Thought Disorder Research Articles

Identificação e intervenção precoce de primeiro episódio psicótico em cenários não especializados

The diagnosis and early intervention of a first episode psychosis is directly related to its prognosis. It is the initial phase of a psychotic disorder, which is a severe mental illness characterized by delusions, hallucinations and/or disorganized behaviour or speech. Commonly, the first assistance to these patients are done by a non-psychiatrist in an emergency or primary care setting. The practitioners must be able to identify and properly manage this condition, without delaying the diagnosis, screening and initiation of the proper treatment.

Differentiation of dissociative psychosis, delirious mania and unspecified dissociative disorder in an adolescent case: a case report

Dissociative psychosis is, it is a condition that usually occurs after a trauma, when psychotic and dissociative symptoms occur together.In this process, disorganized behaviors increase, insight is lost, and hallucinations become worse.It usually results in sudden improvement over a period of several days to several weeks and most patients remain amnesic into the dissociative psychosis phase. A sixteen-year-old female adolescent was brought in with severe manic and psychotic complaints that started suddenly a week ago.In-mental-status-examination; her associations, thought content and perception examination were particularly striking.During-the-hospitalization-process, passivity, delusional delusions of misidentification, and disorganized speech and behavior were also observed.The adolescent, whose complaints regressed in the fourth week, was amnesic during the episode.This study aims to present the differential diagnosis and treatment process of dissociative psychosis, delirious mania, and unspecified dissociative disorder in an adolescent female.

Orbitofrontal cortex hypergyrification in hallucinating schizophrenia patients: Surface ratio as a promising brain biomarker

The study of brain gyrification may provide useful information on the cytoarchitecture and connectivity of the brain. One of the methods that have been developed to estimate brain gyrification, known as surface ratio (SR), has not yet been studied in schizophrenia. Here we aimed to assess whether SR could provide new insights on the brain structure of schizophrenia patients and the severity of symptoms. We also computed a more established brain gyrification measure, namely absolute mean curvature (AMC). We analyzed 63 magnetic resonance images, 25 from schizophrenia patients with treatment-resistant auditory verbal hallucinations (SCH-H), 18 from schizophrenia patients without hallucinations (SCH-NH), and 20 from healthy controls (HC). The SR measure revealed that SCH-H patients had a more folded orbitofrontal cortex than SCH-NH patients and HC. Gyrification in this region was also negatively associated with positive symptoms, specifically with the delusions and conceptual disorganization items, only in the SCH-H group. Regarding the AMC measure, we identified two areas where HC showed more gyrification than SCH-H patients, but no relationships arose with symptoms. The hypergyrification of the orbitofrontal cortex displayed by SCH-H patients, as captured by the SR measure, suggests aberrant and/or excessive wiring in these patients, which in turn could give rise to auditory verbal hallucinations. Alternatively, we comment on potential compensatory mechanisms that may better explain the negative association between orbitofrontal gyrification and positive symptomatology. The SR measure captured the most relevant differences and associations, making it a promising biomarker in schizophrenia.

Analyzing language ability in first-episode psychosis and their unaffected siblings: A diffusion tensor imaging tract-based spatial statistics analysis study

Schizophrenia (SZ) is a highly heritable mental disorder, and language dysfunctions play a crucial role in diagnosing it. Although language-related symptoms such as disorganized speech were predicted by the polygenic risk for SZ which emphasized the common genetic liability for the disease, few studies investigated possible white matter integrity abnormalities in the language-related tracts in those at familial high-risk for SZ. Also, their results are not consistent. In this current study, we examined possible aberrations in language-related white matter tracts in patients with first-episode psychosis (FEP, N = 20), their siblings (SIB, N = 20), and healthy controls (CON, N = 20) by applying whole-brain Tract-Based Spatial Statistics and region-of-interest analyses. We also assessed language ability by Thought and Language Index (TLI) using Thematic Apperception Test (TAT) pictures and verbal fluency to see whether the scores of these language tests would predict the differences in these tracts. We found significant alterations in language-related tracts such as inferior longitudinal fasciculus (ILF) and uncinate fasciculus (UF) among three groups and between SIB and CON. We also proved partly their relationship with the language test as indicated by the significant correlation detected between TLI Impoverished thought/language sub-scale and ILF. We could not find any difference between FEP and CON. These results showed that the abnormalities, especially in the ILF and UF, could be important pathophysiological vulnerability indexes of schizophrenia. Further studies are required to understand better the role of language as a possible endophenotype in schizophrenia with larger samples.

