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Olarewaju E, Dumas G, Palaniyappan L. Disorganized Communication and Social Dysfunction in Schizophrenia: Emerging Concepts and Methods. Curr Psychiatry Rep 2023; 25:671-681. [PMID: 37740852 DOI: 10.1007/s11920-023-01462-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
PURPOSE OF REVIEW In this review, we embrace the emerging field of second-person neuroscience to address disorganization in schizophrenia. We argue that the focus of interest for disorganization is the interpersonal space where shared mental processes ('social mind') occur based on the bio-behavioural synchrony between two (or more) interacting people. We lay out several bio-behavioural measures that can capture the component parts of this process. In particular, we highlight the real-time imaging technology of hyperscanning that enables multi-person analysis of naturalistic social interaction. We illustrate how these measures can be used in empirical studies by posing disorganization as a problem of interpersonal processing. RECENT FINDINGS Traditionally, disorganized speech and behaviour have been studied as the product of hidden cognitive processes ('private mind'). A dysfunction in these processes was attributed to the brain afflicted by the illness ('brain-bound mechanisms'). But this approach has contributed to challenges in measuring and quantifying disorganization. Consequently, the single-brain focus has not provided satisfactory clarity or led to effective treatments for persistent social dysfunction in schizophrenia. Social dysfunction is a core feature of schizophrenia. This dysfunction arises from disorganized interpersonal interaction that typifies the social profile of affected individuals. We outline challenges in employing several emerging concepts and methods and how they can be addressed to investigate the mechanisms of social dysfunction in schizophrenia.
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Affiliation(s)
- Emmanuel Olarewaju
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Integrated Program in Neuroscience, McGill University, Montreal, QC, Canada
| | - Guillaume Dumas
- Department of Psychiatry, CHU Sainte Justine Research Center, University of Montreal, Montreal, QC, Canada
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.
- Robarts Research Institute, Western University, London, ON, Canada.
- Department of Medical Biophysics, Western University, London, Canada.
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Palaniyappan L, Homan P, Alonso-Sanchez MF. Language Network Dysfunction and Formal Thought Disorder in Schizophrenia. Schizophr Bull 2023; 49:486-497. [PMID: 36305160 PMCID: PMC10016399 DOI: 10.1093/schbul/sbac159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pathophysiological inquiries into schizophrenia require a consideration of one of its most defining features: disorganization and impoverishment in verbal behavior. This feature, often captured using the term Formal Thought Disorder (FTD), still remains to be one of the most poorly understood and understudied dimensions of schizophrenia. In particular, the large-scale network level dysfunction that contributes to FTD remains obscure to date. STUDY DESIGN In this narrative review, we consider the various challenges that need to be addressed for us to move towards mapping FTD (construct) to a brain network level account (circuit). STUDY RESULTS The construct-to-circuit mapping goal is now becoming more plausible than it ever was, given the parallel advent of brain stimulation and the tools providing objective readouts of human speech. Notwithstanding this, several challenges remain to be overcome before we can decisively map the neural basis of FTD. We highlight the need for phenotype refinement, robust experimental designs, informed analytical choices, and present plausible targets in and beyond the Language Network for brain stimulation studies in FTD. CONCLUSIONS Developing a therapeutically beneficial pathophysiological model of FTD is a challenging endeavor, but holds the promise of improving interpersonal communication and reducing social disability in schizophrenia. Addressing the issues raised in this review will be a decisive step in this direction.
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Affiliation(s)
- Lena Palaniyappan
- Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Western University, London, Canada
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital of the University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University and ETH Zurich, Zurich, Switzerland
| | - Maria F Alonso-Sanchez
- Robarts Research Institute, Western University, London, Ontario, Canada
- CIDCL, Fonoaudiología, Facultad de Medicina, Universidad de Valparaíso, Valparaiso, Chile
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Fuentes-Claramonte P, López-Araquistain L, Sarró S, Sans-Sansa B, Ortiz-Gil J, Maristany T, Salvador R, McKenna PJ, Pomarol-Clotet E. Brain functional correlates of formal thought disorder in schizophrenia: examining the frontal/dysexecutive hypothesis. Psychol Med 2021; 51:2446-2453. [PMID: 32338241 DOI: 10.1017/s0033291720001063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND One hypothesis proposed to underlie formal thought disorder (FTD), the incoherent speech is seen in some patients with schizophrenia, is that it reflects impairment in frontal/executive function. While this proposal has received support in neuropsychological studies, it has been relatively little tested using functional imaging. This study aimed to examine brain activations associated with FTD, and its two main factor-analytically derived subsyndromes, during the performance of a working memory task. METHODS Seventy patients with schizophrenia showing a full range of FTD scores and 70 matched healthy controls underwent fMRI during the performance of the 2-back version of the n-back task. Whole-brain corrected, voxel-based correlations with FTD scores were examined in the patient group. RESULTS During 2-back performance the patients showed clusters of significant inverse correlation with FTD scores in the inferior frontal cortex and dorsolateral prefrontal cortex bilaterally, the left temporal cortex and subcortically in the basal ganglia and thalamus. Further analysis revealed that these correlations reflected an association only with 'alogia' (poverty of speech, poverty of content of speech and perseveration) and not with the 'fluent disorganization' component of FTD. CONCLUSIONS This study provides functional imaging support for the view that FTD in schizophrenia may involve impaired executive/frontal function. However, the relationship appears to be exclusively with alogia and not with the variables contributing to fluent disorganization.
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Affiliation(s)
- P Fuentes-Claramonte
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Spain
| | | | - S Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Spain
| | - B Sans-Sansa
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - J Ortiz-Gil
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Spain
- Hospital de Granollers, Spain
| | | | - R Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Spain
| | - P J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Spain
| | - E Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Spain
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Park J, Lho SK, Hwang WJ, Moon SY, Oh S, Kim M, Kwon JS. Impaired error-related processing in patients with first-episode psychosis and subjects at clinical high risk for psychosis: An event-related potential study. Psychiatry Clin Neurosci 2021; 75:219-226. [PMID: 33864656 DOI: 10.1111/pcn.13219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/05/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
AIM Impaired event-related potential (ERP) indices reflecting performance-monitoring systems have been consistently reported in patients with schizophrenia. However, whether these impairments exist from the beginning of the early phase of psychosis, such as in first-episode psychosis (FEP) patients and individuals at clinical high risk (CHR) for psychosis, has not yet been clearly ascertained. METHODS Thirty-seven FEP patients, 22 CHR subjects, and 22 healthy controls (HC) performed a visual go/no-go task so that three ERP components associated with performance monitoring-error-related negativity (ERN), correct response negativity (CRN), and error positivity (Pe) -could be assessed. Repeated-measures analysis of variance (ANOVA) with age and sex as covariates was used to compare ERN, CRN, and Pe across the groups. RESULTS Repeated-measures ANOVA with age and sex as covariates revealed that compared with HC, FEP patients and CHR subjects showed significantly smaller ERN amplitudes at the Fz (F = 4.980, P = 0.009) and FCz (F = 3.453, P = 0.037) electrode sites. Neither CRN nor Pe amplitudes showed significant differences across the FEP, CHR, and HC groups. CONCLUSION These findings suggest that performance monitoring is already compromised during the early course of psychotic disorders, evident in FEP patients and CHR subjects, as reflected in the reduced ERN amplitude. Considering these findings, ERN could serve as a potential indicator of early-stage psychosis.
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Affiliation(s)
- Jihye Park
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Silvia Kyungjin Lho
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wu Jeong Hwang
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Sun-Young Moon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sanghoon Oh
- Department of Psychiatry, Eulji University Uijeongbu Eulji Medical Center, Gyeonggi, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea
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Seow TXF, Benoit E, Dempsey C, Jennings M, Maxwell A, McDonough M, Gillan CM. A dimensional investigation of error-related negativity (ERN) and self-reported psychiatric symptoms. Int J Psychophysiol 2020; 158:340-348. [PMID: 33080287 PMCID: PMC7612131 DOI: 10.1016/j.ijpsycho.2020.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 08/05/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Alterations in error processing are implicated in a range of DSM-defined psychiatric disorders. For instance, obsessive-compulsive disorder (OCD) and generalised anxiety disorder show enhanced electrophysiological responses to errors-i.e. error-related negativity (ERN)-while others like schizophrenia have an attenuated ERN. However, as diagnostic categories in psychiatry are heterogeneous and also highly intercorrelated, the precise mapping of ERN enhancements/impairments is unclear. To address this, we recorded electroencephalograms (EEG) from 196 participants who performed the Flanker task and collected scores on 9 questionnaires assessing psychiatric symptoms to test if a dimensional framework could reveal specific transdiagnostic clinical manifestations of error processing dysfunctions. Contrary to our hypothesis, we found non-significant associations between ERN amplitude and symptom severity of OCD, trait anxiety, depression, social anxiety, impulsivity, eating disorders, alcohol addiction, schizotypy and apathy. A transdiagnostic approach did nothing to improve signal; there were non-significant associations between all three transdiagnostic dimensions (anxious-depression, compulsive behaviour and intrusive thought, and social withdrawal) and ERN magnitude. In these same individuals, we replicated a previously published transdiagnostic association between goal-directed learning and compulsive behaviour and intrusive thought. Possible explanations discussed are (i) that associations between the ERN and psychopathology might be smaller than previously assumed, (ii) that these associations might depend on a greater level of symptom severity than other transdiagnostic cognitive biomarkers, or (iii) that task parameters, such as the ratio of compatible to incompatible trials, might be crucial for ensuring the sensitivity of the ERN to clinical phenomena.
