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Linguistic anomalies in the language of patients with schizophrenia. Schizophr Res Cogn 2023; 31:100273. [DOI: 10.1016/j.scog.2022.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 11/13/2022] Open
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Fuentes-Claramonte P, Soler-Vidal J, Salgado-Pineda P, Ramiro N, Garcia-Leon MA, Cano R, Arévalo A, Munuera J, Portillo F, Panicali F, Sarró S, Pomarol-Clotet E, McKenna P, Hinzen W. Processing of linguistic deixis in people with schizophrenia, with and without auditory verbal hallucinations. Neuroimage Clin 2022; 34:103007. [PMID: 35468569 PMCID: PMC9059152 DOI: 10.1016/j.nicl.2022.103007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/24/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022]
Abstract
Auditory verbal hallucinations (AVH) are a key symptom of schizophrenia (SZ) defined by anomalous perception of speech. Anomalies of processing external speech stimuli have also been reported in people with AVH, but it is unexplored which specific dimensions of language are processed differently. Using a speech perception task (passive listening), we here targeted the processing of deixis, a key dimension of language governing the contextual anchoring of speech in interpersonal context. We designed naturalistic speech stimuli that were either non-personal and fact-reporting (‘low-deixis’ condition), or else involved rich deictic devices such as the grammatical first and second persons, direct questions, and vocatives (‘high-deixis’). We asked whether neural correlates of deixis obtained with fMRI would distinguish patients with and without frequent hallucinations (AVH + vs AVH−) from controls and each other. Results showed that high-deixis relative to low-deixis was associated with clusters of increased activation in the bilateral middle temporal gyri extending into the temporal poles and the inferior parietal cortex, in all groups. The AVH + and AVH− groups did not differ. When unifying them, the SZ group as a whole showed altered activity in the precuneus, midline regions and inferior parietal cortex. These results fail to confirm deictic processing anomalies specific to patients with AVH, but reveal such anomalies across SZ. Hypoactivation of this network may relate to a cognitive mechanism for attributing and anchoring thought and referential speech content in context.
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Affiliation(s)
- Paola Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Joan Soler-Vidal
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; Benito Menni Complex Assistencial en Salut Mental, Germanes Hospitalàries, Sant Boi de Llobregat, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Nuria Ramiro
- Hospital Sant Rafael, Germanes Hospitalàries, Barcelona, Spain
| | - Maria Angeles Garcia-Leon
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Ramon Cano
- Hospital Mare de Déu de la Mercè, Germanes Hospitalàries, Barcelona, Spain
| | - Antonio Arévalo
- Hospital Sagrat Cor, Germanes Hospitalàries, Martorell, Spain
| | - Josep Munuera
- Hospital Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Francisco Portillo
- Benito Menni Complex Assistencial en Salut Mental, Germanes Hospitalàries, Sant Boi de Llobregat, Spain
| | - Francesco Panicali
- Benito Menni Complex Assistencial en Salut Mental, Germanes Hospitalàries, Sant Boi de Llobregat, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Peter McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Wolfram Hinzen
- Universitat Pompeu Fabra, Barcelona, Spain; Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
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Shivakumar V, Sreeraj VS, Kalmady SV, Gangadhar BN, Venkatasubramanian G. Pars Triangularis Volume Asymmetry and Schneiderian First Rank Symptoms in Antipsychotic-naïve Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:507-513. [PMID: 34294619 PMCID: PMC8316654 DOI: 10.9758/cpn.2021.19.3.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022]
Abstract
Objective Schizophrenia is a disorder of language and self, with first-rank symptoms (FRS) as one of the predominant features in a subset of patients. Abnormal language lateralization is hypothesized to underlie the neurobiology of FRS in schizophrenia. The role of Broca's area with its right-hemispheric counterpart, consisting of pars triangularis (PTr) and pars opercularis (POp) of the inferior frontal gyrus in FRS is undetermined. We compared the volumes and asymmetries of PTr & POp in anti-psychotic-naive schizophrenia patients with FRS (FRS[+]) with those without FRS (FRS[-]) and healthy-controls (HC) using three dimensional, interactive, semi-automated volumetric morphometry. Methods Antipsychotic naïve FRS(+) (n = 27), FRS(-) (n = 24) and HC (n = 51) were carefully assessed with structured and semi-structured clinical tools. T1-weighted images were acquired in a 3T scanner. Volumes of regions of interest were measured independently for both sides using slicer-3D software, and asymmetry indices were calculated. Results FRS(+) but not FRS(-) had a significant volume deficit in right PTr after controlling for the potential confounding effects of age, sex, and intracranial volume (p = 0.029). There was a significant leftward asymmetry of PTr in patients with FRS (i.e., leftward asymmetry in patients) (p = 0.026). No significant volume/asymmetry abnormalities were observed in POp. Conclusion Study findings suggest reduced right PTr volume with leftward asymmetry to be associated with FRS in schizophrenia. This is consistent with the loss of Yakovlevian torque in schizophrenia. Role of PTr in the neurobiology of schizophrenia as a disorder of self, speech, and social cognition needs further systematic evaluation in future research.
