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Gabrielle FF, Refaat G, Mahmoud DAM, Ezzat L, Hassan Kasem RE. The psychopathology among the offspring of schizophrenia and bipolar I disorder patients in an Egyptian sample: A comparative study. Int J Soc Psychiatry 2024; 70:482-488. [PMID: 38390657 DOI: 10.1177/00207640231216354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
BACKGROUND A variety of psychiatric illnesses can develop in children of parents who suffer from bipolar affective disorder. AIMS The purpose of the research was to investigate, among the offsprings of patients diagnosed with schizophrenia and bipolar disorder type I, the prevalence of a variety of psychiatric diseases as well as a range of behavioral abnormalities. METHOD This was a cross-sectional observational comparative study. The outpatient psychiatric clinics at Shebin Elkom Mental Health Hospital, Menofia Governorate, Egypt 500 offspring (there were 250 offspring of parents both diagnosed with schizophrenia and 250 offsprings born to parents with bipolar affective disorder). RESULTS Statistically significant association of male gender with somatic complaints, social problems, and attention problems in the bipolar offspring group. In addition, there was a statistically significant association between female gender and anxiety or depression in the bipolar offspring group. Moreover, there was a statistically significant association between male gender and thought problems and aggressive behavior in the schizophrenia group. Assessment of psychiatric symptoms using K-SADS in relation to gender revealed a statistically significant association of male gender with affective disorder, behavioral disorder, and substance use disorder in the bipolar offspring group. Moreover, there was a statistically significant association between female gender and psychotic disorder in the schizophrenia group. CONCLUSION We concluded that offspring with bipolar illness had a significant association with somatic symptoms, anxiety/depressive disorder, social issues, attention problems, and aggressive behavior. Schizophrenia offspring were strongly related to thought issues.
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Affiliation(s)
- Fiby Fayez Gabrielle
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghada Refaat
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Lina Ezzat
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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2
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Gooding DC. Social anhedonia and other indicators of risk for schizophrenia: Theory and inquiry. Psychiatry Res 2023; 319:114966. [PMID: 36436399 DOI: 10.1016/j.psychres.2022.114966] [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: 10/03/2022] [Revised: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 11/21/2022]
Abstract
In this commentary, the author traces theoretical contributions that fueled her interest in the role of social/interpersonal striving, relating, and enjoyment in terms of schizophrenia. Social anhedonia is discussed in the context of schizophrenia. The author reviews selective empirical evidence indicating that social anhedonia has a unique role in terms of risk for schizophrenia as well as schizophrenia outcome. Other risk indicators for adult schizophrenia-spectrum outcomes are briefly considered. The author discusses the measurement of social anhedonia across the lifespan and transdiagnostically. Finally, this commentary offers a critique of current strategies for risk calculation.
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Affiliation(s)
- Diane Carol Gooding
- Department of Psychology, University of Wisconsin-Madison, Madison, WI 53706, United States; Department of Psychiatry, University of Wisconsin-Madison, United States of America.
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3
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Chang X, Zhao W, Kang J, Xiang S, Xie C, Corona-Hernández H, Palaniyappan L, Feng J. Language abnormalities in schizophrenia: binding core symptoms through contemporary empirical evidence. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:95. [PMID: 36371445 PMCID: PMC9653408 DOI: 10.1038/s41537-022-00308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Both the ability to speak and to infer complex linguistic messages from sounds have been claimed as uniquely human phenomena. In schizophrenia, formal thought disorder (FTD) and auditory verbal hallucinations (AVHs) are manifestations respectively relating to concrete disruptions of those abilities. From an evolutionary perspective, Crow (1997) proposed that "schizophrenia is the price that Homo sapiens pays for the faculty of language". Epidemiological and experimental evidence points to an overlap between FTD and AVHs, yet a thorough investigation examining their shared neural mechanism in schizophrenia is lacking. In this review, we synthesize observations from three key domains. First, neuroanatomical evidence indicates substantial shared abnormalities in language-processing regions between FTD and AVHs, even in the early phases of schizophrenia. Second, neurochemical studies point to a glutamate-related dysfunction in these language-processing brain regions, contributing to verbal production deficits. Third, genetic findings further show how genes that overlap between schizophrenia and language disorders influence neurodevelopment and neurotransmission. We argue that these observations converge into the possibility that a glutamatergic dysfunction in language-processing brain regions might be a shared neural basis of both FTD and AVHs. Investigations of language pathology in schizophrenia could facilitate the development of diagnostic tools and treatments, so we call for multilevel confirmatory analyses focused on modulations of the language network as a therapeutic goal in schizophrenia.
