Thought disorder

A deficiency of niacin also affects the nervous system. Numbness is initially observed and later, paralysis, particularly in the extremities is common. Severe cases are characteri2ed by tremor and a spastic or ataxic gait and are frequentiy associated with peripheral neuritis. Left untreated, severe thought disorders can ensue (1). 

Psychoses. Major thought disorders involving distorted perception and hallucinations. 

Neuroleptics or antipsychotics suppress the positive symptoms of schizophrenia such as combativeness, hallucinations and formal thought disorder. Some also alleviate the negative symptoms such as affective blunting, withdrawal and seclusiveness. Neuroleptics also produce a state of apathy and emotional indifference. Most neuroleptics block dopamine D2-receptors but some, like clozapine, also block dopamine D4-receptors or serotonin 5-hydroxytryptamine2A-receptors. 

Thought disorders. The patient believes that other people can read and control their thoughts. 

During weeks 2 and 3, the goals should be to improve socialization, self-care habits, and mood. Improvement in formal thought disorder may require an additional 6 to 8 weeks. 

Amphetamine and cocaine psychoses mimic subtypes of schizophrenia, but there is no classic thought disorder and there are no negative symptoms. 

Psychosis In psychotic children, administration of methylphenidate may exacerbate symptoms of behavior disturbance and thought disorder. 

Caplan, R., Guthrie, D., Tang, B., Komo, S., and Asarnow, R.F. (2000) Thought disorder in childhood schizophrenia replication and update of concept. J Am Acad Child Adolesc Psychiatry 39 771-778. 

Kiddie-Formal Thought Disorder Story Game and Kiddie Formal Thought Disorder Scale (K-FTDS) (Caplan et al., 1989) Procedures for eliciting and scoring speech samples Child 5-13... 

Thought Disorder Index (TDI) (Arboleda and Holzmann, 1985) Codes thought disorder from speech samples Child 5-16... 

Arboleda, C. and Holzman, P. (1985) Thought disorder in children at risk for psychosis. Arch Gen Psychiatry 42 1004-1013. 

Caplan, R., Perdue, S., Tanguay, R, and Fish, B. (1990) Formal thought disorder in childhood onset schizophrenia and schizotypal personality disorder. / Child Psychol Psychiatry 31 1103-1114. 

Antipsychotic medications, previously referred to as major tranquilizers or neuroleptics, are effective for the treatment of a variety of psychotic symptoms—such as hallucinations, delusions, and thought disorders—regardless of etiology. The term major tranquilizer is a misnomer because sedation is generally a side effect, and not the principal treatment effect. Similarly, the term neuroleptic is based on the neurological side effects characteristic of older antipsychotic drugs, such as catalepsy in animals and extrapyramidal side effects (EPS) in humans. 

Cognitive impairment positive formal thought disorder such as tangentialitv, loss of goals, incoherence, looseness of associations, neologisms. 

Antipsychotic effect. In schizophrenic patients, they improve thought disorders, blunted affect, withdrawal and self centered behaviour. They also improve the hallucinations and delusions. 

Iwanami A, OkajimaY, Kuwakado D, etal. Event-related potentials and thought disorder in schizophrenia. Sc/ zop/ r Res 2000 42 187-191. 

In contrast to Kraepelin, who emphasized the progressive course and poor outcome, the Swiss psychiatrist Eugen Bleuler ( 6) used a much broader concept of schizophrenia. Focusing on the thought disorder and the inconsistent, inappropriate, and disorganized affect, he identified four fundamental symptoms ... 

FIG. 5-3. Effects of neuroleptics on thought disorder and behavioral symptoms of schizophrenia. BPRS, Brief Psychiatric Rating Scale TDI, Thought Disorder Index. (From Davis JM, Barter JT, Kane JM. Antipsychotic drugs. In Kaplan HI, Sadock BJ, eds. Comprehensive textbook of psychiatry, 5th ed. Baltimore Williams Wilkins, 1989 1604, with permission.)... 

A collaborative VA study (364) found that the addition of imipramine or a monoamine oxidase inhibitor to CPZ did not benefit chronic psychotic patients any more than CPZ alone. Further, the addition of an amphetamine was slightly harmful. This finding has since been replicated in several studies on apathetic schizophrenic patients (365). A study of chronic ambulatory schizophrenics compared amitriptyline plus perphenazine with perphenazine alone ( 366). While they found the combination slightly better in ameliorating depressive symptoms, it was at the cost of a slight increase in patients thought disorder. 

Hurt SW, Hoizman PS, Davis JM. Thought disorder. Arch Gen Psychiatry 1983 40 1281-1285. 

Although the DSM-IV distinguishes between psychotic features that are either mood-congruent or mood-incongruent, the usefulness of this distinction remains controversial. Pope and Lipinski (12) found that schizophrenic symptoms were present in 20% to 50% of manic patients and that many of the delusions were mood-incongruent (i.e., delusions of persecution, catatonic symptoms, formal thought disorder, and auditory hallucinations not consistent with the mood state). 

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