Disorganised symptoms

What are disorganised symptoms in people with schizophrenia?

Key features of the symptoms of disorganisation include disorganised speech and behaviour, as well as inappropriate affect. Severely disorganised speech is difficult to follow, being incoherent, irrelevant and/or illogical. These symptoms are sometimes referred to as positive formal thought disorder. Disorganised speech may also be deprived of content, which is sometimes referred to as negative formal thought disorder symptoms. Disorganised behaviour includes bizarre or inappropriate behaviour, actions or gestures. Inappropriate (incongruous) affect involves exhibiting incorrect emotional responses for a given context.

Symptoms of disorganisation have been identified as risk factors for poor illness outcome, and have a significant negative effect on a person’s day-to-day functioning and quality of life. There is evidence to suggest that disorganisation symptoms may be associated with impaired cognitive performance.

What is the evidence regarding disorganised symptoms?

Moderate to high quality evidence found small to medium-sized associations between positive and negative formal thought disorder and poor cognition in the areas of memory, attention, processing speed, planning, semantic processing, social cognition, and social functioning. Positive formal thought disorder was particularly associated with poor inhibition and syntactic comprehension, while negative formal thought disorder was particularly associated with poor fluency. There was also a medium-sized association between poor insight (overall unawareness of having a mental disorder) and increased disorganised symptoms.

There was a small to medium-sized effect of more formal thought disorder symptoms in people with schizophrenia than in people with bipolar disorder. This effect was significant only in non-acute, stable patients.

High quality evidence shows significant concordance of disorganisation symptoms in siblings with schizophrenia. Low quality evidence suggests unclear concordance in twins with schizophrenia.

February 2022

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Last updated at: 4:53 pm, 21st March 2022
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