The development of interpersonal relationships in individuals with schizophrenia.

Three research assistants developed 2-week-long relationships with 15 patients with schizophrenia hospitalized at an inpatient psychiatric facility. Research assistants were assigned to no more than six patients during any one 2-week period. At the beginning and end of each 2-week relationship period, interactions between research assistants and patients were videotaped, and research assistants' negative and positive responses to patients were measured. Interaction partners' negative responses to patients increased over time. There were stable individual differences among patients in the degree to which they were liked by the research assistants and in how frequently research assistants made negative comments about patients. There were individual differences among research assistants in the degree to which they responded positively to patients. Patient strangeness and lack of pleasant conversational content were associated with the negative responses of research assistants.

A twin study of alexithymia.

BACKGROUND: Factors contributing to the development of alexithymia and the nature of alexithymia's relation with trait negative and positive affectivity are unclear. In this study, a twin approach was used to examine the degree of genetic and environmental contributions to the different facets of alexithymia, and the nature of their relations to trait negative and positive affectivity. METHOD: Forty-five monozygotic and 32 same-sex dizygotic twin pairs completed the Toronto Alexithymia Scale-20, the Eysenck Personality Inventory, and a zygosity questionnaire. RESULTS: Model fitting analyses indicated that familial influences contributed significantly to all three facets of alexithymia. Parameter estimates and intraclass correlations suggested, though could not confirm, that it was shared environmental factors that contributed to difficulty identifying and communicating emotions (ID and COM), but shared genetic factors that contributed to externally oriented thinking (EOT). Between-twin cross-trait twin analyses revealed strong correlations between ID and neuroticism, and between COM and extraversion, and suggested that it is shared familial influences which account for these associations. CONCLUSIONS: The results of this study indicate that: (a) the different facets of alexithymia are influenced by familial factors; (b) the previously noted associations between ID and COM and trait affectivity are not merely methodological artifacts; and (c) the associations between ID and COM and trait affectivity are influenced by familial factors. The results also suggest that ID and COM are largely influenced by shared environmental factors, but that EOT is influenced by genetic factors.

Residential caregiver attitudes toward seriously mentally ill persons.

Previous research has found that caregiver attitudes are associated with the course of illness of seriously mentally ill (SMI) persons. This study examined whether variation in caregiver attitudes could be accounted for by (a) staff caregivers and/or (b) SMI persons. Group home staff were asked to describe each SMI group home resident and to describe the relationship they had with each resident. We recorded the number of positive and negative statements made by each staff member about each resident's character, behaviors, and the interactions staff had with them. Overall, the variation in positive staff statements about group home residents was significantly accounted for by the residents. In general, the variation in negative staff statements was significantly accounted for by staff. However, the variation in negative staff statements about the character of residents was accounted for by both staff and residents.

Aberrant semantic and affective processing in people at risk for psychosis.

Semantic and affective processing were examined in people at risk for psychosis. The participants were 3 groups of college students: 41 people with elevated Perceptual Aberration and Magical Ideation (PerMag) scores, 18 people with elevated Social Anhedonia (SocAnh) scores, and 100 control participants. Participants completed a single-word, continuous presentation pronunciation task that included semantically related words, affectively valenced words, and semantically unrelated and affectively neutral words. PerMag participants exhibited increased semantic priming and increased sensitivity to affectively valenced primes. SocAnh participants had increased sensitivity to affectively valenced targets.

Word production in schizophrenia and its relationship to positive symptoms.

We explored relationships between positive symptoms of schizophrenia and neurocognitive functions (language and memory). The semantic and phonemic associations among words produced in a verbal fluency task by 26 participants diagnosed with DSM-III-R schizophrenia were examined. Formal thought disorder was associated with producing fewer contextually related words and with producing more unrelated words. In contrast, hallucinations were associated with producing more related words. Our results suggest associations between formal thought disorder and impaired memory, and between hallucinations and increased lexical activation/excessive synaptic pruning.

Peculiarity and reported childhood maltreatment.

