Formal Thought Disorder

Some patients with schizophrenia experience a range of difficulties in language function. These difficulties often depend on speech, attention, and memory mechanisms. Among the notable problems are derailment, poverty of content of speech, and associational disturbances. Schizophrenic speech is often highly repetitive, difficult to comprehend, and at times uninformative, and it may contain neologisms, oddities of expression, and illogical features. There is no clear aphasic disturbance in schizophrenia.

Formal thought disorder is the clinical term used to describe manifestations of language abnormalities in schizophrenia. Studies using clinical rating scales have found that 50% of patients with schizophrenia manifest some form of communication disorder at a moderate or greater level. The most common abnormalities are in the domains of verbal productivity (e.g., the amount of speech produced) and speech connectedness (e.g., the logic, coherence, and referential nature of speech). Much less common (less than 10%) are disorders such as neologisms and word approximations (Peralta et al. 1992). These disturbances are not diagnostic; rather, they are nonspecific features. However, there is some evidence for communication disorder being useful in distinguishing mood disorders (both bipolar and depressive disorders) from schizophrenia (Andreasen and Grove 1986; Cuesta and Peralta 1993). Poverty of speech is an indicator of risk for poor functional outcome; as alogia, it is considered a negative symptom. It is associated with reductions in emotional tone and in vocal inflection and spontaneity. Disconnected patterns of speech are associated with bizarre behavior and inappropriate affect.

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