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S116. PRAGMATIC COMPREHENSION IN SCHIZOPHRENIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Individuals with schizophrenia (SCZ) frequently show a severe and widespread impairment in the communicative-pragmatic domain. They exhibit difficulties in the comprehension of a wide range of communicative- pragmatic expressions, such as indirect speech acts (ISA), irony, metaphors, proverb and idioms. Communicative disorders play an important role in the in the social impairment experienced by these patients, and they are frequently associated with functional and social outcome. However, results of previous studies showed large variation across different samples, communicative phenomena and type of pragmatic task investigated. As a result, the state of the evidence for communicative difficulties in SCZ is not completely clear. We performed a systematic review of previous literature assessing pragmatic comprehension in schizophrenia, and a meta-analysis of the evidence. The aim of the meta-analysis was to: 1) investigate differences in pragmatic comprehension between individuals with SCZ and HC 2) compare differences in pragmatic comprehension across different phenomena, i.e. irony, figurative language (FL, idioms, proverbs and metaphors), and ISA. Methods We used the “PRISMA Statement” guidelines for transparent reporting of a systematic review, and the study was preregistered on Prospero Register of Systematic Review. We performed a systematic literature search on the following database: PyschInfo, Pubmed and Google Scholar. 1 2020 Congress of the Schizophrenia International Research Society Selection of the studies was conducted according to the following inclusion criteria: (a) empirical study, (b) quantitative measures of pragmatic comprehension of participants with SCZ, (c) sample including at least two individuals with SCZ (d) inclusion of a comparison group. Finally, 37 studies were identified as eligible for inclusion, and among these 27 studies provided enough data to be included in the meta-analysis. We used mixed effects regression models for each relevant pragmatic phenomena, i.e. FL, irony and ISA, to calculate summary effect sizes (Cohen’s d). Results The results showed significant meta-analytic effects of schizophrenia in pragmatic comprehension of FL (22 studies, d: -1.74, 95% CIs: -2.49 -0.93, p < .001), irony (12 studies, d: -1.42, 95% CIs: -2.3 -0.5, p = .001,), and ISA (3 studies, d: -1.37, 95% CIs: -1.9 -0.8, p < .001). The standardized effect sizes were large, thus indicating that individual with SCZ have serious difficulties in the comprehension of the different communicative expressions compared to healthy individuals. The heterogeneity between studies was significant (FL: Q(32) =245.1, p < .0001, and ISA: Q(3) = 25.2, p < .0001). The rank correlation test indicated evidence for publication bias for figurative language (Kendall’s tau (K) = -0.35, p < 0.001), while was not significant for irony and ISA (Irony: K = -0.33, p = 0.13, ISA: K = -1.00, p = 0.08). Discussion Overall, we found that individuals with SCZ showed clear difficulties in the comprehension of different pragmatic expression, i.e. FL, irony and ISA, compared to healthy controls. This result is in line with previous studies indicating pragmatic impairment as a core deficit in schizophrenia. The effects were large for all the pragmatic phenomena, with figurative expressions showing the largest effect followed by irony and ISA. However, we reported the presence of publication bias for studies investigating figurative language expressions. Heterogeneity between studies was large and significant for all the three phenomena, thus suggesting a large variability across studies in the characteristic of the tasks used to investigate pragmatic ability, and in the characteristics of the experimental samples assessed.

