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Emotion identification, discrimination and expression in encephalitis survivor children.


Encephalitis is swelling of the brain. Viral infections are the most general cause of the condition. Encephalitis arise in a huge amount in many countries of Asia such as Cambodia, China, Indonesia, Japan, Laos, Malaysia, Myanmar, Philippines, Korea, Thailand, Vietnam, Taiwan South-eastern Russian Federation and the Indian subcontinent. China, Korea, Japan, Taiwan and Thailand are those countries which have had faced outbreaks in the past but have controlled the disease primarily by vaccination. On the other hand Vietnam, Cambodia, Myanmar, India, Nepal and Malaysia are some of those countries that still have periodic endemics.

A variant of Encephalitis i.e. Japanese Encephalitis (JE) is a major pediatric problem in many parts of India. In mid 1950s encephalitis was first documented in Vellore and Pondicherry in India. In 1973 the initial and main epidemic of encephalitis occurred in Bankura & Burdwan districts of West Bengal. Other wide spread epidemics were documented from Andhra Pradesh, Assam, Karnataka, Tamil Nadu, Uttar Pradesh and West Bengal in 1976. Encephalitis cases were documented from 21 states and Union Territories in 1978. While in 1978 the Directorate of NVBDCP (National Vector Borne Disease Control Programme) is scrutinizing encephalitis prevalence in the country. Moreover, records mentioned that the most unpleasant ever documented epidemic in India was documented from Uttar Pradesh in the year 1988 when 4485 cases with 1413 deaths were documented from eight districts with case fatality rate of 31.5%. In Uttar Pradesh basically Gorakhpur region experienced the most severe epidemic in 1988 with 875 cases (Rathi et al 1993). The extremely affected states consist of Andhra Pradesh, Assam, Bihar, Goa, Karnataka, Manipur, Tamil Nadu, Uttar Pradesh and West Bengal. Epidemics of encephalitis typically correspond with monsoons and post-monsoon time when the vector density is high. On the other hand, in prevalent areas, infrequent cases may take place during the year.

The Acute Encephalitis Syndrome or Japanese encephalitis reported in the region of Gorakhpur is greatly terrible. The poor drainage system and water logging in rainy season is one of the main reasons for increasing mosquitoes in Gorakhpur. For the precedent 30 years, rains in the region of Gorakhpur are synonymous with children dying of encephalitis. An endemic of viral encephalitis was documented from July to November 2005 in Gorakhpur. It was considered the highest and a large amount of harsh endemic in 3 decades in which 5,737 people were affected in 7 districts of eastern Uttar Pradesh. In 2012, 557 encephalitis deaths have occurred and since then six months very small improvement has been made in the fight against this fatal disease. Encephalitis that has declared 50,000 lives in Gorakhpur in the previous 30 years. The locals call 'monsoon of death', because a large quantity of deaths happen in the monsoon months between July and October. The major risk that looms across this district (Gorakhpur) has so far been uncared. The recent entero-viral type of encephalitis, which has taken over the mantle of the killer form the Japanese Encephalitis and this, spreads by water.

Neurological and Emotional Deficits: Even though more or less all age groups are affected with encephalitis but the majority of the cases are in younger age groups. Cases in areas where disease is prevalent are generally reported from age groups below 15 years. Throughout the exploration of endemics a variety of epidemiological studies conducted which detected that though both sexes are affected with encephalitis but males out number females. Encephalitis represents a harsh syndrome in children with a high early deficits and mortality. Mortality was considerably associated to a short prodromal stage, deep coma, abnormalities in tone and breathing and decerebrised posturing. Some previous studies mentioned that acute JE at younger age, with higher body temperature, high white cell count in CSF, and deep coma present at hospital admission were markers for unfavourable results (sequlae or deadly). Sequelae of the illness become harsher when the preliminary illness is prolonged or is connected with focal neurologic deficits. Short-term studies of post JE disability confirmed neurologic sequelae in 25%-75% of survivors. Reduced IQ was documented among 32% of JE survivors. Obviously harsh dystonia is essential and solemn sequelae of encephalitis and may arise as the consequence of thalamus, midbrain, or basal ganglia involvement in a variety of combinations. The majority of the sequelae persist to recover over years. In most cases, those neurological functions which have a huge area of demonstration in the cortex (like cortical motor deficit, memory loss, intellectual deficits, speech abnormalities) are affected very commonly and so happen in a huge amount of patients in the opening phase but improve to a large amount since the unaffected neurons in that division of the cortex take over the function in contrast to those neurological functions which have a little area of demonstration similar to substantia nigra, that arise in fewer patients but have extremely little possibility of improvement. This happen because of total damage to small collections of neurons (like substantia nigra resulting in Parkinsonism, cranial nerve nuclei resulting in cranial paralysis) with sparing of inadequate number of neurons to take over the lost function and compensate.

