Examination of formal thought disorder and its clinical correlates with the Turkish Version of the Thought and Language Disorder Scale (TALD-TR) in schizophrenia

A qualitative study of hermeneutic analysis in individuals with schizophrenia, psychiatrists and psychiatric nurses writings on selected narratives

WHAT IS KNOWN ON THE SUBJECT?: In daily psychiatric practice, understanding individuals often involves formulating the clinical case, which may lead to viewing them solely as symptoms to be solved. Consequently, it can be challenging to see the individual beyond their symptoms. However, trying to understand the individual by his/her writings about narratives can offer broader perspectives and extend beyond being a medium for patients to express their experiences. On understanding writing, hermeneutics will be a resourceful method. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study aims to propose a reevaluation of the nature of therapeutic communication among individuals with schizophrenia, psychiatrists, and psychiatric nurses by interpreting their writings on the same written narratives through a hermeneutic analysis. Our study has unique features compared to previous studies on communication between mental health professionals and patients. We directly investigated the act of understanding through the writings of the three groups of participants. The participants were also engaged in reading and writing about the narratives instead of relying on clinical interviews or self-report questionnaires. To the best of our knowledge, our study is the first hermeneutic study to examine the nature of reflection while all three groups encounter the same narratives as readers. IMPLICATIONS FOR PRACTICE?: The results point to the need for psychiatrists/psychiatric nurses to develop new perspectives and skills in understanding/interacting with individuals with schizophrenia. Our study could be a pioneer sample in applying hermeneutics as a prevailing method to mental health nursing practice.

ABSTRACT

INTRODUCTION: Understanding individuals with schizophrenia is an essential but challenging phenomenon in psychiatry.

AIM/QUESTION

This study proposes a reevaluation of the nature of therapeutic communication among individuals with schizophrenia, psychiatrists and psychiatric nurses by interpreting their writings on the same written narratives through a hermeneutic analysis.

METHOD

In this study, employing a qualitative descriptive methodology utilising hermeneutic analysis, participants read the five narratives, wrote down their opinions on each narratives and answered nine questions to express their own personal writing experiences.

RESULTS

Participants from each group acted as both 'readers' and 'authors' while rewriting the selected five short narratives based on their own sense of readings. The expression, rewriting refers to the act of reading and written interpretations of participants and researchers in this study. While individuals with schizophrenia primarily focused on the text (narrative) in their readings and writings, psychiatrists and psychiatric nurses tended to focus on reader (themselves) in their interpretations.

DISCUSSION

Although reading should be approached as a process of discovery rather than merely seeking predetermined knowledge, psychiatrists and psychiatric nurses read the narratives as if the author were a patient or as the signs of an illness.

IMPLICATIONS FOR PRACTICE

The results point to the need for psychiatrists/psychiatric nurses to develop new perspectives and skills in understanding and interacting with individuals with schizophrenia.

Deciphering language disturbances in schizophrenia: A study using fine-tuned language models

This research presents two stable language metrics, namely Successful Prediction Rate (SPR) and Disfluency (DF), to objectively quantify the linguistic disturbances associated with schizophrenia. These novel language metrics can capture both off-topic responses and incoherence in patients' speech by modeling speech information and fine-tuning techniques. Additionally, these metrics exhibit cultural sensitivity while providing a more comprehensive evaluation of linguistic abnormalities in schizophrenia. This research fine-tuned the ELECTRA Pretrained Language Model on a 750 MB text corpus obtained from major Chinese mental health forums. The effectiveness of the fine-tuned language model is verified on a group comprising 38 individuals diagnosed with schizophrenia and 25 meticulously matched healthy controls. The study explores the association between the fine-tuned language model and the Positive and Negative Syndrome Scale (PANSS) items. The results demonstrate that SPR is higher in healthy controls, indicating better language understanding by the pre-trained language model. Conversely, DF is higher in individuals with schizophrenia, indicating more inconsistent language structure. The relationship between linguistic features and P2 (conceptual disorganization) reveals that patients with positive P2 exhibit lower SPR and higher DF. Binary logistic regression using the combined SPR and DF features achieves 84.5 % accuracy in classifying P2, exceeding the performance of traditional features by 20.5 %. Moreover, the proposed linguistic features outperform traditional linguistic features in discriminating FTD (formal thought disorder), as demonstrated by multivariate linear regression analysis.

