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“Formal Thought Disorder” in Homeless Young Adults with Elevated Schizotypal Traits: Underlying Dimensional Structure…

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“Formal Thought Disorder” in Homeless Young Adults with Elevated Schizotypal Traits: Dimensional Structure and Cognitive Correlates Cliff Deyo (BA, GDipSocSci - Psych, BSocSci - Hons, MA) Department of Psychology Faculty of Human Sciences Macquarie University Empirical thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Psychology (Clinical Neuropsychology), Macquarie University, submitted March 31, 2015. ii TABLE OF CONTENTS Table of Tables……………………………………………………………….……….….…...v General Abstract………………………………………………………………………..…….vi Declaration…………………………………………………………………………….…... .viii Acknowledgements…………………………………………………………………………...ix GENERAL INTRODUCTION………...………………………………………………..…..1 Measuring FTD by Objective Rating Scale………………………...………………......…...3 Scale for the Assessment of Thought, Language, and Communication……………....…...3 Thought and Language Index and Other Rating Scales……………………………….…..4 FTD Dimensionality……………………………………………………………….…..….....4 Factor Analytic Research and FTD Dimensionality…………………………….……..….5 A Concise Review of FTD Research……………………………………….…….……....…7 Qualitative Differences in FTD Between Diagnoses……………...………….…. …....….8 The Course of FTD………………………………...……………………….…......…..…..9 FTD in Childhood and Adolescence, and Progression to Psychosis……………..…..…..10 Parental Communication Deviance…………………………………...……………….…10 Functional Implications of FTD…………………………………………….…...…….....11 Cognitive Models of FTD……………………….……………..…………....……….……13 Cognitive Correlates of FTD………………..………...……………………………..…….15 Brain Structure and Functional Correlates of FTD……...…..…….. ……….…………….19 Schizotypy……………………………………………………..…...…….…………..……21 Continuum FTD Research…………………………….……………………….…...…….22 The Present Research Program…………………………………………………….…….....22 REFERENCES…….................................................................................................................25 PAPER 1: “Formal Thought Disorder” in Homeless Young Adults with Elevated Schizotypal Traits: Underlying Dimensional Structure…........……….............................44 ABSTRACT…………………………...………………………………………………...…...45 INTRODUCTION…………………………………………………………………………... 47 Aims and Hypotheses…………………………………...……………………………..…...52 METHOD…………………………………...………………………………………………..53 Sample and Participant Selection……………………………………...…………………...53 Materials………………………………………...……………………………….................54 Cognitive Screening Measures. ……………………………………………...…………..54 Inadequate Effort. …………………………...….…………………………………….. 54 Verbal IQ ………………….………………………….………………...……………...54 Performance IQ………………………………………………………...……………....55 Clinical Interviews and Inventories………………………………………………….…55 Personality Measures…………………………………………………………………...56 Thought Disorder Scales…………………………………...……….……………….....57 Procedure………………………………………………………….………………………..58 Statistical Approaches………………………...…………….……………………………...59 Preliminary Investigation of Data…………………………………………….………...60 Preliminary Investigation of the TLC Data for PCA………………………………...... 61 Preliminary Investigation of the TLI Data for PCA..…………………………….……..62 RESULTS…………………………………………………………………………………….62 Basic and Clinical Descriptives…………………………………………………………….62 iii Formal Thought Disorder: Severity and Dimensional Structure…………………………...67 Frequency and Severity of TLC Ratings………………………………...……….………67 Frequency and Severity of TLI Ratings………………………………...………...…….. 70 PCA of the TLC………………………………………………………...………………..72 PCA of the TLI………………………………………………...…………………….…...74 Relationships Between TLC and TLI Component Scores………………………….….…..76 Relationships Between TLC and TLI Component Scores and Psychosis-like Traits….…..78 Relationships Between TLC and TLI Component Scores and IQ Measures…....................78 Relationships Between TLC and TLI Component Scores and SPQ Odd Speech……….....78 Post-hoc Investigations……………………………………………………………...……..78 DISCUSSION…………………………………………………………………………...…...80 Severity and Frequency of FTD…………………………………………………...…..…...81 Dimensionality of FTD……………………………………………………………...….….82 Associations Between TLC and TLI Components…………………………………………83 Associations of TLC/TLI Components with Psychosis-like Traits………………...…...…84 Associations of TLC/TLI Components with IQ Measures………………………...……....84 Future Research…………………………………………………………………...….…….86 Limitations and Strengths…………………………………………………………………..87 Conclusions…………………………………………………………………………............88 REFERENCES…………………………………………………………………...……….. ...89 Paper Two: The Dimensional Nature of “Formal Thought Disorder” in Homeless Young Adults with Elevated Schizotypal Traits: Cognitive Correlates ……103 ABSTRACT ………………………………………………………...…………………...…104 INTRODUCTION………………………………………………………….……………….106 Aims and Hypothesis……………………………………………………………….