Thought disorder explained

Thought disorder
Synonyms:Formal thought disorder (FTD), thinking disorder
Field:Psychiatry, clinical psychology

A thought disorder (TD) is a disturbance in cognition which affects language, thought and communication.[1] [2] Psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia (a reasoning disorder characterized by expression of illogical or delusional thoughts), word salad, and delusions—all disturbances of thought content and form. Two specific terms have been suggested—content thought disorder (CTD) and formal thought disorder (FTD). CTD has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an FTD:[3] a disruption of the form (or structure) of thought.[4] Also known as disorganized thinking, FTD results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses[5] [6] (including mood disorders, dementia, mania, and neurological diseases).[5] [7] Disorganized speech leads to an inference of disorganized thought.[8] Thought disorders include derailment,[9] pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking.[7] One of the first known cases of thought disorders, or specifically OCD as it is known today, was in 1691. John Moore, who was a bishop, had a speech in front of Queen Mary II, about "religious melancholy."[10]

Formal thought disorder affects the form (rather than of the content) of thought.[11] Unlike hallucinations and delusions, it is an observable, objective sign of psychosis. FTD is a common core symptom of a psychotic disorder, and may be seen as a marker of severity and as an indicator of prognosis.[7] [12] It reflects a cluster of cognitive, linguistic, and affective disturbances that have generated research interest in the fields of cognitive neuroscience, neurolinguistics, and psychiatry.[7]

Eugen Bleuler, who named schizophrenia, said that TD was its defining characteristic.[13] Disturbances of thinking and speech, such as clanging or echolalia, may also be present in Tourette syndrome;[14] other symptoms may be found in delirium.[15] A clinical difference exists between these two groups. Patients with psychoses are less likely to show awareness or concern about disordered thinking, and those with other disorders are aware and concerned about not being able to think clearly.[16]

Content thought disorder

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 which include obsessive-compulsive disorder and mania.[17] At the core of thought content disorder are abnormal beliefs and convictions (after taking the person's culture and background into consideration) ranging from overvalued ideas to fixed delusions. These beliefs and delusions are typically 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 contradictory beliefs and prejudices or biases. Individuals vary considerably, and a person's thinking may also shift from time to time.

Content thought disorder is not limited to delusions. Other possible abnormalities include suicidal, violent, and homicidal ideas[18] and:[19]

In psychosis, delusions are the most common thought content disorder. A delusion is a firm, fixed belief based on inadequate grounds, not amenable to rational argument or evidence to the contrary, which is out of sync with a person's regional, cultural, or educational background. Delusions are common in people with mania, depression, schizoaffective disorder, delirium, dementia, substance use disorders, schizophrenia, and delusional disorders. Common examples in a mental status examination include the following:[20]

Formal thought disorder

Formal thought disorder (FTD) is also known as disorganized speech. Evidence of disorganized thinking, it is a hallmark feature of schizophrenia.[4] [6] FTD, a disorder of the form (rather than content) of thought, encompasses hallucinations and delusions[11] and is an observable sign of psychosis. As a common, core symptom of psychosis, it may be seen as a marker of severity and a predictor of prognosis.[7] [12] FTD reflects a cluster of cognitive, linguistic, and affective disturbances which has generated research interest from the fields of cognitive neuroscience, neurolinguistics, and psychiatry.[7]

It can be subdivided into clusters of positive and negative symptoms and objective (rather than subjective) symptoms. On the scale of positive and negative symptoms, they have been grouped into positive formal thought disorder (posFTD) and negative formal thought disorder (negFTD).[12] [11] Positive subtypes were pressure of speech, tangentiality, derailment, incoherence, and illogicality; negative subtypes were poverty of speech and poverty of content. The two groups were posited to be at either end of a spectrum of normal speech, but later studies showed them to be poorly correlated. A comprehensive measure of FTD is the Thought and Language Disorder (TALD) Scale.[22] The Kiddie Formal Thought Disorder Rating Scale (K-FTDS) can be used to assess the presence of formal thought disorder in children and their childhood. Although it is very extensive and time-consuming, its results are in great detail and reliable.[23]

Nancy Andreasen preferred to identify TDs as thought-language-communication disorders (TLC disorders).[24] Up to seven domains of FTD have been described on the Thought, Language, Communication (TLC) Scale, with most of the variance accounted for by two or three domains.[11] Some TLC disorders are more suggestive of severe disorder, and are listed with the first 11 items.[24]

Diagnoses

The DSM V categorizes FTD as "a psychotic symptom, manifested as bizarre speech and communication." FTD may include incoherence, peculiar words, disconnected ideas, or a lack of unprompted content expected from normal speech.[25] Clinical psychologists typically assess FTD by initiating an exploratory conversation with patients and observing the patient's verbal responses.[26]

FTD is often used to establish a diagnosis of schizophrenia; in cross-sectional studies, 27 to 80 percent of patients with schizophrenia present with FTD. A hallmark feature of schizophrenia, it is also widespread amongst other psychiatric disorders; up to 60 percent of those with schizoaffective disorder and 53 percent of those with clinical depression demonstrate FTD, suggesting that it is not exclusive to schizophrenia. About six percent of healthy subjects exhibit a mild form of FTD.[27]

