Disorganization and Disintegration in Schizophrenia: Metacognitive Capacity and Speech Content Across Levels of Conceptual Disorganization

Abstract

Disorganized speech can disrupt effective communication in schizophreniaspectrum disorders (SSDs). Recent work has tied disorganized speech to deficits in metacognition, or one’s ability to integrate experiences to form complex mental representations. Specifically, recent work has shown that metacognitive deficits may emerge only at higher levels of disorganized speech, suggesting a possible exponential relationship. Additionally, lexical analysis studies have linked word use in SSDs (e.g., pronoun use) to both metacognition and speech organization. The present study aims to 1) broadly characterize the nature of the relationship between metacognitive capacity and disorganized speech; 2) compare metacognitive capacity across levels of speech disorganization; and 3) examine word use across levels of speech disorganization. Results provide limited, preliminary support that the relationship between metacognitive capacity and speech disorganization is exponential. Results also show that as levels of speech disorganization increase, there are small, clinically relevant decreases in metacognitive capacity, especially in metacognitive mastery. Similarly, there are small, unexpected changes in speech across social words, first-person pronouns, and time orientation words. Although associations are correlational, results have some clinical implications, especially to tailor metacognitive interventions for use with patients with high levels of disorganized speech. Future research should address limitations of this study by including participants with extreme disorganized speech and by including multidimensional measures of disorganized speech.