Disorders of thought

Disorders of thought

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  Disorders of thought Presenter-Niranjan Chairperson- Dr. Th Bihari singh
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  What if todaywasn’t my seminar!!?
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  Scenario-1 • Well itslhd have been snowfall in here. So that i could have come by ice skating to hospital !!! • Could make ice balls and played with patients • And when tired would do sun bath lying beside someone special !!! • Slhd fly down to my place daily after the work !1
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  Scenario - 2 •I hope today is again band so that i can finish off duties soon and watch sm film • Once im done here ll go room and do gobi manchurian but this time i have to chop cauliflower bit small • How about start using history taking format instead writing down all history.
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  Scenario - 3 •I think v can increase the dose to optimum dose of olanzepine for pt no3 • As bed no 4 pts party has some problem back in their home , slhd ask the consultant for discharge on reguest • Ll go market to buy cauliflower after im done with the duty
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  Types of thinking •Process of thinking was divided by fish into 3 types • 1. undirected fantasy thinking • 2. imaginative thinking • Rational / conceptual thinking
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  1. undirected fantasythinking • Autistic or dereistic thinking • Quite common process of thinking(day dreaming etc..) • Might be more in certain individuals with adverse life events or when placed with repeated disappointments • Shizophrenia, shizotypal personalities, psychosis, DD
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  2. imaginative thinking •Generation of novel ideas and creative outputs which constitute art or discoveries in science • 1. mental imagery-ability to create image based mental representations of world • 2. counterfactual thinking- capacity to disengage from reality in order to think of events and experiences that have not occurred or may never occur • 3.symbolic representation- use of concepts or images to represent real world objects. Basis of language, art and maths.
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  Rational / conceptualthinking • Problem solving-set of cognitive process that we apply to reach a goal • Reasoning- cognitive process that we use to make inferences from knowledge to draw a conclusion.
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  • Thinking ismore than language and language is more than thinking -philips dale
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  • Thinking canbe defined as cognitive rearrangement or manipulation of both information from environment and the symbols stored in long term memory. • Requires • 1. images • 2.words • 3. language
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  Plan to sitdown associations (thought) ask sir dhananjay is talking pull over the chair coffee came this chair is dirty legs are paining phone is ringing how abt that chair its getting cooler constellation goal
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  Model of associationsby jasper • Thinking(psychological performance) and thoughts(psychological events) can be seen to flow in an uninterrupted sequence so that one or more associations with resulting further psychological events, may arise from each thought. • Constellation- mass of possible associations resulting in a psychic event. • Determining tendency- consistent flow of thinking towards its goal .
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  Disorders of thought •Possesion (source of water) • Stream ( flow of river) • Content ( water, mud etc..) • Form (liquid form of water)
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  stream • Volubility- copious,pressured speech, excessive talking. Seen in mania( tachylogia, verbomania , logorrhea) • Flight of ideas- thoughts follow each other rapidly, no general directions, connection between successive thoughts appears due to chance factors(clang or verbal associations) , usually understood, easily distracted, reversible,. Seen in mania, f-20, organic states, mixed affective states • Prolixity- “ordered flight of ideas” or marginal flight of ideas Goal reached, clag or verbal associations are not so marked, speed of emergence of thoughts are not so fast, unlike tedious elaboration of details in circumstantiality
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  • Retardation- trainof thought is slowed down , number of ideas and mental image themselves are decreased. Although Goal directed they proceeds so slowly with morbid preoccupation with gloomy thoughts that the person may fail to reach goal. Little initiation to begin planning or spontaneous activity. Seen in F-20 , depression • Circumstantiality- slow thinking with many unnecessary and trivial details, but finally point is reached..seen in epileptic personality, obsessional personality, person who tires to impress, F-20, dementia • Tangentiality- replying to a question in a oblique,tangential or even irrelevant manner.
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  • Thought blocking(thought derivation, snapping off ) - sudden arrest of train of thoughts leaving a “blank” . A new thought may begin after the pause. With no recall of what was being said or going to be said. seen in F-20, also in anxious or exhausted states. • Perservation- disturbance of thought where retaining a constellation of ideas long after they have to be appropriate. Organic states to be ruled out.
