2026 ECNP Congress

PS01-1041

Investigating emotional experience and thought disorganization across treatment-resistant and responsive schizophrenia during emotional stimulation under electroencephalographic recording

Claudio Ricci — F. Iannotta, C. Ceparano, A. Catino, W. Del Monaco, G. Pezzullo, A. de Bartolomeis, F. Iasevoli · University of "Federico II", Department of Neuroscience - University of Naples "Federico II", Naples, Italy

2026 ECNP Congress

Introduction

Treatment-resistant schizophrenia (TRS) is increasingly conceptualized as a biologically distinct phenotype, characterized by specific neurochemical and synaptic alterations, reduced cortico–temporal synchronization, and functional disconnection [1]. Thought disorganization is a central dimension of psychosis and a strong predictor of disability, impaired functioning, communicative difficulties, and reduced insight and treatment response.

Electroencephalography (EEG) has identified characteristic oscillatory abnormalities in schizophrenia [2]. Emotional EEG paradigms engage naturalistic emotion–cognition processes and offer a sensitive way to detect subtype-specific cortical disruptions.

This study extends this framework by examining whether emotional stimulation differentiates schizophrenia subtypes not only through EEG–disorganization coupling, but also through the relationship between subjective emotional experience (valence and arousal) and thought disorganization.

Aims

To determine whether emotional stimulation differentiates treatment-resistant and treatment-responsive schizophrenia through distinct patterns of coupling between EEG activity, subjective emotional experience, and thought disorganization.

Methods

Fourteen individuals with schizophrenia (6 treatment-responsive, SCZ; 8 treatment-resistant, TRS; 9 males, 5 females; mean age 43 ± 9 years;) viewed neutral, positive, and negative emotional video clips during 14-channel EEG recording (Emotiv EPOC X). Relative spectral power (delta, theta, alpha, beta, gamma) was extracted across cortical regions.

Thought disorganization was assessed using a PANSS-derived index (P2, N5, N7, G10, G16). EEG–disorganization correlations were computed for each clip separately in SCZ and TRS and compared using Fisher r-to-z transformation. ANCOVA models including demographic and clinical variables were used to test robustness.

After each clip, participants rated their emotional experience using Likert-type scales. Valence and arousal indices were derived, and their associations with thought disorganization were examined within each group.

Results

A significant clip-by-subtype interaction emerged, with differences between SCZ and TRS observed exclusively during the positive clip.

In SCZ, greater thought disorganization was associated with lower posterior delta power (ρ = −0.83) and higher posterior beta–gamma activity (ρ = +0.79), indicating a coherent spectro-clinical profile. No associations emerged in TRS (ρ ≈ 0). Fisher r-to-z tests confirmed significant subtype differences, and ANCOVA models yielded medium-to-large effect sizes (ηp² = 0.30–0.38).

Subjective emotional experience showed preserved basic affective processing in both groups, with a positive association between valence and arousal (SCZ: r = 0.54; TRS: r = 0.76). However, their relationship with thought disorganization differed: in SCZ, emotional dimensions were associated with disorganization (valence: r = −0.87; arousal: r = −0.69), whereas in TRS no meaningful associations emerged (valence: r ≈ 0.01; arousal: r = 0.26).

Conclusions

Emotional stimulation differentiates schizophrenia subtypes through presence versus absence of coupling between thought disorganization, EEG activity, and subjective emotional experience.

Basic emotional processing is preserved in TRS, but its relationship with thought organization is disrupted, indicating the core deficit lies in integration rather than emotional reactivity.

Converging EEG–symptom and emotion–symptom findings support a model of TRS as a disorder of cross-domain disintegration, in which neural activity, subjective experience, and cognitive organization become decoupled.

This multi-level decoupling suggests a candidate biomarker of treatment resistance and indicates that assessing coupling across domains could improve subtype differentiation, illness stratification, and development of targeted interventions.

References

  1. Kane JM et al. Treatment-resistant schizophrenia: definition and treatment response. Am J Psychiatry. 2019.
  2. Newson JJ, Thiagarajan TC. EEG frequency bands in psychiatric disorders. Front Hum Neurosci. 2019.