Speech under stress: Affective and cognitive reactivity in schizophrenia and their functional correlates

Disorganized speech is a core diagnostic criterion of schizophrenia, yet mechanisms driving its variability remain unclear. Building on evidence from schizotypy and first-episode psychosis literature, we examined whether affective and cognitive systems influence speech disorganization in schizophrenia. Thirty-five individuals with schizophrenia (n = 35) and 37 healthy controls completed a validated speech paradigm across three conditions: neutral, affective, and cognitive load. Trained raters assessed disorganized speech using the Communication Disturbances Index (CDI). Reactivity was quantified using standardized residual change scores. The schizophrenia group exhibited significantly greater disorganized speech across all conditions (d = 0.58-0.89). Of note, affective reactivity emerged only when using regression-based analyses controlling for neutral condition disorganization, not with repeated-measures ANOVA-revealing important methodological considerations for detecting subtle stress-vulnerability patterns. Despite well-documented cognitive deficits in schizophrenia, cognitive reactivity was not observed. Both affective and cognitive reactivity showed medium inverse correlations with neurocognitive functioning (r = -0.36 to -0.41), but lower correlations with social or role functioning, contrasting with findings in earlier illness stages. These results demonstrate that disorganized speech in schizophrenia is contextually sensitive, with reactivity patterns linked to cognitive impairment. Furthermore, it builds upon prior evidence in schizotypy and first-episode psychosis groups, establishing associations across the psychosis-spectrum. Future research should explore how reactivity patterns evolve across illness stages to inform tailored interventions targeting emotion regulation and cognitive remediation based on individual reactivity profiles.