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FISH's DISORDERS OF THOUGHT AND SPEECH.pptx
1. Chapter 4: DISORDERS OF
THOUGHT & SPEECH
F i s h ’ s C l i n i c a l P a t h o l o g y
S i g n s & S y m p t o m s i n P s y c h i a t r y
D r . E d w i n E . D e L a C r u z J r .
2 n d Y e a r R e s i d e n t
B i c o l M e d i c a l C e n t e r - D e p a r t m e n t o f P s y c h i a t r y
2. DISORDERS OF INTELLIGENCE
• I N T E L LIG E NCE
• abilit y to t h in k an d act rat ion ally an d logically
• measu red wit h test s of t h e abil it y of t he in d iv idu al to solve probl ems
an d to form con cepts th rough t h e u se of words, n u mber s, symbols,
pat tern s an d n on - verbal material
• Most com m o n way of m easu rin g in tell ig en ce is in terms of t h e
d i s t ribu t ion of s c ores i n t h e p o p u lati on .
• 2 grou ps of su bject s wit h l ow intel ligen ce o r what is n ow termed
‘ l e a rn in g d i s abil it y ’ o r ‘ i n te l le ctu al d i sabi l ity ’:
• lowest en d of th e n o rm al ran ge - a qu ant itat ive deviat io n from t he
n ormal
• in dividu als with specific learn in g disabilities
3. DISORDERS OF INTELLIGENCE
• C AT EG ORI ES O F L E ARNI NG D I S AB IL IT Y :
• borderlin e (IQ = 70−90)
• mild (IQ = 50−69)
• moderate (IQ = 35−49)
• severe (IQ = 20−34)
• profou n d (IQ < 20)
• Dementia is a lo ss of in tellig en ce resu lt in g from brain disease,
ch aracteriz ed by distu rban ces of mu ltipl e cor ti cal fu n ction s, in clu din g
t h in kin g, memor y, compreh en sion an d o rien t at io n , amon g ot h er s
• ‘schizophrenic dementia’.
4. DISORDERS OF THINKING
• L e g iti mate u s e s of t h e w o rd “ think”:
• U n di re cted f a n tasy t h in ki n g (wh ich , in t h e past , h as also been termed
au t ist ic or dereist ic t h in kin g)
• I m a gin ative t h i n kin g - does n ot go beyon d th e ration al an d th e
possible
• R a t ion al t h in k in g o r C o n ceptu al t h i n kin g - at tempt s to solve a
problem.
5. Undirected Fantasy or ‘Autistic’ Thinking
• Q u ite c o mmon , b u t c e r t ai n i n d i vidu als w h e n f a ce d w i t h re p eated
d i s appoi n tmen ts o r a d ver se l i f e c i rcu mstan ce s m a y e n gage i n e x c e ssi ve
u n di re cted f a n t asy t h in k in g .
• E x c e ssi ve ‘ a u t isti c’ t h i n ki n g i n s c h iz oph ren ia w a s pa r tl y t h e re s u lt of
f o r mal t h ough t d i s orde r
• N o t h e l pfu l i n d e s c ri bin g o r u n de r stan din g a l l s u bt ypes of
s c h izoph ren ia
6. Classification of Disorders of Thinking
• An y classificat ion of disorder s of t h in kin g is bou n d to be arbit rar y, at
l e a st t o a c e r t ain e x te n t .
• It is obviou s t hat th is di vis io n is somewh at ar t ifi cial becau s e be lief an d
re a son in g c a n n ot b e s h arpl y s e parated .
• Apar t from th ese two dis o rde r s , on e can also con sid er disorde r s of t h e
st ream o r progress of t hough t , wh ich is also a som ew h at arbit rar y
c o n cept .
