Individuals with schizophrenia display odd, unusual and idiosyncratic behavior that results from defects in ego functioning. One aspect of this is loosening of ego boundaries. What I mean by fluid or loose ego boundaries is that there seems to be difficulties distinguishing internal fantasy and thoughts from external reality. Moreover, one’s internal world is not integrated. There appears to be internal chaos, confusion, and sometimes, overwhelming anxiety. This is the result of impairment in the primary autonomous ego functions. This constitutes basic contact with reality and integration of thought feelings, and perceptions.In acute phase of schizophrenia, there are five areas of disturbance (symptoms) that should be assessed. These include a disturbance of:
1. Thought form
2. Thought content
3. Perception
4. Emotion
5. Behavior
Most of these symptoms will be readily apparent in an interview.
Disturbance of Thought Form: This may be a “formal thought disorder”. Thinking is illogical and often incomprehensible. Characteristics of a formal thought disorder include (among others):
1. Loose Associations: Disconnection of ideas- jumping from topic to topic, often midsentence.
2. Overinclusivness: use of irrelevant information that interrupts logical thought.
3. Neologisms: Creation of new words- may have meaning to client.
4. Blocking: Speech simply stops mid-sentence- speech may start again in a few minutes, often in another place. May be the interference of hallucinations.
5. Clanging: Choice of words based on sounds- often rhymes a primary word in one sentence with a word in a previous sentence.
6. Echolalia: repeating words without concern for meaning.
7. Concreteness: Lack of ability to think in abstract terms.
8. Alogia: Also called poverty of speech. Speaks little, without intentional resistance. Individuals with a formal thought disorder, (which is pathognomonic of schizophrenia) appear to be caught up in an idiosyncratic world and have a relatively “unique” way of communicating. Other psychotic disorders may exhibit formal thought disorder.
Schizophreniform Disorder is virtually identical in the initial clinical presentation to schizophrenia except (according to the DSM-IV):
1. there is a shorter duration
2. the diagnosis does not require impaired occupational or social functioning (however, it is hard to imagine how psychosis would not impair functioning).
In addition, symptoms are usually more turbulent and functioning after the acute episode is usually better. An individual who presents with Brief Psychotic Disorder may also have formal thought disorder, but duration can be as short as one day and no longer than one month.
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