1
|
Peng Z, Li Q, Liu X, Zhang H, Luosang-Zhuoma, Ran M, Liu M, Tan X, Stein MJ. A new schizophrenia screening instrument based on evaluating the patient's writing. Schizophr Res 2024; 266:127-135. [PMID: 38401411 DOI: 10.1016/j.schres.2024.02.003] [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] [Received: 02/22/2023] [Revised: 01/18/2024] [Accepted: 02/10/2024] [Indexed: 02/26/2024]
Abstract
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.
Collapse
Affiliation(s)
- Zulai Peng
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Qingjun Li
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Xinglan Liu
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Huangzhiheng Zhang
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Luosang-Zhuoma
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Manli Ran
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Maohang Liu
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| | - Xiaolin Tan
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China.
| | - Mark J Stein
- Chongqing Mental Health Center, Chongqing, China; Affiliated Hospital of Southwest University, Chongqing, China
| |
Collapse
|
2
|
Olarewaju E, Dumas G, Palaniyappan L. Disorganized Communication and Social Dysfunction in Schizophrenia: Emerging Concepts and Methods. Curr Psychiatry Rep 2023; 25:671-681. [PMID: 37740852 DOI: 10.1007/s11920-023-01462-4] [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] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW In this review, we embrace the emerging field of second-person neuroscience to address disorganization in schizophrenia. We argue that the focus of interest for disorganization is the interpersonal space where shared mental processes ('social mind') occur based on the bio-behavioural synchrony between two (or more) interacting people. We lay out several bio-behavioural measures that can capture the component parts of this process. In particular, we highlight the real-time imaging technology of hyperscanning that enables multi-person analysis of naturalistic social interaction. We illustrate how these measures can be used in empirical studies by posing disorganization as a problem of interpersonal processing. RECENT FINDINGS Traditionally, disorganized speech and behaviour have been studied as the product of hidden cognitive processes ('private mind'). A dysfunction in these processes was attributed to the brain afflicted by the illness ('brain-bound mechanisms'). But this approach has contributed to challenges in measuring and quantifying disorganization. Consequently, the single-brain focus has not provided satisfactory clarity or led to effective treatments for persistent social dysfunction in schizophrenia. Social dysfunction is a core feature of schizophrenia. This dysfunction arises from disorganized interpersonal interaction that typifies the social profile of affected individuals. We outline challenges in employing several emerging concepts and methods and how they can be addressed to investigate the mechanisms of social dysfunction in schizophrenia.
Collapse
Affiliation(s)
- Emmanuel Olarewaju
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Guillaume Dumas
- Department of Psychiatry, CHU Sainte Justine Research Center, University of Montreal, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
- Robarts Research Institute, Western University, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
| |
Collapse
|
3
|
Misiak B, Piotrowski P, Samochowiec J. Assessment of interrelationships between cognitive performance, symptomatic manifestation and social functioning in the acute and clinical stability phase of schizophrenia: insights from a network analysis. BMC Psychiatry 2023; 23:774. [PMID: 37875888 PMCID: PMC10594890 DOI: 10.1186/s12888-023-05289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND It has been shown that various aspects of clinical manifestation of schizophrenia are strongly related to social functioning. However, it remains unknown as to whether similar factors predict social functioning at various stages of psychosis. Therefore, the present study aimed to compare the effects of interconnections between various domains of psychopathology and neurocognition on social functioning in people during acute phase of psychosis and those during remission of positive and disorganization symptoms using a network analysis. METHODS Two independent samples of individuals with schizophrenia spectrum disorders were enrolled (89 inpatients during acute phase and 90 outpatients during remission of positive and disorganization symptoms). Clinical assessment covered the levels of functioning, positive, negative and depressive symptoms. Cognition was recorded using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Data were analyzed by means of the network analysis. Two separate networks of clinical symptoms, social functioning, and cognition (i.e., in patients during acute phase of psychosis and remitted outpatients with schizophrenia) were analyzed and compared with respect to the measures of centrality (betweenness, closeness, strength, and expected influence) and edge weights. RESULTS In both networks, the majority of centrality metrics (expected influence, strength, and closeness) had the highest values for the RBANS scores of attention (the sum of scores from two tasks, i.e., digit span and coding) and immediate memory. In both networks, social functioning was directly connected to positive, negative and depressive symptoms as well as the RBANS scores of attention and language. Additionally, in remitted patients, social functioning was directly connected to the RBANS score of immediate memory. CONCLUSIONS Findings from the present study indicate the central role of cognitive deficits, especially those related to attention, processing speed, working and immediate memory in shaping functional impairments regardless of schizophrenia phase. Therapeutic interventions that aim to improve functional capacity need to target these domains of neurocognitive performance.