Asuhan Keperawatan Jiwa pada Ny. R Dengan Masalah Utama Risiko Perilaku Kekerasan Akibat Skizofrenia Tak Terinci di Ruang Arimbi RSJD dr. Amino Gondohutomo Provinsi Jawa Tengah

Schizophrenia is a syndrome with a variety of causes, where each patient exhibits different clinical manifestations, therapeutic responses, and disease progression. Clinical manifestations of schizophrenia include disorganized speech, restlessness, pacing, and aggression, often exhibited through violent behavior. According to WHO data, in 2019, approximately 24 million people worldwide suffered from schizophrenia (WHO, 2019). The purpose of this paper is to understand the nursing care process for Mrs. R, with the main issue being the risk of violent behavior due to unspecified schizophrenia. The writing method used is a descriptive case study through a nursing process approach, where the assessment is conducted using interview techniques, observation, documentation review, and literature study. The nursing diagnoses identified include the risk of violent behavior, self-concept disturbance: low self-esteem, and self-care deficit. The interventions developed involve implementing strategies for both the patient and the family. The evaluation of the nursing care for Mrs. R showed that the diagnosis of risk of violent behavior was partially resolved, and the self-care deficit was resolved.

A Study on the Contemporary Meaning of Social Disorganization Factors: Focusing on Violent Crimes in Seoul

A Study on the Contemporary Meaning of Social Disorganization Factors: Focusing on Violent Crimes in Seoul

Schizotypal traits and their relationship to reading abilities in healthy adults

Schizotypal traits (i.e., personality characteristics that range from mild eccentricities to more pronounced schizophrenia-like perceptions, thought patterns, and behaviours) have been associated with a variety of cognitive impairments, including difficulties in language processing. Although these difficulties span several aspects of language (e.g., semantic processing, verbal fluency, visual word recognition), it is unclear whether reading abilities are also affected. Thus, the current study employed the Schizotypal Personality Questionnaire (SPQ) – Brief (Raine and Benishay, 1995) to examine how schizotypal traits impact both word-level and text-level reading skills (using a battery of standardized assessments) in a sample of healthy young adults. We found some evidence that higher schizotypal traits, specifically, increased Disorganized factor scores (reflecting aberrant thinking, communication patterns, and behaviour), were associated with reduced word-level reading abilities. However, this finding did not remain significant after correcting for multiple comparisons. Overall, our study suggests that reading may be another aspect of language affected by schizotypal traits, although additional research (with greater power) is needed to further explore and confirm this finding.

Characteristics of isoniazid-induced psychosis: a systematic review of case reports and case series

PurposeIsoniazid, a first-line antitubercular drug, is associated with nervous system adverse drug reactions such as seizures, peripheral neuropathy, and psychosis. This systematic review of case reports and case series aimed to characterize the demographic, social, and clinical factors associated with isoniazid-induced psychosis in patients with active tuberculosis (TB) and those who received isoniazid for latent TB infection (LTBI).MethodsWe comprehensively searched the Embase, PubMed, and Scopus databases to identify relevant studies published between the date of inception of the database and June 2024.ResultsA total of 28 studies, including 21 case reports and 7 case series involved 37 patients who developed isoniazid-induced psychosis. A higher frequency of isoniazid-induced psychosis was observed during the first 2 months of treatment, with a relatively early onset observed among patients aged 18 years or less. Delusions and/or hallucinations are the common symptoms of isoniazid-induced psychosis. Psychomotor disturbances, disorganized speech or formal thought disorder, disorganized or abnormal behaviour, and neuropsychiatric symptoms (sleep disturbances, hostility or aggression, confusion, affective symptoms, anxiety symptoms, and cognitive difficulties) were the other symptoms observed in the included studies. More than 80% of cases rechallenged with isoniazid resulted in the recurrence of psychotic symptoms.ConclusionPatients with TB and LTBI should be assessed for psychotic and neuropsychiatric symptoms during isoniazid therapy, mainly in the first 2 months. Further research is required to understand the impact of underlying risk factors, such as genetic predisposition and isoniazid pharmacokinetics, as well as the clinical utility and dosage recommendations of pyridoxine for managing isoniazid-induced psychosis.

