More than words: Speech production in first-episode psychosis predicts later social and vocational functioning

Michael Mackinley; Roberto Limongi; Angélica María Silva; Julie Richard; Priya Subramanian; Hooman Ganjavi; Lena Palaniyappan

doi:10.3389/fpsyt.2023.1144281

More than words: Speech production in first-episode psychosis predicts later social and vocational functioning

Front Psychiatry. 2023 Apr 14:14:1144281. doi: 10.3389/fpsyt.2023.1144281. eCollection 2023.

Authors

Michael Mackinley^{1

2}, Roberto Limongi¹, Angélica María Silva¹, Julie Richard³, Priya Subramanian³, Hooman Ganjavi³, Lena Palaniyappan^{1

3

4

5}

Affiliations

¹ Robarts Research Institute, University of Western Ontario, London, ON, Canada.
² Lawson Health Research Institute, London, ON, Canada.
³ Department of Psychiatry, University of Western Ontario, London, ON, Canada.
⁴ Department of Medical Biophysics, Western University, London, ON, Canada.
⁵ Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.

Abstract

Background: Several disturbances in speech are present in psychosis; however, the relationship between these disturbances during the first-episode of psychosis (FEP) and later vocational functioning is unclear. Demonstrating this relationship is critical if we expect speech and communication deficits to emerge as targets for early intervention.

Method: We analyzed three 1-min speech samples using automated speech analysis and Bayes networks in an antipsychotic-naive sample of 39 FEP patients and followed them longitudinally to determine their vocational status (engaged or not engaged in employment education or training-EET vs. NEET) after 6-12 months of treatment. Five baseline linguistic variables with prior evidence of clinical relevance (total and acausal connectives use, pronoun use, analytic thinking, and total words uttered in a limited period) were included in a Bayes network along with follow-up NEET status and Social and Occupational Functioning Assessment Scale (SOFAS) scores to determine dependencies among these variables. We also included clinical (Positive and Negative Syndrome Scale 8-item version (PANSS-8)), social (parental socioeconomic status), and cognitive features (processing speed) at the time of presentation as covariates.

Results: The Bayes network revealed that only total words spoken at the baseline assessment were directly associated with later NEET status and had an indirect association with SOFAS, with a second set of dependencies emerging among the remaining linguistic variables. The primary (speech-only) model outperformed models including parental socioeconomic status, processing speed or both as latent variables.

Conclusion: Impoverished speech, even at subclinical levels, may hold prognostic value for functional outcomes and warrant consideration when providing measurement based care for first-episode psychosis.

Keywords: First Episode Psychosis; NEET (neither education employment or training); language; schizophrenia; thought disorder.