The Reality Distortion and Thought Disorganisation Dimensions

  • Lorenzo TarsitaniEmail author
  • Annalisa Maraone


The Reality Distortion dimension is characterised by erroneous perception or cognition of reality and includes disorders of thought content as well as illusions and hallucinations. Because psychotic experiences can be observed in patients with nonpsychotic mental disorders and in healthy subjects, the classical dichotomous definition of psychosis has been questioned in favour of a continuum view. Structural and functional brain abnormalities and hyperactivity of dopaminergic systems as correlates of reality distortion are mainly inferred from studies of schizophrenia. SVARAD scores across categorical diagnoses have detected low but clinically significant levels of reality distortion in patients with depressive disorders, obsessive-compulsive disorder, eating disorders, and borderline personality disorder. Antipsychotics are effective in reducing positive psychotic symptoms, and they can have an important role in the treatment of reality distortion in nonpsychotic mental disorders. Specific psychological interventions (mainly cognitive-behavioural therapy) addressing reality distortion symptoms have shown significant improvement in patients with psychotic disorders. The Thought Disorganisation dimension reflects an abnormal organisation of thought, which can lead to both disorganised speech and behaviour. In addition to schizophrenia, the disorganisation dimension can be detected in other mental disorders. The neurobiology underlying the Thought Disorganisation dimension is not completely understood. Structural neuroimaging in patients with thought disorders has found changes in different areas. The glutamate metabolism pathway has been described as a potential molecular mechanism influencing cognition and disorganisation in schizophrenia. Using the SVARAD with psychiatric inpatients, Thought Disorganisation dimension symptoms were detected in patients with severe nonpsychotic disorders, as well as mood disorders and borderline personality disorders. Treatment for Thought Disorganisation dimension symptoms presents some controversies, but some antipsychotic agents appear more effective than others, and psychosocial intervention might reduce the impact of disorganisation on functioning.


Reality distortion Delusion Hallucination Disorganisation Formal thought disorder 


  1. 1.
    Kraepelin E. Psychiatrie. Nine editions. Leipzig: Abel; 1883.Google Scholar
  2. 2.
    Jaspers K. Allgemeine psychopathologie (7th edn). Berlin: Springer; 1959.Google Scholar
  3. 3.
    Kiran C, Chaudhury S. Understanding delusions. Ind Psychiatry J. 2009;18(1):3–18.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Esquirol E. Mental maladies; a treatise on Insanity. Philadelphia, PA: Lea and Blanchard; 1845.Google Scholar
  5. 5.
    Berrios GE. The history of mental symptoms: descriptive psychopathology since the nineteenth century. Cambridge: Cambridge University Press; 1996.CrossRefGoogle Scholar
  6. 6.
    Waters F, Fernyhough C. Hallucinations: a systematic review of points of similarity and difference across diagnostic classes. Schizophr Bull. 2017;43(1):32–43.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Canstatt C. Handbuch der Medizinischen klinik. Stuttgart: Enke; 1841.Google Scholar
  8. 8.
    Feuchtersleben E. v. Lehrbuch der Ärztlichen Seelenkunde. Wien: Gerold; 1845.Google Scholar
  9. 9.
    Bürgy M. The Concept of psychosis: historical and phenomenological aspects. Schizophr Bull. 2008;34(6):1200–10.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Flemming CF. Pathologie und Therapie der Psychosen. Berlin: Hirschwald; 1859.Google Scholar
  11. 11.
    Möbius PJ. Über die Einteilung der Krankheiten. Neurologische Betrachtungen Centralbibliothek Nervenheilkd Psychiatr. 1892;15:289–301.Google Scholar
  12. 12.
    Kraepelin E. Psychiatrie: Ein Lehrbuch für Studirende und Aerzte. 5th ed. Leipzig: JA Barth; 1896.Google Scholar
  13. 13.
    Bleuler E. Dementia praecox oder Gruppe der Schizophrenien. Leipzig: Deuticke; 1911.Google Scholar
  14. 14.
    Hoenig J. The concept of Schizophrenia. Kraepelin-Bleuler-Schneider. Br J Psychiatry. 1983;142:547–56.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Hoff P. Emil Kraepelin und die Psychiatrie als Klinische Wissenschaft. Ein Beitrag zum Selbstverständnis Psychiatrischer Forschung. Berlin: Springer; 1994.CrossRefGoogle Scholar
  16. 16.
    Jaspers K. Allgemeine psychopathologie. Berlin: Springer; 1913.Google Scholar
  17. 17.
