Functional MRI examination of empathy for pain in people with schizophrenia reveals abnormal activation related to cognitive perspective-taking but typical activation linked to affective sharing

Functional MRI examination of empathy for pain in people with schizophrenia reveals abnormal activation related to cognitive perspective-taking but typical activation linked to affective sharing

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J Psychiatry Neurosci 2017;42(4):262-272

Damien Vistoli, PhD; Marie-Audrey Lavoie, PhD; Stephanie Sutliff, MSc; Philip L. Jackson, PhD; Amélie M. Achim, PhD


Background: Schizophrenia is associated with important disturbances in empathy that are related to everyday functioning. Empathy is classically defined as including affective (sharing others’ emotions) and cognitive (taking others’ cognitive perspectives) processes. In healthy individuals, studies on empathy for pain revealed specific brain systems associated with these sets of processes, notably the anterior middle cingulate (aMCC) and anterior insula (AI) for affective sharing and the bilateral temporoparietal junction (TPJ) for the cognitive processes, but the integrity of these systems in patients with schizophrenia remains uncertain.

Methods: Patients with schizophrenia and healthy controls performed a pain empathy task while undergoing fMRI scanning. Participants observed pictures of hands in either painful or nonpainful situations and rated the level of pain while imagining either themselves (self) or an unknown person (other) in these situations.

Results: We included 27 patients with schizophrenia and 21 healthy controls in our analyses. For the pain versus no pain contrast, patients showed overall typical activation patterns in the aMCC and AI, with only a small part of the aMCC showing reduced activation compared with controls. For the other versus self contrast, patients showed an abnormal modulation of activation in the TPJ bilaterally (extending to the posterior superior temporal sulcus, referred to as the TPJ/pSTS).

Limitations: The design included an unnecessary manipulation of the visual perspective that reduced the number of trials for analysis. The sample size may not account for the heterogeneity of schizophrenia.

Conclusion: People with schizophrenia showed relatively intact brain activation when observing others’ pain, but showed abnormalities when asked to take the cognitive perspectives of others.

Submitted July 8, 2016; Revised Dec. 2, 2016; Accepted Jan. 5, 2017; Early-released May 30, 2017

Acknowledgements: This work was supported by grants from the Natural Sciences and Engineering Research Council of Canada (NSERC #435556-2013) and the Fonds de Recherche du Québec Santé (FRQ-S) to A. Achim, and from the Brain and Behavior Foundation to P. Jackson. The FRQ-S also supported the team through salary grants (A. Achim and P. Jackson), a studentship (M.-A. Lavoie) and a postdoctoral award (D. Vistoli). S. Sutliff was supported by studentships from the Réseau de Bio-Imagerie du Québec (RBIQ) and the Centre Thématique de Recherche en Neurosciences (CTRN). Support was also provided by the Consortium d’imagerie en neuroscience et santé mentale de Québec (CINQ) for protocol development and MRI acquisition via a Platform Support Grant (PSG-3456) from the Brain Canada Foundation. The authors thank the health professionals in Québec who collaborated on the project, notably the professionals from the Clinique Notre-Dame-des-Victoires, the Centre de Traitement et de Réadaptation de Nemours and the External clinic, all linked to the Institut Universitaire en Santé Mentale de Québec. Finally, the authors also thank FE and PEM for their technical help.

Affiliations: From the Centre de recherche CERVO, Québec, Qué., Canada (Vistoli, Lavoie, Sutliff, Jackson, Achim); the École de psychologie, Université Laval, Québec, Qué., Canada (Vistoli, Lavoie, Jackson); the Laboratoire de Psychologie et NeuroCogniton (LPNC), CNRS UMR 5105, Université Grenoble Alpes, Grenoble, France (Vistoli); the Département de Psychiatrie et neurosciences, Faculté de médecine, Université Laval, Québec, Qué., Canada (Sutliff, Achim); and the Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Université Laval, Québec, Qué., Canada (Jackson).

Competing interests: None declared.

Contributors: D. Vistoli, M.-A. Lavoie, P.L. Jackson and A.M. Achim designed the study, and acquired and analyzed the data. S. Sutliff also contributed to data acquisition. D. Vistoli, P.L. Jackson and A.M. Achim wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.160136

Correspondence to: A.M. Achim, Centre de recherche CERVO, 2601, de la Canardière, Québec QC G1J 2G3;