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Affiliation(s)
- Venkataram Shivakumar
- Department of Integrative Medicine, National Institute of Mental Health & NeuroSciences (NIMHANS), Bangalore, India
| | | | - Sunil Vasu Kalmady
- Alberta Machine Intelligence Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health & NeuroSciences (NIMHANS), Bangalore, India
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Ceraso A, Lin JJ, Schneider-Thoma J, Siafis S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM, Leucht S. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2020; 8:CD008016. [PMID: 32840872 PMCID: PMC9702459 DOI: 10.1002/14651858.cd008016.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The symptoms and signs of schizophrenia have been linked to high levels of dopamine in specific areas of the brain (limbic system). Antipsychotic drugs block the transmission of dopamine in the brain and reduce the acute symptoms of the disorder. An original version of the current review, published in 2012, examined whether antipsychotic drugs are also effective for relapse prevention. This is the updated version of the aforesaid review. OBJECTIVES To review the effects of maintaining antipsychotic drugs for people with schizophrenia compared to withdrawing these agents. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including the registries of clinical trials (12 November 2008, 10 October 2017, 3 July 2018, 11 September 2019). SELECTION CRITERIA We included all randomised trials comparing maintenance treatment with antipsychotic drugs and placebo for people with schizophrenia or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated risk ratios (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD) or standardised mean differences (SMD), again based on a random-effects model. MAIN RESULTS The review currently includes 75 randomised controlled trials (RCTs) involving 9145 participants comparing antipsychotic medication with placebo. The trials were published from 1959 to 2017 and their size ranged between 14 and 420 participants. In many studies the methods of randomisation, allocation and blinding were poorly reported. However, restricting the analysis to studies at low risk of bias gave similar results. Although this and other potential sources of bias limited the overall quality, the efficacy of antipsychotic drugs for maintenance treatment in schizophrenia was clear. Antipsychotic drugs were more effective than placebo in preventing relapse at seven to 12 months (primary outcome; drug 24% versus placebo 61%, 30 RCTs, n = 4249, RR 0.38, 95% CI 0.32 to 0.45, number needed to treat for an additional beneficial outcome (NNTB) 3, 95% CI 2 to 3; high-certainty evidence). Hospitalisation was also reduced, however, the baseline risk was lower (drug 7% versus placebo 18%, 21 RCTs, n = 3558, RR 0.43, 95% CI 0.32 to 0.57, NNTB 8, 95% CI 6 to 14; high-certainty evidence). More participants in the placebo group than in the antipsychotic drug group left the studies early due to any reason (at seven to 12 months: drug 36% versus placebo 62%, 24 RCTs, n = 3951, RR 0.56, 95% CI 0.48 to 0.65, NNTB 4, 95% CI 3 to 5; high-certainty evidence) and due to inefficacy of treatment (at seven to 12 months: drug 18% versus placebo 46%, 24 RCTs, n = 3951, RR 0.37, 95% CI 0.31 to 0.44, NNTB 3, 95% CI 3 to 4). Quality of life might be better in drug-treated participants (7 RCTs, n = 1573 SMD -0.32, 95% CI to -0.57 to -0.07; low-certainty evidence); probably the same for social functioning (15 RCTs, n = 3588, SMD -0.43, 95% CI -0.53 to -0.34; moderate-certainty evidence). Underpowered data revealed no evidence of a difference between groups for the outcome 'Death due to suicide' (drug 0.04% versus placebo 0.1%, 19 RCTs, n = 4634, RR 0.60, 95% CI 0.12 to 2.97,low-certainty evidence) and for the number of participants in employment (at 9 to 15 months, drug 39% versus placebo 34%, 3 RCTs, n = 593, RR 1.08, 95% CI 0.82 to 1.41, low certainty evidence). Antipsychotic drugs (as a group and irrespective of duration) were associated with more participants experiencing movement disorders (e.g. at least one movement disorder: drug 14% versus placebo 8%, 29 RCTs, n = 5276, RR 1.52, 95% CI 1.25 to 1.85, number needed to treat for an additional harmful outcome (NNTH) 20, 95% CI 14 to 50), sedation (drug 8% versus placebo 5%, 18 RCTs, n = 4078, RR 1.52, 95% CI 1.24 to 1.86, NNTH 50, 95% CI not significant), and weight gain (drug 9% versus placebo 6%, 19 RCTs, n = 4767, RR 1.69, 95% CI 1.21 to 2.35, NNTH 25, 95% CI 20 to 50). AUTHORS' CONCLUSIONS For people with schizophrenia, the evidence suggests that maintenance on antipsychotic drugs prevents relapse to a much greater extent than placebo for approximately up to two years of follow-up. This effect must be weighed against the adverse effects of antipsychotic drugs. Future studies should better clarify the long-term morbidity and mortality associated with these drugs.