    Strauss JS. Hallucinations and delusions as points on continua function. Arch Gen Psychiatry. 1969;21:581–6.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Claridge G. Final remarks and future directions. In: Claridge G, editor. Schizotypy. Implications for Illness and Health. Oxford: Oxford University Press; 1997. p. 301–17.CrossRefGoogle Scholar
  19. 19.
    Peters ER, Joseph SA, Garety PA. Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophr Bull. 1999;25(3):553–76.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Stefanis NC, Hanssen M, Smirnis NK, Avramopoulos DA, Evdokimidis IK, Stefanis CN, et al. Evidence that three dimensions of psychosis have a distribution in the general population. Psychol Med. 2002;32(2):347–58.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Verdoux H, van Os J. Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophr Res. 2002;54(1-2):59–65.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Linscott RJ, van Os J. An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med. 2013;43:1133–49.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Van Os J, Schizophrenia KS. Lancet. 2009;374:635–45.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Tien AY. Distributions of hallucinations in the population. Soc Psychiatry Psychiatr Epidemiol. 1991;26:287–92.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Posey TB, Losch ME. Auditory Hallucinations of Hearing Voices in 375 Normal Subjects. Imag Cogn Personal. 1983;3(2):99–113.CrossRefGoogle Scholar
  26. 26.
    Barrett TR, Etheridge JB. Verbal hallucinations in normals. I: People who hear voices. Appl Cogn Psychol. 1992;6:379–87.CrossRefGoogle Scholar
  27. 27.
    Al-Issa I. Social and cultural aspects of hallucinations. Psychol Bull. 1977;84:570–87.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Schwab MEA. study of reported hallucinations in a Southeastern county. Ment Health Soc. 1977;4:344–54.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Morgan C, Fisher H, Hutchinson G, Frissa S, study team SELCH, Hotopf M, et al. Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample. Acta Psychiatr Scand. 2009;119:226–35.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Johns LC, Nazroo JY, Bebbington P, Kuipers E. Occurrence of hallucinatory experiences in a community sample and ethnic variations. Br J Psychiatry. 2002;180:174–8.PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    van Os J, Hanssen M, Bijl R-V, Ravelli A. Straus (1969) revisited: a psychosis continuum in the general population? Schizophr Res. 2000;45:11–20.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    van Os J, Hanssen M, Bijl RV, Vollebergh W. Prevalence of psychotic disorder and community level of psychotic symptoms: an urban–rural comparison. Arch Gen Psychiatry. 2001;58:663–8.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Zammit S, Kounali D, Cannon M, et al. Psychotic experiences and psychotic disorders at age 18 in relation to psychotic experiences at age 12 in a longitudinal population-based cohort study. Am J Psychiatry. 2013;170:742–50.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    van Os J, Linscott RJ. Introduction: the extended psychosis phenotype – relationship with schizophrenia and with ultrahigh risk status for psychosis. Schizophr Bull. 2012;38:227–30.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Hanssen M, Peeters F, Krabbendam L, Radstake S, Verdoux H, van Os J. How psychotic are individuals with non-psychotic disorders? Soc Psychiatry Psychiatr Epidemiol. 2003;38:149–54.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Honings S, Drukker M, Groen R, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2015;30:1–15.Google Scholar
  37. 37.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  38. 38.
    Wigman JT, van Nierop M, Vollebergh WA, Lieb R, Beesdo-Baum K, Wittchen HU, et al. Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity implications for diagnosis and ultra-high risk research. Schizophr Bull. 2012;38:247–57.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Hamner MB, Frueh BC, Ulmer HG, Arana GW. Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1999;45(7):846–52.PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Foa EB, Kozak MJ, Goodman WK, Hollander E, Jenike MA, Rasmussen SA. DSM-IV field trial: obsessive-compulsive disorder. Am J Psychiatry. 1995;152:90–6.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Raveendranathan D, Narayanaswamy JC, Reddi SV. Response rate of catatonia to electroconvulsive therapy and its clinical correlates. Eur Arch Psychiatry Clin Neurosci. 2012;262(5):425–30.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Ropacki SA, Jeste DV. Epidemiology of and risk factors for psychosis of Alzheimer’s disease: a review of 55 studies published from 1990 to 2003. Am J Psychiatry. 2005;162(11):2022–30.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Ostling S, Gustafson D, Blennow K, Börjesson-Hanson A, Waern M. Psychotic symptoms in a population-based sample of 85-year-old individuals with dementia. J Geriatr Psychiatry Neurol. 2011;24(1):3–8.PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    Forsaa EB, Larsen JP, Wentzel-Larsen T, Goetz CG, Stebbins GT, Aarsland D, et al. A 12-year population-based study of psychosis in Parkinson disease. Arch Neurol. 2010;67(8):996–1001.PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    DeLisi LE, Sakuma M, Tew W, Kushner M, Hoff AL, Grimson R. Schizophrenia as a chronic active brain process: a study of progressive brain structural change subsequent to the onset of schizophrenia. Psychiatry Res. 1997;74:129–40.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Lieberman J, Chakos M, Wu H, Hoffman E, Robinson D, Bilder R. Longitudinal study of brain morphology in first episode schizophrenia. Biol Psychiatry. 2001;49:487–99.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Johnstone EC, Crow TJ, Frith CD, Husband J, Kreel L. Cerebral ventricular size and cognitive impairment in chronic schizophrenia. Lancet. 1976;2:924–6.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Ward KE, Friedman L, Wise A, Schulz SC. Metaanalysis of brain and cranial size in schizophrenia. Schizophr Res. 1996;22:197–213.PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Wringht IC, Rabe-Hesketh S, Woodruff PW, David AS, Murray RM, Bullmore ET. Meta-analysis of regional brain volumes in schizophrenia. Am J Psychiaty. 2000;157(1):16–25.CrossRefGoogle Scholar
  50. 50.
