واکنش‌پذیری زبانی و عملکرد کاری در اسکیزوفرنی

Abstract Some studies have found that the speech of certain schizophrenia patients becomes more disordered in stressful laboratory situations. It is unknown, however, whether affective reactivity of speech is associated with stress responsiveness of symptoms in the real world. This study examines whether language-reactive patients report more stress-related impairments in work functioning than language-nonreactive patients. Forty-six patients provided speech samples and completed a work history interview. It was found that the language-reactive patients were more likely than the language-nonreactive patients to endorse items pertaining to social anxiety and difficulty relating to others as reasons for their work difficulties. This suggests that language-reactive patients are more sensitive to social stressors than language-nonreactive patients.

Introduction Docherty and colleagues have found that the speech of approximately 50% of patients with schizophrenia becomes more disordered when difficult, stressful topics are discussed, suggesting that some patients may be more sensitive to stress than others (Docherty et al., 1994, Docherty et al., 1998 and Docherty and Hebert, 1997). This effect, termed “affective reactivity of language symptoms”, has been hypothesized to be one possible manifestation of a more general hyperreactivity to stress (Docherty, 1996). Recent examinations of the correlates of affective reactivity in schizophrenia patients suggest that lifetime severity of positive symptoms (Docherty and Hebert, 1997), startle eyeblink response magnitudes (Docherty and Grillon, 1995 and Docherty et al., 2001), and familiality of the disorder (Docherty et al., 1996b and Docherty et al., 1998) are all associated with the effect. Despite Docherty and Hebert's (1997) earlier recommendations, the real-life implications of affective reactivity of language symptoms in schizophrenia have yet to be investigated. It is still unknown whether affective reactivity of speech is associated with impairment in the ability to function in stressful situations such as work. While work is usually associated with many benefits including financial remuneration, social status and an opportunity to interact with others, employment can also have significant negative effects on people's psychological health and day-to-day effectiveness (Warr, 1995). For instance, stress in the workplace has been found to occasionally contribute to the development or exacerbation of psychotic symptoms (Doering et al., 1998 and Muntaner et al., 1991). Work stress can deter individuals suffering from a mental illness from finding and/or maintaining a job (Westermeyer and Harrow, 1987). Given the probable existence of a stress-reactive subgroup of schizophrenia patients, it is likely that language-reactive patients would experience more impairments in their work functioning. The primary goal of this exploratory study, therefore, was to examine whether language-reactive schizophrenia patients would report significantly more stress-related impairments in their work functioning than language-nonreactive patients. Participants in this study were interviewed about their work history and were asked to complete a self-report measure of 16 specific reasons for work disruption. Since language-reactive patients are believed to endure greater internal agitation, it was hypothesized that they would report symptoms of anxiety, depression, and stress as being much more disruptive in their efforts to find and/or hold a job than would language-nonreactive patients. It was also hypothesized that, compared to the language-nonreactive group, language-reactive patients would identify stress and symptom exacerbation as primary reasons for leaving their jobs.

Results 3.1. Sample characteristic Table 1 presents the characteristics of the sample, grouped by language reactivity. The language-reactive and language-nonreactive patients were similar with respect to diagnosis, age, sex, education, global assessment of functioning, and age at first contact with treatment services. 3.2. Work functioning All patients had held at least one job prior to the onset of schizophrenia and 73% reported having held at least one job since the onset of their illness. The total duration of employment (any job) since the onset of schizophrenia varied greatly among patients, ranging from 1 month to 24 years. In terms of the primary reason for leaving their jobs, 36% of the patients who had worked after the onset of their illness quit because they found their job too stressful or because they had problems with their co-workers, 29% quit for other reasons, 13% were fired or laid off, and 23% had to stop working because of an exacerbation of psychiatric or physical symptoms. Language-reactive and language-nonreactive patients did not differ on any of these variables. The WDC ratings for the language-reactive and language-nonreactive patients are presented in Table 2. The two groups did not differ on the expected items, but did differ significantly on two of the items related to attitudes toward others. The language-reactive patients reported that difficulties in relating to others and fear of social relationships were more disruptive to their work efforts than the language-nonreactive patients. This suggests that the language-reactive patients' functioning was more vulnerable specifically to social stressors.