Nonverbal Social Communication and Gesture Control in Schizophrenia

Walther, Sebastian; Stegmayer, Katharina; Sulzbacher, Jeanne; Vanbellingen, Tim; Müri, René M.; Strik, Werner; Bohlhalter, Stephan

doi:10.1093/schbul/sbu222

Cited by 105 publications

(148 citation statements)

References 58 publications

(100 reference statements)

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“…In the light of these findings, it is likely that inefficient gesture performance may contribute to impaired social functioning and functional outcome. Given that poor social perception impaired gesture performance [17], poor gesture performance in first-episode patients may result from poor social cognition at the very onset of the disorder. In fact, deficits in social cognition were reported even before the actual onset of psychosis, for instance in adolescents at risk for psychosis [48], and may already substantially impact social functioning in first-episode patients.…”

Section: Discussionmentioning

confidence: 99%

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Gesture Performance in First- and Multiple-Episode Patients with Schizophrenia Spectrum Disorders

et al. 2016

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Background/Aim: Gesturing plays an important role in social behavior and social learning. Deficits are frequent in schizophrenia and may contribute to impaired social functioning. Information about deficits during the course of the disease and presence of severity and patterns of impairment in first-episode patients is missing. Hence, we aimed to investigate gesturing in first- compared to multiple-episode schizophrenia patients and healthy controls. Methods: In 14 first-episode patients, 14 multiple-episode patients and 16 healthy controls matched for age, gender and education, gesturing was assessed by the comprehensive Test of Upper Limb Apraxia. Performance in two domains of gesturing - imitation and pantomime - was recorded on video. Raters of gesture performance were blinded. Results: Patients with multiple episodes had severe gestural deficits. For almost all gesture categories, performance was worse in multiple- than in first-episode patients. First-episode patients demonstrated subtle deficits with a comparable pattern. Conclusions: Subjects with multiple psychotic episodes have severe deficits in gesturing, while only mild impairments were found in first-episode patients independent of age, gender, education and negative symptoms. The results indicate that gesturing is impaired at the onset of disease and likely to further deteriorate during its course.

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Section: Discussionmentioning

confidence: 99%

“…In addition, it was shown that pantomiming meaningless gestures was particularly disturbed [15], which is associated with poor frontal lobe function [16]. Furthermore, disturbed nonverbal social perception is linked to poor gesture performance in schizophrenia [17]. …”

Section: Introductionmentioning

confidence: 99%

Gesture Performance in First- and Multiple-Episode Patients with Schizophrenia Spectrum Disorders

et al. 2016

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“…fMRI studies suggest the existence of similar domain-specific long-range connections between specialized cortical regions and the limbic system, e.g., for emotional face processing, between the fusiform gyrus, the amygdala, and the orbitofrontal cortex [23, 24]. In the motor domain, the capacity to recognize nonverbal information such as hand gestures is strongly linked to the performance of hand gestures [25], suggesting a parallel organization with direct connections between brain areas of action perception and those of action planning [26]. The cortical connections of the motor system include areas of executive control and action planning (rostral to primary motor cortex) and parietal areas of action perception (see right panel of Fig.…”

Section: Outline Of Synopsismentioning

confidence: 99%

“…Two studies noted an association of impaired gesture performance with frontal lobe dysfunction and motor abnormalities in schizophrenia [25, 126]. In addition, patients have problems interpreting the hand gestures of others correctly [129].…”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 99%

“…Furthermore, they tend to misperceive neutral gestures as threatening [37] and incidental movements as gestures [36]. We demonstrated a generalized deficit – such as in gesture performance, gesture knowledge, nonverbal perception, and tool use – in schizophrenia [25]. In contrast to controls, performance was correlated between the tasks assessing nonverbal social perception, gesture performance, gesture recognition, and tool use.…”

