Feedback processing in schizophrenia: effects of affective value and remedial action

Error-monitoring deficits in schizophrenia have been found, but results with respect to feedback processing and remedial action were unclear. The present study examined the role of emotion in feedback processing in medication-free patients with recent-onset schizophrenia. Patients and controls performed a time-estimation task, and brain activation was measured with functional magnetic resonance imaging (fMRI). Participants had to estimate a 1-s interval and received feedback about their performance in the form of words or facial expressions. Patients performed the task at the same level as the controls and used the feedback to improve performance. Brain activation following the feedback stimuli in the rostral cingulate zone differed between groups, but this effect depended on the modality of the feedback stimulus. Patients showed a differential response to verbal and facial feedback in the rostral cingulate zone, whereas healthy controls did not differ between modalities. Furthermore, activation in the rostral cingulate zone following facial feedback was negatively related to severity of the disease as expressed by the scores on positive symptom subscale of the Positive and Negative Syndrome Scale. Both findings point in the direction of a specific deficit in patients which is related to the emotional impact of external feedback.