Effects of social cognitive impairment on speech disorder in schizophrenia

Use of reference markers in the speech of people with schizophrenia spectrum disorders: Evidence from two referential communication tasks manipulating common ground with the interaction partner

Introduction

People with schizophrenia spectrum disorders present with language dysfunctions, yet we know little about their use of reference markers (indefinite markers, definite markers, pronouns or names), a fundamental aspect of efficient speech production.

Methods

Twenty-five (25) participants with a recent-onset schizophrenia spectrum disorder (SZ) and 25 healthy controls (HC) completed two referential communication tasks. The tasks involved presenting to an interaction partner a series of movie characters (character identification task) and movie scenes composed of six images (narration task). A manipulation was introduced such that half of the movies could be considered as Likely-Known by the interaction partner, whereas the other half was Likely-Unknown. The analyses focused on the reference markers used to present the movie characters during the tasks.

Results

During the character identification task, the SZ group used fewer names and more pronouns than the HC. During the narration task, the SZ group used fewer names and more definite references when initially introducing the main story characters, while no group effect emerged for subsequent mentions of the characters. The observed effects of conditions were generally present across both groups, except for a lesser adjustment in the use of definite markers when introducing the story characters.

Conclusions

While some group differences emerged, people with SZ were generally sensitive to the manipulation regarding their interaction partner's likely knowledge of the characters. A better understanding of the conditions in which speech production is affected in SZ could help promote more efficient communication.

Schizophasia and Cognitive Impairment in Schizophrenia: A Literature Review

BACKGROUND

Cognitive functions are the basis for the development of language skills. Cognitive disorders occur in schizophrenia and may be present even before the first symptoms of psychosis. Language deficits are also mentioned as one of the diagnostic symptoms of this disease.

METHODS

A literature search was performed using the PubMed database. Articles comparing linguistic and cognitive functioning in schizophrenia were searched for. Following the inclusion and exclusion criteria, twenty-six original articles were selected.

RESULTS

Most studies have observed a partial correlation between language and cognitive deficits. The correlation most often involved some cognitive functions or some components of language assessment.

CONCLUSIONS

The correlation reported in many studies shows that there is a correlation between language and cognitive deficits in schizophrenia. However, numerous studies contradict these reports. It is, therefore, possible that this correlation exists, but not in all patients. Future research should therefore be aimed at identifying in which patients this correlation is present.

Schizophrenia: Communication Disorders and Role of the Speech-Language Pathologist

PURPOSE

This clinical focus article aims to provide a comprehensive overview of schizophrenia and understanding of communication disorders resulting from its psychopathology. Schizophrenia is a spectrum disorder with varying levels of symptom expression. It is characterized by positive and negative symptoms that can cause communication disorders of different severity levels. Communication difficulties manifest as a range of symptoms such as alogia, disorganized speech, and impaired social communication. These challenges may result in receptive and expressive language deficits that lead to misunderstandings, reduced social interactions, and difficulties expressing thoughts and emotions effectively. The purpose of this clinical focus article is to explore the role of the speech-language pathologist (SLP) in assessing and treating communication disorders presented in schizophrenia.

CONCLUSIONS

In order to understand the role of the SLP in assessing and treating communication disorders in schizophrenia, it is imperative to understand the overall course, etiology, assessment, and treatment consideration of this condition. SLPs can provide services in the areas of social skills training and community-based intervention contexts.

Weighing the role of social cognition and executive functioning in pragmatics in the schizophrenia spectrum: A systematic review and meta-analysis

Pragmatic impairment is diffused in schizophrenia spectrum disorders, but the literature still debates its neurocognitive underpinnings. This systematic review and meta-analysis aimed to investigate the neurocognitive correlates of pragmatic disorders in schizophrenia and determine the weight of social cognition and executive functioning on such disorders. Of the 2,668 records retrieved from the literature, 16 papers were included in the systematic review, mostly focused on non-literal meanings and discourse production in schizophrenia. Ten studies were included in the meta-analysis: pragmatics was moderately associated with both social cognition and executive functions (especially inhibition), but the link with social cognition was stronger. The mediation analysis showed that social cognition mediated the relationship between executive functions and pragmatics. Based on this, we proposed a hierarchical neurocognitive model where pragmatics stems from social cognition, while executive functions are the fertile ground supporting the other two domains, and we discuss its theoretical and clinical implications.

