Trastorno del lenguaje y vocabulario receptivo en pacientes con esquizofrenia de edad avanzada / Language disorder and receptive vocabulary in elderly patients with schizophreni

Objetivo: Estudiar las características del lenguaje y del vocabulario receptivo en 50 pacientes que padecen esquizofrenia y 5 que padecen trastorno esquizoafectivo, todos de evolución crónica. Método: Se sigue un diseño descriptivo correlacional y explicativo con un método de recogida de datos cuantitativo; se aplican la escala Thought, Language and Communication (TLC) y el test Peabody. Resultados: Los participantes tienen una media de 61.47 años (σ=8.00), llevan internados en el centro una media de 19.47años (σ=10.29). Con la TLC se evalúan dos dimensiones del trastorno del pensamiento: la hipoproductividad y la desconexión verbal. La desconexión correlaciona positivamente con el Peabody y los años de ingreso, mientras que la subproducción verbal correlaciona con años de ingreso y edad. El Peabody correlaciona con el grado de formación, con los años de ingreso y con la desconexión de TLC. Conclusiones Los participantes presentan alteraciones del lenguaje, particularmente pobreza del habla y desconexión verbal con puntuaciones que varían de leve a moderado. Los pacientes más formados comprenden mejor el vocabulario. La subproducción verbal es mayor con más edad y con más años de ingreso, mientras que la desconexión es mayor en los pacientes con más años de ingreso. Presentan mayores dificultades en la comprensión del vocabulario cuando aumentan los años de ingreso y cuando tienen más dificultades en la desconexión.(AU)

Objective: To study the characteristics of language and receptive vocabulary in 50 patients suffering from schizophrenia and 5 suffering from schizoaffective disorder, all with chronic evolution. Method: A descriptive, correlational, and explanatory design with a quantitative data collection method was used, applying the Thought, Language and Communication (TLC) scale and the Peabody Test. Results: The participants have a mean age of 61.47years (σ=8.00), they have been in the centre for an average of 19.47years (σ=10.29). Two dimensions of thought disorder are assessed with the TLC: hypoproductivity and verbal disengagement. Disconnectedness correlates positively with the Peabody and years of entry, whereas verbal underproduction correlates with years of entry and age. The Peabody correlates with the degree of education, and with years of entry, and TLC disconnection. Conclusions: Participants present language impairment, particularly poor speech and verbal disconnection with scores ranging from mild to moderate. The more educated patients have a better understanding of vocabulary. Verbal underproduction is higher with older age and more years of admission. Disconnection is higher in patients with more years of admission. They present greater difficulties in understanding vocabulary as the years of admission increase, and when they have more difficulties in disconnection.(AU)

Perfil lingüístico de personas adultas con esquizofrenia residentes en un centro sociosanitario / Linguistic profile of adults with schizophrenia residents in a facility health

Las alteraciones lingüísticas son frecuentes en personas con esquizofrenia, es por ello, por lo que se persigue conocer en profundidad el lenguaje de estas personas; y encontrar relaciones entre los resultados del Neurobel y del TLC. La metodología de investigación es cuantitativa. Se aplica la Escala Thought, language, and Communication (TLC) y el Neurobel a 70 pacientes con esquizofrenia y 5 con trastorno esquizoafectivo. Los resultados indican que estos participantes tienen dificultades en todos los ítems que se han medido del TLC en orden de mayor a menor dificultad encontramos las siguientes: pérdida de la finalidad, tangencialidad, contenido, descarrilamiento y falta de lógica. En Neurobel encontramos mejores puntuaciones en la comprensión que en la expresión; pero si tenemos en cuenta los resultados de manera individualizada, se observan mejores resultados en repetición, discriminación de fonemas; y peores resultados en completar oraciones. Como conclusión existe un alto nivel de correlación entre los resultados del Neurobel con los resultados del TLC, lo que es importante ya que puede ser uno de los factores etiológicos de la psicopatología que afecta al lenguaje de los pacientes con esquizofrenia (AU)

