Thought disorder

Thought disorder
Other namesFormal thought disorder (FTD)
Cloth embroidered by a schizophrenia sufferer.jpg
An embroidered cloth produced by a schizophrenia patient, showing the nonsensical associations between words and ideas characteristic of thought disorder
SpecialtyPsychiatry

Thought disorder (TD) refers to disorganized thinking as evidenced by disorganized speech.[1] Specific thought disorders include derailment, poverty of speech, tangentiality, illogicality, perseveration, and thought blocking.[1] TD is a hallmark feature of schizophrenia, but is also associated with other conditions including mood disorders, dementia, mania, and neurological diseases.[2][3]

Psychiatrists consider formal thought disorder as being one of two types of disordered thinking, with the other type being content thought disorder which include delusions. The latter involves "content" while the former involves "form". Although the term "thought disorder" can refer to either type, some psychiatric texts and this article use the term to refer to formal thought disorder.

Eugen Bleuler, who named schizophrenia, held that thought disorder was its defining characteristic.[4] However, formal thought disorder is not unique to schizophrenia or psychosis. It is often a symptom of mania, and less often it can be present in other mental disorders such as depression.[1] Clanging or echolalia may be present in Tourette syndrome.[5] Patients with a clouded consciousness, like that found in delirium, also have a formal thought disorder.[6]

However, there is a clinical difference between these two groups. Those with schizophrenia or psychosis are less likely to demonstrate awareness or concern about the disordered thinking.[7] Clayton and Winokur have suggested that this results from a fundamental inability to use the same type of Aristotelian logic as others.[8] On the other hand, patients with a clouded consciousness, referred to as "organic" patients, usually do demonstrate awareness and concern, and complain about being "confused" or "unable to think straight"; Clayton and Winokur suggest that this is because their thought disorder results, instead, from various cognitive deficits.[6]

Thought form and process, Thought content[edit]

The term "thought disorder" confuses even medical students, residents, and experienced clinicians. It has no commonly accepted definition, though some consensus has emerged in the past decade (2016). Some use it to just mean formal thought disorder or disorganized speech. Some use it more broadly to refer to disorganized speech, confusion, delusions, including even hallucinations.[9] Still others loosely use it to mean cognitive disorder, which is even broader. In 1962, Frank Fish suggested that cognitive abnormalities can be divided in 4 groups: perceptual disorders, thought content disorders, thought process disorders, and thought form disorders.[10]

In psychiatric clinical settings, most common perceptual disorders are various hallucinations. Most thought content disorders, which are abnormalities of beliefs and experience interpretations, are various delusions. Thought process disorders, which are the abnormalities of idea and language formations before expression, include pressured speech and blocking. Thought form disorders—i.e. the proper formal thought disorders—which are the abnormalities of language expression both in speech and writing, include incoherence, and tagentiality or derailment. The symptoms that a patient exhibits in a single instance may not fit exclusively into just one of these categories. Also, the patients can have abnormalities in just one or more, or all categories.[10]

Excluding perceptual and thought content disorders, "thought disorder" or "formal thought disorder" in a psychiatric text sometimes (or preferably[11]) refers to the disorders of thought form and process.[10][11] (See another example in SAPS under the heading "Positive Formal Thought Disorder".) This article focuses on mostly formal thought disorders, especially in the type section.

Types, Signs and Symptoms[edit]

Thought disorder may be on a continuum with normal behaviors. Normal people may have it occasionally including when fatigued or disinhibited, when writers use language creatively, when people in certain disciplines—such as politicians, administrators, philosophers, ministers, and scientists—use language pedantically, or when people who has low intelligence or little education use language similarly to patients with severe psychopathology.[12]

In considering whether an individual has thought disorder, patterns of their speech are closely observed. Although it is normal to exhibit some of the followings some of the time, it is the degree, frequency, and the resulting functional impairment that leads to the conclusion that the person being observed has a thought disorder.[13] The patient should be evaluated within contexts. Can the patient control the abonormality? Can the abnormality be changed or corrected with prompting or a subject change? Are there other symptoms? What are the patient's backgrounds, such as educational and intelligent levels?[12] Also, impaired attention, poor memory, and difficulty formulating abstract concepts may reflect thought disorder, and can be observed or assesed with mental status tests such as serial sevens or memory tests.[10]

There are many named subtypes of thought disorder which may be confusing, especially when referred to outside the context of being a thought disorder subtype.[14] The subtypes found in the literature may include:

