Predictive value of thought disorder in new-onset psychosis

ObjectiveThis research addresses the relationship of formal thought disorder in the early stages of psychotic illness to the long-term outcome of mental health many years later. The specific topic of concern was to evaluate the prognostic significance of thought disorder on the severity of psychosis over time.MethodsSubjects with new-onset psychosis were evaluated on a variety of measures including education, physical health, Brief Psychiatric Rating Scale scores. They were also given the Thought, Language, and Communication Scale to evaluate thought disorder. Subjects were interviewed again at 10 and 20 years to evaluate variations in outcome. Appropriate statistical methods were used to evaluate changes in the level of functioning over time.ResultsThought disorder was not unique to schizophrenia. Bipolar patients presented with significant positive thought disorder at the onset of psychosis. Overtime positive thought disorder gradually improved in most patients. Negative thought disorder was more persistent, especially in subjects with schizophrenia. Initial psychosis with thought disorder characterized by poverty of content seemed to be associated with poor long-term outcome.ConclusionFormal thought disorder can predict outcome in some cases of psychosis. Not all types of thought disorder have the same prognostic implication. Positive forms of thought disorder (pressured speech, tangentiality) had no significant predictive value. Negative thought disorder (particularly poverty of speech and poverty of content) tend to predict a chronic, more unrelenting course of illness.     

Cocaine-induced paranoia and psychosis proneness

OBJECTIVE: The aim of this study was to determine whether individuals who experience transient cocaine-induced paranoia are vulnerable to psychosis. METHOD: The subjects were 20 cocaine-dependent men who had been using more than 5 g of cocaine per week and were undergoing substance abuse treatment; half reported binge-limited cocaine-induced paranoia. The men were assessed with the Perceptual Aberration Scale and the Magical Ideation Scale, self-report measures of symptoms thought to precede the development of functional psychosis. RESULTS: The combined scores on the Perceptual Aberration Scale and Magical Ideation Scale were strongly correlated with a history of cocaine-induced paranoia. The sensitivity, specificity, and positive and negative predictive power were 80.0%, 90.0%, 88.9%, and 81.8%, respectively. CONCLUSIONS: Heavy cocaine users who experience transient paranoia while intoxicated may be at higher risk for development of psychosis than cocaine users who do not experience paranoia.     

The association between eye-tracking dysfunctions and thought disorder in psychosis

The relationship between the presence of smooth-pursuit eye-movement dysfunctions and degree of thought disorder was assessed in four groups: schizophrenics, manics, atypical psychotic patients, and normal persons. A positive relationship, constant for all groups, was found to be significant but low. Impaired eye tracking accounted for 4.22% of the total variance of thought disorder. Diagnosis accounted for over 10% of the thought-disorder variance. Although there is a tendency for those persons with poor eye tracking to have higher amounts of thought disorder than those with unimpaired eye tracking, all psychotic patients, regardless of diagnostic class, tended to have thought disorder scores in the pathological range, as measured by the Thought Disorder Index. Although the data may be viewed as supporting similar hypothetical processes that underlie pursuit dysfunctions and thought disorder, the greater likelihood exists that the coupling of thought disorder and eye-tracking dysfunctions may be explained differently in the schizophrenia and in the major affective disorders.     

The predictive value of thought disorder in manic psychosis.

Twenty-two patients with mania were evaluated for a variety of psychiatric phenomena. These items along with demographic data were used to predict relapse over a 36-month period in a multiple regression model. Formal thought disorder at the onset of illness was a strong predictor of relapse (F = 39, p < 0.001). The quality of the thought disorder was the most significant prognostic indicator. The predictive value of negative thought disorder was not enhanced by the addition of other symptomatic or demographic variables.     

Two new scales of formal thought disorder in schizophrenia

Information provided by patients and respective carers may help to understand formal thought disorder (FTD) in schizophrenia. Two scales, one for patients (FTD-patient) and one for carers (FTD-carer), were constructed to assess pragmatics, cognitive, paralinguistic, and non-verbal aspects of communication. In the first scale the patients themselves assess their verbal communication; in the second scale the carer assesses the speech of the respective patient. Both scales exhibited internal reliability and evidence of good test-retest reliability. Higher total scores on both scales (FTD-patient and FTD-carer) were significantly associated with positive FTD, but not with negative FTD. Principal component analysis of the scales yielded a multidimensional structure. It is suggested that FTD in schizophrenia may be associated with a range of deficits (e.g. pragmatics, lexical activation, working memory, sustained attention). These scales, in conjunction with the clinician's assessment, can provide a more comprehensive picture of FTD in schizophrenia, revealing its dimensions and making it possible to establish associations between symptoms of FTD and neuropsychological, neurophysiologic, and neuroimaging data. In addition, they provide service users' and carers' perspectives for the assessment of communication in schizophrenia.     