A new schizophrenia screening instrument based on evaluating the patient's writing

Formal Thought Disorder (FTD) is a defining feature of schizophrenia, which is often assessed through patients' speech. Meanwhile, the written language is less studied. The aim of the present study is to establish and validate a comprehensive clinical screening scale, capturing the full variety of empirical characteristics of writing in patients with schizophrenia. The 16-item Screening Instrument for Schizophrenic Features in Writing (SISFiW) is derived from detailed literature review and a "brainstorming" discussion on 30 samples written by patients with schizophrenia. One hundred and fifty-seven participants (114 patients with an ICD-10 diagnoses of schizophrenia; 43 healthy control subjects) were interviewed and symptoms assessed with the Positive and Negative Syndrome Scale (PANSS) and the Scale for the Assessment of Thought, Language, and Communication (TLC). Article samples written by each participant were rated with the SISFiW. Results demonstrated significant difference of the SISFiW-total between the patient group and healthy controls [(3.61 ± 1.72) vs. (0.49 ± 0.63), t = 16.64, p<0.001]. The inter-rater reliability (weighted kappa = 0.72) and the internal consistency (Cronbach's alpha coefficient = 0.613) were acceptable, but correlations with the criterion (PANSS and TLC) were unremarkable. The ROC analysis indicated a cutoff point at 2 with the maximal sensitivity (93.0 %)/specificity (93.0 %). Discriminant analysis of the SISFiW items yielded 8 classifiers that discriminated between the diagnostic groups at a perfect overall performance (with 90.4 % of original and 88.5 % cross-validated grouped cases classified correctly). This instrument appears to be practicable and reliable, with relatively robust discriminatory power, and may serve as a complementary tool to existing FTD rating scales.

Narrative-Derived Indices of Metacognition among People with Schizophrenia: Associations with Self-Reported and Performance-Based Social Functioning

Metacognitive functioning-which broadly encompasses the mental processes involved in thinking about the thinking of one's self and the thinking of others-is often impaired among individuals living with schizophrenia and may contribute to difficulties in social and interpersonal functioning. Although the majority of studies assessing metacognition among individuals with schizophrenia use standardized, laboratory-based measurements, an increasing number of studies have measured metacognitive capacity using natural language produced by individuals living with mental illness. At the same time, less is known about how language-derived indices of metacognitive function relate to key social outcomes among people with schizophrenia. The primary objective of this study was to employ a validated language coding system (the Metacognition Assessment Scale, Abbreviated; MAS-A) to assess metacognitive functioning from the spoken life narratives of individuals with schizophrenia (n = 32) and community controls (n = 15). Among individuals with schizophrenia, we also examined the associations between language-derived metacognition and measures of self-reported and performance-based social functioning. Our results suggest that most aspects of metacognition in our sample were not significantly diminished in people with schizophrenia compared to community controls. Unexpectedly, the MAS-A subscale related to one's ability to master psychological difficulties was rated higher among individuals with schizophrenia. Further, our results suggest that among people with schizophrenia, higher metacognitive functioning in the domain of self-reflectivity was associated with poorer self-reported social functioning, while a greater metacognitive awareness of other individuals' minds was associated with better scores on aspects of performance-based social functioning. Collectively, these results underscore the utility of assessing metacognitive functioning via life-story narratives to understand social outcomes and highlight possible aspects of resiliency among individuals who have experienced a serious mental illness.

Linguistic findings in persons with schizophrenia-a review of the current literature

INTRODUCTION

Alterations of verbalized thought occur frequently in psychotic disorders. We characterize linguistic findings in individuals with schizophrenia based on the current literature, including findings relevant for differential and early diagnosis.

METHODS

Review of literature published via PubMed search between January 2010 and May 2022.

RESULTS

A total of 143 articles were included. In persons with schizophrenia, language-related alterations can occur at all linguistic levels. Differentiating from findings in persons with affective disorders, typical symptoms in those with schizophrenia mainly include so-called "poverty of speech," reduced word and sentence production, impaired processing of complex syntax, pragmatic language deficits as well as reduced semantic verbal fluency. At the at-risk state, "poverty of content," pragmatic difficulties and reduced verbal fluency could be of predictive value.

DISCUSSION

The current results support multilevel alterations of the language system in persons with schizophrenia. Creative expressions of psychotic experiences are frequently found but are not in the focus of this review. Clinical examinations of linguistic alterations can support differential diagnostics and early detection. Computational methods (Natural Language Processing) may improve the precision of corresponding diagnostics. The relations between language-related and other symptoms can improve diagnostics.