  • Alogia (also poverty of speech)[15] – A poverty of speech, either in amount or content. Under negative/positive symptom classification of schizophrenia, it is classified as a negative symptom. When classifying symptoms into more dimensions, poverty of speech content—paucity of meaningful content with normal amount of speech—is a disorganization symptom, whereas poverty of speech—loss of speech production—is a negative symptom.[15] Under SANS, thought blocking is considered a part of alogia, and so is increased latency in response.[16]
  • Blocking[17] – An abrupt stop in the middle of a train of thought; the individual may or may not be able to continue the idea.[18] This is a type of formal thought disorder that can be seen in schizophrenia.[1]
  • Circumstantiality (also circumstantial thinking, or circumstantial speech)[17] - An inability to answer a question without giving excessive, unnecessary detail.[19] This differs from tangential thinking, in that the person does eventually return to the original point. For example, the patient answers the question "how have you been sleeping lately?" with “Oh, I go to bed early, so I can get plenty of rest. I like to listen to music or read before bed. Right now I’m reading a good mystery. Maybe I’ll write a mystery someday. But it isn’t helping, reading I mean. I have been getting only 2 or 3 hours of sleep at night.”[20]
  • Clanging or Clang association[17] – a severe form of flight of ideas whereby ideas are related only by similar or rhyming sounds rather than actual meaning.[18] This may be heard as excessive rhyming and/or alliteration. e.g. "Many moldy mushrooms merge out of the mildewy mud on Mondays." "I heard the bell. Well, hell, then I fell." It is most commonly seen in bipolar affective disorder (manic phase), although it is often observed in patients with primary psychoses, namely schizophrenia and schizoaffective disorder.
  • Derailment (also loose association and knight's move thinking)[17] – Thought frequently moves from one idea to another which is obliquely related or unrelated, often appearing in speech but also in writing, [21] e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."[22]
  • Distractible speech – During mid speech, the subject is changed in response to a nearby stimulus. e.g. "Then I left San Francisco and moved to... Where did you get that tie?"[23]
  • Echolalia[24] – Echoing of another's speech[18] that may only be committed once, or may be continuous in repetition. This may involve repeating only the last few words or last word of the examiner's sentences. This can be a symptom of Tourette's Syndrome. e.g. "What would you like for dinner?", "That's a good question. That's a good question. That's a good question. That's a good question."
  • Evasion - the next logical idea in a sequence is replaced with another idea closely but not accurately or appropriately related to it. Also called paralogia and perverted logic.[25][26] Example: "I... er ah... you are uh... I think you have... uh-- acceptable erm... uh... hair."
  • Flight of ideas[17] - a form of formal thought disorder marked by abrupt leaps from one topic to another, possibly with discernable links between successive ideas, perhaps governed by similarities between subjects or, in somewhat higher grades, by rhyming, puns, and word plays, or by innocuous environmental stimuli – e.g., the sound of birds chirping. It is most characteristic of the manic phase of bipolar illness.[18]
  • Illogicality[27] – Conclusions are reached that do not follow logically (non-sequiturs or faulty inferences). e.g. "Do you think this will fit in the box?" draws a reply like "Well duh; it's brown, isn't it?"
  • Incoherence (word salad)[17] – Speech that is unintelligible because, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish,[18] e.g. the question "Why do people comb their hair?" elicits a response like "Because it makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons, hello please!"
  • Loss of goal[28] - Failure to follow a train of thought to a natural conclusion,[29] e.g. "Why does my computer keep crashing?", "Well, you live in a stucco house, so the pair of scissors needs to be in another drawer."
  • Neologisms[17] – forms completely new words or phrases whose origins and meanings are usually unrecognizable. Example is "I got so angry I picked up a dish and threw it at the geshinker."[30] These may also involve elisions of two words that are similar in meaning or in sound.[citation needed] Although neologisms may sometimes refer to words that are formed incorrectly but whose origins are understandable (e.g. "headshoe" for hat), these can be more clearly referred to as word approximations.[31]
  • Overinclusion[24] is failure to eliminate ineffective, inappropriate, irrelevant, extraneous details associated with a particular stimulus.[32][33]
  • Perseveration[24] – Persistent repetition of words or ideas even when another person attempts to change the topic.[18] e.g. "It's great to be here in Nevada, Nevada, Nevada, Nevada, Nevada." This may also involve repeatedly giving the same answer to different questions. e.g. "Is your name Mary?" "Yes." "Are you in the hospital?" "Yes." "Are you a table?" "Yes." Perseveration can include palilalia and logoclonia, and can be an indication of organic brain disease such as Parkinson's.
  • Phonemic paraphasia – Mispronunciation; syllables out of sequence. e.g. "I slipped on the lice and broke my arm."[citation needed]
  • Pressure of speech[27] – Unrelenting, rapid speech without pauses.[18] It may be difficult to interrupt the speaker, and the speaker may continue speaking even when a direct question is asked.
  • Poverty of content of speech[15] is paucity of meaningful content with normal amount of speech.[15] The amount of speech in replies is adequate but speech tends to be vague, overconcrete, overgeneralized, repetitive, stereortyped, and conveys little information.[16] For example, this is a response to the question why the patient was in a hospital: “I often contemplate—it is a general stance of the world—it is a tendency which varies from time to time—it defines things more than others—it is in the nature of habit—this is what I would like to say to explain everything.”[32]
  • Self mentions – Patient repeatedly and inappropriately refers back to self. e.g. "What's the time?", "It's 7 o'clock. That's my problem."[citation needed]
  • Semantic paraphasia – Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book."[citation needed]
  • Stilted speech[34] – Speech characterized by the use of words or phrases that are flowery, excessive, and pompous.[18] e.g. "The attorney comported himself indecorously."
  • Tangentiality[17] – Wandering from the topic and never returning to it or providing the information requested.[18] e.g. in answer to the question "Where are you from?", a response "My dog is from England. They have good fish and chips there. Fish breathe through gills."
  • Verbigeration[35] –Meaningless and stereotyped repetition of words or phrases replacing understandble speech, as seen in schizophrenia.[35][36]
  • Word approximations – Old words used in a new and unconventional way. e.g. "His boss was a seeover."[citation needed]

Word Usage[edit]

Thought Disorder[edit]

