Schizophrenia bulletin
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Schizophrenia bulletin · Jan 1986
Thought, language, and communication in schizophrenia: diagnosis and prognosis.
Using the Scale for the Assessment of Thought, Language, and Communication (TLC), we examined the frequency of "thought disorder" in 94 normal volunteers and 100 psychiatric patients (25 each suffering from manic disorder, schizoaffective disorder, schizophrenic disorder, disorganized type, and schizophrenic disorder, paranoid type). We observed the manics to have a substantial amount of thought disorder and the normals to have a modest amount, suggesting that thought disorder is probably not pathognomonic of schizophrenia. ⋯ Evaluation of the patients 6 months later indicated that most types of thought disorder remit in the manics, while they persist in the schizophrenics; patients with schizoaffective disorder also tend to improve substantially. The strongest predictor of outcome was the presence of negative thought disorder.
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Schizophrenia bulletin · Jan 1986
Schizophrenic thought disorder at followup: its persistence and prognostic significance.
To assess the prominence, persistence, and prognostic significance of positive thought disorder in schizophrenia, we studied a large sample of psychiatric inpatients at the acute phase and then followed them up twice--1 1/2-2 years and 4 years after hospital discharge. Positive thought disorder was more prominent at the acute phase in schizophrenic and manic patients than in other types of psychotic and nonpsychotic disorders. At followup, positive thought disorder did not persist for all schizophrenics, but a significantly larger percentage of schizophrenic than other psychotic and nonpsychotic patients followed a course in which positive thought disorder was either persistently or episodically present. ⋯ Positive thought disorder was one of several central features of the active schizophrenic disorder. Among schizophrenics, it was related to other major types of psychopathology, especially delusions, another positive symptom with cognitive-ideational elements. Severe positive thought disorder after the acute phase indicated a sustained episode, and suggested a more severe type of schizophrenia with a poorer prognosis.
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The authors used a reliable scale to assess quantity and quality of thought disorder in manic, schizophrenic, schizoaffective manic, and schizoaffective depressed patients. High levels of thought disorder occurred in all psychotic groups except in the schizoaffective depressed group. Manic patients produced thought disorders that revealed both prominent combinatory thinking and intrusions of irrelevant ideas into the stream of discourse, usually with flippancy and humor. ⋯ The schizoaffective manic patients more strongly resembled the schizophrenic patients in their production of idiosyncratic verbalizations and in confused thinking. Schizoaffective depressed patients showed a strikingly constricted output, but produced a few noteworthy absurd responses, and in that respect resembled the schizophrenic patients. The authors suggest that quality of thought disorder differs in schizophrenia and in mania, and that the thought disorder of schizoaffective conditions resembles that of schizophrenia.
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Schizophrenia bulletin · Jan 1981
Long-term community care: mental health policy in the face of reality.
Nursing homes play an important role in the care of chronic mental patients, and they could be used as one base on which to build a better system of care. Carling, in his article "Nursing Homes and Chronic Mental Patients: A Second Opinion," appears to question aspects of this contention. His efforts in this regard are interesting but unconvincing, though his thoughtful comments usefully elaborate the problems inherent in trying to incorporate nursing homes into the mainstream of mental health care. ⋯ Meanwhile, mental health policy must face the reality that nursing homes are providing useful services to many chronic mental patients who have been inadequately served by current community care programs. This is not likely to change in the foreseeable future. Policy advocates need to attend to practical alternatives, not just to idealized possibilities.
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Through a critical review of Shadish and Bootzin's (1981) work in "Nursing Homes and Chronic Mental Patients," the author defines the larger context in which this national problem occurs, presents important distinctions among various subgroups of nursing home residents, and summarizes some of the most glaring historical inadequacies of using institutions as the core of a mental health system. Through this approach, the presentation raises serious questions about Shadish and Bootzin's proposal to use nursing homes as a foundation on which to reconstruct an improved community services system for chronically mentally ill persons.