{"id":1482,"date":"2010-12-06T09:39:41","date_gmt":"2010-12-06T09:39:41","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/thought\/"},"modified":"2023-11-01T16:42:46","modified_gmt":"2023-11-01T16:42:46","slug":"thought","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-psychiatric-interview\/characteristics-of-the-mental-status-examination\/thought\/","title":{"rendered":"Thought"},"content":{"rendered":"<hr \/>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Thought<\/strong><\/span> is the ability to generate a <span style=\"color: #33cccc;\"><strong>goal-oriented<\/strong><\/span>, <span style=\"color: #33cccc;\"><strong>logical sequence<\/strong><\/span> of <em>impressions<\/em>, <em>ideas<\/em>, <em>symbols<\/em> and <em>associations<\/em> that result from a problem or task, and which leads to a conclusion based on reality. Thought is therefore an <span style=\"color: #33cccc;\"><strong>internal process<\/strong><\/span>, to be distinguished by <span style=\"text-decoration: underline;\">form<\/span> and <span style=\"text-decoration: underline;\">content<\/span>.<\/span><\/p>\n<hr \/>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong><em>Formal Thought Disturbance:<\/em><\/strong><\/span> The formal process of thinking is characterised by <span style=\"text-decoration: underline;\">normal speed<\/span> and a <span style=\"text-decoration: underline;\">normal sequence of associations<\/span> between thoughts that are experienced as coherent and logical.<\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">A dysfunction in this formal process may be observed during the anamnesis, but may also be subjective and should be checked with the patient:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Inhibited<\/strong><\/span> (<em>delayed<\/em>) <span style=\"color: #33cccc;\"><strong>thought<\/strong><\/span> implies that the patient experiences their speed of thinking as <span style=\"text-decoration: underline;\">slow<\/span> or <span style=\"text-decoration: underline;\">halting<\/span>. In such cases, the physician will observe <span style=\"text-decoration: underline;\">delayed responses<\/span> to questions; the patient may <span style=\"text-decoration: underline;\">pause<\/span> or even <span style=\"text-decoration: underline;\">stop responding<\/span> entirely. This inhibited or delayed thought process is characteristic of a <span style=\"text-decoration: underline;\">depressive disorder<\/span>, but may also occur in <span style=\"text-decoration: underline;\">expressive phatic disorders<\/span>, such as dementia, when the patient speaks in telegrams and has difficulty finding words. A delayed or halting thought process may also be indicative of the negative symptoms of <span style=\"text-decoration: underline;\">schizophrenia<\/span>. The patient\u2019s thought process may appear slow, but on further exploration, the patient reports to subjectively possess a normal speed of thought but feels forced to consider a huge number of options before they can express themselves. This may reflect a highly nuanced way of thinking, but is also indicative of <span style=\"text-decoration: underline;\">OCD<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Pressured<\/strong><\/span> (<em>racing<\/em>) <span style=\"color: #33cccc;\"><strong>thought<\/strong><\/span> implies that the patient feels pressurised by a <span style=\"text-decoration: underline;\">large number of insights<\/span> or <span style=\"text-decoration: underline;\">recurrent thoughts<\/span> in rapid succession. This is usually accompanied by <span style=\"color: #33cccc;\"><strong>tachylalia<\/strong><\/span> (<em>accelerated speech<\/em>) and <span style=\"color: #33cccc;\"><strong>logorrhoea<\/strong><\/span> (<em>word flux<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Circumstantial<\/strong> <strong>thought<\/strong><\/span> indicates that the patient lacks ability to <span style=\"text-decoration: underline;\">distinguish major from minor issues<\/span>, so they get lost in detail. This is indicative of non-psychiatric disorders such as <span style=\"text-decoration: underline;\">epilepsy<\/span>, but also of compulsions associated with e.g. <em>OCD<\/em>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Derailed<\/strong> <strong>thought<\/strong><\/span> (<em>also Loose Association\/Knight\u2019s Move thinking<\/em>) implies that the patient is unable to <span style=\"text-decoration: underline;\">keep track of normal associative thought sequences<\/span>. This loss may manifest itself in an increased <span style=\"color: #33cccc;\"><strong>associative thinking<\/strong><\/span> (<em>flight of ideas<\/em>), whereby the stream of thought frequently changes content through <span style=\"text-decoration: underline;\">new associations<\/span>, such as sound associations (<em>clanging<\/em>). This loose form of successive thoughts becomes clear on further investigation or in the course of recording the anamnesis. Derailed thought is indicative of <span style=\"text-decoration: