Pfuhlmann B, Franzek E, Stöber G
Psychiatrische Klinik und Poliklinik, Universität Würzburg.
Fortschr Neurol Psychiatr. 1997 Dec;65(12):531-9. doi: 10.1055/s-2007-996360.
Formal thought disorders are usually regarded as a central symptom of schizophrenic psychoses, but nevertheless as diagnostically non-specific. Karl Leonhard, therefore, differentiated in his classification of endogenous psychoses between a whole lot of diagnostically specific types of formal thought disorders. He described two psychoses, of which formal thought disorder is the main psychopathological feature, i.e. confusion psychosis and cataphasia. By means of an analysis of tape-recorded utterances of patients with such psychoses we demonstrate the phenomenological differentiation of the distinct types of thought disorder in these psychoses. In confusion psychosis the disturbance concerns the thematic organisation and target-oriented direction of the train of thought. Characteristically, an "incoherence of thematic choice" results, reflecting a disturbance on the level of organisation of discourse. The concepts, ideas and themes itself are organised in a logically correct manner and are comprehensible. The thought disorder in cataphasia, however, shows severe logical faults in the connection of concepts and ideas, as a result of which single themes and ideas become a logical and incomprehensible. Moreover, cataphasic thought disorder goes beyond the level of discourse organisation and extends to disturbances of linguistic functions including mistakes on a semantical and syntactic level. These observations correspond well with the widely accepted assumption of a modular organisation of cognitive and linguistic processes. The thought disorder in prognostically unfavourable cataphasia concerns "basal" logical, semantic and syntactic systems, which remain uninfluenced in the prognostically favourable confusion psychosis. In the latter, therefore, the disorder is restricted to the higher functions of organisation of discourse.
形式思维障碍通常被视为精神分裂症性精神病的核心症状，但在诊断上并非特异性症状。因此，卡尔·莱昂哈德在内源性精神病的分类中，区分了许多具有诊断特异性的形式思维障碍类型。他描述了两种以形式思维障碍为主要精神病理特征的精神病，即错乱性精神病和言语急促杂乱症。通过对患有此类精神病患者的录音话语进行分析，我们展示了这些精神病中不同类型思维障碍的现象学差异。在错乱性精神病中，思维紊乱涉及思维链的主题组织和目标导向方向。其特征是出现“主题选择的不连贯性”，这反映了话语组织层面的紊乱。概念、想法和主题本身的组织方式在逻辑上是正确的且易于理解。然而，言语急促杂乱症中的思维障碍在概念和想法的联系上存在严重逻辑错误，结果单个主题和想法变得不合逻辑且难以理解。此外，言语急促杂乱性思维障碍超出了话语组织层面，还扩展到语言功能的紊乱，包括语义和句法层面的错误。这些观察结果与认知和语言过程模块化组织这一被广泛接受的假设非常吻合。预后不良的言语急促杂乱症中的思维障碍涉及“基础”的逻辑、语义和句法系统，而在预后良好的错乱性精神病中这些系统未受影响。因此，在后者中，紊乱仅限于话语组织的高级功能。
