Arousability in schizophrenia: relationship to emotional and physiological reactivity and symptom severity.

OBJECTIVE: Socioenvironmental stressors have been linked with increased symptom severity and relapse in those with schizophrenia. However, little is known about how individual differences in stress reactivity may contribute to these outcomes. METHOD: This study examined the association between the temperament characteristic of arousability and changes in negative affect and cardiovascular activity during a challenge task in 58 in-patients with diagnosis of schizophrenia and 21 controls. RESULTS: In the patient group, levels of arousability were significantly associated with increases in negative affect in response to the task and greater severity of affective symptoms. Levels of arousability were associated with decreased heart rate during the challenge task in our patient group. CONCLUSION: These findings suggest that greater attention be given to individual differences, such as temperament and personality characteristics, and their role in the experience of stressors, including emotional and physiological response, as well as symptom development.

Communication disturbances in schizophrenia and mania.

BACKGROUND: A "natural language" measure was developed for classifying type and severity of communication disturbance in the speech of psychotic patients by assessing their linguistic reference performance. METHODS: This measure was applied to speech samples of schizophrenic, manic, and nonpsychiatric subjects, and the groups were compared on levels and types of communication failures. RESULTS: The speech of the schizophrenic and manic subjects contained much higher frequencies of each of six types of communication failures than did the speech of the control subjects. Proportions of the different types of unclarity differed among the diagnostic groups. CONCLUSIONS: This method provides a measure of overall severity of communication disturbance, discriminates the speech of schizophrenic and manic subjects from that of nonpsychiatric subjects, and reflects some differences in distribution of types of communication failure in schizophrenic vs manic patients. The measure may be helpful in elucidating cognitive weaknesses underlying psychotic communication failures.

Affective reactivity of cognitive functioning and family history in schizophrenia.

This article reports the results of two related studies investigating the association between affective reactivity of cognitive functioning in schizophrenia and family psychiatric history. In Study #1, we examined affective reactivity of positive formal thought disorder symptoms in 29 schizophrenic inpatients. We found that thought disorder was greatly exacerbated by negative affect in those patients with a family history of schizophrenia (SFH) (n = 11), and not in those without the family history (SNFH) (n = 18). In Study #2, we replicated this finding with a stable outpatient sample (n = 10). We also administered dichotic listening tests using affectively neutral and affectively negative stimuli, and found that right-ear advantage was more markedly diminished on the affectively negative task than on the neutral task in the SFH (n = 6) but not the SNFH (n = 4) subjects. These findings support our hypothesis that cognitive symptoms in schizophrenia are exacerbated by negative affect, and that this affective reactivity of symptoms is associated with a familial form of the disorder.

Abnormal laterality in schizophrenics and their parents.

Previous studies found that schizophrenics do not show the normal right ear-left hemisphere perceptual advantage on language-related dichotic tests of lateralized cerebral function. We report evidence of a similar abnormality in non-schizophrenic parents of schizophrenic patients. Perceptual asymmetry was first measured with a dichotic word test which had previously yielded differences between schizophrenics and controls. The parents (n = 18) demonstrated a lower right ear advantage (REA) than controls (n = 10) (p = 0.05), but performed similarly to their schizophrenic offspring (n = 10). The same subjects were given two additional tests. Neutral words were paired with words of a positive emotional valence in one test, and with words of a negative emotional valence in the other. On these two tests, the parents were more similar to the controls than to their offspring with the schizophrenics demonstrating a lower REA than their parents (p = 0.005) on the negative test. These results suggest that schizophrenics and their parents have similar abnormalities in hemispheric activation at baseline only, but when listening to words with negative emotional valence, only the schizophrenics demonstrate a further decrease in left hemispheric activation.

Expressed emotion and language disturbances in parents of stable schizophrenia patients.

Nineteen healthy parents of long-term schizophrenia outpatients were assessed for levels of expressed emotion (EE) and for characteristics of communication style which are putative markers of vulnerability to schizophrenia. We administered measures of communication deviance, linguistic reference performance, global disorganization, and positive formal thought disorder. Parents high in EE showed significantly poorer linguistic reference performance and greater disorganization in their speech than parents low in EE. These findings support the idea that high EE in some individuals may be associated with cognitive characteristics indicative of a vulnerability to schizophrenia, and this may account in part for the well-established association between EE level in parents and prognosis in patients.

Cognitive deficits and thought disorder: II. An 8-month followup study.

Schizophrenic (n = 21) and manic (n = 19) patients were followed up an average of 8 months after an index assessment during an acute admission. These patients were tested at both assessments with laboratory tasks measuring distractibility and reality monitoring and were examined with clinical ratings of positive and negative thought disorder. For manic patients, none of the measures predicted the patients' clinical state of followup, while negative thought disorder, although rare, was temporally stable. For the schizophrenic patients, both negative thought disorder and distractibility were temporally stable, and more severe negative thought disorder was found at index assessment in patients who were psychotic at followup. The differential utility of laboratory and clinical indices for the prediction of overall clinical state is related to these data.

