Modelling difficulties in abstract thinking in psychosis: the importance of socio-developmental background

ABSTRACT

Introduction: Abstract thinking is important in modern understanding of neurocognitive abilities, and a symptom of thought disorder in psychosis. In patients with psychosis, we assessed if socio-developmental background influences abstract thinking, and the association with executive functioning and clinical psychosis symptoms.

Methods: Participants (n = 174) had a diagnosis of psychotic or bipolar disorder, were 17–65 years, intelligence quotient (IQ) > 70, fluent in a Scandinavian language, and their full primary education in Norway. Immigrants (N = 58) were matched (1:2) with participants without a history of migration (N = 116). All participants completed a neurocognitive and clinical assessment. Socio-developmental background was operationalised as human developmental index (HDI) of country of birth, at year of birth. Structural equation modelling was used to assess the model with best fit.

Results: The model with best fit, χ² = 96.591, df = 33, p < .001, confirmed a significant indirect effect of HDI scores on abstract thinking through executive functioning, but not through clinical psychosis symptoms.

Conclusions: This study found that socio-developmental background influences abstract thinking in psychosis by indirect effect through executive functioning. We should take into account socio-developmental background in the interpretation of neurocognitive performance in patients with psychosis, and prioritise cognitive remediation in treatment of immigrant patients.

KEYWORDS:

• Psychosis
• schizophrenia
• immigrants
• abstract thinking
• executive functioning

Acknowledgements

The authors would like to thank the participants in the Thematically Organised Psychosis study and the clinicians collaborating in patient recruitment for their contribution. They would like to thank the United Nations Development Programme for providing and allowing the use of HDI data. They would also like to thank Thomas Bjella, Eivind Bakken, Åshild Maria Eftevåg Ragnhild Storli and Jeanette Haatveit for administration and data processing. Finally, they would like to acknowledge the important contribution of the thorough and considerate reviews received upon submission to Cognitive Neuropsychiatry.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

A. O. Berg http://orcid.org/0000-0003-0025-5612

Additional information

Funding

Funding for this study was provided by the KG Jebsen Stiftelsen [grant #SKGJ-Med-008], the Norwegian Research Council [grants #223273 and #213974/H10], and the Regional Health Authority for South-Eastern Norway [grant #2010007]. Neither had any role in study design, data collection, analysis and interpretation, writing of the report or the decision to submit the paper for publication.