Thought Disorder in Schizophrenia

The Schizophrenia Spectrum

The schizophrenia spectrum is a set of related disorders with distinct symptoms associated with each diagnosis. Some disorders on the schizophrenia spectrum include schizophrenia, schizotypal personality disorder, schizoaffective disorder, and a few others.

The dysfunction that schizophrenia causes affects thought processes, mood, the senses, and, more broadly, the ability to easily speak and think with clarity and logic.

What Are Thought Disorders?

Thought disorders disrupt the flow of regular thinking and communication processes, causing widespread dysfunction that can extend to emotions, behavior, and the development of a sense of self.

Thought disorders are not unique to schizophrenia, nor do all people with schizophrenia experience thought disorders.

The National Institute of Health estimates that 50% of people with schizophrenia can be diagnosed with a formal thought disorder.

Types of Thought Disorders

The portion of people with schizophrenia who experience thought disorders has a variation or combination of some of the following types:

Ambivalence

One of the great hallmarks of thought disorders in people with schizophrenia is ambivalence. It has become a commonly used term, but it's an uncommon thought disorder with stricter terms in psychiatry.

In this thought disorder, a person simultaneously holds two opposite or contradictory thoughts or feelings, and the thought or feeling processes do not resolve through reasoning or mental effort alone.

Ambivalence creates a roadblock to decision-making and acting decisively. It can be a source of frustration in communication, in feeling fulfilled in goal setting, and in acting freely in ways that provide positive emotions that others come by as a matter of course, or without awareness.

Thought Withdrawal

This thought disorder is strongly indicative of schizophrenia spectrum disorders. By an unconscious and unforeseen force, a person with schizophrenia can suddenly become silent and withdrawn, gripped by thought withdrawal and removed from external input.

Speech and responsiveness become absent, and the person may remain unaware of their surroundings despite intervention.

Thought Blocking

Thought blocking happens often while people with schizophrenia speak, abruptly blocking what they mean to express.

Linear thought sharply curves into misdirection, leaving a sentence unfinished or obscured, beyond the person's ability or comfort to continue.

While awareness of the present moment remains clear, the person experiencing the block can quickly abandon the line of thought after the block occurs.

Loose Associations

Here, a line of thought derails, as well, but results in many ideas only loosely connected (or wholly disconnected) and offered rapidly.

Leaps in loosely tied meanings lead to unclear speech, with an obscure connection between the starting points and the conclusions the person intends to reach.

Thought Broadcasting

Thought broadcasting is tied to the processes of delusion.

The person affected by thought broadcasting believes that others around them can hear their thoughts; in effect, their thoughts are "broadcast" silently from the person's mind and beyond the person's control to others.

The perceived broadcasting of thoughts is troubling for people on the schizophrenia spectrum. It can create a sense of anxiety and loss of privacy that defies the freedom to think and be as they choose without external influences.

Word Salad

Word salad is an uncommon thought disorder that often appears in people on the spectrum who experience intense symptoms. Words spoken or written may have no connection and be strung together randomly (or so it appears to others).

Phrases may hold a hidden and significant meaning that only the person on the spectrum knows (but has no discernible meaning to those who hear it).

Neologisms

Put simply, neologisms are invented words by some people living with schizophrenia spectrum disorders.

These unique creations of language may also show a deeply held belief or an idea singular to the person's experience.

The invented word may have structure and meaning that others can understand to some degree, but even so, neologisms may create difficulty in gaining social acceptance due to the perception of the strange and unfamiliar word (or biases along the spectrum more broadly).

Clang Associations

This thought disorder relies on the phonetic effect or the pure sound of words.

Director of the Saks Institute for Mental Health Law, Policy, and Ethics at USC, Dr. Elyn Saks, wrote of a clang association in her memoir The Center Cannot Hold: My Journey Through Madness.

Recalling an episode in her time as a student at Yale Law School, studying with friends, she proclaimed, “We’ve got to case the joint! I don’t believe in joints, but they do hold your body together.”

The same word or phoneme may be repeated, but the only link is the different senses or forms that are close in sound.

