Tangential thought
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Tangential Thought in Schizophrenia and Psychotic Disorders
Introduction to Tangential Thought
Tangential thought, a form of formal thought disorder, is characterized by a person's speech veering off-topic and failing to return to the original point. This symptom is commonly observed in schizophrenia and other psychotic disorders, impacting communication and cognitive coherence.
Computational Analysis of Tangential Thought
CoVec Tool for Measuring Thought Disorder
Recent advancements in computational linguistics have introduced tools like CoVec, which can objectively measure thought disorders such as tangentiality. CoVec analyzes the semantic similarity of words produced during tasks like semantic fluency tests. Studies have shown that CoVec can differentiate between controls and patients with schizophrenia, particularly those exhibiting derailment and tangentiality 13. Patients with tangentiality demonstrated significantly lower coherence in their speech patterns, as measured by CoVec's Coherence-5 and Coherence-10 metrics 13.
Replication Studies
Further research has replicated these findings in different patient samples, including those experiencing first-episode psychosis. These studies confirmed that patients with derailment and tangentiality had lower coherence scores compared to those without these thought disorders . This consistency across studies underscores the reliability of CoVec as a tool for detecting subtle differences in thought disorder severity.
Tangential Thought in Paranoid vs. Non-Paranoid Schizophrenia
Comparative Analysis
Research comparing paranoid and non-paranoid schizophrenia has found that tangentiality is more prevalent in chronic paranoid schizophrenics. However, other forms of thought disorder appear similarly across both subtypes . This suggests that while tangentiality may be a distinguishing feature in paranoid schizophrenia, it is not exclusive to it.
Tangential Thought in Mood Disorders
Challenging the Kraepelinian Dichotomy
The traditional Kraepelinian dichotomy separates severe mental illnesses into disorders of thought (e.g., schizophrenia) and disorders of mood (e.g., bipolar disorder). However, recent reviews suggest that severe mood disorders, such as mania, also exhibit thought disorders like tangentiality. This overlap challenges the clear-cut distinction between schizophrenia and psychotic mood disorders . In mania, the breakdown of selective attention mechanisms leads to the processing of tangential stimuli, contributing to disordered thinking .
Prognostic Implications of Thought Disorder
Long-Term Outcomes
The presence of thought disorder in early psychosis can have varying prognostic implications. Positive thought disorders, including tangentiality, do not significantly predict long-term outcomes. In contrast, negative thought disorders, such as poverty of speech, are associated with poorer long-term outcomes, particularly in schizophrenia . This distinction highlights the importance of differentiating between types of thought disorder when assessing prognosis.
Conclusion
Tangential thought is a significant symptom in schizophrenia and other psychotic disorders, impacting communication and cognitive coherence. Computational tools like CoVec provide objective measures to assess and track this symptom. The prevalence of tangentiality in both paranoid schizophrenia and severe mood disorders challenges traditional diagnostic boundaries, emphasizing the need for nuanced understanding and assessment of thought disorders in psychosis.
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