Collapse
Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, Wroclaw, 50-367, Poland.
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, Wroclaw, 50-367, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
4
|
Nour MM, McNamee DC, Liu Y, Dolan RJ. Trajectories through semantic spaces in schizophrenia and the relationship to ripple bursts. Proc Natl Acad Sci U S A 2023; 120:e2305290120. [PMID: 37816054 PMCID: PMC10589662 DOI: 10.1073/pnas.2305290120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/31/2023] [Indexed: 10/12/2023] Open
Abstract
Human cognition is underpinned by structured internal representations that encode relationships between entities in the world (cognitive maps). Clinical features of schizophrenia-from thought disorder to delusions-are proposed to reflect disorganization in such conceptual representations. Schizophrenia is also linked to abnormalities in neural processes that support cognitive map representations, including hippocampal replay and high-frequency ripple oscillations. Here, we report a computational assay of semantically guided conceptual sampling and exploit this to test a hypothesis that people with schizophrenia (PScz) exhibit abnormalities in semantically guided cognition that relate to hippocampal replay and ripples. Fifty-two participants [26 PScz (13 unmedicated) and 26 age-, gender-, and intelligence quotient (IQ)-matched nonclinical controls] completed a category- and letter-verbal fluency task, followed by a magnetoencephalography (MEG) scan involving a separate sequence-learning task. We used a pretrained word embedding model of semantic similarity, coupled to a computational model of word selection, to quantify the degree to which each participant's verbal behavior was guided by semantic similarity. Using MEG, we indexed neural replay and ripple power in a post-task rest session. Across all participants, word selection was strongly influenced by semantic similarity. The strength of this influence showed sensitivity to task demands (category > letter fluency) and predicted performance. In line with our hypothesis, the influence of semantic similarity on behavior was reduced in schizophrenia relative to controls, predicted negative psychotic symptoms, and correlated with an MEG signature of hippocampal ripple power (but not replay). The findings bridge a gap between phenomenological and neurocomputational accounts of schizophrenia.
Collapse
Affiliation(s)
- Matthew M. Nour
- Department of Psychiatry, University of Oxford, OxfordOX3 7JX, United Kingdom
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, LondonWC1B 5EH, United Kingdom
| | - Daniel C. McNamee
- Champalimaud Research, Centre for the Unknown, 1400-038Lisbon, Portugal
| | - Yunzhe Liu
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing100875, China
- Chinese Institute for Brain Research, Beijing102206, China
| | - Raymond J. Dolan
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, LondonWC1B 5EH, United Kingdom
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing100875, China
- Wellcome Centre for Human Neuroimaging, University College London, LondonWC1N 3AR, United Kingdom
| |
Collapse
|
5
|
Silva AM, Limongi R, MacKinley M, Ford SD, Alonso-Sánchez MF, Palaniyappan L. Syntactic complexity of spoken language in the diagnosis of schizophrenia: A probabilistic Bayes network model. Schizophr Res 2023; 259:88-96. [PMID: 35752547 DOI: 10.1016/j.schres.2022.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023]
Abstract
In the clinical linguistics of schizophrenia, syntactic complexity has received much attention. In this study, we address whether syntactic complexity deteriorates within the six months following the first episode of psychosis in those who develop a diagnosis of schizophrenia. We collected data from a cohort of twenty-six first-episode psychosis and 12 healthy control subjects using the Thought and Language Index interview in response to three pictures from the Thematic Apperception Test at first assessment and after six months (the time of consensus diagnosis). An automated labeling (part-of-speech tagging) for specific syntactic elements calculated large and granular syntactic complexity indices with a focus on clause complexity as a particular case from this spoken language data. Probabilistic reasoning leveraging the conditional independence properties of Bayes networks revealed that consensus diagnosis of schizophrenia predicted a decrease in nominal subjects per clause among individuals with first episode psychosis. From the entire sample, we estimate a 95.4 % probability that a 50 % decrease in mean nominal subjects per clause after six months is explained by the presence of first episode psychosis. Among those with psychosis, a 30 % decrease in this clause-complexity index after six months of experiencing the first episode predicted with 95 % probability a consensus diagnosis of schizophrenia, representing a conditional relationship between a longitudinal decrease in syntactic complexity and a diagnosis of schizophrenia. We conclude that an early drift towards linguistic disorganization/impoverishment of clause complexity-at the granular level of nominal subject per clause-is a distinctive feature of schizophrenia that decreases longitudinally, thus differentiating schizophrenia from other psychotic illnesses with shared phenomenology.
