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Language lies at the confluence of the biological, physiological, psychological, and social processes underlying human behaviour. Recently, some developments in the cognitive and linguistic sciences have contributed to better understanding language in either normal subjects or subjects with language communication disorders, such as some people with psychosis (1,2). Improvements in data analysis techniques and artificial intelligence technology have led to the development of advanced methods for investigating language, mainly regarding the structure of speech. In the context of psychosis, the term schizophrenia is used to designate a group of disorders with several common features involving a wide range of behavioural differences; it is not a single pathological entity with a well-defined series of symptoms. Language, which is unique to each individual, can reflect how patients cope with their disease. The aim of this preliminary study was to describe and analyze the main characteristics and patterns of discourse from people with the disorganized type of schizophrenia who exhibited prominent negative symptoms (3,4). MethodUsing the ALCESTE computer-assisted method, a discourse analysis was performed on 24 one-hour free-speech recordings of 3 patients (5–7). The recordings were made by the same therapist with the patients’ informed prior consent during a 3-month period. The ALCESTE method is based on a top-down hierarchical classification program that selects classes of vocabulary, each defined by a pool of words that are mathematically linked together and occur most frequently, that is, those that the speaker tends to repeat (5–7). These classes subscribe to different types of discourse, each of which shows a specific set of vocabulary and syntax. In each class, the mathematically linked words then support some descriptions, ideas, or thoughts that also link, allowing us to make some correlations. Results and DiscussionThe rate of occurrence of words from the 24 one-hour free-speech samples of the schizophrenia patients with negative symptoms was reduced in comparison with the language production of either normal subjects or schizophrenia patients with positive symptoms, based on a prior analysis of the same number of free-speech sessions using the same ALCESTE method (8–10). The language production of schizophrenia patients with negative symptoms is restricted, as has been shown previously (3,11). No unknown terms (neologisms or agrammaticisms) occurred, as was previously reported in schizophrenia patients with positive symptoms (3,9,10, 12,13). During the 3-month period of speech-pattern recording, only 2 topics emerged. This poverty of content is not seen in the discourse of normal subjects or schizophrenia patients with positive symptoms (8–10). Various ratios between word categories (such as verb–adjective and noun–adjective), markers of the person (personal, possessive, demonstrative, or relative pronouns), and some linguistic markers (such as markers of the relationship between speaker and listener) were as high in patients with negative symptoms as in those patients with positive symptoms and in normal subjects (8,9). The patients with schizophrenia could communicate at least orally with other subjects. The patients’ various types of discourse were always quite coherent and understandable to the listener. Some speech patterns reported elsewhere were not seen (3,13). One type of discourse found in each of the 3 patients focused mainly on various members of the patient’s family and people linked to the patients’ life. The speech samples were unsophisticated, with no metaphors or imaginary ideas: it was a linear metonymic language. The language did not show any impairments or confusion: it was poor but correct. Patients seemed to communicate efficiently and easily with their listeners, without any of the communication disturbances or disorganization of the speech mentioned by various authors in connection with schizophrenia (3,12,13). Patients also did not show any deficits in the planning, cohesion, or self- monitoring of discourse, contrary to what has been observed in the case of people with schizophrenia who had positive symptoms (9). Regarding syntax, various family members were the subjects of discourse via the nominative and possessive third-person pronouns. Patients did not talk about themselves. A second topic consisted of the patients’ diseases, their treatments, the hospital environment, and their present circumstances. Here, mainly first-person pronouns were used. The patients presented themselves clearly as the subjects of their discourse: “I am” and “I have” (Table 1). They succeeded in staying in the present when talking about their diseases, symptoms, and treatments (using for example, such words as anguish, insomnia, suicide, nervy, injury, admission to hospital, rescue squad, take care, injection, and various medicinal terms). The main feature of this discourse was that the patients acquired a place by speaking about their own mental disorders. Some sense of identity, however minimum, seems to be achieved in this way by subjects suffering from all kinds of mental or other pathologies. The finding that a possible feeling of identity is reflected in the discourse of a person with schizophrenia is of great importance, since this characteristic was observed in the speech of normal subjects in previous studies but not in that of schizophrenia patients with delusions who had delirious speech patterns (8–10). This suggests that the minimum sense of identity produced by the disease itself enables patients to avoid positive symptoms, particularly delusions.