The other side of the social interaction: Theory of mind impairments in people with schizophrenia are linked to other people's difficulties in understanding them

BACKGROUND

People with schizophrenia (SZ) often present with theory of mind (ToM) deficits and with speech production deficits. While a link has been established between ToM abilities and symptoms of thought disorder, much less is known about other aspects of speech production in SZ.

STUDY DESIGN

This is a case-control study in which 25 stable outpatients with recent-onset SZ (27.1 years, 22 men) and 22 matched healthy controls (25.6 years, 16 men) performed a collaborative, verbal production task with a real interaction partner. Blind raters scored how easy participants made it to understand them (Facility ratings), how interesting they were to listen to (Interest ratings) and how expressive they were (Expressivity ratings). ToM was assessed with the Combined Stories Test and Sarfati's cartoon task. Symptoms were assessed with the PANSS five-factor version.

STUDY RESULTS

Compared to healthy controls, SZ received significantly lower ratings for all three aspects of their verbal productions (Facility, Interest and Expressivity), despite the raters being blind to group membership. Interestingly, the Facility ratings were linked to ToM performance in the SZ group, which suggest that SZ participants who have difficulties understanding others (ToM deficits) also make it harder for others to understand them. Other notable findings include a strong link between the Expressivity ratings and the Interest ratings for both groups, and significant correlations between the Facility ratings and Cognitive/Disorganisation symptoms, and between the Expressivity ratings and both Negative and Depression/Anxiety symptoms in SZ.

CONCLUSION

Studying speech production during real, collaborative social interactions could help move beyond the individual approach to SZ deficits, making it possible to involve the interaction partners to promote more efficient communication for people with schizophrenia.

Clinical and computational speech measures are associated with social cognition in schizophrenia spectrum disorders

In this study, we compared three domains of social cognition (emotion processing, mentalizing, and attribution bias) to clinical and computational language measures in 63 participants with schizophrenia spectrum disorders. Based on the active inference model for discourse, we hypothesized that emotion processing and mentalizing, but not attribution bias, would be related to language disturbances. Clinical ratings for speech disturbance assessed disorganized and underproductive dimensions. Computational features included speech graph metrics, use of modal verbs, use of first-person pronouns, cosine similarity of adjacent utterances, and measures of sentiment; these were represented by four principal components. We found that higher clinical ratings for disorganized speech were predicted by greater impairments in both emotion processing and mentalizing, and that these relationships remained significant when accounting for demographic variables, overall psychosis symptoms, and verbal ability. Similarly, a computational speech component reflecting insular speech was consistently predicted by impairment in emotion processing. There were notable trends for computational speech components reflecting underproductive speech and decreased content-rich speech predicting mentalizing ability. Exploratory longitudinal analyses in a small subset of participants (n = 17) found that improvements in both emotion processing and mentalizing predicted improvements in disorganized speech. Attribution bias did not demonstrate strong relationships with language measures. Altogether, our findings are consistent with the active inference model of discourse and suggest greater emphasis on treatments that target social cognitive and language systems.

Mild vs. moderate: How behavioral speech measures predict metacognitive capacity across different levels of formal thought disorder

Disorganized speech is a key component of formal thought disorder (FTD) in schizophrenia. Recent work has tied disorganized speech to deficits in metacognition, or one's ability to integrate experiences to form complex mental representations. The level of FTD at which differences in metacognitive capacity emerge remains unclear. Across two studies, using different cut scores to form FTD groups, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and automated analysis methods. Clinical interviews were coded for disorganized speech and metacognition using the Communication Disturbances Index (CDI), Coh-Metrix multidimensional indices, and Metacognition Assessment Scale. In Study 1, we examined CDI and Coh-Metrix's ability to predict metacognition in FTD (n = 16) and non-FTD (n = 29) groups. We hypothesized the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. In Study 2, we conducted the same analyses with an independent sample using more stringent FTD cut scores (FTD: n = 23; non-FTD: n = 23). Analyses indicated that at a moderate but not mild cutoff: 1) automated methods differentiated FTD and non-FTD groups, 2) differences in metacognition emerged, and 3) behavioral measures accounted for significant variance (34%) in metacognition. Results emphasize the importance of setting the FTD cutoff at a moderate level and using samples that contain high levels of FTD. Findings extend research linking FTD and metacognition and demonstrate the benefit of pairing trained rater and automated speech measures.

