Lexical Characteristics of Anticipatory and Consummatory Anhedonia in Schizophrenia: A Study of Language in Spontaneous Life Narratives

Automated measures of speech content and speech organization in schizophrenia: Test-retest reliability and generalizability across demographic variables

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.

Remote Assessment of Negative Symptoms of Schizophrenia

In contrast to the validated scales for face-to-face assessment of negative symptoms, no widely accepted tools currently exist for remote monitoring of negative symptoms. Remote assessment of negative symptoms can be broadly divided into 3 categories: (1) remote administration of an existing negative-symptom scale by a clinician, in real time, using videoconference technology to communicate with the patient; (2) direct inference of negative symptoms through detection and analysis of the patient's voice, appearance, or activity by way of the patient's smartphone or other device; and (3) ecological momentary assessment, in which the patient self-reports their condition upon receipt of periodic prompts from a smartphone or other device during their daily routine. These modalities vary in cost, technological complexity, and applicability to the different negative-symptom domains. Each modality has unique strengths, weaknesses, and issues with validation. As a result, an optimal solution may be more likely to employ several techniques than to use a single tool. For remote assessment of negative symptoms to be adopted as primary or secondary endpoints in regulated clinical trials, appropriate psychometric standards will need to be met. Standards for substituting 1 set of measures for another, as well as what constitutes a "gold" reference standard, will need to be precisely defined and a process for defining them developed. Despite over 4 decades of progress toward this goal, significant work remains to be done before clinical trials addressing negative symptoms can utilize remotely assessed secondary or primary outcome measures.

Narrative identity in the psychosis spectrum: A systematic review and developmental model

Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.

Narrating ambiguous loss: Deficiencies in narrative processing and negative appraisal of consequences

OBJECTIVE

To compare narrative coping with physical and psychological ambiguous loss (AL) and definite loss in terms of distancing (vs. narrative immersion), meaning-making, and subjective biographical consequences.

METHODS

Thirty adults who had lost a parent to death, to going missing, or to Alzheimer disease (N = 90, 67 females; mean age 36.73 years, SD = 7.27; mean time since loss 9.0 years) narrated two loss-related and three control memories.

RESULTS

Individuals with AL were not more immersed in the loss experience, but less successful in finding meaning and in evaluating the loss and its consequences positively compared to those with a definite loss. These group differences were not due to differences in depression, posttraumatic stress disorder, and protracted grief.

CONCLUSIONS

Ambiguity of loss renders meaning-making and coherently narrating loss more difficult, leading to more negative affect, suggesting interventions that help narrating loss coherently in a self-accepting way.

Lowering costs for large-scale screening in psychosis: a systematic review and meta-analysis of performance and value of information for speech-based psychiatric evaluation

OBJECTIVE

Obstacles for computational tools in psychiatry include gathering robust evidence and keeping implementation costs reasonable. We report a systematic review of automated speech evaluation for the psychosis spectrum and analyze the value of information for a screening program in a healthcare system with a limited number of psychiatrists (Maputo, Mozambique).

METHODS

Original studies on speech analysis for forecasting of conversion in individuals at clinical high risk (CHR) for psychosis, diagnosis of manifested psychotic disorder, and first-episode psychosis (FEP) were included in this review. Studies addressing non-verbal components of speech (e.g., pitch, tone) were excluded.

RESULTS

Of 168 works identified, 28 original studies were included. Valuable speech features included direct measures (e.g., relative word counting) and mathematical embeddings (e.g.: word-to-vector, graphs). Accuracy estimates reported for schizophrenia diagnosis and CHR conversion ranged from 71 to 100% across studies. Studies used structured interviews, directed tasks, or prompted free speech. Directed-task protocols were faster while seemingly maintaining performance. The expected value of perfect information is USD 9.34 million. Imperfect tests would nevertheless yield high value.

CONCLUSION

Accuracy for screening and diagnosis was high. Larger studies are needed to enhance precision of classificatory estimates. Automated analysis presents itself as a feasible, low-cost method which should be especially useful for regions in which the physician pool is insufficient to meet demand.

Lexical analysis of emotional responses to "real-world" experiences in individuals with schizophrenia

Abnormalities in emotion perception, expression, and experience are considered a core component of schizophrenia. Previous laboratory studies have demonstrated that while individuals with schizophrenia report levels of positive emotions comparable to healthy individuals in response to positive stimuli, they also report co-occurring negative emotions in response to such stimuli. However, it is unknown whether this response pattern extends to "real world" naturalistic environments. To examine this question, we employed an experience sampling method (ESM) approach using mobile electronic devices to collect information up to 10 times/day over a two-day period from 53 individuals with schizophrenia and 19 non-clinical controls. As part of each experience sample, participants completed brief open-ended responses and answered questions about their emotional responses to three recent events (neutral, positive, and negative). Additionally, participants completed diagnostic and clinical measures. Lexical analyses were used to analyze ESM-based word production and characterize emotion word use. Compared to non-clinical controls, individuals with schizophrenia reported similar levels of positive emotion, but significantly higher negative emotion, which was associated with increased negative symptoms. The schizophrenia group used more anxiety words in response to negative and neutral events, and more anger words in response to positive events. Increased use of anger words was linked with elevations in positive symptoms as well as symptoms of depression, while use of sadness words was linked with anhedonia. Our findings support the co-activation of negative emotion hypothesis documented in laboratory settings and provide evidence of its ecological validity. Implications for functioning and future directions are discussed.