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  Form disorders • Formof thought means “arrangement of thoughts”. That is how logically they are connected(syndesis) • Healthy thinking should have: constancy, organisation, continuity • Schneider claimed 5 features of formal thought disorder- derailment, substitution, omission, fusion, drivelling • Formal thought disorder- conceptual or abstract thinking disorder. Characterised by loosing of associations, neologisms, illogical constructs • Transitory thinking- derailments, ommisions, substitutions. • Drivelling thinking- muddling together all the thoughts • Desultory thinking-grammatically correct but sudden ideas force their way from time to time
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  • Loosening ofassociations- disturbance in logical progression, failure to communicate , unrelated ideas shifting from one another • 1. knights move thinking or derailment- odd tangential association between the ideas. Words makes sense but not sentences. • 2. talking past the point- (vorbeireden)seems to get close to the point of discussion but skirts around and never actually reaches it. • 3.verbigeration /word salad/ paraphrasia/ schizophasia- senseless repetition of sounds or phrases
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  possesion • Obsession- intrusive,ego dystonic, irrational, against will, fails to resist, may have temporary relief by yeilding compulsions, associated with marked dysfunction. • Obsessional thoughts images ruminations, phobias, illness doubts, impulses Thought alienation-thoughts are under the control of outside forces and are participating in it. Thought insertion-thoughts are not mine inserted by outside
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  • Ruminations- trainof thoughts usually unproductive, prolonged on particular topic, repeatedly experienced, felt as less intrusive, no compulsions, usually involves past incident. seen in OCD, depression, melancholia • Thought withdrawal- taken away against his will by outside forces. Usually associated with thought blocking. The experience is passive • Thought broadcasting- thoughts are leaving himself and being diffused widely out of his control. The experience is passive • thought echo- type of auditory hallucination where hears ones own thought spoken aloud gedenkenlautwerden- hearing ones own thought spoken just before or at the same time as occurring Echo de la pensee-hearing them spoken after the thoughts have occurred.
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  content • Worry- subjectivesense of tension or uneasiness. • Phobias- persistent, pathological, unrealistic fear of an object, situation • Somatic symptoms- bodily complains which are varied in anatomical location and are usually are not associated with any pathology • Religious preoccupation- seen n OCD • Excessive day dreaming- schizotypal personality • Homicidal ideas-F-20, ASP • Philosophical ideas • Magical ideas
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  • Depressive cognition-ideas of worthlessness, helplessness, hopelessness • Suicidal ideas • DSH- • Inflated self esteem- mania, narsissictic personality • Delusion-a false, firm, unshakeable belief that is out of keeping with patients socio-cultural background
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  Vectors or dimensionsof delusion Conviction Extension Bizarreness Disorganization Pressure Affective response Deviant behavior
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  Dimensions of delusions •Affective response- degree to which pts emotions are involved with it. • Bizarreness-degree to which they differ from reality • Conviction-degree to which pt is convinced of the belief • Disorganizations- degree to which delusions are internally consistent, logical, and systematized. • Deviant behaviour- acting out on beliefs • Extension- degree to which his believes involves pts life • Preoccupation-degree to which the pt is preoccupied and concerned with his expressed beliefs • Systematization- framework created around delusions
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  Origins of aDelusion- Conrad Trema Apophany Anastrophy Consolidatio n Residuum
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  • Trema –delusional mood • Apophany – search for and finding a new meaning for psychological events • Anastrophy- heightening of psychosis • Consolidation- forming a new world or psychological set based on new meanings • Residuum – eventual autistic state
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  Primary delusions • Primarydelusions- are the one that appears suddenly and with full conviction but with out any mental events leading upto it. Primary delusional experience (apophony) may be of • 1. delusional mood or atmosphere-he knows that some thing is wrong going around him that concerns him but he does not know what it is. • Delusional intuition/autochthonos delusion- appears fully formed inside his mind.seen in organic states, epileptic psychosis, personality disorders or even in normal individuals. • Delusional perception- attribution of a new meaning, usually in the sense of self reference, to a normal perceived object. Its different from delusion of misinterpretation. • Delusional memories- distorted or false memories coming spontaneously into the mind
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  • Core featureof a primary or autochthonous delusion is that it is ultimately “ Ununderstandable” - Jaspers • Eg: a female patient with schizophrenia believes that men enter her flat anesthetize her and gang rape her every night.
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  Secondary delusions or delusionlike ideas • Delusions derived from apparently preceding morbid experience. Like primary hallucinations, affective states, existing delusions. • Overvalued ideas-is a thought because of associated feeling tone, takes precedence over all other ideas and maintains for a period of time. Less fixed than delusions, some degree of basis in reality
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  • Delusion ofreference- • Delusion of persecutions • Delusion of misidentification- Capgrass syndrome-familiar person is replaced by nearly identical duplicate. Fregoli syndromes- familiar person acquires different physical identities while psychological identity remains the same. Syndrome of intermetamorphosis-changing his physical identity Syndrome of subjective doubles- another person has physically transformed into pts own self. • Delusion of control • Delusion of infidelity • Delusion of love(de clerambolt syndrome)
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  Content of delusions persecution infidelity love Grandiose guilt Nihilistic poverty
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  • Grandiose delusions-grandiose identity, ability, mission • Delusion of illhealth • Delusion of guilt • Nihilistic delusion(cotard syndrome) • Delusions of enormity • Delusion of poverty • Bizarre delusions Pathology of delusions-1. cognitive underpinnings of delusional beliefs. Focusing on reasoning biases, attention and attributional biases, relevance of emotional and theory of mind . 2. Neuroimaging perspective- persecutory delusion- cingulate gyrus activation , entorhinal cortex – positive symptoms
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  Resolution of delusion •Integration- show low conviction in their belief, but remain preoccupied with ideas. Usually keen to discuss and try understand what happened in non psychotic terms • Sealing over- completely reject their beliefs preoccupation drops to zero. Reluctant to discuss their experiences • Encapsulation-retain high conviction but preocccupation and interference decreases
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  •Thank you