The characteristics of FTD vary amongst disorders. A number of studies indicate that FTD in mania is marked by irrelevant intrusions and pronounced combinatory thinking, usually with a playfulness and flippancy absent from patients with schizophrenia.[28] [29] [30] The FTD present in patients with schizophrenia was characterized by disorganization, neologism, and fluid thinking, and confusion with word-finding difficulty.[30]

There is limited data on the longitudinal course of FTD.[31] The most comprehensive longitudinal study of FTD by 2023 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.[32]

Possible causes

Several theories have been developed to explain the causes of formal thought disorder. It has been proposed that FTD relates to neurocognition via semantic memory. Semantic network impairment in people with schizophreniameasured by the difference between fluency (e.g. the number of animals' names produced in 60 seconds) and phonological fluency (e.g. the number of words beginning with "F" produced in 60 seconds)predicts the 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.[33]

FTD in schizophrenia has been found to be associated with structural and functional abnormalities in the language network, where structural studies have found bilateral grey matter deficits; deficits in the bilateral inferior frontal gyrus, bilateral inferior parietal lobule and bilateral superior temporal gyrus are FTD correlates.[27] Other studies did not find an association between FTD and structural aberrations of the language network, however, and regions not included in the language network have been associated with FTD.[27] Future research is needed to clarify whether there is an association with FTD in schizophrenia and neural abnormalities in the language network.[27]

Transmitter systems which might cause FTD have also been investigated. Studies have found that glutamate dysfunction, due to a rarefaction of glutamatergic synapses in the superior temporal gyrus in patients with schizophrenia, is a major cause of positive FTD.[27]

The heritability of FTD has been demonstrated in a number of family and twin studies. Imaging genetics studies, using a semantic verbal-fluency task performed by the participants during functional MRI scanning, revealed that alleles linked to glutamatergic transmission contribute to functional aberrations in typical language-related brain areas.[27] FTD is not solely genetically determined, however; environmental influences, such as allusive thinking in parents during childhood, and environmental risk factors for schizophrenia (including childhood abuse, migration, social isolation, and cannabis use) also contribute to the pathophysiology of FTD.[34]

The origins of FTD have been theorised from a social-learning perspective. Singer and Wynne said that familial communication patterns play a key role in shaping the development of FTD; dysfunctional social interactions undermine a child's development of cohesive, stable mental representations of the world, increasing their risk of developing FTD.[35]

Treatments

Antipsychotic medication is often used to treat FTD. Although the vast majority of studies of the efficacy of antipsychotic treatment do not report effects on syndromes or symptoms, six older studies report the effects of antipsychotic treatment on FTD.[36] [37] [38] [39] [40] [41] These studies and clinical experience indicate that antipsychotics are often an effective treatment for patients with positive or negative FTD, but not all patients respond to them.

Cognitive behavioural therapy (CBT) is another treatment for FTD, but its effectiveness has not been well-studied.[27] Large randomised controlled trials evaluating the effectiveness of CBT for treating psychosis often exclude individuals with severe FTD because it reduces the therapeutic alliance required by the therapy.[42] However, provisional evidence suggests that FTD may not preclude the effectiveness of CBT.[42] Kircher and colleagues have suggested that the following methods should be used in CBT for patients with FTD:[27]

Signs and symptoms

Language abnormalities exist in the general population, and do not necessarily indicate a condition.[43] They can occur in schizophrenia and other disorders (such as mania or depression), or in anyone who may be tired or stressed.[1] To distinguish thought disorder, patterns of speech, severity of symptoms, their frequency, and any resulting functional impairment can be considered.[24]

Symptoms of TD include derailment,[9] pressured speech, poverty of speech, tangentiality, and thought blocking.[7] 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 TD, and can be observed and assessed with mental-status tests such as serial sevens or memory tests.[44]

Types

Thirty symptoms (or features) of TD have been described, including:[11]

A poverty of speech in amount or content, it is classified as a negative symptom of schizophrenia. When further classifying symptoms, poverty of speech content (little meaningful content with a normal amount of speech) is a disorganization symptom.[45] Under SANS, thought blocking is considered a part of alogia, and so is increased latency in response.

An instance where ideas are related only by similar or rhyming sounds rather than actual meaning.[49] [50] This may be heard as excessive rhyming or alliteration ("Many moldy mushrooms merge out of the mildewy mud on Mondays", or "I heard the bell. Well, hell, then I fell"). It is most commonly seen in the manic phase of bipolar disorder, although it is also often observed in patients with schizophrenia and schizoaffective disorder.

[53] Echoing of another's speech,[49] once or in repetition. It may involve repeating only the last few words (or the last word) of another person's sentences, and is common on the autism spectrum and in Tourette syndrome.[54] [55] [56]

A form of FTD marked by abrupt leaps from one topic to another, possibly with discernible links between successive ideas, perhaps governed by similarities between subjects or by rhyming, puns, wordplay, or innocuous environmental stimuli (such as the sound of birds chirping). It is most characteristic of the manic phase of bipolar disorder.

[59] Conclusions are reached which do not follow logically (non sequiturs or faulty inferences). "Do you think this will fit in the box?" is answered with, "Well of course; it's brown, isn't it?"

