Search

Negative content of auditory verbal hallucinations (AVH) is a strong predictor of distress and impairment. This paper quantifies emotional voice-content in order to explore both subjective (i.e. perceived) and objectively (i.e. linguistic sentiment) measured negativity and investigates associations with distress. Clinical and non-clinical participants with frequent AVH (n = 40) repeated and recorded their AVH verbatim directly upon hearing. The AVH were analyzed for emotional valence using Pattern, a rule-based sentiment analyzer for Dutch. The AVH of the clinical individuals were compared to those of non-clinical voice-hearers on emotional valence and associated with experienced distress. The mean objective valence of AVH in patients was significantly more negative than those of non-clinical voice-hearers. In the clinical individuals a larger proportion of the voice-utterances was negative (34.7% versus 18.4%) in objective valence. The linguistic valence of the AVH showed a significant, strong association with the perceived negativity, amount of distress and disruption of life, but not with the intensity of distress. Our results indicate that AVH of patients have a more negative linguistic content than those of non-clinical voice-hearers, which is associated with the experienced distress. Thus, patients not only perceive their voices as more negative, objective analyses confirm this. [ABSTRACT FROM AUTHOR]

Background: Given the growing focus on deprescribing, it is crucial to thoroughly evaluate our benzodiazepine prescribing practices considering the potential risks., Aim: To investigate the prevalence and predictors of benzodiazepine prescriptions during psychiatric hospitalization and as discharge medication., Method: This retrospective electronic patient file study included psychiatric admissions at the UMC Utrecht between 12/01/01 and 21/04/01. Descriptive statistics were used to evaluate prevalence of benzodiazepine prescriptions in youth and adults. Multivariate regression analyses were performed to predict factors associated with benzodiazepine prescriptions and dosage., Results: In total, we analyzed data from 856 admissions of youth and 4002 admissions of adults. 36.0% of the youth were prescribed benzodiazepines during admission and 14.8% at discharge. Associated factors were age (OR: 1.38) and bipolar disorder (OR: 3.98). In adults, 69.7% were prescribed benzodiazepines during admission and 37.6% at discharge. Associated factors were length of hospital stay (OR: 1.01) and anxiety disorders (OR: 2.53). Male sex, age (resp. higher and lower), and a longer length of stay predicted benzodiazepine dosages for both youth (B = 3.48; 95% CI: 0.83-0.07) and adults (B = 2.17; 95% CI: -0.04-0.05)., Conclusion: Benzodiazepines are frequently prescribed during inpatient stays and at discharge in youth and adults, offering opportunities for deprescribing.

