Talking about Health: A Topic Analysis of Narratives from Individuals with Schizophrenia and Other Serious Mental Illnesses.

Individuals with schizophrenia have higher mortality and shorter lifespans. There are a multitude of factors which create these conditions, but one aspect is worse physical health, particularly cardiovascular and metabolic health. Many interventions to improve the health of individuals with schizophrenia have been created, but on the whole, there has been limited effectiveness in improving quality of life or lifespan. One potential new avenue for inquiry involves a more patient-centric perspective; understanding aspects of physical health most important, and potentially most amenable to change, for individuals based on their life narratives. This study used topic modeling, a type of Natural Language Processing (NLP) on unstructured speech samples from individuals (n = 366) with serious mental illness, primarily schizophrenia, in order to extract topics. Speech samples were drawn from three studies collected over a decade in two geographically distinct regions of the United States. Several health-related topics emerged, primarily centered around food, living situation, and lifestyle (e.g., routine, hobbies). The implications of these findings for how individuals with serious mental illness and schizophrenia think about their health, and what may be most effective for future health promotion policies and interventions, are discussed.

Exploring the racial diagnostic bias of schizophrenia using behavioral and clinical-based measures.

There is evidence that African Americans are 2.4 times more likely to be diagnosed with a schizophrenia-spectrum diagnosis compared with White individuals, who are more likely to receive an affective diagnosis. The reason for these diagnostic discrepancies is unclear, however, 2 explanations have garnered attention: epigenetic differences and systematic error or bias in the diagnostic process. The latter is the focus of the present study and it is hypothesized that the bias involves cultural insensitivity on the part of the clinician. The present study has investigated bias-driven diagnostic disparities between African Americans and White individuals, by using traditional symptom rating scales, clinical diagnoses, and objective, behaviorally based measures. Data was aggregated from 3 separate studies conducted on outpatients (N = 251) with schizophrenia-spectrum or affective disorders. The present study used computationally derived acoustic markers of speech to tap hallmark negative symptoms (e.g., blunted affect or alogia) and behavioral-based markers of language failures to tap disorganization. Clinician symptom ratings were made using the Brief Psychiatric Rating Scale. Our findings confirmed the diagnostic bias between African Americans and White individuals though there were no differences on clinician symptom ratings. On the other hand, the computerized and behavioral measures revealed more speech disorder and less blunted affect in African Americans versus White individuals. Moderation analysis suggests that behaviorally based measures impact the relationship between race and diagnosis; however, this was largely unsupported for race and clinical symptom ratings. Further research is needed to disentangle normative variations from psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Schizophrenia, narrative, and neurocognition: The utility of life-stories in understanding social problem-solving skills.

OBJECTIVE: Schizophrenia researchers have focused on phenomenological aspects of the disorder to better understand its underlying nature. In particular, development of personal narratives-that is, the complexity with which people form, organize, and articulate their "life stories"-has recently been investigated in individuals with schizophrenia. However, less is known about how aspects of narrative relate to indicators of neurocognitive and social functioning. The objective of the present study was to investigate the association of linguistic complexity of life-story narratives to measures of cognitive and social problem-solving abilities among people with schizophrenia. METHOD: Thirty-two individuals with a diagnosis of schizophrenia completed a research battery consisting of clinical interviews, a life-story narrative, neurocognitive testing, and a measure assessing multiple aspects of social problem solving. Narrative interviews were assessed for linguistic complexity using computerized technology. RESULTS: The results indicate differential relationships of linguistic complexity and neurocognition to domains of social problem-solving skills. More specifically, although neurocognition predicted how well one could both describe and enact a solution to a social problem, linguistic complexity alone was associated with accurately recognizing that a social problem had occurred. In addition, linguistic complexity appears to be a cognitive factor that is discernible from other broader measures of neurocognition. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Linguistic complexity may be more relevant in understanding earlier steps of the social problem-solving process than more traditional, broad measures of cognition, and thus is relevant in conceptualizing treatment targets. These findings also support the relevance of developing narrative-focused psychotherapies. (PsycINFO Database Record

Analyzing Confabulations in Schizophrenia and Healthy Participants.