Rhyming may also guide the flow of speech in clang associations, additionally, but with an ambiguous meaning throughout articulation.

The Cognitive Symptom Domain in the Schizophrenia Spectrum

A mix of the neurobiology and behavioral traits of schizophrenia underlies the appearance of the cognitive symptom domain on the schizophrenia spectrum.

When the brain's biology causes cognitive processes to collide, distortions in thought and communication emerge, affecting observable behavior and speech in people with cognitive dysfunction.

Types of Symptoms in the Cognitive Domain of the Schizophrenia Spectrum

Cognitive symptoms are separated from thought disorders directly, but they’re related to one another.

Though not all people living on the schizophrenia spectrum experience thought disorders, thought disorders may develop from the primary and underlying cognitive symptom domain that is featured broadly across the schizophrenia spectrum.

Some examples of the cognitive symptom domain include:

Social Cognition

The journal Nature reports that social processes follow particular neural pathways that can overlap throughout affected areas of the brain in people on the schizophrenia spectrum.

As a result, cognition is affected by symptoms of the spectrum, spanning various aspects of socializing, and while some strengths are retained, others can be challenging.

The challenges people on the schizophrenia spectrum often face extend primarily to reflective rather than reflexive aspects of social engagement, such as determining facial expression, understanding changes in vocal qualities, and mentalizing how thoughts relate interpersonally.

Contrasting the reflective processes of socializing, the reflexive actions taken in conversation and socializing remain intact. The preserved cognitions include things like discerning social cues, showing mutual emotion, and matching shared body language.

Attention and Vigilance

“Sustained attention” (as attention and vigilance are often called) is heavily affected by the sleep-wake cycle, Science Direct reports here. It is inseparable from physiology (or the functional processes of biology), as noted, and factors that complicate sustaining attention include sleep deprivation, drowsiness, and prescription drugs that affect the central nervous system.

Difficulties in sustaining attention manifest in various day-to-day circumstances. For example, determining signals in the environment and separating them from background noise remains difficult for those on the schizophrenia spectrum.

Even though attention and vigilance can be challenging, they do not appear to relate to the severity of overall symptoms, providing a partial means to manage and sustain attention through lifestyle and sleep management.

Executive Function

Planning and problem solving, cognitive flexibility, and self-regulating behavior in goal-directed action are a few of the areas of executive function.

Organizing the ins and outs of achieving goals, switching between tasks or ideas, and managing emotion and behavior greatly affect the well-being of people on the schizophrenia spectrum.

Managing relationships becomes difficult here as well, as does sustaining employment, due to barriers in decision-making and time management (and how those factors affect people’s perceptions and the demands of business operations).

Development in Treatments for Cognitive Symptoms

No treatments for the underlying factors of the primary cognitive symptoms exist, currently, and they are a major source of dysfunction for many on the schizophrenia spectrum.

To date, new medications have treated historically difficult symptoms of schizophrenia with some success (e.g., negative symptoms), but options for cognitive symptoms remain elusive.

The Schizophrenia Spectrum, Self-understanding, and Communication

Humans depend on communication and engaging with others to develop their personality and sense of self. However, the breakdown of communication and thought processes in some people who live on the schizophrenia spectrum prohibits the natural processes that build self-understanding and how others relate.

Experts have believed that thought disorders in schizophrenia are partly an issue of communication, even in the early observations.

Clinicians and researchers noted this in a review of communication on the schizophrenia spectrum, quoting Eugen Bleuler (the psychiatrist who invented the word schizophrenia):

"Bleuler classically confirms this perspective when he notes that the primary symptoms of schizophrenia 'find their expression in language.'"

Language is strongly linked to schizophrenia spectrum disorders, and following that trait, the concurrent effect on identity:

A recent examination by the National Institute of Health adds the dimensions of self-perception to the equation:

"…Thus, the data are now robust and unequivocally point to self-disorders as crucial trait phenomena, perhaps defining the extension of the schizophrenia spectrum… the diagnostic comparisons consistently show that self-disorders selectively hyper aggregate in schizophrenia."

