Differential lexical correlates of social cognition and metacognition in schizophrenia; a study of spontaneously-generated life narratives.

OBJECTIVES: Social cognition and metacognition have been identified as important cognitive domains in schizophrenia, which are separable from general neurocognition and predictive of functional and treatment outcomes. However, one challenge to improved models of schizophrenia has been the conceptual overlap between the two. One tool used in previous research to develop cognitive models of psychopathology is language analysis. In this article we aimed to clarify distinctions between social cognition and metacognition in schizophrenia using computerized language software. METHODS: Fifty-eight (n=58) individuals with schizophrenia completed the Metacognitive Assessment Scale Abbreviated and measures of social cognition using the Hinting, Eyes, BLERT and Picture Arrangement test. A lexical analysis of participants' speech using Language Inquiry and Word Count software was conducted to examine relative frequencies of word types. Lexical characteristics were examined for their relationships to social cognition and metacognition. RESULTS: We found that lexical characteristics indicative of cognitive complexity were significantly related to level of metacognitive capacity while social cognition was related to second-person pronoun use, articles, and prepositions, and pronoun use overall. The relationships between lexical variables and metacognition persisted after controlling for demographics, verbal intelligence, and overall word count, but the same was not true for social cognition. CONCLUSIONS: Our findings provided support for the view that metacognition requires more synthetic and complex verbal and linguistic operations, while social cognition is associated with the representation and clear identification of others.

Lexical Characteristics of Emotional Narratives in Schizophrenia: Relationships With Symptoms, Functioning, and Social Cognition.

Previous research has suggested that complexity of speech, speech rate, use of emotion words, and use of pronouns are all potential indicators of important clinical components of schizophrenia, but little research has examined the relationships of these disturbances to cognitive variables impaired in schizophrenia, including social cognition. The current study examined these lexical differences to better characterize the cognitive substrates of speech disturbances in schizophrenia. Brief narratives of individuals with schizophrenia (n = 42) and non-clinical controls (n = 48) were compared according to their lexical characteristics, and these were examined for relationships to social cognition and real-world functioning. Significant differences between the groups were found in words per sentence (related to functioning, but not negative symptoms) as well as pronoun use (related to attributional style and theory of mind). Additionally, lexical characteristics effectively distinguished individuals with schizophrenia from non-clinical controls. Language disturbances in schizophrenia seem related to social cognition impairments and real-world functioning, and are a robust indicator of clinical status.

Neuropsychological characteristics of verbal and non-verbal fluency in schizophrenia patients.

This review paper provides analyses confirming correlation between various brain regions activity, particularly its prefrontal portions, and schizophrenia patients' performance in verbal fluency tests. Various factors modifying patients' performance in the aforementioned tasks were singled out and discussed. Systematically we have reviewed the results of non-verbal fluency tests conducted in the schizophrenic patients. The authors also summarizes findings of earlier studies stressing the role of semantic fluency as a predictor of first-episode psychosis. Verbal and non-verbal fluency tests engage complex cognitive processes and executive functions in patients. As a result, the interpretation of their results is often complicated and requires special competences. The tests are popular neuropsychological tools used for assessment of verbal memory, executive functions, visual-spatial abilities and psychomotor speed in patients with mental and neurological disorders. The aim of this paper is to discuss diagnostic tools used for measuring both types of fluency (verbal and non-verbal), test interpretation methods, as well as their usefulness in clinical diagnostics and scientific research.

Verbatim recall in formal thought disorder in schizophrenia: a study of contextual influences.

INTRODUCTION: We have previously reported that people with schizophrenia and formal thought disorder (FTD) were disproportionately impaired in recalling sentences verbatim and in judging their plausibility. We proposed that these deficits were due to impairment in integrating higher-order semantic information to construct a global whole. However, it is also possible that a lower-level linguistic problem affecting lexical activation could account for this pattern. METHODS: The present study analysed and compared the sentence repetition errors produced by people with FTD, people with schizophrenia who were non-FTD and healthy controls. Errors due to failure of activation of the target lexical items were differentiated from those due to erroneous integration of information. RESULTS: People with FTD produced significantly more unrelated lexical substitutions and omissions in their corpora than the other two groups, indicating an impairment of activation. In addition, they made significantly more erroneous contextual inferences and unrelated references, suggesting they were impaired in reconstructing the global whole from successfully activated items. CONCLUSION: These findings are consistent with a dual process account of impairments in FTD. Difficulties in repeating and judging sentence acceptability arises due to a combination of difficulty with activation and deficits in using linguistic context to process and produce speech. It is suggested that processing difficulties in FTD result from an impairment in using semantic context to drive lexical access and construction of a global whole.

