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Motivations Language has evolved as human’s primary communication tool. It allows us to flexibly manage the amount of information disclosed in communication to deal with complex social situations. Language impairment is a hallmark feature of schizophrenia, which could also be observed to a lesser extent in patients’ unaffected siblings. It significantly affects patients’ social functioning and clinical outcome. Despite ample evidence showing deficits across linguistic levels in schizophrenia, our understanding of patients’ performance in real-life communication, especially under non-cooperative (competitive or tactical) situations, is very limited. In this study we developed a novel method (conversational analysis paradigm, CAP) to investigate both cooperative and competitive communication performance in terms of verbal information value management among patients with schizophrenia and their unaffected siblings compared with healthy controls, and explored their relationships with clinical and cognitive functions. Methods Two studies were conducted. Study one consisted of a validation study (n=40) for CAP and a cross-sectional (n=130) study in investigating verbal information management in schizophrenia and healthy participants. Performance was compared between patients with schizophrenia spectrum disorders (n=65) and matched healthy controls (n=65). Relationships between cognitive functions, clinical features, social competence, and CAP performance were also investigated. In study two, CAP performances were compared among 31 pairs of patients with schizophrenia, their healthy siblings and 31 matched healthy controls (total n=93) to examine verbal information management deficits as a trait in siblings. Schizotypal personality trait was also measured to investigate the potential relationship with CAP in siblings and healthy controls. Results The CAP test demonstrated good inter-rater reliability (ICC 0.82) and adequate internal consistency (Cronbach’s alpha 0.71--‐0.72). Patients showed poorer performance in verbal information management under both cooperative and competitive conditions, which were associated with psychotic symptoms and social functioning. Patients’ poorer cooperatively communicating information, but not competitive controlling information, was associated with their cognitive functions. Performance of patients’ healthy siblings was intermediate between patients and healthy controls, especially during competitive communication. Verbal information management skills were correlated with schizotypal personality trait in siblings but not controls. More deviant verbal information management skills under competitive conditions were closely related to impaired immediate social network in patients and siblings. Discussion This study empirically documented the impaired verbal information management tactics in patients with schizophrenia and their healthy siblings compared using CAP. This specific domain of language impairment was related with cognitive functions, psychotic symptoms, real-life functioning, and schizotypal personality trait. Significance The current study has taken the first attempt to demonstrate an impairment of verbal information transfer in schizophrenia using a newly developed ecological test. Results of this study laid the groundwork for understanding language impairments related to schizophrenia, suggesting verbal information management as a candidate endophenotype of schizophrenia with intervention implications. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

M.A. (Psychology) / The present study investigated the diagnostic usefulness of a content analysis of the verbal behaviour of schizophrenic patients. The schizophrenic condition was approached via a cognitive social developmental model of personality. The high-risk schizophrenic constitutionally does not seem to be equipped to cope with potential threats from his environment, such as unstable conditions or ambigious interpersonal relationships and communication. He could subsequently adjust poorly to his environment and he learns to perceive, process and produce information in a disturbed manner. The disturbance seems particularly evident in the schizophrenic person's incompetent communication with and participation in his world. He could progress further towards a condition characterized by withdrawal, fear and other forms of mental suffering, and a lack of identity. These three abovementioned features of the schizophrenic condition - as viewed relative to "normal" states - were introduced into three experimental situations, represented respectively by the words "daydreaming", "pain" and a topic "self". Each of the 25 diagnozed male schizophrenics were asked to talk about these concepts (presented to them in the form of words written on cards) in any way they liked. Their responses to these situations were analyzed by means of a specifically designed content analysis model of verbal behaviour. For the purpose of this study, verbal behaviour denotes the person's relative degree of communicative competence, which appears to reflect the nature and progress of his schizophrenic condition. Verbal behaviour was interdependently analyzed on three levels. The first of these, language structure, assessed the schizophrenic person in terms of the more latent aspects of disturbed thinking, such as thought blocking and failure to integrate ideas. An assessment was also made of these language deviations as they were reflected in syntactical structures. On a second level, semantic content, subjects' verbal productions were analysed in terms of themes which represented their major preoccupations. The effect of the three experimental situations on the semantic content of the subjects' responses was also investigated. The third level of content analysis, language behaviour, dealt with the schizophrenic individual's verbal and nonverbal reactions to his perceived environment. It appears that the schizophrenic person projects his condition through his communicative competence, into symbolic representations of his condition. The projections seem to coincide with stages of progression of the schizophrenic condition, or degree of disturbance. This tendency, as well as certain others investigated in the present study, ted to the formation of hypotheses which can be investigated in further research. It would appear that the quantification of communicated material in the clinical or other interview, has diagnostic value.