• Disord er s of t h e con t rol of th in k in g, in wh ich th e su bject is n ot in
c o n trol of t h e i r t h ough ts, w h i ch m a y e ve n b e f o rei gn t o t h e m
7. Disorders of the Stream of Thought
• D i s orde r s of t e mpo
• F l i gh t of I d e a s
• I n h i bit ion o r S l o win g of T h i n kin g
• C i rc u mstan tial ity
• D i s orde r s of c o n t in u it y
• Pe r se ve rat ion
• T h o u gh t B l o ck in g
8. Disorders of Tempo
• F L I G HT O F I D E AS
• t h ou gh t s follow each ot h er
rapidly
• n o gen eral direction of
t h in kin g
• con n ect ion s bet ween
su ccessive t h ou gh t s appear
to be du e to ch an ce factor s
• typical of man ia
• occasion ally occu r s in
in dividu als wit h
sch iz oph ren ia
9. Disorders of Tempo
• I N H I B I TI ON
• t rain of t h ou gh t is slowed
down an d t h e n u mber of
ideas an d men tal images th at
presen t t h emselves is
decreased
• difficu lt y in makin g
decision s, lack of
con cen tration an d loss of
clarit y of t h in kin g
• seen in bot h depression an d
t h e rare con dit ion of man ic
st u por
10. Disorders of Tempo
• C I RCUMS TANT IALI T Y
• t h i n k i n g p r o c e e d s s l o w l y w i t h
m a n y u n n e c e s s a r y a n d t r i v i a l
d e t a i l s , b u t f i n a l l y t h e p o i n t i s
r e a c h e d
• g o a l of t h i n k i n g i s n e v e r
c o m p l e t e l y l o s t a n d t h i n k i n g
p r o c e e d s t o w a r d s i t b y a n
i n t r i c a t e a n d c o n v o l u t e d p a t h
• re g a rd e d a s a f e a t u re of t h e
c o n s t e l l a t i o n of p e r s o n a l i t y
t r a i t s o c c a s i o n a l l y a s s o c i a t e d
w i t h e p i l e p s y
• c a n a l s o o c c u r i n l e a r n i n g
d i s a b i l i t y, o b s e s s i o n a l
p e r s o n a l i t y t r a i t s , s c h i z o p h r e n i a
& s c h i z o a f f e c t i v e d i s o r d e r
11. Disorders of the Continuity of Thinking
• P E R S EVE RATI ON
• m e n t a l o p e r a t i o n s p e r s i s t
b e y o n d t h e p o i n t a t w h i c h t h e y
a r e r e l e va n t a n d t h u s p r e v e n t
p r o g r e s s of t h i n k i n g .
• m a y b e m a i n l y v e r b a l o r
i d e a t i o n a l
• r e l a t e d t o t h e s e v e r i t y of t h e
t a s k f a c i n g t h e pa t i e n t , s o t h a t
t h e m o r e d i f f i c u l t t h e p r o b l e m ,
t h e m o r e l i ke l y i t i s t h a t
p e r s e v e r a t i o n w i l l o c c u r
• n o t a p r o b l e m of v o l i t i o n , w h i c h
h e l p s d i f f e r e n t i a t e i t f r o m
v e r ba l s t e re o t y p y, w h i c h i s a
f r e q u e n t s p o n t a n e o u s r e p e t i t i o n
of a w o r d o r p h r a s e t h a t i s n o t
i n a n y w a y r e l a t e d t o t h e
c u r r e n t s i t u a t i o n
12. Disorders of the Continuity of Thinking
• T H O UGH T B LOCKI NG
• s u d d e n a r r e s t of t h e t r a i n of
t h o u g h t , l e a v i n g a ‘ b l a n k ’
• p a t i e n t s w h o r e t a i n s o m e
i n s i g h t , t h i s m a y b e a t e r r i f y i n g
e x p e r i e n c e ; t h i s s u g g e s t s t h a t
t h o u g h t b l o c k i n g d i f f e r s f r o m
t h e m o r e c o m m o n e x p e r i e n c e of
s u d d e n l y l o s i n g o n e ’s t r a i n of
t h o u g h t , w h i c h t e n d s t o o c c u r
w h e n o n e i s e x h a u s t e d o r v e r y
a n x i o u s
• h i g h l y s u g g e s t i v e of
s c h i z o p h r e n i a
• e x h a u s t e d a n d a n x i o u s m a y a l s o
l o s e t h e t h r e a d of t h e
c o n v e r s a t i o n a n d m a y a p p e a r t o
h a v e t h o u g h t b l o c k i n g
13. Obsessions, Compulsion and Disorders of the Possession of Thought
• Normall y on e ex p eri en ces one ’s t h in kin g as bein g on e’s own , althou gh
t h is sen se of per son al possession is ne ve r in t he foregrou n d of one ’s
c o n sciou sn ess .
• On e also h as t h e fe e lin g that on e is in con tro l of on e’s th in kin g . In
s o m e psych iat ric i lln es s es th ere is a loss of con t rol o r sen se of
p o sse ssion of t h in ki n g .
