Higher order language impairments can predict the transition of ultrahigh risk state to psychosis—An empirical study

Abstract

Aim Higher order language skills, for example, non‐literal language, humour, prosody deal with ‘what is meant’ and they are necessary for communicative exchange and relationships; No study has investigated their link with conversion to psychosis. The purpose of this study was to determine whether such skills could act as predictors of the onset of psychosis, and compare those of individuals converting and non‐converting to psychosis with control of cognitive functions. Methods Seventy‐three patients, aged 15 to 32 years, fulfilling ultrahigh risk criteria took part: 14% of whom were receiving antipsychotic drugs. The study was observational, prospective and longitudinal in nature, and scheduled for 60 months. Pragmatic language skills were evaluated using the Polish version of the right hemisphere language battery. The ultrahigh risk (UHR) criteria were evaluated with Comprehensive Assessment of At‐Risk Mental States; attention, intelligence and verbal fluency were controlled. Results The conversion rate was 25%; converters demonstrated impaired humour comprehension and metaphor explanation abilities; composite score of pragmatic language was associated with a hazard ratio of 6.0 (95% CI 1.8‐20.5) and AUC of .73. Verbal fluency was an independent predictor of conversion, but attention and intelligence were not; pragmatic language skills were associated with social function but not with prodromal symptoms. Conclusions The results suggest that deficits in humour comprehension and metaphor explanation could predict conversion to psychosis. These findings could improve diagnosis and create implications for speech and language therapy in UHR groups. Further studies on the mechanisms of pragmatic skills should analyze their relationship with abstract measures and semantic coherence.

Linguistic findings in persons with schizophrenia—a review of the current literature

“… Spitzer, 1993 ). Impaired metaphor explanation due to overreliance on context-unspecific, dominant word meanings was found to precede the conversion to schizophrenia ( Heinz et al, 1996 ; Pawełczyk et al, 2021 ), suggesting a fundamental aspect of the disposition to psychotic experiences. Consistent with a reduced use of context based comprehension, pragmatic dysfunctions could be attributed to disturbed top-down processing ( Stephane et al, 2014 ).…”

“…Individuals at clinical high-risk furthermore showed marked impairment in semantic but not phonematic VF ( Becker et al, 2010 ; Magaud et al, 2010 ), predictive of transition to manifest psychosis ( Becker et al, 2010 ). On the other hand, an association between decreased phonematic VF and transition to schizophrenia has also been demonstrated ( Pawełczyk et al, 2021 ). Underlying the VF deficits may be a specific impairment in word selection despite intact single-word retrieval, which in individuals at ultra-high-risk correlated with both disorganized and negative symptoms ( Vargas et al, 2018 ).…”

“…More equivocal findings emerged from comprehensive studies of pragmatics: Here, individuals at ultra-high-risk showed significant impairments in understanding inferential meanings, in discourse analysis, and in the socio-emotional domain, but better performance in metaphor explanation and in the cognitive domain than individuals with first psychotic episode ( Pawełczyk et al, 2019 ). However, transition to schizophrenia was specifically associated with impairments in humor comprehension and metaphor explanation ( Pawełczyk et al, 2021 ).…”

Exploring the relationship between frequent cannabis use, vocal changes and language use

“…The potential to assess speech on a large scale, and at repeated intervals, could help in the identification of early signs of mental health problems and track changes in performance over time that might be predictive or indicative of changes in mental health. Indeed, previous work has shown exceptional promise of speech measures in terms of predicting, identifying and monitoring psychotic disorders such as schizophrenia or bipolar disorder (Agurto et al, Jul 2020a;Bedi et al, 2015;Pawełczyk et al, 2021;Wanderley Espinola et al, 2022).…”

Συσχέτιση Των Διαταραχών Ακουστικής Επεξεργασίας Με Τη Διαταραχή Στη Ροή Της Σκέψης Σε Ασθενείς Με Σχιζοφρένεια

“…Έχουν δημοσιευτεί ήδη δύο μελέτες (Bedi et al, 2015;Pawełczyk et al, 2020), όπου εξετάστηκε η ομιλία ατόμων αυτής της ομάδας δύο φορές, λαμβάνοντας υπόψη ποια άτομα είχαν εμφανίσει ψύχωση στη δεύτερη εξέταση. Τα αποτελέσματα είναι ενθαρρυντικά, όσον αφορά την προγνωστική αξία συγκεκριμένων στοιχείων, ιδίως στην περίπτωση που η ανάλυση της ομιλίας των ασθενών έγινε με ηλεκτρονικά μέσα (Bedi et al, 2015).…”