Deficits in Abstract Thinking Assessed by Theme Identification in Patients with Schizophrenia

Jooyoung Oh; Ji-Won Chun; Jae-Jin Kim

doi:10.16946/kjsr.2013.16.1.25

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Oh, Chun, and Kim: Deficits in Abstract Thinking Assessed by Theme Identification in Patients with Schizophrenia

Original Article

Korean J Schizophr Res 2013;16(1):25-31.

Published online: 17 January 2013

DOI: https://doi.org/10.16946/kjsr.2013.16.1.25

Deficits in Abstract Thinking Assessed by Theme Identification in Patients with Schizophrenia

Jooyoung Oh, MD¹, Ji-Won Chun, PhD², Jae-Jin Kim, MD, PhD^1,^2,

¹Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea

²Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

Address for correspondence: Jae-Jin Kim, Department of Psychiatry, Yonsei University Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea Tel: 02-2019-3341, Fax: 02-3462-4304 E-mail: jaejkim@yonsei.ac.kr

Revised 25 February 201310 April 2013 Accepted 11 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Patients with schizophrenia often have a concrete thinking or an impairment in abstract thinking, but there has been a limitation in quantitatively measuring this cognitive function. The aim of the current study was to investigate a deficit in abstract thinking in patients with schizophrenia using the theme identification task.

Methods

Twenty subjects with schizophrenia and 20 healthy volunteers participated in the behavioral study for theme identification. The visual stimuli were composed of a series of pictures, which contained positive or negative emotional situations. Three words, indicating a main theme of the picture, a theme-related item and a theme-unrelated item, respectively, were presented in the bottom of the pictures, and participants had to select a theme.

Results

The patient group selected theme words at significantly lower rate in both emotional conditions than the control group (positive, p=0.002; negative, p=0.001). Especially, in the negative condition, the patient group more selected theme-unrelated items than the control group (p=0.001). The rates of theme identification were inversely correlated with scores of the Social Anhedonia Scale (positive, r=-0.440, p=0.007; negative, r=-0.366, p=0.028).

Conclusion

Patients with schizophrenia exhibited an impairment in abstract thinking, and it was remarkable in the negative condition. The ability to think abstractly was associated with the severity of social anhedonia. The impairment of abstract thinking may become one of the reasons for poor social functioning in socially anhedonic patients.

Keywords: Schizophrenia, Abstract thinking, Emotion, Theme identification, Anhedonia

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Fig. 1.

Examples of the theme identification task (Left) and the emotion recognition task (Right).

Fig. 2.

Selection rate of related versus unrelated words in the wrong trials on the theme identification task. ∗ : p＜0.01. SPR : schizophrenia.

Table 1.

Clinical characteristics of the subjects

Characteristic	Normal (N=20)	Schizophrenia (N=20)	p-value∗
Male/Female	9/11	10/10	0.752
Age (years)	32.6±8.1	31.7±7.50	0.733
Education (years)	15.8±1.6	13.2±2.40	＜0.001
P-AS	12.6±5.9	19.4±9.40	0.019
S-AS	07.6±4.1	15.9±6.80	＜0.001
Duration of illness (years)		6.3 ±5.70
PANSS_positive		18.7±7.40
PANSS_negative		17.8±6.00
PANSS_general		38.5±11.7
PANSS_total		74.9±23.5

^∗ : by chi-square for categorical variable and independent sample t-test for continuous variable. P-AS : Physical Anhedonia Scale, S-AS : Social Anhedonia Scale, PANSS : Positive And Negative Syndrome Scale

Table 2.

Behavioral responses in the theme identification task

	Normal	Schizophrenia	p-value
Response rate (%)	092.2±19.60	88.3±20.30	0.543
Correct Response rate (%)
Positive	077.1±9.200	58.2±22.90	0.001
Negative	078.8±10.30	60.8±20.20	0.002
Overall	078.0±8.200	59.5±19.60	0.001
Response time (msec)
Positive	738.9±232.2	914.7±334.6	0.061
Negative	840.6±380.9	1,076.0±470.7	0.090
Overall	789.8±257.8	995.4±341.0	0.038

^∗ : by independent sample t-test, Values are mean±SD. Response time : Mean response time during the theme identification task

Table 3.

Behavioral responses in the emotion recognition task

	Normal	SPR	p-value	F
Positive picture			0.773	0.258
Mean number of positive response	12.9±1.90	11.5±2.80
Mean number of neutral response	1.7±1.5	2.2±2.4
Mean number of negative response	0.9±0.9	1.2±1.5
Negative picture			0.499	0.702
Mean number of positive response	0.8±1.1	1.2±1.2
Mean number of neutral response	3.8±3.5	2.5±1.8
Mean number of negative response	10.9±3.50	9.8±3.8
Positive_RT (msec)	638.2±224.1	934.4±323.4	0.002
Negative_RT (msec)	673.6±242.1	885.1±336.8	0.031

^∗ : by ANCOVA (covariate : education) for mean number of response and independent sample t-test for response time, Values are mean±SD. SPR : schizophrenia. Positive_RT : Mean response time during the emotion recognition task with positive picture, Negative_RT : Mean response time during the emotion recognition task with negative picture

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