14. Obsessions and Compulsions
O B S ES S I ON
• a l s o t e rmed a r u m i n ati on
• a t h ou ght t hat per s is t s an d
dom in ates an in d ividu al ’s
th in kin g despite the
in d iv idu al’s awaren ess t hat
t h e th ou gh t is eit he r en t ire ly
w it h out pu rpose o r e lse h as
pe r sisted an d dominated t h ei r
t h in kin g be yon d t he poin t of
re l e van ce o r u s e fu ln ess
• con tent is of ten of a nat u re
as to cause t h e su ffe rer great
a n x i et y a n d e ve n g u i lt
15. Obsessions and Compulsions
CO M P ULS I ON
• o b s ession al m o tor a ct s
• resu lt from an obsession al
im pu lse th at l eads d irect ly to
t h e a c ti on
• m ay be m ediated by an
obsession al men tal image or
t h ou ght
16. Thought Alienation
• Thought alienation - t h ou gh t s are un der t h e cont rol of an out side
a g e n cy o r t h at o t h e r s a re pa r ti cipatin g i n t h e ir t h in ki n g
• Thought inser tion - t h ou gh ts are be in g in se r ted in to t he ir m in d an d
t h e y re c ogn iz e t h em a s b e i n g f o rei gn a n d c o m i n g f ro m w i t h ou t
• Thought deprivation - t h ou ght s su dden l y disappear an d are wit h drawn
f ro m t h ei r m i n d b y a f o re ign i n f l u en ce
17. Disorders of Content of Thinking
• Delusion - a false, u n sh akeabl e be li efe t hat is o ut of keep in g w it h th e
pat i en t’s s o c ial a n d c u l t u ral ba ckgrou n d .
• Primar y Delusion (apophany)
• d e l u sion al m o od
• d e l u sion al p e rce pti on
• s u dde n d e l u si on al i d e a
• Secondar y Delusion - arising from some other morbid experience
18. Delusions
• Delusions of Per secution
• Delusions of Infidelity
• Delusions of Love
• Grandiose Delusions
• Delusions of Ill Health
• Delusions of Guilt
• Nihilistic Delusions
• Delusions of Pover ty
19. Disorders of the Form of Thinking
• Th e term ‘formal t h ou gh t d isorder ’ is a syn on ym for disorder s of
con cept u al o r abstract t h ink in g th at are most common l y s een in
s c h izoph ren ia a n d o rgan i c b r ai n d i s o rde r s
• S c h n e ide r s u gge sted t h ere we re t h re e f e at u res of h e a lt hy t h i n ki n g :
• Constancy: c o mpl ete d t h ough t t h at d o e s n o t c h an ge i n c o n ten t
• Organisation : con ten t s are related to each ot h er in con sciou sn ess
a n d d o n o t b l e n d w i t h e a c h o t h er
• Continuity : c o n t in u it y of t h e s e n se c o n t i n u um
• Transitor y Thinking
• Drivelling Thinking
• Desultor y Thinking
20. Speech Disorder
• Stammering and Stuttering
• Mutism
• Talking Past the Point (Vorbeireden )
• Neologisms
• Speech Confusions and Schizophasia
• Aphasia
• Receptive Aphasia
• Intermediate Aphasia
• Expressive Aphasia
Disorders of thought include disorders of intelligence, stream of thought and possession of
thought, obsessions and compulsions and disorders of the content and form of thinking.
Intelligence is the ability to think and act rationally and logically. In practice, intelligence is measured with tests of the ability of the individual to solve problems and to form concepts through the use of words, numbers, symbols, patterns and non-verbal material.
The most common way of measuring intelligence is in terms of the distribution of scores in the population. The person who has an intelligence score on the 75 percentile has a score that is such that 75 percent of the appropriate population score less and 25 percent score more. Some intelligence tests used for children give a score in terms of the mental age, which is the score achieved by the average child of the corresponding chronological age. For historical reasons, most intelligence tests are designed to give a mean IQ of the population of 100 with a standard deviation of 15. Even if the distribution of scores is not normal, percentiles can be converted into standard units without difficulty and this is probably the best way of measuring intelligence.
Intelligence scores in a group of randomly chosen subjects of the same age tends to have a normal distribution, but this only applies over most of the range of scores. Towards the lower end of the range there is an increase in the incidence of low intelligence that is the result of brain damage caused by inherited disorders, birth trauma, infections and so on.
