Word use in first-person accounts of schizophrenia

Grammatical impairment in schizophrenia: An exploratory study of the pronominal and sentential domains

Schizophrenia (SZ) is a severe mental disorder associated with a variety of linguistic deficits, and recently it has been suggested that these deficits are caused by an underlying impairment in the ability to build complex syntactic structures and complex semantic relations. Aiming at contributing to determining the specific linguistic profile of SZ, we investigated the usage of pronominal subjects and sentence types in two corpora of oral dream and waking reports produced by speakers with SZ and participants without SZ (NSZ), both native speakers of Brazilian Portuguese. Narratives of 40 adult participants (20 SZ, and 20 NSZ-sample 1), and narratives of 31 teenage participants (11 SZ undergoing first psychotic episode, and 20 NSZ-sample 2) were annotated and statistically analyzed. Overall, narratives of speakers with SZ presented significantly higher rates of matrix sentences, null pronouns-particularly null 3Person referential pronouns-and lower rates of non-anomalous truncated sentences. The high rate of matrix sentences correlated significantly with the total PANSS scores, suggesting an association between the overuse of simple sentences and SZ symptoms in general. In contrast, the high rate of null pronouns correlated significantly with positive PANSS scores, suggesting an association between the overuse of null pronominal forms and the positive symptoms of SZ. Finally, a cross-group analysis between samples 1 and 2 indicated a higher degree of grammatical impairment in speakers with multiple psychotic episodes. Altogether, the results strengthen the notion that deficits at the pronominal and sentential levels constitute a cross-cultural linguistic marker of SZ.

Clues from caregiver emotional language usage highlight the link between putative social environment and the psychosis-risk syndrome

Familial emotional word usage has long been implicated in symptom progression in schizophrenia. However, few studies have examined caregiver emotional word usage prior to the onset of psychosis, among those with a clinical high-risk (CHR) syndrome. The current study examined emotional word usage in a sample of caregivers of CHR individuals (N = 37) and caregivers of healthy controls (N = 40) and links with clinical symptoms in CHR individuals. Caregivers completed a speech sample task in which they were asked to speak about the participant; speech samples were then transcribed and analyzed for general positive (e.g. good) and negative (e.g., worthless) emotional words as well as words expressing three specific negative emotions (i.e., anxiety, anger, and sadness) using Linguistic Inquiry and Word Count (LIWC). Findings indicated that (1) CHR caregivers used more negative and anxiety words compared to control caregivers; and (2) less positive word usage among CHR caregivers were related to more positive symptomatology among CHR individuals. These findings point toward the utility of automated language analysis in assessing the intersections between caregiver emotional language use and psychopathology.

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

Technological advances in artificial intelligence and natural language processing have increased efficiency of assessing speech content and speech organization in schizophrenia. Despite these developments, there has been little focus on the psychometrics of these approaches. Using two common assessments, the current study addressed this gap by: 1) measuring test-retest reliability; and 2) assessing whether speech content and/or speech organization generalize across demographics. To test these aims, we examined psychometric properties of the Linguistic Inquiry Word Count (LIWC), a speech content measure, and the Coh-Metrix, a speech organization measure. Across baseline to six month (n = 101) and baseline to one year (n = 47) narrative speech samples, we generally observed fair reliability for speech content measures and fair to good reliability for speech organization measures. Regarding demographics, multiple speech indices varied by race, income, and education. The lack of excellent reliability scores for speech indices holds important implications for examining speech variables in clinical trials and highlights the dynamic nature of speech. This work illustrates the importance of designing speech content and speech organization measures with external validity across demographic factors. Future studies examining speech in schizophrenia should account for potential biases against demographic groups introduced by linguistic analysis tools.

Construing journeys to recovery from psychosis: A qualitative analysis of first-person accounts

PURPOSE

To perform a qualitative analysis of the factors that were construed as salient in facilitating the process of recovery in the narratives of people with psychosis who had their first-person accounts (FPAs) published in an academic journal.

METHODS

Computerized textual analysis was undertaken of 156 FPAs written by persons who had experienced psychosis and published in the Schizophrenia Bulletin between 1979 and 2020. Constructs were extracted from the FPAs and coded in terms of Mental health treatment and therapy, Self-management and Multiple factors; recovery processes (Connectedness, Hope, Identity, Meaning and Empowerment), Struggles and Turning points.

RESULTS

Psychosis impacted on individuals in profound and diverse ways. This was reflected in the different pathways to recovery included in the FPAs. Underlying the different pathways was the salience of re-engagement in the shared reality of others; development of a cohesive and positive self; empowerment through the use of self-management strategies, and making sense of experience through reconstruing what was meaningful. Personal constructs identified in the FPAs provided insight into both challenges faced and alternative avenues of movement that were perceived as available.

