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A thought disorder (TD) is any disturbance in
cognition Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
that adversely affects
language Language is a structured system of communication. The structure of a language is its grammar and the free components are its vocabulary. Languages are the primary means by which humans communicate, and may be conveyed through a variety of met ...
and thought content, and thereby communication. A variety of thought disorders were said to be characteristic of people with
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
. A content-thought disorder is typically characterized by the experience of multiple
delusion A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or som ...
al 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 disorganized thinking, results in disorganized speech and is recognized as a major feature of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
and other psychoses. FTD is also associated with conditions including
mood disorders A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
mania Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
, and
neurological diseases A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weak ...
. Disorganized speech leads to an inference of disorganized thoughts. Types of thought disorders include
derailment In rail transport, a derailment occurs when a rail vehicle such as a train comes off its rails. Although many derailments are minor, all result in temporary disruption of the proper operation of the railway system and they are a potentially ...
, pressured speech, poverty of speech, tangentiality,
verbigeration 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 ...
, and thought blocking. Formal thought disorder is a disorder of the form of thought rather than of content of thought that covers
hallucination A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combinatio ...
s and
delusion A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or som ...
s. 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 have generated research interest in the fields of cognitive neuroscience, neurolinguistics, and psychiatry.
Eugen Bleuler Paul Eugen Bleuler (; ; 30 April 1857 – 15 July 1939) was a Swiss psychiatrist and humanist most notable for his contributions to the understanding of mental illness. He coined several psychiatric terms including "schizophrenia", "schizoid", ...
, who named
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, held that thought disorder was its defining characteristic.Colman, A. M. (2001) ''Oxford Dictionary of Psychology'', Oxford University Press. However, disturbances of thinking and speech such as
clanging In psychology and psychiatry, clanging or clang association refers to a mode of speech characterized by association of words based upon sound rather than concepts. For example, this may include compulsive rhyming or alliteration without apparent l ...
or
echolalia Echolalia is the unsolicited repetition of vocalizations made by another person (when repeated by the same person, it is called palilalia). In its profound form it is automatic and effortless. It is one of the echophenomena, closely related t ...
may be present in
Tourette syndrome Tourette syndrome or Tourette's syndrome (abbreviated as TS or Tourette's) is a common neurodevelopmental disorder that begins in childhood or adolescence. It is characterized by multiple movement (motor) tics and at least one vocal (phonic) ...
, or other symptoms as found in
delirium Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
. 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 clearly.


