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Neural Correlates of Formal Thought Disorder in Schizophrenia
Preliminary Findings From a Functional Magnetic Resonance Imaging Study
Tilo T. J. Kircher, MD, PhD;
P. F. Liddle, PhD, MRCPsych;
Michael J. Brammer, PhD;
Steve C. R. Williams, PhD;
Robin M. Murray, MD, MRCPsych;
Philip K. McGuire, MD, PhD, MRCPsych
Arch Gen Psychiatry. 2001;58:769-774.
Background Formal thought disorder (FTD) is a core symptom of schizophrenia, but
its pathophysiology is little understood. We examined the neural correlates
of FTD using functional magnetic resonance imaging.
Methods Blood oxygenation level–dependent contrast was measured using
functional magnetic resonance imaging while 6 patients with schizophrenia
and 6 control subjects spoke about 7 Rorschach inkblots for 3 minutes each.
In patients, varying degrees of thought-disordered speech were elicited during
each "run." In a within-subject design, the severity of positive FTD was correlated
with the level of blood oxygenation level–dependent contrast in the
2 runs that showed the highest variance of FTD in each patient.
Results The severity of positive FTD in patients was negatively correlated (P<.001) with signal changes in the left superior and
middle temporal gyri. Positive correlations were evident in the cerebellar
vermis, the right caudate body, and the precentral gyrus.
Conclusions The severity of positive FTD was inversely correlated with the level
of activity in the Wernicke area, a region implicated in the production of
coherent speech. Reduced activity in this area might contribute to the articulation
of incoherent speech. Because of the small sample size, these findings should
be considered preliminary.
From the Section of Neuroimaging (Drs Kircher and McGuire), the Division
of Psychological Medicine (Dr Murray), the Department of Biostatistics and
Computing (Dr Brammer), and the Neuroimaging Research Unit (Dr Williams),
Institute of Psychiatry and GKT School of Medicine, De Crespigny Park, London;
the Department of Psychiatry, University of British Columbia, Vancouver (Dr
Liddle); and the Department of Psychiatry, University of Tuebingen, Tuebingen,
Germany (Dr Kircher).
Corresponding author: Tilo T. J. Kircher, MD, PhD, Department of
Psychiatry, University of Tuebingen, Osianderstr. 24, D-72076 Tuebingen, Germany
(e-mail: tilo.kircher{at}uni-tuebingen.de).
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