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Loch AA, Gondim JM, Argolo FC, Lopes-Rocha AC, Andrade JC, van de Bilt MT, de Jesus LP, Haddad NM, Cecchi GA, Mota NB, Gattaz WF, Corcoran CM, Ara A. Detecting at-risk mental states for psychosis (ARMS) using machine learning ensembles and facial features. Schizophr Res 2023; 258:45-52. [PMID: 37473667 PMCID: PMC10448183 DOI: 10.1016/j.schres.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/26/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
AIMS Our study aimed to develop a machine learning ensemble to distinguish "at-risk mental states for psychosis" (ARMS) subjects from control individuals from the general population based on facial data extracted from video-recordings. METHODS 58 non-help-seeking medication-naïve ARMS and 70 healthy subjects were screened from a general population sample. At-risk status was assessed with the Structured Interview for Prodromal Syndromes (SIPS), and "Subject's Overview" section was filmed (5-10 min). Several features were extracted, e.g., eye and mouth aspect ratio, Euler angles, coordinates from 51 facial landmarks. This elicited 649 facial features, which were further selected using Gradient Boosting Machines (AdaBoost combined with Random Forests). Data was split in 70/30 for training, and Monte Carlo cross validation was used. RESULTS Final model reached 83 % of mean F1-score, and balanced accuracy of 85 %. Mean area under the curve for the receiver operator curve classifier was 93 %. Convergent validity testing showed that two features included in the model were significantly correlated with Avolition (SIPS N2 item) and expression of emotion (SIPS N3 item). CONCLUSION Our model capitalized on short video-recordings from individuals recruited from the general population, effectively distinguishing between ARMS and controls. Results are encouraging for large-screening purposes in low-resource settings.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil.
| | - João Medrado Gondim
- Instituto de Computação, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Felipe Coelho Argolo
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Caroline Lopes-Rocha
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Julio Cesar Andrade
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Martinus Theodorus van de Bilt
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Leonardo Peroni de Jesus
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Natalia Mansur Haddad
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Natalia Bezerra Mota
- Instituto de Psiquiatria (IPUB), Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Research Department at Motrix Lab - Motrix, Rio de Janeiro, Brazil
| | - Wagner Farid Gattaz
- Laboratório de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil
| | - Cheryl Mary Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters VA Medical Center Bronx, NY, USA
| | - Anderson Ara
- Statistics Department, Federal University of Paraná, Curitiba, PR, Brazil
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Lopes-Rocha AC, de Paula Ramos WH, Argolo F, Gondim JM, Mota NB, Andrade JC, Jafet AF, de Medeiros MW, Serpa MH, Cecchi G, Ara A, Gattaz WF, Corcoran CM, Loch AA. Gesticulation in individuals with at risk mental states for psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:30. [PMID: 37160916 PMCID: PMC10169854 DOI: 10.1038/s41537-023-00360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
Nonverbal communication (NVC) is a complex behavior that involves different modalities that are impaired in the schizophrenia spectrum, including gesticulation. However, there are few studies that evaluate it in individuals with at-risk mental states (ARMS) for psychosis, mostly in developed countries. Given our prior findings of reduced movement during speech seen in Brazilian individuals with ARMS, we now aim to determine if this can be accounted for by reduced gesticulation behavior. Fifty-six medication-naïve ARMS and 64 healthy controls were filmed during speech tasks. The frequency of specifically coded gestures across four categories (and self-stimulatory behaviors) were compared between groups and tested for correlations with prodromal symptoms of the Structured Interview for Prodromal Syndromes (SIPS) and with the variables previously published. ARMS individuals showed a reduction in one gesture category, but it did not survive Bonferroni's correction. Gesture frequency was negatively correlated with prodromal symptoms and positively correlated with the variables of the amount of movement previously analyzed. The lack of significant differences between ARMS and control contradicts literature findings in other cultural context, in which a reduction is usually seen in at-risk individuals. However, gesture frequency might be a visual proxy of prodromal symptoms, and of other movement abnormalities. Results show the importance of analyzing NVC in ARMS and of considering different cultural and sociodemographic contexts in the search for markers of these states.
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Affiliation(s)
- Ana Caroline Lopes-Rocha
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | | | - Felipe Argolo
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - João Medrado Gondim
- Instituto de Computação, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Natalia Bezerra Mota
- Instituto de Psiquiatria (IPUB), Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Research department at Motrix Lab - Motrix, Rio de Janeiro, Brazil
| | - Julio Cesar Andrade
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Andrea Fontes Jafet
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Matheus Wanderley de Medeiros
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mauricio Henriques Serpa
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | | | - Anderson Ara
- Statistics Department, Federal University of Paraná, Curitiba, PR, Brazil
| | - Wagner Farid Gattaz
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil
| | - Cheryl Mary Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- James J. Peters VA Medical Center, Bronx, NY, USA
| | - Alexandre Andrade Loch
- Laboratorio de Neurociencias (LIM 27), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Laboratorio de Neuroimagem em Psiquiatria (LIM 21), Instituto de Psiquiatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Karp EL, Williams TF, Ellman LM, Strauss GP, Walker EF, Corlett PR, Woods SW, Powers AR, Gold JM, Schiffman JE, Waltz JA, Silverstein SM, Mittal VA. Self-reported Gesture Interpretation and Performance Deficits in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2023; 49:746-755. [PMID: 36939086 PMCID: PMC10154698 DOI: 10.1093/schbul/sbac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND AND HYPOTHESIS Deficits in performing and interpreting communicative nonverbal behaviors, such as gesture, have been linked to varied psychopathology and dysfunction. Some evidence suggests that individuals at risk for psychosis have deficits in gesture interpretation and performance; however, individuals with internalizing disorders (eg, depression) may have similar deficits. No previous studies have examined whether gesture deficits in performance and interpretation are specific to those at risk for psychosis. Additionally, the underlying mechanisms (eg, cognition) and consequences (eg, functioning) of these deficits are poorly understood. STUDY DESIGN This study examined self-reported gesture interpretation (SRGI) and performance (SRGP) in those at clinical high risk for psychosis (CHR; N = 88), those with internalizing disorders (INT; N = 51), and healthy controls (HC; N = 53). Participants completed questionnaires, clinical interviews, and neurocognitive tasks. STUDY RESULTS Results indicated that the CHR group was characterized by significantly lower SRGI scores than the HC or INT groups (d = 0.41); there were no differences among groups in SRGP. Within CHR participants, greater deficits in SRGP were associated with lower verbal learning and memory (r = -.33), but not general intelligence or processing speed. Furthermore, gesture deficits were associated with higher cross-sectional risk for conversion to a full psychotic disorder in the CHR group. CONCLUSIONS Overall, these findings suggest that specific subdomains of gesture may reflect unique vulnerability for psychosis, self-report may be a viable assessment tool in understanding these phenomena, and gesture dysfunction may signal risk for transition to psychosis.
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Affiliation(s)
- Erica L Karp
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Trevor F Williams
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
| | - Gregory P Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA 30602, USA
| | - Elaine F Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA 30322, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Albert R Powers
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - James M Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Jason E Schiffman
- Department of Psychological Science, University of California, 4201 Social and Behavioral Sciences Gateway, Irvine, CA 92697, USA
| | - James A Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA
| | - Steven M Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Vijay A Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL 60208, USA
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Djordjevic M, Glumbić N, Brojčin B, Banković S, Žunić Pavlović V. Differences in pragmatic communication skills of adults with intellectual disabilities and dual diagnoses. Front Psychiatry 2023; 14:1072736. [PMID: 36816408 PMCID: PMC9934929 DOI: 10.3389/fpsyt.2023.1072736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Pragmatics includes a set of skills related to language structure and meaning that allow the speaker to use the language appropriately and in accordance with different communication situations. The aim of this research was to determine the differences in pragmatic communication skills of adults with intellectual disabilities, dual diagnoses, and typical development, and to determine the effects of gender, age, the level of intellectual functioning and speech comprehension on their achievements on two assessment instruments. METHODS The sample included 180 adults (60 typically developing participants, 60 with intellectual disabilities, and 60 participants with dual diagnoses). We used two instruments to assess pragmatic communication skills - Communication Checklist - Adult, CC-A, and the Assessment Battery for Communication, ABaCo. In order to test the differences between the three groups of participants, we used canonical discriminant analysis. RESULTS Discriminant analysis revealed two significant canonical functions. Function one (speech comprehension and the level of intellectual disability, social engagement, and paralinguistic scale) differentiates between typically developing participants and participants with dual diagnoses the most. The second canonical function (language structure, linguistic scale, paralinguistic scale, extralinguistic scale, and context scale) differentiates between participants with intellectual disabilities and participants with dual diagnoses the most. According to the results, age did not affect pragmatic achievements. DISCUSSION Pragmatic skills are very complex, and different instruments measure different dimensions of these abilities. The results of this research lead to the conclusion that we can differentiate between the pragmatic abilities of typically developing people, people with intellectual disabilities, and those with dual diagnoses with the help of the ABaCo battery and the CC-A questionnaire.
