The document summarizes a presentation on thought and thought disorders. It defines thought, describes different types of thinking (fantasy, imaginative, rational), and characteristics of healthy thinking. It then discusses thought disorders, formal thought disorders, and specific disorders like flight of ideas, poverty of speech, circumstantiality, and loose associations. Research on thought disorders in schizophrenia is mentioned, focusing on structural brain abnormalities and biomarkers.

1. CHAIR PERSON: DR JEYASEELAN
PRESENTOR: DR USHA NANDHINI
DATE: 18/07/2018

2. TOPICS
 Thought definition
 Types of thinking
 Healthy thinking
 Thought disorders
 Assessment of thought disorders
 Formal thought disorders
 Researches
 References

3. THOUGHT
 Thought - what we think
 Language of the mind[propositional thought - hear in
the mind, imaginal thought – see in the mind]
 Goal oriented flow of ideas and associations that leads
to reality oriented conclusion.
 An idea or opinion produced by thinking or occurring
suddenly in the mind

4. TYPES OF THINKING
 Fantasy [ autistic or dereistic]
 Imaginative
 Rational or conceptual

5. FANTASY THINKING
 There is very little contact with reality.
 Day dreaming
 Carrying on day to day activities
 To compensate for disappointments in life or to escape from unpleasant situations.
 Neurotic triats
initially deliberate and sporadic
↓
more established
↓
believes the contents
↓
accepted as fact.
 Pathological lying
 dissociative disorder
 Delusion like ideas
 Denial of external events- ego defense mechanisms
 Bleuler – excessive autistic thinking in schizophrenia is part of thought disorder

6. FANTASY THINKING

8. IMAGINATIVE THINKING
 Contact with reality
 Components
1. Mental imagery: create image based mental
representations of the world
2. Counterfactual thinking: capacity to disengage
from the reality and think of events and experiences
that haven’t occurred
3. Symbolic representation: use of concepts or
images to represent real world objects.
 Maternal reverie

9. IMAGINATIVE THINKING

10. RATIONAL OR CONCEPTUAL
THINKING
 Problem solving and reasoning
 Problem solving- cognitive process used to overcome the
obstacles to reach a goal
 Reasoning- cognitive process used to make inferences from
knowledge and to draw conclusions
 Analogical reasoning: application of solutions to already
known problems.
 Inductive reasoning: use of specific known instances to
draw inferences about unknown instances.
 Deductive reasoning: argument in which if the premises
are true conclusion cannot be false

11. ANALOGICAL REASONING

12. INDUCTIVE REASONING

13. DEDUCTIVE REASONING

14. HEALTHY THINKING
 Described by Schneider
 Constancy: characteristic of a completed thought that
doesn’t change in content
 Organization: contents of thought are related to each
other in consciousness and do not blend with each
other and separated in organized way
 Continuity: heterogeneous subsidiary thoughts,
sudden ideas or observations that emerge are arranged
in order in the content of conciousness.

15. THOUGHT - ASPECTS
 Thought content: thoughts occurring in mind.
 Thought process: thoughts are formulated , organized
and expressed. Normal thoughts are linear ,organized
and goal directed.

16. THOUGHT DISORDERS
 Any disturbance of thinking that affects language ,
communication and thought content
 Disturbances of thoughts : change in nature of
individual thoughts i.e. disorder of content of
thoughts [ obsession& compulsions, delusions and
overvalued idea]
 Disturbances of thinking process: change in speed or
form of relationships between thoughts, individual
thoughts are unremarkable in nature[ formal thought
disorders]

17. THOUGHT DISORDERS
 Disorders of stream
 Disorders of form
 Disorders of content
 Disorders of possession

18. Formal thought disorders
 Disruption of normal flow of thought
 Disturbances in organization and expression of thoughts
 BLEULER – formal thought disorders are core feature of
schizophrenia.
 Syndrome with different symptoms resulting in thought ,
language and communication problems .
 FTD – abnormality in amount and form of speech
 Amount: poverty and pressure of speech
 Form : disconnection symptoms[distractible speech, loss of
goal, loose associations, illogicality and incoherence]

19. SCHNEIDER
 Derailment : thought slides on to subsidiary thought
 Substitution: major thought is substituted by
subsidiary one
 Omission : senseless omission of a thought or part of it
 Fusion: heterogeneous elements of thoughts are
interwoven with each other
 Driveling: disordered intermixture of constituent part
of one complex thought

20.  POSITIVE FTD: false concepts by blending together of
incongruous elements
 NEGATIVE FTD: Loss of previous ability to think

21. CLINICAL ASSESSMENT
 Assessed during the course of interview
 Patients speech, writings and behaviour
 Sample of speech
 Verbatim record

