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Zurich Studies of Depressive and Schizophrenic Patients

Onset of Improvement in Depressive Patients

In a series of studies of psychiatric patients ascertained shortly after hospital admission, we investigated the time course of recovery from depression by quantifying changes in psychopathology syndrome scores over time and by parallel assessment of speaking behavior and voice sound characteristics. Our analyses yielded no indication of a delayed onset of action of antidepressants. The onset of improvement occurred in the great majority of patients (79.1%) within the first 12 days of treatment. Early improvement was highly predictive of later outcome, since 67.6% of the patients showing improvement within the first 12 days were responders at the end of the observation period. Inversely, 92% of the responders at the end of the observation period exhibited an onset of improvement within the first 12 days. Early improvement could not be attributed to a few HAMD items, because score reductions were observed for virtually all items at early stages of treatment.
The analysis of the patients’ speaking behavior and voice sound characteristics yielded, in 62.8% of the cases, an essentially parallel development over time for the HAMD scores on the one hand, and acoustic variables on the other. The time course of improvement thus appeared to have a strong biological component and was unlikely to be attributable to the expectations of doctors and patients.

Speech Characteristics in Acute Schizophrenic Patients

Based on a sample of 45 hospitalized, acute-schizophrenic patients and 45 carefully matched controls, we investigated the nonverbal characteristics of schizophrenic speech by means of an "acoustic" speech analysis and determined the extent to which speaking behavior and speech sound characteristics had adjusted toward normal values at the time of hospital release. Using a multivariate discriminant function, totally 77 (85.6%) individuals of our patient and control sample could be correctly classified by a set of 12 acoustic variables at entry into study. At hospital release the majority of patients (64.4%) still exhibited speech impairment although acute psychopathology had significantly improved.

Speech Characteristics in Chronic Schizophrenic Patients

Based on a sample of 42 chronic schizophrenic patients and 42 carefully matched controls, we investigated potential relationships between acoustic variables on the one hand, and negative syndromes, positive syndromes and affective disturbances, on the other. A set of 12 acoustic variables allowed an almost perfect discrimination between schizophrenic patients and normal subjects. Acute side-effects of medication did not explain this finding. However, the question of whether the observed changes in speaking behavior and voice sound characteristics were caused by longterm neuroleptic treatment, for example, as a consequence of tardive dyskinesia, could not be answered by our investigation.
In view of a biological validation of the negative-positive model of schizophrenia, discriminant analysis yielded conclusive proof of a close relationship between acoustic variables and the severity of the negative and positive component of schizophrenia. In particular, by means of "objective" acoustic variables and under the constraint of reproducibility, 75.9% of patients were correctly classified as low or high scorers with respect to the negative syndrome, 71.9% of patients with respect to the positive syndrome, and 79.4% of patients with respect to their depressive symptomatology.

References

Braun S, Annovazzi C, Botella C, Bridler B, Camussi E, Delfino JP, Mohr C, Moragrega I, Papagno C, Pisoni A, Soler C, Seifritz E, Stassen HH: Assessing Chronic Stress, Coping Skills and Mood Disorders through Speech Analysis. A Self-Assessment "Voice App" for Laptops, Tablets, and Smartphones. Psychopathology 2016; 49(6): 406-419 [get the article]
Delfino JP, Barragán E, Botella C, Braun S, Bridler R, Camussi E, Chafrat V, Lott P, Mohr C, Moragrega I, Papagno C, Sanchez S, Seifritz E, Soler C, Stassen HH: Quantifying Insufficient Coping Behavior under Chronic Stress. A cross-cultural study of 1,303 students from Italy, Spain, and Argentina. Psychopathology 2015; 48: 230-239
Braun S, Botella C, Bridler R, Chmetz F, Delfino JP, Herzig D, Kluckner VJ, Mohr C, Moragrega I, Schrag Y, Seifritz E, Soler C, Stassen HH: Affective State and Voice: Cross-Cultural Assessment of Speaking Behavior and Voice Sound Characteristics. A Normative Multi-Center Study of 577+36 Healthy Subjects. Psychopathology 2014; 47(5): 327-340
Mohr C, Braun S, Bridler R, Chmetz F, Delfino JP, Kluckner VJ, Lott P, Schrag Y, Seifritz E, Stassen HH: Insufficient Coping Behavior under Chronic Stress and Vulnerability to Psychiatric Disorders. Psychopathology 2014; 47: 235-243
Stassen HH, Delfino JP, Kluckner VJ, Lott P, Mohr C: Vulnerabilität und psychische Erkrankung. Swiss Archives of Neurology and Psychiatry 2014; 165(5): 152-157
Stassen HH (2004) Veränderungen der Sprechmotorik. In: T.Jahn (ed) Bewegungsstörungen bei psychischen Erkrankungen. Springer Heidelberg: 107-125
Stassen HH, Angst J (2002) Wirkung und Wirkungseintritt in der Antidepressiva-Behandlung. In: Böker H and Hell D (eds) Therapie der affektiven Störungen. Stuttgart und New York: Schattauer 141-165
Lott PR, Guggenbühl S, Schneeberger A, Pulver AE, Stassen HH (2002) Linguistic analysis of the speech output of schizophrenic, bipolar, and depressive patients. Psychopathology 35(4): 220-227
Püschel J., Stassen HH, Bomben G, Scharfetter C and Hell D (1998) Speaking behavior and voice sound characteristics in acute schizophrenia. J. Psychiatric Research 32, 89-97
Stassen HH, Kuny S, Hell D (1998) The speech analysis approach to determining onset of improvement under antidepressants. Eur. Neuropsychopharmacology 8(4), 303-310
Kuny S, Stassen HH, Hell D (1997) Kognitive Beeinträchtigungen in der Depression. Schweiz Arch Neurol Psychiatrie 150,3: 18-25
Stassen HH (1995) Affekt und Sprache. Stimm- und Sprachanalysen bei Gesunden, depressiven und schizophrenen Patienten. Monographien aus dem Gesamtgebiete der Psychiatrie, Bd. 79. Berlin, Heidelberg: Springer
Stassen HH, Albers M, Püschel J, Scharfetter C, Tewesmeier M, Woggon B (1995) Speaking behavior and voice sound characteristics associated with negative schizophrenia. J Psychiat Res. 29, 277-296
Kuny S, Stassen HH (1993) Speaking behavior and voice sound characteristics in depressive patients during recovery. J Psychiat Res. 27, 289-307
scatter plot
Fig. 3b: Differences in mean energy per second as a function of experimental conditions: (1) counting/freehand speech [text1], (2) reading out loud emotionally neutral text [text2], and reading out loud emotionally stimulating text [text3]. When counting or producing freehand speech, subjects tend to speak in a somewhat louder voice compared to reading out loud. The differences between the experimental conditions are smaller in healthy volunteers than the differences between "affected" and "recovered" in depressive or psychotic patients.
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