Content-thought disorder

Content-thought disorder is a thought disturbance in which a person experiences multiple, fragmented delusions, typically a feature of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
and some other
mental disorders A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
including
obsessive–compulsive disorder Obsessive–compulsive disorder (OCD) is a mental and behavioral disorder in which an individual has intrusive thoughts and/or feels the need to perform certain routines repeatedly to the extent where it induces distress or impairs general ...
and
mania Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
. At the core of thought-content disturbance are abnormal beliefs and convictions, after accounting for the person's culture and backgrounds; these range from
overvalued ideas 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 ...
to fixed delusions. Typically, abnormal beliefs and delusions are non-specific diagnostically, even if some delusions are more prevalent in one disorder than another. Neurotypical thoughtconsisting of awareness, concerns, beliefs, preoccupations, wishes, fantasies, imagination, and conceptscan 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. Content-thought disorder is not limited to delusions. Other possible abnormalities include suicidal ideas, violent ideas, and homicidal ideas as well as the following: * 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 *
Compulsive behavior Compulsive behavior is defined as performing an action persistently and repetitively. Compulsive behaviors could be an attempt to make obsessions go away. The act is usually a small, restricted and repetitive behavior, yet not disturbing in a pa ...
: the need to perform an act persistently and repetitivelywithout it necessarily leading to an actual reward or pleasureto reduce distress *
Magical thinking Magical thinking, or superstitious thinking, is the belief that unrelated events are causally connected despite the absence of any plausible causal link between them, particularly as a result of supernatural effects. Examples include the idea that ...
: 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 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 ...
: false or exaggerated belief that is held with conviction but not with delusional intensity *
Phobias A phobia is an anxiety disorder defined by a persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoi ...
: irrational fears of objects or circumstances In
psychosis 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 ...
, 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, or educational background. Delusions are common in people with
mania Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
, depression,
schizoaffective disorder Schizoaffective disorder (SZA, SZD or SAD) 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 (usually psychosis) and a mood disorder: ...
,
delirium Delirium (also known as acute confusional state) is an organically caused decline from a previous baseline of mental function that develops over a short period of time, typically hours to days. Delirium is a syndrome encompassing disturbances in ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
substance use disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and ...
s,
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, and
delusional disorders A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some o ...
. Common examples in
mental status examination 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 t ...
include the following: *
Erotomania Erotomania, also known as de Clérambault's Syndrome, named after French psychiatrist Gaëtan Gatian de Clérambault, is listed in the DSM-5 as a subtype of a delusional disorder. It is a relatively uncommon paranoid condition that is character ...
: belief that someone is in love with oneself *
Grandiose delusions Grandiose delusions (GD), also known as delusions of grandeur or expansive delusions, are a subtype of delusion that occur in patients with a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disord ...
: belief that one is the greatest, strongest, fastest, richest, and/or most intelligent person ever *
Persecutory delusion A persecutory delusion is a common type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by a ...
: belief that the person, or someone to whom the person is close, is being malevolently treated in some way *
Ideas of reference and delusions of reference Ideas of reference and delusions of reference describe the phenomenon of an individual experiencing innocuous events or mere coincidences and believing they have strong personal significance. It is "the notion that everything one perceives in the ...
: belief that insignificant remarks, coincident events, or innocuous objects in one's environment have personal meaning or significance *
Thought broadcasting In psychiatry, thought broadcasting is the belief that others can hear or are aware of an individual's thoughts. The person experiencing this symptom can also think that their thoughts are being broadcast through different media, such as the telev ...
: belief that others can hear or are aware of one's thoughts *
Thought insertion Thought insertion is defined by the ICD-10 as the delusion that one's thoughts are not one's own, but rather belong to someone else and have been inserted into one's mind. The person experiencing the thought insertion delusion will not necessarily ...
: 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 In psychiatry, thought withdrawal is the delusional belief that thoughts have been 'taken out' of the patient's mind, and the patient has no power over this. It often accompanies thought blocking. The patient may experience a break in the flow of th ...
: belief that thoughts have been "taken out" of one's mind, and that one has no power over this * Influence: belief that other people or external agents are covertly exerting power over oneself * Outside control: belief that outside forces are controlling one's thoughts, feelings, and actions *
Infidelity Infidelity (synonyms include cheating, straying, adultery, being unfaithful, two-timing, or having an affair) is a violation of a couple's emotional and/or sexual exclusivity that commonly results in feelings of anger, sexual jealousy, and riva ...
: belief that a partner is cheating on oneself * Somatic: belief that one has a disease or medical condition * Nihilistic: belief that the mind, the body, the world at large, or parts thereof no longer exist


Formal thought disorder


Overview

Formal thought disorder (FTD), or simply ''thought disorder'', is also known as disorganized speech. It is evident from disorganized thinking, and is one of the hallmark features of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
. Formal thought disorder is a disorder of the form of thought rather than of the content of thought that covers
hallucination A hallucination is a perception in the absence of an external stimulus that has the qualities of a real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. Hallucination is a combinatio ...
s and
delusion A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or som ...
s. 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 Cognitive neuroscience is the scientific field that is concerned with the study of the biological processes and aspects that underlie cognition, with a specific focus on the neural connections in the brain which are involved in mental proces ...
,
neurolinguistics Neurolinguistics is the study of neural mechanisms in the human brain that controls the comprehension, production, and acquisition of language. As an interdisciplinary field, neurolinguistics draws methods and theories from fields such as n ...
, and
psychiatry Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry. Initial psych ...
. 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 Pressure of speech or pressured speech is a tendency to speak rapidly and frenziedly. Pressured speech is motivated by an urgency that may not be apparent to the listener. The speech produced is difficult to interpret. Such speech may be too fas ...
, tangentiality,
derailment In rail transport, a derailment occurs when a rail vehicle such as a train comes off its rails. Although many derailments are minor, all result in temporary disruption of the proper operation of the railway system and they are a potentially ...
, incoherence, and
illogicality As the study of argument is of clear importance to the reasons that we hold things to be true, logic is of essential importance to rationality. Arguments may be logical if they are "conducted or assessed according to strict principles of Validity ( ...
. 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 Nancy Coover Andreasen (born November 11, 1938) is an American neuroscientist and neuropsychiatrist. She currently holds the Andrew H. Woods Chair of Psychiatry at the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa. ...
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.