There are, therefore, two groups of subjects with low intelligence or what is now termed ‘learning disability’ or ‘intellectual disability’. The first group comprises individuals whose intelligence is at the lowest end of the normal range and is therefore a quantitative deviation from the normal. The other group of individuals with learning disability comprise individuals with specific learning disabilities.
Many cases of learning disability are of unknown etiology and thus, regardless of cause, learning disability tends to be categorized as borderline (IQ = 70−90), mild (IQ = 50−69), moderate (IQ = 35−49), severe (IQ = 20−34) and profound (IQ < 20). More detailed clinical descriptions of these categories are provided in the ICD-10 Classification of Mental and Behavioral Disorders (World Health Organization, 1992).
Dementia is a loss of intelligence resulting from brain disease, characterized by disturbances of multiple cortical functions, including thinking, memory, comprehension and orientation, among others (World Health Organization, 1992). Individuals with schizophrenia tend to exhibit specific deficits in multiple cognitive domains (Sharma & Antonova, 2003) and these deficits have, in the past, been termed ‘schizophrenic dementia’.
These deficits do not, however, represent a true dementia and are best considered as part of the psychopathology of schizophrenia rather than as a form of dementia (McKenna et al., 1990). In particular, impairments of working and semantic memory seen in schizophrenia have been linked to dysfunction of the temporal cortex, frontal cortex and hippocampus (Kuperberg & Heckers, 2000). These kinds of cognitive impairments can have a significant impact on social functioning and may be amenable to remediation (Katsumi et al., 2017).
The verb ‘to think’ is used rather loosely in English. Leaving aside such uses as ‘to give an opinion’ or ‘to pay attention’ there are three legitimate uses of the word ‘think’.
These are:
• undirected fantasy thinking (which, in the past, has also been termed autistic or dereistic
thinking)
• imaginative thinking, which does not go beyond the rational and the possible
• rational thinking or conceptual thinking, which attempts to solve a problem.
It is obvious that the bounds between undirected fantasy thinking and imaginative thinking are not sharp, as it may be difficult to decide where fantasy ends and legitimate speculation begins. In the same way the boundary between imaginative thinking and rational thinking is not sharp.
Undirected fantasy thinking is quite common, but certain individuals when faced with repeated disappointments or adverse life circumstances may engage in excessive undirected fantasy thinking. Bleuler (1911) believed that excessive ‘autistic’ thinking in schizophrenia was partly the result of formal thought disorder. Although the fantastic delusions of some individuals with chronic schizophrenia could be explained in this way, Bleuler’s explanation is not helpful in describing or understanding all subtypes of schizophrenia
Any classification of disorders of thinking is bound to be arbitrary, at least to a certain extent. Thus, it has been customary to divide thought disorders into disorders of content and disorders of form; or to put it into more familiar language, disorders of belief and disorders of reasoning. It is obvious that this division is somewhat artificial because belief and reasoning cannot be sharply separated. Apart from these two disorders, one can also consider disorders of the stream or progress of thought, which is also a somewhat arbitrary concept. Finally, there are disorders of the control of thinking, in which the subject is not in control of their thoughts, which may even be foreign to them. This might be considered as a disorder of volition or ego-consciousness. Realizing that any division is bound to be arbitrary, it is suggested that for the sake of discussion we divide thought disorders into those of the stream of thought, the possession of thought, the content of thought and the form of thought.
Disorders of the stream of thought can be further divided into disorders of tempo and
disorders of continuity.
Flight of Ideas
In flight of ideas thoughts follow each other rapidly; there is no general direction of thinking; and the connections between successive thoughts appear to be due to chance factors which, however, can usually be understood. The patient’s speech is easily diverted to external stimuli and by internal superficial associations. The progress of thought can be compared to a game of dominoes in which one-half of the first piece played determines one-half of the next piece to be played. The absence of a determining tendency to thinking allows the associations of the train of thought to be determined by chance relationships, verbal associations of all kinds (such as assonance, alliteration and so on), clang associations, proverbs, maxims and clichés. The chance linkage of thoughts in flight of ideas is demonstrated by the fact that one could completely reverse the sequence of the record of a flight of ideas, and the progression of thought would be understood just as well (or just as poorly).