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Affiliation(s)
- Anna Ceraso
- Department of Clinical and Experimental Sciences, Section of Psychiatry, University of Brescia, Brescia, Italy
| | - Jessie Jingxia Lin
- School of Nursing, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Johannes Schneider-Thoma
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Spyridon Siafis
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Magdolna Tardy
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München, Germany
| | - Katja Komossa
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
| | | | - Werner Kissling
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - John M Davis
- Maryland Psychiatric Research Center, Baltimore, MD, USA
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, School of Medicine, Munich, Germany
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Abstract
PURPOSE OF REVIEW To better understand the shared basis of language and mental health, this review examines the behavioral and neurobiological features of aberrant language in five major neuropsychiatric conditions. Special attention is paid to genes implicated in both language and neuropsychiatric disorders, as they reveal biological domains likely to underpin the processes controlling both. RECENT FINDINGS Abnormal language and communication are common manifestations of neuropsychiatric conditions, and children with impaired language are more likely to develop psychiatric disorders than their peers. Major themes in the genetics of both language and psychiatry include master transcriptional regulators, like FOXP2; key developmental regulators, like AUTS2; and mediators of neurotransmission, like GRIN2A and CACNA1C.
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Bora E, Yalincetin B, Akdede BB, Alptekin K. Neurocognitive and linguistic correlates of positive and negative formal thought disorder: A meta-analysis. Schizophr Res 2019; 209:2-11. [PMID: 31153670 DOI: 10.1016/j.schres.2019.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/15/2019] [Accepted: 05/13/2019] [Indexed: 12/31/2022]
Abstract
Executive dysfunction and language impairment are the most prominent neuropsychological models of formal thought disorder (FTD) in schizophrenia. However, available studies have provided contradictory findings regarding the accuracy of these models. Furthermore, specific neurocognitive underpinnings of positive FTD (PosFTD) and negative FTD (NegFTD) are not clear. Following the systematic review of schizophrenia studies, a random-effects meta-analysis of the relationship between FTD and neurocognition/language in schizophrenia was conducted in 52 reports including 2805 patients. Neurocognition was significantly associated with both PosFTD (r = -0.21, CI = -0.14 to -0.27) and NegFTD (r = -0.24, CI = -0.18 to -0.30). Both PosFTD (r = ranged from -0.18 to -0.27) and NegFTD (r = ranged from -0.19 to -0.23) were significantly correlated with verbal memory, visual memory, attention, and processing speed. In meta-analyses of executive functions, PosFTD was significantly associated with working memory (r = -0.21), planning (r = -0.19), and inhibition (r = -0.21) and NegFTD was significantly associated with planning (r = -0.27), fluency (r = -0.27), and working memory (r = -0.24). In meta-analyses of linguistic variables, PosFTD was associated with deficits in syntactic comprehension (r = -0.27) and semantic processing (r = -0.18). In contrast, NegFTD was associated only with semantic comprehension (r = -0.21). Both PosFTD and NegFTD were significantly associated with executive dysfunction, neurocognitive deficits and semantic dysfunction but syntactic deficits were more specific to PosFTD. There were also some distinct patterns of relationships between the pattern of executive dysfunction and types of FTD. Fluency deficit was associated more strongly with NegFTD and poor inhibition was more specifically related to PosFTD. Current findings suggest that neurocognitive and linguistic correlates of PosFTD and NegFTD might be partly different.