Schizophrenia: Communication Disorders and Role of the Speech-Language Pathologist.

PURPOSE: This clinical focus article aims to provide a comprehensive overview of schizophrenia and understanding of communication disorders resulting from its psychopathology. Schizophrenia is a spectrum disorder with varying levels of symptom expression. It is characterized by positive and negative symptoms that can cause communication disorders of different severity levels. Communication difficulties manifest as a range of symptoms such as alogia, disorganized speech, and impaired social communication. These challenges may result in receptive and expressive language deficits that lead to misunderstandings, reduced social interactions, and difficulties expressing thoughts and emotions effectively. The purpose of this clinical focus article is to explore the role of the speech-language pathologist (SLP) in assessing and treating communication disorders presented in schizophrenia. CONCLUSIONS: In order to understand the role of the SLP in assessing and treating communication disorders in schizophrenia, it is imperative to understand the overall course, etiology, assessment, and treatment consideration of this condition. SLPs can provide services in the areas of social skills training and community-based intervention contexts.

Disordered semantic activation in disorganized discourse in schizophrenia: a new pragma-linguistic tool for structure and meaning reconstruction.

BACKGROUND: Disorganized speech, manifested as derailment, tangentiality, incoherence and loss of goal, occurs commonly in schizophrenia. Studies of language processing have demonstrated that semantic activation in schizophrenia is often disordered and, moreover, the ability to use contextual cues is impaired. AIMS: To reconstruct the origins and most plausible intended meanings of disorganized discourse sequences in a clinical interview with a patient with thought-disordered schizophrenia. METHODS & PROCEDURES: We assessed the so-called pragmatic felicity of every turn using a novel tool called the Overall Comprehensibility of Turn (OCT) Scale. In addition to felicity analysis, all topics and referents of turns were registered. Three most disorganized discourse sequences from the transcribed interview were chosen for the thematic and semantic analysis, in which we attempted to reconstruct the structure and meaning of those sequences utilizing (1) the notion of discourse model extending up to contextual background knowledge, (2) the (re)occurrence of topical items, together with (3) the knowledge from findings of disordered semantic activation in schizophrenia. OUTCOMES & RESULTS: The linguistic analyses showed that the disrupted sequences were characterized by (1) unexpected, seemingly irrelevant topic intrusion, (2) pragmatically inappropriate chain of topic extensions, and (3) fuzzy reference together with disturbed ordering of propositions. The underlying causes seemed to be, respectively, (1) long-term semantic activation of topics, which popped out sporadically along the conversation, (2) overreliance on lexical-semantic associations, and (3) the inability to sequence the utterances and link them together using explicit or implicit bridging assumptions necessary to a coherent and cohesive message. All scrutinized passages violated the expectations of the addressee in on-line conversation. However, the post-hoc analysis showed that they contained items which were relevant to the global topic. CONCLUSIONS & IMPLICATIONS: Latent sources, motivations and even meanings, at least to some extent, of seemingly disorganized utterances can become analysable through linguistic analyses. The results suggest that continuity in the treatment is essential, because a practitioner who shares background knowledge with the patient has better opportunities to capture the relevance of the superficially disorganized utterances. Moreover, especially the most disorganized sequences should warrant thorough attention because they can convey, beneath their unexpected or obscure surface structure, items which are psychologically important to the patient. The results of this study should be taken into account in the training of interactional skills of professionals who work with schizophrenia patients.

Affective reactivity of speech in patients with schizophrenia and their non-schizophrenic relatives.

BACKGROUND: Studies about cognitive functioning of patients with schizophrenia (language problems in particular) are very limited in Iran. This study aims at evaluating the affective reactivity of speech in Turkish-speaking schizophrenic patients and their non-schizophrenic relatives. METHODS: In a cross-sectional setting, 30 outpatients with schizophrenia were compared with 30 first-degree non-schizophrenic family members and 30 non-clinical controls. The audio-taped speech samples (10 min each) were analyzed blindly for frequencies of referential communication failure. Levels of referential communication disturbance in speech samples (Communication Disturbance Index, CDI) during two separate sessions were compared in affectively positive versus affectively negative conditions. RESULTS: All three groups showed significantly higher frequencies of communication disturbances in the affectively negative condition. The affective reactivity of speech was significant in patients with schizophrenia compared with the controls but not the unaffected relatives. The severity of positive or negative symptoms was not correlated with CDI or level of affective reactivity. CONCLUSION: This study was carried out in a Turkish-speaking sample and supports the idea that referential communication disturbances may be linked to vulnerability to schizophrenia while affective reactivity is associated with manifest illness. Language differences may affect the observed impact of symptom severity on communication failures.

