The document summarizes a presentation on thought and thought disorders. It defines thought, describes different types of thinking (fantasy, imaginative, rational), and characteristics of healthy thinking. It then discusses thought disorders, formal thought disorders, and specific disorders like flight of ideas, poverty of speech, circumstantiality, and loose associations. Research on thought disorders in schizophrenia is mentioned, focusing on structural brain abnormalities and biomarkers.
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Formal thought disorders
1. CHAIR PERSON: DR JEYASEELAN
PRESENTOR: DR USHA NANDHINI
DATE: 18/07/2018
2. TOPICS
Thought definition
Types of thinking
Healthy thinking
Thought disorders
Assessment of thought disorders
Formal thought disorders
Researches
References
3. THOUGHT
Thought - what we think
Language of the mind[propositional thought - hear in
the mind, imaginal thought – see in the mind]
Goal oriented flow of ideas and associations that leads
to reality oriented conclusion.
An idea or opinion produced by thinking or occurring
suddenly in the mind
4. TYPES OF THINKING
Fantasy [ autistic or dereistic]
Imaginative
Rational or conceptual
5. FANTASY THINKING
There is very little contact with reality.
Day dreaming
Carrying on day to day activities
To compensate for disappointments in life or to escape from unpleasant situations.
Neurotic triats
initially deliberate and sporadic
↓
more established
↓
believes the contents
↓
accepted as fact.
Pathological lying
dissociative disorder
Delusion like ideas
Denial of external events- ego defense mechanisms
Bleuler – excessive autistic thinking in schizophrenia is part of thought disorder
8. IMAGINATIVE THINKING
Contact with reality
Components
1. Mental imagery: create image based mental
representations of the world
2. Counterfactual thinking: capacity to disengage
from the reality and think of events and experiences
that haven’t occurred
3. Symbolic representation: use of concepts or
images to represent real world objects.
Maternal reverie
10. RATIONAL OR CONCEPTUAL
THINKING
Problem solving and reasoning
Problem solving- cognitive process used to overcome the
obstacles to reach a goal
Reasoning- cognitive process used to make inferences from
knowledge and to draw conclusions
Analogical reasoning: application of solutions to already
known problems.
Inductive reasoning: use of specific known instances to
draw inferences about unknown instances.
Deductive reasoning: argument in which if the premises
are true conclusion cannot be false
14. HEALTHY THINKING
Described by Schneider
Constancy: characteristic of a completed thought that
doesn’t change in content
Organization: contents of thought are related to each
other in consciousness and do not blend with each
other and separated in organized way
Continuity: heterogeneous subsidiary thoughts,
sudden ideas or observations that emerge are arranged
in order in the content of conciousness.
15. THOUGHT - ASPECTS
Thought content: thoughts occurring in mind.
Thought process: thoughts are formulated , organized
and expressed. Normal thoughts are linear ,organized
and goal directed.
16. THOUGHT DISORDERS
Any disturbance of thinking that affects language ,
communication and thought content
Disturbances of thoughts : change in nature of
individual thoughts i.e. disorder of content of
thoughts [ obsession& compulsions, delusions and
overvalued idea]
Disturbances of thinking process: change in speed or
form of relationships between thoughts, individual
thoughts are unremarkable in nature[ formal thought
disorders]
18. Formal thought disorders
Disruption of normal flow of thought
Disturbances in organization and expression of thoughts
BLEULER – formal thought disorders are core feature of
schizophrenia.
Syndrome with different symptoms resulting in thought ,
language and communication problems .
