Thought disorder in mid-childhood as a predictor of adulthood diagnostic outcome: findings from the New York High-Risk Project

Gooding, Diane C.; Ott, S. Looser; Roberts, Simone A.; Erlenmeyer‐Kimling, L.

doi:10.1017/s0033291712001791

Cited by 55 publications

(39 citation statements)

References 43 publications

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“…79 An extensive body of empirical research, using a variety of measures to assess TD, has confirmed the presence of mild TD or odd speech in clinically unaffected relatives of SZ patients 42,44,[81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98] and in high-risk offspring. 20,[99][100][101][102][103][104][105][106] Notably, the biological relatives of SZ (RelSZ) adoptees have significantly higher TD scores than adoptive RelSZ. 92 Similarly, idiosyncratic verbalizations are significantly more prevalent in adopted biological offspring of SZ mothers than in adopted offspring of control mothers.…”

Section: Introductionmentioning

confidence: 99%

Thought Disorder in Schizophrenia and Bipolar Disorder Probands, Their Relatives, and Nonpsychiatric Controls

Morgan

Coleman

Ülgen

et al. 2017

Schizophrenia Bulletin

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Thought disorder (TD) has long been associated with schizophrenia (SZ) and is now widely recognized as a symptom of mania and other psychotic disorders as well. Previous studies have suggested that the TD found in the clinically unaffected relatives of SZ, schizoaffective and bipolar probands is qualitatively similar to that found in the probands themselves. Here, we examine which quantitative measures of TD optimize the distinction between patients with diagnoses of SZ and bipolar disorder with psychotic features (BP) from nonpsychiatric controls (NC) and from each other. In addition, we investigate whether these same TD measures also distinguish their respective clinically unaffected relatives (RelSZ, RelBP) from controls as well as from each other. We find that deviant verbalizations are significantly associated with SZ and are co-familial in clinically unaffected RelSZ, but are dissociated from, and are not co-familial for, BP disorder. In contrast, combinatory thinking was nonspecifically associated with psychosis, but did not aggregate in either group of relatives. These results provide further support for the usefulness of TD for identifying potential non-penetrant carriers of SZ-risk genes, in turn enhancing the power of genetic analyses. These findings also suggest that further refinement of the TD phenotype may be needed in order to be suitable for use in genetic studies of bipolar disorder.

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Section: Introductionmentioning

confidence: 99%

Thought Disorder in Schizophrenia and Bipolar Disorder Probands, Their Relatives, and Nonpsychiatric Controls

Morgan

Coleman

Ülgen

et al. 2017

Schizophrenia Bulletin

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“…These data support the concept of disorganized communication as a potential endophenotype or stable trait marker for schizophrenia risk, consistent with the finding that disorganized communication aggregates in family members of individuals with schizophrenia (Levy et al, 2010) and predicts psychosis onset also in genetic high-risk individuals(Ott et al., 2002). Of note, the relevance of subthreshold thought disorder for emergent schizophrenia and related psychotic disorders is evident also from studies of 1) speech analysis, using audio recordings and transcripts, in both clinical high risk (Bearden et al, 2011) and genetic high risk (Gooding et al, 2012; Gooding et al., 2013) cohorts; and 2) studies of speech illusion (the tendency to find spurious meaning in the noise of overlapping speech), which is increased in those CHR participants who go on to develop psychosis (Hoffman et al, 2007). …”

Section: Discussionmentioning

confidence: 99%

“…N = 52–161) of cohort sizes in prior studies that evaluated trajectories of symptoms in autism, bipolar disorder and psychosis (M’Bailara et al, 2013; Ozonoff et al, 2011; Pelayo-Teran et al, 2014). Future studies including longitudinal assay of structural and functional integrity of the left superior temporal gyrus and its connectivity with other nodes relevant to language, as well as analysis of speech transcripts (Bearden et al, 2011; Gooding et al, 2012; Gooding et al, 2013) and speech interpretation (Hoffman et al, 2007), may carry added benefit. In addition, therapeutics beyond dopamine antagonists, that similarly target the superior temporal gyrus and related neuroanatomic regions (such as noninvasive brain stimulation and/or language-based remediation strategies) may also be considered in conjunction with putative neuroimaging and/or speech analysis biomarkers.…”

Section: Discussionmentioning

confidence: 99%

Symptom trajectories and psychosis onset in a clinical high-risk cohort: The relevance of subthreshold thought disorder

