Thought disorder

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Thought disorder
Other namesFormal thought disorder (FTD), thinking disorder
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Cloth embroidered by a person diagnosed with schizophrenia; non-linear text has multiple colors of thread.
Specialty Psychiatry, clinical psychology

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication. [1] [2] Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, paralogia (a reasoning disorder characterized by expression of illogical or delusional thoughts), word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD: [3] a disruption of the form (or structure) of thought. [4] Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses [5] [6] (including mood disorders, dementia, mania, and neurological diseases). [7] [5] [8] Disorganized speech leads to an inference of disorganized thought. [9] Thought disorders include derailment, [10] pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. [8] One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy." [11]

Contents

Formal thought disorder affects the form (rather than the content) of thought. [12] Unlike hallucinations and delusions, it is an observable, objective sign of psychosis. [12] FTD is a common core symptom of a psychotic disorder, and may be seen as a marker of severity and as an indicator of prognosis. [8] [13] It reflects a cluster of cognitive, linguistic, and affective disturbances that have generated research interest in the fields of cognitive neuroscience, neurolinguistics, and psychiatry. [8]

Eugen Bleuler, who named schizophrenia, said that TD was its defining characteristic. [14] Disturbances of thinking and speech, such as clanging or echolalia, may also be present in Tourette syndrome; [15] other symptoms may be found in delirium. [16] A clinical difference exists between these two groups. Patients with psychoses are less likely to show awareness or concern about disordered thinking, and those with other disorders are aware and concerned about not being able to think clearly. [17]

Content thought disorder

Thought content is the subject of an individual's thoughts, or the types of ideas expressed by the individual. [18] Mental health professionals define normal thought content as the absence of significant abnormalities, distortions, or harmful thoughts. [19] Normal thought content aligns with reality, is appropriate to the situation, and does not cause significant distress or impair functioning. [19]

A person's cultural background must be considered when assessing thought content. Abnormalities in thought content differ across cultures. [20] Specific types of abnormal thought content can be features of different psychiatric illnesses. [21]

Examples of disordered thought content include:

Formal thought disorder

Thought process is a person's form, flow, and coherence of thinking. [23] This is how they use language and put ideas together. A normal thought process is logical, linear, meaningful, and goal-directed. [18] A logical, linear thought process is one that demonstrates rational connections between thoughts in a way that is sequential that allows others to understand. [18] [23] Thought process is not what a person thinks, rather it is how a person expresses their thoughts. [25]

Formal thought disorder (FTD), also known as disorganized speech or disorganized thinking, is a disorder of a person's thought process in which they are unable to express their thoughts in a logical and linear fashion. [26] To be considered FTD, disorganized thinking must be severe enough that it impairs effective communication. [27] Disorganized speech is a core symptom of psychosis, and therefore can be a feature of any condition that has a potential to cause psychosis, including schizophrenia, mania, major depressive disorder, delirium, postpartum psychosis, major neurocognitive disorder, and substance induced psychosis. [18] FTD reflects a cluster of cognitive, linguistic, and affective disturbances, and has generated research interest from the fields of cognitive neuroscience, neurolinguistics, and psychiatry. [8]

It can be subdivided into clusters of positive and negative symptoms and objective (rather than subjective) symptoms. [13] On the scale of positive and negative symptoms, they have been grouped into positive formal thought disorder (posFTD) and negative formal thought disorder (negFTD). [13] [12] Positive subtypes were pressure of speech, tangentiality, derailment, incoherence, and illogicality; [13] negative subtypes were poverty of speech and poverty of content. [12] [13] The two groups were posited to be at either end of a spectrum of normal speech, but later studies showed them to be poorly correlated. [12] A comprehensive measure of FTD is the Thought and Language Disorder (TALD) Scale. [28] The Kiddie Formal Thought Disorder Rating Scale (K-FTDS) can be used to assess the presence of formal thought disorder in children and their childhood. [29] Although it is very extensive and time-consuming, its results are in great detail and reliable. [30]

Nancy Andreasen preferred to identify TDs as thought-language-communication disorders (TLC disorders). [31] [32] Up to seven domains of FTD have been described on the Thought, Language, Communication (TLC) Scale, with most of the variance accounted for by two or three domains. [12] Some TLC disorders are more suggestive of severe disorder, and are listed with the first 11 items. [32]

Diagnoses

The DSM-V categorizes FTD as "a psychotic symptom, manifested as bizarre speech and communication." FTD may include incoherence, peculiar words, disconnected ideas, or a lack of unprompted content expected from normal speech. [33] Clinical psychologists typically assess FTD by initiating an exploratory conversation with patients and observing the patient's verbal responses. [34]

FTD is often used to establish a diagnosis of schizophrenia; in cross-sectional studies, 27 to 80 percent of patients with schizophrenia present with FTD. A hallmark feature of schizophrenia, it is also widespread amongst other psychiatric disorders; up to 60 percent of those with schizoaffective disorder and 53 percent of those with clinical depression demonstrate FTD, suggesting that it is not exclusive to schizophrenia. About six percent of healthy subjects exhibit a mild form of FTD. [35] The DSM-V-TR mentions that less severe FTD may happen during the initial (prodromal) and residual periods of schizophrenia. [27]

The characteristics of FTD vary amongst disorders. A number of studies indicate that FTD in mania is marked by irrelevant intrusions and pronounced combinatory thinking, usually with a playfulness and flippancy absent from patients with schizophrenia. [36] [37] [38] The FTD present in patients with schizophrenia was characterized by disorganization, neologism, and fluid thinking, and confusion with word-finding difficulty. [38]

There is limited data on the longitudinal course of FTD. [39] The most comprehensive longitudinal study of FTD by 2023 found a distinction in the longitudinal course of thought-disorder symptoms between schizophrenia and other psychotic disorders. The study also found an association between pre-index assessments[ clarification needed ] of social, work and educational functioning and the longitudinal course of FTD. [40]