The patients give record of severe onset with fever with changed sensorium. Various patients might show change in behaviour. There might be the past of convulsions. Febrile seizures may perhaps mimic a case of Japanese encephalitis but the sensorium is not changed. The focal neurological deficits might or might not be absent. Troubles of sensorium are reflected like lethargy, somnolence, irritability, apathy or loss of consciousness. The patient could build up complexity to speech and other neurological deficits similar to ocular palsies, hemiplegia, tremor and ataxia. There may also be loss of bladder and bowel control. The focal neurological signs might be stationary or progressive. About 5% to 70% patients who get well from the severe occurrence might have neurological sequelae depending upon the age and harshness of the disease viz mental impairment, severe emotional instability, personality changes, paralysis etc.

Neuropsychiatric descriptions have paying attention generally on memory deficits as the most salient neuropsychological indicator of encephalitis (Bak et al., 2001). On the other hand, neuropsychological research has shown that impairment to the amygdala can outcome in deficits in recognizing facial and vocal expressions of fear, and similarly that impairment to insular cortex and basal ganglia can consequence in deficits in recognizing facial and vocal expressions of disgust (Calder et al., 2001). Since these regions are significantly affected in the severe cases of encephalitis, and deficits in emotion recognition should be manifest in this disorder. Amazingly, up till now, there has been no study looking in more specify at emotion processing in encephalitis disease. For that reason the present study is designed to reflect on the occurrence of recognition deficits for facially and vocally displayed basic emotions in encephalitis, using well-established and standardized psychological procedures. Emotion regulation is an essential module of healthy development; thus far some previous studies scrutinize neural correlates of emotion regulation in childhood. Few studies consider children's neurophysiologic responses to prominent and socially considerable emotional distracters-emotional faces that are interconnected to broader emotion regulation capabilities. Corresponding with the demonstration of other moody features in children, emotion regulation comprises a set of competencies to adjust affective states (Shields & Cicchetti, 1998). Instances of emotion regulatory strategies contain self-soothing, refraining upsetting events and challenging stimuli (Schwartz & Proctor, 2000), and inhibiting or initiating emotionally focused actions (Eisenberg et al., 2001).

Emotion regulation is a distinct word that encompasses a number of behavioural construct that jointly explained orderly changes that happen in the situation when emotions are stimulated (Cole et al., 2004). The changes can consist of two different types of regulatory phenomena i.e. those processes that regulate an emotion (Gross, 1998) and those processes (e.g. memory, behaviour) that are regulated by emotions (Campos et al., 2004; Cole et al., 2004). On the other hand the term emotion identification refers to an individual's capability to be aware of emotional responses that arise during various every day interactions.


1. To investigate the presence of emotion identification deficits for basic emotions (facial display) in encephalitis survivor children.

2. To understand the nature of emotion identification, discrimination and expression among encephalitis survivor children as well as normal children.

3. To examine which emotion among the six basic emotions are better identified and discriminated by both groups.


Sample: A total of 60 children (aged 5-15 years) participated in this study. Out of 60, thirty were encephalitis survivors selected from the Physical Medical Rehabilitation (P.M.R) Center, Manovikas Center and Psychiatry department of B.R.D. Medical College, Gorakhpur. The valid permission to contact and interview these survivors are granted by the appropriate authorities. The remaining 30 were the matched control group taken from the private schools of some locality. All the participants belonged to low socio-economic-status. All participants and/or their parents had given consent to participate in the study.