Both of these theoretical positions - the linguistics and the behavioristic - are introduced here as parallel structures within which a study of language can proceed. As this study is developed, each strand is evident to some extent, with a synthesis of the two evolving in a psycholinguistic model which characterizes actual language use. This model, with the addiction of a bilingual dimension, is then discussed in light of schizophrenic language deviations.

Thesis (MA (General Linguistics))—University of Stellenbosch, 2009. / ENGLISH ABSTRACT: It is well-known that there is an important relationship between language and schizophrenia, given that many of the primary symptoms of schizophrenia are language related (Cutting 1985; Wróbel 1990; Sadock & Sadock 2003; Paradis 2008). Furthermore, research has shown that certain schizophrenic bilinguals exhibit different symptoms in their first language (L1) than in their second language (L2) (De Zulueta 1984; De Zulueta, Gene-Cos & Grachev 2001; Paradis 2008; Southwood, Schoeman & Emsley 2009). This thesis investigates the L2 use of schizophrenic bilinguals to determine whether there are significant differences between the types and frequency of errors made in spontaneous L2 use by schizophrenic versus normal (i.e. non-schizophrenic) bilinguals. Four schizophrenic bilinguals and four normal bilinguals (the control group) participated in this study. The controls were matched to the schizophrenics in terms of age, gender, level of education, L1 (Afrikaans) and L2 (English). Informal, thirty minute interviews were conducted with each of the eight participants, recorded on video (for the schizophrenics) or audio tape (for the controls) and carefully transcribed. Each participant's speech sample was then analyzed grammatically by means of Morice & Ingram's (1982) assessment tool. This analysis involved determining the complexity of utterances (with reference to mean length of utterance, lexical density, and number of sentence-initial and sentence-medial conjunctions) and identifying phonological, morphological, lexical, syntactic and semantic errors. In this way a language profile was created for each participant and the differences between the two groups (schizophrenics and controls) were tested for statistical significance. On the basis of the results of these statistical tests, it is argued that the locus of differences between schizophrenic and normal L2 use is semantics, rather than any of the other aspects of grammar. The thesis concludes with a discussion of the main findings of the study, some criticisms of the assessment tool and suggestions for future research in this field. / AFRIKAANSE OPSOMMING: Navorsing dui op 'n belangrike verhouding tussen taal en skisofrenie, aangesien baie van die primêre simptome van skisofrenie taalverwant is (Cutting 1985; Wróbel 1990; Sadock & Sadock 2003; Paradis 2008). Verder dui navorsing ook daarop dat sekere skisofreniese tweetaliges verskillende simptome toon in hul eerstetaal (T1) as in hul tweedetaal (T2) (De Zulueta 1984; De Zulueta, Gene-Cos & Grachev 2001; Paradis 2008; Southwood, Schoeman & Emsley 2009). Hierdie tesis ondersoek die T2 gebruik van skisofreniese tweetaliges om vas te stel of daar beduidende verskille tussen die tipe en die gereeldheid van die foute is wat in spontane T2 gebruik deur skisofreniese teenoor normale (d.w.s nie-skisofreniese) tweetaliges gemaak word. Vier skisofreniese tweetaliges en vier normale tweetaliges (die kontrolegroep) het deelgeneem aan hierdie studie. Die skisofreniese groep en die kontrolegroep is eenders in terme van ouderdom, geslag, vlak van skoolopleiding, T1 (Afrikaans) en T2 (Engels). Informele dertig-minuut lange onderhoude is gevoer met elk van die agt deelnemers, opgeneem op video (vir die skisofrene) en op band (vir die kontrolegroep) en noukeurig getranskribeer. Elke deelnemer se spraakdata is hierna grammatikaal geanaliseer deur middel van Morice & Ingram se (1982) assesseringsinstrument. Hierdie analise het die volgende ingehou: die vasstel van die kompleksiteit van uitinge (met betrekking tot gemiddelde