Magazine article Clinical Psychiatry News

Thought Disorder Might Be Predictive of Psychosis

Magazine article Clinical Psychiatry News

Thought Disorder Might Be Predictive of Psychosis

Article excerpt

Thought disorder can precede psychosis by years and, in some cases, help predict its outcome.

A prospective study of patients with new-onset psychosis found high rates of thought disorder, regardless of the patients' underlying mental illness.

After 20 years of follow-up, thought disorder had remitted significantly more in bipolar patients than in patents with schizophrenia or schizoaffective disorder.

"Positive symptoms seemed to fade away over time and were less prominent [by 20 years' follow-up] in all groups," Dr. James A. Wilcox and his colleagues reported in the August issue of the journal. "By contrast, the more negative symptoms seemed to persist in schizophrenia and were less relenting overall."

Dr. Wilcox of the University of Arizona and his coauthors followed 188 patients with new-onset psychosis for 20 years.

In all, 68 had been diagnosed with schizophrenia, 60 with schizoaffective disorder, and 60 with bipolar disorder in the manic state. All of the patients provided a detailed personal history and were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Thought, Language, and Communication (TLC). Patients were reinterviewed at 10 and 20 years after initial presentation ( Compr. Psychiatry 2012;53:674-8).

The initial BPRS evaluation indicated that all patients were severely or extremely ill, with a mean score of 86 for those with schizophrenia, 81 for those with schizoaffective disorder, and 78 for those with bipolar disorder. The baseline mean TLC scores were 33, 32, and 29, respectively.

At the 10-year follow-up, the authors were able to re-assess 86% of the cohort. "We found that levels of thought disorder remained significantly higher in patients with schizophrenia than in all other groups," they noted. In contrast, "levels of thought disorder dropped considerably in patients with schizoaffective disorder and very significantly in subjects with bipolar disorder."

The mean TLC score at that evaluation was 23 for those with schizophrenia, 20 for those with schizoaffective disorder, and only 3 for those with bipolar disorder. The mean BPRS scores reflected a similar trend: They remained high for the schizophrenia and schizoaffective groups (70 and 68, respectively), and were significantly lower for those with bipolar disorder (38). …

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