Persistent repetition of words or ideas, even when another person tries to change the subject.[49] ("It's great to be here in Nevada, Nevada, Nevada, Nevada, Nevada.") It may also involve repeatedly giving the same answer to different questions ("Is your name Mary?" "Yes." "Are you in the hospital?" "Yes." "Are you a table?" "Yes"). Perseveration can include palilalia and logoclonia, and may indicate an organic brain disease such as Parkinson's disease.

[64] Rapid speech without pauses, which is difficult to interrupt.

Viewing innocuous stimuli as having a specific meaning for the self[65] ("What's the time?" "It's 7 o'clock. That's my problem").

Speech characterized by words or phrases which are flowery, excessive, and pompous[49] ("The attorney comported himself indecorously").

Wandering from the topic and never returning to it, or providing requested information[49] [67] ("Where are you from?" "My dog is from England. They have good fish and chips there. Fish breathe through gills").

[68] Meaningless, stereotyped repetition of words or phrases which replace understandable speech; seen in schizophrenia.

Terminology

Psychiatric and psychological glossaries in 2015 and 2017 defined thought disorder as disturbed thinking or cognition which affects communication, language, or thought content including poverty of ideas, neologisms, paralogia, word salad, and delusions[69] [17] (disturbances of thought content and form), and suggested the more-specific terms content thought disorder (CTD) and formal thought disorder (FTD). CTD was defined as a TD characterized by multiple fragmented delusions,[70] [17] and FTD was defined as a disturbance in the form or structure of thinking.[71] [72] The 2013 DSM-5 only used the term FTD, primarily as a synonym for disorganized thinking and speech.[73] This contrasts with the 1992 ICD-10 (which only used the word "thought disorder", always accompanied with "delusion" and "hallucination")[74] and a 2002 medical dictionary which generally defined thought disorders similarly to the psychiatric glossaries[75] and used the word in other entries as the ICD-10 did.[76]

A 2017 psychiatric text describing thought disorder as a "disorganization syndrome" in the context of schizophrenia:The text said that some clinicians use the term "formal thought disorder" broadly, referring to abnormalities in thought form with psychotic cognitive signs or symptoms,[77] and studies of cognition and subsyndromes in schizophrenia may refer to FTD as conceptual disorganization or disorganization factor.

Some disagree:

Course, diagnosis, and prognosis

It was believed that TD occurred only in schizophrenia, but later findings indicate that it may occur in other psychiatric conditions (including mania) and in people without mental illness.[78] Not all people with schizophrenia have a TD; the condition is not specific to the disease.

When defining thought-disorder subtypes and classifying them as positive or negative symptoms, Nancy Andreasen found[79] that different subtypes of TD occur at different frequencies in those with mania, depression, and schizophrenia. People with mania have pressured speech as the most prominent symptom, and have rates of derailment, tangentiality, and incoherence as prominent as in those with schizophrenia. They are likelier to have pressured speech, distractibility, and circumstantiality.

People with schizophrenia have more negative TD, including poverty of speech and poverty of content of speech, but also have relatively high rates of some positive TD. Derailment, loss of goal, poverty of content of speech, tangentiality and illogicality are particularly characteristic of schizophrenia.[80] People with depression have relatively-fewer TDs; the most prominent are poverty of speech, poverty of content of speech, and circumstantiality. Andreasen noted the diagnostic usefulness of dividing the symptoms into subtypes; negative TDs without full affective symptoms suggest schizophrenia.[81]

She also cited the prognostic value of negative-positive-symptom divisions. In manic patients, most TDs resolve six months after evaluation; this suggests that TDs in mania, although as severe as in schizophrenia, tend to improve. In people with schizophrenia, however, negative TDs remain after six months and sometimes worsen; positive TDs somewhat improve. A negative TD is a good predictor of some outcomes; patients with prominent negative TDs are worse in social functioning six months later. More prominent negative symptoms generally suggest a worse outcome; however, some people may do well, respond to medication, and have normal brain function. Positive symptoms vary similarly.

A prominent TD at illness onset suggests a worse prognosis, including:

TD which is unresponsive to treatment predicts a worse illness course. In schizophrenia, TD severity tends to be more stable than hallucinations and delusions. Prominent TDs are more unlikely to diminish in middle age, compared with positive symptoms. Less-severe TD may occur during the prodromal and residual periods of schizophrenia. Treatment for thought disorder may include psychotherapy, such as cognitive behavior therapy (CBT), and psychotropic medications.[82]

The DSM-5 includes delusions, hallucinations, disorganized thought process (formal thought disorder), and disorganized or abnormal motor behavior (including catatonia) as key symptoms of psychosis. Schizophrenia-spectrum disorders such as schizoaffective disorder and schizophreniform disorder typically consist of prominent hallucinations, delusions and FTD; the latter presents as severely disorganized, bizarre, and catatonic behavior. Psychotic disorders due to medical conditions and substance use typically consist of delusions and hallucinations. The rarer delusional disorder and shared psychotic disorder typically present with persistent delusions.[83] FTDs are commonly found in schizophrenia and mood disorders, with poverty of speech content more common in schizophrenia.[84]

