1. Disorders of Thoughts

2. Introduction Thinking Abstract thinking
Fantasy or autistic: common, excessive with repeated disappointment
Imaginative
Rational or conceptual
Abstract thinking
Thinking characterized by the ability to grasp the essentials of a whole, to break a whole into its parts, and to discern common properties

3. Introduction … Three aspects involved in normal thinking
Stream of thought
Amount and speed of the thought pattern
Flow
Manner in which thoughts are linked together
Content
Subject that is being thought about

4. Introduction … Features of healthy thinking (Schneider)
Constancy
Organization
Continuity
In clinical practice
It is useful to determine exactly what the patient believes with regard to their thoughts and
Record it verbatim in the clinical notes

5. Disorder of Thoughts Disorders Intelligence Stream of thoughts
Possession of thoughts
Content of thoughts
Form of thinking

6. A: Disorder of Intelligence
Intelligence: ability to think and act rationally and logically
Intelligence testing was introduced by Alfred Binet in 20th century
IQ score was computed by dividing the mental age by chronological age and multiplying by 100
Average IQ 100

7. A: Disorder of Intelligence …
Low intelligence “learning or “intellectual disability”
Brain damage due to genetic, pregnancy / birth problems, health problems
lQ 70 or > and specific learning disability

8. B: Disorders of the Stream of Thoughts
Disorders of thought tempo
Flight of ideas, inhibition or slowing of thinking, circumstantiality
Disorders of the continuity of thinking
Perseveration, thought blocking

9. 1): Disorders of Thought Tempo
Flight of ideas (with or without pressure of speech)
Thought follow each other rapidly
No general direction of thinking
Connections between successive thoughts appear to be due to chance factors which, however can be understood
Mostly in mania, schizophrenia when excited, euphoric, organic state i.e. hypothalamus lesion

10. 1): Disorders of Thought Tempo …
In acute mania incoherence occurs

11. 1): Disorders of Thought Tempo …
Inhibition or slowing of thinking
Train of though is slowed down
Number of ideas and mental images that present themselves is decreased
Difficult making decisions, lack of concentration, loss of clarity of thinking, diminution in active attention - poor registration

12. 1): Disorders of Thought Tempo …
Loss of memory
Strange indescribable sensation in the head
Diagnostic challenge mistaken for dementia
Seen in depression, rare condition of manic stupor
Majority have difficulties with thinking rather than inhibition

13. 1): Disorders of Thought Tempo …
Circumstantiality
Thinking proceeds slowly with many unnecessary and trivial details, but finally the point is reached
Goal of thinking is never completely lost
Thinking proceed towards the goal by an intricate and convoluted path
Seen learning disability, obsessional personality trait

14. 2): Disorders of the Continuity of Thinking
Perseveration
Mental operations persist beyond the point at which they are relevant
Prevent progress of thinking
May be mainly verbal or ideational
Common in generalized and local organic disorders of the brain,

15. 2): Disorders of the Continuity of Thinking …
Thought blocking
Sudden arrest of the train of thought, leaving a blank
Entirely new thought may begin
Terrifying experience when gain insight
Seen in schizophrenia
In exhaustion or anxiety lose thread of the conversation may appear to have thought blocking

16. C: Disorders of the Possession of Thought
A person is in control of his or her own thinking
Loss of control or sense of possession of thinking

17. C: Disorders of the Possession …
Obsession
Thought persists and dominate
Awareness thought is either entirely without purpose or beyond the point of relevance or usefulness
Obsessional mental images, ideas, fears and impulses
Cause sufferer great anxiety and even guilt; repugnant; against person’s will

18. C: Disorders of the Possession …
Obsession occurs in obsessional states, depression, schizophrenia and occasionally in organic states

19. C: Disorders of the Possession …
Compulsion
Merely obsessional motor acts
Result from obsessional impulse or mediated by an obsessional mental image or thought
Common in post encephalitic parkinsonism, OCD

20. C: Disorders of the Possession …
Thought alienation
Experience that thoughts are under the control of an outside agency or
Others are participating in their thinking
Result from obsessional impulse or mediated by an obsessional mental image or thought
Commonly associated with schizophrenia

21. C: Disorders of the Possession …
Experience of thought alienation include
Thought insertion
Thought being placed in minds
Recognize them as being foreign and coming from without