underline;\">mania<\/span>, but also of non-psychiatric disorders such as <span style=\"text-decoration: underline;\">epilepsy<\/span>. This loss of normal associative thought sequences may take such a form that all coherence is lost and the patient is no longer comprehensible, not even after a request for clarification. This incoherence is a indication of <span style=\"text-decoration: underline;\">schizophrenia<\/span>, <span style=\"text-decoration: underline;\">mania<\/span>, but also of non-psychiatric disorders such as <span style=\"text-decoration: underline;\">epilepsy<\/span> and <span style=\"text-decoration: underline;\">receptive phatic disturbances<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Concrete thinking<\/strong><\/span> (<em>concretism<\/em>) implies that the patient prefers to give a <span style=\"text-decoration: underline;\">literal meaning<\/span> to an abstract cognitive concept. This may be indicative of <span style=\"text-decoration: underline;\">schizophrenia<\/span> or <span style=\"text-decoration: underline;\">mental retardation<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong><em>Though Content Disturbance:<\/em> <\/strong><\/span>The physician may observe that a patient is <span style=\"text-decoration: underline;\">uncomfortable<\/span> about certain matters, and this concern is decisive for the contents of the patient\u2019s thoughts. <\/span><\/p>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Dysfunctions in the content of thought are ultimately determined by exploring the thought-contents of the patient:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Poverty of thought<\/strong><\/span> implies that the patient has <span style=\"text-decoration: underline;\">few ideas<\/span>, or clings to a <span style=\"text-decoration: underline;\">limited number<\/span> of topics. This poverty of thought is often accompanied by a <span style=\"text-decoration: underline;\">reduction in speech output<\/span> and is indicative of a <span style=\"text-decoration: underline;\">depressive disorder<\/span>, <span style=\"text-decoration: underline;\">schizophrenia<\/span> (<em>indication of the negative symptom cluster<\/em>), <span style=\"text-decoration: underline;\">autism<\/span>, and advanced stages of <span style=\"text-decoration: underline;\">dementia<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Preoccupation<\/strong><\/span> implies that the patient is unduly occupied by a <span style=\"text-decoration: underline;\">limited set of thoughts<\/span>. Preoccupation is indicative of <span style=\"text-decoration: underline;\">anxiety disorders<\/span>, <span style=\"text-decoration: underline;\">trauma<\/span>, <span style=\"text-decoration: underline;\">stress disorders<\/span>, <span style=\"text-decoration: underline;\">depressive disorders<\/span>, <span style=\"text-decoration: underline;\">somatoform disorder<\/span>, <span style=\"text-decoration: underline;\">paraphilia<\/span>, <span style=\"text-decoration: underline;\">schizophrenia<\/span> and <span style=\"text-decoration: underline;\">eating disorders<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Obsession<\/strong><\/span> implies that the patient is <span style=\"text-decoration: underline;\">entirely occupied<\/span> by a limited set of thought and is guided by them, without loss of sense of reality. A patient who suffers from an obsession experiences his obsessive thoughts as intrusive and can only with the greatest of efforts block these thoughts. These thoughts are almost always disturbing, in particular since the patient experiences them as an infringement on his autonomy. Obsessions are a characteristic sign of <span style=\"text-decoration: underline;\">OCD<\/span>, whereby a fear of something or someone absorbs the patient entirely, and are accompanied by particular acts (<em>compulsions<\/em>) to neutralise them.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Rumination<\/strong><\/span> implies that the patient constantly <span style=\"text-decoration: underline;\">reconsiders<\/span> and <span style=\"text-decoration: underline;\">ponders<\/span> over <span style=\"text-decoration: underline;\">bad feelings<\/span>, <span style=\"text-decoration: underline;\">experiences<\/span> and <span style=\"text-decoration: underline;\">problems<\/span> from the past, real or imaginary, without ever reaching a solution. <span style=\"color: #33cccc;\"><strong>Worrying<\/strong><\/span>\u00a0implies that a patient is concerned over <span style=\"text-decoration: underline;\">potential relevant events<\/span> in the future. Rumination is indicative of a <span style=\"text-decoration: underline;\">depressive disorder<\/span> or a <span style=\"text-decoration: underline;\">post-traumatic stress disorder<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Ideas of reference<\/strong><\/span> suggest that the patient has the belief or perception that <span style=\"text-decoration: underline;\">irrelevant<\/span>, <span style=\"text-decoration: underline;\">unrelated<\/span> or <span style=\"text-decoration: underline;\">innocuous phenomena<\/span> in the world <span style=\"text-decoration: underline;\">refer to them<\/span> directly or have <span style=\"text-decoration: underline;\">special personal significance<\/span>, when they do not. In case of referential ideas, the patient is still open to correction.