Disordered speech has long been recognized as one of the core features of schizophrenia; it is stable across the course of the disorder, and has been identified as a rate limiter of functional outcome (e.g., social skills, scholastic achievement, vocational success). While much of the recent research on thought disorder has focused on the mechanisms behind disordered speech, we have observed a very limited transfer to clinical applications that promote gains in communication skills. The purpose of this study was to evaluate the efficacy of a novel treatment, Structured Therapy for the Enhancement of Purposeful Speech (STEPS), based in behavioural learning principles, to increase goal-directed speech in individuals with schizophrenia. The current study is one of the first to evaluate an intervention specifically aimed at increasing the core symptom of disorganized speech and evaluating change across multiple indicators of discourse. STEPS is based in principles of operant conditioning, wherein sessions take place three times per week for a total of three weeks. In a single-case multiple baseline design, participants (N=3) received positive reinforcement for engaging in goal-directed speech and directive feedback for committing speech errors, thereby increasing or decreasing frequency of that behaviour, respectively. Participants were assessed before, during, and after treatment on a series of thought disorder and speech coherence measures. Primary outcome measures included change in frequency of communication errors within sessions over the course of treatment and severity of thought disorder on standard disorder measures at three assessments points. Participants demonstrated a significant reduction in number of communication errors across unstructured conversations and structured storytelling components such that all participants engaged in significantly more goal-directed communication during treatment sessions compared to baseline performance. Furthermore, all participants were rated as expressing less severe disconnected speech according to a gold-standard measure of thought disorder. Effective communication is central to successful social interactions from building new interpersonal relationships, advocating for oneself to medical professionals, to demonstrating appropriate skills during interviews. The results of this study suggest that this symptom is amenable to change and can be treated in order to promote real-world functional gains. / Thesis (Master, Psychology) -- Queen's University, 2012-08-28 14:24:36.471

Indiana University-Purdue University Indianapolis (IUPUI) / 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>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.

