In patients with schizophrenia, symptoms improvement can be uncorrelated with quality of life improvement.

OBJECTIVES: Quality of life has been found to be associated with symptoms in patients with schizophrenia. Nevertheless, the mechanism that underlies this association is still unclear. The objective of this paper is to prospectively evaluate the quality of life of patients with schizophrenia in relation to the concurrent evolution of their symptoms, their expectations and their perceived position in life. METHODS: Participants included 306 outpatients with schizophrenia who were interviewed at baseline, 6 and 12 months, about their quality of life (Outcome revealed by Preference in Schizophrenia, OPS) and symptoms (Positive and Negative Syndrome Scale, PANSS). RESULTS: Quality of life relative to subject expectations remained stable over time. A decrease in symptoms was correlated to an increase in both expectations and perceived position in life but did not correlate to quality of life. CONCLUSION: The level of expectations seems to play a major role in the subjective assessment of quality of life in patients with schizophrenia. Symptom improvement is not necessarily associated with quality of life improvement relative to subject expectations. Caregivers should be aware of this result so as to deal with possible disappointments in patients receiving a new efficient treatment.

Behavioral measures and event-related potentials reveal different aspects of sentence processing and comprehension in patients with major depression.

BACKGROUND: We used the method of event-related potentials (ERPs) during standard semantic judgment task to explore the functional relationship between the deficit in semantic comprehension in women with depression and the potential dysfunction of brain processes mediating language comprehension. METHOD: Eleven patients with major depression and 13 healthy participants were required to read congruous and incongruous sentences and to judge if they made sense. Accuracy and reaction times for semantic judgment were analyzed conjointly with the latency and the peak amplitudes of N100, P200, N400 and LPC components which were recorded at the final word of correctly judged sentences. RESULTS: Patients were less accurate in semantic judgment in comparison to healthy participants. They exhibited slower reaction times and prolonged latency of the N400 and the LPC. A congruity effect was observed in both groups in P200, N400 and LPC interval. The peak amplitude of the ERP components did not differ between patients and healthy participants. In patients lower accuracy was correlated with more prolonged N400 latency and more negative N400 amplitude for congruous sentence endings. Age correlated with prolonged latency and amplitude reduction of the LPC component. LIMITATIONS: Small number of participants, exclusively female patients. CONCLUSIONS: Combined analyses of behavior and ERP measures of semantic processes in depression showed that semantic impairments, motor slowness and a delay in the timing of neural processes which mediate language comprehension might be functionally related and may be influenced by the age of the patients.

[The understanding of metaphors in schizophrenia and depression. An experimental approach]. / La compréhension des métaphores dans la schizophrénie et la dépression. Une approche expérimentale.