Associations between theory of mind and clinical symptoms in recent onset schizophrenia spectrum disorders

INTRODUCTION

People with schizophrenia often present with Theory of mind (ToM) deficits, and the link between these deficits and clinical symptoms remains to be refined, for instance through the use of more recent assessment methods. The objective of this study was to examine the associations between a psychometrically sound ToM task and the clinical symptoms of schizophrenia as measured with the five dimensions of the Positive and Negative Syndrome Scale (PANSS) namely positive, negative, cognitive/disorganization, depression/anxiety and excitability/hostility, while controlling for non-social cognitive abilities.

METHODS

Seventy participants with recent-onset schizophrenia spectrum disorders (SSD) were assessed for ToM using the Combined stories task (COST) and for clinical symptoms using the PANSS.

RESULTS

The results revealed significant correlations between ToM and the positive (r = -0.292, p = 0.015) and cognitive/disorganization (r = -0.480, p < 0.001) dimensions when controlling for non-social cognitive abilities. In contrast, the negative symptoms dimension was only significantly correlated with ToM when non-social cognitive abilities were not controlled for (r = -0.278, p = 0.020).

DISCUSSION

Very few prior studies used the five-dimensions of the PANSS to examine the link with ToM and this study is the first to rely on the COST, which includes a non-social control condition. This study highlights the importance of taking non-social cognitive abilities into account when considering the relationship between ToM and symptoms.

What areas of everyday functioning are affected by theory of mind deficits in recent-onset schizophrenia spectrum disorders?

AIM

Functional recovery is now a recognized treatment goal for schizophrenia. It is therefore important to better understand the cognitive and psychological factors that influence functioning. Theory of mind (ToM) deficits are common in schizophrenia and have been linked to greater impairments in functioning. The current study aimed to identify which specific areas of functioning are linked to ToM in a group of 54 patients with a recent-onset of a schizophrenia spectrum disorder.

METHODS

ToM was assessed with the Combined Stories Test (COST). Several areas of functioning were rated based on an extensive semi-structured interviews.

RESULTS

Among the different areas of functioning that were examined, ToM showed a significant, positive relationship with ratings for productive activities (e.g. work or school) as well as with collaboration to psychiatric care.

CONCLUSION

These results suggest that ToM can impair functioning especially in situations in which patients need to collaborate with others, including the interactions with the clinical team.

Automatic Schizophrenia Detection Using Multimodality Media via a Text Reading Task

Schizophrenia is a crippling chronic mental disease that affects people worldwide. In this work, an automatic schizophrenia detection algorithm is proposed based on the reading deficit of schizophrenic patients. From speech and video modalities, the automatic schizophrenia detection algorithm illustrates abnormal speech, head movement, and reading fluency during the reading task. In the speech modality, an acoustic model of speech emotional flatness in schizophrenia is established to reflect the emotional expression flatness of schizophrenic speech from the perspective of speech production and perception. In the video modality, the head-movement-related features are proposed to illustrate the spontaneous head movement caused by repeated reading and unconscious movement, and the reading-fluency-related features are proposed to convey the damaged degree of schizophrenic patients' reading fluency. The experimental data of this work are 160 segments of speech and video data recorded by 40 participants (20 schizophrenic patients and 20 normal controls). Combined with support vector machines and random forest, the accuracy of the proposed acoustic model, the head-movement-related features, and the reading-fluency-related features range from 94.38 to 96.50%, 73.38 to 83.38%, and 79.50 to 83.63%, respectively. The average accuracy of the proposed automatic schizophrenia detection algorithm reaches 97.50%. The experimental results indicate the effectiveness of the proposed automatic detection algorithm as an auxiliary diagnostic method for schizophrenia.

Referential communication in people with recent-onset schizophrenia-spectrum disorders

People with schizophrenia present with language production impairments, yet very few studies examine language production in the context of collaborative, verbal interaction tasks performed with a real interaction partner. The current study relied on a referential communication paradigm in which participants with schizophrenia (SZ) and healthy controls (HC) presented a series of movie characters to their interaction partner, whose role was to identify and place the characters in the same order. The HC spontaneously provided more information when presenting characters that their interaction partner was unlikely to know than when presenting very well-known characters, and the magnitude of this adjustment was positively correlated with their performance on a theory of mind task. In contrast, people with SZ showed a significantly reduced (absent) adjustment to the likely-known vs. likely-unknown nature of the characters, and no correlation emerged with ToM. Further examination of the verbal productions revealed that HC often combined movie-related information (ex: character's name or movie title) and descriptive information whereas people with SZ more often used description only to present the characters. Overall, this study adds to our knowledge about referential choices in SZ in the context of collaborative verbal interactions with a real interaction partner.

