The examination of sleep hygiene, quality of life, and schizotypy in young adults.

The co-occurrence of sleep disruption and schizophrenia-spectrum symptomology is common, with current research supporting the use of interventions, such as cognitive behavioral therapy for insomnia (CBTi), which include sleep hygiene education. Sleep hygiene refers to patterns of pre-sleep behaviors that can promote or impair sleep. These behaviors are easily identified and modifiable, potentially holding promise as targets of research and clinical practice. However, there is little research examining sleep hygiene in those at-risk for schizophrenia, measured through clusters of sub-clinical symptoms known as schizotypy. Given the likelihood poor sleep exacerbates negative emotions, thus serving as an etiologically relevant stressor, the study of sleep hygiene in at-risk populations appears warranted. Additionally, quality of life (QOL) has previously been shown to be negatively associated with sleep hygiene and schizophrenia-spectrum risk. As such, QOL domains were included to quantify the extent pre-sleep habits and dimensional schizotypy impact individuals' wellbeing. Data was collected from a non-clinical sample of 385 young adults (M = 20.83, SD = 3.61). As anticipated, higher schizotypy was correlated with poorer sleep hygiene and reduced QOL, although only negative schizotypy predicted QOL in the final regression model controlling for sex differences. Sex differences were present for all variables of interest except disorganized schizotypy. Post-hoc item-level analyses suggested that higher levels of schizotypy were correlated with emotional rumination prior to sleep, while increased negative schizotypy was associated with reduced QOL. Future research should further evaluate sleep hygiene as a potentially relevant risk variable in the development of schizophrenia-spectrum symptomology and associated decline in QOL.

Schizotypy, Lifestyle Behaviors, and Health Indicators in a Young Adult Sample.

Problematic lifestyle behaviors and high rates of physical illness are well documented in people with schizophrenia, contributing to premature mortality. Yet, there is a notable absence of research examining general lifestyle and health issues in participants at risk for psychosis. This form of research may help identify concerns that exist during prodromal periods related to future outcomes. Accordingly, the current study examined lifestyle and health in a nonclinical sample of 530 young adults with varying levels of schizotypy. Increasing symptom severity was associated with greater somatic symptoms and poorer sleep quality across positive, negative, and disorganized domains. Elevated negative and disorganized symptoms were associated with significantly reduced health-related quality of life, while evidence for reduced engagement in health behaviors was largely limited to those with elevated negative schizotypy. No relationships emerged between symptom presentation/severity and body mass index or substance use, although zero-order correlations suggested an association between disorganized schizotypy and nicotine use. The pattern of relationships in the current study was consistent with findings from the ultra-high risk and clinical literature suggesting that lifestyle and health concerns may exist on a continuum with psychosis. Future research should seek to clarify if these patterns are associated with long-term physical or mental health outcomes.

Cognitive Failures and the Role of Emotion in Dimensional Schizotypy: A Replication and Extension.

INTRODUCTION: Cognitive failures are commonplace within the general population but may be particularly heightened in those with higher levels of schizotypy. This is especially salient in the context of enduring trait and momentary state negative emotion which often contributes to increases in daily impairments, leading to a more debilitating and distracted life. Particularly, individuals with elevated levels of schizotypy may be more likely to experience cognitive failures, especially in the presence of negative trait emotion such as depression, anxiety, and stress. However, little is known about the influence of state emotion and the distinct roles that state and trait emotion may have with cognitive failures and schizotypy. METHODS: To replicate and extend previous findings, 306 (58% males) undergraduate students aged 18-50 years (M = 19.343; SD = 2.493) completed self-report measures of cognitive failures, trait and state emotion, and schizotypy. Mediation and moderation analyses were performed in SPSS to examine the potential effects of trait and state emotion on the relationship between schizotypy and cognitive failures. RESULTS: Consistent with previous findings, mood symptomology, in addition to negative affect, mediated cognitive failures in those with higher levels of schizotypy. However, in our sample, positive affect did not appear to buffer against cognitive failures. CONCLUSION: The findings of the present study suggest there may be a nuanced relationship between both negative trait and state emotions on the relationships between cognitive failures and schizotypy. Understanding the interaction of enduring versus momentary emotion on cognition as they relate to an elevated risk for developing schizophrenia-spectrum phenomena may be a point for earlier and more targeted interventions.