Linguistic alterations are frequent in people with schizophrenia, which is why the aim is to gain in-depth knowledge of the language of these people and to find relationships between the results of the Neurobel and the TLC. The research methodology is quantitative. The Thought, language, and Communication Scale (TLC) and the Neurobel were applied to 70 patients with schizophrenia and 5 with schizoaffective disorder. The results indicate that these participants have difficulties in all the items measured in the TLC, in order from most to least difficult: loss of purpose, tangentiality, content, derailment and illogicality. In Neurobel, we found better scores in comprehension than in expression; but if we consider the results individually, we observe better results in repetition, phoneme discrimination; and worse results in sentence completion. In conclusion, there is a high level of correlation between the Neurobel results and the TLC results, which is important as it may be one of the aetiological factors of the psychopathology affecting the language of patients with schizophrenia (AU)

Neurocognitive and linguistic correlates of positive and negative formal thought disorder: A meta-analysis.

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.

Marcas biográficas de la narrativa biomédica. Autopercepción y resistencias encarnadas / Tracing biomedical narratives in biography. Self-perception and embodied resistances

A partir de una etnografía realizada en Galicia entre 2013 y 2014, el presente texto aborda el impacto que tiene la praxis biomédica en entornos terapéuticos, particularmente en la elaboración de significados personales sobre el sufrimiento psíquico. A partir de diferentes relatos biográficos de personas diagnosticadas de esquizofrenia, se destacan algunos elementos discursivos y prácticas atencionales que interfieren en los marcos de referencia desde los que las personas afectadas identifican posibles causas de su malestar. Desde una perspectiva socioeducativa, dialógica y crítica, se señala cómo, más allá de la existencia de determinadas estructuras de poder, por medio de la puesta en valor de los saberes en primera persona, resulta posible situar alternativas, tácticas y objetivos a desarrollar en la gestión social del malestar

Based on an ethnographic study conducted in Galicia (Spain) during 2013-2014, this paper analyses the impact of biomedical praxis in therapeutic environments, particularly on how people diagnosed with mental disorders attribute personal meanings to their own psychic suffering. Drawing from different personal biographical accounts of people diagnosed with schizophrenia, we highlight certain biomedical discourses and practices actually interfering the way in which they identify the causes of their own suffering. As an attempt to step beyond the hegemonic frameworks and practices in dealing with mental suffering, we propose some other theoretical approaches (e.g. socio-educational, dialogical, and critical ones), emphasizing personal grounded knowledge among other alternative options

Evaluación de la dimensión semántica y fonológica en pacientes con esquizofrenia / Evaluation of the semantic and phonological dimension in patients with schizophrenia

Antecedentes y objetivo: La esquizofrenia se caracteriza por una distorsión del pensamiento, las percepciones, las emociones, el lenguaje, la conciencia de sí mismo y la conducta. Afecta a más de 21 millones de personas en todo el mundo y es una de las 10 enfermedades más incapacitantes según la Organización Mundial de la Salud; sin embargo, existe escasa evidencia sobre el déficit lingüístico con el que cursa la enfermedad. Metodología: Se trata de un estudio transversal y cuasi-experimental donde se analizan los datos de diferentes pruebas lingüísticas de las áreas de semántica y fonología en una muestra compuesta por 96 sujetos, de los cuales 48 (50%) tienen esquizofrenia y componen el grupo experimental y otros 48 (50%) no tienen ninguna enfermedad mental y componen el grupo control. Según la clasificación de Crow, el 56,2% de los participantes con esquizofrenia (27 sujetos) presentaba sintomatología positiva y el 43,8% (21 sujetos) presentaba sintomatología negativa. Resultados: Se observa un patrón de déficit según la sintomatología, así como una afectación de las áreas lingüísticas evaluadas (semántica y fonología). Conclusiones: La esquizofrenia cursa con déficit lingüístico en la semántica y en la fonología, siendo necesario evaluar dichas áreas lingüísticas para poder intervenir logopédica y multidisciplinarmente sobre ellas