Possible causes

Several theories have been developed to explain the causes of formal thought disorder. It has been proposed that FTD relates to neurocognition via semantic memory. [41] Semantic network impairment in people with schizophrenia—measured by the difference between fluency (e.g. the number of animals' names produced in 60 seconds) and phonological fluency (e.g. the number of words beginning with "F" produced in 60 seconds)—predicts the severity of formal thought disorder, suggesting that verbal information (through semantic priming) is unavailable. [41] Other hypotheses include working memory deficit (being confused about what has already been said in a conversation) and attentional focus. [41]

FTD in schizophrenia has been found to be associated with structural and functional abnormalities in the language network, where structural studies have found bilateral grey matter deficits; deficits in the bilateral inferior frontal gyrus, bilateral inferior parietal lobule and bilateral superior temporal gyrus are FTD correlates. [35] Other studies did not find an association between FTD and structural aberrations of the language network, however, and regions not included in the language network have been associated with FTD. [35] Future research is needed to clarify whether there is an association with FTD in schizophrenia and neural abnormalities in the language network. [35]

Transmitter systems which might cause FTD have also been investigated. Studies have found that glutamate dysfunction, due to a rarefaction of glutamatergic synapses in the superior temporal gyrus in patients with schizophrenia, is a major cause of positive FTD. [35]

The heritability of FTD has been demonstrated in a number of family and twin studies. Imaging genetics studies, using a semantic verbal-fluency task performed by the participants during functional MRI scanning, revealed that alleles linked to glutamatergic transmission contribute to functional aberrations in typical language-related brain areas. [35] FTD is not solely genetically determined, however; environmental influences, such as allusive thinking in parents during childhood, and environmental risk factors for schizophrenia (including childhood abuse, migration, social isolation, and cannabis use) also contribute to the pathophysiology of FTD. [42]

The origins of FTD have been theorised from a social-learning perspective. Singer and Wynne said that familial communication patterns play a key role in shaping the development of FTD; dysfunctional social interactions undermine a child's development of cohesive, stable mental representations of the world, increasing their risk of developing FTD. [43]

Treatments

Antipsychotic medication is often used to treat FTD. Although the vast majority of studies of the efficacy of antipsychotic treatment do not report effects on syndromes or symptoms, six older studies report the effects of antipsychotic treatment on FTD. [44] [45] [46] [47] [48] [49] These studies and clinical experience indicate that antipsychotics are often an effective treatment for patients with positive or negative FTD, but not all patients respond to them.

Cognitive behavioural therapy (CBT) is another treatment for FTD, but its effectiveness has not been well-studied. [35] Large randomised controlled trials evaluating the effectiveness of CBT for treating psychosis often exclude individuals with severe FTD because it reduces the therapeutic alliance required by the therapy. [50] However, provisional evidence suggests that FTD may not preclude the effectiveness of CBT. [50] Kircher and colleagues have suggested that the following methods should be used in CBT for patients with FTD: [35]

Signs and symptoms

Language abnormalities exist in the general population, and do not necessarily indicate a condition. [51] They can occur in schizophrenia and other disorders (such as mania or depression), or in anyone who may be tired or stressed. [1] [52] To distinguish thought disorder, patterns of speech, severity of symptoms, their frequency, and any resulting functional impairment can be considered. [32]

Symptoms of FTD include derailment, [10] pressured speech, poverty of speech, tangentiality, and thought blocking. [8] The most common forms of FTD observed are tangentiality and circumstantiality. [53] FTD is a hallmark feature of schizophrenia, but is also associated with other conditions that can cause psychosis (including mood disorders, dementia, mania, and neurological diseases). [4] [7] [52] Impaired attention, poor memory, and difficulty formulating abstract concepts may also reflect TD, and can be observed and assessed with mental-status tests such as serial sevens or memory tests. [54]

Types

Thirty symptoms (or features) of TD have been described, including: [55] [12]

Terminology

Psychiatric and psychological glossaries in 2015 and 2017 defined thought disorder' as disturbed thinking or cognition which affects communication, language, or thought content including poverty of ideas, neologisms, paralogia, word salad, and delusions [7] [87] (disturbances of thought content and form), and suggested the more-specific terms content thought disorder (CTD) and formal thought disorder (FTD). [2] CTD was defined as a TD characterized by multiple fragmented delusions, [88] [87] and FTD was defined as a disturbance in the form or structure of thinking. [89] [90] The 2013 DSM-5 only used the term FTD, primarily as a synonym for disorganized thinking and speech. [91] This contrasts with the 1992 ICD-10 (which only used the word "thought disorder", always accompanied with "delusion" and "hallucination") [92] and a 2002 medical dictionary which generally defined thought disorders similarly to the psychiatric glossaries [93] and used the word in other entries as the ICD-10 did. [94]

A 2017 psychiatric text describing thought disorder as a "disorganization syndrome" in the context of schizophrenia:

"Thought disorder" here refers to disorganization of the form of thought and not content. An older use of the term "thought disorder" included the phenomena of delusions and sometimes hallucinations, but this is confusing and ignores the clear differences in the relationships between symptoms that have become apparent over the past 30 years. Delusions and hallucinations should be identified as psychotic symptoms, and thought disorder should be taken to mean formal thought disorders or a disorder of verbal cognition.

— Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA [82]

The text said that some clinicians use the term "formal thought disorder" broadly, referring to abnormalities in thought form with psychotic cognitive signs or symptoms, [95] and studies of cognition and subsyndromes in schizophrenia may refer to FTD as conceptual disorganization or disorganization factor. [82]

Some disagree:

Unfortunately, "thought disorder" is often involved rather loosely to refer to both FTD and delusional content. For the sake of clarity, the unqualified use of the phrase "thought disorder" should be discarded from psychiatric communication. Even the designation "formal thought disorder" covers too wide a territory. It should always be made clear whether one is referring to derailment or loose associations, flight of ideas, or circumstantiality.