INTRODUCTION: Since the first clinical descriptions of schizophrenia, clinical practitioners have been interested in the difficulties experienced by patients with schizophrenia in interpreting the meaning of metaphors. A long tradition of proverb tests intended either for clinical or experimental use, has revealed that the difficulties in metaphor interpretation experienced by patients with schizophrenia refer to a large number of different types of interpretational errors (eg literality, concretism, or autistic, idiosyncratic and bizarre responses). A number of studies have adopted an experimental approach to investigating the dynamics of the cognitive processes that underlie the difficulties in accessing figurative meaning experienced by patients with schizophrenia. However, limited in the way they operationalise these phenomena and/or by their psycho-linguistic reference models, these studies have focused on only one aspect of metaphor: for example, multiple-choice tasks have tested the tendency of patients with schizophrenia to interpret metaphors literally ("literality bias"), whereas lexical decision tasks have investigated the importance that such patients attach to a single word in the expression ("concretism"). The first aim of our study was to investigate, in parallel and without confound, the respective contributions of the literality and concretism biases in the interpretation of metaphor in patients with schizophrenia. The second aim was to examine the question of the specificity of difficulties in accessing figurative meaning in patients with schizophrenia by comparing their performance profiles with those of patients with depression. The third aim was to examine the influence of the patients' clinical symptomatology on their result profiles. METHOD: The participants consisted of 25 patients with schizophrenia (DSM IV, 1994), 18 patients with major depression (DSM IV) and 22 healthy controls. All the participants were matched on socio-demographic variables (age, vocabulary level and level of education). The participants had to complete a task consisting of 10 metaphorical sentences (eg "Ce milieu est un panier de crabes"=lit. "This place is a basket of crabs", fig. "What a bunch of sharks"). The participants had to choose only one word from a set of 4 responses: the figurative meaning (eg "magouille"=dishonest person), the literal meaning (eg "vivier"="pond"), the concrete meaning of the final word (eg "crustacé"="crustacean") and one unassociated word (eg "journal"=newspaper). The inter-group comparison and the symptomatic assessment of the patients (PANSS, Kay et al., 1987, TLC, Andreasen et al. 1979 for the schizo-phrenic and HAMD, Hamilton, 1960 and ERD, Widlöcher, 1983 for the depressive patients) made it possible to investigate the specificity of these difficulties in metaphor understanding amongst patients with schizophrenia, together with the effect of the severity of the symptomatology on the response profiles. RESULTS: The results reveal that the literality bias and concreteness bias influenced the interpretation of metaphors in both groups of patients when compared with the control subjects. Furthermore, the results reveal a common bias towards literal responses (11%) and to concrete responses (4%) among both the patients with schizophrenia and those with depression. An important finding of our study is the heterogeneity of the performance observed in the schizo-phrenic and the depressive patients. Amongst the patients with schizophrenia, erroneous metaphor interpretation was influenced by the severity of the formal thought disorders (Andreasen et al., 1979), whereas in the patients with depression, it depended on the severity of the depressive symptomatology (Hamilton, 1960) and the psychomotor-retardation (Widlöcher, 1983). DISCUSSION: This study represents a preliminary stage in studying metaphor understanding among patients with schizophrenia and major depression, and addresses new questions for further research, which may enhance exploration of the cognitive bases of these disorders.

Differing mental health practice among general practitioners, private psychiatrists and public psychiatrists.

BACKGROUND: Providing care for mental health problems concerns General Practitioners (GPs), Private Psychiatrists (PrPs) and Public Psychiatrists (PuPs). As patient distribution and patterns of practice among these professionals are not well known, a survey was planned prior to a re-organisation of mental health services in an area close to Paris METHODS: All GPs (n = 492), PrPs (n = 82) and PuPs (n = 78) in the South-Yvelines area in France were informed of the implementation of a local mental health program. Practitioners interested in taking part were invited to include prospectively all patients with mental health problem they saw over an 8-day period and to complete a 6-month retrospective questionnaire on their mental health practice. 180 GPs (36.6%), 45 PrPs (54.9%) and 63 PuPs (84.0%) responded. RESULTS: GPs and PrPs were very similar but very different from PuPs for the proportion of patients with anxious or depressive disorders (70% v. 65% v. 38%, p < .001), psychotic disorders (5% v. 7% v. 30%, p < .001), previous psychiatric hospitalization (22% v. 26 v. 61%, p < .001) and receiving disability allowance (16% v. 18% v. 52%, p < .001). GPs had fewer patients with long-standing psychiatric disorders than PrPs and PuPs (52%, 64% v. 63%, p < .001). Time-lapse between consultations was longest for GPs, intermediate for PuPs and shortest for PrPs (36 days v. 26 v. 18, p < .001). Access to care had been delayed longer for Psychiatrists (PrPs, PuPs) than for GPs (61% v. 53% v. 25%, p < .001). GPs and PuPs frequently felt a need for collaboration for their patients, PrPs rarely (42% v. 61%. v. 10%, p < .001). Satisfaction with mental health practice was low for all categories of physicians (42.6% encountered difficulties hospitalizing patients and 61.4% had patients they would prefer not to cater for). GPs more often reported unsatisfactory relationships with mental health professionals than did PrPs and PuPs (54% v. 15% v. 8%, p < .001). CONCLUSION: GP patients with mental health problems are very similar to patients of private psychiatrists; there is a lack of the collaboration felt to be necessary, because of psychiatrists' workload, and because GPs have specific needs in this respect. The "Yvelines-Sud Mental Health Network" has been created to enhance collaboration.

