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Zamperoni G, Tan EJ, Rossell SL, Meyer D, Sumner PJ. Evidence for the factor structure of formal thought disorder: A systematic review. Schizophr Res 2024; 264:424-434. [PMID: 38244319 DOI: 10.1016/j.schres.2024.01.006] [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: 09/12/2023] [Revised: 12/14/2023] [Accepted: 01/01/2024] [Indexed: 01/22/2024]
Abstract
Disorganised speech, or, formal thought disorder (FTD), is considered one of the core features of psychosis, yet its factor structure remains debated. This systematic review aimed to identify the core dimensions of FTD. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA), a systematic review was conducted on the FTD factor analytic literature. Sixteen studies were identified from PsycINFO, PubMed and Web of Science between October 1971 and January 2023. Across the 39 factor analyses investigated, findings demonstrated the prominence of a three-factor structure. Broad agreement was found for two factors within the three-factor model, which were typically referred to as disorganisation and negative, with the exact nature of the third dimension requiring further clarification. The quality assessment revealed some methodological challenges relating to the assessment of FTD and conducted factor analyses. Future research should clarify the exact nature of the third dimension across different patient groups and methodologies to determine whether a consistent transdiagnostic concept of FTD can be elucidated.
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Affiliation(s)
- Georgia Zamperoni
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University of Technology, VIC 3122, Australia.
| | - Eric J Tan
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University of Technology, VIC 3122, Australia; Memory Ageing & Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Susan L Rossell
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University of Technology, VIC 3122, Australia; Department of Psychiatry, St Vincent's Hospital, VIC 3065, Australia
| | - Denny Meyer
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University of Technology, VIC 3122, Australia; Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, VIC 3122, Australia
| | - Philip J Sumner
- Centre for Mental Health and Brain Sciences, School of Health Sciences, Swinburne University of Technology, VIC 3122, Australia
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2
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Fradkin I, Nour MM, Dolan RJ. Theory-Driven Analysis of Natural Language Processing Measures of Thought Disorder Using Generative Language Modeling. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1013-1023. [PMID: 37257754 DOI: 10.1016/j.bpsc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/19/2023] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Natural language processing (NLP) holds promise to transform psychiatric research and practice. A pertinent example is the success of NLP in the automatic detection of speech disorganization in formal thought disorder (FTD). However, we lack an understanding of precisely what common NLP metrics measure and how they relate to theoretical accounts of FTD. We propose tackling these questions by using deep generative language models to simulate FTD-like narratives by perturbing computational parameters instantiating theory-based mechanisms of FTD. METHODS We simulated FTD-like narratives using Generative-Pretrained-Transformer-2 by either increasing word selection stochasticity or limiting the model's memory span. We then examined the sensitivity of common NLP measures of derailment (semantic distance between consecutive words or sentences) and tangentiality (how quickly meaning drifts away from the topic) in detecting and dissociating the 2 underlying impairments. RESULTS Both parameters led to narratives characterized by greater semantic distance between consecutive sentences. Conversely, semantic distance between words was increased by increasing stochasticity, but decreased by limiting memory span. An NLP measure of tangentiality was uniquely predicted by limited memory span. The effects of limited memory span were nonmonotonic in that forgetting the global context resulted in sentences that were semantically closer to their local, intermediate context. Finally, different methods for encoding the meaning of sentences varied dramatically in performance. CONCLUSIONS This work validates a simulation-based approach as a valuable tool for hypothesis generation and mechanistic analysis of NLP markers in psychiatry. To facilitate dissemination of this approach, we accompany the paper with a hands-on Python tutorial.