OBJECTIVES: Confabulations occur in schizophrenia and certain severe neuropsychiatric conditions, and to a lesser degree in healthy individuals. The present study used a forced confabulation paradigm to assess differences in confabulation between schizophrenia patients and healthy controls. METHODS: Schizophrenia patients (n=60) and healthy control participants (n=19) were shown a video with missing segments, asked to fill in the gaps with speculations, and tested on their memory for the story. Cognitive functions and severity of symptoms were also evaluated. RESULTS: Schizophrenia patients generated significantly more confabulations than healthy control participants and had a greater tendency to generate confabulations that were related to each other. Schizophrenic confabulations were positively associated with temporal context confusions and formal thought disorder, and negatively with delusions. CONCLUSIONS: Our findings show that the schizophrenia patients generate more confabulations than healthy controls and schizophrenic confabulations are associated with positive symptoms. (JINS, 2016, 22, 911-919).

Idea density in the life-stories of people with schizophrenia: Associations with narrative qualities and psychiatric symptoms.

Disordered speech and language deficits are well-documented in schizophrenia-spectrum disorders. Researchers often assess speech samples using manualized rating systems, though recently computerized language assessment methods have been used more frequently in the study of speech from people with schizophrenia. Most typically, these computerized assessments measure aspects of expressivity (i.e., pause durations, prosody) or use word-count technology; less attention has focused on similar methods that can capture more sophisticated aspects of linguistic complexity (e.g., idea density). The primary objective of the present study was to assess idea density - via a computerized measure - in the life-story narratives of people with schizophrenia (n=32) compared to a group of community control participants (n=15). In the schizophrenia group, we also examined associations between idea density, narrative qualities rated via a manualized measure, and psychiatric symptoms. Our findings indicate that idea density is diminished in individuals with schizophrenia compared to controls. Further, our results suggest that though people with schizophrenia with richer idea density tended to have more developed insight into illness, they also had higher levels of depression, anxiety, and avolition. Implications of these results and suggestions for future research are discussed.

Vocal expression in schizophrenia: Less than meets the ear.

Abnormalities in nonverbal communication are a hallmark of schizophrenia. Results from studies using symptom rating scales suggest that these abnormalities are profound (i.e., 3-5 SDs) and occur across virtually every channel of vocal expression. Computerized acoustic analytic technologies, used to overcome practical and psychometric limitations with symptom rating scales, have found much more benign and isolated abnormalities. To better understand vocal deficits in schizophrenia and to advance acoustic analytic technologies for clinical and research applications, we examined archived speech samples from 5 separate studies, each using different speaking tasks (patient N = 309; control N = 117). We sought to: (a) use Principal Component Analysis (PCA) to identify independent vocal expression measures from a large set of variables, (b) quantify how patients with schizophrenia are abnormal with respect to these variables, (c) evaluate the impact of demographic and contextual factors (e.g., study site, speaking task), and (d) examine the relationship between clinically-rated psychiatric symptoms and vocal variables. PCA identified 7 independent markers of vocal expression. Most of these vocal variables varied considerably as a function of context and many were associated with demographic factors. After controlling for context and demographics, there were no meaningful differences in vocal expression between patients and controls. Within patients, vocal variables were associated with a range of psychiatric symptoms-though only pause length was significantly associated with clinically rated negative symptoms. The discussion centers on explaining the apparent discordance between clinical and computerized speech measures.

The relationship between stigma sentiments and self-identity of individuals with schizophrenia.

OBJECTIVE: Stigma sentiments are the attitudes held toward a culturally devalued label or group. The present study measures schizophrenia stigma sentiments and self-identity to assess self-stigma experienced by people with schizophrenia. METHOD: Ninety individuals with schizophrenia and 23 controls with no history of psychosis rated the evaluation, potency, and activity of "A person with schizophrenia or schizoaffective disorder," (stigma sentiments) and of "Myself as I really am" (self-identity). t tests, correlations, and regression analysis were used to (a) test relationships among stigma sentiments and self-identity in the groups separately; (b) test a model for predicting self-identity in the schizophrenia group, using stigma sentiments, current symptoms, and current functioning; and (c) compare the participant groups' stigma sentiments and self-identities. RESULTS: The evaluation category of self-identity and of stigma sentiment were correlated in the schizophrenia group, r(88) = .44, p < .001, but not in the control group. Current symptoms and the evaluation category of stigma sentiments were significant predictors of the evaluation category of self-identity in the schizophrenia group. The evaluation and potency stigma sentiments reported by the 2 groups did not differ; the control group rated itself more favorably on evaluation and potency than did the schizophrenia group. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Self-evaluation of individuals with schizophrenia was less favorable than self-evaluation of individuals with no psychosis history, and evaluation attitudes held by individuals with schizophrenia regarding the schizophrenia label were associated with their self-identity. Results suggest preliminary utility of this simple measure in identifying self-stigma experienced by individuals with schizophrenia.

