Sounds and Syllables in Schizophrenia

Speech and language disturbances have been recognized as core components of schizophrenia since the early days of modern psychiatry. In his description of “dementia praecox,” which is often credited as the first modern characterization of schizophrenia, German psychiatrist Emil Kraepelin described both positive (e.g. incoherence, derailment, stereotypy, neologisms) and negative symptoms (e.g. mutism) associated with speech.

Another psychiatry pioneer, Eugen Bleuler, noted that the primary symptoms of schizophrenia “find their expression in language,” but “here the abnormality lies not in language itself, but in what it has to say.” 

“The words, phrases, sentences, and dialogues from our patients say so much,”  wrote Sunny Tang, assistant professor of psychiatry at the Feinstein Institutes for Medical Research and the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in a recent article on Psychiatric Times. “So does their breaths in between, and their voice and its dynamics, and the cadence and tonality used. These are the building blocks and foundations of our work as psychiatrists, whether we are an analyst in an armchair, dissecting and reconstructing a patient’s narrative, or a biological psychiatrist with pen in hand, translating the patient’s report into scales and delving for correlates in the brain.” 

Even the most innovative methods of biological psychiatry—from neuroimaging to magnetoencephalography—cannot replace patient reports. “Syllable and sound are still the primary means for taking the measure of thoughts and emotions,” according to Tang.

Since the 1980s, researchers have been able to quantify speech disturbance in patients. They found that many features were shared with speech from patients in manic episodes, although mania was associated with greater positive thought disorder and schizophrenia with greater negative thought disorder.

“Through advancements of machine learning and artificial intelligence, we have new tools for taking the measure of speech and thought disturbance,” explained Dr. Tang. “Methods for extracting information from speech can be roughly divided into two areas. First, acoustics analysis extracts and quantifies information on pitch, amplitude, and vocal qualities on a millisecond-by-millisecond scale. Second, lexical analysis focuses on the content of speech, including word choice, grammar, the ideas being represented, and the relationship between words and ideas.”

Recently, Tang and her colleagues compared traditional clinical rating scales with “natural language processing” (NLP) methods for differentiating speech in individuals with schizophrenia spectrum disorders from that of comparison participants without schizophrenia. “When classifying participants into either the schizophrenia or health comparison group, we found machine learning algorithms performed significantly better using NLP-derived features (87 percent accuracy) than clinical ratings (68 percent accuracy), suggesting that important information is being captured by NLP.”

Perhaps, with additional research, it will soon be possible to link specific speech markers to changes in specific brain circuits. However, speech disturbance in schizophrenia is likely multifaceted and should not be treated as a single uniform entity.

“It is important to remember that our mission is the healing and well-being of individuals and families,” wrote Dr. Tang. “This is not technology for the sake of novelty, no matter how nifty the gadget. Finally, the availability of brain measures should not mandate reliance on pharmacology over psychosocial interventions—quite the opposite. Automated language processing can be harnessed to measure changes in thought and brain structure on a personalized level. This layer of technology should not occlude the individual but rather allow clinicians to delve deeper into each unique case.”

Psychosocial interventions are central to the Warner treatment model at Colorado Recovery which emphasizes the experience of empowerment, the strengthening of social relationships, and overall support for people with schizophrenia to improve all aspects of their lives. Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.