Collapse
Affiliation(s)
- Angelica M Silva
- Robarts Research Institute, Western University, London, Ontario, Canada.
| | - Roberto Limongi
- Robarts Research Institute, Western University, London, Ontario, Canada; Department of Psychology, Western University, London, Canada; Faculty of Human and Social Sciences, Wilfred Laurier University, Brantford, Ontario, Canada
| | - Michael MacKinley
- Robarts Research Institute, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Sabrina D Ford
- Lawson Health Research Institute, London, Ontario, Canada
| | | | - Lena Palaniyappan
- Robarts Research Institute, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Canada; Department of Medical Biophysics, Western University, London, Canada
| |
Collapse
|
6
|
Bayer JMM, Spark J, Krcmar M, Formica M, Gwyther K, Srivastava A, Selloni A, Cotter M, Hartmann J, Polari A, Bilgrami ZR, Sarac C, Lu A, Yung AR, McGowan A, McGorry P, Shah JL, Cecchi GA, Mizrahi R, Nelson B, Corcoran CM. The SPEAK study rationale and design: A linguistic corpus-based approach to understanding thought disorder. Schizophr Res 2023; 259:80-87. [PMID: 36732110 PMCID: PMC10387495 DOI: 10.1016/j.schres.2022.12.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/27/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023]
Abstract
AIM Psychotic symptoms are typically measured using clinical ratings, but more objective and sensitive metrics are needed. Hence, we will assess thought disorder using the Research Domain Criteria (RDoC) heuristic for language production, and its recommended paradigm of "linguistic corpus-based analyses of language output". Positive thought disorder (e.g., tangentiality and derailment) can be assessed using word-embedding approaches that assess semantic coherence, whereas negative thought disorder (e.g., concreteness, poverty of speech) can be assessed using part-of-speech (POS) tagging to assess syntactic complexity. We aim to establish convergent validity of automated linguistic metrics with clinical ratings, assess normative demographic variance, determine cognitive and functional correlates, and replicate their predictive power for psychosis transition among at-risk youths. METHODS This study will assess language production in 450 English-speaking individuals in Australia and Canada, who have recent onset psychosis, are at clinical high risk (CHR) for psychosis, or who are healthy volunteers, all well-characterized for cognition, function and symptoms. Speech will be elicited using open-ended interviews. Audio files will be transcribed and preprocessed for automated natural language processing (NLP) analyses of coherence and complexity. Data analyses include canonical correlation, multivariate linear regression with regularization, and machine-learning classification of group status and psychosis outcome. CONCLUSIONS This prospective study aims to characterize language disturbance across stages of psychosis using computational approaches, including psychometric properties, normative variance and clinical correlates, important for biomarker development. SPEAK will create a large archive of language data available to other investigators, a rich resource for the field.