Tools and Procedure: In the present study each participant had completed three tasks which were developed as a part of the study. These tasks were performed in the following order:

(1) The Emotion Identification Task: In the first task a set of stimuli consisted of six basic emotion based faces (two male adult and four female adult) (Ekman & Friesen, 1976) that are full-face pose, presented in forms of black & white /grayscale images. In this task, a single face displaying one of six basic emotions was shown and participants were asked to identify which emotion label was most appropriate to the photograph. This task began with the word ''READY'' presented in front of the participant followed by the target face. Participants were asked to view photographs and identify the appropriate alternatives (anger, happiness, surprise, disgust, sadness, and fear). Participants can respond while the faces were presented. They were asked to response as quickly and accurately as possible. The presentation order for all six faces was initially randomised and this order was used for all participants. The task took approximately ten minutes to complete with the opportunity for a rest break after every trial. After the participants had completed this task, an accuracy score was calculated from the total correct responses where the maximum score was 6.

(2) The Emotion Discrimination Task: In the second task a set of stimuli consisted of black and white images of four adults (one male and three females) (Ekman & Friesen, 1976) posing six different expressions (anger, happiness, surprise, disgust, sadness, fear) was used. The faces of six basic emotions displayed a full-face pose, in which each face was paired with one neutral face to discriminate them. The emotion discrimination task involves the simultaneous presentation of these two faces of one individual, with expressing the two different emotions. Participants were asked to discriminate appropriately between two facial expressions. In this task, the emotion based faces that were shown, were paired with a neutral face for each condition such that if an emotional expression was the ''go'' target, then a neutral facial expression was the ''no go'' non target (i.e., neutral-anger, neutral-happiness, neutral-surprise, neutral-disgust, neutral-sadness, and neutral-fear). The task required participants to discriminate between two given facial expression. Facial stimuli were presented in form of paired images. Participants were instructed to specify which emotion expressing the two given faces. Subjects were not tell what the ''no go'' faces were and what the ''go'' faces. Participants were asked to respond as rapidly and correctly as possible. After that the procedure of stimulus presentation and response collection were continuously done. Presentation order for each image was initially randomised and the same presentation order was administered to all participants. The task took about 15 minutes to complete. A rest break was provided after each presentation of paired stimuli. An accuracy score was calculated from the total correct responses, where the maximum score was 6.

(3) The Expression Task- In the last task a set of stimuli which involved six emotionally evocative videotaped vignettes was used. The vignettes portray primarily six basic emotions as assessed by adults and child judges. Each emotion occurs briefly in vignettes and most of them are animated videotapes. In this task the six videotaped vignettes were presented on a Laptop. Participants were rated on five point scale after watching that how much they properly express their emotions towards the videotapes, which aroused such emotions. The task began with the process of one-by-one presentation of videotaped vignettes in front of participants. Children individually viewed six emotionally evocative videotaped vignettes and then the children were individually rated on five point scale after watching all vignettes. Each video was based on different emotion. They were then asked whether they themselves had felt (none, a little, average/medium, much, very much). The stimulus materials appear to be effective elicitors of emotion for most children. While children were watched the vignettes, their facial expression were scored by codes ranged from none=1, for a little=2, for medium=3, for much=4 to for very much=5. The presentation order of the 6 stimuli was initially randomised and then presented in this fixed order across participants. Overall, this task took around 30 minute to complete. Scores are calculated on the basis of rating scales obtained from the participant's responses, where the maximum score was 5.


The scores found on the responses on two emotion based task (i.e., emotion identification task and emotion discrimination tasks) were obtained in the form of frequency. Therefore, on the basis of these frequencies on six basic emotions two separate chi square were performed between encephalitis group and normal group. But the responses on third emotion based task (i.e., expression task) were obtained through 5 point rating scales, hence these responses were subjected to a one way between group ANOVA (group: encephalitis group and normal group) for six dependent variables namely (anger, happiness, surprise, disgust, sadness and fear).

