Psychology of Thought Disorders

Thought Process

• Neologism: using novel words or existing words in a novel fashion
• Thought block: sudden arrest of the train of thought, leaving a "blank"
• Clang associations: speech based on sound, such as rhyming and punning (e.g., "My car is red. I've been in bed. It hurts my head.")

Thought Content

• Suicidal ideation/homicidal ideation:
  • Ask if the patient feels like harming themselves or others
  • Identify if the plan is well-formulated
  • Ask if the patient has an intent (e.g., if released right now, would they go and harm themselves or others?)
  • Ask if the patient has means to kill themselves (e.g., firearms in the house, multiple prescription bottles)
• Delusions:
  • False, unshakeable belief that is out of keeping with the patient's social and cultural background
  • Themes of delusion:
    • Persecutory (paranoid): others/organizations trying to inflict harm on the patient
    • Delusion of jealousy: common in men, may develop gradually, delusion of unfaithfulness of spouse (infidelity)
    • Delusion of love "erotomania" (De Clerambault's Syndrome): being loved by a man who is inaccessible, high status, never spoken before, unable to reveal his love for her
    • Grandiose (expansive): beliefs of exaggerated self-importance (e.g., wealth, special powers, beauty)
    • Religious delusions: preoccupation with false beliefs of a religious nature
    • Delusions of reference: idea that objects/events/people have a personal significance for the patient
    • Delusion of guilt and worthlessness: e.g., minor past faults will be exposed, being sinful, deserves to be punished
    • Nihilistic delusion: belief about non-existence of some person/thing + pessimistic ideas (e.g., career is gone, Cotard's Syndrome: failures of bodily functions)
    • Hypochondriacal delusions: belief of ill health despite contrary medical evidence

Disorders of Thought Possession

• Thought insertion: delusion that some thoughts have been implanted by an outside agency
• Thought withdrawal: delusion that thoughts have been taken out of the patient's mind
• Thought broadcasting: delusion that the patient's unspoken thoughts are known to other people

Thought Content

• Overvalued ideas: ideas held with a lot of emotion but with some degree of ambivalence and doubts about the belief
• Extracampine hallucinations: perceiving a sensation from beyond the limits of the sense organ (e.g., visions from outside visual field, hearing voices from far away)
• Reflex hallucinations: stimulus in one sensory modality causing a hallucination in a different sensory modality (e.g., music causing visual hallucination)
• Hypnogogic and hypnopompic hallucinations: occurs at the point of falling to or waking from sleep, usually brief and elementary

Other Perceptual Disturbances

• Depersonalization: a feeling that the patient's body parts are abnormal, unreal
• Derealization: a feeling that the external environment is abnormal, unreal

Cognition

• The ability to use intellect, thought, and ideas to comprehend inner and outer realities
• A combination of cortical functions is involved in cognition, including language, memory, attention, perception, judgment, reasoning, and recognition

Orientation

• Orientation to person, place, and time is a basic cognitive function
• Patients should know who they are, where they are, and what the time and date are

Memory

• Immediate memory: essentially an assessment of attention, tested by asking patients to repeat the names of three unrelated objects
• Short-term memory: typically tested by asking the patient to recall the three objects after a few minutes
• Long-term memory: assessed through the patient's ability to accurately recall events in recent months and throughout the course of a lifetime

Attention and Concentration

• Attention: the ability to sustain interest in a stimulus
• Concentration: the ability to maintain mental effort
• Tested using tasks such as counting backward by 7s, spelling "world" backward, and reciting the months backward

Abstract Thinking

• The capacity to conceptualize meanings of words beyond the most literal interpretation
• Includes the ability to analyze information according to themes, to generalize according to categories, to appreciate double meanings, to make comparisons, to hypothesize, and to reason using deductive and inductive thinking
• Tested using approaches such as identifying similarities and interpreting proverbs

Insight

• The patient's understanding of how they are feeling, presenting, and functioning, as well as the potential causes of their psychiatric presentation
• Assessment of insight focuses on whether patients recognize that they are ill, comprehend that their problems are deviations from normal, understand that their behavior may affect others, and appreciate that treatment may be helpful in alleviating symptoms

Judgment

• The person's capacity to make good decisions and act on them
• The level of judgment may or may not correlate to the level of insight
• Tested using scenarios such as "What would you do if you found a stamped envelope on the sidewalk?"