Individuals with Schizophrenia display odd, unusual, and idiosyncratic behavior that results from defects in ego functioning. One aspect of this is the loosening of ego boundaries. What I mean by fluid or loose ego boundaries is that there seems to be difficulty distinguishing internal fantasy and thoughts from external reality. Moreover, one's internal world is not integrated. There appears to be internal chaos, confusion, and sometimes, overwhelming anxiety. This is the result of impairment in the primary autonomous ego functions. This constitutes basic contact with reality and integration of thoughts, feelings, and perceptions.

In the acute phase of Schizophrenia, there are five areas of disturbance (symptoms) that should be assessed. These include a disturbance of:

1. Thought form

2. Thought content

3. Perception

4. Emotion

5. Behavior

Most of these symptoms will be readily apparent in an interview.

Terms:

1. Disturbance of Thought Form: Thinking is illogical and often incomprehensible.

2. Loose Associations: Disconnection of ideas - jumping from topic to topic, often mid-sentence.

3. Overinclusivness: Use of irrelevant information that interrupts logical thought.

4. Neologisms: Creation of new words - may have meaning to the client.

5. Blocking: Speech simply stops mid-sentence; speech may start again in a few minutes, often in another place. This may be the interference of hallucinations.

6. Clanging: Choice of words based on sounds - the client often rhymes a primary word in one sentence with a word in a previous sentence.

7. Echolalia: Repeating words without concern for meaning.

8. Concreteness: Lack of ability to think in abstract terms.

9. Alogia: Also called poverty of speech. Speaks little, without intentional resistance.

Individuals with Schizophrenia appear to be caught up in an idiosyncratic world and have a relatively "unique" way of communicating.

Other psychotic disorders may exhibit disturbance of thought. Schizophreniform Disorder is virtually identical in the initial clinical presentation to Schizophrenia except:

1. There is a shorter duration.

2. The diagnosis does not require impaired occupational or social functioning (however, it is hard to imagine how psychosis would not impair functioning).