Visual Searching Pattern of Patients with Schizophrenia in the Idea-of-Reference-Provoking Situation

Seungjin Choi; Jooyoung Oh; Il-Ho Park; Jae-Jin Kim

doi:10.4306/jknpa.2014.53.4.195

Journal List > J Korean Neuropsychiatr Assoc > v.53(4) > 1017681

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Choi, Oh, Park, and Kim: Visual Searching Pattern of Patients with Schizophrenia in the Idea-of-Reference-Provoking Situation

Original Article

Journal of Korean Neuropsychiatric Association 2014; 53(4): 195-205.

Published online: 29 July 2014

DOI: https://doi.org/10.4306/jknpa.2014.53.4.195

Visual Searching Pattern of Patients with Schizophrenia in the Idea-of-Reference-Provoking Situation

Seungjin Choi, MD¹, Jooyoung Oh, MD¹, Il-Ho Park, MD, PhD², Jae-Jin Kim, MD, PhD^1,³

¹Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea.

²Department of Psychiatry & Behavioral Sciences, International St. Mary's Hospital, Incheon, Korea.

³Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.

Address for correspondence: Jae-Jin Kim, MD, PhD. Department of Psychiatry, Yonsei University Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea. Tel +82-2-2019-3341, Fax +82-2-3462-4304, jaejkim@yonsei.ac.kr

Received 10 October 2013 Revised 20 February 2014 Accepted 19 May 2014

Abstract

Objectives

Patients with schizophrenia often present the idea of reference in social situations ; however, the number of research studies examining the nature of the idea of reference and the visual searching pattern in social situations is limited. The aim of this study was to investigate behavioral and visual searching characteristics of patients with schizophrenia in social situations in which the idea of reference can be provoked.

Methods

Eighteen subjects with schizophrenia (eight males) and 18 healthy volunteers (seven males) performed the idea-of-reference-provoking task, which was composed of movie clips with scenes of two women sitting on a bench 1 m away. The participants' reactions were rated using questionnaires for self-reference, malevolent intentions, and anxiety. Visual scan path was monitored during performance of the task.

Results

There were significant group differences in the reactions on self-reference, malevolent intentions, and anxiety. The visual searching pattern in patients with schizophrenia was to avoid looking at the women's body area in every movie clip. However, there was no significant difference in the face area in both groups.

Conclusion

A distinct visual strategy in schizophrenia may affect the self-referential bias and paranoid response. The absence of difference in attention to a core information region (face) may suggest the possibility of inferential errors as well as the cause of self-referential bias and paranoid responses.

Keywords: Schizophrenia, Idea of reference, Eye tracking

Figures and Tables

Fig. 1

A : A schematic description of the conditions of the idea of reference evoking task. B : Representative scan-path of participants, cen-ter of a circle : fixation point, circle's radius : relates to fixation duration, connecting line between circles : sac-cade movement. C : The areas of in-terest for analysis.

Fig. 2

Scatter plot of the glance count in each context.

Fig. 3

Scatter plot of the fixation count in each context.

Table 1

Demographic and clinical characteristics of participants

Values are mean±SD or n (%). ^*: Chi-square for categorical variable and independent t-test for continuous variable. PA : Paranoia Scale, PANSS : Positive and Negative Syndrome Scale, SD : Standard deviation

Table 2

Self-referential perception, malevolent interpretation and anxiety reaction scores

Values are median (minimum and maximum ranges). Self-referential perception : self-referential perception score, Malevolent interpretation : malevolent interpretation score, and Anxiety reaction : anxiety reaction score. ^*: By Mann-Whitney U test

Table 3

General eye gaze data

Values are median (minimum and maximum ranges). ^*: By Mann-Whitney U test

Table 4

Glance count, fixation count and time in the body and face areas

Values are median (minimum and maximum ranges). ^*: By Mann-Whitney U test

Table 5

Context effect on glance count, fixation count and time in the area of interest

Values are median (minimum and maximum ranges). ^*: For Friedman test, ^†: Results with a significance level of p<0.05 in post hoc paired t-test & Bonferroni-correction. R : Referential, NR : Non-referential, NC : No conversation

Notes

The authors have no financial conflicts of interest.

References

1. Freeman D. Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev. 2007; 27:425–457.

2. Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell'Olio M, et al. Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States. Aust N Z J Psychiatry. 2005; 39:964–971.

3. Birchwood M, Smith J, Macmillan F, Hogg B, Prasad R, Harvey C, et al. Predicting relapse in schizophrenia: the development and implementation of an early signs monitoring system using patients and families as observers, a preliminary investigation. Psychol Med. 1989; 19:649–656.

4. Carpenter WT Jr, Strauss JS, Bartko JJ. Flexible system for the diagnosis of schizophrenia: report from the WHO International Pilot Study of Schizophrenia. Science. 1973; 182:1275–1278.

5. Couture SM, Penn DL, Roberts DL. The functional significance of social cognition in schizophrenia: a review. Schizophr Bull. 2006; 32:Suppl 1. S44–S63.

6. Addington J, Saeedi H, Addington D. Influence of social perception and social knowledge on cognitive and social functioning in early psychosis. Br J Psychiatry. 2006; 189:373–378.

