Hostname: page-component-6bf8c574d5-956mj Total loading time: 0 Render date: 2025-02-17T00:26:31.584Z Has data issue: false hasContentIssue false
  • English
  • Français

Measuring disorganized speech in schizophrenia: automated analysis explains variance in cognitive deficits beyond clinician-rated scales

Published online by Cambridge University Press:  25 April 2018

K. S. Minor ,
J. A. Willits ,
M. P. Marggraf ,
M. N. Jones  and
P. H. Lysaker
K. S. Minor*
Affiliation:
Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, USA
J. A. Willits
Affiliation:
Department of Psychology, University of California-Riverside, Riverside, CA, USA
M. P. Marggraf
Affiliation:
Department of Psychology, Indiana University- Purdue University Indianapolis, Indianapolis, IN, USA
M. N. Jones
Affiliation:
Department of Psychology, Indiana University, Bloomington, IN, USA
P. H. Lysaker
Affiliation:
Roudebush VA Medical Center, Indianapolis, IN, USA Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
*
Author for correspondence: K. S. Minor, E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Conveying information cohesively is an essential element of communication that is disrupted in schizophrenia. These disruptions are typically expressed through disorganized symptoms, which have been linked to neurocognitive, social cognitive, and metacognitive deficits. Automated analysis can objectively assess disorganization within sentences, between sentences, and across paragraphs by comparing explicit communication to a large text corpus.

Method

Little work in schizophrenia has tested: (1) links between disorganized symptoms measured via automated analysis and neurocognition, social cognition, or metacognition; and (2) if automated analysis explains incremental variance in cognitive processes beyond clinician-rated scales. Disorganization was measured in schizophrenia (n = 81) with Coh-Metrix 3.0, an automated program that calculates basic and complex language indices. Trained staff also assessed neurocognition, social cognition, metacognition, and clinician-rated disorganization.

Results

Findings showed that all three cognitive processes were significantly associated with at least one automated index of disorganization. When automated analysis was compared with a clinician-rated scale, it accounted for significant variance in neurocognition and metacognition beyond the clinician-rated measure. When combined, these two methods explained 28–31% of the variance in neurocognition, social cognition, and metacognition.

Conclusions

This study illustrated how automated analysis can highlight the specific role of disorganization in neurocognition, social cognition, and metacognition. Generally, those with poor cognition also displayed more disorganization in their speech—making it difficult for listeners to process essential information needed to tie the speaker's ideas together. Our findings showcase how implementing a mixed-methods approach in schizophrenia can explain substantial variance in cognitive processes.

