title: The communicative impairment as a core feature of schizophrenia: Frequency of pragmatic deficit, cognitive substrates, and relation with quality of life.
abstract: Impairments in specific aspects of pragmatic competence, supporting the use of language in context, are largely documented in schizophrenia and might represent an indicator of poor outcome. Yet pragmatics is rarely included in clinical settings. This paper aims to promote a clinical consideration of pragmatics as a target of assessment and intervention. We investigated the frequency of the pragmatic deficit, its cognitive substrates, and the relation with quality of life.
  
  
  
  Pragmatic abilities were compared in a sample of patients with schizophrenia and healthy controls based on a comprehensive pragmatic test (APACS). We assessed also for psychopathology, cognition, social cognition, and quality of life. We explored the co-occurrence of deficits in different domains, and we used multiple regressions to investigate the effect of cognition and social cognition on pragmatics, and of pragmatics on quality of life.
  
  
  
  Pragmatic abilities, especially comprehending discourse and non-literal meanings, were compromised in schizophrenia, with 77% of patients falling below cutoff. Pragmatic deficit co-occurred with cognitive or socio-cognitive deficits in approximately 30% of cases. Multiple regression analysis confirmed the interplay of cognition and social cognition in pragmatic behavior. Quality of life was predicted by symptoms and by pragmatic abilities.
  
  
  
  The high frequency of impairment suggests that the pragmatic deficit is a core feature of schizophrenia, associated with quality of life. Cognitive and socio-cognitive abilities might represent necessary though not sufficient building blocks for the acquisition of pragmatic abilities throughout development. Therefore, a more precise incorporation of pragmatics in the description of the pathology is of high clinical and translational relevance.
authors.affiliation: Center for Neurocognition, Epistemology and theoretical Syntax, Scuola Universitaria Superiore IUSS Pavia, Piazza della Vittoria 15, 27100, Pavia, Italy. Electronic address: valentina.bambini@iusspavia.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Bambini
authors.affiliation: IRCCS Fondazione Ospedale San Camillo, Via Alberoni 70, Lido di Venezia (Venezia), Italy. Electronic address: giorgio.arcara@gmail.com.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Arcara
authors.affiliation: Department of Clinical Neurosciences, IRCSS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milano, Italy. Electronic address: bechi.margherita@hsr.it.
authors.forename: Margherita
authors.initials: M
authors.lastname: Bechi
authors.affiliation: Department of Clinical Neurosciences, IRCSS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milano, Italy. Electronic address: buonocore.mariachiara@hsr.it.
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Buonocore
authors.affiliation: Department of Clinical Neurosciences, IRCSS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milano, Italy. Electronic address: cavallaro.roberto@hsr.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cavallaro
authors.affiliation: Department of Clinical Neurosciences, IRCSS San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milano, Italy; Vita Salute San Raffaele University, Via Olgettina, 58, 20132, Milano, Italy. Electronic address: bosia.marta@hsr.it.
authors.forename: Marta
authors.initials: M
authors.lastname: Bosia
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003071:Cognition; D003147:Communication Disorders / Q000150:complications / Q000523:psychology*; D032882:Comprehension; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D012559:Schizophrenia / Q000150:complications; D012565:Schizophrenic Psychology; D012919:Social Behavior