Background: Incoherent speech is a core diagnostic symptom of schizophrenia-spectrum disorders (SSD) that can be studied using semantic space models. Since linguistic connectives signal relations between words, they and their surrounding words might represent linguistic loci to detect unusual coherence in speech. Therefore, we investigated whether connectives' measures are useful to assess incoherent speech in SSD., Methods: Connectives and their surrounding words were extracted from transcripts of spontaneous speech of 50 SSD-patients and 50 control participants. Using word2vec, two different cosine similarities were calculated: those of connectives and their surrounding words (connectives-related similarity), and those of free-of-connectives words-chunks (non-connectives similarity). Differences between groups in proportion of five types of connectives were assessed using generalized logistic models, and connectives-related similarity was analyzed through non-parametric multivariate analysis of variance. These features were evaluated in classification tasks to differentiate between groups., Results: SSD-patients used less contingency (e.g., because) (p = .008) and multiclass connectives (e.g., as) (p < .001) than control participants. SSD-patients had higher minimum similarity of multiclass (adj-p = .04) and temporality connectives (e.g., after) (adj-p < .001), narrower similarity-range of expansion (e.g., and) (adj-p = .002) and multiclass connectives (adj-p = .04), and lower maximum similarity of expansion connectives (adj-p = .005). Using connectives' features alone, SSD-patients and controls could be distinguished with 85 % accuracy., Discussion: Our results show that SSD-speech can be distinguished from speech of control participants with high accuracy, based solely on connectives' features. We conclude that including connectives could strengthen computational models to categorize SSD., Competing Interests: Declaration of competing interest All authors declare that they have no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Natural language processing (NLP) tools are increasingly used to quantify semantic anomalies in schizophrenia. Automatic speech recognition (ASR) technology, if robust enough, could significantly speed up the NLP research process. In this study, we assessed the performance of a state-of-the-art ASR tool and its impact on diagnostic classification accuracy based on a NLP model. We compared ASR to human transcripts quantitatively (Word Error Rate (WER)) and qualitatively by analyzing error type and position. Subsequently, we evaluated the impact of ASR on classification accuracy using semantic similarity measures. Two random forest classifiers were trained with similarity measures derived from automatic and manual transcriptions, and their performance was compared. The ASR tool had a mean WER of 30.4%. Pronouns and words in sentence-final position had the highest WERs. The classification accuracy was 76.7% (sensitivity 70%; specificity 86%) using automated transcriptions and 79.8% (sensitivity 75%; specificity 86%) for manual transcriptions. The difference in performance between the models was not significant. These findings demonstrate that using ASR for semantic analysis is associated with only a small decrease in accuracy in classifying schizophrenia, compared to manual transcripts. Thus, combining ASR technology with semantic NLP models qualifies as a robust and efficient method for diagnosing schizophrenia., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Clinicians routinely use impressions of speech as an element of mental status examination. In schizophrenia-spectrum disorders, descriptions of speech are used to assess the severity of psychotic symptoms. In the current study, we assessed the diagnostic value of acoustic speech parameters in schizophrenia-spectrum disorders, as well as its value in recognizing positive and negative symptoms., Methods: Speech was obtained from 142 patients with a schizophrenia-spectrum disorder and 142 matched controls during a semi-structured interview on neutral topics. Patients were categorized as having predominantly positive or negative symptoms using the Positive and Negative Syndrome Scale (PANSS). Acoustic parameters were extracted with OpenSMILE, employing the extended Geneva Acoustic Minimalistic Parameter Set, which includes standardized analyses of pitch (F0), speech quality and pauses. Speech parameters were fed into a random forest algorithm with leave-ten-out cross-validation to assess their value for a schizophrenia-spectrum diagnosis, and PANSS subtype recognition., Results: The machine-learning speech classifier attained an accuracy of 86.2% in classifying patients with a schizophrenia-spectrum disorder and controls on speech parameters alone. Patients with predominantly positive v. negative symptoms could be classified with an accuracy of 74.2%., Conclusions: Our results show that automatically extracted speech parameters can be used to accurately classify patients with a schizophrenia-spectrum disorder and healthy controls, as well as differentiate between patients with predominantly positive v. negatives symptoms. Thus, the field of speech technology has provided a standardized, powerful tool that has high potential for clinical applications in diagnosis and differentiation, given its ease of comparison and replication across samples.

Background: In medical speech and writing, the article before &lsquo;patient&rsquo; is often omitted, while this would be ungrammatical in Standard Dutch., Aim: To investigate how and when the article is omitted in medical Dutch., Method: An online questionnaire was distributed among individuals with a medical background., Results: 85 respondents participated in this study. The participants showed a strong preference to omit the definite article (&lsquo;the&rsquo;) befor the word &lsquo;patient&rsquo; and related words. This phenomenon seemed independent of the function of the word in the sentence, or of the sentence construction. However, the indefinite article (&lsquo;a&rsquo;) was not omitted in the same situations., Conclusion: Doctors speak a different language, namely a variety of Standard Dutch in which the omission of the definite article befor &lsquo;patient&rsquo; is preferred. We conclude that this phenomenon can be explained by recognizing &lsquo;patient&rsquo; as a substitute for the name of the patient.

Background: It has long been thought that women with a schizophrenia spectrum disorder have a more favorable course than men. However, this is not the case, even though they become ill later in life and are less likely to have comorbid drug abuse. Guidelines for prescribing antipsychotics are based on research with mostly male participants, and by following these guidelines we are doing our female patients a disservice. Gender and sex differences lead to differences in preferences, pharmacokinetics and pharmacodynamics., Aim: Providing an overview of antipsychotics for women with a schizophrenia spectrum disorder and discuss the consequences for practice., Method: A clinically oriented study of the literature., Results: Women reach higher plasma levels than men when they receive the same dose of antipsychotic drugs (except for lurasidone and quetiapine). The effect of antipsychotics is also greater in women, because estrogens increase the brain&rsquo;s dopamine sensitivity. This leads to higher risks of side effects. Clinical guidelines differ for women at different stages of life because estrogens greatly contribute to the sex differences seen in the efficacy and tolerability of antipsychotics., Conclusion: Clinicians should be aware that women should be treated differently with antipsychotics than men.

