Disorder of thought ssy


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  • Guilt : Put to death or imprisoned for life Poisoned : the Pt feels mentally & physically changed and the only way in which they can account for it is by assuming that poison. : Influence – passivity in context of schizophrenia - hypnotism, witchcraft.
  • Obsessional fear of contamination leads to compulsive washing
  • Scheider claims that individual with Schizo complained of 3 diff disorders of thinking that corresspond to these 3 features of normal / non disordered thinking
  • Disorder of thought ssy

    1. 1. Disorder of ThoughtDisorder of Thought By Shahnaz Syeda 14 Jun 2012 1st Yr M & SP Dept of Clinical Psychology LGBRIMH
    2. 2. ThoughtThought Thought generally refers to any mental or intellectual activity involving an individuals subjective consciousness.  Act of thinking Thought Thought underlies almost all human action and interactions, Understanding its physical and meta physical origins, process and effects has been a longstanding goal of many academic disciplines – biology, philosophy, psychology and sociology.
    3. 3. Types of thinkingTypes of thinking 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. Fantasy – escape from reality , short duration , to move the mind from poverty to riches. eg day dream Imaginative – creative, novel out puts , usually with a end in mind .Artists, Rationale / conceptual – scientist
    4. 4. Disorder of content of thinkingDisorder of content of thinking Content :The color of thought.What is the person ‘thinking’? DISORDER in content is interpreted with respect to the general assumptions about normality and abnormality, as it is most often done by an external observer.
    5. 5. From ‘delude’, derived from a Latin word which means to mock Presence of delusion A loss of touch with reality, = Psychosis Phenominologically/ subjectively indistinguishable form a true belief Definitions Types of Delusions The origin of Delusions Types of Primary Delusions The Content of Delusions
    6. 6. DEFINITIONSDEFINITIONS “A false unshakeable belief which arises from internal morbid processes. It is easily unrecognizable when it is out of keeping with the person’s educational and cultural background” -Max Hamilton False unshakeable belief Morbid origin Out of keeping with the cultural and social background
    7. 7. JasperJasper According to Jaspers -They are held with unusual conviction -They are not amenable to logic/external influences -The absurdity of their content is manifest to other people
    8. 8. ExampleExample A man believed that his wife was unfaithful to him because the fifth lamp- post along on the left was unlit. Here belief may be culturally acceptable or even true but clearly delusional because of evidence evinced for holding the belief.
    9. 9. OVERVALUED IDEASOVERVALUED IDEAS Thought which, because of associated feeling tone, takes precedence over all ideas and maintains this precedence permanently or for a long period of time. Overvalued ideas are deeply held personal convictions that are understandable when the patient's background is known. For example, if a patient has two family members who have just developed cancer then the patient may have the belief that cancer is an illness that is contagious.
    10. 10. TO BE DISTINGUISED FROM AN OVERVALUED IDEATO BE DISTINGUISED FROM AN OVERVALUED IDEA OVERVALUED IDEAS  Associated with very strong affect  Not held firmly  Person has at least some level of doubt as to its truthfulness  Not recognized as absurd  Acceptable  Can occur in both healthy and mentally ill people. DELUSIONS  Need not be associated with affect  Firmly sustained belief  Person with a delusion is absolutely convinced that delusion is real  Recognized as absurd  Can not be accepted  Occur in mentally ill people
    11. 11. According to Conrad….According to Conrad…. The 5 stages in the development of delusions: 1) Trema: Delusional mood representing a change in perception 2) Apophany: A search for, and finding of new meanings to psychological events 3) Anastrophy: Heightening of psychosis 4) Consolidation: Formation of a new world based on new meanings 5) Residuum: Remaining autistic deficit.