    Lawrie SM, Abukmeil SS. Brain abnormalities in schizophrenia: a systematic and quantitative review of volumetric magnetic resonance imaging studies. Br J Psychiatry. 1998;172:110–20.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Nelson MD, Saykin AJ, Flashman LA, Riordan HJ. Hippocampal volume reduction in schizophrenia as assessed by magnetic resonance imaging: a meta-analytic study. Arch Gen Psychiatry. 1998;55:433–40.CrossRefPubMedGoogle Scholar
  52. 52.
    Woodruff PW, McManus IC, David AS. Meta-analysis of corpus callosum size in schizophrenia. J Neurol Neurosurg Psychiatry. 1995;58:457–61.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Vita A, De Peri L, Silenzi C, Dieci M. Brain morphology in first-episode schizophrenia: a meta-analysis of quantitative magnetic resonance imaging studies. Schizophr Res. 2006;82:75–88.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Csernansky JG, Cronenwett WJ. Neural networks in schizophrenia. Am J Psychiatry. 2008;165:937–9.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Ellison-Wright I, Glahn DC, Laird AR, Thelen SM, Bullmore E. The Anatomy of first-episode and chronic schizophrenia: an anatomical likelihood estimation meta-analysis. Am J Psychiatry. 2008;165:1015–23.PubMedPubMedCentralCrossRefGoogle Scholar
  56. 56.
    Glahn DC, Laird AR, Ellison-Wright I, Thelen SM, Robinson JL, Lancaster JL, et al. Meta-analysis of gray matter anomalies in schizophrenia: application of anatomic likelihood estimation and network analysis. Biol Psychiatry. 2008;64:774–81.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Shenton ME, Dickey CC, Frumin M, McCarley RWA. review of MRI findings in schizophrenia. Schizophr Res. 2001;49:1–52.PubMedPubMedCentralCrossRefGoogle Scholar
  58. 58.
    Kubicki M, McCarley R, Westin CF, Park HJ, Maier S, Kikinis R, et al. A review of diffusion tensor imaging studies in schizophrenia. J Psychiatr Res. 2007;41:15–30.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Kanaan RA, Kim JS, Kaufmann WE, Pearlson GD, Barker GJ, McGuire PK. Diffusion tensor imaging in schizophrenia. Biol Psychiatry. 2005;58:921–9.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Ellison-Wright I, Bullmore E. Meta-analysis of diffusion tensor imaging studies in schizophrenia. Schizophr Res. 2009;108:3–10.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Schizophrenia ANC. the fundamental questions. Brain Res Brain Res Rev. 2000;31:106–12.CrossRefGoogle Scholar
  62. 62.
    Liddle PF. Functional imaging—schizophrenia. Br Med Bull. 1996;52:486–94.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Hubl D, Koenig T, Strik W, Federspiel A, Kreis R, Boesch C, et al. Pathways that make voices: white matter changes in auditory hallucinations. Arch Gen Psychiatry. 2004;61:658–68.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Andreasen N. The scale for the assessment of positive symptoms (SAPS). Iowa City, IA: University of Iowa; 1984.Google Scholar
  65. 65.
    Bopp MHA, Zöllner R, Jansen A, Dietsche B, Krug A, Kircher TTJ. White matter integrity and symptom dimensions of schizophrenia: a diffusion tensor imaging study. Schizophr Res. 2017;184:59–68.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Curcic-Blake B, Nanetti L, van der Meer L, Cerliani L, Renken R, Pijnenborg GH, et al. Not on speaking terms: hallucinations and structural network disconnectivity in schizophrenia. Brain Struct Funct. 2015;220(1):407–18.PubMedCrossRefPubMedCentralGoogle Scholar
  67. 67.