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Affiliation(s)
- T X F Seow
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
| | - E Benoit
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - C Dempsey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - M Jennings
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - A Maxwell
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - M McDonough
- St. Patrick's University Hospital, Dublin, Ireland
| | - C M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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Dwyer K, David AS, McCarthy R, McKenna P, Peters E. Linguistic alignment and theory of mind impairments in schizophrenia patients' dialogic interactions. Psychol Med 2020; 50:2194-2202. [PMID: 31500678 DOI: 10.1017/s0033291719002289] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impairments of contextual processing and theory of mind (ToM) have both been offered as accounts of the deviant language characterising formal thought disorder (FTD) in schizophrenia. This study investigated these processes in patients' dialogue. We predicted that FTD patients would show a decrement in linguistic alignment, associated with impaired ToM in dialogue. METHODS Speech samples were elicited via participation in an interactive computer-based task and a semi-structured interview to assess contextual processing abilities and ToM skills in dialogue, respectively, and from an interactive card-sorting task to measure syntactic alignment. Degree of alignment in dialogue and the syntactic task, and evidence of ToM in (i) dialogue and (ii) a traditional ToM task were compared across schizophrenia patients with FTD (n = 21), non-FTD patients (n = 22) and healthy controls (n = 21). RESULTS FTD patients showed less alignment than the other two groups in dialogue, and than healthy controls on the syntactic task. FTD patients showed poorer performance on the ToM task than the other two groups, but only compared to the healthy controls in dialogue. The FTD group's degree of alignment in dialogue was correlated with ToM performance in dialogue but not with the traditional ToM task or with syntactic alignment. CONCLUSIONS In dialogue, FTD patients demonstrate an impairment in employing available contextual information to facilitate their own subsequent production, which is associated with a ToM deficit. These findings indicate that a contextual processing deficit impacts on exploiting representations via the production system impoverishing the ability to make predictions about upcoming utterances in dialogue.
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Affiliation(s)
- Karen Dwyer
- Department of English Language and Literature, University College London, London, UK
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Anthony S David
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Institute of Mental Health, University College London, London, UK
| | - Rosaleen McCarthy
- Department of Psychology, University of Southampton, Southampton, UK
- Wessex Neurological Centre, Southampton General Hospital, Southampton University Hospital Trust, Tremona Road, Southampton, UK
| | - Peter McKenna
- FIDMAG Research Foundation, Germanes Hospitalàries, Barcelona, Spain
- CIBERSAM, Madrid , Spain
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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7
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Donaldson KR, Roach BJ, Ford JM, Lai K, Sreenivasan KK, Mathalon DH. Effects of conflict and strategic processing on neural responses to errors in schizophrenia. Biol Psychol 2018; 140:9-18. [PMID: 30428312 DOI: 10.1016/j.biopsycho.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 01/25/2023]
Abstract
The error-related negativity (ERN) and error-positivity (Pe) are commonly linked to error-detection and strategic processing. Studies have documented the influence of conflict probability on ERN amplitude. However, the influence of conflict probability on ERN/Pe in schizophrenia, where such components are reduced, is unknown. A modified flanker paradigm was used to examine how the probability of conflict modulates ERN and Pe amplitudes in patients with schizophrenia (n = 33) and healthy controls (n = 25). Increased ERN was observed in response to errors on low probability, incongruent trials. No such differences were observed in Pe. While ERN and Pe showed significantly reduced amplitudes in patients relative to controls, patients showed normal condition-dependent ERN and reaction-time modulation. This suggests that while the neural mechanisms generating the ERN and Pe are compromised in schizophrenia, those modulating task performance strategy and neurophysiological responses to errors based on conflict probability are intact.
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Affiliation(s)
- Kayla R Donaldson
- Psychiatry Service, Veterans Affairs San Francisco Healthcare System, 4150 Clement Street, San Francisco, CA, 94121, United States
| | - Brian J Roach
- Psychiatry Service, Veterans Affairs San Francisco Healthcare System, 4150 Clement Street, San Francisco, CA, 94121, United States
| | - Judith M Ford
- Psychiatry Service, Veterans Affairs San Francisco Healthcare System, 4150 Clement Street, San Francisco, CA, 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, United States
| | - Karen Lai
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095, United States
| | - Kartik K Sreenivasan
- Division of Science and Mathematics, New York University Abu Dhabi, 19 Washington Square North, New York, NY, 10011, United States
| | - Daniel H Mathalon
- Psychiatry Service, Veterans Affairs San Francisco Healthcare System, 4150 Clement Street, San Francisco, CA, 94121, United States; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, United States.
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Sevilla G, Rosselló J, Salvador R, Sarró S, López-Araquistain L, Pomarol-Clotet E, Hinzen W. Deficits in nominal reference identify thought disordered speech in a narrative production task. PLoS One 2018; 13:e0201545. [PMID: 30086142 PMCID: PMC6080774 DOI: 10.1371/journal.pone.0201545] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 07/17/2018] [Indexed: 01/02/2023] Open
Abstract
Formal thought disorder (TD) is a neuropathology manifest in formal language dysfunction, but few behavioural linguistic studies exist. These have highlighted problems in the domain of semantics and more specifically of reference. Here we aimed for a more complete and systematic linguistic model of TD, focused on (i) a more in-depth analysis of anomalies of reference as depending on the grammatical construction type in which they occur, and (ii) measures of formal grammatical complexity and errors. Narrative speech obtained from 40 patients with schizophrenia, 20 with TD and 20 without, and from 14 healthy controls matched on pre-morbid IQ, was rated blindly. Results showed that of 10 linguistic variables annotated, 4 showed significant differences between groups, including the two patient groups. These all concerned mis-uses of noun phrases (NPs) for purposes of reference, but showed sensitivity to how NPs were classed: definite and pronominal forms of reference were more affected than indefinite and non-pronominal (lexical) NPs. None of the measures of formal grammatical complexity and errors distinguished groups. We conclude that TD exhibits a specific and differentiated linguistic profile, which can illuminate TD neuro-cognitively and inform future neuroimaging studies, and can have clinical utility as a linguistic biomarker.
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Affiliation(s)
- Gabriel Sevilla
- Grammar & Cognition Lab, Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Joana Rosselló
- Grammar & Cognition Lab, Department of Catalan Philology and General Linguistics, Universitat de Barcelona, Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Biomedicina en Red en Salud Mental), Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Biomedicina en Red en Salud Mental), Barcelona, Spain
| | | | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Biomedicina en Red en Salud Mental), Barcelona, Spain
| | - Wolfram Hinzen
- Grammar & Cognition Lab, Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Catalan Institute for Advanced Studies and Research (ICREA), Barcelona, Spain
- * E-mail:
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9
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Sirivichayakul S, Kanchanatawan B, Thika S, Carvalho AF, Maes M. Eotaxin, an Endogenous Cognitive Deteriorating Chemokine (ECDC), Is a Major Contributor to Cognitive Decline in Normal People and to Executive, Memory, and Sustained Attention Deficits, Formal Thought Disorders, and Psychopathology in Schizophrenia Patients. Neurotox Res 2018; 35:122-138. [PMID: 30056534 DOI: 10.1007/s12640-018-9937-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 12/15/2022]
Abstract
Eotaxin is increased in neurodegenerative disorders and schizophrenia, and preclinical studies indicate that eotaxin may induce cognitive deficits. This study aims to examine whether peripheral levels of eotaxin impact cognitive functioning in healthy volunteers and formal thought disorder (FTD) and psychopathology in schizophrenia patients. Serum levels of eotaxin were assayed and cognitive tests were performed on a sample of 40 healthy participants and 80 schizophrenia patients. Among healthy participants, eotaxin levels were significantly associated with episodic/semantic memory, executive functions, Mini Mental State Examination, emotion recognition, and sustained attention. In addition, age-related effects on these cognitive measures were partly mediated by eotaxin. The super-variable "age-eotaxin" predicted a large part of the variance in cognitive functions among healthy participants, and hence, eotaxin may act as an "accelerated brain aging chemokine" (ABAC). In schizophrenia, eotaxin levels had a strong impact on formal thought disorders and psychopathology. In schizophrenia, increased eotaxin strongly impacts memory and sustained attention, which together to a large extent determine FTD. FTD together with memory deficits predicts around 92.5% of the variance in psychopathology. Moreover, the effects of eotaxin are partially mediated by executive functioning, while the effects of male sex on FTD and psychopathology are mediated by eotaxin. In healthy subjects, eotaxin strongly impacts executive functioning and multiple cognitive domains. In schizophrenia, peripheral levels of eotaxin strongly impact both negative symptoms and psychosis (hallucinations and delusions), and these eotaxin effects are mediated by impairments in frontal functioning, memory, sustained attention, and FTD. Eotaxin is an endogenous cognitive deteriorating chemokine (ECDC) and a novel therapeutic target for age-related cognitive decline and schizophrenia as well.