Clinical evolution after self-induced or accidental traumatism: a controlled study of the extent and the specificity of suicidal catharsis.

BACKGROUND: The cathartic effect has been related to the short-term decrease of depressive symptomatology following the suicide attempt. This study aimed to clarify the extent of this clinical improvement to non self-induced traumas and other suicidal dimensions. METHODS: Twenty-six recent suicide attempters were compared with 21 control subjects admitted to the surgical ward after an accident-induced trauma. They completed several assessments the day after the admission and one week after discharge: Hamilton and Carroll Depression scales, Barratt Impulsivity Scale, Hopelessness scale, State-Trait Anxiety Inventory, MMPI (abbreviated version), Global Assessment Scale. RESULTS: Depression, anxiety-state, two sub-scales of the MMPI (Hysteria, Depression) and general functioning improved significantly in the suicide attempters group. Measures of impulsivity and hopelessness remained stable during the follow-up. LIMITATIONS: These results cannot not be generalized to all suicide attempters and we did not take account of the lethality and severity of the suicidal method used. CONCLUSION: Our study supports the specific role of deliberate self-aggression in the cathartic effect and the trait value of both impulsivity and hopelessness.

[A new patient focused scale for measuring quality of life in schizophrenic patients: the Schizophrenia Quality of Life Scale (SOL)]. / Création et validation d'un autoquestionnaire mesurant la qualité de vie de patients souffrant de schizophrénie: l'échelle schizophrenia quality of life (SOL).

UNLABELLED: RATIONALE/OBJECTIVE: Quality of Life (QOL) has been recognized as an important measure of the outcome of patients by clinicians and policy makers in Mental Health. The emerging consensus in the health field that personal values and the patient's preferences are important in monitoring the quality of medical care outcomes makes it even more important to assess the patient's perspectives. Unfortunately, there is little consensus about what constitutes QOL or how to measure it, particularly in psychotic patients. The objective of this study is to report the stages of development and validation of a QOL questionnaire based on issues pertinent to patients with schizophrenia. METHOD: During a first phase, identical pattern were identified among interviews (conducted by psychologists) of schizophrenic patients (DSM IV, n = 100), mental health staff (n = 20) and families (n = 20). The data gathered in the first phase were discussed and organized, by 25 experts, into a structure that made up the skeleton of the scale (133 items, 17 factors). Based on a prospective epidemiological study conducted with 337 French psychiatrists, a validation analysis of structural and psychometric proprieties was performed. Finally reliability of the scale was assessed by a second test/retest (D0, D7) study (n = 100). RESULTS: A total of 686 schizophrenic, schizophreniform or schizoaffective patients (DSM IV) were included. Internal consistency analysis identified 14 factors (74 items), all with a Cronbach's alpha of at least 0.75: professional life (0.95), affective and sexual life (0.92), illness knowledge (0.90), relationship (0.92), life satisfaction, (0.87), coping with drugs (0.79), drugs impact on the body (0.87), daily life (0.83), family relationship (0.81), future (0.88), security feeling (0.84), leisure (0.87), money management (0.76) and autonomy (0.75). Construct validity was confirmed (Pearson test) using established clinical (Brief Psychiatry Rating Scale and Clinical Global Improvement), social (Psychological Aptitude Rating Scale) and generic quality of life (Functional Status questionnaire) measures, correlation coefficient was significant for all factors but 2 in the BPRS (illness knowledge and coping with drugs) and 3 in the CGI (illness knowledge, coping with drugs and life satisfaction). Lastly, test/retest indicated high reliability for each factor (p < 0.001), the lower correlation coefficient (r) was 0.526. CONCLUSIONS: The Schizophrenia Quality Of Life-scale (SOL), based on a patient's point of view approach, is an efficient, multidimensional instrument designed for the measurement of the consequences of schizophrenia on individuals' lives.

