Neurocognitive and Social Cognitive Correlates of Formal Thought Disorder in Schizophrenia Patients

University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln U.S. Department of Veterans Affairs Staff Publications U.S. Department of Veterans Affairs 2006 Neurocognitive and social cognitive correlates of formal thought disorder in schizophrenia patients Kenneth L. Subotnik University of California - Los Angeles, [email protected] Keith H. Nuechterlein University of California - Los Angeles, [email protected] Michael F. Green University of California - Los Angeles William P. Horan University of California - Los Angeles, [email protected] Tasha M. Nienow University of California - Los Angeles See next page for additional authors Follow this and additional works at: https://digitalcommons.unl.edu/veterans Subotnik, Kenneth L.; Nuechterlein, Keith H.; Green, Michael F.; Horan, William P.; Nienow, Tasha M.; Ventura, Joseph; and Nguyen, Annie T., "Neurocognitive and social cognitive correlates of formal thought disorder in schizophrenia patients" (2006). U.S. Department of Veterans Affairs Staff Publications. 76. https://digitalcommons.unl.edu/veterans/76 This Article is brought to you for free and open access by the U.S. Department of Veterans Affairs at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in U.S. Department of Veterans Affairs Staff Publications by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Authors Kenneth L. Subotnik, Keith H. Nuechterlein, Michael F. Green, William P. Horan, Tasha M. Nienow, Joseph Ventura, and Annie T. Nguyen This article is available at DigitalCommons@University of Nebraska - Lincoln: https://digitalcommons.unl.edu/ veterans/76 Schizophrenia Research 85 (2006) 84–95 www.elsevier.com/locate/schres Neurocognitive and social cognitive correlates of formal thought disorder in schizophrenia patients Kenneth L. Subotnik a,*, Keith H. Nuechterlein a,b, Michael F. Green a,c, William P. Horan a, Tasha M. Nienow a, Joseph Ventura a, Annie T. Nguyen a a Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 300 UCLA Medical Plaza, Room 2240, Los Angeles, CA 90095-6968, USA b Department of Psychology, University of California, Los Angeles, USA c Veterans Affairs Greater Los Angeles Healthcare System, USA Received 7 February 2006; accepted 3 March 2006 Available online 19 April 2006 Abstract The neurocognitive and social cognitive correlates of two types of formal thought disorder (i.e., bizarre-idiosyncratic and concrete thinking) were examined in 47 stable outpatients with schizophrenia. Both types of thinking disturbance were related to impairments in verbal learning, intrusions in verbal memory, immediate auditory memory, sustained attention, and social schema knowledge. Distractibility during an immediate memory task was associated with more frequent bizarre verbalizations but not concreteness. Impaired verbal learning rate and intrusions in verbal memory independently contributed to the prediction of bizarre responses, whereas intrusions in verbal memory and impaired immediate memory independently contributed to concrete thinking. This pattern of findings is consistent with the view that neurocognitive and, possibly, social cognitive deficits underlie these two aspects of formal thinking disturbance in schizophrenia. D 2006 Elsevier B.V. All rights reserved. Keywords: Schizophrenia; Proverbs; Neurocognition; Social cognition; Formal thought disorder; Concrete thinking 1. Introduction word usage (Holzman et al., 1986). Thought disorder has been considered to be a core feature of schizo- Formal thought disorder is a multifaceted construct phrenia (Bleuler, 1950) and has been described as that encompasses a diverse set of thinking disturban- either a positive symptom (Andreasen and Olsen, ces, including loose and indirect associations, overly 1982) or as part of the disorganization syndrome abstract or concrete responses, illogicality, inappro- (Liddle, 1987). Longitudinal studies have found that priate intrusion of personal material, and unusual the severity of thought disorder in schizophrenia is moderately stable typically (Adler and Harrow, 1974; * Corresponding author. Asarnow and MacCrimmon, 1982; Docherty et al., E-mail address: [email protected] (K.L. Subotnik). 