Emotional intelligence and schizophrenia spectrum disorders: a critical review

Emotional intelligence (EI) is a theoretical construct postulated by Mayer and Salovey to designate the ability to perceive, understand, use and manage emotions. The study of EI in schizophrenia offers new insights into the disorder’s cognitive and functional impacts.

Objectives

To comprehensively review studies analyzing EI impairment in schizophrenia spectrum disorders using standardized instruments.

Methods

Searches were run on MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov and SciELO databases. The only validated instrument used was the Multifactor Emotional Intelligence Scale (MSCEIT). Articles that used all branches of the MSCEIT to assess EI in schizophrenia spectrum disorders and healthy controls were included in the review.

Results

We found 30 articles on this topic. The studies analyzed showed a significant impairment of MSCEIT total score in patients with schizophrenia spectrum disorders when compared to healthy controls. In relation to the MSCEIT branches, understanding of emotions and management of emotions are the most impaired branches.

Conclusion

Since most studies are cross-sectional, it is not possible to establish a cause and effect relationship between EI deficits and schizophrenia spectrum disorders. Therefore, longitudinal studies are needed to establish a clearer relationship between these variables. By so doing, we may be able to intervene for prevention and management of these disorders, aiming at better quality of life for patients.

Emotional intelligence; schizophrenia; psychotic disorders

Disorder	Study	Study design	Sample size	Results	Study limitations and bias
Schizophrenia	Albacet⁸	Cross-sectional	37 clinical subjects + 37 first degree relatives + 37 healthy controls	Impairment in MSCEIT score for the clinical sample and for the first degree relatives.	- Small sample. - Groups were not well matched for age, gender and IQ.
Schizophrenia	Brambilla⁹	Clinical Trial	31 schizophrenia patients	They found that 4-months’ treatment with intranasal oxytocin was related to improvement in the understanding emotions branch of MSCEIT.	- Small, mainly male and young sample. - Unable to tell if the effects were seen only in social cognition or in general cognition as well.
Schizophrenia	Cicero¹⁰	Cross-sectional	45 schizophrenia patients + 28 healthy controls	They found that the clinical sample had worse MSCEIT performance when compared to controls. Positive symptoms were related to poorer perception and management of emotions.	- Small sample. - Unable to establish causal effects.
Schizophrenia	Dawson¹¹	Cross-sectional	20 clinical subjects + 20 healthy controls	Impairment in MSCEIT score, social functioning and Neurocognition for the clinical sample.	- Small sample. - Samples were not well matched for premorbid intelligence.
Schizophrenia	Eack¹²	Cross-sectional (validity)	64 clinical subjects (37 with schizophrenia + 23 with schizoaffective disorder + 4 with schizophreniform disorder)	They report that the MSCEIT has adequate internal consistency and reliability to evaluate the sample. They also found a shift in the EI factor structure in the sample when compared to healthy subjects.	- Small sample. - Patients were selected from a clinical trial of CET.
Schizophrenia	Eack¹³	Retrospective	64 clinical subjects (same as the previous study - Eack et al.¹²) + normative sample with 2563 subjects	They confirm the previous finding of a shift in the factor structure of EI in patients with schizophrenia.	- Small clinical sample. - Absence of demographically-matched controls known to be free from mental disorders.
Schizophrenia	Eack¹⁴	Randomized controlled trial	58 early-course outpatients with schizophrenia spectrum disorders	They found CET to be an effective approach for improving cognitive deficits in the sample.	- Small sample.
Schizophrenia	Eack¹⁵	Clinical trial	58 early-course schizophrenia outpatients	They found CET had an impact on EI measures and correlated this result with the functional outcome.	- Small sample. - Unable to discard type I error.
Schizophrenia	Frajo-Apor¹⁶	Cross-sectional	56 paranoid schizophrenia patients and 84 healthy controls	They found that the clinical sample had poorer EI than the controls. They found this effect was mediated by non-social cognition.	- They suggest that more tools could be used to assess EI. - Different treatments for different patients in the clinical sample. - Some of the patients were symptomatic during the tests.
