Alarabi Mohammed, Burton Leah, Powell Valerie, Isinger Tanner, Agarwal Sri Mahavir, Remington Gary
Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Canada.
Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Can J Psychiatry. 2025 Mar;70(3):229-239. doi: 10.1177/07067437241293985. Epub 2024 Nov 4.
Formal thought disorders (FTDs), a core feature of schizophrenia, have been subdivided into positive and negative types, and are clinically assessed by examining speech (objective) or patient introspection (subjective). Despite being associated with poorer treatment response and worse outcomes, FTDs have been understudied in patients with schizophrenia, in particular treatment-resistant schizophrenia (TRS) or schizoaffective disorder. We aimed to explore the relationship between the severity of positive and negative FTDs and neurocognition as well as social/occupational functioning in this clinical subgroup.
This was a retrospective chart review conducted at the Clozapine Clinic at the Centre for Addiction and Mental Health, Toronto, Canada. We reviewed charted standardized assessment of FTDs using the Thought and Language Disorder (TALD) scale, neurocognition using the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), and functioning using the Social and Occupational Functioning Assessment Scale (SOFAS) between October 2022 and June 2023. Following the original factor structure of the TALD, we computed 4- factor scores that combined positive or negative and objective or subjective FTDs. We then explored the correlation between the scores from each TALD factor and the neurocognition and functioning scores.
We analysed data for 23 outpatients on clozapine. After the Bonferroni adjustment, total TALD scores, indicating overall severity of FTDs, were strongly and inversely correlated with SOFAS scores ( < 0.001). A strong inverse correlation was found between the objective positive TALD factor and Letter-Number Span verbal working memory scores, (21) = -0.63, < 0.001.
Our results demonstrate the strong relationship between FTDs, neurocognition, and social/occupational functioning in a sample of TRS outpatients. Within the cognitive domains assessed, verbal working memory impairment had the strongest correlation with positive FTDs, such as derailment or tangentiality. These findings highlight the value of employing standardized psychopathological scales for FTDs in clinical practice.
形式思维障碍（FTDs）是精神分裂症的核心特征，已被细分为阳性和阴性类型，临床上通过检查言语（客观）或患者内省（主观）进行评估。尽管FTDs与较差的治疗反应和更差的预后相关，但在精神分裂症患者中，尤其是难治性精神分裂症（TRS）或精神分裂症性障碍患者中，对其研究较少。我们旨在探讨该临床亚组中阳性和阴性FTDs的严重程度与神经认知以及社会/职业功能之间的关系。
这是一项在加拿大多伦多成瘾与心理健康中心氯氮平诊所进行的回顾性病历审查。我们回顾了2022年10月至2023年6月期间使用思维和语言障碍（TALD）量表对FTDs进行的标准化评估图表、使用精神分裂症简易认知评估工具（B - CATS）对神经认知进行的评估图表，以及使用社会和职业功能评估量表（SOFAS）对功能进行的评估图表。按照TALD的原始因素结构，我们计算了4个因素得分，这些得分将阳性或阴性以及客观或主观的FTDs进行了合并。然后，我们探讨了每个TALD因素得分与神经认知和功能得分之间的相关性。
我们分析了23名服用氯氮平的门诊患者的数据。经过Bonferroni校正后，表明FTDs总体严重程度的TALD总分与SOFAS得分呈强烈负相关（<0.001）。在客观阳性TALD因素与字母 - 数字广度言语工作记忆得分之间发现了强烈的负相关，（21）=- 0.63，<0.001。
我们的结果表明，在TRS门诊患者样本中，FTDs、神经认知和社会/职业功能之间存在密切关系。在所评估的认知领域中，言语工作记忆损害与阳性FTDs（如思维脱逸或离题）的相关性最强。这些发现凸显了在临床实践中使用标准化精神病理量表评估FTDs的价值。