Abstract Early recognition of schizophrenia could lead to a better clinical course and a better prognosis. Therefore, researchers have started to investigate the possible vulnerability markers of schizophrenia. Both genetic and environmental factors have been found to be essential in the understanding of the development of psychiatric disorders. The present study is part of an extensive Finnish adoptive family study of schizophrenia. The substudies of this thesis focused on investigating the predictive value of thought disorder measured by Thought Disorder Index (TDI) in terms of the future psychiatric disorders of adoptees at high risk (HR, biological mother with a diagnosis of schizophrenia or paranoid psychosis) and low risk (LR, biological mother with no diagnosed psychosis) for schizophrenia, who had no psychiatric diagnosis at the initial assessment (n = 171). The adoptees' psychiatric status was first re-assessed based on the DSM-III-R criteria in a re-interview 11 years later and then based on the available national hospital discharge registers 16 years later. The predictive value of thought disorder as a sign of vulnerability to mental disorder was clarified by examining the stability of thought disorder (n = 158). The adoptees' TDI scores were evaluated twice at a median interval of 12 years (the adoptees' median ages at evaluation were 22 and 36 years). Furthermore, the possible genotype-environment effect in the development of thought disorder was investigated by assessing the adoptees' thought disorders at the initial and follow-up assessments as well as the CD (Communication Deviance) of their adoptive parents at the initial assessment (n = 89). High scores on several TDI variables at the initial assessment were shown to predict a follow-up diagnosis of a psychiatric disorder among all adoptees. These TDI variables were found to be stable over time, which enhanced the predictive value of thought disorder. There was an association between the thought disorder of the adoptees and the CD of their parents. Furthermore, the genotype - environment interactions were also related to the presence of thought disorder. The results of these investigations provide new information to the prevention of mental disorders, especially among person with prodromal symptoms of psychosis, such as mood disorders and cognitive dysfunctions. / Tiivistelmä Skitsofrenian varhaisen tunnistamisen myötä saattaa olla mahdollista kohentaa skitsofrenian ennustetta. Siksi tutkijat selvittävät mahdollisia skitsofreniaan altistavia ja ennakoivia tekijöitä. Sekä geneettiset että ympäristöstä johtuvat tekijät ovat nousseet olennaisiksi seikoiksi psykiatristen häiriöiden kehittymisen ymmärtämisessä. Tämä tutkimus on osa laajempaa Suomalaista adoptiolapsitutkimusta. Tutkimuksen tavoitteena oli selvittää ennustavatko Thought Disorder Index -asteikolla (TDI) mitatut ajatushäiriöt tutkimushetkellä oireettomien (eivät täyttäneet psykiatrisen diagnoosin kriteereitä) riski (biologinen äidillä skitsofrenia tai paranoidinen psykoosi diagnoosi)- ja verrokkiadoptiolasten (biologisella äidillä ei psykoosi diagnoosia) tulevaa mielenterveyttä (n = 171). Adoptiolasten psykiatrinen status arvioitiin 11 vuotta myöhemmin tehdyssä seurantatutkimuksessa DSM-III-R -kriteeristöllä ja tämän jälkeen vielä seuraamalla 16 vuotta kansallisia sairaaloiden uloskirjoitusrekistereitä. Ajatushäiriöiden ennustearvoa toimia haavoittuvuusindikaattoreina selvitettiin tutkimalla ajatushäiriöiden pysyvyyttä (n = 158). Adoptiolasten TDI pisteet arvioitiin kahdesti heidän ollessa 22- ja 36-vuotiaita, tutkimuksen alussa ja 12 vuoden (mediaani) seuranta-ajan jälkeen. Lisäksi mahdollista perimä-ympäristötekijöiden yhdysvaikutusta ajatushäiriöiden kehittymisessä tutkittiin arvioimalla adoptiolasten adoptiovanhempien kommunikaatiohäiriöt (CD) alkututkimuksessa ja adoptiolasten ajatushäiriöt sekä alku- että seurantatutkimuksessa (N = 89). Eräät alkututkimuksessa mitatut kohonneet TDI-muuttujat (TDR = TDI-astekon kokonaispistemäärä, 0.50 vakavuusaste ja omituinen sanojen käyttö) ennustivat seurannassa adoptiolasten psykiatrisen diagnoosin kriteerien täyttymistä. Kyseiset TDI-muuttujat olivat myös pysyviä ja täten niiden ennustearvo vahvistui. Adoptiolasten ajatushäiriöiden kehittyminen alku- ja seurantatutkimuksen välillä oli yhteydessä alkututkimuksessa mitattuun adoptiovanhempien kommunikaatiohäiriöiden esiintyvyyteen ja perimän ja ympäristön yhdysvaikutus tuli esille. Tämän tutkimuksen tulokset tuovat uutta tietoa ennaltaehkäisevälle mielenterveystyölle, erityisesti niiden henkilöiden kohdalla, joilla esiintyy joitakin huolestuttavia, erityisesti psykoosin ennakko-oireita kuten mieliala-oireita ja kognitiivisia muutoksia.

Formal thought disorder (FTD), or disorganized speech, is one of the central signs of schizophrenia; however, little is known about the etiology of FTD. To identify new genetic loci associated with FTD, we conducted the first genome-wide association meta-analysis of two datasets of 835 cases of FTD and 2,694 controls with 729,454 single-nucleotide polymorphisms (SNPs). Logistic regression analysis of FTD as a binary trait, adjusted for age and sex, was performed using PLINK. For meta-analysis of two datasets, the fixed-effect model in PLINK was applied. Through meta-analysis we identified 61 SNPs associated with FTD with p < 10-4. The most significant association with FTD was observed with rs1783925 (p = 4.4 × 10-7) within PKNOX2 gene at 11q24.2 while the second interesting locus was rs2277644 (p = 1.18 × 10-5) within MYH13 at 17p13. Haplotype analyses of PKNOX2 and MYH13 loci further supported the associations with FTD. The third locus was PHF2 at 9q22.31 (the top SNP was rs12238738 with p = 2.08 × 10-5) while the fourth locus was GPC6 at 13q32 (the top SNP was rs17196161 with p = 3.12 × 10-5). In conclusion, we identified four new loci (PKNOX2, MYH13, PHF2, and GPC6) associated with FTD. These findings offer the potential for new insights into the pathogenesis of FTD and schizophrenia.

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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.