Collapse
Affiliation(s)
- J M M Bayer
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - J Spark
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Krcmar
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - M Formica
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - K Gwyther
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Srivastava
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Selloni
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Cotter
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J Hartmann
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - A Polari
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | - C Sarac
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - A Lu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alison R Yung
- Orygen, Parkville, Victoria, Australia; Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Australia; School of Health Sciences, University of Manchester, United Kingdom
| | - A McGowan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - P McGorry
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - J L Shah
- McGill Department of Psychiatry & Douglas Research Hospital, Montreal, Canada
| | - G A Cecchi
- IBM TJ Watson Research Center, Yorktown Heights, NY, USA
| | - R Mizrahi
- McGill Department of Psychiatry & Douglas Research Hospital, Montreal, Canada
| | - B Nelson
- Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - C M Corcoran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA; James J. Peters Veterans Administration, Bronx, NY, USA
| |
Collapse
|
7
|
Lundin NB, Cowan HR, Singh DK, Moe AM. Lower cohesion and altered first-person pronoun usage in the spoken life narratives of individuals with schizophrenia. Schizophr Res 2023; 259:140-149. [PMID: 37127466 PMCID: PMC10524354 DOI: 10.1016/j.schres.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/17/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Usage of computational tools to quantify language disturbances among individuals with psychosis is increasing, improving measurement efficiency and access to fine-grained constructs. However, few studies apply automated linguistic analysis to life narratives in this population. Such research could facilitate the measurement of psychosis-relevant constructs such as sense of agency, capacity to organize one's personal history, narrative richness, and perceptions of the roles that others play in one's life. Furthermore, research is needed to understand how narrative linguistic features relate to cognitive and social functioning. In the present study, individuals with schizophrenia (n = 32) and individuals without a psychotic disorder (n = 15) produced personal life narratives within the Indiana Psychiatric Illness Interview. Narratives were analyzed using the Coh-Metrix computational tool. Linguistic variables analyzed were indices of connections within causal and goal-driven speech (deep cohesion), unique word usage (lexical diversity), and pronoun usage. Individuals with schizophrenia compared to control participants produced narratives that were lower in deep cohesion, contained more first-person singular pronouns, and contained fewer first-person plural pronouns. Narratives did not significantly differ between groups in lexical diversity, third-person pronoun usage, or total word count. Cognitive-linguistic relationships emerged in the full sample, including significant correlations between greater working memory capacity and greater deep cohesion and lexical diversity. In the schizophrenia group, social problem-solving abilities did not correlate with linguistic variables but were associated with cognition. Findings highlight the relevance of psychotherapies which aim to promote recovery among individuals with psychosis through the construction of coherent life narratives and increasing agency and social connectedness.
Collapse
Affiliation(s)
- Nancy B Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA.
| | - Henry R Cowan
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA.
| | - Divnoor K Singh
- Department of Neuroscience, The Ohio State University, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Suite 460, Columbus, OH 43210, USA; Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH 43210, USA.
| |
Collapse
|
8
|
Pelizza L, Leuci E, Maestri D, Quattrone E, Azzali S, Paulillo G, Pellegrini P. Disorganization in first episode affective psychosis: Treatment response and clinical considerations from a 2-year follow-up study in a "real world" setting. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:151-158. [PMID: 38520114 DOI: 10.1016/j.rpsm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/09/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Disorganization is a crucial domain in affective psychoses. However, it has received poor research attention, especially at the illness onset. The aims of this study were: (a) to monitor the longitudinal course of disorganization in young people with first episode affective psychosis (FEAP) across 2 years of follow-up, and (b) to investigate any relevant correlation of disorganized symptoms with psychopathology, functioning and the specific treatment elements of an "Early Intervention in Psychosis" (EIP) protocol along the follow-up period. MATERIALS AND METHODS Seventy-five FEAP participants (aged 12-35 years) completed the Positive And Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF). Spearman's rank correlation coefficients were calculated. RESULTS During the follow-up, disorganized symptoms showed significant enduring positive correlations with PANSS items representing delusional thought content and uncooperativeness, as well as a persistent negative association with the GAF score. Across the 2-year follow-up period, FEAP individuals also had a relevant reduction in disorganization levels. This symptom decrease was specifically related with the combination of antipsychotic medication with the specific psychosocial components of our EIP intervention offered to FEAP patients during the first 12 months of treatment. CONCLUSIONS Disorganization is relevant in FEAP subjects already at their enrollment in specialized EIP protocols. However, it decreases over time, together with the delivery of specific, combined (person-tailored) EIP interventions.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Davide Maestri
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addiction, Azienda USL-IRCCS di Reggio Emilia, Via Amendola n.2, 43100 Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addiction, Azienda USL di Parma, Largo Palli n. 1/A, 43100 Parma, Italy
| |
Collapse
|
9
|
Minor KS, Lundin NB, Myers EJ, Fernández-Villardón A, Lysaker PH. Automated measures of speech content and speech organization in schizophrenia: Test-retest reliability and generalizability across demographic variables. Psychiatry Res 2023; 320:115048. [PMID: 36645988 DOI: 10.1016/j.psychres.2023.115048] [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: 09/13/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
Technological advances in artificial intelligence and natural language processing have increased efficiency of assessing speech content and speech organization in schizophrenia. Despite these developments, there has been little focus on the psychometrics of these approaches. Using two common assessments, the current study addressed this gap by: 1) measuring test-retest reliability; and 2) assessing whether speech content and/or speech organization generalize across demographics. To test these aims, we examined psychometric properties of the Linguistic Inquiry Word Count (LIWC), a speech content measure, and the Coh-Metrix, a speech organization measure. Across baseline to six month (n = 101) and baseline to one year (n = 47) narrative speech samples, we generally observed fair reliability for speech content measures and fair to good reliability for speech organization measures. Regarding demographics, multiple speech indices varied by race, income, and education. The lack of excellent reliability scores for speech indices holds important implications for examining speech variables in clinical trials and highlights the dynamic nature of speech. This work illustrates the importance of designing speech content and speech organization measures with external validity across demographic factors. Future studies examining speech in schizophrenia should account for potential biases against demographic groups introduced by linguistic analysis tools.