Section: Mapping Symptoms Onto Brain Systems: Empirical Evidence For mentioning

confidence: 99%

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Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

et al. 2017

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Schizophrenia research has been in a deadlock for many decades. Despite important advances in clinical treatment, there are still major concerns regarding long-term psychosocial reintegration and disease management, biological heterogeneity, unsatisfactory predictors of individual course and treatment strategies, and a confusing variety of controversial theories about its etiology and pathophysiological mechanisms. In the present perspective on schizophrenia research, we first discuss a methodological pitfall in contemporary schizophrenia research inherent in the attempt to link mental phenomena with the brain: we claim that the time-honored phenomenological method of defining mental symptoms should not be contaminated with the naturalistic approach of modern neuroscience. We then describe our Systems Neuroscience of Psychosis (SyNoPsis) project, which aims to overcome this intrinsic problem of psychiatric research. Considering schizophrenia primarily as a disorder of interindividual communication, we developed a neurobiologically informed semiotics of psychotic disorders, as well as an operational clinical rating scale. The novel psychopathology allows disentangling the clinical manifestations of schizophrenia into behavioral domains matching the functions of three well-described higher-order corticobasal brain systems involved in interindividual human communication, namely, the limbic, associative, and motor loops, including their corticocortical sensorimotor connections. The results of several empirical studies support the hypothesis that the proposed three-dimensional symptom structure, segregated into the affective, the language, and the motor domain, can be specifically mapped onto structural and functional abnormalities of the respective brain systems. New pathophysiological hypotheses derived from this brain system-oriented approach have helped to develop and improve novel treatment strategies with noninvasive brain stimulation and practicable clinical parameters. In clinical practice, the novel psychopathology allows confining the communication deficits of the individual patient, shifting attention from the symptoms to the intact resources. We have studied this approach and observed important advantages for therapeutic alliances, personalized treatment, and de-escalation strategies. Future studies will further conjoin clinical definitions of psychotic symptoms with brain structures and functions, and disentangle structural and functional deficit patterns within these systems to identify neurobiologically distinct subsyndromes. Neurobiologically homogeneous patient groups may provide new momentum for treatment research. Finally, lessons learned from schizophrenia research may contribute to developing a comprehensive perspective on human experience and behavior that integrates methodologically distinct, but internally consistent, insights from humanities and neuroscience.

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The current conceptualization of negative symptoms in schizophrenia

Marder¹,

2017

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Negative symptoms have long been conceptualized as a core aspect of schizophrenia. They play a key role in the functional outcome of the disorder, and their management represents a significant unmet need. Improvements in definition, characterization, assessment instruments and experimental models are needed in order to foster research aimed at developing effective interventions. A consensus has recently been reached on the following aspects: a) five constructs should be considered as negative symptoms, i.e. blunted affect, alogia, anhedonia, asociality and avolition; b) for each construct, symptoms due to identifiable factors, such as medication effects, psychotic symptoms or depression, should be distinguished from those regarded as primary; c) the five constructs cluster in two factors, one including blunted affect and alogia and the other consisting of anhedonia, avolition and asociality. In this paper, for each construct, we report the current definition; highlight differences among the main assessment instruments; illustrate quantitative measures, if available, and their relationship with the evaluations based on rating scales; and describe correlates as well as experimental models. We conclude that: a) the assessment of the negative symptom dimension has recently improved, but even current expert consensus-based instruments diverge on several aspects; b) the use of objective measures might contribute to overcome uncertainties about the reliability of rating scales, but these measures require further investigation and validation; c) the boundaries with other illness components, in particular neurocognition and social cognition, are not well defined; and d) without further reducing the heterogeneity within the negative symptom dimension, attempts to develop successful interventions are likely to lead to great efforts paid back by small rewards.

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Nonverbal Social Communication and Gesture Control in Schizophrenia

Cited by 105 publications

References 58 publications

Gesture Performance in First- and Multiple-Episode Patients with Schizophrenia Spectrum Disorders

Gesture Performance in First- and Multiple-Episode Patients with Schizophrenia Spectrum Disorders

Systems Neuroscience of Psychosis: Mapping Schizophrenia Symptoms onto Brain Systems

The current conceptualization of negative symptoms in schizophrenia

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