ABNORMALITIES IN THINKING

April 26, 2013  Nursing Path  No comments

  • Autistic thinking: an abnormal absorption with the self distinguished by the interpersonal communication difficulties, a short attention span, and inability to relate others
A. Abnormalities of Stream of Thought
  • Flight of ideas: the thoughts follow each other rapidly and there is no general direction of thinking, seen in mania /excited schizophrenics.
  • Prolixity: ordered flight of ideas seen in hypomania.
  • Pressure of thoughts: Rapid abundant varying thoughts associated with pressure of speech and flight of ideas.
  • Poverty of thoughts: Few, slow, unvaried thoughts associated with poverty of speech.
  • Thought block: Sudden cessation of thought flow with complete emptying of the mind not caused by an external influence.
B. Abnormalities of Form of thought
  • ‘Formal thought disorder’: a synonym for the disorders of conceptual or abstract thinking which occur in schizophrenia and coarse brain disease.
  • Tangentiality: Replies are oblique, tangential or even irrelevant.
  • Looseness of Association:  (asyndesis) more severe version of tangentiality.
  • Derailment: a pattern of spontaneous speech where ideas slip off onto another one, which is clearly but obliquely related or completely unrelated.
  • Neologism: completely new word or phrase whose deviation cannot be understood.
C. Abnormal Thought Content
  • Overvalued Ideas: “A thought which, because of the associated feeling tone, takes precedence over all other ideas and maintains this precedence permanently or for a long period of time.”
  • Delusions: Unshakable false beliefs out of keeping with the person’s cultural background not arrived at through logic thinking and not amenable to reasoning.
  • Delusional mood:  the patient has the knowledge that there is something going on around him which concerns him, but he does not know what it is.
  • Delusional memory: a primary delusion which is recalled as arising as result of a memory.
  • Delusional perception (apophanous perception): the attribution of a new meaning, usually in the sense of self-reference, to a normally perceived object.
  • Autochthonous delusions: a primary delusion which appeasers to arise fully formed in the patient’s mind without explanation.
Delusional Contents:
  • Persecutory (paranoid) delusion: Delusion of being persecuted (cheated, mistreated, etc.)
  • Grandiose delusion: Delusion of exaggerated self-importance, power or identity.
  • Delusion of reference: Delusion that some events and others‟ behaviour refer to oneself.
      • “Idea of Reference”: misattribution of events as referring to oneself.
  • Delusion of jealousy: Delusion that a loved person (wife/husband) is unfaithful (infidelity delusion).
  • Delusions of love (‘fantasy lover’,  ‘erotomania’): Delusion that someone, (usually inaccessible, high social class person) is deeply in love with the patient.
  • Nihilistic delusion: Delusion of nonexistence of self, part of the body, belongings, others or the world.
  •  Delusion of self - accusation: Delusion that a patient has done something sinful, with excessive feeling of remorse and guilt.
  • Delusion of influence: Delusion that person’s thoughts, actions, or feelings are controlled by outside forces.
  • Passivity phenomena: person reports being made feel, made think or made act.
  • Delusions of Replacement (Capgras Syndrome): a belief that important people in one's life have been replaced by impostors.
Delusions can be either :
  • Mood-Congruent Delusion – Delusional content has association to mood:
- in depressed mood: delusion of self - accusation.
- in elevated mood: grandiose delusion.
  • Mood-Incongruent Delusions –   Delusional content has no association to mood, e.g. patient with elevated mood has delusion of thought insertion.
Delusions can also be either:
  • Systematized Delusion - Delusion united by a single event or theme e.g. delusion of jealousy/thematically well connected with each other.
  • Bizarre Delusion - Totally odd and strange delusional belief, e.g. delusion that person’s acts are controlled by stars.
D. Abnormalities of Possession of thought
  • Obsessions:
    • Repetitive ideas, images, feelings or urges insistently entering person’s mind despite resistance. They are unwanted, distressful and recognized as senseless and irrational. Obsessions are frequently followed by compelling actions (compulsions)
  • Common Obsessional Contents:
    •  dirt/contamination/cleaning
    •  orderliness/symmetry
    •  doubts/checking/counting
    •  aggressive impulses/inappropriate acts
    •  religion (blasphemous thoughts)
    •  ruminations: obsessional thoughts.
    •  rituals: certain repeated compulsions.
  • Thought Alienation:
    • Thought Insertion: Delusion that some of person’s thoughts being put into the mind by an external force (other people, certain agency).
    • Thought Withdrawal: Delusion that some of person’s thoughts being taken out of the mind.
    • Thought Broadcasting: Delusion that others can read or hear the person’s thoughts, as they are broadcast over the air, radio or some other unusual way.
  • Dysmorphophobia: a type overvalued idea where the patient believes one aspect of his body is abnormal or conspicuously deformed.
References
  1. Psychiatry, Third Edition. Edited by Allan Tasman, Jerald Kay, Jeffrey A. Lieberman, Michael B. First and Mario Maj. John Wiley & Sons, Ltd, 2008.
  2. Sims, A. Symptoms in the Mind: An Introduction to Descriptive Psychopathology (3rd ed). Elsevier, 2002.
  3. Fish, F. Clinical Psychopathology, Signs and Symptoms in Psychiatry. Bristol: J. Wright & Sons. 1967.

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