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Affiliation(s)
- Xiao Chang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Zhangjiang Fudan International Innovation Center, Shanghai, China
| | - Wei Zhao
- MOE-LCSM, School of Mathematics and Statistics, Hunan Normal University, Changsha, PR China
| | - Jujiao Kang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
- Shanghai Center for Mathematical Sciences, Shanghai, China
| | - Shitong Xiang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Chao Xie
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Hugo Corona-Hernández
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China.
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Zhangjiang Fudan International Innovation Center, Shanghai, China.
- Shanghai Center for Mathematical Sciences, Shanghai, China.
- Department of Computer Science, University of Warwick, Coventry, UK.
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4
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Bilgrami ZR, Sarac C, Srivastava A, Herrera SN, Azis M, Haas SS, Shaik RB, Parvaz MA, Mittal VA, Cecchi G, Corcoran CM. Construct validity for computational linguistic metrics in individuals at clinical risk for psychosis: Associations with clinical ratings. Schizophr Res 2022; 245:90-96. [PMID: 35094918 PMCID: PMC10062407 DOI: 10.1016/j.schres.2022.01.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/21/2022]
Abstract
Language deficits are prevalent in psychotic illness, including its risk states, and are related to marked impairment in functioning. It is therefore important to characterize language impairment in the psychosis spectrum in order to develop potential preventive interventions. Natural language processing (NLP) metrics of semantic coherence and syntactic complexity have been used to discriminate schizophrenia patients from healthy controls (HC) and predict psychosis onset in individuals at clinical high-risk (CHR) for psychosis. To date, no studies have yet examined the construct validity of key NLP features with respect to clinical ratings of thought disorder in a CHR cohort. Herein we test the association of key NLP metrics of coherence and complexity with ratings of positive and negative thought disorder, respectively, in 60 CHR individuals, using Andreasen's Scale of Assessment of Thought, Language and Communication (TLC) Scale to measure of positive and negative thought disorder. As hypothesized, in CHR individuals, the NLP metric of semantic coherence was significantly correlated with positive thought disorder severity and the NLP metrics of complexity (sentence length and determiner use) were correlated with negative thought disorder severity. The finding of construct validity supports the premise that NLP analytics, at least in respect to core features of reduction of coherence and complexity, are capturing clinically relevant language disturbances in risk states for psychosis. Further psychometric study is required, in respect to reliability and other forms of validity.
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Affiliation(s)
- Zarina R Bilgrami
- Icahn School of Medicine at Mount Sinai New York, NY, USA; Department of Psychology, Emory University, Atlanta, GA, USA.
| | - Cansu Sarac
- Icahn School of Medicine at Mount Sinai New York, NY, USA; Department of Psychology, Long Island University-Brooklyn, 1 University Plaza, Brooklyn, NY, USA
| | | | | | - Matilda Azis
- Department of Psychosis Studies, Kings College, London, UK
| | | | - Riaz B Shaik
- Icahn School of Medicine at Mount Sinai New York, NY, USA
| | | | - Vijay A Mittal
- Northwestern University, Department of Psychology, Evanston, IL, USA
| | | | - Cheryl M Corcoran
- Icahn School of Medicine at Mount Sinai New York, NY, USA; James J. Peters VA Medical Center Bronx, NY, USA
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5
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Putri DE, Afrizal A, Hamidi D, Effendy E, Susilawati FY, Wenny BP. Relationship of Family Resilience with Relapse in People with Schizophrenia. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.7651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: The relapse of people with Schizophrenia is a global problem. One of the problems of treating Schizophrenia is relapse. It becomes heavy because of the problem of family resilience in caring for people with Schizophrenia.
