Thought disorder in hospitalized and nonhospitalized chronic schizophrenic and nonpsychiatric patients.

Investigated the separate effects of length of illness and length of hospitalization on vocabulary and concept formation performance of 90 chronic schizophrenic and nonpsychiatric patients. Ss were approximately matched for length of illness but differed in time spent in hospitals (several years or a few months); they were compared on vocabulary associative interference and on concept formation indices from the Object Sorting Test. Schizophrenic in- and outpatients were subdivided into paranoids and nonparanoids and equated on severity of disturbance. Results indicate that both prolonged hospitalization and diagnostic status were associated with thought disorder, especially associative intrusions in vocabulary and idiosyncratic thinking. These indices appeared most efficient in distinguishing between schizophrenic and nonpsychiatric patients and between paranoid and nonparanoid schizophrenics. (French abstract) (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Varieties of "disordered" thinking on the Rorschach: Findings in schizophrenic and nonschizophrenic patients.

Assessed 71 schizophrenic and nonschizophrenic hospitalized patients on 3 scales for aspects indicative of a thinking disorder on the Rorschach: disruption of logical thought, irrelevant or personalized associations, and elaboration in affective terms. Each scale could be reliably scored according to the criteria described. The scales correlated significantly with other Rorschach scores suggestive of thought disorder. All 3 scales were significantly higher in schizophrenic Ss than in depressed Ss (p     

Lexical cohesion and formal thought disorder during and after psychotic episodes.

Compared speech samples obtained from 10 schizophrenics (mean age 28 yrs), 11 manics (mean age 26.2 yrs), 11 schizoaffectives (mean age 25.8 yrs), and 10 normals (mean age 33.6 yrs) for the amount of lexical cohesion both within and between clauses. Two speech samples were obtained for each patient: one shortly after admission to a psychiatric hospital and another several weeks following discharge. All psychiatric patients showed evidence of formal thought disorder at admission, and all 3 groups showed a significant decline in the extent of thought disorder at follow-up. There were no differences between groups with regard to between-clause lexical cohesion at either point in time. Within-clause lexical cohesion did distinguish among the psychiatric groups at the 1st assessment interval; schizophrenics showed less within-clause lexical cohesion than the manics or schizoaffective patients. The manics and the schizoaffectives showed a significant decline in the amount of within-clause lexical cohesion from initial assessment to follow-up. The schizophrenics exhibited a modest decline in the amount of between-clause lexical cohesion. Results indicate that diagnostic differences in lexical cohesion depended on the specificity of the measure and suggest that there are subtle differences between the forms of verbal-communication impairment observed in schizophrenic and affective disorders. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eye tracking in patients with unipolar and bipolar affective disorders in remission.

Examined patients (20–66 yrs old) with a history of recurrent affective disorder on a variety of smooth-pursuit and saccadic eye-tracking tasks and on psychomotor analogs of these tasks. The 25 unipolar and 24 bipolar Ss were compared to 24 schizophrenics; all Ss were in remission. Results indicate that the performance of the 2 affective-disorder groups was not significantly different from that of the controls on any of these tasks. Smooth-pursuit tracking error was greater for Ss receiving Li and for those with a higher frequency of prior episodes of the disorder. When the pursuit eye movements of these Ss were compared to those of the schizophrenics, the latter produced more tracking error than both affective-disorder groups but significantly so only with respect to unipolar Ss. Although findings are consistent with the interpretation that tracking dysfunction is not a trait characteristic of affective disorders, further investigations contrasting remitted patients with bipolar and schizophrenic disorders are needed to determine the specificity of deviant tracking to schizophrenia. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Poststroke bipolar affective disorder: clinical subtypes, concurrent movement disorders, and anatomical correlates

The authors describe 9 patients with bipolar affective disorder associated with cerebrovascular lesions. Eight had negative family histories of affective disorders and late age at onset (after age 40) of manic-depressive symptoms. Only one, with positive family history of affective disorders, developed mood swings before age 40. Clinical subtypes of bipolar disorder and patterns of affective cycling in these stroke patients resembled those previously reported in functional bipolar disorder. Five patients had concurrent hyperkinetic movement disorders, and one depressed patient presented with unilateral left-sided parkinsonism that disappeared during a manic switch. In most patients, bipolar affective disorder was associated with right hemisphere lesions that involved subcortical and midline structures. Findings suggest that damage to frontal-basal ganglia-thalamocortical circuits by subcortical vascular lesions may simultaneously provoke disorders of movement and mood regulation.     

