Christine Passerieux

Can verbalization remedy the theory of mind deficit in schizophrenia

Several studies provide convincing evidence of a specific deficit in the theory of mind (ToM) in some patients with schizophrenia. This ToM deficit consists of an inability to attribute relevant mental states to others, and studies suggest it has to be regarded as functional and remediable through the use of reinforced context processing. To investigate this, the present study compares the performances of 25 schizophrenics and 25 matched controls in a task exploring ToM before and after the introduction of verbal material into the task, initially conceived as nonverbal. All the controls and half of the schizophrenic subjects who did not initially perform at the best level remediated with verbalization, while 9 of the schizophrenics exhibited no remediation. These poor performers are characterized by a longer duration of illness. The cognitive plasticity and the characteristics of patients who do/do not remediate are discussed in the light of findings obtained with the Wisconsin Card Sorting Test. The clinical implication of these results is important since they suggest that some patients would benefit from cognitive rehabilitation in terms of their ability to attribute relevant mental states to others.

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.

On understanding idiomatic language : The salience hypothesis assessed by ERPs

Gioras [Giora, R., 1997. Understanding figurative and literal language: the Graded Salience Hypothesis. Cogn. Linguist. 7 (1), 183-206; Giora, R., 2003. On Our Mind: Salience Context and Figurative Language. Oxford Univ. Press, New York] Graded Salience Hypothesis states that more salient meanings-coded meanings foremost on our mind due to conventionality, frequency, familiarity, or prototypicality-are accessed faster than and reach sufficient levels of activation before less salient ones. This research addresses predictions derived from this model by examining the salience of familiar and predictable idioms, presented out of context. ERPs recorded from 30 subjects involved in reading and lexical decision tasks to (strongly/weakly) salient idioms and (figurative/literal) targets indicate that N400 amplitude was smaller for the last word of the strongly salient idioms than for the weakly salient idioms. Moreover, N400 amplitude of probes related to the salient meaning of strongly salient idioms was smaller than those of the 3 other conditions. In addition, response times to salient interpretations (the idiomatic meanings of highly salient idioms and the literal interpretations of less salient idioms) were shorter compared to the other conditions. These findings support Gioras Graded Salience Hypothesis. They show that salient meanings are accessed automatically, regardless of figurativity.

N400 anomalies in schizophrenia are correlated with the severity of formal thought disorder

We explored the link between N400 anomalies and clinical profile in schizophrenia patients. N400 was recorded in 50 schizophrenia patients and 40 healthy controls during a lexical decision task with semantic priming. Comparison between controls and schizophrenia patients showed the classical anomalies reported for N400 in schizophrenia patients: greater amplitude for related words and lack of N400 effect. Analyses of the correlations between N400 effect and various symptoms of schizophrenia (formal thought disorder, positive symptoms, negative symptoms, overall symptoms, mean neuroleptic dose) or socioeducational data (age, vocabulary level, number of years of study) revealed that only the correlation with formal thought disorder was significant: the higher the scores for formal thought disorder, the lower the N400 effect observed.

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.

The emotional paradox: Dissociation between explicit and implicit processing of emotional prosody in schizophrenia

People with schizophrenia show well-replicated deficits on tasks of explicit recognition of emotional prosody. However it remains unclear whether they are still sensitive to the implicit cues of emotional prosody, particularly when they exhibit high levels of social anhedonia. A dual processing model suggesting a dissociation between the neural networks involved in explicit and implicit recognition of emotional prosody has yet to be validated. 21 participants with schizophrenia and 21 controls were recruited. In the explicit recognition task, individuals listened to semantically neutral words pronounced with two different emotions and judged their emotional prosody. In the vocal emotional Stroop task, patients and controls listened to words with a positive or negative emotional valence pronounced with congruent or incongruent emotional prosody and judged their emotional content. Patients were also assessed with the Chapman Anhedonia Questionnaire and the Schizophrenic Communication Disorders scale. Individuals with schizophrenia were impaired in their explicit recognition of emotional prosody related to controls. In contrast, they showed a vocal emotional Stroop effect that was identical to controls for reaction time and greater for accuracy: patients were still sensitive to implicit emotional prosody. In addition the vocal emotional Stroop score increased with social anhedonia but was unrelated to communication disorders. Whereas explicit vocal affect recognition is impaired, implicit processing of emotional prosody seems to be preserved in schizophrenia. Our results provide evidence that at a behavioural level, the implicit and explicit processing of emotional prosody can be dissociated. Remediation of emotional prosody recognition in schizophrenia should target cognitive rather than sensory processes.