Comparative Study of Personality Trait Characteristics and Reactivity in Schizophrenia Using a Film Clip Paradigm.

The empirical examination of personality characteristics related to the experience of strong negative emotions and the associated physiological response may help account for idiosyncratic responses to life events in schizophrenia. The current study examines the relationship between levels of neuroticism and arousability and physiological and emotional reactivity during the viewing of film clips with differing emotional valance. Data were collected on emotional and cardiovascular and cortisol reactivity across experimental conditions for a sample of outpatients diagnosed with schizophrenia and a comparison group of nonpsychiatric controls. Levels of both neuroticism and arousability were significantly associated with increased negative emotion and physiological reactivity during the negative film clip task, although different patterns emerged across participant groups. Most notably, trait characteristics were inversely related to heart rate reactivity in patients but not controls. This relationship remained significant even after we controlled for disengagement coping behaviors. Cortisol response was not related to personality characteristics in either participant group. Findings were generally consistent with previous research, providing additional evidence for the role of trait characteristics in the response to events.

Internal versus external auditory hallucinations in schizophrenia: symptom and course correlates.

INTRODUCTION: The auditory hallucinations associated with schizophrenia are phenomenologically diverse. "External" hallucinations classically have been considered to reflect more severe psychopathology than "internal" hallucinations, but empirical support has been equivocal. METHODS: We examined associations of "internal" versus "external" hallucinations with (1) other characteristics of the hallucinations, (2) severity of other symptoms and (3) course of illness variables, in a sample of 97 stable outpatients with schizophrenia or schizoaffective disorder who experienced auditory hallucinations. RESULTS: Patients with internal hallucinations did not differ from those with external hallucinations on severity of other symptoms. However, they reported their hallucinations to be more emotionally negative, distressing and long-lasting, less controllable and less likely to remit over time. They also were more likely to experience voices commenting, conversing or commanding. However, they also were more likely to have insight into the self-generated nature of their voices. Patients with internal hallucinations were not older, but had a later age of illness onset. CONCLUSIONS: Differences in characteristics of auditory hallucinations are associated with differences in other characteristics of the disorder, and hence may be relevant to identifying subgroups of patients that are more homogeneous with respect to their underlying disease processes.

Confabulations in schizophrenia.

INTRODUCTION: Current theories of confabulation are based primarily on the observation of neurological patients. The present paper evaluates these theories based on evidence from schizophrenia. Schizophrenia is unique in that it presents with a pathophysiology which differs from that of other neuropsychiatric conditions, and yet the candidate's deficits that various theories of confabulation implicate are often simultaneously present in schizophrenia. METHODS: A selective review of literature on schizophrenic and neurological confabulations was undertaken. RESULTS: Schizophrenic confabulation differs from neurological confabulation in terms of its characteristic features and association with symptoms, cognition and linguistic functions. Current evidence also suggests that confabulation may be conceptualized as a special class of delusions pertaining to memory phenomena. CONCLUSIONS: Schizophrenia presents with confabulations that cannot be fully accounted for by the existing theories. It also presents with confabulations with unique features, which have different cognitive correlates and relation to other symptoms of the condition.

Stress reactivity of emotional and verbal speech content in schizophrenia.

Speech fundamental frequencies (SFFs) are nonverbal sound frequencies that convey emotion in speech. The degree of SFF long-term averaged spectra (LTAS) convergence between conversants reflects aspects of conversant-reported quality of the interaction (e.g., emotional synchrony). This study investigated whether SFF LTAS convergence between inpatients diagnosed with schizophrenia (n = 20) and an interviewer was associated with severity of illness (SOI), formal speech disturbance (FSD), and stress reactivity of FSD. Participants provided speech samples describing stressful and nonstressful life experiences. In the stress condition, SFF LTAS was negatively correlated with SOI and FSD. Moreover, patients exhibiting stress reactivity of FSD also evidenced stress reactivity of SFF LTAS. These findings suggest that the emotional and verbal contents of speech are disrupted by stress in schizophrenia, and SOI is associated with FSD and reduced emotional communication during stressful conditions. The interaction between stress reactivity of FSD and SFF LTAS supports the construct validity of a reactivity dimension in schizophrenia.

Schizophrenia and the sense of self.