22. FORMAL THOUGHT DISORDERS
 Flight of ideas
 Retarded thinking
 Circumstantiality
 Preservation
 Thought blocking
 Tangentiality
 Incoherence
 Derailment
 Loosening of associations
 Neologisms
 Poverty of speech
 Pressure of speech

23. FLIGHT OF IDEAS
 Acceleration of flow of thinking
 Rapid succession of thoughts
 No general direction of thinking
 Logical connection present
 Easy distractibility [ external stimulus & internal
superficial associations]
 Associations – chance factors or verbal
 Verbal – clang , puns and rhymes
 Clang – a 2nd word with sound similar to 1st
 Puns – a 2nd meaning of first word
 Typical of mania
 Also in schizophrenia, organic brain disease

24. FLIGHT OF IDEAS/ ACCELERATED
THINKING

25. Example
 பேர் என்னம்மா? ஜீவ மணி ,ஹெலன் ஜீவ
மணி, ஹெலனா கிரிஸ்டியன், நான்
ெிந்து ,நான் இப்ே ோர்வதி ,ோர்வதி
ஹநத்தியில ஹோட்டு ஹெவப்பு கலர்ல
இருக்கும், உன் ஷால் கூட ெிவப்புதான்
,எனக்கு ஒரு ஷால் ஹகாடு.

26. PROLIXITY
 Prolixity – ordered flight of ideas
 Marginal variety of flight of ideas
 Associations are not so marked and acceleration is not
as fast in flight of ideas
 Patients lose thread only for a few moments and finally
reach their goal
 In hypomania

27. PRESSURE OF SPEECH
 Amount of spontaneous speech is increased which is
difficult to interrupt
 Variety of thoughts
 Thought process is accelerated
 Loud and emphatic
 > 150 words per minute.

28. INHIBITION OR SLOWING OF
THINKING
 Thought process slowed down
 Few thoughts [ ideas and mental images]
 Lack of concentration, loss of clarity and difficulty in
making decisions
 Defective attention- poor registration
 Loss of memory and cognitive deficits [ Difficult to
differentiate from dementia]
 Depression and manic stupor
 Depression – anxious preoccupations and increased
distractibility due to anxiety.

29. RETARDATION OF THINKING

30. POVERTY OF SPEECH
 Patient has few thoughts that lack in variety and richness
 Thoughts move slowly through the mind
 Spontaneous speech is restricted
 Answers are brief, concrete and uneloborated
 Example: ஹேயர் என்னம்மா?........... எழிலரெி
.எதுக்கு ொஸ்ேிட்டல் வந்து
இருக்கீங்க?................
 எதுக்கு ொஸ்ேிட்டல் வந்து இருக்கீங்க?………
உடம்பு ெரி இல்லல.
 என்ன ஆச்சும்மா?…………
 என்ன ஆச்சும்மா? ……………வயிறு வலி

31. CIRCUMSTANTIAL THINKING
 Non linear thought pattern
 Thinking proceeds slowly with unnecessary and trivial
details but finally the goal is reached.
 Goal of thinking not lost completely
 Proceeds in intricate and convoluted path
 In OCD – excess detail is introduced anxiously to avoid any
omissions
 Learning disabilities and temporal lobe epilepsy[
Geschwind syndrome-interictal changes in personality
progressing over time. Includes hypergraphia,
hyperreligiosity, atypical sexuality, circumstantiality and
intensified mental life]

32. CIRCUMSTANTIALITY

33. TANGENTIALITY
 Train of thought wanders away , goal is lost and is
never reached
 At first the patients give answers that is appropriate to
the general topic but not answering the questions .
 Seen in anxiety, schizophrenia, dementia and
delerium.

34. TANGENTIALITY

35. PERSEVERATION
 Disturbance of flow of thinking
 mental operations persist beyond the point at which they
are relevant and thus prevent progress of thinking.
 Persistence of response to an earlier stimulus even after
new stimulus has been presented
 may be mainly verbal or ideational.
 Organic disorders- frontal lobe injury
 Example:1. Who is our CM? EPS
2. Where are you from? EPS
3. Are you married? EPS

36. THOUGHT BLOCKING
 Sudden arrest of the train of thought, leaving a
‘blank’. An entirely new thought may begin
 Snapping off
 Not caused by any distractions
 Normal persons- anxious and exhausted
 Schizophrenia- thought withdrawal

38. THOUGHT BLOCKING

39. DERAILMENT
 Characterized by discourse consisting of sequence of
unrelated or remotely related ideas.
 Slippage of ideas further and further away from point
of discussion.
 Euphoria , hysteria and schizophrenia
 Entgleisen[ derailment]- Schneider
 Asyndesis- Cameron
 Knight’s move thinking- Peter McKellar

40. DERAILMENT

41. LOOSENING OF ASSOCIATIONS
 Coined by Bleuler
 pattern of spontaneous speech in which things said in
juxtaposition lack a meaningful relationship .
 there is idiosyncratic shifting from one frame of
reference to another.
 The speech is often described as being ‘disjointed’