The cognitive aspect of formal thought disorder and its relationship with global social functioning and the quality of life in schizophrenia

PURPOSE

It was expected that using a comprehensive scale like the Thought and Language Disorder Scale (TALD) for measurement of FTD would enable assessing its heterogeneity and its associations with cognitive impairment and functionality. This study has aimed to analyze the relationship between formal thought disorder (FTD) and cognitive functions, functionality, and quality of life in schizophrenia.

METHODS

This cross-sectional exploratory study included 46 clinical participants meeting the DSM-5 diagnostic criteria for schizophrenia and 35 healthy individuals as the control groups. Data were acquired by means of the Turkish language version of the TALD, the Positive and Negative Syndrome Scale, the Clinical Global Impression Scale, the Functioning Assessment Short Test, the Social Functioning Scale, the World Health Organization Quality of Life Instrument-Short Form, and a neuropsychological test battery on executive functions, working memory, verbal fluency, abstract thinking, and response inhibition. Correlation analyses were conducted to detect significant relationships.

RESULTS

The clinical group scored failures in all cognitive tests. The objective positive FTD was associated with deficits in executive functions and social functioning. The objective negative FTD was associated with poor performance in all cognitive domains, physical quality of life, and social and global functioning. The subjective negative FTD was negatively correlated with psychological quality of life.

CONCLUSION

This study demonstrated that objective FTD factors reflect different underlying cognitive deficits and correlate with different functioning domains. Significant correlation was determined between subjective negative FTD and psychological quality of life. Given the close relationship of FTD with functioning and quality of life, the FTD-related cognitive deficits should be the key treatment goal in schizophrenia.

Natural language processing methods are sensitive to sub-clinical linguistic differences in schizophrenia spectrum disorders

Computerized natural language processing (NLP) allows for objective and sensitive detection of speech disturbance, a hallmark of schizophrenia spectrum disorders (SSD). We explored several methods for characterizing speech changes in SSD (n = 20) compared to healthy control (HC) participants (n = 11) and approached linguistic phenotyping on three levels: individual words, parts-of-speech (POS), and sentence-level coherence. NLP features were compared with a clinical gold standard, the Scale for the Assessment of Thought, Language and Communication (TLC). We utilized Bidirectional Encoder Representations from Transformers (BERT), a state-of-the-art embedding algorithm incorporating bidirectional context. Through the POS approach, we found that SSD used more pronouns but fewer adverbs, adjectives, and determiners (e.g., "the," "a,"). Analysis of individual word usage was notable for more frequent use of first-person singular pronouns among individuals with SSD and first-person plural pronouns among HC. There was a striking increase in incomplete words among SSD. Sentence-level analysis using BERT reflected increased tangentiality among SSD with greater sentence embedding distances. The SSD sample had low speech disturbance on average and there was no difference in group means for TLC scores. However, NLP measures of language disturbance appear to be sensitive to these subclinical differences and showed greater ability to discriminate between HC and SSD than a model based on clinical ratings alone. These intriguing exploratory results from a small sample prompt further inquiry into NLP methods for characterizing language disturbance in SSD and suggest that NLP measures may yield clinically relevant and informative biomarkers.

The link between formal thought disorder and social functioning in schizophrenia: A meta-analysis

BACKGROUND

Formal thought disorder (FTD) and social functioning impairments are core symptoms of schizophrenia. Although both have been observed for over a century, the strength of the relationship between FTD and social functioning remains unclear. Furthermore, a variety of methodological approaches have been used to assess these constructs-which may contribute to inconsistency in reported associations. This meta-analysis aimed to: (a) systematically test the relationship between FTD and social functioning and (b) determine if the methodology used to assess FTD and/or social functioning moderates this relationship.

METHODS

Following Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a targeted literature search was conducted on studies examining the relationship between FTD and social functioning. Correlations were extracted and used to calculate weighted mean effect sizes using a random effects model.