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Affiliation(s)
- Isaac Fradkin
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom.
| | - Matthew M Nour
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom; Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Raymond J Dolan
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, London, United Kingdom; Wellcome Trust Centre for Human Neuroimaging, University College London, London, United Kingdom; State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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3
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Stuck Inside: How Social Functioning in Schizophrenia Changed During the COVID-19 Pandemic. J Nerv Ment Dis 2022; 210:915-924. [PMID: 35703234 PMCID: PMC9712495 DOI: 10.1097/nmd.0000000000001558] [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] [Indexed: 01/07/2023]
Abstract
Social distancing policies enacted during the COVID-19 pandemic altered our social interactions. People with schizophrenia, who already exhibit social deficits, may have been disproportionally impacted. In this pilot study, we a) compared prepandemic social functioning to functioning during the pandemic in people with schizophrenia ( n = 21) who had data at both time points; and b) examined if patterns of decline in schizophrenia differed from healthy controls ( n = 21) across a series of repeated-measures analyses of variance. We observed larger declines in social functioning in schizophrenia (η 2 = 0.07, medium effect size) during the pandemic compared with the control group. Between-group declines did not extend to other domains, suggesting that declines are specific to social functioning. Our findings signal that treatments focusing on reconnecting people with schizophrenia to their social networks should be prioritized. Future studies should continue tracking social functioning after the pandemic to illustrate patterns of recovery.
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Argote M, Sescousse G, Brunelin J, Fakra E, Nourredine M, Rolland B. Association between formal thought disorder and cannabis use: a systematic review and meta-analysis. SCHIZOPHRENIA 2022; 8:78. [PMID: 36175509 PMCID: PMC9523063 DOI: 10.1038/s41537-022-00286-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/10/2022] [Indexed: 10/26/2022]
Abstract
AbstractFormal thought disorder (FTD) is a multidimensional syndrome mainly occurring along the psychosis continuum. Cannabis use is known to increase symptoms of psychosis, particularly positive symptoms. However, the impact of cannabis use on FTD in individuals presenting symptoms along the psychosis continuum remains unclear. To address this knowledge gap, we conducted a meta-analysis examining the association between cannabis use and FTD in those individuals. We hypothesized that cannabis would worsen FTD. We conducted a systematic search of the PubMed, ScienceDirect, PsycINFO, Web of Science, Embase and Google Scholar databases up to July 2022. The results were collated through a random-effects model using the statistical software R. Reference lists of included studies were searched for additional relevant publications. Nineteen studies were included, totalling 1840 cannabis users and 3351 non-cannabis users. The severity of FTD was found to be higher in cannabis users (SMD = 0.21, 95%CI [0.12–0.29], p = 0.00009). Subgroup analyses revealed that FTD severity was increased among cannabis users, regardless of the disorder severity: healthy individuals (SMD = 0.19, 95%CI [0.05–0.33], p = 0.02); patients with first-episode psychosis (SMD = 0.21, 95%CI [0.01–0.41], p = 0.04); patients with schizophrenia (SMD = 0.25, 95%CI [0.11–0.38], p = 0.005). Between-group differences were not significant. In line with its already known effect on positive symptoms in psychosis, cannabis use appears to be associated with increased FTD severity all along the psychosis continuum. Future research should consider potential confounding variables such as other substance use disorders and explore how FTD dimensions are impacted by cannabis use.
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Amendola S, Presaghi F, Teo AR, Cerutti R. Psychometric Properties of the Italian Version of the 25-Item Hikikomori Questionnaire for Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610408. [PMID: 36012042 PMCID: PMC9408307 DOI: 10.3390/ijerph191610408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 05/27/2023]
Abstract
Hikikomori is a form of social withdrawal that is commonly described as having an onset during adolescence, a life stage when other psychiatric problems can also emerge. This study aimed to adapt the 25-item Hikikomori Questionnaire (HQ-25) for the Italian adolescent population, examining its psychometric properties; associations between hikikomori and psychoticism, depression, anxiety, problematic internet use (PIU), psychotic-like experiences (PLEs), to confirm convergent validity of the HQ-25; and the interaction effect between symptoms of hikikomori and PIU in predicting PLEs. Two-hundred and twenty-one adolescents participated in the study. Measures included the HQ-25, the Psychoticism subscale of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, the Depression and Anxiety subscales of the Brief Symptom Inventory, the Internet Disorder Scale, and the Brief Prodromal Questionnaire. Data showed a satisfactory fit for a three-factor model for the HQ-25 that is consistent with the original study on the HQ-25. Three factors (socialization, isolation, and emotional support) were associated with psychopathology measures. Six participants reported lifetime history of hikikomori. Symptoms of hikikomori and PIU did not interact in predicting PLEs. This is the first study to validate the HQ-25 in a population of adolescents. Findings provide initial evidence of the adequate psychometric properties of the Italian version of the HQ-25 for adolescents.