DeVylder

Muchomba

Gill

et al. 2014

Schizophrenia Research

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Background Prior studies have implicated baseline positive and negative symptoms as predictors of psychosis onset among individuals at clinical high risk (CHR), but none have evaluated latent trajectories of symptoms over time. This study evaluated the dynamic evolution of symptoms leading to psychosis onset in a CHR cohort. Method 100 CHR participants were assessed quarterly for up to 2.5 years. Latent trajectory analysis was used to identify patterns of symptom change. Logistic and proportional hazards models were employed to evaluate the predictive value for psychosis onset of baseline symptoms and symptom trajectories. Results Transition rate to psychosis was 26%. Disorganized communication (i.e., subthreshold thought disorder) presented an increased hazard for psychosis onset, both at baseline (Hazard Ratio (95% CI) = 1.4 (1.1–1.9)) and as a trajectory of high persistent disorganized communication (Hazard Ratio (95% CI) = 2.2 (1.0–4.9)). Interval clinical data did not improve the predictive value of baseline symptoms for psychosis onset. Conclusions High baseline disorganized communication evident at ascertainment tended to persist and lead to psychosis onset, consistent with prior behavioral and speech analysis studies in similar cohorts. Remediation of language dysfunction therefore may be a candidate strategy for preventive intervention.

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“…the disruption in flow of meaning in language (derailment, tangentiality) 2 . This language disturbance is an early core feature of schizophrenia, evident in subtle form prior to initial psychosis onset, in cohorts of both familial 3 and clinical [4][5][6][7] high-risk youths, as assessed using clinical ratings. Beyond clinical ratings, there has been an effort to characterize early subtle language disturbances in clinical high-risk (CHR) individuals using linguistic analysis, with the aim of improving prediction.…”

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confidence: 99%

Prediction of psychosis across protocols and risk cohorts using automated language analysis

et al. 2018

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Language and speech are the primary source of data for psychiatrists to diagnose and treat mental disorders. In psychosis, the very structure of language can be disturbed, including semantic coherence (e.g., derailment and tangentiality) and syntactic complexity (e.g., concreteness). Subtle disturbances in language are evident in schizophrenia even prior to first psychosis onset, during prodromal stages. Using computer-based natural language processing analyses, we previously showed that, among English-speaking clinical (e.g., ultra) high-risk youths, baseline reduction in semantic coherence (the flow of meaning in speech) and in syntactic complexity could predict subsequent psychosis onset with high accuracy. Herein, we aimed to cross-validate these automated linguistic analytic methods in a second larger risk cohort, also English-speaking, and to discriminate speech in psychosis from normal speech. We identified an automated machine-learning speech classifier -comprising decreased semantic coherence, greater variance in that coherence, and reduced usage of possessive pronouns -that had an 83% accuracy in predicting psychosis onset (intra-protocol), a cross-validated accuracy of 79% of psychosis onset prediction in the original risk cohort (cross-protocol), and a 72% accuracy in discriminating the speech of recent-onset psychosis patients from that of healthy individuals. The classifier was highly correlated with previously identified manual linguistic predictors. Our findings support the utility and validity of automated natural language processing methods to characterize disturbances in semantics and syntax across stages of psychotic disorder. The next steps will be to apply these methods in larger risk cohorts to further test reproducibility, also in languages other than English, and identify sources of variability. This technology has the potential to improve prediction of psychosis outcome among at-risk youths and identify linguistic targets for remediation and preventive intervention. More broadly, automated linguistic analysis can be a powerful tool for diagnosis and treatment across neuropsychiatry.Key words: Automated language analysis, prediction of psychosis, semantic coherence, syntactic complexity, high-risk youths, machine learning (World Psychiatry 2018;17:67-75) Language offers a privileged view into the mind: it is the basis by which we infer others' thought processes, such that disorganized language is considered to reflect disorder in thought. Language disturbance is prevalent in schizophrenia and is related to functional disability, given that an individual needs to think and speak clearly in order to maintain friends and a job 1 . In schizophrenia, the speaker "violates the syntactical and semantic conventions which govern language usage", yielding reduction in syntactic complexity (concrete speech, poverty of content) and loss of semantic coherence, e.g. the disruption in flow of meaning in language (derailment, tangentiality) 2. This language disturbance is an early core feature of sch...

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Thought disorder in mid-childhood as a predictor of adulthood diagnostic outcome: findings from the New York High-Risk Project

Abstract: These findings suggest that negative thought disorder may have a specific association with schizotypy, rather than a more general association with psychosis. The findings also support consideration of negative thought disorder as an endophenotypic indicator of a schizophrenia diathesis.

Cited by 55 publications

References 43 publications

Thought Disorder in Schizophrenia and Bipolar Disorder Probands, Their Relatives, and Nonpsychiatric Controls

Thought Disorder in Schizophrenia and Bipolar Disorder Probands, Their Relatives, and Nonpsychiatric Controls

Symptom trajectories and psychosis onset in a clinical high-risk cohort: The relevance of subthreshold thought disorder

Prediction of psychosis across protocols and risk cohorts using automated language analysis

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