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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. May 2001; 70(5): 597–604.
PMCID: PMC1737346

Affective-prosodic deficits in schizophrenia: profiles of patients with brain damage and comparison with relation to schizophrenic symptoms


OBJECTIVE—Although affective prosody seems to be a dominant and lateralised communication function of the right hemisphere, focal lesions of either hemisphere may cause problems with its modulation. When impairment occurs after brain damage, the profiles of affective-prosodic disturbances differ depending on the hemisphere injured. Patients with left brain damage (LBD) improve their performance whereas patients with right brain damage (RBD) do not when the verbal-articulatory demands of the test stimuli are reduced systematically. One of the major arguments for a right hemispheric contribution to schizophrenia has been the documentation of affective prosodic deficits under the assumption that these abnormalities reflect right hemispheric dysfunction. Thus, an essential question to resolve is whether the profile of affective prosodic disturbances in schizophrenia is similar to LBD or RBD, or represents a unique variation.
METHODS—Data were collected from four subject groups: 45 chronic, medication-stabilised, schizophrenic patients, 10 patients with focal LBD, nine patients with focal RBD, and 19 controls. All groups were tested on the aprosodia battery, which uses stimuli having incrementally reduced verbal-articulatory demands. Schizophrenic and aphasic symptoms were evaluated using standard assessment tools.
RESULTS—For patients with impaired performance on the aprosodia battery, schizophrenic patients were statistically identical to patients with RBD and robustly different from those with LBD. Thirty eight schizophrenic patients (84.4%) were found to have some type of affective prosodic deficit with the predominant pattern indicating, at minimum, right posterior sylvian dysfunction (57.8%). When schizophrenic symptoms and aprosodic deficits were examined using a principal component analysis, affective comprehension and repetition loaded uniquely as separate factors.
CONCLUSIONS—The profile of affective-prosodic deficits found in impaired schizophrenic patients is characteristic of RBD, supporting the concept that schizophrenia is a bihemispheric disease process. These deficits may also represent cardinal symptoms of schizophrenia as they are highly prevalent and, except for spontaneous affective prosody, are not associated statistically with traditional clusters of schizophrenic symptoms.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Andreasen NC. Affective flattening and the criteria for schizophrenia. Am J Psychiatry. 1979 Jul;136(7):944–947. [PubMed]
  • Ross ED, Mesulam MM. Dominant language functions of the right hemisphere? Prosody and emotional gesturing. Arch Neurol. 1979 Mar;36(3):144–148. [PubMed]
  • Ross ED. The aprosodias. Functional-anatomic organization of the affective components of language in the right hemisphere. Arch Neurol. 1981 Sep;38(9):561–569. [PubMed]
  • Buck R, Duffy RJ. Nonverbal communication of affect in brain-damaged patients. Cortex. 1980 Oct;16(3):351–362. [PubMed]
  • Ross ED, Thompson RD, Yenkosky J. Lateralization of affective prosody in brain and the callosal integration of hemispheric language functions. Brain Lang. 1997 Jan;56(1):27–54. [PubMed]
  • Ross ED, Rush AJ. Diagnosis and neuroanatomical correlates of depression in brain-damaged patients. Implications for a neurology of depression. Arch Gen Psychiatry. 1981 Dec;38(12):1344–1354. [PubMed]
  • Ross ED, Stewart RS. Pathological display of affect in patients with depression and right frontal brain damage. An alternative mechanism. J Nerv Ment Dis. 1987 Mar;175(3):165–172. [PubMed]
  • Schneider F, Gur RC, Gur RE, Shtasel DL. Emotional processing in schizophrenia: neurobehavioral probes in relation to psychopathology. Schizophr Res. 1995 Sep;17(1):67–75. [PubMed]
  • Sweet LH, Primeau M, Fichtner CG, Lutz G. Dissociation of affect recognition and mood state from blunting in patients with schizophrenia. Psychiatry Res. 1998 Dec 14;81(3):301–308. [PubMed]
  • Flack WF, Jr, Laird JD, Cavallaro LA. Emotional expression and feeling in schizophrenia: effects of specific expressive behaviors on emotional experiences. J Clin Psychol. 1999 Jan;55(1):1–20. [PubMed]
  • Andreasen NC, Alpert M, Martz MJ. Acoustic analysis: an objective measure of affective flattening. Arch Gen Psychiatry. 1981 Mar;38(3):281–285. [PubMed]
