Failure to translate emotion into motivated behaviour is believed to contribute to the formation of negative symptoms in schizophrenia. Schizophrenia patients have also been found to have reduced experiential pleasure, affecting both the anticipatory and consummatory components. Emotion expression has been found to be reduced in schizophrenia patients. These neuropsychological and emotion deficits, known as emotion-behaviour decoupling, may therefore be closely related to negative symptoms, which are major obstacles to treatments. Dr. Raymond Chan and his team from the Neuropsychology and Applied Cognitive Neuroscience (NACN) Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology have shown that patients with schizophrenia, major depressive disorder and bipolar disorder exhibited exhibit a lowered capacity to experience pleasure as well as a lack of motivation, the pattern of emotion-behaviour dissociation is different across schizophrenia, bipolar disorder and major depressive disorder. Although evidence gathered in Dr. Chan’s previous cross-sectional research generally supported this notion, very limited studies have adopted a longitudinal approach to investigate the predictive ability of emotion-behaviour decoupling, experiential pleasure and expression, for moderate-to-long term clinical and functional outcome in schizophrenia patients,

To address this important knowledge gap, Dr. Raymond and his team collaborated with Dr. Simon Lui of the University of Hong Kong, and clinicians in Hong Kong Castle Peak Hospital, to investigate this important area. They recruited 127 first-episode schizophrenia patients with baseline measures of emotion-behaviour coupling, experiential pleasure and expression and re-assessed 85 patients more than 2 years afterwards. A second-generation negative symptom scale, the Clinical Assessment Interview for Negative Symptoms (CAINS) and a clinician-rated social functioning scale were used as end-point outcome. They categorized the baseline cohort empirically into groups with different degree of emotion-behaviour coupling, experiential pleasure and expression using cluster analysis. Their results suggested that the cluster with more severe emotion-behaviour decoupling and experiential pleasure deficits showed the worst end-point social functioning and more severe end-point negative symptoms. Emotion expression deficits appeared to play little role in differentiating subjects into different clinical and functional outcome.

Taken together, this work provides important empirical evidence for potential use of neurocognitive markers and emotion processing deficits in identifying schizophrenia patients with poor moderate-to-long term outcome. This work also provides evidence for longitudinal association between emotion-behaviour decoupling and negative symptoms of schizophrenia. Dr. Chan and Dr. Lui have embarked on another project to further investigate the 10-year clinical and functional outcome of this cohort.

Drs. Raymond Chan and Simon Lui are the co-corresponding authors of this study. This study is supported by the General Research Fund of Research Grant Council granted to Simon Lui. Raymond Chan was supported by the Scientific Foundation of Institute of Psychology, Chinese Academy of Sciences and the Phillip K.H. Wong Foundation.

The paper is now available online from Asian Journal of Psychiatry
-        Lui SSY*, Wang LL, Lau WYS, Shing E, Yeung HKH, Tsang KCM, Zhan EN, Cheung ESL, Ho KKY, Hung KSY, Cheung EFC, Chan RCK* (2023). Emotion-behaviour decoupling and experiential pleasure deficits predict negative symptoms and functional outcome in first-episode schizophrenia patients. Asian Journal of Psychiatry. 81：103467.

Related papers:
-        Lui, S.S. Y., Liu, A. C. Y., Chui, W. W. H., Li, Z., Geng, F., Wang, Y., Heerey, E. A., Cheung, E. F. C., Chan, R. C.. K. * (2016). The nature of anhedonia and avolition in patients with first-episode schizophrenia. Psychological Medicine 46(2), 437-447.
-        Lui, S. S. Y., Shi, Y. F., Au, A. C. W., Tsui, C. F., Chan, C. K. Y., Leung, M M. W., Wong, P. T. Y., Wang, Y., Yan, C., Chan, R. C. K.* (2016). Affective experience and motivated behavior in schizophrenia spectrum disorders: Evidence from clinical and non-clinical samples. Neuropsychology. 30(6), 673-684.
-        Xie, D. J.,#, Lui, S. S. Y.#, Geng, F. L., Yang, Z. Y., Zou, Y. M., Li, Y., Yeung, H. K. H., Cheung, E. F. C., Heerey, E. A., Chan, R. C. K.* (2018). Dissociation between affective experience and motivated behaviour in schizophrenia patients and their unaffected first-degree relatives and schizotypal individuals. Psychological Medicine, 48(9), 1474-1483.
-        Wang, Y. Y., Ge, M. H., Zhu, G. H., Jiang, N. Z., Wang, G. Z., Lv, S. X., Zhang, Q., Guo, J. N., Tian, X., Lui, S. S. Y., Cheung, E. F. C., Heerey, E. A., Sun, H. W.*, Chan, R. C. K. * (2020). Emotion-behaviour decoupling in individuals with schizophrenia, bipolar disorder and major depressive disorder. Journal of Abnormal Psychology, 129(4), 331–342.

LIU Chen
Institute of Psychology
Chinese Academy of Sciences
Beijing 100101, China.
E-mail: liuc@psych.ac.cn