Functional analysis of the deficit in semantic context processes in schizophrenic patients: an event-related potentials study.

AIM: Schizophrenic patients exhibit a deficit in the semantic context processing strategies which might be responsible for the language and communication disorders that are characteristic of this condition. The aim of our study was to identify the nature of the contextualization processes which are lacking in schizophrenic patients, by distinguishing between processes for the generation of expectations and processes of semantic integration. PATIENTS AND METHOD: Thirteen schizophrenic patients and 12 healthy controls performed two tasks: (a) a lexical decision task (LDT) with a highly structured sentence context and whose experimental characteristics made it possible to call strongly on predictive strategies, and (b) a LDT with classic semantic priming (the context being reduced to a single word). In this latter task, the small number of related words did not prompt the generation of expectations but instead called on the postlexical integration process. The event-related potentials (ERP) were recorded during the administration of the task. RESULTS AND CONCLUSION: In the sentence task, we observed a modulation in the N400 amplitude due to the presence of expectations both in the schizophrenic and control participants: predictable words evoked a small N400 amplitude compared to the non-predictable words. In contrast, in the simple (priming) task, the semantic link evoked an N400 amplitude modulation in the control group exclusively. Our results indicate that schizophrenics could be able to use context to activate expectations for the most highly predictable item, and that their deficit appears when the processing strategy is based on the integration of the context stored in working memory.

[Cultural adaptation and validation of questionnaires measuring satisfaction with the French health system]. / Adaptation culturelle et validation de questionnaires de satisfaction à l'égard du système de santé français.

Two questionnaires measuring satisfaction of the population with regard to health care offer were constructed from measures validated in the USA (the Consumer Satisfaction Survey Questionnaire or CSS, and the Visit-Specific Satisfaction questionnaire, the VSQ). This work was comprised two stages: i) translation and cultural adaptation of the American instrument to the French health care context, implicating 6 translators, users and experts; and ii) a telephone survey in the general population (n = 706) to test the psychometric qualities of the French instrument (content and internal validity). The French version, the CSS-VF comprises 9 scales: access to primary care, access to secondary care, scope for choice, health cover, communication with and competence of GPs, communication with specialists, competence of specialists, human qualities of practitioners and overall satisfaction. The VSQ-VF, which measures satisfaction with the last medical consultation is unidimensional. The results of the psychometric analyses are good overall, and endorse the use of these scales in assessment studies.

[Formal thought disorders: French translation of the Thought, Language and Communication assessment scale]. / Troubles formels de la pensée: traduction française de l'échelle d'évaluation de la pensée, du langage et de la communication.