Affective instability, family history of mood disorders, and neurodevelopmental disturbance.

The association between affective instability and both family history of mood disorders and signs of neurodevelopmental disturbance was examined in a sample of 303 adults. Affective instability was measured using the borderline personality disorder “affective instability due to a marked reactivity of mood” diagnostic criterion as assessed dimensionally using the Personality Disorder Interview—IV. Participants were interviewed concerning family history of mood disorders, with family history coded using the Family History Research Diagnostic Criteria. Minor physical anomalies, inconsistent hand use, and dermatoglyphic asymmetries were used to index neurodevelopmental disturbance. Affective instability was associated with elevated rates of family history of mood disorders, particularly among individuals who exhibited inconsistent hand use and greater minor physical anomalies. These associations could not be accounted for by shared variance with age, gender, negative affect, or personal history of mood disorders. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A study of "atypical schizophrenia". Comparison with schizophrenia and affective disorder by sex, age of admission, precipitant, outcome, and family history

Eighty-five cases of atypical schizophrenia were compared with 200 of schizophrenia, 100 of bipolar (mania), and 225 of unipolar (depression) affective disorder. Comparisons were made on the basis of sex, age at admission, precipitating factors, outcome, and a family history of schizophrenia or of affective disorder. The atypical schizophrenia differed remarkably from the schizophrenia and most closely resembled the bipolar affective disorder when allowance was made for a younger age at onset and a higher frequency of precipitants. An analysis of symptoms verified the predominance of schizophrenic features in the atypical schizophrenia, but also showed a high percentage (80%) of patients who had one or more manic symptoms at index admission. It is concluded that great care should be taken in diagnosing schizophrenia in a patient who also has manic symptoms.     

The risk for psychiatric disorders in relatives of schizophrenic and control probands: a comparison of three independent studies

BACKGROUND: Although replication is the heart of science, psychiatric geneticists rarely have the opportunity to replicate findings, especially more than once. METHODS: This article reviews results from three independent family studies of schizophrenia on which one of us conducted diagnostic reviews: the Danish Adoption Study (DAS), the Iowa 500 non-500 family study (IFS), and the Roscommon Family Study (RFS). We utilized DSM-III or DSM-III-R criteria and meta-analysis techniques. RESULTS: The odds ratios (OR) in personally interviewed, first degree biological relatives of schizophrenic and matched control probands for schizophrenia, other non-affective psychoses (ONAP), schizotypal personality disorder (SPD), unipolar affective illness (UPAI), bipolar affective illness (BPAI), and anxiety disorders were homogeneous across studies. For alcoholism, ORs were significantly heterogeneous. Schizophrenia, SPD and ONAP strongly aggregated in relatives of schizophrenic probands with decreasing common OR estimates of 16.2, 5.0 and 4.0, respectively. The common OR for anxiety disorders was 1.1, indicating no familial co-aggregation. For UPAI and BPAI, the common ORs exceeded unity (1.3 and 1.9, respectively), although only the former was statistically significant. CONCLUSIONS: Schizophrenia strongly aggregates in families and shares familial factors with SPD and ONAP but not anxiety disorders. The familial factors of aetiological importance for schizophrenia and affective illness may be weakly related. With the exception of alcoholism, the patterns of psychiatric disorders in relatives of schizophrenic and control probands in these three studies were sufficiently similar that, despite their methodological differences, they can probably be viewed as replications of one another.     

Self-experienced vulnerability, prodromic symptoms and coping strategies before schizophrenic and affective episodes

For the first time, the present study explores self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and affective episodes. 33 schizophrenic and 29 depressive patients were assessed retrospectively for preepisodic alterations by means of the "Bonn Scale for the Assessment of Basic Symptoms- BSABS" after complete recovery from the acute episode. 97% of the schizophrenic and 93% of the depressive patients showed preepisodic alterations. In the schizophrenic group the first alteration occurred with a median of 10 weeks and in the depressive group with a median of 18 weeks before the onset of the acute episode. With regard to self-experienced vulnerability depressive cases were significantly less tolerant to stress, i.e work under time pressure or unusual, unexpected requirements. With regard to prodromal symptoms schizophrenics showed significantly more often interpersonal irritation and certain perception and thought disturbances, whereas depressive patients reported more often adynamia and certain disturbances of proprioception. 73% of the schizophrenic patients and 90% of the depressive patients reacted to early symptoms with coping strategies. The preepisodic alterations in schizophrenic patients could be described in terms of mild psychotic productivity, early symptoms of depressive patients could be described as a mild depressive syndrome. Prospective studies are necessary to show if assessment of mild psychotic productivity could be used for early diagnosis and early intervention in schizophrenia.     

