thought disorders

1. -Dr Tanushi
Tambi

2. Any mental or
intellectual activity
involving an individual’s
subjective
consciousness.

3. TYPES OF THINKING
Allows the person to deny
reality
Which does not go beyond
rational
Which attempts to solve a
problem

4. DISORDERS OF THOUGHT

6. Disorders of
Thought Tempo
• Flight of Ideas
• Circumstantiality
• Inhibition/Slowness
of thinking
Disorders of
Continuity of
thinking
• Perseveration
• Thought block

7. •Thoughts follow each other rapidly
•No general direction of thinking (no goal)
•Connections between successive thoughts
appear to be due to chance factors
•Typically seen in Mania

8. •In hypomania,
speed of emergence of ideas is not so fast;
patient reaches the goal
•Occasionally seen in –
Schizophrenia
Organic states such as lesions of hypothalamus

9. Disorders of
Thought Tempo
• Flight of Ideas
• Circumstantiality
• Inhibition/Slowness
of thinking
Disorders of
Continuity of
thinking
• Perseveration
• Thought block

10. •Occurs when thinking proceeds slowly with many
trivial and unnecessary details
•But finally the point is reached.
•Seen in – epilepsy patients
indiv. with obsessional traits
mental retardation.

11. Disorders of
Thought Tempo
• Flight of Ideas
• Circumstantiality
• Inhibition/Slowness
of thinking
Disorders of
Continuity of
thinking
• Perseveration
• Thought block

12. Inhibition/Slowness of thinking
•Thinking is goal directed
•But proceeds so slowly, with such morbid
preoccupation with gloomy thoughts, that the
person may fail to achieve those goals.

13. •Difficulty in concentration
• There is loss of clarity of thought and poor
registration of those events he needs to
remember
•Seen in – depression
rarely in Manic stupor
•Can be mistakenly diagnosed as dementia

14. Disorders of
Thought Tempo
• Flight of Ideas
• Circumstantiality
• Inhibition/Slowness
of thinking
Disorders of
Continuity of
thinking
• Perseveration
• Thought block

15. •A response given appropriately to first stimulus, but
inappropriately to next different stimulus
• It may be verbal or ideational
•Common in generalized and local organic disorders of the
brain.

16. Disorders of
Thought Tempo
• Flight of Ideas
• Circumstantiality
• Inhibition/Slowness
of thinking
Disorders of
Continuity of
thinking
• Perseveration
• Thought block

17. Thought block
•Occurs when there is sudden arrest in train of thought,
leaving a ‘blank’
•an entirely new thought may then begin
•Seen in patients with- schizophrenia
anxiety

20. Obsessions
•Thought that persists and dominates an individual’s
thinking despite the person’s awareness that it is
without purpose and irrelevant.
•Important feature-
A. thought causes sufferer a great anxiety and guilt.
B. Appears against patient’s will
•We can only call a mental event an obsession if it is
normally under the control of the patient and can be
resisted by the patient.

21. Compulsion
s•Obsession Compulsion(motor acts)
•Important feature- compulsions will cause relief in
symptoms of anxiety caused d/to obsessions.
•Obsessions are seen in- obsessional states
schizophrenia
organic states
•But compulsive features are common in post
encephalitic parkinsonism.

23. Thought Alienation
•THOUGHT ALIENATION- Patient has the
experience that their thoughts are under the control of
an outside agency or that others are participating in
their thinking.
•THOUGHT INSERTION- thoughts that do not
have the feeling of familiarity of being his own, but he
feels that they have been put in his mind
commonly associated with schizophrenia

24. •THOUGHT WITHDRAWL- Patient believes
that his thoughts are in some way being taken out
of his mind;
a feeling of loss resulting from this process
•THOUGHT BROADCAST- patient
experiences his thoughts withdrawn from his mind
and then projected over a wide area

26. Delusions
•Unshakable assumption about the world the patient
inhabits, which he does not create by a process of logical
conscious thought but from false premises.
•Cannot be deduced from other morbid phenomenon
•Delusion like ideas- can be deduced from other morbid
phenomenon
•Overvalued ideas- thought that, because of the
associated feeling tone, takes precedence over all other
ideas for a long time

27. •Primary delusions are seen in-
schizophrenia, certain organic states as
well as psychotic illnesses.
•Schneider (1959) suggested that delusional
experiences can be reduced to three forms:
– delusional mood
– delusional perception
– sudden delusional idea.

28. •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.
•In the delusional perception is the attribution of
a new meaning, usually in the sense of self-
reference, to a normally perceived object.
• In the sudden delusional idea, a delusion
appears fully formed in the patient’s mind.