    12. 12. Primary DelusionPrimary Delusion -New meaning arises in connection with some other psychological event -Ultimately un-understandable -diagnostic of schizophrenia, -may occur in epileptic psychosis
    13. 13. PRIMARY DELUSION True delusion Does not arise from affective state or previous attitude Origin from : Generally It is always self-referent, momentous, urgent, and with overwhelming personal significance Ultimately un-understandable. A new symbolic meaning is attached to percept, intuition, memory Delusional perception Sudden delusional idea Delusional mood Delusional memory
    14. 14. DELUSIONAL MOODDELUSIONAL MOOD Person has the knowledge that there is something going on around him which concerns him, but does not know what it is. DELUSIONAL PERCEPTIONDELUSIONAL PERCEPTION Delusional perception is the attribution of a new meaning usually in the sense of self reference,to a normally perceived object. Important feature of this symptom is its two- memberedness. memory + delusional significance Eg: person says that he is of royal descent because he remembers that the spoon he used as a boy had a crown on it
    15. 15. SUDDEN DELUSIONAL IDEASUDDEN DELUSIONAL IDEA Delusion appears fully formed in the person’s mind. Autochthonous delusion Eg: person says that he is of royal descent because when he was taken to a military parade as a little boy the king saluted him. (Delusion is contained within the memory and there is no two-memberedness.)
    16. 16. Primary Delusional experiences – reported more in acute schizophrenia Less common in chronic schizophrenia
    17. 17. Secondary DelusionSecondary Delusion Those that arise from some other morbid experience Can be understood from the person’s cultural/emotional background Often transient Can occur in Schizophrenia, other psychotic conditions NOT an overvalued idea
    18. 18. Understandable with respect to the mood state or after viewing psychiatric history and MSE Originates in response to: other psychopathology -  Mood  Cultural contents  Personality traits  Primary delusions  Hallucinations  Formal thought disorder SECONDARY DELUSIONSECONDARY DELUSION
    19. 19. Secondary DelusionSecondary Delusion  In schizophrenia once primary delusional experience have occurred they are commonly integrated into some sort of delusional system.  This Elaboration  Ie .The story a deluded person builds around the delusion ‘delusional work’. Where apparently logical consequences and inferences are made around the delusion.  Systematization & Non Systematized  There is one basic delusion. The rest of the delusional beliefs are related to that, being systematically built over it. Systematization is seen as more or less. The degree depends upon the retention of integrity in the deluded person.
    20. 20. ORIGIN OF DELUSION The ultimate alteration from normal : Reality Perception Pre-morbid personality Social constraints Superego Poor communication A key experience Impaired cognition + Impaired attribution Delusion! Adaptive New identity/ purpose Freedom and protection
    21. 21. Factors concerned with the origins ofFactors concerned with the origins of delusionsdelusions Disorder of brain functioning Background influences of temperament and personality Maintenance of self esteem Role of affect As a response to perceptual disturbances As a response to depersonalization Associated with cognitive overload. -Brockington.
    22. 22. Content of DelusionContent of Delusion It is determined by the emotional, social, cultural, educational environment of the person. Important to distinguish from the Form, which would be determined by the type of illness.
    23. 23. DELUSION OF PERSECUTIONDELUSION OF PERSECUTION Harm, in any form, by an external agency, which may be identified or just a vague influence It may also arise from auditory hallucinations, bodily hallucinations, passivity Seen in Schizophrenia, Organic conditions Associated secondary delusions – Delusions of reference: people talking about him Delusions of guilt : justification of persecution at times Delusions of being poisoned/ infected : explanatory nature Delusions of influence : from passivity feelings
    24. 24. DELUSION OF JEALOUSYDELUSION OF JEALOUSY Morbid jealousy may be expressed in many ways Psychotic jealousy has Delusions of infidelity Origin autochthonous or an etiology in the deluded person : Alcohol abuse •Impotence •Punch-drunk syndrome •Previous promiscuous behavior •Homosexual fantasies •Internal conflicts The perceived threat : loss of exclusive possession of partner Violent behavior
    25. 25. DELUSIONS OF LOVEDELUSIONS OF LOVE Erotomania Convinced that the person is in love with her, although the alleged lover may never have spoken to her. May pester the victim with letters Also seen in Manic Depressive Psychosis Abnormal parent-child relationships may be present de-Clerembault’s Syndrome : Seen in women
    26. 26. DELUSIONS OF GRANDIOSITYDELUSIONS OF GRANDIOSITY Primary : Schizophrenia, Delusions of special purpose, Delusions of Invention Secondary : Mania. Supported by hallucinatory voices or confabulations May also be seen in drug dependence, organic syndromes.