Background: Currently, clinical practice lacks a usable biomarker for the detection and differentiation of depression. Such a biomarker may be found in speech, from which important information can be distilled using automated speech analysis., Aim: To provide an overview of the fast-developing field of automated speech analysis for depression., Method: We summarize the current literature on speech features in depression., Results: Current computational models can detect depression with high accuracy, rendering them applicable for diagnostic tools based on automatic speech analysis. Such tools are developing at a fast rate., Conclusion: Some challenges are still in the way of clinical implementation. For example, results differ largely between studies due to much variation in methodology. Furthermore, privacy and ethical issues need to be addressed before tools can be used.

Background: This special issue discusses the roles and functions of language in psychiatric practice from different perspectives. As an introduction, we discuss the phenomenon &lsquo;language&rsquo; as an object of scientific investigation., Aim: To give a brief introduction to this theme issue., Method: After a terminological introduction and an outline of linguistics, we discuss some of the cognitive processes that enable humans to produce and interpret verbal utterances., Results: The mental lexicon, the dictionary in our head, plays a central role in both language production and understanding. The starting point for language comprehension is recognizing basic form elements in the speech or sign stream (phonemes). Next, the perceiver must determine how words are related grammatically in order to deduce sentence meanings. We distinguish three successive steps in the production of language: conceptualizing, formulating and articulating., Conclusion: Production and understanding words and sentences rely on a complex interplay of cognitive processes. In communication, we use words and sentences to convey and recognize intentions. This requires close cooperation between interlocutors.

Background: Differentiating the behavioural variant of frontotemporal dementia from a depression is challenging. Recent development of automated speech analyses might add to diagnostic., Aim: To investigate the value of automated speech analyses in differentiating bvFTD from a depressive disorder., Method: A semistructured interview was recorded in 15 patients with bvFTD, 15 patients with a depressive disorder and 15 healthy controls, which was transcribed and analysed. Acoustic and semantic values were extracted and classified using machine learning., Results: Acoustic values showed an 80% accuracy for differentiating bvFTD from depressive disorder and semantic values showed an 70.8% accuracy., Conclusion: Acoustic as well as semantic values show significant differences between bvFTD and depressive disorder. In automated speech analyses researches should consider privacy matters as well as possible confounders like age, sex and ethnicity. This study should be repeated in a larger population.

Background: Auditory verbal hallucinations (AVHs) are heterogeneous regarding phenomenology and etiology. This has led to the proposal of AVHs subtypes. Distinguishing AVHs subtypes can inform AVHs neurocognitive models and also have implications for clinical practice. A scarcely studied source of heterogeneity relates to the AVHs linguistic characteristics. Therefore, in this study we investigate whether linguistic features distinguish AVHs subtypes, and whether linguistic AVH-subtypes are associated with phenomenology and voice-hearers' clinical status., Methods: Twenty-one clinical and nineteen non-clinical voice-hearers participated in this study. Participants were instructed to repeat verbatim their AVHs just after experiencing them. AVH-repetitions were audio-recorded and transcribed. AVHs phenomenology was assessed using the Auditory Hallucinations Rating Scale of the Psychotic Symptom Rating Scales. Hierarchical clustering analyses without a priori group dichotomization were performed using quantitative measures of sixteen linguistic features to distinguish sets of AVHs., Results: A two-AVHs-cluster solution best partitioned the data. AVHs-clusters significantly differed in linguistic features (p < .001); AVHs phenomenology (p < .001); and distribution of clinical voice-hearers (p < .001). The "expanded-AVHs" cluster was characterized by more determiners, more prepositions, longer utterances (all p < .01), and mainly contained non-clinical voice-hearers. The "compact-AVHs" cluster had fewer determiners and prepositions, shorter utterances (all p < .01), more negative content, higher degree of negativity (both p < .05), and predominantly came from clinical voice-hearers., Discussion: Two voice-speech clusters were recognized, differing in syntactic-grammatical complexity and negative phenomenology. Our results suggest clinical voice-hearers often hear negative, "compact-voices", understandable under Broca's right hemisphere homologue and memory-based mechanisms. Conversely, non-clinical voice-hearers experience "expanded-voices", better accounted by inner speech AVHs models., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The prevalence of mental illness has remained stable in recent decades, yet the use of psychotropic drugs has increased. This trend suggests that psychotropic drugs are being prescribed with an unnecessary frequency. Internationally, there is growing attention for deprescribing., Aim: To investigate what experiences and needs patients and their loved ones/relatives have with regard to deprescribing of psychotropics., Method: An online questionnaire was distributed among members of the MIND mental health care panel, which consists of (former) patients with a psychiatric disorder and their loved ones., Results: A total of 564 respondents took part in this survey. Most patients have phased out/stopped their psychotropic drugs (83.8%). This was usually done at the initiative of the patient (66.7%), in consultation with the practitioner (72.9%). The practitioner only took the initiative to deprescribe in 15.1% of the cases. In 68.6% tapering was not discussed at the start of psychotropic drug use. Patients did not experience willingness from practitioners in deprescribing, and would like to discuss deprescribing more often (79.5%)., Conclusion: There is an undeniable demand among patients and near ones for more emphasis on deprescribing of psychotropic drugs. We advise to include this topic in the shared decision making process.

