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Yu, Kim, Lee, Jang, Jung, Lee, Choi, and Park: Symptomatic Conceptualization of Disorganized Speech in Patients with Schizophrenia
Original Article

Korean J Schizophr Res 2015;18(2):51-58.

Published online: 17 January 2015

DOI: https://doi.org/10.16946/kjsr.2015.18.2.51

Symptomatic Conceptualization of Disorganized Speech in Patients with Schizophrenia

Jung Min Yu, MD1, Bomi Kim, MD2, Kyung-Min Lee, MD2, Eun Young Jang, PhD3, Hyun-Jin Jung, MD1, Kang-Uk Lee, MD, PhD4, Joonho Choi, MD, PhD3, 5, Seon-Cheol Park, MD, PhD2, 6

1Department of Psychiatry, Chuncheon National Hospital, Chuncheon, Korea

2Department of Psychiatry, Yong-In Mental Hospital, Yongin, Korea

3Department of Psychiatry, Hanyang University Guri Hospital, Guri, Korea

4Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Korea

5Department of Psychiatry, Hanyang University College of Medicine, Seoul, Korea

6Institute of Mental Health, Hanyang University, Seoul, Korea

Address for correspondence: Seon-Cheol Park, Department of Psychiatry, Yong-In Mental Hospital, 940 Jungbu-daero, Giheung-gu, Yongin 17089, Korea Tel: 031-288-0203, Fax: 031-288-0184, E-mail: cogito-ergo-sum@hanmail.net

Our study was supported by the Choi Shin-Hai Neuropsychiatry Research Fund (2013) of the Korean Foundation of Neuropsychiatry Research. The funding source had no further role in the study design, in the collection, analysis and interpretation of the data, in the writing of the report or in the decision to submit the paper for publication.

      Revised 10 June 20158 September 2015       Accepted 11 August 2015

Copyright © 2015 Korean Society for Schizophrenia Research

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Our study aimed to present the distinctive correlates of disorganized speech in patients with schizophrenia, using the Scale for the Assessment of Thought, Language and Communication (TLC scale).

Methods

We compared the formal thought and other clinical characteristics between schizophrenia inpatients with (n=82) and without (n=80) disorganized speech. Psychometric scales including the TLC scale, Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Calgery Depression Scale for Schizophrenia (CDSS) and Word Fluency Test (WFT) were used. The presence or absence of disorganized speech was established using transformed dummy variable of score on the Clinician-Rated Dimension of Psychosis Symptom Severity (CRDPSS).

Results

After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the poverty of contents of speech (p=0.001), distractible speech (p＜0.0001), tan-gentiality (p＜0.0001), derailment (p＜0.0001), incoherence (p＜0.0001), ilogicality (p＜0.0001), word approximations (p=0.003), loss of goal (p＜0.0001), blocking (p=0.006) and self-reference (p=0.002) items than those without disorganized speech. With defining the mentioned item scores as covariates, binary logistic regression model predicted that derailment (p=0.0001) and poverty of contents of speech (p＜0.0001) were significant independent-correlates of disorganized speech in patients with schizophrenia.

Conclusion

Our findings suggest that derailment and poverty of contents of speech are significant correlates of disorganized speech in patients with schizophrenia. Our findings might be used to evaluate disorganized speech in patients with schizophrenia efficiently.

Keywords: Disorganized speech, Formal thought disorder, Derailment, Poverty of contents of speech, Schizophrenia

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Table 1.
Comparison of baseline variables and assessment scale scores in schizophrenia patients with and without disorganized speech
Total sample (n=166) Disorganized speech Statistical coefficients Unadjusted p value Adjusted p value∗
Present (n=84) Absent (n=82)
Age, mean (SD) years 46.7 (11.2)0 49.7 (10.2)0 43.8 (11.2)00, t=3.556 ＜0.0001 -
Male, n (%) 85 (51.2)0 50 (59.5)0 35 (42.7)00, χ2=4.710 0.030 -
Unmarried, n (%) 128 (79.0)0 69 (85.2)0 59 (72.8)00, χ2 =3.722 0.054 0.342
Unemployed, n (%) 156 (95.1)0 80 (96.4)0 76 (93.8)00, χ2=0.578 0.447 0.446
Below high school graduate, n (%) 108 (73.0)0 58 (79.5)0 50 (66.7)00, χ2=3.066 0.080 0.869
Religious affiliation, n (%) 99 (61.9)0 50 (61.7)0 49 (62.0)00, χ2=0.001 0.969 0.217
Hospital χ2=3.135 0.077 0.139
 A 144 (86.7)0 69 (82.1)0 75 (91.5)00,
 B 22 (13.3)0 15 (17.9)0 7 (8.5)000,
Age at onset,† mean (SD) years 25.0 (6.9)00 24.8 (6.4)00 25.5 (7.5)000, t=-0.575 0.567 0.073
Brief Psychiatric Rating Scale, mean (SD) 40.1 (12.3)0 47.4 (11.5)0 32.7 (8.1)000, t=9.533 ＜0.0001 -
Young Mania Rating Scale, mean (SD) 7.3 (6.9)00 10.7 (7.4)00 3.9 (4.2)000, t=7.386 ＜0.0001 -
Calgary Depression Scale, mean (SD) 1.8 (2.6)00 1.5 (2.4)00 2.0 (2.7)000, t=-1.022 0.308 0.045
Word Fluency Test, mean (SD) 11.4 (6.0)00 9.5 (5.7)00 13.3 (5.7)000, t=-4.226 ＜0.0001 -
Chlorpromazine equivalent dose, mean (SD) mg 911.4 (952.5) 1057.9 (783.0) 777.3 (1,089.9) t=1.908 0.058 0.423

