Maud Champagne-Lavau

Pragmatics, theory of mind and executive functions after a right-hemisphere lesion: Different patterns of deficits

Abstract The occurrence of a right-hemisphere lesion can interfere with pragmatic abilities, and particularly with the processing of non-literal speech acts in which the listener has to identify the speakers intention. A few studies have shown that RHD individuals may exhibit moderate difficulties in tasks requiring attribution of second-order mental states (ToM), suggesting a link between pragmatic and ToM abilities. Although links seem to exist between pragmatic abilities, ToM and executive functions in other populations, no study had tested those three abilities in RHD individuals to explore the possible co-occurrence of impairments in these three abilities. This study evaluated pragmatic and ToM abilities and executive functions in 15 RHD individuals and 15 healthy control participants. The results suggest that the ability to understand pragmatic aspects of language is closely associated with the ability to make inferences about other peoples intentions. More interestingly, the association of ToM deficits with executive dysfunction rather than executive dysfunction alone might be the best predictor of different patterns of pragmatic deficits found in different RHD subgroups of patients.

Pragmatic and executive dysfunction in schizophrenia

Abstract Many studies have reported that patients with schizophrenia (SZ) can be impaired in their pragmatic abilities, typically affecting the processing of non-literal speech acts (e.g., metaphors, indirect requests). Various hypotheses have been proposed to account for impairments in understanding non-literal language, such as executive dysfunction or problems attributing mental states to others; the latter is referred to as theory of mind (ToM) abilities. The aim of this study was to explore whether pragmatic deficits do or do not coexist with ToM impairments and/or impairments of executive functions in schizophrenia. Twenty SZ patients and twenty matched healthy control (HC) participants – all right-handed and native French-speakers – were tested individually for three abilities: (a) pragmatic, (b) ToM (original first- and second-order mental state attribution tasks) and (c) executive functions. The main results showed that SZ patients exhibit pragmatic impairments which co-occurred with an executive dysfunction such as a lack of flexibility and a ToM deficit. Subsequent analyses of covariance suggested that ToM could play a role in pragmatic understanding while flexibility did not. Our study gives partial support to neuroimaging literature showing an impaired involvement of the prefrontal cortex in such processing in schizophrenia.

Effects of cognitive remediation therapies on psychotic symptoms and cognitive complaints in patients with schizophrenia and related disorders: A randomized study

BACKGROUND Cognitive remediation therapy (CRT) has proven to be effective in treating cognitive deficits in schizophrenia. The current study aimed to assess the efficacy of CRT on psychotic symptoms and cognitive complaints. METHODS We contrasted the changes in symptoms and cognitive complaints in patients with schizophrenia and related disorders who received 2 novel CRTs, one targeting mental state attribution, and the other, mental flexibility, compared with a control group given treatment as usual. Twenty-four patients with schizophrenia and related disorders were pseudo-randomly assigned to 1 of 3 groups. Psychotic symptoms and subjective complaints about their cognitive deficits were evaluated twice in each group, before and after therapy. Scores obtained pre- and post-therapy were compared between the groups. RESULTS The therapies were well-tolerated by the participants, and no one dropped out of the study. Symptoms decreased after therapy, but not in the control group. The mental flexibility group showed the most improvement. Moreover, patients in this group described a subjective diminution of their cognitive deficits. CONCLUSIONS Our results demonstrate that CRT can be useful to reduce clinical symptoms while they suggest an impact of CRT on cognitive complaints in patients with schizophrenia.

Do patients with schizophrenia attribute mental states in a referential communication task

Introduction. Many studies have reported that individuals with schizophrenia (SZ) may have impaired social cognition, resulting in communication disorders and theory of mind (ToM) impairments. However, the classical tasks used to assess impaired ToM ability are too complex. The aim of this study was to assess ToM ability using both a classical task and a referential communication task that reproduces a ‘‘natural’’ conversation situation. Methods. Thirty-one participants with schizophrenia and 29 matched healthy participants were tested individually on a referential communication task and on a standard ToM task. Results and Conclusion. The main results showed that SZ participants had difficulties using reference markers and attributing mental states in both ToM tasks. Contrary to healthy participants, they exhibited a tendency to ineffectively mark the information they used (indefinite articles for old information and/or definite articles for new information) and had problems using information they shared with the experimenter.

Theory of mind and context processing in schizophrenia: the role of cognitive flexibility.

The present study sought to identify whether cognitive flexibility and context processing may impact theory of mind (ToM) ability in schizophrenia. Thirty two patients with schizophrenia and 29 matched healthy participants were tested individually on their ToM ability using a task involving attribution and comprehension of a speakers ironic intent. This task made it possible to determine whether the degree of incongruity between contextual information and a target sentence has an impact on the attribution of ironic intent to the protagonists of a story. Participants were also assessed on their cognitive flexibility and working memory. The main results revealed that participants with schizophrenia correctly perceived contextual information cueing attribution of ironic intent to the protagonist of the stimulus, but they showed difficulty to correctly integrate this information, performing significantly worse than healthy participants when they attributed mental states. However, some participants with schizophrenia performed like healthy control participants on the ToM task while others did not. A lack of flexibility seems to differentiate the two schizophrenia subgroups thereby obtained, suggesting that cognitive flexibility has an impact on ToM performances in schizophrenia. These difficulties were not associated with clinical symptoms. Such results will have an impact on cognitive remediation.

