Stability of formal thought disorder and referential communication disturbances in schizophrenia

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.     

Neurophysiological evidence for disturbances of conflict processing in patients with schizophrenia

Deficits in cognition are a hallmark of schizophrenia. In the present study, the authors investigated the effects of schizophrenia on the neural correlates of conflict processing in a single-trial version of the Stroop task by using event-related brain potentials. Relative to matched controls, patients with schizophrenia showed increased Stroop interference in response time, but this effect was eliminated when the effect of response slowing was controlled. In controls, conflict processing was associated with a negative wave peaking between 400 and 500 ms (N450) and conflict sustained potential (SP) peaking between 600 and 800 ms after stimulus onset. In patients with schizophrenia, the amplitude of the N450 was significantly attenuated and the conflict SP was absent. These results provide evidence for the existence of altered neural processes associated with conflict processing that may be associated with dysfunction of the anterior cingulate and prefrontal cortex in patients with schizophrenia.     

An innovative approach to clinical communication in schizophrenia: the approaches to schizophrenia communication checklists

Side effects from antipsychotic medications can have a profound effect on patients' lives and may adversely affect their willingness to comply with treatment. Identification of side effects through improved communication between psychiatrists, other members of the healthcare team, and their patients might increase treatment compliance. The Approaches to Schizophrenia Communication (ASC) Steering Group developed two simple, practical checklists for use in the busy clinical setting. The ASC-Self-Report (ASC-SR) checklist is completed by the patient and comprises a list of the more common or clinically important side effects of antipsychotic treatment. The ASC-Clinic (ASC-C) checklist is completed by both clinician and patient together, being used as the basis for a semi-structured interview. In a multicenter pilot study set up to evaluate the utility of checklists, 86% of patients responding considered the ASC-SR to be useful in communicating their problems to psychiatrists and other members of the healthcare team. All healthcare team respondents found both checklists to be helpful when discussing side effect problems with their patients. Moreover, 41% and 47% of healthcare team respondents reported that the ASC-SR and ASC-C, respectively, had assisted them in identifying side-effect problems not previously acknowledged. Preliminary evaluation of the ASC-SR and ASC-C in this multicenter pilot study suggests that both tools were user-friendly, encouraged communication between patients and healthcare professionals about antipsychotic drug side effects, and could readily integrated into everyday clinical practice.     

Private and inner speech and the regulation of social speech communication

To further investigate the possible regulatory role of private and inner speech in the context of referential social speech communications, a set of clear and systematically applied measures is needed. This study addresses this need by introducing a rigorous method for identifying private speech and certain sharply defined instances of inaudible inner speech. Using this classification system, longitudinal data were gathered from 10 pairs of children performing a referential communication task at 4.5, 6.5, and 8.5 years of age. Results demonstrated children's substantial production of private and inner speech in this communicative situation, with speech forms varying in amount and type as a function of age, communicative role (speaker or listener), and the complexity of the material to be communicated. It is suggested that private and inner speech embedded in discourse may serve a regulatory role in social speech communication.     

Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder.     

Video-based assessment of interpersonal problem solving skills in patients with schizophrenia, their siblings and non-psychiatric controls

The aim of this study was to analyze social functioning in patients with schizophrenia and their biological relatives with a Swedish version of the video-based vignette test Assessment of Interpersonal Problem Solving Skills (AIPSS). In a new video production with simulated "real life" situations we tested the ability to receive, process and send social information in 25 individuals with a DSM-IV diagnosis of schizophrenia, 20 siblings to patients with schizophrenia and 25 randomly selected non-psychiatric controls. The test proved to have good validity and interrater reliability. After controlling for positive or negative symptoms, patients had poor performance especially in acting out solutions leading to effective problem solving. Siblings generally did not differ from controls, but showed some deficiencies in non-verbal language. To conclude, AIPSS is appropriate for use in a Swedish-speaking context and might be useful in research on vulnerability indicators and in assessment of treatment interventions.     

Referential communication abilities of learning-disabled, language-learning-disabled, and normal school-age children

Past research in referential communication has indicated normally developing children show developmental progression in ability to communicate a specific referent to a listener. In one paradigm subjects were given lists of word-pairs in which one member of each pair was designated as the referent. It was shown that communicating about referents found in word-pairs associated in some way was more difficult than communicating about referents in dissimilar word-pairs. The present study extended this methodology to learning-disabled children. Learning-disabled, language-learning-disabled, and normally achieving children were asked to communicate about 30 pictured referents on three different tasks. On Tasks 1 and 2 each subject was asked to give a clue for the referent that would distinguish it from the other picture. Stimuli for Task 1 were 30 pairs of pictures that were related in some way and the stimuli for Task 2 were 30 pairs of unrelated pictures. Task 3 required the subjects to evaluate the adequacy of the examiner's clues for Task 1 stimuli. The disabled subjects were matched to the normally achieving subjects on the basis of receptive vocabulary age. Few differences were noted among the groups' performances on these referential communication tasks. Implications include the importance of vocabulary and concept development to referential communication.     

