The cognitive basis of disorganization symptomatology in schizophrenia and its clinical correlates: toward a pathogenetic approach to disorganization.

This article focuses on the schizophrenic disorganization syndrome, which was initially described by Bleuler (who used the term "dissociation") as lying at the heart of schizophrenia. While adopting a neo-Bleulerian approach, we describe schizophrenic disorganization using a pathogenetic hypothesis and a three-part structure. First, we discuss previous approaches to characterizing and defining schizophrenic disorganization, providing arguments in favor of a complementary approach to describing schizophrenic disorganization that relies on a pathogenetic analysis of the disorganization syndrome, and especially thought and language disorders. Second, we present two possible cognitive pathophysiological mechanisms that may explain schizophrenic disorganization: (1) a deficit in the integration of contextual information, based on the results of semantic priming studies; and (2) a theory of mind deficit, based on the results of studies of the attribution of mental states to others. We propose a cognitive model of schizophrenic dysfunctioning on the basis of these two anomalies. Third, we summarize our published findings to examine the implications of these two cognitive pathophysiological mechanisms for schizophrenic disorganization. On the basis of the same two anomalies, we then propose and illustrate a neo-Bleulerian approach to the assessment of communication disorders that is critical to the improvement of schizophrenic disorganization's clinical description.