Purpose: This study aimed to determine the correlation between family resilience and relapse in people with Schizophrenia in the Public Health Center Padang or Puskesmas Padang working area. The research population was families who cared for people with Schizophrenia in the working area of Puskemas Padang. It determined with the purposive sampling method, and based on that, 139 families determined as respondents. The data collected using the instruments to measure family resilience was the Family Resilience Assessment Scale (FRAS) questionnaire. For relapse, the researchers asked the frequency of people with schizophrenia treatment for one year.
Result: The results of this study indicate that more than half of the respondents (60.4%) have moderate family resilience and more than half (71,2%) have low relapse rates. So it can be concluded that there is a significant relationship between family resilience and people with schizophrenia relapse (P=0.000).
Conclusion: Family resilience can reduce relapse in people with Schizophrenia. Family efforts in increasing family resilience include a positive outlook, having social and economic resources, and expressing stable emotions in solving a problem.
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6
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The clinical relevance of formal thought disorder in the early stages of psychosis: results from the PRONIA study. Eur Arch Psychiatry Clin Neurosci 2022; 272:403-413. [PMID: 34535813 PMCID: PMC8938366 DOI: 10.1007/s00406-021-01327-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/27/2021] [Indexed: 10/27/2022]
Abstract
BACKGROUND Formal thought disorder (FTD) has been associated with more severe illness courses and functional deficits in patients with psychotic disorders. However, it remains unclear whether the presence of FTD characterises a specific subgroup of patients showing more prominent illness severity, neurocognitive and functional impairments. This study aimed to identify stable and generalizable FTD-subgroups of patients with recent-onset psychosis (ROP) by applying a comprehensive data-driven clustering approach and to test the validity of these subgroups by assessing associations between this FTD-related stratification, social and occupational functioning, and neurocognition. METHODS 279 patients with ROP were recruited as part of the multi-site European PRONIA study (Personalised Prognostic Tools for Early Psychosis Management; www.pronia.eu). Five FTD-related symptoms (conceptual disorganization, poverty of content of speech, difficulty in abstract thinking, increased latency of response and poverty of speech) were assessed with Positive and Negative Symptom Scale (PANSS) and the Scale for the Assessment of Negative Symptoms (SANS). RESULTS The results with two patient subgroups showing different levels of FTD were the most stable and generalizable clustering solution (predicted clustering strength value = 0.86). FTD-High subgroup had lower scores in social (pfdr < 0.001) and role (pfdr < 0.001) functioning, as well as worse neurocognitive performance in semantic (pfdr < 0.001) and phonological verbal fluency (pfdr < 0.001), short-term verbal memory (pfdr = 0.002) and abstract thinking (pfdr = 0.010), in comparison to FTD-Low group. CONCLUSIONS Clustering techniques allowed us to identify patients with more pronounced FTD showing more severe deficits in functioning and neurocognition, thus suggesting that FTD may be a relevant marker of illness severity in the early psychosis pathway.
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7
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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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8
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Abstract
James is a 7½-year-old boy born in Vietnam to a mother with mental illness. Little is known about his early history; he spent the first 6 months of his life in an orphanage, followed by foster care and a disrupted adoption. He moved to the U.S. at age 1½ and joined his current adoptive family at age 4 years. Shortly thereafter, James' psychiatric nurse practitioner diagnosed him with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Pragmatic language and syntax deficits were also noted from an early age.James is now exhibiting anxiety, perseverative beliefs, and regression in his toileting. He began "talking to himself in his room" and using neologisms. A school-based evaluation resulted in educational diagnoses of ADHD and ASD based on social disconnectedness and invading others' personal space. James' parents felt "something else was going on" and sought a second opinion with a multidisciplinary team (consisting of a pediatric psychologist and a developmental pediatrician). Considering James' history, previous assessments, and their assessment battery (Behavior Assessment System for Children, Behavior Rating Inventory of Executive Function, and Autism Diagnostic Observation Schedule, and Rorschach Inkblot Test), the team characterized his current symptoms as an emerging psychotic disorder.Several consultations occurred over the next 9 months of the school term. First, clinicians in the psychiatry department confirmed symptoms of functional decline, cognitive disorganization, and hallucinations, which were attributed to post-traumatic stress rather than a psychotic disorder. Second, adding to the diagnostic uncertainty, when James started an atypical antipsychotic medication and was under good symptom control, the school team believed that ADHD-not psychosis-best accounted for his presentation. There was significant contention between the medical team and consulting school psychologist regarding the extent to which data from the parental history and Rorschach should be considered in formulating the patient's diagnosis.Two-and-a-half years later, James was weaned off risperidone to manage a new side effect of tics. He subsequently manifested significant paranoia with reactive aggression toward peers for imagined slights and insults that he could "swear he heard." A different school-contracted psychologist's re-evaluation corroborated the diagnosis of schizophrenia based on the several years of unfolding clinical observations. Acting from the supposition that early-onset psychosis was too rare and too stigmatizing a condition to apply to a "kid who's just having trouble paying attention," the first school psychologist remained adamant that ADHD and ASD were the most appropriate diagnoses, and James would be ill-served "pumped full of neuroleptics."He returns now to the original Developmental Behavioral Pediatric consulting team. What would you do to try to bridge this impasse?