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Affiliation(s)
- Emre Bora
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir 35340, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey; Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Carlton South, Victoria 3053, Australia.
| | - Berna Yalincetin
- Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey
| | - Berna Binnur Akdede
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir 35340, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, Dokuz Eylul University Medical School, Izmir 35340, Turkey; Department of Neuroscience, Dokuz Eylul University, Izmir 35340, Turkey
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Brazo P, Beaucousin V, Lecardeur L, Razafimandimby A, Dollfus S. Social cognition in schizophrenic patients: the effect of semantic content and emotional prosody in the comprehension of emotional discourse. Front Psychiatry 2014; 5:120. [PMID: 25309458 PMCID: PMC4159994 DOI: 10.3389/fpsyt.2014.00120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/16/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The recognition of the emotion expressed during conversation relies on the integration of both semantic processing and decoding of emotional prosody. The integration of both types of elements is necessary for social interaction. No study has investigated how these processes are impaired in patients with schizophrenia during the comprehension of an emotional speech. Since patients with schizophrenia have difficulty in daily interactions, it would be of great interest to investigate how these processes are impaired. We tested the hypothesis that patients present lesser performances regarding both semantic and emotional prosodic processes during emotional speech comprehension compared with healthy participants. METHODS The paradigm is based on sentences built with emotional (anger, happiness, or sadness) semantic content uttered with or without congruent emotional prosody. The study participants had to decide with which of the emotional categories each sentence corresponded. RESULTS Patients performed significantly worse than their matched controls, even in the presence of emotional prosody, showing that their ability to understand emotional semantic content was impaired. Although prosody improved performances in both groups, it benefited the patients more than the controls. CONCLUSION Patients exhibited both impaired semantic and emotional prosodic comprehensions. However, they took greater advantage of emotional prosody adjunction than healthy participants. Consequently, focusing on emotional prosody during carrying may improve social communication.
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Affiliation(s)
- Perrine Brazo
- Service de Psychiatrie, Centre Hospitalier Universitaire de Caen , Caen , France ; UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
| | - Virginie Beaucousin
- Laboratoire de Psychopathologie et Neuropsychologie, Université de Paris 8 , Saint Denis , France
| | - Laurent Lecardeur
- Service de Psychiatrie, Centre Hospitalier Universitaire de Caen , Caen , France ; UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
| | - Annick Razafimandimby
- UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
| | - Sonia Dollfus
- Service de Psychiatrie, Centre Hospitalier Universitaire de Caen , Caen , France ; UMR6301 Imagerie et Stratégies Thérapeutiques des Pathologies Cérébrales et Tumorales (ISTCT), ISTS Team, Université de Caen Basse-Normandie , Caen , France
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Rapp AM, Steinhäuser AE. Functional MRI of sentence-level language comprehension in schizophrenia: a coordinate-based analysis. Schizophr Res 2013; 150:107-13. [PMID: 23911258 DOI: 10.1016/j.schres.2013.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 06/18/2013] [Accepted: 07/06/2013] [Indexed: 11/18/2022]
Abstract
Numerous authors have hypothesised that abnormal pathways for language play a key role in the pathophysiology of schizophrenia, a notion that is supported by structural imaging and post-mortem findings especially in patients with thought disorder and auditory verbal hallucinations. Recently, an increasing number of functional magnetic resonance imaging (fMRI) investigations addressed language comprehension schizophrenia. We present a systematic review of the fMRI-studies on sentence- and text-level language comprehension in schizophrenia. 13 studies met the inclusion criteria. Additional studies specifically addressed language lateralization. Coordinates for differential contrasts for healthy controls>patients reported in these studies indicate that the left fronto-temporal language network is altered in schizophrenia. 33 out of the 51 reported coordinates are located in the left hemisphere. Overactivation in schizophrenia extends into premotor areas and is about equally divided among the left and right hemispheres. Several negative studies indicate heterogeneity within schizophrenia, which could possibly be related to the severity of thought disorder or auditory verbal hallucinations of patients. Activation changes related to thought disorder within schizophrenia (n=4 studies) include the inferior frontal and superior temporal gyri and are moderately lateralized to the left hemisphere. Although current fMRI literature is still insufficient to draw decisive conclusions, results point towards functionally altered pathways for language in schizophrenia. This notion is also plausible from the viewpoint of psychopathology especially since hallmark symptoms of the disease, thought disorder, auditory verbal hallucinations and alogia, are expressed in terms of language or represent abnormalities of language function.
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Affiliation(s)
- Alexander M Rapp
- Department of Psychiatry, University of Tübingen, Calwerstrasse 14, 72076 Tübingen, Germany.