    Poletti M, Gebhardt E, Raballo A. Corollary discharge, self-agency, and the neurodevelopment of the psychotic mind. JAMA Psychiat. 2017;74:1169.CrossRefGoogle Scholar
  68. 68.
    Ford JM, Mathalon DH, Heinks T, Kalba S, Faustman WO, Roth WT. Neurophysiological evidence of corollary discharge dysfunction in schizophrenia. Am J Psychiatry. 2001;158(12):2069–71.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Rossum V. Arch Int Pharmacodyn Ther. 1966;160:492–4.PubMedPubMedCentralGoogle Scholar
  70. 70.
    Angrist BM, Gershon S. The phenomenology of experimentally induced amphetamine psychosis—preliminary observation. Biol Psychiatry. 1970;2:95–107.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Matthysse S. Dopamine and the pharmacology of schizophrenia: the state of the evidence. J Psychiatr Res. 1974;11:107–13.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Stevens J. An anatomy of schizophrenia? Arch Gen Psychiatry. 1973;29:177–89.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Abi-Dargham A, Gil R, Krystal J, Baldwin RM, Seibyl JP, Bowers M, et al. Increased striatal dopamine transmission in schizophrenia: confirmation in a second cohort. Am J Psychiatry. 1998;155(6):761–7.PubMedPubMedCentralGoogle Scholar
  74. 74.
    Abi-Dargham A, Rodenhiser J, Printz D, Zea-Ponce Y, Gil R, Kegeles LS, et al. Increased baseline occupancy of D2 receptors by dopamine in schizophrenia. Proc Natl Acad Sci U S A. 2000;97(14):8104–9.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Zakzanis KK, Hansen KT. Dopamine D2 densities and the schizophrenic brain. Schizophr Res. 1998;32(3):201–6.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Bell DS. The experimental reproduction of amphetamine psychosis. Arch Gen Psychiatry. 1973;29:35–40.PubMedCrossRefPubMedCentralGoogle Scholar
  77. 77.
    Griffith JJ, Oates J, Cavanaugh J. Paranoid episodes induced by drugs. JAMA. 1968;205:39.Google Scholar
  78. 78.
    Lieberman JA, Kane JM, Sarantakos S, et al. Prediction of relapse in schizophrenia. Arch Gen Psychiatry. 1987;44:597–603.PubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Laruelle M, Abi-Dargham A, van Dyck CH, Gil R, D’Souza CD, Erdos J, et al. Single photon emission computerized tomography imaging of amphetamine-induced dopamine release in drug-free schizophrenic subjects. Proc Natl Acad Sci U S A. 1996;93(17):9235–40.PubMedPubMedCentralCrossRefGoogle Scholar
  80. 80.
    Kapur S. Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. Am J Psychiatry. 2003;160(1):13–23.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Kapur S, Mizrahi R, Li M. From dopamine to salience to psychosis--linking biology, pharmacology and phenomenology of psychosis. Schizophr Res. 2005;79(1):59–68.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Roncero C, Comín M, Daigre C, Grau-López L, Martínez-Luna N, Eiroa-Orosa FJ, et al. Clinical differences between cocaine-induced psychotic disorder and psychotic symptoms in cocaine-dependent patients. Psychiatry Res. 2014;216(3):398–403.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Fénelon G, Alves G. Epidemiology of psychosis in Parkinson’s disease. J Neurol Sci. 2010;289(1-2):12–7.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Park SY, Kang UG. Hypothetical dopamine dynamics in mania and psychosis its pharmacokinetic implications Original Research Article. Prog Neuro-Psychopharmacol Biol Psychiatry. 2013;43:89–95.CrossRefGoogle Scholar
  85. 85.
    Corlett PR, Taylor JR, Wang XJ, Fletcher PC, Krystal JH. Toward a neurobiology of delusions. Prog Neurobiol. 2010;92(3):345–69.PubMedPubMedCentralCrossRefGoogle Scholar
  86. 86.
    Healy D. The creation of psychopharmacology. Cambridge, MA: Harvard University Press; 2002.CrossRefGoogle Scholar
  87. 87.
    Guttmacher MS. Phenothiazine treatment in acute schizophrenia; effectiveness: the National Institute of Mental Health Psychopharmacology Service Center Collaborative Study Group. Arch Gen Psychiatry. 1964;10:246–61.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Hogarty GE, Ulrich RF, Mussare F, Aristigueta N. Drug discontinuation among long term, successfully maintained schizophrenic outpatients. Dis Nerv Syst. 1976;37:494–500.PubMedPubMedCentralGoogle Scholar
  89. 89.
    Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet. 2013;382(9896):951–62.CrossRefPubMedGoogle Scholar
  90. 90.
    Lehman AF, Kreynbuhl J, Buchanan RW, Dickerson FB, Dixon LB, Goldberg R, et al. The Schizophrenia Patient Outcomes Research Team (PORT): updated treatment recommendations 2003. Schizophr Bull. 2004;30:193–217.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Kuipers E, Fowler D, Garety P, Chisholm D, Freeman D, Dunn G, et al. London-East Anglia randomized controlled trial of cognitive-behavioural therapy for psychosis, III: follow-up and economic evaluation at 18 months. Br J Psychiatry. 1998;173:61–8.PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Tarrier N, Yusupoff L, Kinney C, McCarthy E, Gledhill A, Haddock G, et al. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ. 1998;317:303–7.PubMedPubMedCentralCrossRefGoogle Scholar
  93. 93.
    Tarrier N, Wittkowski A, Kinney C, McCarthy E, Morris J, Humphreys L. Durability of the effects of cognitive-behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up. Br J Psychiatry. 1999;174:500–4.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Garety P, Fowler D, Kuipers E, Freeman D, Dunn G, Bebbington P, et al. London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. II: predictors of outcome. Br J Psychiatry. 1997;171:420–6.PubMedCrossRefPubMedCentralGoogle Scholar
  95. 95.
    Morrison AP, Turkington D, Wardle M, Spencer H, Barratt S, Dudley R, et al. A preliminary exploration of predictors of outcome and cognitive mechanisms of change in cognitive behaviour therapy for psychosis in people not taking antipsychotic medication. Behav Res Ther. 2012;50(2):163–7.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    Morrison AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother. 2001;29:257–76.Google Scholar
  97. 97.
    Kumari V, Fannon D, Peters ER, ffytche DH, Sumich AL, Premkumar P, et al. Neural changes following cognitive behaviour therapy for psychosis: a longitudinal study. Brain. 2011;134(8):2396–407.PubMedPubMedCentralCrossRefGoogle Scholar
  98. 98.
    Fridlund AJ. Human facial expression: an evolutionary view. San Diego, CA: Academic Press; 1994.Google Scholar
  99. 99.
    Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PEA. cognitive model of persecutory delusions. Br J Clin Psychol. 2002;41(Pt 4):331–47.PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Hardy-Baylé MC, Sarfati Y, Passerieux C. The cognitive basis of disorganization symptomatology in schizophrenia and its clinical correlates: toward a pathogenetic approach to disorganization. Schizophr Bull. 2003;29(3):459–71.PubMedCrossRefPubMedCentralGoogle Scholar
  101. 101.
    Guy W. Assessment manual for psychopharmacology ECDEU. Rockville, MD: U.S. Department of Health and Human Services; 1976.Google Scholar
  102. 102.
    Crow TJ. Molecular pathology of schizophrenia: more than one disease process? Br Med J. 1980;280:66–8.PubMedPubMedCentralCrossRefGoogle Scholar
  103. 103.
    Liddle PF. Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychol Med. 1987;17:49–57.PubMedCrossRefPubMedCentralGoogle Scholar
  104. 104.
    Andreasen N. The scale for the assessment of negative symptoms (SANS). Iowa City, IA:University of Iowa; 1983.Google Scholar
  105. 105.
    Pancheri P, Romiti R, Maselli P, Marconi PL. SCADIS: una nuova scala per la valutazione della disorganizzazione. 2. Omogeneità, struttura fattoriale, validità concorrente, attendibilità. Giorn Ital Psicopat. 1996;3:232–46.Google Scholar
  106. 106.
    Brugnoli R, Pacitti F, Tarsitani L, Troisi A, Rossi A, Pancheri P. Dimensione disorganizzazione in corso di schizofrenia e funzionamento sociale. Giorn Ital Psicopat. 2006;12:208–16.Google Scholar
  107. 107.
    Picardi A, Viroli C, Tarsitani L, Miglio R, de Girolamo G, Dell’Acqua G, et al. Heterogeneity and symptom structure of schizophrenia. Psychiatry Res. 2012;198:386–94.PubMedCrossRefPubMedCentralGoogle Scholar
  108. 108.
    Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10:799–812.CrossRefGoogle Scholar
  109. 109.
    Thomas P, Fraser W. Linguistics, human communication, and psychiatry. Br J Psychiatry. 1994;165:585–92.PubMedCrossRefPubMedCentralGoogle Scholar
  110. 110.
    Yudofsky SC, Hales RE. The American Psychiatric publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric Association; 2002.Google Scholar
  111. 111.
