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Biomedical subjects

I Leudar

Publications and source records attributed to I Leudar.

14 recordsLinked to original sources
PubMed2004

Do people with schizophrenia display theory of mind deficits in clinical interactions?

BACKGROUND: Having a 'theory of mind' (ToM) means that one appreciates one's own and others' mental states, and that this appreciation guides interactions with others. It has been proposed that ToM is impaired in schizophrenia and experimental studies show that patients with schizophrenia have problems with ToM, particularly during acute episodes. The model predicts that communicative problems will result from ToM deficits. METHOD: We analysed 35 encounters (> 80 h of recordings) between mental health professionals and people with chronic schizophrenia (out-patient consultations and cognitive behaviour therapy sessions) using conversation analysis in order to identify how the participants used or failed to use ToM relevant skills in social interaction. RESULTS: Schizophrenics with ongoing positive and negative symptoms appropriately reported first and second order mental states of others and designed their contributions to conversations on the basis of what they thought their communicative partners knew and intended. Patients recognized that others do not share their delusions and attempted to reconcile others' beliefs with their own but problems arose when they try to warrant their delusional claims. They did not make the justification for their claim understandable for their interlocutor. Nevertheless, they did not fail to recognize that the justification for their claim is unconvincing. However, the ensuing disagreement did not lead them to modify their beliefs. CONCLUSIONS: Individuals with schizophrenia demonstrated intact ToM skills in conversational interactions. Psychotic beliefs persisted despite the realization they are not shared but not because patients cannot reflect on them and compare them with what others believe.

Adult↗
PubMed1999

Dialogical engagement with voices: a single case study.

This paper raises the possibility that a dialogical, or discursive, model of human experience may be useful in helping someone who experiences verbal hallucinations. The model regards verbal hallucinations as a variety of inner speech with dialogical properties. The explication of these properties in the context of a personal narrative allowed the individual to engage in dialogue with the voices, through the medium of a new, supportive and positive voice. This process made it possible to introduce moral responses to distressing and potentially dangerous imperative verbal hallucinations, through the mediation of the new voice. Her dialogical engagement with this voice enabled her to deal effectively with troublesome voices, and was a powerful source of self-esteem. We briefly present the theoretical perspective underlying this approach, and compare and contrast the approach with cognitive-behavioural techniques.

Cognitive Behavioral Therapy↗
PubMed1997

What voices can do with words: pragmatics of verbal hallucinations.

BACKGROUND: In this paper we consider verbal hallucinations as inner speech with pragmatics. The specific pragmatic properties of verbal hallucinations investigated included the number of voices, the characteristics that individuate the voices, the sequential characteristics of the dialogues between voice hearers and their voices, the dialogical positioning of voices hearers, voices and other individuals, and how the voices influence voice hearers' activities. METHODS: These properties were examined in structured interviews with 28 individuals, 14 of whom had a diagnosis of schizophrenia, while 14 were students who did not use psychiatric services. RESULTS: The analysis showed that voices were most frequently individuated with reference to individuals significant to voice hearers. The talk with voices was typically mundane and related to voice hearers' on-going activities, as is the case for ordinary inner speech. The voices were typically orientated towards the voice hearer, without direct access to each other or to other people. Contrary to received wisdom, the voices typically did not impel actions of voice hearers, rather they influenced voice hearers' decisions on how to act. This was so irrespective of the diagnostic status of informants. Finally, we have found some differences between the voices of informants with, and without, schizophrenia. These concerned the alignment of voices, the type of action required by a voice and the degree of dialogical engagement between voices and voice hearers. CONCLUSIONS: We conclude that verbal hallucinations can be fruitfully considered to be a genus of inner speech. Pragmatics can be used as a framework to distinguish verbal hallucinations in different populations.

Adult↗
PubMed1996

The reliability and characteristics of the brief syntactic analysis.

BACKGROUND: Linguistic analysis is of great potential benefit to psychiatry as a research and assessment tool, but the skill and time it demands means that it has not been widely used. This paper describes a much simplified form of syntactic analysis. METHOD: A detailed protocol for the Brief Syntactic Analysis (BSA) was written, based on earlier work by Morice and Ingram. Three psychiatrists were trained in its use, and inter-rater reliability established through independent ratings of 12 transcripts taken from a mixed group of psychiatric patients and a group of non-psychiatric controls. Concurrent reliability of the BSA against the Morice and Ingram analysis was established by comparing measures from the two methods on 16 transcripts of mixed patients. RESULTS: There were high levels of agreement between the three psychiatrists and between the BSA and the Morice and Ingram analysis, although one-way ANOVA indicated that for some variables there were small but statistically significant absolute differences between the two. The reasons for this were discussed. A principal components analysis confirmed the presence of three factors corresponding closely to the three families of linguistic variables. CONCLUSIONS: The results indicate that psychiatrists can be trained to use a syntactic analysis with high levels of agreement. The BSA, which takes much less time to complete, produces measures that are comparable with the original analysis from which it was derived.

Cognition Disorders↗
PubMed1994

Self-monitoring in speech production: effects of verbal hallucinations and negative symptoms.