Effects of Genes and Environment on the Schizophrenia Spectrum

Genetic factors can play a role in the development of schizophrenia (and the potential for thought disorders), but schizophrenia spectrum disorders are not strictly genetic.

Stressors in the environment can play an equally important role due to the conditions in which a person living on the schizophrenia spectrum experiences them.

If environmental conditions impose stressors that overwhelm the brain's ability to withstand them, the potential for disorder may arise.

The added vulnerabilities to stressors create difficulty in daily functioning and have effects on communication and self-perception.

Social acceptance may be restricted or withdrawn by people in the community due to the views of behavioral signs of schizophrenia spectrum disorders, and consequently, a reduced frequency of communication.

Sense of self can become disordered by circumstance in this way, and also by available resources for care in the regions where people on the schizophrenia spectrum live.

Diagnosis of Thought Disorder in Schizophrenia

Thought disorders do not always show up with consistency in people on the schizophrenia spectrum’s symptoms, and the severity of symptoms and thought disorder can vary over time.

Interviewing people who may have a schizophrenia spectrum disorder is one of the first courses of action healthcare professionals take, in addition to clinical personality or cognitive tests.

In patient interviews and tests, identifying an appropriate diagnosis will focus partly on the presence of a thought disorder.

Considering thought disorders as targets to treat specifically can be helpful, as clinicians use the presence of thought disorder to devise treatment plans and supportive services that better treat them.

Medications for Treatment of the Cognitive Symptom Domain

Medications to treat the cognitive symptom domain have not been developed or gained approval by the Federal Drug Administration in the US, and atypical antipsychotics used to treat symptoms of the schizophrenia spectrum show no proven effect, as of yet.

There have, however, been psychotherapy techniques shown to improve thought disorders.

Psychotherapeutic Treatments for Thought Disorders

Psychotherapy improves the health of people living on the schizophrenia spectrum with some success, even extending into resolving delusions.

Similar interventions to treat thought disorder focus on examining thought processes or finding solutions through communication-based treatments that target social and daily functioning challenges.

Some of the psychotherapeutic treatments developed include:

Cognitive Remediation Therapy (CRT)

This treatment consists of a structured program of drills and techniques to improve cognitive deficits in memory, attention, and executive function (planning, organizing, and regulating emotions).

Cognitive Behavioral Therapy (CBT)

This therapy involves challenging people's automatic thoughts and how those thoughts affect emotions and behavior.

Patients undergoing CBT treatment work through written exercises that help challenge distorted thought processes, which can improve thinking efficiency and reduce difficult emotions. Patients also attend therapy sessions based on principles of talk therapy.

Aerobic Exercise with Cognitive Training

This therapy combines aerobic exercise with cognitive remediation to leverage the enhanced effects of physical activity on mental resilience.

Aerobic Exercise with Cognitive Training

This therapy combines aerobic exercise with cognitive remediation to leverage the enhanced effects of physical activity on mental resilience.

Communication-based Therapy or Group Therapy

These treatments are prescribed to improve psychosocial abilities in a structured setting; their design aims to support daily living and practices that promote healthy social bonds and communication styles.

Attitudes on Mental Disorders as a Positive Impact on Wellbeing

Mental health and advocacy for people with mental disorders have become a fair public and media topic, and many take action on social media to advocate for the schizophrenia spectrum.

As a result, the chance to fight stereotypes and stigma reaches a broader audience and may inspire people to reach out to a person who deals with a mental disorder to offer support.

People with schizophrenia and disorders that cause distorted thought processes are especially vulnerable to isolation, stereotypes, and prejudice. But with greater support, they may live healthier, more rewarding lives and increase their likelihood of recovery.

*Disclaimer: This site's blogs have not been reviewed by a medical professional. Its content is intended solely for informational, illustrative, and expressive purposes only. Nothing in any content on the site should replace, substitute, or inform the advice of healthcare providers or any medical caretaker. Please consult a qualified medical professional to verify the information provided here.