Computational linguistic analysis applied to a semantic fluency task to measure derailment and tangentiality in schizophrenia.

Although rating scales to assess formal thought disorder exist, there are no objective, high-reliability instruments that can quantify and track it. This proof-of-concept study shows that CoVec, a new automated tool, is able to differentiate between controls and patients with schizophrenia with derailment and tangentiality. According to ratings from the derailment and tangentiality items of the Scale for the Assessment of Positive Symptoms, we divided the sample into three groups: controls, patients without formal thought disorder, and patients with derailment/tangentiality. Their lists of animals produced during a one-minute semantic fluency task were processed using CoVec, a newly developed software that measures the semantic similarity of words based on vector semantic analysis. CoVec outputs were Mean Similarity, Coherence, Coherence-5, and Coherence-10. Patients with schizophrenia produced fewer words than controls. Patients with derailment had a significantly lower mean number of words and lower Coherence-5 than controls and patients without derailment. Patients with tangentiality had significantly lower Coherence-5 and Coherence-10 than controls and patients without tangentiality. Despite the small samples of patients with clinically apparent thought disorder, CoVec was able to detect subtle differences between controls and patients with either or both of the two forms of disorganization.

The aprosody of schizophrenia: Computationally derived acoustic phonetic underpinnings of monotone speech.

OBJECTIVE: Acoustic phonetic methods are useful in examining some symptoms of schizophrenia; we used such methods to understand the underpinnings of aprosody. We hypothesized that, compared to controls and patients without clinically rated aprosody, patients with aprosody would exhibit reduced variability in: pitch (F0), jaw/mouth opening and tongue height (formant F1), tongue front/back position and/or lip rounding (formant F2), and intensity/loudness. METHODS: Audiorecorded speech was obtained from 98 patients (including 25 with clinically rated aprosody and 29 without) and 102 unaffected controls using five tasks: one describing a drawing, two based on spontaneous speech elicited through a question (Tasks 2 and 3), and two based on reading prose excerpts (Tasks 4 and 5). We compared groups on variation in pitch (F0), formant F1 and F2, and intensity/loudness. RESULTS: Regarding pitch variation, patients with aprosody differed significantly from controls in Task 5 in both unadjusted tests and those adjusted for sociodemographics. For the standard deviation (SD) of F1, no significant differences were found in adjusted tests. Regarding SD of F2, patients with aprosody had lower values than controls in Task 3, 4, and 5. For variation in intensity/loudness, patients with aprosody had lower values than patients without aprosody and controls across the five tasks. CONCLUSIONS: Findings could represent a step toward developing new methods for measuring and tracking the severity of this specific negative symptom using acoustic phonetic parameters; such work is relevant to other psychiatric and neurological disorders.

A potential new form of jail diversion and reconnection to mental health services: II. Demonstration of feasibility.

Given fragmentation between mental health and criminal justice systems, we tested the feasibility of implementing a potential new form of pre-booking jail diversion. Our "linkage system" consists of three steps: (i) individuals with serious mental illnesses and an arrest history give special consent to be enrolled in a statewide database; (ii) if an officer has an encounter with an enrolled patient and runs a routine background check, he or she receives an electronic message to call; and (iii) the "linkage specialist" provides brief telephonic assistance to the officer. Of 206 eligible individuals, 199 (96.6%) opted in, the database received 679 hits, and the linkage specialist received 31 calls (and in at least three cases an arrest was probably averted). The mean number of arrests was 0.59 ± 0.92 in the year before enrollment (38.7% arrested) and 0.48 ± 0.83 during the 12-month intervention (30.7% arrested). Implementation is feasible, and a signal that the system might reduce incarceration was detected, encouraging development of a larger study.

A potential new form of jail diversion and reconnection to mental health services: I. Stakeholders' views on acceptability.

The most effective point of intervention to prevent unnecessary arrest/incarceration of persons with serious mental illnesses is the initial encounter with police. We piloted a new police-mental health linkage system. When officers run an enrolled participant's name/identifiers, they receive an electronic message that the person has mental health considerations and that they should call for information. The linkage specialist receives the call and assists telephonically. In this qualitative study to examine acceptability of the linkage system, we conducted nine focus groups with diverse stakeholders (e.g., enrolled patients, officers). Focus groups revealed that patients enrolled with the hope that the linkage system would prevent negative interactions with police and minimize risk of arrest. Officers reported preferring not to arrest mental health patients and were genuinely invested in helping them, and felt that the linkage system might be an additional tool during encounters. Findings revealed acceptability of the intervention, and further research is warranted.

Associations of acoustically measured tongue/jaw movements and portion of time speaking with negative symptom severity in patients with schizophrenia in Italy and the United States.

This is the first cross-language study of the effect of schizophrenia on speech as measured by analyzing phonetic parameters with sound spectrography. We hypothesized that reduced variability in pitch and formants would be correlated with negative symptom severity in two samples of patients with schizophrenia, one from Italy, and one from the United States. Audio recordings of spontaneous speech were available from 40 patients. From each speech sample, a file of F0 (pitch) and formant values (F1 and F2, resonance bands indicating the moment-by-moment shape of the oral cavity), and the portion of the recording in which there was speaking ("fraction voiced," FV), was created. Correlations between variability in the phonetic indices and negative symptom severity were tested and further examined using regression analyses. Meaningful negative correlations between Scale for the Assessment of Negative Symptoms (SANS) total score and standard deviation (SD) of F2, as well as variability in pitch (SD F0) were observed in the Italian sample. We also found meaningful associations of SANS affective flattening and SANS alogia with SD F0, and of SANS avolition/apathy and SD F2 in the Italian sample. In both samples, FV was meaningfully correlated with SANS total score, avolition/apathy, and anhedonia/asociality.

Self-assessment of functional status in schizophrenia.

With new treatments targeting features of schizophrenia associated with functional disability, there is a need to evaluate the validity of ratings of everyday outcomes. It is unknown whether patients can validly self-report on aspects of their functional status, which would be a potentially economical method for obtaining outcome data. In this study, 67 older schizophrenia outpatients provided self-ratings of everyday real-world functioning using the specific levels of functioning scale (SLOF). They were also administered assessments of neuropsychological performance, performance-based measures of functional capacity and social skills, clinical symptoms, and quality of life. Case managers, unaware of other ratings, also generated SLOF ratings. Based on discrepancy scores, participants were categorized as accurate raters (n=24), underestimators (n=16), or overestimators (n=27) of their functional status as compared to case managers' ratings. Patients' self-rated functional status was correlated with their subjective quality of life, but remarkably unassociated with case manager ratings of functional status or their own performance on functional capacity or social skills measures. Case manager ratings, however, were highly correlated with performance on functional capacity and social skills measures. Patients who underestimated their real world performance had better cognitive skills and greater self-rated depression than those who overestimated. Accurate raters demonstrated greater social skills than both overestimators and underestimators, while overestimators were most cognitively and functionally impaired. Accurate ratings of everyday outcomes in schizophrenia may require systematic observation of real world outcomes or performance-based measures, as self-reports were inconsistent with objective information.