This paper reports results of a study on self-monitoring in speech production. Thirty schizophrenics, varying in verbal hallucination and in negative symptoms status, and 17 controls were tested on the reporter test. The position of interruptions of the speech-flow to repair errors was used to indicate whether the detection of the errors was through monitoring of internal phonetic plans or through external acoustic feedback. We have found that the internal error detection was twice as frequent in controls as in schizophrenics. The relevance of this finding to Frith's (1992) model of schizophrenia is discussed. Our conclusion is that the problem with internal monitoring of phonetic plans is common to all schizophrenics, and not just to those with verbal hallucinations.

Adolescent↗
PubMed1993

Syntactic processing and written language output in first onset psychosis.

Written language samples from 45 schizophrenic patients were compared with those from 15 manics and 18 non-psychiatrically ill control subjects. We used the Hunt test to generate written language samples. This consists of 32 simple propositions describing the manufacture of Aluminum. Subjects are asked to rewrite the propositions in a more concise style. Analysis of the subjects' responses yields measures of syntactic complexity as well as syntactic and semantic errors. Schizophrenics performed as well as the other groups as far as complexity was concerned. This was quite unexpected, given the substantial evidence from speech studies that schizophrenic utterance is characterized by low syntactic complexity. Both patient groups also made more errors and had difficulty in integrating information successfully, compared with controls. Some of these differences were related to educational differences between the groups, as well as impairments in attention and working memory. A possible mechanism for these relationships is outlined. The results suggest that although working memory and attention have an important bearing on linguistic performance, there is in addition, a specific failure of language processing.

Adolescent↗
PubMed1992

Self-repair in dialogues of schizophrenics: effects of hallucinations and negative symptoms.

This paper concerns the discourse features of verbal hallucinations and negative symptoms of schizophrenia. A total of 46 schizophrenics, varying in verbal hallucination and in negative symptoms status, and 22 controls were tested on the Reporter Test. The frequency with which they issued inadequate instructions, attempted to repair the inadequacies, and the success of repairs were compared. We observed that schizophrenics, on the whole, issued more wrong and incomplete instructions. This was in part related to their worse working memory, but it was not affected by verbal hallucinations or negative symptoms. We observed, further, that schizophrenics had no particular problems monitoring messages for inadequacies. We did find, however, that schizophrenics with verbal hallucinations had a specific problem with self-repairing wrong instructions. We interpret these results in the framework of Hoffman's (1986b) plan disruption-based model of verbal hallucinations; the Frith (1987) and Frith and Done (1988) internal monitoring model of positive and negative symptoms; and finally Frith and Frith's (1990) model of negative and positive schizophrenia and we use the results to specify the models.

Adult↗
PubMed1986

Psychiatric and behaviour disturbance in mental handicap.

This study reports on the relationship between behavioural and psychiatric perceptions of mentally handicapped subjects. A Standardised Psychiatric Interview schedule was found to characterise psychiatric problems in the mentally handicapped along eight dimensions: depression, neurasthenia, psychoticism, phobias, histrionic elation, hypochondria, mental retardation and medication effects. A Behavioural Disturbance Scale characterised disturbances along six dimensions: aggressive conduct, mood disturbance, withdrawal, antisocial conduct, idiosyncratic mannerisms and self-injury. The relationships between the two modes of assessment were investigated using multiple regression. Clinical features were not expressed in behaviour disturbances, nor were they related to age, sex or hospitalisation. The communicativeness of an interviewee was, however, found to limit the detection of depression.

Adolescent↗
PubMed1985

How to keep quiet: some withdrawal strategies in mentally handicapped adults.

In mental handicap, communication is frequently disrupted not only by the lack of linguistic skills but also by behaviour problems, in particular communicative withdrawal. Three cases illustrate types of withdrawal and interview features and show how the Communicative Style Scale (CSS) is used to analyse strategies by which mentally handicapped subjects maintain withdrawal.

Adult↗
PubMed1984

Behaviour disturbance and mental handicap: typology and longitudinal trends.

Behaviour disturbance was investigated in mentally handicapped adults who were living in hospital or at home. The first part of the study describes an empirically derived typology of disturbed behaviour patterns and gives the details of a scale by means of which behaviour disturbance can be quantified along six dimensions: aggression, mood disturbance, communicativeness, antisocial conduct, idiosyncratic mannerisms, and self-injury. The second part of the study used the scale in a longitudinal study of behavioural disturbance. Different forms of disturbed behaviour exhibited different kinds of longitudinal stability, and the long-term changes in one aspect of disturbance depended on subjects' other disturbance scores.

Adolescent↗
PubMed1983

Recognition of emotion from facial expression in mental handicap.

When mildly and severely mentally retarded people saw photographs showing expressions of basic emotions their overall performance was found to be correlated with intelligence. Certain specific patterns of confusion were determined, clinically the most significant being an inability to cope with high intensity emotions.

Adult↗
PubMed1981

Social familiarity and communication in Down syndrome.

The communication of eight Down syndrome individuals with strangers and with acquaintances was analysed. The spontaneity of their speech and the communicative demands they made on their audiences were found to be low. Some of them broke rules of conversation by not answering questions. Surprisingly, their speech was not more spontaneous with acquaintances. It was further observed that Down syndrome individuals' conversations were in the main restricted to comments on current actions. However, different postures are adopted and different body mobility exhibited depending on partner familiarity. It is concluded that Down syndrome persons prefer to express intimacy/social distance in non-verbal modalities.

Adolescent↗