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PubMed2006

Impaired emotion processing in remitted patients with bipolar disorder.

In the present study, we examined whether there is an impairment in affect matching abilities in remitted patients with bipolar disorder and if this could be attributed to problems with facial perception per se and/or the ability to perceive the relative valence of facial expressions indicating emotions. We examined 19 patients with bipolar disorder I, currently remitted, and 30 healthy controls (15 men), matched on age, education, and gender, using two computerized tests: matching facial identity [Kinney's Identity Matching Test (KIMT)] and matching facial emotional expressions [Kinney's Affect Matching Test (KAMT)]. Patients with bipolar disorder performed significantly worse than the healthy group on the KAMT, but not on the KIMT. Performance on the KAMT and KIMT did not correlate with age of onset and duration of illness, or with manic or depressive residual symptoms. The present findings support the differential deficit hypothesis regarding impaired affect perception in bipolar disorder during remission. Patients' deficits were restricted to the matching of facial emotional expressions despite their intact perception of facial identity.

Adult↗

PubMed1998

Botulinum toxin type A for facial rejuvenation. United States and United Kingdom perspectives.

BACKGROUND: Botulinum A toxin has been well documented as a successful treatment for hyperfunctional upper facial expression lines. Currently, there are two commercial sources for botulinum toxin--Botox and Dysport. Only Botox is currently available in the United States; however, both Botox and Dysport are available in a number of European and other countries. OBJECTIVES: There are several differences between these two sources of botulinum toxin, including different potency of their dosage units. This article will review the uses of these two sources of botulinum toxin and discuss the dilution and dosing of botulinum toxin for facial expression lines. RESULTS: One unit of Botox is approximately equivalent in potency to 4 U of Dysport. CONCLUSIONS: Both commercial types of botulinum toxin can be used interchangeably with appropriate dosage selection.

Botulinum Toxins, Type A↗

PubMed2006

Assessment of persistent pain or distress and adequacy of analgesia in preterm ventilated infants.

Indicators of persistent pain in preterm neonates are poorly defined. In the setting of a double blind, placebo-controlled trial investigating morphine use in ventilated preterm infants (NEOPAIN Trial) we aimed to identify factors that may be useful in assessing persistent pain. Twenty-two babies (morphine 12; placebo 10) were assessed for comfort, pain or distress and clinical staff described the factors they had considered. This assessment was performed during the first period of duty with the baby. Based on this, they stated which study drug they believed the infant was receiving. Eighty-nine assessments were made in total (1-14 per baby). The drug was correctly identified on 71% of occasions. Staff considered one or more of the following factors: infant activity; response to routine care; known pain-related behaviours; posture/quality of movements; respiratory effort; synchrony with ventilator; blood pressure and heart rate. Four factors most frequently identified babies receiving placebo: facial expressions of pain, high activity levels, poor response to handling and poor synchrony with ventilation. Absence of pain-related behaviour was less discriminating. Observation of a good response to handling, good synchrony with ventilation, a "settled" baby, normal blood pressure and heart rate were poor discriminators. Hypotension and poor respiratory drive were noted exclusively in babies receiving morphine infusions. Facial expressions of pain, high activity levels, poor response to routine care, and poor ventilator synchrony were associated with placebo versus morphine therapy, and may be considered useful markers for persistent pain in preterm infants.

Age Factors↗

PubMed1997

A new technique for hypoglossal-facial nerve repair.

Hypoglossal reinnervation of the facial nerve may be required after a proximal facial nerve injury. The classic hypoglossal-facial graft procedure involves transection of the donor hypoglossal nerve, resulting in hemiglottic paralysis that, in association with paralysis of other cranial nerves, may cause speech and swallowing difficulties. Multiple lower cranial nerve palsies in conjunction with facial paralysis, as may occur after procedures such as skull base surgery, contraindicate the use of such techniques. The successful use of XII-VII "interposition jump grafts" without hemiglossal weakness has been described However, a prolonged recovery period and weaker facial reanimation have been seen. In order to attain maximum facial reinnervation while preserving hypoglossal function, we have developed a new technique of XII-VII repair. This method involves mobilization of the intratemporal portion of the facial nerve remnant, achieving a single anastomosis with the hypoglossal nerve, which has been partially incised. This technique has been used in three patients to date, with 6 to 11 months follow-up. In all cases facial tone and symmetry have been restored and voluntary facial expression accomplished. The authors conclude that by employing the techniques described highly satisfactory cosmetic and functional results may be expected, without compromising hypoglossal nerve function.