Diagnoses

The
DSM V DSM or dsm may refer to: Science and technology * Deep space maneuver * Design structure matrix or dependency structure matrix, a representation of a system or project * Diagnostic and Statistical Manual of Mental Disorders ** DSM-5, the fifth e ...
categorises FTD as "a psychotic symptom, manifested as bizarre speech and communication." FTD may include incoherence, peculiar words, disconnected ideas, or a lack of the unprompted content we would expect from normal speech.
Clinical psychologists Clinical psychology is an integration of social science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically based distress or dysfunction and to promote subjective well-being and persona ...
typically assess FTD by initiating an exploratory conversation with patients and observing the patient's verbal responses. FTD is often used to establish a diagnosis of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, and as such, in cross-sectional studies 27–80% of patients with schizophrenia present with FTD. FTD, although a hallmark feature of schizophrenia, is also widespread amongst those with other
psychiatric disorders A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
; up to 60% of those with
schizoaffective disorder Schizoaffective disorder (SZA, SZD or SAD) 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 (usually psychosis) and a mood disorder: ...
, and 53% of those with
clinical depression Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introdu ...
show FTD, suggesting FTD is not pathognomonic of schizophrenia. Around 6% of healthy probands show a mild form of FTD. The characteristics of FTD vary amongst disorders. Multiple studies show that FTD in
mania Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
is marked by irrelevant intrusions and pronounced combinatory thinking, usually with a playfulness and flippancy lacking in patients with schizophrenia. The FTD present in patients with schizophrenia, however, was characterised by disorganisation,
neologism A neologism Greek νέο- ''néo''(="new") and λόγος /''lógos'' meaning "speech, utterance"] is a relatively recent or isolated term, word, or phrase that may be in the process of entering common use, but that has not been fully accepted int ...
, and fluid thinking; as well as confusion with word-finding difficulty. There is limited data on the Longitudinal study, longitudinal course of FTD. The most comprehensive longitudinal study of FTD done to date found a distinction in the longitudinal course of thought disorder symptoms between schizophrenia and other psychotic disorders. The study also found an association between pre-index assessments of social, work and educational functioning and the longitudinal course of FTD.


Speculative Causes

Several theories have been developed to explain the causes of formal thought disorder. It has been proposed that formal thought disorder relates to
neurocognition Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain, ultimately served by the substrate of the brain's neurological matrix (i.e. at the cellular a ...
via
semantic memory Semantic memory refers to general world knowledge that humans have accumulated throughout their lives. This general knowledge (word meanings, concepts, facts, and ideas) is intertwined in experience and dependent on culture. We can learn about n ...
.
Semantic network A semantic network, or frame network is a knowledge base that represents semantic relations between concepts in a network. This is often used as a form of knowledge representation. It is a directed or undirected graph consisting of vertices, ...
impairment in people with schizophrenia measured by the difference between fluency ( e.g. number of animals' names produced in 60 seconds) and phonological fluency (e.g. number of words beginning with "F" produced in 60 seconds) predicts the severity of formal thought disorder, suggesting that verbal information (through
semantic priming Priming is a phenomenon whereby exposure to one stimulus influences a response to a subsequent stimulus, without conscious guidance or intention. The priming effect refers to the positive or negative effect of a rapidly presented stimulus (priming ...
) is unavailable. Other hypotheses include
working memory Working memory is a cognitive system with a limited capacity that can hold information temporarily. It is important for reasoning and the guidance of decision-making and behavior. Working memory is often used synonymously with short-term memory, ...
deficit (being confused about what has already been said in a conversation) and attentional focus. FTD in schizophrenia has been found to be associated with structural and functional abnormalities in the language network. Structural studies have found bilateral
grey matter Grey matter is a major component of the central nervous system, consisting of neuronal cell bodies, neuropil (dendrites and unmyelinated axons), glial cells (astrocytes and oligodendrocytes), synapses, and capillaries. Grey matter is distingui ...
deficits in the language network. In particular, the bilateral
inferior frontal gyrus The inferior frontal gyrus (IFG), (gyrus frontalis inferior), is the lowest positioned gyrus of the frontal gyri, of the frontal lobe, and is part of the prefrontal cortex. Its superior border is the inferior frontal sulcus (which divides it f ...
, bilateral
inferior parietal lobule The inferior parietal lobule (subparietal district) lies below the horizontal portion of the intraparietal sulcus, and behind the lower part of the postcentral sulcus. Also known as Geschwind's territory after Norman Geschwind, an American neurolo ...
and bilateral superior temporal gyrus to be FTD correlates. However, there are studies that did not find an association between FTD and structural aberrations of the language network and regions not included in the language network have been associated with FTD. Thus, future research is needed to clarify whether there is an association with FTD in schizophrenia and neural abnormalities in the language network. There has also been investigation into the transmitter systems that might cause FTD. Studies have found that
glutamate Glutamic acid (symbol Glu or E; the ionic form is known as glutamate) is an α-amino acid that is used by almost all living beings in the biosynthesis of proteins. It is a non-essential nutrient for humans, meaning that the human body can syn ...
dysfunction, due to a rarefication of glutamatergic synapses in the superior temporal gyrus in patients' schizophrenia, is a major cause for positive FTD. The heritability of FTD has been demonstrated in myriad family and twin studies. Imaging genetics studies, using a semantic verbal fluency task performed by the participants during
functional MRI Functional magnetic resonance imaging or functional MRI (fMRI) measures brain activity by detecting changes associated with blood flow. This technique relies on the fact that cerebral blood flow and neuronal activation are coupled. When an area o ...
scanning, revealed that
allele An allele (, ; ; modern formation from Greek ἄλλος ''állos'', "other") is a variation of the same sequence of nucleotides at the same place on a long DNA molecule, as described in leading textbooks on genetics and evolution. ::"The chro ...
s linked to glutamatergic transmission contribute to functional aberrations in typical language-related brain areas. However, FTD is not solely
genetically determined Biological determinism, also known as genetic determinism, is the belief that human behaviour is directly controlled by an individual's genes or some component of their physiology, generally at the expense of the role of the environment, whether ...
: environmental influences, such as allusive thinking in parents during childhood, and general environmental risk factors for schizophrenia (childhood abuse, migration, social isolation,
cannabis ''Cannabis'' () is a genus of flowering plants in the family Cannabaceae. The number of species within the genus is disputed. Three species may be recognized: ''Cannabis sativa'', '' C. indica'', and '' C. ruderalis''. Alternatively ...
, etc.) also contribute to the pathophysiology of FTD. The origins of FTD have also been conceptualized from a social-learning perspective. Singer and Wynne contended that familial communication patterns play a key role in shaping the development of FTD— believing that dysfunctional social interactions undermine a child's development of cohesive, stable mental representations of the world, therefore increasing their risk of developing FTD.


