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Achim AM, Knutsen D, Roy MA, Gadio S, Fossard M. Use of reference markers in the speech of people with schizophrenia spectrum disorders: Evidence from two referential communication tasks manipulating common ground with the interaction partner. Schizophr Res Cogn 2025; 40:100343. [PMID: 39867750 PMCID: PMC11763843 DOI: 10.1016/j.scog.2024.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 12/20/2024] [Accepted: 12/26/2024] [Indexed: 01/28/2025]
Abstract
Introduction People with schizophrenia spectrum disorders present with language dysfunctions, yet we know little about their use of reference markers (indefinite markers, definite markers, pronouns or names), a fundamental aspect of efficient speech production. Methods Twenty-five (25) participants with a recent-onset schizophrenia spectrum disorder (SZ) and 25 healthy controls (HC) completed two referential communication tasks. The tasks involved presenting to an interaction partner a series of movie characters (character identification task) and movie scenes composed of six images (narration task). A manipulation was introduced such that half of the movies could be considered as Likely-Known by the interaction partner, whereas the other half was Likely-Unknown. The analyses focused on the reference markers used to present the movie characters during the tasks. Results During the character identification task, the SZ group used fewer names and more pronouns than the HC. During the narration task, the SZ group used fewer names and more definite references when initially introducing the main story characters, while no group effect emerged for subsequent mentions of the characters. The observed effects of conditions were generally present across both groups, except for a lesser adjustment in the use of definite markers when introducing the story characters. Conclusions While some group differences emerged, people with SZ were generally sensitive to the manipulation regarding their interaction partner's likely knowledge of the characters. A better understanding of the conditions in which speech production is affected in SZ could help promote more efficient communication.
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Affiliation(s)
- Amélie M. Achim
- Département de Psychiatrie et neurosciences, Université Laval, Centre de recherche VITAM and Centre de recherche CERVO, 2480, de la Canardière, Québec, QC G1J 2G3, Canada
| | - Dominique Knutsen
- Univ. Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, F-59000 Lille, France
| | - Marc-André Roy
- Département de Psychiatrie et neurosciences, Université Laval, Centre de recherche CERVO, 2525, chemin de la Canardière, Québec, QC G1J 2G3, Canada
| | - Souleymane Gadio
- Centre de recherche VITAM, 2480, de la Canardière, Québec, QC G1J 2G3, Canada
| | - Marion Fossard
- Institut des sciences logopédiques, Université de Neuchâtel, Rue Pierre-à-Mazel 7, CH-2000 Neuchâtel, Switzerland
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de Lacy N, Ramshaw MJ. Predicting new onset thought disorder in early adolescence with optimized deep learning implicates environmental-putamen interactions. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.23.23297438. [PMID: 37961085 PMCID: PMC10635181 DOI: 10.1101/2023.10.23.23297438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Background Thought disorder (TD) is a sensitive and specific marker of risk for schizophrenia onset. Specifying factors that predict TD onset in adolescence is important to early identification of youth at risk. However, there is a paucity of studies prospectively predicting TD onset in unstratified youth populations. Study Design We used deep learning optimized with artificial intelligence (AI) to analyze 5,777 multimodal features obtained at 9-10 years from youth and their parents in the ABCD study, including 5,014 neural metrics, to prospectively predict new onset TD cases at 11-12 years. The design was replicated for all prevailing TD cases at 11-12 years. Study Results Optimizing performance with AI, we were able to achieve 92% accuracy and F1 and 0.96 AUROC in prospectively predicting the onset of TD in early adolescence. Structural differences in the left putamen, sleep disturbances and the level of parental externalizing behaviors were specific predictors of new onset TD at 11-12 yrs, interacting with low youth prosociality, the total parental behavioral problems and parent-child conflict and whether the youth had already come to clinical attention. More important predictors showed greater inter-individual variability. Conclusions This study provides robust person-level, multivariable signatures of early adolescent TD which suggest that structural differences in the left putamen in late childhood are a candidate biomarker that interacts with psychosocial stressors to increase risk for TD onset. Our work also suggests that interventions to promote improved sleep and lessen parent-child psychosocial stressors are worthy of further exploration to modulate risk for TD onset.
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Affiliation(s)
- Nina de Lacy
- Huntsman Mental Health Institute, Salt Lake City, UT 84103
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84103
| | - Michael J. Ramshaw
- Huntsman Mental Health Institute, Salt Lake City, UT 84103
- Department of Psychiatry, University of Utah, Salt Lake City, UT 84103
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Chaves MF, Rodrigues C, Ribeiro S, Mota NB, Copelli M. Grammatical impairment in schizophrenia: An exploratory study of the pronominal and sentential domains. PLoS One 2023; 18:e0291446. [PMID: 37699027 PMCID: PMC10497169 DOI: 10.1371/journal.pone.0291446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023] Open
Abstract
Schizophrenia (SZ) is a severe mental disorder associated with a variety of linguistic deficits, and recently it has been suggested that these deficits are caused by an underlying impairment in the ability to build complex syntactic structures and complex semantic relations. Aiming at contributing to determining the specific linguistic profile of SZ, we investigated the usage of pronominal subjects and sentence types in two corpora of oral dream and waking reports produced by speakers with SZ and participants without SZ (NSZ), both native speakers of Brazilian Portuguese. Narratives of 40 adult participants (20 SZ, and 20 NSZ-sample 1), and narratives of 31 teenage participants (11 SZ undergoing first psychotic episode, and 20 NSZ-sample 2) were annotated and statistically analyzed. Overall, narratives of speakers with SZ presented significantly higher rates of matrix sentences, null pronouns-particularly null 3Person referential pronouns-and lower rates of non-anomalous truncated sentences. The high rate of matrix sentences correlated significantly with the total PANSS scores, suggesting an association between the overuse of simple sentences and SZ symptoms in general. In contrast, the high rate of null pronouns correlated significantly with positive PANSS scores, suggesting an association between the overuse of null pronominal forms and the positive symptoms of SZ. Finally, a cross-group analysis between samples 1 and 2 indicated a higher degree of grammatical impairment in speakers with multiple psychotic episodes. Altogether, the results strengthen the notion that deficits at the pronominal and sentential levels constitute a cross-cultural linguistic marker of SZ.
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Affiliation(s)
- Monica F. Chaves
- Department of Letters and Literature, Pontifical Catholic University of Rio de Janeiro, PUC-Rio, Rio de Janeiro, RJ, Brazil
| | - Cilene Rodrigues
- Department of Letters and Literature, Pontifical Catholic University of Rio de Janeiro, PUC-Rio, Rio de Janeiro, RJ, Brazil
| | - Sidarta Ribeiro
- Brain Institute, Federal University of Rio Grande do Norte, UFRN, Natal, RN, Brazil
| | - Natália B. Mota
- Department of Psychiatry, Federal University of Rio de Janeiro, UFRJ, Rio de Janeiro, RJ, Brazil
| | - Mauro Copelli
- Department of Physics, Federal University of Pernambuco, UFPE, Recife, PE, Brazil
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Achim AM, Roy MA, Fossard M. The other side of the social interaction: Theory of mind impairments in people with schizophrenia are linked to other people's difficulties in understanding them. Schizophr Res 2023; 259:150-157. [PMID: 35906170 DOI: 10.1016/j.schres.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND People with schizophrenia (SZ) often present with theory of mind (ToM) deficits and with speech production deficits. While a link has been established between ToM abilities and symptoms of thought disorder, much less is known about other aspects of speech production in SZ. STUDY DESIGN This is a case-control study in which 25 stable outpatients with recent-onset SZ (27.1 years, 22 men) and 22 matched healthy controls (25.6 years, 16 men) performed a collaborative, verbal production task with a real interaction partner. Blind raters scored how easy participants made it to understand them (Facility ratings), how interesting they were to listen to (Interest ratings) and how expressive they were (Expressivity ratings). ToM was assessed with the Combined Stories Test and Sarfati's cartoon task. Symptoms were assessed with the PANSS five-factor version. STUDY RESULTS Compared to healthy controls, SZ received significantly lower ratings for all three aspects of their verbal productions (Facility, Interest and Expressivity), despite the raters being blind to group membership. Interestingly, the Facility ratings were linked to ToM performance in the SZ group, which suggest that SZ participants who have difficulties understanding others (ToM deficits) also make it harder for others to understand them. Other notable findings include a strong link between the Expressivity ratings and the Interest ratings for both groups, and significant correlations between the Facility ratings and Cognitive/Disorganisation symptoms, and between the Expressivity ratings and both Negative and Depression/Anxiety symptoms in SZ. CONCLUSION Studying speech production during real, collaborative social interactions could help move beyond the individual approach to SZ deficits, making it possible to involve the interaction partners to promote more efficient communication for people with schizophrenia.
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Affiliation(s)
- Amélie M Achim
- Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, (room 4873), 1050, avenue de la Médecine, Quebec City G1V 0A6, QC, Canada; Centre de recherche CERVO, 2601, de la Canardière, Quebec City G1J 2G3, QC, Canada.
| | - Marc-André Roy
- Département de psychiatrie et neurosciences, Université Laval, Pavillon Ferdinand-Vandry, (room 4873), 1050, avenue de la Médecine, Quebec City G1V 0A6, QC, Canada; Centre de recherche CERVO, 2601, de la Canardière, Quebec City G1J 2G3, QC, Canada
| | - Marion Fossard
- Institut des sciences logopédiques, Université de Neuchâtel, Rue Pierre-à-Mazel 7, CH-2000 Neuchâtel, Switzerland
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Zhang H, Parola A, Zhou Y, Wang H, Bliksted V, Fusaroli R, Hinzen W. Linguistic markers of psychosis in Mandarin Chinese: Relations to theory of mind. Psychiatry Res 2023; 325:115253. [PMID: 37245483 DOI: 10.1016/j.psychres.2023.115253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/30/2023]
Abstract
Disorganized and impoverished language is a key feature of schizophrenia (Sz), but whether and which linguistic changes previously observed in Indo-European languages generalize to other languages remains unclear. Targeting Mandarin Chinese, we aimed to profile aspects of grammatical complexity that we hypothesized would be reduced in schizophrenia in a task of verbalizing social events. 51 individuals with Sz and 39 controls participated in the animated triangles task, a standardized measure of theory of mind (ToM), in which participants describe triangles moving in either a random or an 'intentional' condition. Results revealed that clauses embedded as arguments in other clauses were reduced in Sz, and that both groups produced such clauses and grammatical aspect more frequently in the intentional condition. ToM scores specifically correlated with production of embedded argument clauses. These results document grammatical impoverishment in Sz in Chinese across several structural domains, which in some of its specific aspects relate to mentalizing performance.