Scale for the evaluation of communication disorders in patients with schizophrenia: A validation study

OBJECTIVE A scale for the evaluation of communication disorders in patients with schizophrenia (Schizophrenia Communication Disorder Scale-SCD) is proposed based on studies showing that cognitive disorders specific to the disorganization seen in schizophrenia consist of context processing deficits and problems in the attribution of mental states. Thus the focus of this scale is on the cognitive difficulties revealed in conversation during a structured interview. METHOD Fifty-six patients with schizophrenia, depression or mania were evaluated. RESULTS AND CONCLUSION Significantly elevated scores on the SCD were present in patients with schizophrenia compared to all other groups. Thus, this scale adds to the tools available for evaluating the language of patients with schizophrenia and helps focus on characteristics that are specific to this psychotic diagnosis.

The study of social cognition with neuroimaging methods as a means to explore future directions of deficit evaluation in schizophrenia

This article discusses the important advances in a recent field of science dealing with the brain processes implicated in understanding social situations and interacting with others. Many behavioral studies on schizophrenia have shown the impairment of these processes and their preferential relation with disorganization and negative syndromes. Brain imaging is a powerful method to identify brain systems participating in these processes in healthy subjects and will be used increasingly to study mental disorders such as schizophrenia. A few preliminary studies have opened this field of research and allowed for the drawing of some limited conclusions. We emphasize the importance of developing an integrated neurocognitive framework to account for the multifaceted nature of social cognition deficits in schizophrenia. Inspired by contemporary models of empathy and social cognition that identify different components such as shared representation, mentalizing, self/other distinction, we show how schizophrenia affects these components at the behavioral and functional levels. We also outline the interest of this model to understand putative abnormalities of contextual integration within the area of mentalization. Finally, we discuss how specialized measures of brain functions during the performance of these precisely defined mental processes might be used as outcome predictors.

Chronic Peripheral Inflammation is Associated With Cognitive Impairment in Schizophrenia: Results From the Multicentric FACE-SZ Dataset

OBJECTIVES Inflammation, measured by abnormal blood C-reactive protein (CRP) level, has been described in schizophrenia (SZ), being inconsistently related to impaired cognitive functions. The aim of the present study is to investigate cognitive impairment associated with abnormal CRP levels in a large multi-centric sample of community-dwelling SZ patients, using a comprehensive neuropsychological battery. METHOD Three hundred sixty-nine community-dwelling stable SZ subjects (76.2% men, mean age 32.7 y) were included and tested with a comprehensive battery of neuropsychological tests. Abnormal CRP level was defined as >3mg/L. RESULTS Multiple factor analysis revealed that abnormal CRP levels, found in 104 patients (28.2%), were associated with impaired General Intellectual Ability and Abstract Reasoning (aOR = 0.56, 95% CI 0.35-0.90, P = .014), independently of age, sex, education level, psychotic symptomatology, treatments, and addiction comorbidities. Abnormal CRP levels were also associated with the decline of all components of working memory (respectively effect size [ES] = 0.25, P = .033; ES = 0.27, P = .04; ES = 0.33, P = .006; and ES = 0.38, P = .004) and a wide range of other impaired cognitive functions, including memory (ES = 0.26, P = .026), learning abilities (ES = 0.28, P = .035), semantic memory (ES = 0.26, P = .026), mental flexibility (ES = 0.26, P = .044), visual attention (ES = 0.23, P = .004) and speed of processing (ES = 0.23, P = .043). CONCLUSION Our results suggest that abnormal CRP level is associated with cognitive impairment in SZ. Evaluating the effectiveness of neuroprotective anti-inflammatory strategies is needed in order to prevent cognitive impairment in SZ.

Correlations of theory of mind deficits with clinical patterns and quality of life in schizophrenia.

Background: Numerous studies have demonstrated the existence of theory of mind (ToM) impairments in patients with schizophrenia. The clinical consequences of these impairments are currently under debate. Accumulated evidence suggests that ToM deficits are linked to negative and disorganization symptoms, but direct correlations are lacking. Moreover, it is unclear whether ToM deficits are related to reduced quality of life (QoL). Methods: To extend the understanding of objective (i.e., clinical symptoms) and subjective (QoL) correlates of impaired ToM, we assessed 206 patients with schizophrenia based on performance of an ecological task (Versailles-Situational Intention Reading, V-SIR), a Communication Disorders Scale (SCD), the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression rating, and a QoL questionnaire (S-QoL). Statistical inferences were drawn from correlations analyses considering both factors/subscales aggregates and single items. Results: ToM performance was negatively correlated to disorganization and negative PANSS factors. Poor V-SIR performance was correlated with “conceptual disorganization,” “difficulties in abstract thinking,” and “apathy/social withdrawal.” The SCD was correlated with “negative,” “disorganization,” and “anxiety/depression” PANSS factors. The S-QoL total score was not significantly correlated with ToM performance. Only the item “difficulties in expressing feelings” was significantly correlated with poorer V-SIR performance. Conclusion: We discuss the intriguing paucity of the results and what they reveal about the difficulties faced by psychiatrists with patients not expressing complaints about lack of social skills.