Treatments

Antipsychotic medication Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of oth ...
is often utilised to treat FTD. The vast majority of studies examining the efficacy of antipsychotic treatment do not report the effects on syndromes or symptoms. Nevertheless, there are six older studies reporting on the effects of antipsychotic treatment on FTD. From these studies and from clinical experience, we know that antipsychotics are often an effective treatment for patients with positive or negative FTD. There is, however, a subgroup of patients with treatment refractory FTD.
Cognitive Behavioural Therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...
is another example of a treatment for FTD. There is currently very little research exploring the effectiveness of CBT for individuals with FTD. Large
randomised controlled trials A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical t ...
evaluating the effectiveness of CBT for treating psychosis often exclude individuals with high levels of FTD due to FTD reducing
therapeutic alliance A therapeutic alliance, or working alliance, is a partnership between a patient and his or her therapist that allows them to achieve goals through agreed-upon tasks. The concept of therapeutic alliance dates back to Sigmund Freud. Over the cour ...
which is associated with key outcomes in therapy. However, there is some provisional evidence suggesting that FTD may not preclude the effectiveness of CBT. Kircher and colleagues have suggested that the following methods should be used in CBT for treating patients with FTD: *Practise structuring, summarising, and feedback methods *Repeat and clarify the core issues and main emotions that the patient is trying to communicate *Gently encourage patients to clarify what they are trying to communicate *Ask patients to clearly state their communication goal *Ask patients to slow down and explain how one point leads to another *Help patients identify the links between ideas *Identify the main affect linked to the thought disorder *Normalise problems with thinking


Signs and symptoms

In the general population, there will always be abnormalities in language and their presence is therefore not always 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 In rail transport, a derailment occurs when a rail vehicle such as a train comes off its rails. Although many derailments are minor, all result in temporary disruption of the proper operation of the railway system and they are a potentially ...
, pressured speech, poverty of speech, tangentiality, and thought blocking. FTD is a hallmark feature of
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, but is also associated with other conditions including
mood disorders A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
,
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
,
mania Mania, also known as manic syndrome, is a mental and behavioral disorder defined as a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together wit ...
, and
neurological diseases A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weak ...
. Impaired
attention Attention is the behavioral and cognitive process of selectively concentrating on a discrete aspect of information, whether considered subjective or objective, while ignoring other perceivable information. William James (1890) wrote that "Atte ...
, poor
memory Memory is the faculty of the mind by which data or information is encoded, stored, and retrieved when needed. It is the retention of information over time for the purpose of influencing future action. If past events could not be remembered, ...
, and difficulty formulating
abstract concept Concepts are defined as abstract ideas. They are understood to be the fundamental building blocks of the concept behind principles, thoughts and beliefs. They play an important role in all aspects of cognition. As such, concepts are studied by s ...
s may also reflect thought disorder, and can be observed or assessed with mental status tests such as serial sevens or memory tests. cited


