Evaluation sensitivity as a moderator of communication disorder in schizophrenia

Department of Psychiatry, University of Pennsylvania, USA.
Psychological Medicine (Impact Factor: 5.94). 05/2009; 39(7):1211-9. DOI: 10.1017/S0033291709005479
Source: PubMed


Communication disturbance (thought disorder) is a central feature of schizophrenia that predicts poor functioning. We investigated the hypothesis that memory and attention deficits interact with beliefs about the gravity of being rejected (i.e. evaluation sensitivity) to produce the symptoms of communication disorder.
Seventy-four individuals diagnosed with schizophrenia or schizo-affective disorder completed a battery of tests assessing neurocognition (attention, working and verbal memory, abstraction), symptomatology (positive, negative and affective), functioning, and dysfunctional beliefs.
Patients with communication deviance (n=33) performed more poorly on the neurocognitive tests and reported a greater degree of sensitivity to rejection than patients with no thought disorder (n=41). In a logistic regression analysis, evaluation sensitivity moderated the relationship between cognitive impairment and the presence of communication disorder. This finding was independent of hallucinations, delusions, negative symptoms, depression and anxiety.
We propose that negative appraisals about acceptance instigate communication anomalies in individuals with a pre-existing diathesis for imperfect speech production.

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    • "Language production deficits in schizophrenia have been associated with deficits in working memory (Melinder & Barch, 2003), poor appreciation of context (Cohen & Servan-Schreiber , 1992), evaluation sensitivity (Grant & Beck, 2009), and processing capacity (Barch & Berenbaum, 1994), amongst others. Unfortunately, this focus on production factors has somewhat masked our understanding of the role of comprehension in the process. "
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    ABSTRACT: Introduction. Language dysfunction is proposed to relate to the speech disturbances in schizophrenia, which are more commonly referred to as formal thought disorder (FTD). Presently, language production deficits in schizophrenia are better characterised than language comprehension difficulties. This study thus aimed to examine three aspects of language comprehension in schizophrenia: (1) the role of lexical processing, (2) meaning attribution for words and sentences, and (3) the relationship between comprehension and production. Methods. Fifty-seven schizophrenia/schizoaffective disorder patients and 48 healthy controls completed a clinical assessment and three language tasks assessing word recognition, synonym identification, and sentence comprehension. Poorer patient performance was expected on the latter two tasks. Results. Recognition of word form was not impaired in schizophrenia, indicating intact lexical processing. Whereas single word synonym identification was not significantly impaired, there was a tendency to attribute word meanings based on phonological similarity with increasing FTD severity. Importantly, there was a significant sentence comprehension deficit for processing deep structure, which correlated with FTD severity. Conclusions. These findings established a receptive language deficit in schizophrenia at the syntactic level. There was also evidence for a relationship between some aspects of language comprehension and speech production/FTD. Apart from indicating language as another mechanism in FTD aetiology, the data also suggest that remediating language comprehension problems may be an avenue to pursue in alleviating FTD symptomatology.
    No preview · Article · Jan 2016 · Cognitive Neuropsychiatry
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    • "In particular, rejection sensitivity (RS) is a type of social anxiety where the person believes he/she is being rejected in ambiguous interpersonal situations and overreacts to disengagement expressed by others (Downey & Feldman, 1996). The person then seeks reassurance, feels vulnerable about their relationships , and/or shows retaliation and aggression (Grant & Beck, 2009; Langens & Schuler, 2005; Lemay & Clark, 2008; Sinclair, Ladny, & Lyndon, 2011). Social anxiety can increase psychosis-like experiences (PLEs) in vulnerable populations (Bentall, Claridge, & Slade, 1989; Olin & Mednick, 1996; Raine et al., 1994) and exacerbate positive symptoms of psychosis, such as paranoia and delusions, via different pathways including avoidance (Achim et al., 2013; Lysaker et al., 2010). "
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    ABSTRACT: Social anxiety due to rejection sensitivity (RS) exacerbates psychosis-like experiences in the general population. While reduced dorsal anterior cingulate cortex (dACC) activity during social rejection in high schizotypy has suggested self-distancing from rejection, earlier stages of mental processing such as feature encoding could also contribute to psychosis-like experiences. This study aimed to determine the stage of mental processing of social rejection that relates to positive schizotypy. Forty-one healthy participants were assessed for schizotypy and RS. Event-related potential amplitudes (ERPs) were measured at frontal, temporal and parieto-occipital sites and their cortical sources (dACC, temporal pole and lingual gyrus) at early (N100) and late (P300 and late slow wave, LSW) timeframes during rejection, acceptance and neutral scenes. ERPs were compared between social interaction types. Correlations were performed between positive schizotypy (defined as the presence of perceptual aberrations, hallucinatory experiences and magical thinking), RS and ERPs during rejection. Amplitude was greater during rejection than acceptance or neutral conditions at the dACC-P300, parieto-occipital-P300, dACC-LSW and frontal-LSW. RS correlated positively with positive schizotypy. Reduced dACC N100 activity during rejection correlated with greater positive schizotypy and RS. Reduced dACC N100 activity and greater RS independently predicted positive schizotypy. An N100 deficit that indicates reduced feature encoding of rejection scenes increases with greater positive schizotypy and RS. Higher RS shows that a greater tendency to misattribute ambiguous social situations as rejecting also increases with positive schizotypy. These two processes, namely primary bottom-up sensory processing and secondary misattribution of rejection, combine to increase psychosis-like experiences.
    Full-text · Article · Jul 2014 · Neuropsychologia
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    ABSTRACT: Poor social and vocational outcomes have long been observed in schizophrenia, and therapeutic outcomes have been modest. Most studies have identified neurocognition and emotion perception as important contributors to social functioning. Recent research has suggested that personal beliefs, attitudes, and expectancies contribute to negative symptoms. However, the impact of specific beliefs and expectancies on social withdrawal in schizophrenia has not been examined. The present study explored: 1. whether asocial beliefs made a significant contribution to social functioning after accounting for neurocognitive performance and emotion perception; and, 2. whether asocial beliefs predicted asocial behavior in a longitudinal design. 123 outpatients diagnosed with schizophrenia or schizoaffective disorder completed tests of neurocognitive performance, emotion perception, asocial beliefs, symptomatology, and functional outcome. A subset of 13 outpatients was retested one year after the initial assessment. Hierarchical regression indicated that asocial beliefs accounted for 18% of the variability in social functioning. Depression and negative symptoms explained another 9% of the dispersion. Contrary to expectations, neurocognition and emotion perception accounted for less than 1% of the variance. In the longitudinal study, baseline asocial beliefs predicted asocial behavior one year later. Asocial beliefs predict poor social functioning in schizophrenia, and may be modifiable by psychological interventions.
    No preview · Article · Feb 2010 · Psychiatry Research
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