Unraveling the Boundaries, Overlaps, and Connections between Schizophrenia and Obsessive-Compulsive Disorder (OCD).

Schizophrenia (SCZ) and obsessive-compulsive disorder (OCD) typically have distinct diagnostic criteria and treatment approaches. SCZ is characterized by delusions, hallucinations, disorganized speech, and cognitive impairments, while OCD involves persistent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The co-occurrence of these disorders increases clinical complexity and poses significant challenges for diagnosis and treatment. Epidemiological studies indicate a significant overlap, with prevalence rates of comorbid OCD in SCZ patients ranging from 12% to 25%, which is higher than in the general population. Etiological hypotheses suggest shared genetic, neurobiological, and environmental factors, with genetic studies identifying common loci and pathways, such as glutamatergic and dopaminergic systems. Neuroimaging studies reveal both overlapping and distinct neural abnormalities, indicating shared and unique neurobiological substrates. Environmental factors, like early life stressors and urbanicity, also contribute to the comorbidity. The overlapping clinical features of both disorders complicate diagnosis. Treatment approaches include combining SSRIs with antipsychotics and cognitive behavioral therapy (CBT). The complexity of SCZ and OCD comorbidity underscores the need for a dimensional, spectrum-based perspective on psychiatric disorders, alongside traditional categorical approaches, to improve diagnosis and treatment outcomes.

Illness-related variables and abnormalities of resting-state brain activity in schizophrenia.

The development of neuroimaging biomarkers in patients with schizophrenia (SCZ) requires a refined clinical characterization. A limitation of the neuroimaging literature is the partial uptake of progress in characterizing disease-related features, particularly negative symptoms (NS) and cognitive impairment (CI). In the present study, we assessed NS and CI using up-to-date instruments and investigated the associations of abnormalities in brain resting-state (rs)-activity with disease-related features. Sixty-two community-dwelling SCZ subjects participated in the study. Multiple regression analyses were performed with the rs-activity of nine regions of interest as dependent variables and disease-related features as explanatory variables. Attention/vigilance deficits were negatively associated with dorsal anterior cingulate rs-activity and, together with depression, were positively associated with right dorsolateral prefrontal cortex rs-activity. These deficits and impairment of Reasoning/problem-solving, together with conceptual disorganization, were associated with right inferior parietal lobule and temporal parietal junction rs-activity. Independent of other features, the NS Expressive Deficit domain was associated with the left ventral caudate, while the Motivational Deficit was associated with the dorsal caudate rs-activity. Neurocognitive deficits and the two negative symptom domains are associated with different neural markers. Replications of these findings could foster the identification of clinically actionable biomarkers of poor functional outcomes.

The Neurobiology of Formal Thought Disorder.

The concept of Formal Thought Disorder (FTD) is an ambiguous and disputed one, even though it has endured as a core psychopathological construct in clinical Psychiatry. FTD can be summarized as a multidimensional construct, reflecting difficulties or idiosyncrasies in thinking, language, and communication in general and is usually subdivided into positive versus negative. In this article, we aim to explore the putative neurobiology of FTD, ranging from changes in neurotransmitter systems to alterations in the functional anatomy of the brain. We also discuss recent critiques of the operationalist view of FTD and how they might fit in its biological underpinnings. We conclude that FTD might be the observable phenotype of many distinct underlying alterations in different proportions.