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Affiliation(s)
- Han Zhang
- Department of Translation and Language Sciences, Universitat Pompeu Fabra, Carrer de Roc Boronat, 138, Barcelona 08018, Spain.
| | - Alberto Parola
- Department of Linguistics, Semiotics and Cognitive Science, Aarhus University, Aarhus, Denmark; The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark
| | - Yuan Zhou
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Huiling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Vibeke Bliksted
- The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark; Psychosis Research Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Riccardo Fusaroli
- Department of Linguistics, Semiotics and Cognitive Science, Aarhus University, Aarhus, Denmark; The Interacting Minds Centre, Institute of Culture and Society, Aarhus University, Aarhus, Denmark; Linguistic Data Consortium, University of Pennsylvania, Philadelphia, USA
| | - Wolfram Hinzen
- Department of Translation and Language Sciences, Universitat Pompeu Fabra, Carrer de Roc Boronat, 138, Barcelona 08018, Spain; Catalan Institute for Advanced Studies and Research (ICREA), Barcelona, Spain
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Achim AM, Achim A, Fossard M. Referential communication in people with recent-onset schizophrenia-spectrum disorders. Front Psychiatry 2022; 13:971256. [PMID: 36159951 PMCID: PMC9500190 DOI: 10.3389/fpsyt.2022.971256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022] Open
Abstract
People with schizophrenia present with language production impairments, yet very few studies examine language production in the context of collaborative, verbal interaction tasks performed with a real interaction partner. The current study relied on a referential communication paradigm in which participants with schizophrenia (SZ) and healthy controls (HC) presented a series of movie characters to their interaction partner, whose role was to identify and place the characters in the same order. The HC spontaneously provided more information when presenting characters that their interaction partner was unlikely to know than when presenting very well-known characters, and the magnitude of this adjustment was positively correlated with their performance on a theory of mind task. In contrast, people with SZ showed a significantly reduced (absent) adjustment to the likely-known vs. likely-unknown nature of the characters, and no correlation emerged with ToM. Further examination of the verbal productions revealed that HC often combined movie-related information (ex: character's name or movie title) and descriptive information whereas people with SZ more often used description only to present the characters. Overall, this study adds to our knowledge about referential choices in SZ in the context of collaborative verbal interactions with a real interaction partner.
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Affiliation(s)
- Amélie M Achim
- Département de Psychiatrie et Neurosciences, Université Laval, Québec, QC, Canada.,Centre de Recherche CERVO and Centre de Recherche VITAM, Québec, QC, Canada
| | - André Achim
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Marion Fossard
- Institut des Sciences Logopédiques, Université de Neuchâtel, Neuchâtel, Switzerland
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Srivastava J, Sinha V, Ketteler D, Jagtiani A. High-Order Language Processing Difficulties in Patients With Schizophrenia: Cross-linguistic and Cross-cultural Results From the Hindi Version of a Newly Developed Language Test. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac029. [PMID: 39144804 PMCID: PMC11319873 DOI: 10.1093/schizbullopen/sgac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Objective To detect subtle linguistic performance deficits in patients with schizophrenia, a test battery was developed in Hindi vernacular language. Method It was a replication study of observational, analytical, and case-control design. Total of 86 participants, namely 43 patients with schizophrenia and 43 controls, were recruited into the study. The patients were evaluated by using PANSS (positive and negative symptoms scale for schizophrenia) for recruitment into the study. Participants from the general population were evaluated with GHQ-12 (General Health Questionnaire-12) to be found to fit as healthy controls. Subsequently, the linguistic performance of patients (on HLFT: Hindi linguistic function test) was compared with that of controls. The HLFT battery was designed, containing 3 blocks by using antonyms, synonyms, homonyms, hyperonyms, hyponyms, distractors, and adages. Result Patients scored significantly less than that of controls in identifying antonyms, distractors, and hyponyms while in identifying homonyms they scored significantly more than that of controls. At block I (antonyms) score of 15.5; at homonym score of 5.5; at hyponym (as in hyponym plus distractor combination) score of 2.5, the sensitivity and specificity for using them as a cutoff to screen for schizophrenia are 60.5% and 67.4%; 86% and 41.9%; 81.4% and 46.5%, respectively. Conclusion Ambiguity processing of taxonomic representation such as antonymia, homonymia, hypo-/hyperonymia, synonymia, and also understanding of adages might be significantly impaired in patients with schizophrenia. The HLFT battery could be used as a quick and sensitive instrument to detect and quantify the linguistic difficulties of patients with schizophrenia.
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Affiliation(s)
- Jayesh Srivastava
- Department of Psychiatry, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - Vishal Sinha
- Department of Psychiatry, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
| | - Daniel Ketteler
- Department of Social Work, Medical School Berlin, Berlin, Germany
| | - Amit Jagtiani
- Department of Psychiatry, Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India
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Pawełczyk A, Łojek E, Żurner N, Gawłowska-Sawosz M, Gębski P, Pawełczyk T. The correlation between white matter integrity and pragmatic language processing in first episode schizophrenia. Brain Imaging Behav 2021; 15:1068-1084. [PMID: 32710335 PMCID: PMC8032571 DOI: 10.1007/s11682-020-00314-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: Higher-order language disturbances could be the result of white matter tract abnormalities. The study explores the relationship between white matter and pragmatic skills in first-episode schizophrenia. Methods: Thirty-four first-episode patients with schizophrenia and 32 healthy subjects participated in a pragmatic language and Diffusion Tensor Imaging study, where fractional anisotropy of the arcuate fasciculus, corpus callosum and cingulum was correlated with the Polish version of the Right Hemisphere Language Battery. Results: The patients showed reduced fractional anisotropy in the right arcuate fasciculus, left anterior cingulum bundle and left forceps minor. Among the first episode patients, reduced understanding of written metaphors correlated with reduced fractional anisotropy of left forceps minor, and greater explanation of written and picture metaphors correlated with reduced fractional anisotropy of the left anterior cingulum. Conclusions: The white matter dysfunctions may underlie the pragmatic language impairment in schizophrenia. Our results shed further light on the functional neuroanatomical basis of pragmatic language use by patients with schizophrenia.
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Affiliation(s)
- Agnieszka Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland.
| | | | - Natalia Żurner
- Adolescent Ward, Central Clinical Hospital of Medical University of Łódź, Łódź, Poland
| | | | - Piotr Gębski
- Scanlab Diagnostyka Medyczna Księży Młyn, Medical Examination Centre, Medical University of Łódź, Łódź, Poland
| | - Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Łódź, Łódź, Poland
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Dwyer K, David AS, McCarthy R, McKenna P, Peters E. Linguistic alignment and theory of mind impairments in schizophrenia patients' dialogic interactions. Psychol Med 2020; 50:2194-2202. [PMID: 31500678 DOI: 10.1017/s0033291719002289] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impairments of contextual processing and theory of mind (ToM) have both been offered as accounts of the deviant language characterising formal thought disorder (FTD) in schizophrenia. This study investigated these processes in patients' dialogue. We predicted that FTD patients would show a decrement in linguistic alignment, associated with impaired ToM in dialogue. METHODS Speech samples were elicited via participation in an interactive computer-based task and a semi-structured interview to assess contextual processing abilities and ToM skills in dialogue, respectively, and from an interactive card-sorting task to measure syntactic alignment. Degree of alignment in dialogue and the syntactic task, and evidence of ToM in (i) dialogue and (ii) a traditional ToM task were compared across schizophrenia patients with FTD (n = 21), non-FTD patients (n = 22) and healthy controls (n = 21). RESULTS FTD patients showed less alignment than the other two groups in dialogue, and than healthy controls on the syntactic task. FTD patients showed poorer performance on the ToM task than the other two groups, but only compared to the healthy controls in dialogue. The FTD group's degree of alignment in dialogue was correlated with ToM performance in dialogue but not with the traditional ToM task or with syntactic alignment. CONCLUSIONS In dialogue, FTD patients demonstrate an impairment in employing available contextual information to facilitate their own subsequent production, which is associated with a ToM deficit. These findings indicate that a contextual processing deficit impacts on exploiting representations via the production system impoverishing the ability to make predictions about upcoming utterances in dialogue.
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Affiliation(s)
- Karen Dwyer
- Department of English Language and Literature, University College London, London, UK
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Anthony S David
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Institute of Mental Health, University College London, London, UK
| | - Rosaleen McCarthy
- Department of Psychology, University of Southampton, Southampton, UK
- Wessex Neurological Centre, Southampton General Hospital, Southampton University Hospital Trust, Tremona Road, Southampton, UK
| | - Peter McKenna
- FIDMAG Research Foundation, Germanes Hospitalàries, Barcelona, Spain
- CIBERSAM, Madrid , Spain
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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Warren N, Flavell J, O'Gorman C, Swayne A, Blum S, Kisely S, Siskind D. Screening for anti-NMDAR encephalitis in psychiatry. J Psychiatr Res 2020; 125:28-32. [PMID: 32203736 DOI: 10.1016/j.jpsychires.2020.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/02/2020] [Accepted: 03/13/2020] [Indexed: 12/19/2022]
Abstract
Anti-NMDAR encephalitis most commonly presents to psychiatric services, so early identification of this disorder is essential. We aim to validate the two screening criteria (Scott et al. and Herken and Pruss) which have been proposed to identify first episode psychosis patients who should have anti-NMDAR antibody testing. The performance of the screening criteria were assessed using anti-NMDAR encephalitis cases published in the literature, and antibody positive and negative cases from a state-wide cohort (Queensland, Australia). Sensitivity, specificity and area under receiver operator characteristic curve analysis was performed. There were 258 anti-NMDAR encephalitis cases and 103 control cases, which demonstrated high performance of both Scott et al. "screening recommended" criteria (sensitivity 97.3%, specificity 85.4%, AUC 0.914) and Herken and Pruss "yellow flags" criteria (sensitivity 91.5%, specificity 83.5%, AUC 0.875). These criteria remained accurate when neurological variables were excluded, and in cases without psychosis. The Scott et al. "screening not recommended", and Herken and Pruss "red flags" criteria did not demonstrate clinical utility for first episode psychosis case screening. The screening criteria with good performance identify an atypical picture of psychiatric presentation with increased risk of anti-NMDAR positivity prior to overt neurological symptoms or investigations and may be beneficial to include in the routine psychiatric assessment process.