Background: Current clinical utility of diagnostic categories in patients with psychosis is in debate. Alternatively, symptom-based dimensional approaches are suggested, but research on their utility and longitudinal stability is at its early phases, showing lack of consistencies. The aims of this prospective study are: 1) to test the stability of structure of symptom dimensions in first episode psychosis patients; 2) to explore the utility of symptom dimensions in predicting clinical and functional outcomes. Methods: This study included a total of 208 with first episode of psychosisspectrum disorders aged 18-65 years who presented to psychiatric services in South London, recruited as part of the Genetics and Psychosis Outcome (GAP) case-control study and EU-GEI multicentre casecontrol study. A subsample of 114 patients were traced after a mean of 6.5 years. Psychopathology was assessed at baseline and at follow-up using OPCRIT and tested with bifactor model, encompassing one general psychosis dimension and five specific symptom dimensions (positive, negative, disorganisation, mania, and depression). Follow up measures on functional outcome (assessed with GAF scale) and clinical outcomes (number and total length of hospitalisations) were derived from clinical records. Predictor role of baseline symptom dimensions was tested by multiple linear regression to predict global functioning; and by negative binomial regression for length of hospitalisation and number of hospital admissions. Results: Factor loadings of disorganisation dimension were most likely to change longitudinally while loadings of positive dimension were most stable. Regarding dimension stability over time, all positive, disorganised and depressive symptoms significantly improved over time while manic and negative symptoms did not significantly differ. In terms of prediction of outcome, baseline manic symptoms were associated with reduced risk of hospitalisation (adj OR 1.56; 95% CI 1.01-2.38), reduced length of hospitalisation (adj IRR= 0.73; 95% CI 0.56-0.95) and better global functioning (β=5.21; 95% CI 2.46-7.95) at follow up. Similarly, depressive symptoms were associated with reduced length of hospitalisation (adj IRR= 0.77; CI 0.61-0.97). On the other hand, baseline positive symptoms were associated with increased risk of hospitalisation (adj OR 1.93; 95% CI 1.25-2.96). No other significant associations were found between the rest of symptom dimensions and outcomes. Discussion: This study provides new evidence on the longitudinal stability of bifactor model of psychosis and, shows that all except manic and negative symptoms significantly improved over time. Whereas affective symptoms (including mania and depression) were associated with good prognosis, positive symptoms seem to predict poor clinical outcomes. The particular and different influence of affective and psychotic symptoms on long-term functional and clinical outcomes may have therapeutic implications and support the potential clinical utility of incorporating symptom-based approach in further outcome research.

University of Turin, and Institute of Neurosciences of Turin
Background: Individuals with schizophrenia (SCZ) frequently show a severe and widespread impairment in the communicative-pragmatic domain. They exhibit difficulties in the comprehension of a wide range of communicative-pragmatic expressions, such as indirect speech acts (ISA), irony, metaphors, proverb and idioms. Communicative disorders play an important role in the in the social impairment experienced by these patients, and they are frequently associated with functional and social outcome. However, results of previous studies showed large variation across different samples, communicative phenomena and type of pragmatic task investigated. As a result, the state of the evidence for communicative difficulties in SCZ is not completely clear. We performed a systematic review of previous literature assessing pragmatic comprehension in schizophrenia, and a meta-analysis of the evidence. The aim of the meta-analysis was to: 1) investigate differences in pragmatic comprehension between individuals with SCZ and HC 2) compare differences in pragmatic comprehension across different phenomena, i.e. irony, figurative language (FL, idioms, proverbs and metaphors), and ISA. Methods: We used the "PRISMA Statement" guidelines for transparent reporting of a systematic review, and the study was preregistered on Prospero Register of Systematic Review. We performed a systematic literature search on the following database: PyschInfo, Pubmed and Google Scholar. 1 2020 Congress of the Schizophrenia International Research Society Selection of the studies was conducted according to the following inclusion criteria: (a) empirical study, (b) quantitative measures of pragmatic comprehension of participants with SCZ, (c) sample including at least two individuals with SCZ (d) inclusion of a comparison group. Finally, 37 studies were identified as eligible for inclusion, and among these 27 studies provided enough data to be included in the meta-analysis. We used mixed effects regression models for each relevant pragmatic phenomena, i.e. FL, irony and ISA, to calculate summary effect sizes (Cohen's d).