Collapse
Affiliation(s)
- Kyle S Minor
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States.
| | - Nancy B Lundin
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, United States
| | - Evan J Myers
- Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, United States
| | | | - Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, United States; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| |
Collapse
|
10
|
Mackinley M, Limongi R, Silva AM, Richard J, Subramanian P, Ganjavi H, Palaniyappan L. More than words: Speech production in first-episode psychosis predicts later social and vocational functioning. Front Psychiatry 2023; 14:1144281. [PMID: 37124249 PMCID: PMC10140590 DOI: 10.3389/fpsyt.2023.1144281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Background Several disturbances in speech are present in psychosis; however, the relationship between these disturbances during the first-episode of psychosis (FEP) and later vocational functioning is unclear. Demonstrating this relationship is critical if we expect speech and communication deficits to emerge as targets for early intervention. Method We analyzed three 1-min speech samples using automated speech analysis and Bayes networks in an antipsychotic-naive sample of 39 FEP patients and followed them longitudinally to determine their vocational status (engaged or not engaged in employment education or training-EET vs. NEET) after 6-12 months of treatment. Five baseline linguistic variables with prior evidence of clinical relevance (total and acausal connectives use, pronoun use, analytic thinking, and total words uttered in a limited period) were included in a Bayes network along with follow-up NEET status and Social and Occupational Functioning Assessment Scale (SOFAS) scores to determine dependencies among these variables. We also included clinical (Positive and Negative Syndrome Scale 8-item version (PANSS-8)), social (parental socioeconomic status), and cognitive features (processing speed) at the time of presentation as covariates. Results The Bayes network revealed that only total words spoken at the baseline assessment were directly associated with later NEET status and had an indirect association with SOFAS, with a second set of dependencies emerging among the remaining linguistic variables. The primary (speech-only) model outperformed models including parental socioeconomic status, processing speed or both as latent variables. Conclusion Impoverished speech, even at subclinical levels, may hold prognostic value for functional outcomes and warrant consideration when providing measurement based care for first-episode psychosis.
Collapse
Affiliation(s)
- Michael Mackinley
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Roberto Limongi
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | | | - Julie Richard
- Department of Psychiatry, University of Western Ontario, London, ON, Canada
| | - Priya Subramanian
- Department of Psychiatry, University of Western Ontario, London, ON, Canada
| | - Hooman Ganjavi
- Department of Psychiatry, University of Western Ontario, London, ON, Canada
| | - Lena Palaniyappan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
- Department of Psychiatry, University of Western Ontario, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- *Correspondence: Lena Palaniyappan,
| |
Collapse
|
11
|
Liang L, Silva AM, Jeon P, Ford SD, MacKinley M, Théberge J, Palaniyappan L. Widespread cortical thinning, excessive glutamate and impaired linguistic functioning in schizophrenia: A cluster analytic approach. Front Hum Neurosci 2022; 16:954898. [PMID: 35992940 PMCID: PMC9390601 DOI: 10.3389/fnhum.2022.954898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Symptoms of schizophrenia are closely related to aberrant language comprehension and production. Macroscopic brain changes seen in some patients with schizophrenia are suspected to relate to impaired language production, but this is yet to be reliably characterized. Since heterogeneity in language dysfunctions, as well as brain structure, is suspected in schizophrenia, we aimed to first seek patient subgroups with different neurobiological signatures and then quantify linguistic indices that capture the symptoms of "negative formal thought disorder" (i.e., fluency, cohesion, and complexity of language production). Methods Atlas-based cortical thickness values (obtained with a 7T MRI scanner) of 66 patients with first-episode psychosis and 36 healthy controls were analyzed with hierarchical clustering algorithms to produce neuroanatomical subtypes. We then examined the generated subtypes and investigated the quantitative differences in MRS-based glutamate levels [in the dorsal anterior cingulate cortex (dACC)] as well as in three aspects of language production features: fluency, syntactic complexity, and lexical cohesion. Results Two neuroanatomical subtypes among patients were observed, one with near-normal cortical thickness patterns while the other with widespread cortical thinning. Compared to the subgroup of patients with relatively normal cortical thickness patterns, the subgroup with widespread cortical thinning was older, with higher glutamate concentration in dACC and produced speech with reduced mean length of T-units (complexity) and lower repeats of content words (lexical cohesion), despite being equally fluent (number of words). Conclusion We characterized a patient subgroup with thinner cortex in first-episode psychosis. This subgroup, identifiable through macroscopic changes, is also distinguishable in terms of neurochemistry (frontal glutamate) and language behavior (complexity and cohesion of speech). This study supports the hypothesis that glutamate-mediated cortical thinning may contribute to a phenotype that is detectable using the tools of computational linguistics in schizophrenia.