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Affiliation(s)
- Nicola Warren
- Metro South Addiction and Mental Health, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Joshua Flavell
- Metro South Addiction and Mental Health, Brisbane, Australia
| | - Cullen O'Gorman
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia; Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia
| | - Andrew Swayne
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia; Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia
| | - Stefan Blum
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia; Mater Centre for Neurosciences, Mater Hospital, Brisbane, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
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Marggraf MP, Lysaker PH, Salyers MP, Minor KS. The link between formal thought disorder and social functioning in schizophrenia: A meta-analysis. Eur Psychiatry 2020; 63:e34. [PMID: 32200776 PMCID: PMC7355127 DOI: 10.1192/j.eurpsy.2020.30] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/26/2020] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Formal thought disorder (FTD) and social functioning impairments are core symptoms of schizophrenia. Although both have been observed for over a century, the strength of the relationship between FTD and social functioning remains unclear. Furthermore, a variety of methodological approaches have been used to assess these constructs-which may contribute to inconsistency in reported associations. This meta-analysis aimed to: (a) systematically test the relationship between FTD and social functioning and (b) determine if the methodology used to assess FTD and/or social functioning moderates this relationship. METHODS Following Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a targeted literature search was conducted on studies examining the relationship between FTD and social functioning. Correlations were extracted and used to calculate weighted mean effect sizes using a random effects model. RESULTS A total of 1,478 participants across 13 unique studies were included in this meta-analysis. A small-medium inverse association (r = -0.23, p < 0.001) was observed between FTD and social functioning. Although heterogeneity analyses produced a significant Q-statistic (Q = 52.77, p = <0.001), the relationship between FTD and social functioning was not moderated by methodology, study quality, demographic variables, or clinical factors. CONCLUSIONS Findings illustrate a negative association between FTD and social functioning. Despite differences in the methodological approach used and type of information assessed, measurement type and clinical factors did not moderate the relationship between FTD and social functioning. Future studies should explore whether other variables, such as cognitive processes (e.g., social cognition), may account for variability in associations between these constructs.
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Affiliation(s)
- Matthew P. Marggraf
- Department of Psychology, Indiana University Purdue University—Indianapolis, Indianapolis, Indiana, USA
| | - Paul H. Lysaker
- Department of Psychology, Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University Purdue University—Indianapolis, Indianapolis, Indiana, USA
| | - Kyle S. Minor
- Department of Psychology, Indiana University Purdue University—Indianapolis, Indianapolis, Indiana, USA
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Bora E, Yalincetin B, Akdede BB, Alptekin K. Neurocognitive and linguistic correlates of positive and negative formal thought disorder: A meta-analysis. Schizophr Res 2019; 209:2-11. [PMID: 31153670 DOI: 10.1016/j.schres.2019.05.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 12/31/2022]
Abstract
Executive dysfunction and language impairment are the most prominent neuropsychological models of formal thought disorder (FTD) in schizophrenia. However, available studies have provided contradictory findings regarding the accuracy of these models. Furthermore, specific neurocognitive underpinnings of positive FTD (PosFTD) and negative FTD (NegFTD) are not clear. Following the systematic review of schizophrenia studies, a random-effects meta-analysis of the relationship between FTD and neurocognition/language in schizophrenia was conducted in 52 reports including 2805 patients. Neurocognition was significantly associated with both PosFTD (r = -0.21, CI = -0.14 to -0.27) and NegFTD (r = -0.24, CI = -0.18 to -0.30). Both PosFTD (r = ranged from -0.18 to -0.27) and NegFTD (r = ranged from -0.19 to -0.23) were significantly correlated with verbal memory, visual memory, attention, and processing speed. In meta-analyses of executive functions, PosFTD was significantly associated with working memory (r = -0.21), planning (r = -0.19), and inhibition (r = -0.21) and NegFTD was significantly associated with planning (r = -0.27), fluency (r = -0.27), and working memory (r = -0.24). In meta-analyses of linguistic variables, PosFTD was associated with deficits in syntactic comprehension (r = -0.27) and semantic processing (r = -0.18). In contrast, NegFTD was associated only with semantic comprehension (r = -0.21). Both PosFTD and NegFTD were significantly associated with executive dysfunction, neurocognitive deficits and semantic dysfunction but syntactic deficits were more specific to PosFTD. There were also some distinct patterns of relationships between the pattern of executive dysfunction and types of FTD. Fluency deficit was associated more strongly with NegFTD and poor inhibition was more specifically related to PosFTD. Current findings suggest that neurocognitive and linguistic correlates of PosFTD and NegFTD might be partly different.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir 35340, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia.
| | - Berna Yalincetin
- Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey
| | - Berna Binnur Akdede
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir 35340, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir 35340, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey
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13
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Pawełczyk A, Kotlicka-Antczak M, Łojek E, Pawełczyk T. Preliminary study of higher-order language and extralinguistic impairments in individuals with high clinical risk of psychosis and first episode of schizophrenia. Early Interv Psychiatry 2019; 13:369-378. [PMID: 28857488 DOI: 10.1111/eip.12482] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/09/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022]
Abstract
AIM Higher-order language functions are associated with understanding indirect speech acts, lexical-semantic processes, the understanding and production of prosody, discourse production and comprehension. Only a few studies imply that language abnormalities may be present in individuals at ultra-high risk for psychosis (UHR) and first-episode of schizophrenia (FE). The purpose of this study was to test the presence of higher-order language dysfunctions in UHR and FE subjects using a standardized comprehensive test battery. METHODS Twenty patients experiencing FE schizophrenia, 33 UHR individuals and 20 healthy controls (HC) took part in the study. Higher-order language and extralinguistic abilities were evaluated using the Right Hemisphere Language Battery (RHLB-PL). The battery consisted of tests covering the comprehension of implicit information, lexico-semantic processing, understanding humour, making inappropriate remarks and comments, understanding and explaining metaphors, understanding prosody and appropriateness of behaviour in communication settings. RESULTS The UHR patients scored lower than HC when comprehending implicit information, discourse and in areas associated with the effectiveness of interpersonal communication; however, they scored higher than the FE participants in explanation of metaphors and processing language information in the context of general knowledge. The FE participants scored lower than healthy controls in comprehension of implicit information, explanation of metaphors, discourse understanding, processing language information in the context of general knowledge and effectiveness of interpersonal communication. CONCLUSIONS The higher-order language dysfunctions mediated by the right hemisphere appear to be present in subjects at UHR of schizophrenia and those experiencing their FE. The results may play a crucial role in diagnostic processes.
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Affiliation(s)
- Agnieszka Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Magdalena Kotlicka-Antczak
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Emila Łojek
- Chair of Neuropsychology, Department of Cognitive Neuropsychology, University of Warsaw, Warsaw, Poland
| | - Tomasz Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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14
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Minor KS, Willits JA, Marggraf MP, Jones MN, Lysaker PH. Measuring disorganized speech in schizophrenia: automated analysis explains variance in cognitive deficits beyond clinician-rated scales. Psychol Med 2019; 49:440-448. [PMID: 29692287 DOI: 10.1017/s0033291718001046] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Conveying information cohesively is an essential element of communication that is disrupted in schizophrenia. These disruptions are typically expressed through disorganized symptoms, which have been linked to neurocognitive, social cognitive, and metacognitive deficits. Automated analysis can objectively assess disorganization within sentences, between sentences, and across paragraphs by comparing explicit communication to a large text corpus. METHOD Little work in schizophrenia has tested: (1) links between disorganized symptoms measured via automated analysis and neurocognition, social cognition, or metacognition; and (2) if automated analysis explains incremental variance in cognitive processes beyond clinician-rated scales. Disorganization was measured in schizophrenia (n = 81) with Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Trained staff also assessed neurocognition, social cognition, metacognition, and clinician-rated disorganization. RESULTS Findings showed that all three cognitive processes were significantly associated with at least one automated index of disorganization. When automated analysis was compared with a clinician-rated scale, it accounted for significant variance in neurocognition and metacognition beyond the clinician-rated measure. When combined, these two methods explained 28-31% of the variance in neurocognition, social cognition, and metacognition. CONCLUSIONS This study illustrated how automated analysis can highlight the specific role of disorganization in neurocognition, social cognition, and metacognition. Generally, those with poor cognition also displayed more disorganization in their speech-making it difficult for listeners to process essential information needed to tie the speaker's ideas together. Our findings showcase how implementing a mixed-methods approach in schizophrenia can explain substantial variance in cognitive processes.
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Affiliation(s)
- K S Minor
- Department of Psychology,Indiana University- Purdue University Indianapolis,Indianapolis, IN,USA
| | - J A Willits
- Department of Psychology,University of California-Riverside,Riverside, CA,USA
| | - M P Marggraf
- Department of Psychology,Indiana University- Purdue University Indianapolis,Indianapolis, IN,USA
| | - M N Jones
- Department of Psychology,Indiana University,Bloomington, IN,USA
| | - P H Lysaker
- Roudebush VA Medical Center,Indianapolis, IN,USA
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15
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de Sousa P, Sellwood W, Griffiths M, Bentall RP. Disorganisation, thought disorder and socio-cognitive functioning in schizophrenia spectrum disorders. Br J Psychiatry 2019; 214:103-112. [PMID: 30139394 DOI: 10.1192/bjp.2018.160] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poor social cognition is prevalent in schizophrenia spectrum disorders. Some authors argue that these effects are symptom-specific and that socio-cognitive difficulties (e.g. theory of mind) are strongly associated with thought disorder and symptoms of disorganisation.AimsThe current review tests the strength of this association. METHOD We meta-analysed studies published between 1980 and 2016 that tested the association between social cognition and these symptoms in schizophrenia spectrum disorders. RESULTS Our search (PsycINFO, MEDLINE and Web of Science) identified 123 studies (N = 9107). Overall effect size as r = -0.313, indicating a moderate association between symptoms and social cognition. Subanalyses yielded a moderate association between symptoms and theory of mind (r = -0.349) and emotion recognition (r = -0.334), but smaller effect sizes for social perception (r = -0.188), emotion regulation (r = -0.169) and attributional biases (r = -0.143). CONCLUSIONS The association is interpreted within models of communication that highlight the importance of mentalisation and processing of partner-specific cues in conversational alignment and grounding.Declaration of interestsNone.
