Inside the mind of poor Tom - A multidimensional approach to determine causes for redundant clothing in patients with schizophrenia

Redundant clothing (RC) is a readily observable feature of schizophrenia. While abnormal thermoregulation, thyroid dysfunction and autonomic dysregulation have been postulated to account for RC, no identified factor yet conclusively explains this enigmatic behaviour. This study attempted to determine the cause(s) of RC in schizophrenia. Two groups of 20 age- and sex-matched patients with and without RC were studied. Socio-demographic and clinical characteristics were recorded, and patients were assessed for psychopathology (Positive and Negative Syndrome Scale (PANSS)), cognitive function (Schizophrenia Cognition Rating Scale (SCoRS)), and autonomic and thyroid function. Those with RC differed significantly from those without RC in education, occupation, marital status and duration of untreated psychosis (DUP). They were more disorganised, more withdrawn, and had significant affective impairment. The RC group also had significantly higher negative, general and total psychopathology scores on the Positive and Negative Syndrome Scale, significantly poorer cognitive function, greater autonomic dysfunction, and lower free T3 and free T4 concentrations. We propose that the dimension of RC could define a subgroup with poorer premorbid functioning and a longer DUP, in whom cognitive dysfunction and prominent negative symptoms coloured the manifestations of deranged thermoregulation secondary to lower thyroid hormone levels and autonomic dysfunction, ultimately resulting in redundant clothing.