The document discusses various disorders of thought and speech. It describes disorders of thought stream such as flight of ideas, inhibition of thinking and circumstantiality. It also discusses disorders of thought continuity like perseveration and thought blocking. Obsessions, compulsions and thought possession disorders are explained. Disorders of thought content like delusions and their types are outlined. Formal thought disorders are also discussed. The document also describes various speech disorders including stuttering, mutism, neologisms, aphasias and their types.

1. Disorders of Thought and Speech
By:
Frezer Aynalem

2. Outline
• Intelligence
• Disorders of thought
- Disorders of stream of thought
- Obsessions, Compulsions and Disorders of
the possession of thought
- Disorders of the content of thought
- Disorders of the form of thought
• Disorders of speech

3. Intelligence
• Is the ability to think and act rationally and logically.
• The most common way of measuring intelligence is in terms
of the distribution scores in the population.
- Percentile
- IQ, Mental age
• Learning disability or intellectual disability
- border line (IQ – 20-90)
- mild (IQ – 50-69)
- Moderate (IQ – 35-49)
- Sever (IQ – 20-34
- Profound (IQ < 20)

4. • 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 (WHO) 1999.
• Schizophrenic dementia – Temporal cortex, Frontal cortex and
Hippocampus.

5. Disorders of thinking
Functions of thinking
• Undirected fantasy thinking (autistic or dereistic)
- Fantasy is usually understood to be the creation of images
or ideas that have no external reality.
• Imaginative thinking
- The term covers Psychological states such as fantasy, the
generation of novel ideas and the creative outputs that
constitute art or discoveries in science.
- Mental imagery - counter factual thinking
- Symbolic representation

6. Rational or Conceptual thinking
• Problem solving – the set of cognitive processes that we apply
to overcome obstacle to reach a goal.
• Reasoning – the cognitive processes that we use to make
inferences from knowledge and to draw conclusion.
I. Disorders of the stream of thought
A) Disorders of Thought Tempo
i) 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.
- Typical of mania

7. • Prolixity – Hypomania
• Schizophrenic (excited), organic states (eg. Lesions of
hypothalamus).
• Without pressure of speech in mixed effective states.
B) 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.
• Depression, manic stupor.
C) Circumstantialities
• Thinking proceeds slowly with many unnecessary and trivial
details but finally the point in reached.
• Epilepsy, learning disability, obsession personality traits.

8. B) Disorders of the continuity of thinking
i) Perseveration
• Occurs when mental operations persist beyond the point at
which they are relevant and thus prevent progress of thinking.
• A response that was appropriate to a first stimulus being
given in appropriately to a second different stimulus.
• Verbal , ideation, or motor.
• A sign of organic brain disease, perhaps the only
pathognomonic sign in psychiatry.
• Not a problem of volition.
• Verbal stereotype – spontaneous repetition of a word or
phrase that is not in any way related to the current situation.

9. ii) Thought blocking
• There is a sudden arrest of the train of thought leaving a
blank.
• Different from loss of train of thought.
• Highly suggestive of schizophrenia.
II) Obsessions, compulsions and
Disorders of the possession of thought.
A) Obsession and compulsion
In some psychiatric illness there is a loss of central or sense of
possession of thinking.

10. • Obsession (rumination) is a thought that persists and
dominates an individual’s thinking despite the individuals
awareness that the thought of either entirely without purpose
or else has persisted and dominated their thinking beyond the
point of relevance or usefulness.
• Content usually causes great anxiety or even guilt.
• Compulsion are merely obsessional motor act.
• It appears against the patient will, but is under the control of
the patient and can be resisted by the patient.
• Images, ideas, thinking, impulses.

11. • Obsessional fears and phobias
- Groundless fear that the patient realises is dominating
without cause.
• Obsessional states,depression, schizophrenia and occasionally
organic states.
• Compulsive features particularly common in post encephalitic
parkinsonism.
B) Thought alienation
• The patient has the experience that their thoughts are under
the control of outside agency or that others are participating
in their thinking.
 Thought insertion
the patient knows that thoughts are being inserted into them
mind and they recognize as being foreign and coming from
without.

12.  Thought deprivation
As they are thinking their thoughts suddenly disappear and
are with drawn from their mind by a foreign influence.
 Thought broadcasting
The patient knows that as they are thinking, everyone else is
thinking in unison with them.
- Common in schizophrenia
IIl) Disorders of the content of thinking
Delusion – customary definition
A False, unshakeable belief that is out of keeping with the
patient’s social and cultural background
- being false is not the essential quality.

13.  True delusion – the result of a primary delusional experience
that can not be deduced from any other morbid psychological
phenomenon.
 Secondary delusion is secondarily derived from some other
morbid psychological phenomenon (delusion like ideas).
 Over valued idea a thought that because of the associational
feeling tone, takes precedence over all other ideas and
maintains this precedence permanently or for along period of
time.
- less fixed.
- some degree of basis in reality.
Primary delusions.
- Three forms of primary delusional experience.

14.  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.
- becomes obvious with a sudden delusional idea or
perception occurs.
 Delusional Idea
- a delusion appears fully formed in the patients mind.
- sometimes AKA autochthonous.
- schizophrenia, depressive disorders, severe personality
disorders.
N.B. if a patient has a very grandiose or bizarre sudden idea, a
diagnosis of schizophrenia should be actively considered.