Aged↗

PubMed2004

Positive emotional priming of facial affect perception in females is diminished by chemosensory anxiety signals.

Chemosensory communication of anxiety is a common phenomenon in vertebrates and improves perceptual and responsive behaviour in the perceiver in order to optimize ontogenetic survival. A few rating studies reported a similar phenomenon in humans. Here, we investigated whether subliminal face perception changes in the context of chemosensory anxiety signals. Axillary sweat samples were taken from 12 males while they were waiting for an academic examination and while exercising ergometric training some days later. 16 subjects (eight females) participated in an emotional priming study, using happy, fearful and sad facial expressions as primes (11.7 ms) and neutral faces as targets (47 ms). The pooled chemosensory samples were presented before and during picture presentation (920 ms). In the context of chemosensory stimuli derived from sweat samples taken during the sport condition, subjects judged the targets significantly more positive when they were primed by a happy face than when they were primed by the negative facial expressions (P = 0.02). In the context of the chemosensory anxiety signals, the priming effect of the happy faces was diminished in females (P = 0.02), but not in males. It is discussed whether, in socially relevant ambiguous perceptual conditions, chemosensory signals have a processing advantage and dominate visual signals or whether fear signals in general have a stronger behavioural impact than positive signals.

Adult↗

PubMed1995

Case report: successful treatment of a case of extreme isolation.

Tom, aged 10, presented as a stiff, plump boy with a very awkward gait and a completely blank facial expression. He was terrified of other children and could allow no one closer than an arm's length away from him. It transpired that for most of his life he had been kept "safe" in his bare room by his parents whose firstborn child had died. After 8 years of treatment he is now studying at a university and although he lives at home he seems to have made some friends. His facial expressions and tone of voice are now appropriate.

Adolescent↗

PubMed2006

Occupational exposures and movement abnormalities among Japanese-American men: the Honolulu-Asia Aging Study.

OBJECTIVE: The authors analyzed data on 1,049 men aged 71-93 years (excluding those with prevalent Parkinson's disease and stroke) from the Honolulu Heart Program (1965-1968) and the Honolulu-Asia Aging Study (1991-1999) to determine whether occupational exposures to pesticides, solvents, metals, manganese, and mercury during middle age were associated with 14 movement abnormalities 25 years later. METHODS: Analyses of variance and multivariate logistic regression were used to assess associations of interest. RESULTS: After adjustment for age, BMI, cognitive functioning, smoking, alcohol drinking, education, and physical activity, there was a positive association between abnormal 'facial expression' and the highest exposure to metals [odds ratio (OR) = 2.62; 95% confidence interval (CI) = 1.35-5.11; trend, p = 0.02], and the highest exposure to mercury (OR = 1.91; 95% CI = 1.04-3.49; trend, p = 0.03). Age was positively associated with all movement abnormalities, and cognitive function, body mass index and physical activity were inversely associated with most movement abnormalities. CONCLUSION: Higher exposure to any metal, and specifically mercury, was associated with abnormal facial expression.

Aged↗

PubMed1997

Disgust implicated in obsessive-compulsive disorder.