— The Mental Status Examination, The Medical Basis of Psychiatry (2016) [96]

Course, diagnosis, and prognosis

It was believed that TD occurred only in schizophrenia, but later findings indicate that it may occur in other psychiatric conditions (including mania) and in people without mental illness. [97] Not all people with schizophrenia have a TD; the condition is not specific to the disease. [98]

When defining thought-disorder subtypes and classifying them as positive or negative symptoms, Nancy Andreasen found [98] that different subtypes of TD occur at different frequencies in those with mania, depression, and schizophrenia. People with mania have pressured speech as the most prominent symptom, and have rates of derailment, tangentiality, and incoherence as prominent as in those with schizophrenia. They are likelier to have pressured speech, distractibility, and circumstantiality. [98] [99]

People with schizophrenia have more negative TD, including poverty of speech and poverty of content of speech, but also have relatively high rates of some positive TD. [98] Derailment, loss of goal, poverty of content of speech, tangentiality and illogicality are particularly characteristic of schizophrenia. [100] People with depression have relatively-fewer TDs; the most prominent are poverty of speech, poverty of content of speech, and circumstantiality. Andreasen noted the diagnostic usefulness of dividing the symptoms into subtypes; negative TDs without full affective symptoms suggest schizophrenia. [98] [99]

She also cited the prognostic value of negative-positive-symptom divisions. In manic patients, most TDs resolve six months after evaluation; this suggests that TDs in mania, although as severe as in schizophrenia, tend to improve. [98] In people with schizophrenia, however, negative TDs remain after six months and sometimes worsen; positive TDs somewhat improve. A negative TD is a good predictor of some outcomes; patients with prominent negative TDs are worse in social functioning six months later. [98] More prominent negative symptoms generally suggest a worse outcome; however, some people may do well, respond to medication, and have normal brain function. Positive symptoms vary similarly. [101]

A prominent TD at illness onset suggests a worse prognosis, including: [82]

TD which is unresponsive to treatment predicts a worse illness course. [82] In schizophrenia, TD severity tends to be more stable than hallucinations and delusions. Prominent TDs are more unlikely to diminish in middle age, compared with positive symptoms. [82] Less-severe TD may occur during the prodromal and residual periods of schizophrenia. [102] Treatment for thought disorder may include psychotherapy, such as cognitive behavior therapy (CBT), and psychotropic medications. [103]

The DSM-5 includes delusions, hallucinations, disorganized thought process (formal thought disorder), and disorganized or abnormal motor behavior (including catatonia) as key symptoms of psychosis. [6] Schizophrenia-spectrum disorders such as schizoaffective disorder and schizophreniform disorder typically consist of prominent hallucinations, delusions and FTD; the latter presents as severely disorganized, bizarre, and catatonic behavior. [4] [6] Psychotic disorders due to medical conditions and substance use typically consist of delusions and hallucinations. [6] [104] The rarer delusional disorder and shared psychotic disorder typically present with persistent delusions. [104] FTDs are commonly found in schizophrenia and mood disorders, with poverty of speech content more common in schizophrenia. [105]

Psychoses such as schizophrenia and bipolar mania are distinguishable from malingering, when an individual fakes illness for other gains, by clinical presentations; malingerers feign thought content with no irregularities in form such as derailment or looseness of association. [106] Negative symptoms, including alogia, may be absent, and chronic thought disorder is typically distressing. [106]

Autism spectrum disorders (ASD) whose diagnosis requires the onset of symptoms before three years of age can be distinguished from early-onset schizophrenia; schizophrenia under age 10 is extremely rare, and ASD patients do not display FTDs. [107] However, it has been suggested that individuals with ASD display language disturbances like those found in schizophrenia; a 2008 study found that children and adolescents with ASD showed significantly more illogical thinking and loose associations than control subjects. [108] The illogical thinking was related to cognitive functioning and executive control; the loose associations were related to communication symptoms and parent reports of stress and anxiety. [108]

Rorschach tests have been useful for assessing TD in disturbed patients. [109] [1] A series of inkblots are shown, and patient responses are analyzed to determine disturbances of thought. [1] The nature of the assessment offers insight into the cognitive processes of another, and how they respond to equivocal stimuli. [110] Hermann Rorschach developed this test to diagnose schizophrenia after realizing that people with schizophrenia gave drastically different interpretations of Klecksographie inkblots from others whose thought processes were considered normal, [111] and it has become one of the most widely used assessment tools for diagnosing TDs. [1]

The Thought Disorder Index (TDI), also known as the Delta Index, was developed to help further determine the severity of TD in verbal responses. [1] TDI scores are primarily derived from verbally-expressed interpretations of the Rorschach test, but TDI can also be used with other verbal samples (including the Wechsler Adult Intelligence Scale). [1] TDI has a twenty-three-category scoring index; each category scores the level of severity on a scale from 0 to 1, with .25 being mild and 1.00 being most severe (0.25, 0.50, 0.75, 1.00). [1]

Criticism

TD has been criticized as being based on circular or incoherent definitions. [112] [ need quotation to verify ] Symptoms of TD are inferred from disordered speech, based on the assumption that disordered speech arises from disordered thought. Although TD is typically associated with psychosis, similar phenomena can appear in different disorders and leading to misdiagnosis. [113]

A criticism related to the separation of symptoms of schizophrenia into negative or positive symptoms, including TD, is that it oversimplifies the complexity of TD and its relationship to other positive symptoms. [114] Factor analysis has found that negative symptoms tend to correlate with one another, but positive symptoms tend to separate into two groups. [114] The three clusters became known as negative symptoms, psychotic symptoms, and disorganization symptoms. [101] Alogia, a TD traditionally classified as a negative symptom, can be separated into two types: poverty of speech content (a disorganization symptom) and poverty of speech, response latency, and thought blocking (negative symptoms). [115] Positive-negative-symptom diametrics, however, may enable a more accurate characterization of schizophrenia. [116]

See also

Related Research Articles

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

Schizophrenia is a mental disorder characterized variously by hallucinations, delusions, disorganized thinking and behavior, and flat or inappropriate affect. Symptoms develop gradually and typically begin during young adulthood and are never resolved. There is no objective diagnostic test; diagnosis is based on observed behavior, a psychiatric history that includes the person's reported experiences, and reports of others familiar with the person. For a diagnosis of schizophrenia, the described symptoms need to have been present for at least six months or one month. Many people with schizophrenia have other mental disorders, especially mood, anxiety, and substance use disorders, as well as obsessive–compulsive disorder (OCD).