RESULTS

A total of 1,478 participants across 13 unique studies were included in this meta-analysis. A small-medium inverse association (r = -0.23, p < 0.001) was observed between FTD and social functioning. Although heterogeneity analyses produced a significant Q-statistic (Q = 52.77, p = <0.001), the relationship between FTD and social functioning was not moderated by methodology, study quality, demographic variables, or clinical factors.

CONCLUSIONS

Findings illustrate a negative association between FTD and social functioning. Despite differences in the methodological approach used and type of information assessed, measurement type and clinical factors did not moderate the relationship between FTD and social functioning. Future studies should explore whether other variables, such as cognitive processes (e.g., social cognition), may account for variability in associations between these constructs.

A meta-analysis of the associations between theory of mind and neurocognition in schizophrenia

Theory of mind (ToM) refers to the ability to infer the mental states of others. ToM is impaired in schizophrenia and these deficits seem to hinder functional recovery. ToM is thus an important, but complex treatment target, supported by several processes. A large number of studies report significant associations between ToM and neurocognition (e.g. memory, attention), but the neurocognitive domains that are most closely linked to ToM remain to be identified. A meta-analysis was conducted to estimate the magnitude of the associations between ToM and neurocognition in people with schizophrenia. Correlations were extracted from the relevant literature, transformed into effect sizes Zr and pooled as weighted means. Focused-tests were employed to test for differences between neurocognitive domains and for differences linked to the characteristics of ToM tasks. Ninety-one studies (N = 5462) were included. Moderate associations emerged between ToM and each neurocognitive domain (Zrs 0.27-0.43), with no significant difference between domains (χ2(8) = 11.89, p = 0.156). Within the domain of executive functions, abstraction showed a stronger association with ToM (χ2(4) = 18.93, p = 0.001). Several ToM tasks characteristics (e.g. modality of stimuli, type of mental state), were significantly related to the magnitude of the associations between ToM and executive functions, visuospatial/problem solving, attention and episodic memory. These results suggest that ToM is linked to a wide range of neurocognitive abilities in schizophrenia, and that ToM tasks are a significant moderator of these associations. The assessment and treatment of ToM should consider the neurocognitive profile of each patient to understand his difficulties and to tailor interventions.

Measuring disorganized speech in schizophrenia: automated analysis explains variance in cognitive deficits beyond clinician-rated scales

BACKGROUND

Conveying information cohesively is an essential element of communication that is disrupted in schizophrenia. These disruptions are typically expressed through disorganized symptoms, which have been linked to neurocognitive, social cognitive, and metacognitive deficits. Automated analysis can objectively assess disorganization within sentences, between sentences, and across paragraphs by comparing explicit communication to a large text corpus.

METHOD

Little work in schizophrenia has tested: (1) links between disorganized symptoms measured via automated analysis and neurocognition, social cognition, or metacognition; and (2) if automated analysis explains incremental variance in cognitive processes beyond clinician-rated scales. Disorganization was measured in schizophrenia (n = 81) with Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Trained staff also assessed neurocognition, social cognition, metacognition, and clinician-rated disorganization.

RESULTS

Findings showed that all three cognitive processes were significantly associated with at least one automated index of disorganization. When automated analysis was compared with a clinician-rated scale, it accounted for significant variance in neurocognition and metacognition beyond the clinician-rated measure. When combined, these two methods explained 28-31% of the variance in neurocognition, social cognition, and metacognition.

CONCLUSIONS

This study illustrated how automated analysis can highlight the specific role of disorganization in neurocognition, social cognition, and metacognition. Generally, those with poor cognition also displayed more disorganization in their speech-making it difficult for listeners to process essential information needed to tie the speaker's ideas together. Our findings showcase how implementing a mixed-methods approach in schizophrenia can explain substantial variance in cognitive processes.

[Impairments of language and communication in schizophrenia]

Disorganized speech is one of the key symptoms of schizophrenia. This article provides an overview of those areas of speech and communication impaired in patients with schizophrenia. Moreover, the state of the art of behavioral interventions is summarized. In conclusion, more well-controlled speech-language therapy studies are required in order to improve participation and communication-related quality of life in schizophrenia.