Keywords

Automated analysiscognitiondisorganized symptomsschizophreniaspeech
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 3 , February 2019 , pp. 440 - 448
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abplanalp, SJ, et al. (2017) Using lexical analysis to identify emotional distress in psychometric schizotypy. Psychiatry Research 255, 412–417.Google Scholar
Allen, HA (1983) Do positive symptom and negative symptom subtypes of schizophrenia show qualitative differences in language production? Psychological Medicine 13, 787–797.Google Scholar
Allen, DN, et al. (2007) Factor analytic support for social cognition as a separable cognitive domain in schizophrenia. Schizophrenia Research 93, 325–333.Google Scholar
Andreasen, NC (1979) Thought, language and communication disorders. II. Diagnostic significance. Archives of General Psychiatry 36, 1325–1330.Google Scholar
Andreasen, N and Grove, WM (1986) Thought, language, and communication in schizophrenia: diagnosis and prognosis. Schizophrenia Bulletin 12, 356–358.Google Scholar
Bedi, G, et al. (2015) Automated analysis of free speech predicts psychosis onset in high-risk youths. NPJ Schizophrenia. doi: 10.1038/npjschz.2015.30.Google Scholar
Bell, MD, Bryson, GJ and Lysaker, PH (1997) Positive and negative affect recognition in schizophrenia: a comparison with substance abuse and normal control subjects. Psychiatry Research 73, 73–82.Google Scholar
Bell, M, et al. (1992) The positive and negative syndrome scale and the brief psychiatric rating scale: reliability, comparability, and predictive validity. Journal of Nervous and Mental Diseases 180, 723–728.Google Scholar
Bell, MD, et al. (1994) Five component model of schizophrenia: assessing the factorial invariance of the PANSS. Psychiatry Research 52, 295–303.Google Scholar
Bell, MD, et al. (2010) Social attribution test--multiple choice (SAT-MC) in schizophrenia: comparison with community sample and relationship to neurocognitive, social cognitive and symptom measures. Schizophrenia Research 122, 164–171.Google Scholar
Bleuler, E (1911) Dementia praecox or the Group of Schizophrenia. (Zinkin, J., Trans.) New York: International Universities Press.Google Scholar
Buck, B and Penn, DL (2015) Lexical characteristics of emotional narratives in schizophrenia: relationships with symptoms, functioning, and social cognition. Journal of Nervous and Mental Diseases 203, 702–708.Google Scholar
Buck, B, Minor, KS and Lysaker, PH (2015) Differential lexical correlates of social cognition and metacognition in schizophrenia: a study of spontaneously-generated life narratives. Comprehensive Psychiatry 58, 138–145.Google Scholar
Cohen, AS and Elvevag, B (2014) Automated computerized analysis of speech in psychiatric disorders. Current Opinion in Psychiatry 27, 203–209.Google Scholar
Cohen, AS, et al. (2017) Can RDoC help find order in thought disorder? Schizophrenia Bulletin 43, 503–508.Google Scholar
Corcoran, R, Mercer, G and Frith, C (1995) Schizophrenia, symptomatology and social inference: investigating theory of mind in people with schizophrenia. Schizophrenia Research 24, 397–405.Google Scholar
Crossley, SA, Salsbury, T and McNamara, DS (2009) Measuring L2 lexical growth using hypernymic relationships. Language Learning 59, 307–334.Google Scholar
De Herdt, A, et al. (2013) Neurocognition in clinical high risk young adults who did or did not convert to a first schizophrenic psychosis: a meta-analysis. Schizophrenia Research 149, 48–55.Google Scholar
Ditman, T and Kuperberg, G (2010) Building coherence: a framework for exploring the breakdown of links across clause boundaries in schizophrenia. Journal of Neurolinguistics 23, 254–269.Google Scholar
Docherty, NM (2005) Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives. Journal of Abnormal Psychology 114, 269–278.Google Scholar
Docherty, NM (2012) On identifying the processes underlying schizophrenic speech disorder. Schizophrenia Bulletin 38, 1327–1335.Google Scholar
Docherty, NM, Miller, TN and Lewis, MA (1997) Communication disturbances in the natural speech of schizophrenic patients and non-schizophrenic parents of patients. Acta Psychiatrica Scandinavica 95, 500–507.Google Scholar
Docherty, NM, et al. (1996) Working memory, attention, and communication disturbances in schizophrenia. Journal of Abnormal Psychology 105, 212–219.Google Scholar
Docherty, NM, et al. (2013) Effects of social cognitive impairment on speech disorder in schizophrenia. Schizophrenia Bulletin 39, 608–616.Google Scholar
Eack, SM, et al. (2010) Assessing social-cognitive deficits in schizophrenia with the Mayer-Salovey Emotional Intelligence Test. Schizophrenia Bulletin 36, 370–380.Google Scholar