Clanging is a symptom of mental disorders, primarily found in patients with schizophrenia and bipolar disorder. This symptom is also referred to as association chaining, and sometimes, glossomania.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

Schizoaffective disorder is a mental disorder characterized by symptoms of both schizophrenia (psychosis) and a mood disorder - either bipolar disorder or depression. The main diagnostic criterion is the presence of psychotic symptoms for at least two weeks without prominent mood symptoms. Common symptoms include hallucinations, delusions, disorganized speech and thinking, as well as mood episodes. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses. Many people with schizoaffective disorder have other mental disorders including anxiety disorders.

In psychology, alogia is poor thinking inferred from speech and language usage. There may be a general lack of additional, unprompted content seen in normal speech, so replies to questions may be brief and concrete, with less spontaneous speech. This is termed poverty of speech or laconic speech. The amount of speech may be normal but conveys little information because it is vague, empty, stereotyped, overconcrete, overabstract, or repetitive. This is termed poverty of content or poverty of content of speech. Under Scale for the Assessment of Negative Symptoms used in clinical research, thought blocking is considered a part of alogia, and so is increased latency in response.

Stimulant psychosis is a mental disorder characterized by psychotic symptoms. It involves and typically occurs following an overdose or several day binge on psychostimulants, although it can occur in the course of stimulant therapy, particularly at higher doses. One study reported occurrences at regularly prescribed doses in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain, depend upon genetics and may persist for months or years. Psychosis may also result from withdrawal from stimulants, particularly when psychotic symptoms were present during use.

In psychology, schizotypy is a theoretical concept that posits a continuum of personality characteristics and experiences, ranging from normal dissociative, imaginative states to extreme states of mind related to psychosis, especially schizophrenia. The continuum of personality proposed in schizotypy is in contrast to a categorical view of psychosis, wherein psychosis is considered a particular state of mind, which the person either has or does not have.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe; some are deprecated, and thus are of historic interest.

Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.

Oneiroid syndrome (OS) is a psychiatric condition marked by dream-like disturbances of consciousness. It is characterised by vivid scenic hallucinations, catatonic symptoms (ranging from stupor to agitation), delusions, and kaleidoscopic psychopathological experiences. The term originates from the Ancient Greek words "ὄνειρος" (óneiros, meaning "dream") and "εἶδος" (eîdos, meaning "form" or "likeness"), translating to "dream-like" or "oneiric" (occasionally described as "nightmare-like").

<span class="mw-page-title-main">Delusions of grandeur</span> Subtype of delusion

Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions, are a subtype of delusion characterized by the extraordinary belief that one is famous, omnipotent, wealthy, or otherwise very powerful or of a high status. Grandiose delusions often have a religious, science fictional, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses fantastical talents, accomplishments, or superpowers.

Brief psychotic disorder—according to the classifications of mental disorders DSM-IV-TR and DSM-5—is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis." This condition may or may not be recurrent, and it should not be caused by another condition.

<span class="mw-page-title-main">Persecutory delusion</span> Delusion involving perception of persecution

A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes. Religious experiences often involve reports of auditory and/or visual phenomena, which sounds seemingly similar to those with schizophrenia who also commonly report hallucinations and delusions. These symptoms may resemble the events found within a religious experience. However, the people who report these religious visual and audio hallucinations also claim to have not perceived them with their five senses, rather, they conclude these hallucinations were an entirely internal process.

Hyperreligiosity is a psychiatric disturbance in which a person experiences intense religious beliefs or episodes that interfere with normal functioning. Hyperreligiosity generally includes abnormal beliefs and a focus on religious content or even atheistic content, which interferes with work and social functioning. Hyperreligiosity may occur in a variety of disorders including epilepsy, psychotic disorders and frontotemporal lobar degeneration. Hyperreligiosity is a symptom of Geschwind syndrome, which is associated with temporal lobe epilepsy.