Background and objective: Schizophrenia is characterized by a distortion of thin-king, perceptions, emotions, language, self-awareness, and behaviour. It affects more than 21 million people worldwide and is one of the 10 most disabling diseases according to the World Health Organization. However, there is little evidence of language deficits in patients with schizophrenia. Method: This is a cross-sectional and quasi-experimental study in which the data of the evaluation of different linguistic tests in the areas of semantics and phonology are analysed. The sample consisted of 96 subjects, 48 of whom (50%) had schizophrenia and made up the experimental group and other 48 (50%) had no mental illness and made up the control group. According to the classification of Crow, 56.2% (27 subjects) presented with positive symptomatology and 43.8% (21 subjects) presented with negative symptoms. Results: A deficit pattern according to the symptomatology was observed, as well as an affectation of all the areas examined in the study (semantics and phonology). Conclusions: Schizophrenia involves a linguistic deficit in semantics and phonology. It is necessary to assess these linguistic areas in order to intervene from a multidisciplinary approach, including speech therapy

Altered topological characteristics of morphological brain network relate to language impairment in high genetic risk subjects and schizophrenia patients.

OBJECTIVE: Evidence suggests relationships between abnormalities in various cortical and subcortical brain structures and language dysfunction in individuals with schizophrenia, and to some extent in those with increased genetic risk for this diagnosis. The topological features of the structural brain network at the systems-level and their impact on language function in schizophrenia and in those at high genetic risk has been less well studied. METHOD: Single-subject morphological brain network was constructed in a total of 71 subjects (20 patients with schizophrenia, 19 individuals at high genetic risk for schizophrenia, and 32 controls). Among these 71 subjects, 56 were involved in our previous neuroimaging studies. Graphic Theoretical Techniques was applied to calculate the global and nodal topological characteristics of the morphological brain network of each participant. Index scores for five language-related cognitive tests were also attained from each participant. RESULTS: Significantly smaller nodal degree in bilateral superior occipital gyri (SOG) were observed in individuals with schizophrenia, as compared to the controls and those at high risk; while significantly reduced nodal betweenness centrality (quantifying the level of a node in connecting other nodes in the network) in right middle frontal gyrus (MFG) was found in the high-risk group, relative to controls. The right MFG nodal efficiency and hub capacity (represented by both nodal degree and betweenness centrality) of the morphological brain network were negatively associated with the wide range achievement test (WRAT) standard performance score; while the right SOG nodal degree was positively associated with the WRAT standard performance score, in the entire study sample. CONCLUSIONS: These findings enhance the understanding of structural brain abnormalities at the systems-level in individuals with schizophrenia and those at high genetic risk, which may serve as critical neural substrates for the origin of the language-related impairments and symptom manifestations of schizophrenia.

Deficits in nominal reference identify thought disordered speech in a narrative production task.

Formal thought disorder (TD) is a neuropathology manifest in formal language dysfunction, but few behavioural linguistic studies exist. These have highlighted problems in the domain of semantics and more specifically of reference. Here we aimed for a more complete and systematic linguistic model of TD, focused on (i) a more in-depth analysis of anomalies of reference as depending on the grammatical construction type in which they occur, and (ii) measures of formal grammatical complexity and errors. Narrative speech obtained from 40 patients with schizophrenia, 20 with TD and 20 without, and from 14 healthy controls matched on pre-morbid IQ, was rated blindly. Results showed that of 10 linguistic variables annotated, 4 showed significant differences between groups, including the two patient groups. These all concerned mis-uses of noun phrases (NPs) for purposes of reference, but showed sensitivity to how NPs were classed: definite and pronominal forms of reference were more affected than indefinite and non-pronominal (lexical) NPs. None of the measures of formal grammatical complexity and errors distinguished groups. We conclude that TD exhibits a specific and differentiated linguistic profile, which can illuminate TD neuro-cognitively and inform future neuroimaging studies, and can have clinical utility as a linguistic biomarker.

Diminished emotional expression in schizophrenia: an interdisciplinary approach based on behavioral interventions.

BACKGROUND: Negative symptoms represent the main cause of disability in schizophrenia, having recently been grouped into two general dimensions: avolition and diminished emotional expression, which includes affective flattening and alogia. The aim of this study was to explore the response of these two symptoms to a set of behavioral interventions based on contingency management, performed in an interdisciplinary context. METHOD: Behaviors of interest were monitored and evaluations before and after the treatment were performed on 9 schizophrenic inpatients with persistent negative symptoms. The program included 12 group double sessions aimed at developing facial expression and verbal communication, and a nursing care plan to generalize and strengthen these behaviors synergistically. RESULTS: there were appreciable differences in facial expression, which were less clear for alogia. The clinical evaluation using PANSS-N did not find notable differences at group level, but the nursing assessment using NOC indicators did. CONCLUSIONS: although difficult to modify, negative symptoms are not insensitive to the influence of behavioral interventions. Specific psychological interventions that address negative symptoms as a priority focus of attention and care need to be promoted and developed, particularly when considering the crucial role of context in their progression.