Elvevag, B, et al. (2007) Quantifying incoherence in speech: an automated methodology and novel application to schizophrenia. Schizophrenia Research 93, 304–316.Google Scholar
Elvevag, B, et al. (2010) An automated method to analyze language use in patients with schizophrenia and their first degree relatives. Journal of Neurolinguistics 23, 270–284.Google Scholar
Elvevag, B, et al. (2016) An examination of the language construct in NIMH's research domain criteria: time for reconceptualization! American Journal of Medical Genetics Part B: Neuropsychiatric Genetics 171, 904–919.Google Scholar
Fanning, JR, Bell, MD and Fiszdon, JM (2012) Is it possible to have impaired neurocognition but good social cognition in schizophrenia? Schizophrenia Research 135, 68–71.Google Scholar
Fineberg, SK, et al. (2016) Self-reference in psychosis and depression: a language marker of illness. Psychological Medicine 46, 2605–2615.Google Scholar
Firmin, R, et al. (2016) Veteran identity as a protective factor: a grounded theory comparison of perceptions of self, illness, and treatment among veterans and non-veterans with schizophrenia. American Journal of Psychiatric Rehabilitation 19, 294–314.Google Scholar
First, MB, et al. (2002) Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
Graesser, AC, McNamara, DS and Kulikowich, J (2011) Coh-Metrix: providing multilevel analyses of text characteristics. Educational Researcher 40, 223–234.Google Scholar
Green, MF (1996) What are the functional consequences of neurocognitive deficits in schizophrenia? American Journal of Psychiatry 153, 321–330.Google Scholar
Green, MF, Kern, RS and Heaton, RK (2004) Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophrenia Research 72, 41–51.Google Scholar
Green, MF, et al. (2008) Social cognition in schizophrenia: an NIMH workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin 34, 1211–1220.Google Scholar
Greig, TC, Bryson, GJ and Bell, MD (2004) Theory of mind performance in schizophrenia: diagnostic, symptoms, and neuropsychological correlates. Journal of Nervous and Mental Diseases 192, 12–18.Google Scholar
Gupta, T, et al. (2018) Automated analysis of written narratives reveals abnormalities in referential cohesion in youth at ultra high risk for psychosis. Schizophrenia Research 192, 82–88.Google Scholar
Hamm, JA, et al. (2012) Metacognition and social cognition in schizophrenia: stability and relationship to concurrent and prospective symptom assessments. Journal of Clinical Psychology 68, 1303–1312.Google Scholar
Harvey, PD, et al. (2000) Clinical, cognitive and functional characteristics of long-stay patients with schizophrenia: a comparison of VA and state hospital patients. Schizophrenia Research 43, 3–9.Google Scholar
Insel, TR (2014) The NIMH Research Domain Criteria (RDoC) project: precision medicine for psychiatry. American Journal of Psychiatry 171, 395–397.Google Scholar
Kay, SR, Fizszbein, A and Opler, LA (1987) The positive and negative syndrome scale for schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Lysaker, PH and Dimaggio, G (2014) Metacognitive capacities for reflection in schizophrenia: implications for developing treatments. Schizophrenia Bulletin 40, 487–491.Google Scholar
Lysaker, PH and Klion, RE (2017) Recovery, Meaning-Making, and Severe Mental Illness: A Comprehensive Guide to Metacognitive Reflection and Insight Therapy. New York: Routledge.Google Scholar
Lysaker, PH, et al. (2002) Insight and personal narratives of illness in schizophrenia. Psychiatry 65, 197–206.Google Scholar
Lysaker, PH, et al. (2005) Metacognition amidst narratives of self and illness in schizophrenia: associations with neurocognition, symptoms, insight, and quality of life. Acta Psychiatrica Scandinavica 112, 64–71.Google Scholar
Lysaker, PH, et al. (2013) Social cognition and metacognition in schizophrenia: evidence of their independence and linkage with outcomes. Acta Psychiatrica Scandinavica 127, 239–247.Google Scholar
Lysaker, PH, et al. (2018) Promoting recovery from severe mental illness: implications from research on metacognition and metacognitive reflection insight therapy. World Journal of Psychiatry 8, 1–11.Google Scholar
Maher, BA, et al. (2005) Quantitative assessment of the frequency of normal associations in the utterances of schizophrenia patients and healthy controls. Schizophrenia Research 78, 219–224.Google Scholar
Manschreck, TC, Maher, BA and Ader, DN (1981) Formal thought disorder, the type-token ratio and disturbed voluntary motor movement in schizophrenia. British Journal of Psychiatry 139, 7–15.Google Scholar
Manschreck, TC, et al. (1991) Reduced primacy and related features in schizophrenia. Schizophrenia Research 5, 35–41.Google Scholar