…….112 METHOD……………………………………………………………………………..…….113 Sample and Participant Selection…………………………………………………..……..113 Materials…………………………………………..……………………………...……….113 Clinical Interviews and Inventories……………………………………………………..113 Personality Measures……………………………………………………………………114 Thought Disorder Scales………………..…………………………………...……….…114 Cognitive Measures………………………………………………………...…….……..115 Processing Speed……………………………………..…………………...……….……116 Attention……………………………………………………………………...…………117 Span of Attention……………………………………………..……………..………..117 Vigilance/Sustained Attention……………………..……..…………………………...117 Memory……………………………………………………………………...….………118 Language/Semantic…………………………………………………………...….……..119 Semantic…………………………………………………………………...………..…..119 Targeted Access. ……………………………………………………………….…….119 Structure/Organisation…………………………………………….……...….…..….. 120 Higher-order Reasoning……………………………………………….……...……….. 120 Executive Function………………………………………………………….…………..121 Working Memory……………………………………………………….….....………121 Planning/Strategy Use……………………………………………………….………..121 Generative Ability…………………………………………………………..…...……122 Set maintenance/Response Inhibition……………………………………….…...…...122 Set-shift……………………………………………………………………...….…….123 Source Monitoring………………………..……………………………………….…..124 iv Procedure…………………………………………………………………………….……126 Statistical Analyses………………...……………………………………………………..126 Preliminary Investigations……………………………………………………………...…128 RESULTS…………………………………………………………………………………...128 Sample Characteristics: Basic Demographic, Clinical, and Personality Descriptives...….128 FTD scales…………………………………………………………………………...….129 TLC……………………………………………..………………………………...…..129 TLI………………………………………………………………………….…….…...129 Cognitive Performances…………………………………………………………......……130 Correlational Analysis………………………………………………………………...…..130 Relationships Between TLC/TLI Dimensions and Demographic, and Clinical Variables………………………….……………………………………………..……...130 Relationships Between Cognitive Domain and TLC/TLI Dimension Scores………..…131 Effects of Cannabis Dependence on Relationships Between Cognitive and TLC/TLI Dimension Scores………………………..….……………………………...135 Post-hoc Regression Analyses Predicting TLC/TLI Dimension Scores from Cognitive Domain Scores……………………..……………………………….......….135 Post-hoc relationships between affective dysregulation and TLC Verbosity score…..139 Summary…………………………………………………………………...…………139 DISCUSSION………………………………………………………………...……...……..139 Associations Between Cognitive Functioning and TLC/TLI Dimensions…....…………..140 Associations Between TLC/TLI Dimensions and Demographic, and Clinical Variables……………………………………………………………………….………...142 Comparisons of Cognitive-FTD Relationships in Current Sample with Previous Research……………..……………………………………………………………...…….142 Cognitive Dysfunction and PFTD…………………………..……………………...…..…145 Cognitive Dysfunction and NFTD……………..…………………………………………146 TLC Verbosity…………….……………………………………………………….……...147 Future Research……………….………………………………………………….…...…..148 Limitations and Strengths……………………………………….……………..………….149 Conclusions………………………….……………………………………………..……..150 REFERENCES……………………………………………………….……….…...….…….151 General Discussion……………….……………………………….…………………...…..173 Paper 1: “Formal Thought Disorder” in Homeless Young Adults with Elevated Schizotypal Traits: Underlying Dimensional Structure………………..…………...…..174 Paper 2: The Dimensional Nature of “Formal Thought Disorder” in Homeless Young Adults with Elevated Schizotypal Traits: Cognitive Correlates.............…....….177 Conclusion....…………….………………………………………………………….…….179 REFERENCES………………………………………………………………………....…...184 APPENDIX………………………………………………………………………………... 194 Final Ethics Approval Letter…….……...…..…………...………………………………..194 v TABLE OF TABLES PAPER 1 Table 1: Sample Demographic, Clinical and Psychopathology Characteristics (N = 92 all, except DASS-21 scores n = 90)..……………..……………………………………....65 Table 2: Frequency and Severity of TLC Scores for Schizotypal, Control, and Schizophrenia samples………….………………………………………………………………….…68 Table 3: Frequency and Severity of TLI Scores for Schizotypal, Control, and Schizophrenia Samples………………………………………….…………………………...…..71 Table 4: Component Loadings Following Principal Components Analysis with Varimax Rotation of the TLC (N = 92)…………….……………………………………….…73 Table 5: Component Loadings Following Principal Components Analysis with Varimax Rotation of the TLI (n = 89)……………………………………………………………....75 Table 6: Pearson Correlations Between TLC and TLI Components (n = 89)……….………...77 Table 7: Pearson Correlations Between TLC and TLI Components, Psychosis-like Traits and IQ Measures……………………………………………………….…….79 PAPER 2 Table 1: Summary of Test Variables Grouped According to Cognitive Domain and Subdomain ………………………………………………………………………………….……125 Table 2: Correlations between TLC/TLI and cognitive domain dimensions; and Steiger’s z-tests
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