This article proposes a french translation of Andreasen's Thought, Language and Communication (TLC) scale (Andreasen, 1979). This scale is widely used in current literature and remains a reference due to the fact that it has made it possible to establish a consensus with regard to formal thought disorders and has contributed to the operationalisation of the concept of dissociation. This scale consists of 18 items. Each item is clearly defined through the use of clinical examples, rated from 0 to 4 as a function of the intensity of the disorder (absent, slight, medium, severe, extreme). The interview conditions are also stated: free interview of minimum 10 minutes followed by a more structured interview. Some items of the TLC are taken directly from the SANS and SAPS. Their translation has been taken over from french translations already validated by Lecrubier and Boyer (1987). The others were translated within the department and have been verified by a native English speaker. The entirely of the translation has been verified by Andreasen. The metrological qualities of this french translation have been studied in a population of 107 schizophrenic patients who fulfilled all the DSM IV criteria: 73 males and 34 females, mean age 33.4 9 years, in or outpatients, all under neuroleptic treatment and all evaluated by an experienced clinician. Thirty one patients have been filmed to assess the interjudge reliability. The results indicate a high level of interjudge consistency (interclass correlation coefficient 0.96). The global score was 17 9.4. In the factorial analysis before rotation we observe a main factor that makes it possible to calculate a global score. The results of factor analysis of the TLC variables after rotation yield five factors that have an eigen value greater than 1. These five factors explain 66% of the variance. All items have a weight greater than 0.45. The first factor includes Poverty of content speech, Tangentiality, Derailment, Incoherence, Illogical thinking, Loss of goal and Perseveration. It reflects thinking disorganisation. The second factor includes Pressure of speech, Circumstantiality, Self reference and Poverty of speech (negative weight). This factor reflects verbal production. The third factor is composed of Clanging, Neologisms, Word approximation and Echolalia. This factor reflects verbal structure. The fourth factor is only composed of Stilted speech and the fifth one composed of Distractible speech and Blocking. These data have been compared to those reported in the literature: Andreasen in 1979 (113 patients: 32 suffering from manic disorder, 36 from depressive disorder and 45 schizophrenic disorder) and in 1986 (194 subjects: 94 controls, 25 suffering from manic disorder, 25 schizoaffective disorder and 50 schizophrenic patients), Harvey in 1992 (115 schizophrenic patients) and Peralta in 1992 (142 schizophrenic patients). Response levels for each item of the TLC french translation were very close to those found in the english versions. Differences in scores can be explained by clinical differences between populations studied. Factorial analyses also correspond well to such versions. In particular, after rotation, the three factorial subscores found representative of disorganisation, verbal production and verbal structure respectively are closed to those proposed by the english versions. In conclusion, the translation of Andreasen's Thought, Language and Communication (TLC) scale (Andreasen 1979) that we propose here therefore appears to exhibit metrological qualities sufficiently close to those reported in literature to permit its generalised use in France.

Lexical decision tasks in depressive patients: semantic priming before and after clinical improvement.

This study was designed to evaluate the effect of semantic priming with a lexical decision task in 22 depressed patients (DSM-III-R, 1987) and 30 control subjects. These patients were evaluated twice: first when they arrived at the hospital, and secondly, after clinical improvement. Clinical improvement was evaluated using standard depression rating scales. A lexical decision task involving semantic relations (related vs. unrelated, e.g., apple-pear) was used to evaluate the processing of semantic information. The results showed that, for the first evaluation, the depressives presented similar semantic priming to control subjects. When we compared semantic priming in the first and the second passes, we observed that its amplitude was identical. The sole difference between the two passes concerns the global reaction time in the depressive group. This last result suggested that, with clinical improvement, the characteristic psychomotor retardation declines. One of the major results concerns the fact that severe depressive patients (first pass) exhibit normal semantic priming in a lexical decision task. These results indicate, in this clinical population, the preservation of controlled processes implicated in this lexical decision task.

Context-dependent information processing in patients with schizophrenia.

Thirty schizophrenic patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders IV criteria for schizophrenia and 30 control participants were shown a set of incomplete sentences, and were asked to complete them with the first word(s) that came to mind. Target sentences included an ambiguous word, the ambiguity of which was not resolved within the clause. However, completion necessarily required participants to select one specific meaning. Each target sentence was preceded by another sentence playing the role of context, which was designed to prime the less frequent meaning of the ambiguous word. The results showed that schizophrenic patients, especially those with thought disorder [on the basis of their TLC scores (Thought, Language and Communication Scale; Andreasen, N.C., 1979. Thought, language and communication disorders. Clinical assessment, definition of terms and evaluation of their reliability. Diagnostic significance. Arch. Gen. Psychiatry 39, 778-782)], used the most common meaning of the ambiguous word more frequently than controls, thus revealing a specific deficit in context use. The deficit was observed whether or not the relation between context and target sentences was made explicit. These results are in line with the cognitive models of schizophrenia that postulate a decreased ability to use context information. However, when considered in the light of prior studies (e.g., Bazin, N., Perruchet, P., 1996. Implicit and explicit memory in patients with schizophrenia. Schizophr. Res. 22, 241-248), they suggest that the deficit in processing contextual information is limited to what Baddeley (Baddeley, A.D., 1982. Domains of recollection. Psychol. Rev. 98, 708-729) called the interactive context (which affects the meaning, or the interpretation, of the target event) in contrast to the independent context (which does not interfere with the meaning-based interpretation of the target event).