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Affiliation(s)
| | - Buranee Kanchanatawan
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Supaksorn Thika
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - André F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Michael Maes
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria.
- IMPACT Strategic Research Center, Barwon Health, Deakin University, Geelong, VIC, Australia.
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10
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Wensing T, Cieslik EC, Müller VI, Hoffstaedter F, Eickhoff SB, Nickl-Jockschat T. Neural correlates of formal thought disorder: An activation likelihood estimation meta-analysis. Hum Brain Mapp 2017; 38:4946-4965. [PMID: 28653797 DOI: 10.1002/hbm.23706] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/24/2017] [Accepted: 06/16/2017] [Indexed: 11/10/2022] Open
Abstract
Formal thought disorder (FTD) refers to a psychopathological dimension characterized by disorganized and incoherent speech. Whether symptoms of FTD arise from aberrant processing in language-related regions or more general cognitive networks, however, remains debated. Here, we addressed this question by a quantitative meta-analysis of published functional neuroimaging studies on FTD. The revised Activation Likelihood Estimation (ALE) algorithm was used to test for convergent aberrant activation changes in 18 studies (30 experiments) investigating FTD, of which 17 studies comprised schizophrenia patients and one study healthy subjects administered to S-ketamine. Additionally, we analyzed task-dependent and task-independent (resting-state) functional connectivity (FC) of brain regions showing convergence in activation changes. Subsequent functional characterization was performed for the initial clusters and the delineated connectivity networks by reference to the BrainMap database. Consistent activation changes were found in the left superior temporal gyrus (STG) and two regions within the left posterior middle temporal gyrus (p-MTG), ventrally (vp-MTG) and dorsally (dp-MTG). Functional characterization revealed a prominent functional association of ensuing clusters from our ALE meta-analysis with language and speech processing, as well as auditory perception in STG and with social cognition in dp-MTG. FC analysis identified task-dependent and task-independent networks for all three seed regions, which were mainly related to language and speech processing, but showed additional involvement in higher order cognitive functions. Our findings suggest that FTD is mainly characterized by abnormal activation in brain regions of the left hemisphere that are associated with language and speech processing, but also extend to higher order cognitive functions. Hum Brain Mapp 38:4946-4965, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Tobias Wensing
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Germany.,Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Germany.,JARA Translational Brain Medicine, Aachen, Germany
| | - Edna C Cieslik
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Germany.,Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Veronika I Müller
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Germany.,Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Germany.,Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Germany.,Institute for Systems Neuroscience, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen, Germany.,JARA Translational Brain Medicine, Aachen, Germany
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11
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Evidence that communication impairment in schizophrenia is associated with generalized poor task performance. Psychiatry Res 2017; 249:172-179. [PMID: 28104564 PMCID: PMC5452682 DOI: 10.1016/j.psychres.2016.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/24/2023]
Abstract
People with schizophrenia exhibit wide-ranging cognitive deficits, including slower processing speed and decreased cognitive control. Disorganized speech symptoms, such as communication impairment, have been associated with poor cognitive control task performance (e.g., goal maintenance and working memory). Whether communication impairment is associated with poorer performance on a broader range of non-cognitive control measures is unclear. In the current study, people with schizophrenia (n =51) and non-psychiatric controls (n =26) completed speech interviews allowing for reliable quantitative assessment of communication impairment. Participants also completed multiple goal maintenance and working memory tasks. In addition, we also examined (a) simple measures of processing speed involving highly automatic prepotent responses and (b) a non-cognitive control measure of general task performance. Schizophrenia communication impairment was significantly associated with poor performance in all cognitive domains, with the largest association found with processing speed (rs =-0.52). Further, communication impairment was also associated with the non-cognitive control measure of poor general task performance (rs =-0.43). In contrast, alogia, a negative speech symptom, and positive symptoms were less if at all related to cognitive task performance. Overall, this study suggests that communication impairment in schizophrenia may be associated with relatively generalized poor cognitive task performance.
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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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Roche E, Lyne J, O'Donoghue B, Segurado R, Behan C, Renwick L, Fanning F, Madigan K, Clarke M. The prognostic value of formal thought disorder following first episode psychosis. Schizophr Res 2016; 178:29-34. [PMID: 27639419 DOI: 10.1016/j.schres.2016.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/09/2016] [Accepted: 09/09/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses and it can be assessed as a categorical or dimensional variable. However, its influence on functional outcome and hospitalisation patterns in early psychosis has not been investigated. We evaluated the relationship between FTD and these outcomes in a first episode psychosis (FEP) sample. MATERIALS AND METHODS A mixed diagnostic FEP cohort was recruited through an Early Intervention in Psychosis Service in Ireland. Participants were assessed at initial presentation and one year later with the MIRECC GAF to evaluate social and occupational functioning domains. Disorganisation (disFTD), verbosity (verFTD) and poverty (povFTD) dimensions of FTD were examined at both time points, as well as a unitary FTD construct. Analyses were controlled for demographic, clinical and treatment variables. RESULTS DisFTD was the only FTD dimension associated with functional outcome, specifically social functioning, on multivariate analysis (beta=0.13, P<0.05). The unitary FTD construct was not associated with functional outcome. DisFTD at FEP presentation predicted a greater number of hospitalisations (adjusted beta=0.24, P<0.001) and prolonged inpatient admission (adjusted OR=1.08, 95% CI 1.02-1.15, P<0.05) following FEP. CONCLUSIONS Longitudinal and dimensional evaluation of FTD has a clinical utility that is distinct from a cross-sectional or unitary assessment. Dimensions of FTD may map onto different domains of functioning. These findings are supportive of some of the changes in DSM-V with an emphasis on longitudinal and dimensional appraisal of psychopathology. Communication disorders may be considered a potential target for intervention in psychotic disorders.
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Affiliation(s)
- Eric Roche
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland.
| | - John Lyne
- Royal College of Surgeons in Ireland and North Dublin Mental Health Services, Ashlin Centre, Beaumont Road, Dublin 9, Ireland
| | - Brian O'Donoghue
- Orygen, National Centre for Excellence in Youth Mental Health, Melbourne, Australia
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research, University College Dublin, Ireland
| | - Caragh Behan
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
| | - Laoise Renwick
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - Felicity Fanning
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
| | - Kevin Madigan
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
| | - Mary Clarke
- DETECT Early Intervention in Psychosis Service, Blackrock Business Park, Blackrock, Dublin, Ireland
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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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de Sousa P, Spray A, Sellwood W, Bentall RP. 'No man is an island'. Testing the specific role of social isolation in formal thought disorder. Psychiatry Res 2015; 230:304-13. [PMID: 26384574 DOI: 10.1016/j.psychres.2015.09.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 07/27/2015] [Accepted: 09/06/2015] [Indexed: 11/24/2022]
Abstract
Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research.