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Affiliation(s)
- Mirjana Djordjevic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Nenad Glumbić
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Branislav Brojčin
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Slobodan Banković
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Vesna Žunić Pavlović
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
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Motion energy analysis during speech tasks in medication-naïve individuals with at-risk mental states for psychosis. SCHIZOPHRENIA 2022; 8:73. [PMID: 36114187 PMCID: PMC9481869 DOI: 10.1038/s41537-022-00283-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/03/2022] [Indexed: 12/16/2022]
Abstract
Movement abnormalities are commonly observed in schizophrenia and at-risk mental states (ARMS) for psychosis. They are usually detected with clinical interviews, such that automated analysis would enhance assessment. Our aim was to use motion energy analysis (MEA) to assess movement during free-speech videos in ARMS and control individuals, and to investigate associations between movement metrics and negative and positive symptoms. Thirty-two medication-naïve ARMS and forty-six healthy control individuals were filmed during speech tasks. Footages were analyzed using MEA software, which assesses movement by differences in pixels frame-by-frame. Two regions of interest were defined—head and torso—and mean amplitude, frequency, and coefficient of variability of movements for them were obtained. These metrics were correlated with the Structured Interview for Prodromal Syndromes (SIPS) symptoms, and with the risk of conversion to psychosis—inferred with the SIPS risk calculator. ARMS individuals had significantly lower mean amplitude of head movement and higher coefficients of movement variability for both head and torso, compared to controls. Higher coefficient of variability was related to higher risk of conversion. Negative correlations were seen between frequency of movement and most SIPS negative symptoms. All positive symptoms were correlated with at least one movement variable. Movement abnormalities could be automatically detected in medication-naïve ARMS subjects by means of a motion energy analysis software. Significant associations of movement metrics with symptoms were found, supporting the importance of movement analysis in ARMS. This could be a potentially important tool for early diagnosis, intervention, and outcome prediction.
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Bachofner H, Scherer KA, Vanbellingen T, Bohlhalter S, Stegmayer K, Walther S. Validation of the Apraxia Screen TULIA (AST) in Schizophrenia. Neuropsychobiology 2022; 81:311-321. [PMID: 35367989 PMCID: PMC9533426 DOI: 10.1159/000523778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deficits in social interaction and community functioning, including impaired use, performance, and perception of hand gestures, are key features in schizophrenia. A well-established tool to assess gesture deficits is the test of upper limb apraxia (TULIA). However, given its time-consuming application based on video analyses, research has proposed the bedside apraxia screen of TULIA (AST). This study aims to test the validity and reliability of the AST to detect gesture abnormalities at bedside in a sample of 27 patients diagnosed with schizophrenia, schizotypal disorder, acute and transient psychotic disorders, or schizoaffective disorder. METHODS Patients completed the 48-item TULIA and the 12-item AST. Two different raters assessed the AST: one at bedside (online) and the other based on the video recordings. RESULTS The total AST scores demonstrated a high parallel reliability, moderate inter-rater reliability on a single-item level, and good construct validities. CONCLUSIONS The psychometric properties of the AST suggest it can well be used for the clinical assessment of gesture deficits in schizophrenia. However, when detailed information is required, the AST rated from video or conducting the full TULIA is recommended. The findings call for refining the selection of the TULIA items for a psychosis-AST bedside test to increase specificity.
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Affiliation(s)
- Hanta Bachofner
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland,*Hanta Bachofner,
| | - Konstantin A. Scherer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | | | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Luzern, Switzerland,University Hospital, University of Zurich, Zurich, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
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Riedl L, Nagels A, Sammer G, Choudhury M, Nonnenmann A, Sütterlin A, Feise C, Haslach M, Bitsch F, Straube B. Multimodal speech-gesture training in patients with schizophrenia spectrum disorder: Effects on quality of life and neural processing. Schizophr Res 2022; 246:112-125. [PMID: 35759877 DOI: 10.1016/j.schres.2022.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/25/2022] [Accepted: 06/11/2022] [Indexed: 12/30/2022]
Abstract
Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia spectrum disorder (SSD) that severely affects quality of life. Interpreting abstract speech and integrating nonverbal information is particularly affected. Considering the difficulty to treat communication dysfunctions with usual intervention, we investigated the possibility to apply a multimodal speech-gesture (MSG) training. In the MSG training, we offered 8 sessions (60 min each) including perceptive and expressive tasks as well as meta-learning elements and transfer exercises to 29 patients with SSD. In a within-group crossover design, patients were randomized to a TAU-first (treatment as usual first, then MSG training) group (N = 20) or a MSG-first (MSG training first, then TAU only) group (N = 9), and were compared to healthy controls (N = 17). Outcomes were quality of life and related changes in the neural processing of abstract speech-gesture information, which were measured pre-post training through standardized psychological questionnaires and functional Magnetic Resonance Imaging, respectively. Pre-training, patients showed reduced quality of life as compared to controls but improved significantly during the training. Strikingly, this improvement was correlated with neural activation changes in the middle temporal gyrus for the processing of abstract multimodal content. Improvement during training, self-report measures and ratings of relatives confirmed the MSG-related changes. Together, we provide first promising results of a novel multimodal speech-gesture training for patients with schizophrenia. We could link training induced changes in speech-gesture processing to changes in quality of life, demonstrating the relevance of intact communication skills and gesture processing for well-being.
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Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University, Giessen, Germany.
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Momoko Choudhury
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Annika Nonnenmann
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Anne Sütterlin
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Chiara Feise
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Maxi Haslach
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Florian Bitsch
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University, Marburg, Germany; Center for Mind, Brain and Behavior (CMBB), Philipps-University Marburg and Justus Liebig University, Giessen, Germany
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Damme KS, Park JS, Vargas T, Walther S, Shankman SA, Mittal VA. Motor abnormalities, depression risk, and clinical course in adolescence. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 2:61-69. [PMID: 35419552 PMCID: PMC9000199 DOI: 10.1016/j.bpsgos.2021.06.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/02/2023] Open
Abstract
Background Motor abnormalities, such as psychomotor agitation and retardation, are widely recognized as core features of depression. However, it is not currently known if motor abnormalities connote risk for depression. Methods Using data from the Adolescent Brain Cognitive Development (ABCD) Study, a nationally representative sample of youth (n=10,835, 9-11 years old), the present paper examines whether motor abnormalities are associated with (a) depression symptoms in early adolescence, (b) familial risk for depression (familial risk loading), and (c) future depression symptoms. Motor abnormalities measures included traditional (DSM) motor signs such as psychomotor agitation and retardation as well as other motor domains such as developmental motor delays and dyscoordination. Results Traditional motor abnormalities were less prevalent (agitation=3.2%, retardation=0.3%) than non-traditional domains (delays=13.79%, coordination=35.5%) among adolescents. Motor dysfunction was associated with depression symptoms (Cohen's ds=0.02 to 0.12). Familial risk for depression was related to motor abnormalities (Cohen's ds=0.08 to 0.27), with the exception of motor retardation. Family vulnerability varied in sensitivity to depression risk (e.g., retardation: .53%; dyscoordination: 32.05%). Baseline endorsement of motor abnormalities predicted future depression symptoms at one-year follow-up. Conclusions These findings suggest that motor signs reflect a novel, promising future direction for examining vulnerability to depression risk in early adolescence.
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Affiliation(s)
- Katherine S.F. Damme
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
| | - Jadyn S. Park
- Department of Psychology, Northwestern University, Evanston, Illinois
- Department of Psychiatry, Northwestern University, Chicago, Illinois
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - Stewart A. Shankman
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
- Department of Psychiatry, Northwestern University, Chicago, Illinois
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois
- Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, Illinois
- Medical Social Sciences, Northwestern University, Chicago, Illinois
- Institute for Policy Research, Northwestern University, Chicago, Illinois
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9
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Pavlidou A, Viher PV, Bachofner H, Weiss F, Stegmayer K, Shankman SA, Mittal VA, Walther S. Hand gesture performance is impaired in major depressive disorder: A matter of working memory performance? J Affect Disord 2021; 292:81-88. [PMID: 34107424 PMCID: PMC8797922 DOI: 10.1016/j.jad.2021.05.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/11/2021] [Accepted: 05/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Individuals with depression exhibit numerous interpersonal deficits. As effective use of gestures is critical for social communication, it is possible that depressed individuals' interpersonal deficits may be due to deficits in gesture performance. The present study thus compared gesture performance of depressed patients and controls and examined whether these deficits relate to cognitive and other domains of dysfunction. METHODS Gesture performance was evaluated in 30 depressed patients and 30 controls using the Test of Upper Limb Apraxia (TULIA). Clinical rating scales were assessed to determine if gesture deficits were associated with motor, cognitive or functional outcomes. RESULTS Compared to controls, depressed patients exhibited impaired gesture performance with 2/3 of the patients demonstrating gesture deficits. Within depressed patients, gesture performance was highly correlated with working memory abilities. In contrast, no association between gesture performance and gestural knowledge, psychomotor retardation, depression severity, or frontal dysfunction was observed in patients. LIMITATIONS This is a cross-sectional study and a larger size would have allowed for confident detection of more subtle, but potentially relevant effects. CONCLUSION Gesture performance is impaired in depressed patients, and appears to be related to poor working memory abilities, suggesting a disruption in the retrieval of gestural cues indicative of a distinct clinical phenomenon that might be related to social functioning.