Clinical and neuroimaging aspects of formal thought disorder in schizophrenia: a brief narrative review

Aim. To analyze current sources regarding the clinical and neuroimaging aspects of formal thought disorder (FTD) in patients with schizophrenia to create an up-to-date pathogenetic model of its main forms. Materials and methods. English-language publications in the Medline database (PubMed) were analyzed for this review. We analyzed only structural magnetic resonance imaging (MRI) studies in which a clear clinical assessment of FTD in schizophrenia is provided and the neuroimaging protocol meets generally accepted standards (as in the ENIGMA Schizophrenia Working Group). For the clinical division of FTD, positive and negative FTD were distinguished according to the positive and negative syndrome scale (PANSS). Results. From a clinical point of view, FTD includes at least 30 phenomena. For clinical and neuroimaging studies, division into positive and negative FTD is used according to the PANSS. Positive FTD is manifested by the disorganization of thinking processes and exhibits mainly in violations of its purposeful sequence. Negative FTD is manifested by violations of the abstract-symbolic way of thinking, lack of spontaneity, and stereotyping. According to morphometric MRI data, atrophic changes in brain regions related to neuronal networks of cognition and impulse control (prefrontal and anterior cingulate cortex), emotional processing (amygdala), abstract thinking, and imagination (lateral occipital cortex) are important for the development of both forms of FTD. Negative FTD is mainly associated with damage to the prefronto-cingulate circles, which are the anatomical and functional substrates of executive functions. A unique feature of positive FTD is atrophy of the structures of the left temporal lobe, which leads to language disorders at the semantic level. Using the method of virtual histology, it was established that both forms of FTD are associated with bilateral changes in astrocytes and dendritic spines in the involved anatomical regions. A positive FTD is also associated with pathological changes in microglia in two hemispheres, while with a negative FTD, microglial damages are present only in the right hemisphere. Conclusions. Positive FTD in schizophrenia is mainly associated with atrophic (astroglial-microglial) processes of cognitive control networks, negative – with the atrophy of networks of semantic processing of verbal information. In both forms, networks of emotional processing, abstract thinking, and imagination are involved. Treatment strategies for FTD should include effects on astroglial and microglial dysfunction.

Linguistic Creativity and Formal Thought Disorder in Schizophrenia

Linguistic Creativity and Formal Thought Disorder in Schizophrenia

Relationships between trauma types and psychotic symptoms: A network analysis of patients with psychotic disorders in a large, multi-country study in East Africa

BackgroundThe link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms. MethodsWe conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific psychotic symptoms were connected. We used an Ising model to estimate the network connections and bridge centrality statistics to identify nodes that may influence trauma types and psychotic symptoms. ResultsThe trauma type “exposure to a war zone” had the highest bridge strength, betweenness, and closeness. The psychotic symptom “odd or unusual beliefs” had the second highest bridge strength. Exposure to a war zone was directly connected to visual hallucinations, odd or unusual beliefs, passivity phenomena, and disorganized speech. Odd or unusual beliefs were directly connected to transportation accidents, physical assault, war, and witnessing sudden accidental death. ConclusionSpecific trauma types and psychotic symptoms may interact bidirectionally. Screening for psychotic symptoms in patients with war-related trauma and evaluating lifetime trauma in patients with odd or unusual beliefs in clinical care may be considered points of intervention to limit stimulating additional psychotic symptoms and trauma exposure. This work reaffirms the importance of trauma-informed care for patients with psychotic disorders.

Psychotic Disorders in Behçet’s Disease: Unraveling the Intricacies of Neuropsychiatric Manifestations: A Case Report

This case report describes a 33-year-old patient with Behçet’s disease who presented with chronic delusions and hostility. Despite receiving immunosuppressive treatment for Behçet’s disease, the patient exhibited unsystematized delusions, disorganized speech, and intense psychic dissociation. Neurological examination and MRI showed no abnormalities, suggesting a psychiatric etiology. Treatment with risperidone and lorazepam led to partial improvement in psychiatric symptoms. The case raises the possibility of schizophrenia co-occurring with Behçet’s disease, although psychosis is rare in this condition. Further research is needed to understand the relationship between psychiatric and neurological manifestations of Behçet’s disease.