Some recent (2015, 2017) pyschiatric/psychological glossaries defined thought disorder as disturbed thinking or cognition that affects communication, language, or thought content including poverty of ideas, neologisms, paralogia, word salad, and delusions[2][3] —which are disturbance of both thought content and thought form—and suggested the more specific terms of content thought disorder and formal thought disorder,[3] with content thought disorder defined as a thought disturbance characterized by multiple fragmented delusions,[37][38] and formal thought disorder defined as disturbance in the form or structure of thinking.[39][40] For example, DSM-5 (2013) only used the word formal thought disorder, mostly as a synonym of disorganized thinking/speech.[41] This is in contrast with ICD-10 (1992) which only used the word "thought disorder", always accompanied with "delusion" and "hallucination" separately,[42] and a general medical dictionary (2002) that although generally defined thought disorders similarly to the psychiatric glossaries,[43] but also used the word in other entries as ICD-10 did.[44]

The recent psychiatric text (2017) also mentioned when describing thought disorder as a "disorganization syndrome" within the context of schizophrenia:

“Thought disorder” here refers to disorganization of the form of thought and not content. An older use of the term “thought disorder” included the phenomena of delusions and sometimes hallucinations, but this is confusing and ignores the clear differences in the relationships between symptoms that have become apparent over the past 30 years. Delusions and hallucinations should be identified as psychotic symptoms, and thought disorder should be taken to mean formal thought disorders or a disorder of verbal cognition.

— Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA[11]

The same text also mentioned that some clinicians use the term "formal thought disorder" broadly referring to abnormalities in thought form plus any psychotic cognitive sign or symptom,[45] and that various studies examining cognition and subsymdromes in schizophrenia may refer to formal thought disorder as "conceptual disorganization" or "disorganization factor."[11]

Still, there may be other dissenting opinions, including:

Unfortunately, “thought disorder” is often involved rather loosely to refer to both formal thought disorder and delusional content. For the sake of clarity, the unqualified use of the phrase “thought disorder” should be discarded from psychiatric communication. Even the designation “formal thought disorder” covers too wide a territory. It should always be made clear whether one is referring to derailment or loose associations, flight of ideas, or circumstantiality.

— The Mental Status Examination, The Medical Basis of Psychiatry (2016)[46]

Alogia[edit]

Alogia, both poverty of speech and poverty of content of speech, had been considered as a "negative symptom" of schizophrenia (for example, see SANS),[16] and was conceived as "negative thought disorder".[15] Factor analysis studies have been classifying negative and positive symptoms of schizophrenia into more dimensions, starting with 3, currently (2017) with 5—psychotic symptoms, negative symptoms, disorganization symptoms (including TD), depression and anxiety, agitation—with "remarkable consistency", and expecting more in the future.[47] With such classifications, poverty of content of speech, i.e. paucity of meaningful content with normal amount of speech, is considered "a disorganization of thought and not a negative symptom and is properly included in the disorganization cluster of symptoms." Only poverty of speech, i.e. loss of speech production, is considered a negative symptom.[15]

Course, Diagnosis, and Prognosis[edit]

It was believed that thought disorder occurred only in schizophrenia, but later findings indicate it may occur in other psychiatric conditions including mania, and occurs even in normal people. Also, people with schizophrenia don't all exhibit thought disorder, so not having any thought disorder doesn't mean the person doesn't have schizophrenia, i.e. the condition is not very specific to the disease.[28]

When adopting specific definitions of thought disorder subtypes and classifying them as positive and negative symptoms, Nancy Andreasen found[28] that different subtypes of thought disorder occur at different frequencies among the manic, depressive, and schizophrenic patients. Manic patients have pressured speech as the most prominent symptom, but also have relatively high rates of derailment, tangentiality, and incoherence which are as prominent as schizophrenic patients. They are likelier to have pressured speech, distractibility, and circumstantiality.[28][48]

Schizophrenic patients have more negative thought disorder including poverty of speech and poverty of content of speech, but also have relatively high rates of certain positive thought disorders.[28] Derailment, loss of goal, poverty of content of speech, tangentiality and illogicality are particularly characteristic of schizophrenia.[49] Depressive patients have relatively less thought disorders; the most prominent are poverty of speech, poverty of content of speech, and circumstantiality. She found the diagnostic usefulness of dividing the symptoms into subtypes, such as having negative thought disorders without the full affective symptoms highly suggest schizophrenia.[28][48]

She also found prognostic values of negative/positive symptom divisions. In manic patients, most thought disorders return to normal levels 6 months after evaluation which suggests that thought disorders in this condition, although as severe as in schizophrenia, tend to be recoverable. In schizophrenic patients, however, negative thought disorders remain after 6 months, and sometimes worsen. Positive thought disorders get better somewhat. Also, negative thought disorder is a good predictor of some outcomes, e.g. patients with prominent negative thought disorders do worse on social functioning 6 months later.[28] So, in general, having more prominent negative symptoms suggest a worse outcome. Nevertheless, the patient may do well, responds to medication, and has normal brain function. The positive symptoms are similar vice versa.[50]

At illness onset, prominent thought disorder also predicts worse prognosis, including:[11]

  • illness begins earlier
  • increase risk of hospitalization
  • decrease functional outcomes
  • increase disability rates
  • increase inappropriate social behaviors

Thought disorder unresponsive to treatment also predicts worse illness course.[11] In schizophrenia, thought disorders' severity tend to be more stable than hallucinations and delusions. Prominent thought disorders are more unlikely to diminish in middle age compared to positive symptoms.[11] Less severe thought disorder may occur during the prodromal and residual periods of schizophrenia.[51]