Results:
The results showed significant meta-analytic effects of schizophrenia in pragmatic comprehension of FL (22 studies, d: -1.74, 95% CIs: -2.49 -0.93, p < .001), irony (12 studies, d: -1.42, 95% CIs: -2.3 -0.5, p = .001,), and ISA (3 studies, d: -1.37, 95% CIs: -1.9 -0.8, p < .001). The standardized effect sizes were large, thus indicating that individual with SCZ have serious difficulties in the comprehension of the different communicative expressions compared to healthy individuals. The heterogeneity between studies was significant (FL: Q(32) =245.1, p < .0001, and ISA: Q(3) = 25.2, p < .0001). The rank correlation test indicated evidence for publication bias for figurative language (Kendall's tau (K) = -0.35, p < 0.001), while was not significant for irony and ISA (Irony: K = -0.33, p = 0.13, ISA: K = -1.00, p = 0.08). Discussion: Overall, we found that individuals with SCZ showed clear difficulties in the comprehension of different pragmatic expression, i.e. FL, irony and ISA, compared to healthy controls. This result is in line with previous studies indicating pragmatic impairment as a core deficit in schizophrenia. The effects were large for all the pragmatic phenomena, with figurative expressions showing the largest effect followed by irony and ISA. However, we reported the presence of publication bias for studies investigating figurative language expressions. Heterogeneity between studies was large and significant for all the three phenomena, thus suggesting a large variability across studies in the characteristic of the tasks used to investigate pragmatic ability, and in the characteristics of the experimental samples assessed.

S117. DOES ADDING AUTOMATED ANALYSIS OF SPEECH COHESION TO DIMENSIONALIZED R-PAS COGNITIVE CODES IMPROVE OUR ABILITY TO ASSESS DISORGANIZED THINKING?
Noelle Warfford* 1 , Gregory J. Meyer 1 , Emily T. O'Gorman 1 , Joshua J. Eblin 2 , Joni L. Mihura 1 1 University of Toledo; 2 Center for Forensic Psychiatry MI Background: Research is increasingly pointing toward the need for a dimensional, rather than categorical, conceptualization of psychopathology. This is particularly true within the literature on psychosis and related disorders. Taking a dimensional approach to conceptualizing psychosis requires deconstructing its components in assessment. The Rorschach Performance Assessment System (R-PAS) contains meta-analytically supported scales with international norms that are used to categorically rate signs of disordered thinking and perceptions in individuals' responses to the Rorschach inkblots. Recently, a new dimensionalized set of scales called the Scales of Problematic Communication and Thinking (SPCT) have been developed for R-PAS with three main components: Disturbed and Confusing Communication, Illogical Verbal Justification, and Incongruous Perceptual Combinations.
Research also suggests that linguistic measures of speech cohesion can be used to successfully predict conversion to psychosis in clinical high-risk patients and may be more related to stable neurocognitive deficits than clinical measures of disorganized speech. Coh-Metrix, an automated speech analysis software, provides over 100 specific measures of linguistic cohesion, such as connectivity, syntax simplicity, and referential cohesion. The purpose of this presentation is twofold: (a) to report recent findings showing the SPCT provides incremental validity over the traditional R-PAS measure of disordered thinking in predicting clinician ratings of disorganized thinking on the PANSS and (b) to determine if Coh-Metrix measures of linguistic cohesion provide incremental validity to SPCT ratings in predicting these PANSS ratings. Methods: R-PAS protocols from a maximum-security inpatient forensic hospital (N = 91) aged 19 to 80 years (M=40) and predominantly male (89%) were coded for thinking and perceptual disturbances using the R-PAS traditional measure of disordered thinking and the 6-point dimensional SPCT measure. The patients' primary clinician provided PANSS ratings. Protocols will be coded for speech cohesion using 15 indices from the automated speech analysis software Coh-Metrix, which were chosen based on a literature review. Results: Interrater reliability was excellent for the SPCT ratings (ICC = 0.97) and good for the PANSS clinician ratings (ICC = 0.71). In a previous study, SPCT ratings showed significant associations with the clinician ratings of disorganized thinking on the PANSS (r = 0.42, p < 0.01, N = 90); hierarchical regression analyses demonstrated incremental validity over the traditional R-PAS measure of disordered thinking (ΔR = 0.28, p < 0.01). Using hierarchical regression analyses, the Coh-Metrix indices of cohesion are predicted to provide incremental validity to the SPCT ratings. Discussion: The SPCT shows promise as a reliable and valid dimensionalized measure for assessing the continuum of clear thinking to psychosis-level disturbances. The measures of linguistic cohesion provided by Coh-Metrix have the potential to offer clinicians a quick, efficient, and objective method for assessing disorganized thinking. The R-PAS international norms are currently being coded for SPCT and, if Coh-Metrix measures provide incremental validity, will be coded for these measures as well. Using these measures in combination with SPCT ratings can provide clinicians with a clearer understanding of this significant component of psychosis.