|Other names||Formal thought disorder (FTD), thinking disorder|
|An embroidered cloth produced by a person with schizophrenia, showing the nonsensical associations between words and ideas characteristic of thought disorder|
A thought disorder (TD) is any disturbance in cognition that adversely affects language and thought content, and thereby communication.A variety of thought disorders were said to be characteristic of people with schizophrenia. A content-thought disorder is typically characterised by the experience of multiple delusional fragments. The term, thought disorder, is often used to refer to a formal thought disorder.
A formal thought disorder (FTD) is a disruption of the form or structure of thought.Formal thought disorder, also known as disorganised thinking, results in disorganised speech, and is recognised as a major feature of schizophrenia, and other psychoses. FTD is also associated with conditions including mood disorders, dementia, mania, and neurological diseases.
Types of thought disorder include derailment,pressured speech, poverty of speech, tangentiality, repeating things, and thought blocking.
Formal thought disorder is a disorder of the form of thought rather than of content of thought that covers hallucinations and delusions.FTD unlike hallucinations and delusions, is an observable objective sign of psychosis. FTD is a common, and core symptom of a psychotic disorder and may be seen as a marker of its severity, and also as a predictor of prognosis. It reflects a cluster of cognitive, linguistic, and affective disturbances, that has generated research interest from the fields of cognitive neuroscience, neurolinguistics, and psychiatry.
Eugen Bleuler, who named schizophrenia, held that thought disorder was its defining characteristic.However, disturbances of thinking and speech such as clanging or echolalia may be present in Tourette syndrome, or other symptoms as found in delirium. A clinical difference exists between these two groups. Those with psychoses are less likely to show an awareness or concern about the disordered thinking, while those with other disorders do show awareness and concerns about not being able to think straight.
Content-thought disorder is a thought disturbance in which a person experiences multiple, fragmented delusions, typically a feature of schizophrenia, and some other mental disorders including obsessive–compulsive disorder, and mania. —without it necessarily leading to an actual reward or pleasure—to reduce distress), magical thinking (belief that one's thoughts by themselves can bring about effects in the world, or that thinking something corresponds with doing the same thing), overvalued ideas (false/exaggerated belief that is held with conviction but not with delusional intensity), ideas of reference (belief that innocuous or coincident events experienced have strong personal significance) or influence (belief that other people or external agents are covertly exerting powers over oneself), persecutory ideas, phobias (irrational fears of objects or circumstances), suicidal ideas, violent ideas, and homicidal ideas.Content-thought disorder is not limited to delusions, other possible abnormalities include preoccupation (centering thought to a particular idea in association with strong affection), obsession (a persistent thought, idea, or image that is intrusive or inappropriate, and is distressing or upsetting), compulsion (the need to perform an act persistently and repetitively
The cores of thought content disturbance are abnormal beliefs and convictions, after accounting for the person's culture and backgrounds, and range from overvalued ideas to fixed delusions. Typically, abnormal beliefs and delusions are non-specific diagnostically, —consisting of awareness, concerns, beliefs, preoccupations, wishes, fantasies, imagination, and concepts—can be illogical, and can contain beliefs and prejudices/biases that are obviously contradictory. Individuals also have considerable variations, and the same person's thinking also may shift considerably from time to time.even if some delusions are more prevalent in one disorder than another. Also, normal, or neurotypical, thought
In psychosis, delusions are the most common thought-content abnormalities.A delusion is a firm and fixed belief based on inadequate grounds not amenable to rational argument or evidence to the contrary, and not in sync with regional, cultural and educational background. Common examples in mental status examination include: erotomanic (belief that someone is in love with oneself), grandiose (belief that one is the greatest, strongest, fastest, richest, and/or most intelligent person ever), persecutory (belief that the person, or someone to whom the person is close, is being malevolently treated in some way), reference (belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance), thought broadcasting (belief that others can hear or are aware of one's thoughts), thought insertion (belief that one's thoughts are not one's own, but rather belong to someone else and have been inserted into one's mind), thought withdrawal (belief that thoughts have been 'taken out' of one's mind, and one has no power over this), outside control (belief that outside forces are controlling one's thoughts, feelings, and actions), infidelity (belief that a partner is cheating on oneself), somatic (belief that one has a disease or medical condition), and nihilistic (belief that the mind, body, the world at large, or parts thereof, no longer exist). Delusions are common in people with mania, depression, schizoaffective disorder, delirium, dementia, substance use disorder, schizophrenia, and delusional disorders
Formal thought disorder (FTD), or simply thought disorder, is also known as disorganized speech – evident from disorganized thinking, and is one of the hallmark features of schizophrenia.Formal thought disorder is a disorder of the form of thought rather than of content of thought that covers hallucinations and delusions. FTD, unlike hallucinations and delusions, is an observable objective sign of psychosis. FTD is a common, and core symptom of a psychotic disorder and may be seen as a marker of its severity, and also as a predictor of prognosis. It reflects a cluster of cognitive, linguistic, and affective disturbances, that has generated research interest from the fields of cognitive neuroscience, neurolinguistics, and psychiatry.