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Affiliation(s)
- Simone Amendola
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabio Presaghi
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, 00185 Rome, Italy
| | - Alan Robert Teo
- Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR 97239, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR 97239, USA
| | - Rita Cerutti
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, 00185 Rome, Italy
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Turner PR, Saeteurn ER. Social Satisfaction and Living Alone: Predictors of Self-Perception of Mental Health Improvement After Psychosis. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac052. [PMID: 39144768 PMCID: PMC11249963 DOI: 10.1093/schizbullopen/sgac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background Psychosis recovery can accompany social and self-stigma for the survivor, which can interfere with the person reaching their personal recovery goals. We hypothesized that there would be a strong association between social satisfaction and self-perceived mental health improvement, and that living alone would be a risk factor to self-perceived improvement. Study Design Our strengths-based quantitative study aims to identify the most important factors to psychosis survivors for their mental health recovery. Survey responses from wave 5 of the Population Assessment of Tobacco and Health (PATH) study were used, specifically from those who self-identified as psychosis survivors (n = 710), analyzing the association between self-reported mental health symptoms, social satisfaction changes in the last year, living alone, and demographic variables, with self-reported mental health recovery in the last year. Study Results Ordinary least squares regression analysis revealed three predictors of self-reported mental health improvement for psychosis survivors: social satisfaction, living alone, and lower anxiety. As hypothesized, social satisfaction was the largest determinant in self-perceived mental health improvement, but contrary to our hypothesis, living alone was a protective factor. Conclusion Prioritizing social satisfaction over group living environments for people recovering after psychosis.
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Affiliation(s)
- Patricia R Turner
- Department of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Emily R Saeteurn
- Department of Social Work, Arizona State University, Phoenix, AZ, USA
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Sorenson RP, Rossell SL, Sumner PJ. Exploring the associations between dimensions of schizotypy and social defeat. PSYCHOSIS 2021. [DOI: 10.1080/17522439.2021.2014943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Rory P. Sorenson
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia
| | - Philip J. Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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More than a biomarker: could language be a biosocial marker of psychosis? NPJ SCHIZOPHRENIA 2021; 7:42. [PMID: 34465778 PMCID: PMC8408150 DOI: 10.1038/s41537-021-00172-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
Automated extraction of quantitative linguistic features has the potential to predict objectively the onset and progression of psychosis. These linguistic variables are often considered to be biomarkers, with a large emphasis placed on the pathological aberrations in the biological processes that underwrite the faculty of language in psychosis. This perspective offers a reminder that human language is primarily a social device that is biologically implemented. As such, linguistic aberrations in patients with psychosis reflect both social and biological processes affecting an individual. Failure to consider the sociolinguistic aspects of NLP measures will limit their usefulness as digital tools in clinical settings. In the context of psychosis, considering language as a biosocial marker could lead to less biased and more accessible tools for patient-specific predictions in the clinic.
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Nogueira AS, Andrade JC, Serpa MH, Alves TM, Freitas EL, Hortêncio L, van de Bilt MT, Rössler W, Gattaz WF, Loch AA. Influence of migration on the thought process of individuals at ultra-high risk for psychosis. BRAZILIAN JOURNAL OF PSYCHIATRY 2020; 43:285-288. [PMID: 32756811 PMCID: PMC8136387 DOI: 10.1590/1516-4446-2019-0685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/13/2020] [Indexed: 08/27/2023]
Abstract
Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student’s t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.
