Thought Disorder in Schizophrenia

The Schizophrenia Spectrum

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

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

What Is Thought Disorder

Thought disorder disrupts the flow of regular thinking and communication processes, causing widespread dysfunction that extends to emotions, behavior, and developing 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.

The portion of people with schizophrenia who experience thought disorders has a variation 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 it, a person simultaneously holds two opposite and contradicting thoughts or feelings, and the thought or feeling processes do not resolve by reasoning or mental effort alone.

Ambivalence creates a roadblock to decision-making, and as a result, the ability to act decisively is challenging.

It can be a source of limitation in communication, feeling fulfilled in goal setting, and acting freely in ways that provide positive emotions.

Thought Withdrawal: This thought disorder strongly indicates schizophrenia. By an unconscious force, a person with schizophrenia can close down, gripped by thought withdrawal and removed from reality. Speech and responsiveness become absent, and it's apparent that the person will remain unaware of the space they occupy despite intervention.

Thought Blocking: Thought blocking happens often while people with schizophrenia speak, abruptly halting what they mean to express. A linear line of thinking sharply curves into misdirection, leaving a sentence unfinished or confused with the person's gaze at great inattention. Consciousness remains but is tenuous.

Loose Associations: Here, a line of thought derails, resulting in many ideas only loosely connected or not connected rationally rapidly offered. Leaps in the subject of their thought lead to tangential speech that has no connection between the starting and endpoints.

Thought Broadcasting: Thought broadcasting is closely related to the processes of delusion. The person affected by thought broadcasting believes that others around them can hear their thoughts, in effect, that they’re being "broadcast" or transmitted silently out of the person's mind and out of their control.

This transmission of thought is troubling for people with schizophrenia, as it creates a high degree of anxiety due to the perceived invasion of privacy that defies the person's comfort and liberty.

Word Salad: Word salad is an uncommon thought disorder that usually indicates a more severe illness. Words may have zero connection and are strewn together randomly.

For example, the nonsense phrase "pie barrel dish maggot" may hold a hidden meaning with significance for the person who connected that strange pairing of words, but they would have no discernible meaning to the average listener.

Neologisms: Put simply, neologisms are made-up words. These anomalies of language may have a deeply held belief or definition that is singular to a person with schizophrenia's experience. This thought disorder creates difficulty for people with schizophrenia to carry on relationships or gain social acceptance.

Clang Associations: This thought disorder relies on the phonetic effect or the pure sound of words. The same word may be repeated throughout a sentence, but the only link is based on the different definitions or meanings of the word. Rhyming can also guide the flow of words, as well, with no apparent reasoning in the content of the words themselves.

Causes and Effects of Thought Disorder in Schizophrenia

A mix of the neurobiology and behavioral traits of schizophrenia underlies the cause of thought disorders on this spectrum.

The irregular patterns of thinking begin when the biology of the brain and behavioral symptoms of schizophrenia collide, dysregulating the standard cognitive (or thought) processes people rely on.

As a result of the collision, distortions in thoughts emerge and affect the observable behavior of the person with schizophrenia.

Early Discoveries on the Schizophrenia Spectrum

Humans depend on communication and engaging with others to develop their personality. However, the breakdown of communication and thought processes in people with schizophrenia by nature reduces their ability to build self-understanding and how they relate to others around them.

The earliest clinical experts believed that thought disorders in schizophrenia are an issue of communication.

In a review of schizophrenia phenomena, Eugen Bleuler (the psychiatrist who named schizophrenia) is quoted to show how strongly and consistently schizophrenia is linked to language: "Bleuler classically confirms this perspective when he notes that the primary symptoms of schizophrenia 'find their expression in language.'"

A recent examination by the National Institute of Health continues the findings of the past but adds the dimensions of self-perception:

"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."

Genes and Environment in Thought Disorder and Schizophrenia

Genetic factors can play a partial role in the development of schizophrenia and thought disorders, but schizophrenia and thought disorders are not strictly genetic.

Stressors in the environment can play an equally important role due to the daily conditions in which a person with schizophrenia lives. If environmental conditions apply stressors that overpower the brain's ability to withstand them, the potential for disorder can arise.

The breakdown of communication and self-perception in thought disorders and schizophrenia creates difficulty in daily functioning with continued exposure to stressors.

Certain areas and systems of the brain (such as the prefrontal cortex and dopamine pathways) are susceptible to environmental stressors, and these regions and pathways are essential for the ability of the brain to reason, think clearly, and manage distress.

Diagnosis of Thought Disorder in Schizophrenia

Thought disorders do not always consistently show up in a person with schizophrenia's symptoms, and the severity of a thought disorder can vary over time.

Separating thought disorder from schizophrenia can be helpful here, as greatly disordered thoughts broadly indicate a more severe condition, which shows how well a patient may do in the future.

Interviewing people who may have schizophrenia is one of the first courses of action healthcare professionals take, in addition to clinical personality tests and cognitive tests, usually administered by a neuropsychologist.

In the interviews and tests taken by patients, identifying an appropriate diagnosis will partly focus on the presence of a thought disorder. With the collected information, clinicians can devise treatment plans and supportive services according to the diagnosis.

Medications for Thought Disorders in Schizophrenia

Medications and therapy help to resolve some of the symptoms of schizophrenia and the underlying factors that cause thought disorders, although symptoms of these two forms of disorders tend to persist and cause relative dysfunction to different degrees over a lifetime.

The most common medications to treat schizophrenia are second-generation antipsychotics, which treat many of the symptoms of the schizophrenia spectrum. These medications also positively affect thought disorders and improve how well the patients' thoughts remain organized.

Psychotherapeutic Treatments for Thought Disorders and Schizophrenia

Psychotherapy improves the health of people with schizophrenia with some success. These interventions mainly 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 the cognitive deficits related to 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 aid their ability to challenge distorted thought processes, which can improve thinking efficiency and reduce difficult emotions. They 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 physical activity's enhanced effect on mental resilience.

Communication-based Therapy or Group Therapy: These treatments are prescribed to improve psychosocial abilities in a structured setting—their design attempts to help with daily living and practices that promote healthy social bonds and communication styles.

The Future of Care: Precision-based Treatments

Precision psychiatry is a developing concept in mental healthcare. It focuses on the biological and environmental uniqueness of individual patients and applies strategies for prevention and recovery, leading to better outcomes.

This precision healthcare relies on biological and behavioral data as measurements for appropriate medical intervention.

Even now, genetic testing shows who will respond to specific medications optimally, as genetic variation can affect how effectively a medication will work.

Machine learning measures risks in current studies and neuroimaging of people known to have schizophrenia and thought disorders. Biodata informs treatment, which acts in part to reduce biases or limitations in the study of mental disorders.

Doctors no longer must rely solely on patient self-reporting to clearly understand and prescribe the best care regimen.

Attitudes on Mental Disorders Going Forwards

Mental health and advocacy for people with mental disorders have become a fair public and media topic. Many more people take action via social media, which is visible to the larger awareness of current generations.

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 and stereotypes. So, with greater support, they can live healthier and more rewarding lives and increase the likelihood of recovery.