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Affiliation(s)
- Paulo de Sousa
- Department of Clinical Psychology, University of Liverpool, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | | | - Richard P Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK
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Laere E, Tee SF, Tang PY. Assessment of Cognition in Schizophrenia Using Trail Making Test: A Meta-Analysis. Psychiatry Investig 2018; 15:945-955. [PMID: 30223641 PMCID: PMC6212701 DOI: 10.30773/pi.2018.07.22] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/10/2018] [Accepted: 07/22/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE The present meta-analysis aimed to analyze the cognitive performance of schizophrenia patients measured by Trail Making Tests (TMT) and the contribution of socio-demographic factors to cognitive impairments. METHODS PubMed and PsycARTICLES databases were searched for the studies published between January 1985 and November 2017. Data were drawn from 19 studies encompassing 1095 patients and 324 controls. The effect size and heterogeneity were assessed with Comprehensive Meta-Analysis version 2 using random-effect model. RESULTS Overall, the results showed that the schizophrenia patients performed significantly (p<0.001) worse than healthy controls in both TMT-A and B. However, concurrent substance abuse, clinical status (inpatient or outpatient), duration of education and duration of illness were not associated with cognitive impairment among the schizophrenia patients. CONCLUSION The present meta-analysis confirmed the cognitive processing speed and flexibility of schizophrenia patients were impaired. However, their duration of education, duration of illness and clinical status (inpatient or outpatient) were not the risk factors.
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Affiliation(s)
- Erna Laere
- Department of Chemical Engineering, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Shiau Foon Tee
- Department of Chemical Engineering, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Pek Yee Tang
- Department of Mechatronics and Biomedical Engineering, Universiti Tunku Abdul Rahman, Kajang, Malaysia
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Pawełczyk A, Łojek E, Żurner N, Gawłowska-Sawosz M, Pawełczyk T. Higher-order language dysfunctions as a possible neurolinguistic endophenotype for schizophrenia: Evidence from patients and their unaffected first degree relatives. Psychiatry Res 2018; 267:63-72. [PMID: 29885556 DOI: 10.1016/j.psychres.2018.05.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 05/21/2018] [Accepted: 05/26/2018] [Indexed: 12/30/2022]
Abstract
The purpose of the study was to examine the presence of pragmatic dysfunctions in first episode (FE) subjects and their healthy first degree relatives as a potential endophenotype for schizophrenia. Thirty-four FE patients, 34 parents of the patients (REL) and 32 healthy controls (HC) took part in the study. Pragmatic language functions were evaluated with the Right Hemisphere Language Battery, attention and executive functions were controlled, as well as age and education level. The parents differed from HC but not from their FE offspring with regard to overall level of language and communication and the general knowledge component of language processing. The FE participants differed from HC in comprehension of inferred meaning, emotional prosody, discourse dimensions, overall level of language and communication, language processing with regard to general knowledge and communication competences. The FE participants differed from REL regarding discourse dimensions. Our findings suggest that pragmatic dysfunctions may act as vulnerability markers of schizophrenia; their assessment may help in the diagnosis of early stages of the illness and in understanding its pathophysiology. In future research the adoptive and biological parents of schizophrenia patients should be compared to elucidate which language failures reflect genetic vulnerability and which ones environmental factors.
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Affiliation(s)
- Agnieszka Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Łódź, Poland.
| | - Emila Łojek
- Chair of Neuropsychology, Faculty of Psychology, University of Warsaw, Poland
| | - Natalia Żurner
- Chair of Psychiatry, Adolescent Ward, Central Clinical Hospital, Medical University of Łódź, Poland
| | | | - Tomasz Pawełczyk
- Chair of Psychiatry, Department of Affective and Psychotic Disorders, Medical University of Łódź, Poland
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18
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Park Y, Han K. Development and evaluation of a Communication Enhancement Program for People with Chronic Schizophrenia: A quasi-experimental pretest-posttest design study. Appl Nurs Res 2018; 42:1-8. [PMID: 30029708 DOI: 10.1016/j.apnr.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/01/2017] [Accepted: 04/18/2018] [Indexed: 11/27/2022]
Abstract
AIM This study aims to develop a Communication Enhancement Program for People with Chronic Schizophrenia (CEP-S), and to evaluate the effects of CEP-S. BACKGROUND People with chronic schizophrenia are characterized by core communication disturbances; therefore, a program to enhance their communication skills is necessary. As such, they are predicted to have difficulty fitting into society, such as relationships with people, due to issues such as having normal communication with others. Therefore, a program to enhance their communication skills is necessary. METHODS This study used a non-equivalent groups design with pre- and post-tests. In order to make a preliminary evaluation of CEP-S, controlled clinical trial was performed by setting experimental group and control group. 20 participants were in the experimental group, and 21 participants were in the control group. Ten sessions of CSE-S were provided over 5 weeks. The data were analyzed using SAS 9.2. Data analysis used descriptive statistics, chi-square and t-tests, and ANCOVA. RESULTS Statistically significant differences were found between the experimental and control groups in terms of the communication disturbance, emotional expression, empathy competence, communication competence, and interpersonal relationship skills. CONCLUSIONS The program improved the communication skills of people diagnosed with chronic schizophrenia and provided evidence for the effectiveness of interventions in improving interpersonal relationship skills. The results of this study will expand mental health care professionals' knowledge of how to increase communication skills when supporting people with chronic schizophrenia.
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Affiliation(s)
- Younghee Park
- Department of Nursing, College of Medicine, Dongguk University, South Korea.
| | - KuemSun Han
- College of Nursing, Korea University, South Korea.
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19
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Gupta T, Hespos SJ, Horton WS, Mittal VA. Automated analysis of written narratives reveals abnormalities in referential cohesion in youth at ultra high risk for psychosis. Schizophr Res 2018; 192:82-88. [PMID: 28454920 PMCID: PMC5656554 DOI: 10.1016/j.schres.2017.04.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/13/2017] [Accepted: 04/13/2017] [Indexed: 12/29/2022]
Abstract
Schizophrenia and at-risk populations are suggested to exhibit referential cohesion deficits in language production (e.g., producing fewer pronouns or nouns that clearly link to concepts from previous sentences). Much of this work has focused on transcribed speech samples, while no work to our knowledge has examined referential cohesion in written narratives among ultra high risk (UHR) youth using Coh-Metrix, an automated analysis tool. In the present study, written narratives from 84 individuals (UHR=41, control=43) were examined. Referential cohesion variables and relationships with symptoms and relevant cognitive variables were also investigated. Findings reveal less word "stem" overlap in narratives produced by UHR youth compared to controls, and correlations with symptom domains and verbal learning. The present study highlights the potential usefulness of automated analysis of written narratives in identifying at-risk youth and these data provide critical information in better understanding the etiology of psychosis. As writing production is commonly elicited in educational contexts, markers of aberrant cohesion in writing represent significant potential for identifying youth who could benefit from further screening, and utilizing software that is easily accessible and free may provide utility in academic and clinical settings.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Chicago, IL, USA.
| | - Susan J Hespos
- Department of Psychology, Northwestern University, Evanston, Chicago, IL, USA
| | - William S Horton
- Department of Psychology, Northwestern University, Evanston, Chicago, IL, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Chicago, IL, USA; Department of Psychiatry, Northwestern University, Evanston, Chicago, IL, USA; Institute for Policy Research, Northwestern University, Evanston, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University, Evanston, Chicago, IL, USA
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20
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Kuperberg GR, Ditman T, Choi Perrachione A. When Proactivity Fails: An Electrophysiological Study of Establishing Reference in Schizophrenia. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2018; 3:77-87. [PMID: 29397083 PMCID: PMC5801772 DOI: 10.1016/j.bpsc.2017.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Schizophrenia is characterized by abnormalities in referential communication, which may be linked to more general deficits in proactive cognitive control. We used event-related potentials to probe the timing and nature of the neural mechanisms engaged as people with schizophrenia linked pronouns to their preceding referents during word-by-word sentence comprehension. METHODS We measured event-related potentials to pronouns in two-clause sentences in 16 people with schizophrenia and 20 demographically matched control participants. Our design crossed the number of potential referents (1-referent, 2-referent) with whether the pronoun matched the gender of its preceding referent(s) (matching, mismatching). This gave rise to four conditions: 1) 1-referent matching ("Edward took courses in accounting but he . . ."); 2) 2-referent matching ("Edward and Phillip took courses but he . . . "); 3) 1-referent mismatching ("Edward took courses in accounting but she . . ."); and 4) 2-referent mismatching ("Edward and Phillip took courses but she . . ."). RESULTS Consistent with previous findings, healthy control participants produced a larger left anteriorly distributed negativity between 400 and 600 ms to 2-referent matching than to 1-referent matching pronouns (the "Nref effect"). In contrast, people with schizophrenia produced a larger centroposterior positivity effect between 600 and 800 ms. Both patient and control groups produced a larger positivity between 400 and 800 ms to mismatching than to matching pronouns. CONCLUSIONS These findings suggest that proactive mechanisms of referential processing, reflected by the Nref effect, are impaired in schizophrenia, while reactive mechanisms, reflected by the positivity effects, are relatively spared. Indeed, patients may compensate for proactive deficits by retroactively engaging with context to influence the processing of inputs at a later stage of analysis.