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Affiliation(s)
- Arthur S Nogueira
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Julio C Andrade
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Mauricio H Serpa
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Paulo, SP, Brazil.,Laboratório de Neuroimagem (LIM-21), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, USP, São Paulo, SP, Brazil
| | - Tania M Alves
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Elder L Freitas
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Lucas Hortêncio
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Martinus T van de Bilt
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Paulo, SP, Brazil
| | - Wulf Rössler
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Paulo, SP, Brazil.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité University of Medicine, Berlin, Germany
| | - Wagner F Gattaz
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Paulo, SP, Brazil
| | - Alexandre A Loch
- Laboratório de Neurociências (LIM 27), Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), São Paulo, SP, Brazil
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Marggraf MP, Lysaker PH, Salyers MP, Minor KS. The link between formal thought disorder and social functioning in schizophrenia: A meta-analysis. Eur Psychiatry 2020; 63:e34. [PMID: 32200776 PMCID: PMC7355127 DOI: 10.1192/j.eurpsy.2020.30] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/26/2020] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Formal thought disorder (FTD) and social functioning impairments are core symptoms of schizophrenia. Although both have been observed for over a century, the strength of the relationship between FTD and social functioning remains unclear. Furthermore, a variety of methodological approaches have been used to assess these constructs-which may contribute to inconsistency in reported associations. This meta-analysis aimed to: (a) systematically test the relationship between FTD and social functioning and (b) determine if the methodology used to assess FTD and/or social functioning moderates this relationship. METHODS Following Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines, a targeted literature search was conducted on studies examining the relationship between FTD and social functioning. Correlations were extracted and used to calculate weighted mean effect sizes using a random effects model. RESULTS A total of 1,478 participants across 13 unique studies were included in this meta-analysis. A small-medium inverse association (r = -0.23, p < 0.001) was observed between FTD and social functioning. Although heterogeneity analyses produced a significant Q-statistic (Q = 52.77, p = <0.001), the relationship between FTD and social functioning was not moderated by methodology, study quality, demographic variables, or clinical factors. CONCLUSIONS Findings illustrate a negative association between FTD and social functioning. Despite differences in the methodological approach used and type of information assessed, measurement type and clinical factors did not moderate the relationship between FTD and social functioning. Future studies should explore whether other variables, such as cognitive processes (e.g., social cognition), may account for variability in associations between these constructs.
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Affiliation(s)
- Matthew P. Marggraf
- Department of Psychology, Indiana University Purdue University—Indianapolis, Indianapolis, Indiana, USA
| | - Paul H. Lysaker
- Department of Psychology, Richard L. Roudebush VAMC, Indianapolis, Indiana, USA
| | - Michelle P. Salyers
- Department of Psychology, Indiana University Purdue University—Indianapolis, Indianapolis, Indiana, USA
| | - Kyle S. Minor
- Department of Psychology, Indiana University Purdue University—Indianapolis, Indianapolis, Indiana, USA
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The Complex Relationship Among Formal Thought Disorders, Neurocognition, and Functioning in Nonacutely Ill Schizophrenia Patients. J Nerv Ment Dis 2020; 208:48-55. [PMID: 31738225 DOI: 10.1097/nmd.0000000000001087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aims of the present study were to 1) evaluate clinical differences between patients suffering from schizophrenia (SZ) with mild versus moderate/severe formal thought disorder (FTD); 2) explore relationships between dimensions of FTD, neuropsychological domains, and global functioning; and 3) compare clinical dimensions of FTD in early and late SZ. One hundred thirty-six individuals with schizophrenia were recruited and evaluated during a nonacute phase of illness. FTD was assessed with the Thought, Language, and Communication Scale. Partial correlations, t-tests, and stepwise regression were undertaken to address the study aims. Patients with moderate/severe FTD performed worse than those with mild FTD for processing speed, reasoning and problem solving, and social cognition, and demonstrated poorer global functioning. Early SZ did not differ from late SZ in terms of negative FTD and difficulty in abstract thinking (DAT). Negative FTD was correlated with reasoning and problem solving; DAT was correlated with social cognition. All clinical dimensions of FTD, regardless of neurocognitive impairment, accounted for a significant amount of variance in global functioning. FTD predicted global functioning, regardless of neurocognitive factors. Due to their stability in different phases of the course of the disease and their strong relationship with other core variables, Neg-FTD and DAT should be investigated as an intermediate phenotype of the illness.