A PET investigation of the attribution of intentions with a nonverbal task.

Several authors have demonstrated that theory of mind is associated with a cerebral pattern of activity involving the medial prefrontal cortex. This study was designed to determine the cerebral regions activated during attribution of intention to others, a task which requires theory-of-mind skills. Eight healthy subjects performed three nonverbal tasks using comic strips while PET scanning was performed. One condition required subjects to attribute intentions to the characters of the comic strips. The other two conditions involved only physical logic and knowledge about objects' properties: one condition involved characters, whereas the other only represented objects. The comparison of the attribution of intention condition with the physical logic with characters condition was associated with rCBF increases in the right middle and medial prefrontal cortex including Brodmann's area (BA) 9, the right inferior prefrontal cortex (BA 47), the right inferior temporal gyrus (BA 20), the left superior temporal gyrus (BA 38), the left cerebellum, the bilateral anterior cingulate, and the middle temporal gyri (BA 21). The comparison of the physical logic with characters condition and the physical logic without characters condition showed the activation of the lingual gyri (BA 17, 18, 19), the fusiform gyri (BA 37), the middle (BA 21) and superior (BA 22, 38) temporal gyri on both sides, and the posterior cingulate. These data suggest that attribution of intentions to others is associated with a complex cerebral activity involving the right medial prefrontal cortex when a nonverbal task is used. The laterality of this function is discussed.

How do people with schizophrenia explain the behaviour of others? A study of theory of mind and its relationship to thought and speech disorganization in schizophrenia.

BACKGROUND: This paper examines the attribution of mental states to others in schizophrenia and its links with thought and speech disorganization. METHODS: Two groups of schizophrenic subjects (15 with and 10 without thought and speech disorganization) were compared with 10 manic subjects and 15 normal controls on their pattern of answers to 14 theory of mind comic strips. RESULTS: Schizophrenic subjects with disorganization and a more severe general psychopathology exhibited more unadaptated interpretations of others' mental states than those without disorganization or the manic or normal controls. Their explanation of other people's behaviour tended to be influenced by the frequency of their actions rather than their mental states. CONCLUSIONS: The disorganization pattern in schizophrenia may be associated with a specific deficit of the cognitive ability referred to as theory of mind, and this deficit could be a state rather than a trait variable. Patients with thought and speech disorders may be more likely to understanding other people's mental states in unambiguous and common situations.

Investigating theory of mind in schizophrenia: influence of verbalization in disorganized and non-disorganized patients.

The ability to attribute intentions to others was studied in 13 disorganized and 13 non-disorganized schizophrenic patients, 13 depressed and 13 normal controls. Subjects were asked to complete 28 comic strips requiring theory of mind skills by choosing one out of three answer cards. The answer cards were simple pictures in a first condition and short sentences in a second condition. This study, which used the cognitive neuropsychological approach, underlies the existence of a link between disorganization patterns in schizophrenia and a deficit in the attribution of intentions to others, independently of the pictorial or verbal form of the mode of answering. In addition, results show that the non-disorganized schizophrenic group, depressed and normal controls perform similarly in both pictorial/verbal conditions. The influence of the absence/presence of verbal material on a task investigating theory of mind in schizophrenia is discussed.

Fluency versus conscious recollection in category-production performance: the performance of schizophrenic patients.

The purpose of this study was to investigate the relative contribution in schizophrenics of automatic processes (fluency) and conscious processes (conscious recollection) for the control of preencoded material in category production tasks. In one condition (Exclusion condition), subjects were told specifically not to produce previously presented words during the category-production task. This condition was compared with a standard category-production task in which subjects were told to produce the six first words that came to mind for a semantic category (Inclusion condition). In the inclusion condition, the effects of conscious control and automatic processes operated in the same direction, whereas in the exclusion condition automatic influences and conscious control were opposed. A recognition task followed the category-production tasks. Since the exclusion condition required conscious control of encoded items, we hypothesized that schizophrenic patients would be less able than control subjects to avoid producing study list items. These results indicated that schizophrenics' performance differed from these of control subjects in the exclusion condition but not in inclusion condition. Recognition performance was similar in both the schizophrenic and the control groups. These results suggest a defective conscious control in schizophrenic patients and confirm the data from the literature on explicit memory in these patients.