Acceptability and effectiveness of a novel cycling training on the parkinsonian motor and psychiatric symptoms in individuals with schizophrenia: A pilot study.

BACKGROUND: Recent evidence suggests that high-speed, low-resistance stationary cycling training (termed as speedwork) alleviates motor symptoms in people with Parkinson's disease. Similar motor symptoms commonly exist in people with schizophrenia (Sz); however, they were neglected in the previous literature. OBJECTIVES: Our objective was to evaluate if speedwork could also be used as a strategy to improve parkinsonian motor symptoms in Sz. We aimed 1) to evaluate the adherence and acceptability of speedwork in Sz, 2) to assess test-retest reliability of the motor assessments that are novel to Sz research, 3) to evaluate the effectiveness of speedwork in improving parkinsonian motor, and 4) psychiatric symptoms in Sz. METHODS: Ten Sz outpatients with concurrent parkinsonian motor symptoms completed 12 sessions (2 sessions/week) of speedwork training. Participants were evaluated on motor functioning and psychiatric symptom severity twice before (double baseline) and twice after (post-completion and 6-wk follow-up) the speedwork training. RESULTS: The adherence to speedwork was high (92 %) and the results of exercise acceptability questionnaire indicate participants found various domains of exercise highly acceptable (overall average 4.49/5). There were improvements in various domains of motor symptoms including, walking speed, functional mobility, static and dynamic balance, and upper extremity motor function after the completion of training (all p < 0.025), with many of these improvements remaining at the 6-wk follow-up. Moreover, there was evidence for improvement in positive psychotic symptoms after the completion of speedwork (p < 0.025). CONCLUSIONS: Speedwork training could be an acceptable and effective strategy to improve motor and psychiatric symptoms in Sz.

The relationship of categorical and phonological verbal fluency to negative schizotypy and social functioning in a non-clinical sample.

INTRODUCTION: Research suggests that levels of schizotypy are related to cognitive and social functioning, with negative schizotypy being particularly related to deficits in verbal fluency (VF) and distinct social skills. Considering the possibility that different VF tasks may involve both shared and unique underlying processes, this study sought to examine the separate contributions of categorical and phonological forms of VF to social functioning in those with varying levels of negative schizotypy. METHODS: Face-to-face interviews were conducted in which 228 college students completed VF tasks, the SPQ-BR, and a social functioning questionnaire. RESULTS: Both phonological and categorical VF were inversely related to levels of negative schizotypy and inversely related to several social functioning domains. High and low levels of negative schizotypy groups were significantly different on elements of social engagement and interpersonal behaviour. In two instances, phonological VF appeared to moderate the relationships between negative schizotypy and specific elements of social functioning. CONCLUSIONS: These findings support a general link between verbal processing and social functioning among those with greater negative schizotypy. Possible avenues of future research are discussed.

Vocal acoustic analysis as a biometric indicator of information processing: implications for neurological and psychiatric disorders.

Vocal expression reflects an integral component of communication that varies considerably within individuals across contexts and is disrupted in a range of neurological and psychiatric disorders. There is reason to suspect that variability in vocal expression reflects, in part, the availability of "on-line" resources (e.g., working memory, attention). Thus, understanding vocal expression is a potentially important biometric index of information processing, not only across but within individuals over time. A first step in this line of research involves establishing a link between vocal expression and information processing systems in healthy adults. The present study employed a dual attention experimental task where participants provided natural speech while simultaneously engaged in a baseline, medium or high nonverbal processing-load task. Objective, automated, and computerized analysis was employed to measure vocal expression in 226 adults. Increased processing load resulted in longer pauses, fewer utterances, greater silence overall and less variability in frequency and intensity levels. These results provide compelling evidence of a link between information processing resources and vocal expression, and provide important information for the development of an automated, inexpensive and uninvasive biometric measure of information processing.

Comparative Study of Personality Trait Characteristics and Reactivity in Schizophrenia Using a Film Clip Paradigm.