FTD – abnormality in amount and form of speech
Amount: poverty and pressure of speech
Form : disconnection symptoms[distractible speech, loss of
goal, loose associations, illogicality and incoherence]
19. SCHNEIDER
Derailment : thought slides on to subsidiary thought
Substitution: major thought is substituted by
subsidiary one
Omission : senseless omission of a thought or part of it
Fusion: heterogeneous elements of thoughts are
interwoven with each other
Driveling: disordered intermixture of constituent part
of one complex thought
20. POSITIVE FTD: false concepts by blending together of
incongruous elements
NEGATIVE FTD: Loss of previous ability to think
21. CLINICAL ASSESSMENT
Assessed during the course of interview
Patients speech, writings and behaviour
Sample of speech
Verbatim record
22. FORMAL THOUGHT DISORDERS
Flight of ideas
Retarded thinking
Circumstantiality
Preservation
Thought blocking
Tangentiality
Incoherence
Derailment
Loosening of associations
Neologisms
Poverty of speech
Pressure of speech
23. FLIGHT OF IDEAS
Acceleration of flow of thinking
Rapid succession of thoughts
No general direction of thinking
Logical connection present
Easy distractibility [ external stimulus & internal
superficial associations]
Associations – chance factors or verbal
Verbal – clang , puns and rhymes
Clang – a 2nd word with sound similar to 1st
Puns – a 2nd meaning of first word
Typical of mania
Also in schizophrenia, organic brain disease
25. Example
பேர் என்னம்மா? ஜீவ மணி ,ஹெலன் ஜீவ
மணி, ஹெலனா கிரிஸ்டியன், நான்
ெிந்து ,நான் இப்ே ோர்வதி ,ோர்வதி
ஹநத்தியில ஹோட்டு ஹெவப்பு கலர்ல
இருக்கும், உன் ஷால் கூட ெிவப்புதான்
,எனக்கு ஒரு ஷால் ஹகாடு.
26. PROLIXITY
Prolixity – ordered flight of ideas
Marginal variety of flight of ideas
Associations are not so marked and acceleration is not
as fast in flight of ideas
Patients lose thread only for a few moments and finally
reach their goal
In hypomania
27. PRESSURE OF SPEECH
Amount of spontaneous speech is increased which is
difficult to interrupt
Variety of thoughts
Thought process is accelerated
Loud and emphatic
> 150 words per minute.
28. INHIBITION OR SLOWING OF
THINKING
Thought process slowed down
Few thoughts [ ideas and mental images]
Lack of concentration, loss of clarity and difficulty in
making decisions
Defective attention- poor registration
Loss of memory and cognitive deficits [ Difficult to
differentiate from dementia]
Depression and manic stupor
Depression – anxious preoccupations and increased
distractibility due to anxiety.
30. POVERTY OF SPEECH
Patient has few thoughts that lack in variety and richness
Thoughts move slowly through the mind
Spontaneous speech is restricted
Answers are brief, concrete and uneloborated
Example: ஹேயர் என்னம்மா?........... எழிலரெி
.எதுக்கு ொஸ்ேிட்டல் வந்து
இருக்கீங்க?................
எதுக்கு ொஸ்ேிட்டல் வந்து இருக்கீங்க?………
உடம்பு ெரி இல்லல.
என்ன ஆச்சும்மா?…………
என்ன ஆச்சும்மா? ……………வயிறு வலி
31. CIRCUMSTANTIAL THINKING
Non linear thought pattern
Thinking proceeds slowly with unnecessary and trivial
details but finally the goal is reached.
Goal of thinking not lost completely
Proceeds in intricate and convoluted path
In OCD – excess detail is introduced anxiously to avoid any
omissions
Learning disabilities and temporal lobe epilepsy[
Geschwind syndrome-interictal changes in personality
progressing over time. Includes hypergraphia,
hyperreligiosity, atypical sexuality, circumstantiality and
intensified mental life]
33. TANGENTIALITY
Train of thought wanders away , goal is lost and is
never reached
At first the patients give answers that is appropriate to
the general topic but not answering the questions .
Seen in anxiety, schizophrenia, dementia and
delerium.
35. PERSEVERATION
Disturbance of flow of thinking
mental operations persist beyond the point at which they
are relevant and thus prevent progress of thinking.
Persistence of response to an earlier stimulus even after
new stimulus has been presented
may be mainly verbal or ideational.
Organic disorders- frontal lobe injury
Example:1. Who is our CM? EPS
2. Where are you from? EPS
3. Are you married? EPS
36. THOUGHT BLOCKING
Sudden arrest of the train of thought, leaving a
‘blank’. An entirely new thought may begin
Snapping off
Not caused by any distractions
Normal persons- anxious and exhausted
Schizophrenia- thought withdrawal
39. DERAILMENT
Characterized by discourse consisting of sequence of
unrelated or remotely related ideas.
Slippage of ideas further and further away from point
of discussion.
Euphoria , hysteria and schizophrenia
Entgleisen[ derailment]- Schneider
Asyndesis- Cameron
Knight’s move thinking- Peter McKellar
41. LOOSENING OF ASSOCIATIONS
Coined by Bleuler
pattern of spontaneous speech in which things said in
juxtaposition lack a meaningful relationship .
there is idiosyncratic shifting from one frame of
reference to another.