[On the dynamics of psychological functioning through speech analysing]. / Dynamique d'un fonctionnement psychologique à travers l'étude de l'énonciation.

OBJECTIVE: The aim of this study is to focus on the clinical aspects of four linguistic indicators that emerge from automatic speech analysis. BACKGROUND: From a theoretical point of view, the number of proposals deals with cognitive activity, the number of modelizations with emotional activity, the number of connections with judgment activity and the number of action verbs can refer to behavioral activity. METHODS: To test these hypotheses we have studied two protocols of Thematic Aperception Test (TAT) randomized from non-clinical groups for the former and from a group of schizophrenic patients for the latter. RESULTS: The outcomes regarding the non-clinical protocols lead to the conclusion that the four indicators are coherent (α=0.93) and correlated; this confirms the clinical data on the cohesive personality of this young lady. The absence of correlations within the schizophrenic protocols reflects the dissociative syndrome of this patient. CONCLUSION: Finally, the study of the dynamics of this protocol, using our four linguistic criteria, confirms both the affective indifference and the increase of behavioral activity of this patient when the mentalization fails. After discussion and despite its capacity to describe clinical cases, the validity of this method needs to be completed (by relating the language indicators to production time stories) in further explorations, even if its reliability is good (α=0.93).

Analysis of a silent voice: a qualitative inquiry of embroidery created by a patient with schizophrenia.

A poster-sized piece of embroidery, completed in the 1960s, hangs in the Glore Psychiatric Museum, a testament to the daily experience of a woman who rarely spoke and was diagnosed with schizophrenia. The embroidery document was analyzed by three researchers who came to agreement on themes via triangulation and constant comparison. The woman's lived experience was considered. The analysis found that although the patient was silent, she was connected in interesting ways to the environment around her. Implications for nursing care include awareness of the importance of milieu to patients, that silence should not be inferred to be detachment, and nurses should continue to develop creative ways to engage patients who may communicate in nontraditional ways.

[Disturbances of emotional prosody in schizophrenia]. / Zaburzenia prozodii emocjonalnej w przebiegu schizofrenii.

Disturbances in understanding and expression of emotional prosody of speech (aprosodia) belong to frequent but rarely described symptoms of schizophrenia, that negatively influence the life quality of patients. The role of prosody in the process of verbal communication is to complement and emphasize the language (linguistic prosody) and affective (emotional prosody) aspects of the spoken announcements. The authors review literature, including studies on functional brain imaging, and analyze profile and ground of the disturbances in the emotional prosody in patients with schizophrenia. Similarly to patients with damage to the right hemisphere, the speech of schizophrenia patients often is monotonous and deprived of emotional coloring, despite preserved experiencing of appropriate emotions, similarly to healthy subjects. In the acoustic speech analysis of patients with schizophrenic psychosis, reduced fundamental frequency of the utterance, clinically defined as aprosodia, was showed. It was noticed that the problems in identifying emotions concern mainly negative emotions and that bigger defects were demonstrated by men. The authors emphasize the need to recognize and include appropriate therapeutic treatments in prosody disturbances, which aim is to improve the well-being and social functioning of the patients.

[Peculiarities of schizophrenic diseases in prelingually deaf persons]. / Besonderheiten schizophrener Erkrankungen bei prälingual Ertaubten.

Diagnostic criteria of schizophrenia, according to Kurt Schneider's first and second range symptoms appear in spoken language. This raises the question of how symptoms of schizophrenia are manifested in prelingually deaf people who mainly communicate with sign language. The article shows that acoustic hallucinations of normal hearing schizophrenic people correspond to visual and tactile hallucinations of the prelingually deaf. An additional similarity is found in a disorder of the structure of the language. These similarities show that schizophrenia does not depend on the acoustic part of language or the acquisition of spoken language.

Evaluation of speech misattribution bias in schizophrenia.

