Emily Connaughton

The phenomenology of inner speech: comparison of schizophrenia patients with auditory verbal hallucinations and healthy controls

BACKGROUND Despite the popularity of inner-speech theories of auditory verbal hallucinations (AVHs), little is known about the phenomenological qualities of inner speech in patients with schizophrenia who experience AVHs (Sz-AVHs), or how this compares to inner speech in the non-voice-hearing general population. METHOD We asked Sz-AVHs (n=29) and a non-voice-hearing general population sample (n=42) a series of questions about their experiences of hearing voices, if present, and their inner speech. RESULTS The inner speech reported by patients and controls was found to be almost identical in all respects. Furthermore, phenomenological qualities of AVHs (e.g. second- or third-person voices) did not relate to corresponding qualities in inner speech. CONCLUSIONS No discernable differences were found between the inner speech reported by Sz-AVHs and healthy controls. Implications for inner-speech theories of AVHs are discussed.

The Fregoli Delusion: A Disorder of Person Identification and Tracking

Fregoli delusion is the mistaken belief that some person currently present in the deluded persons environment (typically a stranger) is a familiar person in disguise. The stranger is believed to be psychologically identical to this known person (who is not present) even though the deluded person perceives the physical appearance of the stranger as being different from the known persons typical appearance. To gain a deeper understanding of this contradictory error in the normal system for tracking and identifying known persons, we conducted a detailed survey of all the Fregoli cases reported in the literature since the seminal Courbon and Fail (1927) paper. Our preliminary reading of these cases revealed a notable lack of definitional clarity. So, we first formulated a classification scheme of different person misidentification delusions so as to identify those cases that qualified as instances of Fregoli according to the above characterization: the mistaken belief that a known person is present in the environment in a different guise to his or her typical appearance. We identified 38 clear cases of this type and set out to answer a series of questions motivated by current hypotheses about the origin of the Fregoli delusion. We asked whether the patients misidentified particular strangers, made reference to the misidentified known persons using wigs or plastic surgery (or other techniques to disguise their appearance), misidentified many different strangers or only one, showed other symptoms (in particular, other misidentification delusions), and made inferences about the motives of the known persons in disguise. We conclude by discussing the implications of our findings for current hypotheses concerning the origin of the Fregoli delusion.

Social cognition and social judgment in schizophrenia

Schizophrenia typically involves poor social functioning. This may be due, in part, to deficits in theory-of-mind, the cognitive ability to reason flexibly about the mental states of others. Patients also have deficits in social knowledge. It is currently unclear how these two impairments interrelate in schizophrenia. To address this issue, 43 patients with schizophrenia and 25 healthy controls completed two theory-of-mind tests and a novel test of social judgment. This latter measure required participants to judge whether various social behaviors were normal or reasonable in the context in which the behaviors occurred. Whereas patients demonstrated clear deficits in theory-of-mind, they performed similarly to controls when judging socially appropriate behaviors and violations of social norms. Patients, however, were less likely than controls to judge social behavior as reasonable when the behavior was impolite but understandable if the characters’ thoughts were taken into account. This latter difficulty correlated with patients’ performance deficits on the theory-of-mind tasks. Overall, findings suggest that basic social knowledge is intact in schizophrenia, though judgments of social behavior are affected by patients’ theory-of-mind deficits.

Belief, delusion, hypnosis, and the right dorsolateral prefrontal cortex: a transcranial magnetic stimulation study

