The effect of limited cognitive resources on communication disturbances in serious mental illness

Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders

Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks - two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) - in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.

Social representations of gender and their influence in Supported Employment: employment specialists' experiences in Sweden

PURPOSE

Gender differences have been found in the outcomes of vocational rehabilitation (VR) and in Supported Employment (SE), therefore, the purpose of this study was to explore employment specialists' (ES) social representations of gender in relation to work and VR and how these social representations influence the ES's work in the VR process according to SE.

METHODS

The qualitative method of focus group discussions was employed. Ten focus groups were held with 39 ESs from four categories of SE organizations in Sweden. Topic analysis was applied to the transcribed material from the focus groups.

RESULTS

Five themes with different social representations about gender and disability in relation to VR and working life formed in the analysis: (1) differences in personal and health factors among VR-participants, (2) gender norms in society influencing VR, (3) energy-intensive environmental issues influencing VR, (4) gender-specific interactions in VR, and (5) gendered paths in the welfare system.

CONCLUSION

Social representations of higher strains on women with disabilities compared to men with disabilities both in private and working life, which reflect the lived experiences of the ESs, is a possible explanation for gender differences in VR and working life for persons with disabilities.IMPLICATIONS FOR REHABILITATIONGender differences in the outcomes of vocational rehabilitation (VR) interventions have been noticed worldwide. In this study, pervasive social representations about gender and disability in relation to VR were found, but also unconsciousness about gender among VR professionals. Therefore, awareness of gender is necessary in VR.Individualized and person-centered approaches to VR like Supported Employment, although considered best practice, might hide structures like gender, which could lead to reproducing discriminating processes and therefore not achieving gender equality in VR. Therefore, knowledge of discrimination is important in VR.Gender-sensitivity in vocational rehabilitation models with a person-centered and individualized approach is needed and there might also be a need to systematically tailor vocational rehabilitation models to reach gender equality in the outcomes of the interventions. Therefore, gender equality indicators are needed for VR models, to evaluate model effectiveness from a gender perspective.

Predicting self-injurious thoughts in daily life using ambulatory assessment of state cognition

Self-injurious thoughts (SITs) fluctuate considerably from moment to moment. As such, "static" and temporally stable predictors (e.g., demographic variables, prior history) are suboptimal in predicting imminent SITs. This concern is particularly true for "online" cognitive abilities, which are important for understanding SITs, but are typically measured using tests selected for temporal stability. Advances in ambulatory assessments (i.e., real-time assessment in a naturalistic environment) allow for measuring cognition with improved temporal resolution. The present study measured relationships between "state" cognitive performance, measured using an ambulatory-based Trail Making Test, and SITs. Self-reported state hope and social connectedness was also measured. Data were collected using a specially designed mobile application (administered 4x/week up to 28 days) in substance use inpatients (N = 99). Consistent with prior literature, state hope and social connectedness was significantly associated with state SITs. Importantly, poorer state cognitive performance also significantly predicted state SITs, independent of hallmark static and state self-report risk variables. These findings highlight the potential importance of "online" cognition to predict SITs. Ambulatory recording reflects an efficient, sensitive, and ecological valid methodology for evaluating subjective and objectives predictors of imminent SITs.

Multimodal assessment of communicative-pragmatic features in schizophrenia: a machine learning approach

An impairment in pragmatic communication is a core feature of schizophrenia, often associated with difficulties in social interactions. The pragmatic deficits regard various pragmatic phenomena, e.g., direct and indirect communicative acts, deceit, irony, and include not only the use of language but also other expressive means such as non-verbal/extralinguistic modalities, e.g., gestures and body movements, and paralinguistic cues, e.g., prosody and tone of voice. The present paper focuses on the identification of those pragmatic features, i.e., communicative phenomena and expressive modalities, that more reliably discriminate between individuals with schizophrenia and healthy controls. We performed a multimodal assessment of communicative-pragmatic ability, and applied a machine learning approach, specifically a Decision Tree model, with the aim of identifying the pragmatic features that best separate the data into the two groups, i.e., individuals with schizophrenia and healthy controls, and represent their configuration. The results indicated good overall performance of the Decision Tree model, with mean Accuracy of 82%, Sensitivity of 76%, and Precision of 91%. Linguistic irony emerged as the most relevant pragmatic phenomenon in distinguishing between the two groups, followed by violation of the Gricean maxims, and then extralinguistic deceitful and sincere communicative acts. The results are discussed in light of the pragmatic theoretical literature, and their clinical relevance in terms of content and design of both assessment and rehabilitative training.