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Affiliation(s)
- Gina R Kuperberg
- Department of Psychology, Tufts University, Medford, Massachusetts; Department of Psychiatry and the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Tali Ditman
- Department of Psychiatry and the Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Evidence that communication impairment in schizophrenia is associated with generalized poor task performance. Psychiatry Res 2017; 249:172-179. [PMID: 28104564 PMCID: PMC5452682 DOI: 10.1016/j.psychres.2016.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/24/2023]
Abstract
People with schizophrenia exhibit wide-ranging cognitive deficits, including slower processing speed and decreased cognitive control. Disorganized speech symptoms, such as communication impairment, have been associated with poor cognitive control task performance (e.g., goal maintenance and working memory). Whether communication impairment is associated with poorer performance on a broader range of non-cognitive control measures is unclear. In the current study, people with schizophrenia (n =51) and non-psychiatric controls (n =26) completed speech interviews allowing for reliable quantitative assessment of communication impairment. Participants also completed multiple goal maintenance and working memory tasks. In addition, we also examined (a) simple measures of processing speed involving highly automatic prepotent responses and (b) a non-cognitive control measure of general task performance. Schizophrenia communication impairment was significantly associated with poor performance in all cognitive domains, with the largest association found with processing speed (rs =-0.52). Further, communication impairment was also associated with the non-cognitive control measure of poor general task performance (rs =-0.43). In contrast, alogia, a negative speech symptom, and positive symptoms were less if at all related to cognitive task performance. Overall, this study suggests that communication impairment in schizophrenia may be associated with relatively generalized poor cognitive task performance.
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22
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Le TP, Najolia GM, Minor KS, Cohen AS. The effect of limited cognitive resources on communication disturbances in serious mental illness. Psychiatry Res 2017; 248:98-104. [PMID: 28038440 PMCID: PMC5378554 DOI: 10.1016/j.psychres.2016.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/06/2016] [Accepted: 12/18/2016] [Indexed: 01/21/2023]
Abstract
Semantically incoherent speech is a pernicious clinical feature of serious mental illness (SMI). The precise mechanisms underlying this deficit remain unclear. Prior studies have found that arousal of negative emotion exaggerates the severity of these communication disturbances; this has been coined "affective reactivity". Recent research suggests that "cognitive reactivity" may also occur, namely reflecting reduced "on-line" cognitive resources in SMI. We tested the hypothesis that communication disturbances manifest as a function of limited cognitive resources in SMI above and beyond that associated with state affectivity. We also investigated individual differences in symptoms, cognitive ability, and trait affect that may be related to cognitive reactivity. We compared individuals with SMI (n=52) to nonpsychiatric controls (n=27) on a behavioral-based coding of communication disturbances during separate baseline and experimentally-manipulated high cognitive-load dual tasks. Controlling for state affective reactivity, a significant interaction was observed such that communication disturbances decreased in the SMI group under high cognitive-load. Furthermore, a reduction in communication disturbances was related to lower trait and state positive affectivity in the SMI group. Contrary to our expectations, limited cognitive resources temporarily relieved language dysfunction. Implications, particularly with respect to interventions, are discussed.
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Affiliation(s)
- Thanh P. Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Gina M. Najolia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Kyle S. Minor
- Department of Psychology, Indiana University–Purdue University Indianapolis, Indianapolis, IN, USA
| | - Alex S. Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA,Send correspondence to: Alex S. Cohen, Ph.D., Louisiana State University, Department of Psychology, 236 Audubon Hall, Baton Rouge, LA, USA 70803, Phone: (225) 578-7017, Fax: (225) 578-4125,
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Abstract
Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.
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Seeman MV. Bilingualism and schizophrenia. World J Psychiatry 2016; 6:192-198. [PMID: 27354960 PMCID: PMC4919257 DOI: 10.5498/wjp.v6.i2.192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/25/2016] [Accepted: 04/07/2016] [Indexed: 02/05/2023] Open
Abstract
Although a bilingual advantage has been described for neurodegenerative disease in general, it is not known whether such an advantage could accrue to individuals suffering from schizophrenia, since language networks are known to be disrupted in this condition. The aim of this minireview was to scan the existing literature to determine: (1) whether individuals with schizophrenia are able to learn a second language as adults; (2) whether clinical assessment, both for the purpose of accurate diagnosis and for the prediction of treatment response, should be carried out in both languages in bilinguals with schizophrenia; (3) whether psychotherapy in schizophrenia is affected by bilingualism; and (4) whether speaking a second language improves outcome in schizophrenia. The literature to date is too sparse to make definitive statements, but: (1) individuals with schizophrenia appear to be capable of learning a new languages as adults; and (2) it is possible that teaching a foreign language may serve as a form of cognitive rehabilitation for this condition. This literature review recommends research into the effects of bilingualism on the outcome of schizophrenia. Included in this review is a retrospective pilot study conducted in Canada, which suggests that employment opportunities for patients with schizophrenia are improved when they speak more than one language. This is important to note because employment is generally problematic in the context of schizophrenia while, at the same time, the ability to obtain work contributes significantly to quality of life.
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Moe AM, Breitborde NJK, Shakeel MK, Gallagher CJ, Docherty NM. Idea density in the life-stories of people with schizophrenia: Associations with narrative qualities and psychiatric symptoms. Schizophr Res 2016; 172:201-5. [PMID: 26925799 DOI: 10.1016/j.schres.2016.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 11/18/2022]
Abstract
Disordered speech and language deficits are well-documented in schizophrenia-spectrum disorders. Researchers often assess speech samples using manualized rating systems, though recently computerized language assessment methods have been used more frequently in the study of speech from people with schizophrenia. Most typically, these computerized assessments measure aspects of expressivity (i.e., pause durations, prosody) or use word-count technology; less attention has focused on similar methods that can capture more sophisticated aspects of linguistic complexity (e.g., idea density). The primary objective of the present study was to assess idea density - via a computerized measure - in the life-story narratives of people with schizophrenia (n=32) compared to a group of community control participants (n=15). In the schizophrenia group, we also examined associations between idea density, narrative qualities rated via a manualized measure, and psychiatric symptoms. Our findings indicate that idea density is diminished in individuals with schizophrenia compared to controls. Further, our results suggest that though people with schizophrenia with richer idea density tended to have more developed insight into illness, they also had higher levels of depression, anxiety, and avolition. Implications of these results and suggestions for future research are discussed.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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Bay N, Bjørnestad J, Johannessen JO, Larsen TK, Joa I. Obstacles to care in first-episode psychosis patients with a long duration of untreated psychosis. Early Interv Psychiatry 2016; 10:71-6. [PMID: 24861169 DOI: 10.1111/eip.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 03/25/2014] [Indexed: 11/30/2022]
Abstract
AIM This qualitative study is a sub-study of the early 'Treatment and Intervention in Psychosis Study' (TIPS-2), a program for early intervention strategies for people experiencing a first episode of psychosis. We aimed to improve knowledge about factors that prevent or delay patients with a long duration of psychosis from accessing psychiatric health-care services at an earlier illness stage and their personal views on the impact of ongoing informational campaigns (ICs) on help-seeking behaviour. METHOD Following an interpretative-phenomenological approach, eight consecutive TIPS-2 patients with duration of untreated psychosis lasting for more than 6 months were interviewed. The interviews were analysed using a meaning condensation procedure. RESULTS Five main themes were identified: (i) participants' failure to recognize symptoms of psychosis; (ii) difficulties expressing their experiences; (iii) concerns about stigma; (iv) poor psychosis detection skills among health-care professionals; and (v) participants' lack of awareness or understanding of ICs. CONCLUSIONS The five themes identified may suggest that despite exposure to the targeted ICs, participants were unable to recognize or understand the severity of their symptoms. Further, although family members or others sometimes recognized the initial symptoms of psychosis development, these symptoms were attributed to reasons other than psychosis. Participants reported that health-care personnel also had trouble identifying emerging signs of psychosis. The ICs need to be carefully crafted to relay information to people who do not consider themselves as currently experiencing signs of psychosis.
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Affiliation(s)
- Nina Bay
- Division of Psychiatry, Regional Centre for Clinical Research in Psychosis, University Hospital of Stavanger, Stavanger, Norway
| | - Jone Bjørnestad
- Division of Psychiatry, Regional Centre for Clinical Research in Psychosis, University Hospital of Stavanger, Stavanger, Norway
| | - Jan O Johannessen
- Division of Psychiatry, Regional Centre for Clinical Research in Psychosis, University Hospital of Stavanger, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Tor K Larsen
- Division of Psychiatry, Regional Centre for Clinical Research in Psychosis, University Hospital of Stavanger, Stavanger, Norway
| | - Inge Joa
- Division of Psychiatry, Regional Centre for Clinical Research in Psychosis, University Hospital of Stavanger, Stavanger, Norway.,Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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de Sousa P, Spray A, Sellwood W, Bentall RP. 'No man is an island'. Testing the specific role of social isolation in formal thought disorder. Psychiatry Res 2015; 230:304-13. [PMID: 26384574 DOI: 10.1016/j.psychres.2015.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 07/27/2015] [Accepted: 09/06/2015] [Indexed: 11/24/2022]
Abstract
Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research.
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Affiliation(s)
- Paulo de Sousa
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK.
| | - Amy Spray
- School of Psychology, Eleanor Rathbone Building, University of Liverpool, Bedford Street South, Liverpool L69 7ZA, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA1 4YG, UK
| | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK
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Eussen MLJM, de Bruin EI, Van Gool AR, Louwerse A, van der Ende J, Verheij F, Verhulst FC, Greaves-Lord K. Formal thought disorder in autism spectrum disorder predicts future symptom severity, but not psychosis prodrome. Eur Child Adolesc Psychiatry 2015; 24:163-72. [PMID: 24817530 DOI: 10.1007/s00787-014-0552-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 04/16/2014] [Indexed: 12/14/2022]
Abstract
Formal thought disorder (FTD) is a disruption in the flow of thought, which is inferred from disorganisation of spoken language. FTD in autism spectrum disorders (ASD) might be a precursor of psychotic disorders or a manifestation of ASD symptom severity. The current longitudinal study is a seven-year follow-up of 91 individuals aged 5-12 years with ASD. We tested (1) whether childhood FTD predicted prodromal symptoms of psychosis in adolescence and (2) whether childhood FTD was associated with greater ASD symptom severity in adolescence. ASD symptom severity was assessed in childhood (T1) and 7 years later (T2), using the autism diagnostic observation schedule (ADOS). At T1, the Kiddie-Formal Thought Disorder Rating Scale (KFTDS) was used to measure symptoms of FTD. At T2, the prodromal questionnaire (PQ) was used to assess prodromal symptoms of psychosis. FTD at T1 did not predict prodromal symptoms of psychosis at T2 in children with ASD. FTD symptoms at T1, namely illogical thinking, predicted ASD symptom severity at T2 and this effect remained significant after controlling for T1 ASD symptom severity. In children with ASD, illogical thinking predicts severity of ASD symptoms in adolescence, but FTD does not predict prodromal symptoms of psychosis.