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Perlini C, Marini A, Garzitto M, Isola M, Cerruti S, Marinelli V, Rambaldelli G, Ferro A, Tomelleri L, Dusi N, Bellani M, Tansella M, Fabbro F, Brambilla P. Linguistic production and syntactic comprehension in schizophrenia and bipolar disorder. Acta Psychiatr Scand 2012; 126:363-76. [PMID: 22509998 DOI: 10.1111/j.1600-0447.2012.01864.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore linguistic abilities in schizophrenia and bipolar disorder. Specifically, the aims of this study were to: i) investigate microlinguistic (lexicon, morphology, syntax) and macrolinguistic (discourse coherence, pragmatics) dimensions of speech production and ii) evaluate syntactic comprehension skills in both schizophrenia and bipolar disorder. METHOD Linguistic performance of 30 Italian-speaking patients with schizophrenia, 30 participants with bipolar disorder and 30 healthy controls comparable for age and educational level has been assessed using a story-telling task and a computer-based test of syntactic comprehension. RESULTS In narrative production, compared with healthy participants, those with schizophrenia had slight problems in speech rate and deficits at both local and global discourse coherence, whereas patients with bipolar disorder showed reduced mean length of utterance. As regards syntactic comprehension, both groups of patients collected more grammatical errors than controls, but they differed with regard to the number and kind of grammatical construction they missed. CONCLUSION Linguistic deficits have been detected in both groups of patients, being, however, more severe and generalized in schizophrenia than in bipolar disorder. Such results help us in improving our understanding of the potential psychopathological overlapping between these disorders.
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Affiliation(s)
- C Perlini
- Department of Public Health and Community Medicine, Section of Psychiatry, InterUniversity Centre for Behavioural Neurosciences, University of Verona, Verona, Italy
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Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Davis JM. Maintenance treatment with antipsychotic drugs for schizophrenia. Cochrane Database Syst Rev 2012:CD008016. [PMID: 22592725 DOI: 10.1002/14651858.cd008016.pub2] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The symptoms and signs of schizophrenia have been firmly linked to high levels of dopamine in specific areas of the brain (limbic system). Antipsychotic drugs block the transmission of dopamine in the brain and reduce the acute symptoms of the disorder. This review examined whether antipsychotic drugs are also effective for relapse prevention. OBJECTIVES To review the effects of maintaining antipsychotic drugs for people with schizophrenia compared to withdrawing these agents. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Specialised Register (November 2008), with additional searches of MEDLINE, EMBASE and clinicaltrials.gov (June 2011). SELECTION CRITERIA We included all randomised trials comparing maintenance treatment with antipsychotic drugs and placebo for people with schizophrenia or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis based on a random-effects model. For continuous data, we calculated mean differences (MD) or standardised mean differences (SMD) again based on a random-effects model. MAIN RESULTS The review currently includes 65 randomised controlled trials (RCT(s)) and 6493 participants comparing antipsychotic medication with placebo. The trials were published from 1959 to 2011 and their size ranged between 14 and 420 participants. In many studies the methods of randomisation, allocation and blinding were poorly reported. Although this and other potential sources of bias limited the overall quality, the efficacy of antipsychotic drugs for maintenance treatment in schizophrenia was clear. Antipsychotic drugs were significantly more effective than placebo in preventing relapse at seven to 12 months (primary outcome; drug 27%, placebo 64%, 24 RCT(s), n=2669, RR 0.40 CI 0.33 to 0.49, number needed to treat for an additional beneficial outcome (NNTB 3 CI 2 to 3). Hospitalisation was also reduced, however, the baseline risk was lower (drug 10%, placebo 26%, 16 RCT(s), n=2090, RR 0.38 CI 0.27 to 0.55, NNT 5 CI 4 to 9). More participants in the placebo group than in the antipsychotic drug group left the studies early due to any reason (at 7-12 months: drug 38%, placebo 66%, 18 RCT(s), n=2420, RR 0.55 CI 0.46 to 0.66, NNTB 4 CI 3 to 5) and due to inefficacy of treatment (at 7-12 months: drug 20%, placebo 50%, 18 RCT(s), n=2420, RR 0.36 CI 0.28 to 0.45, NNTB 3 CI 2 to 4). Quality of life was better in drug-treated participants (3 RCT(s), n=527, SMD -0.62 CI -1.15 to -0.09). Conversely, antipsychotic drugs as a group and irrespective of duration, were associated with more participants experiencing movement disorders (e.g. at least one movement disorder: drug 16%, placebo 9%, 22 RCT(s), n=3411, RR 1.55 CI 1.25 to 1.93, NNTH 25 CI 13 to 100), sedation (drug 13%, placebo 9%, 10 RCT(s), n=146, RR 1.50 CI 1.22 to 1.84, number needed to treat for an additional harmful outcome (NNTH) not significant) and weight gain (drug 10%, placebo 6%, 10 RCT(s), n=321, RR 2.07 CI 1.31 to 3.25, NNTH 20 CI 14 to 33). The results of the primary outcome were robust in a number of subgroup, meta-regression and sensitivity analyses, the main exception being that the drug-placebo difference in longer trials was smaller than in shorter trials. AUTHORS' CONCLUSIONS The results clearly demonstrate the superiority of antipsychotic drugs compared to placebo in preventing relapse. This effect must be weighed against the side effects of antipsychotic drugs. Future studies should focus on outcomes of social participation and clarify the long-term morbidity and mortality associated with these drugs.