This study examined whether reported childhood maltreatment is associated with elevated levels of peculiar perceptions and beliefs. Participants were an unselected sample of 458 college students. Peculiarity was measured using the Perceptual Aberration and Magical Ideation scales. Childhood maltreatment was measured using the Physical Punishment scale from the Assessing Environments III, the Sexual Abuse Scale, and the Childhood Experiences Questionnaire. Higher levels of peculiarity were associated with reported childhood maltreatment among both males and females. These associations could not be accounted for by shared variance with negative affect or by scores on the Marlowe-Crowne Social Desirability Scale. Individuals who reported a history of childhood maltreatment were 10.5 times more likely than individuals who did not report such a history to have deviantly high Perceptual Aberration scores. These findings are consistent with the hypothesis that childhood maltreatment can contribute to elevated levels of peculiarity, and they raise the possibility that at least some of the unusual perceptions and beliefs exhibited by individuals with psychiatric disorders such as personality disorders and major depressive disorder can be traced, at least in part, to a history of childhood maltreatment.

A twin study of individual differences in perceptual asymmetry.

Individual differences in perceptual asymmetry have been associated with individual differences in cognitive abilities, personality characteristics, and psychiatric symptoms, for which between-person variation appears to be genetically influenced. Perceptual asymmetry scores are also associated with direction of handedness, for which between-person variation does not appear to be genetically influenced. To assess whether between-person variation of perceptual asymmetry scores is genetically influenced, we examined asymmetry on a freevision task of face processing, the Chimeric Faces Task (CFT), in a sample of 31 monozygotic (MZ) and 20 same-sex dizygotic (DZ) twin pairs. MZ and DZ within twin-pair resemblances were compared to assess genetic and familial influences on asymmetric hemispheric function. We found that twins within a pair were no more likely to resemble each other than were unrelated individuals. The results suggest that the between-person variation in CFT perceptual asymmetry is not influenced by genes or shared environment.

Alexithymia and the interpretation of hostile-provoking situations.

BACKGROUND: To examine the relationship between alexithymia and the interpretation of hostility-provoking situations. METHODS: Sixty-two college students completed the TAS-20 and the Test for the Interpretation of Provoking Situations (TIPS). The TIPS measures how accurately participants can select the most likely explanation for the occurrence of a hypothetical, potentially provoking situation; it also measures how accurately participants judge whether explanations for events are innocent or noninnocent. RESULTS: Higher levels of alexithymia were associated with greater degrees of accuracy in interpreting the innocence of interpersonal information. The facets of alexithymia that were most strongly associated with interpretation accuracy varied by gender. CONCLUSIONS: Alexithymia is not associated with a general affect recognition deficit. The results are consistent with social factors playing a central role in alexithymia.

Interpersonal interactions in individuals with schizophrenia: individual differences among patients and their partners.

We examined 60 face-to-face ten-minute interactions between individuals with schizophrenia and college students. We studied patient responses to the students and student responses to the patients. Following each interaction, participants provided reports of their current mood and how well they liked their interaction partner. The interactions were audio- and video-taped, which allowed us to measure the frequency of patient and student smiles and eye contact, patient strangeness, and the pleasantness of the conversational content. We found individual differences among patients in the degree to which they were liked by students. Patient strangeness was associated with interaction partner negative responses to patients. In addition, the pleasantness of the conversational content was associated with how well patient and student were liked by one another. Sixteen percent of the variance in patient smiling was accounted for by the particular student with whom the patient interacted. The results of this study highlight the importance of attending to both intrapersonal and interactional factors for understanding patient interpersonal functioning.

Language generation in schizophrenia and mania: the relationships among verbosity, syntactic complexity, and pausing.

We examined the relationships among verbosity, syntactic complexity, and pausing in the speech of 21 Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.) (DSM-III-R) diagnosed schizophrenic participants and 19 DSM-III-R diagnosed manic participants. We found that less verbosity was associated with both less syntactic complexity and greater pausing. In addition, less syntactic complexity was associated with greater pausing. The strength of these associations did not differ significantly between the two diagnostic groups. We propose that deficits in verbosity, syntactic complexity, and pausing are all related to a disturbance in message generation. We discuss the consistency of this hypothesis with previous research linking information processing and frontal lobe deficits to disturbances in verbosity, syntactic complexity, and pausing.