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Affiliation(s)
- Mart L J M Eussen
- Department of Child and Adolescent Psychiatry, Erasmus Medical Center Sophia Rotterdam, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands,
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Lexical use in emotional autobiographical narratives of persons with schizophrenia and healthy controls. Psychiatry Res 2015; 225:40-49. [PMID: 25480546 DOI: 10.1016/j.psychres.2014.10.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 09/26/2014] [Accepted: 10/04/2014] [Indexed: 11/23/2022]
Abstract
Language dysfunction has long been described in schizophrenia and most studies have focused on characteristics of structure and form. This project focuses on the content of language based on autobiographical narratives of five basic emotions. In persons with schizophrenia and healthy controls, we employed a comprehensive automated analysis of lexical use and we identified specific words and semantically or functionally related words derived from dictionaries that occurred significantly more often in narratives of either group. Patients employed a similar number of words but differed in lower expressivity and complexity, more self-reference and more repetitions. We developed a classification method for predicting subject status and tested its accuracy in a leave-one-subject-out evaluation procedure. We identified a set of 18 features that achieved 65.7% accuracy in predicting clinical status based on single emotion narratives, and 74.4% accuracy based on all five narratives. Subject clinical status could be determined automatically more accurately based on narratives related to anger or happiness experiences and there were a larger number of lexical differences between the two groups for these emotions compared to other emotions.
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Dwyer K, David A, McCarthy R, McKenna P, Peters E. Higher-order semantic processing in formal thought disorder in schizophrenia. Psychiatry Res 2014; 216:168-76. [PMID: 24594202 DOI: 10.1016/j.psychres.2014.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 11/17/2022]
Abstract
Higher-order semantic impairments and lack of sensitivity to linguistic context have both been implicated in formal thought disorder (FTD) in schizophrenia. Most investigations have focused on comprehension. We investigated the processing of higher-order semantic relations and the role of emotional arousal in FTD patients' linguistic comprehension and production. We compared FTD schizophrenia patients (n=14) with non-FTD schizophrenia patients (n=18) and healthy controls (n=15) on sense-judgment and repetition tasks, in emotionally negative and neutral conditions. We predicted that the FTD group would display poor sensitivity compared to the other two groups in comprehension and production, and that this would be exacerbated by sentence complexity and negative emotional arousal. The emotional manipulation was not robustly successful, and did not affect task performance in the patient groups. FTD patients made significantly more errors on sense-judgments and repetition than the other two groups. Complexity affected all groups to a similar extent in sense-judgments, but affected FTD patients disproportionately in the repetition task. These results support the view that a lack of sensitivity to context underlies FTD in comprehension and production stages of processing. Patients fail to utilise linguistic context to integrate lexical forms into a global whole and guide their access to lexical targets.
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Affiliation(s)
- Karen Dwyer
- Kings College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Anthony David
- Kings College London, Institute of Psychiatry, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, UK
| | - Rosaleen McCarthy
- University of Southampton, Department of Psychology, Southampton, UK; Wessex Neurological Centre, Southampton General Hospital, Southampton University Hospital Trust,Tremona Road, Southampton, UK
| | - Peter McKenna
- FIDMAG Research Foundation, Germanes Hospitalàries, Barcelona, Spain; CIBERSAM, Spain
| | - Emmanuelle Peters
- Kings College London, Institute of Psychiatry, Department of Psychology, London, UK; National Institute for Health Research (NIHR), Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, UK.
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Speech disturbances and quality of life in schizophrenia: differential impacts on functioning and life satisfaction. Compr Psychiatry 2014; 55:693-8. [PMID: 24315617 DOI: 10.1016/j.comppsych.2013.10.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/28/2013] [Accepted: 10/31/2013] [Indexed: 12/11/2022] Open
Abstract
Speech disturbances in schizophrenia impact on the individual's communicative ability. Although they are considered a core feature of schizophrenia, comparatively little work has been done to examine their impact on the life experiences of patients. This study aimed to examine the relationship between schizophrenia speech disturbances, including those traditionally known as formal thought disorder (TD), and quality of life (QoL). It assessed effects on functioning (objective QoL) and satisfaction (subjective QoL) concurrently, while controlling for the influence of neurocognition and depression. Fifty-four patients with schizophrenia/schizoaffective disorder were administered the MATRICS Consensus Cognitive Battery (MCCB), the PANSS, MADRS (with separate ratings for negative TD [verbal underproductivity] and positive TD [verbal disorganisation and pressured speech]) and Lehman's QOLI assessing both objective and subjective QoL. Ratings of positive and negative TD, depression, and general neurocognition were entered into hierarchical regressions to explore their relationship with both life functioning and satisfaction. Verbal underproductivity was a significant predictor of objective QoL, while pressured speech had a trend association with subjective QoL. This suggests a differential relationship between speech disturbances and QoL. Verbal underproductivity seems to affect daily functioning and relations with others, while pressured speech is predictive of satisfaction with life. The impact of verbal underproductivity on QoL suggests it to be an important target for rehabilitation in schizophrenia.
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Lepage M, Bodnar M, Bowie CR. Neurocognition: clinical and functional outcomes in schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:5-12. [PMID: 24444318 PMCID: PMC4079224 DOI: 10.1177/070674371405900103] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Schizophrenia is characterized by significant heterogeneity in outcome. The last decades have witnessed a significant interest in identifying factors that can moderate or influence clinical and functional outcomes in people with schizophrenia. One factor of particular interest is neurocognition, as performance on various measures of cognitive abilities, such as memory, attention, and executive functions, have been consistently related to functional outcome and, to a lesser extent, clinical outcome. This review aims to provide an up-to-date description of recent studies examining the association between neurocognition and clinical and (or) functional outcomes. In the first section, studies examining neurocognitive performance in relation to clinical outcome are examined. When clinical outcome is defined dichotomously (for example, comparing remitted and nonremitted), verbal memory performance consistently exhibits a strong association with clinical status, with the poor outcome group showing the largest deficits. In the second section, studies exploring the relation between neurocognition and various dimensions of functional outcome are reviewed. These dimensions include independent living, social functioning, and vocational functioning, among others. Again, a strong link between neurocognitive deficits and impairments in several aspects of functioning clearly emerges from this review. Finally, several measurement issues are discussed that pertain to the need to standardize definitions of clinical and (or) functional outcomes, the importance of defining cognitive domains consistently across studies, and distinguishing between one's competence to perform tasks and what one actually does in everyday life. Addressing these measurement issues will be key to studies examining the development of effective interventions targeting neurocognitive functions and their impact on clinical and functional outcomes.
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Affiliation(s)
- Martin Lepage
- Professor, Department of Psychiatry, McGill University, Montreal, Quebec
| | - Michael Bodnar
- Research Associate, Douglas Mental Health University Institute, Montreal, Quebec
| | - Christopher R Bowie
- Associate Professor, Department of Psychology, Queen's University, Kingston, Ontario
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Docherty NM, McCleery A, Divilbiss M, Schumann EB, Moe A, Shakeel MK. Effects of social cognitive impairment on speech disorder in schizophrenia. Schizophr Bull 2013; 39:608-16. [PMID: 22416265 PMCID: PMC3627757 DOI: 10.1093/schbul/sbs039] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2012] [Indexed: 12/14/2022]
Abstract
Disordered speech in schizophrenia impairs social functioning because it impedes communication with others. Treatment approaches targeting this symptom have been limited by an incomplete understanding of its causes. This study examined the process underpinnings of speech disorder, assessed in terms of communication failure. Contributions of impairments in 2 social cognitive abilities, emotion perception and theory of mind (ToM), to speech disorder were assessed in 63 patients with schizophrenia or schizoaffective disorder and 21 nonpsychiatric participants, after controlling for the effects of verbal intelligence and impairments in basic language-related neurocognitive abilities. After removal of the effects of the neurocognitive variables, impairments in emotion perception and ToM each explained additional variance in speech disorder in the patients but not the controls. The neurocognitive and social cognitive variables, taken together, explained 51% of the variance in speech disorder in the patients. Schizophrenic disordered speech may be less a concomitant of "positive" psychotic process than of illness-related limitations in neurocognitive and social cognitive functioning.
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Affiliation(s)
- Nancy M Docherty
- Department of Psychology, Kent State University, Kent, OH 44242, USA.
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Abstract
Speech of people with schizophrenia is often difficult to follow. There is evidence that neuropsychological deficits associated with schizophrenia explain some of the variance in speech disorder, but its nature and causes overall are not well understood. This study rated speech samples from 60 schizophrenic outpatients for thought disorder, conceptual disorganization, linguistic structural breakdown, and communication failure. A battery of neuropsychological tests potentially relevant to coherent speech production was administered, and associations between these variables and the speech measures were assessed. Consistent with previous research, the measure of functional effect, communication failure, was more highly associated with neuropsychological test performance than were the measures of putative cause: thought disorder, conceptual disorganization, or linguistic structural breakdown. Performance on tests of attention, immediate memory, working memory, organizational sequencing, and conceptual sequencing all were significantly related to the frequency of communication failures in the speech. In hierarchical regression, attention, working memory, and conceptual sequencing each contributed significantly and together explained 29% of the variance. Some other potential contributors to test in future research include auditory attention, internal source memory, emotional disturbances, and social cognitive deficits.
