Neural correlates of emotional processing in psychosis risk and onset – A systematic review and meta-analysis of fMRI studies

Highlights • The neural bases of altered emotion processing in psychosis are still unclear. • Systematic review indicated widespread activation decreases to emotion in first-episode psychosis. • Evidence in people at clinical high-risk for psychosis lacked convergence. • These findings were corroborated by image-based meta-analyses.
Aberrant emotion processing is a well-established component of psychotic disorders and is already present at the first episode of psychosis (FEP). However, the role of emotion processing abnormalities in the emergence of psychosis and the underlying neurobiology remain unclear. Here, we systematically reviewed functional magnetic resonance studies that used emotion processing task paradigms in FEP patients, and in people at clinical high-risk for psychosis (CHRp). Image-based meta-analyses with Seed-based d Mapping on available studies (n = 6) were also performed. Compared to controls, FEP patients showed decreased neural responses to emotion, particularly in the amygdala and anterior cingulate cortex. There were no significant differences between CHRp subjects and controls, but a high degree of heterogeneity was identified across studies. The role of altered emotion processing in the early phase of psychosis may be clarified through more homogenous experimental designs, particularly in the CHRp population.