Association between cumulative trauma and severity of psychotic symptoms among patients experiencing psychosis

Psychosis-related trauma is a prevalent condition that significantly impacts patients and often leads to an increased reliance on psychiatric nursing services. This study aimed to provide a deeper understanding of the complex relationship between cumulative trauma and the severity of psychosis symptoms among patients experiencing psychosis. Utilizing a cross-sectional research design, data were collected from 76 community-dwelling patients recruited. Patients' sociodemographic and clinical data, Cumulative Trauma Measure scores, and psychosis symptom severity scale scores were collected. A significant difference was observed between collective identity trauma and the presence of hallucinations and abnormal psychomotor behavior (Z = 4.1 and 2.69, respectively). Significant differences were also observed between role identity trauma and the presence of delusions and abnormal psychomotor behavior (Z = 3.86 and 2.06, respectively); attachment trauma and the presence of hallucinations, abnormal psychomotor behavior, and mania (Z = 2.16, 2.12, and 2.11, respectively); and survival trauma and the presence of disorganized speech (Z = 2.61). Moreover, there was a significant difference regarding secondary trauma and the presence of hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, depression, and mania (Z = 4.29, 2.15, 2.11, 2.12, 4.42, and 3.39, respectively). In conclusion, total cumulative trauma explained 44.2 %, 25.8 %, 24.7 %, 16.2 %, 13.6 %, and 13.2 % of the severity of delusion, hallucination, depression, mania, abnormal psychomotor behavior, and disorganized speech, respectively, among patients experiencing psychosis. Implication for nursing practice, by recognizing the nuanced interplay between cumulative trauma and diverse manifestations of psychosis symptoms, nursing professionals can tailor their approaches to provide more holistic and patient-centered care that may significantly contribute to improved patient outcomes and the overall well-being of individuals navigating the complex landscape of psychosis-related trauma.

Current State of Application of Formal Thought Disorder Screening Methods in First-Degree Relatives of Patients With Schizophrenia: A Narrative Review

Abstract: Historically, formal thought disorder (FTD) has been considered one of the distinctive key symptoms of schizophrenia and is still regarded as an important early warning sign and a marker of illness severity with solid predictive value. Recent studies are able to found that the presence of FTD is predictive of the subsequent diagnosis of schizophrenia and often precedes the frank clinical picture by several months. Much effort has been put into developing scales that can reliably detect FTD and can be readily applied in routine clinical practice. This narrative review investigated the use of FTD as a screening tool to assess risk in first-degree relatives of patients with schizophrenia. The results show that the use of these scales in firstdegree relatives of schizophrenic individuals during clinical contact and counseling is still an exception, despite their uniquely heightened vulnerability profile. To our knowledge, this is the first time that the application of FTD screening methods in first-degree relatives of schizophrenic individuals has been reviewed in a structured way.

Differences in the neural correlates of schizophrenia with positive and negative formal thought disorder in patients with schizophrenia in the ENIGMA dataset

Formal thought disorder (FTD) is a clinical key factor in schizophrenia, but the neurobiological underpinnings remain unclear. In particular, the relationship between FTD symptom dimensions and patterns of regional brain volume loss in schizophrenia remains to be established in large cohorts. Even less is known about the cellular basis of FTD. Our study addresses these major obstacles by enrolling a large multi-site cohort acquired by the ENIGMA Schizophrenia Working Group (752 schizophrenia patients and 1256 controls), to unravel the neuroanatomy of FTD in schizophrenia and using virtual histology tools on implicated brain regions to investigate the cellular basis. Based on the findings of previous clinical and neuroimaging studies, we decided to separately explore positive, negative and total formal thought disorder. We used virtual histology tools to relate brain structural changes associated with FTD to cellular distributions in cortical regions. We identified distinct neural networks positive and negative FTD. Both networks encompassed fronto-occipito-amygdalar brain regions, but positive and negative FTD demonstrated a dissociation: negative FTD showed a relative sparing of orbitofrontal cortical thickness, while positive FTD also affected lateral temporal cortices. Virtual histology identified distinct transcriptomic fingerprints associated for both symptom dimensions. Negative FTD was linked to neuronal and astrocyte fingerprints, while positive FTD also showed associations with microglial cell types. These results provide an important step towards linking FTD to brain structural changes and their cellular underpinnings, providing an avenue for a better mechanistic understanding of this syndrome.

