Exploring a multifactorial, clinical model of thought disorder : application of a dimensional, transdiagnostic approach.

psychosis;thought disorder;dimensionality

Mara Ann Hart

University:University of Louisville

Department:Psychological and Brain Sciences

关键词: psychosis;    thought disorder;    dimensionality;   

Others  :  https://ir.library.louisville.edu/cgi/viewcontent.cgi?article=3941&context=etd

美国|英语

来源: The Universite of Louisville's Institutional Repository

【 摘 要 】

Background: Bleuler saw thought disorder as the core defining feature of psychotic phenomena, reflective of the “splitting of the psychic functions” that occurred when, in the process of thinking, one’s ideas and feelings disconnect, becoming fragmented and competing functions. Unfortunately, interest in thought disorder as the conceptual core of psychosis was lost with rise of the modern DSM system, paralleling the shift towards a more simplistic, categorical way of defining psychiatric disorders. Aims: This study examined thought disorder from a dimensional perspective, with the aim of disentangling qualitative heterogeneity and diverse sources of influence. Analyses were based on a large, transdiagnostic sample (n = 322), including individuals diagnosed with schizophrenia, schizoaffective disorder, and bipolar disorder. Structural equation modeling was used to estimate the unique and combined effects of family psychiatric history, age-at-onset, affective state, and sex on two dimensions of thought disorder, namely idiosyncratic thinking and combinatory thinking. We also explored the utility of categorical (i.e. DSM) diagnosis, by estimating the relative proportion of variance it accounted for within the model. Results: The overall model accounted for 11% of variance in idiosyncratic thinking and 3% of the variance in combinatory thinking. Negative affect was the strongest predictor of idiosyncratic thinking (r = .27), although this effect was significantly more robust in those with a family history of psychosis (r = .37) compared to those without (r = .02). DSM diagnosis was a significant predictor of IV, explaining 7% of unique variance when entered into the full model compared to 9% of the variance when estimated independently, which suggests that the portion of variance explained by diagnosis was largely independent of other predictors in the model. Discussion: The pattern of associations among family psychiatric history, age-at-onset, and negative affect that predicted idiosyncratic thinking are suggestive of a developmental process. This hypothesis is explored in the context of previous research. The broad implications of this research on the classification and study of psychosis is also discussed.