Types

There are many types of thought disorder. They are also referred to as symptoms of formal thought disorder of which 30 are described including:
Alogia In psychology, alogia (; from Greek ἀ-, "without", and λόγος, "speech" + New Latin -ia) is poor thinking inferred from speech and language usage. "alogia An impoverishment in thinking that is inferred from observing speech and language beha ...
(also ''poverty of speech'') :A poverty of speech, either in amount or content. Under negative/positive symptom classification of schizophrenia, it is classified as a negative symptom. When classifying symptoms into more dimensions, poverty of speech content—paucity of meaningful content with normal amount of speech—is a disorganization symptom, whereas poverty of speech—loss of speech production—is a negative symptom. *"... In this way, alogia is conceived of as a 'negative thought disorder.' ..." *"... The paucity of meaningful content in the presence of a normal amount of speech that is sometimes included in alogia is actually a disorganization of thought and not a negative symptom and is properly included in the disorganization cluster of symptoms. ..." Under SANS, thought blocking is considered a part of alogia, and so is increased latency in response. Blocking or thought blocking (also ''deprivation of thought'' and ''obstructive thought''). : An abrupt stop in the middle of a train of thought which may or not be able to be continued. Circumstantial speech (also ''circumstantial thinking'')Houghtalen, Rory P; McIntyre, John S (2017). "7.1 Psychiatric Interview, History, and Mental Status Examination of the Adult Patient". In Sadock, Virginia A; Sadock, Benjamin J; Ruiz, Pedro (eds.). Kaplan & Sadock's Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer. HISTORY AND EXAMINATION, Thought Process/Form, Table 7.1–6. Examples of Disordered Thought Process/Form. . indicates and briefly defines the follow types: Clanging, Circumstantial, Derailment (loose associations), Flight of ideas, Incoherence (word salad), Neologism, Tangential, Thought blocking : An inability to answer a question without giving excessive, unnecessary detail. This differs from tangential thinking, in that the person does eventually return to the original point. For example, the patient answers the question "how have you been sleeping lately?" with "Oh, I go to bed early, so I can get plenty of rest. I like to listen to music or read before bed. Right now I'm reading a good mystery. Maybe I'll write a mystery someday. But it isn't helping, reading I mean. I have been getting only 2 or 3 hours of sleep at night."
Clanging In psychology and psychiatry, clanging or clang association refers to a mode of speech characterized by association of words based upon sound rather than concepts. For example, this may include compulsive rhyming or alliteration without apparent l ...
: A severe form of flight of ideas whereby ideas are related only by similar or rhyming sounds rather than actual meaning. This may be heard as excessive rhyming and/or alliteration. e.g. "Many moldy mushrooms merge out of the mildewy mud on Mondays." "I heard the bell. Well, hell, then I fell." It is most commonly seen in
bipolar disorder Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that last from days to weeks each. If the elevated mood is severe or associated with ...
(manic phase), although it is often observed in patients with primary psychoses, namely
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
and
schizoaffective disorder Schizoaffective disorder (SZA, SZD or SAD) 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 (usually psychosis) and a mood disorder: ...
.
Derailment In rail transport, a derailment occurs when a rail vehicle such as a train comes off its rails. Although many derailments are minor, all result in temporary disruption of the proper operation of the railway system and they are a potentially ...
(also ''loose association'' and ''knight's move thinking'') : Thought frequently moves from one idea to another which is obliquely related or unrelated, often appearing in speech but also in writing, e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California." Distractible speech : During mid speech, the subject is changed in response to a nearby stimulus. e.g. "Then I left San Francisco and moved to... Where did you get that tie?"
Echolalia Echolalia is the unsolicited repetition of vocalizations made by another person (when repeated by the same person, it is called palilalia). In its profound form it is automatic and effortless. It is one of the echophenomena, closely related t ...
* "Form of Thought. Disorders of the form of thought are objectively observable in patients' spoken and written language. The disorders include looseness of associations, derailment, incoherence, tangentiality, circumstantiality, neologisms, echolalia, verbigeration, word salad, and mutism." * "Thought Process. ... Disorders of thought process include flight of ideas, thought blocking, impaired attention, poverty of thought content, poor abstraction abilities, perseveration, idiosyncratic associations (e.g., identical predicates and clang associations), overinclusion, and circumstantiality." : Echoing of another's speech that may only be committed once, or may be continuous in repetition. This may involve repeating only the last few words or last word of the examiner's sentences. This can happen immediately after a stimuli, or months to years later. Echolalia is commonly seen with Autism and Tourette's Syndrome, although there are plenty of disorders that it can be attributed to. e.g. "What would you like for dinner?", "''What would you like for dinner?" "''That's a good question." "''That's a good question''." Evasion : The next logical idea in a sequence is replaced with another idea closely but not accurately or appropriately related to it. Also called ''paralogia'' and ''perverted logic''. Example: "I... er ah... you are uh... I think you have... uh-- acceptable erm... uh... hair."