Impairment of semantic categorization processes among thought-disordered schizophrenic patients.

OBJECTIVE: To explore semantic categorization strategies in patients with schizophrenia. METHOD: A short-term memory-recognition task that reveals the effects associated with categorization was created and applied to 2 groups of patients with schizophrenia and depression. RESULTS: Only the schizophrenic subgroup with formal thought disorder (measured using Andreasen's Thought, Language, and Communication [TLC] scale) exhibited a deficiency in semantic categorization strategies during the task. CONCLUSION: These results support the hypothesis of the impairment of the processes involved in the processing of contextual information in patients with schizophrenia who suffer from formal thought disorder.

Heterogeneity in cognitive functioning of schizophrenic patients evaluated by a lexical decision task.

BACKGROUND: The disorganization pattern in schizophrenia, which involves formal thought disorders, is thought to be correlated with a deficit in integrative processes of contextual information. We tested the hypothesis that thought disordered schizophrenics, unlike non-though disordered schizophrenics, would present a deficit in the processing of the context during a task which involves these integrative processes. METHODS: A group of 22 schizophrenic patients diagnosed in accordance with DSM-III-R criteria and a group of 11 control subjects were compared using a semantic priming version of the lexical decision task. The experimental design used low-level structuration of verbal material to reveal the difficulty that schizophrenic patients encounter in using semantic regularities. RESULTS: A significant difference in priming effect was found between the three groups. Control subjects and non-thought disordered schizophrenics exhibit a priming effect for related word pairs when compared with unrelated pairs (respectively F(1,10) = 17.7; P < 0.002 and f(1,10) = 14.5; P > 0.003) but thought disordered schizophrenics did not (F(1,10) < 1; NS). CONCLUSIONS: This finding provides evidence for the cognitive heterogeneity of schizophrenic subjects. This absence of priming effect in thought-disordered schizophrenic subjects supports the hypothesis that these patients present a deficit in the post-lexical controlled information processing that permits the integration of semantic information.

Syntactic and semantic processing in schizophrenic patients evaluated by lexical-decision tasks.

Two lexical-decision tasks with 500-ms stimulus-onset asynchrony were conducted with 34 schizophrenic patients. This group consisted of 24 schizophrenic patients with thought disorder (TD) and 10 schizophrenic patients without thought disorder (NTD), 14 psychiatric controls (depressive illness), 20 hospitalized controls, and 20 normal controls. One lexical-decision task with semantic relations (related vs. unrelated, Experiment 1) and 1 task with syntactic relations (congruent vs. incongruent; Experiment 2) were used to evaluate processing of different lexical information. In Experiment 1, although all control groups and NTD schizophrenic patients showed semantic priming, TD schizophrenic patients did not. In Experiment 2, all groups showed a significant syntactic effect. These findings provide evidence for an abnormality in semantic processing and the preservation of syntactic processing in TD schizophrenic patients, thus suggesting a deficit in the processing of semantic information under certain conditions when compared with normal syntactic processing.

Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips.

Several clinical and experimental data suggest that some people with schizophrenia have an impaired ability to attribute relevant mental states to other people. We tested this notion in 24 schizophrenic patients and two control groups, who performed a task devised to test understanding of the intentions of nonverbal comic strip characters. Only the schizophrenic subjects with thought and speech disorganization had specific difficulties attributing mental states to others. The findings support cognitive models which postulate a link between planning process disorders and a deficit in mentalizing skills. The hypothesis that the more frequent an action is in everyday life, the more easily it is understood by schizophrenic subjects, is discussed.