22. C: Disorders of the Possession …
Thought deprivation or withdraw
Thought are suddenly disappear and are taken from people’s mind by a foreign influence
Suggested to be subjective experience of thought blocking and omission

23. C: Disorders of the Possession …
Thought broadcasting
As people are thinking, everyone else is thinking in unison with them
Other people might be able to access them
Experience of hearing one’s thoughts spoken aloud as the result others can hear them

24. D: Disorders of the Content of Thinking
Delusion
Customary: false, unshakable beliefs
Belief firmly held on inadequate grounds
Not affected by rational arguments
Not a conventional belief
Need not be false
e.g., delusional jealousy, then discover partner actually is unfaithful

25. D: Disorders of the Content of Thinking
Need not be totally unshakeable
Cognitive therapy for delusions; many patients have some insight
Wrongly arrived at belief
Primary delusion - “out of the blue”
Secondary delusion - “arises out of” e.g.. hallucination
Overvalued idea
Unreasonable, sustained false beliefs, less firm
Bizarre or non bizarre

26. D: Disorders of the Content of Thinking
Delusions of persecutory (commonly paranoid)
Primary delusional experiences, auditory / bodily hallucinations, experience of passivity i.e. hypnotism, demonical possession, witchcraft, waves
Delusion of reference
Others talking, slandering, spying on him/her
Self reference, common in severe depression i.e. believe they are extremely wicked, other people know this, quite justifiably spying on them

27. D: Disorders of the Content of Thinking
Delusions of guilt
Believes s/he is about to be put to death or imprisoned for life; are bad or evil, ruined others
Delusions of infidelity “delusion of jealousy”
Been suspicious, sensitive, and mildly jealous
Seen in affective psychosis, organic brain disorders, associated with alcohol dependency syndrome

28. D: Disorders of the Content of Thinking
Delusions of love (fantasy lover syndrome and erotomania)
Convinced that some person is in love with them although the alleged lover may never have spoken to them
Seen in abnormal personality states, sometimes schizophrenia
Grandiose delusions
Believe they are God, Queen of England, famous star, skilled

29. D: Disorders of the Content of Thinking
Grandiose delusions …
Important person who is able to help others; special power or ability
Expansive may be supported by auditory hallucination i.e. hearing voices of God or saints confirming their elevated status
Commonly associated with manic psychosis in the context of bipolar affective disorder

30. D: Disorders of the Content of Thinking
Delusions of ill health
Worry about health i.e. believe they have a serious disease such as cancer, brain tumor; incurable diseases; preoccupations with facial or bodily appearance
Characteristic feature of depressive illnesses
Many puerperal women fear or believe that the newborn child has learning disabilities of some kind

31. D: Disorders of the Content of Thinking
Nihilistic delusions (negation)
Denies existence of body, mind, loved ones and the world around them
Assert they have no mind, intelligence
Occur in the context of severe, agitated depression, schizophrenia and states of delirium
Delusion of poverty
Believe are impoverished and destitution is facing them

32. D: Disorders of the Content of Thinking
Delusion of control
Beliefs that one’s actions, behavior or feeling are not under personal control or own doing
Imposed by an external force
Delusion of mind reading
Believe that people can read one’s mind or know one’s thoughts

33. E: Disorders of the Form of Thinking
Disorder of conceptual or abstract thinking
Deficits in cognition
Commonly seen in schizophrenia, organic brain disorders
Over inclusion (Cameron, 1994)
Inability to narrow down the operations of thinking and bring into action the organized attitudes and specific responses relevant to the task at hand

34. E: Disorders of the Form of Thinking
Disorder of conceptual or abstract thinking …
Concrete style of thinking (Goldstein, 1944)
Due to the loss of abstract attitude
Five features of formal thought disorder (Schneider, 1930)
Derailment, substitution, omission, fusion and driveling

35. E: Disorders of the Form of Thinking
Varieties of objective thought disorder
Transitory thinking
Characterized by derailments, substitutions and omissions
Driveling thinking
Loss of preliminary organization, have a critical attitude
Desultory thinking
Speech is grammatically correct, sudden ideas force their way in from time to time

36. References
Casey P. & Kelly B (2007) Fish’s Clinical Psychopathology; signs and Symptoms in Psychiatry 3rd Edition