Evidence of disturbances of deep levels of semantic cohesion within personal narratives in schizophrenia

Since initial conceptualizations, schizophrenia has been thought to involve core disturbances in the ability to form complex, integrated ideas. Although this has been studied in terms of formal thought disorder, the level of involvement of altered latent semantic structure is less clear. To explore this question, we compared the personal narratives of adults with schizophrenia (n=200) to those produced by an HIV+ sample (n=55) using selected indices from Coh-Metrix. Coh-Metrix is a software system designed to compute various language usage statistics from transcribed written and spoken language documents. It differs from many other frequency-based systems in that Coh-Metrix measures a wide range of language processes, ranging from basic descriptors (e.g., total words) to indices assessing more sophisticated processes within sentences, between sentences, and across paragraphs (e.g., deep cohesion). Consistent with predictions, the narratives in schizophrenia exhibited less cohesion even after controlling for age and education. Specifically, the schizophrenia group spoke fewer words, demonstrated less connection between ideas and clauses, provided fewer causal/intentional markers, and displayed lower levels of deep cohesion. A classification model using only Coh-Metrix indices found language markers correctly classified participants in nearly three-fourths of cases. These findings suggest a particular pattern of difficulties cohesively connecting thoughts about oneself and the world results in a perceived lack of coherence in schizophrenia. These results are consistent with Bleuler's model of schizophrenia and offer a novel way to understand and measure alterations in thought and speech over time.

Is There Any Relation Between Impaired Emotion Perception and Thought Disorder in Schizophrenia?

Introduction

Many patients with schizophrenia demonstrate an impaired recognition of emotions as well as thought disorder. However, there may be a correlation between these core impairment domains of schizophrenia. The objective of the present study was to investigate the relationship between the perception of emotion and thought disturbance in schizophrenia.

Methods

The sample consisted of 53 patients with schizophrenia and 38 healthy controls. The Emotions Battery of the University of Pennsylvania Computerised Neuropsychological Test Battery (PennCNP) and the Thought Language Index (TLI) were used to examine the association of the perception of emotion and thought disorders.

Results

Statistical analyses revealed that patients with schizophrenia had poor performance on the recognition of happy, sad, fear, anger, and neutral facial emotion expressions compared to controls. Severity of negative and disorganisation symptoms in schizophrenia patients was found to be related to negative emotions (fear, anger, etc.). Moreover, results revealed that disorganised thoughts are related to misidentification of positive emotions (happy).

Conclusions

Our results suggested that emotion perception disturbances could be associated with disorganised thought in schizophrenia. Impaired recognition and misinterpretation of positive emotions may contribute to the occurrence of disorganised thought.

Speech-language intervention in schizophrenia: an integrative review

ABSTRACT Objective: to perform an integrative review to identify speech and language pathology intervention for schizophrenia. Methods: the review covered SCIELO, PUBMED, OXFORD JOURNALS and SCIENCEDIRECT databases for speech and language pathology intervention studies for schizophrenia. A narrative synthesis was adopted considering the level of clinical and methodological heterogeneity amid studies. Results: the results demonstrated an increase in publications since 2012 with 11 articles meeting the criteria. Language and discourse assessment were the speech and language pathology privileged procedures. Conclusion: the review indicates that the most eligible intervention was assessment, that studies’ methodology were heterogeneous and that the communication disorders identified were related to discursive, pragmatic and syntactic disorders, which evidences the importance of more systematized intervention procedures and research on schizophrenic patients.

Can RDoC Help Find Order in Thought Disorder?

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

Relation of formal thought disorder to symptomatic remission and social functioning in schizophrenia

OBJECTIVE

The aim of this cross-sectional study is to examine the relation of formal thought disorder (FTD) with symptomatic remission (SR) and social functioning in patients with schizophrenia.

METHOD

The study was carried out with a sample consisting of 117 patients diagnosed with schizophrenia according to DSM-IV. The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Thought and Language Index (TLI), and the Personal and Social Performance Scale (PSP). We used logistic regression in order to determine the relation between FTD and SR and linear regression to identify the strength of association between FTD and social functioning.

RESULTS

Logistic regression analysis revealed that poverty of speech (odds ratio: 1.47, p<0.01) and peculiar logic (odds ratio: 1.66, p=0.01) differentiated the remitted patients from the non-remitted ones. Linear regression analysis showed that the PSP total score was associated with poverty of speech and peculiar logic items of the TLI (B=-0.23, p<0.01, B=-0.24, p=0.01, respectively).

CONCLUSION

Our findings suggest that poverty of speech and peculiar logic are the specific domains of FTD which are related to both SR status and social functioning in patients with schizophrenia.