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Abstract
It has been 30 years since Holzman introduced a special issue of the Schizophrenia Bulletin entitled “Thought Disorder in Schizophrenia.” He pointed out in his Editor’s Introduction that in contrast to the explosion of interest at that time in the biological aspects of schizophrenia, there were important areas of study that represented “... relatively neglected aspects of the psychopathology of schizophrenia, namely the varieties of thinking disorders (emphasis added) characteristic of schizophrenic patients and their possible underlying mechanisms.” Perhaps presciently, he ended his introduction by expressing hope that the articles included in that issue would lead to further intensive study of the cognitive (emphasis added) dysfunctions in schizophrenia. There has, indeed, been extensive research conducted in further understanding cognitive dysfunctions in schizophrenia, but considerably less so in understanding thought disorder.
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Affiliation(s)
- Mara Hart
- Department of Psychological and Brain Sciences, Belknap Campus, University of Louisville, Louisville, KY 40292
| | - Richard R. J. Lewine
- Department of Psychological and Brain Sciences, Belknap Campus, University of Louisville, Louisville, KY 40292
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10
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Morgan CJ, Coleman MJ, Ulgen A, Boling L, Cole JO, Johnson FV, Lerbinger J, Bodkin JA, Holzman PS, Levy DL. Thought Disorder in Schizophrenia and Bipolar Disorder Probands, Their Relatives, and Nonpsychiatric Controls. Schizophr Bull 2017; 43:523-535. [PMID: 28338967 PMCID: PMC5463905 DOI: 10.1093/schbul/sbx016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thought disorder (TD) has long been associated with schizophrenia (SZ) and is now widely recognized as a symptom of mania and other psychotic disorders as well. Previous studies have suggested that the TD found in the clinically unaffected relatives of SZ, schizoaffective and bipolar probands is qualitatively similar to that found in the probands themselves. Here, we examine which quantitative measures of TD optimize the distinction between patients with diagnoses of SZ and bipolar disorder with psychotic features (BP) from nonpsychiatric controls (NC) and from each other. In addition, we investigate whether these same TD measures also distinguish their respective clinically unaffected relatives (RelSZ, RelBP) from controls as well as from each other. We find that deviant verbalizations are significantly associated with SZ and are co-familial in clinically unaffected RelSZ, but are dissociated from, and are not co-familial for, BP disorder. In contrast, combinatory thinking was nonspecifically associated with psychosis, but did not aggregate in either group of relatives. These results provide further support for the usefulness of TD for identifying potential non-penetrant carriers of SZ-risk genes, in turn enhancing the power of genetic analyses. These findings also suggest that further refinement of the TD phenotype may be needed in order to be suitable for use in genetic studies of bipolar disorder.