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Affiliation(s)
- Anastasia Pavlidou
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland.
| | - Petra V Viher
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Hanta Bachofner
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Florian Weiss
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Katharina Stegmayer
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
| | - Stewart A Shankman
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA; Northwestern University, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA; Northwestern University, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Institute for Innovations in Developmental Sciences (DevSci), Evanston, Chicago, IL, USA
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry, Translation Research Center, Bern, Switzerland
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10
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Abstract
Individuals diagnosed with psychotic disorders exhibit abnormalities in the perception of expressive behaviors, which are linked to symptoms and visual information processing domains. Specifically, literature suggests these groups have difficulties perceiving gestures that accompany speech. While our understanding of gesture perception in psychotic disorders is growing, gesture perception abnormalities and clues about potential causes and consequences among individuals meeting criteria for a clinical high-risk (CHR) syndrome is limited. Presently, 29 individuals with a CHR syndrome and 32 healthy controls completed an eye-tracking gesture perception paradigm. In this task, participants viewed an actor using abstract and literal gestures while presenting a story and eye gaze data (eg, fixation counts and total fixation time) was collected. Furthermore, relationships between fixation variables and both symptoms (positive, negative, anxiety, and depression) and measures of visual information processing (working memory and attention) were examined. Findings revealed that the CHR group gazed at abstract gestures fewer times than the control group. When individuals in the CHR group did gaze at abstract gestures, on average, they spent significantly less time fixating compared to controls. Furthermore, reduced fixation (ie, count and time) was related to depression and slower response time on an attentional task. While a similar pattern of group differences in the same direction appeared for literal gestures, the effect was not significant. These data highlight the importance of integrating gesture perception abnormalities into vulnerability models of psychosis and inform the development of targeted treatments for social communicative deficits.
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Affiliation(s)
- Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL,To whom correspondence should be addressed; Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, US; tel: 847-467-5907, fax: 847-467-5707, e-mail:
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL
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11
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Damme KSF, Schiffman J, Ellman LM, Mittal VA. Sensorimotor and Activity Psychosis-Risk (SMAP-R) Scale: An Exploration of Scale Structure With Replication and Validation. Schizophr Bull 2021; 47:332-343. [PMID: 33047134 PMCID: PMC7965079 DOI: 10.1093/schbul/sbaa138] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Sensorimotor abnormalities precede and predict the onset of psychosis. Despite the practical utility of sensorimotor abnormalities for early identification, prediction, and individualized medicine applications, there is currently no dedicated self-report instrument designed to capture these important behaviors. The current study assessed and validated a questionnaire designed for use in individuals at clinical high-risk for psychosis (CHR). METHODS The current study included both exploratory (n = 3009) and validation (n = 439) analytic datasets-that included individuals identified as meeting criteria for a CHR syndrome (n = 84)-who completed the novel Sensorimotor Abnormalities and Psychosis-Risk (SMAP-R) Scale, clinical interviews and a finger-tapping task. The structure of the scale and reliability of items were consistent across 2 analytic datasets. The resulting scales were assessed for discriminant validity across CHR, community sample non-psychiatric volunteer, and clinical groups. RESULTS The scale showed a consistent structure across 2 analytic datasets subscale structure. The resultant subscale structure was consistent with conceptual models of sensorimotor pathology in psychosis (coordination and dyskinesia) in both the exploratory and the validation analytic dataset. Further, these subscales showed discriminant, predictive, and convergent validity. The sensorimotor abnormality scales discriminated CHR from community sample non-psychiatric controls and clinical samples. Finally, these subscales predicted to risk calculator scores and showed convergent validity with sensorimotor performance on a finger-tapping task. CONCLUSION The SMAP-R scale demonstrated good internal, discriminant, predictive, and convergent validity, and subscales mapped on to conceptually relevant sensorimotor circuits. Features of the scale may facilitate widespread incorporation of sensorimotor screening into psychosis-risk research and practice.
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Affiliation(s)
- Katherine S F Damme
- Department of Psychology, Northwestern University, Evanston, IL
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL
| | | | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL
- Institute for Innovations in Developmental Sciences (DevSci), Northwestern University, Evanston and Chicago, IL
- Department of Psychiatry, Northwestern University, Chicago, IL
- Medical Social Sciences, Northwestern University, Chicago, IL
- Institute for Policy Research (IPR), Northwestern University, Chicago, IL
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12
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He Y, Steines M, Sammer G, Nagels A, Kircher T, Straube B. Modality-specific dysfunctional neural processing of social-abstract and non-social-concrete information in schizophrenia. Neuroimage Clin 2021; 29:102568. [PMID: 33524805 PMCID: PMC7851842 DOI: 10.1016/j.nicl.2021.102568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/09/2022]
Abstract
Schizophrenia is characterized by marked communication dysfunctions encompassing potential impairments in the processing of social-abstract and non-social-concrete information, especially in everyday situations where multiple modalities are present in the form of speech and gesture. To date, the neurobiological basis of these deficits remains elusive. In a functional magnetic resonance imaging (fMRI) study, 17 patients with schizophrenia or schizoaffective disorder, and 18 matched controls watched videos of an actor speaking, gesturing (unimodal), and both speaking and gesturing (bimodal) about social or non-social events in a naturalistic way. Participants were asked to judge whether each video contains person-related (social) or object-related (non-social) information. When processing social-abstract content, patients showed reduced activation in the medial prefrontal cortex (mPFC) only in the gesture but not in the speech condition. For non-social-concrete content, remarkably, reduced neural activation for patients in the left postcentral gyrus and the right insula was observed only in the speech condition. Moreover, in the bimodal conditions, patients displayed improved task performance and comparable activation to controls in both social and non-social content. To conclude, patients with schizophrenia displayed modality-specific aberrant neural processing of social and non-social information, which is not present for the bimodal conditions. This finding provides novel insights into dysfunctional multimodal communication in schizophrenia, and may have potential therapeutic implications.
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Affiliation(s)
- Yifei He
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany.
| | - Miriam Steines
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
| | - Gebhard Sammer
- Cognitive Neuroscience at Centre for Psychiatry, Justus-Liebig University Giessen, Giessen, Germany
| | - Arne Nagels
- Department of General Linguistics, Johannes-Gutenberg University Mainz, Mainz, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany; Center for Mind, Brain and Behavior - CMBB, Hans-Meerwein-Straße 6, 35032 Marburg, Germany
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13
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Pavlidou A, Walther S. Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia. Front Psychol 2021; 11:607312. [PMID: 33488466 PMCID: PMC7817610 DOI: 10.3389/fpsyg.2020.607312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
Movement abnormalities are prevalent across all stages of schizophrenia contributing to poor social functioning and reduced quality of life. To date, treatments are scarce, often involving pharmacological agents, but none have been shown to improve movement abnormalities effectively. Virtual reality (VR) is a tool used to simulate virtual environments where behavioral performance can be quantified safely across different tasks while exerting control over stimulus delivery, feedback and measurement in real time. Sensory information is transmitted via a head mounted display allowing users to directly interact with virtual objects and bodies using gestures and body movements in the real world to perform different actions, permitting a sense of immersion in the simulated virtual environment. Although, VR has been widely used for successful motor rehabilitation in a variety of different neurological domains, none have been exploited for motor rehabilitation in schizophrenia. The objectives of this article are to review movement abnormalities specific to schizophrenia, and how VR can be utilized to restore and improve motor functioning in patients with schizophrenia. Constructing VR-mediated motor-cognitive interventions that can help in retaining and transferring the learned outcomes to real life are also discussed.
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Affiliation(s)
- Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
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14
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Corcoran CM, Mittal VA, Bearden CE, E Gur R, Hitczenko K, Bilgrami Z, Savic A, Cecchi GA, Wolff P. Language as a biomarker for psychosis: A natural language processing approach. Schizophr Res 2020; 226:158-166. [PMID: 32499162 PMCID: PMC7704556 DOI: 10.1016/j.schres.2020.04.032] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022]
Abstract
Human ratings of conceptual disorganization, poverty of content, referential cohesion and illogical thinking have been shown to predict psychosis onset in prospective clinical high risk (CHR) cohort studies. The potential value of linguistic biomarkers has been significantly magnified, however, by recent advances in natural language processing (NLP) and machine learning (ML). Such methodologies allow for the rapid and objective measurement of language features, many of which are not easily recognized by human raters. Here we review the key findings on language production disturbance in psychosis. We also describe recent advances in the computational methods used to analyze language data, including methods for the automatic measurement of discourse coherence, syntactic complexity, poverty of content, referential coherence, and metaphorical language. Linguistic biomarkers of psychosis risk are now undergoing cross-validation, with attention to harmonization of methods. Future directions in extended CHR networks include studies of sources of variance, and combination with other promising biomarkers of psychosis risk, such as cognitive and sensory processing impairments likely to be related to language. Implications for the broader study of social communication, including reciprocal prosody, face expression and gesture, are discussed.
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Affiliation(s)
- Cheryl M Corcoran
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, CA, USA; Department of Psychology, Semel Institute for Neuroscience and Human Behavior, Brain Research Institute, University of California Los Angeles, CA, USA; Department of Psychology, University of California Los Angeles, CA USA
| | - Raquel E Gur
- Brain Behavior Laboratory, Neuropsychiatry Division, Department of Psychiatry, Philadelphia, PA 19104, USA
| | - Kasia Hitczenko
- Department of Linguistics, Northwestern University, Evanston, IL, USA
| | - Zarina Bilgrami
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aleksandar Savic
- Department of Diagnostics and Intensive Care, University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | - Guillermo A Cecchi
- Computational Biology Center-Neuroscience, IBM T.J. Watson Research Center, Yorktown Heights, NY, USA
| | - Phillip Wolff
- Department of Psychology, Emory University, Atlanta, GA, USA.