Pharmacotherapy of schizophrenia and affective disorders: Behavioral correlates of diagnostic and demographic variables.

Time sampled observations of objectively defined ward behaviors in 116 schizophrenic, affective, and schizoaffective patients during baseline and medication periods revealed that schizophrenics displayed less scanning, social interaction, participation, and laughing/smiling. S. E. Tureff's (1978) Observational Record of Inpatient Behavior was used. The behavioral measures were relatively insensitive to demographic variables and strongly dependent on environmental context, but the measures did not change greatly over time for the major diagnostic categories, in spite of pharmacological interventions that included therapeutic doses of antipsychotic, antidepressant, and antimanic drugs. However, within diagnostic categories, patient clusters were extracted on the basis of amount and direction of behavior change, and for the affective patients, differential change was predictable from baseline response frequencies. Findings are discussed in terms of their potential usefulness for exploring dose-response and rate-dependence effects of psychotropic drugs in clinical populations and in terms of their potential for contributing to the resolution of the responder–nonresponder controversy in pharmacopsychiatry. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychophysiological reactions to films by chronic schizophrenics: II. Individual differences in resting levels and reactivity.

Resting skin-resistance, heart-rate, and reactivity data to 1 of 2 tension-arousing films were obtained from 2 normal comparison groups and a sample of drug-free chronic schizophrenics. The schizophrenics were subdivided into 3 subsamples on the basis of the number of deviant associations given to a word-association test. The resting skin-resistance data failed to discriminate between normals and schizophrenics; however, meaningful differences were found among the schizophrenic subsamples such that increasing thought disturbance was associated with increasing basal resistance levels. Basal heart-rate data did indicate faster heart rate for all schizophrenic subsamples compared with both normal groups. Reactivity data also indicated different results for the 2 indexes. Skin-resistance indexes failed to indicate any differences between schizophrenics and normals or among the schizophrenic samples. 1 heart-rate index suggested less reactivity for schizophrenics than for normals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cognitive neuroscience view of schizophrenic thought disorder

The experimental association psychology approach to mental associations has been the conceptual background for the concept of schizophrenia. Cognitive neuroscience methods and concepts can be used to study various forms of schizophrenic thought disorder. In particular, the concepts of semantic associative and working memory can be applied fruitfully to schizophrenia research. Semantic associative networks can be simulated with self-organizing feature maps. Dysfunctional lexical access can be modeled in terms of low signal-to-noise ratio in intra- or between-network information processing. Evidence for the crucial role of dopamine in this function is presented, and a general neurocomputational model of schizophrenic thought disorder is developed. This model capitalizes on basic aspects of neural information processing (i.e., neuromodulation and neuroplasticity) and allows a parsimonious explanation of a number of otherwise inexplicable or unrelated clinical phenomena and experimental results.     

Eye tracking dysfunction in schizophrenia: Characterization of component eye movement abnormalities, diagnostic specificity, and the role of attention.

To characterize oculomotor components and diagnostic specificity of eye tracking abnormalities in schizophrenia, we examined a large consecutively admitted series of psychotic patients and matched controls. The most common abnormality in schizophrenic patients was low gain (slow) pursuit eye movements (47% of cases). Pursuit and saccadic eye movement abnormalities were no more severe in schizophrenic Ss than in those with affective psychoses, except that high rates of catch-up saccades were unique to schizophrenic Ss (17% of cases). These findings indicate that impaired pursuit eye movements are a major cause of eye tracking impairments in schizophrenia, that tracking dysfunctions commonly occur in affective psychoses, and that markedly high rates of catch-up saccades during eye tracking may be specific to schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Left-handedness and thought disorder in the schizophrenias.