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Affiliation(s)
- Paulo de Sousa
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK.
| | - Amy Spray
- School of Psychology, Eleanor Rathbone Building, University of Liverpool, Bedford Street South, Liverpool L69 7ZA, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA1 4YG, UK
| | - Richard P Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building Block B, Liverpool L69 3GL, UK
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Brown M, Kuperberg GR. A Hierarchical Generative Framework of Language Processing: Linking Language Perception, Interpretation, and Production Abnormalities in Schizophrenia. Front Hum Neurosci 2015; 9:643. [PMID: 26640435 PMCID: PMC4661240 DOI: 10.3389/fnhum.2015.00643] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 11/12/2015] [Indexed: 12/27/2022] Open
Abstract
Language and thought dysfunction are central to the schizophrenia syndrome. They are evident in the major symptoms of psychosis itself, particularly as disorganized language output (positive thought disorder) and auditory verbal hallucinations (AVHs), and they also manifest as abnormalities in both high-level semantic and contextual processing and low-level perception. However, the literatures characterizing these abnormalities have largely been separate and have sometimes provided mutually exclusive accounts of aberrant language in schizophrenia. In this review, we propose that recent generative probabilistic frameworks of language processing can provide crucial insights that link these four lines of research. We first outline neural and cognitive evidence that real-time language comprehension and production normally involve internal generative circuits that propagate probabilistic predictions to perceptual cortices - predictions that are incrementally updated based on prediction error signals as new inputs are encountered. We then explain how disruptions to these circuits may compromise communicative abilities in schizophrenia by reducing the efficiency and robustness of both high-level language processing and low-level speech perception. We also argue that such disruptions may contribute to the phenomenology of thought-disordered speech and false perceptual inferences in the language system (i.e., AVHs). This perspective suggests a number of productive avenues for future research that may elucidate not only the mechanisms of language abnormalities in schizophrenia, but also promising directions for cognitive rehabilitation.
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Affiliation(s)
- Meredith Brown
- Department of Psychiatry–Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, CharlestownMA, USA
- Department of Psychology, Tufts University, MedfordMA, USA
| | - Gina R. Kuperberg
- Department of Psychiatry–Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, CharlestownMA, USA
- Department of Psychology, Tufts University, MedfordMA, USA
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Xu JQ, Hui CLM, Longenecker J, Lee EHM, Chang WC, Chan SKW, Chen EYH. Executive function as predictors of persistent thought disorder in first-episode schizophrenia: a one-year follow-up study. Schizophr Res 2014; 159:465-70. [PMID: 25261043 DOI: 10.1016/j.schres.2014.08.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/06/2014] [Accepted: 08/30/2014] [Indexed: 11/25/2022]
Abstract
Language disorganization is an important clinical indicator of acute psychosis, yet the longitudinal course and pathogenesis are not well understood. Executive dysfunction has been suggested as a vital contributor to formal thought disorder (FTD) and may serve as a stable predictor of symptomatic risk. The paper reports a one-year prospective study of language disorganization in sixty patients with first-episode schizophrenia-spectrum disorders and investigates executive function as a predictor of persistent FTD one year after illness onset. FTD was captured using the Clinical Language Disorder Rating Scale (CLANG), which segregates language abnormalities into three empirically validated levels: syntactic, semantic, and production. After one year, patients' syntactic and semantic deficits were substantially reduced, but production impairments persisted. Patients' improvement of semantic impairment was associated with reduced disorganized symptoms while production impairment was associated with negative symptoms. We further identified two different patterns of baseline executive function predictors for both residual semantic and production impairment. We found that sustained FTD at the semantic level was predicted by both sustained attention and planning at illness onset, while residual production failure was only predicted by sustained attention. In conclusion, the present paper documents the distinct characteristics of psycholinguistic levels in FTD and isolates two different patterns of executive function predictors for persistent semantic and production language disorganization at follow-up. The findings help to disentangle FTD dimensions at different levels of language production processes, which provide clinical implications for targeting patients at risk for prolonged FTD concordant upon executive dysfunction at illness onset.
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Affiliation(s)
- Jia-Qi Xu
- Department of Psychiatry, The University of Hong Kong, Hong Kong.
| | | | | | | | - Wing-Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong
| | | | - Eric Yu-Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Salas CE, Gross JJ, Turnbull OH. Reappraisal generation after acquired brain damage: The role of laterality and cognitive control. Front Psychol 2014; 5:242. [PMID: 24711799 PMCID: PMC3968762 DOI: 10.3389/fpsyg.2014.00242] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/04/2014] [Indexed: 11/13/2022] Open
Abstract
In the past decade, there has been growing interest in the neuroanatomical and neuropsychological bases of reappraisal. Findings suggest that reappraisal activates a set of areas in the left hemisphere (LH), which are commonly associated with language abilities and verbally mediated cognitive control. The main goal of this study was to investigate whether individuals with focal damage to the LH (n = 8) were more markedly impaired on a reappraisal generation task than individuals with right hemisphere lesions (RH, n = 8), and healthy controls (HC, n = 14). The reappraisal generation task consisted of a set of ten pictures from the IAPS, depicting negative events of different sorts. Participants were asked to quickly generate as many positive reinterpretations as possible for each picture. Two scores were derived from this task, namely difficulty and productivity. A second goal of this study was to explore which cognitive control processes were associated with performance on the reappraisal task. For this purpose, participants were assessed on several measures of cognitive control. Findings indicated that reappraisal difficulty - defined as the time taken to generate a first reappraisal - did not differ between LH and RH groups. However, differences were found between patients with brain injury (LH + RH) and HC, suggesting that brain damage in either hemisphere influences reappraisal difficulty. No differences in reappraisal productivity were found across groups, suggesting that neurological groups and HC are equally productive when time constraints are not considered. Finally, only two cognitive control processes inhibition and verbal fluency- were inversely associated with reappraisal difficulty. Implications for the neuroanatomical and neuropsychological bases of reappraisal generation are discussed, and implications for neuro-rehabilitation are considered.
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Affiliation(s)
- Christian E. Salas
- Centre for Cognitive Neuroscience, School of Psychology, Bangor UniversityBangor, UK
- Unidad de Psicoterapia Dinámica, Instituto Psiquiátrico J. H. BarakSantiago, Chile
| | - James J. Gross
- Department of Psychology, Stanford UniversityStanford, CA, USA
| | - Oliver H. Turnbull
- Centre for Cognitive Neuroscience, School of Psychology, Bangor UniversityBangor, UK
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Ferretti F, Cosentino E. Time, language and flexibility of the mind: The role of mental time travel in linguistic comprehension and production. PHILOSOPHICAL PSYCHOLOGY 2013. [DOI: 10.1080/09515089.2011.625119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Matsumoto K, Kircher TTJ, Stokes PRA, Brammer MJ, Liddle PF, McGuire PK. Frequency and neural correlates of pauses in patients with formal thought disorder. Front Psychiatry 2013; 4:127. [PMID: 24133459 PMCID: PMC3794379 DOI: 10.3389/fpsyt.2013.00127] [Citation(s) in RCA: 12] [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: 06/13/2013] [Accepted: 09/26/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pauses during speech may reflect the planning and monitoring of discourse, two processes putatively impaired in patients with schizophrenia, particularly those with formal thought disorder (FTD). We used functional MRI to examine the neural correlates of between-clause and of filled pauses, which are respectively associated with speech planning and speech monitoring. METHODS BOLD contrast was measured while six schizophrenia patients with FTD and six healthy subjects spoke about Rorshach inkblots. In an event-related design, we examined activity associated with pauses that occurred between clauses and with pauses that were filled. RESULTS There was no significant group difference in the frequency of between-clause pauses but patients with FTD made strikingly fewer filled pauses than controls. Between-clause pauses were associated with activation in the anterior part of the left superior temporal gyrus (STG) and the left insula in controls and the engagement of these regions was significantly attenuated in patients. CONCLUSION The anterior part of the left STG and the left insula are normally involved in both the planning and monitoring of discourse. The attenuated engagement of these regions with between-clause pauses and the striking infrequency of filled pauses in the patients are consistent with cognitive models implicating defective speech planning and speech monitoring in schizophrenia, especially in relation to FTD.
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Affiliation(s)
- Kazunori Matsumoto
- Department of Psychosis Studies, Institute of Psychiatry, King's College London , London , UK ; Department of Preventive Psychiatry, Tohoku University Graduate School of Medicine , Sendai , Japan
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Todder D, Avissar S, Schreiber G. Non-Linear Dynamic Analysis of Inter-Word Time Intervals in Psychotic Speech. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2013; 1:2200107. [PMID: 27170852 PMCID: PMC4819231 DOI: 10.1109/jtehm.2013.2268850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/27/2013] [Accepted: 06/07/2013] [Indexed: 11/23/2022]
Abstract
“Language is a form and not a substance”
— Ferdinand de Saussure Objective: Analyses of speech processes in schizophrenia are invariably focused on words as vocal signals. The results of such analyses are, however, strongly related to content, and may be language- and culture-dependent. Little attention has been paid to a pure measure of the form of speech, unrelated to its content: inter-words time intervals. Method: 15 patients with schizophrenia and 15 healthy volunteers are recorded spontaneously speaking for 10–15 min. Recordings are analyzed for inter-words time intervals using the following non-linear dynamical methods: unstable periodic orbits, correlation dimension, bi-spectral analysis, and symbolic dynamics. Results: The series of inter-word time intervals in normal speech have the characteristics of a low-dimensional chaotic attractor with a correlation dimension of \documentclass[12pt]{minimal}
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}{}$3.2\pm 1.1$\end{document}. Deconstruction of the attractor appears in psychosis with re-establishment after anti-psychotic treatment. Shannon entropy, a measure of the complexity in the time series, calculated from symbolic dynamics, is higher for psychotic speech, which is also characterized by higher levels of phase coupling: higher bicoherence, obtained using bi-spectral analysis. Conclusion: Non-linear dynamical methods applied to ITIs thus enable a content-independent, pure measure of the form of normal thought, its distortion in psychosis, and its restoration under treatment.