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Affiliation(s)
- Stefan Leucht
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München Klinikum rechts der Isar, München,Germany.
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Reddy R, Fleet-Michaliszyn S, Condray R, Yao JK, Keshavan MS, Reddy R. Reduction in perseverative errors with adjunctive ethyl-eicosapentaenoic acid in patients with schizophrenia: Preliminary study. Prostaglandins Leukot Essent Fatty Acids 2011; 84:79-83. [PMID: 21211955 PMCID: PMC3033407 DOI: 10.1016/j.plefa.2010.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 12/01/2010] [Accepted: 12/06/2010] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Patients with schizophrenia have significant cognitive deficits, generally resistant to conventional treatment. This preliminary study examined the effects of ethyl-eicosapentanoate (EPA) on an executive function in early course patients. PATIENTS AND METHODS Patients with schizophrenia were given, after an informed consent, 2 g of an EPA daily for 24 weeks, in an open-label study. The Wisconsin Card Sort Test (WCST) was administered at baseline, weeks 4, 12 and 24. RESULTS The 27 patients, with a mean duration of illness of 4.2 years, were all receiving atypical antipsychotics; treatment remained unchanged for the study. Perseverative errors - the key measure derived from WCST - were significantly reduced from the baseline mean of 28.2 to 18.4 errors at week 24. Positive symptoms also improved significantly. There were no correlations between EPA levels and any clinical or other neuropsychological measures. CONCLUSION These findings suggest that an EPA has procognitive effects for patients with schizophrenia, but controlled trials are required.
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Affiliation(s)
- R Reddy
- University of Toledo School of Medicine, OH, USA.
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Lesh TA, Niendam TA, Minzenberg MJ, Carter CS. Cognitive control deficits in schizophrenia: mechanisms and meaning. Neuropsychopharmacology 2011; 36:316-38. [PMID: 20844478 PMCID: PMC3052853 DOI: 10.1038/npp.2010.156] [Citation(s) in RCA: 358] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 08/11/2010] [Accepted: 08/11/2010] [Indexed: 12/27/2022]
Abstract
Although schizophrenia is an illness that has been historically characterized by the presence of positive symptomatology, decades of research highlight the importance of cognitive deficits in this disorder. This review proposes that the theoretical model of cognitive control, which is based on contemporary cognitive neuroscience, provides a unifying theory for the cognitive and neural abnormalities underlying higher cognitive dysfunction in schizophrenia. To support this model, we outline converging evidence from multiple modalities (eg, structural and functional neuroimaging, pharmacological data, and animal models) and samples (eg, clinical high risk, genetic high risk, first episode, and chronic subjects) to emphasize how dysfunction in cognitive control mechanisms supported by the prefrontal cortex contribute to the pathophysiology of higher cognitive deficits in schizophrenia. Our model provides a theoretical link between cellular abnormalities (eg, reductions in dentritic spines, interneuronal dysfunction), functional disturbances in local circuit function (eg, gamma abnormalities), altered inter-regional cortical connectivity, a range of higher cognitive deficits, and symptom presentation (eg, disorganization) in the disorder. Finally, we discuss recent advances in the neuropharmacology of cognition and how they can inform a targeted approach to the development of effective therapies for this disabling aspect of schizophrenia.
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Affiliation(s)
- Tyler A Lesh
- Department of Psychiatry, UC Davis Imaging Research Center, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Tara A Niendam
- Department of Psychiatry, UC Davis Imaging Research Center, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Michael J Minzenberg
- Department of Psychiatry, UC Davis Imaging Research Center, Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Cameron S Carter
- Department of Psychiatry, UC Davis Imaging Research Center, Davis School of Medicine, University of California, Sacramento, CA, USA
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Niendam TA, Jalbrzikowski M, Bearden CE. Exploring predictors of outcome in the psychosis prodrome: implications for early identification and intervention. Neuropsychol Rev 2009; 19:280-93. [PMID: 19597747 PMCID: PMC2745530 DOI: 10.1007/s11065-009-9108-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 07/02/2009] [Indexed: 12/18/2022]
Abstract
Functional disability is a key component of many psychiatric illnesses, particularly schizophrenia. Impairments in social and role functioning are linked to cognitive deficits, a core feature of psychosis. Retrospective analyses demonstrate that substantial functional decline precedes the onset of psychosis. Recent investigations reveal that individuals at clinical-high-risk (CHR) for psychosis show impairments in social relationships, work/school functioning and daily living skills. CHR youth also demonstrate a pattern of impairment across a range of cognitive domains, including social cognition, which is qualitatively similar to that of individuals with schizophrenia. While many studies have sought to elucidate predictors of clinical deterioration, specifically the development of schizophrenia, in such CHR samples, few have investigated factors relevant to psychosocial outcome. This review integrates recent findings regarding cognitive and social-cognitive predictors of outcome in CHR individuals, and proposes potential directions for future research that will contribute to targeted interventions and improved outcome for at-risk youth.