15.  Delusional perception
- is the attribution of a new meaning, usually in the sense of
self reference to normally perceived object.
- cannot be understood as a rising from the patients effective
state or previous attitudes.
* Delusional misinterpretation.
* Delusional memory
- Idea - Perception
Secondary delusions and systematization
- can be understood as a rising from some other morbid experience.
- secondary to depressed moods and hallucinations.
- personality
- systematized and non systematized
The Content of Delusions

16. Delusions of persecution
- most common
- believe someone is malevolent to them.
• May occur in the context of primary delusional experience,
hallucinations or experience of passivity.
• Delusions of reference – slandering or spying
• To be put to death - being poisoned
• Robbed of inheritance
• Delusions of influences
• Paranoia – used as substitute for persecutory
- correct meaning delusional
Delusions of infidelity
• Morbid jealousy with delusions of infidelity.
• Schizophrenia, organic (esp alcohol dependency sxx), affective
psychosis.

17. Delusions of love (fantasy lover sxx) (erotomania).
- The patient is convinced that some person is in love with them
although the alleged lover many never have spoken to them.
Grandiose delusions
- More or less expansive.
- Associated with Hallucinations or confabulation.
- More common in manic psychosis in context of Bipolar.
Delusions of ill health
- Characteristics of depressive illness
- Hypochondriacal delusions.
- Delusional preoccupations with facial or bodily appearance
- Delusional dysmorphophobia
Delusions of guilt
- Associated with depression.
- In severe depression may take on grandiose character.
- May give rise to Delusion of persecution.

18. Nihilistic delusions (negation)
• The patient denies the existence of their body, their mind
their loved ones and the world around them.
• Occurs in sever depression, schizophrenia and states of
delirium.
Delusions of poverty
• The patient is convinced that they are impoverished and
believe that destitution is facing them and their family.
 The reality of delusions.
- Discrepancy between the delusions and the patients
behavior.
- suicides or Homicides.
 The pathology underlying delusions.

19. IV) Disorders of the form of thinking
• Formal thought disorders or disorders of conceptual or abstract
thinking.
• Usually associated with schizophrenia and organic brain
disorders.
• Condensation - Displacement
• Faulty use and symbol
 Features of formal thought disorder
• Derailment – the thought slides onto a subsidiary thought.
• Substitution – a major thought is substituted by a subsidiary
one.
• Omission – the senseless o mission on of a thought or part of it.
• Fusion – Heterogeneous elements of thought are inter woven
with each other.
• Drivelling – Disordered intermixture of constitute parts of one
complex thought.

20. Three features of healthy thinking
 Constancy – a completed thought that does not change in
content unless and until superseded by another consciously
derived thought.
 Organization - that contents of thought are related to each
other in consciousness and do not blend with each other, but
are separated in an organized way.
 Continuity - there is continuity of the sense continuum,
thought are arranged in order in the whole content of
consciousness.
Three variety of objective thought disorder.
Transitory thinking
- Characterized by derailment, substitutions and omissions.

21. Drivelling thinking
• The patient has a preliminary outline of a complicated
thought with all its necessary particulars, but losses
preliminary organization of thought, so all the constituents
parts got muddled together.
Desultory thinking
• Speech is grammatically correct but sudden ideas forces their
way in from time to time.

22. Speech Disorders
1) Stammering and Stuttering
- In stammering the normal flow of speech is interpreted by pauses
and the interjection of repeated words or parts of words.
- Stuttering is difficultly in uttering speech sounds at the beginning
of words.
- Unusually begins at almost age 4
B > G
- often improves with time
2) Mutism
- the complete loss of speech.
- children – emotional or psychiatric disorders.
- Adults – hysteria, depression, schizophrenia or organic brain
disorders.
3) Talking past the point (Vorbeireden)
- In this disorder the content of the patient replies to questions show
that they understand what has been asked but have responded by
talking about an associated topic.

23. In dissociative or conversion disorder, acute schizophrenia in
catatonic states.
4) Neologisms
- new words that are constructed by the patient or ordinary
words that are used in a new way.
- Seen in schizophrenia.
5) Speech confusions and schizophasia
- Speech that is profoundly confused but are none theless able
to carry out responsible work that does not involve the use of
words.
- Schizophasia AKA speech confusion and word salad.
5) Aphasia
- Aphasia or dysphasia is a disorder of speech resulting from
interference with the functions of certain areas of the brain.

24. A) Receptive aphasias
i) Pure word deafness
- The patient hears words but cannot understand then.
- In the dominant temporal lobe
ii) Agnosic alexia
- The patient can see but cannot read words
- Lesions of the left visual cortex and the corpus callosum
iii) Visual asymbolia (cortical visual aphasia)
- There is disorganization of visual word schemas so that
word cannot be recognized and motor word schemas
cannot be activated.
- Angular and supra marginal gyri of parietal lobe.
- Difficulty to read and write.
- They can understand the words or sentences that they
cannot read aloud.

25. B) Inter mediate aphasia
i) Nominal (amnesic) aphasia
- The patient cannot name objects.
- They find it difficult to carry out verbal and written commands
and they cannot write spontaneously but can copy written
material.
- Diffuse brain damage or focal lesions eg. Dominant
temporoparital region.
ii) Central (conduction) aphasia
- Substantial disturbances in language function with impairments
of speech and writing.
- Faculty in grammar and syntax and there is paraphasia. Is
destruction of words with interpolation of more or less grabled
words.
- Both the receptive and expressive aspects of speech may be
affected.

26. C) Expressive aphasias
i) Cortical motor aphasia (Broca’s, verbal or expressive)
- Broca’s area in the posterior 2/3 of 3rd frontal convolution and
association fibers from speech center in 1st temporal convolution.
- Difficulty putting their thought in to words.
- If severe one word, phrase or yes or no
- Less severe they understand what is said to them and knows
what they want but cannot find the right words
- Telegram style speech
ii) Pure word – dumbness
- The patient is unable to speak spontaneously to repeat words and
to read a loud, but can write spontaneously copy and write
dictation.
- Lesion beneath the region of the insula.
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