    Covington MA, He C, Brown C, Naçi L, McClain JT, Fjordbak BS, et al. Schizophrenia and the structure of language: the linguist’s view. Schizophr Res. 2005;77:85–98.PubMedCrossRefPubMedCentralGoogle Scholar
  112. 112.
    Dwyer K, Peters E, McKenna P, David A, McCarthy R. Verbatim recall in formal thought disorder in schizophrenia: a study of contextual influences. Cogn Neuropsychiatry. 2014;19(4):337–58.PubMedCrossRefPubMedCentralGoogle Scholar
  113. 113.
    Stirling J, Hellewell J, Blakey A, Deakin W. Thought disorder in schizophrenia is associated with both executive dysfunction and circumscribed impairments in semantic function. Psychol Med. 2006;36:475–84.PubMedCrossRefPubMedCentralGoogle Scholar
  114. 114.
    Tan EJ, Rossell SL. Building a neurocognitive profile of thought disorder in schizophrenia using a standardized test battery. Schizophr Res. 2014;152:242–5.PubMedCrossRefPubMedCentralGoogle Scholar
  115. 115.
    Docherty NM, Hawkins KA, Hoffman RE, Quinlan DM, Rakfeldt J, Sledge WH. Working memory, attention and communication disturbances in schizophrenia. J Abnorm Psychol. 1996;105:212–9.PubMedCrossRefPubMedCentralGoogle Scholar
  116. 116.
    Higashima M, Urata K, Kawasaki Y, Maeda Y, Sakai N, Mizukoshi C, et al. P300 and the thought disorder factor extracted by factor-analytic procedures in schizophrenia. Biol Psychiatry. 1998;44:115–20.PubMedCrossRefPubMedCentralGoogle Scholar
  117. 117.
    Drake RJ, Dunn G, Tarrier N, Haddock G, Haley C, Lewis S. The evolution of symptoms in the early course of non-affective psychosis. Schizophr Res. 2003;63:171–9.PubMedCrossRefPubMedCentralGoogle Scholar
  118. 118.
    Picardi A, Battisti F, de Girolamo G, Morosini P, Norcio B, Bracco R, et al. Symptom structure of acute mania: a factor study of the 24-item Brief Psychiatric Rating Scale in a national sample of patients hospitalized for a manic episode. J Affect Disord. 2008;108:183–9.PubMedCrossRefPubMedCentralGoogle Scholar
  119. 119.
    Perugi G, Medda P, Swann AC, Reis J, Rizzato S, Mauri M. Phenomenological subtypes of severe bipolar mixed states: a factor analytic study. Compr Psychiatry. 2014;55:799–806.PubMedCrossRefPubMedCentralGoogle Scholar
  120. 120.
    Pacchiarotti I, Nivoli AM, Mazzarini L, Kotzalidis GD, Sani G, Koukopoulos A, et al. The symptom structure of bipolar acute episodes: in search for the mixing link. J Affect Disord. 2013;149:56–66.PubMedCrossRefPubMedCentralGoogle Scholar
  121. 121.
    Perlick DA, Rosenheck RA, Clarkin JF, Sirey J, Raue P. Symptoms predicting inpatient service use among patients with bipolar affective disorder. Psychiatr Serv. 1999;50:806–12.PubMedCrossRefPubMedCentralGoogle Scholar
  122. 122.
    Ventura J, Lukoff D, Nuechterlein KH, Liberman RP, Green MF, Shaner A. Brief Psychiatric Rating Scale (BPRS) expanded version: scales, anchor points, and administration manual. Int J Methods Psychiatr Res. 1993;3:227–43.Google Scholar
  123. 123.
    Kay SR, Fiszbein A, Opler LA. The Positive And Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261–76.PubMedCrossRefPubMedCentralGoogle Scholar
  124. 124.
    Dazzi F, Shafer A, Lauriola M. Meta-analysis of the Brief Psychiatric Rating Scale e Expanded (BPRSE) structure and arguments for a new version. J Psychiatr Res. 2016;81:140–51.PubMedCrossRefPubMedCentralGoogle Scholar
  125. 125.
    Pancheri P. La 3-TRE una scala per la valutazione rapida della sintomatologia schizofrenica. I: basi teoriche, descrizione, campi di applicazione. Riv Psichiatr. 1995;30:205–23.Google Scholar
  126. 126.
    Goldman-Rakic PS, Selemon LD. Functional and anatomical aspects of prefrontal pathology in schizophrenia. Schizophr Bull. 1997;23:437–58.PubMedCrossRefPubMedCentralGoogle Scholar
  127. 127.