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15
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Gesture deficits and apraxia in schizophrenia. Cortex 2020; 133:65-75. [PMID: 33099076 DOI: 10.1016/j.cortex.2020.09.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 02/07/2023]
Abstract
Aberrant performance of skilled action has long been noted in schizophrenia and relatedly, recent reports have demonstrated impaired use, performance, and perception of hand gestures in this group. Still, this deficit is not acknowledged as apraxia, which to the broader medical field, characterizes impairments in skilled actions. Understanding the relationship between apraxia and schizophrenia may shed an invaluable new perspective on disease mechanism, and highlight novel treatment opportunities as well. To examine this potential link, we reviewed the evidence for the types of praxis errors, associated psychopathology, and cerebral correlates of the praxis deficit in schizophrenia. Notably, the review indicated that gesture deficits are severe enough to be considered genuine apraxia in a substantial proportion of patients (about 25%). Further, other potential contributors (e.g., hypokinetic motor abnormalities, cognitive impairment) are indeed associated with gesture deficits in schizophrenia, but do not sufficiently explain the abnormality. Finally, patients with praxis deficits have altered brain structure and function including the left parieto-premotor praxis network and these neural correlates are specific to the praxis deficit. Therefore, we argue that the gestural disorder frequently observed in schizophrenia shares both the clinical and neurophysiological features of true apraxia, as in other neuropsychiatric disorders with impaired higher order motor control, such as Parkinson's disease.
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16
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Walther S, Kunz M, Müller M, Zürcher C, Vladimirova I, Bachofner H, Scherer KA, Nadesalingam N, Stegmayer K, Bohlhalter S, Viher PV. Single Session Transcranial Magnetic Stimulation Ameliorates Hand Gesture Deficits in Schizophrenia. Schizophr Bull 2020; 46:286-293. [PMID: 31634401 PMCID: PMC7442336 DOI: 10.1093/schbul/sbz078] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Social interaction is impaired in schizophrenia, including the use of hand gestures, which is linked to poor social perception and outcome. Brain imaging suggests reduced neural activity in a left-lateralized frontoparietal network during gesture preparation; therefore, gesturing might be improved through facilitation of left hemispheric brain areas or via disruption of interhemispheric inhibition from the right homolog. This study tested whether repetitive transcranial magnetic stimulation (rTMS) protocols would improve gesture performance in schizophrenia. This randomized, placebo-controlled, double-blind, crossover trial applied 3 different protocols of rTMS separated by 48 h. Twenty right-handed schizophrenia patients and 20 matched healthy controls received facilitatory intermittent theta burst stimulation (iTBS) over the left inferior frontal gyrus (IFG), inhibitory continuous theta burst stimulation (cTBS) over right inferior parietal lobe (IPL), and placebo over left IPL in randomized order. Primary outcome was change in the test of upper limb apraxia (TULIA), rated from video recordings of hand gesture performance. Secondary outcome was change in manual dexterity using the coin rotation task. Participants improved on both tasks following rTMS compared with baseline. Only patients improved gesture performance following right IPL cTBS compared with placebo (P = .013). The results of the coin rotation parallel those of the TULIA, with improvements following right IPL cTBS in patients (P = .001). Single sessions of cTBS on the right IPL substantially improved both gesture performance accuracy and manual dexterity. The findings point toward an inhibition of interhemispheric rivalry as a potential mechanism of action.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland,To whom correspondence should be addressed; Translational Research Center, University Hospital of Psychiatry, University of Bern, Murtenstrasse 21, 3008 Bern, Switzerland; tel: 41-31-632-8979, fax: +41 31 632 8950, e-mail:
| | - Maribel Kunz
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Manuela Müller
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Caroline Zürcher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Irena Vladimirova
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Hanta Bachofner
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Konstantin A Scherer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Niluja Nadesalingam
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | - Petra V Viher
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
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17
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Walther S, Alexaki D, Stegmayer K, Vanbellingen T, Bohlhalter S. Conceptual disorganization impairs hand gesture performance in schizophrenia. Schizophr Res 2020; 215:467-468. [PMID: 31500999 DOI: 10.1016/j.schres.2019.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/30/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
| | - Danai Alexaki
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
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18
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Riedl L, Nagels A, Sammer G, Straube B. A Multimodal Speech-Gesture Training Intervention for Patients With Schizophrenia and Its Neural Underpinnings - the Study Protocol of a Randomized Controlled Pilot Trial. Front Psychiatry 2020; 11:110. [PMID: 32210849 PMCID: PMC7068208 DOI: 10.3389/fpsyt.2020.00110] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 02/07/2020] [Indexed: 01/02/2023] Open
Abstract
UNLABELLED Dysfunctional social communication is one of the most stable characteristics in patients with schizophrenia that also affects quality of life. Interpreting abstract speech and integrating nonverbal modalities is particularly affected. Considering the impact of communication on social life but failure to treat communication dysfunctions with usual treatment, we will investigate the possibility to improve verbal and non-verbal communication in schizophrenia by applying a multimodal speech-gesture training (MSG training). Here we describe the newly developed MSG training program and the study design for the first clinical investigation. The intervention contains perceptive rating (match/mismatch of sentence and gesture) and memory tasks (n-back tasks), imitation and productive tasks (e.g., SG fluency-similar to verbal fluency where words are accompanied by gesture). In addition, we offer information about gesture as meta-learning element as well as homework for reasons of transfer to everyday life as part of every session. In the MSG training intervention, we offer eight sessions (60 min each) of training. The first pilot study is currently conducted as a single-center, randomized controlled trial of speech-gesture intervention versus wait-list control with a follow-up. Outcomes are measured through pre-post-fMRI and standardized psychological questionnaires comparing two subject groups (30 patients with schizophrenia and 30 healthy controls). Patients and healthy controls are randomized in two intervention groups (with 20 being in the wait-training group and 10 in the training-follow-up group). With our study design we will be able to demonstrate the beneficial effect of the MSG training intervention on behavioral and neural levels. CLINICAL TRIAL REGISTRATION DRKS.de, identifier DRKS00015118.
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Affiliation(s)
- Lydia Riedl
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Arne Nagels
- Department of English and Linguistics, Johannes-Gutenberg-University, Mainz, Germany
| | - Gebhard Sammer
- Department of Psychiatry and Psychotherapy, Justus-Liebig-University, Gießen, Germany
| | - Benjamin Straube
- Translational Neuroimaging Lab, Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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19
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Schülke R, Straube B. Transcranial Direct Current Stimulation Improves Semantic Speech-Gesture Matching in Patients With Schizophrenia Spectrum Disorder. Schizophr Bull 2019; 45:522-530. [PMID: 30304518 PMCID: PMC6483581 DOI: 10.1093/schbul/sby144] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with schizophrenia spectrum disorders (SSD) have severe deficits in speech and gesture processing that contribute considerably to the burden of this disorder. Brain imaging shows left inferior frontal gyrus involvement for impaired processing of co-verbal gestures in patients with schizophrenia. Recently, transcranial direct current stimulation (tDCS) of the left frontal lobe has been shown to modulate processing of co-verbal gestures in healthy subjects. Although tDCS has been used to reduce symptoms of patients with SSD, the effects of tDCS on gesture processing deficits remain hitherto unexplored. OBJECTIVE Here we tested the hypothesis that inhibitory cathodal tDCS of the left frontal lobe decreases pathological dysfunction and improves semantic processing of co-verbal gestures in patients with SSD. METHODS We measured ratings and reaction times in a speech-gesture semantic relatedness assessment task during application of frontal, frontoparietal, parietal, and sham tDCS to 20 patients with SSD and 29 healthy controls. RESULTS We found a specific effect of tDCS on speech-gesture relatedness ratings of patients. Frontal compared to parietal and sham stimulation significantly improved the differentiation between related and unrelated gestures. Placement of the second electrode (right frontal vs parietal) did not affect the effect of left frontal stimulation, which reduced the preexisting difference between patients and healthy controls. CONCLUSION Here we show that left frontal tDCS can improve semantic co-verbal gesture processing in patients with SSD. tDCS could be a viable tool to normalize processing in the left frontal lobe and facilitate direct social communicative functioning in patients with SSD.
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Affiliation(s)
- Rasmus Schülke
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany
| | - Benjamin Straube
- Translational Neuroimaging Marburg (TNM), Department of Psychiatry and Psychotherapy and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University, Marburg, Germany,To whom correspondence should be addressed; Rudolf-Bultmann-Str. 8, Marburg 35039, Germany; tel: +49-(0)-6421-58-66429, fax: +49-(0)-6421-5865406, e-mail:
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20
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Motion energy analysis reveals altered body movement in youth at risk for psychosis. Schizophr Res 2018; 200:35-41. [PMID: 28587814 PMCID: PMC5712481 DOI: 10.1016/j.schres.2017.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Growing evidence suggests that movement abnormalities occur prior to the onset of psychosis. Innovations in technology and software provide the opportunity for a fine-tuned and sensitive measurement of observable behavior that may be particularly useful to detecting the subtle movement aberrations present during the prodromal period. METHODS In the present study, 54 youth at ultrahigh risk (UHR) for psychosis and 62 healthy controls participated in structured clinical interviews to assess for an UHR syndrome. The initial 15min of the baseline clinical interview was assessed using Motion Energy Analysis (MEA) providing frame-by-frame measures of total movement, amplitude, speed, and variability of both head and body movement separately. RESULTS Result showed region-specific group differences such that there were no differences in head movement but significant differences in body movement. Specifically, the UHR group showed greater total body movement and speed of body movements, and lower variation in body movement compared to healthy controls. However, there were no significant associations with positive, negative or disorganized symptom domains. CONCLUSION This study represents an innovative perspective on gross motor function in the UHR group. Importantly, the automated approach used in this study provides a sensitive and objective measure of body movement abnormalities, potentially guiding novel assessment and prevention of symptom development in those at risk for psychosis.