Chi square results, (table 1) indicate that most frequency of respondents differed significantly. The frequency of the normal group was found to be higher than encephalitis group on six basic emotions namely (anger, happiness, surprise, disgust and sadness and fear). The frequency of groups (i.e., encephalitis group and normal group) was found to be significant at the level of four basic emotions (i.e., anger disgust, fear, surprise) which revealed that in comparison to normal group the encephalitis survivors have less identify these basic emotions.

A close perusal of Chi square result, (table 2) shows that the frequency of the two type of group differed significantly on discrimination in six basic emotions. The encephalitis group was found to be less discriminative on six basic emotions namely (anger, happiness surprise, disgust, sadness and fear). The result revealed that emotion discrimination was found greater in normal group in comparison to encephalitis group.

A close perusal of ANOVA result (table 6) indicated that respondents differed significantly on expression of six basic emotions. The main effect of group was found significant on four basic emotions namely anger [F (1, 59) = 7.22; P<.01]; happiness [F (1, 59) = 5.80; P<.01]; surprise [F (1, 59) = 7.59; P<.01]; and fear [F (1, 59) = 19.59; P<.01]. The mean values revealed that at these four basic emotions encephalitis survivors were less expressive than their normal counterparts.


The present study investigated various aspects of emotion regulation in children suffering from encephalitis and found significant deficits in recognizing and discriminating facial expressions of six basic emotions. In the present piece of work, effort made to know the emotion identification, emotion discrimination and expression in encephalitis survivors. It is supposed that in encephalitis survivors, emotion regulation have been affected in comparison to normal group, and the findings of the study suggested it may be the fact. A close perusal of results indicated that encephalitis group and normal group differed on three emotion based task. The first task which was used to measure the identification of six basic emotions was emotion identification task on which the normal group was found to be better than encephalitis group that is supported on the basis of present results. Similarly in the second task regarding emotion discrimination the encephalitis group were poorly performed. In comparison to normal group the encephalitis group was less discriminate between two emotion based faces. Likewise in the third task namely expression task the results shows that in comparison to normal group the encephalitis group have less expressive.

It is significant that the normal group children have shown more desire for identify the six basic emotions than encephalitis group children. It is also shown that in comparison to encephalitis group the normal group interestingly discriminate between two emotion based faces and express their emotions appropriately This may be the cause of impairments in emotion regulation of encephalitis survivors. To put it briefly, the deficits in emotion regulation make it meaningful to seem more intimately at this type of impairment in a larger group of people suffering from antibody associated encephalitis. It may well be that impaired emotion processing shapes a foundation symptom of this disorder in calculation to the well-described memory deficits (Vollmer et al., 1993). A great number of dissimilar structures take part in identifying the emotion shown in a face: the occipito-temporal cortices, amygdala, orbitofrontal cortex, basal ganglia, and right parietal cortices, along with others. These structures are involved in various processes and at different points in occasion, making it hard to consign a particular utility to a structure. Areas of the occipital and posterior temporal visual cortices take part a significant function in perceptual processing of emotionally pertinent visual stimuli. Converging neuroscience studies have revealed that specific brain regions are concerned in the dispensation of faces for instance the fusiform gyrus and superior temporal sulcus. Discriminatory impairments in identifying facial emotions devoid of a deficit in facial identity, and on the contrary, have been accounted demonstrating that dissimilar features of faces are processed in detach neural subsystems. Numerous studies with imaging techniques have also examined these features of face identification in humans, and recommended a spatial and temporal dissociation in the processing of identity and emotion. Additional disconnection of neural networks has been verified for processing particular facial emotions, with the concerned regions together with cortical (prefrontal, frontal and orbito-frontal cortices, occipito-temporal junction, cingulate cortex and secondary somatosensory cortex) and subcortical structures (amygdale, basal ganglia and insula). The amygdala has often been connected with processing fearful faces and sad faces, whereas the cingulated sulcus is triggered by happy faces. A another study investigating the neural substrate of identifying sad faces recommends a contribution of the temporal pole and the amygdala (Blair et al., 1999) Happiness is the largely identified expression. According to the norms established by Ekman and Friesen (1976), mean accuracy for identification of facial expressions of happiness reaches 100% (Young, Hellawell, Van De Wal, & Johnson, 1996). Thus far, most participants of normal group as well as the encephalitis group have not displayed problems in identifying joyful facial expressions (e.g. Adolphs, Damasio, Tranel, & Damasio, 1996). Different neural structures have been concerned in the perception of joyful facial expressions, together with the basal ganglia (Morris et al., 1996; Morris et al., 1998), inferior/orbitofrontal cortex (Dolan et al., 1996; Gorno-Tempini et al., 2001), anterior cingulate cortex (Dolan et al., 1996; Kesler-West et al., 2001) and the amygdala (Breiter, Etcoff et al., 1996; Pessoa et al., 2002; Winston, et al., 2003; Yang et al., 2002). Functional imaging studies have pointed to creation of different neural structures for the period of perceiving of joyful faces. Therefore, evidence regarding neural correlates of perceiving facial expressions of happiness and sadness is fewer precise. Findings from functional imaging studies are revealing implementation of the orbitofrontal and cingulate cortex (Blair et al.,1999; Sprengelmeyer et al., 1998) for the period of the expression of anger. Disgust seems to stimulate preferentially basal ganglia and insula. On the other hand, the neural substrate implicated in the recognition of surprise and its implication to the viewer has not yet been investigated. Until now, no major studies have determined on the neural correlates connected with the identification of surprised facial expressions. However, findings of some previous studies shows that identification of surprised facial expressions involves the medial temporal lobes, which have been concerned earlier in the reaction to contextually new or unique stimuli (Gabrieli et al., 1997; Stern et al., 1996). Therefore the identification of facial expressions of surprise in others may be associated to recognition or assessment of new stimuli in the surroundings, which is thought of as an early step in memory formation sub served by the parahippocampal area (Fernandez et al., 1998). A large amount of proceeding studies advocate confirmation dissociation as well as an overlapping of the cerebral structures implicated in processing diverse facial emotions. Moreover, these findings sustain the notion of partially different neural system for identifying altered emotional facial expressions.