A patient with panic disorder eventuating in psychosis: nosologic implications

The DSM-III-R subclassifies panic disorder (PD) under the anxiety disorders (or anxiety and phobic neuroses) along with phobic, obsessive compulsive (OCD), generalized anxiety and posttraumatic stress disorder (PTSD). Although allowances are made for the specification of the current degree of impairment as severe, e.g., at least eight panic attacks monthly, avoidance behavior resulting in being completely house-bound or compulsions being the major life activity, the anxiety disorder category does not provide for the simultaneous occurrence of associated psychotic features as part of the disorder. In fact, depending on the circumstances, diagnostic hierarchial principles, in the DSM-III-R, require dual diagnoses or a diagnosis of the more pervasive disorder only, if elements of both anxiety and psychosis are present. In contradistinction to the anxiety disorder category, the DSM-III-R recognizes a myriad of psychotic features, including delusions, hallucinations, thought insertion and broadcasting, as extreme manifestations of the affective syndromes. The following case report of a patient with panic disorder, culminating in a florid psychosis, puts into question current official nosology. Conflicting outcome data from the schizophreniform disorders may be due, in part, to the mislabelling of patients with psychoses secondary to severe anxiety disorders as schizophreniform.     

DSM-III: problems in diagnosis of paranoia and obsessive-compulsive disorder

The diagnoses of paranoia and obsessive-compulsive disorder are not adequately dealt with either conceptually or phenomenologically in DSM-III. A case of monosymptomatic hypochondriacal psychosis illustrating this point is presented. The question of whether this disorder should be diagnosed as paranoia, obsessive-compulsive disorder or an atypical affective disorder is discussed.     

Psychosomatic disorder and psychosis

A review of the available literature suggested the relative infrequency of psychosomatic disorder among psychotic patients. The hypothesis was derived that psychosomatic disorder may serve as a defence against psychosis, from which it follows that severe psychotic breakdown (e.g. schizophrenia) should be less common than expected among patients liable to psychosomatic disorder. The introduction of a new item sheet at the Bethlem Royal and Maudsley Hospitals, with a specific heading concern with psychosomatic disorder, afforded an oppoetunity of investigating this hypothesis. From the first 1,034 in-patients scored on the new item sheet, 126 had incidentally had a psychosomatic disorder. These 126 psychosomatic cases matched with a control group for age, sex, social class, marital status and country origin, and the distribution of psychiatric diagnose studied in each case. There were 8 schizophrenics among the 126 psychosomatic cases compared with 16 schizophrenics among the controls. This difference is in the predicted direction, burt not significant. An unexpected incidental significant finding was a high incidence of phobic reaction in the psychosomatic group. The implications of the lower incidence of schiphrenia in the psychosomatic group are discussed; in particular the danger of sudden attack on the psychosomatic symptoms either by psychotherapeutic or pharmacological methods.     

Comparison of ketamine-induced thought disorder in healthy volunteers and thought disorder in schizophrenia.

OBJECTIVE: This study sought to determine whether thought disorder induced in healthy volunteers by the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine resembles the thought disorder found in patients with schizophrenia. METHOD: The Scale for the Assessment of Thought, Language, and Communication was used to assess thought disorder in healthy volunteers (N = 10) who received subanesthetic doses of ketamine and in a group of clinically stable inpatients with schizophrenia (N = 15) who did not receive ketamine. RESULTS: Mean scores on the Scale for the Assessment of Thought, Language, and Communication for patients with schizophrenia and healthy volunteers receiving ketamine did not differ significantly. Moreover, three of the four highest rated test items in both groups were the same. CONCLUSIONS: These data suggest that ketamine-induced thought disorder in healthy volunteers is not dissimilar to the thought disorder in patients with schizophrenia and provide support for the involvement of the NMDA receptor in a cardinal symptom of schizophrenia.     

表现痴呆妄想的偏执性精神障碍1例报道

偏执性精神障碍是以妄想为主要表现的一组精神病。以被害和嫉妒妄想较为常见,以痴呆为主要表现罕见。本文报告1例如下。     

Cognitive functioning in recent onset psychosis

The purpose of the study was to compare the cognitive functioning of persons with a recent onset of psychosis with schizophrenia-spectrum disorders and bipolar disorder and nonpsychiatric controls. A total of 56 persons with a schizophrenia-spectrum disorder and 60 with bipolar disorder, all with a recent onset psychosis, and 312 nonpsychiatric controls were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Wisconsin Card Sorting Test (WCST). Comparison of the three groups through analysis of covariance indicated a significant difference among the groups for all of the cognitive variables. Pairwise contrasts of the two recent onset groups showed a significant difference favoring the bipolar disorder group on RBANS Language (p = 0.020) and Total (p = 0.050) and a marginally significant difference on RBANS Immediate Memory (p = 0.053) but not on the other RBANS variables or on the WCST. Cognitive performance is broadly impaired in recent onset psychosis, with a cognitive advantage to bipolar disorder patients compared with schizophrenia-spectrum patients.