Sense of self (SOS)--understood as the foundation upon which individuals experience their daily lives--has been increasingly investigated in schizophrenia. A disrupted SOS is thought to represent a platform for the experience of psychiatric symptoms, social cognitive deficits, and other abnormalities of consciousness. Few studies, however, have investigated the specificity of disrupted SOS to schizophrenia. The primary objective of the present study was to test the hypothesis that SOS is deficient in schizophrenia patients compared to both nonpsychiatric controls and patients with psychotic bipolar disorder. Using select scales from the Assessment of Self Descriptions, the present study assessed SOS from spontaneous narratives provided by schizophrenia patients (N = 50), bipolar patients with psychotic features (N = 17), and nonpsychiatric controls (N = 24). Our findings indicate that facets of SOS-in particular, certain aspects of agency and relatedness to others-are deficient in schizophrenia compared to nonpsychiatric controls and bipolar patients with psychotic features, even when overall level of functioning and psychiatric symptoms are accounted for. Implications of these results are discussed.

Effects of social cognitive impairment on speech disorder in schizophrenia.

Disordered speech in schizophrenia impairs social functioning because it impedes communication with others. Treatment approaches targeting this symptom have been limited by an incomplete understanding of its causes. This study examined the process underpinnings of speech disorder, assessed in terms of communication failure. Contributions of impairments in 2 social cognitive abilities, emotion perception and theory of mind (ToM), to speech disorder were assessed in 63 patients with schizophrenia or schizoaffective disorder and 21 nonpsychiatric participants, after controlling for the effects of verbal intelligence and impairments in basic language-related neurocognitive abilities. After removal of the effects of the neurocognitive variables, impairments in emotion perception and ToM each explained additional variance in speech disorder in the patients but not the controls. The neurocognitive and social cognitive variables, taken together, explained 51% of the variance in speech disorder in the patients. Schizophrenic disordered speech may be less a concomitant of "positive" psychotic process than of illness-related limitations in neurocognitive and social cognitive functioning.

Neurocognitive predictors of source monitoring in schizophrenia.

RATIONALE: Source monitoring (SM) is a metacognitive process involved in making judgments about the origin of information by recruiting cognitive processes. Deficits in SM have been linked to positive symptoms of schizophrenia. We investigated whether certain neurocognitive functions - specifically attention, working memory, and organizational sequencing - were associated with SM in a sample of schizophrenia patients. METHODS: Attention (Auditory Continuous Performance Test), organizational sequencing (Trail-Making Test B-A), working memory (Digits Backward), and internal SM were assessed in 45 outpatients diagnosed with schizophrenia or schizoaffective disorder. RESULTS: Standard multiple regression analysis showed attention, working memory and organizational sequencing together predicted SM. Organizational sequencing was the only significant individual predictor, with better organizational sequencing ability being associated with better SM. Hierarchical regression analysis showed that working memory by itself did not result in a significant predictive model of SM, but adding organizational sequencing led to a significant change from the working memory model and resulted in a significant overall model, accounting for 26% of the variance in SM. CONCLUSIONS: Neurocognitive functions were associated with SM in schizophrenia. Organizational sequencing, which requires an awareness of self-generated actions, predicted SM performance even after controlling for working memory.

Predicting social functioning in schizotypy: an investigation of the relative contributions of theory of mind and mood.

Theory of mind (ToM) is an aspect of social cognition that refers to the ability to make inferences about the thoughts, feelings, and intentions of other people. It is believed to be related to social functioning. Previous investigations of ToM in schizotypy have yielded mixed results. Using a correlational approach, the present study explored the relationship between schizotypal traits, ToM, neurocognition, depressed mood, and social functioning in a sample of 50 undergraduate students. Schizotypy was related to poor social functioning. Contrary to predictions, schizotypal traits were not associated with impaired ToM. In fact, schizotypal traits were associated with enhanced performance on a ToM task that involved detection of ironic statements. However, strong relationships emerged among schizotypy, depressed mood, and social functioning, highlighting the need to also examine depression when assessing the relations between elevated schizotypy and poor social functioning.

On identifying the processes underlying schizophrenic speech disorder.

Speech of people with schizophrenia is often difficult to follow. There is evidence that neuropsychological deficits associated with schizophrenia explain some of the variance in speech disorder, but its nature and causes overall are not well understood. This study rated speech samples from 60 schizophrenic outpatients for thought disorder, conceptual disorganization, linguistic structural breakdown, and communication failure. A battery of neuropsychological tests potentially relevant to coherent speech production was administered, and associations between these variables and the speech measures were assessed. Consistent with previous research, the measure of functional effect, communication failure, was more highly associated with neuropsychological test performance than were the measures of putative cause: thought disorder, conceptual disorganization, or linguistic structural breakdown. Performance on tests of attention, immediate memory, working memory, organizational sequencing, and conceptual sequencing all were significantly related to the frequency of communication failures in the speech. In hierarchical regression, attention, working memory, and conceptual sequencing each contributed significantly and together explained 29% of the variance. Some other potential contributors to test in future research include auditory attention, internal source memory, emotional disturbances, and social cognitive deficits.

