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Targeting the communicative impairment in schizophrenia with a neuropragmatic approach

Marta Bosia1, 2*, Giorgio Arcara3, Margherita Bechi2, Mariachiara Buonocore2, Roberto Cavallaro1, 2 and Valentina Bambini4
  • 1 Vita-Salute San Raffaele University, Italy
  • 2 San Raffaele Hospital (IRCCS), Italy
  • 3 IRCCS Fondazione Ospedale San Camillo, Italy
  • 4 Istituto Universitario di Studi Superiori di Pavia (IUSS), Italy

Schizophrenia is a devastating chronic mental disorder, characterized by a heterogeneous cohort of symptoms, as well as neurocognitive and social cognitive deficits that contribute to the disability associated to the disease. Language is also impaired in patients with schizophrenia and alterations of communication have been largely documented since the first descriptions of the illness (1). However, it is only in recent years that multidisciplinary approaches combining psychiatry, linguistics, and neuroscience of language have paved the way to a more structured research of linguistic disruption in schizophrenia. Evidence from these studies not only allowed to disentangle the specific domains that are compromised (2,3), but also led to the hypothesis that language impairment might be considered a biomarker of schizophrenia (4) and that in-depth linguistic analysis of speech might have diagnostic value (5). In this context, less attention has so far been paid to the pragmatic domain even if pragmatic breakdowns are largely documented in schizophrenia, with a plethora of studies reporting breakdowns in comprehension of idioms, metaphors and irony (6,7,8), as well as failures in maintaining thematic coherence and respecting the rules of conversation (9,10). In recent studies, we reported that pragmatic abilities, evaluated with the comprehensive test Assessment of Pragmatic Abilities and Cognitive Substrates (11), are widely compromised in patients, intertwined with specific symptoms and cognitive domains and directly contribute to the functional impairment, thus suggesting that the pragmatic deficit might be a core feature of schizophrenia and a target for treatment (12,13). In the present study, we address the so-called “concretism” with a new perspective bridging the psychiatric and the linguistic approaches. The notion of concretism traces back to the early ‘900 when the psychiatrist Eugen Bleuler identified the “lack of abstract thinking” and “tendency to stick to the literal meaning of the expressions” manifested by patients as diagnostic symptoms of schizophrenia. Although the psychiatric tradition has made extensive use of verbal tests for a clinical evaluation of concretism, a specifically linguistic exploration of this phenomenon, through an analysis that takes into account lexical and pragmatic aspects of patients’ speech, has not yet been attempted. We investigated the relationship between the phenomenon of concretism, pragmatics and concreteness as a specific lexical/semantic dimension, in sample of 43 patients with schizophrenia and 37 healthy controls. All subjects were assessed with APACS. Answers provided in the APACS Figurative Language 2 task, evaluating the comprehension of figurative expressions (5 idiomatic expressions, 5 metaphors, and 5 proverbs) through verbal explanation, were transcribed and annotated at the lexical-semantic level. Content words were rated for concreteness on a 1-7 scale. The results of the analysis highlighted that patients use significantly more concrete content words compared to controls when asked to solve figurative expressions, with more pronounced differences for the lexical category of names and for the class of proverbs. Finally, in the subgroup of patients, we also investigated the relationship between lexical concreteness and psychopathological, as well as neurocognitive and social cognitive domains, showing a significant correlation between lexical-semantic concreteness and deficits in social cognition. The results therefore suggest that the notion of concretism has a lexical-semantic counterpart, which emerges at the pragmatic level and directly influences social abilities. In conclusion, our results suggest that neuropragmatic studies in patients with schizophrenia may have relevant clinical application potentials. Indeed, specific pragmatic impairments may represent a biomarker of schizophrenia, being associated with genetic, neuroanatomical, and electrophysiological signatures and have diagnostic and prognostic value, especially in patients at high-risk for psychosis. Moreover, given their strong relationship with both social and global functioning, pragmatic abilities also appear a promising target for rehabilitative interventions.

References

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Keywords: psychosis, pragmatics, neurocognition, social cogntion, Daily functioning, Rehabilitation, concreteness

Conference: XPRAG.it Behavioral and Neural Evidence on Pragmatic Processing , Genoa, Italy, 10 Jun - 11 Jun, 2017.

Presentation Type: Oral Presentation

Topic: Patients studies on pragmatic abilities

Citation: Bosia M, Arcara G, Bechi M, Buonocore M, Cavallaro R and Bambini V (2019). Targeting the communicative impairment in schizophrenia with a neuropragmatic approach. Front. Psychol. Conference Abstract: XPRAG.it Behavioral and Neural Evidence on Pragmatic Processing . doi: 10.3389/conf.fpsyg.2017.71.00006

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Received: 10 May 2017; Published Online: 25 Jan 2019.

* Correspondence: Dr. Marta Bosia, Vita-Salute San Raffaele University, Milan, Italy, bosia.marta@hsr.it