Thought blocking

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Thought blocking is a neuropsychological symptom expressing a sudden and involuntary silence within a speech, and eventually an abrupt switch to another topic. [1]

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When thought blocking, some people may express themselves in a manner that is not understandable to others. They may repeat words involuntarily or make up new words.[ citation needed ]

When doctors diagnose thought blocking they consider a variety of causes, such as schizophrenia, anxiety, petit mal seizures, dissociation, bradyphrenia, aphasia, dementia or delirium. [2]

Schizophrenia

Thought blocking occurs most often in people with psychiatric illnesses, most commonly schizophrenia. [3] A person's speech is suddenly interrupted by silences that may last a few seconds to a minute or longer. [4] [5] When the person begins speaking again, after the block, they will often speak about an unrelated subject. Blocking is also described as an experience of unanticipated, quick and total emptying of the mind. [6] People with schizophrenia commonly experience thought blocking and may interpret the experience in peculiar ways. [6] For example, a person with schizophrenia might remark that another person has removed their thoughts from their brain. [6]

When evaluating a patient for schizophrenia, a physician may look for thought blocking. [7] In schizophrenia, patients experience two types of symptoms: positive and negative. Positive symptoms include behavior added on to a person's daily functioning. For instance, delusions, hallucinations, disorganized speech, disorganized behavior and thought are all positive symptoms. In contrast, negative symptoms are characterized by missing parts of the average individual's persona, including flat affect, apathy, speaking very little, not finding enjoyment in any activity, and not attending to basic acts of daily living (ADLs), such as bathing, eating, and wearing clean clothes.

Anxiety

Generalized anxiety disorder (GAD) is defined as excessive worry about matters in two or more separate subjects for at least six months. [8] When a person experiences an anxiety attack, they may become so hyperfocused on the distressing stimuli and/or overwhelmed with the situation that regular speech is difficult for that person to produce. The thought blocking that occurs in this instance is usually short lived because anxiety attacks are transient. After an episode occurs, a person is typically able to resume their normal way of speaking.

Seizures

Thought blocking is associated with petit mal seizure. As such, it can be hard for people to organize their speech, resulting in thought blocking. [9]

Dissociation and Post-traumatic stress disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a psychiatric disorder that can occur after a person experiences a traumatic event and is significantly handicapped because of it, and can develop inappropriate coping strategies. [10] These maladaptive approaches can include, but are not limited to, dissociative symptoms: depersonalization and derealization. When these dissociative symptoms surface, they can be extremely intrusive and result in a person not being able to focus on their diction, or manner of speaking, and result in thought blocking. People with PTSD may find that blocking of thought occurs more often if they have not addressed the source of their PTSD. [ citation needed ]

Cognitive & Motor Disorder

In older adults, blocking of thought can be a feature of several cognitive and motor disorders, including underlying dementia and delirium. It is common that as a person ages, they may become forgetful and/or lose their train of thought. When it becomes more persistent and affects one's ability to carry out their ADLs (activities of daily living), a major neurocognitive disorder like dementia is among the possible causes. [11] In addition, thought blocking can occur in patients with parkinsonism, a disorder that features slowing of movement, muscle rigidity, and impairment. The distinguishing feature between parkinsonism and Parkinson's disease is that the causes of parkinsonism are numerous, including drugs, toxins, metabolic disorders, and head trauma. [12] Furthermore, a stroke can result in a disordered speech process such as thought blocking. [2] When a stroke affects the middle cerebral artery (MCA), it can result in damage to the Wernicke's area or Broca's area. As such, people afflicted can understand speech well but have problems saying the words they want to, or be able to speak but have nonsensical syntax and word choice. These symptoms are referred to as aphasias, and aphasias can present with thought blocking. [2]

Related Research Articles

<span class="mw-page-title-main">Catatonia</span> Psychiatric behavioral syndrome

Catatonia is a complex neuropsychiatric behavioral syndrome that is characterized by abnormal movements, immobility, abnormal behaviors, and withdrawal. The onset of catatonia can be acute or subtle and symptoms can wax, wane, or change during episodes. It has historically been related to schizophrenia, catatonia is most often seen in mood disorders. It is now known that catatonic symptoms are nonspecific and may be observed in other mental, neurological, and medical conditions. Catatonia is not a stand-alone diagnosis, and the term is used to describe a feature of the underlying disorder.

<span class="mw-page-title-main">Psychosis</span> Abnormal condition of the mind

Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

Dissociative identity disorder (DID), previously named multiple personality disorder and commonly referred to as split personality disorder or dissociative personality disorder, is a member of the family of dissociative disorders classified by the DSM-V, DSM-V-TR, ICD 10, ICD 11, and Merck Manual for diagnosis. Dissociative identity disorder is characterized by primarily dissociative disorder symptoms, secondary key symptoms are shared with complex PTSD, borderline and schizotypal personality disorders and tertiary key symptoms are shared with fibromyalgia, sleep disturbances, eating disorders, and body dysmorphic symptoms. Personality states alternately show in a person's behavior; however, presentations of the disorder vary. Dissociative identity disorder is usually caused by excessive and unendurable stress and or trauma, which commonly happens in childhood. The sense of a unified Identity develops from a variety of experiences and sources. In a child who is overwhelmed, the factors that should have blended together or become integrated overtime instead remain separate. Childhood adversity and abuse often leads to the development of dissociative identity disorder, but not exclusively.

