Nancy M. Docherty

Affective reactivity of language in schizophrenia.

Thirty acutely schizophrenic inpatients each provided two speech samples: one on affectively negative, “high-stress” topics and one on affectively positive, “low-stress” topics. We analyzed these using two different, established methods for assessment of deviance in natural language, including clinical measures of thought disorder and linguistic measures of reference performance. For the group as a whole, the speech on negative topics contained more disorder than did the speech on positive topics, as rated both clinically and linguistically, and these differences were sizeable and highly significant. Level of language disturbance and degree of affective reactivity of language symptoms correlated positively with severity of the positive syndrome but were not associated in either direction with negative syndrome severity. Affective reactivity of symptoms is discussed as a variable potentially relevant to studies of psychophysiology and subtyping in schizophrenia.

Stability of formal thought disorder and referential communication disturbances in schizophrenia.

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.

Life Events and High-Trait Reactivity Together Predict Psychotic Symptom Increases in Schizophrenia

Psychotic symptoms are exacerbated by stressful life events in schizophrenia patients as a group. Some individuals appear to be more vulnerable than others in this regard. This study tested whether schizophrenia patients are highly emotionally reactive compared with controls and whether the level of trait emotional reactivity in patients influences the degree to which they respond to life stressors with exacerbations of psychosis. Schizophrenic outpatients and nonpsychiatric controls were assessed for levels of trait emotional reactivity, arousability, and trait anxiety. Severity of symptoms was also rated in the patients. Patients were then followed up 9 months later, assessed for independent stressful life events occurring during the month before the follow-up session, and reassessed for symptom levels. The patients scored higher than the control subjects on all 3 measures of reactivity at the initial assessment. At follow-up, the occurrence of potentially stressful life events predicted increases in psychotic symptoms in patients, and there was a significant interaction between level of initial trait reactivity and the occurrence of life events in the prediction of these increases. High-trait-reactive patients showed increases in psychotic symptoms in response to life stressors, whereas low-trait-reactive patients did not. These findings support the idea that patients as a group have higher than normal levels of trait reactivity and also that patients with very high levels of trait reactivity are at elevated risk of psychotic relapse under stress. Such patients might benefit particularly from interventions designed to assist them in coping with potentially stressful life events and circumstances.

Comparative affective reactivity of different types of communication disturbances in schizophrenia

Twenty-nine schizophrenic outpatients provided speech samples on affectively positive and negative topics. These samples were assessed for several different types of communication failures by using the Communication Disturbances Index. Frequencies of overinclusive references, ambiguous word meanings, and ambiguous referents increased in the affectively negative condition; frequencies of missing referents and instances of syntactic unclarity did not change across affective conditions. Degree of overall affective reactivity of speech was associated with severity of the core positive schizophrenic syndrome. These findings support the idea that different types of schizophrenic communication disturbances are associated with different underlying pathophysiological processes, that some are more reactive to affect than others, and that affective reactivity of these symptoms is associated with the positive schizophrenic process.

Affective reactivity of symptoms as a process discriminator in schizophrenia

Evidence from naturalistic and laboratory studies indicates that schizophrenic symptoms are exacerbated by stress or arousal of negative affect in some patients and not in others. Affective reactivity of symptoms may reflect a pathophysiological process or set of processes present only in a subset of cases of schizophrenia and, therefore, may constitute a dimension potentially relevant to subtyping efforts aimed at discriminating separate processes within the disorder. This paper reviews the evidence a) that affective reactivity of symptoms exists in some but not all schizophrenic patients, b) that this dimension corresponds with other variables that also are putative process discriminators, and c) that it is associated with a more global pathological reactivity to sensory and affective stimuli. Hypotheses as to its biological substrata, relevance to treatment, and importance to larger diagnostic issues are discussed.

Attentional Dysfunction, Social Perception, and Social Competence: What Is the Nature of the Relationship?

The aim of this study was to examine the nature of the relationship between attentional dysfunction and social competence deficits in patients with schizophrenia. Attentional functioning, social perception, and social competence were assessed in 56 inpatients. Measures of vigilance and span of apprehension were administered to assess attentional functioning. Social perception was assessed with an audiovisual measure of affect recognition. Social competence was rated from a role-play task. Span of apprehension and auditory vigilance emerged as specific predictors of social competence. Affect recognition was tested as a mediator and a moderator of the relationship between attentional dysfunction and social competence. Affect recognition was found to moderate the relationship between span of apprehension and social competence.

Attributional Style in Delusional Patients: A Comparison of Remitted Paranoid, Remitted Nonparanoid, and Current Paranoid Patients With Nonpsychiatric Controls

Many studies have found that people experiencing persecutory delusions have a marked tendency to use external-personal attributions when establishing the causes of negative events. Although nonclinical populations also tend to attribute negative events to external causes, those causes are typically believed to be universal in nature, rather than personal. The central goal of the present study was to investigate whether individuals with remitted persecutory delusions would display this external-personal bias regarding negative events, in comparison to remitted patients whose delusions were not paranoid in nature and to nonpsychiatric controls. Results indicate that currently paranoid patients were significantly more likely than all other groups, including the remitted paranoid group, to use external-personal attributions in negative events. Interestingly, all patient groups also were found to be significantly more likely than the controls to use internal-personal and internal-universal attributions when explaining negative events.

Internal source monitoring and thought disorder in schizophrenia.

A new task was developed to examine source monitoring in 52 patients with schizophrenia. Patients and nonpsychiatric controls were not found to differ on recognition memory, source discrimination, or attribution bias when the between group difference in IQ was controlled. However, among patients, source discrimination was significantly related to severity of thought disorder. After controlling for IQ and verbal working memory, thought-disordered patients were significantly poorer than nonthought-disordered patients at discriminating the source of previously presented information. Results suggest that internal source monitoring is specifically related to thought disorder in patients with schizophrenia.

Normal personality characteristics in schizophrenia: a review of the literature involving the FFM.

Schizophrenia is generally viewed as a disruption of normal functioning because of an underlying core illness. A number of theorists have speculated that this core illness may unilaterally disrupt normal personality functioning. However, recent data suggests that the relationship may be more complex and reciprocal than previously conceptualized. Furthermore, basic personality characteristics appear to be associated with numerous clinical phenomena. This article reviews the empirical literature pertaining to normal personality characteristics [structured around the five-factor model (FFM) of personality] in individuals with schizophrenia. Evidence suggests that certain personality characteristics may be uniquely related to the etiology of psychosis, as well as symptom severity, occupational functioning, cigarette smoking, substance use and violent behavior, social isolation, and suicidality in patients with schizophrenia. The implications of these findings and suggestions for future research are discussed.

Stress and arousability in schizophrenia

This paper examines trait arousability (TA), a temperament characteristic, in 47 stable outpatients with schizophrenia and 50 non-psychiatric controls. Self-reported levels of stress were obtained during a negative and positive memory speech task. Levels of TA, and the association of TA scores with reported stress during the speech tasks, were examined both between and within groups. In addition, TA scores were examined in relation to symptom presentation in the patient group. Patients reported higher levels of trait arousability and higher levels of stress than controls. Trait arousability scores were significantly associated with reported stress in one of the speech condition in patients, and with the severity of positive and affective symptoms. These results suggest that temperament characteristics of an individual with schizophrenia may be related to stress responsiveness and symptom presentation.