Neurocognitive vulnerability, interpersonal criticism, and the emergence of unusual thinking by schizophrenic patients during family transactions

Background: This study examined whether the combination of patients' neuroc ognitive deficits and criticism by others would predict the emergence of pa tients' unusual thinking during stressful family transactions. Methods: When clinically stable, 41 patients with recent-onset schizophreni a completed 2 versions of a visual vigilance task, the Continuous Performan ce Test (CPT). One CPT emphasized early perceptual processing, while the ot her stressed immediate, working memory. On a separate occasion, patients an d family members participated in a 20-minute interaction in which the numbe r of relatives' criticisms and patients' unusual thoughts was assessed. Results: In a hierarchical regression model, after entering performance on the CPT demanding immediate, working memory, and the number of criticisms b y family members, the interaction of CPT performance and criticism signific antly predicted the number of patients' unusual thoughts during the family session (r(2) change=0.09; P=.03). Post hoc analyses revealed chat the numb er of criticisms and odd thoughts correlated significantly (r=0.59, P=.03) for patients who had poor memory-load CPT performance, but were unrelated ( r=-0.07) for patients who did well on the memory-load CPT. The CPT emphasiz ing early visual processing, either alone or in combination with interperso nal criticism, did not predict the number of patients' unusual thoughts dur ing the interaction. Conclusion: The results suggest that the combination of patients' working m emory deficits and interpersonal criticism jointly predicts psychotic think ing, consistent with a model of schizophrenia that emphasizes the interacti on of neurocognitive vulnerability and psychosocial stress factors.