BACKGROUND: The attribution of self-generated speech to others could explain the experience of verbal hallucinations. To test this hypothesis, we developed a task to simultaneously evaluate (A) operations of self-other distinction and (B) operations that have the same cognitive demands as in A apart from self-other distinction. By adjusting A to B, operations of self-other distinction were specifically evaluated. METHOD: Thirty-nine schizophrenia patients and 26 matched healthy controls were required to distinguish between self-generated, other-generated and non-generated (self or other) sentences. The sentences were in the first, second or third person and were read in a male or female voice in equal proportions. Mixed multi-level logistic regression models were used to investigate the effect of group, sentence source, pronoun and gender of the heard sentences on response accuracy. RESULTS: Patients differed from controls in the recognition of self-generated and other-generated sentences but not in general recognition ability. Pronoun was a significant predictor of response accuracy but without any significant interaction with group. Differences in the gender of heard sentences were not significant. Misattribution bias differentiated groups only in the self-other direction. CONCLUSIONS: These data support the theory that misattribution of self-generated speech to others could result in verbal hallucinations. The syntactic (pronoun) factor could impact self-other distinction in subtypes of verbal hallucinations that are phenomenologically defined whereas the acoustic factor (gender of heard speech) is unlikely to affect self-other distinction.

Reduced gray matter volume of Brodmann's Area 45 is associated with severe psychotic symptoms in patients with schizophrenia.

Previous literature has suggested an important role of inferior frontal gyrus, which mainly consists of Brodmann's Area (BA) 44 and 45, in the pathophysiology of schizophrenia. While recent neuroimaging techniques have revealed differential functional correlates of BA 44 and 45 in healthy individuals, previous studies have not yet separately evaluated the gray matter volume reduction of BA 44 and 45 and their relationships to psychotic symptoms in patients with schizophrenia. In the present study, magnetic resonance images were obtained from 29 right-handed male patients with schizophrenia and from 29 age- and handedness-matched healthy male controls. The reliable manual tracing methodology was employed to measure the gray matter volume of BA 44 and BA 45. The severities of psychotic symptoms were evaluated using the five-factor model of positive and negative syndrome scale in the patient group. A significant gray matter volume reduction of both the BA 44 and BA 45 was found bilaterally in the patients with schizophrenia compared with the healthy controls. Among these inferior frontal sub-regions, reduced volume of right BA 45 revealed the largest effect size. In addition, the reduced volume of BA 45 in left hemisphere showed a significant association with the increased severity of delusional behavior, while the severity of disorganized and positive symptoms were correlated with the bilateral BA 45 volumes in the patient group. The findings support an important role of inferior frontal gyrus in the pathophysiology of schizophrenia. The present study further demonstrated that BA 45 might especially contribute to the production of psychotic symptoms in the patients with schizophrenia.

Verbal fluency in schizophrenia: does cognitive performance reflect the same underlying mechanisms in patients and healthy controls?

Verbal fluency is impaired in patients with schizophrenia, but the association with other cognitive domains remains unclear. Forty-seven patients with schizophrenia (DSM-IV) and 47 controls matched by age, gender, years of education, and vocabulary (Wechsler Adult Intelligence Scale-III) were assessed in terms of sociodemographic, clinical, and cognitive variables. Healthy controls performed significantly better than patients with schizophrenia in all cognitive measures. However, the way these cognitive domains were related differed across groups. Semantic fluency (SF) and phonological fluency (PF) were predicted by working memory (WM) in patients with schizophrenia, whereas the predictor in the healthy controls was processing speed (PS). Moreover, after dividing the sample of patients according to their performance on fluency tests, we found that a worse performance on SF or PF was predicted by WM. However, for patients with a better performance on fluency, the pattern was similar to that of healthy controls. Cognition may show a different pattern of interaction in schizophrenia, with less impaired patients showing a closer pattern to healthy controls. Therefore, we suggest that, depending on the severity of cognitive deficits, performance on neuropsychological tests may not reflect the same underlying mechanisms.

Conversations between carers and people with schizophrenia: a qualitative analysis using leximancer.

We examined conversations between people with schizophrenia (PwS) and family or professional carers with whom they interacted frequently. We allocated PwS to one of two communication profiles: Low-activity communicators talked much less than their conversational partners, whereas high-activity communicators talked much more. We used Leximancer text analytics software to analyze the conversations. We found that carers used different strategies to accommodate to the PwS's behavior, depending on the PwS's communication profile and their relationship. These findings indicate that optimal communication strategies depend on the PwS's conversational tendencies and the relationship context. They also suggest new opportunities for qualitative assessment via intelligent text analytics technologies.

Schizophrenia, language and evolution (or the schizophrenias as logopathies).