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Affiliation(s)
- Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | | | - Ayse Ulgen
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY
| | - Lenore Boling
- Psychology Research Laboratory, McLean Hospital, Belmont, MA
| | - Jonathan O Cole
- Psychology Research Laboratory, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | | | - Jan Lerbinger
- Psychology Research Laboratory, McLean Hospital, Belmont, MA
| | - J Alexander Bodkin
- Psychology Research Laboratory, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Philip S Holzman
- Psychology Research Laboratory, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Deborah L Levy
- Psychology Research Laboratory, McLean Hospital, Belmont, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
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11
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Evidence that communication impairment in schizophrenia is associated with generalized poor task performance. Psychiatry Res 2017; 249:172-179. [PMID: 28104564 PMCID: PMC5452682 DOI: 10.1016/j.psychres.2016.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/24/2023]
Abstract
People with schizophrenia exhibit wide-ranging cognitive deficits, including slower processing speed and decreased cognitive control. Disorganized speech symptoms, such as communication impairment, have been associated with poor cognitive control task performance (e.g., goal maintenance and working memory). Whether communication impairment is associated with poorer performance on a broader range of non-cognitive control measures is unclear. In the current study, people with schizophrenia (n =51) and non-psychiatric controls (n =26) completed speech interviews allowing for reliable quantitative assessment of communication impairment. Participants also completed multiple goal maintenance and working memory tasks. In addition, we also examined (a) simple measures of processing speed involving highly automatic prepotent responses and (b) a non-cognitive control measure of general task performance. Schizophrenia communication impairment was significantly associated with poor performance in all cognitive domains, with the largest association found with processing speed (rs =-0.52). Further, communication impairment was also associated with the non-cognitive control measure of poor general task performance (rs =-0.43). In contrast, alogia, a negative speech symptom, and positive symptoms were less if at all related to cognitive task performance. Overall, this study suggests that communication impairment in schizophrenia may be associated with relatively generalized poor cognitive task performance.
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12
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Roche E, Lyne J, O'Donoghue B, Segurado R, Behan C, Renwick L, Fanning F, Madigan K, Clarke M. The prognostic value of formal thought disorder following first episode psychosis. Schizophr Res 2016; 178:29-34. [PMID: 27639419 DOI: 10.1016/j.schres.2016.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses and it can be assessed as a categorical or dimensional variable. However, its influence on functional outcome and hospitalisation patterns in early psychosis has not been investigated. We evaluated the relationship between FTD and these outcomes in a first episode psychosis (FEP) sample. MATERIALS AND METHODS A mixed diagnostic FEP cohort was recruited through an Early Intervention in Psychosis Service in Ireland. Participants were assessed at initial presentation and one year later with the MIRECC GAF to evaluate social and occupational functioning domains. Disorganisation (disFTD), verbosity (verFTD) and poverty (povFTD) dimensions of FTD were examined at both time points, as well as a unitary FTD construct. Analyses were controlled for demographic, clinical and treatment variables. RESULTS DisFTD was the only FTD dimension associated with functional outcome, specifically social functioning, on multivariate analysis (beta=0.13, P<0.05). The unitary FTD construct was not associated with functional outcome. DisFTD at FEP presentation predicted a greater number of hospitalisations (adjusted beta=0.24, P<0.001) and prolonged inpatient admission (adjusted OR=1.08, 95% CI 1.02-1.15, P<0.05) following FEP. CONCLUSIONS Longitudinal and dimensional evaluation of FTD has a clinical utility that is distinct from a cross-sectional or unitary assessment. Dimensions of FTD may map onto different domains of functioning. These findings are supportive of some of the changes in DSM-V with an emphasis on longitudinal and dimensional appraisal of psychopathology. Communication disorders may be considered a potential target for intervention in psychotic disorders.
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Affiliation(s)
- Eric Roche
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland.
| | - John Lyne
- Royal College of Surgeons in Ireland and North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland
| | - Brian O'Donoghue
- Orygen, National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research, University College Dublin, Ireland
| | - Caragh Behan
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
| | - Laoise Renwick
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - Felicity Fanning
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
| | - Kevin Madigan
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
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13
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Andersen DB, Vernal DL, Bilenberg N, Væver MS, Stenstrøm AD. Early-Onset Schizophrenia: Exploring the Contribution of the Thought Disorder Index to Clinical Assessment. Scand J Child Adolesc Psychiatr Psychol 2015. [DOI: 10.21307/sjcapp-2016-005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background:
Differentiating diagnostically between schizophrenia and emotional and personality disorders with psychotic or psychotic-like symptoms is a challenging task. It is especially difficult when working with adolescent patients, because their symptoms tend to manifest at lower levels as compared with adult patients. Thought disorder is a core symptom of schizophrenia, and the Rorschach Inkblot Method is widely used for the assessment of formal thought disorder.