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Affiliation(s)
- Tara A Niendam
- UC Davis Department of Psychiatry & Behavioral Sciences, UC Davis Imaging Research Center, 4701 X Street, Suite E, Sacramento, CA 95816, USA.
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Dab S, Morais J, Frith C. Comprehension, encoding, and monitoring in the production of confabulation in memory: a study with schizophrenic patients. Cogn Neuropsychiatry 2004; 9:153-82. [PMID: 16571579 DOI: 10.1080/13546800344000039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of the present study was to test the hypotheses proposed by Nathaniel-James and collaborators (Nathaniel-James & Frith, 1996; Nathaniel-James, Foong, & Frith, 1996) to account for the cognitive deficits involved in the production of confabulations in schizophrenic patients: impairments in comprehension, memory encoding, and memory monitoring. METHOD Five patients were investigated in this multiple single-case study. Comprehension abilities were investigated in several tests in which a memory bias was avoided. The encoding deficit hypothesis was tested by manipulating cues at encoding and/or retrieval. "Memory monitoring" abilities were examined in two tasks: the Hayling test for all patients and an AB-AC word pairs learning task for two patients. RESULTS Four of the patients produced an abnormal level of confabulations in story and fable learning tests. All patients exhibited encoding deficits and specific comprehension difficulties. However, some demonstrated preserved memory monitoring abilities. Across different tests, it was observed that the more the confabulations occurred, the more severe were the comprehension difficulties. CONCLUSION The results are in favour of the hypothesis that verbal comprehension difficulties lead to the production of confabulation. They are inconsistent with the idea that memory monitoring impairment is necessarily involved.
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Affiliation(s)
- Saskia Dab
- Université Libre de Bruxelles, Research Unit in Cognitive Neuroscience, Belgium.
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15
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Meilijson SR, Kasher A, Elizur A. Language performance in chronic schizophrenia: a pragmatic approach. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2004; 47:695-713. [PMID: 15212578 DOI: 10.1044/1092-4388(2004/053)] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
In this study, the authors examined the language of 43 participants with chronic schizophrenia under the basic assumption that a paradigmatic shift is needed in the methodology used to investigate the language of schizophrenia. The pragmatic protocol (C. Prutting and D. Kirchner, 1987) was chosen as the method of analysis to attain a general profile of pragmatic abilities. The results showed that the participants with schizophrenia exhibited a high degree of inappropriate pragmatic abilities compared to participants with mixed anxiety-depression disorder and participants with hemispheric brain damage, as previously assessed by Prutting and Kirchner. Statistical methods for clustering analysis yielded 5 distinct parameter clusters: Topic, Speech Acts, Turn-Taking, Lexical, and Nonverbal. Group clustering analysis of the 43 participants with schizophrenia produced 3 distinct groups with different profiles: minimal impairment, lexical impairment, and interactional impairment. The results are discussed in terms of theoretical implications in the area of pragmatics, the diagnosis of schizophrenia, and other goals.
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Affiliation(s)
- Sara R Meilijson
- Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel.
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Bagner DM, Melinder MRD, Barch DM. Language comprehension and working memory language comprehension and working memory deficits in patients with schizophrenia. Schizophr Res 2003; 60:299-309. [PMID: 12591591 DOI: 10.1016/s0920-9964(02)00280-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The present study examined the hypothesis that patients with schizophrenia have deficits in language comprehension compared to normal controls, and that these deficits are associated with disturbances in working memory (WM). In addition, we hypothesized that language comprehension deficits would be associated with the severity of specific symptoms in the patients (formal thought disorder and hallucinations). Participants were 27 stable outpatients with schizophrenia and 28 demographically similar controls. Language comprehension was measured by presenting sentences auditorily that varied in length and syntactic complexity, followed by two or three comprehension questions. We measured working memory by administering a reading span task. Results indicated that, as predicted, language comprehension deficits were significantly greater in patients with schizophrenia than controls. Also as predicted, working memory was strongly correlated with language comprehension performance in both patients with schizophrenia and controls. Contrary to our predictions, language comprehension and working memory deficits were not associated with either formal thought disorder or hallucinations.
