University Hospital of Neurology and Psychiatry “St. Naum”, Luben Russev Sofia, Bulgaria; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstraße Munich, Germany; Neuro-Cognitive Psychology, Department of Psychology, Ludwig-Maximilians-University, Leopoldstr. Munich, Germany. [03] Petya Terziivanova, Department of Psychiatry, Medical University, Sofia, Bulgaria; University Hospital of Neurology and Psychiatry “St. Naum”, Luben Russev Sofia, Bulgaria. [04] Hans-Juergen Moeller, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstraße Munich, Germany. [05] Kristina Hennig-Fast, Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Nussbaumstraße Munich, Germany; Neuro-Cognitive Psychology, Department of Psychology, Ludwig-Maximilians-University, Leopoldstr. Munich, Germany; Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse, Vienna, Austria.

We have recently found that patients with paranoid schizophrenia experience abnormally elevated subjective emotional arousal (SEA) in response to low-arousing/neutral but not to high-arousing/aversive social scenes. The aim of the present study was to test an explanation of this finding by exploring the relative contributions of psychosis and antipsychotic pharmacotherapy. We compared the SEA to the same two types of stimuli in 15 actively psychotic and 15 therapeutically improved post-psychotic inpatients with paranoid schizophrenia contrasted to 30 healthy controls. The results revealed that the SEA to the neutral stimuli was significantly higher in the psychotic than in the post-psychotic subgroup, being abnormally high in both of them relative to controls. Conversely, their SEA to the aversive stimuli was as high as that of the controls. Additionally, we demonstrated that during psychosis the patients experience low-arousing/neutral scenes as if they are high-arousing, thus misattributing emotional salience to them. During the post-psychotic phase this deficient differentiation between salient and nonsalient stimuli is partially restored. We discussed how these findings and their explanations could bridge the gap between objective neurobiological and subjective psychological mechanisms of psychotic-symptom formation and antipsychotic-treatment response, respectively. We argued that an elevated endogenous SEA underlies subjective symptoms of psychosis and accordingly is a key target for antipsychotic pharmacotherapy. We further proposed a practical application of our simple SEA-rating-task as a promising neurobehavioral probe for fMRI studies of these mechanisms as well as a potential surrogate endpoint measure of antipsychotic-treatment response, including in clinical trials of novel antipsychotic drugs.

Antipsychotic Pharmacotherapy, Paranoid Schizophrenia Psychosis, Emotional Arousal, Emotional Experience, Emotional Salience Misattribution, Social Cognition

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