title: Schizophrenia, culture and neuropsychology: sensory deficits, language impairments and social functioning in Chinese-speaking schizophrenia patients.
abstract: BACKGROUND
  While 20% of schizophrenia patients worldwide speak tonal languages (e.g. Mandarin), studies are limited to Western-language patients. Western-language patients show tonal deficits that are related to impaired emotional processing of speech. However, language processing is minimally affected. In contrast, in Mandarin, syllables are voiced in one of four tones, with word meaning varying accordingly. We hypothesized that Mandarin-speaking schizophrenia patients would show impairments in underlying basic auditory processing that, unlike in Western groups, would relate to deficits in word recognition and social outcomes.
  
  
  METHODS
  Altogether, 22 Mandarin-speaking schizophrenia patients and 44 matched healthy participants were recruited from New York City. The auditory tasks were: (1) tone matching; (2) distorted tunes; (3) Chinese word discrimination; (4) Chinese word identification. Social outcomes were measured by marital status, employment and most recent employment status.
  
  
  RESULTS
  Patients showed deficits in tone-matching, distorted tunes, word discrimination and word identification versus controls (all p<0.0001). Impairments in tone-matching across groups correlated with both word identification (p<0.0001) and discrimination (p<0.0001). On social outcomes, tonally impaired patients had 'lower-status' jobs overall when compared with tonally intact patients (p<0.005) and controls (p<0.0001).
  
  
  CONCLUSIONS
  Our study is the first to investigate an interaction between neuropsychology and language among Mandarin-speaking schizophrenia patients. As predicted, patients were highly impaired in both tone and auditory word processing, with these two measures significantly correlated. Tonally impaired patients showed significantly worse employment-status function than tonally intact patients, suggesting a link between sensory impairment and employment status outcome. While neuropsychological deficits appear similar cross-culturally, their consequences may be language- and culture-dependent.
authors.affiliation: Columbia University Mailman School of Public Health, New York, NY, USA. lhy2001@columbia.edu
authors.forename: L
authors.initials: L
authors.lastname: Yang
authors.forename: S
authors.initials: S
authors.lastname: Chen
authors.forename: C-M
authors.initials: CM
authors.lastname: Chen
authors.forename: F
authors.initials: F
authors.lastname: Khan
authors.forename: G
authors.initials: G
authors.lastname: Forchelli
authors.forename: D C
authors.initials: DC
authors.lastname: Javitt
mesh_terms: D000293:Adolescent; D000328:Adult; D001213:Asian / Q000523:psychology*; D044466:Asian People; D016022:Case-Control Studies; D003469:Culture; D004641:Emigration and Immigration; D004644:Emotions; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007806:Language Disorders / Q000208:ethnology / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D009519:New York City; D010898:Pitch Perception / Q000502:physiology*; D021641:Recognition, Psychology / Q000502:physiology; D012559:Schizophrenia / Q000150:complications / Q000208:ethnology / Q000503:physiopathology*; D012565:Schizophrenic Psychology; D012917:Social Adjustment; D013067:Speech Perception / Q000502:physiology*; D055815:Young Adult