Thought Disorder Research Articles

Omodysplasia is an extremely rare short-limb skeletal dysplasia characterized by severe micromelic dwarfism with predominantly rhizomelic shortening of the upper and lower limbs. Type 1 omodysplasia, alsoknown as autosomal recessive omodysplasia, is caused by a mutation in the GPC6 gene. This is the first caseof a patient with schizophrenia genetically diagnosed with omodysplasia type 1. A 27-year-old, universitygraduate, bilingual, single white woman was brought to the emergency psychiatry clinic with psychomotor agitation, anxiety, persecutory delusions, and hallucinations. On the basis of the patient’s background,she was diagnosed with omodysplasia type 1 in early childhood. In addition, she was diagnosed withschizophrenia 8 years ago. Informed consent was obtained from the patient and her mother, who had anadvance directive. Schizophrenia is a neurodevelopmental disorder caused by both genetic and environmental factors. GPC6 is also associated with formal thought disorder (FTD), which is a common symptom ofschizophrenia. GPC6 gene mutation in FTD is located on chromosome 13, such as that of autosomal recessive omodysplasia. Although this case could be coincidental, it may contribute to current genetic studiesthat have an important place in the etiology of schizophrenia.Cite this article as: Poyraz E, Firidin S, Göverti D, Ulu B, Bülbül A, Özer T. Autosomal recessive omodysplasia (GPC6-related)with treatment-resistant schizophrenia. Neuropsychiatr Invest. 2025, 63, 0015, doi:10.5152/NeuropsychiatricInvest.2025.25015.

PurposeThis study aims to investigate the efficacy of metacognitive training (MCT) as an adjunctive treatment strategy for schizophrenia, particularly its impact on negative symptoms and potential mechanisms.Patients and MethodsThis study included a total of 73 inpatients with schizophrenia. 36 patients were in the MCT group and 37 patients were in the control group. Both groups of patients were receiving a single second-generation antipsychotic drug treatment. The MCT group underwent a 4-week MCT program consisting of 8 modules, while the control group received non-cognitive psychological support for the same duration and frequency. The Positive and Negative Syndrome Scale (PANSS) five-factor model and negative symptom two-factor model were used to assess psychiatric symptoms, and the Snyder’s Self-Monitoring Scale (SSMS) and the Personal and Social Performance Scale (PSP) were used as functional evaluation indicators.ResultsAfter treatment, compared to the control group, the MCT group had significantly lower scores in the PANSS total score (p<0.001), negative factor (p=0.002), and hostility factor (p=0.046). Further, the PSP score (p<0.001) and SSMS score (p=0.042) were significantly improved. In the two-factor analysis of negative symptoms, the MCT group showed significant improvements in both diminished expression (DE) symptoms (p<0.001) and social amotivation (SA) symptoms (p=0.010) after treatment. Multivariate linear regression analysis revealed that changes in the reduction rates of P2 (Conceptual disorganization), N7 (stereotyped thinking), and SA scores had a significant impact on the reduction in DE scores; changes in the reduction rates of P6 (Suspiciousness/persecution) and DE scores had a significant impact on the reduction rate of SA scores (p<0.05).ConclusionMCT can improve the clinical symptoms and functions of patients with schizophrenia, especially in the DE factor characterized by conceptual disorganization and stereotyped thinking, and the SA factor prominent in suspiciousness/persecution symptom. This provides insights for the precise treatment of negative symptoms.

Schizotypy offers a useful and unifying construct for understanding schizophrenia-spectrum psychopathology. Current conceptualizations and findings support a three-factor model of schizotypy consisting of positive, negative, and disorganized dimensions. However, recent studies have suggested four- and five-factor structures. The present study compared and examined the extent to which each factor model predicted interview and questionnaire outcome measures. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were employed to compare the three-factor model with five competing models using the items from the Multidimensional Schizotypy Scale (MSS) in 10,814 adults. We subsequently compared the supported models in terms of the prediction of interview (n = 339) and questionnaire assessed symptoms (n of 1,342 to 1,430) using hierarchical linear regressions. The three-, four-, and five-factor models provided the best fit. However, the four-and five-factor models generally did not improve the prediction of outcome measures, although exploratory analyses suggest some potential value for the negative schizotypy subfactor model. The present findings, along with previous validation studies, support positive, negative, and disorganized factors. Ultimately, we recommend that alternative factor and subfactor models of schizotypy should be developed from conceptual, not atheoretical-exploratory approaches.

Disorganization and disintegration in schizophrenia: Metacognitive capacity across levels of conceptual disorganization.