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  24. ↑ Eberle, David J.; Maercker, Andreas (March 2022). "Preoccupation as psychopathological process and symptom in adjustment disorder: A scoping review". Clinical Psychology & Psychotherapy. 29 (2): 455–468. doi:10.1002/cpp.2657. ISSN   1063-3995. PMC   9291616 . PMID   34355464.
  25. ↑ "ADMSEP - Clinical Simulation Initiative eModules". www.admsep.org. Retrieved 14 January 2025.
  26. ↑ "APA Dictionary of Psychology". dictionary.apa.org. Retrieved 14 January 2025.
  27. 1 2 American Psychiatric Association, ed. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-TR (Fifth edition, text revision ed.). Washington, DC: American Psychiatric Association Publishing. ISBN   978-0-89042-575-6.
  28. ↑ Kircher T, Krug A, Stratmann M, Ghazi S, Schales C, Frauenheim M, et al. (December 2014). "A rating scale for the assessment of objective and subjective formal Thought and Language Disorder (TALD)". Schizophrenia Research. 160 (1–3): 216–21. doi: 10.1016/j.schres.2014.10.024 . hdl: 10576/4730 . PMID   25458572.
  29. ↑ Sandgrund, Alice; Schaefer, Charles E., eds. (2000). Play diagnosis and assessment (2nd ed.). New York: Wiley. ISBN   978-0-471-25457-7.
  30. ↑ de Bruin, Esther I.; Verheij, Fop; Wiegman, Tamar; Ferdinand, Robert F. (January 2007). "Assessment of formal thought disorder: The relation between the Kiddie Formal Thought Disorder Rating Scale and clinical judgment". Psychiatry Research. 149 (1–3): 239–246. doi:10.1016/j.psychres.2006.01.018. PMID   17156854.
  31. ↑ Andreasen, N. C. (1 January 1986). "Scale for the Assessment of Thought, Language, and Communication (TLC)". Schizophrenia Bulletin. 12 (3): 473–482. doi:10.1093/schbul/12.3.473. ISSN   0586-7614. PMID   3764363.
  32. 1 2 3 Andreasen NC (November 1979). "Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability". Archives of General Psychiatry. 36 (12): 1315–21. doi:10.1001/archpsyc.1979.01780120045006. PMID   496551.
  33. ↑ Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). Arlington, VA: American Psychiatric Association. 2013. ISBN   9780890425558.
  34. ↑ "Thought Disorder | Johns Hopkins Psychiatry Guide". www.hopkinsguides.com.
  35. 1 2 3 4 5 6 7 8 Kircher, Tilo; Bröhl, Henrike; Meier, Felicitas; Engelen, Jennifer (June 2018). "Formal thought disorders: from phenomenology to neurobiology". The Lancet Psychiatry. 5 (6): 515–526. doi:10.1016/S2215-0366(18)30059-2. PMID   29678679. S2CID   5036067.
  36. ↑ Holzman, P. S.; Shenton, M. E.; Solovay, M. R. (January 1986). "Quality of Thought Disorder in Differential Diagnosis". Schizophrenia Bulletin. 12 (3): 360–372. doi:10.1093/schbul/12.3.360. PMID   3764357.
  37. ↑ Nestor, Paul G.; Shenton, Martha E.; Wible, Cindy; Hokama, Hiroto; O'Donnell, Brian F.; Law, Susan; McCarley, Robert W. (February 1998). "A neuropsychological analysis of schizophrenic thought disorder". Schizophrenia Research. 29 (3): 217–225. doi:10.1016/S0920-9964(97)00101-1. PMID   9516662.
  38. 1 2 Solovay, Margie R. (January 1987). "Comparative Studies of Thought Disorders: I. Mania and Schizophrenia". Archives of General Psychiatry. 44 (1): 13–20. doi:10.1001/archpsyc.1987.01800130015003. PMID   3800579.
  39. ↑ Yalincetin, Berna; Bora, Emre; Binbay, Tolga; Ulas, Halis; Akdede, Berna Binnur; Alptekin, Koksal (July 2017). "Formal thought disorder in schizophrenia and bipolar disorder: A systematic review and meta-analysis". Schizophrenia Research. 185: 2–8. doi:10.1016/j.schres.2016.12.015. PMID   28017494.
  40. ↑ Marengo, J. T.; Harrow, M. (January 1997). "Longitudinal Courses of Thought Disorder in Schizophrenia and Schizoaffective Disorder". Schizophrenia Bulletin. 23 (2): 273–285. doi:10.1093/schbul/23.2.273. PMID   9165637.
  41. 1 2 3 Harvey PD, Keefe RS, Eesley CE (2017). "12.10 Neurocognition in Schizophrenia". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. RELATIONSHIP OF NEUROCOGNITIVE IMPAIRMENT TO SCHIZOPHRENIA SYMPTOMS, Formal Thought Disorder. ISBN   978-1-4511-0047-1.
  42. ↑ de Sousa, Paulo; Spray, Amy; Sellwood, William; Bentall, Richard P. (December 2015). "'No man is an island'. Testing the specific role of social isolation in formal thought disorder". Psychiatry Research. 230 (2): 304–313. doi:10.1016/j.psychres.2015.09.010. PMID   26384574.
  43. ↑ Singer, Margaret Thaler; WYNNE, LC (February 1965). "Thought Disorder and Family Relations of Schizophrenics: IV. Results and Implications". Archives of General Psychiatry. 12 (2): 201–212. doi:10.1001/archpsyc.1965.01720320089010. PMID   14237630.
  44. ↑ Cuesta, Manuel J.; Peralta, Victor; De Leon, Jose (January 1994). "Schizophrenic syndromes associated with treatment response". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 18 (1): 87–99. doi:10.1016/0278-5846(94)90026-4. PMID   7906897.
  45. ↑ Wang, X; Savage, R; Borisov, A; Rosenberg, J; Woolwine, B; Tucker, M; May, R; Feldman, J; Nemeroff, C; Miller, A (October 2006). "Efficacy of risperidone versus olanzapine in patients with schizophrenia previously on chronic conventional antipsychotic therapy: A switch study". Journal of Psychiatric Research. 40 (7): 669–676. doi:10.1016/j.jpsychires.2006.03.008. PMID   16762371.
  46. ↑ Remberk, Barbara; Namysłowska, Irena; Rybakowski, Filip (December 2012). "Cognition and communication dysfunctions in early-onset schizophrenia: Effect of risperidone". Progress in Neuro-Psychopharmacology and Biological Psychiatry. 39 (2): 348–354. doi:10.1016/j.pnpbp.2012.07.007. PMID   22819848.
  47. ↑ Namyslowska, Irena (January 1975). "Thought disorders in schizophrenia before and after pharmacological treatment". Comprehensive Psychiatry. 16 (1): 37–42. doi:10.1016/0010-440X(75)90018-8. PMID   1109833.
  48. ↑ Hurt, Stephen W. (December 1983). "Thought Disorder: The Measurement of Its Changes". Archives of General Psychiatry. 40 (12): 1281–1285. doi:10.1001/archpsyc.1983.01790110023005. PMID   6139992.