Conceptual sequencing and disordered speech in schizophrenia.

This study examined associations between impairments of attention, memory, and conceptual sequencing ability, and specific schizophrenia thought and language symptoms. Speech samples of stable schizophrenia outpatients were assessed for frequencies of six different types of communication failures. The classification of types of failures was based on hypothesized differences in underlying cognitive process. Frequencies of the four types of communication failures believed to involve language structural weaknesses all were significantly and fairly strongly related to conceptual sequencing ability. In addition, regression analyses indicated that each of these four types of communication failures was associated with a unique configuration of attentional, memorial, and conceptual sequencing processes. In contrast, the two types of communication disturbances not suggestive of language structural problems were not positively associated with any of the cognitive weaknesses assessed.

Communication disturbances in relatives beyond the age of risk for schizophrenia and their associations with symptoms in patients.

This article provides a detailed examination of subclinical disturbances in the natural speech of healthy relatives beyond the age of risk for schizophrenia. Speech samples from 43 stable schizophrenia outpatients, 42 nonschizophrenia parents of patients (pairs only), and 23 control subjects matched to the parents were analyzed for frequencies of six specific types of communication failures. The parents had higher overall communication disturbance ratings than the control subjects. The specific types of failures that occurred more frequently were unclarities caused by (1) language structural breakdown, (2) use of vague, overinclusive words, and (3) use of words with ambiguous meanings. In intrafamilial analyses, higher levels of communication disturbance in parents were associated with greater severity of illness in their patient offspring. These results support the idea that communication disturbances may be one manifestation of a stable genetic vulnerability to schizophrenia. The nature of the failures identified suggests the possible involvement of weaknesses in specific areas of cognitive functioning.

Schizophrenia outpatients' perceptions of their parents: is expressed emotion a factor?

The factors that mediate the association between expressed emotion (EE) and relapse in schizophrenia patients are still unknown. Many researchers hypothesize that interactions with high-EE individuals are stressful for patients, leaving them vulnerable to relapse. It would be useful to investigate whether patients perceive interactions with high-EE parents as stressful. In this study, associations were examined between levels of EE in parents and the types of personal memories patients had about these parents. EE ratings were obtained for both parents of 27 schizophrenia outpatients, and patients were asked to describe "happy, nonstressful" memories and "unhappy, stressful" memories during 2 interviews. Patients recounted fewer nonstressful memories and more stressful memories about high-versus low-EE parents. Implications of these results are discussed.

Comparative affective reactivity of different types of communication disturbances in schizophrenia.

Twenty-nine schizophrenic outpatients provided speech samples on affectively positive and negative topics. These samples were assessed for several different types of communication failures by using the Communication Disturbances Index. Frequencies of overinclusive references, ambiguous word meanings, and ambiguous referents increased in the affectively negative condition; frequencies of missing referents and instances of syntactic unclarity did not change across affective conditions. Degree of overall affective reactivity of speech was associated with severity of the core positive schizophrenic syndrome. These findings support the idea that different types of schizophrenic communication disturbances are associated with different underlying pathophysiological processes, that some are more reactive to affect than others, and that affective reactivity of these symptoms is associated with the positive schizophrenic process.

Affective reactivity of speech in schizophrenia patients and their nonschizophrenic relatives.

This study compared levels of referential communication disturbance in speech samples from 41 stable schizophrenia outpatients, 46 parents of patients, and 23 nonpsychiatric control participants in affectively positive versus affectively negative conditions. The speech of the patients and parents showed elevated frequencies of reference failures in the affectively positive condition compared with control participants: the speech of the patients became more disordered in the affectively negative condition, whereas the speech of the parents did not. These results support the idea that referential communication disturbances reflect vulnerability, as well as overt illness, but that affective reactivity of these disturbances is associated mainly with the manifest illness. These findings are consistent with biological, cognitive, and psychological theories about the processes underlying stress responsiveness of schizophrenic symptoms more generally.

Affective reactivity of language symptoms, startle responding, and inhibition in schizophrenia.

The speech of some schizophrenia patients becomes markedly more disordered when negative affect is aroused. The authors tested associations between affective reactivity of speech and responsiveness and inhibition on an acoustic startle task in a sample of 27 outpatients. Patients whose language was reactive to negative affect showed significantly higher initial startle amplitudes than those whose language was not reactive. However, they also showed greater habituation to repeated startle stimuli over trials, even after differences in initial amplitudes were controlled statistically. These findings suggest that affective reactivity of speech is associated with higher initial startle responsiveness but also with greater habituation and, conversely, that patients who are relatively nonreactive to excitatory affective and sensory stimuli are also less reactive to inhibitory input.

Working memory, attention, and communication disturbances in schizophrenia.