    27. 27. Delusions of ill HealthDelusions of ill Health Seen in Depression, Schizophrenia, personality disorders. In depressive patients, they feel that they have an incurable disease. In Schizophrenia it may be due to a bodily hallucination or a depressed mood. Chronic Hypochondriasis may be secondary to a personality disorder.
    28. 28. HYPOCHONDRIACAL DELUSIONSHYPOCHONDRIACAL DELUSIONS Delusions of Body odor/ Halitosis or Olfactory reference syndrome Delusion of Infestation – Ekbom Syndrome Delusion of Ugliness or misshapenness or Dysmorphophobic delusion These delusions could also involve the spouse or children Violent behavior may be associated Seen with affective psychosis, Depression, Paranoid Schizophrenia, Delusional disorder, Drug abuse, CVD, Senile Dementia, Personality disorders (Paranoid and
    29. 29. DELUSION OF NIHILISMDELUSION OF NIHILISM Seen in Severe Depression, Delirium, Schizophrenia. Patient denies the existence of his body, his mind, his loved ones and the world around him. Subjective changes in his own attitude is confused with the world. The reverse of Grandiosity. In persecution the extreme blame is on an external agency. Cotard’s Syndrome : Psychotic depression in elderly, Nihilistic and Hypochondriacal delusions, may be dramatic, grandiose; agitation or retardation. The underlying feeling tone is of total negativism as though nothing exists.
    30. 30. Delusions of GuiltDelusions of Guilt Usually seen in Depression. Patient feels he is a sinner and that he has ruined his family’s life. Often leads to suicide. It may give rise to delusion of persecution.
    31. 31. DELUSIONAL MISIDENTIFICATIONDELUSIONAL MISIDENTIFICATION Face processing disorder. Could occur with People, Animals, Objects, Self. There is usually an important emotional connotation involved. Capgras’ Syndrome: A close family member replaced by a stranger who is an exact double. Usually the deluded person shared an ambivalent relationship with that family member previously. Delusion of Intermetamorphosis: A member of the family becomes a stranger, though the deluded person cannot describe any perceptual changes in the person. Delusion of Fregoli: everyone else – same person in disguise Delusion of Subjective Doubles: Another person been physically transformed into own self.
    32. 32. Seen mostly in Schizophrenia Also in Manic Depressive Psychosis and in Organic Conditions
    33. 33. COMMUNICATED INSANITYCOMMUNICATED INSANITY A delusion transferred from a psychotic person to a person with whom they have a close association. The recipient shares the belief. Psychosis of association. The partner is usually socially deprived or disadvantaged.
    34. 34. Disorders ofDisorders of Possession of thoughtPossession of thought Control byControl by - The Self- The Self - Others- Others Obsessions and compulsions Thought alienation
    35. 35. ObsessionsObsessions Coined by Esquirol in 1838 Schneider’s definition ◦ one cannot get rid ◦ Content of consciousness ◦ Realizes senseless ◦ Persists without cause
    36. 36. ObsessionsObsessions Individuals own thoughts One thought/act is resisted unsuccessfully Unpleasantly repetitive FISH : a thought that persists and dominates an individual’s thinking despite the individual’s awareness that the thought is either entirely without purpose or else has persisted and dominated their thinking beyond the point of relevance or usefulness.