Psychoses such as schizophrenia and bipolar mania are distinguishable from malingering, when an individual fakes illness for other gains, by clinical presentations; malingerers feign thought content with no irregularities in form such as derailment or looseness of association. Negative symptoms, including alogia, may be absent, and chronic thought disorder is typically distressing.[85]

Autism spectrum disorders (ASD) whose diagnosis requires the onset of symptoms before three years of age can be distinguished from early-onset schizophrenia; schizophrenia under age 10 is extremely rare, and ASD patients do not display FTDs.[86] However, it has been suggested that individuals with 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 parent reports of stress and anxiety.[87]

Rorschach tests have been useful for assessing TD in disturbed patients.[88] A series of inkblots are shown, and patient responses are analyzed to determine disturbances of thought. The nature of the assessment offers insight into the cognitive processes of another, and how they respond to equivocal stimuli.[89] Hermann Rorschach developed this test to diagnose schizophrenia after realizing that people with schizophrenia gave drastically different interpretations of Klecksographie inkblots from others whose thought processes were considered normal,[90] and it has become one of the most widely used assessment tools for diagnosing TDs.

The Thought Disorder Index (TDI), also known as the Delta Index, was developed to help further determine the severity of TD in verbal responses. TDI scores are primarily derived from verbally-expressed interpretations of the Rorschach test, but TDI can also be used with other verbal samples (including the Wechsler Adult Intelligence Scale). TDI has a twenty-three-category scoring index; each category scores the level of severity on a scale from 0 to 1, with .25 being mild and 1.00 being most severe (0.25, 0.50, 0.75, 1.00).

Criticism

TD has been criticized as being based on circular or incoherent definitions.[91] Symptoms of TD are inferred from disordered speech, based on the assumption that disordered speech arises from disordered thought. Although TD is typically associated with psychosis, similar phenomena can appear in different disorders and leading to misdiagnosis.[92]

A criticism related to the separation of symptoms of schizophrenia into negative or positive symptoms, including TD, is that it oversimplifies the complexity of TD and its relationship to other positive symptoms. Factor analysis has found that negative symptoms tend to correlate with one another, but positive symptoms tend to separate into two groups.[93] The three clusters became known as negative symptoms, psychotic symptoms, and disorganization symptoms. Alogia, a TD traditionally classified as a negative symptom, can be separated into two types: poverty of speech content (a disorganization symptom) and poverty of speech, response latency, and thought blocking (negative symptoms).[94] Positive-negative-symptom diametrics, however, may enable a more accurate characterization of schizophrenia.[95]