CONCLUSIONS

Processes that support individuals re-engaging with the shared reality of others are central to recovery. Supportive relationships and fostering open dialogue were consistent themes across the different pathways that recovery journeys took. Establishing a meaningful lifestyle and recovering a positive sense of identity were a key challenge following psychosis onset. Appreciation of experiences contained in FPAs has the potential to enhance the effectiveness and humanity of mental health care.

Basic self-disturbance in schizotypy

AIM

Phenomenological researchers argue that schizophrenia spectrum disorders are primarily disorders of the basic self. To test this argument, we compared self-report and lexical measures of basic self-disturbance between schizophrenia spectrum (high-schizotypy) and non-spectrum groups (low-schizotypy).

METHODS

From an initial sample (n = 310) screened with the (SPQ), n = 39 were classified as high schizotypy (z > 1.28 on at least one SPQ factor scale) and were compared to a randomly selected low-schizotypy group (z < 1 on all three SPQ factor scales; n = 41). Participants wrote four narratives about personal and fictional experiences and completed the Ego Strength Questionnaire and a self-report version of the Schizophrenia Proneness Instrument. The written narratives were subjected to linguistic inquiry to examine pronoun usage (lexical measures).

RESULTS

The high-schizotypy group reported higher levels of basic symptoms, lower ego strength, and used third-person and personal pronouns more frequently than the low-schizotypy group. Self-report measures correlated significantly with lexical measures. Self-report and lexical measures were useful tools in predicting high schizotypy, correctly classifying 68% and 69% of schizotypy and non-schizotypy, respectively.

CONCLUSION

In line with phenomenologists' arguments, high schizotypy was associated, to some extent, with basic self-disturbance.

Schizophrenia Detection Using Machine Learning Approach from Social Media Content

Schizophrenia is a severe mental disorder that ranks among the leading causes of disability worldwide. However, many cases of schizophrenia remain untreated due to failure to diagnose, self-denial, and social stigma. With the advent of social media, individuals suffering from schizophrenia share their mental health problems and seek support and treatment options. Machine learning approaches are increasingly used for detecting schizophrenia from social media posts. This study aims to determine whether machine learning could be effectively used to detect signs of schizophrenia in social media users by analyzing their social media texts. To this end, we collected posts from the social media platform Reddit focusing on schizophrenia, along with non-mental health related posts (fitness, jokes, meditation, parenting, relationships, and teaching) for the control group. We extracted linguistic features and content topics from the posts. Using supervised machine learning, we classified posts belonging to schizophrenia and interpreted important features to identify linguistic markers of schizophrenia. We applied unsupervised clustering to the features to uncover a coherent semantic representation of words in schizophrenia. We identified significant differences in linguistic features and topics including increased use of third person plural pronouns and negative emotion words and symptom-related topics. We distinguished schizophrenic from control posts with an accuracy of 96%. Finally, we found that coherent semantic groups of words were the key to detecting schizophrenia. Our findings suggest that machine learning approaches could help us understand the linguistic characteristics of schizophrenia and identify schizophrenia or otherwise at-risk individuals using social media texts.

Natural language processing methods are sensitive to sub-clinical linguistic differences in schizophrenia spectrum disorders

Computerized natural language processing (NLP) allows for objective and sensitive detection of speech disturbance, a hallmark of schizophrenia spectrum disorders (SSD). We explored several methods for characterizing speech changes in SSD (n = 20) compared to healthy control (HC) participants (n = 11) and approached linguistic phenotyping on three levels: individual words, parts-of-speech (POS), and sentence-level coherence. NLP features were compared with a clinical gold standard, the Scale for the Assessment of Thought, Language and Communication (TLC). We utilized Bidirectional Encoder Representations from Transformers (BERT), a state-of-the-art embedding algorithm incorporating bidirectional context. Through the POS approach, we found that SSD used more pronouns but fewer adverbs, adjectives, and determiners (e.g., "the," "a,"). Analysis of individual word usage was notable for more frequent use of first-person singular pronouns among individuals with SSD and first-person plural pronouns among HC. There was a striking increase in incomplete words among SSD. Sentence-level analysis using BERT reflected increased tangentiality among SSD with greater sentence embedding distances. The SSD sample had low speech disturbance on average and there was no difference in group means for TLC scores. However, NLP measures of language disturbance appear to be sensitive to these subclinical differences and showed greater ability to discriminate between HC and SSD than a model based on clinical ratings alone. These intriguing exploratory results from a small sample prompt further inquiry into NLP methods for characterizing language disturbance in SSD and suggest that NLP measures may yield clinically relevant and informative biomarkers.