DSM-5 include delusions, hallucinations, disorganized thought process (formal thought disorder), and disorganized or abnormal motor behavior (including catatonia) as key symptoms in "pyschosis." Although not specific to different diagnoses, some aspects of psychosis are characteristic of some diagnoses. Schizophrenia spectrum disorders (e.g., schizoaffective disorder, schizophreniform disorder) typically consist of prominent hallucinations and/or delusions as well as formal thought disorder—displayed as severe behavioral abnormalities including disorganized, bizarre, and catatonic behavior. Psychotic disorders due to general medical conditions and substance-induced psychotic disorders typically consist of delusions and/or hallucinations. Delusional disorder and shared psychotic disorder, which are more rare, typically consist of persistent delusions.[52] Research found that most formal thought disorders are commonly found in schizophrenic and mood disorders, but poverty of speech content are more common in schizophrenia.[53]

Experienced clinicians may distinguish true psychosis, such as in schizophrenia and bipolar mania, from malingering, when an individual fakes illness for other gains, by clinical presentations. For example, malingerers feign thought contents with no irregularities in form such as derailment or looseness of associations. Negative symptoms including alogia may not be present. In addition, chronic thought disorder is typically distressing.[54]

Typically, autism spectrum disorders (ASD), whose diagnosis requires onset prior to 3 years of age, can be distinguished from early-onset schizophrenia by disease onset (schizophrenia prior to age 10 is extremely rare) and the fact that ASD patients don't display formal thought disorders.[55] However, it has been suggested that individuals with autism spectrum disorders (ASD) display language disturbances like those found in schizophrenia; a 2008 study found that children and adolescents with ASD showed significantly more illogical thinking and loose associations than control subjects. The illogical thinking was related to cognitive functioning and executive control; the loose associations were related to communication symptoms and to parent reports of stress and anxiety.[56]

Relationship with Neurocognitive Impairment[edit]

It has been proprosed that thought disorder relates to neurocognition via semantic memory. Semantic network impairment in schizophrenic patients—measured by the difference between fluency (number of animals's names produced in 60 seconds) and phonological fluency (number of words beginning with “F” produced in 60 seconds)—predicts severity of formal thought disorder, suggesting that patients may not have verbal information (semantic priming) available. Other hypotheses include working memory deficit (being confused about what has already been said in a conversation) and attentional focus.[57]

Criticisms[edit]

The concept of thought disorder has been criticized as being based on circular or incoherent definitions.[58] For example, thought disorder is inferred from disordered speech, based on the assumption that disordered speech arises because of disordered thought. Incoherence, or word salad, refers to speech that is unconnected and conveys no meaning to the listener.[18]

Furthermore, although thought disorder is typically associated with psychosis, similar phenomena can appear in different disorders, potentially leading to misdiagnosis—for example, in the case of incomplete yet potentially fruitful thought processes.[citation needed]

Another criticism relates to the separation of schizophrenic symptoms into negative/positive symptoms including thought disorder, that it oversimpliflies the complexity of thought disorder and its relationship with other positive symptoms. Later factor analysis works found that negative symptoms tend to correlate with one another, while positive symptoms tend to separate into two groups.[59] The three clusters become known roughly as negative symptoms, psychotic symptoms, and disorganization symtpoms.[50][47] Alogia, a thought disorder traditionally classified as a negative symptoms, can be separated into two separate groups: poverty of speech content as a disorganization symptom, and poverty of speech, response latency, and thought blocking as negative symptoms.[60] Nevertheless, the creative efforts that led to the positive/negative symptom separation may allow the more accurate characterization of schizophrenia in the later works.[61]

Content Thought Disorder[edit]

When excluding hallucinations, which can be categorized as a perceptual disorder, "content thought disorder" is a thought disturbance which a person exhibits delusions that may be multiple, fragmented, and bizarre, typically found in schizophrenia and other mental disorders including obsessive–compulsive disorder and mania.[37][38] Thought content disorder is not limited to just delusions, other possible abnormalities include preoccupation (centering thought to a particular idea in association with strong affection), obsession (persistent thought, idea, or image that is intrusive or inappropriate that are distressing or upsetting), compulsion (need to perform an act persistently and repetitively—without it necessarily leading to an actual reward or pleasure—to reduce distress), magical thinking (belief that one's thoughts by themselves can bring about effects in the world or that thinking something corresponds with doing it), overvalued ideas (false/exaggerated belief that is held with conviction but not with delusional intensity), ideas of reference (belief that innocuous or coincident events experienced have strong personal significance) or influence (belief that other people or external agents are covertly exerting powers over oneself), persecutory ideas,[62][63] phobias (irrational fears of objects or circumstances),[64][32] suicidal ideas, violent ideas, and homicidal ideas.[65]

The cores of thought content disturbance are abnormal beliefs and convictions, after accounting for the person's culture and backgrounds, and range from overvalued ideas to fixed delusions. Typically, abnormal beliefs and delusions are non-specific diagnostically,[66] even if some delusions are more prevalent in one disorder than another.[67] Also, normal thought—consisting of awareness, concerns, beliefs, preoccupations, wishes, fantasies, imagination, and concepts—can be illogical, and can contain beliefs and prejudices/biases that are obviously contradictory.[68][69] Individuals also have considerable variations, and the same person's thinking also shifts considerably from time to time.[70]