uitingslengte, leksikale digtheid, en die getal van sinsinisiële en sinsinterne voegwoorde) en die identifisering van fonologiese, morfologiese, leksikale, sintaktiese en semantiese foute. Op hierdie wyse is 'n taalprofiel vir elke deelnemer opgestel en die verskille tussen die twee groepe (skisofreniese- en kontrolegroep) is getoets vir statistiese beduidendheid. Op grond van die resultate van hierdie statistiese toetse word daar geargumenteer dat semantiek, eerder as enige van die ander aspekte van grammatika, die lokus van die belangrikste verskil tussen skisofreniese en normale T2 gebruik is. Die tesis sluit af met 'n bespreking van die belangrikste bevindinge van die studie, enkele kritiese opmerkings oor die assesseringsinstrument, asook voorstelle vir verdere navorsing in hierdie veld.

Semantic clustering has been used as a measure of learning strategies in a number of clinical populations and has been found to be deficient in individuals with Schizophrenia, but less attention has been paid to the dynamic use of this strategy over the course of fixed-order learning trials. In the current study, we examined this pattern of clustering use over trials in a sample of individuals with Schizophrenia, and explored whether the addition of this dynamic information would help us to better predict specific executive deficits. Results suggested that a decrease in semantic clustering across trials was associated with some executive deficits in the predicted manner. Nonetheless, the overall semantic clustering index generally proved more effective for the purposes, suggesting that in this population, the addition of dynamic information in strategy use is not likely to add considerably to clinical prediction and understanding.

Thesis (MPhil (General Linguistics))—University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The term "schizophrenia" refers to a psychiatric condition which affects an individual's thought and speech (Eaton and Chen 2006). The verbal expression of schizophrenics can therefore be used as a tool for insight into the nature of schizophrenia as well as the cognitive processes of schizophrenics (Wróbel 1990:1). This thesis reports on a comparative evaluation of three pragmatic assessment tools, namely the Pragmatic Protocol (Prutting and Kirchner 1987), the Profile of Communicative Appropriateness (Penn 1985), and the Framework for Assessing (Children's) Conversational Skills (Rumble 1988), in order to establish which of these tools is most suitable for assessing the first language (L1) and second language (L2) pragmatic abilities of late bilingual schizophrenics. Four late bilingual schizophrenic patients participated in this study. A thirty minute informal interview was conducted with each of the participants in both their L1 and L2 and the speech samples were transcribed and then analysed by means of each of the pragmatic assessment tools. A careful examination of the results yielded by the three assessment tools, showed, firstly, that when presenting the results of a pragmatic assessment of schizophrenic speech, it is crucial that both quantitative and qualitative information be included: if the latter is excluded, a significant amount of information is hidden from the clinicians and/or linguists doing the assessment, as well as the people to whom they report their findings. Secondly, with respect to the characteristics of schizophrenic speech, the three instruments used in this study show that whereas most of the aspects of schizophrenics' linguistic abilities seem intact, their pragmatic skills are definitely impaired. Thirdly, regarding differential symptomatology in bilingual schizophrenics, this study concludes that none of the three assessment tools contributes to a better understanding of this phenomenon, and that, in fact, it is highly unlikely that any pragmatic assessment tool would be able to capture this phenomenon. Finally, it is recommended that clinicians assess bilingual patients in both languages, whenever possible, in order to determine the full range of symptoms experienced by the patient, to gain