Objective:
In this study, which is situated within ongoing clinical practice, we investigated whether the Rorschach test is helpful for assessing early-onset schizophrenia due to its ability to detect thought disorder. We also wanted to examine whether the Thought Disorder Index (TDI) is superior to the Comprehensive System (CS) for differentiating between patients with early-onset schizophrenia and non-psychotic patients experiencing auditory and visual hallucinations. An additional aim was to examine whether the TDI correlated with the Positive and Negative Syndrome Scale (PANSS).
Methods:
Twenty-three subjects between the ages of 12 and 18 years were examined with the use of the Rorschach test, and the protocols were scored according to both the TDI and the CS. All subjects were also assessed with the Positive and Negative Syndrome Scale. The sample included 14 subjects who fulfilled the criteria for schizophrenia and 9 subjects who were experiencing hallucinations that emanated from severe emotional and relational problems but who had different non-psychotic disorders.
Results:
Although the two groups could not be distinguished with regard to their total scores for thought disorder, the identification of specific thought disorder types proved useful for differential diagnosis. Verbalizations that were categorized by the TDI as “absurd responses,” “fluidity,” “contamination,” “autistic logic,” and “word-finding difficulty” were only given by patients who had been diagnosed with schizophrenia. When patients’ responses were scored with the use of the CS, the “contamination” score was the only one found to be specific to schizophrenia.
Conclusions:
Although the sample size limits the conclusions that can be drawn, the results indicate that the TDI may be superior to the CS for the identification of thought disorder specific to—but not always present in—adolescents with schizophrenia. In other words, the absence of severe thought disorder is not synonymous with the absence of severe psychopathology, but the presence of the most severe thought disorder types (i.e., “absurd responses,” “fluidity,” “incoherence,” “contamination,” and “autistic logic”) seems to be a strong indicator of schizophrenic psychopathology.
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Affiliation(s)
| | - Ditte Lammers Vernal
- Research Unit for Child and Adolescent Psychiatry, Aalborg University Hospital , Denmark , Denmark
| | - Niels Bilenberg
- Research Unit for Child and Adolescent Psychiatry, Child and Adolescent Psychiatric University Clinic , Odense , Denmark
| | | | - Anne Dorte Stenstrøm
- Research Unit for Child and Adolescent Psychiatry, Child and Adolescent Psychiatric University Clinic , Odense , Denmark
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14
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Roche E, Creed L, MacMahon D, Brennan D, Clarke M. The Epidemiology and Associated Phenomenology of Formal Thought Disorder: A Systematic Review. Schizophr Bull 2015; 41:951-62. [PMID: 25180313 PMCID: PMC4466171 DOI: 10.1093/schbul/sbu129] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Authors of the Diagnostic and Statistical Manual, Fifth Edition (DSM-V) have recommended to "integrate dimensions into clinical practice." The epidemiology and associated phenomenology of formal thought disorder (FTD) have been described but not reviewed. We aimed to carry out a systematic review of FTD to this end. METHODS A systematic review of FTD literature, from 1978 to 2013, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 881 abstracts were reviewed and 120 articles met inclusion criteria; articles describing FTD factor structure (n = 15), prevalence and longitudinal course (n = 41), role in diagnosis (n = 22), associated clinical variables (n = 56), and influence on outcome (n = 35) were included. Prevalence estimates for FTD in psychosis range from 5% to 91%. Dividing FTD into domains, by factor analysis, can accurately identify 91% of psychotic diagnoses. FTD is associated with increased clinical severity. Poorer outcomes are predicted by negative thought disorder, more so than the typical construct of "disorganized speech." CONCLUSION FTD is a common symptom of psychosis and may be considered a marker of illness severity. Detailed dimensional assessment of FTD can clarify diagnosis and may help predict prognosis.