Ever since the distinction between praecox dementia and manic-depressive illness made by Kraepelin in 1899, many changes have occurred in the way these conditions and especially their boundaries are conceived. The clearest example is the extraordinary increase in the diagnoses of bipolar disease with respect to those of schizophrenia. But there have also been important changes within each one of these categories. In the first case, the separation of schizo- affective and cycloid psychoses, and in the second, the distinction between mono and bipolar disease. Then there is the description of innumerable forms of monopolar depression1 or, on the contrary, the postulation of the existence of only one endogenous-melancholic syndrome by Tellenbach, an idea which is shall come up again, although from another methodological perspective, in the concept of major depression of DSM III. The present author thinks that this state of nosological confusion has to do, on one hand, with the improper combination of descriptive and etiological criteria,and on the other, with the application of categorical criteria to complex realities, without an organic basis supporting them.The present author proposes a logopathies/thymopathies dichotomy. The first would include all forms of schizophrenia,paraphrenias and paranoias. The second would correspond to the affective disorders and also to a great part of the so called "anxiety disorders". In this first part he develops the subject of the logopathies, trying to demonstrate the legitimacy of the concept upon the basis of three fundamental arguments: (i) Alteration of the thought/language as a nucleus of schizophrenic suffering. (ii) Schizophrenia is a constitutive element of the human condition. And (iii)Schizophrenia appears as a perturbation of Verstehen (understanding),as described by Heidegger in Being and Time as one of the ways Dasein (human being) is present in the world, together with Befindlichkeit (attunement or state-of mind),which is precisely what would be altered in thymopathies.

Evaluation sensitivity as a moderator of communication disorder in schizophrenia.

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.

Reduced language lateralization in first-episode schizophrenia: an fMRI index of functional asymmetry.

Patients with schizophrenia exhibit a decrease or loss of normal anatomical brain asymmetry that also extends to functional levels. We applied functional magnetic resonance imaging (fMRI) to investigate language lateralization in patients with schizophrenia during their first episode of illness, thus excluding effects of chronic illness and treatment. Brain regions activated during language tasks of verb generation and passive music listening were explored in 12 first-episode patients with schizophrenia and 17 healthy controls. Regions of interest corresponded to Broca's area in the inferior frontal gyrus (IFG) and Wernicke's area in the superior temporal sulcus (STS). Patients with schizophrenia had significantly smaller lateralization indices in language-related regions than controls. A similar effect was observed in their IFG and STS regions. There was no difference between the groups in the auditory cortex for the music task. Patients with schizophrenia demonstrated greater activation than the controls in temporal regions: the difference was larger in patients with more severe positive symptom subscores. In conclusion, patients with schizophrenia demonstrated loss of normal functional brain asymmetry, as reflected in diminished lateralization of language-related activation in frontal and temporal regions. This phenomenon was already present during their first episode of psychosis, possibly reflecting developmental brain abnormalities of the illness.

Is schizophrenia the price of human central nervous system complexity?

The purpose of the present study was to determine if there is evidence to support the hypothesis that schizophrenia is a human-specific disorder associated with the need for highly complex central nervous system (CNS) development. A review was therefore undertaken of published literature relevant to the identification of human-specific CNS development. There was no clear evidence found at the macroscopic, microscopic or molecular level that suggests unique changes have occurred in the evolution of the human CNS. Rather, highly significant changes in the size of the frontal lobe, increases in numbers of specific cell types, changes in gene expression and changes in genome sequence all seem to be involved in the evolution of the human CNS. Human-specific changes in CNS development are wide ranging. The modification in CNS structure and function that has resulted from these changes affects many pathways and behaviours that appear to be also affected in subjects with schizophrenia. Therefore there is evidence to support the hypothesis that schizophrenia is a disease that develops because of derangements to human-specific CNS functions that have emerged since our species diverged from non-human primates.

Formal thought disorder, neuropsychology and insight in schizophrenia.

BACKGROUND: Information provided by patients with schizophrenia and their respective carers is used to study the descriptive psychopathology and neuropsychology of formal thought disorder (FTD). SAMPLING AND METHODS: Relatively intellectually preserved schizophrenia patients (n = 31) exhibiting from no to severe positive FTD completed a self-report scale of FTD, a scale of insight as well as several tests of executive and semantic function. The patients' carers completed another scale of FTD to assess the patients' speech. RESULTS: FTD as self-reported by patients was significantly associated with the synonyms test performance and severity of the reality distortion dimension. FTD as assessed by a clinician and by the patients' carers was significantly associated with executive test performance and performance in a test of associative semantics. Overall insight was significantly associated with severity of the reality distortion dimension and graded naming test performance, but was not associated with self-reported FTD or severity of FTD as assessed by the clinician or carers. CONCLUSIONS: The self-reported experience of FTD has different clinical and neuropsychological correlates from those of FTD as assessed by clinicians and carers. The assessment of FTD by patients and carers used along with the clinician's assessment may further the study of this group of symptoms.