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Affiliation(s)
- Nancy M. Docherty
- To whom correspondence should be addressed; tel: 330-672-7670, fax: 330-672-3786, e-mail:
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The relationship of verbal learning and verbal fluency with written story production: implications for social functioning in first episode psychosis. Schizophr Res 2012; 138:212-7. [PMID: 22551682 DOI: 10.1016/j.schres.2012.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/21/2012] [Accepted: 04/02/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Impairments in speech, communication and Theory of Mind are common in schizophrenia, and compromise social functioning. Some of these impairments may already be present pre-morbidly. This study aimed to investigate verbal functions in relation to written story production and social functioning in people experiencing a first episode of psychosis (FEP). METHOD Two groups of participants: FEP (N=31) and healthy controls (HC, N=31), completed measures of clinical status, social functioning, a series of neuropsychological tests targeting verbal functioning, and the "Frog Where Are You?" story production task. RESULTS Story results showed reduced efficiency (words per minute) and self-monitoring (corrections per minute) for FEP compared with HC groups (p<0.01). The FEP group performed significantly poorer than the HC group on most indices of verbal learning and verbal fluency. Story production was positively associated with verbal learning and verbal fluency for the FEP group only (p<0.05). Premorbid function decline was associated with impaired verbal learning and memory for the FEP group. CONCLUSION Individuals with FEP show a childhood history of reduced social and academic performance that is associated with skills essential for daily social interactions, as evidenced by the findings for story production, verbal learning and verbal fluency.
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Bosco FM, Bono A, Bara BG. Recognition and repair of communicative failures: the interaction between Theory of Mind and cognitive complexity in schizophrenic patients. JOURNAL OF COMMUNICATION DISORDERS 2012; 45:181-197. [PMID: 22402250 DOI: 10.1016/j.jcomdis.2012.01.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 11/21/2011] [Accepted: 01/27/2012] [Indexed: 05/31/2023]
Abstract
UNLABELLED The aim of the present research is to perform a detailed and empirical investigation of schizophrenia patients' deficits in recognizing and recovering a communicative failure. In particular, this paper investigates the role of Theory of Mind (ToM) and of the complexity of the mental representations involved in explaining patients' deficits in recognizing and recovering different kinds of communicative failures, i.e. failure of the expressive act, failure of communicative meaning and failure of the communicative effect. Twenty-two patients with schizophrenia and an equal number of healthy controls took part in the experiment. The experimental protocol consisted of videotaped stories in which two agents interact, showing a communicative failure; the participants were asked to recognize and repair the observed failure. Some classical ToM tests (Sally and Ann, Modified Smarties and a selection of six Strange Stories) were also administered. Our results revealed a deficit in patients, when compared with healthy controls, in recognizing and recovering communicative failures. Furthermore, focusing on schizophrenia patients' performance per se, we observed a trend with regard to the increasing difficulty of understanding and recognizing different kinds of communicative failures, i.e. failure of expression act, failure of communicative meaning, and failure of the communicative effect. LEARNING OUTCOMES The reader becomes aware that schizophrenic patients perform less well than healthy controls in recognizing and recovering different kinds of communicative failures, and of the role played by Theory of Mind, and representational complexity involved in such different kinds of failures, in explaining patients' performance.
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Affiliation(s)
- Francesca M Bosco
- Center for Cognitive Science, Department of Psychology, University of Turin, and Neuroscience Institute of Turin, Italy
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Becker TM, Cicero DC, Cowan N, Kerns JG. Cognitive control components and speech symptoms in people with schizophrenia. Psychiatry Res 2012; 196:20-6. [PMID: 22365272 PMCID: PMC4445960 DOI: 10.1016/j.psychres.2011.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/01/2011] [Accepted: 10/04/2011] [Indexed: 10/28/2022]
Abstract
Previous schizophrenia research suggests poor cognitive control is associated with schizophrenia speech symptoms. However, cognitive control is a broad construct. Two important cognitive control components are poor goal maintenance and poor verbal working memory storage. In the current research, people with schizophrenia (n=45) performed three cognitive tasks that varied in their goal maintenance and verbal working memory storage demands. Speech symptoms were assessed using clinical rating scales, ratings of disorganized speech from typed transcripts, and self-reported disorganization. Overall, alogia was associated with both goal maintenance and verbal working memory tasks. Objectively rated disorganized speech was associated with poor goal maintenance and with a task that included both goal maintenance and verbal working memory storage demands. In contrast, self-reported disorganization was unrelated to either amount of objectively rated disorganized speech or to cognitive control task performance, instead being associated with negative mood symptoms. Overall, our results suggest that alogia is associated with both poor goal maintenance and poor verbal working memory storage and that disorganized speech is associated with poor goal maintenance. In addition, patients' own assessment of their disorganization is related to negative mood, but perhaps not to objective disorganized speech or to cognitive control task performance.
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Affiliation(s)
- Theresa M. Becker
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
| | - David C. Cicero
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
| | - Nelson Cowan
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
| | - John G. Kerns
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
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Galletly C, Crichton J. Accomplishments of the thought disordered person: A case study in psychiatrist–patient interaction. Med Hypotheses 2011; 77:900-4. [DOI: 10.1016/j.mehy.2011.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
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Cabana A, Valle-Lisboa JC, Elvevåg B, Mizraji E. Detecting order-disorder transitions in discourse: implications for schizophrenia. Schizophr Res 2011; 131:157-64. [PMID: 21640558 DOI: 10.1016/j.schres.2011.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 04/15/2011] [Accepted: 04/18/2011] [Indexed: 10/18/2022]
Abstract
Several psychiatric and neurological conditions affect the semantic organization and content of a patient's speech. Specifically, the discourse of patients with schizophrenia is frequently characterized as lacking coherence. The evaluation of disturbances in discourse is often used in diagnosis and in assessing treatment efficacy, and is an important factor in prognosis. Measuring these deviations, such as "loss of meaning" and incoherence, is difficult and requires substantial human effort. Computational procedures can be employed to characterize the nature of the anomalies in discourse. We present a set of new tools derived from network theory and information science that may assist in empirical and clinical studies of communication patterns in patients, and provide the foundation for future automatic procedures. First we review information science and complex network approaches to measuring semantic coherence, and then we introduce a representation of discourse that allows for the computation of measures of disorganization. Finally we apply these tools to speech transcriptions from patients and a healthy participant, illustrating the implications and potential of this novel framework.
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Affiliation(s)
- Alvaro Cabana
- Group of Cognitive Systems Modeling, Biophysical Section. Facultad de Ciencias, Universidad de la República, Iguá 4225, Montevideo 11400, Uruguay
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Bearden CE, Wu KN, Caplan R, Cannon TD. Thought disorder and communication deviance as predictors of outcome in youth at clinical high risk for psychosis. J Am Acad Child Adolesc Psychiatry 2011; 50:669-80. [PMID: 21703494 PMCID: PMC3124656 DOI: 10.1016/j.jaac.2011.03.021] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 02/18/2011] [Accepted: 03/30/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Given the fundamental role of thought disorder in schizophrenia, subtle communication disturbance may be a valuable predictor of subsequent development of psychosis. Here we examined the contribution of thought and communication disturbance to the prediction of outcome in adolescents identified as putatively prodromal for psychosis. METHOD Transcribed speech samples were elicited from 105 adolescents (54 identified as being at clinical high risk for a first episode of psychosis [CHR], and 51 demographically comparable comparison subjects) and coded for formal thought disorder (FTD) and linguistic cohesion. We then examined the association of baseline FTD/cohesion with conversion to psychosis and social and role outcome at follow-up, approximately 1 year later. RESULTS At baseline, CHR patients who subsequently converted to psychosis (CHR+) showed an elevated rate of illogical thinking and poverty of content (POC) in their speech, relative to both typically developing controls and CHR patients who did not convert to psychosis (CHR-). CHR+ youth also used significantly less referential cohesion at baseline, indicating that they provide fewer references to persons, objects, or events mentioned in preceding utterances. Multiple regression models indicated that, among measures of FTD/cohesion, illogical thinking was uniquely predictive of subsequent conversion to psychosis, whereas POC and referential cohesion were significant predictors of social and role functioning, respectively. CONCLUSIONS Despite the absence of fully psychotic symptoms, putatively prodromal individuals evidence signs of communication disturbance that are qualitatively similar to those seen in schizophrenia and are predictive of both conversion to psychosis and psychosocial outcome. These findings suggest that FTD measures have prognostic significance for at-risk youth.
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Affiliation(s)
- Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California–Los Angeles, Los Angeles, CA 90095, USA.
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Oneiric activity in schizophrenia: Textual analysis of dream reports. Conscious Cogn 2011; 20:337-48. [DOI: 10.1016/j.concog.2010.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 03/08/2010] [Accepted: 04/16/2010] [Indexed: 11/23/2022]
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Birkett P, Clegg J, Bhaker R, Lee KH, Mysore A, Parks R, Woodruff P. Schizophrenia impairs phonological speech production: a preliminary report. Cogn Neuropsychiatry 2011; 16:40-9. [PMID: 20544437 DOI: 10.1080/13546801003787459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Schizophrenia causes clinically conspicuous impairment of syntax and semantics as part of the disorganisation syndrome; however, little is known regarding its effect on the phonological stage of speech, where word meanings are resolved into speech imagery. METHODS We used a "tongue-twister" task to probe phonological speech production and its clinical associations in six schizophrenia patients and 16 controls. RESULTS Errors induced by phonological similarity were more common in the patients (p=.003), were positively associated with psychomotor poverty symptoms (p=.02) and negatively associated with reality distortion symptoms (p=.03). CONCLUSIONS Our findings suggest that phonological speech production is markedly disrupted by schizophrenia. Further, this phonological abnormality is distinct from disorganisation syndrome.
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Affiliation(s)
- Paul Birkett
- Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK.