  49. ↑ Spohn, H. E.; Coyne, L.; Larson, J.; Mittleman, F.; Spray, J.; Hayes, K. (January 1986). "Episodic and Residual Thought Pathology in Chronic Schizophrenics: Effect of Neuroleptics". Schizophrenia Bulletin. 12 (3): 394–407. doi:10.1093/schbul/12.3.394. PMID   2876514.
  50. 1 2 Palmier-Claus, Jasper; Griffiths, Robert; Murphy, Elizabeth; Parker, Sophie; Longden, Eleanor; Bowe, Samantha; Steele, Ann; French, Paul; Morrison, Anthony; Tai, Sara (2 October 2017). "Cognitive behavioural therapy for thought disorder in psychosis" (PDF). Psychosis. 9 (4): 347–357. doi:10.1080/17522439.2017.1363276.
  51. ↑ Çokal, Derya; Sevilla, Gabriel; Jones, William Stephen; Zimmerer, Vitor; Deamer, Felicity; Douglas, Maggie; Spencer, Helen; Turkington, Douglas; Ferrier, Nicol; Varley, Rosemary; Watson, Stuart; Hinzen, Wolfram (19 September 2018). "The language profile of formal thought disorder". npj Schizophrenia. 4 (1): 18. doi:10.1038/s41537-018-0061-9. PMC   6145886 . PMID   30232371.
  52. 1 2 Thought Disorder (2016) , 25.3. What Are the Boundaries of Thought Disorder?., pp. 498–499.
  53. ↑ "UpToDate". www.uptodate.com. Retrieved 14 January 2025.
  54. ↑ Thought Disorder (2016) , 25.2. Definition., pp. 497–498.citedFish FJ (1962). Schizophrenia. Bristol, England: Bright.
  55. ↑ Thought Disorder (2016) , 25.4. What Are the Common Types of Thought Disorder?, pp. 498–499.
  56. ↑ Phenomenology of Schizophrenia (2017) , THE SYMPTOMS OF SCHIZOPHRENIA, Categories of Negative Symptoms.
    • "... In this way, alogia is conceived of as a 'negative thought disorder.' ..."
    • "... The paucity of meaningful content in the presence of a normal amount of speech that is sometimes included in alogia is actually a disorganization of thought and not a negative symptom and is properly included in the disorganization cluster of symptoms. ..."
  57. ↑ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008) , "6 Psychiatric Rating Scales", Table 6–5 Scale for the Assessment of Negative Symptoms (SANS), p. 44.
  58. 1 2 3 4 5 Houghtalen, Rory P; McIntyre, John S (2017). "7.1 Psychiatric Interview, History, and Mental Status Examination of the Adult Patient". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. HISTORY AND EXAMINATION, Thought Process/Form, Table 7.1–6. Examples of Disordered Thought Process/Form. ISBN   978-1-4511-0047-1. indicates and briefly defines the follow types: Clanging, Circumstantial, Derailment (loose associations), Flight of ideas, Incoherence (word salad), Neologism, Tangential, Thought blocking
  59. ↑ Videbeck S (2017). "8. Assessment". Psychiatric-Mental Health Nursing (7th ed.). Wolters Kluwer. CONTENT OF THE ASSESSMENT, Thought Process and Content, p. 232. ISBN   9781496355911.
  60. ↑ Videbeck (2017) , Chapter 16 Schizophrenia, APPLICATION OF THE NURSING PROCESS, Thought Process and Content, p. 446.
  61. 1 2 3 4 5 6 7 Videbeck, S (2008). Psychiatric-Mental Health Nursing, 4th ed. Philadelphia: Wolters Kluwers Health, Lippincott Williams & Wilkins.
  62. ↑ "Thought disorder" (PDF). Retrieved 26 February 2020.
  63. ↑ APA dictionary of psychology (2015) , p. 299 "derailment n. a symptom of thought disorder, often occurring in individuals with schizophrenia, marked by frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea. It is usually manifested in speech (speech derailment) but can also be observed in writing. Derailment is essentially equivalent to loosening of associations. See cognitive derailment; thought derailment."
  64. 1 2 Thought Disorder (2016) , 25.4.2.8. Distractible Speech, p. 502.
  65. ↑ "Distractible speech". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 3 March 2020.
  66. 1 2 3 4 5 Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008) , "10 Schizophrenia", CLINICAL FEATURES, Thought, pp. 168–169.
    • "Form of Thought. Disorders of the form of thought are objectively observable in patients' spoken and written language. The disorders include looseness of associations, derailment, incoherence, tangentiality, circumstantiality, neologisms, echolalia, verbigeration, word salad, and mutism."
    • "Thought Process. ... Disorders of thought process include flight of ideas, thought blocking, impaired attention, poverty of thought content, poor abstraction abilities, perseveration, idiosyncratic associations (e.g., identical predicates and clang associations), overinclusion, and circumstantiality."
  67. ↑ Ganos, Christos; Ogrzal, Timo; Schnitzler, Alfons; Münchau, Alexander (September 2012). "The pathophysiology of echopraxia/echolalia: Relevance to Gilles De La Tourette syndrome". Movement Disorders. 27 (10): 1222–1229. doi:10.1002/mds.25103. PMID   22807284.
  68. ↑ Fred R. Volkmar; et al. (2005). Handbook of autism and pervasive developmental disorders. Vol. 1: Diagnosis, development, neurobiology, and behavior (3rd ed.). Hoboken, NJ: John Wiley. ISBN   978-0-470-93934-5. OCLC   60394857.[ page needed ]
  69. ↑ Duffy, Joseph R. (2013). Motor speech disorders: substrates, differential diagnosis, and management (Third ed.). St. Louis, MI. ISBN   978-0-323-07200-7. OCLC   819941855.{{cite book}}: CS1 maint: location missing publisher (link)[ page needed ]
  70. ↑ "Evasion". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 23 February 2020.
  71. ↑ Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2017) , Appendix B Glossary of Psychiatry and Psychology Terms. "evasion ... consists of suppressing an idea that is next in a thought series and replacing it with another idea closely related to it. Also called paralogia; perverted logic."
  72. ↑ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008) , "Chapter 6 Psychiatric Rating Scales", OTHER SCALES, Table 6–6 Scale for the Assessment of Positive Symptoms (SAPS), Positive formal thought disorder, p. 45 includes and defines Derailment, Tangentiality, Incoherence, Illogicality, Circumstantiality, Pressure of speech, Distractible speech, Clanging.