Measuring Panic as a Facet of Anxiety on Students’ Oral and Written Assessment in The University of Bamenda, Cameroon

Aim: The growing concern about the declining academic performance of students in Cameroon schools and colleges provokes varied reflections on the possible factors. One, but less obvious issue is anxiety, manifested in forms like agitation, excessive worrying, restlessness, and panic. While these variants are all critical in appreciating the connections with classroom assessment, this paper primarily isolates and focuses on panic, given its common visible expression among students. Specifically, the paper centers on how panic affects the performance of students in oral and written classroom assessments at the University of Bamenda.
 Methods: Systematic random and purposive sampling techniques were used to select 327 second-year students from the Faculty of Arts, Higher Teacher Training College, and the Faculty of Science to participate in the study. A sequential explanatory research design aided by a structured questionnaire, interview, and observation was used to collect quantitative and qualitative data. The qualitative data were analyzed using descriptive statistics, while the likelihood ratio test was used to test the hypothesis. 
 Results: The findings showed that panic has a high significant effect on students’ performance in assessment (Chi-square = 232.054, df = 60, P = 0.000, far <0.05).
 Conclusion: The findings indicated, among others, that when students exhibit panic during assessments, they lose concentration, forget what they studied, easily make errors, and experience disorganized speech, especially during oral assessments.
 Recommendation: To reduce this type of anxiety during assessment, there is a need for intensive rehearsals before assessment, the avoidance of panic triggers, especially from invigilators, and fairness in time allocation for both oral and written assessments.

Classification of schizophrenic traits in transcriptions of audio spectra from patient literature: artificial intelligence models enhanced by geometric properties

Schizophrenia is a severe mental illness that affects approximately 1% of the global population and presents significant challenges for patients, families, and healthcare professionals. Characterized by symptoms such as delusions, hallucinations, disorganized speech or behavior, and cognitive impairment, this condition has an early onset and chronic trajectory, making it a debilitating challenge. Schizophrenia also imposes a substantial burden on society, exacerbated by the stigma associated with mental disorders. Technological advancements, such as computerized semantic, linguistic, and acoustic analyses, are revolutionizing the understanding and assessment of communication alterations, a significant aspect in various severe mental illnesses. Early and accurate diagnosis is crucial for improving prognosis and implementing appropriate treatments. In this context, the advancement of Artificial Intelligence (AI) has provided new perspectives for the treatment of schizophrenia, with machine learning techniques and natural language processing allowing a more detailed analysis of clinical, neurological, and behavioral data sets. The present article aims to present a proposal for computational models for the identification of schizophrenic traits in texts. The database used in this article was created with 139 excerpts of patients' speeches reported in the book “Memories of My Nervous Disease” by German judge Daniel Paul Schreber, classifying them into three categories: 1 - schizophrenic, 2 - with schizophrenic traits and 3 - without any relation to the disorder. Of these speeches, 104 were used for training the models and the others 35 for validation.Three classification models were implemented using features based on geometric properties of graphs (number of vertices, number of cycles, girth, vertex of maximum degree, maximum clique size) and text entropy. Promising results were observed in the classification, with the Decision Tree-based model [1] achieving 100% accuracy, the KNN- k-Nearest Neighbor model observed with 62.8% accuracy, and the 'centrality-based' model with 59% precision. The high precision rates, observed when geometric properties are incorporated into Artificial Intelligence Models, suggest that the models can be improved to the point of capturing the language deviation traits that are indicative of schizophrenic disorders. In summary, this study paves the way for significant advances in the use of geometric properties in the field of psychiatry, offering a new data-based approach to the understanding and therapy of schizophrenia.