The effect of language production manipulations on negative thought disorder and discourse coherence disturbances in schizophrenia.

This study was designed to test the following hypotheses about the mechanisms underlying language disturbances in schizophrenia: (1) negative thought disorder (reduced verbosity and syntactic complexity, increased pausing) reflects a deficit generating a discourse plan; and (2) discourse coherence disturbances (tangential responses, loss of goal, derailment, non-sequiturs, distractible speech) reflect a deficit maintaining a discourse plan. Thirty-nine participants with, DSM-III-R schizophrenia listened to two stories and answered a series of questions after each story. We manipulated two factors: (1) the presence of context before the stories (to influence generating a discourse plan); and (2) question type (structured vs. unstructured; designed to influence maintaining a discourse plan). Consistent with our hypotheses, low context was associated with less verbose and syntactically complex speech. In addition, patients produced more discourse coherence disturbances when responding to unstructured than when responding to structured questions.

Childhood abuse, alexithymia and personality disorder.

I examined the relationships among childhood abuse, alexithymia, and personality disorder. Participants were 60 adults who were receiving outpatient psychotherapy. Both the participants and their therapists used the Toronto Alexithymia Scale to provide independently information concerning the client's level of alexithymia. The therapists provided information concerning DSM-III-R personality disorder diagnoses, and participants completed portions of the Personality Diagnostic Questionnaire-Revised. Information concerning childhood abuse history was obtained from the therapists. As expected, childhood abuse, alexithymia, and personality disorder were all associated with each other. The abilities to identify and communicate emotions were differentially associated with childhood abuse and personality disorder.

Language production and thought disorder in schizophrenia.

The authors examined the relationship between language production (LP) processes and thought disorder. Thirty-nine schizophrenic or schizoaffective participants completed tasks measuring discourse planning, monitoring, and grammatical-phonological encoding, as well as an interview used to rate thought disorder. The authors found that different LP processes were differentially related to different thought disorder subtypes. Incompetent references were strongly and selectively related to discourse planning performance. In addition, word approximations-neologisms were strongly and specifically associated with grammatical-phonological encoding performance. The article concludes with a discussion of the implications of these results for understanding the multifaceted nature and etiology of thought disorder.

Alexithymia, anger, and interpersonal behavior.

BACKGROUND: We explored the relationship between alexithymia and interpersonal behavior, particularly the expression of anger. METHODS: Ninety-eight college students completed the Toronto Alexithymia Scale. A median split was used to divide participants into a low-alexithymia and a high-alexithymia group. The experimenter intentionally engaged in a series of anger-provoking behaviors. RESULTS: Compared to individuals in the low-alexithymia group, individuals in the high-alexithymia group were more interpersonally avoidant and exhibited more nonverbal anger, yet there was a trend for them to describe their lab experience as more pleasant. Among individuals in the high-alexithymia group, the different measures of anger and interpersonal behavior were less strongly associated than they were among individuals in the low-alexithymia group. CONCLUSIONS: The results provide evidence of a complex association between alexithymia and anger, and of the lack of coherence in the communication of individuals with high levels of alexithymia.

The categorization of thought disorder.

We describe the development of a new system for categorizing thought disorder. In the development phase (Study 1), we examined the degree to which speech samples and definitions of thought disorder subtypes taken from: (1) the Scale for the Assessment of Thought, Language, and Communication (TLC); (2) the Thought Disorder Index (TDI); and (3) the Assessment of Bizarre-Idiosyncratic Thinking (BIT), reflected disturbances in form versus disturbances in content. Ratings were provided by naive judges, experienced clinicians, and linguistic experts. The results contributed to the development of a new system dividing thought disorder into disturbances in (1) fluency, (2) discourse coherence, (3) content, and (4) social convention. In the validation phase (Study 2), 21 schizophrenic and 19 manic subjects were interviewed, interpreted proverbs, and responded to Rorschach cards. Subjects' speech was rated using the TLC, TDI, and BIT. We also measured hallucinations, delusions, and digit span performance. The results of Study 2 provided evidence supporting the validity of our new categorization system.