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Affiliation(s)
- Eric Roche
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland;
| | - Lisa Creed
- Cluain Mhuire Community Mental Health Service, Dublin, Ireland
| | | | | | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Dublin, Ireland
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15
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Roisko R, Wahlberg KE, Hakko H, Tienari P. Association of adoptive child's thought disorders and schizophrenia spectrum disorders with their genetic liability for schizophrenia spectrum disorders, season of birth and parental Communication Deviance. Psychiatry Res 2015; 226:434-40. [PMID: 25746170 DOI: 10.1016/j.psychres.2014.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 07/31/2014] [Accepted: 12/22/2014] [Indexed: 12/14/2022]
Abstract
Joint effects of genotype and the environment have turned out to be significant in the development of psychotic disorders. The purpose of the present study was to assess the association of an adoptive child׳s thought and schizophrenia spectrum disorders with genetic and environmental risk indicators and their interactions. A subgroup of the total sample used in the Finnish Adoptive Family Study was considered in the present study. The subjects were 125 adoptees at a high (n=53) or low (n=72) genetic risk of schizophrenia spectrum disorders and their adoptive parents. The risk factors evaluated were the adoptive child's genetic risk for schizophrenia spectrum disorders, winter or spring birth and parental Communication Deviance (CD). Thought disorders in the adoptees were assessed using the Thought Disorder Index and diagnoses were made according to DSM-III-R criteria. The adoptive child׳s Thought Disorder Index was only associated with parental Communication Deviance. The adoptive child's heightened genetic risk or winter or spring birth or parental CD or their interactions did not predict the adoptee's schizophrenia spectrum disorder. The results suggest that studies taking several risk indicators and their interactions into account may change views on the mutual significance of well-known risk factors.
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Affiliation(s)
- Riikka Roisko
- Oulu University Hospital, Department of Psychiatry, Box 26, FI-90029 OYS, Finland.
| | - Karl-Erik Wahlberg
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| | - Helinä Hakko
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
| | - Pekka Tienari
- Institute of Clinical Medicine, Department of Psychiatry, University of Oulu, Oulu, Finland
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16
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DeVylder JE, Muchomba FM, Gill KE, Ben-David S, Walder DJ, Malaspina D, Corcoran CM. Symptom trajectories and psychosis onset in a clinical high-risk cohort: the relevance of subthreshold thought disorder. Schizophr Res 2014; 159:278-83. [PMID: 25242361 PMCID: PMC4254175 DOI: 10.1016/j.schres.2014.08.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/03/2014] [Accepted: 08/06/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies have implicated baseline positive and negative symptoms as predictors of psychosis onset among individuals at clinical high risk (CHR), but none have evaluated latent trajectories of symptoms over time. This study evaluated the dynamic evolution of symptoms leading to psychosis onset in a CHR cohort. METHOD 100 CHR participants were assessed quarterly for up to 2.5 years. Latent trajectory analysis was used to identify patterns of symptom change. Logistic and proportional hazards models were employed to evaluate the predictive value for psychosis onset of baseline symptoms and symptom trajectories. RESULTS Transition rate to psychosis was 26%. Disorganized communication (i.e., subthreshold thought disorder) presented an increased hazard for psychosis onset, both at baseline (Hazard Ratio (95% CI)=1.4 (1.1-1.9)) and as a trajectory of high persistent disorganized communication (Hazard Ratio (95% CI)=2.2 (1.0-4.9)). Interval clinical data did not improve the predictive value of baseline symptoms for psychosis onset. CONCLUSIONS High baseline disorganized communication evident at ascertainment tended to persist and lead to psychosis onset, consistent with prior behavioral and speech analysis studies in similar cohorts. Remediation of language dysfunction therefore may be a candidate strategy for preventive intervention.
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Affiliation(s)
- Jordan E. DeVylder
- New York State Psychiatric Institute at Columbia University, 1051 Riverside
Drive, New York, NY, USA,Columbia University School of Social Work, New York, NY, USA
| | | | - Kelly E. Gill
- New York State Psychiatric Institute at Columbia University, 1051 Riverside
Drive, New York, NY, USA
| | - Shelly Ben-David
- New York State Psychiatric Institute at Columbia University, 1051 Riverside Drive, New York, NY, USA.
| | - Deborah J. Walder
- Department of Psychology, Brooklyn College & The Graduate Center of the
City University of New York, USA
| | - Dolores Malaspina
- Creedmoor Psychiatric Center, New York Office of Mental Health, New York, NY, USA; NYU Department of Psychiatry, New York, NY, USA.