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21
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Dutschke LL, Stegmayer K, Ramseyer F, Bohlhalter S, Vanbellingen T, Strik W, Walther S. Gesture impairments in schizophrenia are linked to increased movement and prolonged motor planning and execution. Schizophr Res 2018; 200:42-49. [PMID: 28709771 DOI: 10.1016/j.schres.2017.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/02/2017] [Accepted: 07/05/2017] [Indexed: 11/17/2022]
Abstract
Schizophrenia patients present with a variety of impaired nonverbal communication skills. Performance of hand gestures is frequently impaired and associated with ratings of motor abnormalities. However, the impact of motor abnormalities to gesture performance remains unclear. To test the association between quantitative measures of motor behavior and qualitative ratings of gesture performance, we quantified movement parameters semi-automatically in videotaped recordings of gesture assessment. Thirty-one patients with schizophrenia (77.4%), schizophreniform (19.4%) or schizoaffective disorder (3.2%) and 32 healthy controls matched for age, gender and education underwent clinical assessment. Performance of the test of upper limb apraxia (TULIA) was video-taped in all subjects. The videos were analyzed with motion energy analysis software (MEA) to determine motion and time parameters. Patients and controls differed significantly in quantitative gesture performance: patients required more movement and more time to complete the tasks. Differences increased in patients with qualitatively impaired gesture production ratings (p<0.01). Group differences were most pronounced in the pantomime domain, when gestures are performed following verbal instruction. In patients, ratings of motor abnormalities correlated with duration of movement, while behavioral disorganization correlated with the amount of movements during gesture performance. Disorder related motor symptoms, aberrant action observation, planning and monitoring as well as internal clock abnormalities may explain the poor performance of hand gestures in schizophrenia. Quantitative video analysis offers a unique possibility to analyze movement patterns as a direct functional output of the motor system. In the future, it may assist monitoring, staging and prognosis in schizophrenia.
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Affiliation(s)
- Lars Levi Dutschke
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Fabian Ramseyer
- Department for Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland.
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22
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Stegmayer K, Bohlhalter S, Vanbellingen T, Federspiel A, Wiest R, Müri RM, Strik W, Walther S. Limbic Interference During Social Action Planning in Schizophrenia. Schizophr Bull 2018; 44:359-368. [PMID: 28575506 PMCID: PMC5814975 DOI: 10.1093/schbul/sbx059] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Schizophrenia is characterized by social interaction deficits contributing to poor functional outcome. Hand gesture use is particularly impaired, linked to frontal lobe dysfunction and frontal grey matter deficits. The functional neural correlates of impaired gesturing are currently unclear. We therefore investigated aberrant brain activity during impaired gesturing in schizophrenia. We included 22 patients with schizophrenia and 25 healthy control participants matched for age, gender, and education level. We obtained functional magnetic resonance imaging data using an event-related paradigm to assess brain activation during gesture planning and execution. Group differences in whole brain effects were calculated using factorial designs. Gesture ratings were performed by a single rater, blind to diagnoses and clinical presentation. During gesture planning and execution both groups activated brain areas of the praxis network. However, patients had reduced dorsolateral prefrontal cortex (DLPFC) and increased inferior parietal lobe (IPL) activity. Performance accuracy was associated with IPL activity in patients. Furthermore, patients activated temporal poles, amygdala and hippocampus during gesture planning, which was associated with delusion severity. Finally, patients demonstrated increased dorsomedial prefrontal cortex activity during planning of novel gestures. We demonstrate less prefrontal, but more IPL and limbic activity during gesturing in schizophrenia. IPL activity was associated with performance accuracy, whereas limbic activity was linked to delusion severity. These findings may reflect impaired social action planning and a limbic interference with gestures in schizophrenia contributing to poor gesture performance and consequently poor social functioning in schizophrenia.
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Affiliation(s)
- Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland,To whom correspondence should be addressed; University Hospital of Psychiatry, Bolligenstrasse 111, 3060 Bern, Switzerland; tel: +41-31-930-9757, fax: +41-31-930-9404, e-mail:
| | - Stephan Bohlhalter
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Tim Vanbellingen
- Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland,Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Andrea Federspiel
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, University Hospital, Inselspital, Bern, Switzerland
| | - René M Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
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van Harten PN, Walther S, Kent JS, Sponheim SR, Mittal VA. The clinical and prognostic value of motor abnormalities in psychosis, and the importance of instrumental assessment. Neurosci Biobehav Rev 2017; 80:476-487. [PMID: 28711662 DOI: 10.1016/j.neubiorev.2017.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/06/2017] [Accepted: 06/13/2017] [Indexed: 01/15/2023]
Abstract
Motor abnormalities comprise several clinical signs intrinsic to psychosis. Critically, these features are of prognostic value in individuals at-risk for psychosis, and for those in early stages of psychotic disorders. Motor abnormalities such as tremor, rigidity, and neurological soft signs often go unrecognized. Currently, advances in this area are limited by a paucity of theoretical conceptions categorizing or linking these behaviours to underlying neurobiology affected in psychosis. However, emerging technological advances have significantly improved the ability to detect and assess motor abnormalities with objective instruments in a timely and reliable manner. Further, converging evidence has laid the groundwork for theoretically and empirically derived categorization and conceptualization. This review summarizes these advances, stressing the importance of motor abnormalities for understanding vulnerability across different stages of psychosis and introducing these innovative instrumental approaches. Patients, researchers and clinicians will benefit from these new developments, as better assessment aids the development of targeted interventions to ultimately improve the care for individuals experiencing psychosis.
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Affiliation(s)
- Peter N van Harten
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands; Psychiatric Centre GGz Central, Amersfoort, The Netherlands.
| | - Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Switzerland
| | | | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston/Chicago, USA
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Osborne KJ, Bernard JA, Gupta T, Dean DJ, Millman Z, Vargas T, Ristanovic I, Schiffman J, Mittal VA. Beat gestures and postural control in youth at ultrahigh risk for psychosis. Schizophr Res 2017; 185:197-199. [PMID: 27914727 PMCID: PMC5449260 DOI: 10.1016/j.schres.2016.11.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 11/16/2022]
Abstract
Beat gestures, rhythmic hand movements that co-occur with speech, appear to be uniquely associated with the cerebellum in healthy individuals. This behavior may also have relevance for psychosis-risk youth, a group characterized by cerebellar dysfunction. This study examined beat gesture frequency and postural sway (a sensitive index of cerebellar functioning) in youth at ultrahigh risk (UHR) for psychosis. Results indicated that decreased beat gesture frequency, but not self-regulatory movement, is associated with elevated postural sway, suggesting that beat gestures may be an important biomarker in this critical population.
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Affiliation(s)
- K Juston Osborne
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA.
| | - Jessica A Bernard
- Texas A&M University, Department of Psychology, College Station, TX, USA; Texas A&M Institute for Neuroscience, College Station, TX, USA
| | - Tina Gupta
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA
| | - Derek J Dean
- University of Colorado Boulder, Department of Psychology, Boulder, CO, USA; University of Colorado Boulder, Center for Neuroscience, Boulder, CO, USA
| | - Zachary Millman
- University of Maryland Baltimore, Department of Psychology, Baltimore, MD, USA
| | - Teresa Vargas
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA
| | - Ivanka Ristanovic
- Northwestern University, Department of Psychology, Evanston, Chicago, IL, USA
| | - Jason Schiffman
- University of Maryland Baltimore, Department of Psychology, Baltimore, MD, USA
| | - Vijay A Mittal
- Northwestern University, Department of Psychology, Department of Psychiatry, Institute for Policy Research, Department of Medical Social Sciences, Evanston, Chicago, IL, USA
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Stegmayer K, Moor J, Vanbellingen T, Bohlhalter S, Müri RM, Strik W, Walther S. Gesture Performance in First- and Multiple-Episode Patients with Schizophrenia Spectrum Disorders. Neuropsychobiology 2017; 73:201-8. [PMID: 27229523 DOI: 10.1159/000446116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 04/02/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Gesturing plays an important role in social behavior and social learning. Deficits are frequent in schizophrenia and may contribute to impaired social functioning. Information about deficits during the course of the disease and presence of severity and patterns of impairment in first-episode patients is missing. Hence, we aimed to investigate gesturing in first- compared to multiple-episode schizophrenia patients and healthy controls. METHODS In 14 first-episode patients, 14 multiple-episode patients and 16 healthy controls matched for age, gender and education, gesturing was assessed by the comprehensive Test of Upper Limb Apraxia. Performance in two domains of gesturing - imitation and pantomime - was recorded on video. Raters of gesture performance were blinded. RESULTS Patients with multiple episodes had severe gestural deficits. For almost all gesture categories, performance was worse in multiple- than in first-episode patients. First-episode patients demonstrated subtle deficits with a comparable pattern. CONCLUSIONS Subjects with multiple psychotic episodes have severe deficits in gesturing, while only mild impairments were found in first-episode patients independent of age, gender, education and negative symptoms. The results indicate that gesturing is impaired at the onset of disease and likely to further deteriorate during its course.
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Affiliation(s)
- Vijay A. Mittal
- *To whom correspondence should be addressed; tel: 847-467-3880, fax: 847-491-7859, e-mail:
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Walther S, Eisenhardt S, Bohlhalter S, Vanbellingen T, Müri R, Strik W, Stegmayer K. Gesture Performance in Schizophrenia Predicts Functional Outcome After 6 Months. Schizophr Bull 2016; 42:1326-1333. [PMID: 27566843 PMCID: PMC5049539 DOI: 10.1093/schbul/sbw124] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The functional outcome of schizophrenia is heterogeneous and markers of the course are missing. Functional outcome is associated with social cognition and negative symptoms. Gesture performance and nonverbal social perception are critically impaired in schizophrenia. Here, we tested whether gesture performance or nonverbal social perception could predict functional outcome and the ability to adequately perform relevant skills of everyday function (functional capacity) after 6 months. In a naturalistic longitudinal study, 28 patients with schizophrenia completed tests of nonverbal communication at baseline and follow-up. In addition, functional outcome, social and occupational functioning, as well as functional capacity at follow-up were assessed. Gesture performance and nonverbal social perception at baseline predicted negative symptoms, functional outcome, and functional capacity at 6-month follow-up. Gesture performance predicted functional outcome beyond the baseline measure of functioning. Patients with gesture deficits at baseline had stable negative symptoms and experienced a decline in social functioning. While in patients without gesture deficits, negative symptom severity decreased and social functioning remained stable. Thus, a simple test of hand gesture performance at baseline may indicate favorable outcomes in short-term follow-up. The results further support the importance of nonverbal communication skills in subjects with schizophrenia.