ABSTRACT Background: Prisoners endure life in confinement, separated from society. The harsh living conditions and stressful environment in prisons, among various other factors, increase the likelihood of inmates developing mental disorders. Female prisoners frequently encounter heightened psychosocial challenges due to a combination of factors, including the demanding prison environment and insufficient familial support. Hence, the present study was conducted to identify the prevalence of psychiatric morbidity in female prisoners. Subjects and Methods: A cross-sectional study was done among convicted female inmates of the Central Prison of Telangana after taking consent and required permissions from authority. The Brief Psychiatric Rating Scale (BPRS) was used to assess psychiatric morbidity among 82 female prisoners. Results: The mean age (± standard deviation) of the study population was 44.42 (±14.12) years. The prevalence of psychiatric morbidity according to BPRS scoring was 76.83%. 54.87% showed somatic concerns, 43.90% depressive symptoms, 30.48% anxiety symptoms, and feelings of guilt present in 21.95%. Psychotic symptoms such as suspiciousness present in 6.09%, hallucinatory behavior in 2.43%, unusual thought content in 5%, blunted affect in 2.43%, and conceptual disorganization in 6.09%. Grandiosity present in one candidate and multiple psychiatric symptoms were observed in many candidates. Conclusion: Within most societies, people with mental disorders face stigma and discrimination. This stigma usually persists in prison, with the person facing isolation due to imprisonment, further affecting their mental health. Data from the study suggest a high prevalence of psychiatric morbidity among female prisoners. Data from the study suggests a high prevalence of psychiatric morbidity among female prisoners, with somatic symptoms being the most common, followed by depressive symptoms. Many candidates had multiple psychiatric symptoms present simultaneously. There is a need for proper identification and treatment of mental illness among this underprivileged group.

7.3 Primary Thought Disorder or Autism with Anxiety and Trauma?

Schizophrenia is a severe chronic mental disorder characterized by hallucinations, delusions, and disorganized speech and behavior. On the other hand, isovaleric acidemia (IVA) is a rare metabolic disorder characterized by the accumulation of isovaleric acid and its metabolic byproducts in the body. To date, there is a notable absence of clinical descriptions concerning the simultaneous occurrence of IVA and schizophrenia in the existing literature. This report presents a clinical case involving the coexistence of IVA and Schizophrenia. A 25-year-old male patient diagnosed with comorbid IVA and schizophrenia was admitted to the psychiatric department due to worsening delusions and auditory hallucinations. Treatment with antipsychotics (clozapine 150mg/day and blonanserin 24mg/day) and metabolic agents (L-carnitine 3g/day and reduced glutathione 1.2g/day) reduced delusion severity, though delusions persisted, while auditory hallucinations resolved. In this case description, the authors describe a rare clinical case in which the patient presents with IVA and schizophrenia. This case discusses the potential pathways through which IVA may precipitate the onset of schizophrenia.

Formal thought disorder (FTD) reflects an impairment in the organisation, goal-directedness, and logical flow of thinking. It is a core feature of psychosis spectrum disorders encountered in patients ranging from early psychosis to chronic schizophrenia. However, less is known about individuals at ultra-high risk (UHR) for psychosis. This study aimed to examine the frequency and factor structure of FTD in UHR individuals and explore its associations with clinical characteristics. FTD was assessed in 122 UHR individuals using relevant items from the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms. We used exploratory factor analysis (EFA) using principal axis factoring to identify factor structures. Associations with clinical characteristics were investigated using two-group comparisons, correlations, and multivariable linear regression models. EFA revealed a three-factor structure-disorganisation, incoherence, and poverty-accounting for 48.50% of the variance. Only the poverty factor was negatively associated with attention composite scores (β = -0.229; p = 0.040) after correcting for age and education. Total FTD and poverty factor scores were negatively correlated with GAF (r = -0.340 and r = -0.343, respectively; p < 0.001). The ones who had impaired role functioning during the past month at admission had higher scores on the total FTD (U = 878.0; p < 0.001) as well as the poverty factor (U = 1166.0; p = 0.011). Our findings indicated that FTD in UHR individuals exhibits a three-factor structure, with the poverty factor significantly linked to global and cognitive functioning.