    Olypher AV, Klement D, Fenton AA. Cognitive disorganization in hippocampus: a physiological model of the disorganization in psychosis. J Neurosci. 2006;26(1):158–68.PubMedCrossRefPubMedCentralGoogle Scholar
  128. 128.
    Sumner PJ, Bell IH, Rossell SL. A systematic review of the structural neuroimaging correlates of thought disorder. Neurosci Biobehav Rev. 2018;84:299.PubMedCrossRefPubMedCentralGoogle Scholar
  129. 129.
    Castner SA, Vosler PS, Goldman-Rakic PS. Amphetamine sensitization impairs cognition and reduces dopamine turnover in primate prefrontal cortex. Biol Psychiatry. 2005;57(7):743–51.PubMedCrossRefPubMedCentralGoogle Scholar
  130. 130.
    Phillips WA, Silverstein SM. Convergence of biological and psychological perspectives on cognitive coordination in schizophrenia. Behav Brain Sci. 2003;26(1):65–82. discussion 82–137.PubMedCrossRefPubMedCentralGoogle Scholar
  131. 131.
    Bertolino A, Sciota D, Brudaglio F, Altamura M, Blasi G, Bellomo A, et al. Working memory deficits and levels of N-acetylaspartate in patients with schizophreniform disorder. Am J Psychiatry. 2003;160(3):483–9.PubMedCrossRefPubMedCentralGoogle Scholar
  132. 132.
    Haig AR, Gordon E, De Pascalis V, Meares RA, Bahramali H, Harris A. Gamma activity in schizophrenia: evidence of impaired network binding. Clin Neurophysiol. 2000;111:1461–8.PubMedCrossRefPubMedCentralGoogle Scholar
  133. 133.
    Hoffman RE, McGlashan TH. Reduced corticocortical connectivity can induce speech perception pathology and hallucinated ‘voices’. Schizophr Res. 1998;30:137–41.PubMedCrossRefPubMedCentralGoogle Scholar
  134. 134.
    Josin GM, Liddle PF. Neural network analysis of the pattern of functional connectivity between cerebral areas in schizophrenia. Biol Cybern. 2001;84:117–22.PubMedCrossRefPubMedCentralGoogle Scholar
  135. 135.
    Silverstein SM, Kovacs I, Corry R, Valone C. Perceptual organization, the disorganization syndrome, and context processing in chronic schizophrenia. Schizophr Res. 2000;43:11–20.PubMedCrossRefPubMedCentralGoogle Scholar
  136. 136.
    Izawa R, Yamamoto S. Spatio-temporal disintegration of visual perception in schizophrenia as revealed by a novel cognitive task, the Searchlight Test. Schizophr Res. 2002;53(1-2):67–74.PubMedCrossRefPubMedCentralGoogle Scholar
  137. 137.
    Bressler SL. Cortical coordination dynamics and the disorganization syndrome in schizophrenia. Neuropsychopharmacology. 2003;28(Suppl 1):S35–9.PubMedCrossRefPubMedCentralGoogle Scholar
  138. 138.
    Kiehl KA, Smith AM, Hare RD, Liddle PF. An event-related potential investigation of response inhibition in schizophrenia and psychopathy. Biol Psychiatry. 2000;48(3):210–21.PubMedCrossRefPubMedCentralGoogle Scholar
  139. 139.
    Minzenberg MJ, Laird AR, Thelen S, Carter CS, Glahn DC. Meta-analysis of 41 functional neuroimaging studies of executive function in schizophrenia. Arch Gen Psychiatry. 2009;66(8):811–22.PubMedPubMedCentralCrossRefGoogle Scholar
  140. 140.
    Weickert TW, Goldberg TE, Gold JM, Bigelow LB, Egan MF, Weinberger DR. Cognitive impairments in patients with schizophrenia displaying preserved and compromised intellect. Arch Gen Psychiatry. 2000;57(9):907–13.PubMedCrossRefPubMedCentralGoogle Scholar
  141. 141.
    Schmahmann J, Pandya D. Fiber Pathways of the Brain. Oxford: Oxford University Press; 2006.CrossRefGoogle Scholar
  142. 142.
    Jia P, Wang L, Meltzer HY, Zhao Z. Common variants conferring risk of schizophrenia: a pathway analysis of GWAS data. Schizophr Res. 2010;122(1):38–42.PubMedPubMedCentralCrossRefGoogle Scholar
  143. 143.
    Coyle JT, Tsai G. The NMDA receptor glycine modulatory site: a therapeutic target for improving cognition and reducing negative symptoms in schizophrenia. Psychopharmacology (Berl). 2004;174(1):32–8.CrossRefGoogle Scholar
  144. 144.