See also

Sources

Notes and References

  1. Hart M, Lewine RR . Rethinking Thought Disorder . Schizophrenia Bulletin . 43 . 3 . 514–522 . May 2017 . 28204762 . 5464106 . 10.1093/schbul/sbx003 .
  2. Thought disorder . thought-disorder . 23 February 2020 .
  3. Web site: Thought Disorder - an overview ScienceDirect Topics. 2021-07-15. www.sciencedirect.com.
  4. Formal thought disorder . formal-thought-disorder . 23 February 2020 .
  5. Disorganized speech . disorganized-speech . 23 February 2020 .
  6. Book: Diagnostic and statistical manual of mental disorders : DSM-5. . 2013 . American Psychiatric Association . 9780890425541 . 88 . 5th .
  7. Roche E, Creed L, MacMahon D, Brennan D, Clarke M . The Epidemiology and Associated Phenomenology of Formal Thought Disorder: A Systematic Review . Schizophrenia Bulletin . 41 . 4 . 951–62 . July 2015 . 25180313 . 4466171 . 10.1093/schbul/sbu129 .
  8. Web site: The Epidemiology and Associated Phenomenology of Formal Thought Disorder: A Systematic Review. 2021-06-06. Schizophrenia Bulletin. 2015. 10.1093/schbul/sbu129. 4466171. 25180313. Roche. E.. Creed. L.. MacMahon. D.. Brennan. D.. Clarke. M.. 41. 4. 951–962.
  9. Derailment . derailment . 23 February 2020 .
  10. Web site: The history of OCD OCD-UK . 2023-05-12 . en-GB.
  11. Kircher T, Bröhl H, Meier F, Engelen J . Formal thought disorders: from phenomenology to neurobiology . The Lancet. Psychiatry . 5 . 6 . 515–526 . June 2018 . 29678679 . 10.1016/S2215-0366(18)30059-2 . 5036067 .
  12. Bora E, Yalincetin B, Akdede BB, Alptekin K . Neurocognitive and linguistic correlates of positive and negative formal thought disorder: A meta-analysis . Schizophrenia Research . 209 . 2–11 . July 2019 . 31153670 . 10.1016/j.schres.2019.05.025 . 167221363 .
  13. Colman, A. M. (2001) Oxford Dictionary of Psychology, Oxford University Press.
  14. Barrera A, McKenna PJ, Berrios GE . Formal thought disorder, neuropsychology and insight in schizophrenia . Psychopathology . 42 . 4 . 264–9 . 2009 . 19521143 . 10.1159/000224150 . 26079338 .
  15. Book: Noble J, Greene HL . Textbook of primary care medicine. 15 January 1996. Mosby. 978-0-8016-7841-7. 1325.
  16. Book: Jefferson JW, Moore DS . Handbook of medical psychiatry . registration . Elsevier Mosby . 2004 . 0-323-02911-6 . 131.
  17. Content-thought disorder . content-thought-disorder . 23 February 2020.
  18. "Suicidal, violent, and homicidal ideation fall under the category of thought content ..."
  19. Book: . Houghtalen RP, Mcintyre JS . Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . 7.1 Psychiatric Interview, History, and Mental Status Examination of the Adult Patient . Table 7.1-5. Elements of the Mental Status Examination with Examples of Abnormal Findings. . Thought content: obsession, delusion, magical thinking, overvalued ideas, ideas of reference or influence, persecutory ideas. .
  20. Book: Sadock BJ . Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . 7.2 Outline for a Psychiatric Examination . MENTAL STATUS, Table 7.2–1. Common Questions for the Psychiatric History and Mental Status. . 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. .
  21. Book: Paula Clayton . Fatemi SH, Clayton PJ . 2016 . The Medical Basis of Psychiatry . 4th . New York . Springer Science+Business Media . 978-1-4939-2528-5 . 10.1007/978-1-4939-2528-5 . Fatemi SH, Folsom TD . 6 Schizophrenia . 6.6. Clinical Findings, 6.6.2. Mental Status Examination in a Subject with Schizophrenia, 6.6.2.5. Thought Form and Content, p. 103 .
  22. Kircher T, Krug A, Stratmann M, Ghazi S, Schales C, Frauenheim M, Turner L, Fährmann P, Hornig T, Katzev M, Grosvald M, Müller-Isberner R, Nagels A . 6 . A rating scale for the assessment of objective and subjective formal Thought and Language Disorder (TALD) . Schizophrenia Research . 160 . 1–3 . 216–21 . December 2014 . 25458572 . 10.1016/j.schres.2014.10.024 . free . 10576/4730 . free .
  23. de Bruin . Esther I. . Verheij . Fop . Wiegman . Tamar . Ferdinand . Robert F. . January 2007 . Assessment of formal thought disorder: The relation between the Kiddie Formal Thought Disorder Rating Scale and clinical judgment . Psychiatry Research . en . 149 . 1–3 . 239–246 . 10.1016/j.psychres.2006.01.018. 17156854 . 9729730 .
  24. Andreasen NC . Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability . Archives of General Psychiatry . 36 . 12 . 1315–21 . November 1979 . 496551 . 10.1001/archpsyc.1979.01780120045006 .
  25. Book: Diagnostic and statistical manual of mental disorders : DSM-5. . 2013 . American Psychiatric Association . Arlington, VA . 9780890425558 . 5th.
  26. Web site: Thought Disorder Johns Hopkins Psychiatry Guide . www.hopkinsguides.com . en.
  27. Kircher . Tilo . Bröhl . Henrike . Meier . Felicitas . Engelen . Jennifer . Formal thought disorders: from phenomenology to neurobiology . The Lancet Psychiatry . 515–526 . en . 10.1016/S2215-0366(18)30059-2 . 1 June 2018. 5 . 6 . 29678679 . 5036067 .
  28. Web site: Holzman . Philip S. . Shenton . Martha E. . Solovay . Margie R. . Quality of Thought Disorder in Differential Diagnosis . Schizophrenia Bulletin . 360–372 . 10.1093/schbul/12.3.360 . 1 January 1986. 12 . 3 . 3764357 .