The authors hypothesized that schizophrenic communication disturbances reflect specific cognitive deficits in the areas of working memory and attention. They examined the cognitive correlates of communication disturbances, as measured by linguistic reference performance, in schizophrenic (n = 48), bipolar (n = 24), and nonpsychiatric control (n = 23) individuals. Reference performance ratings in the schizophrenic patients were associated with scores on tests of working memory and attention and were not related to performance on concept formation or verbal fluency tests. In contrast, in the bipolar and nonpsychiatric individuals, reference performance was associated with concept formation and verbal fluency test scores but was not related to performance on tests of working memory. Implications with respect to the processes underlying schizophrenic communication disturbances are discussed.

Factor analysis of the Communication Disturbances Index.

The present study utilized factor analysis to investigate possible underlying processes in schizophrenic thought disorder. Using the Communication Disturbances Index [CDI; Arch. Gen. Psychiatry, 53, (1996) 358], a measure of disruption in the communication of meaning from speaker to listener, we examined the speech of 58 stable schizophrenia outpatients for six different types of referential communication disturbances. We calculated instances of disturbance per 100 words and then factor-analyzed our data using the SAS statistical package. Principal components analysis with an oblique rotation produced both a two- and a three-factor solution, depending on factor inclusion criteria. In the three-factor solution, the first two factors reflected weaknesses in language structural organization and in concept-boundary definition, respectively. The third factor appeared to reflect weaknesses in specific facets of memory functioning. In the two-factor solution, the aforementioned structural organization and concept-boundary definition factors were combined into a single executive functioning factor. Results from the study may be heuristic in the development of models of language disturbance in schizophrenia patients.

Linguistic reference performance in parents of schizophrenic patients.

Clinicians have often reported observing subtle signs of thought disorder or communication difficulties in parents of schizophrenic patients. Ascertaining empirically whether these impressions are valid and, if so, clarifying the nature of such disturbances is important for at least two reasons. First, it could assist in elucidating the etiologies of the illness. If distinguishing parental characteristics could be clearly defined, then further research could be undertaken to determine to what extent they represent genetic vulnerability markers, pathogenic environmental influences, or behavioral responses to having a disordered offspring. Secondly, it could facilitate our understanding of the cognitive processes involved in schizophrenia or in the constitutional vulnerability to schizophrenia.

Expressed emotion and differentiation of self in the relatives of stable schizophrenia outpatients.

This study examined "trait" variables associated with high and low levels of expressed emotion in the parents of long-term stable schizophrenia outpatients. Self-descriptions collected from patients, their parents, and control participants matched to the parents were rated for levels of differentiation and integration, substantiality, relatedness, and self-criticism using established methods. The parents as a group did not differ from controls on any of the self-description variables. When parents were classified based on their expressed emotion status, those with low expressed emotion showed higher levels of differentiation and integration than those with high expressed emotion. Low expressed emotion parents were also lower on self-criticism. There was no difference between expressed emotion groups on substantiality or relatedness. These findings support the idea that high expressed emotion in parents of long-term stable outpatients may be a manifestation in part of relatively low levels of differentiation and integration of self in the parents. Furthermore, though patients as a group scored lower than parents on differentiation and integration and substantiality, patients' ratings on these two variables also correlated with those of their parents, suggesting that these variables are to some extent familially determined.

Development and preliminary validation of a questionnaire assessment of expressed emotion.

A questionnaire for management of expressed emotion was constructed. It consisted of two scales, criticism and emotional overinvolvement. The questionnaire and the Camberwell Family Interview were then administered to relatives of schizophrenics and preliminary assessments of scale reliabilities and concurrent validities were done. Both questionnaire scales were reliable. With respect to validity the criticism scale correctly classified 88% of the subjects relative to the criticism scale of the interview. The emotional overinvolvement scale was less satisfactory (67%) but still assisted in classification of over-all expressed emotion. Expressed emotion, classification by the questionnaire, correctly identified 84% of the subjects with respect to the interview.

Cognitive characteristics of the parents of schizophrenic patients.

This article reviews the empirical literature on cognition and communication in the parents of schizophrenic patients to address the questions of whether these parents as a group show evidence of any distinguishing cognitive characteristics and, if so, what those characteristics might be. Included in the review are studies of thought and communication disorder, and psychometric studies of cognitive functioning. We included only those that used reliable measures and included control groups in their designs. Taken together, the findings provide substantial evidence that nonschizophrenic parents of schizophrenic patients as a group demonstrate subtle cognitive difficulties in the area of concept formation and maintenance. There are also indications of other cognitive anomalies that will require further study. We discuss the importance of clarifying the etiological relevance of these findings and of pursuing further research in this area.

Communication deviance, attention, and schizotypy in parents of schizophrenic patients.

Singer and Wynne's measures of communication deviance were adapted for use with conversational speech and applied to audiotaped speech samples of schizophrenic patients, their parents, and matched nonpsychiatric control subjects. The parents demonstrated levels of language disturbance similar to those of the patients and higher than those of controls. Language deviance in the parents was positively associated with distractibility on a matched-task digit-span measure of attention and with severity scores on a separate schizotypy scale. These findings are discussed with respect to possible cognitive variables underlying the language disturbances and their potential relevance to schizophrenic etiology.