Collapse
Affiliation(s)
- Liangbing Liang
- Graduate Program in Neuroscience, Western University, London, ON, Canada
- Robarts Research Institute, Western University, London, ON, Canada
| | | | - Peter Jeon
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Sabrina D. Ford
- Robarts Research Institute, Western University, London, ON, Canada
- London Health Sciences Centre, Victoria Hospital, London, ON, Canada
| | - Michael MacKinley
- Robarts Research Institute, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Jean Théberge
- Department of Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
| | - Lena Palaniyappan
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| |
Collapse
|
12
|
Lundin NB, Jones MN, Myers EJ, Breier A, Minor KS. Semantic and phonetic similarity of verbal fluency responses in early-stage psychosis. Psychiatry Res 2022; 309:114404. [PMID: 35066310 PMCID: PMC8863651 DOI: 10.1016/j.psychres.2022.114404] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
Abstract
Linguistic abnormalities can emerge early in the course of psychotic illness. Computational tools that quantify similarity of responses in standardized language-based tasks such as the verbal fluency test could efficiently characterize the nature and functional correlates of these disturbances. Participants with early-stage psychosis (n=20) and demographically matched controls without a psychiatric diagnosis (n=20) performed category and letter verbal fluency. Semantic similarity was measured via predicted context co-occurrence in a large text corpus using Word2Vec. Phonetic similarity was measured via edit distance using the VFClust tool. Responses were designated as clusters (related items) or switches (transitions to less related items) using similarity-based thresholds. Results revealed that participants with early-stage psychosis compared to controls had lower fluency scores, lower cluster-related semantic similarity, and fewer switches; mean cluster size and phonetic similarity did not differ by group. Lower fluency semantic similarity was correlated with greater speech disorganization (Communication Disturbances Index), although more strongly in controls, and correlated with poorer social functioning (Global Functioning: Social), primarily in the psychosis group. Findings suggest that search for semantically related words may be impaired soon after psychosis onset. Future work is warranted to investigate the impact of language disturbances on social functioning over the course of psychotic illness.
Collapse
Affiliation(s)
- Nancy B. Lundin
- Department of Psychological and Brain Sciences and Program in Neuroscience, Indiana University, Bloomington, IN, USA; Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Michael N. Jones
- Department of Psychological and Brain Sciences and Cognitive Science Program, Indiana University, Bloomington, IN, USA
| | - Evan J. Myers
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Alan Breier
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA; Eskenazi Midtown Prevention and Recovery Center for Early Psychosis, Indianapolis, IN, USA.
| | - Kyle S. Minor
- Department of Psychology, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA; Eskenazi Midtown Prevention and Recovery Center for Early Psychosis, Indianapolis, IN, USA
| |
Collapse
|
13
|
KOTA M, UEZONO S, ISHIBASHI Y, KURAMOCHI S, KITAKAZE S, KAGANOI S. Outcomes of Physiotherapy on Activities of Daily Living and Discharge to the Community in Psychiatric Long-term Care Ward Patients. Phys Ther Res 2022; 25:84-91. [DOI: 10.1298/ptr.e10159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/12/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Munetsugu KOTA
- Department of Health Sciences, Hiroshima Cosmopolitan University, Japan
| | - Sae UEZONO
- Department of Rehabilitation, Hirakawa Hospital, Japan
| | | | | | | | - Seiji KAGANOI
- Department of Rehabilitation, Geisei Hospital, Japan
| |
Collapse
|