  29. Nestor . Paul G. . Shenton . Martha E. . Wible . Cindy . Hokama . Hiroto . O'Donnell . Brian F. . Law . Susan . McCarley . Robert W. . A neuropsychological analysis of schizophrenic thought disorder . Schizophrenia Research . 217–225 . en . 10.1016/S0920-9964(97)00101-1 . 9 February 1998. 29 . 3 . 9516662 . 9040191 .
  30. Solovay . Margie R. . Shenton . Martha E. . Holzman . Philip S. . Comparative Studies of Thought Disorders: I. Mania and Schizophrenia . Archives of General Psychiatry . 13–20 . 10.1001/archpsyc.1987.01800130015003 . 1 January 1987. 44 . 1 . 3800579 .
  31. Yalincetin . Berna . Bora . Emre . Binbay . Tolga . Ulas . Halis . Akdede . Berna Binnur . Alptekin . Koksal . Formal thought disorder in schizophrenia and bipolar disorder: A systematic review and meta-analysis . Schizophrenia Research . 2–8 . 10.1016/j.schres.2016.12.015 . July 2017. 185 . 28017494 . 205076099 .
  32. Web site: Marengo . Joanne T. . Harrow . Martin . Longitudinal Courses of Thought Disorder in Schizophrenia and Schizoaffective Disorder . Schizophrenia Bulletin . 273–285 . 10.1093/schbul/23.2.273 . 1 January 1997. 23 . 2 . 9165637 .
  33. Book: Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . Harvey PD, Keefe RS, Eesley CE . 12.10 Neurocognition in Schizophrenia . RELATIONSHIP OF NEUROCOGNITIVE IMPAIRMENT TO SCHIZOPHRENIA SYMPTOMS, Formal Thought Disorder.
  34. de Sousa . Paulo . Spray . Amy . Sellwood . William . Bentall . Richard P. . 'No man is an island'. Testing the specific role of social isolation in formal thought disorder . Psychiatry Research . 304–313 . en . 10.1016/j.psychres.2015.09.010 . 15 December 2015. 230 . 2 . 26384574 . 19166732 .
  35. Singer . M. T. . Wynne . L. C. . Thought Disorder and Family Relations of Schizophrenics . Archives of General Psychiatry . 201–212 . 10.1001/archpsyc.1965.01720320089010 . February 1965. 12 . 2 . 14237630 .
  36. Cuesta . M. J. . Peralta . V. . de Leon . J. . Schizophrenic syndromes associated with treatment response . Progress in Neuro-Psychopharmacology & Biological Psychiatry . 87–99 . 10.1016/0278-5846(94)90026-4 . January 1994. 18 . 1 . 7906897 . 27738445 .
  37. Wang . Xiaohong . Savage . Robert . Borisov . Andrey . Rosenberg . Jill . Woolwine . Bobbi . Tucker . Melanie . May . Roberta . Feldman . Jacqueline . Nemeroff . Charles B. . Miller . Andrew H. . Efficacy of risperidone versus olanzapine in patients with schizophrenia previously on chronic conventional antipsychotic therapy: a switch study . Journal of Psychiatric Research . 669–676 . 10.1016/j.jpsychires.2006.03.008 . October 2006. 40 . 7 . 16762371 .
  38. Remberk . Barbara . Namysłowska . Irena . Rybakowski . Filip . Cognition and communication dysfunctions in early-onset schizophrenia: effect of risperidone . Progress in Neuro-Psychopharmacology & Biological Psychiatry . 348–354 . 10.1016/j.pnpbp.2012.07.007 . 3 December 2012. 39 . 2 . 22819848 . 207410186 .
  39. Web site: APA PsycNet . psycnet.apa.org . en.
  40. Hurt . S. W. . Holzman . P. S. . Davis . J. M. . Thought disorder. The measurement of its changes . Archives of General Psychiatry . 1281–1285 . 10.1001/archpsyc.1983.01790110023005 . December 1983. 40 . 12 . 6139992 .
  41. Web site: Spohn . H. E. . Coyne . L. . Larson . J. . Mittleman . F. . Spray . J. . Hayes . K. . Episodic and residual thought pathology in chronic schizophrenics: effect of neuroleptics . Schizophrenia Bulletin . 394–407 . 10.1093/schbul/12.3.394 . 1986. 12 . 3 . 2876514 .
  42. Palmier-Claus . Jasper . Griffiths . Robert . Murphy . Elizabeth . Parker . Sophie . Longden . Eleanor . Bowe . Samantha . Steele . Ann . French . Paul . Morrison . Anthony . Tai . Sara . Cognitive behavioural therapy for thought disorder in psychosis . Psychosis . 347–357 . 10.1080/17522439.2017.1363276 . 2 October 2017. 9 . 4 . 149368351 .
  43. Çokal. Derya. Sevilla. Gabriel. Jones. William Stephen. Zimmerer. Vitor. Deamer. Felicity. Douglas. Maggie. Spencer. Helen. Turkington. Douglas. Ferrier. Nicol. Varley. Rosemary. Watson. Stuart. 2018-09-19. The language profile of formal thought disorder. npj Schizophrenia. en. 4. 1. 18. 10.1038/s41537-018-0061-9. 30232371. 2334-265X. 6145886.
  44. cited Book: Fish FJ . 1962 . Schizophrenia . Bristol, England . Bright .
    • "... 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. ..."
  46. Blocking . blocking . 23 February 2020 .
  47. 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
  48. Book: Videbeck S . 2017 . Psychiatric-Mental Health Nursing . 7th . Wolters Kluwer . 9781496355911 . 8. Assessment . CONTENT OF THE ASSESSMENT, Thought Process and Content, p. 232. .
  49. Book: Videbeck, S . Psychiatric-Mental Health Nursing, 4th ed. . 2008 . Wolters Kluwers Health, Lippincott Williams & Wilkins . Philadelphia.
  50. Web site: Thought disorder . 26 February 2020.
  51. "derailment n. a symptom of thought disorder, often occurring in individuals with schizophrenia, marked by frequent interruptions in thought and jumping from one idea to another unrelated or indirectly related idea. It is usually manifested in speech (speech derailment) but can also be observed in writing. Derailment is essentially equivalent to loosening of associations. See cognitive derailment; thought derailment."