Psychiatric classificatory systems consider obsessions and compulsions as forms of anxiety disorder. However, the neurology of diseases associated with obsessive-compulsive symptoms suggests the involvement of fronto-striatal regions likely to be involved in the mediation of the emotion of disgust, suggesting that dysfunctions of disgust should be considered alongside anxiety in the pathogenesis of obsessive-compulsive behaviours. We therefore tested recognition of facial expressions of basic emotions (including disgust) by groups of participants with obsessive-compulsive disorder (OCD) and with Gilles de la Tourette's syndrome (GTS) with an without co-present obsessive-compulsive behaviours (GTS with OCB; GTS without OCB). A group of people suffering from panic disorder and generalized anxiety were also included in the study. Both groups with obsessive-compulsive symptoms (OCD; GTS with OCB) showed impaired recognition of facial expressions of disgust. Such problems were not evident in participants with panic disorder and generalized anxiety, or for participants with GTS without obsessions or compulsions, indicating that the deficit is closely related to the presence of obsessive-compulsive symptoms. Participants with OCD were able to assign words to emotion categories without difficulty, showing that their problem with disgust is linked to a failure to recognize this emotion in others and not a comprehension or response criterion effect. Impaired recognition of disgust is consistent with the neurology of OCD and with the idea that abnormal experience of disgust may be involved in the genesis of obsessions and compulsions.

Adult↗

PubMed1992

Dissociating spontaneous and deliberate expressions of pain: signal detection analyses.

Neuro-anatomical and behavioral findings suggest that spontaneous and deliberate facial expressions are regulated by separate systems. The present study examined whether spontaneous and deliberate expressions of pain could be distinguished and, if so, the dimensions on which they differ. Forty subjects were exposed to electric shocks that varied from painless to strong pain. They also simulated facial reactions to the same levels. Observers rated the apparent pain in subjects' expressions and whether they were feigned or genuine. Signal detection analyses indicated that the intensity of deliberate expressions was greater than spontaneous expressions at levels below strong pain. Observers were able to distinguish between deliberate and spontaneous expressions to a modest degree. The intensity of deliberate expressions was related to role-playing ability. The results suggest that deliberate and spontaneous expressions of pain probably differ in intensity, topography and temporal features. They suggest that facial expressions of pain have different determinants than other forms of pain behavior.

Adult↗

PubMed2000

Arrangement of the orbicularis oris muscle in different types of cleft lips.

A thorough knowledge of the anatomy of the labial region, especially the arrangement of the muscle fibers, is essential for the success of primary repair of the cleft lip. Pared lateral and medial edges from 20 unilateral incomplete cleft lips and 25 unilateral complete cleft lips were obtained during primary surgery. Three specimens of normal lips were taken from unclaimed infant cadavers as the controls. They were prepared for routine histological studies and were examined to study the direction of muscle fibers. Intrinsic and extrinsic bundles were identified in both lateral and medial sides of specimens of both cleft types. The intrinsic bundle was not displaced but was interrupted by the cleft. The extrinsic bundle in the lateral side of both cleft types ran upward along the lateral cleft margin, whereas in the medial side it ran horizontally to terminate close to the medial cleft margin. The extrinsic bundle is the retractor, which is associated with facial expression, whereas the intrinsic bundle is the constrictor of the mouth. Because there are two functional components in the orbicularis oris muscle, identifying and repairing them separately will enable each of them to accomplish their distinctive functions.

Cadaver↗

PubMed1998

Function of the nasal muscles in normal subjects assessed by dynamic MRI and EMG: its relevance to rhinoplasty surgery.

The external nose is generally considered to have a relatively static shape. Movement of the nose and the potential for change of external shape and the internal airway have been assessed by (1) cadaver dissection and (2) dynamic studies during a standardized series of facial expressions in 13 subjects; video recording of the movement of skin markers, electromyography, and moving magnetic resonance images. A standard description of muscle anatomy is presented. The dynamic investigations indicated the following. Video analysis showed the components of muscle action: dilatation, constriction of the nostril, depression of the tip, vertical contraction in the bridge, and elevation of the alar, in different expressions. Electromyography confirmed muscle actions during expression and phonation. Magnetic resonance imaging demonstrated large changes in the external shape of the nose and nasal aperture due to muscle actions. Muscle function should be given greater consideration in aesthetic and cleft rhinoplasty.

Electromyography↗

PubMed2006

A modified longitudinally split segmental rectus femoris muscle flap transfer for facial reanimation: anatomic basis and clinical applications.