Flight of ideas 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 i ...
: A form of formal thought disorder marked by abrupt leaps from one topic to another, possibly with discernable links between successive ideas, perhaps governed by similarities between subjects or, in somewhat higher grades, by
rhyming A rhyme is a repetition of similar sounds (usually, the exact same phonemes) in the final stressed syllables and any following syllables of two or more words. Most often, this kind of perfect rhyming is consciously used for a musical or aesthetic ...
, puns, and word plays, or by innocuous environmental stimuli – e.g., the sound of birds chirping. It is most characteristic of the manic phase of bipolar illness.
Illogicality As the study of argument is of clear importance to the reasons that we hold things to be true, logic is of essential importance to rationality. Arguments may be logical if they are "conducted or assessed according to strict principles of Validity ( ...
includes and defines Derailment, Tangentiality, Incoherence, Illogicality, Circumstantiality, Pressure of speech, Distractible speech, Clanging. : Conclusions are reached that do not follow logically (non-sequiturs or faulty inferences). e.g. "Do you think this will fit in the box?" draws a reply like "Well of course; it's brown, isn't it?" Incoherence or word salad : Speech that is unintelligible because, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish, e.g. the question "Why do people comb their hair?" elicits a response like "Because it makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons, hello please!"
Neologism A neologism Greek νέο- ''néo''(="new") and λόγος /''lógos'' meaning "speech, utterance"] is a relatively recent or isolated term, word, or phrase that may be in the process of entering common use, but that has not been fully accepted int ...
s : forms completely new words or phrases whose origins and meanings are usually unrecognizable. Example is "I got so angry I picked up a dish and threw it at the geshinker." These may also involve elisions of two words that are similar in meaning or in sound. Although neologisms may sometimes refer to words that are formed incorrectly but whose origins are understandable (e.g. "headshoe" for hat), these can be more clearly referred to as word approximations. Overinclusion : The failure to eliminate ineffective, inappropriate, irrelevant, extraneous details associated with a particular stimulus. * "This form of thought is most characteristic of mania and tends to be overinclusive, with difficulty in excluding irrelevant, extraneous details from the association."
Perseveration Perseveration, in the fields of psychology, psychiatry, and speech-language pathology, is the repetition of a particular response (such as a word, phrase, or gesture) regardless of the absence or cessation of a stimulus. It is usually caused by a ...
: Persistent repetition of words or ideas even when another person attempts to change the topic. e.g. "It's great to be here in Nevada, Nevada, Nevada, Nevada, Nevada." This may also involve repeatedly giving the same answer to different questions. e.g. "Is your name Mary?" "Yes." "Are you in the hospital?" "Yes." "Are you a table?" "Yes." Perseveration can include
palilalia Palilalia (from the Greek πάλιν (''pálin'') meaning "again" and λαλιά (''laliá'') meaning "speech" or "to talk"), a complex tic, is a language disorder characterized by the involuntary repetition of syllables, words, or phrases. It ha ...
and
logoclonia 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 ...
, and can be an indication of organic brain disease such as
Parkinson's Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms becom ...
.
Phonemic paraphasia Paraphasia is a type of language output error commonly associated with aphasia, and characterized by the production of unintended syllables, words, or phrases during the effort to speak. Paraphasic errors are most common in patients with fluent for ...
: Mispronunciation; syllables out of sequence. e.g. "I slipped on the lice and broke my arm." Pressured speech : Rapid speech without pauses, difficult to interrupt. Referential thinking : "Patients tendency to view innocuous stimuli as having a specific meaning for the self." This could be seen as them repeatedly and inappropriately referring back to self. e.g. "What's the time?", "It's 7 o'clock. That's my problem."
Semantic paraphasia Paraphasia is a type of language output error commonly associated with aphasia, and characterized by the production of unintended syllables, words, or phrases during the effort to speak. Paraphasic errors are most common in patients with fluent for ...
: Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book." Stilted speech : Sentences may be stilted or vague. Speech characterized by the use of words or phrases that are flowery, excessive, and pompous, e.g. "The attorney comported himself indecorously."
Tangential speech Tangential speech or tangentiality is a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation.''Forensic Aspects of Communication Sciences an ...
: Wandering from the topic and never returning to it or providing the information requested. For example, in answer to the question "Where are you from?", the person answers "My dog is from England. They have good fish and chips there. Fish breathe through gills."
Verbigeration 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 ...
"Word salad describes the stringing together of words that seem to have no logical association, and verbigeration describes the disappearance of understandable speech, replaced by strings of incoherent utterances." : Meaningless and stereotyped repetition of words or phrases replacing understandable speech, as seen in schizophrenia.