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12
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Horan WP, Wynn JK, Gabrielian S, Glynn SM, Hellemann GS, Kern RS, Lee J, Marder SR, Sugar CA, Green MF. Motivational and cognitive correlates of community integration in homeless veterans entering a permanent supported housing program. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2019; 90:181-192. [PMID: 31021133 DOI: 10.1037/ort0000420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Homelessness is a major public health problem, and serious mental illness (SMI) is highly prevalent in the homeless population. Although supported housing services-which provide permanent housing in the community along with case management-improve housing outcomes, community integration typically remains poor, and little is known about the underlying determinants of poor community integration postresidential placement. The general SMI literature has indicated that motivational and cognitive ability factors are key determinants of successful community integration, which provides a foundation for examining this issue. This study evaluated whether interview- and performance-based assessments of motivation, nonsocial and social-cognitive ability, and psychiatric symptoms were associated with community integration indices in 2 samples of homeless veterans either with (N = 96) or without (N = 80) a psychotic disorder who had recently been admitted to a supported housing program but who had not yet attained housing. Motivation indices, including experiential negative symptoms and defeatist performance attitudes, stood out as the most robust correlates (rs = -.30 to -.69) of community integration across both samples, particularly for social role participation. Demographics, general psychiatric symptoms, and nonsocial cognition showed generally weak relations with community integration, though social cognition showed a few relations. The consistent findings across samples point to the importance of motivational factors for understanding the determinants of poor community integration in this complex population. Further, interventions that target motivational challenges may have widespread usefulness for enhancing community integration outcomes beyond obtaining housing. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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13
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de Sousa P, Sellwood W, Griffiths M, Bentall RP. Disorganisation, thought disorder and socio-cognitive functioning in schizophrenia spectrum disorders. Br J Psychiatry 2019; 214:103-112. [PMID: 30139394 DOI: 10.1192/bjp.2018.160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Poor social cognition is prevalent in schizophrenia spectrum disorders. Some authors argue that these effects are symptom-specific and that socio-cognitive difficulties (e.g. theory of mind) are strongly associated with thought disorder and symptoms of disorganisation.AimsThe current review tests the strength of this association. METHOD We meta-analysed studies published between 1980 and 2016 that tested the association between social cognition and these symptoms in schizophrenia spectrum disorders. RESULTS Our search (PsycINFO, MEDLINE and Web of Science) identified 123 studies (N = 9107). Overall effect size as r = -0.313, indicating a moderate association between symptoms and social cognition. Subanalyses yielded a moderate association between symptoms and theory of mind (r = -0.349) and emotion recognition (r = -0.334), but smaller effect sizes for social perception (r = -0.188), emotion regulation (r = -0.169) and attributional biases (r = -0.143). CONCLUSIONS The association is interpreted within models of communication that highlight the importance of mentalisation and processing of partner-specific cues in conversational alignment and grounding.Declaration of interestsNone.
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Affiliation(s)
- Paulo de Sousa
- Department of Clinical Psychology,University of Liverpool,UK
| | - William Sellwood
- Division of Health Research,Faculty of Health and Medicine,Lancaster University,UK
| | | | - Richard P Bentall
- Clinical Psychology Unit,Department of Psychology,University of Sheffield,UK
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14
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Tan EJ, Rossell SL. Language comprehension and neurocognition independently and concurrently contribute to formal thought disorder severity in schizophrenia. Schizophr Res 2019; 204:133-137. [PMID: 30126817 DOI: 10.1016/j.schres.2018.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 07/20/2018] [Accepted: 08/13/2018] [Indexed: 11/18/2022]
Abstract
Formal thought disorder (FTD) in schizophrenia is a prevalent symptom that has a significant impact on patients but low remediation options. This is largely due to a still unclear aetiology, where both neurocognitive and language dysfunction have been shown to contribute. Given established relationships between neurocognition and language themselves, this study aimed to examine if language comprehension impairments have a significant effect on FTD severity independent of neurocognition. 54 schizophrenia/schizoaffective disorder patients (M = 43.35, SD = 10.74) completed three measures of language comprehension along with the MATRICS Consensus Cognitive Battery and the D-KEFS Colour Word Interference Test. Symptomatology was assessed using the Positive and Negative Symptom Scale and the Scale for the Assessment of Thought, Language and Communication. Hierarchical linear regression analyses revealed syntactic sentence processing had a significant, and independent, contribution to positive FTD severity above neurocognition, while semantic sentence processing and single word semantic processing did not. The findings support the existence of a specific relationship between language comprehension dysfunction and FTD; however the question of generalisation to all aspects of language processing or FTD types needs further investigation. The establishment of a specific language-related impairment in schizophrenia which contributes independently to FTD severity supports the benefit of language-based remediation approaches for alleviating FTD symptoms and their effects. Clinical, aetiological and nosological implications of the results are discussed.