Background &nbsp; Women with a schizophrenia-spectrum disorder (SSD) have a better clinical profile than men at the start of their illness but lose this advantage within the first few years of living with SSD. There are benefits to be gained across different areas in the care currently offered to women with psychosis. Aim &nbsp; To describe point of improvement in the care for women with SSD. Method &nbsp; Review or relevant literature. Results &nbsp; An important point for improvement is the early detection of female-specific signs of a first episode of psychosis, to shorten the duration of untreated psychosis, with prompt access to early intervention services. Special attention should be paid to sexual health, and to any history of childhood trauma. Antipsychotics clearly require dosing and prescription tailored to the female body, considering hormonal life phases such as menopause. Switching to prolactin-sparing medications can benefit both mental and somatic health. Finally, hormone replacement therapy should be considered for postmenopausal women. Conclusion &nbsp; By providing female-specific care, women with SSD can live up to their full potential.

Psychiatry is in dire need of a method to aid early detection of symptoms. Recent developments in automatic speech analysis prove promising in this regard, and open avenues for implementation of speech-based applications to detect psychiatric symptoms. The current survey was conducted to assess positions with regard to speech recordings among a group (n = 675) of individuals who experience psychiatric symptoms. Overall, respondents are open to the idea of speech recordings in light of their mental welfare. Importantly, concerns with regard to privacy were raised. Given that speech recordings are privacy sensitive, this requires special attention upon implementation of automatic speech analysis techniques. Furthermore, respondents indicated a preference for speech recordings in the presence of a clinician, as opposed to a recording made at home without the clinician present. In developing a speech marker for psychiatry, close collaboration with the intended users is essential to arrive at a truly valid and implementable method., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Language abnormalities are a core symptom of schizophrenia-spectrum disorders and could serve as a potential diagnostic marker. Natural language processing enables quantification of language connectedness, which may be lower in schizophrenia-spectrum disorders. Here, we investigated connectedness of spontaneous speech in schizophrenia-spectrum patients and controls and determine its accuracy in classification. Using a semi-structured interview, speech of 50 patients with a schizophrenia-spectrum disorder and 50 controls was recorded. Language connectedness in a semantic word2vec model was calculated using consecutive word similarity in moving windows of increasing sizes (2-20 words). Mean, minimal and variance of similarity were calculated per window size and used in a random forest classifier to distinguish patients and healthy controls. Classification based on connectedness reached 85% cross-validated accuracy, with 84% specificity and 86% sensitivity. Features that best discriminated patients from controls were variance of similarity at window sizes between 5 and 10. We show impaired connectedness in spontaneous speech of patients with schizophrenia-spectrum disorders even in patients with low ratings of positive symptoms. Effects were most prominent at the level of sentence connectedness. The high sensitivity, specificity and tolerability of this method show that language analysis is an accurate and feasible digital assistant in diagnosing schizophrenia-spectrum disorders., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