    Neill JC, Barnes S, Cook S, Grayson B, Idris NF, McLean SL, Harte MK. Animal models of cognitive dysfunction and negative symptoms of schizophrenia: focus on NMDA receptor antagonism. Pharmacol Ther. 2010;128(3):419–32.PubMedCrossRefPubMedCentralGoogle Scholar
  145. 145.
    Adler CM, Malhotra AK, Elman I, Goldberg T, Egan M, Pickar D, et al. Comparison of ketamine-induced thought disorder in healthy volunteers and thought disorder in schizophrenia. Am J Psychiatry. 1999;156(10):1646–9.PubMedCrossRefPubMedCentralGoogle Scholar
  146. 146.
    Allen RM, Young SJ. Phencyclidine-induced psychosis. Am J Psychiatry. 1978;135(9):1081–4.PubMedCrossRefPubMedCentralGoogle Scholar
  147. 147.
    Stone JM, Dietrich C, Edden R, Mehta MA, De Simoni S, Reed LJ, et al. Ketamine effects on brain GABA and glutamate levels with 1H-MRS: relationship to ketamine-induced psychopathology. Mol Psychiatry. 2012;17(7):664.PubMedCrossRefPubMedCentralGoogle Scholar
  148. 148.
    Stone JM, Pepper F, Fam J, Furby H, Hughes E, Morgan C, et al. Glutamate, N-acetyl aspartate and psychotic symptoms in chronic ketamine users. Psychopharmacology (Berl). 2014;231(10):2107–16.CrossRefGoogle Scholar
  149. 149.
    Merritt K, Egerton A, Kempton MJ, Taylor MJ, McGuire PK. Nature of glutamate alterations in schizophrenia: a meta-analysis of proton magnetic resonance spectroscopy studies. JAMA Psychiat. 2016;73(7):665–74.CrossRefGoogle Scholar
  150. 150.
    Thomas EHX, Bozaoglu K, Rossell SL, Gurvich C. The influence of the glutamatergic system on cognition in schizophrenia: a systematic review. Neurosci Biobehav Rev. 2017;77:369–87.PubMedCrossRefPubMedCentralGoogle Scholar
  151. 151.
    Lee J, Park S. Working memory impairments in schizophrenia: a meta-analysis. J Abnorm Psychol. 2005;114(4):599–611.PubMedCrossRefPubMedCentralGoogle Scholar
  152. 152.
    Corves C, Engel RR, Davis J, Leucht S. Do patients with paranoid and disorganized schizophrenia respond differently to antipsychotic drugs? Acta Psychiatr Scand. 2014;130(1):40–5.PubMedCrossRefPubMedCentralGoogle Scholar
  153. 153.
    Harvey PD, Keefe RSE. Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. Am J Psychiatry. 2001;158:176–84.PubMedCrossRefPubMedCentralGoogle Scholar
  154. 154.
    Weiss EM, Bilder RM, Fleischhacker WW. The effects of second-generation antipsychotics on cognitive functioning and psychosocial outcome in schizophrenia. Psychopharmacology (Berl). 2002;162:11–7.CrossRefGoogle Scholar
  155. 155.
    Stip E, Chouinard S, Boulay LJ. On the trail of a cognitive enhancer for the treatment of schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29(2):219–32.PubMedCrossRefPubMedCentralGoogle Scholar
  156. 156.
    Cavelti M, Homan P, Vauth R. The impact of thought disorder on therapeutic alliance and personal recovery in schizophrenia and schizoaffective disorder: an exploratory study. Psychiatry Res. 2016;239:92–8.PubMedCrossRefPubMedCentralGoogle Scholar
  157. 157.
    Hamm J, Firmin RL. Disorganization and individual psychotherapy for schizophrenia: a case report of metacognitive reflection and insight therapy. J Contemp Psychother. 2017;46:227.CrossRefGoogle Scholar
  158. 158.
    Norman RM, Malla AK, Cortese L, Cheng S, Diaz K, McIntosh E, et al. Symptoms and cognition as predictors of community functioning: a prospective analysis. Am J Psychiatry. 1999;156:400–5.PubMedPubMedCentralGoogle Scholar
  159. 159.
    Pilling S, Bebbington P, Kuipers E, Garety P, Geddes J, Orbach G, et al. Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychol Med. 2002;32(5):763–82.PubMedPubMedCentralGoogle Scholar
  160. 160.
    Ventura J, Thames AD, Wood RC, Guzik LH, Hellemann GS. Disorganization and reality distortion in schizophrenia: a meta- analysis of the relationship between positive symptoms and neurocognitive deficits. Schizophr Res. 2010;121(1-3):1–14.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Human NeurosciencesSapienza University of RomeRomeItaly

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