The empirical examination of personality characteristics related to the experience of strong negative emotions and the associated physiological response may help account for idiosyncratic responses to life events in schizophrenia. The current study examines the relationship between levels of neuroticism and arousability and physiological and emotional reactivity during the viewing of film clips with differing emotional valance. Data were collected on emotional and cardiovascular and cortisol reactivity across experimental conditions for a sample of outpatients diagnosed with schizophrenia and a comparison group of nonpsychiatric controls. Levels of both neuroticism and arousability were significantly associated with increased negative emotion and physiological reactivity during the negative film clip task, although different patterns emerged across participant groups. Most notably, trait characteristics were inversely related to heart rate reactivity in patients but not controls. This relationship remained significant even after we controlled for disengagement coping behaviors. Cortisol response was not related to personality characteristics in either participant group. Findings were generally consistent with previous research, providing additional evidence for the role of trait characteristics in the response to events.

Internal versus external auditory hallucinations in schizophrenia: symptom and course correlates.

INTRODUCTION: The auditory hallucinations associated with schizophrenia are phenomenologically diverse. "External" hallucinations classically have been considered to reflect more severe psychopathology than "internal" hallucinations, but empirical support has been equivocal. METHODS: We examined associations of "internal" versus "external" hallucinations with (1) other characteristics of the hallucinations, (2) severity of other symptoms and (3) course of illness variables, in a sample of 97 stable outpatients with schizophrenia or schizoaffective disorder who experienced auditory hallucinations. RESULTS: Patients with internal hallucinations did not differ from those with external hallucinations on severity of other symptoms. However, they reported their hallucinations to be more emotionally negative, distressing and long-lasting, less controllable and less likely to remit over time. They also were more likely to experience voices commenting, conversing or commanding. However, they also were more likely to have insight into the self-generated nature of their voices. Patients with internal hallucinations were not older, but had a later age of illness onset. CONCLUSIONS: Differences in characteristics of auditory hallucinations are associated with differences in other characteristics of the disorder, and hence may be relevant to identifying subgroups of patients that are more homogeneous with respect to their underlying disease processes.

Speech deficits in serious mental illness: a cognitive resource issue?

Speech deficits, notably those involved in psychomotor retardation, blunted affect, alogia and poverty of content of speech, are pronounced in a wide range of serious mental illnesses (e.g., schizophrenia, unipolar depression, bipolar disorders). The present project evaluated the degree to which these deficits manifest as a function of cognitive resource limitations. We examined natural speech from 52 patients meeting criteria for serious mental illnesses (i.e., severe functional deficits with a concomitant diagnosis of schizophrenia, unipolar and/or bipolar affective disorders) and 30 non-psychiatric controls using a range of objective, computer-based measures tapping speech production ("alogia"), variability ("blunted vocal affect") and content ("poverty of content of speech"). Subjects produced natural speech during a baseline condition and while engaging in an experimentally-manipulated cognitively-effortful task. For correlational analysis, cognitive ability was measured using a standardized battery. Generally speaking, speech deficits did not differ as a function of SMI diagnosis. However, every speech production and content measure was significantly abnormal in SMI versus control groups. Speech variability measures generally did not differ between groups. For both patients and controls as a group, speech during the cognitively-effortful task was sparser and less rich in content. Relative to controls, patients were abnormal under cognitive load with respect only to average pause length. Correlations between the speech variables and cognitive ability were only significant for this same variable: average pause length. Results suggest that certain speech deficits, notably involving pause length, may manifest as a function of cognitive resource limitations. Implications for treatment, research and assessment are discussed.

The development of the Lifestyle and Habits Questionnaire-brief version: relationship to quality of life and stress in college students.

The authors describe the development and preliminary evaluation of the Lifestyle and Habits Questionnaire-brief version (LHQ-B). Three hundred seventy-seven undergraduate students (ages 18-25) participated. Responses were collected through either a web-based or face-to-face survey. Data reductive procedures were used with a preexisting lifestyle inventory to create an abbreviated measure. The relationship between lifestyle domains and indicators of wellbeing (levels of stress and quality of life (QOL)) were also examined. Eight lifestyle domains, encompassing 42 items, were identified and found to have good psychometric properties. The resulting LHQ-B measure can be self-administered/scored and contains norm-referenced feedback. The domains of psychological health, physical health and exercise, and sense of purpose were the best predictors of QOL while psychological health, social concern, and the accident prevention domains predicted levels of stress. The results support the use of the LHQ-B in lifestyle research or as a self-administered measure promoting self-awareness of lifestyle behaviors/attitudes in young adults (18-25 years).

