Disturbed communication in schizophrenia: the role of poor pragmatics and poor mind-reading

Background. Disturbed speech in schizophrenia may reflect pragmatic deficits of expressive language. Pragmatic comprehension deficits also occur in schizophrenia. This study investigated whether poor ‘mind-reading’ (i.e. a general difficulty with inferring and monitoring other people's thoughts) causes pragmatic language impairments of both expression and comprehension in patients with schizophrenia. Method. Mind-reading (or theory of mind) was tested in patients with schizophrenia and in healthy controls using a false-belief picture-sequencing task. Pragmatic comprehension skills were assessed using a test of non-literal speech interpretation. Clinical ratings of formal thought disorder (FTD) indexed the expressive language deficits of patients. To control for possible contributory effects of executive dysfunction, inhibitory control was tested using capture picture-sequences and executive-planning was tested using the Tower of London task. Results. False-belief picture-sequencing, understanding of irony and understanding of metaphors were all selectively impaired in the patients. Poor mind-reading (indexed by high error rate in sequencing false-belief stories) was associated with poor understanding of irony, but was unrelated to poor understanding of metaphors. Whereas poor appreciation of irony and poor mind-reading were associated with high ratings of positive formal thought disorder, high ratings of negative formal thought disorder were associated with poor understanding of metaphors and executive dysfunction. Conclusions. Whereas poor mind-reading may contribute to positive aspects of formal thought disorder and impaired appreciation of irony in patients with schizophrenia; negative features of formal thought disorder and poor understanding of metaphors appear better explained by abnormal semantics. Overall, the findings of this study support the view that the functional basis of formal thought disorder in schizophrenia is not unitary.

[1]  J. Todd.  Language and thought in schizophrenia. , 1949, Cincinnati journal of medicine.

[2]  Y. Sarfati,et al.  How do people with schizophrenia explain the behaviour of others? A study of theory of mind and its relationship to thought and speech disorganization in schizophrenia , 1999, Psychological Medicine.

[3]  David Newby.  ‘Cloze’ procedure refined and modified , 1998, British Journal of Psychiatry.

[4]  J. Morton,et al.  The cognitive basis of a biological disorder: autism , 1991, Trends in Neurosciences.

[5]  D. Sperber,et al.  Relevance: Communication and cognition, 2nd ed. , 1995 .

[6]  C. Frith,et al.  Schizophrenia, symptomatology and social inference: Investigating “theory of mind” in people with schizophrenia , 1995, Schizophrenia Research.

[7]  S. Glucksberg.  Understanding Metaphors , 1998 .

[8]  J. Cutting,et al.  Preference for denotative as opposed to connotative meanings in schizophrenics , 1990, Brain and Language.

[9]  R. Frith.  Conversational conduct and the symptoms of schizophrenia. , 1996, Cognitive neuropsychiatry.

[10]  M. Coltheart,et al.  Mentalising, executive planning and disengagement in schizophrenia , 2001 .

[11]  J. McGrath,et al.  The cognitive neuropsychology of schizophrenia. , 1997 .

[12]  J. Gray,et al.  Comprehension of irony in Schizophrenia , 1998 .

[13]  D. R. Gorham,et al.  Use of the proverbs test for differentiating schizophrenics from normals. , 1956, Journal of consulting psychology.

[14]  Y. Sarfati,et al.  Attribution of intentions to others in people with schizophrenia: a non-verbal exploration with comic strips , 1997, Schizophrenia Research.

[15]  M. Shenton,et al.  A comparison of clinical and linguistic indices of deviance in the verbal discourse of schizophrenics , 1995, Applied Psycholinguistics.

[16]  R. Hoffman,et al.  Mapping abnormalities in language and cognition. , 1985 .

[17]  M. Birchwood,et al.  ‘Theory of mind’ skills during an acute episode of psychosis and following recovery , 1998, Psychological Medicine.

[18]  S. Baron-Cohen,et al.  Mechanical, behavioural and Intentional understanding of picture stories in autistic children , 1986 .

[19]  Zenon W. Pylyshyn,et al.  When is attribution of beliefs justified? [P&W] , 1978, Behavioral and Brain Sciences.

[20]  A. Baddeley,et al.  The Spot-the-Word test: a robust estimate of verbal intelligence based on lexical decision. , 1993, The British journal of clinical psychology.

[21]  G. Tucker,et al.  Language of dysfunction in schizophrenia. , 1996, European journal of disorders of communication : the journal of the College of Speech and Language Therapists, London.

[22]  A. Luria.  Higher Cortical Functions in Man , 1980, Springer US.

