A rating scale for the assessment of objective and subjective formal Thought and Language Disorder (TALD)

Michael Grosvald,Tobias Hornig,Lena Turner,Tilo Kircher,Michael Katzev,Rüdiger Müller-Isberner,Sayed Ghazi,Michael Frauenheim,Christian Schales,Paul Fährmann,Axel Krug,Arne Nagels,Mirjam Stratmann

doi:10.1016/j.schres.2014.10.024

Michael Grosvald, Tobias Hornig + Show 11 more

Open Access

https://doi.org/10.1016/j.schres.2014.10.024

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Abstract

Formal thought disorder (FTD) is a core syndrome of schizophrenia. However, patients with other diagnoses, such as mania and depression amongst others, also present with FTD. We introduce a novel, comprehensive clinical rating scale, capturing the full variety of FTD phenomenology including subjective experiences.The 30-item Thought and Language Disorder (TALD) scale is based on a detailed review of the literature, encompassing all formal thought disorder symptoms reported from the early 20th century onwards. Objectively observable symptoms as well as subjective phenomena were included. Two hundred and ten participants (146 patients ICD-10 diagnoses: depression n=63, schizophrenia n=63, mania n=20; 64 healthy control subjects) were interviewed and symptoms rated with the TALD, TLC, HAMD, YMRS and SAPS/SANS. A principal component analyses was performed for the TALD to differentiate sub-syndromes.The principal component analysis revealed four FTD factors; objective and subjective as well as positive and negative factor dimensions. The correlation analyses with the TLC and the SAPS/SANS FTD sub-scores demonstrated the factor validity for the objective factors. The different diagnoses showed a distinct pattern of symptom severity in each of the factors, with mania patients exhibiting the highest value in the positive, objective dimension.The scale showed good psychometric results, which makes it a practicable, nosologically-open instrument for the detailed assessment of all FTD dimensions. The results strengthen the importance of subjective symptom assessment reported by the patient.

Highlights

Formal thought disorders (FTDs) are present in the majority of psychiatric patients, such as in schizophrenia, mania, depression, organic diseases, and personality disorders
Comprehensive clinical rating scale, capturing the full variety of FTD phenomenology including subjective experiences
The 30-item Thought and Language Disorder (TALD) scale is based on a detailed review of the literature, encompassing all formal thought disorder symptoms reported from the early 20th century onwards

Summary

Introduction

Formal thought disorders (FTDs) are present in the majority of psychiatric patients, such as in schizophrenia, mania, depression, organic diseases, and personality disorders. Despite this fact, FTD has traditionally been most closely linked to schizophrenia, since Bleuler (1911) saw “loosening of associations” (“Lockerung der Assoziationen”) (Bleuler, 1911) as its most fundamental symptom. Specific rating scales for FTD have been developed. Several scales require the detailed coding of recorded verbal transcripts on paper (Johnston and Holzman, 1979; Liddle et al, 2002), a reliable method, which, is extremely time consuming. Other scales focus primarily on very specific linguistic (Docherty et al, 1996; Chen et al, 1999; Bazin et al, 2005) or psychodynamic hypotheses (Johnston and Holzman, 1979), but neglect the broad variety of FTD symptoms

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