Disorders of Thought

Introduction
Thought generally refers to any mental or intellectual ac
tivity involving an individuals subjective consciousness.
Thinking allows us to make sense of or model the world
in different ways and to represent or interpret it in ways
that are significant to us. Three legitimate uses of the
word think
1. Undirected Fantasy Thinking (which, in the past, has a
lso been termed autistic or dereistic thinking)
2. Imaginative Thinking - Does not go beyond the ration
al possible.
3. Rational thinking or conceptual thinking - which atte
mpts to solve a problem.

Disorders of Thinking
Undirected fantasy or autistic thinking
Quite common.
Individuals with repeated disappointments or adv
erse life circumstances Excessive
Feature of Schizophrenia Bleuler included it as o
ne of his 4 As of Schizophrenia.
Bleuler believed that excessive autistic thinking in
schizophrenia was partly the result of formal though
t disorder.

Classification of Disorders of Thin

king

A. Disorders of stream of thought,

B. Disorders of the possession of thought,
C. Disorders of the content of thought
D. Disorders of the form of thought.

Though Form

Flights of ideas
-Thoughts follow each other rapidly; there is no general di
rection of thinking;
Easily diverted to external stimuli and by internal superfic
ial associations.
Absence of a determining tendency to thinking allows the
associations of the train of thought to be determined by c
hance relationships, verbal associations of all kinds (such
as assonance, alliteration and so on), clang associations, p
roverbs, maxims and clichs.
Reverse the sequence of the record Progression of the t
hought can be understood. (Fishs Clinical Psychopatholog
y)

 Andreasen (1979) states flight of ideas is a derailme

nt that occurs rapidly in the context of pressured spe
ech. Recommends
i. Absence of pressure of speech - derailment,
and ii. Presence of pressure of speech flight of ide
as.
The argument then becomes, acc. to her, not about
derailment and flight, but about the presence or abs
ence of pressure of speech.

Prolixity
- In hypomania so-called ordered flight of ideas occ
urs in which, despite many irrelevances, the patient i
s able to return to the task in hand.
Clang & verbal associations are not so marked, and
the speed of emergence of thoughts is not as fast
as in flight of ideas.
Although these patients cannot keep accessory thou
ghts out of the main stream, they only lose the threa
d for a few moments and finally reach their goal.

CIRCUMSTANTIALITY
Thinking proceeds slowly with many unnecessary a
nd trivial details, but finally the point is reached.
Goal of thinking is never completely lost and thinkin
g proceeds towards it by an intricate and convoluted
path. Seen in context with learning disability and in
individuals with obsessional personality traits.
Historically regarded as a personality trait associated
with epilepsy.
Circumstantial replies or statements may last for ma
ny minutes if the speaker is not interrupted and urge
d to get to the point.

PERSEVERATION

Mental operations persist beyond the point at which they are

relevant and, thus, prevent progress of thinking.
Related to the severity of the task The more complicated th
e task , more the chances that he will persevere.
Found in - Organic disorders of the brain.
Not a problem of volition Which differentiates it from verba
l stereotypy - Frequent spontaneous repetition of a word or p
hrase that is not in any way related to the current situation.
Example On being asked the name of the previous Prime Mi
nister the patient replies John Major, on being asked the nam
e of the present Prime Minister the patient replies John Major
. No I mean John Major. Two types - Logoclonia & Palilalia (F
ishs Clinical Psychopathology)

 According to Andreasan (1979) Perseveration is Per

sistent repetition of words, ideas, or subjects so that, on
ce a patient begins a particular subject or uses a particu
lar word, he continually returns to it in the process of s
peaking.
Examples 1. "I think I'll put on my hat, my hat, my hat,
my hat. 2. Interviewer: "Tell me what you are like, what
kind of person you are." Patient: "I'm from Marshalltow
n, Iowa. That's 60 miles northwest, northeast of Des Mo
ines, Iowa. And I'm married at the present time. I'm 36
years old. My wife is 35. She lives in Garwin, Iowa. Tha
t's 15 miles southeast of Marshalltown, Iowa. I'm gettin
g a divorce at the present time. And I am at presently in
a mental institution in Iowa City, Iowa, which is a hundr
ed miles southeast of Marshalltown, Iowa."

Clang Associations
- A pattern of speech in which sounds rather than meaningful relatio
nships appear to govern word choice, so that the intelligibility of the s
peech is impaired and redundant words are introduced.
In addition to rhyming relationships, may also include punning associ
ations.
Example."I'm not trying to make noise. I'm trying to make sense. If
you can make sense out of nonsense, well, have fun. I'm trying to ma
ke sense out of sense.
I'm not making sense (cents) anymore. I have to make dollars. (Andr
easan, 1979)
Alliterations
- The same consonant sound at the commencement of two or more s
tressed syllables of a word group. Example - ill, illegitimate, illusio
n.