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Affiliation(s)
- Doron Todder
- Ben Gurion University of the Negev Psychiatry Department Beer Sheva Israel 84105
| | - Sofia Avissar
- Ben Gurion University of the Negev Clinical Pharmacology Department Beer Sheva Israel 84105
| | - Gabriel Schreiber
- Ben Gurion University of the Negev Faculty of Health Sciences Beer Sheva Israel 84105
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Houthoofd S, Morrens M, Sabbe B, Schrijvers D, Vandendriessche F, Hulstijn W, de Bruijn ERA. Trait and state aspects of internal and external performance monitoring in schizophrenia. Int J Psychophysiol 2013; 87:42-51. [PMID: 23127478 DOI: 10.1016/j.ijpsycho.2012.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 10/25/2012] [Accepted: 10/27/2012] [Indexed: 11/16/2022]
Affiliation(s)
- S Houthoofd
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium.
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Chan KK, Mak WW. Shared decision making in the recovery of people with schizophrenia: The role of metacognitive capacities in insight and pragmatic language use. Clin Psychol Rev 2012; 32:535-44. [DOI: 10.1016/j.cpr.2012.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Revised: 04/29/2012] [Accepted: 06/11/2012] [Indexed: 11/16/2022]
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24
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Error processing-associated event-related potentials in schizophrenia and unaffected siblings. Int J Psychophysiol 2012; 84:74-9. [DOI: 10.1016/j.ijpsycho.2012.01.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 01/06/2012] [Accepted: 01/10/2012] [Indexed: 11/22/2022]
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25
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Becker TM, Cicero DC, Cowan N, Kerns JG. Cognitive control components and speech symptoms in people with schizophrenia. Psychiatry Res 2012; 196:20-6. [PMID: 22365272 PMCID: PMC4445960 DOI: 10.1016/j.psychres.2011.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/01/2011] [Accepted: 10/04/2011] [Indexed: 10/28/2022]
Abstract
Previous schizophrenia research suggests poor cognitive control is associated with schizophrenia speech symptoms. However, cognitive control is a broad construct. Two important cognitive control components are poor goal maintenance and poor verbal working memory storage. In the current research, people with schizophrenia (n=45) performed three cognitive tasks that varied in their goal maintenance and verbal working memory storage demands. Speech symptoms were assessed using clinical rating scales, ratings of disorganized speech from typed transcripts, and self-reported disorganization. Overall, alogia was associated with both goal maintenance and verbal working memory tasks. Objectively rated disorganized speech was associated with poor goal maintenance and with a task that included both goal maintenance and verbal working memory storage demands. In contrast, self-reported disorganization was unrelated to either amount of objectively rated disorganized speech or to cognitive control task performance, instead being associated with negative mood symptoms. Overall, our results suggest that alogia is associated with both poor goal maintenance and poor verbal working memory storage and that disorganized speech is associated with poor goal maintenance. In addition, patients' own assessment of their disorganization is related to negative mood, but perhaps not to objective disorganized speech or to cognitive control task performance.
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Affiliation(s)
- Theresa M. Becker
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
| | - David C. Cicero
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
| | - Nelson Cowan
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
| | - John G. Kerns
- University of Missouri, Department of Psychological Sciences, Columbia, MO, U.S.A
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Schizophrenia, dissociation, and consciousness. Conscious Cogn 2011; 20:1042-9. [PMID: 21602061 DOI: 10.1016/j.concog.2011.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 01/26/2011] [Accepted: 04/26/2011] [Indexed: 11/21/2022]
Abstract
Current thinking suggests that dissociation could be a significant comorbid diagnosis in a proportion of schizophrenic patients with a history of trauma. This potentially may explain the term "schizophrenia" in its original definition by Bleuler, as influenced by his clinical experience and personal view. Additionally, recent findings suggest a partial overlap between dissociative symptoms and the positive symptoms of schizophrenia, which could be explained by inhibitory deficits. In this context, the process of dissociation could serve as an important conceptual framework for understanding schizophrenia, which is supported by current neuroimaging studies and research of corollary discharges. These data indicate that the original conception of "split mind" may be relevant in an updated context. Finally, recent data suggest that the phenomenal aspects of dissociation and conscious disintegration could be related to underlying disruptions of connectivity patterns and neural integration.
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Tower of London versus real life analogue planning in schizophrenia with disorganization and psychomotor poverty symptoms. J Int Neuropsychol Soc 2011; 17:474-84. [PMID: 21473804 DOI: 10.1017/s135561771100018x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuropsychological models propose qualitatively distinct planning impairments in the psychomotor poverty and disorganization syndromes in schizophrenia. It was proposed that poor plan initiation in psychomotor poverty would lead to longer initial planning times, while poor plan execution in disorganization would lead to greater inefficiency. Participants with psychomotor poverty (n = 30) and disorganization (n = 29) symptoms were contrasted with healthy controls (n = 28) to elucidate distinct planning impairments. Planning was compared in the Tower of London task versus real life analogue performance in the form of a board-game style diary planning task. The specificity of planning impairments was investigated by controlling for current IQ. The disorganization group demonstrated inefficient planning across both tasks, with poor performance on the Tower of London but not on the real life analogue task remaining after intelligence levels were taken into account. Initial planning times did not differ between groups. Previous associations between poor planning and symptoms may have been driven by poor planning with disorganization symptoms and associated lower order impairments in executive function or the semantic system. Targeting these impairments in people with disorganization symptoms may lead to a greater chance of success in promoting generalization to the real world.
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Ziauddeen H, Dibben C, Kipps C, Hodges JR, McKenna PJ. Negative schizophrenic symptoms and the frontal lobe syndrome: one and the same? Eur Arch Psychiatry Clin Neurosci 2011; 261:59-67. [PMID: 20711784 DOI: 10.1007/s00406-010-0133-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 08/02/2010] [Indexed: 10/19/2022]
Abstract
The negative symptoms of schizophrenia have been considered to be a psychiatric form of the frontal lobe syndrome. However, no studies have compared these two disorders at the clinical level. In this study, 12 negative symptom schizophrenic patients and 11 patients with behavioural variant frontotemporal dementia (bv-FTD) were rated for negative symptoms and for occurrence of frontal lobe behaviours in everyday life. They were also rated for speech disorder and were given a series of executive tests. Both patient groups showed positive ratings on negative symptoms and frontal lobe behaviours in daily life; however, the schizophrenic patients had higher negative symptom scores and the bv-FTD patients had higher carer ratings on frontal behaviours in daily life. Both groups were impaired on the executive tests, but the bv-FTD patients showed significantly greater impairment on verbal fluency and a test requiring inhibition of prepotent responses. A minority of the bv-FTD patients unexpectedly showed speech abnormalities typically associated with schizophrenia. The findings indicate that the negative syndrome in schizophrenia and the frontal lobe syndrome resemble each other clinically in important respects. Some of the differences may be attributable to the additional presence of disinhibition in the frontal lobe syndrome.