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

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

Language in schizophrenia and aphasia: the relationship with non-verbal cognition and thought disorder

Objective: To determine the relationship between language abnormalities and broader cognitive impairment and thought disorder by examining language and cognition in schizophrenia and aphasia (a primary language disorder).Methods: Cognitive and linguistic profiles were measured with a battery of standardised tests, and compared in a clinical population of n = 50 (n = 30 with schizophrenia and n = 20 with aphasia) and n = 61 non-clinical comparisons (n = 45 healthy controls and n = 16 non-affected first-degree relatives of patients with schizophrenia).Results: Both clinical groups showed linguistic deficits. Verbal impairment was more severe in participants with aphasia, whereas non-verbal performance was more affected in participants with schizophrenia. In schizophrenia, but not in aphasia, verbal and non-verbal performance were associated. Formal thought disorder was associated with impairment in executive function and in grammatical, but not naming, tasks.Conclusion: While patients with schizophrenia and aphasia showed language impairments, the nature and cognitive basis of these impairments may be different; language performance disassociates from broader cognitive functioning in aphasia but may be an intrinsic expression of a broader cognitive impairment in schizophrenia. Thought disorder may represent a core malfunction of grammatical processing. Results suggests that communicative ability may be a valid target in cognitive remediation strategies in schizophrenia.

Differential Valuation and Learning From Social and Nonsocial Cues in Borderline Personality Disorder

BACKGROUND

Volatile interpersonal relationships are a core feature of borderline personality disorder (BPD) and lead to devastating disruption of patients' personal and professional lives. Quantitative models of social decision making and learning hold promise for defining the underlying mechanisms of this problem. In this study, we tested BPD and control subject weighting of social versus nonsocial information and their learning about choices under stable and volatile conditions. We compared behavior using quantitative models.

METHODS

Subjects (n = 20 BPD, n = 23 control subjects) played an extended reward learning task with a partner (confederate) that requires learning about nonsocial and social cue reward probability (the social valuation task). Task experience was measured using language metrics: explicit emotions/beliefs, talk about the confederate, and implicit distress (using the previously established marker self-referentiality). Subjects' weighting of social and nonsocial cues was tested in mixed-effect regression models. Subjects' learning rates under stable and volatile conditions were modeled (Rescorla-Wagner approach) and group × condition interactions tested.

RESULTS

Compared to control subjects, BPD subject debriefings included more mentions of the confederate and less distress language. BPD subjects also weighted social cues more heavily but had blunted learning responses to (nonsocial and social) volatility.

CONCLUSIONS

This is the first report of patient behavior in the social valuation task. The results suggest that BPD subjects expect higher volatility than control subjects. These findings lay the groundwork for a neurocomputational dissection of social and nonsocial belief updating in BPD, which holds promise for the development of novel clinical interventions that more directly target pathophysiology.

The language profile of formal thought disorder

Formal thought disorder (FTD) is clinically manifested as disorganized speech, but there have been only few investigations of its linguistic properties. We examined how disturbance of thought may relate to the referential function of language as expressed in the use of noun phrases (NPs) and the complexity of sentence structures. We used a comic strip description task to elicit language samples from 30 participants with schizophrenia (SZ), 15 with moderate or severe FTD (SZ + FTD), and 15 minimal or no FTD (SZ−FTD), as well as 15 first-degree relatives of people with SZ (FDRs) and 15 neurotypical controls (NC). We predicted that anomalies in the normal referential use of NPs, sub-divided into definite and indefinite NPs, would identify FTD; and also that FTD would also be linked to reduced linguistic complexity as specifically measured by the number of embedded clauses and of grammatical dependents. Participants with SZ + FTD produced more referential anomalies than NC and produced the fewest definite NPs, while FDRs produced the most and thus also differed from NC. When referential anomalies were classed according to the NP type in which they occurred, the SZ + FTD group produced more anomalies in definite NPs than NC. Syntactic errors did not distinguish groups, but the SZ + FTD group exhibited significantly less syntactic complexity than non-SZ groups. Exploratory regression analyses suggested that production of definite NPs distinguished the two SZ groups. These results demonstrate that FTD can be identified in specific grammatical patterns which provide new targets for detection, intervention, and neurobiological studies.

Using lexical analysis to identify emotional distress in psychometric schizotypy

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

Deictic and Propositional Meaning-New Perspectives on Language in Schizophrenia

Emerging linguistic evidence points at disordered language behavior as a defining characteristic of schizophrenia. In this article, we review this literature and demonstrate how a framework focusing on two core functions of language-reference and propositional meaning-can conceptualize schizophrenic symptoms, identify important variables for risk assessment, diagnosis, and treatment, and inform cognitive behavioral therapy and other remedial approaches. We introduce the linguistic phenomena of deictic anchoring and propositional complexity, explain how they relate to schizophrenic symptoms, and show how they can be tracked in language behavior.