Social Cognition Deficit in Schizophrenia: Accounting for Pragmatic Deficits in Communication Abilities?

Schizophrenic individuals show impairments in language affecting what is referred to as the pragmatic component of language, typically the processing of non-literal language (e.g., irony, metaphor, indirect request). Such non-literal utterances require the ability to process the speakers utterance beyond its literal meaning in order to allow one to grasp the speakers intention by reference to the contextual information. This paper gives a selective literature review showing that different cognitive processes-specific to language or not-may underlie the processing of pragmatic aspects of language, and particularly of non-literal language in schizophrenia. Indeed, the fact that many other disorders (e.g., right hemisphere lesion, traumatic brain injury, autism) are characterized by pragmatic impairments may reflect a heterogeneous range of underlying functional deficits that have to be determined. Evidence is reviewed suggesting that cooccurrence of a deficit in non-literal language understanding and a deficit in theory of mind may be accounted for by an impairment in context processing associated with a lack of flexibility.

Individuals with Autism Spectrum Disorders Do Not Use Social Stereotypes in Irony Comprehension

Social and communication impairments are part of the essential diagnostic criteria used to define Autism Spectrum Disorders (ASDs). Difficulties in appreciating non-literal speech, such as irony in ASDs have been explained as due to impairments in social understanding and in recognizing the speaker’s communicative intention. It has been shown that social-interactional factors, such as a listener’s beliefs about the speaker’s attitudinal propensities (e.g., a tendency to use sarcasm, to be mocking, less sincere and more prone to criticism), as conveyed by an occupational stereotype, do influence a listener’s interpretation of potentially ironic remarks. We investigate the effect of occupational stereotype on irony detection in adults with High Functioning Autism or Asperger Syndrome (HFA/AS) and a comparison group of typically developed adults. We used a series of verbally presented stories containing ironic or literal utterances produced by a speaker having either a “sarcastic” or a “non-sarcastic” occupation. Although individuals with HFA/AS were able to recognize ironic intent and occupational stereotypes when the latter are made salient, stereotype information enhanced irony detection and modulated its social meaning (i.e., mockery and politeness) only in comparison participants. We concluded that when stereotype knowledge is not made salient, it does not automatically affect pragmatic communicative processes in individuals with HFA/AS.

Different Patterns of Theory of Mind Impairment in Mild Cognitive Impairment

Theory of Mind refers to the ability to infer other’s mental states, their beliefs, intentions, or knowledge. To date, only two studies have reported the presence of Theory of Mind impairment in mild cognitive impairment (MCI). In the present study,we evaluated 20 MCI patients and compared them with 25 healthy control participants using two Theory of Mind tasks. The first task was a false belief paradigm as frequently used in the literature, and the second one was a referential communication task,assessing Theory of Mind in a real situation of interaction and which had never been used before in this population. The results showed that MCI patients presented difficulties inferring another person’s beliefs about reality and attributing knowledge to them in a situation of real-life interaction. Two different patterns of Theory of Mind emerged among the patients. In comparison with the control group, some MCI patients demonstrated impairment only in the interaction task and presented isolated episodicmemory impairment, while others were impaired in both Theory of Mind tasks and presented cognitive impairment impacting both episodic memory and executive functioning. Theory of Mind is thus altered in the very early stages of cognitive impairment even in real social interaction, which could impact precociously relationships in daily life.

Characteristics of current tasks that contribute to mentalizing judgments: does the engagement of the participants in the social interaction matter? Comment on Achim et al. (2013).

In a recent article, Achim et al. (2013) discussed the different sources of information that contribute to mentalizing judgments in current theory-of-mind (ToM) tasks. The authors rightly emphasized the dynamic aspect of real-life social interaction, suggesting that taking account of the ongoing changes occurring during social interaction would make ToM tasks more ecological. They proposed a framework (i.e., the Eight Sources of Information Framework) that specifies the 8 sources of information we get from the environment and/or from our memories to attribute mental states to others. Nevertheless, we believe that a central aspect of ToM is missing in this framework: the engagement (or not) of the participant in the social interaction during ToM assessment. Indeed, this framework fails to consider how the participant who takes part in the ToM task manages this information, depending on the fact that he or she is involved in the interaction or not and how the information concerning the agent may impact the participant attribution of mental states. We reviewed several arguments and results from the ToM literature suggesting that merely observing a social interaction is not equivalent to participating in an interaction in terms of cognitive processes involved in the attribution of mental states to others.

Theory of mind and context processing in schizophrenia: the role of social knowledge

The present study sought to determine whether social knowledge such as speaker occupation stereotypes may impact theory of mind (ToM) ability in patients with schizophrenia (SZ). Thirty individuals with SZ and 30 matched healthy control (HC) participants were tested individually on their ToM ability using a paradigm showing that stereotypes such as speaker occupation influences the extent to which speaker ironic intent is understood. ToM ability was assessed with open questions on the speaker ironic intent, irony rating, and mockery rating. Social perception was also assessed through politeness rating. The main results showed that SZ participants, like HC participants, were sensitive to the social stereotypes. They used these stereotypes adequately to attribute mental states such as speaker ironic intent to a protagonist while they found it difficult to explicitly judge and attribute negative attitude and emotion, as evidenced by mockery rating. No difference was found between the two groups regarding social perception ability. These performances were not associated with clinical symptoms. The integration of contextual information seems to be a good target for cognitive remediation aiming to increase social cognition ability.