Narrative Qualities in Schizophrenia

Abstract

Schizophrenia spectrum disorders often involve a profound diminishment in people's ability to coherently narrate their lives. Unknown is whether narrative difficulties of persons with schizophrenia differ from those with other disabilities, and how they relate to clinical or neurocognitive aspects of schizophrenia. To address both issues, personal narratives were obtained for 25 participants with schizophrenia spectrum disorders and a comparison group of eight legally blind participants and four with major depressive disorders. Flexibility of abstract thought and positive, negative, and emotional discomfort symptoms were assessed among the schizophrenia group. ANCOVA comparing scores on our scale to assess narrative development, controlling for age, found the schizophrenia group narratives significantly more impoverished than the comparison group on multiple dimensions, including self-worth and agency. Neurocognitive impairment and negative symptoms were significant predictors of impoverishment in the schizophrenia group. Results may highlight deficits that could be addressed in psychotherapy or rehabilitation to promote recovery.

A review of autobiographical memory studies on patients with schizophrenia spectrum disorders

“…However, they explained that positive symptoms will impact abstract/flexible thinking, hence it may have been associated with plausibility in the narrative. Poor plausibility in narrative reflected low function in socializing.1.0 2) Lack of awareness in patients was not 3) associated with positive or negative symptoms (i.e., neurocognition) and quality of life. 4) Lack of awareness was associated with poor performance in verbal memory. 5) Association between high levels of positive symptoms with poorer temporal conceptual connection, and plausibility in narratives was observed. 6) Plausibility in narrative was associated with quality of life (i.e., social function).10Lysaker et al (2005) [46]Outpatients, n = 16Control group:-Blind participants, n = 8-MDD, n = 4• Narrative interview (with STAND*)1) The quality of narrative in patients was significantly poorer than controls in terms of self-worth (i.e., experiencing themselves as valuable to others) and agency (i.e., ability to sense that they can affect events in their own lives), indicating that patients consider their past to be of current social value, have a passive connection to others, and believe that their lives are controlled by outside forces.Authors believed that negative symptoms (i.e., diminishing affect; volition) caused them to have little emotion; resulting in the telling of a thin story without much context.1.0 2) Negative symptoms and neurocognitive impairment were predictors of the poor quality of patient narratives. 3) No evidence that observed narrative disruptions were associated with levels of depression/anxiety or positive symptoms. 4) Awareness of illness was significantly associated with insight and judgement.11Lysaker et al (2005) [45]Patients, n = 6 (average flexibility in abstract thinking); n = 10 (below average)• IPII* (with NCRS*)1) After a 5-month vocational rehabilitation, no significant result was observed in narrative coherence among patients.Authors believed that patients with intact neurocognitive abilities may be able to develop more coherent stories after vocational rehabilitation, which provided patients with working experiences and helped them to gain a sense of identity and develop personal potential.0.818 2) However, the patient with average flexibility in abstract thinking seemed to improve in narrative coherence after 5-months vocational rehabilitation.12McLeod et al (2006) [47]UKPatients, n = 20Controls, n = 20Samples were matched with age, education level, premorbid IQ, level of depression, and general memory ability.• AMI*• AMT*1) Patients showed a U-shaped temporal gradient, as they performed significantly worse in early adulthood than other periods of time (i.e., childhood and recent), in terms of personal facts.Authors interpreted that patients’ AM retrieval process was aborted prematurely, possibly reflecting a general deficit of response inhibition.U-shaped pattern: patients’...…”

“… ▪ Elvevåg et al, 2003 [39]Free recall of 20 important events from participants’ lives and attribution of ages and times for each event [100] ▪ Cuervo-Lombard et al, 2007 [50]Singer & Moffitt’s (1992) Self-defining memories (SDMs) questionnaire requiring participants to recall three important memories which help to define who they are. ▪ Raffard et al, 2009 [58] ▪ Raffard et al, 2010 [64] ▪ Berna et al, 2011a [66] ▪ Berna et al, 2011b [66] ▪ Holm et al, 2016 [82] ▪ Holm et al, 2017 [85]Diary record [101] ▪ Pernot-Marino et al, 2010 [62]Kuhn & McPartland’s (1954) “Twenty-Statements” Test (TST) of I am statements ▪ Bennouna-Greene et al, 2012 [70]Life story chapters [102] requiring participants recall their life stories, and divide them into different chapters. ▪ Holm et al, 2016 [82]Life Narrative [103]: to recall 7 the most important past events, and narrate a story with those memories ▪ Alle et al, 2015 [78] ▪ Alle, d’Argembeau, et al, 2016 [83] ▪ Alle, Gandolphe, et al, 2016 [81]Indiana Psychiatric Illness Interview (i.e., IPII) [104]. IPII is to access one’s narrative with mental illness, including their life story, their understanding of illness, and lived experience of having such illness, and lastly how the illness control or being controlled. ▪ Lysaker, Davis et al, 2005 [45] ▪ Lysaker, France et al, 2005 [45] ▪ Lysaker, Buck et al, 2006 [49] ▪ Lysaker, Buck et al, 2008 [56] ▪ Roe et al, 2008 [57] ▪ Lysaker et al, 2008 [56] ▪ Buck et al, 2015 [79] ▪ Moe et al, 2016 [84] ▪ Willits et al, 2018 [86]Narrative interview: “tell a story of your life”, “describe yourself as fully as you can” ▪ Lysaker, et al, 2005 [46] ▪ Saavedra, 2010 [61] ▪ Moe & Docherty, 2014 [73] ▪ Holm et al, 2018 [89]...…”

“…Twenty-six studies [39, 45, 46, 49, 50, 56–58, 61, 62, 64, 66, 70, 73, 78, 79, 81–86, 89] used open-ended retrieval methods. Under this method, the studies were more likely to focus on the quality of AMs, such as meaning making, content, insight, self-worth, coherence, temporal conceptual context, plausibility, and so on.…”

Impaired coherence of life narratives of patients with schizophrenia

“…From the perspective of psychopathology, we argue that the reduced coherence of patients’ life narratives is related to disorders of the self in schizophrenia 40 . We suggest that the relationship between life story and self should be examined under the light of two complementary perspectives.…”

“…Executive functioning, particularly mental flexibility and strategic retrieval of information in memory, was assessed with (1) the Trail-Making Test (TMT, Part A and B) 38 and (2) the semantic and phonologic verbal fluency tasks 39 . We selected executive functions considered to be particularly involved in life narration and autobiographical reasoning abilities 23 40 .…”