Schizophrenia	Frajo-Apor¹⁷	Cross-sectional	58 schizophrenia outpatients and 60 bipolar disorder I outpatients	They demonstrate that the schizophrenia sample performed worse on the MSCEIT when compared to the bipolar disorder patients (except for the emotion perception branch). They also correlated the difference to non-social cognition.	- They used the BACS to evaluate non-social cognition in both groups, although it is only validated for schizophrenia samples. - Some patients were not in full remission.
Schizophrenia	Green¹⁸	Cross-sectional	- 50 individuals with prodromal risk syndrome for psychosis + 34 demographically comparable controls. - 81 first-episode schizophrenia + 46 demographically comparable controls. - 53 chronic schizophrenia + 47 demographically comparable controls.	They found the clinical samples to have impairment on general MSCEIT performance. There was no significant difference in MSCEIT performance during the different phases of illness, except for the perception of emotions branch.	- Some patients were using antipsychotic medications. - The sample was mainly young. - Unable to establish causal effects.
Schizophrenia	Kee¹⁹	Cross-sectional	50 schizophrenia and 39 non-psychiatric controls	The clinical sample had poorer EI than controls. The MSCEIT score was worse in patients with negative symptoms and those with poorer community functioning.	- Small sample. - Unable to discard type I error. - Unable to evaluate if the severity of symptoms was related to the chronicity of disease, to emotional traits or to the long-term exposure to antipsychotic medications.
Schizophrenia	Lin²⁰	Cross-sectional	174 schizophrenia and 20 schizoaffective disorder	They found MSCEIT to have a two-factor structure in the schizophrenia sample. Factor 1 broadly associated with the regulation and management of emotions and factor 2 related with facial emotion perception.	- Unable to establish causal effects.
Schizophrenia	Mao²¹	Cross-sectional	76 schizophrenia and 738 healthy controls	They found MSCEIT-TC (Traditional Chinese Version) to be reliable and valid for assessment of EI in the schizophrenic sample. When comparing the groups, they found EI impairment in the clinical sample. The impact was more important for the Understanding Emotions and Managing Emotions branches.	- Unable to establish the causal effects. - Cross-cultural assessment of EI.
Schizophrenia	McCleery²²	Prospective observational cohort	41 clinical subjects	The results showed that there were no changes in emotional abilities over the 5-year period. Furthermore, EI had no significant longitudinal influence on community functioning after five years.	- Small sample size. - Absence of healthy controls.
Schizophrenia	O’Reilly²³	Prospective observational cohort	89 schizophrenia (10 violent)	The violent group performed worse on MSCEIT than the nonviolent group. The study also found that the severity of symptoms had a strong inverse correlation with MSCEIT performance.	- The sample was in a secure forensic environment. - The sample was majority male.
Schizophrenia	Wojtalik²⁴	Cross-sectional	51 early-course, stabilized schizophrenia or schizoaffective disorder patients.	Patients with lower scores for Facilitating, Managing and Using emotions exhibited reduced gray matter density in the left parahippocampal gyrus. Those with poorer results in Facilitating and Managing emotions exhibited reduced right posterior cingulate gray matter density.	- Moderate sample size. - Absence of healthy controls. - Unable to evaluate causal effects.
Schizophrenia	Tso²⁵	Cross-sectional	29 schizophrenia patients, 23 healthy controls.	They suggested that compromised visual integration was a significant predictor of low EI scores, mainly due to a reduction in perception of ocular contact.	- Unable to evaluate causal effects. - Moderate sample size.
Schizophrenia	Hurtado²⁶	Cross-sectional	19 schizophrenia (17 paranoid and 2 indefinite subtype), 15 borderline personality disorder and 18 healthy controls.	Both groups of patients exhibited significantly lower performance in terms of total MSCEIT scores. Schizophrenia patients exhibited impairment in perception, facilitation and understanding of emotions in relation to the control group.	- Unable to evaluate causal effects. - Small sample size and exploratory nature.

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

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[1] Correspondence: Elisa Brietzke. Rua Borges Lagoa, 570, Vila Clementino. 04038-000 - São Paulo, SP - Brazil. Tel.: +55 (11) 55764991. E-mail: elisabrietzke@hotmail.com