In this report, we describe an unknown patient who presented to the emergency department with severe catatonia and a constellation of symptoms indicative of a primary psychotic disorder. Simultaneously, the patient exhibited severe autobiographical memory impairment suggestive of a comorbid dissociative disorder. Our report offers insight into a rare instance in which catatonia, a primary psychotic disorder, and dissociative disorder may have intersected in a clinical case. While the patient was successfully treated with lorazepam for his catatonia, his psychotic symptoms responded only minimally to several antipsychotic trials. Ultimately, his psychotic symptoms, disorganized speech and behavior, and autobiographical memory impairment were refractory to treatment, including dual clozapine-risperidone therapy. Remarkably, the patient scored an 8/30 on the Montreal Cognitive Assessment with multidomain deficits in executive function, naming, delayed recall, language, and abstraction. Finally, the patient demonstrated limited vocabulary in his native language, consistent with low educational attainment. Based on his presentation and hospital course, a differential diagnosis, which included unspecified primary psychotic disorder with catatonia, dissociative amnesia, neurodevelopmental disorder, and cognitive malingering, was proposed. The findings from this case highlight the occurrence of co-existing psychotic and dissociative disorders with multidomain neurocognitive deficits and clinical challenges in treating these cases.

Study of Formal Thought disorder symptoms in adults with Level 1 Autism Spectrum Disorder: Correlations between TALD, ADOS-2, and other neuropsychological dimensions

Assessing language abnormalities using NLP methods in speech excerpts of individuals at ultra-high risk for bipolar disorder

Cognition in Treatment Resistant versus Non- Treatment Resistant Schizophrenia

Long acting injectables: new therapeutic weapons in the battle for shortening the Duration of Untreated Psychosis

Game On: Assessing the Therapeutic Benefits of Board Games in Schizophrenia Management

Psychotic symptoms during puerperium. Regarding a clinical case

“Unspecified Dissociative Disorder: A Case Report”

Gesture impairments are increasingly recognized as a core feature of schizophrenia, apparent across different domains and gesture categories. However, the potential differential effects of specific symptom domains on distinct types of gestures are unknown. The current study aimed to investigate whether specific domains of negative symptoms (NS) and formal thought disorder (FTD) relate to different aspects of gesture performance in patients with schizophrenia. Gesture accuracy was assessed using the well-established test of upper limb apraxia, which examines performance across 2 domains and 3 semantic categories in 87 patients with schizophrenia and 57 age- and gender-matched controls. Further, we used standardized clinical rating scales to assess NS and FTD across their different subdomains. Patients performed worse than controls in both domains and all gesture categories. Further, both NS and FTD were associated with gesture impairments, yet the associations were distinct. Negative symptoms, particularly avolition and affective flattening, as well as Objective Negative FTD, were specifically linked to reduced performance of pantomime meaningless gestures. Conversely, Objective Positive FTD was associated with a broader range of gesture deficits, impacting both imitation and pantomime domains, including intransitive and transitive gestures. Our findings reveal that gesture impairments in schizophrenia vary across distinct symptom domains, indicating that NS and FTD contribute differently to motor and cognitive dysfunctions suggesting different underlying neural mechanisms. These insights can guide targeted interventions to address specific gesture deficits based on underlying psychopathology.

BackgroundDisorganization symptoms are a core feature of schizophrenia, encompassing cognitive, affective, and behavioral manifestations such as formal thought and language disorders (FTD), motor disorganization, and inappropriate affect. Notably, FTD is considered the only symptom in schizophrenia influenced by genetic factors. Disorganization symptoms are strong predictors of non-response to antipsychotic treatment and are associated with abnormal brain activity and functional dysconnectivity. While disorganization is a hallmark of schizophrenia, it may also represent a dimensional phenotype with varying expression across the population. Its neurobiological basis likely involves disrupted synaptic and network connectivity. However, detecting disorganization remains challenging for clinicians due to its subtle and often non-pathological presentation. AI methods could assist by standardizing and automatizing diagnostic procedures, reducing clinician bias, and accelerating evaluation processes.Aims & ObjectivesThe goal of this project is to develop an AI-based Decision Support System (DSS) to automate the assessment of disorganization in schizophrenia patients and, more broadly, in the general population, according to the view that thought disorganization is a dimensional phenotype with solid neurobiological underpinnings and varying degrees of expression.MethodWe are testing AI-based methods to detect objective measures of thought and behavioral disorganization, including speech analysis, the Thought and Language Disorder (TALD) scale, gait and motor movement analysis, facial expression analysis, and neural responses to emotionally salient stimuli. The study recruits at least 60 schizophrenia patients, their first-degree relatives, and case-matched non-affected participants. Clinical, psychopathological, and cognitive data are collected per standard clinical procedures. Data are integrated with information from various sources:Emotional response: EEG helmet and IoT sensors detect disorganized emotional responses to stimuli.Language analysis: Natural Language Processing (NLP) techniques analyze speech and language abnormalities using the TALD scale and TASCAM DR40-X recordings.Movement and facial expression: Kinect recordings assess disorganization-related alterations in gait, fine motor movements, and emotional expressions during resting and behaviorally stimulated states.These multimodal data are used to train a Machine Learning/Deep Learning model, creating a predictive algorithm to quantify disorganization. Data are pre-processed, structured, and inputted into classifiers designed for the disorganization dimension, with outputs provided to a meta-classifier to assess disorganization severity in the individual.ResultsRecruitment is ongoing, with approximately 30 schizophrenia patients and 30 non-affected participants tested. Interim analyses will be conducted in February and March, with recruitment concluding in April. Preliminary data on the full sample will be available by May. AI algorithms are being trained on public databases to evaluate speech, facial expression, and movement performance metrics. The DeepTALD system has been implemented to automate scoring of the TALD scale. Preliminary results show a strong positive correlation (ρ = 0.72) between DeepTALD and clinician scores of TALD items on synthetic speech.Discussion & ConclusionsEarly results suggest that the DeepTALD system is a reliable tool for automating the detection of language and thought disorders. Future developments will focus on quantifying thought disorganization intensity at baseline and under stimulus. Ultimately, the goal is to create applications that monitor thought disorganization by tracking speech, movements, and facial expressions in naturalistic settings.