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Affiliation(s)
- H Ziauddeen
- Department of Psychiatry, University of Cambridge, UK
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30
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Thought Disorder in Schizophrenia: A Reappraisal of Older Formulations and an Overview of Some Recent Studies. Cogn Neuropsychiatry 2010. [DOI: 10.1080/135468000395790] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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31
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Schettino A, Lauro LR, Crippa F, Anselmetti S, Cavallaro R, Papagno C. The comprehension of idiomatic expressions in schizophrenic patients. Neuropsychologia 2009; 48:1032-40. [PMID: 19963000 DOI: 10.1016/j.neuropsychologia.2009.11.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 11/03/2009] [Accepted: 11/30/2009] [Indexed: 11/30/2022]
Abstract
Recent fMRI and TMS studies on idiom comprehension have shown that the prefrontal cortex is involved in idiom processing. Since schizophrenic patients exhibit prefrontal structural changes and dysexecutive behavioural deficits, we hypothesised an impairment in idiom comprehension, correlating with performance on executive tasks. In this study, idiom comprehension was evaluated by means of a sentence-to-picture-matching task in 45 schizophrenic patients and 45 control subjects, matched for age and educational level. The task included 62 idiomatic and 62 literal sentences. Participants were presented with a written sentence, either literal or idiomatic, followed by a picture, which appeared below the sentence. They were instructed to judge whether the picture represented the meaning of the sentence or not, and responded by pressing one of two response keys. Half of the items correctly represented the meaning, half did not. Reaction times and accuracy were measured. Schizophrenics were impaired in both types of idiomatic sentence. However, their performance was particularly poor in the case of ambiguous idioms. Wisconsin Card Sorting Test and Digit Sequencing were the unique predictors of performance for idiom comprehension in general, while thought disorganization was not. Cognitive decline either did not appear to predict performance.
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Affiliation(s)
- Antonio Schettino
- Dipartimento di Psicologia, Università di Milano-Bicocca, Milano, Italy
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32
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Dibben CRM, Rice C, Laws K, McKenna PJ. Is executive impairment associated with schizophrenic syndromes? A meta-analysis. Psychol Med 2009; 39:381-392. [PMID: 18588741 DOI: 10.1017/s0033291708003887] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A key neuropsychological proposal in schizophrenia is that negative and disorganization symptoms are associated with different patterns of impairment on executive tasks. METHOD Studies reporting correlations between positive, negative or disorganization symptoms and any type of executive test were meta-analysed. The influence of moderating factors was also examined, including age, treatment and stage of illness and whether symptoms were relapsing or persistent. The magnitudes of the correlations were compared with those for general intellectual impairment. RESULTS Pooled correlations between executive impairment and both negative symptoms and disorganization were significant in the small-to-moderate range. That for positive symptoms ('reality distortion'), however, was close to zero. The pattern of correlations among different executive tests differed significantly for negative symptoms and disorganization. Patients with stable clinical pictures showed significantly higher correlations with executive impairment than those with relapsing and remitting illnesses. Both negative symptoms and disorganization also correlated significantly with general intellectual function as indexed by current IQ. CONCLUSIONS Meta-analysis supports the view that negative symptoms and disorganization are associated with partially dissociable patterns of executive impairment. However, co-existent general intellectual impairment has been an important confounding factor in the studies to date.
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33
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Chaos in schizophrenia associations, reality or metaphor? Int J Psychophysiol 2009; 73:179-85. [PMID: 19166884 DOI: 10.1016/j.ijpsycho.2008.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 12/22/2008] [Accepted: 12/22/2008] [Indexed: 11/23/2022]
Abstract
There is evidence that schizophrenic associations display "chaotic", random-like behavior and decreased predictability. The evidence suggests a hypothesis that the "chaotic" mental disorganization could be explained within the concept of nonlinear dynamics and complexity in the brain that may cause chaotic neural organization. Testing of the hypothesis in the present study was performed using nonlinear analysis of bilateral electrodermal activity (EDA) during resting state and an association test in 56 schizophrenic patients and 44 healthy participants. EDA is a suitable measure of brain and autonomic activity reflecting neurobiological changes in schizophrenia that may indicate changes in nonlinear neural dynamics related to associative process. The results show that quantitative indices of chaotic dynamics (the largest Lyapunov exponents) calculated from EDA signals recorded during rest and the association test are significantly higher in schizophrenia patients than in the control group and increase during the test in comparison to the resting state. The difference was confirmed by statistical methods and using surrogate data testing that rejected an explanation within the linear statistical framework. The results provide supportive evidence that pseudo-randomness of schizophrenic associations and less predictability could be linked to increased complexity of nonlinear neural dynamics, although certain limitations in data interpretation must be taken into account.
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34
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Berenbaum H, Kerns JG, Vernon LL, Gomez JJ. Cognitive correlates of schizophrenia signs and symptoms: I. Verbal communication disturbances. Psychiatry Res 2008; 159:147-56. [PMID: 18423608 PMCID: PMC2581735 DOI: 10.1016/j.psychres.2007.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 04/10/2006] [Accepted: 08/16/2007] [Indexed: 11/26/2022]
Abstract
We examined the relations between verbal communication disturbances and several hypothesized etiological factors in 47 schizophrenia spectrum individuals. Both alogia and disturbed discourse coherence were associated with poor planning abilities. Alogia and discourse coherence were differentially associated with performance on tasks measuring fluency, working memory, word finding abilities, and concentration/attention.
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Affiliation(s)
- Howard Berenbaum
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL 61820, United States.
| | - John G. Kerns
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Laura L. Vernon
- Department of Psychology, University of Illinois at Urbana-Champaign
| | - Jose J. Gomez
- Department of Psychology, University of Illinois at Urbana-Champaign
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Abstract
This research examined whether facets of schizotypy were differentially related to cognitive control and emotion-processing traits. In a confirmatory factor analysis (N = 261), a 3-factor model of schizotypy exhibited good fit and fit significantly better than a 2-factor model. In addition, only disorganized schizotypy was associated with poor cognitive control (specifically, prepotent inhibition). Moreover, disorganized but not positive schizotypy was associated with increased emotional confusion and increased emotionality. In contrast, negative schizotypy was associated with increased emotional confusion but decreased emotionality. These results suggest that disorganized schizotypy is related to dysregulation of both cognition and emotion and that negative schizotypy might reflect deficits in the experience and processing of emotion and not just in emotional expression.
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Affiliation(s)
- John G Kerns
- Department of Psychological Sciences, University of Missouri--Columbia, 65211, USA.
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36
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Morris SE, Yee CM, Nuechterlein KH. Electrophysiological analysis of error monitoring in schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 115:239-50. [PMID: 16737389 DOI: 10.1037/0021-843x.115.2.239] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this study, the authors sought to determine whether abnormalities exhibited by schizophrenia patients in event-related potentials associated with self-monitoring--the error-related negativity (ERN) and the correct response negativity (CRN)--persist under conditions that maximize ERN amplitude and to examine relationships between the ERN and behavior in schizophrenia. Participants performed a flanker task under 2 contingencies: one encouraging accuracy and another emphasizing speed. Compared with healthy participants, in schizophrenia patients the ERN was reduced in the accuracy condition, and the CRN was enhanced in the speed condition. The amplitude of a later ERP component, the error positivity, did not differ between groups in either task condition. Reduced self-correction and increased accuracy following errors were associated with larger ERNs in both groups. Thus, ERN generation appears to be abnormal in schizophrenia patients even under conditions demonstrated to maximize ERN amplitude; however, functional characteristics of the ERN appear to be intact.
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Affiliation(s)
- Sarah E Morris
- Department of Psychology, University of California, Los Angeles, CA, USA.
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37
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Covington MA, He C, Brown C, Naçi L, McClain JT, Fjordbak BS, Semple J, Brown J. Schizophrenia and the structure of language: the linguist's view. Schizophr Res 2005; 77:85-98. [PMID: 16005388 DOI: 10.1016/j.schres.2005.01.016] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2004] [Revised: 01/21/2005] [Accepted: 01/26/2005] [Indexed: 12/21/2022]
Abstract
Patients with schizophrenia often display unusual language impairments. This is a wide ranging critical review of the literature on language in schizophrenia since the 19th century. We survey schizophrenic language level by level, from phonetics through phonology, morphology, syntax, semantics, and pragmatics. There are at least two kinds of impairment (perhaps not fully distinct): thought disorder, or failure to maintain a discourse plan, and schizophasia, comprising various dysphasia-like impairments such as clanging, neologism, and unintelligible utterances. Thought disorder appears to be primarily a disruption of executive function and pragmatics, perhaps with impairment of the syntax-semantics interface; schizophasia involves disruption at other levels. Phonetics is also often abnormal (manifesting as flat intonation or unusual voice quality), but phonological structure, morphology, and syntax are normal or nearly so (some syntactic impairments have been demonstrated). Access to the lexicon is clearly impaired, manifesting as stilted speech, word approximation, and neologism. Clanging (glossomania) is straightforwardly explainable as distraction by self-monitoring. Recent research has begun to relate schizophrenia, which is partly genetic, to the genetic endowment that makes human language possible.
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Affiliation(s)
- Michael A Covington
- Artificial Intelligence Center, The University of Georgia, 111 Boyd GSRC, Athens, GA 30602-7415, USA.