  73. ↑ Thought Disorder (2016) , 25.4.2.6. Neologisms, p. 502.
  74. ↑ Rohrer JD, Rossor MN, Warren JD (February 2009). "Neologistic jargon aphasia and agraphia in primary progressive aphasia". Journal of the Neurological Sciences. 277 (1–2): 155–9. doi:10.1016/j.jns.2008.10.014. PMC   2633035 . PMID   19033077.
  75. ↑ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008) , "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 29
  76. ↑ Akiskal HS (2016). "1 The Mental Status Examination". In Fatemi SH, Clayton PJ (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 1.5.5. Speech and Thought., pp. 8–10. doi:10.1007/978-1-4939-2528-5. ISBN   978-1-4939-2528-5.
    • "This form of thought is most characteristic of mania and tends to be overinclusive, with difficulty in excluding irrelevant, extraneous details from the association."
  77. ↑ APA dictionary of psychology (2015) , p. 751overinclusion n. failure of an individual to eliminate ineffective or inappropriate responses associated with a particular stimulus.
  78. ↑ Kurowski, Kathleen; Blumstein, Sheila E. (February 2016). "Phonetic basis of phonemic paraphasias in aphasia: Evidence for cascading activation". Cortex. 75: 193–203. doi:10.1016/j.cortex.2015.12.005. PMC   4754157 . PMID   26808838.
  79. ↑ "Pressured speech". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 23 February 2020.
  80. ↑ Cicero, David C.; Kerns, John G. (April 2011). "Unpleasant and pleasant referential thinking: Relations with self-processing, paranoia, and other schizotypal traits". Journal of Research in Personality. 45 (2): 208–218. doi:10.1016/j.jrp.2011.02.002. PMC   4447705 . PMID   26028792.
  81. ↑ Buckingham, Hugh W.; Rekart, Deborah M. (January 1979). "Semantic paraphasia". Journal of Communication Disorders. 12 (3): 197–209. doi:10.1016/0021-9924(79)90041-8. PMID   438359.
  82. 1 2 3 4 5 6 Lewis SF, Escalona R, Keith SJ (2017). "12.2 Phenomenology of Schizophrenia". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. THE SYMPTOMS OF SCHIZOPHRENIA, Disorganization, Thought Disorder. ISBN   978-1-4511-0047-1.
    • As quoted in the templated quote.
    • "Thought disorder is the most studied form of the disorganization symptoms. It is referred to as "formal thought disorder," or "conceptual disorganization," or as the "disorganization factor" in various studies that examine cognition or subsyndromes in schizophrenia. ..."
  83. ↑ "Tangential speech". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 23 February 2020.
  84. ↑ "Blocking". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 23 February 2020.
  85. 1 2 Clinical Manifestations of Psychiatric Disorders (2017) , THINKING DISTURBANCES, Continuity. "Word salad describes the stringing together of words that seem to have no logical association, and verbigeration describes the disappearance of understandable speech, replaced by strings of incoherent utterances."
  86. ↑ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008) , "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 32
  87. 1 2 "Content-thought disorder". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 23 February 2020.
  88. ↑ Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2017) , "Appendix B: Glossary of Psychiatry and Psychology Terms" "content thought disorder Disturbance in thinking in which a person exhibits delusions that may be multiple, fragmented, and bizarre."
  89. ↑ Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2017) , "Appendix B: Glossary of Psychiatry and Psychology Terms" "formal thought disorder Disturbance in the form of thought rather than the content of thought; thinking characterized by loosened associations, neologisms, and illogical constructs; thought process is disordered, and the person is defined as psychotic. Characteristic of schizophrenia."
  90. ↑ APA dictionary of psychology (2015) , p. 432 "formal thought disorder disruptions in the form or structure of thinking. Examples include derailment and tangentiality. It is distinct from TD, in which the disturbance relates to thought content."
  91. ↑ American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. ISBN   978-0-89042-555-8.
    • As the proper FTD: "Schizophrenia Spectrum and Other Psychotic Disorders", Key Features That Define the Psychotic Disorders, Disorganized Thinking (Speech), p. 88 "Disorganized thinking (formal thought disorder) is typically inferred from the individual's speech. ..."
    • As possibly something else: "Dissociative Disorders", Differential Diagnosis, Psychotic disorders, p. 296 "... Dissociative experiences of identity fragmentation or possession, and of perceived loss of control over thoughts, feelings, impulses, and acts, may be confused with signs of formal thought disorder, such as thought insertion or withdrawal. ..."
  92. ↑ "The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines (CDDG)" (PDF). World Health Organization. 1992. Archived (PDF) from the original on 17 October 2004.
    • F06.2 Organic delusional [schizophrenia-like] disorder, p.59: Features suggestive of schizophrenia, such as bizarre delusions, hallucinations, or thought disorder, may also be present. ... Diagnostic guidelines ... Hallucinations, thought disorder, or isolated catatonic phenomena may be present. ...
    • F20.0 Paranoid schizophrenia, p. 80: ... Thought disorder may be obvious in acute states, but if so it does not prevent the typical delusions or hallucinations from being described clearly. ...
    • F20.1 Hebephrenic schizophrenia, p. 81: ... In addition, disturbances of affect and volition, and thought disorder are usually prominent. Hallucinations and delusions may be present but are not usually prominent. ...