a better indication of the severity of the illness and to track the progress of the illness. / AFRIKAANS OPSOMMING: Die term "skisofrenie" verwys na 'n psigiatriese toestand wat 'n individu se denkprosesse en spraak beïnvloed (Eaton en Chen 2006). Die verbale uitinge van skisofrene kan dus gebruik word om insig oor die aard van skisofrenie, sowel as die kognitiewe prosesse van skisofrene, te verkry (Wróbel 1990:1). Hierdie tesis lewer verslag oor 'n vergelykende evaluering van drie pragmatiese assesseringsinstrumente, naamlik die "Pragmatic Protocol" (Prutting en Kirchner 1987), die "Profile of Communicative Appropriateness" (Penn 1985), en die "Framework for Assessing (Children's) Conversational Skills" (Rumble 1988), om sodoende vas te stel watter een van hierdie drie die mees gepaste instrument is vir die assessering van tweetalige skisofrene se pragmatiese vaardighede in hul eerstetaal (T1) en tweedetaal (T2), spesifiek in gevalle waar die T2 later (d.w.s. nie binne die eerste sewe lewensjare nie) verwerf is. Vier sulke tweetalige skisofrene het deelgeneem aan die studie. Daar is met elkeen van die deelnemers 'n informele onderhoud gevoer vir 30 minute in hul T1, gevolg deur 30 minute in hul T2. Die onderhoude is getranskribeer en daarna geanaliseer deur middel van elk van die drie assesseringsinstrumente. 'n Noukeurige ondersoek en vergelyking van die resultate van die drie instrumente het eerstens getoon dat dit belangrik is om die resultate van 'n pragmatiese analise van skisofreniese spraak op beide 'n kwantitatiewe en kwalitatiewe wyse aan te bied: wanneer kwalitatiewe inligting weggelaat word, bly 'n betekenisvolle hoeveelheid van die informasie verborge vir die klinici en/of taalwetenskaplikes wat die assessering doen, asook die mense aan wie hulle hulle bevindinge rapporteer. Tweedens, met betrekking tot die eienskappe van skisofreniese spraak, wys die drie instrumente wat in hierdie studie gebruik is dat alhoewel meeste aspekte van skisofrene se taalvaardighede ongeskonde is, hulle pragmatiese vaardighede ooglopend aangetas is. Derdens, rakende differensiële simptomatologie in tweetalige skisofrene kom hierdie studie tot die gevolgtrekking dat geen van die drie instrumente bydra tot 'n beter begrip van hierdie verskynsel nie, en dat dit selfs hoogs onwaarskynlik is dat enige pragmatiese assesseringsinstrument hierdie verskynsel sou kon vaslê. Uiteindelik word daar aanbeveel dat klinici, wanneer dit ookal moontlik is, tweetalige pasiënte in beide tale behoort te assesseer om sodoende die volledige reeks van simptome wat 'n pasiënt ervaar vas te stel, om 'n beter aanduiding te bekom oor die erns van die siekte, en om die progressie van die siekte te volg.

The characteristics of patient speech are used in clinical settings to make assumptions about the thought processes of people with psychotic disorders such as schizophrenia. However, there have not been any studies of the language of people with schizophrenia that present evidence drawn from a large group of speakers. This study employs a combination of quantitative and qualitative methods to determine whether 140 medicated individuals diagnosed with schizophrenia exhibit the linguistic abnormalities claimed in the literature. It also compares the speech of people with schizophrenia with that of people diagnosed with depression in order to assess whether there is a statistically significant difference in presence and/or frequency of abnormal speech between the two groups. Ultimately this study finds that all of the specific types of abnormal language behavior described in the literature do occur among a large group of individuals with schizophrenia. However, many such behaviors also occur among individuals with depression; there was a significant difference between the two groups for three of the twelve categories of language features assessed in this study, which were peculiar word choice, illogicality and distractibility. Further characteristics of the language of individuals with schizophrenia were also found, which could be a basis for improving clinical diagnostic materials.