On the boundaries of blunt affect/alogia across severe mental illness: implications for Research Domain Criteria.

There is growing awareness that reduced expressive behaviors (e.g., blunt affect, alogia, psychomotor retardation) are characteristic of a range of psychiatric conditions, including mood and schizophrenia-spectrum disorders. From a Research Domain Criteria (RDoC) perspective, it would be critical to determine whether these symptoms manifest similarly across diagnostic groups--as they may share common pathophysiological underpinnings. The present study employed computerized acoustic analysis of speech produced in reaction to a range of visual stimuli in 48 stable outpatients with schizophrenia and mood disorders to offer preliminary understanding of this issue. Speaking assessments were administered 1 week-apart to examine how temporal stability might vary as a function of clinical diagnosis and symptom severity. Speech characteristics generally did not differ between groups and were similarly, and for the most part, highly stable over time. Aspects of speech were significantly associated with severity of psychosis and negative symptoms, but not with clinical depression/anxiety severity. Moreover, stability of speech characteristics generally did not vary as a function of diagnostic group or clinical severity. The magnitudes of group differences were almost exclusively in the negligible to small range. Speech production was associated with social functioning deficits. In sum, these preliminary data suggest that speech variables tap a stable and clinically important facet of psychopathology that cut across diagnostic categories. Computerized acoustic analysis of speech appears to be a promising method for understanding the pathological manifestation of these variables.

Attribution biases in schizophrenia: relationship to clinical and functional impairments.

BACKGROUND: Patients with schizophrenia exhibit impairment in their ability to accurately recognize facial emotions in others, and the severity of this emotion perception deficit has been associated with poorer functioning. However, the mechanisms underlying facial emotion perception deficits are poorly understood. There is evidence to suggest that patients, particularly those with certain positive symptoms, may misinterpret other people's facial expressions as having an overly negative valence. The present study examined the degree to which attribution biases in facial emotion perception are associated with psychiatric symptomatology and social and occupational impairments. SAMPLING AND METHODS: The error profiles from a facial emotion perception test were analyzed and compared for 67 schizophrenic state hospital inpatients and 21 nonpsychiatric controls. Attribution bias scores were separately computed for each of six types of emotion. RESULTS: The error profiles were remarkably similar for patients as a group and controls. Within the patient group, severity of positive symptoms was associated with more 'fear' misperceptions. Patients with relatively high levels of 'anger' misperceptions tended to have more severe disorganization and negative symptoms and more pronounced functional impairments. Interestingly, patients who erroneously reported seeing relatively high levels of 'shame' and 'happiness' showed better functioning and less severe symptoms. CONCLUSIONS: Attribution biases appear to play a role in contributing to functional impairments in patients with schizophrenia. The lack of an isomorphic attribution bias across patients highlights the importance of considering schizophrenia heterogeneity when attempting to understand and treat social cognitive deficits.

Computerized measurement of negative symptoms in schizophrenia.

Accurate measurement of negative symptoms is crucial for understanding and treating schizophrenia. However, current measurement strategies are reliant on subjective symptom rating scales, which often have psychometric and practical limitations. Computerized analysis of patients' speech offers a sophisticated and objective means of evaluating negative symptoms. The present study examined the feasibility and validity of using widely-available acoustic and lexical-analytic software to measure flat affect, alogia and anhedonia (via positive emotion). These measures were examined in their relationships to clinically-rated negative symptoms and social functioning. Natural speech samples were collected and analyzed for 14 patients with clinically-rated flat affect, 46 patients without flat affect and 19 healthy controls. The computer-based inflection and speech rate measures significantly discriminated patients with flat affect from controls, and the computer-based measure of alogia and negative emotion significantly discriminated the flat and nonflat patients. Both the computer and clinical measures of positive emotion/anhedonia corresponded to functioning impairments. The computerized method of assessing negative symptoms offered a number of advantages over the symptom scale-based approach.

Normal personality characteristics in schizophrenia: a review of the literature involving the FFM.

