Longitudinal Courses of Thought Disorder in Schizophrenia and Schizoaffective Disorder

Abstract

This research examined the longitudinal courses of thought disorder in schizophrenia, schizoaffective disorder, and other psychotic and nonpsychotic disorders. One-hundred-eighty young psychiatric inpatients were prospectively diagnosed at an early stage of illness and followed up and evaluated for thought disorder at 2, 4.5, and 7.5 years post-index hospitalization. Patterns of thought disorder were examined in relation to diagnosis, index thought disorder, demographic characteristics, prognostic factors, clinical states of psychosis, outcome at followup, and treatment. Courses of frequent and persistent thought disorder were most frequently found in schizophrenia. The prevalence and course of thought disorder over time in schizoaffective disorder laid between those in schizophrenia and those in other psychotic disorders. Demographic factors were not predictive of the course of thought disorder. Diagnosis, the presence of thought disorder at index, pre-index work and academic competence, and pre-index social functioning were associated with courses of thought disorder (when courses were classified as remitted/infrequent and frequent/persistent). The longitudinal relationships between thought disorder and psychosis suggested that, in schizophrenia, thought disorder is not simply a function of psychosis. Thought disorder appeared more closely tied to the presence of psychosis over time in schizoaffective disorder. Increased inquiry into the factors associated with different courses of thought disorder across psychiatric disturbances appears merited.

Understanding thought disorder in schizophrenia-spectrum disorders : exploring the relation and implications of affect.

“…Unfortunately, other studies that exhibited differences in remission rates between those with mania and schizophrenia did not discuss specific differences in pharmacological treatment (Andreasen & Grove, 1986;Jampala et al, 1989). Additional support for the role of affect in thought disorder in schizophrenia is illustrated by the findings from Marengo & Harrow (1997) that showed a negative correlation for thought disorder symptoms and anti-depressant medication for the total sample at baseline, and for schizophrenia only at two-year follow-up. However, no specific information was provided about sample characteristics or other pharmacological treatments for those receiving the anti-depressant medication.…”

“…Building on the early research from the CFS mentioned above, Marengo and Harrow (1997) evaluated the longitudinal course of thought disorder at admission, and again 2, 4.5, and 7.5 years after admission. Of the forty-five individuals with schizophrenia evaluated, 71% exhibited thought disorder at index.…”

“…However, examination of thought disorder longitudinally suggests that thought disorder remits almost completely in mania (Andreasen & Grove, 1986;Jampala et al, 1989) and somewhat in schizoaffective disorder (Andreasen & Grove, 1986;Marengo & Harrow, 1997), including significantly greater reductions overall in mania compared to schizophrenia (Harrow et al, 1982). While evaluated in several studies, findings regarding thought disorder and depression were often only vaguely discussed or neglected altogether.…”

“…The speculations about schizoaffective disorder are even more ambiguous, with discussion of the heterogeneous and "transitional" nature of the diagnosis (Andreasen & Grove, 1986, p. 358) and the suggestion that the combination of thought disorder, psychosis, and affective states may implicate a meaningful pattern for schizoaffective disorder, specifically (Marengo & Harrow, 1997).…”

Exploring a multifactorial, clinical model of thought disorder : application of a dimensional, transdiagnostic approach.

“…Thought disorder severity has been shown to increase as a function of illness duration (Maeda et al, 2007;Spohn et al, 1986) as well as number of hospitalizations (Marengo & Harrow, 1997;Spohn et al, 1986). However, inconsistent evidence also exists.…”