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38
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Mulder CL, Koopmans GT, Hengeveld MW. Lack of motivation for treatment in emergency psychiatry patients. Soc Psychiatry Psychiatr Epidemiol 2005; 40:484-8. [PMID: 16003598 DOI: 10.1007/s00127-005-0913-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND A lack of motivation for treatment on the part of patients is a major problem for emergency psychiatric services. Little is known about its determinants. The aim of this study was to investigate determinants of treatment motivation in emergency psychiatric patients. METHOD A cross-sectional study of 719 patients was made. Motivation for treatment and other clinical variables were assessed using the Severity of Psychiatric Illness scale and the Brief Psychiatric Rating Scale. RESULTS In all, 47% of patients were not motivated for treatment and they also had severe clinical problems. Lack of motivation was associated with danger to others [odds ratio (OR) 2.03; confidence interval (CI) 1.21-3.40], substance abuse (OR 1.71; CI 1.09-2.67), suspiciousness (OR 1.4; CI 1.19-1.64), grandiosity (OR 1.19; CI 1.01-1.4), anxiety (OR 0.74; CI 0.64-0.86), and GAF score (OR 0.98; CI 0.96-0.99). CONCLUSIONS Lack of motivation for treatment is a common phenomenon among severely mentally ill patients seen by emergency psychiatric services. Lack of motivation was associated with danger and paranoid symptoms. Motivational techniques as well as involuntary treatment may help to overcome problems due to lack of motivation in these patients.
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Affiliation(s)
- Cornelis L Mulder
- Mental Health Group Europort, 5250, 3008, AG Rotterdam, The Netherlands
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39
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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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40
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Bates AT, Liddle PF, Kiehl KA, Ngan ETC. State dependent changes in error monitoring in schizophrenia. J Psychiatr Res 2004; 38:347-56. [PMID: 15003441 DOI: 10.1016/j.jpsychires.2003.11.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Revised: 10/31/2003] [Accepted: 11/14/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to determine if error negativity/error-related negativity (N(e)/ERN), error positivity (P(e)), correct response negativity (CRN) or correct response positivity (P(c)) amplitude are influenced by state changes in schizophrenia. Event-related potentials (ERPs) were recorded from nine schizophrenic patients while they performed a simple go/no-go task during the early stages of an acute episode and again following 6 weeks of treatment with antipsychotics. ERPs were also recorded from nine healthy participants while they performed the same task. Response-locked potentials were computed for errors of commission and for correct responses. Scores for reality distortion syndrome, psychomotor poverty syndrome and disorganization syndrome were determined for the schizophrenic participants before and after treatment using the Signs and Symptoms of Psychotic Illness (SSPI) Scale. N(e)/ERN amplitude was significantly reduced, compared with that in healthy participants, in the schizophrenic patients when acutely ill, and increased significantly following treatment. N(e)/ERN amplitude remained significantly larger in the healthy group than in the patients with schizophrenia after treatment. This study suggests that N(e)/ERN and CRN amplitude are modulated by clinical state in schizophrenia and provides further support to findings that decreased N(e)/ERN amplitude is a potentially useful trait marker for schizophrenia, while P(c) and P(e) amplitude are not abnormal.
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Affiliation(s)
- Alan T Bates
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
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41
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Metsänen M, Wahlberg KE, Saarento O, Tarvainen T, Miettunen J, Koistinen P, Läksy K, Tienari P. Early presence of thought disorder as a prospective sign of mental disorder. Psychiatry Res 2004; 125:193-203. [PMID: 15051180 DOI: 10.1016/j.psychres.2004.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2003] [Accepted: 01/01/2004] [Indexed: 11/21/2022]
Abstract
The purpose of this study was to assess whether premorbid signs, such as thought disorder, could predict the subsequent manifestation of psychiatric disorders. A group of 75 adoptees at high genetic risk for schizophrenia and 96 low-risk adoptees without any psychiatric disorder at the initial assessment were assessed blindly with the Thought Disorder Index (TDI). Their psychiatric status was re-assessed according to DSM-III-R criteria in a re-interview 11 years later and based on available registers 16 years later. High scores on several TDI variables at the initial assessment predicted a psychiatric disorder of all adoptees at follow-up. Prediction was statistically unsuccessful among the high-risk adoptees because of the small number of cases, but high scores at the 0.50 severity level did predict mental disorders among the low-risk adoptees.
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Affiliation(s)
- Miia Metsänen
- Päijät-Häme Central Hospital, Keskussairaalankatu 7, FIN-15850 Lahti, Finland.
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Harrow M, Jobe TH, Herbener ES, Goldberg JF, Kaplan KJ. Thought disorder in schizophrenia: working memory and impaired context. J Nerv Ment Dis 2004; 192:3-11. [PMID: 14718770 DOI: 10.1097/01.nmd.0000105994.78952.b6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This research was designed to provide data on whether thought disorder in schizophrenia patients is due to difficulty in holding external stimuli or the external context online in working memory. We assessed 231 early phase acute inpatients, including 68 schizophrenic patients and 38 bipolar manic patients. Patients were administered a thought disorder test that requires holding stimuli online in working memory as they respond and another in which the stimuli is in direct view of the patients throughout the test procedure. The results indicated that patients who were thought disordered on the test requiring holding the external stimuli online in memory also were more thought disordered on the test that provides full vision of the stimuli throughout the testing (p < 0.001). Thus, schizophrenia patients vulnerable to thought disorder show thought disorder regardless of whether or not they are required to hold the stimuli online in memory. Overall, the data did not support the formulation that thought disorder is primarily a consequence of failure to hold external stimuli or contextual material online in working memory. An alternate view of thought disorder is presented.
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Affiliation(s)
- Martin Harrow
- Department of Psychiatry MC 912, University of Illinois at Chicago, 1601 West Taylor St, Chicago, IL 60612, USA
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43
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Harrow M, O'Connell EM, Herbener ES, Altman AM, Kaplan KJ, Jobe TH. Disordered verbalizations in schizophrenia: a speech disturbance or thought disorder? Compr Psychiatry 2003; 44:353-9. [PMID: 14505295 DOI: 10.1016/s0010-440x(03)00113-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This research provides empirical data relevant to the long-standing theoretical issue of whether disordered speech in schizophrenia should be viewed as a speech disturbance or a thought disorder. The study analyzed whether schizophrenia patients with disordered speech on one test also show strange nonverbal behavior and unrealistic ideas on other assessments. One hundred eighty-four patients, including 55 schizophrenia patients, were assessed at the acute phase and followed up twice, over 4.5 years. Patients were assessed (1) with a standardized measure that can elicit disordered speech, (2) with a different measure that can elicit an atypical sorting of objects and an intermingling of personal ideas, and (3) for delusions (unrealistic thinking). Schizophrenia patients with disordered speech on the Proverbs Test also (1) sorted objects strangely on the Object Sorting Test (P <.05), (2) showed an intermingling of personal ideas into their thinking (P <.01), and (3) had delusional ideas when assessed at two successive follow-ups over a multiyear period (P <.001). The data suggest that most schizophrenia patients and other psychotic patients with disordered speech also show strange nonverbal behavior and unrealistic ideas/beliefs. These data support a theoretical framework in which disordered speech in schizophrenia and other types of psychotic patients is viewed as not just due to a speech disorder, but is often part of a broader constellation that includes gross reality distortions, strange behavior and ideas, and disordered thinking.
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Affiliation(s)
- Martin Harrow
- Department of Psychiatry, University of Illinois College of Medicine, Chicago 60612, USA
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Liddle PF, Ngan ETC, Caissie SL, Anderson CM, Bates AT, Quested DJ, White R, Weg R. Thought and Language Index: an instrument for assessing thought and language in schizophrenia. Br J Psychiatry 2002; 181:326-30. [PMID: 12356660 DOI: 10.1192/bjp.181.4.326] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Subtle formal thought disorders are difficult to quantify. Their relationship to florid thought disorder is unknown. AIMS To assess the interrater reliability, sensitivity and factor structure of a new assessment instrument, the Thought and Language Index (TLI), and to determine if minor aberrations detectable in the speech of healthy individuals are related to the more severe formal thought disorders characteristic of schizophrenia. METHOD Interrater reliability was evaluated by determining the intraclass correlation for the ratings by five assessors. Factor analysis of the TLI scores of 87 patients was performed, and TLI scores in matched patients and controls were compared. RESULTS The intraclass correlation was good for individual TLI items, and excellent for sub-scale scores. Factor analysis identified three groups of approximately orthogonal disorders. Mild speech aberrations were observed in healthy participants and in patients with schizophrenia. The prevalence of mild aberrations was correlated with the prevalence of definite formal thought disorders. CONCLUSIONS The TLI is reliable and capable of detecting subtle disorders. Some mild aberrations occurring in the speech of healthy individuals appear to be attenuated forms of the florid disorders characteristic of schizophrenia.
