HVO1 − Von Carl Wernicke zu Computational Psychiaty: Syndrombasierte Pathogeneseforschung am Beispiel Formaler Denkstörungen
Categorical classifications are used for more than a century in clinical psychiatry. This has hindered aetiological research. Syndrom based approaches are more apt for pathogenetic research. Novel approaches are on the horizon, using big data and machine learning methods to delineate new biotypes. These ideas will be exempified at hand of Formal Thought Disorders (FTD). They arepresent in most psychiatric disorders and in some healthy subjects. We present a comprehensive and integrative, multilevel account on what we currently know about FTD, covering environmental influences, genetics, cellular and transmitter levels, experimental and neuropsychology, brain imaging and phenomenology. FTD is a dimensional, phenomenologically defined construct, which can clinically be subdivided into positive (pFTD) versus negative (nFTD) as well as objective versus subjective symptom clusters. Since FTDs have been traditionally linked to schizophrenia, studies in other diagnoses are scarce. Aetiologically, FTD is the only symptom under genetic influence in schizophrenia (linkage studies), while familial communication patterns (“allusive thinking”) have also been associated with it. pFTDs are related to synaptic rarefication in the glutamate system of the superior and middle lateral temporal cortices. Left superior temporal gyrus (STG) cortical volume is decreased in schizophrenia patients (SZ) with pFTD in structural magnetic resonance imaging (sMRI) studies and shows reversed activation in functional MRI (fMRI) experiments during speech production. An outlook will be given on machine learning appoaches using multi-omics, multi-level data for classification and prediction.
Literature: Tilo Kircher, Henrike Bröhl, Felicitas Meier, Jennifer Engelen. Formal Thought Disorders (FTD): From Phenomenology to Neurobiology. Lancet Psychiatry, 2018
Prof. Dr. Tilo Kircher
Philipps-University Marburg, Department for Psychiatry and Psychotherapy, Marburg, Germany