FTD is a complex, multidimensional syndrome characterized by deficiencies in the logical organizing of thought needed to achieve goals. FTD can be subdivided into clusters of positive and negative symptoms, as well as objective versus subjective symptoms. Within the scale of positive and negative symptoms they have been grouped into positive formal thought disorder (posFTD) and negative formal thought disorder (negFTD).Positive subtypes were those of pressure of speech, tangentiality, derailment, incoherence, and illogicality. Negative subtypes were those of poverty of speech and poverty of content. The two groups were posited to be at either end of a spectrum of normal speech. However, later studies showed these to be poorly correlated. A comprehensive measure of formal thought disorder is the Thought and Language Disorder (TALD) Scale.
Nancy Andreasen preferred to call the thought disorders collectively as thought-language-communication disorders (TLC disorders).Within the Thought, Language, Communication (TLC) Scale up to seven domains of FTD have been described with most of the variance accounted for by just two or three domains. Some TLC disorders are more suggestive of a severe disorder and given priority by listing them in the first 11 items.
It has been proposed that formal thought disorder relates to neurocognition via semantic memory. Semantic network impairment in people with schizophrenia—measured by the difference between fluency (number of animals' names produced in 60 seconds) and phonological fluency (number of words beginning with "F" produced in 60 seconds)—predicts severity of formal thought disorder, suggesting that verbal information (through semantic priming) is unavailable. Other hypotheses include working memory deficit (being confused about what has already been said in a conversation) and attentional focus.
In the general population there will always be abnormalities in language, and their presence or absence is therefore not diagnostic of any condition. Language abnormalities can occur in schizophrenia and other disorders such as mania or depression, and can also occur in anybody who may simply be tired or stressed.To distinguish thought disorder, patterns of speech, severity of symptoms, their frequency, and resulting functional impairment can be considered.
Symptoms of thought disorder include derailment,pressured speech, poverty of speech, tangentiality, and thought blocking. FTD is a hallmark feature of schizophrenia, but is also associated with other conditions including mood disorders, dementia, mania, and neurological diseases. Impaired attention, poor memory, and difficulty formulating abstract concepts may also reflect thought disorder, and can be observed or assessed with mental status tests such as serial sevens or memory tests.
There are many types of thought disorder.They are also referred to as symptoms of formal thought disorder of which 30 are described including:
Some recent (2015, 2017) psychiatric/psychological glossaries defined thought disorder as disturbed thinking or cognition that affects communication, language, or thought content including poverty of ideas, neologisms, paralogia, word salad, and delusions —which are disturbance of both thought content and thought form—and suggested the more specific terms of content thought disorder and formal thought disorder, with content thought disorder defined as a thought disturbance characterized by multiple fragmented delusions, and formal thought disorder defined as disturbance in the form or structure of thinking. For example, DSM-5 (2013) only used the word formal thought disorder, mostly as a synonym of disorganized thinking and disorganized speech. This is in contrast with ICD-10 (1992) which only used the word "thought disorder", always accompanied with "delusion" and "hallucination" separately, and a general medical dictionary (2002) that although generally defined thought disorders similarly to the psychiatric glossaries, but also used the word in other entries as ICD-10 did.