A communication disorder is any disorder that affects an individual's ability to comprehend, detect, or apply language and speech to engage in dialogue effectively with others. The delays and disorders can range from simple sound substitution to the inability to understand or use one's native language.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis is made when the person has symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion for a diagnosis of schizoaffective disorder is the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. It is imperative for providers to accurately diagnose patients, as treatment and prognosis differ greatly for most of these diagnoses.

<span class="mw-page-title-main">Thought disorder</span> Disorder of thought form, content or stream

A thought disorder (TD) is any disturbance in cognition that adversely affects language and thought content, and thereby communication.

In psychology, alogia is poor thinking inferred from speech and language usage. There may be a general lack of additional, unprompted content seen in normal speech, so replies to questions may be brief and concrete, with less spontaneous speech. This is termed poverty of speech or laconic speech. The amount of speech may be normal but conveys little information because it is vague, empty, stereotyped, overconcrete, overabstract, or repetitive. This is termed poverty of content or poverty of content of speech. Under Scale for the Assessment of Negative Symptoms used in clinical research, thought blocking is considered a part of alogia, and so is increased latency in response.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization can consist of a detachment within the self, regarding one's mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, lacking in significance or being outside reality while looking in. It can be described as feeling like one is on “autopilot” and that the person's sense of individuality or selfhood has been hindered or suppressed.

<span class="mw-page-title-main">Nightmare disorder</span> Medical condition

Nightmare disorder is a sleep disorder characterized by repeated intense nightmares that most often center on threats to physical safety and security. The nightmares usually occur during the REM stage of sleep, and the person who experiences the nightmares typically remembers them well upon waking. More specifically, nightmare disorder is a type of parasomnia, a subset of sleep disorders categorized by abnormal movement or behavior or verbal actions during sleep or shortly before or after. Other parasomnias include sleepwalking, sleep terrors, bedwetting, and sleep paralysis.

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Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike/surreal, or visually distorted.

Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in the DSM 5, published in 2013. The disorder is no longer listed in the 11th revision of the International Classification of Diseases (ICD-11).

Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception. People with dissociative disorders use dissociation as a defense mechanism, pathologically and involuntarily. The individual experiences these dissociations to protect themselves. Some dissociative disorders are triggered by psychological trauma, but depersonalization-derealization disorder may be preceded only by stress, psychoactive substances, or no identifiable trigger at all.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of autistic spectrum disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States

References

  1. ↑ World Health Organization (2023). "MB25.3 Thought blocking". International Classification of Diseases, eleventh revision – ICD-11. Genova – icd.who.int.
  2. 1 2 3 Tani, Masayuki; Iwanami, Akira (October 2013). "[Disorder of train of thought in the elderly]". Nihon Rinsho. Japanese Journal of Clinical Medicine. 71 (10): 1793–1797. ISSN   0047-1852. PMID   24261209.
  3. ↑ Raymond Lake, C. (January 2008). "Disorders of thought are severe mood disorders: the selective attention defect in mania challenges the Kraepelinian dichotomy a review". Schizophrenia Bulletin. 34 (1): 109–117. doi:10.1093/schbul/sbm035. ISSN   0586-7614. PMC   2632389 . PMID   17515440.
  4. ↑ Nurcombe Barry, Ebert Michael H, "Chapter 4. The Psychiatric Interview" (Chapter). Ebert MH, Loosen PT, Nurcombe B, Leckman JF: CURRENT Diagnosis & Treatment: Psychiatry, p.2e: "AccessMedicine | the Psychiatric Interview: Introduction". Archived from the original on 2011-07-22. Retrieved 2010-07-20..
  5. ↑ "Blocking". APA Dictionary of Psychology. Washington, DC: American Psychological Association. n.d. Retrieved 28 February 2020.
  6. 1 2 3 Gelder, Mayou, Geddes (2005). Psychiatry. New York, NY; Oxford University Press Inc.
  7. ↑ Administration, Substance Abuse and Mental Health Services (June 2016). "Table 3.22, DSM-IV to DSM-5 Schizophrenia Comparison". www.ncbi.nlm.nih.gov. Retrieved 2020-11-10.
  8. ↑ Munir, Sadaf; Takov, Veronica (2020), "Generalized Anxiety Disorder", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   28722900 , retrieved 2020-11-14
  9. ↑ Abood, Waleed; Bandyopadhyay, Susanta (2020), "Postictal Seizure State", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   30252260 , retrieved 2020-11-14
  10. ↑ Treatment (US), Center for Substance Abuse (2014). "Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD". www.ncbi.nlm.nih.gov. Retrieved 2020-11-14.
  11. ↑ Hugo, Julie; Ganguli, Mary (August 2014). "Dementia and Cognitive Impairment: Epidemiology, Diagnosis, and Treatment". Clinics in Geriatric Medicine. 30 (3): 421–442. doi:10.1016/j.cger.2014.04.001. ISSN   0749-0690. PMC   4104432 . PMID   25037289.
  12. ↑ Shrimanker, Isha; Tadi, Prasanna; Sánchez-Manso, Juan Carlos (2020), "Parkinsonism", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   31194381 , retrieved 2020-11-14
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