In psychiatric patients, delusions are the most common thought content abnormalities.[10] A delusion is a firm and fixed belief based on inadequate grounds not amendable to rational argument or evidence to the contrary, and not in sync with regional, cultural and educational background. Common examples in mental status examination include: erotomanic (belief that someone is in love with oneself), grandiose (belief that one is the greatest, strongest, fastest, richest, and/or most intelligent person ever), persecutory (belief that the person or someone to whom the person is close is being malevolently treated in some way), reference (belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance), thought broadcasting (belief that others can hear or are aware of an individual's thoughts), thought insertion (belief that one's thoughts are not one's own, but rather belong to someone else and have been inserted into one's mind),[71] thought withdrawal (belief that thoughts have been 'taken out' of one's mind, and one has no power over this), outside control (belief that outside forces are controlling one's thoughts, feelings, and actions),[72] infidelity (belief that the love partner is cheating on oneself), somatic (belief that one has a disease or medical condition), and nihilistic (belief that the mind, body, or the world at large, or parts thereof, no longer exists).[64] Delusions are common in people with mania, depression, schizoaffective disorder, delirium, dementia, substance use disorder, schizophrenia, and delusional disorders[66]

See also[edit]

References[edit]

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  2. ^ a b Kaplan and Sadock's Comprehensive Textbook of Psychiatry (2017), Appendix B: Glossary of Psychiatry and Psychology Terms. "thought disorder Any disturbance of thinking that affects language, communication, or thought content; the hallmark feature of schizophrenia. Manifestations range from simple blocking and mild circumstantiality to profound loosening of associations, incoherence, and delusions; characterized by a failure to follow semantic and syntactic rules that is inconsistent with the person’s education, intelligence, or cultural background."
  3. ^ a b c APA dictionary of psychology (2015), p. 1086. "thought disorder a cognitive disturbance that affects communication, language, or thought content, including poverty of ideas, neologisms, paralogia, word salad, and delusions. A thought disorder is considered by some to be the most important mark of schizophrenia (see also schizophrenic thinking), but it is also associated with mood disorders, dementia, mania, and neurological diseases (among other conditions). Also called thought disturbance. See content thought disorder; formal thought disorder."
  4. ^ Colman, A. M. (2001) Oxford Dictionary of Psychology, Oxford University Press. ISBN 0-19-860761-X
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  7. ^ Jefferson, James W.; Moore, David Scott (2004). Handbook of medical psychiatry. Elsevier Mosby. p. 131. ISBN 0-323-02911-6.
  8. ^ Clayton, Paula J.; Winokur, George (1994). The Medical basis of psychiatry. Philadelphia: Saunders. pp. 13–14. ISBN 0-7216-6484-9.
  9. ^ Thought Disorder (2016), 25.1. Introduction., p. 497.
  10. ^ a b c d e Thought Disorder (2016), 25.2. Definition., pp. 497-498. cited Fish, FJ (1962). Schizophrenia. Bristol, England: Bright.
  11. ^ a b c d e f g Lewis, Stephen F; Escalona, Rodrigo; Keith, Samuel J (2017). "12.2 Phenomenology of Schizophrenia". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. THE SYMPTOMS OF SCHIZOPHRENIA, Disorganization, Thought Disorder. ISBN 978-1-4511-0047-1.
    • As quoted in the templated quote.
    • "Thought disorder is the most studied form of the disorganization symptoms. It is referred to as “formal thought disorder,” or “conceptual disorganization,” or as the “disorganization factor” in various studies that examine cognition or subsyndromes in schizophrenia. ..."
  12. ^ a b Thought Disorder (2016), 25.3. What Are the Boundaries of Thought Disorder?., pp. 498-499.
  13. ^ Andreasen NC (November 1979). "Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability". Arch. Gen. Psychiatry. 36 (12): 1315–21. doi:10.1001/archpsyc.1979.01780120045006. PMID 496551.
  14. ^ Thought Disorder (2016), 25.4. What Are the Common Types of Thought Disorder?, pp. 498-499.
  15. ^ a b c d e f Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA, Categories of Negative Symptoms.
    • "... In this way, alogia is conceived of as a “negative thought disorder.” ..."
    • "... The paucity of meaningful content in the presence of a normal amount of speech that is sometimes included in alogia is actually a disorganization of thought and not a negative symptom and is properly included in the disorganization cluster of symptoms. ..."
  16. ^ a b c Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "6 Psychiatric Rating Scales", Table 6–5 Scale for the Assessment of Negative Symptoms (SANS), p. 44.
  17. ^ a b c d e f g h Houghtalen, Rory P; McIntyre, John S (2017). "7.1 Psychiatric Interview, History, and Mental Status Examination of the Adult Patient". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. HISTORY AND EXAMINATION, Thought Process/Form, Table 7.1–6. Examples of Disordered Thought Process/Form. ISBN 978-1-4511-0047-1. indicates and briefly defines the follow types: Clanging, Circumstantial, Derailment (loose associations), Flight of ideas, Incoherence (word salad), Neologism, Tangential, Thought blocking
  18. ^ a b c d e f g h i j Videbeck, S (2008). Psychiatric-Mental Health Nursing, 4th ed. Philadelphia: Wolters Kluwers Health, Lippincott Williams & Wilkins.
