Abnormal emotional intensity processing in individuals at clinical high risk for psychosis: evidence from event-related potentials

Eur Arch Psychiatry Clin Neurosci. 2026 Jul 4. doi: 10.1007/s00406-026-02301-2. Online ahead of print.

ABSTRACT

BACKGROUND: Social cognitive impairment is a key vulnerability marker for psychosis and is commonly observed in individuals at clinical high risk (CHR). However, the neurophysiological mechanisms underlying abnormalities in emotional intensity processing remain unclear. This study investigated behavioral and electrophysiological responses to emotional intensity in CHR individuals using an event-related potential (ERP) paradigm.

METHODS: Thirty CHR participants, 29 healthy controls (HCs), and an exploratory sample of 30 individuals with schizophrenia (SCZ) completed the Emotional Intensity Recognition Task (EIRT) during high-density EEG recording. Behavioral measures included reaction time (RT) and accuracy and were analyzed across six basic emotional categories. ERP components, including N100, N170, P200, P300, and LPP, were analyzed across predefined frontal, central, parietal, and occipital regions. ERP analyses also included neutral expressions because identifiable EEG event markers were available. Associations between ERP indices, behavioral performance, and clinical symptoms were also examined.

RESULTS: CHR individuals showed significantly slower RTs than HCs across emotional conditions, while accuracy remained comparable. ERP analyses, including neutral expressions where EEG markers were available, revealed altered modulation of emotional face processing across multiple temporal stages. Group-related effects were most consistently observed for P300 amplitude and LPP latency, suggesting atypical attentional allocation and late evaluative processing in CHR individuals. Exploratory correlation analyses suggested associations between selected ERP indices and clinical symptoms; however, these findings were not corrected for multiple comparisons and should be interpreted cautiously. Exploratory unadjusted comparisons with the SCZ group suggested group differences in selected ERP measures, but these findings should be interpreted cautiously because the SCZ group was older and was not collected concurrently with the primary CHR and HC samples.

CONCLUSIONS: Individuals at clinical high risk for psychosis exhibit slowed behavioral responses and altered ERP modulation during emotional intensity processing. These findings suggest that the EIRT-ERP paradigm may help characterize social-cognitive and neurophysiological alterations in the psychosis prodrome. Larger longitudinal studies are needed to determine whether these ERP measures have predictive value for functional outcomes or transition to psychosis.

PMID:42400657 | DOI:10.1007/s00406-026-02301-2