Use of term

Some recent (2015, 2017) psychiatric/psychological glossaries defined thought disorder as disturbed thinking or
cognition Cognition refers to "the mental action or process of acquiring knowledge and understanding through thought, experience, and the senses". It encompasses all aspects of intellectual functions and processes such as: perception, attention, thought, ...
that affects
communication Communication (from la, communicare, meaning "to share" or "to be in relation with") is usually defined as the transmission of information. The term may also refer to the message communicated through such transmissions or the field of inquir ...
,
language Language is a structured system of communication. The structure of a language is its grammar and the free components are its vocabulary. Languages are the primary means by which humans communicate, and may be conveyed through a variety of met ...
, or thought content including
poverty of ideas This glossary covers terms found in the psychiatry, psychiatric literature; the word origins are primarily Greek language, Greek, but there are also Latin language, Latin, French language, French, German language, German, and English language, Engl ...
,
neologisms A neologism Greek νέο- ''néo''(="new") and λόγος /''lógos'' meaning "speech, utterance"] is a relatively recent or isolated term, word, or phrase that may be in the process of entering common use, but that has not been fully accepted int ...
, paralogia, word salad, and delusions "thought disorder Any disturbance of thinking that affects language, communication, or thought content; the hallmark feature of schizophrenia. Manifestations range from simple blocking and mild circumstantiality to profound loosening of associations, incoherence, and delusions; characterized by a failure to follow semantic and syntactic rules that is inconsistent with the person's education, intelligence, or cultural background." which are disturbance of both thought content and thought formand suggested the more specific terms of #Content Thought Disorder, content thought disorder and formal thought disorder, with content thought disorder defined as a thought disturbance characterized by multiple fragmented delusions, "content thought disorder Disturbance in thinking in which a person exhibits delusions that may be multiple, fragmented, and bizarre." and formal thought disorder defined as disturbance in the form or structure of thinking. For example,
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
(2013) only used the word formal thought disorder, mostly as a
synonym A synonym is a word, morpheme, or phrase that means exactly or nearly the same as another word, morpheme, or phrase in a given language. For example, in the English language, the words ''begin'', ''start'', ''commence'', and ''initiate'' are all ...
of disorganized thinking and disorganized speech. This is in contrast with
ICD-10 ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, ...
(1992) which only used the word "thought disorder", always accompanied with "delusion" and "hallucination" separately, * F06.2 Organic delusional chizophrenia-likedisorder, p.59: Features suggestive of schizophrenia, such as bizarre delusions, hallucinations, or thought disorder, may also be present. ... ''Diagnostic guidelines'' ... Hallucinations, thought disorder, or isolated catatonic phenomena may be present. ... * F20.0 Paranoid schizophrenia, p. 80: ... Thought disorder may be obvious in acute states, but if so it does not prevent the typical delusions or hallucinations from being described clearly. ... * F20.1 Hebephrenic schizophrenia, p. 81: ... In addition, disturbances of affect and volition, and thought disorder are usually prominent. Hallucinations and delusions may be present but are not usually prominent. ... and a general
medical dictionary A medical dictionary is a lexicon for words used in medicine. The three major medical dictionaries in the United States are '' Stedman's'', ''Taber's'', and ''Dorland's''. Other significant medical dictionaries are distributed by Elsevier. Dict ...
(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: 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:


Course, diagnosis, and prognosis

It was believed that thought disorder occurred only in
schizophrenia Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, 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 Nancy Coover Andreasen (born November 11, 1938) is an American neuroscientist and neuropsychiatrist. She currently holds the Andrew H. Woods Chair of Psychiatry at the Roy J. and Lucille A. Carver College of Medicine at the University of Iowa. ...
found cited * * * that 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: * illness begins earlier * increased risk of hospitalization * decreased functional outcomes * increased disability rates * increased inappropriate social behaviors 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 In medicine, a prodrome is an early sign or symptom (or set of signs and symptoms) that often indicates the onset of a disease before more diagnostically specific signs and symptoms develop. It is derived from the Greek word ''prodromos'', meaning ...
and residual periods of schizophrenia. Treatment for thought disorder may include psychotherapy such as cognitive behavior therapy (CBT) and/or psychotropic medications.
DSM-5 The ''Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition'' (DSM-5), is the 2013 update to the ''Diagnostic and Statistical Manual of Mental Disorders'', the taxonomic and diagnostic tool published by the American Psychiatric ...
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, certain 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 disorderdisplayed 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 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 ...
, such as in schizophrenia, and bipolar mania, from
malingering Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work. Malingering is not a medical diagnosis, but may be recorded as a "focus of c ...
, 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 disorder The autism spectrum, often referred to as just autism or in the context of a professional diagnosis autism spectrum disorder (ASD) or autism spectrum condition (ASC), is a neurodevelopmental disorder, neurodevelopmental condition (or conditions) ...
s (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.
Rorschach Rorschach may refer to: * Hermann Rorschach, a Swiss psychiatrist ** Rorschach test, his psychological evaluation method involving inkblots * Rorschach (character), a character from the comics ''Watchmen'' * Rorschach (comic book), a 2020 comic * ...
inkblots have shown to be a very useful tool in assessing thought disorder in disturbed patients. A series of inkblots are shown and the responses to them by the patients are recorded and further analyzed to determine disturbances of thought. The nature of the assessment itself offers insight to the cognitive processes of another and how they respond to equivocal stimuli.
Hermann Rorschach Hermann Rorschach (; 8 November 1884 – 2 April 1922) was a Swiss psychiatrist and psychoanalyst. His education in art helped to spur the development of a set of inkblots that were used experimentally to measure various unconscious parts of the s ...
first developed this test as a measure for diagnosing schizophrenia after realizing that people with schizophrenia gave drastically different interpretations of Klecksographie inkblots as compared to others who's thought process was considered normal. It has since been one of the most widely used assessment tools in diagnosing thought disorders. The Thought Disorder Index (TDI), also called the Delta Index, was developed to help further determine the severity of thought disorder in verbal responses. TDI scores are mainly derived from verbally expressed interpretations of the Rorschach Inkblot Test, but TDI can also be used with other verbal samples including the
Wechsler Adult Intelligence Scale The Wechsler Adult Intelligence Scale (WAIS) is an IQ test designed to measure intelligence and cognitive ability in adults and older adolescents. The original WAIS (Form I) was published in February 1955 by David Wechsler, as a revision of the ...
. TDI includes a twenty-three-category scoring index. Each category scores the level of severity on a scale from 0–1, with .25 being mild and 1.00 being most severe (.25, .50, .75, 1.00).


Criticisms

The concept of thought disorder has been criticized as being based on circular or incoherent definitions. Bentall, R. (2003) ''Madness explained: Psychosis and Human Nature''. London: Penguin Books Ltd. 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 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 ...
, similar phenomena can appear in different disorders, potentially leading to misdiagnosis—for example, in the case of incomplete yet potentially fruitful thought processes. 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 Factor analysis is a statistical method used to describe variability among observed, correlated variables in terms of a potentially lower number of unobserved variables called factors. For example, it is possible that variations in six observed ...
studies found that negative symptoms tend to correlate with one another, while positive symptoms tend to separate into two groups. cited * * * 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. "The two-syndrome concept as formulated by T. J. Crow was especially important in spurring research into the nature of negative symptoms. ...—but this does not diminish the creative efforts that led to these scales or importance of these scales for research. In fact, it was only through careful analysis of the structure of symptoms in these scales that a more accurate characterization of the phenomenology of schizophrenia was possible."


See also

*
Aphasia Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in t ...
*
Auditory processing disorder Auditory processing disorder (APD), rarely known as King-Kopetzky syndrome or auditory disability with normal hearing (ADN), is a neurodevelopmental disorder affecting the way the brain processes auditory information. Individuals with APD usually ...
* Emil Kraepelin's dream speech *
Speech and language pathology Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...


References


Further reading

* * * * * {{DEFAULTSORT:Thought Disorder Psychosis *