Though, further studies are essential to maintain this assert. Hence earlier findings mentioned that if deficits in emotion regulation turn out to be symptomatic for Encephalitis, it has been recommended that feasible deficits in emotion regulation should be assessed usually for optimal social adjustment of these survivors. The findings of main effect between encephalitis group and normal group have significant effect on six basic emotions. These results support to the result of (Ekman and Friesen 1976) in some attends.


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Nisha Kumari (*)

(*) Research Scholar, Department of Psychology, D.D.U. Gorakhpur University, Gorakhpur- 273009., India

Received : November 18,2017

Revised Februarys 13,2018

Accepted : March 19, 2018
Table 1: Frequency and Chi square for Emotion Identification

Emotion                  Frequency
           Encephalitis  Normal  [chi square]
           (N=30)        (N=30)

Happiness  27            28       .21
Sadness    24            26       .48
Anger      17            29      13.4 (**)
Disgust    16            28      12.26 (**)
Fear        8            25      19.44 (**)
Surprise    7            22      14.98 (**)

(**) p<.01

Table 2: Frequency and Chi square for Emotion Discrimination

Emotion                  Frequency
           Encephalitis  Normal  [chi square]
           (N=30)        (N=30)

Happiness  25            30       5.44 (*)
Sadness    23            28       3.24 (*)
Anger      17            26       6.64 (**)
Disgust    17            23       3.56 (*)
Fear        9            24      15.12 (**)
Surprise    7            17       6.92 (**)

(*) p<.05, (**) p<.01

Table 3: Mean, SD and F Value of Emotion expressions as a function of

           Encephalitis Group   Normal Group
Dependent  (N=30)              (N=30)         F
Variable   Mean    S.D         Mean  S.D

Anger      .56     .50          .86  .34       7.22 (**)
Happiness  .83     .37         1.00  .00       5.80 (**)
Surprise   .23     .43          .56  .50       7.59 (**)
Disgust    .53     .50          .76  .43      NS
Sadness    .76     .43          .93  .25      NS
Fear       .30     .46          .80  .40      19.59 (**)

N=60, (**) P<.01
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Author:Kumari, Nisha
Publication:Indian Journal of Community Psychology
Date:Sep 1, 2018
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