Thought Flow
Pressure of thought

1. Difficulty in making decisions,

2. Lack of concentration and
3. Loss of clarity of thinking.
Also a diminution in active attention, so that events are po
orly registered. Patient complains of 1. Loss of memory
2. May lead to development of an overvalued or delusional
idea that thoughts are going out of his mind. The appare
nt cognitive deficits in individuals with slowing of thinking i
n depression may lead to a mistaken diagnosis of dementi
a (Pseudo- dementia). Seen in 1. Depression, and 2. Ma
nic stupor (very rare). (Fishs Clinical Psychopathology)

 Poverty of Thought
Commonly used in clinical practice - Similar to inhibi
tion or slowing of thinking.
Not mentioned in Fishs Clinical Psychopathology.
Andreasan (1979) has mentioned two concepts whic
h can be placed under Poverty of Thought
1. Poverty of Speech 2. Poverty of Content of Spee
ch

 Poverty of Speech
Restriction in the amount of spontaneous speech, so that r
eplies to questions tend to be brief, concrete, and unelaborat
ed. Unprompted additional information is rarely provided.
Replies may be monosyllabic, and some questions may be lef
t unanswered altogether.
Interviewer may find himself frequently prompting the patie
nt to encourage elaboration of replies.
Must allow the patient adequate time to answer and to elabo
rate his answer. (Andreasan, 1979)
Example of Poverty of Speech Interviewer: "Do you think t
here's a lot of corruption in government?" Patient: "Yeah, se
em to be." I: "Do you think Haldeman and Ehrlichman and
Mitchell have been fairly treated?" P: "I don't know." I: "W
ere you working at all before you came to the hospital?" P:
"No."

 Poverty of Content of Speech Although replies ar

e long enough so that speech is adequate in amount,
it conveys little information.
Alternatively, the patient may provide enough infor
mation to answer the question, but require many wo
rds to do so, so that a lengthy reply can be summariz
ed in a sentence or two.

THOUGHT BLOCKING
Thought blocking occurs when there is a sudden arrest of t
he train of thought, leaving a blank.
An entirely new thought may then begin. May be a terrify
ing experience; Differs from the more common experienc
e of suddenly losing ones train of thought, which tends to
occur when one is exhausted or very anxious.
Should only be judged to be present if a person voluntarily
describes losing his thought or if on questioning by the inte
rviewer he indicates that that was his reason for pausing.
May give rise to the delusion that thoughts have been with
drawn from the head. Highly suggestive of schizophrenia.
Thought can be seen in both speech and in the motor act
which is being performed when the thought block occurred
, Sperrung.

Thought Content
delusion

Obsessions vs compulsions Obses

sion
Thought that persists and dominates an individuals t
hinking despite the individuals awareness that the t
hought is either entirely without purpose or else has
persisted and dominated their thinking beyond the p
oint of relevance or usefulness.
Content is often such that can cause the sufferer gre
at anxiety and even guilt.
Appears against the persons will.
Normally under control and can resisted, thus we ha
ve obsessional fears, ideas, images and impulses but
not obsessional hallucinations or mood.

 Forms of Obsessions 1. Obsessional Images - Vivid images that occupy the patients mind. At ti
mes so vivid that they can be mistaken for pseudohallucinations. Exam
ple - One patient was obsessed by an image of his own gravestone that cl
early had his name engraved on it.
2. Obsessional ideas - Take the form of ruminations on all kinds of topics
ranging from why the sky is blue to the possibility of committing fellatio
with God.
3. Contrast thinking in which the patient is compelled to think the opposit
e of what is said. Example - Compulsive blasphemy, in case of a devout
patient who was compelled to make blasphemous rhymes, so that when t
he priest said God Almighty, she was compelled to think Sod Allshitey.
4. Obsessional impulses may be impulses to touch, count or arrange obje
cts, or impulses to commit antisocial acts.
5. Obsessional fears or phobias consist of a groundless fear that the patie
nt realises is dominating without a cause, and must be distinguished fro
m the hysterical and learned phobias.

Obsessions vs compulsions-compul
sion
Compulsions - Merely obsessional motor acts. May re

sult from
1. an obsessional impulse that leads directly to the act
ion, i.e. Compulsions can occur without obsessions as
well, or 2. they may be mediated by an obsessional m
ental image or thought, as, for example, when the obs
essional fear of contamination leads to compulsive wa
shing.
Obsessions occur in obsessional states, depression,
schizophrenia, occasionally in organic states; Com
pulsive features appear to be particularly common in
post-encephalitic parkinsonism

Thought Possesion
Thought alienation The patient has the experience that their thoughts
are under the control of an outside agency or that others are participati
ng in their thinking.
1. Thought insertion - The patient knows that thoughts are being inserte
d into their mind and they recognize them as being foreign and coming
from without; commonly associated with schizophrenia but not unique
to it.
2. Thought Withdrawal - the patient finds that as they are thinking, their
thoughts suddenly disappear and are withdrawn from their mind by a f
oreign influence. It has been suggested as the subjective experience of
thought blocking and omission.
3. Thought broadcasting, the patient knows that as they are thinking, ev
eryone else is thinking in unison with them. Psychoanalytic Interpreta
tion Boundary between the ego and the surrounding world has broke
n down. An experience is described as ego-syntonic if it is consistent
with the goals and needs of the ego and/or consistent with the individu
als ideal self-image; the reverse is the case for ego-dystonicity.