ConclusionIn studies of the language production of subjects suffering from schizophrenia, it is necessary to distinguish between patients with positive symptoms and those with negative symptoms. Their speech patterns have to be analyzed separately, which has not been the case up to now, since they differ in too many respects. Funding and SupportThis research was supported by grant # ACI COGNITIQUE, COG 13b of the French Ministère de la Recherche et de la Technologie. References1. Thomas P, Fraser W. Linguistics, human communication and psychiatry. Br J Psychiatry 1994;65:585–92. 2. Goldberg T, Weinberger D. Thought disorder in schizophrenia: a reappraisal of older formulations and overview of some recent studies. Cogn Neuropsychiatry 2000;74:1–19. 3. Andreasen NC, Flaum M. Schizophrenia: the characteristic symptoms. Schizophr Bull 1991;17:27–49. 4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed. Washington (DC): American Psychiatric Association Press; 1994. 5. Benzécri JP. Pratique de l’analyse des données : linguistique et lexicologie. Paris: Dunod; 1981. 6. Reinert M. Classification hiérarchique descendante: un algorithme pour le traitement des tableaux logiques de grandes dimensions. In: Diday E, Escoufier Y, Lebart L, Pages J, Schektman Y, Tomassone R, editors. Proceedings of the 4th international symposium on data analysis and informatics; 1985 Oct 9–11; Versailles (France). Amsterdam: North-Holland; 1986. p 23–8. 7. Noël-Jorand MC, Reinert M. Comparison of textual analysis applied to two lectures written three years apart by the same author: the language satellites. Psychol Rep 2003;92:449–67. 8. Noël-Jorand MC, Reinert M, Bonnon M, Therme P. Discourse analysis and psychological adaptation to high altitude hypoxia. Stress Med 1995;11:27–39. 9. Noël-Jorand MC, Reinert M, Giudicelli S, Dassa D. A new approach to discourse analysis in psychiatry, applied to schizophrenic patient speech. Schizophr Res 1997;25:183–98. 10. Noël-Jorand MC, Reinert M, Giudicelli S, Dassa D. Structure mathématique du langage : l’analyse distributionnelle. Nouvelle approche dans l’analyse de discours en psychiatrie. Ann Psychiatr 1997;12:245–57. 11. Barch DM, Berenbaum H. The effects of language production manipulations on negative thought disorder and discourse coherence disturbances in schizophrenia. Psychiatry Res 1997;71:115–27. 12. Chaika E. Understanding psychotic speech: beyond Freud and Chomsky. Sringfield (IL): Charles C Thomas; 1990. p 310. 13. Rochester SR, Martin JR. Crazy talk: a study of the discourse of schizophrenic speakers. New York: Plenum Press; 1979. Author(s)Manuscript received June 2003, revised, and accepted July 2003. 1. Associate Professor, Biomathematics and Statistics Department, Timone University, Medical School of Marseilles, Marseilles, France. 2. Engineer-Researcher, CNRS ESA-8085, Mathematics and Sociology, Versailles-St-Quentin University, Versailles, France. 3. Professor, Psychiatric Department, Timone Hospital, Marseilles, France. 4. Staff Psychiatrist, Psychiatric Department, Timone Hospital, Marseilles, France. Address for correspondence: Dr M-C Noël-Jorand, Département de Biomathématiques, Statistiques et Informatique Médicale, Faculté de Médecine-la-Timone, 27 boulevard Jean Moulin, 13385 Marseille Cedex 5, France e-mail: marie-christine.noel-jorand@medecine.univ-mrs.fr
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