Determining the effectiveness of the third person interview in the level of insight psychotic patients

The goal of this study was to determine the effectiveness of the third person interview in increasing the level of insight and cooperation in psychotic patients. We used a quasi-experimental posttest design with an alternative method group. A number of 40 individuals with a definite diagnosis of psychosis were selected using a simple random sampling, and were put randomly in an experimental group (third person interview) and an alternative control group (clinical interview). The results indicated that using the third person interview, the insight level of the psychotic patients increased in all dimensions of insight, except awareness of flat or blunted affect and awareness of unsociability. The results of the independent t-test samples showed no significant difference in cooperation between the two groups of psychotic patients. It seems that the ability to consider one's mental viewpoint from other's, is dependent on the relative ability of psychotic patients to represent other's mental states (theory of mind). But, psychotic patients have severe impairment in the ability to represent their own mental states, resulting in an impairment in the recognition of their mental disorder, psychotic symptoms, the need for therapy, and social consequences of their mental disorder.

Language and hope in schizophrenia-spectrum disorders

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Third-person Diagnostic Interview on the Cognitive Insight Level of Psychotic Patients with an Insight at the Denial Level

OBJECTIVES

According to the previous findings, the third-person technique improved the clinical insight of psychotic patients, therefore the present study aims to examine the effect of a third-person interview compared to a first-person interview on the level of cognitive insight of psychotic patients with an insight at the denial level.

MATERIALS AND METHODS

In this study, using interviews and questionnaires, a total number of 44 patients of Razi Psychiatric Educational and Treatment Center with an insight at the denial level being assessed using diagnostic interviews were divided randomly into two groups. Then, the two groups of patients' cognitive insights were evaluated using Beck Cognitive Insight Scale.

RESULTS

The findings indicated that in psychotic patients with an insight at the denial level, the third-person technique of interview compared to the first-person had little effect on the improvement of overall cognitive insight and its components, including self-reflection and self-assurance; however, this effect was not strong enough to make a significant difference between the two groups of patients.

CONCLUSION

According to the study findings, we can conclude that the third-person interview compared to the first-person interview has no effect on the improvement of the cognitive insight of psychotic patients with an insight at the denial level. This finding is consistent with the previous studies indicating that although the theory of mind has some correlations with the clinical insight of patients, it has no effect on their cognitive insight.

First-person Pronoun Use in Spoken Language as a Predictor of Future Depressive Symptoms: Preliminary Evidence from a Clinical Sample of Depressed Patients

Several theories suggest that self-focused attention plays an important role in the maintenance of depression. However, previous studies have predominantly relied on self-report and laboratory-based measures such as sentence completion tasks to assess individual differences in self-focus. We present a prospective, longitudinal study based on a sample of 29 inpatients with clinical depression, investigating whether an implicit, behavioural measure of self-focused attention, i.e., the relative frequency of first-person singular pronouns in naturally spoken language, predicts depressive symptoms at follow-up over and above initial depression. We did not find a significant cross-sectional association between depressive symptoms and first-person singular pronoun use. However, first-person singular pronoun use significantly predicted depressive symptoms approximately 8 months later, even after controlling for depressive symptoms at baseline or discharge. Exploratory analyses revealed that this effect was mainly driven by the use of objective and possessive self-references such as 'me' or 'my'. Our findings are in line with theories that highlight individual differences in self-focused attention as a predictor of the course of depression. Moreover, our findings extend previous work in this field by adopting an unobtrusive approach of non-reactive assessment, capturing naturally occurring differences in self-focused attention. We discuss possible clinical applications of language-based assessments and interventions with regard to self-focus. Copyright © 2016 John Wiley & Sons, Ltd.

KEY PRACTITIONER MESSAGE

Naturally occurring individual differences in first-person singular pronoun use provide an unobtrusive way to assess patients' automatic self-focused attention. Frequent use of first-person singular pronouns predicts an unfavourable course of depression. Self-focused language might offer innovative ways of tracking and targeting therapeutic change.

A Hierarchical Generative Framework of Language Processing: Linking Language Perception, Interpretation, and Production Abnormalities in Schizophrenia

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.

Invited commentary on . . . Word use in first-person accounts of schizophrenia

The use of pronouns and causal attributions in personal accounts has been analysed to distinguish between schizophrenia and mood disorders. The implications for both cognitive processing and the underlying pathology of symptoms are explored. Context is identified as a key variable in the analysis and interpretation of text.