Comparisons of verbal fluency brain correlates between adults and adolescents suffering from schizophrenia spectrum disorders: A pilot study

Background and Objectives: Prefrontal cortex (PFC) dysfunctions leading to cognitive deficits refer to a core feature of schizophrenia spectrum disorders (SSD). This exploratory study compares the effect of SSD on two stages of maturation of PFC. Methods: Using functional magnetic resonance imaging (fMRI), we measured the brain correlates related to a verbal fluency task (a hallmark executive function test) in 12 patients with SSD: 6 adolescents (SSD-ado) and 6 adults (SSD-adu). Results: SSD-ado showed greater activation in insula, thalamus and hIP1 whereas SSDadu recruited more intensively precentral gyrus and temporal pole to resolve the task. Thus, adolescents with SSD seem to adopt less frontal mediated strategic processes. In contrast, adults seem to be able to use PFC mediated strategy despite the well-known deleterious effect of SSD on the PFC. Conclusions: This first exploratory study revealed that adults and adolescents with SSD seemed not to use the same strategy to resolve a verbal fluency task. Thus, despite the illness, which is known to have a deleterious influence on PFC, adult patients seem to be able to recruit these resources to perform an executive function task. Further studies are needed in order to confirm and extend these new and preliminary results (AU)

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Analysis of errors in verbal fluency tasks in patients with chronic schizophrenia

Background and Objectives: Even if verbal fluency deficits have been described in Schizophrenia, error pattern in this test has not been analyzed in detail in the literature. The pattern analysis of such errors could contribute to the understanding of the factors that influence poor task performance in schizophrenia. In this study we analyzed the intrusion and perseveration errors in verbal fluency tasks in patients with chronic schizophrenia. Methods: 87 patients diagnosed with Chronic Schizophrenia and 87 healthy controls were included in this investigation and were assessed with four Phonological and Semantic Verbal Fluency tasks. Results: The results of this study showed that at least half of schizophrenic patients produced perseverative errors on verbal fluency and about made intrusion errors. The severity of negative symptoms, the severity of Formal Thought Disorder and pharmacological variables were significant moderators to errors in Verbal Fluency performance. Conclusions: Errors in Verbal Fluency can be explained by the interaction of different variables in patients with schizophrenia. Schizophrenia is a psychological pathology with great phenomenological complexity and its particularities can only be explained by the consideration of the multiple factors involved in its manifestation

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Language and hope in schizophrenia-spectrum disorders.

Hope is integral to recovery for those with schizophrenia. Considering recent advancements in the examination of clients' lexical qualities, we were interested in how clients' words reflect hope. Using computerized lexical analysis, we examined social, emotion, and future words' relations to hope and its pathways and agency components. Forty-five clients provided detailed narratives about their life and mental illness. Transcripts were analyzed using the Linguistic Inquiry and Word Count program (LIWC), which assigns words to categories (e.g., "anxiety") based on a pre-existing dictionary. Correlations and linear multiple regression were used to examine relationships between lexical qualities and hope. Hope and its subcomponents had significant or trending bivariate correlations in expected directions with several emotion-related word categories (anger and sadness) but were not associated with expected categories such as social words, positive emotions, optimism, achievement, and future words. In linear multiple regressions, no LIWC variable significantly predicted hope agency, but anger words significantly predicted both total hope and hope pathways. Our findings indicate lexical analysis tools can be used to investigate recovery-oriented concepts such as hope, and results may inform clinical practice. Future research should aim to replicate our findings in larger samples.