  93. ↑ The British Medical Association Illustrated Medical Dictionary. Dorling Kindersley. 2002. p. 547. ISBN   0-7513-3383-2. thought disorders Abnormalities in the structure or content of thought, as reflected in a person's speech, writing, or behaviour. ...
  94. ↑ The BMA Illustrated Medical Dictionary (2002)
    • p. 470 psychosis: ... Symptoms include delusions, hallucinations, thought disorders, loss of affect, mania, and depression. ...
    • p. 499-500 schizophrenia: ... The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. ...
  95. ↑ Matorin AA, Shah AA, Ruiz P (2017). "8 Clinical Manifestations of Psychiatric Disorders". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. THINKING DISTURBANCES, Flow and Form Disturbances. ISBN   978-1-4511-0047-1. Although formal thought disorder typically refers to marked abnormalities in the form and flow or connectivity of thought, some clinicians use the term broadly to include any psychotic cognitive sign or symptom.
  96. ↑ The Mental Status Examination (2016), 1.6.2. Disturbances in Thinking., pp. 14–15.
  97. ↑ Wensing, T.; Cieslik, E. C.; Müller, V. I.; Hoffstaedter, F.; Eickhoff, S. B.; Nickl-Jockschat, T. (2017). "Neural correlates of formal thought disorder: An activation likelihood estimation meta-analysis". Human Brain Mapping. 38 (10): 4946–4965. doi:10.1002/hbm.23706. PMC   5685170 . PMID   28653797.
  98. 1 2 3 4 5 6 7 Thought Disorder (2016) , 25.5. Diagnostic and Prognostic Significance of Thought Disorder, pp. 502–503.cited
    • Andreasen NC (November 1979). "Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability". Archives of General Psychiatry. 36 (12): 1315–21. doi:10.1001/archpsyc.1979.01780120045006. PMID   496551.
    • Andreasen NC (November 1979). "Thought, language, and communication disorders. II. Diagnostic significance". Archives of General Psychiatry. 36 (12): 1325–30. doi:10.1001/archpsyc.1979.01780120055007. PMID   496552.
    • Andreasen NC, Hoffrnann RE, Grove WM (1984). Alpert M (ed.). Mapping abnormalities in language and cognition. New York: Guilford Press. pp. 199–226.{{cite book}}: |work= ignored (help)
  99. 1 2 Coryell W, Clayton PJ (2016). "4 Bipolar Illness". In Fatemi SH, Clayton PJ (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 4.7. Clinical Picture, 4.7.2. Symptoms, p. 59. doi:10.1007/978-1-4939-2528-5. ISBN   978-1-4939-2528-5.
  100. ↑ Oyebode F (2015). "10 Disorder of Speech and Language". Sims' Symptoms in the Mind: Textbook of Descriptive Psychopathology (5th ed.). Saunders Elsevier. Schizophrenic Language Disorder, CLINICAL DESCRIPTION AND THOUGHT DISORDER, p. 167. ISBN   978-0-7020-5556-0.
  101. 1 2 Thought Disorder (2016) , 25.6. Relationship Between Thought Disorders and Other Symptoms of Schizophrenia., pp. 503–504.
  102. ↑ DSM-5 (2013) , Schizophrenia Spectrum and Other Psychotic Disorders, Key Features That Define the Psychotic Disorders, Disorganized Thinking (Speech), p. 88.
  103. ↑ "Thought Disorder | Johns Hopkins Psychiatry Guide". www.hopkinsguides.com. Retrieved 15 July 2021.
  104. 1 2 Ivleva EI, Tamminga CA (2017). "12.16 Psychosis as a Defining Dimension in Schizophrenia". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. DSM-5: AN UPDATED DEFINITION OF PSYCHOSIS. ISBN   978-1-4511-0047-1.
  105. ↑ Akiskal HS (2017). "13.4 Mood Disorders: Clinical Features". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. BIPOLAR DISORDERS, Bipolar I Disorder, Acute Mania. ISBN   978-1-4511-0047-1.
  106. 1 2 Ninivaggi FJ (2017). "28.1 Malingering". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. CLINICAL PRESENTATIONS OF MALINGERING, Psychological Symptomatology: Clinical Presentations, Psychosis. ISBN   978-1-4511-0047-1.
  107. ↑ Sikich L, Chandrasekhar T (2017). "53 Early-Onset Psychotic Disorders". In Sadock VA, Sadock BJ, Ruiz P (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. DIFFERENTIAL DIAGNOSIS, Autism Spectrum Disorders. ISBN   978-1-4511-0047-1.
  108. 1 2 Solomon M, Ozonoff S, Carter C, Caplan R (September 2008). "Formal thought disorder and the autism spectrum: relationship with symptoms, executive control, and anxiety". Journal of Autism and Developmental Disorders. 38 (8): 1474–84. doi:10.1007/s10803-007-0526-6. PMC   5519298 . PMID   18297385.
  109. ↑ Hart, Mara; Lewine, Richard R. J. (May 2017). "Rethinking Thought Disorder". Schizophrenia Bulletin. 43 (3): 514–522. doi:10.1093/schbul/sbx003. PMC   5464106 . PMID   28204762.
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  111. ↑ "What's behind the Rorschach inkblot test?". BBC News. 24 July 2012. Retrieved 15 July 2021.
  112. ↑ Bentall, R. (2003) Madness explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN   0-7139-9249-2 [ page needed ]
  113. ↑ Tufan, Ali Evren; Bilici, Rabia; Usta, Genco; Erdoğan, Ayten (December 2012). "Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report". Child and Adolescent Psychiatry and Mental Health. 6 (1): 25. doi: 10.1186/1753-2000-6-25 . PMC   3404901 . PMID   22726236.
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  115. ↑ Miller DD, Arndt S, Andreasen NC (2004). "Alogia, attentional impairment, and inappropriate affect: their status in the dimensions of schizophrenia". Comprehensive Psychiatry. 34 (4): 221–6. doi:10.1016/0010-440X(93)90002-L. PMID   8348799.
  116. ↑ Phenomenology of Schizophrenia (2017) , THE SYMPTOMS OF SCHIZOPHRENIA, Negative Symptoms. "The two-syndrome concept as formulated by T. J. Crow was especially important in spurring research into the nature of negative symptoms ... but this does not diminish the creative efforts that led to these scales or importance of these scales for research. In fact, it was only through careful analysis of the structure of symptoms in these scales that a more accurate characterization of the phenomenology of schizophrenia was possible."

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