29. Secondary delusions & Systematization
•Can be understood as arising from some other morbid
experience such as
- depressive mood
-psychogenic or stress reactions
•Ex- a depressed person with decreased self esteem may
think he is responsible for a crime which he did not commit
in reality

31. DELUSION of GRANDIOSITY:
•Patients may believe they are God, the Queen of
England, a famous rock star, skilled sportspersons or great
inventors.
•These delusions may be supported by auditory
hallucinations, which tell the patient that they are
important
•Most commonly associated with Manic psychoses in the
context of bipolar affective disorder

32. DELUSION OF PERSECUTION:
•It may occur in the context of
primary delusional experiences,
auditory hallucinations,
bodily hallucinations, or
experiences of passivity.
•Ideas and delusions of reference can occur in
schizophrenia,
depressive illness and
other psychotic illnesses.

33. DELUSION OF LOVE:
•Also described as ‘the fantasy lover syndrome’ and
‘erotomania’.
•The patient is convinced that some person is in love with
them although the alleged lover may never have even
spoken
•Might pester the victim with letters and unwanted
attention of all kinds.
•Occasionally, it may be found in abnormal personality state.

34. DELUSIONS OF ILL-HEALTH:
•Patient develops concerns about health and may develop
delusions or overvalued ideas of ill health
•Individuals with delusions of ill health believe that they
have a serious disease, such as cancer, tuberculosis, AIDS, a
brain tumour, etc.
•Delusions of ill health can be seen in:
depressive illnesses,
schizophrenia

35. DELUSION OF GUILT:
•In mild depression, the patient may be self-reproachful
and self-critical.
•In severe depressive illness, self-reproach may take the
form of delusions of guilt, when the patient believes that
they are a bad or evil person and have ruined their family.
•In very severe depression, the delusions may even appear
to take on a grandiose character and the patient may
assert that they are the most evil person in the world.
•Delusions of guilt may also give rise to delusions of
persecution.

36. DELUSION OF POVERTY:
•The patient with delusions of poverty is convinced
that they are impoverished and believe that their
family is going through misery.
•Typical of depression.

37. DELUSION OF INFIDELITY:
•Patient tends to have morbid jealousy
•Often he is suspicious, sensitive and mildly
jealous before the onset of the illness.
•Delusions of infidelity may occur in:
– schizophrenia
– organic brain disorders
– alcohol dependence syndrome
– affective psychosis

38. NIHILISTIC DELUSIONS:
•Occur when the patient denies the existence of their body
/mind / their loved ones and the world around them.
•They may assert that they have no mind, no intelligence,
or that their body or body parts do not exist
•Seen in:
-severe, agitated depression
-schizophrenia
-delirium.

40. FEATURES OF HEALTHY THINKING
According to Schneider:
•Constancy: characteristic of a completed thought that does
not change in content unless it is superseded by another
consciously derived thought.
• Organisation: contents of thought are related to each
other in consciousness and are separated in an organized way.
• Continuity: There is a continuity of the sense continuum

41. Schneiders’ features of formal thought disorder
• Thought slides into a supplementary
thoughtDerailment
• Major thought is substituted by a
supplementary oneSubstitution
• Senseless omission of a thought or a
part of itOmission
• Heterogeneous elements of thought are
interwoven with each otherFusion
• Disordered intermixture of constituent
parts of one thoughtDriveling

42. Formal thought disorders
are characterized by
disturbance in the form or
flow and connectivity of
thought
Formal Thought Disorders

43. 1. TANGENTIALITY:
•Patient tends to wander away from the intended
point
•Such that the central idea is not communicated
•Ex-
Q- Where is your home address?
A- You touched a good topic. I bought my home for
3 crore but due to demonetisation I had only 70L.
And I don’t know I am very frustrated and pissed
of…

44. 2. WORD SALAD
•a/k/a - Schizophasia
•Incoherent and incomprehensible mixture of words
and phrases

45. 3. NEOLOGISM
•New words that are constructed by the patient or
ordinary words that are used in a new way
•New words are such formed that
-derivation cannot be understood
-distortion of another word
-word that has been incorrectly constructed
•In motor aphasia, phonetic structure of word is
distorted

46. 4. LOOSENING OF ASSOSCIATION
•Speech disturbance involving a disorder of logical
progression of thought
•Manifested as a failure to communicate verbally
adequately
•Unrelated and unconnected ideas shift from one subject to
another

47. 5. CLANG ASSOCIATION:
•Refers to a sequence of thoughts stimulated by the sound
of preceding words rather than their meaning
•May lead to rhyming
•Seen in manic patients