  19. ^ Videbeck, S (2017). "8. Assessment". Psychiatric-Mental Health Nursing (7th ed.). Wolters Kluwer. CONTENT OF THE ASSESSMENT, Thought Process and Content, p. 232. ISBN 9781496355911.
  20. ^ Videbeck (2017), Chapter 16 Schizophrenia, APPLICATION OF THE NURSING PROCESS, Thought Process and Content, p. 446.
  21. ^ APA dictionary of psychology (2015), p. 299 "derailment n. a symptom of thought disorder, often occurring in individuals with schizophrenia, marked by frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea. It is usually manifested in speech (speech derailment) but can also be observed in writing. Derailment is essentially equivalent to loosening of associations. See cognitive derailment; thought derailment."
  22. ^ Thought Disorder (2016), 25.4.2.8. Distractible Speech, p. 502.
  23. ^ Thought Disorder (2016), 25.4.2.8. Distractible Speech, p. 502.
  24. ^ a b c Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "10 Schizophrenia", CLINICAL FEATURES, Thought, pp. 168-169.
    • "Form of Thought. Disorders of the form of thought are objectively observable in patients’ spoken and written language. The disorders include looseness of associations, derailment, incoherence, tangentiality, circumstantiality, neologisms, echolalia, verbigeration, word salad, and mutism."
    • "Thought Process. ... Disorders of thought process include flight of ideas, thought blocking, impaired attention, poverty of thought content, poor abstraction abilities, perseveration, idiosyncratic associations (e.g., identical predicates and clang associations), overinclusion, and circumstantiality."
  25. ^ APA dictionary of psychology (2015), p. 389. "evasion n. 1. a form of paralogia in which an idea that is logically next in a chain of thought is replaced by another idea closely but not accurately or appropriately related to it. 2. elusion or avoidance."
  26. ^ Kaplan & Sadock's Comprehensive Textbook of Psychiatry (2017), Appendix B Glossary of Psychiatry and Psychology Terms. "evasion ... consists of suppressing an idea that is next in a thought series and replacing it with another idea closely related to it. Also called paralogia; perverted logic."
  27. ^ a b Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 6 Psychiatric Rating Scales", OTHER SCALES, Table 6–6 Scale for the Assessment of Positive Symptoms (SAPS), Positive formal thought disorder, p. 45 includes and defines Derailment, Tangentiality, Incoherence, Illogicality, Circumstantiality, Pressure of speech, Distractible speech, Clanging.
  28. ^ a b c d e f g Thought Disorder (2016), 25.5. Diagnostic and Prognostic Significance of Thought Disorder, pp. 502-503. cited
    • Andreasen NC (November 1979). "Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability". Arch. Gen. Psychiatry. 36 (12): 1315–21. doi:10.1001/archpsyc.1979.01780120045006. PMID 496551.
    • Andreasen, NC (1979). "The clinical assessment of thought, language, and communication disorders: II. Diagnostic significance". Arch Gen Psychiatry. 36: 1325–1330.
    • Andreasen, NC; Hoffrnann, RE; Grove, WM (1984). Alpert, M (ed.). Mapping abnormalities in language and cognition. Controversies in schizophrenia, 1985. New York: Guilford Press. pp. 199–226.
  29. ^ Oyebode, Femi (2015). "10 Disorder of Speech and Language". Sims’ Symptoms in the Mind (5th ed.). Elsevier. Schizophrenic Language Disorder, Clinical Description and Thought Disorder, p. 167. ISBN 978-0-7020-5556-0.
  30. ^ Thought Disorder (2016), 25.4.2.6. Neologisms, p. 502.
  31. ^ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 29
  32. ^ a b c Akiskal, Hagop S (2016). "1 The Mental Status Examination". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 1.5.5. Speech and Thought., pp. 8-10. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5.
    • "This form of thought is most characteristic of mania and tends to be overinclusive, with difficulty in excluding irrelevant, extraneous details from the association."
  33. ^ APA dictionary of psychology (2015), p. 751. overinclusion n. failure of an individual to eliminate ineffective or inappropriate responses associated with a particular stimulus.
  34. ^ Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA, Disorganization, Thought Disorder. "In its more mild manifestations, thought disorders do not preclude essential communication. Speech is frequently stilted or vague, and sentences may be incomplete. ..."
  35. ^ a b Clinical Manifestations of Psychiatric Disorders (2017), THINKING DISTURBANCES, Continuity. "Word salad describes the stringing together of words that seem to have no logical association, and verbigeration describes the disappearance of understandable speech, replaced by strings of incoherent utterances."
  36. ^ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 4 Signs and Symptoms in Psychiatry", GLOSSARY OF SIGNS AND SYMPTOMS, p. 32
  37. ^ a b Kaplan and Sadock's Comprehensive Textbook of Psychiatry (2017), "Appendix B: Glossary of Psychiatry and Psychology Terms" "content thought disorder Disturbance in thinking in which a person exhibits delusions that may be multiple, fragmented, and bizarre."
  38. ^ a b APA dictionary of psychology (2015), p. 242 "content-thought disorder a type of thought disturbance, typically found in schizophrenia and some other mental disorders (e.g., obsessive-compulsive disorder, mania), characterized by multiple fragmented delusions."
  39. ^ Kaplan and Sadock's Comprehensive Textbook of Psychiatry (2017), "Appendix B: Glossary of Psychiatry and Psychology Terms" "formal thought disorder Disturbance in the form of thought rather than the content of thought; thinking characterized by loosened associations, neologisms, and illogical constructs; thought process is disordered, and the person is defined as psychotic. Characteristic of schizophrenia."