The present study was conducted to investigate the intra-muscular neurovascular anatomy and the intra-muscular tendon distribution of the rectus femoris muscle to reassess the reliability of technique of harvesting a longitudinally split segmental muscle flap, and to present our clinical experience on usefulness of the longitudinally split segmental rectus femoris muscle flap as a method for reconstruction of the paralysed face in a series of 25 patients. Twenty fresh cadavers were systemically injected with lead oxide, gelatin and water. Based on the anatomy of intra-muscular neurovascular structure in the rectus femoris muscle, 25 consecutive patients with established facial paralysis were treated by using a two-stage method combining neurovascular free-muscle transfer with cross-face nerve grafting. Follow-ups were 15-24 months. All of the 25 patients showed significantly improvement in the appearance of the oral commissure and oral competence. Satisfactory results of facial reanimation were obtained in 23 patients. Among these cases, near-natural facial expression was achieved. Recovery continued up to 2 years postoperatively. There were two cases having poor movement of transferred muscle 2 years postoperatively. No complications occurred in the donor site. In conclusion, the present study has demonstrated the suitability for subdivision of the segment muscle flap of the rectus femoris into two functional units with a common neurovascular pedicle. This series has further demonstrated the safety and reliability of using the rectus femoris muscle flap for facial reanimation.

Adolescent↗

PubMed2003

Neocortical modulation of the amygdala response to fearful stimuli.

BACKGROUND: The cortical circuitry involved in conscious cognitive processes and the subcortical circuitry involved in fear responses have been extensively studied with neuroimaging, but their interactions remain largely unexplored. A recent functional magnetic resonance imaging (fMRI) study demonstrated that the engagement of the right prefrontal cortex during the cognitive evaluation of angry and fearful facial expressions is associated with an attenuation of the response of the amygdala to these same stimuli, providing evidence for a functional neural network for emotional regulation. METHODS: In the current study, we have explored the generalizability of this functional network by using threatening and fearful non-face stimuli derived from the International Affective Picture System (IAPS), as well as the influence of this network on peripheral autonomic responses. RESULTS: Similar to the earlier findings with facial expressions, blood oxygen level dependent fMRI revealed that whereas perceptual processing of IAPS stimuli was associated with a bilateral amygdala response, cognitive evaluation of these same stimuli was associated with attenuation of this amygdala response and a correlated increase in response of the right prefrontal cortex and the anterior cingulate cortex. Moreover, this pattern was reflected in changes in skin conductance. CONCLUSIONS: The current results further implicate the importance of neocortical regions, including the prefrontal and anterior cingulate cortices, in regulating emotional responses mediated by the amygdala through conscious evaluation and appraisal.

Adult↗

PubMedDate not supplied

The origin of intermittent exhalation (A! Ha! Ha!) peculiar to human laugh.

Since Darwin (1872), the origin of the laugh with an intermittent exhalation "A! Ha! Ha!" which is peculiar to human, has been a great question. The author found out that this laugh is caused by the three sets of emotion. Firstly, light surprise or discovery. The ability to estimate "light" is absolutely important, because the amount of the first exhalation "A!" caused by the stimulation is decided by the amount of "surprise" felt by the subject. The ability to estimate the amount of "surprise" to be "light", makes the partial exhalation "A!". Secondly, consciousness of this harmlessness or delight, and thirdly, the following expectation of some safe circumstances. The author proved this theory by electromyography (EMG), photoplethysmography and galvanic skin reaction (GSR). The similarity between the facial EMG distribution pattern of "the beginning of laugh" and "the light surprise" was proved by electromyography about many facial muscles, with special fine electrode which did not disturb any natural facial expression of the subjects. Plethysmography and GSR proved light sympathetic tension and following relaxation when laughing. The author also suggests relationships between human laugh and human history such as the origin of clothing, language, and use of fire, which are specific in human.

Animals↗

PubMed1990

Social-cognitive correlates of children's understanding of displaced aggression.

