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Evaluation sensitivity as a moderator of communication disorder in schizophrenia

  • P. M. Grant (a1) and A. T. Beck (a1)

Communication disturbance (thought disorder) is a central feature of schizophrenia that predicts poor functioning. We investigated the hypothesis that memory and attention deficits interact with beliefs about the gravity of being rejected (i.e. evaluation sensitivity) to produce the symptoms of communication disorder.


Seventy-four individuals diagnosed with schizophrenia or schizo-affective disorder completed a battery of tests assessing neurocognition (attention, working and verbal memory, abstraction), symptomatology (positive, negative and affective), functioning, and dysfunctional beliefs.


Patients with communication deviance (n=33) performed more poorly on the neurocognitive tests and reported a greater degree of sensitivity to rejection than patients with no thought disorder (n=41). In a logistic regression analysis, evaluation sensitivity moderated the relationship between cognitive impairment and the presence of communication disorder. This finding was independent of hallucinations, delusions, negative symptoms, depression and anxiety.


We propose that negative appraisals about acceptance instigate communication anomalies in individuals with a pre-existing diathesis for imperfect speech production.

Corresponding author
*Address for correspondence: P. M. Grant, Ph.D., Room 2032, 3535 Market Street, Philadelphia, PA 19104-3309, USA. (Email:
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Agresti, A (2007). Introduction to Categorical Data Analysis, 2nd edn. Wiley: Hoboken, NJ.
Andreasen, NC (1983). The Scale for the Assessment of Positive Symptoms (SAPS). University of Iowa: Iowa City.
Andreasen, NC (1984). The Scale for the Assessment of Negative Symptoms (SANS). University of Iowa: Iowa City.
Andreasen, NC, Arndt, S, Alliger, R, Miller, D, Flaum, M (1995). Symptoms of schizophrenia. Methods, meanings and mechanisms. Archives of General Psychiatry 52, 341351.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edn, text revision. American Psychiatric Association: Washington, DC.
Beck, AT (1976). Cognitive Therapy and the Emotional Disorders. Meridian: New York.
Beck, AT, Freeman, A, Davis, D and Associates (2004). Cognitive Therapy of Personality Disorders, 2nd edn. Wiley: New York.
Beck, AT, Steer, RA (1990). Beck Anxiety Inventory Manual. The Psychological Corporation: San Antonio.
Beck, AT, Steer, RA, Brown, GK (1996). The Beck Depression Inventory, 2nd edn. The Psychological Corporation: San Antonio.
Beck, AT, Steer, RA, Brown, GK, Weissman, A (1991). Factor analysis of the Dysfunctional Attitude Scale in a clinical population. Psychological Assessment 3, 478483.
Blankstein, KR, Segal, ZV (2001). Cognitive assessment. In Handbook of Cognitive-Behavioral Therapies (ed. Dobson, K. S.), pp. 4085. Guilford Press: New York.
Bleuler, E (1911). Dementia Praecox or the Group of Schizophrenias (translated by J. Zinkin, published in 1950). International Universities Press, Inc.: New York.
Cohen, AS, Docherty, NM (2005). Effects of positive affect on speech disorder in schizophrenia. Journal of Nervous and Mental Disease 193, 839842.
Docherty, NM (1996). Affective reactivity of symptoms as a process discriminator in schizophrenia. Journal of Nervous and Mental Disease 184, 535541.
Docherty, NM (2005). Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives. Journal of Abnormal Psychology 114, 269278.
Docherty, NM, DeRosa, M, Andreasen, NC (1996). Communication disturbances in schizophrenia and mania. Archives of General Psychiatry 53, 358364.
Docherty, NM, Evans, IM, Sledge, WH, Seibyl, JP, Krystal, JH (1994). Affective reactivity of language in schizophrenia. Journal of Nervous and Mental Disease 182, 98102.
Docherty, NM, Gordinier, SW, Hall, MJ, Cutting, LP (1999). Communication disturbances in relatives beyond the age of risk for schizophrenia and their associations with symptoms in patients. Schizophrenia Bulletin 25, 851862.
Docherty, NM, Gordinier, SW, Hall, MJ, Dombrowski, ME (2004). Referential communication disturbances in the speech of nonschizophrenic siblings of schizophrenia patients. Journal of Abnormal Psychology 113, 399405.
Docherty, NM, Hall, MJ, Gordinier, SW (1998). Affective reactivity of speech in schizophrenia patients and their nonschizophrenic relatives. Journal of Abnormal Psychology 107, 461467.
Fienberg, SE (1991). The Analysis of Cross-Classified Categorical Data. The MIT Press: Cambridge, MA.
Glahn, DC, Cannon, TD, Gur, RE, Ragland, JD, Gur, RC (2000). Working memory constrains abstraction in schizophrenia. Biological Psychiatry 47, 3442.
Grant, P, Beck, AT (2008). Defeatist beliefs as mediators of cognitive impairment, negative symptoms and functioning in schizophrenia. Schizophrenia Bulletin. Published online: 27 February 2008. doi:10.1093/schbul/sbn008.
Gur, RC, Jaggi, JL, Ragland, JD, Resnick, SM, Shtasel, D, Muenz, L, Gur, RE (1993). Effects of memory processing on regional brain activation: cerebral blood flow in normal subjects. International Journal of Neuroscience 72, 3144.