[23]  N C Andreasen,et al.  Negative symptoms in schizophrenia , 1982 .

[24]  Kurt Goldstein,et al.  Abstract and concrete behavior an experimental study with special tests. , 1941 .

[25]  Daniel C. Dennett,et al.  Brainstorms: Philosophical Essays on Mind and Psychology , 1981 .

[26]  T. Shallice.  Specific impairments of planning. , 1982, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[27]  H. A. Allen,et al.  Positive symptoms and the organization within and between ideas in schizophrenic speech , 1985, Psychological Medicine.

[28]  C. Frith,et al.  Exploring ‘theory of mind’ in people with schizophrenia , 1996, Psychological Medicine.

[29]  P. McKenna,et al.  The Positive: Negative Dichotomy in Schizophrenia , 1990, British Journal of Psychiatry.

[30]  M. Spitzer,et al.  A cognitive neuroscience view of schizophrenic thought disorder. , 1997, Schizophrenia bulletin.

[31]  S. Rochester,et al.  Crazy Talk: A Study of the Discourse of Schizophrenic Speakers , 1979 .

[32]  D. Premack,et al.  Does the chimpanzee have a theory of mind? , 1978, Behavioral and Brain Sciences.

[33]  M. Coltheart,et al.  Defective Self and/or Other Mentalising in Schizophrenia: A Cognitive Neuropsychological Approach. , 1997, Cognitive neuropsychiatry.

[34]  N. Cameron.  Schizophrenic Thinking in a Problem-Solving Situation , 1939 .

[35]  Don McNicol,et al.  The Comprehension and Production of Complex Syntax in Schizophrenia , 1985, Cortex.

[36]  T. Oltmanns,et al.  Predictability as an Index of Impaired Verbal Communication in Schizophrenic and Affective Disorders , 1983, British Journal of Psychiatry.

[37]  E. Brunet,et al.  Investigating theory of mind in schizophrenia: influence of verbalization in disorganized and non-disorganized patients , 1999, Schizophrenia Research.

[38]  N C Andreasen,et al.  Thought, language, and communication disorders. II. Diagnostic significance. , 1979, Archives of general psychiatry.

[39]  W. Kintsch.  Metaphor comprehension: A computational theory , 2000, Psychonomic bulletin & review.

[40]  R. Blair,et al.  Dissociation between 'theory of mind' and executive functions in a patient with early left amygdala damage. , 2001, Brain : a journal of neurology.

[41]  John Dack,et al.  Abstract and concrete. , 2002 .

[42]  D. Copolov,et al.  Linguistic Impairment in Early Psychosis , 1994, The Journal of nervous and mental disease.

[43]  J. Ingram,et al.  Language complexity and age of onset of schizophrenia , 1983, Psychiatry Research.

[44]  C. Frith,et al.  The appreciation of visual jokes in people with schizophrenia: a study of ‘mentalizing’ ability , 1997, Schizophrenia Research.

[45]  Donald T. Stuss,et al.  Frontal lobes and language , 1989, Brain and Language.

[46]  T. Goldberg,et al.  Thought Disorder in Schizophrenia: A Reappraisal of Older Formulations and an Overview of Some Recent Studies , 2000 .

[47]  C. Polkey,et al.  "Theory of mind" impairments and their relationship to executive functioning following frontal lobe excisions. , 2001, Brain : a journal of neurology.

[48]  M. Broome,et al.  Thought disorder , 2017, BJPsych Advances.

[49]  J. Mcgrath.  Ordering thoughts on thought disorder , 1990, Schizophrenia Research.

[50]  Sam Glucksberg,et al.  Commentary on Nonliteral Language: Processing and Use , 1995 .

[51]  T. Goldberg,et al.  Cognitive substrates of thought disorder, I: the semantic system. , 1998, The American journal of psychiatry.

[52]  L. J. Chapman,et al.  Confusion of figurative and literal usages of words by schizophrenics and brain damaged patients. , 1960, Journal of abnormal and social psychology.

[53]  A. Féline,et al.  The comprehension of metaphors in schizophrenia. , 1997, Psychopathology.

[54]  R. Hu.  Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) , 2003 .

[55]  Max Coltheart,et al.  Mentalising, schizotypy, and schizophrenia , 1999, Cognition.

[56]  S. Glucksberg,et al.  Property attribution in metaphor comprehension , 1997 .

[57]  E. Chaika,et al.  A linguist looks at “schizophrenic” language , 1974 .

[58]  D. Povinelli,et al.  Mindblindness. An Essay on Autism and Theory of Mind Simon Baron-Cohen 1995 , 1996, Trends in Neurosciences.