  • Leff J, Abberton E. Voice pitch measurements in schizophrenia and depression. Psychol Med. 1981 Nov;11(4):849–852. [PubMed]
  • Levin S, Hall JA, Knight RA, Alpert M. Verbal and nonverbal expression of affect in speech of schizophrenic and depressed patients. J Abnorm Psychol. 1985 Nov;94(4):487–497. [PubMed]
  • Fricchione G, Sedler MJ, Shukla S. Aprosodia in eight schizophrenic patients. Am J Psychiatry. 1986 Nov;143(11):1457–1459. [PubMed]
  • Alpert M, Rosen A, Welkowitz J, Sobin C, Borod JC. Vocal acoustic correlates of flat affect in schizophrenia. Similarity to Parkinson's disease and right hemisphere disease and contrast with depression. Br J Psychiatry Suppl. 1989 May;(4):51–56. [PubMed]
  • Borod JC, Alpert M, Brozgold A, Martin C, Welkowitz J, Diller L, Peselow E, Angrist B, Lieberman A. A preliminary comparison of flat affect schizophrenics and brain-damaged patients on measures of affective processing. J Commun Disord. 1989 Apr;22(2):93–104. [PubMed]
  • Murphy D, Cutting J. Prosodic comprehension and expression in schizophrenia. J Neurol Neurosurg Psychiatry. 1990 Sep;53(9):727–730. [PMC free article] [PubMed]
  • Haskins B, Shutty MS, Kellogg E. Affect processing in chronically psychotic patients: development of a reliable assessment tool. Schizophr Res. 1995 May;15(3):291–297. [PubMed]
  • Leentjens AF, Wielaert SM, van Harskamp F, Wilmink FW. Disturbances of affective prosody in patients with schizophrenia; a cross sectional study. J Neurol Neurosurg Psychiatry. 1998 Mar;64(3):375–378. [PMC free article] [PubMed]
  • Cutting J, Murphy D. Preference for denotative as opposed to connotative meanings in schizophrenics. Brain Lang. 1990 Oct;39(3):459–468. [PubMed]
  • DiSimoni FG, Darley FL, Aronson AE. Patterns of dysfunction in schizophrenic patients on an aphasia test battery. J Speech Hear Disord. 1977 Nov;42(4):498–513. [PubMed]
  • Taylor MA, Abrams R. Cognitive impairment patterns in schizophrenia and affective disorder. J Neurol Neurosurg Psychiatry. 1987 Jul;50(7):895–899. [PMC free article] [PubMed]
  • Cutting J. The role of right hemisphere dysfunction in psychiatric disorders. Br J Psychiatry. 1992 May;160:583–588. [PubMed]
  • Coger RW, Serafetinides EA. Schizophrenia, corpus callosum, and interhemispheric communication: a review. Psychiatry Res. 1990 Nov;34(2):163–184. [PubMed]
  • Merriam AE, Gardner EB. Corpus callosum function in schizophrenia: a neuropsychological assessment of interhemispheric information processing. Neuropsychologia. 1987;25(1B):185–193. [PubMed]
  • Raine A, Andrews H, Sheard C, Walder C, Manders D. Interhemispheric transfer in schizophrenics, depressives, and normals with schizoid tendencies. J Abnorm Psychol. 1989 Feb;98(1):35–41. [PubMed]
  • Schlanger BB, Schlanger P, Gerstman LJ. The perception of emotionally toned sentences by right hemisphere-damaged and aphasic subjects. Brain Lang. 1976 Jul;3(3):396–403. [PubMed]
  • Seron X, Van der Kaa MA, Vanderlinden M, Remits A, Feyereisen P. Decoding paralinguistic signals: effect of semantic and prosodic cues on aphasics' comprehension. J Commun Disord. 1982 Jun;15(3):223–231. [PubMed]
  • de Bleser R, Poeck K. Analysis of prosody in the spontaneous speech of patients with CV-recurring utterances. Cortex. 1985 Sep;21(3):405–415. [PubMed]
  • Cancelliere AE, Kertesz A. Lesion localization in acquired deficits of emotional expression and comprehension. Brain Cogn. 1990 Jul;13(2):133–147. [PubMed]
  • Ross ED. Prosody and brain lateralization. Fact vs fancy or is it all just semantics? Arch Neurol. 1988 Mar;45(3):338–339. [PubMed]
  • Ross ED, Harney JH, deLacoste-Utamsing C, Purdy PD. How the brain integrates affective and propositional language into a unified behavioral function. Hypothesis based on clinicoanatomic evidence. Arch Neurol. 1981 Dec;38(12):745–748. [PubMed]
  • Speedie LJ, Coslett HB, Heilman KM. Repetition of affective prosody in mixed transcortical aphasia. Arch Neurol. 1984 Mar;41(3):268–270. [PubMed]
  • Blonder LX, Bowers D, Heilman KM. The role of the right hemisphere in emotional communication. Brain. 1991 Jun;114(Pt 3):1115–1127. [PubMed]
  • Oldfield RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia. 1971 Mar;9(1):97–113. [PubMed]
  • Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. [PubMed]
  • Ross ED, Edmondson JA, Seibert GB, Homan RW. Acoustic analysis of affective prosody during right-sided Wada Test: a within-subjects verification of the right hemisphere's role in language. Brain Lang. 1988 Jan;33(1):128–145. [PubMed]