Speech production and disorganization in schizotypy: Investigating the role of cognitive and affective systems

Diminished productivity and elevated disorganization have been detected in the speech of individuals with schizotypy. However, the underlying mechanisms for these disruptions are not well understood. Separate lines of research suggest potential contributions from cognitive and affective systems. In this study, disorganized speech and speech production were examined in speech samples generated by schizotypy (n = 47) and non-schizotypy (n = 51) groups by assessing "reactivity" (i.e., a change in experimental compared with baseline conditions) across baseline, affective, and dual-task (i.e., cognitive) conditions. Relationships with social functioning were also examined within each group. Three key findings emerged: 1) compared to the non-schizotypy group, those with schizotypy exhibited diminished speech production in the affective condition and affective reactivity was observed; 2) the schizotypy group displayed greater levels of disorganized speech in dual-task conditions and cognitive reactivity was observed; and 3) affective reactivity for disorganized speech was linked to worse social functioning within the schizotypy group. This study provides evidence that cognitive and affective systems are uniquely involved in separate characteristics of speech in schizotypy. At this stage, cognitive systems appear to have a specific role in the organization of speech, whereas affective systems are more heavily involved in speech production. Regarding the association between affective reactivity and social functioning, previous research has demonstrated individuals highly reactive to emotional stimuli carry additional risk for conversion to psychosis. Future research identifying a subset with schizotypy who demonstrate affective reactivity could lead to a better understanding of links between schizotypy and future psychosis symptoms.

The Ability of Patients With Schizophrenia to Comprehend and Produce Sincere, Deceitful, and Ironic Communicative Intentions: The Role of Theory of Mind and Executive Functions

Patients with schizophrenia are often described as impaired in several cognitive domains. Specifically, patients with schizophrenia often exhibit problems in solving tasks requiring theory of mind (ToM), i.e., the ability to ascribe mental states to oneself and others, communicative-pragmatic ability, i.e., the ability to use language and non-verbal expressive means to convey meaning in a given context, and executive functions (EF). This study aims to investigate the role of cognitive functions, such as general intelligence, selective attention, processing speed, and especially EF (working memory, cognitive flexibility, inhibition, and planning), and ToM in explaining the performance of individual with schizophrenia in comprehending and producing communicative acts expressed with different communicative intentions (i.e., sincere, deceitful, and ironic), and realized through linguistic and extralinguistic/non-verbal expressive means. Thirty-two patients with schizophrenia and an equal number of healthy controls performed tasks aiming to investigate their capacity to comprehend and produce sincere, deceitful, and ironic communicative acts in addition to a series of cognitive tasks evaluating EF and ToM. The results indicated that individuals with schizophrenia performed worse than the controls in the comprehension and production of all pragmatic phenomena investigated, as well as in all the cognitive functions examined. The patients with schizophrenia also exhibited an increasing trend of difficulty in comprehending and producing sincere, deceitful, and ironic communicative acts expressed through either linguistic or extralinguistic means. Furthermore, a multiple regression analysis of the patients' performance on the pragmatic tasks revealed that overall, the role of attention, general intelligence, and processing speed did not appear to significantly explain the patients' communicative-pragmatic performance. The inclusion of EF into the analysis did not contribute to increase the explained variance of the patients' ability to comprehend and produce the various pragmatic phenomena investigated. Only the addition of ToM could significantly increase the explained variance, but only in the comprehension and production of deceit expressed by language and the production of sincere communicative acts, also limited to linguistic production. We conclude that neither EF nor ToM are able to explain the decreasing trend detected in the patients' pragmatic performance.

Can RDoC Help Find Order in Thought Disorder?

Thought disorder is a pernicious and nonspecific aspect of numerous serious mental illnesses (SMIs) and related conditions. Despite decades of empirical research on thought disorder, our present understanding of it is poor, our clinical assessments focus on a limited set of extreme behaviors, and treatments are palliative at best. Applying a Research Domain Criteria (RDoC) framework to thought disorder research offers advantages to explicate its phenotype; isolate its mechanisms; and develop more effective assessments, treatments, and potential cures. In this commentary, we discuss ways in which thought disorder can be understood within the RDoC framework. We propose operationalizing thought disorder within the RDoC construct of language using psycholinguistic sciences, to help objectify and quantify language within individuals; technologically sophisticated paradigms, to allow naturalistic behavioral sampling techniques with unprecedented ecological validity; and computational modeling, to account for a network of interconnected and dynamic linguistic, cognitive, affective, and social functions. We also highlight challenges for understanding thought disorder within an RDoC framework. Thought disorder likely does not occur as an isomorphic dysfunction in a single RDoC construct, but rather, as multiple potential dysfunctions in a network of RDoC constructs. Moreover, thought disorder is dynamic over time and context within individuals. In sum, RDoC is a useful framework to integrate multidisciplinary research efforts aimed at operationalizing, understanding, and ameliorating thought disorder.