The purpose of this research was (1) to provide a detailed description of developmental differences in the understanding of displaced aggression during the grade school years and (2) to identify social-cognitive correlates of this development. Seventy-two children aged 5, 7, and 9 viewed, and answered questions about, four videotaped stories involving displaced aggression. In another session they were given three tests of social cognition. One was a person perception task which tapped the tendency to refer to physical or psychological attributes. A second was a recursive thinking task which assessed their awareness that people can think about each other. Third, Selman's puppy story was used to assess their awareness that words or facial expressions do not always reflect the way a person feels, and that a person may not always know what he or someone else really feels. The understanding of displaced aggression increased significantly with increasing age. This understanding was significantly related to the person perception task for 5-year-olds, and to the Selman task for 7- and 9-year-olds. The results were discussed in terms of a developing awareness of possible discrepancies between feelings and physical behavior, facial expressions, or words.

Aggression↗

PubMed2001

Emotion in criminal offenders with psychopathy and borderline personality disorder.

BACKGROUND: Criminal offenders with a diagnosis of psychopathy or borderline personality disorder (BPD) share an impulsive nature but tend to differ in their style of emotional response. This study aims to use multiple psychophysiologic measures to compare emotional responses to unpleasant and pleasant stimuli. METHODS: Twenty-five psychopaths as defined by the Hare Psychopathy Checklist and 18 subjects with BPD from 2 high-security forensic treatment facilities were included in the study along with 24 control subjects. Electrodermal response was used as an indicator of emotional arousal, modulation of the startle reflex as a measure of valence, and electromyographic activity of the corrugator muscle as an index of emotional expression. RESULTS: Compared with controls, psychopaths were characterized by decreased electrodermal responsiveness, less facial expression, and the absence of affective startle modulation. A higher percentage of psychopaths showed no startle reflex. Subjects with BPD showed a response pattern very similar to that of controls, ie, they showed comparable autonomic arousal, and their startle responses were strongest to unpleasant slides and weakest to pleasant slides. However, corrugator electromyographic activity in subjects with BPD demonstrated little facial modulation when they viewed either pleasant or unpleasant slides. CONCLUSIONS: The results support the theory that psychopaths are characterized by a pronounced lack of fear in response to aversive events. Furthermore, the results suggest a general deficit in processing affective information, regardless of whether stimuli are negative or positive. Emotional hyporesponsiveness was specific to psychopaths, since results for offenders with BPD indicate a widely adequate processing of emotional stimuli.

Adult↗

PubMedDate not supplied

Reducing the subconscious frown by endoscopic resection of the corrugator muscles.

Certain patients subconsciously frown whenever concentrating or conversing. This hyperactivity of their corrugator muscles gives them an unattractive mean or angry look. Prominent glabellar frown lines eventually result from making this facial expression repeatedly. If such patients undergo an open coronal browlift, their corrugator muscles are resected routinely. However, patients who do not need or want a browlift seldom agree to a coronal incision just for access to their corrugators. To address this problem, the author devised an endoscopic operation to approach and resect the corrugators through three 5-mm hairline incisions. In this initial series, the subconscious tendency to frown when concentrating or conversing was reduced to about 20% of the preoperative level. This resulted in a more pleasant facial appearance.

Adult↗

PubMed2002

The role of affect and reasoning in a patient with a delusion of misidentification.

INTRODUCTION: This study investigated a patient with a delusion of misidentification (DM) resembling a Capgras delusion. Instead of the typical Capgras delusion--the false belief that someone has been replaced by an almost identical impostor--patient MF misidentified his wife as his former business partner. METHOD: Detailed investigation of MF's face processing, affective response and affect perception, and ability to evaluate, and reject, implausible ideas was undertaken. RESULTS: MF's visual processing of identity, gender, and age of familiar and unknown faces was intact but he was unable to identify the facial expressions of anger, disgust, and fear, or to match faces across expressions. MF also showed a reduced affective responsiveness to his environment, and impaired reasoning ability. CONCLUSIONS: We propose that MF's delusion of misidentification resulted from a combination of affective deficits, including impairment of both affective response and affect perception, in addition to an inability to evaluate, and reject, implausible ideas. These deficits, in combination with specific life events at the time of onset of the delusion, may have contributed to the form and content of the delusion. In addition, the results raise the possibility that the processing of face identity and facial expression are not as independent as previously proposed in models of face processing.

Journal Article↗