  • Lenhardt ML. Factors in affective discrimination of speech. Neurology. 1978 Mar;28(3):309–310. [PubMed]
  • Heilman KM, Bowers D, Speedie L, Coslett HB. Comprehension of affective and nonaffective prosody. Neurology. 1984 Jul;34(7):917–921. [PubMed]
  • Weintraub S, Mesulam MM, Kramer L. Disturbances in prosody. A right-hemisphere contribution to language. Arch Neurol. 1981 Dec;38(12):742–744. [PubMed]
  • Emmorey KD. The neurological substrates for prosodic aspects of speech. Brain Lang. 1987 Mar;30(2):305–320. [PubMed]
  • Heilman KM, Scholes R, Watson RT. Auditory affective agnosia. Disturbed comprehension of affective speech. J Neurol Neurosurg Psychiatry. 1975 Jan;38(1):69–72. [PMC free article] [PubMed]
  • Darby DG. Sensory aprosodia: a clinical clue to lesions of the inferior division of the right middle cerebral artery? Neurology. 1993 Mar;43(3 Pt 1):567–572. [PubMed]
  • Starkstein SE, Federoff JP, Price TR, Leiguarda RC, Robinson RG. Neuropsychological and neuroradiologic correlates of emotional prosody comprehension. Neurology. 1994 Mar;44(3 Pt 1):515–522. [PubMed]
  • Kawasaki Y, Maeda Y, Sakai N, Higashima M, Yamaguchi N, Koshino Y, Hisada K, Suzuki M, Matsuda H. Regional cerebral blood flow in patients with schizophrenia: relevance to symptom structures. Psychiatry Res. 1996 May 31;67(1):49–58. [PubMed]
  • Peralta V, de Leon J, Cuesta MJ. Are there more than two syndromes in schizophrenia? A critique of the positive-negative dichotomy. Br J Psychiatry. 1992 Sep;161:335–343. [PubMed]
  • Gur RE, Mozley PD, Shtasel DL, Cannon TD, Gallacher F, Turetsky B, Grossman R, Gur RC. Clinical subtypes of schizophrenia: differences in brain and CSF volume. Am J Psychiatry. 1994 Mar;151(3):343–350. [PubMed]
  • Borod JC, Martin CC, Alpert M, Brozgold A, Welkowitz J. Perception of facial emotion in schizophrenic and right brain-damaged patients. J Nerv Ment Dis. 1993 Aug;181(8):494–502. [PubMed]
  • Feinberg TE, Rifkin A, Schaffer C, Walker E. Facial discrimination and emotional recognition in schizophrenia and affective disorders. Arch Gen Psychiatry. 1986 Mar;43(3):276–279. [PubMed]
  • Schneider F, Gur RC, Gur RE, Shtasel DL. Emotional processing in schizophrenia: neurobehavioral probes in relation to psychopathology. Schizophr Res. 1995 Sep;17(1):67–75. [PubMed]
  • Poole JH, Tobias FC, Vinogradov S. The functional relevance of affect recognition errors in schizophrenia. J Int Neuropsychol Soc. 2000 Sep;6(6):649–658. [PubMed]
  • Kishimoto H, Kuwahara H, Ohno S, Takazu O, Hama Y, Sato C, Ishii T, Nomura Y, Fujita H, Miyauchi T, et al. Three subtypes of chronic schizophrenia identified using 11C-glucose positron emission tomography. Psychiatry Res. 1987 Aug;21(4):285–292. [PubMed]
  • Paulman RG, Devous MD, Sr, Gregory RR, Herman JH, Jennings L, Bonte FJ, Nasrallah HA, Raese JD. Hypofrontality and cognitive impairment in schizophrenia: dynamic single-photon tomography and neuropsychological assessment of schizophrenic brain function. Biol Psychiatry. 1990 Feb 15;27(4):377–399. [PubMed]
  • Cleghorn JM, Garnett ES, Nahmias C, Brown GM, Kaplan RD, Szechtman H, Szechtman B, Franco S, Dermer SW, Cook P. Regional brain metabolism during auditory hallucinations in chronic schizophrenia. Br J Psychiatry. 1990 Oct;157:562–570. [PubMed]
  • Sabri O, Erkwoh R, Schreckenberger M, Owega A, Sass H, Buell U. Correlation of positive symptoms exclusively to hyperperfusion or hypoperfusion of cerebral cortex in never-treated schizophrenics. Lancet. 1997 Jun 14;349(9067):1735–1739. [PubMed]
  • O'Leary DS, Andreasen NC, Hurtig RR, Kesler ML, Rogers M, Arndt S, Cizadlo T, Watkins GL, Ponto LL, Kirchner PT, et al. Auditory attentional deficits in patients with schizophrenia. A positron emission tomography study. Arch Gen Psychiatry. 1996 Jul;53(7):633–641. [PubMed]
  • O'Leary DS, Andreason NC, Hurtig RR, Hichwa RD, Watkins GL, Ponto LL, Rogers M, Kirchner PT. A positron emission tomography study of binaurally and dichotically presented stimuli: effects of level of language and directed attention. Brain Lang. 1996 Apr;53(1):20–39. [PubMed]
  • Borod JC, Welkowitz J, Alpert M, Brozgold AZ, Martin C, Peselow E, Diller L. Parameters of emotional processing in neuropsychiatric disorders: conceptual issues and a battery of tests. J Commun Disord. 1990 Aug-Oct;23(4-5):247–271. [PubMed]

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