Cognitive impairments, emotion, stress, and language in schizophrenia

Language symptoms in schizophrenia are exacerbated by arousal of negative affect; the extent of this effect varies widely among patients. The present study assessed predictors of affective speech reactivity. Based on earlier research, it was expected that speech reactivity would be predicted by a combination of neurocognitive and emotional variables. We assessed patients (n=50) for baseline depression; neurocognitive functioning in the domains of sustained attention, immediate auditory memory, organizational sequencing, and conceptual sequencing ability; and clarity of speech communication in both stress and non-stress conditions. Twenty-three subject-nominated "significant others" (SOs) also participated in the study, and were assessed for levels of expressed emotion (EE) as an index of relationship stressors. Patients, in turn, rated the subjective stressfulness of being in the presence of their SOs, from which the propensity to perceive interpersonal experiences as stressful was calculated by regressing out EE ratings. As predicted, baseline depression and sensitivity to interpersonal stressors were related to affective reactivity of speech, with stress sensitivity mediating the relationship between depression and speech reactivity. Contrary to expectations, baseline neurocognitive functioning was not related to speech reactivity. These findings are discussed in terms of their implications for understanding both schizophrenic language disturbance and stress vulnerability.