| | - Cheryl M. Corcoran
- New York State Psychiatric Institute at Columbia University, 1051 Riverside
Drive, New York, NY, USA
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17
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Pragmatic use of language by children who develop schizophrenia in adult life. Schizophr Res 2013; 147:181-186. [PMID: 23557685 DOI: 10.1016/j.schres.2013.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/08/2013] [Accepted: 03/05/2013] [Indexed: 11/21/2022]
Abstract
At eleven years of age all children in a UK national birth cohort wrote short stories about the life they expected to be leading at age 25. Using a data linkage exercise, we identified those who later developed schizophrenia, affective psychosis, or other non-psychotic psychiatric disorders in later life based on the PSE CATEGO diagnostic system. The majority of these had completed the written essays. Controls from the reference population were selected, matched for gender, IQ and social and economic status. The essays were scored using well established methods for assessing pragmatic use of language, namely narrative coherence and linguistic cohesion. We hypothesised that children pre-morbid for schizophrenia (Pre-Scz) would obtain low scores on all these measures. However this general hypothesis was largely disproved by the data, although some unpredicted gender effects were found. It is concluded that thought is organised in an unexceptional way in adolescents before they develop schizophrenia, once the data are corrected for any lowering of general cognitive ability in the Pre-Scz cases.
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18
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Gooding DC, Ott SL, Roberts SA, Erlenmeyer-Kimling L. Thought disorder in mid-childhood as a predictor of adulthood diagnostic outcome: findings from the New York High-Risk Project. Psychol Med 2013; 43:1003-1012. [PMID: 22932128 DOI: 10.1017/s0033291712001791] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thought disorder has been proposed as an indicator of schizotypy, which is considered to be necessary but not sufficient for the development of schizophrenia. It is unclear whether thought disorder is an indicator of susceptibility (i.e. an endophenotype) for schizophrenia. The goal of the present study was to elucidate the role of thought disorder in relation to schizotypy by examining its presence in high-risk individuals during mid-childhood. Method The sample consisted of 265 subjects drawn from the New York High-Risk Project. Individuals at high risk for schizophrenia (i.e. offspring of parents with schizophrenia) were compared with individuals at low risk for schizophrenia (i.e. offspring of parents with affective disorder or offspring of psychiatrically normal parents). Videotaped interviews were rated for thought disorder using the Scale for the Assessment of Thought, Language, and Communication (TLC). The same subjects were administered diagnostic interviews in late adolescence/early adulthood. RESULTS Although positive thought disorder was equally present in subjects with affective and non-affective psychoses, negative thought disorder (namely, poverty of speech and poverty of content of speech) was elevated only in subjects with schizophrenia-related psychosis. Logistic regression analyses revealed that negative thought disorder added to the prediction of schizophrenia-related psychosis outcomes over and above positive thought disorder. CONCLUSIONS These findings suggest that negative thought disorder may have a specific association with schizotypy, rather than a more general association with psychosis. The findings also support consideration of negative thought disorder as an endophenotypic indicator of a schizophrenia diathesis.
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Affiliation(s)
- D C Gooding
- University of Wisconsin-Madison, Madison, WI, USA.
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19
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Radanovic M, Sousa RTD, Valiengo L, Gattaz WF, Forlenza OV. Formal Thought Disorder and language impairment in schizophrenia. ARQUIVOS DE NEURO-PSIQUIATRIA 2012; 71:55-60. [DOI: 10.1590/s0004-282x2012005000015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 07/13/2012] [Indexed: 01/08/2023]
Abstract
Schizophrenia is a psychiatric illness in which disorders of thought content are a prominent feature. The disruption of normal flow of thought, or “Formal Thought Disorder” (FTD), has been traditionally assessed through the content and form of patients’ speech, and speech abnormalities in schizophrenia were considered as a by-product of the disruption in conceptual structures and associative processes related to psychosis. This view has been changed due to increasing evidence that language per se is impaired in schizophrenia, especially its semantic, discursive, and pragmatic aspects. Schizophrenia is currently considered by some authors as a “language related human specific disease” or “logopathy”, and the neuroanatomical and genetic correlates of the language impairment in these patients are under investigation. Such efforts may lead to a better understanding about the pathophysiology of this devastating mental disease. We present some current concepts related to FTD as opposed to primary neurolinguistic abnormalities in schizophrenia.
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