Descriptive Psychopathology: The Signs and Symptoms of ...

237 Chapter 9: Disturbances in speech and languageExample:Q: “Mrs. Brown, where does it hurt?”A: “I’m away ...She didn’t come here ...She didn’t see ...It’s over there by thetree ... I can’t get this water on.”Formal thought disorder (FTD)The thought disorder literature traditionally blends the concepts of disorders ofthinking with disorders of language. 26 FTD, however, is best described andapplied to the discrimination of clinical syndromes as a form of aphasia. Oncetermed schizaphasia or cataphasia because of its presumed specificity to schizophrenia,27 FTD is recognized as consistent with the diagnosis of schizophrenia,but not pathognomonic of the condition. 28 When it occurs in schizophrenia, FTDis associated with emotional blunting, frontal lobe executive function problems,poor response to standard pharmacotherapy, long-term chronicity, and similarpathology in relatives. 29A historical perspectiveNineteenth and early twentieth century psychopathologists identified FTD by thepatient’s characteristic speech abnormalities. Later writers assumed that the disorderedspeech reflected disordered thinking, thus the term “thought disorder”. 30“Thinking disorder” became the clinical euphemism for schizophrenia, as opposedto “mood disorder” as the term for manic-depression. This aspect of the field ofpsychopathology has never recovered from this error, as investigators vainly searchfor the specific cognitive process distinguishing the two classes of illness.The focus on the thinking behind the speech rather than the speech itself addsto the confusion as disparate findings are reported for the same term that is usedto mean different things. Some investigators apply validated cognitive tests ofvarious aspects of thinking, while others rely on projective tests with poorreliability and validity, such as the Rorschach Test. Still others focus on the lexicalaspects of speech rather than the form of speech from an aphasiologist’s perspective.31 The last approach is taken here.Bleuler considered the thinking behind the speech as basic to his understandingof schizophrenia. Looseness of associations reflected a proposed autistic or dereisticthinking, the patient’s thoughts non-goal-directed, the content fantasy, and thepatient associating by sound, alliteration, or non-essential details until the centralidea was lost.Cameron continued the search for the characteristic schizophrenic thinkingproblem, and used the term asyndetic thinking to describe a lack of causal linkage