∗ : Adjusted for the effects of age, gender, and total scores on the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Word Fluency Test

† : n=131

Table 2.
Comparison of thought, language and communication item scores in schizophrenia patients with and without disorganized speech
Total sample (n=166) Disorganized speech
 Statistical coefficients Unadjusted p value Adjusted p value∗
Present (n=84) Absent (n=82)
Poverty of speech, mean (SD) 0.9 (1.0) 0.9 (1.0) 0.8 (0.9) t=0.830 0.408 0.381
Poverty of content of speech, mean (SD) 1.2 (1.2) 1.7 (1.3) 0.6 (0.8) t=7.172 ＜0.0001 0.001
Pressure of speech, mean (SD) 0.4 (0.7) 0.6 (0.8) 0.2 (0.5) t=4.087 ＜0.0001 0.020
Distractible speech, mean (SD) 0.5 (1.0) 0.9 (1.2) 0.2 (0.5) t=4.870 ＜0.0001 ＜0.0001
Tangentiality, mean (SD) 1.0 (1.3) 1.9 (1.3) 0.2 (0.5) t=11.034 ＜0.0001 ＜0.0001
Derailment, mean (SD) 1.1 (1.3) 2.0 (1.3) 0.2 (0.5) t=12.357 ＜0.0001 ＜0.0001
Incoherence, mean (SD) 0.7 (1.2) 1.3 (1.4) 0.1 (0.2) t=8.346 ＜0.0001 ＜0.0001
Illogicality, mean (SD) 1.0 (1.3) 1.7 (1.4) 0.3 (0.6) t=8.300 ＜0.0001 ＜0.0001
Clanging, mean (SD) 0.2 (0.6) 0.3 (0.8) 0.1 (0.2) t=3.123 0.002 0.105
Neologisms, mean (SD) 0.1 (0.5) 0.2 (0.7) 0.1 (0.1) t=3.188 0.002 0.298
Word approximations, mean (SD) 0.3 (0.7) 0.5 (0.9) 0.1 (0.2) t=4.252 ＜0.0001 0.003
Circumstiantiality, mean (SD) 0.8 (0.9) 1.1 (1.0) 0.4 (0.6) t=6.184 ＜0.0001 0.03
Loss of goal, mean (SD) 1.0 (1.1) 1.7 (1.0) 0.3 (0.5) t=12.061 ＜0.0001 ＜0.0001
Perservation, mean (SD) 0.5 (0.8) 0.7 (1.0) 0.2 (0.5) t=4.438 ＜0.0001 0.025
Echolalia, mean (SD) 0.1 (0.1) 0.1 (0.2) 0.1 (0.1) t=1.423 0.162 0.223
Blocking, mean (SD) 0.5 (0.9) 0.8 (1.0) 0.2 (0.6) t=4.625 ＜0.0001 0.006
Stilted speech, mean (SD) 0.5 (0.8) 0.5 (0.9) 0.5 (0.8) t=-0.185 0.853 0.624
Self-reference, mean (SD) 0.6 (0.9) 0.9 (1.0) 0.4 (0.7) t=3.404 0.001 0.002
Paraphasia, phonemic, mean (SD) 0.1 (0.4) 0.1 (0.5) 0.1 (0.1) t=2.163 0.034 0.864
Paraphasia, semantic, mean (SD) 0.2 (0.6) 0.3 (0.8) 0.1 (0.1) t=3.814 ＜0.0001 0.032
Total score, mean (SD) 11.1 (10.0) 18.1 (9.5) 4.5 (4.7) t=12.336 ＜0.0001 ＜0.0001

∗ : Adjusted for the effects of age, gender, and total scores on the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Word Fluency Test

Table 3.
Binary logistic regression analysis to identify predictors of presence of disorganized speech
B SE Wald Adjusted p-value∗ Adjusted OR∗ 95% CI
Poverty of content of speech 1.099 0.337 10.648 ＜0.0010 3.000 1.551-5.8030
Derailment 1.915 0.410 21.854 ＜0.0001 6.787 3.041-15.149

∗ : Adjusted for the effects of age, gender, and total scores on the Brief Psychiatric Rating Scale, Young Mania Rating Scale, and Word Fluency Test

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