Manschreck, TC, et al. (2012) Frequency of normative word associations in the speech of individuals at familial high-risk for schizophrenia. Schizophrenia Research 140, 99–103.Google Scholar
Marggraf, MP, et al. (2018) Semantic coherence in psychometric schizotypy: an investigation using latent semantic analysis. Psychiatry Research 259, 63–67.Google Scholar
Mayer, JD, Salovey, P and Caruso, DR (2002) Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT): User's Manual. Toronto, ON: Multi-Health Systems, Inc.Google Scholar
McCarthy, PM and Jarvis, S (2010) MTLD, voc-D, and HD-D: a validation study of sophisticated approaches to lexical diversity assessment. Behavior Research Methods 42, 381–392.Google Scholar
McCleery, A, et al. (2015) Latent structure of cognition in schizophrenia: a confirmatory factor analysis of the MATRICS consensus cognitive battery (MCCB). Psychological Medicine 45, 2657–2666.Google Scholar
McNamara, DS, et al. (2006) Validating Coh-Metrix. In Sun, R and Miyake, N (eds). Proceedings of the 28th Annual Conference of Cognitive Science Society. Austin, TX: Cognitive Science Society, pp. 573–578.Google Scholar
McNamara, DS, et al. (2014) Automated Evaluation of Text and Discourse with Coh-Metrix. Cambridge, UK: Cambridge University Press.Google Scholar
Merrill, AM, et al. (2017) Evidence that communication impairment in schizophrenia is associated with generalized poor task performance. Psychiatry Research 249, 172–179.Google Scholar
Minor, KS and Lysaker, PH (2014) Necessary, but not sufficient: links between neurocognition, social cognition, and metacognition in schizophrenia are moderated by disorganized symptoms. Schizophrenia Research 159, 198–204.Google Scholar
Minor, KS, et al. (2015 a) Lexical analysis in schizophrenia: how emotion and social word use informs our understanding of clinical presentation. Journal of Psychiatric Research 64, 74–78.Google Scholar
Minor, KS, et al. (2015 b) The impact of premorbid adjustment, neurocognition, and depression on social and role functioning in patients in an early psychosis program. Australian and New Zealand Journal of Psychiatry 49, 444–452.Google Scholar
Minor, KS, et al. (2015 c) Conceptual disorganization weakens links in cognitive pathways: disentangling neurocognition, social cognition, and metacognition in schizophrenia. Schizophrenia Research 169, 153–158.Google Scholar
Minor, KS, et al. (2016) Affective systems induce formal thought disorder in early-stage psychosis. Journal of Abnormal Psychology 125, 537–542.Google Scholar
Minor, KS, et al. (2018) Words matter: implementing the electronically activated recorder in schizotypy. Personality Disorders: Theory, Research, and Treatment 9, 133–143.Google Scholar
Moe, AM, et al. (2016) Idea density in the life-stories of people with schizophrenia: associations with narrative qualities and psychiatric symptoms. Schizophrenia Research 172, 201–205.Google Scholar
Nuechterlein, KH, et al. (2008) The MATRICS consensus cognitive battery, part 1: test selection, reliability, and validity. American Journal of Psychiatry 165, 203–213.Google Scholar
O'Leary, DS, et al. (2000) Cognitive correlates of the negative, disorganized, and psychotic symptom dimensions of schizophrenia. Journal of Neuropsychiatry & Clinical Neurosciences 12, 4–15.Google Scholar
Pinkham, AE, et al. (2003) Implications for the neural basis of social cognition for the study of schizophrenia. American Journal of Psychiatry 160, 815–824.Google Scholar
Pinkham, AE, et al. (2014) The social cognition psychometric evaluation study: results of the expert survey and RAND panel. Schizophrenia Bulletin 40, 813–823.Google Scholar
Semerari, A, et al. (2003) How to evaluate metacognitive functioning in psychotherapy? The metacognitive assessment scale and its applications. Clinical Psychology & Psychotherapy 10, 238–261.Google Scholar
Thorp, SR, et al. (2012) Older patients with schizophrenia: does military veteran status matter? American Journal of Geriatric Psychiatry 20, 248–256.Google Scholar
Ventura, J, Wood, RC and Hellemann, GS (2013) Symptom domains in neurocognitive functioning can help differentiate social cognitive processes in schizophrenia: a meta-analysis. Schizophrenia Bulletin 39, 102–111.Google Scholar
Ventura, J, et al. (2010) Disorganization and reality distortion in schizophrenia: a meta-analysis of the relationship between positive symptoms and neurocognitive deficits. Schizophrenia Research 121, 1–14.Google Scholar
Willits, JA, et al. (in press) Evidence of disturbances of deep levels of semantic cohesion within personal narratives in schizophrenia. Schizophrenia Research. doi: 10.1016/j.schres.2017.11.014.Google Scholar