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland;,*To whom correspondence should be addressed; University Hospital of Psychiatry Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland; tel: +41-31-930-9483; fax: +41-31-930-9958, e-mail:
| | - Sarah Eisenhardt
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Stephan Bohlhalter
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland;,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - Tim Vanbellingen
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland;,Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - René Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
| | - Katharina Stegmayer
- Translational Research Center, University Hospital of Psychiatry Bern, Bern, Switzerland
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28
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Structural brain correlates of defective gesture performance in schizophrenia. Cortex 2016; 78:125-137. [DOI: 10.1016/j.cortex.2016.02.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 10/12/2015] [Accepted: 02/27/2016] [Indexed: 01/13/2023]
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Affiliation(s)
- Sebastian Walther
- Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland;
| | - Vijay A. Mittal
- Department of Psychology, Department of Psychiatry, Northwestern University, Evanston, IL
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Bernard JA, B Millman Z, Mittal VA. Beat and metaphoric gestures are differentially associated with regional cerebellar and cortical volumes. Hum Brain Mapp 2015; 36:4016-30. [PMID: 26174599 DOI: 10.1002/hbm.22894] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/02/2015] [Accepted: 06/26/2015] [Indexed: 11/08/2022] Open
Abstract
Gestures represent an integral aspect of interpersonal communication, and they are closely linked with language and thought. Brain regions for language processing overlap with those for gesture processing. Two types of gesticulation, beat gestures and metaphoric gestures are particularly important for understanding the taxonomy of co-speech gestures. Here, we investigated gesture production during taped interviews with respect to regional brain volume. First, we were interested in whether beat gesture production is associated with similar regions as metaphoric gesture. Second, we investigated whether cortical regions associated with metaphoric gesture processing are linked to gesture production based on correlations with brain volumes. We found that beat gestures are uniquely related to regional volume in cerebellar regions previously implicated in discrete motor timing. We suggest that these gestures may be an artifact of the timing processes of the cerebellum that are important for the timing of vocalizations. Second, our findings indicate that brain volumes in regions of the left hemisphere previously implicated in metaphoric gesture processing are positively correlated with metaphoric gesture production. Together, this novel work extends our understanding of left hemisphere regions associated with gesture to indicate their importance in gesture production, and also suggests that beat gestures may be especially unique. This provides important insight into the taxonomy of co-speech gestures, and also further insight into the general role of the cerebellum in language.
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Affiliation(s)
- Jessica A Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado.,Department of Psychology, Texas A&M University, College Station, Texas
| | - Zachary B Millman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland
| | - Vijay A Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado.,Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado.,Department of Psychology, Northwestern University, Evanston, Illinois
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Walther S, Stegmayer K, Sulzbacher J, Vanbellingen T, Müri R, Strik W, Bohlhalter S. Nonverbal social communication and gesture control in schizophrenia. Schizophr Bull 2015; 41:338-45. [PMID: 25646526 PMCID: PMC4332963 DOI: 10.1093/schbul/sbu222] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Schizophrenia patients are severely impaired in nonverbal communication, including social perception and gesture production. However, the impact of nonverbal social perception on gestural behavior remains unknown, as is the contribution of negative symptoms, working memory, and abnormal motor behavior. Thus, the study tested whether poor nonverbal social perception was related to impaired gesture performance, gestural knowledge, or motor abnormalities. Forty-six patients with schizophrenia (80%), schizophreniform (15%), or schizoaffective disorder (5%) and 44 healthy controls matched for age, gender, and education were included. Participants completed 4 tasks on nonverbal communication including nonverbal social perception, gesture performance, gesture recognition, and tool use. In addition, they underwent comprehensive clinical and motor assessments. Patients presented impaired nonverbal communication in all tasks compared with controls. Furthermore, in contrast to controls, performance in patients was highly correlated between tasks, not explained by supramodal cognitive deficits such as working memory. Schizophrenia patients with impaired gesture performance also demonstrated poor nonverbal social perception, gestural knowledge, and tool use. Importantly, motor/frontal abnormalities negatively mediated the strong association between nonverbal social perception and gesture performance. The factors negative symptoms and antipsychotic dosage were unrelated to the nonverbal tasks. The study confirmed a generalized nonverbal communication deficit in schizophrenia. Specifically, the findings suggested that nonverbal social perception in schizophrenia has a relevant impact on gestural impairment beyond the negative influence of motor/frontal abnormalities.
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Affiliation(s)
| | | | | | - Tim Vanbellingen
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland; Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
| | - René Müri
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland; Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry, Bern, Switzerland
| | - Stephan Bohlhalter
- Department of Clinical Research, University Hospital, Inselspital, Bern, Switzerland; Neurology and Neurorehabilitation Center, Kantonsspital Luzern, Luzern, Switzerland
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Mittal VA, Dean DJ, Bernard JA, Orr JM, Pelletier-Baldelli A, Carol EE, Gupta T, Turner J, Leopold DR, Robustelli BL, Millman ZB. Neurological soft signs predict abnormal cerebellar-thalamic tract development and negative symptoms in adolescents at high risk for psychosis: a longitudinal perspective. Schizophr Bull 2014; 40:1204-15. [PMID: 24375457 PMCID: PMC4193696 DOI: 10.1093/schbul/sbt199] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION There is an emerging consensus that neurological soft signs (NSS) may not be "soft" at all but rather may reflect neuropathy, particularly in the cerebellum and thalamus. However, our understanding of connective tract abnormalities is limited, and to date, there have been no investigations examining NSS and longitudinal white matter development during the prodrome. Mapping the correlates of NSS in ultrahigh-risk (UHR) youth offers potential for highlighting a viable biomarker as well as for advancing understanding of pathogenic processes during the adolescent risk period. METHODS A total of 68 (33 UHR and 35 healthy control) adolescents were assessed with an NSS inventory, structured interviews, and diffusion tensor imaging. Fractional anisotropy (FA) of theoretically relevant cerebellar-thalamic tracts was calculated (left/right superior cerebellar peduncles [SCPs]). Twelve months later, a subset of 30 (15 UHR and 15 control) participants returned for follow-up diffusion tension imaging/clinical assessments. RESULTS UHR youth exhibited elevated NSS across domains. While there were no group differences in the integrity of the SCPs at baseline, controls showed a normative increase while the UHR group showed a decrease in FA over 12 months. NSS predicted a longitudinal decrease in cerebellar-thalamic FA and elevations in negative but not positive symptoms 12 months later. DISCUSSION Findings of abnormal white matter development provide direct empirical evidence to support prominent neurodevelopmental theories. The predictive relationships between NSS and longitudinal cerebellar-thalamic tract integrity and negative symptom course provide insight into the role of cognitive dysmetria in the high-risk period and inform on a unique biomarker tied to core features underlying psychosis.
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Affiliation(s)
- Vijay A. Mittal
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO;,*To whom correspondence should be addressed; Department of Psychology and Neuroscience, University of Colorado at Boulder, 345 UCB, Boulder, CO 80309-0345, US; tel: 310-923-2822, fax: 303-492-4616, e-mail:
| | - Derek J. Dean
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Jessica A. Bernard
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Joseph M. Orr
- Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO
| | - Andrea Pelletier-Baldelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Emily E. Carol
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Tina Gupta
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Jessica Turner
- Department of Psychology, Georgia State University, Atlanta, GA
| | - Daniel R. Leopold
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO;,Center for Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Briana L. Robustelli
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Zachary B. Millman
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
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Millman ZB, Goss J, Schiffman J, Mejias J, Gupta T, Mittal VA. Mismatch and lexical retrieval gestures are associated with visual information processing, verbal production, and symptomatology in youth at high risk for psychosis. Schizophr Res 2014; 158:64-8. [PMID: 25000911 PMCID: PMC4152422 DOI: 10.1016/j.schres.2014.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/04/2014] [Accepted: 06/08/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Gesture is integrally linked with language and cognitive systems, and recent years have seen a growing attention to these movements in patients with schizophrenia. To date, however, there have been no investigations of gesture in youth at ultra high risk (UHR) for psychosis. Examining gesture in UHR individuals may help to elucidate other widely recognized communicative and cognitive deficits in this population and yield new clues for treatment development. METHOD In this study, mismatch (indicating semantic incongruency between the content of speech and a given gesture) and retrieval (used during pauses in speech while a person appears to be searching for a word or idea) gestures were evaluated in 42 UHR individuals and 36 matched healthy controls. Cognitive functions relevant to gesture production (i.e., speed of visual information processing and verbal production) as well as positive and negative symptomatologies were assessed. RESULTS Although the overall frequency of cases exhibiting these behaviors was low, UHR individuals produced substantially more mismatch and retrieval gestures than controls. The UHR group also exhibited significantly poorer verbal production performance when compared with controls. In the patient group, mismatch gestures were associated with poorer visual processing speed and elevated negative symptoms, while retrieval gestures were associated with higher speed of visual information-processing and verbal production, but not symptoms. CONCLUSIONS Taken together these findings indicate that gesture abnormalities are present in individuals at high risk for psychosis. While mismatch gestures may be closely related to disease processes, retrieval gestures may be employed as a compensatory mechanism.