A review of autobiographical memory studies on patients with schizophrenia spectrum disorders

BACKGROUND

Patients suffering from schizophrenia spectrum disorders demonstrate various cognitive deficiencies, the most pertinent one being impairment in autobiographical memory. This paper reviews quantitative research investigating deficits in the content, and characteristics, of autobiographical memories in individuals with schizophrenia. It also examines if the method used to activate autobiographical memories influenced the results and which theoretical accounts were proposed to explain the defective recall of autobiographical memories in patients with schizophrenia.

METHODS

PsycINFO, Web of Science, and PubMed databases were searched for articles published between January 1998 and December 2018. Fifty-seven studies met the inclusion criteria. All studies implemented the generative retrieval strategy by inducing memories through cue words or pictures, the life-stage method, or open-ended retrieval method. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement guidelines were followed for this review.

RESULTS

Most studies reported that patients with schizophrenia retrieve less specific autobiographical memories when compared to a healthy control group, while only three studies indicated that both groups performed similarly on memory specificity. Patients with schizophrenia also exhibited earlier reminiscence bumps than those for healthy controls. The relationship between comorbid depression and autobiographical memory specificity appeared to be independent because patients' memory specificity improved through intervention, but their level of depression remained unchanged. The U-shaped retrieval pattern for memory specificity was not consistent. Both the connection between the history of attempted suicide and autobiographical memory specificity, and the relationship between psychotic symptoms and autobiographical memory specificity, remain inconclusive. Patients' memory specificity and coherence improved through cognitive training.

CONCLUSIONS

The overgeneral recall of autobiographical memory by patients with schizophrenia could be attributed to working memory, the disturbing concept of self, and the cuing method implemented. The earlier reminiscence bump for patients with schizophrenia may be explained by the premature closure of the identity formation process due to the emergence of psychotic symptoms during early adulthood. Protocol developed for this review was registered in PROSPERO (registration no: CRD42017062643).

Using lexical analysis to identify emotional distress in psychometric schizotypy

Through the use of lexical analysis software, researchers have demonstrated a greater frequency of negative affect word use in those with schizophrenia and schizotypy compared to the general population. In addition, those with schizotypy endorse greater emotional distress than healthy controls. In this study, our aim was to expand on previous findings in schizotypy to determine whether negative affect word use could be linked to emotional distress. Schizotypy (n=33) and non-schizotypy groups (n=33) completed an open-ended, semi-structured interview and negative affect word use was analyzed using a validated lexical analysis instrument. Emotional distress was assessed using subjective questionnaires of depression and psychological quality of life (QOL). When groups were compared, those with schizotypy used significantly more negative affect words; endorsed greater depression; and reported lower QOL. Within schizotypy, a trend level association between depression and negative affect word use was observed; QOL and negative affect word use showed a significant inverse association. Our findings offer preliminary evidence of the potential effectiveness of lexical analysis as an objective, behavior-based method for identifying emotional distress throughout the schizophrenia-spectrum. Utilizing lexical analysis in schizotypy offers promise for providing researchers with an assessment capable of objectively detecting emotional distress.

Language and hope in schizophrenia-spectrum disorders

Hope is integral to recovery for those with schizophrenia. Considering recent advancements in the examination of clients' lexical qualities, we were interested in how clients' words reflect hope. Using computerized lexical analysis, we examined social, emotion, and future words' relations to hope and its pathways and agency components. Forty-five clients provided detailed narratives about their life and mental illness. Transcripts were analyzed using the Linguistic Inquiry and Word Count program (LIWC), which assigns words to categories (e.g., "anxiety") based on a pre-existing dictionary. Correlations and linear multiple regression were used to examine relationships between lexical qualities and hope. Hope and its subcomponents had significant or trending bivariate correlations in expected directions with several emotion-related word categories (anger and sadness) but were not associated with expected categories such as social words, positive emotions, optimism, achievement, and future words. In linear multiple regressions, no LIWC variable significantly predicted hope agency, but anger words significantly predicted both total hope and hope pathways. Our findings indicate lexical analysis tools can be used to investigate recovery-oriented concepts such as hope, and results may inform clinical practice. Future research should aim to replicate our findings in larger samples.

Self-reference in psychosis and depression: a language marker of illness

BACKGROUND

Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects.

METHOD

We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns.

RESULTS

Consistent with others' work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical).

CONCLUSIONS

Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.

Lexical analysis in schizophrenia: how emotion and social word use informs our understanding of clinical presentation

BACKGROUND

The words people use convey important information about internal states, feelings, and views of the world around them. Lexical analysis is a fast, reliable method of assessing word use that has shown promise for linking speech content, particularly in emotion and social categories, with psychopathological symptoms. However, few studies have utilized lexical analysis instruments to assess speech in schizophrenia. In this exploratory study, we investigated whether positive emotion, negative emotion, and social word use was associated with schizophrenia symptoms, metacognition, and general functioning in a schizophrenia cohort.

METHODS

Forty-six participants generated speech during a semi-structured interview, and word use categories were assessed using a validated lexical analysis measure. Trained research staff completed symptom, metacognition, and functioning ratings using semi-structured interviews.

RESULTS

Word use categories significantly predicted all variables of interest, accounting for 28% of the variance in symptoms and 16% of the variance in metacognition and general functioning. Anger words, a subcategory of negative emotion, significantly predicted greater symptoms and lower functioning. Social words significantly predicted greater metacognition.

CONCLUSIONS

These findings indicate that lexical analysis instruments have the potential to play a vital role in psychosocial assessments of schizophrenia. Future research should replicate these findings and examine the relationship between word use and additional clinical variables across the schizophrenia-spectrum.