Correlates and retrospectively reported antecedents of alexithymia.

Two experiments were conducted in order to examine the relationship between alexithymia and: 1) family environment; 2) discomfort and ambivalence experiencing and expressing emotion; and 3) dissociation. Research participants in both experiments were college students. We examined the ability to identify and communicate emotion using the Toronto Alexithymia Scale. In Experiment 1, we found that alexithymia was significantly correlated with ambivalence concerning expression of emotion (measured using the Ambivalence over Emotional Expressiveness Questionnaire) and with discomfort concerning negative emotional states (measured using a new instrument called the Emotional Experience Discomfort Scale). Higher levels of alexithymia were associated with retrospective reports of diminished family expressiveness (measured using the Expressiveness subscale of the Family Environment Scale) and with feeling less emotionally safe during childhood (measured using a new instrument called the Childhood Experiences Questionnaire). In Experiment 2, we found that alexithymia was significantly correlated with dissociative experiences (measured using the Dissociative Experiences Scale). However, alexithymia and dissociation differed in the way they were associated with retrospective reports of different aspects of family expressiveness (measured using the Family Expressiveness Questionnaire). High levels of dissociation were associated with increased negative dominant family communication. In contrast, high levels of alexithymia were associated with low levels of positive family communication.

The relationship between information processing and language production.

We explored the relationships between information processing and language in order to further the understanding of language disturbances in psychiatric patients. To assess the impact of reduced processing capacity on language, 50 undergraduates completed an interview concurrent with a category monitoring task and a control interview without a concurrent task. Syntactic complexity, verbosity, and pause patterns were all disrupted by a reduction in processing capacity. In addition, individual differences in syntactic complexity and information processing were significantly associated, even after accounting for verbal intelligence. We discuss the relevance of the results for understanding language disturbances in psychopathology and hypothesize that a reduction in processing capacity may underlie the decreased syntactic complexity, decreased verbal output, and increased pause length found in schizophrenia.

Somatic sensations, anxiety, and control in panic disorder.

This case study of a woman with panic disorder with agoraphobia illustrates the relationships among somatic sensations, anxiety, and the subjective sense of control, and of these three factors to panic disorder. Helping the client alter her caffeine intake and dietary habits led to a significant reduction in panic attacks, but had less impact on her anxiety levels and sense of control. In the second stage of treatment, enhancing the client's sense of control through problem-solving training led to lower levels of anxiety. Implications for treatment and the prevention of relapse in panic disorder are discussed.

Schizophrenia and personality: exploring the boundaries and connections between vulnerability and outcome.

This article discusses the issues and evidence concerning the relationship between schizophrenia and personality. We examine personality dimensions in individuals with schizophrenia, both before and after the onset of their psychoses, and in their relatives. Schizophrenia is associated with high levels of peculiarity and neuroticism and with low levels of extraversion. The relationships between schizophrenia and both psychopathy and creativity remain unclear. Personality dimensions vary in the manner in which they are associated with a variety of correlates of psychopathology, such as prognosis. We recommend that psychopathologists interested in schizophrenia devote more attention to the study of personality.

Neuropsychological correlates of alogia and affective flattening in schizophrenia.

We examined whether two negative symptoms, alogia and affective flattening, were more strongly associated with dysfunction of certain brain regions than with others in a sample of 27 schizophrenic subjects. Neuropsychological tests were used to measure the integrity of functioning of different brain regions. Functioning of left and right frontal regions was assessed by word fluency and design fluency, respectively, and functioning of the left temporo-hippocampal region was assessed by Hebb's digit-sequences recall test. Measures of alogia and affective flattening were obtained using the Scale for the Assessment of Negative Symptoms. The results indicated that more severe levels of these negative symptoms were associated with poorer performance on the fluency tests. These relationships were fairly specific as indicated in two ways: (1) only certain neuropsychological measures were associated with negative symptoms; and (2) poor performance on fluency tests was not associated with all psychiatric symptoms. In addition, affective flattening, but not alogia, appeared to be associated with lateralized dysfunction.