The relation between language dysfunction and handedness was examined in a sample of 58 male schizophrenic patients. Severity and type of language dysfunction were assessed using ratings on categories of thought disorder derived from the Schedule of Affective Disorders and Schizophrenia (Spitzer & Endicott, 1977). Hand preferred for writing was the criterion for handedness. In this sample, the incidence of left-handedness was raised and left-handedness was associated with the presence and severity of thought disorder. These findings are congruent with the hypothesis that a sizable proportion of left-handed schizophrenic individuals are left-handed because of a disruption in the pattern of hemispheric dominance that also impairs language functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive substrates of thought disorder, I: the semantic system

OBJECTIVE: Few studies have explored in detail the relation of cognitive deficits in attention, working memory, and semantics to thought disorder. The authors sought to determine whether thought disorder resides in the semantic system or elsewhere. METHOD: Twenty-three normal comparison subjects and 23 patients with schizophrenia participated in the study. All subjects received tests of executive function and working memory, including the Wisconsin Card Sorting Test and the Letter-Number Span test; a test of deployment of attentional resources; and tests of semantic processing and language comprehension, including the Peabody Picture Vocabulary Test, the Speed and Capacity of Language-Processing Test, the Boston Naming Test, and tests of semantic verbal fluency and phonologic verbal fluency, from which was derived a difference score. All patients were also administered the Scale for the Assessment of Thought, Language, and Communication to assess thought disorder. RESULTS: The normal subjects were compared with the schizophrenic patients who were rated as having mild thought disorder (N=13) or moderate to severe thought disorder (N=10). While differences between the schizophrenic subgroups and the comparison subjects were observed on nearly all tests, a large difference in effect size between the two schizophrenic subgroups was apparent only in the verbal fluency difference score. In a series of multiple regression analyses, two variables made significant contributions to the prediction of positive thought disorder: the verbal fluency difference score and the Peabody Picture Vocabulary Test score. CONCLUSIONS: These results suggest that clinically rated thought disorder is associated with and may result from semantic processing abnormalities. In particular, patients with more severe thought disorder may have difficulty accessing semantic items because of disorganization of the semantic systems and, to a more limited degree, may also lack a semantic or conceptual knowledge base.     

Thought disorder in adolescent-onset schizophrenia

The nature of the thinking disturbances found in adolescent-onset psychotic conditions is not as well-characterized as the thought disorders found in adult psychotic patients. We used the Thought Disorder Index to examine whether schizophrenic patients in whom psychotic symptoms appear in adolescence show the same characteristic features of thought disorder as do adult schizophrenics. Quantitative and qualitative features of thought disorder were assessed in psychiatric inpatients with adolescent-onset schizophrenia, psychotic depression, and nonpsychotic conditions compared with normal control adolescents. Elevated thought disorder occurred in all groups of adolescents hospitalized for an acute episode of psychiatric illness. The magnitude of the elevation and the frequency of occurrence of disordered thinking were greatest in the psychotic adolescents. The qualitative features of the thought disturbances found in the schizophrenic adolescents were distinct from those observed in adolescents with psychotic depression. The thinking of the schizophrenic adolescents resembled that of adult schizophrenics. In both conditions thought disorder is characterized by idiosyncratic word usage, illogical reasoning, perceptual confusion, loss of realistic attunement to the task, and loosely related ideas.     

Gender, social competence, and symptomatology in schizophrenia: A longitudinal analysis.

The relationship between gender and social skill measured by performance on a role play test was examined in a sample of 57 schizophrenics, 33 affective disorder patients, and 20 nonpatient controls. Female schizophrenics were more skilled than male schizophrenics, but no gender differences were present in the affective patients or the controls. Longitudinal analyses conducted on the schizophrenic group indicated that the superior social skill of women was stable over the year following a symptom exacerbation. Symptoms and social adjustment improved for both men and women over the year, but did not differ according to gender. The implications of the results for gender differences in the long-term outcome of schizophrenia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive Impairments and Disordered Speech in Schizophrenia: Thought Disorder, Disorganization, and Communication Failure Perspectives.

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Systematic search for variation in the human norepinephrine transporter gene: identification of five naturally occurring missense mutations and study of association with major psychiatric disorders

The complete coding region of the norepinephrine transporter (NET) gene was systematically screened for genetic variants in 137 unrelated individuals (including 46 probands with bipolar affective disorder and 45 schizophrenic probands, as well as 46 blood donors) using single-strand conformation analysis. We identified 13 DNA sequence variants, among them five missense substitutions. The missense substitutions Val69Ile, Thr99Ile, Val245Ile, Val449Ile, and Gly478Ser are located at putative transmembrane domains (TMD) 1, 2, 4, 9, and 10, respectively. The Thr99Ile substitution is at the 5th position of the putative leucine-zipper in TMD2. In a case-control study distribution of missense substitutions was found to be similar in 103 patients with bipolar affective disorder, in 228 schizophrenia patients and in 187 controls, indicating that presence of these variants is not causally related to major psychiatric diseases. The detection of a highly polymorphic silent 1287G/A polymorphism was utilized to demonstrate biallelic expression of the NET in adult human brain.