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Schizophrenia Bulletin 2000 26(4):879-891;
© 2000 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

Thought Disorder in Schizophrenia and Mania: Impaired Context

Martin Harrow, Ph.D., Professor and Director of Psychology, Kristin E. Green, M.S.W., James R. Sands, Ph.D., Assistant Professor, Thomas H. Jobe, M.D., Professor, Joseph F. Goldberg, M.D., Assistant Professor of Psychiatry, Kalman J. Kaplan, Ph.D., Professor and Eileen M. Martin, Ph.D., Ph.D., Associate Professor
Department of Psychiatry, University of Illinois College of Medicine Chicago, Illinois
UCLA Los Angeles, California
Department of Psychiatry, University of Illinois College of Medicine Chicago, Illinois
Department of Psychiatry, University of Illinois College of Medicine Chicago, Illinois
Payne Whitney Clinic, The New York Hospital, Cornell University Medical College New York City, New York
Department of Psychology, Wayne State University Detroit, Michigan
Department of Psychiatry, University of Illinois College of Medicine Chicago, Illinois

Send reprint requests to Dr. M. Harrow, Dept. of Psychiatry (M/C 912), 1601 W. Taylor St., Chicago, IL 60612-7327; e-mail: mharrow{at}psych.uic.edu

This research studied hypotheses that positive thought disorder in schizophrenia is influenced by patients' not taking in immediate target contextual material, thereby losing vital cues that guide thought processes. We assessed 164 acute inpatients (including 55 schizophrenia and 31 bipolar disorder patients), using standardized measures of thought disorder. We also used new measures that assessed (1) total ignoring of context, and (2) straying from the context. Results were as follows: (1) only 9 percent of the schizophrenia patients showed strong evidence of completely ignoring the external context; (2) straying from the external context while simultaneously maintaining part of the context was significantly more common than complete absence of context (p<0.01); (3) patients with thought disorder strayed from the context significantly more than patients without thought disorder (p<0.001); and (4) straying from the context was involved in the thought disorder of some, but not all, schizophrenia and mania patients. The data suggest that thought disorder in schizophrenia is not typically due to a failure to "hear" or to take in the relevant contextual material necessary for an appropriate response. Loss of context is involved in some, but not all, thought disorder in schizophrenia and mania.

Keywords: Schizophrenia / bipolar manic disorders / context / thought disorder / working memory / associative processes


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