Understanding the abstract role of speech in communication at 12 months

Adult humans recognize that even unfamiliar speech can communicate information between third parties, demonstrating an ability to separate communicative function from linguistic content. We examined whether 12-month-old infants understand that speech can communicate before they understand the meanings of specific words. Specifically, we test the understanding that speech permits the transfer of information about a Communicator's target object to a Recipient. Initially, the Communicator selectively grasped one of two objects. In test, the Communicator could no longer reach the objects. She then turned to the Recipient and produced speech (a nonsense word) or non-speech (coughing). Infants looked longer when the Recipient selected the non-target than the target object when the Communicator had produced speech but not coughing (Experiment 1). Looking time patterns differed from the speech condition when the Recipient rather than the Communicator produced the speech (Experiment 2), and when the Communicator produced a positive emotional vocalization (Experiment 3), but did not differ when the Recipient had previously received information about the target by watching the Communicator's selective grasping (Experiment 4). Thus infants understand the information-transferring properties of speech and recognize some of the conditions under which others' information states can be updated. These results suggest that infants possess an abstract understanding of the communicative function of speech, providing an important potential mechanism for language and knowledge acquisition.     

Understanding anhedonia in schizophrenia through lexical analysis of natural speech

Anhedonia is a negative prognostic indicator in schizophrenia. However, the underlying nature of this emotional deficit is unclear. Laboratory studies examining patients’ emotional reactions under controlled circumstances have failed to find evidence for a diminished hedonic response, instead finding that patients’ reactions to laboratory stimuli are characterised by high levels of negative emotion. The present study employed lexical analysis of natural speech in 52 patients and 49 non-patient controls while they discussed separate neutral, pleasant and unpleasant autobiographical memories. Patients with clinically rated anhedonia, versus other patients and controls, showed a dramatic increase in negative emotion expression when discussing pleasurable memories, but they showed no corresponding decrease in positive emotion. These findings provide further evidence that “anhedonia” is more reflective of negative emotional states than the absence of positive ones. These findings also raise questions about how positive and negative emotions can be simultaneously co-activated in patients with schizophrenia.     

Oculomotor delayed response abnormalities in young offspring and siblings at risk for schizophrenia

Individuals with schizophrenia are know to demonstrate cognitive and behavioral difficulties, particularly alterations in executive functions, including working memory. It is unclear whether these deficits reflect trait-related vulnerability to schizophrenia indicators and can be assessed by studying nonpsychotic relatives of patients with schizophrenia. In this study, we used an oculomotor delayed response (ODR) paradigm to examine spatial working memory in 37 "high-risk" child and adolescent offspring and siblings (age range=6-25 years) of patients with schizophrenia or schizoaffective disorder. Compared with 37 age- and sex-matched healthy controls (age range=6-23 years), high-risk subjects showed nonsignificantly greater errors in the ODR task at longer delay intervals. Statistical analyses suggested that performance improved with age in healthy control subjects, whereas it worsened with age in high-risk subjects. In both groups, the ODR errors were generally associated with poorer sustained attention (Continuous Performance Test: visuospatial d prime), somewhat poorer executive function (Wisconsin Card Sorting Test), and elevated Heinrichs-Buchanan neurological soft signs scores. These findings indicate the presence of spatial working memory abnormalities in individuals at risk for schizophrenia. Furthermore, these abnormalities may be progressive in nature. The ODR task is a valuable indicator of prefrontal cortical function and spatial working memory and may be a potentially valuable marker for familial risk of schizophrenia.     

From paraphasia through speech disorders to disconnected thinking in schizophrenia]

The author considers paraphrasia to be the principle of the pathophysiology of the nervous system and the clinical manifestations of nervous and mental diseases, which he designates as a disintegrative deviation in the irradiation of nerve processes. By taking as a starting point some of the concepts of Wedensky, Jackson, Pavlov, and Uchtomsky, it would be possible to divide the disintegrative deviation into nondissolutive, dissolutive, and dominant deviations. The paper shows that it is possible to observe typical cases of disintegrative deviation at the speech level (with the necessary modifications) in connection with paraphasic forms of aphasia, the making of mistakes in speaking, and disconnectedness of though in schizophrenia (Kraepilin's derailments).     

Expressed emotion, communication deviance, and culture in families of patients with schizophrenia: a review of the literature

The aim of this article is to critically review the literature on expressed emotion (EE), communication deviance (CD), and culture in families of patients with schizophrenia. There is growing evidence that EE and CD are highly linked. Yet the two constructs together predict the development of schizophrenia and the associated symptoms better than either construct alone. In this article, the authors review data indicating that both the expression and the levels of high EE and CD vary by ethnicity. It may be especially difficult for family members to communicate coherently and in a less critical manner when focusing on patients' inability to sustain particular cultural norms and values that are endorsed by their family and ethnic background. The authors propose that more attention to the role of culture in EE and CD and greater focus on the proper assessment of these variables would further enhance our understanding of these constructs.