Flight of ideas is typical of mania. In hypomania so-called ordered flight of ideas occurs in which, despite many irrelevances, the patient is able to return to the task in hand. In this condition clang and verbal associations are not so marked and the speed of emergence of thoughts is not as fast as in flight of ideas, so that this marginal variety of flight of ideas has been called ‘prolixity’. Although these patients cannot keep accessory thoughts out of the main stream, they only lose the thread for a few moments and finally reach their goal. Unlike the tedious elaboration of details in circumstantiality, these patients have a lively embellishment of their thinking. In acute mania, flight of ideas can become so severe that incoherence occurs, because before one thought is formulated into words another forces its way forward.
Flight of ideas occasionally occurs in individuals with schizophrenia when they are excited and in individuals with organic states, including, for example, lesions of the hypothalamus, which are associated with a range of psychological effects, including features of mania and disturbances of personality (Lishman, 1998).
Inhibition or Slowing of Thinking
With inhibition or slowing of thinking, the train of thought is slowed down and the number of ideas and mental images that present themselves is decreased. This is experienced by the patient as difficulty in making decisions, lack of concentration and loss of clarity of thinking. There is also a diminution in active attention, so that events are poorly registered. This leads the patient to complain of loss of memory and to develop an overvalued or delusional idea that they are going out of their mind. The lack of concentration and the general fuzziness in thinking are often associated with a strange indescribable sensation ‘in the head’, so that at times it is difficult to decide whether the patient is complaining about a physical or a psychiatric symptom. The apparent cognitive deficits in individuals with slowing of thinking in depression may lead to a mistaken diagnosis of dementia.
Slowing of thinking is seen in both depression and the rare condition of manic stupor. Many individuals with depression, however, may not have slowing of thinking but may experience difficulties with thinking owing to anxious preoccupations and increased distractibility due to anxiety.
Circumstantiality
Circumstantiality occurs when thinking proceeds slowly with many unnecessary and trivial details, but finally the point is reached. The goal of thinking is never completely lost and thinking proceeds towards it by an intricate and convoluted path. Historically, this disorder has been regarded as a feature of the constellation of personality traits occasionally associated with epilepsy (Sadock et al., 2009). Circumstantiality, however, can also occur in the context of learning disability and in individuals with obsessional personality traits, as well as schizophrenia and schizoaffective disorder (Tan et al., 2015).
Perseveration
Perseveration occurs when mental operations persist beyond the point at which they are relevant and thus prevent progress of thinking. Perseveration may be mainly verbal or ideational. Thus, a patient may be asked the name of the previous prime minister and reply ‘David Cameron’. On being asked the name of the present prime minister he may reply ‘David Cameron. No, I mean David Cameron’. This symptom is related to the severity of the task facing the patient, so that the more difficult the problem, the more likely it is that perseveration will occur. Perseveration is common in generalized and local organic disorders of the brain, and, when present, provides strong support for such a diagnosis.
In the early stages of perseveration, as in the above case, the patient may recognize their difficulty and try to overcome it. In Alzheimer’s disease, perseveration may relate to working memory deficits (Miozzo et al., 2013). It is clear that this is not a problem of volition, which helps differentiate it from verbal stereotypy, which is a frequent spontaneous repetition of a word or phrase that is not in any way related to the current situation. In verbal stereotypy, the same word or phrase is used regardless of the situation, whereas in perseveration a word, phrase or idea persists beyond the point at which it is relevant.
Thought Blocking
Thought blocking occurs when there is a sudden arrest of the train of thought, leaving a ‘blank’. An entirely new thought may then begin. In patients who retain some insight, this may be a terrifying experience; this suggests that thought blocking differs from the more common experience of suddenly losing one’s train of thought, which tends to occur when one is exhausted or very anxious. When thought blocking is clearly present it is highly suggestive of schizophrenia. However, patients who are exhausted and anxious may also lose the thread of the conversation and may appear to have thought blocking
https://unsplash.com/photos/TvN54bnuQg8
An obsession (also termed a rumination) is 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. One of the most important features of obsessions is that their
content is often of a nature as to cause the sufferer great anxiety and even guilt.
Compulsions are, in fact, merely obsessional motor acts. They may result from an obsessional impulse that leads directly to the action, or they may be mediated by an obsessional mental image or thought, as, for example, when the obsessional fear of contamination leads to compulsive washing.
In thought alienation the patient has the experience that their thoughts are under the control of an outside agency or that others are participating in their thinking.
In pure thought insertion the patient knows that thoughts are being inserted into their mind
and they recognise them as being foreign and coming from without; this symptom, although
commonly associated with schizophrenia, is not unique to schizophrenia, and a range of
related phenomena have also been described (Mullins & Spence, 2003).