Semantic memory organization on verbal fluency test «Human Body Parts» in patients with chronic schizophrenia diagnosis and healthy controls

Background and Objectives: The cognitive impairments known as schizophrenia have been extensively reported in the literature. The severity of such impairments has been shown to vary depending on the cognitive domain that is being studied. Impairments in performance in VF tasks have also been extensively reported by comparing schizophrenic patients on the one hand with healthy controls and patients suffering from other mental disorders on the other, and it is suggested that such impairments can be considered as part of the neuropsychological endophenotype for schizophrenia. This study analyzed the organization of semantic memory in patients with chronic schizophrenia by means of the «Human Body Parts» VF task. Methods: 44 patients with chronic schizophrenia and 44 healthy controls were examined, paired by age, sex, years of education, and handedness. The organization of semantic memory was derived from the construction of semantic maps obtained by means of correspondence analysis. Results: Performance in the VF task studied was significantly lower in the patients group. The semantic maps obtained from the CoA show a semantic organization partly differential in both groups of participants. Conclusions: The hypothesis that there would be better performance because this is a test that has a selfreferential key was partially rebutted. Although there was a deficit in performance, the findings from this study suggest that such performance cannot be accounted for by lack of organization in semantic networks or clinical variables (AU)

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Are idiom comprehension difficulties in patients with schizophrenia due to working memory and executive deficits?

Background and Objectives: We investigated idiom comprehension in patients with schizophrenia, and the involvement of working memory and executive functions in this comprehension. Methods: Nineteen patients with schizophrenia aged 22-46 years (mean = 34.73 years) took part in this study, and were matched for age and education level with a control group. Our assessment consisted of (1) an experimental task assessing idiom comprehension through short stories, (2) three tasks assessing verbal, visuospatial and multimodal spans, and (3) four tasks assessing executive functions (Hayling test, Stroop test, Wisconsin Card Sorting Test and Trail Making Test). Results and Conclusion: Results highlighted several deficits in the comprehension of idioms in patients with schizophrenia. An executive deficit is not sufficient to explain these difficulties. Nevertheless, the conceptual disorganization observed in the patients conduce them to not focus their attention on the relevant elements avoiding the comprehension of idioms (AU)

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Can the Acoustic Analysis of Expressive Prosody Discriminate Schizophrenia?

Emotional states, attitudes and intentions are often conveyed by modulations in the tone of voice. Impaired recognition of emotions from a tone of voice (receptive prosody) has been described as characteristic symptoms of schizophrenia. However, the ability to express non-verbal information in speech (expressive prosody) has been understudied. This paper describes a useful technique for quantifying the degree of expressive prosody deficits in schizophrenia, using a semi-automatic method, and evaluates this method's ability to discriminate between patient and control groups. Forty-five medicated patients with a diagnosis of schizophrenia were matched with thirty-five healthy comparison subjects. Production of expressive prosodic speech was analyzed using variation in fundamental frequency (F0) measures on an emotionally neutral reading task. Results revealed that patients with schizophrenia exhibited significantly more pauses (p < .001), were slower (p < .001), and showed less pitch variability in speech (p < .05) and fewer variations in syllable timing (p < .001) than control subjects. These features have been associated with «flat¼ speech prosody. Signal processing algorithms applied to speech were shown to be capable of discriminating between patients and controls with an accuracy of 93.8%. These speech parameters may have a diagnostic and prognosis value and therefore could be used as a dependent measure in clinical trials.

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.

Formal thought disorder: self-report in non-clinical populations

This study present data from 300 unselected individuals who had completed the Formal Thought Disorder-Self Scale (FTD-S) (Study 1) and from a separate sample of over 150 unselected individuals who had completed the FTD-S and also had a relative or friend complete the Formal Thought Disorder-Other Scale (FTD-O) (Study 2). The questionnaire, originally devised to measure self-ratings of thought disorder in clinical samples, was adapted from a yes-no questionnaire to a 4 point Likert format, to more sensitively determine the extent to which such characteristics may be reported amongst the healthy population. Principal Components Analysis of the FTD-S scale suggested a three-component solution for which we proposed the nomenclature of: odd speech, conversational ability and working memory deficit. Study 2 found that the FTD-S (self-report) and the FTD-O (other rated) reached a significant but low correlation (r= .29; p <0.01); these findings are discussed in terms of its significance for self-report of Formal Thought Disorder and proneness to psychosis (AU)

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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.