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Schizophrenia Bulletin 2003 29(3):459-471;
© 2003 by Oxford University Press and the Maryland Psychiatric Research Center (MPRC)
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© Oxford University Press

The Cognitive Basis of Disorganization Symptomatology in Schizophrenia and Its Clinical Correlates: Toward a Pathogenetic Approach to Disorganization

Marie-Christine Hardy-Baylé, M.D., Ph.D., Professor of Psychiatry, Yves Sarfati, M.D., Ph.D., Professor of Psychiatry and Christine Passerieux, M.D., Ph.D., Psychiatrist
Laboratoire Universitaire de Recherche, University of Paris V, and Department of Psychiatry, Centre Hospital ier de Versailles Le Chesnay, France

Send reprint requests to Dr. Y. Sarfati, Centre Hospitalier de Versailles, Hôpital Mignot, Consultation de Psychiatrie et de Psychologie, 177, rue de Versailles, 78157 Le Chesnay, France; e-mail: ysarfati{at}ch-versailles.fr

This article focuses on the schizophrenic disorganization syndrome, which was initially described by Bleuler (who used the term "dissociation") as lying at the heart of schizophrenia. While adopting a neo-Bleulerian approach, we describe schizophrenic disorganization using a pathogenetic hypothesis and a three-part structure. First, we discuss previous approaches to characterizing and defining schizophrenic disorganization, providing arguments in favor of a complementary approach to describing schizophrenic disorganization that relies on a pathogenetic analysis of the disorganization syndrome, and especially thought and language disorders. Second, we present two possible cognitive pathophysiological mechanisms that may explain schizophrenic disorganization: (1) a deficit in the integration of contextual information, based on the results of semantic priming studies; and (2) a theory of mind deficit, based on the results of studies of the attribution of mental states to others. We propose a cognitive model of schizophrenic dysfunctioning on the basis of these two anomalies. Third, we summarize our published findings to examine the implications of these two cognitive pathophysiological mechanisms for schizophrenic disorganization. On the basis of the same two anomalies, we then propose and illustrate a neo-Bleulerian approach to the assessment of communication disorders that is critical to the improvement of schizophrenic disorganization's clinical description.

Keywords: Schizophrenia / disorganization / semantic priming / contextual information / theory of mind / communication disorders


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