In thought deprivation, the patient fifinds that as they are thinking, their thoughts
suddenly disappear and are withdrawn from their mind by a foreign inflfluence. It has
been suggested that this is the subjective experience of thought blocking and ‘omission’.
In thought broadcasting, the patient knows that as they are thinking, everyone else is
thinking in unison with them. While this is the defifinition of thought broadcasting provided
by Fish (Hamilton, 1974), there are also a number of other difffferent defifinitions. For
example, the term has been used to describe the belief that one’s thoughts are quietly
escaping from one’s mind and that other people might be able to access them, and the
experience of hearing one’s thoughts spoken aloud and believing that, as a result, other
people can hear them; these various defifinitions are reviewed by Pawar and Spence (2003)
delusion is a false, unshakeable belief that is out of keeping with the patient’s social and cultural background. The fact that a delusion is false makes it easy to recognise but this is not its essential quality
In the delusional mood the patient has the knowledge that there is something going on around him that concerns him, but he does not know what it is.
delusional perception is the attribution of a new meaning, usually in the sense of self-reference, to a normally perceived object. The new meaning cannot be understood as arising from the patient’s affective state or previous attitudes.
For example, if the patient says that they are of royal descent because they remember that the spoon they used as a child had a crown on it, this is really a delusional perception because there is the memory and also the delusional signifificance, i.e., the ‘two memberedness’.
On the other hand, if the patient says that they are of royal descent because when they were taken to a military parade as a small child the king saluted
them, then this is a sudden delusional idea because the delusion is contained within the memory
Secondary delusions can be understood as arising from some other morbid experience.
Some authors have tried to explain all delusions as a result of some other morbid phenom
enon. Psychoanalysts have stressed the role of projection in the formation of delusions, but
as projection commonly occurs in individuals without psychosis, some other explanation is
necessary to account for the excessive projection that occurs in delusions, particularly those
of persecution.
delusion is a false, unshakeable belief that is out of keeping with the patient’s social and cultural background. The fact that a delusion is false makes it easy to recognise but this is not its essential quality
In the delusional mood the patient has the knowledge that there is something going on around him that concerns him, but he does not know what it is.
delusional perception is the attribution of a new meaning, usually in the sense of self-reference, to a normally perceived object. The new meaning cannot be understood as arising from the patient’s affective state or previous attitudes.
For example, if the patient says that they are of royal descent because they remember that the spoon they used as a child had a crown on it, this is really a delusional perception because there is the memory and also the delusional signifificance, i.e., the ‘two memberedness’. On the other hand, if the patient says that they are of royal descent because when they were taken to a military parade as a small child the king saluted
them, then this is a sudden delusional idea because the delusion is contained within the memory
Secondary delusions can be understood as arising from some other morbid experience.
Some authors have tried to explain all delusions as a result of some other morbid phenom
enon. Psychoanalysts have stressed the role of projection in the formation of delusions, but
as projection commonly occurs in individuals without psychosis, some other explanation is
necessary to account for the excessive projection that occurs in delusions, particularly those
of persecution.
delusion is a false, unshakeable belief that is out of keeping with the patient’s social and cultural background. The fact that a delusion is false makes it easy to recognise but this is not its essential quality
In the delusional mood the patient has the knowledge that there is something going on around him that concerns him, but he does not know what it is.
delusional perception is the attribution of a new meaning, usually in the sense of self-reference, to a normally perceived object. The new meaning cannot be understood as arising from the patient’s affective state or previous attitudes.
For example, if the patient says that they are of royal descent because they remember that the spoon they used as a child had a crown on it, this is really a delusional perception because there is the memory and also the delusional signifificance, i.e., the ‘two memberedness’. On the other hand, if the patient says that they are of royal descent because when they were taken to a military parade as a small child the king saluted
them, then this is a sudden delusional idea because the delusion is contained within the memory
Secondary delusions can be understood as arising from some other morbid experience.
Some authors have tried to explain all delusions as a result of some other morbid phenom
enon. Psychoanalysts have stressed the role of projection in the formation of delusions, but
as projection commonly occurs in individuals without psychosis, some other explanation is
necessary to account for the excessive projection that occurs in delusions, particularly those
of persecution.
https://unsplash.com/photos/GKLIsLZxhj0
Disorders of thought include disorders of intelligence, stream of thought and possession of
thought, obsessions and compulsions and disorders of the content and form of thinking.