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Ventura J, Thames AD, Wood RC, Guzik LH, Hellemann GS. Disorganization and reality distortion in schizophrenia: a meta-analysis of the relationship between positive symptoms and neurocognitive deficits. Schizophr Res 2010; 121:1-14. [PMID: 20579855 PMCID: PMC3160271 DOI: 10.1016/j.schres.2010.05.033] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 05/23/2010] [Accepted: 05/26/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Factor analytic studies have shown that in schizophrenia patients, disorganization (e.g., conceptual disorganization and bizarre behavior) is a separate dimension from other types of positive symptoms such as reality distortion (delusions and hallucinations). Although some studies have found that disorganization is more strongly linked to neurocognitive deficits and poor functional outcomes than reality distortion, the findings are not always consistent. METHODS A meta-analysis of 104 studies (combined n=8015) was conducted to determine the magnitude of the relationship between neurocognition and disorganization as compared to reality distortion. Additional analyses were conducted to determine whether the strength of these relationships differed depending on the neurocognitive domain under investigation. RESULTS The relationship between reality distortion and neurocognition was weak (r=-.04; p=.03) as compared to the moderate association between disorganization and neurocognition (r=-.23; p<.01). In each of the six neurocognitive domains that were examined, disorganization was more strongly related to neurocognition (r's range from -.20 to -.26) than to reality distortion (r's range from .01 to -.12). CONCLUSIONS The effect size of the relationship between neurocognition and disorganization was significantly larger than the effect size of the relationship between neurocognition and reality distortion. These results hold across several neurocognitive domains. These findings support a dimensional view of positive symptoms distinguishing disorganization from reality distortion.
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Affiliation(s)
- Joseph Ventura
- UCLA Department of Psychiatry, 300 Medical Plaza, Room 2243, Los Angeles CA 90095-6968, United States.
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Abstract
This is the first of two articles that discuss higher-order language and semantic processing in schizophrenia. This article reviews clinical characterizations of language output and the phenomenon of positive thought disorder, as well as more principled characterizations of language output in schizophrenia. It also gives an overview of evidence for the predominant theory of language dysfunction in schizophrenia: that it arises from abnormalities in (a) semantic memory and/or (b) working memory and executive function. The companion article (Part 2) focuses on the study of language in schizophrenia using online psycholinguistic methods and considers how the study of schizophrenia may inform our understanding of normal language processing.
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Affiliation(s)
- Gina R Kuperberg
- Department of Psychology, Tufts University, 490 Boston Avenue, Medford, MA 02155, USA
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Ditman T, Kuperberg GR. Building coherence: A framework for exploring the breakdown of links across clause boundaries in schizophrenia. JOURNAL OF NEUROLINGUISTICS 2010; 23:254-269. [PMID: 20383285 PMCID: PMC2851098 DOI: 10.1016/j.jneuroling.2009.03.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Clinically, patients with schizophrenia show prominent abnormalities at the discourse level, with production characterized by tangential and illogical relationships between ideas and unclear references. Despite these clinical manifestations, most studies of language in schizophrenia have focused on semantic relationships between single words and the build-up of meaning within single-clause sentences. The present paper discusses the few studies that have gone beyond clause boundaries to fully understand language impairments in schizophrenia. We also give an overview of a relevant literature that considers the neurocognitive mechanisms by which coherence links are established across clauses in healthy adults, providing a framework that may guide future research in this area.
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Affiliation(s)
- Tali Ditman
- Department of Psychology, Tufts University, Medford, MA 02155
- Department of Psychiatry and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Bldg 149, 13th Street, Charlestown, MA 02129, USA
| | - Gina R Kuperberg
- Department of Psychology, Tufts University, Medford, MA 02155
- Department of Psychiatry and Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Bldg 149, 13th Street, Charlestown, MA 02129, USA
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Minor KS, Cohen AS. Affective reactivity of speech disturbances in schizotypy. J Psychiatr Res 2010; 44:99-105. [PMID: 19616790 DOI: 10.1016/j.jpsychires.2009.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 06/02/2009] [Accepted: 06/17/2009] [Indexed: 11/18/2022]
Abstract
Speech disturbances (SD) are a pernicious symptom of schizophrenia that increase when negative emotion is elicited. This increase is referred to as affective reactivity (AR). Although considerable research has examined SD in schizophrenia, few studies have investigated this symptom in individuals at risk for the disorder, who demonstrate schizophrenia-like, or schizotypic, traits. In the present study, we examined: (1) SD severity in schizotypy, (2) how SD varies as a function of stress reactivity in schizotypy, and (3) the relationship between SD/AR with Quality of Life (QOL). Individuals with psychometrically-defined schizotypy (n=83) and controls (n=22) completed a laboratory procedure in which they produced speech while viewing pleasant and stressful photographs. This speech was analyzed for subtle speech disorder using a well-validated measure. We found that the schizotypy group demonstrated significant increases in SD across both baseline and stressful conditions compared to the control group. AR was not significantly different between the groups. Within the schizotypy group, severity of disorganized schizotypy symptoms was associated with high levels of SD and AR while interpersonal schizotypy was associated with low levels of SD and AR. AR was also related to increased objective QOL in the schizotypy group. This study highlights the role of stress reactivity across the schizophrenia-spectrum. Moreover, the incongruous relationships between disorganized and interpersonal symptoms with SD underscore the marked heterogeneity in processes across schizotypy.
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Affiliation(s)
- Kyle S Minor
- Department of Psychology, Louisiana State University, 206 Audubon Hall, Baton Rouge, LA 70803, USA.
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Trémeau F, Antonius D, Goggin M, Czobor P, Butler P, Malaspina D, Gorman JM. Emotion antecedents in schizophrenia. Psychiatry Res 2009; 169:43-50. [PMID: 19615757 DOI: 10.1016/j.psychres.2008.06.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 07/06/2007] [Accepted: 06/12/2008] [Indexed: 11/18/2022]
Abstract
Emotion antecedents are defined as external or internal events that cause emotions in individuals. Their study brings us insight into individuals' emotion processing. Emotion antecedents have rarely been studied in schizophrenia. Thirty individuals with schizophrenia and 30 non-patient comparison subjects, matched by gender and age, related events when they felt extremely angry, disgusted, fearful, happy, sad and surprised. Each antecedent was summarized in a written sentence and 20 judges matched the antecedent with the correct emotion. The antecedents of individuals with schizophrenia were less frequently matched with their emotion than the antecedents of non-patient comparison subjects for all emotions. Moreover, error pattern analyses revealed distinct deficits for the emotion "fear". In the schizophrenia group, fear antecedents were more frequently judged as non-emotional, and non-fear antecedents were more often judged as fear antecedents when compared to the control group. A deficit in fear processing correlated with the Suspiciousness item on the Brief Psychiatric Rating Scale. Our results indicate differences in emotion processing in schizophrenia. Error pattern results are consistent with impairment in the appraisal of fear. Lower accuracy rates with schizophrenia subjects' antecedents may reflect lower emotion awareness for all emotions in schizophrenia. This study furthers the understanding of deficits in basic emotion processing in schizophrenia.
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Affiliation(s)
- Fabien Trémeau
- Clinical Research and Evaluation Facility, Nathan S. Kline Institute for Psychiatric Research and Rockland Psychiatric Center, Orangeburg, NY 10962, USA.
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Abstract
BACKGROUND Communication disturbance (thought disorder) is a central feature of schizophrenia that predicts poor functioning. We investigated the hypothesis that memory and attention deficits interact with beliefs about the gravity of being rejected (i.e. evaluation sensitivity) to produce the symptoms of communication disorder. METHOD Seventy-four individuals diagnosed with schizophrenia or schizo-affective disorder completed a battery of tests assessing neurocognition (attention, working and verbal memory, abstraction), symptomatology (positive, negative and affective), functioning, and dysfunctional beliefs. RESULTS Patients with communication deviance (n=33) performed more poorly on the neurocognitive tests and reported a greater degree of sensitivity to rejection than patients with no thought disorder (n=41). In a logistic regression analysis, evaluation sensitivity moderated the relationship between cognitive impairment and the presence of communication disorder. This finding was independent of hallucinations, delusions, negative symptoms, depression and anxiety. CONCLUSIONS We propose that negative appraisals about acceptance instigate communication anomalies in individuals with a pre-existing diathesis for imperfect speech production.
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Affiliation(s)
- P M Grant
- Department of Psychiatry, University of Pennsylvania, USA.
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Dadich A, Muir K. Tricks of the Trade in Community Mental Health Research: Working With Mental Health Services and Clients. Eval Health Prof 2009; 32:38-58. [DOI: 10.1177/0163278708328738] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The complexities of research in the community mental health sector are seldom acknowledged in existing literature; this article attempts to address this void. It presents the methodological challenges experienced in the longitudinal evaluation of the Housing and Accommodation Support Initiative—a program that supports people with chronic mental illness toward long-term recovery. The evaluation provides a case study for understanding methodological problems in community mental health research, which include working with organizations that experience high staff turnover; staff members who have large caseloads; and clients who have chronic mental illness. Although not applicable to all research designs, the suggested strategies highlight the importance of innovation, flexibility, and balance between research theory and practical limitations when conducting community mental health research.
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Affiliation(s)
- Ann Dadich
- Centre for Industry and Innovation Studies, University
of Western Sydney, Australia,
| | - Kristy Muir
- Social Policy Research Centre, University of New South
Wales
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Kerns JG, Becker TM. Communication disturbances, working memory, and emotion in people with elevated disorganized schizotypy. Schizophr Res 2008; 100:172-80. [PMID: 18068952 PMCID: PMC2323906 DOI: 10.1016/j.schres.2007.11.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 10/29/2007] [Accepted: 11/01/2007] [Indexed: 12/01/2022]
Abstract
This study examined whether people with elevated disorganized schizotypy would differ from control participants on characteristics associated with disorganization symptoms in schizophrenia and also whether disorganized schizotypy was associated with problems processing emotion. People with disorganized schizotypy (n=32) exhibited greater communication disturbances (CD) than control participants (n=34) for emotionally negative topics but not for positive topics. In addition, the disorganized group exhibited poorer performance on a working memory task but not on a psychometrically matched verbal intelligence task. In addition, poor working memory was associated with increased CD for negative topics and, after controlling for group differences in working memory, group differences in CD were not significant. Moreover, the disorganized group exhibited greater emotional ambivalence and ambivalence was associated with increased CD in the disorganized group. These results suggest that people with disorganized schizotypy exhibit some similar characteristics to people with schizophrenia who have disorganization symptoms and that disorganized schizotypy is also associated with poor emotion processing.
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Affiliation(s)
- John G Kerns
- Department of Psychological Sciences, University of Missouri, Columbia, MO 65211, United States.
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