  52. Distractible speech . distractible-speech . 3 March 2020 .
    • "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."
  54. Ganos. Christos . Ogrzal. Timo . Schnitzler. Alfons . Münchau. Alexander . 2012-09-01 . The pathophysiology of echopraxia/echolalia: Relevance to Gilles De La Tourette syndrome . Movement Disorders . en . 27. 10 . 1222–1229 . 10.1002/mds.25103. 22807284. 22422642.
  55. Book: Handbook of autism and pervasive developmental disorders . 1: Diagnosis, development, neurobiology, and behavior. 2005. John Wiley. Fred R. Volkmar . etal . 978-0-470-93934-5. 3rd . Hoboken, NJ. 60394857.
  56. Book: Duffy, Joseph R. . Motor speech disorders: substrates, differential diagnosis, and management. 2013. 978-0-323-07200-7. Third . St. Louis, MI. 819941855.
  57. Evasion . evasion . 23 February 2020 .
  58. "evasion ... consists of suppressing an idea that is next in a thought series and replacing it with another idea closely related to it. Also called paralogia; perverted logic."
  59. includes and defines Derailment, Tangentiality, Incoherence, Illogicality, Circumstantiality, Pressure of speech, Distractible speech, Clanging.
  60. Martin Rossor . Rohrer JD, Rossor MN, Warren JD . Neologistic jargon aphasia and agraphia in primary progressive aphasia . Journal of the Neurological Sciences . 277 . 1–2 . 155–9 . February 2009 . 19033077 . 2633035 . 10.1016/j.jns.2008.10.014 .
  61. Book: . Fatemi SH, Clayton PJ . 2016 . The Medical Basis of Psychiatry . 4th . New York . Springer Science+Business Media . 978-1-4939-2528-5 . 10.1007/978-1-4939-2528-5 . Akiskal HS . 1 The Mental Status Examination . 1.5.5. Speech and Thought., pp. 8–10 .
    • "This form of thought is most characteristic of mania and tends to be overinclusive, with difficulty in excluding irrelevant, extraneous details from the association."
  62. overinclusion n. failure of an individual to eliminate ineffective or inappropriate responses associated with a particular stimulus.
  63. Kurowski. Kathleen. Blumstein. Sheila E.. February 2016. Phonetic Basis of Phonemic Paraphasias in Aphasia: Evidence for Cascading Activation. Cortex; A Journal Devoted to the Study of the Nervous System and Behavior. 75. 193–203. 10.1016/j.cortex.2015.12.005. 0010-9452. 4754157. 26808838.
  64. Pressured speech . pressured-speech . 23 February 2020 .
  65. Cicero. David C.. Kerns. John G.. 2011-04-01. Unpleasant and Pleasant Referential Thinking: Relations with Self- Processing, Paranoia, and Other Schizotypal Traits. Journal of Research in Personality. 45. 2. 208–218. 10.1016/j.jrp.2011.02.002. 0092-6566. 4447705. 26028792.
  66. Buckingham. H. W.. Rekart. D. M.. May 1979. Semantic paraphasia. Journal of Communication Disorders. 12. 3. 197–209. 10.1016/0021-9924(79)90041-8. 0021-9924. 438359.
  67. Tangential speech . tangential-speech . 23 February 2020 .
  68. "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."
  69. "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."
  70. "content thought disorder Disturbance in thinking in which a person exhibits delusions that may be multiple, fragmented, and bizarre."
  71. "formal thought disorder Disturbance in the form of thought rather than the content of thought; thinking characterized by loosened associations, neologisms, and illogical constructs; thought process is disordered, and the person is defined as psychotic. Characteristic of schizophrenia."
  72. "formal thought disorder disruptions in the form or structure of thinking. Examples include derailment and tangentiality. It is distinct from TD, in which the disturbance relates to thought content."
  73. Book: . American Psychiatry Association . Diagnostic and Statistical Manual of Mental Disorders . 2013 . American Psychiatric Publishing . Arlington . 978-0-89042-555-8 . 5th . registration .
    • As the proper FTD: "Schizophrenia Spectrum and Other Psychotic Disorders", Key Features That Define the Psychotic Disorders, Disorganized Thinking (Speech), p. 88 "Disorganized thinking (formal thought disorder) is typically inferred from the individual's speech. ..."
    • As possibly something else: "Dissociative Disorders", Differential Diagnosis, Psychotic disorders, p. 296 "... Dissociative experiences of identity fragmentation or possession, and of perceived loss of control over thoughts, feelings, impulses, and acts, may be confused with signs of formal thought disorder, such as thought insertion or withdrawal. ..."
  74. Web site: 1992 . The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines (CDDG) . . https://web.archive.org/web/20041017011412/http://www.who.int/classifications/icd/en/bluebook.pdf . 2004-10-17 . live .
    • F06.2 Organic delusional [schizophrenia-like] disorder, 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. ...
  75. Book: . 2002 . The British Medical Association Illustrated Medical Dictionary . Dorling Kindersley . 0-7513-3383-2 . 547 . thought disorders Abnormalities in the structure or content of thought, as reflected in a person's speech, writing, or behaviour. ... .
    • p. 470 psychosis: ... Symptoms include delusions, hallucinations, thought disorders, loss of affect, mania, and depression. ...