There is a pressing need for better pharmacological treatment strategies for psychiatric disorders as current treatment often results in partial symptom remission and unwanted side effects. A point of entry may be the glutamatergic system since glutamatergic dysregulation contributes to multiple psychiatric disorders. We evaluated the evidence from randomized controlled trials (RCTs) regarding the use of the glutamatergic drug riluzole in mental illnesses; and conducted preliminary meta-analyses of its effectiveness in treating obsessive-compulsive disorder (OCD) and depression. A systematic search was performed using PubMed (Medline), Embase, Cochrane Database of Systematic Reviews and PsycINFO. Meta-analyses were performed using Comprehensive Meta-Analysis software. Twenty-three RCTs were included for qualitative analysis and showed positive effects of adjunctive/monotherapy riluzole in patients with OCD, depression, autism, substance abuse and schizophrenia. Seven studies were also used for quantitative analysis, which revealed positive but non-significant effects on OCD and depression. Riluzole was generally well tolerated with few serious adverse events. The studies included in this systematic review were highly heterogeneous and the number of studies was limited per diagnostic condition. Moreover, few studies have examined riluzole as a single treatment. We suggest carrying out further work to provide definitive evidence for the benefit of riluzole in psychiatric illness., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Verbal communication disorders are a hallmark of many neurological and psychiatric illnesses. Recent developments in computational analysis provide objective characterizations of these language abnormalities. We conducted a meta-analysis assessing semantic space models as a diagnostic or prognostic tool in psychiatric or neurological disorders. Diagnostic test accuracy analyses revealed reasonable sensitivity and specificity and high overall efficacy in differentiating between patients and controls (n=1680: Hedges' g =.73, p=.001). Analyses of full sentences (Hedges' g =.95 p <.0001) revealed a higher efficacy than single words (Hedges' g = .51, p <.0001). Specifically, models examining psychotic patients (Hedges' g =.96, p=.003) and those with autism (Hedges' g = .84, p <.0001) were highly effective. Our results show semantic space models are effective as a diagnostic tool in a variety of psychiatric and neurological disorders. The field is still exploratory in nature; techniques differ and models are only used to distinguish patients from healthy controls so far. Future research should aim to distinguish between disorders and perhaps explore newer semantic space tools like word2vec., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The dominance relationships in a group of adult male cats were studied by means of paired encounters in an observation arena which was equally familiar to both animals. In order to develop a good operational technique a pilot study was undertaken. Dominance relationships were determined by using criteria based upon approach/withdrawal or threatening postures similar to those described by Leyhausen (1973). During the encounters two conflicting tendencies seemed to appear: efforts to avoid confrontation and agonistic interactions. The intensity of the reaction varied from pair to pair. Some kinds of behaviour, not considered to be agonistic (such as exploration and, to a lesser extent, rubbing and urine marking), were performed more frequently by the dominant male. Furthermore it was shown that in the course of the experiments, the number of encounters in which no dominance could be assessed increased, probably due to increasing familiarity. The results of a pilot study on the effect of castration and testosterone treatment upon dominance relationships are also presented., (Copyright © 1977. Published by Elsevier B.V.)

In a simulated open-field situation we tried to obtain information about the ability of tomcats to distinguish between urine marks of differing ages. Reactions to these marks were sniffing, sniffing intensively and "Flehmen". The variables we chose to demonstrate a possible discriminatory ability between urine marks of different ages were: (1) latency, i.e. the time that elapses between the cat's release in the observation arena and the finding of a urine mark, (2) the number of occurrences of Flehmen after sniffing, (3) the frequency of sniffing and Flehmen, (4) the duration of the first sniffing bout and (5) the occurrence of a return to the same scent source during an observation. Our most striking observation was that fresh urine marks (maximum age, 4 hours) were explored first, before marks more than one day old; the other variables did not differ dramatically although we observed a general decline in the intensity of the reaction with increasing age of the urine marks. We also found that the visual characteristics of a urine mark play an important role, particularly in the occurrence of returns. Furthermore we found that the reactions of sniffing and Flehmen are linked with an attempt to identify the donor. All results, including the possible influence upon marking behaviour of the presence or absence of fresh marks, are discussed in the light of the use of a "time plan" spacing mechanism by the domestic tomcat as had been suggested in earlier literature., (Copyright © 1977. Published by Elsevier B.V.)