Disorganized Speech and Metacognition in Schizophrenia: Differential Relations and a Comparison of Behavioral Speech Measures

Abstract

Disorganized speech is a core feature of schizophrenia. It is a key component of formal thought disorder (FTD). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. In this study, we aimed to 1) explore the relationship between disorganized speech and metacognition and 2) compare trained rater and emerging automated analysis methods. Positive and Negative Syndrome Scale (PANSS) and Indiana Psychiatric Illness Interviews (IPII) were conducted; the IPII was coded for disorganized speech using the Communication Disturbances Index (CDI) and Coh-Metrix multidimensional indices. Metacognition was rated using the Metacognition Assessment Scale. We compared FTD (n = 16; PANSS conceptual disorganization ≥ 3) and non-FTD (n = 29; PANSS conceptual disorganization < 3) groups on metacognition and examined CDI and Coh-Metrix’s ability to account for variance in metacognition. We hypothesized that the FTD group would have lower metacognition and that both CDI and Coh-Metrix would account for significant variance in metacognition. Analyses indicated metacognition did not differ between groups and neither measure accounted for significant variance in metacognition. Results also showed that the CDI was able to distinguish the groups. Overall, results suggest little relationship between FTD and metacognition. Findings also indicate that trained rater measures of disorganized speech may have clinical utility in classifying FTD. Future research examining these constructs should address important limitations of this study by ensuring adequate levels of FTD in the study sample and by assessing neurocognition.