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Affiliation(s)
- Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, The Alfred Hospital, Melbourne, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, Australia.
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, Monash University Central Clinical School, The Alfred Hospital, Melbourne, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, Australia
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15
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de Sousa P, Sellwood W, Eldridge A, Bentall RP. The role of social isolation and social cognition in thought disorder. Psychiatry Res 2018; 269:56-63. [PMID: 30145302 DOI: 10.1016/j.psychres.2018.08.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/13/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
Abstract
A better understanding of how social factors relate to the psychological processes in thought disorder (TD) is necessary for the development of effective psychological interventions. Sixty-eight participants diagnosed with psychosis (18-65; 47.1% female) were recruited and evaluated on social cognition (Hinting Task, HT; and reading the mind in the eyes test, RMET), social isolation (size of social network, frequency and quality of contact), psychotic symptoms (Positive and Negative Syndrome Scale, PANSS) and TD (Thought, Language and Communication Disorders Scale, TLC). A mediation model was tested with isolation as the predictor, TD as the outcome, and performance on HT and RMET as the mediators. The final model, with adjustment for comorbid symptoms (i.e. delusions, suspiciousness, hallucinations, and negative symptoms), supported full mediation and explained a significant amount of the observed variance (60%). Performance on the HT was a significant mediator of the relationship between social isolation and TD. From the covariates, delusions contributed independently and significantly to TD. The implications of the findings for psychological practice, and TD-specific interventions, are discussed as well as the limitations of the study. Further avenues for symptom-specific research are discussed, in particular with reference to more complex psychosocial models.
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Affiliation(s)
- Paulo de Sousa
- Department of Clinical Psychology, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool L69 3GB, United Kingdom.
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA1 4YG, United Kingdom
| | - Alaw Eldridge
- Resettle, Merseycare NHS Foundation Trust, Liverpool, L24 8RN, United Kingdom
| | - Richard P Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2L, United Kingdom
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16
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Seeman MV. Solitude and schizophrenia. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2016. [DOI: 10.1080/17522439.2016.1264992] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mary V. Seeman
- Department of Psychiatry, University of Toronto, Toronto, Canada
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17
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Abstract
Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations.
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18
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Michael J, Park S. Anomalous bodily experiences and perceived social isolation in schizophrenia: An extension of the Social Deafferentation Hypothesis. Schizophr Res 2016; 176:392-397. [PMID: 27344986 PMCID: PMC8070733 DOI: 10.1016/j.schres.2016.06.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Disturbances of the bodily self are fundamental to the phenomenological experience of individuals with schizophrenia, a population at risk for social isolation. Both proprioception and exteroception contribute to a sense of consistent body boundary that contains the self across time and space, and this process is influenced by self-other (social) interactions. However, the relationship between social isolation, exteroception, and in-the-moment changes in body representation has not been elucidated. We investigated susceptibility to anomalous bodily experiences with a phantom nose induction procedure that elicits a sensation that one's nose is changing (Pinocchio Illusion: PI) in relation to exteroceptive awareness and social isolation. METHODS 25 individuals with schizophrenia (SZ) and 15 matched controls (CO) participated in a PI induction procedure to quantify susceptibility to bodily aberrations and a tactile discrimination task to assess exteroception. Clinical symptoms in SZ and schizotypy in CO were assessed, in addition to a self-report measure of perceived social isolation. RESULTS Compared to CO, SZ showed increased PI and impaired tactile discriminability. SZ reported greater loneliness than CO. PI scores were correlated with increased loneliness and decreased tactile discriminability. CONCLUSIONS Greater susceptibility to anomalous bodily experiences, together with reduced exteroceptive awareness and increased loneliness, is compatible with the framework of Hoffman's Social Deafferentation Hypothesis, which posits that a functional "amputation" from one's social environment could lead to a reorganization of the social brain network, resulting in hallucinations and delusions. These findings underscore the importance of the relationship between social isolation and self-disturbances in schizophrenia.