Natural language processing for defining linguistic features in schizophrenia: A sample from Turkish speakers

Natural language processing (NLP) provides fast and accurate extraction of features related to the language of schizophrenia. We utilized NLP methods to test the hypothesis that schizophrenia is associated with altered linguistic features in Turkish, a non-Indo-European language, compared to controls. We also explored whether these possible altered linguistic features were language-dependent or -independent. We extracted and compared speech in schizophrenia (SZ, N = 38) and healthy well-matched control (HC, N = 38) participants using NLP. The analysis was conducted in two parts. In the first one, mean sentence length, total completed words, moving average type-token ratio to measure the lexical diversity, and first-person singular pronoun usage were calculated. In the second one, we used parts-of-speech tagging (POS) and Word2Vec in schizophrenia and control. We found that SZ had lower mean sentence length and moving average type-token ratio but higher use of first-person singular pronoun. All these significant results were correlated with the Thought and Language Disorder Scale score. The POS approach demonstrated that SZ used fewer coordinating conjunctions. Our methodology using Word2Vec detected that SZ had higher semantic similarity than HC and K-Means could differentiate between SZ and HC into two distinct groups with high accuracy, 86.84 %. Our findings showed that altered linguistic features in SZ are mostly language-independent. They are promising to describe language patterns in schizophrenia which proposes that NLP measurements may allow for rapid and objective measurements of linguistic features.

Language and communication rehabilitation in patients with schizophrenia: A narrative review

Language impairments often appear in patients with schizophrenia and are potential targets for rehabilitation. Clinical practice and research should be intimately connected. The aim was to perform a narrative review of the assessment and intervention tools that have been used for the rehabilitation of schizophrenia patients with language and communication impairments. Two types of tools, general and specific, were developed for both purposes. General tools include the Positive and Negative Syndrome Scale for assessment, and the Integrated Psychological Therapy for intervention. The specific tools used to evaluate language and communication impairments include the Scale for the Assessment of Thought, Language and Communication, the Formal Thought Disorder scales (for caregivers and patients), and the Thought and Language Disorder scale. The most recent language-specific intervention tools include the Cognitive Pragmatic Treatment, Conecta-2, Let's talk! Multimodal Speech-Gesture training, Speech Therapy Intervention Group, and PragmaCom. These tools primarily involve psychopathology/psychiatry, psychology, linguistics, speech and language therapy, and nursing. In conclusion, a wide range of assessment and intervention tools are available for the rehabilitation of language and communication impairments associated with schizophrenia. An integrative and interdisciplinary approach should always be considered for rehabilitation of language and communication in patients with schizophrenia throughout their lifetime.

Psychomotor agitation and irritability in adolescents with manic episode: Clinical data from three inpatient units

OBJECTIVES

We aimed to investigate the characteristics of adolescents with Bipolar disorder-I with irritability and agitation (Mania+IA) compared to those without irritability and agitation (Mania-IA) in a multi-center representative sample.

METHODS

Data of 145 patients from three tertiary-care inpatient units between 2016 and 2021 were obtained. Psychomotor agitation was defined as a score of ≥3 on the YMRS "Increased Motor Activity--Energy" item, irritability as a score of ≥4 on the YMRS 'irritability' item, and severity anchors of speech and thought disturbance on the YMRS '6 and 7' items.

RESULTS

Previous manic episodes (p = 0.013), involuntary hospitalization (p = 0.006), psychotic features (p = 0.001), formal thought disorder (p = 0.010) and aggressive/disruptive behavior (p = 0.021) were more frequent in the Mania+IA group. Conversely, depressive episodes (p = 0.006) and family history of depression (p = 0.024) were more frequent in the Mania-IA group. The Mania+IA had poorer functioning at the time of discharge.

CONCLUSIONS

Irritability and agitation were closely related to complications, psychotic symptoms and thought disorder. Assessment and monitoring of psychomotor agitation and irritability may help child and adolescent psychiatrists to predict clinical difficulties and appropriate interventions.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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