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Disorganized speech is a symptom that frequently is associated with disorders of thought or perception (the inability to form coherent or logical thoughts). Disorganized speech can take many forms, including repetition of words or phrases, nonsensical speech, the invention of new words (neologisms), the appearance of speaking with people who are not there, pressured or rushed speech, jumbled speech (word salad), or other forms of incoherent speech. Disorganized speech is one of the main symptoms of certain forms of schizophrenia, although any condition that impairs thought can cause this symptom. Disorganized speech may be associated with other symptoms such as auditory or visual hallucinations, unusual behavior patterns, abnormal motor behavior, mood changes (including depression), delusions, and lack of ability to carry out daily functions. Other causes of disorganized speech
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Jameson, J. Larry, et al. Harrison's Principles of Internal Medicine, 20th Ed. New York: McGraw-Hill Education, 2018.
Medically reviewed by Alex Klein, PsyD — Written by Yvette Brazier — Updated on October 13, 2020
Disorganization is a symptom of schizophrenia. In the past, doctors considered “disorganized schizophrenia” to be a subtype of the condition, but this is no longer the case. As a symptom of schizophrenia, “disorganization” refers to incoherent and illogical thoughts and behaviors. While this issue once defined a subtype of schizophrenia, mental health professionals no longer use any subtypes when diagnosing or classifying the condition. This is because the qualities that defined these subtypes are not stable. As a result, the subtypes are not reliable or useful, when making a diagnosis, for example. The fifth, and latest, edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published in 2013, defines schizophrenia as a single condition, which may or may not include disorganization.
The following are the key types of schizophrenia symptoms. We give examples and more details below.
A person with delusions believes things that are untrue, such as that someone is persecuting them or that they have extraordinary powers or gifts. Some people with schizophrenia hide to protect themselves from an imagined pursuer. Someone having a hallucination sees, feels, tastes, or smells things that are not there. For example, a person may hear voices that seem real, even though they are not. Having “disorganized speech and thoughts” refers to an inability to form coherent or logical thoughts, and this leads to disorganized speech. During a conversation, a person with this symptom might leap from one topic to another. When the issue is severe, a person’s speech may be garbled and impossible for someone else to understand. Disorganized or catatonic behavior can vary from being childlike and silly to aggressive and violent. This type of symptom can also involve excessive movements, unusual actions, freezing in place, or not responding to instructions or communication. There may also be unprovoked agitation or sexual behavior in public. A person having “negative symptoms” of schizophrenia may be unable to carry out routine tasks, such as taking care of personal hygiene. They may withdraw from others and be unable to show emotion, and this may involve avoiding eye contact or speaking in a monotone. Experts are not sure what causes schizophrenia. Research suggests that the issue lies in the function of the brain and that genetic and environmental factors may play a role. Risk factorsThe following factors appear to increase the risk of developing schizophrenia:
Genetic factors may contribute significantly to the development of schizophrenia, and experts are still investigating this link. In addition, an imbalance in the neurotransmitters dopamine, glutamate, and serotonin may affect how the brain of a person with schizophrenia reacts to sights, sounds, and other stimuli. This could explain why loud noises and bright lights can be so disturbing for people with the condition, and it may also underlie hallucinations. Problems with connections in the brain may also play a role. Meanwhile, a range of factors related to pregnancy can increase the chances of having schizophrenia. One such factor is age: The first child born to either younger or older parents may have a higher risk of developing schizophrenia than a person born to parents aged 25–29 years, according to some research. Also, if a viral infection occurs during pregnancy, it may pass to the fetus and increase the risk of schizophrenia. It is unclear which viruses affect this risk, but they may include influenza, herpes, toxoplasmosis, and rubella. Additionally, maternal malnutrition during pregnancy may increase the risk of schizophrenia, according to some research. A person’s experiences during early life may also contribute to their risk of schizophrenia. Studies suggest that people with a genetic susceptibility may be more likely to develop the condition if they experience extreme stress during childhood, due to abuse or trauma, for example. Also, using recreational drugs during adolescence may increase the risk of developing schizophrenia. Recreational drug use is common among people with the condition, though it is still unclear whether the use is a cause or an effect of the condition. If a person sees a doctor about symptoms of schizophrenia, the doctor will ask about:
They may run tests to rule out other causes of the symptoms, such as substance use or a brain injury. The tests may include:
If the doctor believes that the person may have schizophrenia, they may perform a psychological evaluation or refer the person to a mental health professional. Diagnostic criteriaFor a diagnosis of schizophrenia, a person must experience at least two of the following five key symptoms. At least one symptom must be among the first three listed. The symptoms are:
Also, the symptoms must have disrupted the person’s work, interpersonal relationships, or self-care. They must also have lasted for at least 6 months. If a person has had symptoms for 1 month or less, the doctor may make a diagnosis of brief psychotic disorder. If the symptoms have lasted 1–6 months, the diagnosis is schizophreniform disorder. People with schizophrenia may need urgent care when their symptoms first appear. They then require ongoing treatment to prevent the symptoms from returning. The best course of action will depend on the type and severity of the symptoms and the person’s overall health, age, and other factors. A treatment plan usually involves medication, psychotherapy, and other forms of personal support. MedicationA doctor will prescribe antipsychotic drugs to adjust the balance of chemicals in the brain and prevent a reoccurrence of symptoms. These drugs can have adverse effects, and it is important to let the person’s healthcare team know about any side effects. The doctor can adjust the dosage or recommend another medication. PsychotherapyPsychotherapy can help people:
Social and vocational trainingThis can help a person live independently. It can be a crucial part of a recovery plan. It might involve a therapist helping a person manage everyday tasks, such as:
It can also involve help finding work, housing, and support groups. HospitalizationWhen symptoms are severe, the person may need to spend time in a hospital. The aim is to reduce symptoms and provide a safe, restful environment, necessary nutrition, and help with hygiene. The importance of following the treatment planPeople with schizophrenia often find it hard to follow their treatment plans. A significant number of people stop taking their medication within the first 12 months of treatment, and doing so can make schizophrenia difficult to manage. Friends, family, and healthcare professionals can provide essential support in this area. People with schizophrenia may experience:
Treatment and support from family and friends, healthcare providers, and the community can help reduce the risk of these problems. Schizophrenia is a serious mental health issue that can involve disorganized thinking, speech, and behavior. It can have a severe impact on a person’s life. Medication, therapy, and other forms of support can reduce symptoms, prevent complications, and help the person live independently and foster relationships. Receiving continual care from loved ones, a healthcare team, and support groups can help a person follow their treatment plan and maintain a good quality of life. Last medically reviewed on October 13, 2020
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