<p>Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (<i>n </i>= 16; PANSS conceptual disorganization ≥ 3) and non-FTD (<i>n</i> = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition. </p>

<p>Formal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD. </p>

Indiana University-Purdue University Indianapolis (IUPUI) / Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (n = 16; PANSS conceptual disorganization ≥ 3) and non-FTD (n = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition.

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[pt] Esta dissertação é um estudo experimental que busca investigar a construção da referência de expressões nominais inseridas em contextos discursivos. Um dos objetivos foi analisar se falantes nativos do português brasileiro fazem uso de informações dadas no contexto para interpretação de expressões nominais definidas. O outro objetivo foi verificar em que medida presença de traços de personalidade esquizotípica em falantes normais interfere na integração de informações contextuais na construção da referência. Para realizar a investigação, foi conduzido um teste de linguagem acompanhado de dois questionários psicométricos para medir traços gerais de personalidade esquizotípica e traços de desordens do pensamento. O experimento foi conduzido com adultos universitários do Rio de Janeiro. Os resultados indicam que no geral os falantes do português brasileiro têm preferência por interpretar uma expressão nominal definida como se referindo a uma única entidade, mas são sensíveis às informações dadas no contexto, de modo que a referência de uma expressão nominal definida pode ser uma classe de indivíduos quando o contexto fornece informações ostensivas nessa direção. Correlações entre os resultados do teste de linguagem e os resultados dos questionários psicométricos sugerem que falantes com baixas habilidades para conversas e afeto constrito apresentam possibilidades interpretativas mais restritas, especialmente quando o contexto favorece referência a um único individuo. Embora, a investigação conduzida sobre a relação entre linguagem e esquizotipia seja preliminar, os resultados encontrados indicam possíveis interferências de traços de personalidade esquizotípica na construção da referência pela linguagem. / [en] This thesis is an experimental study to investigate how the reference of nominal expressions is built within a discourse context. The first goal was to analyze how native speakers of Brazilian Portuguese use contextual information in interpreting definite descriptions. The second goal was to determine whether or not traces of schizotypal personality can interfere in the integration of contextual information in building reference. The linguistic experimental study was accompanied by two psychometric scales. The psychometric scales were used to measure general traits of schizotypal personality and thought disorders. The participants in the experiment were adult native speakers of Brazilian Portuguese from Rio de Janeiro, and the results showed that in general the participants had a significant preference for interpreting a definite description as referring to a single entity. However, they were sensitive to contextual information and reference to a group of entities (king reading) was licensed when the context was favorable. Correlations between the linguistic results and the results of the psychometric scales suggest that speakers with low conversational ability and constricted affect are more restrictive in their interpretation choices, displaying a greater preference for reference to a single entity, especially in contexts favoring single entity reference. Although this is a preliminary investigation, our experimental findings indicate that traits of schizotypy can interfere in how reference is built within language.