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Bates AT, Kiehl KA, Laurens KR, Liddle PF. Error-related negativity and correct response negativity in schizophrenia. Clin Neurophysiol 2002; 113:1454-63. [PMID: 12169328 DOI: 10.1016/s1388-2457(02)00154-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To examine error-related negativity (ERN) and correct response negativity (CRN) in schizophrenia in light of two previous conflicting reports, and to determine their relation to disorganization, psychomotor poverty and reality distortion. METHODS Event-related potentials were recorded from 21 schizophrenic and 21 control participants who performed a simple go/no-go task. Response-locked potentials were computed for errors of commission and for correct-hits. Scores for reality distortion syndrome, psychomotor poverty syndrome and disorganization syndrome were determined for each schizophrenic participant using the Signs and Symptoms of Psychotic Illness (SSPI) scale. RESULTS ERN produced during error trials and CRN produced during correct trials were significantly larger in the control participant group than in the schizophrenic participant group. In the schizophrenic patients, ERN amplitude was negatively correlated with psychomotor poverty syndrome score and CRN amplitude was negatively correlated with disorganization syndrome score. CONCLUSIONS Decreased ERN and CRN in the schizophrenic participant group suggests abnormal internal behavior monitoring in schizophrenic patients. Patients with high disorganization symptoms may employ an abnormal strategy for comparing actual response outcome with desired response outcome, while patients with psychomotor poverty may be less emotionally responsive to errors.
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Affiliation(s)
- Alan T Bates
- Department of Psychiatry, University of British Columbia, BC, Vancouver, Canada
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46
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Kerns JG, Berenbaum H. Cognitive impairments associated with formal thought disorder in people with schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2002. [DOI: 10.1037/0021-843x.111.2.211] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Stratta P, Daneluzzo E, Bustini M, Prosperini P, Rossi A. Processing of context information in schizophrenia: relation to clinical symptoms and WCST performance. Schizophr Res 2000; 44:57-67. [PMID: 10867312 DOI: 10.1016/s0920-9964(99)00142-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Failure in contextual information processing has been hypothesized as being the single function responsible for several impairments in cognitive tasks and symptoms, through an involvement of the prefrontal cortex, in patients with schizophrenia. A variant of the Continuous Performance Test (CPT) designed specifically to elicit deficits in the processing of contextual information has been administered to 20 schizophrenic patients and 20 healthy controls. The relation to Wisconsin Card Sorting Test (WCST), relatively specific to prefrontal damage and executive dysfunctioning, and clinical status by using scales for the assessment of positive, negative symptoms and outcome has been investigated. The data show that multi-episode schizophrenic patients manifest inability to use contextual information to inhibit habitual response to an ambiguous stimulus and to maintain information across delay, without a general attention deficit. We also found a relationship between contextual reasoning and WCST unique errors, hallucinations, formal thought disorders, and outcome evaluation. Our results further support the hypothesis that the deficit of contextual reasoning could account for cognitive impairments and symptoms of patients with schizophrenia.
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Affiliation(s)
- P Stratta
- Department of Psychiatry, S. Salvatore Hospital, L'Aquila, Italy
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48
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Abstract
OBJECTIVE There is little systematic evidence to determine if patients with thought disorder are aware of their impaired communication. Awareness versus unawareness of deficit has important implications for neurocognitive models of thought disorder. The aims of this study were to assess awareness of impaired communication in patients prone to thought disorder, and to explore associations between degree of awareness of thought disorder, objective measurement of thought disorder and performance on tests sensitive to impaired executive ability. METHOD Thirty-one patients with schizophrenia, 16 patients with mania and 20 well controls were included. Subjects completed a new instrument to assess awareness of thought disorder, the Communication Awareness Scale (CAS). Thought disorder was rated from free speech samples scored with Andreasen's Scale for the Assessment of Thought Language and Communication. Four tests sensitive to impaired executive ability were administered. RESULTS Subjects with higher levels of positive thought disorder had significantly higher CAS scores. Unexpectedly, those with lower scores on executive ability had significantly higher scores on the CAS. CONCLUSIONS The significant correlation between objective levels of positive thought disorder and higher scores on the CAS suggests that, overall, patients with thought disorder are aware of their deficit. A neurocognitive model of thought disorder is described that involves a dissociation between the ability to monitor errors (required for accurate awareness of deficit) and the ability to correct errors (required for the production of efficient communication).
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Affiliation(s)
- J McGrath
- Queensland Centre for Schizophrenia Research, Wolston Park Hospital, Wacol, Australia.
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49
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Pantelis C, Barber FZ, Barnes TR, Nelson HE, Owen AM, Robbins TW. Comparison of set-shifting ability in patients with chronic schizophrenia and frontal lobe damage. Schizophr Res 1999; 37:251-70. [PMID: 10403197 DOI: 10.1016/s0920-9964(98)00156-x] [Citation(s) in RCA: 275] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuropsychological studies of patients with schizophrenia have consistently identified deficits on tests sensitive to frontal lobe function. One paradigm that has been widely used is that of attentional set-shifting using the Wisconsin Card Sorting Test (WCST). In the present study, patients with chronic schizophrenia and with frontal lobe lesions were assessed on a computerised set-shifting task that provides a componential analysis of the WCST by distinguishing between intra-dimensional and extra-dimensional set-shifting. Out of 51 patients with schizophrenia, those with high IQ (n =24) were compared with patients with lesions in prefrontal cortex (n = 22) and with normal control subjects (n= 18). These three groups were well matched for age, sex and National Adult Reading Test (NART) IQ. The schizophrenic group showed a significantly higher rate of attrition at the intra-dimensional shift stage of learning compared with the other two groups. At the extra-dimensional shift stage, both the schizophrenic and frontal lesioned groups showed greater attrition than controls. Further, patients with schizophrenia who were able to learn the intradimensional reversal stage required more trials and made significantly more errors at that stage than the other two groups. In comparison with high IQ patients with schizophrenia, those with low IQ performed at a lower level but showed a qualitatively similar pattern of performance, providing further evidence that the set-shifting deficits were not simply explained by any global intellectual decline. Patients with schizophrenia who dropped out at the extradimensional shift stage had higher negative symptom scores compared with patients dropping out at previous learning stages, while patients failing at the intra-dimensional shift stage had lower scores for bradyphrenia (slowness of thought). The results suggest that patients with chronic schizophrenia fail to 'learn set' and are impaired at both set-shifting and concept formation. The relevance of these findings to understanding the nature of prefrontal cortical deficits in chronic schizophrenia is discussed. The implication of these findings to the rehabilitation of these patients is considered.
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Affiliation(s)
- C Pantelis
- Department of Psychiatry, The University of Melbourne, Parkville, Australia.
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Abstract
Despite accumulating evidence that patients with schizophrenia perform poorly in mentalising tasks, doubts remain about the primacy of the role played by defective mentalising in schizophrenia. This study investigated the relationship between mentalising ability and self-reported schizotypal traits in non-clinical adults who reported no history of psychiatric illness in order to test two counter-proposals: (1) defective mentalising is a primary cause of psychotic symptoms in schizophrenia; and (2) defective mentalising in schizophrenia is a secondary consequence of the chronic asociality that is typical of general psychiatric illness. Mentalising ability was tested using a false-belief picture sequencing task that has been used elsewhere to demonstrate poor mentalising in patients with schizophrenia. Evidence of selective mentalising deficits in high schizotypal non-clinical subjects discounted the view that defective mentalising is restricted to psychiatric illness and strengthened the case for continuity models of psychosis-proneness. Furthermore, evidence that poor mentalisers in the normal population are more likely to self-report psychotic-like traits, as well as asocial or idiosyncratic behaviours, refuted suggestions that defective mentalising is linked solely to asocial symptomatology and supported the view that defective mentalising may have a fundamental role to play in the explanation of psychotic symptoms. In order to specify what that role might be, alternative theoretical accounts of defective mentalising were tested. Neither executive planning deficits nor failure to inhibit cognitively salient inappropriate information could adequately explain the pattern of selective mentalising deficits found in high schizotypal non-clinical subjects. Our findings suggest that there exists a domain-specific cognitive module that is dedicated to inferring and representing mental states which, when dysfunctional, causes defective mentalising that manifests phenomenologically in psychotic-like traits and impoverished social awareness of variable expression and ranging severity.
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Affiliation(s)
- R Langdon
- Department of Psychology, Macquarie University, Sydney, NSW, Australia.
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