According to the Two-Factor theory of delusional belief (see e.g. Coltheart at al., 2011), there exists a cognitive system dedicated to the generation, evaluation, and acceptance or rejection of beliefs. Studies of the neuropsychology of delusion provide evidence that this system is neurally realized in right dorsolateral prefrontal cortex (rDLPFC). Furthermore, we have shown that convincing analogues of many specific delusional beliefs can be created in nonclinical subjects by hypnotic suggestion and we think of hypnosis as having the effect of temporarily interfering with the operation of the belief system, which allows acceptance of the delusional suggestions. If the belief system does depend on rDLPFC, then disrupting the activity of that region of the brain by the application of repetitive transcranial magnetic stimulation (rTMS) will increase hypnotizability. Dienes and Hutton (2013) have reported such an experiment except that it was left DLPFC to which rTMS was applied. An effect on a subjective measure of hypnotizability was observed, but whether there was an effect on an objective measure could not be determined. We report two experiments. The first was an exact replication of the Dienes and Hutton experiment; here we found no effect of rTMS to lDLPFC on any hypnotic measure. Our second experiment used rTMS applied to right rather then left DLPFC. This right-sided stimulation enhanced hypnotizability (when hypnotic response was measured objectively), as predicted by our hypothesis. These results imply a role for rDLPFC in the cognitive process of belief evaluation, as is proposed in our two-factor theory of delusion. They are also consistent with a conception of the acceptance of a hypnotic suggestion as involving suspension of disbelief.

Indirect task instructions better reveal theory-of-mind impairment, independent of executive dysfunction, in schizophrenia

Theory of mind (TOM) impairments associate significantly with executive deficits in schizophrenia, consistent with the proposal that executive abilities can limit TOM task performance, and confounding identification of those patients who would benefit most from targeted mentalising interventions. 50 schizophrenia patients and 30 healthy controls completed an executive battery and four TOM tasks that were alike with regards generating overt measures of causal false-belief reasoning, but differed with regards using indirect (vs. more direct) instructions. Only the TOM tasks that used indirect instructions to elicit spontaneous false-belief inferences revealed impairment, independent of executive dysfunction, in the schizophrenia patients.

Masked and unmasked priming in schizophrenia

Dehaene et al. (2003) showed an absence of conscious, but not masked, conflict effects when patients with schizophrenia performed a number-categorisation priming task. We aimed to replicate these influential results using a different word-categorisation priming task. Counter to Dehaene et al.s findings, 21 patients and 20 healthy controls showed similar congruence effects for both masked and visible primes. Within patients, a reduced congruence effect for visible primes associated with longer duration of illness and more severe behavioural disorganisation. Patients, unlike controls, were no slower to respond to targets that followed visible compared to masked primes. Conscious conflict effects on priming tasks are not universally reduced in schizophrenia but may associate with chronicity and behavioural disorganisation. That patients were no slower when the preceding primes were clearly visible accords with evidence elsewhere that information processing in schizophrenia is driven more by immediate conscious experience and constrained less by prior events.

Social knowldge and social cognition dissociate in schizophrenia

Introduction: Longitudinal studies of women with eating disorders report variable outcomes and there are few consistent predictors of outcome. Aim: The study aims were to describe the course and putative predictors of outcome of community women with disordered eating. Method: One hundred and twenty-two young women (mean age 28.596.3 years) identified in a general population based survey (1) with eating disorder symptoms of clinical severity agreed to participate in a follow-up study. The present paper reports on results at two years. Eating disorder symptoms, health related quality of life, general psychological function, help-seeking, and defence style were assessed at baseline, and two years by questionnaire. Results: Eighty-seven women (71%) completed the two year followup. Multiple linear regression analyses were used to identify demographic and other characteristics related to the EDEQ global score and to the SF12 mental score at the two year follow-up. At two years of follow-up the mean EDEQ global score was 3.1, 59.8% of women had experienced at least one day out of role during the past four weeks, and the mean SF12 mental component score was 38.0. In the multivariate model, a higher level of immature defence style and baseline binge eating severity, significantly predicted higher levels of eating disorder symptom severity at two years. A higher level of immature defence style, higher general psychological disturbance, lower BMI, and not reporting home duties as main work, were associated with poorer quality of life. Conclusions: The relevance of defence style to personality structure and as a main predictor of outcome in women with eating disorders will be discussed. Reference 1. Mond JM, Hay PJ, Rodgers B, Owen, C. Self-recognition of disordered eating among women with bulimic-type eating disorders: a community-based study. Int J Eat Disord in press.