Gur, RE, Nimgaonkar, VL, Almsay, L, Calkins, ME, Ragland, JD, Pogue-Geile, MF, Kanes, S, Blangero, J, Gur, RC (2007). Neurocognitive endophenotypes in a multiplex multigenerational family study of schizophrenia. American Journal of Psychiatry 164, 813819.
Haddock, G, Wolfenden, M, Lowens, I, Tarrier, N, Bentall, R (1995). Effect of emotional salience on thought disorder in patients with schizophrenia. British Journal of Psychiatry 167, 618620.
Harrow, M, Marengo, J, McDonald, C (1986). The early course of schizophrenic thought disorder. Schizophrenia Bulletin 12, 208224.
Haslam, J (1811). Illustrations of Madness (ed. Porter, R., 1988). Routledge: New York.
Jaccard, J (2001). Interaction Effects in Logistic Regression. Sage Publications: London.
Kerns, J, Berenbaum, H (2003). The relationship between formal thought disorder and executive functioning component processes. Journal of Abnormal Psychology 112, 339352.
Kerns, JG (2007 a). Experimental manipulation of cognitive control processes causes an increase in communication disturbances in healthy volunteers. Psychological Medicine 37, 9951004.
Kerns, JG (2007 b). Verbal communication impairments and cognitive control components in people with schizophrenia. Journal of Abnormal Psychology 116, 279289.
Kerns, JG, Becker, TM (2008). Communication disturbances, working memory, and emotion in people with elevated disorganized schizotypy. Schizophrenia Research 100, 172180.
Kerns, JG, Berenbaum, H (2002). Cognitive impairments associated with formal thought disorder in people with schizophrenia. Journal of Abnormal Psychology 111, 211224.
Knudsen, EI (2007). Fundamental components of attention. Annual Review of Neuroscience 30, 5778.
Kraemer, HC, Stice, E, Kazdin, A, Offord, D, Kupfer, D (2001). How do risk factors work together? Mediators, moderators, and independent, overlapping, and proxy risk factors. American Journal of Psychiatry 158, 848856.
Kraepelin, E (1913). Dementia Praecox and Paraphrenia (translated by R. M. Barclay, published in 1971). Robert E. Krieger Publishing: Huntington, New York.
Levelt, WJM (1989). Speaking: From Intention to Articulation. MIT Press: Cambridge, MA.
Liddle, PF (1987). The symptoms of chronic schizophrenia: a re-examination of the positive–negative dichotomy. British Journal of Psychiatry 151, 145151.
McKenna, PJ, Oh, TM (2005). Schizophrenic Speech: Making Sense of Bathroots and Ponds that Fall in Doorways. Cambridge University Press: New York.
Nahor, AB, Vanicelli, M (1976). The influence of instructional set on schizophrenic vs. organic concreteness. Confinia Psychiatrica 19, 8995.
Norman, RMG, Malla, AK, Cortese, L, Cheng, S, Diaz, K, McIntosh, E, McLean, TS, Rickwood, A, Voruganti, LP (1999). Symptoms and cognition as predictors of community functioning: a prospective analysis. American Journal of Psychiatry 156, 400405.
Nurnberger, JIJ, Blehar, MC, Kaufmann, CA, York-Cooler, C, Simpson, SG, Harkavy-Friedman, J, Severe, JB, Malaspina, D, Reich, T (1994). Diagnostic interview for genetic studies: rationale, unique features, and training: NIMH Genetics Initiative. Archives of General Psychiatry 51, 849859; discussion 863–864.
Phillips, WA, Silverstein, SM (2003). Convergence of biological and psychological perspectives on cognitive coordination in schizophrenia. Behavioral and Brain Sciences 26, 6582; discussion 82–137.
Rector, NA (2004). Dysfunctional attitudes and symptom expression in schizophrenia: differential associations with paranoid delusions and negative symptoms. Journal of Cognitive Psychotherapy: An International Quarterly 18, 163173.
Rosenfarb, IS, Goldstein, MJ, Mintz, J, Nuechterlein, KH (1995). Expressed emotion and subclinical psychopathology observable within the transactions between schizophrenic patients and their family members. Journal of Abnormal Psychology 104, 259267.
Rosenfarb, IS, Nuechterlein, KH, Goldstein, MJ, Subotnik, KL (2000). Neurocognitive vulnerability, interpersonal criticism, and the emergence of unusual thinking by schizophrenic patients during family transactions. Archives of General Psychiatry 57, 11741179.
Shimkunas, A (1972). Demand for intimate self-disclosure and pathological verbalizations in schizophrenia. Journal of Abnormal Psychology 80, 197205.
Strauss, JS, Carpenter, WT (1974). The prediction of outcome in schizophrenia II: Relationships between prediction and outcome variables. Archives of General Psychiatry 31, 3742.
Titone, D, Levy, DL (2004). Lexical competition and spoken word identification in schizophrenia. Schizophrenia Research 68, 7585.
Titone, D, Levy, DL, Holzman, PS (2000). Contextual insensitivity in schizophrenic language processing: evidence from lexical ambiguity. Journal of Abnormal Psychology 109, 761767.
Titone, D, Libben, M, Niman, M, Ranbom, L, Levy, DL (2007). Conceptual combination in schizophrenia: contrasting property and relational interpretations. Journal of Neurolinguistics 20, 92110.
Uhlhaas, PJ, Silverstein, SM, Phillips, WA, Lovell, PG (2004). Evidence for impaired visual context processing in schizotypy with thought disorder. Schizophrenia Research 68, 249260.
Weissman, A (1978). The Dysfunctional Attitudes Scale: A Validation Study. University of Pennsylvania: Philadelphia, PA.
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Psychological Medicine
  • ISSN: 0033-2917
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