2003) but becomes exacerbated during acute episodes 0920-9964/$ - see front matter D 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2006.03.007 K.L. Subotnik et al. / Schizophrenia Research 85 (2006) 84–95 85 of illness. However, even in relatively stable out- but also to correctly identify the consensually derived patients, the frequency of thinking disturbance has meaning of the proverb. been found to be greater among patients with Despite the clinical significance and stability of schizophrenia than nonpsychiatric controls (Sponheim thought disorder, relatively little is known about its et al., 2003). Formal thought disorder appears to neurocognitive underpinnings (Kerns and Berenbaum, lessen in geriatric patients with chronic schizophrenia, 2002). Formal thought disorder has been found to but this might be an artifact of decreased verbal relate to impairments in attention (Docherty and productivity in older patients (Bowie et al., 2005). Gordinier, 1999; Harvey et al., 1998; Moser et al., This pattern of findings suggests that formal thought 2001; Nuechterlein et al., 1986; Silverstein et al., disorder reflects, in part, state-like exacerbations in 1991; Sowell et al., 2000), memory (Harvey et al., illness but also might be associated with more stable 1998; Nestor et al., 1998; Serper et al., 1990), and underlying neurocognitive impairments. This conclu- executive functions (Barrera et al., 2005; Nestor et al., sion is supported by longitudinal studies that have 1998). However, few studies have examined multiple found the relationship between thought disorder and neurocognitive domains as correlates of formal discrete neurocognitive deficits to be stronger during thought disorder within the same sample. In addition, periods of stabilization than during acute episodes few, if any, studies have included measures of social (Asarnow and MacCrimmon, 1982; Nuechterlein et cognition. Furthermore, the specific contributions of al., 1986; Pandurangi et al., 1994). Neuropsycholo- these measures beyond their correlations with general gists and experimental psychopathologists have fre- intellectual ability have not been adequately studied. quently assessed the quality of thinking using proverb Prior studies of the neurocognitive contributors to interpretation tasks (Lezak, 1995). Accurate interpre- bizarre-idiosyncratic thinking have produced incon- tation of proverbs requires the individual to report the sistent results. In their study of the determinants of consensually recognized meaning from the symbols in idiosyncratic thinking, Harrow et al. (1989) noted that the proverb. Bizarre-idiosyncratic thinking is defined idiosyncratic responses are often not recognized as as a unique response that often deviates from social such by the speaker and can be reduced when the norms and that may contain confused, contradictory, speaker is directed to focus on the quality of the or illogical verbalizations. Consequently, idiosyncratic response. These observations led them to hypothesize responses are typically inappropriate or inadequate in that bizarre-idiosyncratic thinking might, at least in relation to the presented stimulus and are often part, result from impaired access to knowledge of what difficult for others to empathize with or understand behavior is socially or contextually appropriate for a (Marengo et al., 1986). Assessment of thought situation and from a reduced ability to monitor their disturbance on proverb interpretation tasks involves verbalizations. In one of the first empirical studies scoring the quality of participants’ responses with designed to identify neurocognitive correlates of standardized dimensional measures of bizarre-idio- bizarre-idiosyncratic thinking Silverstein et al. (1993) syncratic and concrete thinking. Patients with schizo- used a battery of linguistic, complex attentional, and phrenia perform more poorly than nonpsychiatric intellectual measures and found that 25% of the controls on proverb interpretation tasks, with their variance in idiosyncratic thinking could be explained responses containing more idiosyncratic and concrete by estimated intellectual ability and arithmetic perfor- thinking disturbances (Carter, 1986; Sponheim et al., mance. Similarly, Carpenter and Chapman (1982) 2003). While patients with schizophrenia have been reported a moderate relationship between bizarre- found to make both idiosyncratic and concrete idiosyncratic thinking and intellectual ability. Howev- thinking errors, these two types of thinking distur- er, Sponheim et al. (2003) failed to find significant bances have been found to be only weakly to relationships between idiosyncratic thinking and intel- moderately related (Craig, 1973; Silverstein et al., lectual ability, memory, or executive abilities. 1993; Sponheim et al., 2003). A third construct based Contradictory findings have also been found with on proverb tasks, correct abstraction, is related to regard to the correlates of concrete thinking. Silver- concrete thinking, but involves not only the ability to stein et al. (1993) found that indices of left and right abstract beyond the concrete elements of the proverb cerebral lateralization from the Luria Nebraska Neu- 86 K.L. Subotnik et al. / Schizophrenia Research

Load more