  40. ^ APA dictionary of psychology (2015), p. 432 "formal thought disorder disruptions in the form or structure of thinking. Examples include derailment and tangentiality. It is distinct from thought disorder, in which the disturbance relates to thought content."
  41. ^ American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. ISBN 978-0-89042-555-8.
    • As the proper formal thought disorder: "Schizophrenia Spectrum and Other Psychotic Disorders", Key Features That Define the Psychotic Disorders, Disorganized Thinking (Speech), p. 88 "Disorganized thinking (formal thought disorder) is typically inferred from the individual’s speech. ..."
    • As possibly something else: "Dissociative Disorders", Differential Diagnosis, Psychotic disorders, p. 296 "... Dissociative experiences of identity fragmentation or possession, and of perceived loss of control over thoughts, feelings, impulses, and acts, may be confused with signs of formal thought disorder, such as thought insertion or withdrawal. ..."
  42. ^ "The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines (CDDG)" (PDF). World Health Organization. 1992. Archived (PDF) from the original on 17 October 2004.
    • F06.2 Organic delusional [schizophrenia-like] disorder, p.59: Features suggestive of schizophrenia, such as bizarre delusions, hallucinations, or thought disorder, may also be present. ... Diagnostic guidelines ... Hallucinations, thought disorder, or isolated catatonic phenomena may be present. ...
    • F20.0 Paranoid schizophrenia, p. 80: ... Thought disorder may be obvious in acute states, but if so it does not prevent the typical delusions or hallucinations from being described clearly. ...
    • F20.1 Hebephrenic schizophrenia, p. 81: ... In addition, disturbances of affect and volition, and thought disorder are usually prominent. Hallucinations and delusions may be present but are not usually prominent. ...
  43. ^ The British Medical Association Illustrated Medical Dictionary. Dorling Kindersley. 2002. p. 547. ISBN 0-7513-3383-2. thought disorders Abnormalities in the structure or content of thought, as reflected in a person’s speech, writing, or behaviour. ...
  44. ^ The BMA Illustrated Medical Dictionary (2002)
    • p. 470 psychosis: ... Symptoms include delusions, hallucinations, thought disorders, loss of affect, mania, and depression. ...
    • p. 499-500 schizophrenia: ... The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. ...
  45. ^ Matorin, Anu A; Shah, Asim A; Ruiz, Pedro (2017). "8 Clinical Manifestations of Psychiatric Disorders". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. THINKING DISTURBANCES, Flow and Form Disturbances. ISBN 978-1-4511-0047-1. Although formal thought disorder typically refers to marked abnormalities in the form and flow or connectivity of thought, some clinicians use the term broadly to include any psychotic cognitive sign or symptom.
  46. ^ The Mental Status Examination (2016), 1.6.2. Disturbances in Thinking., pp. 14-15.
  47. ^ a b Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA.
    • "... By the mid-1980s, factor analytic techniques were being more broadly applied to the assessment of the symptoms of schizophrenia, and separate investigators found that three dimensions or subsyndromes of schizophrenia could be derived from rating scales. ... "
    • "... Scales or combinations of scales that include more diverse examples of psychopathology lead to the reliable derivation of psychotic, negative, disorganization, depression and anxiety, and agitation dimensions. ..."
    • "... there has been a remarkable consistency in the finding of these same five factors. ..."
    • "... This dissection of the syndrome of schizophrenia into subsyndromes will multiply if more and more elaborate assessments of signs, symptoms, and history are completed. ..."
  48. ^ a b Coryell, William; Clayton, Paula J (2016). "4 Bipolar Illness". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 4.7. Clinical Picture, 4.7.2. Symptoms, p. 59. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5.
  49. ^ Oyebode, Femi (2015). "10 Disorder of Speech and Language". Sims' Symptoms in the Mind: Textbook of Descriptive Psychopathology (5th ed.). Saunders Elsevier. Schizophrenic Language Disorder, CLINICAL DESCRIPTION AND THOUGHT DISORDER, p. 167. ISBN 978-0-7020-5556-0.
  50. ^ a b Thought Disorder (2016), 25.6. Relationship Between Thought Disorders and Other Symptoms of Schizophrenia., pp. 503-504.
  51. ^ DSM-5 (2013), Schizophrenia Spectrum and Other Psychotic Disorders, Key Features That Define the Psychotic Disorders, Disorganized Thinking (Speech), p.88.
  52. ^ Ivleva, Elena I; Tamminga, Carol A (2017). "12.16 Psychosis as a Defining Dimension in Schizophrenia". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. DSM-5: AN UPDATED DEFINITION OF PSYCHOSIS. ISBN 978-1-4511-0047-1.
  53. ^ Akiskal, Hagop S (2017). "13.4 Mood Disorders: Clinical Features". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. BIPOLAR DISORDERS, Bipolar I Disorder, Acute Mania. ISBN 978-1-4511-0047-1.
  54. ^ {{cite book | editor1-last = Sadock | editor1-first = Virginia A | editor2-last = Sadock | editor2-first = Benjamin J | editor3-last = Ruiz | editor3-first = Pedro | year = 2017 | title = Kaplan & Sadock's Comprehensive Textbook of Psychiatry | edition = 10th | isbn = 978-1-4511-0047-1 | publisher = Wolters Kluwer | last1 = Ninivaggi | first1 = Frank John | chapter = 28.1 Malingering | at = CLINICAL PRESENTATIONS OF MALINGERING, Psychological Symptomatology: Clinical Presentations, Psychosis.