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Affiliation(s)
- Zachary B. Millman
- University of Colorado Boulder Department of Psychology and Neuroscience
| | | | - Jason Schiffman
- University of Maryland, Baltimore County Department of Psychology
| | - Johana Mejias
- University of Colorado Boulder Department of Psychology and Neuroscience
| | - Tina Gupta
- University of Colorado Boulder Department of Psychology and Neuroscience
| | - Vijay A. Mittal
- University of Colorado Boulder Department of Psychology and Neuroscience,University of Colorado Boulder Center for Neuroscience
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Straube B, Green A, Sass K, Kircher T. Superior temporal sulcus disconnectivity during processing of metaphoric gestures in schizophrenia. Schizophr Bull 2014; 40:936-44. [PMID: 23956120 PMCID: PMC4059440 DOI: 10.1093/schbul/sbt110] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The left superior temporal sulcus (STS) plays an important role in integrating audiovisual information and is functionally connected to disparate regions of the brain. For the integration of gesture information in an abstract sentence context (metaphoric gestures), intact connectivity between the left STS and the inferior frontal gyrus (IFG) should be important. Patients with schizophrenia have problems with the processing of metaphors (concretism) and show aberrant structural connectivity of long fiber bundles. Thus, we tested the hypothesis that patients with schizophrenia differ in the functional connectivity of the left STS to the IFG for the processing of metaphoric gestures. During functional magnetic resonance imaging data acquisition, 16 patients with schizophrenia (P) and a healthy control group (C) were shown videos of an actor performing gestures in a concrete (iconic, IC) and abstract (metaphoric, MP) sentence context. A psychophysiological interaction analysis based on the seed region from a previous analysis in the left STS was performed. In both groups we found common positive connectivity for IC and MP of the STS seed region to the left middle temporal gyrus (MTG) and left ventral IFG. The interaction of group (C>P) and gesture condition (MP>IC) revealed effects in the connectivity to the bilateral IFG and the left MTG with patients exhibiting lower connectivity for the MP condition. In schizophrenia the left STS is misconnected to the IFG, particularly during the processing of MP gestures. Dysfunctional integration of gestures in an abstract sentence context might be the basis of certain interpersonal communication problems in the patients.
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Affiliation(s)
- Benjamin Straube
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, 35039 Marburg, Germany;
| | - Antonia Green
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, 35039 Marburg, Germany
| | - Katharina Sass
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland 4072, Australia
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, 35039 Marburg, Germany
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Hembram M, Simlai J, Chaudhury S, Biswas P. First rank symptoms and neurological soft signs in schizophrenia. PSYCHIATRY JOURNAL 2014; 2014:931014. [PMID: 24701561 PMCID: PMC3950954 DOI: 10.1155/2014/931014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 12/25/2013] [Indexed: 11/18/2022]
Abstract
The aim of the study was to compare the neurological soft signs (NSS) in schizophrenia patients with and without first rank symptoms (FRS), their first degree relatives (FDR), and normal controls. The study was conducted on 60 schizophrenia patients diagnosed according to ICD 10 DCR and categorized into groups with and without FRS using Schedules for Clinical Assessment in Neuropsychiatry, 30 FDRs of the study sample, and 30 normal controls matched for age, education, and handedness. All the subjects gave written informed consent. Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms were applied to have a comprehensive assessment of the symptoms. NSS were assessed using Extended Standard Neurological Assessment Instrument. The correlations between NSS and clinical symptoms were relatively modest but significant. There was a weak relation between NSS and positive symptom severity. The FDR of schizophrenia patients had significantly lower NSS scores than schizophrenia patients, but only FDR of schizophrenia patients without FRS had significantly higher scores than normal controls. Our results indicate that NSS are more prominent in schizophrenia patients with negative symptoms and support the theory of NSS being a trait marker of schizophrenia particularly in those without FRS.
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Affiliation(s)
- Mahesh Hembram
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India
| | - Jayati Simlai
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Rural Medical College & Hospital, Pravara Institute of Medical Sciences (Deemed University), District Ahmednagar, Loni, Maharashtra 413736, India
| | - Parthasarathi Biswas
- Department of Psychiatry, Ranchi Institute of Neuropsychiatry and Allied Sciences, Ranchi, Jharkhand 834006, India
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Walther S, Vanbellingen T, Müri R, Strik W, Bohlhalter S. Impaired gesture performance in schizophrenia: Particular vulnerability of meaningless pantomimes. Neuropsychologia 2013; 51:2674-8. [DOI: 10.1016/j.neuropsychologia.2013.08.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 08/02/2013] [Accepted: 08/23/2013] [Indexed: 12/22/2022]
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Abstract
Early phenomenological descriptions of schizophrenia have acknowledged the existence of milder schizophrenia spectrum disorders characterized by the presence of attenuated symptoms typically present in chronic schizophrenia. The investigation of the schizophrenia spectrum disorders offers an opportunity to elucidate the pathophysiological mechanisms giving rise to schizophrenia. Differences and similarities between subjects with schizotypal personality disorder (SPD), the prototypical schizophrenia personality disorder, and chronic schizophrenia have been investigated with genetic, neurochemical, imaging, and pharmacological techniques. Patients with SPD and the more severely ill patients with chronic schizophrenia share cognitive, social, and attentional deficits hypothesized to result from common neurodevelopmentally based cortical temporal and prefrontal pathology. However, these deficits are milder in SPD patients due to their capacity to recruit other related brain regions to compensate for dysfunctional areas. Individuals with SPD are also less vulnerable to psychosis due to the presence of protective factors mitigating subcortical DA hyperactivity. Given the documented close relationship to other schizophrenic disorders, SPD will be included in the psychosis section of DSM-5 as a schizophrenia spectrum disorder as well as in the personality disorder section.
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Abstract
BACKGROUND Nonverbal communication is a critical feature of successful social interaction and interpersonal rapport. Social exclusion is a feature of schizophrenia. This experimental study investigated if the undisclosed presence of a patient with schizophrenia in interaction changes nonverbal communication (ie, speaker gesture and listener nodding). METHOD 3D motion-capture techniques recorded 20 patient (1 patient, 2 healthy participants) and 20 control (3 healthy participants) interactions. Participants rated their experience of rapport with each interacting partner. Patients' symptoms, social cognition, and executive functioning were assessed. Four hypotheses were tested: (1) Compared to controls, patients display less speaking gestures and listener nods. (2) Patients' increased symptom severity and poorer social cognition are associated with patients' reduced gesture and nods. (3) Patients' partners compensate for patients' reduced nonverbal behavior by gesturing more when speaking and nodding more when listening. (4) Patients' reduced nonverbal behavior, increased symptom severity, and poorer social cognition are associated with others experiencing poorer rapport with the patient. RESULTS Patients gestured less when speaking. Patients with more negative symptoms nodded less as listeners, while their partners appeared to compensate by gesturing more as speakers. Patients with more negative symptoms also gestured more when speaking, which, alongside increased negative symptoms and poorer social cognition, was associated with others experiencing poorer patient rapport. CONCLUSIONS Patients' symptoms are associated with the nonverbal behavior of patients and their partners. Patients' increased negative symptoms and gesture use are associated with poorer interpersonal rapport. This study provides specific evidence about how negative symptoms impact patients' social interactions.
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Affiliation(s)
- Mary Lavelle
- School of Electronic Engineering & Computer Science, University of London, London, UK.
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Walther S, Vanbellingen T, Müri R, Strik W, Bohlhalter S. Impaired pantomime in schizophrenia: Association with frontal lobe function. Cortex 2013; 49:520-7. [DOI: 10.1016/j.cortex.2011.12.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 12/20/2011] [Accepted: 12/28/2011] [Indexed: 10/14/2022]
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Straube B, Green A, Sass K, Kirner-Veselinovic A, Kircher T. Neural integration of speech and gesture in schizophrenia: evidence for differential processing of metaphoric gestures. Hum Brain Mapp 2012; 34:1696-712. [PMID: 22378493 DOI: 10.1002/hbm.22015] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 11/21/2011] [Accepted: 11/22/2011] [Indexed: 11/11/2022] Open
Abstract
Gestures are an important component of interpersonal communication. Especially, complex multimodal communication is assumed to be disrupted in patients with schizophrenia. In healthy subjects, differential neural integration processes for gestures in the context of concrete [iconic (IC) gestures] and abstract sentence contents [metaphoric (MP) gestures] had been demonstrated. With this study we wanted to investigate neural integration processes for both gesture types in patients with schizophrenia. During functional magnetic resonance imaging-data acquisition, 16 patients with schizophrenia (P) and a healthy control group (C) were shown videos of an actor performing IC and MP gestures and associated sentences. An isolated gesture (G) and isolated sentence condition (S) were included to separate unimodal from bimodal effects at the neural level. During IC conditions (IC > G ∩ IC > S) we found increased activity in the left posterior middle temporal gyrus (pMTG) in both groups. Whereas in the control group the left pMTG and the inferior frontal gyrus (IFG) were activated for the MP conditions (MP > G ∩ MP > S), no significant activation was found for the identical contrast in patients. The interaction of group (P/C) and gesture condition (MP/IC) revealed activation in the bilateral hippocampus, the left middle/superior temporal and IFG. Activation of the pMTG for the IC condition in both groups indicates intact neural integration of IC gestures in schizophrenia. However, failure to activate the left pMTG and IFG for MP co-verbal gestures suggests a disturbed integration of gestures embedded in an abstract sentence context. This study provides new insight into the neural integration of co-verbal gestures in patients with schizophrenia.