42. INCOHERNCE[ WORD SALAD]
 Pattern of speech that is incomprehensible
 confused or unintelligible mixture of seemingly
random words and phrases
 Set of words or phrases used together without any
arbitrary connection or grammatical rules
 Schizophasia- speech confusion or word salad
 occurs in schizophrenia

44. NEOLOGISMS
 New words are constructed by the patient or ordinary words are used
in a new way mainly in schizophrenia.
 Catatonia - mannerisms or stereotypes. The patient may distort the
pronunciation of some words in the same way as they distort some
movements of their body.
 Stock word instead of the correct one. Example- patient may use the word
‘car’ and call an airplane an ‘air car’ and a boat a ‘sea car’
 Severe positive formal thought disorder- words are fused together in the
same way as concepts are blended with one another.
 Derailment: example - a patient used the word ‘relativity’ instead of the
word ‘relationship.’
 Technical neologism- using a technical term for a private experience that
cannot be expressed in ordinary words.
 Hallucinations: The ‘voices’ may use neologisms and this may lead the
patient to use them as well.
 Malapropisms- conspicuously misused words
 Paraphasia :motor aphasia- use the wrong word, invent new words, or
distort the phonetic structure of words.,

45. VORBEIREDEN -TALKING PAST THE
POINT
 Patient understands what has been asked but responds
by talking about an associated topic
 Example: what is the color of grass? – white
what is the color of snow?- green
 Pseudodementia: hebephrenic schizophrenia
 Dissociative disorders
 Gansers syndrome: approximate answers
 Catatonia

46. CLANG ASSOCIATIONS
 A 2nd word with sounds similar to first word is used
rather than by meaning

47. VERBIGERATION
 Verbigeration: speech is reduced to senseless
repetition of words, sounds or phrases
 A form of stereotypy
 A type of incoherence

48. OVER INCLUSIVENESS
 Ideas that are remotely linked to the concept become
incorporated within it in the patients thinking
 Inability to preserve conceptual boundaries [Cameron]
 Schizophrenia
 Example: what are the essentials of room? Wall ,
doors, chairs and window

49. CONCRETE THINKING
 Abstractions and symbols are interpreted superficially
without tact, finesse and awareness of nuance
 Goldstein
 Schizophrenia
 Proverb testing

50. THOUGHT DISORDERS IN
SCHIZOPHRENIA
 Psychological theories :
 CAMERON:
1. Asyndesis: lack of adequate connection between two sucessive
thoughts
2. Metonyms: imprecise expressions or use of substitute term or
phrase instead of exact one
3. Interpenetration of themes: patients speech contain elements
which belong to task in hand interspersed by stream of fantasy
4. Over inclusion: inability to maintain the boundaries of
problem and to resist operations within correct limits
 GOLDSTEIN:
concrete thinking: there is a loss of abstract attitude. The
patient is unable to free himself from the superficial concrete
aspects of thinking

51.  SCHNEIDER:
3 types of disordered thinking
1. Transitory thinking: characterized by derailments,
omissions and substitutions. Grammatical and
syntactical structures distorted
2. Drivelling thinking: patient has a preliminary outline of
complicated thought but loses all preliminary
organisations, so that all constituent part gets muddled
3. Desultory thinking: speech is grammatically correct but
sudden ideas force their way from time to time.
Conversations leap from one topic to other

53.  Frith: failure of self monitoring resulting in thought
disorder
 Inability to edit out irrelevant or perseverating phrases
 Thought is undermined by absence of goal or plan
 Intrusion of thoughts that do not fit into overall goal
 Above results in disorganized thought

54.  Bleuler’s 4 A’s
1. Affective disturbance
2. Ambivalence
3. Autism
4. Disturbances of thought association

55. DELUSIONS OF CONTROL OF
THOUGHT
 Patient ascribes his own internal thought process to
outside influences – passivity
 Thoughts as foreign or alien, not emanating from
himself and not within his control
 Unable to discriminate between himself and outside
world
 Passivity of thought, thought withdrawal, thought
broadcasting and thought insertion[ first rank
symptoms of schizophrenia]

57. RESEARCHES
 FTD- lack of hemispheric asymmetry in language
areas
 FTD: Structural abnormalities in left STG, left planum
temporale and orbito frontal cortex
 FTD ; schizophrenia trait marker
 Eotaxin – ECDC [ endogenous cognitive deteriorating
chemokine] is increased in patients with FTD’s

58. REFERENCES
 SIMS- symptoms in the mind- Femi Oyebode
 Fish clinical psychopathology
 Kaplon and Sadock’s synopsis of psychiatry
 Shorter oxford textbook of psychiatry – Paul Harrison,
Philip Cowen, Mina Fazel , Tom burns
 internet

59. THANK YOU