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Affiliation(s)
- Jamie Michael
- Department of Psychology, Vanderbilt University, 111, 21(st) Avenue South, Nashville, TN 37240, United States.
| | - Sohee Park
- Department of Psychology, Vanderbilt University, 111, 21(st) Avenue South, Nashville, TN 37240, United States.
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19
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Moe AM, Breitborde NJK, Shakeel MK, Gallagher CJ, Docherty NM. Idea density in the life-stories of people with schizophrenia: Associations with narrative qualities and psychiatric symptoms. Schizophr Res 2016; 172:201-5. [PMID: 26925799 DOI: 10.1016/j.schres.2016.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 11/18/2022]
Abstract
Disordered speech and language deficits are well-documented in schizophrenia-spectrum disorders. Researchers often assess speech samples using manualized rating systems, though recently computerized language assessment methods have been used more frequently in the study of speech from people with schizophrenia. Most typically, these computerized assessments measure aspects of expressivity (i.e., pause durations, prosody) or use word-count technology; less attention has focused on similar methods that can capture more sophisticated aspects of linguistic complexity (e.g., idea density). The primary objective of the present study was to assess idea density - via a computerized measure - in the life-story narratives of people with schizophrenia (n=32) compared to a group of community control participants (n=15). In the schizophrenia group, we also examined associations between idea density, narrative qualities rated via a manualized measure, and psychiatric symptoms. Our findings indicate that idea density is diminished in individuals with schizophrenia compared to controls. Further, our results suggest that though people with schizophrenia with richer idea density tended to have more developed insight into illness, they also had higher levels of depression, anxiety, and avolition. Implications of these results and suggestions for future research are discussed.
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Affiliation(s)
- Aubrey M Moe
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
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20
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Roche E, Segurado R, Renwick L, McClenaghan A, Sexton S, Frawley T, Chan CK, Bonar M, Clarke M. Language disturbance and functioning in first episode psychosis. Psychiatry Res 2016; 235:29-37. [PMID: 26699880 DOI: 10.1016/j.psychres.2015.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 12/11/2022]
Abstract
Language disturbance has a central role in the presentation of psychotic disorders however its relationship with functioning requires further clarification, particularly in first episode psychosis (FEP). Both language disturbance and functioning can be evaluated with clinician-rated and performance-based measures. We aimed to investigate the concurrent association between clinician-rated and performance-based measures of language disturbance and functioning in FEP. We assessed 108 individuals presenting to an Early Intervention in Psychosis Service in Ireland. Formal thought disorder (FTD) dimensions and bizarre idiosyncratic thinking (BIT) were rated with structured assessment tools. Functioning was evaluated with a performance-based instrument, a clinician-rated measure and indicators of real-world functioning. The disorganisation dimension of FTD was significantly associated with clinician-rated measures of occupational and social functioning (Beta=-0.19, P<0.05 and Beta=-0.31, P<0.01, respectively). BIT was significantly associated with the performance-based measure of functioning (Beta=-0.22, P<0.05). Language disturbance was of less value in predicting real-world measures of functioning. Clinician-rated and performance-based assessments of language disturbance are complementary and each has differential associations with functioning. Communication disorders should be considered as a potential target for intervention in FEP, although further evaluation of the longitudinal relationship between language disturbance and functioning should be undertaken.
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Affiliation(s)
- Eric Roche
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
| | - Ricardo Segurado
- UCD CSTAR, School of Public Health, Physiotherapy and Population Science, University College Dublin, Belfield, Dublin, Ireland.
| | - Laoise Renwick
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Nursing, Midwifery and Social Work, University of Manchester, UK.
| | - Aisling McClenaghan
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland.
| | - Sarah Sexton
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland.
| | - Timothy Frawley
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland.
| | - Carol K Chan
- School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
| | - Maurice Bonar
- School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
| | - Mary Clarke
- Dublin and East Treatment and Early Care Team (DETECT) Service, Blackrock, Co Dublin, Ireland; School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin, Ireland.
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