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Affiliation(s)
- Benjamin Straube
- Department of Psychiatry und Psychotherapy, Philipps-University Marburg, Rudolf-Bultmann-Strasse 8, D-35039 Marburg, Germany.
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Motor agency: a new and highly sensitive measure to reveal agency disturbances in early psychosis. PLoS One 2012; 7:e30449. [PMID: 22383963 PMCID: PMC3288008 DOI: 10.1371/journal.pone.0030449] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 12/16/2011] [Indexed: 11/27/2022] Open
Abstract
Background Early diagnosis of young adults at risk of schizophrenia is essential for preventive approaches of the illness. Nevertheless, classic screening instruments are difficult to use because of the non-specific nature of the signs at this pre-onset phase of illness. The objective of the present contribution was to propose an innovating test that can probe the more specific symptom of psychosis, i.e., the sense of agency, which is defined as being the immediate experience of oneself as the cause of an action. More specifically, we tested whether motor agency is abnormal in early psychosis. Methods Thirty-two young symptomatic patients and their age-matched controls participated in the study. 15 of these patients were at ultra high-risk for developing psychosis (UHR), and 17 patients were suffering from first-episode psychosis (FEP). Patients' neurocognitive capacities were assessed through the use of seven neuropsychological tests. A motor agency task was also introduced to obtain an objective indicator of the degree of sense of agency, by contrasting force levels applied during other and self-produced collisions between a hand-held objet and a pendulum. Results As reported in the literature for adult controls, healthy adolescents used more efficient force levels in self than in other-imposed collisions. For both UHR and FEP patients, abnormally high levels of grip force were used for self-produced collisions, leading to an absence of difference between self and other. The normalized results revealed that motor agency differentiated patients from controls with a higher level of sensitivity than the more classic neuropsychological test battery. Conclusions This study is in favour of the existence of an abnormal sense of agency early in the psychotic illness. Because it is quick and none verbal, motor agency may be a valuable tool to use in complement to classic interviews, especially when investigating complex ineffable experiences that are difficult to explicitly describe.
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Abstract
OBJECTIVE The 'embodied cognition' hypothesis suggests a close relationship between internal self-representations and the outward expression of social behaviours and emotions. Given self-awareness disturbances in patients with first-rank symptoms (FRS), we hypothesized that these patients would show abnormal social behaviours. In this study, we examined the social interactive skills of patients with first-episode psychosis during an interview, together with changes in performance over time. METHOD We analysed previously unreported data from 227 patients with first-episode psychosis (90 with, and 137 without, FRS) who took part in the WHO multicentre study on the Determinants of Outcome of Severe Mental Disorders. They were assessed on the Psychological Impairment Rating Schedule (PIRS) and examined again after 2 years. RESULTS A principal component analysis on the Psychosocial Impairment Rating Schedule produced two factors (interactive skills; withdrawal from interactions). Patients with FRS showed greater impairments in the domain linked to 'interactive skills', which remained 2 years after the first experience of a psychotic illness. These findings were not explained by clinical characteristics, or presence of non-FRS delusions. CONCLUSION Self-awareness deficits, as indexed by the FRS symptom cluster, are linked to deficits in social interactive behaviours. These abnormalities are indicative of 'social dysmetria' in this group, which involves difficulties conveying motor aspects of behaviours, volition and affect to facilitate mutual communication. These findings point to the utility of behavioural assessment scales in clinical and research settings.
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Affiliation(s)
- F Waters
- Centre for Clinical Research in Neuropsychiatry, Graylands Hospital, Perth, Australia
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Abstract
Personality disorders are gaining a similar level of attention in the primary care literature as afforded to mood, anxiety, and substance abuse disorders. A personality disorder-comorbid with a medical or other psychiatric diagnosis-presents a challenge for primary care physicians because of diagnostic and treatment dilemmas, as well as management of the physician's interpersonal reaction to the patient. This article reviews research on prevalence, clinical presentation and assessment, and treatment, with specific recommendations for primary care physicians. Strategies to enhance the physician-patient relationship, including the use of empathic skills and the facilitation of physician well-being, are presented. Integrating these tools into routine practice can lead to more satisfying treatment relationships between primary care physicians and patients who have personality disorders.
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Affiliation(s)
- Maria Devens
- University of Illinois at Chicago, Department of Family Medicine (m/c 663), 1919 W. Taylor Street, Chicago, IL 60612, USA.
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Mittal VA, Tessner KD, Walker EF. Elevated social Internet use and schizotypal personality disorder in adolescents. Schizophr Res 2007; 94:50-7. [PMID: 17532188 PMCID: PMC2323598 DOI: 10.1016/j.schres.2007.04.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 03/29/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In the past decade, the use of the Internet as a forum for communication has exponentially increased, and research indicates that excessive use is associated with psychiatric symptoms. The present study examined the rate of Internet use in adolescents with personality disorders, with a focus on schizotypal personality disorder (SPD), which is characterized by marked interpersonal deficits. Because the Internet provides an easily accessible forum for anonymous social interaction and constitutes an environment where communication is less likely to be hampered by interpersonal deficits, it was hypothesized that SPD youth will spend significantly more time engaging in social activities on the Internet than controls. METHODS Self-reports of daily Internet use in adolescents with SPD (n=19), a control group with other personality disorders (n=22) and a non-psychiatric control group (n=28) were collected. RESULTS Analyses revealed that the SPD participants reported significantly less social interaction with 'real-life' friends, but used the Internet for social interaction significantly more frequently than controls. Chat room participation, cooperative Internet gaming, and to a lesser degree, e-mail use, were positively correlated with ratings of SPD symptom severity and Beck Depression Inventory scores. DISCUSSION Findings are discussed in light of the potential benefits and risks associated with Internet use by socially isolated SPD youth.
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Affiliation(s)
- Vijay A Mittal
- Emory University, Psychology, Department of Psychology, 235 Dental Building, 1462 Clifton Road, Atlanta, GA 30322, USA.
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Mittal VA, Hasenkamp W, Sanfilipo M, Wieland S, Angrist B, Rotrosen J, Duncan EJ. Relation of neurological soft signs to psychiatric symptoms in schizophrenia. Schizophr Res 2007; 94:37-44. [PMID: 17543502 DOI: 10.1016/j.schres.2007.04.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 04/18/2007] [Accepted: 04/23/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Although several studies have identified abnormal rates of neurological soft signs (NSS) as a manifestation of CNS dysfunction in schizophrenia, differences in sample populations have contributed to a discrepancy in empirical findings. Furthermore, little is known about the potential of NSS to predict a clinical response to antipsychotic medications. The present study tests the associations between NSS and schizophrenia symptomatology and examines NSS as a potential marker for predicting treatment response. METHODS Nineteen unmedicated male schizophrenia patients were treated prospectively with haloperidol for six weeks. The subjects were assessed for pre and post-treatment NSS and schizophrenia symptomatology (Brief Psychiatric Rating Scale, BPRS). RESULTS NSS at baseline were significantly associated with baseline symptoms on the Positive, Negative, and Psychological Discomfort BPRS subscales. NSS showed a strong trend toward improvement during six weeks of a prospective haloperidol trial. Hierarchical linear regression analyses indicated that more severe baseline NSS predicted poorer response to haloperidol treatment as measured by post-treatment BPRS Total subscale scores. DISCUSSION NSS at untreated baseline are associated with baseline symptom severity, and elevated NSS are predictive of a smaller degree of improvement in symptoms after antipsychotic treatment. These findings are consistent with the hypothesis that NSS are linked to the neuropathology that underlies schizophrenia symptomatology and course.
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Affiliation(s)
- Vijay A Mittal
- Emory University, Department of Psychology, 235 Dental Building, 1462 Clifton Road, Atlanta, GA 30322, United States.
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Mittal VA, Dhruv S, Tessner KD, Walder DJ, Walker EF. The relations among putative biorisk markers in schizotypal adolescents: minor physical anomalies, movement abnormalities, and salivary cortisol. Biol Psychiatry 2007; 61:1179-86. [PMID: 17188254 DOI: 10.1016/j.biopsych.2006.08.043] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 08/30/2006] [Accepted: 08/30/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence suggests that prenatal insult may play a role in the etiology of psychotic disorders. Minor physical anomalies (MPA) are an indicator of abnormal fetal development and are elevated in individuals at genetic and behavioral risk for psychosis. Yet, there has been little empirical research on the relationships between MPAs and other neurobiological risk indicators. We hypothesized that the frequency of MPAs (an external marker of prenatal central nervous system [CNS] disruption) would be associated with two other biomarkers suggestive of disruptions in fetal neurodevelopment: movement abnormalities (an indicator of striatal abnormalities) and heightened cortisol secretion (an indicator of hypothalamic-pituitary-adrenal [HPA]/hippocampal function). METHODS Participants with schizotypal personality disorder (SPD; n = 39) and both normal (n = 47) and other personality disorders (n = 28) control subjects were administered structured diagnostic interviews and assessed for MPAs, movement abnormalities, and salivary cortisol. RESULTS Schizotypal personality disorder participants showed significantly greater MPAs and movement abnormalities and higher cortisol than both the normal and other personality disorders groups. Hierarchical linear regression analyses revealed that higher rates of MPAs were linked with greater movement abnormalities and salivary cortisol. CONCLUSIONS The findings suggest that MPAs serve as a marker of neurodevelopmental abnormalities that affect striatal and hippocampal regions.
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Affiliation(s)
- Vijay A Mittal
- Emory University, Department of Psychology, Atlanta, Georgia 30322, USA.
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