  55. ^ Sikich, Linmarie; Chandrasekhar, Tara (2017). "53 Early-Onset Psychotic Disorders". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. DIFFERENTIAL DIAGNOSIS, Autism Spectrum Disorders. ISBN 978-1-4511-0047-1.
  56. ^ Solomon M, Ozonoff S, Carter C, Caplan R (2008). "Formal thought disorder and the autism spectrum: relationship with symptoms, executive control, and anxiety". J Autism Dev Disord. 38 (8): 1474–84. doi:10.1007/s10803-007-0526-6. PMC 5519298. PMID 18297385.
  57. ^ Harvey, Philip D; Keefe, Richard SE; Eesley, Charles E (2017). "12.10 Neurocognition in Schizophrenia". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. RELATIONSHIP OF NEUROCOGNITIVE IMPAIRMENT TO SCHIZOPHRENIA SYMPTOMS, Formal Thought Disorder. ISBN 978-1-4511-0047-1.
  58. ^ Bentall, R. (2003) Madness explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN 0-7139-9249-2
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    • Arndt, S; Alliger, RJ; Andreasen, NC (1991). "The positive and negative symptom distinction: the failure of a two-dimensional model". Br J Psychiatry. 158: 317–322.
    • Bilder, RM; Mukhedee, S; Rieder, RO; Pandurangi, AK (1985). "Symptomatic and neuropsychological components of defect states". Schizophr Bull. 11: 409–419.
    • Liddle, PF (1987). "The symptoms of chronic schizophrenia: a reexamination of the positive-negative dichotomy". Br J Psychiatry. 151: 145–151.
  60. ^ Miller, D; Arndt, S; Andreasen, N (2004). "Alogia, attentional impairment, and inappropriate affect: Their status in the dimensions of schizophrenia". Comprehensive Psychiatry. 34: 221–226.
  61. ^ Phenomenology of Schizophrenia (2017), THE SYMPTOMS OF SCHIZOPHRENIA, Negative Symptoms. "The two-syndrome concept as formulated by T. J. Crow was especially important in spurring research into the nature of negative symptoms. ...—but this does not diminish the creative efforts that led to these scales or importance of these scales for research. In fact, it was only through careful analysis of the structure of symptoms in these scales that a more accurate characterization of the phenomenology of schizophrenia was possible."
  62. ^ Houghtalen, Rory P; Mcintyre, John S (2017). "7.1 Psychiatric Interview, History, and Mental Status Examination of the Adult Patient". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. Table 7.1-5. Elements of the Mental Status Examination with Examples of Abnormal Findings. ISBN 978-1-4511-0047-1. Thought content: obsession, delusion, magical thinking, overvalued ideas, ideas of reference or influence, persecutory ideas.
  63. ^ Kaplan and Sadock's Concise Textbook of Clinical Psychiatry (2008), "Chapter 1 Psychiatric History and Mental Status Examination", MENTAL STATUS EXAMINATION, Thought Disorder, Thought Content., p. 7.
  64. ^ a b Sadock, Benjamin J (2017). "7.2 Outline for a Psychiatric Examination". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. MENTAL STATUS, Table 7.2–1. Common Questions for the Psychiatric History and Mental Status. ISBN 978-1-4511-0047-1. Thought content: Delusions— persecutory (paranoid), grandiose, infidelity, somatic, sensory, thought broadcasting, thought insertion, ideas of reference, ideas of unreality, phobias, obsessions, compulsions, ambivalence, autism, dereism, blocking, suicidal or homicidal preoccupation, conflicts, nihilistic ideas, hypochondriasis, depersonalization, derealization, flight of ideas, idé fixe, magical thinking, neologisms.
  65. ^ Psychiatric Interview, History, and Mental Status Examination of the Adult Patient (2017), HISTORY AND EXAMINATION, Risk Assessment "Suicidal, violent, and homicidal ideation fall under the category of thought content..."
  66. ^ a b Clinical Manifestations of Psychiatric Disorders (2017), THINKING DISTURBANCES, Thought Content, Disturbances in Thought Contents.
  67. ^ Clinical Manifestations of Psychiatric Disorders (2017), THINKING DISTURBANCES, Thought Content, Delusions.
  68. ^ Clinical Manifestations of Psychiatric Disorders (2017), THINKING DISTURBANCES, Thought Content.
  69. ^ Clinical Manifestations of Psychiatric Disorders (2017), THINKING DISTURBANCES, Types of Thinking.
  70. ^ Clinical Manifestations of Psychiatric Disorders (2017), THINKING DISTURBANCES, Normal Thinking.
  71. ^ Psychiatric Interview, History, and Mental Status Examination of the Adult Patient (2017), HISTORY AND EXAMINATION, Thought Content & Table 7.1–7. Examples of Delusional Thought
  72. ^ Fatemi, S Hossein; Folsom, Timothy D (2016). "6 Schizophrenia". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. 6.6. Clinical Findings, 6.6.2. Mental Status Examination in a Subject with Schizophrenia, 6.6.2.5. Thought Form and Content, p. 103. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5.

Other references[edit]

  • VandenBos, Gary R, ed. (2015). APA dictionary of psychology (2nd ed.). Washington, DC: American Psychological Association. doi:10.1037/14646-000. ISBN 978-1-4338-1944-5.
  • Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro, eds. (2017). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. ISBN 978-1-4511-0047-1.
  • Sadock, B. J.; Sadock, VA (2008). Kaplan and Sadock's Concise Textbook of Clinical Psychiatry. Lippincott Williams & Wilkins. ISBN 9780781787468.
  • Andreasen, Nancy C (2016). "25 Thought Disorder". In Fatemi, S Hossein; Clayton, Paula J (eds.). The Medical Basis of Psychiatry (4th ed.). New York: Springer Science+Business Media. pp. 497–505. doi:10.1007/978-1-4939-2528-5. ISBN 978-1-4939-2528-5.

Further reading[edit]

  • Peter J. McKenna; Tomasina M. Oh (2005). Schizophrenic Speech: Making Sense of Bathroots and Ponds that Fall in Doorways. Cambridge University Press. ISBN 978-0-521-81075-3.