Thought disorder

Thought disorder
Classification and external resources
Specialty Psychiatry

Thought disorder (TD) or formal thought disorder (FTD) refers to disorganized thinking as evidenced by disorganized speech.[1] Specific thought disorders include derailment, poverty of speech, tangentiality, illogicality, perseveration, neologism, and thought blocking.[1]

Psychiatrists consider formal thought disorder as being one of two types of disordered thinking, with the other type being delusions. The latter involves "content" while the former involves "form". Although the term "thought disorder" can refer to either type, in common parlance it refers most often to a disorder of thought "form" also known as formal thought disorder.

Eugen Bleuler, who named schizophrenia, held that thought disorder was its defining characteristic.[2] However, formal thought disorder is not unique to schizophrenia or psychosis. It is often a symptom of mania, and less often it can be present in other mental disorders such as depression.[1] Clanging or echolalia may be present in Tourette syndrome.[3] Patients with a clouded consciousness, like that found in delirium, also have a formal thought disorder.[4]

However, there is a clinical difference between these two groups. Those with schizophrenia or psychosis are less likely to demonstrate awareness or concern about the disordered thinking.[5] Clayton and Winokur have suggested that this results from a fundamental inability to use the same type of Aristotelian logic as others.[6] On the other hand, patients with a clouded consciousness, referred to as "organic" patients, usually do demonstrate awareness and concern, and complain about being "confused" or "unable to think straight"; Clayton and Winokur suggest that this is because their thought disorder results, instead, from various cognitive deficits.[4]

Signs and symptoms

In considering whether an individual has thought disorder, patterns of their speech are closely observed. Although it is normal to exhibit some of the following during times of extreme stress (e.g. a cataclysmic event or the middle of a war) it is the degree, frequency, and the resulting functional impairment that leads to the conclusion that the person being observed has a thought disorder.[7][8]

Diagnosis

The concept of thought disorder has been criticized as being based on circular or incoherent definitions.[10] For example, thought disorder is 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 unconnected and conveys no meaning to the listener.[9]

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.

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.[11]

See also

References

  1. 1 2 3 4 5 Yudofsky, Stuart C.; Hales, Robert E. (2002). The American Psychiatric Publishing Textbook of Clinical Psychiatry. Washington, DC: American Psychiatric Association. ISBN 1-58562-032-7. OCLC 49576699.
  2. Colman, A. M. (2001) Oxford Dictionary of Psychology, Oxford University Press. ISBN 0-19-860761-X
  3. Barrera A, McKenna PJ, Berrios GE (2009). "Formal thought disorder, neuropsychology and insight in schizophrenia". Psychopathology 42 (4): 264–9. doi:10.1159/000224150. PMID 19521143.
  4. 1 2 John Noble; Harry L. Greene (15 January 1996). Textbook of primary care medicine. Mosby. p. 1325. ISBN 978-0-8016-7841-7.
  5. Jefferson, James W.; Moore, David Scott (2004). Handbook of medical psychiatry. Elsevier Mosby. p. 131. ISBN 0-323-02911-6.
  6. Clayton, Paula J.; Winokur, George (1994). The Medical basis of psychiatry. Philadelphia: Saunders. pp. 13–14. ISBN 0-7216-6484-9.
  7. Andreasen NC. Thought, language, and communication disorders. I. A Clinical assessment, definition of terms, and evaluation of their reliability. Archives of General Psychiatry 1979;36(12):1315–21. PMID 496551.
  8. Sadock, B.J. and Sadock, V.A. Kaplan and Sadock's Synopsis of Psychiatry. 9th ed. 2003: Table 7.1–6 p 239.
  9. 1 2 3 4 5 6 7 8 9 10 11 12 Videbeck, S (2008). Psychiatric-Mental Health Nursing, 4th ed. Philadelphia: Wolters Kluwers Health, Lippincott Williams & Wilkins.
  10. Bentall, R. (2003) Madness explained: Psychosis and Human Nature. London: Penguin Books Ltd. ISBN 0-7139-9249-2
  11. Solomon M, Ozonoff S, Carter C, Caplan R (2008). "Formal thought disorder and the autism spectrum: relationship with symptoms, executive control, and anxiety". J Autism Dev Disord 38 (8): 1474–84. doi:10.1007/s10803-007-0526-6. PMID 18297385.

Further reading

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