    37. 37. CompulsionCompulsion Prudish person – sexual thought Religious person – blasphemous thoughts Timid person – torture , murder Merely obsessional motor acts Obsessive thought compulsive act = Relief ….. temporary
    38. 38. ObsessionsObsessions Images – vivid images occupy the Pt mind Ideas - why sky is blue Impulses – touch count , Diff between compulsion & Ob impulsesDiff between compulsion & Ob impulses Impulse in mind acted again & again compulsion
    39. 39. ObsessionsObsessions Themes ◦ Dirt & contamination ◦ Aggression ◦ Religious ◦ Sexual ◦ Inanimate-impersonal ◦ miscellaneous
    40. 40. ObsessionsObsessions OCD Depression Schizophrenia Postencephalitic states Compulsion common in post encephalitic parkinson
    41. 41. Thought alienationThought alienation Thoughts are not his own Under control of an outside agency Others are participating in his thinking
    42. 42. Thought alienationThought alienation Thought insertion – common in schizophrenia though not unique Thought deprivation – suddenly disappear or withdrawn by foreign influence Thought broadcasting – everyone else is thinking in unison with them. Others can hear his thoughts Psychoanalytic interpretation – the boundary between the ego and the surrounding world has broken down
    43. 43. Disorders of form of thoughtDisorders of form of thought Thought are : Logical flow of ideas Cannot be observed directly Therefore language is relied on in form of speech, writing or other symbolic creation
    44. 44. FormForm Arrangement of parts – Oxford dictionary Formal thought disorder- disorder of conceptual / abstract thinking Disturbances in form are disturbances in the logical process of thought or logical connection between ideas
    45. 45. Clinical assessmentClinical assessment Assessed during course of interview, silence, by abstract questions Need to document speech sample - Diagnosis -Assessment of progress Verbatim written account or recording audio sample
    46. 46. Types of formal thought disordersTypes of formal thought disorders Positive and negative positive –produces false concepts by blending together incongruous elements eg: derailment negative- lost previous ability to think eg: poverty of speech
    47. 47. SchneiderSchneider Five features of FTD: Derailment- slides on to a subsidiary Substitution- major thought substituted Omission- senseless omission Fusion- heterogeneous elements are interwoven Drivelling- disordered intermixture
    48. 48. SchneiderSchneider Features of healthy thinking Constancy : Persistence of completed thought Organization :Thoughts related to each other & do not blend with each other but separated in organized way. Continuity: Thoughts are arranged in order and are in continuum
    49. 49. Three objective thought disordersThree objective thought disorders Transitory thinking Drivelling thinking- muddled parts Desultory thinking- sudden ideas force their way
    50. 50. Transitory thinking : - Grammatical & syntactical structures are both disturbed. - Continuity is not loosened. - Intention itself is affected. Drivelling thinking - Pt has - a preliminary outline of a - - complicated thought but - - looses preliminary organization of the thought so that all the constituent parts get muddled together Desultory thinking : - Grammatically & syntactically correct - Sudden ideas force their way time to time - Each idea – simple & suitable thought.
    51. 51. Healthy FTD Schizophrenic Constancy Derailment Transitory Substitution Omission Organization Drivelling Drivelling Continuity Fusion Desultory  Scheider claims that individual with Schizo complained of 3 diff disorders of thinking that corresspond to these 3 features of normal / non disordered thinking
    52. 52. STREAM (progress) OFSTREAM (progress) OF THOUGHTTHOUGHT Disorders of tempo  Flight of ideas  Inhibition or retardation of thinking Circumstantiality
    53. 53. Disorders of continuity  Perseveration Thought blocking
    54. 54. Flight of ideas The thoughts follow each other rapidly. There is no general direction of thinking. The connections between successive thoughts appear to be due to chance factors Absence of determining tendency
    55. 55. Birmingham, Kingstanding see the king he is standing king, king, sing, sing  Mania (typical)  excited schizophrenics (occasional)  Organicity; especially lesions of hypothalamus  Mixed affective states (flight of ideas without pressure of speech)
    56. 56. Prolixity (ordered flight of ideas)  In hypomania ordered flight of ideas occur – Lively embelishment Despite many irrelevances, the patient is able to return to the task in hand.  The speed of emergence of thoughts is not as fast as in flight of ideas.
    57. 57. Inhibition or retardation ofInhibition or retardation of thinkingthinking The train of thought is slowed down no. of ideas and mental images which present themselves is decreased. Diminution of active attention – events are poorly registered. Retarded depression Manic stupor
    58. 58. CircumstantialityCircumstantiality Thinking proceeds slowly with many unnecessary details but the point is finally reached. Tedious elaboration weakness of judgment and egocentricity. Occur in context of learning disability & Individuals with obsessional personality traits
    59. 59. Disorders of continuityDisorders of continuity Thought blocking A sudden arrest of the train of thought, leaving a blank. An entirely new thought may then begin. Almost diagnostic of schizophrenia Exhausted and anxious patients may easily lose the thread of the conversation and may appear to block
    60. 60. Perseveration:  Is a senseless repetition of a goal- directed action/speech which has already served its purpose/beyond relevance. Catatonia Coarse Brain Disease
    61. 61. Thank youThank you