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Affiliation(s)
- Daniel M Bagner
- Department of Psychology, Washington University, Box 1125, One Brookings Drive, 63130, St. Louis, MO, USA
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Salomé F, Boyer P, Fayol M. The effects of psychoactive drugs and neuroleptics on language in normal subjects and schizophrenic patients: a review. Eur Psychiatry 2000; 15:461-9. [PMID: 11175923 DOI: 10.1016/s0924-9338(00)00520-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The aim of this survey is to present an overview of research into psychopharmacology as regards the effects of different psychoactive drugs and neuroleptics (NL) on language in normal subjects and schizophrenic patients. Eighteen studies that have investigated the effects of different drugs (alcohol, amphetamines, secobarbital, L-dopa, psilocybin, ketamine, fenfluramine) and neuroleptics (conventional and atypical) on language are reviewed. There are no studies concerning the effects of neuroleptics on language in healthy subjects. The results of the effects of other molecules indicate that language production can be increased (alcohol, amphetamine, secobarbital), rendered more complex (d-amphetamine), more focused (L-dopa) or more unfocused (psilocybin) and clearly impaired (ketamine). For schizophrenic patients, most studies show that conventional neuroleptic treatments, at a therapeutic dosage and in acute or chronic mode, reduce language disorders at all levels (clinic, linguistic, psycholinguistic). In conjunction with other molecules, the classical NL, when administered at a moderate dosage and in chronic mode, modify language in schizophrenia, either by improving the verbal flow and reducing pauses and positive thought disorder (NL + amphetamine) or by inducing an impairment in the language measurements (NL + fenfluramine). Clinical, methodological and theoretical considerations of results are debated in the framework of schizophrenic language disorders.
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Affiliation(s)
- F Salomé
- CNRS UMR 7593, Hôpital de la Pitié-Salpêtrière, 47, Boulevard de l'hôpital, 75651 Paris, France.
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Gernsbacher MA, Tallent KA, Bolliger CM. Disordered discourse in schizophrenia described by the Structure Building Framework. DISCOURSE STUDIES 1999; 1:355-372. [PMID: 25484620 PMCID: PMC4255942 DOI: 10.1177/1461445699001003004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article reviews the phenomena of disordered discourse often manifested in schizophrenia. It argues that the Structure Building Framework, a model of the general cognitive processes and mechanisms underlying discourse, can be used to account for these phenomena. According to the Structure Building Framework, the goal of comprehension is to build coherent mental representations or structures. Building a mental structure involves several component subprocesses: laying a foundation, mapping relevant information onto that foundation, and shifting to initiate a new substructure. Building a mental structure also involves at least two general cognitive mechanisms: enhancement of relevant activation and suppression of irrelevant or inappropriate activation. We suggest that schizophrenics who exhibit verbose disordered discourse have inefficient suppression mechanisms, are impaired in laying a foundation, and tend to shift too often. We also speculate that schizophrenics who exhibit impoverished disordered discourse have inefficient enhancement mechanisms and are impaired with the cognitive process of mapping.
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Condray R, Steinhauer SR, van Kammen DP, Kasparek A. Working memory capacity predicts language comprehension in schizophrenic patients. Schizophr Res 1996; 20:1-13. [PMID: 8794488 DOI: 10.1016/0920-9964(95)00061-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The association between language comprehension and working memory capacity was evaluated in 25 male DSM-III-R schizophrenic patients (14 inpatients; 11 outpatients), and in 11 male normal controls (no lifetime DSM-III-R disorder). Patients and controls did not differ significantly on age and education. Language comprehension was examined as a function of two types of processing demand: grammatical complexity (complex versus simple sentences) and presentation rate (accelerated versus conversational). Schizophrenic patients showed significantly reduced language comprehension and decreased working memory capacity for language, compared with controls. Patients showed general difficulty in comprehending accurately, rather than exhibiting problems with specific grammatical structures. Subject groups were highly accurate and did not differ in their ability to perceive the individual words in sentences presented at the accelerated rate (intelligibility). Presentation rate and grammatical complexity affected comprehension accuracy in all groups, however, with increases in rate and complexity producing decreases in understanding. Of most importance, theoretically, is the finding that working memory capacity predicted language comprehension accuracy in both schizophrenic patients and normal controls. Results suggest that language comprehension deficits in schizophrenic patients may involve a general dysfunction that is associated with working memory capacity for language.
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Affiliation(s)
- R Condray
- Department of Veterans Affairs, Pittsburgh, PA 15206, USA
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