The speech is often described as being ‘disjointed’
42. INCOHERNCE[ WORD SALAD]
Pattern of speech that is incomprehensible
confused or unintelligible mixture of seemingly
random words and phrases
Set of words or phrases used together without any
arbitrary connection or grammatical rules
Schizophasia- speech confusion or word salad
occurs in schizophrenia
43.
44. NEOLOGISMS
New words are constructed by the patient or ordinary words are used
in a new way mainly in schizophrenia.
Catatonia - mannerisms or stereotypes. The patient may distort the
pronunciation of some words in the same way as they distort some
movements of their body.
Stock word instead of the correct one. Example- patient may use the word
‘car’ and call an airplane an ‘air car’ and a boat a ‘sea car’
Severe positive formal thought disorder- words are fused together in the
same way as concepts are blended with one another.
Derailment: example - a patient used the word ‘relativity’ instead of the
word ‘relationship.’
Technical neologism- using a technical term for a private experience that
cannot be expressed in ordinary words.
Hallucinations: The ‘voices’ may use neologisms and this may lead the
patient to use them as well.
Malapropisms- conspicuously misused words
Paraphasia :motor aphasia- use the wrong word, invent new words, or
distort the phonetic structure of words.,
45. VORBEIREDEN -TALKING PAST THE
POINT
Patient understands what has been asked but responds
by talking about an associated topic
Example: what is the color of grass? – white
what is the color of snow?- green
Pseudodementia: hebephrenic schizophrenia
Dissociative disorders
Gansers syndrome: approximate answers
Catatonia
46. CLANG ASSOCIATIONS
A 2nd word with sounds similar to first word is used
rather than by meaning
48. OVER INCLUSIVENESS
Ideas that are remotely linked to the concept become
incorporated within it in the patients thinking
Inability to preserve conceptual boundaries [Cameron]
Schizophrenia
Example: what are the essentials of room? Wall ,
doors, chairs and window
49. CONCRETE THINKING
Abstractions and symbols are interpreted superficially
without tact, finesse and awareness of nuance
Goldstein
Schizophrenia
Proverb testing
50. THOUGHT DISORDERS IN
SCHIZOPHRENIA
Psychological theories :
CAMERON:
1. Asyndesis: lack of adequate connection between two sucessive
thoughts
2. Metonyms: imprecise expressions or use of substitute term or
phrase instead of exact one
3. Interpenetration of themes: patients speech contain elements
which belong to task in hand interspersed by stream of fantasy
4. Over inclusion: inability to maintain the boundaries of
problem and to resist operations within correct limits
GOLDSTEIN:
concrete thinking: there is a loss of abstract attitude. The
patient is unable to free himself from the superficial concrete
aspects of thinking
51. SCHNEIDER:
3 types of disordered thinking
1. Transitory thinking: characterized by derailments,
omissions and substitutions. Grammatical and
syntactical structures distorted
2. Drivelling thinking: patient has a preliminary outline of
complicated thought but loses all preliminary
organisations, so that all constituent part gets muddled
3. Desultory thinking: speech is grammatically correct but
sudden ideas force their way from time to time.
Conversations leap from one topic to other
52.
53. Frith: failure of self monitoring resulting in thought
disorder
Inability to edit out irrelevant or perseverating phrases
Thought is undermined by absence of goal or plan
Intrusion of thoughts that do not fit into overall goal
Above results in disorganized thought
54. Bleuler’s 4 A’s
1. Affective disturbance
2. Ambivalence
3. Autism
4. Disturbances of thought association
55. DELUSIONS OF CONTROL OF
THOUGHT
Patient ascribes his own internal thought process to
outside influences – passivity
Thoughts as foreign or alien, not emanating from
himself and not within his control
Unable to discriminate between himself and outside
world
Passivity of thought, thought withdrawal, thought
broadcasting and thought insertion[ first rank
symptoms of schizophrenia]
56.
57. RESEARCHES
FTD- lack of hemispheric asymmetry in language
areas
FTD: Structural abnormalities in left STG, left planum
temporale and orbito frontal cortex
FTD ; schizophrenia trait marker
Eotaxin – ECDC [ endogenous cognitive deteriorating
chemokine] is increased in patients with FTD’s
58. REFERENCES
SIMS- symptoms in the mind- Femi Oyebode
Fish clinical psychopathology
Kaplon and Sadock’s synopsis of psychiatry
Shorter oxford textbook of psychiatry – Paul Harrison,
Philip Cowen, Mina Fazel , Tom burns
internet