Schizophrenia is generally viewed as a disruption of normal functioning because of an underlying core illness. A number of theorists have speculated that this core illness may unilaterally disrupt normal personality functioning. However, recent data suggests that the relationship may be more complex and reciprocal than previously conceptualized. Furthermore, basic personality characteristics appear to be associated with numerous clinical phenomena. This article reviews the empirical literature pertaining to normal personality characteristics [structured around the five-factor model (FFM) of personality] in individuals with schizophrenia. Evidence suggests that certain personality characteristics may be uniquely related to the etiology of psychosis, as well as symptom severity, occupational functioning, cigarette smoking, substance use and violent behavior, social isolation, and suicidality in patients with schizophrenia. The implications of these findings and suggestions for future research are discussed.

The cognitive origins of specific types of schizophrenic speech disturbances.

OBJECTIVE: Cognitive impairments associated with schizophrenia might be expected to have a marked impact on the ability to produce coherent speech, yet associations between cognitive performance and speech disorder have typically been weak. Findings on this question may have been limited by measurement methods and by the heterogeneity of speech disorder. This study examined the contributions of impairments in sustained attention and sequencing abilities to schizophrenic speech disorder, measured in terms of communication failures and divided into different types of disorder. METHOD: Samples of natural speech were collected from severely ill inpatients with schizophrenia and nonpsychiatric comparison subjects and rated for frequencies of six types of communication failures: four structural and two nonstructural types. Subjects also completed a battery of cognitive tests assessing several facets of attention and sequencing ability. Hierarchical regression was used to identify cognitive contributors to communication failures. RESULTS: Impaired sustained attention was associated with more frequent structural and nonstructural communication failures. As predicted, impaired sequencing, and in particular conceptual sequencing, also made a substantial contribution to the structural communication failures, but not to the nonstructural ones. These findings held when global level of impairment was controlled statistically. Performance on the tests of attention and sequencing explained 56% of the variance in structural speech disorder. CONCLUSIONS: Schizophrenic speech disorder is heterogeneous in form and in cognitive underpinnings. Impairments in attention and sequencing abilities are highly predictive of communication failures related to language structure.

Attentional dysfunction, social perception, and social competence: what is the nature of the relationship?

The aim of this study was to examine the nature of the relationship between attentional dysfunction and social competence deficits in patients with schizophrenia. Attentional functioning, social perception, and social competence were assessed in 56 inpatients. Measures of vigilance and span of apprehension were administered to assess attentional functioning. Social perception was assessed with an audiovisual measure of affect recognition. Social competence was rated from a role-play task. Span of apprehension and auditory vigilance emerged as specific predictors of social competence. Affect recognition was tested as a mediator and a moderator of the relationship between attentional dysfunction and social competence. Affect recognition was found to moderate the relationship between span of apprehension and social competence.

Diminished emotionality and social functioning in schizophrenia.

There is indirect evidence to suggest that a subgroup of patients with schizophrenia exhibit a diminished capacity to experience both positive and negative emotions. To date however, no studies have focused specifically on this diminished emotionality (DE). The main objective of the present project was to determine whether patients with self-reported DE differed from other patients in level of social functioning, physical and social anhedonia, and negative/deficit symptoms. Seventy-three state hospital patients with DSM-IV diagnosed schizophrenia and 22 nonpsychiatric controls were examined. Results provided mixed support for the present hypotheses. Patients with self-reported DE (N = 10) versus those without (N = 63) had poorer social functioning, similar levels of physical and social anhedonia, and significantly less severe negative/deficit symptoms. Moreover, there was a substantial amount of discrepancy between patients' self-reported levels of emotionality and the ratings of their emotionality as made by trained observers. Implications of these results are discussed.

Stress and arousability in schizophrenia.

This paper examines trait arousability (TA), a temperament characteristic, in 47 stable outpatients with schizophrenia and 50 non-psychiatric controls. Self-reported levels of stress were obtained during a negative and positive memory speech task. Levels of TA, and the association of TA scores with reported stress during the speech tasks, were examined both between and within groups. In addition, TA scores were examined in relation to symptom presentation in the patient group. Patients reported higher levels of trait arousability and higher levels of stress than controls. Trait arousability scores were significantly associated with reported stress in one of the speech condition in patients, and with the severity of positive and affective symptoms. These results suggest that temperament characteristics of an individual with schizophrenia may be related to stress responsiveness and symptom presentation.

Stability of formal thought disorder and referential communication disturbances in schizophrenia.

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.