Facial emotion perception in schizophrenia: Does sex matter?

AIM: To review the literature on sex differences in facial emotion perception (FEP) across the schizophrenia spectrum.

METHODS: We conducted a systematic review of empirical articles that were included in five separate meta-analyses of FEP across the schizophrenia spectrum, including meta-analyses that predominantly examined adults with chronic schizophrenia, people with early (onset prior to age 18) or recent-onset (experiencing their first or second psychotic episode or illness duration less than 2 years) schizophrenia, and unaffected first-degree relatives of people with schizophrenia. We also examined articles written in English (from November 2011 through June 2015) that were not included in the aforementioned meta-analyses through a literature search in the PubMed database. All relevant articles were accessed in full text. We examined all studies to determine the sample sizes, diagnostic characteristics, demographic information, methodologies, results, and whether each individual study reported on sex differences. The results from the meta-analyses themselves as well as the individual studies are reported in tables and text.

RESULTS: We retrieved 134 articles included in five separate meta-analyses and the PubMed database that examined FEP across the schizophrenia spectrum. Of these articles, 38 examined sex differences in FEP. Thirty of these studies did not find sex differences in FEP in either chronically ill adults with schizophrenia, early-onset or recently diagnosed people with schizophrenia, or first-degree relatives of people with schizophrenia. Of the eight studies that found sex differences in FEP, three found that chronically ill women outperformed men, one study found that girls with early-onset schizophrenia outperformed boys, and two studies found that women (including first-degree relatives, adults with schizophrenia, and the healthy control group) outperformed men on FEP tasks. In total, six of the eight studies that examined sex differences in FEP found that women outperformed men across the schizophrenia spectrum.

CONCLUSION: Evidence to date suggests few sex differences in FEP in schizophrenia; both men and women across the schizophrenia spectrum have deficits in FEP.

Idea density in the life-stories of people with schizophrenia: Associations with narrative qualities and psychiatric symptoms

Disordered speech and language deficits are well-documented in schizophrenia-spectrum disorders. Researchers often assess speech samples using manualized rating systems, though recently computerized language assessment methods have been used more frequently in the study of speech from people with schizophrenia. Most typically, these computerized assessments measure aspects of expressivity (i.e., pause durations, prosody) or use word-count technology; less attention has focused on similar methods that can capture more sophisticated aspects of linguistic complexity (e.g., idea density). The primary objective of the present study was to assess idea density - via a computerized measure - in the life-story narratives of people with schizophrenia (n=32) compared to a group of community control participants (n=15). In the schizophrenia group, we also examined associations between idea density, narrative qualities rated via a manualized measure, and psychiatric symptoms. Our findings indicate that idea density is diminished in individuals with schizophrenia compared to controls. Further, our results suggest that though people with schizophrenia with richer idea density tended to have more developed insight into illness, they also had higher levels of depression, anxiety, and avolition. Implications of these results and suggestions for future research are discussed.

'No man is an island'. Testing the specific role of social isolation in formal thought disorder

Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research.

Formal thought disorder in autism spectrum disorder predicts future symptom severity, but not psychosis prodrome

Formal thought disorder (FTD) is a disruption in the flow of thought, which is inferred from disorganisation of spoken language. FTD in autism spectrum disorders (ASD) might be a precursor of psychotic disorders or a manifestation of ASD symptom severity. The current longitudinal study is a seven-year follow-up of 91 individuals aged 5-12 years with ASD. We tested (1) whether childhood FTD predicted prodromal symptoms of psychosis in adolescence and (2) whether childhood FTD was associated with greater ASD symptom severity in adolescence. ASD symptom severity was assessed in childhood (T1) and 7 years later (T2), using the autism diagnostic observation schedule (ADOS). At T1, the Kiddie-Formal Thought Disorder Rating Scale (KFTDS) was used to measure symptoms of FTD. At T2, the prodromal questionnaire (PQ) was used to assess prodromal symptoms of psychosis. FTD at T1 did not predict prodromal symptoms of psychosis at T2 in children with ASD. FTD symptoms at T1, namely illogical thinking, predicted ASD symptom severity at T2 and this effect remained significant after controlling for T1 ASD symptom severity. In children with ASD, illogical thinking predicts severity of ASD symptoms in adolescence, but FTD does not predict prodromal symptoms of psychosis.