The recent psychiatric text (2017) also mentioned when describing thought disorder as a "disorganization syndrome" within the context of schizophrenia:
"Thought disorder" here refers to disorganization of the form of thought and not content. An older use of the term "thought disorder" included the phenomena of delusions and sometimes hallucinations, but this is confusing and ignores the clear differences in the relationships between symptoms that have become apparent over the past 30 years. Delusions and hallucinations should be identified as psychotic symptoms, and thought disorder should be taken to mean formal thought disorders or a disorder of verbal cognition.
The same text also mentioned that some clinicians use the term "formal thought disorder" broadly referring to abnormalities in thought form plus any psychotic cognitive sign or symptom,and that various studies examining cognition and subsymdromes in schizophrenia may refer to formal thought disorder as "conceptual disorganization" or "disorganization factor."
Still, there may be other dissenting opinions, including:
Unfortunately, "thought disorder" is often involved rather loosely to refer to both formal thought disorder and delusional content. For the sake of clarity, the unqualiﬁed use of the phrase "thought disorder" should be discarded from psychiatric communication. Even the designation "formal thought disorder" covers too wide a territory. It should always be made clear whether one is referring to derailment or loose associations, ﬂight of ideas, or circumstantiality.
It was believed that thought disorder occurred only in schizophrenia, but later findings indicate it may occur in other psychiatric conditions including mania, and occurs even in people without mental illness. Also, people with schizophrenia don't all exhibit thought disorder, so not having any thought disorder doesn't mean the person doesn't have schizophrenia, i.e. the condition is not very specific to the disease.
When adopting specific definitions of thought disorder subtypes and classifying them as positive and negative symptoms, Nancy Andreasen foundthat different subtypes of thought disorder occur at different frequencies among those with manic, depression, and schizophrenia. People with mania have pressured speech as the most prominent symptom, but also have relatively high rates of derailment, tangentiality, and incoherence which are as prominent as in those with schizophrenia. They are likelier to have pressured speech, distractibility, and circumstantiality.
People with schizophrenia have more negative thought disorder including poverty of speech and poverty of content of speech, but also have relatively high rates of certain positive thought disorders.Derailment, loss of goal, poverty of content of speech, tangentiality and illogicality are particularly characteristic of schizophrenia. People with depression have relatively less thought disorders; the most prominent are poverty of speech, poverty of content of speech, and circumstantiality. She found the diagnostic usefulness of dividing the symptoms into subtypes, such as having negative thought disorders without the full affective symptoms highly suggest schizophrenia.
She also found prognostic values of negative/positive symptom divisions. In manic patients, most thought disorders return to normal levels 6 months after evaluation which suggests that thought disorders in this condition, although as severe as in schizophrenia, tend to be recoverable. In people with schizophrenia, however, negative thought disorders remain after six months, and sometimes worsen. Positive thought disorders get better somewhat. Also, negative thought disorder is a good predictor of some outcomes, e.g. patients with prominent negative thought disorders do worse on social functioning six months later.So, in general, having more prominent negative symptoms suggest a worse outcome. Nevertheless, some people may do well, respond to medication, and have normal brain function. The positive symptoms are similar vice versa.
At illness onset, prominent thought disorder also predicts worse prognosis, including:
Thought disorder unresponsive to treatment also predicts worse illness course.In schizophrenia, thought disorders' severity tend to be more stable than hallucinations and delusions. Prominent thought disorders are more unlikely to diminish in middle age compared to positive symptoms. Less severe thought disorder may occur during the prodromal and residual periods of schizophrenia.
DSM-5 include delusions, hallucinations, disorganized thought process (formal thought disorder), and disorganized or abnormal motor behavior (including catatonia) as key symptoms in "psychosis." Although not specific to different diagnoses, some aspects of psychosis are characteristic of some diagnoses. Schizophrenia spectrum disorders (e.g., schizoaffective disorder, schizophreniform disorder) typically consist of prominent hallucinations and/or delusions as well as formal thought disorder—displayed as severe behavioral abnormalities including disorganized, bizarre, and catatonic behavior. Psychotic disorders due to general medical conditions and substance-induced psychotic disorders typically consist of delusions and/or hallucinations. Delusional disorder and shared psychotic disorder, which are more rare, typically consist of persistent delusions. Research found that most formal thought disorders are commonly found in schizophrenia and mood disorders, but poverty of speech content is more common in schizophrenia.