    • p. 499-500 schizophrenia: ... The main symptoms are various forms of delusions such as those of persecution (which are typical of paranoid schizophrenia); hallucinations, which are usually auditory (hearing voices), but which may also be visual or tactile; and thought disorder, leading to impaired concentration and thought processes. ...
  77. Book: . Matorin AA, Shah AA, Ruiz P . Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . 8 Clinical Manifestations of Psychiatric Disorders . THINKING DISTURBANCES, Flow and Form Disturbances. . 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. .
  78. Neural correlates of formal thought disorder: An activation likelihood estimation meta-analysis. 2017. 10.1002/hbm.23706. 5685170. 28653797. Wensing. T.. Cieslik. E. C.. Müller. V. I.. Hoffstaedter. F.. Eickhoff. S. B.. Nickl-Jockschat. T.. Human Brain Mapping. 38. 10. 4946–4965.
  79. cited
    • Andreasen NC . Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability . Archives of General Psychiatry . 36 . 12 . 1315–21 . November 1979 . 496551 . 10.1001/archpsyc.1979.01780120045006 .
    • Andreasen NC . Thought, language, and communication disorders. II. Diagnostic significance . Archives of General Psychiatry . 36 . 12 . 1325–30 . November 1979 . 496552 . 10.1001/archpsyc.1979.01780120055007 .
    • Book: Andreasen NC, Hoffrnann RE, Grove WM . 1984 . Mapping abnormalities in language and cognition . Alpert M . Controversies in schizophrenia, 1985 . New York . Guilford Press . 199–226 .
  80. Book: Oyebode F . 2015 . Sims' Symptoms in the Mind: Textbook of Descriptive Psychopathology . 5th . Saunders Elsevier . 978-0-7020-5556-0 . 10 Disorder of Speech and Language . Schizophrenic Language Disorder, CLINICAL DESCRIPTION AND THOUGHT DISORDER, p. 167. .
  81. Book: Fatemi SH, Clayton PJ . 2016 . The Medical Basis of Psychiatry . 4th . New York . Springer Science+Business Media . 978-1-4939-2528-5 . 10.1007/978-1-4939-2528-5 . Coryell W, Clayton PJ . 4 Bipolar Illness . 4.7. Clinical Picture, 4.7.2. Symptoms, p. 59..
  82. Web site: Thought Disorder Johns Hopkins Psychiatry Guide. 2021-07-15. www.hopkinsguides.com. en.
  83. Book: Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . Ivleva EI, Tamminga CA . 12.16 Psychosis as a Defining Dimension in Schizophrenia . DSM-5: AN UPDATED DEFINITION OF PSYCHOSIS.
  84. Book: Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . Akiskal HS . 13.4 Mood Disorders: Clinical Features . BIPOLAR DISORDERS, Bipolar I Disorder, Acute Mania..
  85. Book: Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . Ninivaggi FJ . 28.1 Malingering . CLINICAL PRESENTATIONS OF MALINGERING, Psychological Symptomatology: Clinical Presentations, Psychosis..
  86. Book: Sadock VA, Sadock BJ, Ruiz P . 2017 . Kaplan & Sadock's Comprehensive Textbook of Psychiatry . 10th . 978-1-4511-0047-1 . Wolters Kluwer . Sikich L, Chandrasekhar T . 53 Early-Onset Psychotic Disorders . DIFFERENTIAL DIAGNOSIS, Autism Spectrum Disorders.
  87. Solomon M, Ozonoff S, Carter C, Caplan R . Formal thought disorder and the autism spectrum: relationship with symptoms, executive control, and anxiety . Journal of Autism and Developmental Disorders . 38 . 8 . 1474–84 . September 2008 . 18297385 . 5519298 . 10.1007/s10803-007-0526-6 .
  88. Hart. Mara. Lewine. Richard R. J.. May 2017. Rethinking Thought Disorder. Schizophrenia Bulletin. 43. 3. 514–522. 10.1093/schbul/sbx003. 0586-7614. 5464106. 28204762.
  89. 1946. Rapaport, D. Diagnostic psychological testing. Chicago: Year Book Publishers, 1945, 1946, pp. 1089, two volumes. $13.00 (both vols.). Journal of Clinical Psychology. en. 2. 3. 301–302. 10.1002/1097-4679(194607)2:3<301::AID-JCLP2270020320>3.0.CO;2-X. 1097-4679.
  90. News: 2012-07-24. What's behind the Rorschach inkblot test?. en-GB. BBC News. 2021-07-15.
  91. [Richard Bentall|Bentall, R.]
  92. Tufan. Ali Evren. Bilici. Rabia. Usta. Genco. Erdoğan. Ayten. 2012-06-22. Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report. Child and Adolescent Psychiatry and Mental Health. 6. 1. 25. 10.1186/1753-2000-6-25. 1753-2000. 3404901. 22726236 . free .
  93. cited
    • Arndt S, Alliger RJ, Andreasen NC . The distinction of positive and negative symptoms. The failure of a two-dimensional model . The British Journal of Psychiatry . 158 . 317–22 . March 1991 . 2036528 . 10.1192/bjp.158.3.317 . 41383575 .
    • Bilder RM, Mukherjee S, Rieder RO, Pandurangi AK . Symptomatic and neuropsychological components of defect states . Schizophrenia Bulletin . 11 . 3 . 409–19 . 1985 . 4035304 . 10.1093/schbul/11.3.409 . free .
    • Liddle PF . The symptoms of chronic schizophrenia. A re-examination of the positive-negative dichotomy . The British Journal of Psychiatry . 151 . 145–51 . August 1987 . 3690102 . 10.1192/bjp.151.2.145 . 15270392 .
  94. Miller DD, Arndt S, Andreasen NC . Alogia, attentional impairment, and inappropriate affect: their status in the dimensions of schizophrenia . Comprehensive Psychiatry . 34 . 4 . 221–6 . 2004 . 8348799 . 10.1016/0010-440X(93)90002-L .
  95. "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."

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