Schizophrenia is a severe psychotic disorder that is diagnosed by the presence of hallucinations or delusions along with disorganized speech, disorganized thought, or negative symptoms that are present for at least six months. Roughly 1 in 10,000 people a year are diagnosed with this psychiatric disorder. It is a chronic disorder requiring a lifetime of treatment of which antipsychotics have been the mainstay of this treatment. First-generation antipsychotics have dystonia, parkinsonism, and development of Tardive Dyskinesia as major side effects, and they are also nonspecific in terms of their actions. Second Generation antipsychotics target more specific dopamine and sometimes serotonin receptors with less dystonic side effects; however, there are additional concerns for the development of metabolic syndrome. This review aims to look at new medication on the market, lumateperone, for the treatment of Schizophrenia. In one four week study with 60mg and 120mg of Lumateperone compared, 4mg of Risperdal, and a placebo found that Lumateperone significantly decreased the total Positive and Negative Syndrome Scale (PANSS) from baseline. Safety analysis of this study also found that Lumateperone was not associated with EPS or significant weight gain. Another study found that 42mg of Lumateperone significantly decreased PANSS score over placebo and 28mg of Lumateperone with associated TEAEs of somnolence, sedation, fatigue, and constipation. In an open-label safety, patients were switched from their current antipsychotic to Lumateperone and then switched back to their previous treatment after six weeks. PATIENTS were found to have statistically significant improvements in metabolic parameters, weight, and endocrine parameters, which were all lost when they were switched back to their previous treatment and their schizophrenic symptoms at pre-trial levels or improved them while on Lumateperone. In a continuation of the previous study over 12 months, 4 TEAEs occurred in 5% or more of the participants: diarrhea, dry mouth, weight decrease, and headache. Prolactin, metabolic labs, BMI, and weight all decreased as compared to the standard of care. Pooled studies revealed EPS related TEAEs were less frequent in patients receiving 42 mg lumateperone over Risperdal. Another pooled study looked at the safety profile; they found patients treated with lumateperone, two TEAEs occurred at twice the placebo rate and at a rate of 5% or more: dry mouth (5% vs. 2.2%) and sedation (24.1% vs. 10.0%) though TEAE discontinuation rates were lower than with Risperdal. Taken together, data from these trials suggest that lumateperone can effectively treat positive symptoms, negative symptoms, and cognitive dysfunction in schizophrenia. Lumateperone entrance to the market introduces an innovative way to treat schizophrenia featuring both a novel mechanism of action and a markedly reduced side effect profile. Further research is needed to determine the efficacy of Lumateperone in treating bipolar disorder in addition to schizophrenia.

Thought disorder, characterized by disruptions in syntactic and semantic elements in language, is a core symptom of psychotic disorders. Understanding this language impairment is key to uncovering the underlying neuropathology and predicting treatment outcomes for individuals with schizophrenia and other psychotic disorders. Binomial ordering preferences (e.g. "salt and pepper" instead of "pepper and salt"), may be a quantifiable correlate of thought disorder and underlying linguistic impairments. We tested whether atypical binomial ordering can serve as a linguistic marker for psychosis symptoms. Participants with early-stage psychotic disorders and controls were recruited, and video-recorded interviews were transcribed for analysis. Identified binomial pairs were assessed using both the Google N-gram database and a logistic regression model to determine ordering preferences. Results showed that while both psychotic participants and controls preferred conventional binomial orderings, participants with psychotic disorders exhibited a higher rate of atypical binomial orderings. The use of atypical orderings was correlated with thought disorder, but not with other psychiatric symptoms or medications. Tracking binomial ordering can be a valuable marker of thought disorder but future studies are needed to determine whether this link remains stable or if it changes with disease progression.