Experienced clinicians may distinguish true psychosis, such as in schizophrenia, and bipolar mania, from malingering, when an individual fakes illness for other gains, by clinical presentations. For example, malingerers feign thought contents with no irregularities in form such as derailment or looseness of associations. Negative symptoms including alogia may not be present. In addition, chronic thought disorder is typically distressing.
Typically, autism spectrum disorders (ASD), whose diagnosis requires onset of symptoms prior to 3 years of age, can be distinguished from early-onset schizophrenia by disease onset occurrence (schizophrenia manifestation under age 10 is extremely rare) and the fact that ASD patients don't display formal thought disorders.However, it has been suggested that individuals with autism spectrum disorders (ASD) display language disturbances like those found in schizophrenia; a 2008 study found that children and adolescents with ASD showed significantly more illogical thinking and loose associations than control subjects. The illogical thinking was related to cognitive functioning and executive control; the loose associations were related to communication symptoms and to parent reports of stress and anxiety.
The concept of thought disorder has been criticized as being based on circular or incoherent definitions. [ need quotation to verify ] For example, symptoms of thought disorder are inferred from disordered speech, based on the assumption that disordered speech arises because of disordered thought. Incoherence, or word salad, refers to speech that is semantically unconnected and conveys no meaning to the listener.
Furthermore, although thought disorder is typically associated with psychosis, similar phenomena can appear in different disorders, potentially leading to misdiagnosis—for example, in the case of incomplete yet potentially fruitful thought processes.[ citation needed ]
Another criticism related to the separation of symptoms of schizophrenia into negative/positive symptoms, including thought disorder, is that it oversimplifies the complexity of thought disorder and its relationship with other positive symptoms. Later factor analysis studies found that negative symptoms tend to correlate with one another, while positive symptoms tend to separate into two groups.The three clusters became roughly known as negative symptoms, psychotic symptoms, and disorganization symptoms. Alogia, a thought disorder traditionally classified as a negative symptom, can be separated into two separate groups: poverty of speech content as a disorganization symptom, and poverty of speech, response latency, and thought blocking as negative symptoms. Nevertheless, the efforts that led to the positive/negative symptom diametrics may allow the more accurate characterization of schizophrenia in the later works.
Psychosis is an abnormal condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations. Other symptoms may include incoherent speech and behavior that is inappropriate for the situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious outcomes.
Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. The diagnosis is made when the person has symptoms of both schizophrenia and a mood disorder—either bipolar disorder or depression—but does not meet the diagnostic criteria for schizophrenia or a mood disorder individually. The main criterion for the schizoaffective disorder diagnosis 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, psychotic bipolar disorder, schizophreniform disorder, or schizophrenia. It is imperative for providers to accurately diagnose patients, as treatment and prognosis differs greatly for each of these diagnoses.
Delusional disorder is a generally rare mental illness in which a person presents delusions, but with no accompanying prominent hallucinations, thought disorder, mood disorder, or significant flattening of affect. Delusions are a specific symptom of psychosis. Delusions can be bizarre or non-bizarre in content; non-bizarre delusions are fixed false beliefs that involve situations that occur in real life, such as being harmed or poisoned. Apart from their delusion or delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not necessarily generally seem odd. However, the preoccupation with delusional ideas can be disruptive to their overall lives.
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.
Kurt Schneider was a German psychiatrist known largely for his writing on the diagnosis and understanding of schizophrenia, as well as personality disorders then known as psychopathic personalities.
Stimulant psychosis is a mental disorder characterized by psychotic symptoms which involves and typically occurs following an overdose on psychostimulants; however, it has also been reported to occur in approximately 0.1% of individuals, or 1 out of every 1,000 people, within the first several weeks after starting amphetamine or methylphenidate therapy. Methamphetamine psychosis, or long-term effects of stimulant use in the brain, depend upon genetics and may persist for some time.
The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood, and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.
