Langdon R, Coltheart M, Ward P B, Catts S V
Macquarie Centre for Cognitive Science, Macquarie University, NSW, Australia.
Psychol Med. 2002 Oct;32(7):1273-84. doi: 10.1017/s0033291702006396.
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.
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.
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.
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.
精神分裂症患者言语紊乱可能反映出表达性语言的语用缺陷。精神分裂症患者也存在语用理解缺陷。本研究调查了“心理理论”能力差（即推断和监测他人想法存在普遍困难）是否会导致精神分裂症患者出现表达和理解方面的语用语言障碍。
使用错误信念图片排序任务对精神分裂症患者和健康对照者进行心理理论测试。使用非字面言语解释测试评估语用理解技能。形式思维障碍（FTD）的临床评分作为患者表达性语言缺陷的指标。为了控制执行功能障碍可能产生的影响，使用捕获图片序列测试抑制控制，使用伦敦塔任务测试执行计划。
患者在错误信念图片排序、理解反讽和理解隐喻方面均出现选择性受损。心理理论能力差（以错误信念故事排序中的高错误率为指标）与反讽理解差相关，但与隐喻理解差无关。反讽理解差和心理理论能力差与积极形式思维障碍的高评分相关，而消极形式思维障碍的高评分与隐喻理解差和执行功能障碍相关。
心理理论能力差可能导致精神分裂症患者形式思维障碍的积极方面以及反讽理解受损；形式思维障碍的消极特征和隐喻理解差似乎更好地由语义异常来解释。总体而言，本研究结果支持精神分裂症中形式思维障碍的功能基础并非单一的观点。