Missing referents, psychotic symptoms, and discriminating the internal from the externalized.

The communicative efficacy of the speech of schizophrenia patients is compromised by the presence of references for which there are no referents. There is evidence that this kind of error is positively associated with the genetic substrate of schizophrenia. The present study was an effort to identify a cognitive process source of these errors by looking at their association with performance on an internal source memory task assessing the ability to remember what one has said out loud versus only thought. Their relationship to psychotic symptoms also was examined. A sample of 110 schizophrenic/schizoaffective outpatients, and 23 nonpsychiatric controls provided 10-min speech samples and completed a battery of memory tests. Patients' symptoms also were rated for severity. Patients performed more poorly than controls on the memory tests, and their speech contained much more frequent references without referents. Frequency of missing referents was associated with scores on the test of internal source memory, even after scores on tests of immediate memory, working memory, and external source memory were regressed out. Missing referents were also related to severity of hallucinations and delusions, and internal source memory performance was related to hallucinations. The findings of this study support the idea that missing referents, hallucinations, and delusions have some common process underpinnings. Impairment in internal source memory appears to be one such process.

Schizotypy, alexithymia, and socioemotional outcomes.

Studies have found higher levels of alexithymia in schizophrenic subjects relative to controls, with an overall higher level of emotional arousal and social withdrawal. The present study is an extension of this research to the assessment of schizotypy in a nonclinical sample. Seventy-two undergraduate students (40 female; 21.6 ± 6.38 years) were recruited to participate in this study. Consistent with earlier research, our results show that both schizotypy and alexithymia are associated with relatively poor socioemotional functioning across the variables of depression, anxiety, social functioning, and overall quality of life. Further, our results show that the significant associations found between alexithymia and these 4 outcome variables was predicated on shared variance with schizotypy. When both alexithymia and schizotypy were regressed onto these variables as independent predictors, the contribution of alexithymia was consistently nonsignificant. The implications of these findings are discussed in terms of hypothesized substrates of alexithymia.

Reality monitoring and its association with social functioning in schizophrenia.

Reality monitoring, or the ability to discriminate internal from external information present in short-term memory, is relevant in the study of schizophrenia. Previous research has linked monitoring impairments with psychotic symptoms and certain forms of communication disturbance. The focus of the present study was to test the hypothesis that there would be specific relationships between reality monitoring in patients with schizophrenia and current and pre-morbid social functioning, beyond the effects of general verbal ability. Fifty outpatients with schizophrenia or schizoaffective disorder were assessed for internal/external reality monitoring deficits, general verbal intelligence, and both current and pre-morbid social functioning. Associations between these variables were assessed. Exploratory analyses also were conducted to determine whether specific types of reality monitoring errors were related to social functioning. Results showed that (a) overall accuracy in reality monitoring was related to pre-morbid social functioning beyond the effects of verbal ability, (b) sensitivity to old versus new information in reality monitoring was related to current social functioning, and (c) a say-report-think reality monitoring error was significantly associated with pre-morbid social functioning. The results support the hypothesis of an association between reality monitoring sensitivity and social functioning.

Referential failures and affective reactivity of language in schizophrenia and unipolar depression.

Reference failures, and their increase in affectively negative conditions (known as affective reactivity of speech), are more frequently observed in schizophrenia patients than in normal controls, but no information is available comparing schizophrenia with depression, ie, a mental disorder closely linked to the concept of affective reactivity. To address this gap in the literature, the present study compared 24 schizophrenia inpatients, 21 unipolar depression inpatients and 21 normal controls. Two 10-minute conversational speech samples (1 on negative and 1 on positive memories) were collected from each patient. The transcripts of the audiotaped interviews were analyzed blindly for frequencies of 6 types of referential failures, employing the Communication Disturbances Index, adapted for use with Italian. The schizophrenia patients made more frequent total reference failures and, specifically, more missing information references than the depression patients. The depression patients made more frequent reference failures than the normal controls, overall, and on most of the specific types of failures. Affective reactivity of speech was observed only for the schizophrenia sample and was greatest for missing information references. This study supports the viability of reference failure analysis as a measure of communication disturbance in a language other than English. The findings indicate that schizophrenia and depression both are associated with high levels of referential failures but that affective reactivity of speech is present only in schizophrenia and not in depression.