Disorganized schizophrenia, or hebephrenia, was a subtype of schizophrenia prior to 2013. Subtypes of schizophrenia were no longer recognized as separate conditions in DSM 5 published in 2013. The disorder is no longer listed in the 11th revision of the International Statistical Classification of Diseases and Related Health Problems, or ICD-11
The Positive and Negative Syndrome Scale (PANSS) is a medical scale used for measuring symptom severity of patients with schizophrenia. It was published in 1987 by Stanley Kay, Lewis Opler, and Abraham Fiszbein. It is widely used in the study of antipsychotic therapy. The scale is known as the "gold standard" that all assessments of psychotic behavioral disorders should follow.
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.
Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time, but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.
Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.
Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients suffering from a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, and a substantial portion of those with substance abuse disorders. GDs are characterized by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. About 10% of healthy people experience grandiose thoughts but do not meet full criteria for a diagnosis of GD.
Brief psychotic disorder — according to the classifications of mental disorders DSM-IV-TR and DSM-5 — is a psychotic condition involving the sudden onset of at least one psychotic symptom lasting 1 day to 1 month, often accompanied by emotional turmoil. Remission of all symptoms is complete with patients returning to the previous level of functioning. It may follow a period of extreme stress including the loss of a loved one. Most patients with this condition under DSM-5 would be classified as having acute and transient psychotic disorders under ICD-10. Prior to DSM-IV, this condition was called "brief reactive psychosis". This condition may or may not be recurrent, and it should not be caused by another condition.
Childhood schizophrenia is essentially the same in characteristics as schizophrenia that develops at a later age, but has an onset before the age of 13, 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
The relationship between religion and schizophrenia is of particular interest to psychiatrists because of the similarities between religious experiences and psychotic episodes; religious experiences often involve auditory and/or visual hallucinations, and those with schizophrenia commonly report similar hallucinations, along with a variety of beliefs that are commonly recognized by modern medical practitioners as delusional. In general, religion has been found to have "both a protective and a risk increasing effect" for schizophrenia.
The Scale for the Assessment of Positive Symptoms (SAPS) is a rating scale to measure positive symptoms in schizophrenia. The scale was developed by Nancy Andreasen and was first published in 1984. SAPS is split into 4 domains, and within each domain separate symptoms are rated from 0 (absent) to 5 (severe). The scale is closely linked to the Scale for the Assessment of Negative Symptoms (SANS) which was published a few years earlier.
Bouffée délirante (BD) is an acute and transient psychotic disorder. It is a uniquely French psychiatric diagnostic term with a long history in France and various French speaking nations: Caribbean, e.g. Haiti, Guadeloupe, Antilles and Francophone Africa. The term BD was originally coined and described by Valentin Magnan (1835-1916), fell into relative disuse and was later revived by Henri Ey (1900-1977).
Hyperreligiosity is a psychiatric disturbance in which a person experiences intense religious beliefs or episodes that interfere with normal functioning. Hyperreligiosity generally includes abnormal beliefs and a focus on religious content or even atheistic content, which interferes with work and social functioning. Hyperreligiosity may occur in a variety of disorders including epilepsy, psychotic disorders and frontotemporal lobar degeneration. Hyperreligiosity is a symptom of Geschwind syndrome, which is associated with temporal lobe epilepsy. It may also present as a generalized behavioral tendency or thought modality, caused by or attributed to learned behaviors and distortions in mental processes connected to cultic abuse. Also can refer to the result of strong sectarian indoctrination, which may influence cognition and/or cause thought distortions, often marked with irrational or egregious reasoning.
Thought content: obsession, delusion, magical thinking, overvalued ideas, ideas of reference or influence, persecutory ideas.
Thought content: Delusions— persecutory (paranoid), grandiose, infidelity, somatic, sensory, thought broadcasting, thought insertion, ideas of reference, ideas of unreality, phobias, obsessions, compulsions, ambivalence, autism, dereism, blocking, suicidal or homicidal preoccupation, conflicts, nihilistic ideas, hypochondriasis, depersonalization, derealization, flight of ideas, idé fixe, magical thinking, neologisms.
thought disorders Abnormalities in the structure or content of thought, as reflected in a person's speech, writing, or behaviour. ...
Although formal thought disorder typically refers to marked abnormalities in the form and flow or connectivity of thought, some clinicians use the term broadly to include any psychotic cognitive sign or symptom.