7. Bora E, Eryavuz A, Kayahan B, Sungu G, Veznedaroglu B. Social functioning, theory of mind and neurocognition in outpatients with schizophrenia; mental state decoding may be a better predictor of social functioning than mental state reasoning. Psychiatry Res. 2006; 145:95–103.

8. Kucharska-Pietura K, David AS, Masiak M, Phillips ML. Perception of facial and vocal affect by people with schizophrenia in early and late stages of illness. Br J Psychiatry. 2005; 187:523–528.

9. Hooker C, Park S. You must be looking at me: the nature of gaze perception in schizophrenia patients. Cogn Neuropsychiatry. 2005; 10:327–345.

10. Harrington L, Siegert RJ, McClure J. Theory of mind in schizophrenia: a critical review. Cogn Neuropsychiatry. 2005; 10:249–286.

11. Greig TC, Bryson GJ, Bell MD. Theory of mind performance in schizophrenia: diagnostic, symptom, and neuropsychological correlates. J Nerv Ment Dis. 2004; 192:12–18.

12. Startup M, Bucci S, Langdon R. Delusions of reference: a new theoretical model. Cogn Neuropsychiatry. 2009; 14:110–126.

13. Green MJ, Williams LM, Davidson D. Visual scanpaths to threat-related faces in deluded schizophrenia. Psychiatry Res. 2003; 119:271–285.

14. Hemsley DR, Garety PA. The formation of maintenance of delusions: a Bayesian analysis. Br J Psychiatry. 1986; 149:51–56.

15. Speechley WJ, Ngan ET. Dual-stream modulation failure: a novel hypothesis for the formation and maintenance of delusions in schizophrenia. Med Hypotheses. 2008; 70:1210–1214.

16. Delerue C, Boucart M. The relationship between visual object exploration and action processing in schizophrenia. Cogn Neuropsychiatry. 2012; 17:334–350.

17. Delerue C, Laprévote V, Verfaillie K, Boucart M. Gaze control during face exploration in schizophrenia. Neurosci Lett. 2010; 482:245–249.

18. Park IH, Ku J, Lee H, Kim SY, Kim SI, Yoon KJ, et al. Disrupted theory of mind network processing in response to idea of reference evocation in schizophrenia. Acta Psychiatr Scand. 2011; 123:43–54.

19. Gumley AI, Gillan K, Morrison AP, Schwannauer M. The development and validation of the Beliefs about Paranoia Scale (Short Form). Behav Cogn Psychother. 2011; 39:35–53.

20. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13:261–276.

21. Holmqvist K. Eye tracking: a comprehensive guide to methods and measures. Oxford: Oxford University Press;2011.

22. Pinkham AE, Brensinger C, Kohler C, Gur RE, Gur RC. Actively paranoid patients with schizophrenia over attribute anger to neutral faces. Schizophr Res. 2011; 125:174–178.

23. Choi S, Park IH, Lee SK, Kim JJ. Characteristics of social perception and their changes after treatment in patients with schizophrenia using the idea of reference provoking task. Korean J Schizophr Res. 2013; 16:69–79.

24. Bestelmeyer PE, Tatler BW, Phillips LH, Fraser G, Benson PJ, St Clair D. Global visual scanning abnormalities in schizophrenia and bipolar disorder. Schizophr Res. 2006; 87:212–222.

25. Gordon E, Coyle S, Anderson J, Healey P, Cordaro J, Latimer C, et al. Eye movement response to a facial stimulus in schizophrenia. Biol Psychiatry. 1992; 31:626–629.

26. Manor BR, Gordon E, Williams LM, Rennie CJ, Bahramali H, Latimer CR, et al. Eye movements reflect impaired face processing in patients with schizophrenia. Biol Psychiatry. 1999; 46:963–969.

27. Williams LM, Loughland CM, Gordon E, Davidson D. Visual scanpaths in schizophrenia: is there a deficit in face recognition? Schizophr Res. 1999; 40:189–199.

28. Rothkopf CA, Ballard DH, Hayhoe MM. Task and context determine where you look. J Vis. 2007; 7:16.1–20.

29. Delerue C, Boucart M. Visual exploration and action processing in schizophrenia. Cogn Neuropsychiatry. 2013; 18:153–167.

30. Hooker C, Park S. Emotion processing and its relationship to social functioning in schizophrenia patients. Psychiatry Res. 2002; 112:41–50.

31. Hoffman EA, Haxby JV. Distinct representations of eye gaze and identity in the distributed human neural system for face perception. Nat Neurosci. 2000; 3:80–84.

32. Gallagher HL, Frith CD. Functional imaging of 'theory of mind'. Trends Cogn Sci. 2003; 7:77–83.

33. Hooker CI, Bruce L, Lincoln SH, Fisher M, Vinogradov S. Theory of mind skills are related to gray matter volume in the ventromedial prefrontal cortex in schizophrenia. Biol Psychiatry. 2011; 70:1169–1178.

34. Clark US, Neargarder S, Cronin-Golomb A. Visual exploration of emotional facial expressions in Parkinson's disease. Neuropsychologia. 2010; 48:1901–1913.

35. Kojima T, Matsushima E, Nakajima K, Shiraishi H, Ando K, Ando H, et al. Eye movements in acute, chronic, and remitted schizophrenics. Biol Psychiatry. 1990; 27:975–989.

TOOLS

Similar articles