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Delusional perceptions<\/strong><\/span> imply that the patient is attributing a <span style=\"text-decoration: underline;\">false mystical meaning<\/span> or a <span style=\"text-decoration: underline;\">sense of threat<\/span> to an otherwise correct perception.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><strong>Delusions<\/strong><\/span> imply that the patient has a belief which <span style=\"text-decoration: underline;\">conflicts<\/span> with the patient\u2019s <span style=\"text-decoration: underline;\">cultural context<\/span>, <span style=\"text-decoration: underline;\">intelligence<\/span> and <span style=\"text-decoration: underline;\">social background<\/span> and is held with <span style=\"color: #33cccc;\"><strong>unshakeable conviction<\/strong><\/span>, despite sufficient or conclusive evidence to the contrary. Almost all delusions are essentially delusions of reference, since the content of a delusion is an inaccurate and often illogical conviction of the relationship that the patient maintains with the outside world. <\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li><span style=\"color: #003366;\">Delusions are further classified according to their content:<\/span>\n<ul>\n<li><span style=\"color: #003366;\"><em><span style=\"color: #33cccc;\"><strong>Paranoid delusions <\/strong><\/span><\/em><span style=\"color: #003366;\">include e<\/span>rotomania, grandiose delusions, religious delusions, delusions of immortality and paranormal delusions.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><em><strong>Delusions related to depression<\/strong><\/em><\/span> (<em>delusions of guilt, sin, poverty or apocalyptic delusions<\/em>) and <span style=\"color: #33cccc;\"><strong>somatic delusions<\/strong><\/span> (<em>denial that one has a physical body or organ or the conviction that one\u2019s body is decomposing<\/em>). Somatic delusions do not require a <span style=\"text-decoration: underline;\">nihilistic content<\/span>, but can be of a sexual or dysmorphic nature (<em>claims to have a disfiguring physical defect<\/em>).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><em><strong>Delusional misidentification<\/strong><\/em><\/span> (<em>Capgras delusion<\/em>) sustains the incorrigible belief that a person close to them has been replaced by an <span style=\"text-decoration: underline;\">identical-looking impostor<\/span>.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span style=\"color: #003366;\">Delusions that influence the thought process itself are known as <em><span style=\"color: #33cccc;\"><strong>passivity delusions<\/strong><\/span><\/em>. The patient holds the unshakeable conviction to have <span style=\"text-decoration: underline;\">lost control over their own thoughts<\/span>. <\/span><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><em><strong>Thought insertion<\/strong><\/em><\/span>, the belief that thoughts have been implanted in the patient\u2019s mind by some outside agent. <\/span><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><em><strong>Thought obstruction\/expansion<\/strong><\/em><\/span>, thoughts are shared with others, and therefore belong to other people too. <\/span><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><em><strong>Thought broadcasting<\/strong><\/em><\/span>, thoughts are audible to everyone. <\/span><span style=\"color: #003366;\"><span style=\"color: #33cccc;\"><em><strong>Mind reading<\/strong><\/em><\/span>, others can read the patient\u2019s thoughts.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<hr \/>\n<p><span style=\"color: #003366;\">Delusions are a characteristic sign of <span style=\"text-decoration: underline;\">psychotic disorders<\/span> (<em>schizophrenia and related disorders<\/em>), but also of a <span style=\"text-decoration: underline;\">psychotic depression<\/span>, <span style=\"text-decoration: underline;\">delirium<\/span>, <span style=\"text-decoration: underline;\">dementia<\/span> and <span style=\"text-decoration: underline;\">non-psychiatric disorders<\/span>, including <span style=\"text-decoration: underline;\">epilepsy<\/span> and <span style=\"text-decoration: underline;\">fronto-temporal brain disorders<\/span>.<\/span><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thought is the ability to generate a goal-oriented, logical sequence of impressions, ideas, symbols and associations that result from a problem or task, and which leads to a conclusion based on reality. Thought is therefore an internal process, to be distinguished by form and content. Formal Thought Disturbance: The formal process of thinking is characterised [&hellip;]<\/p>\n","protected":false},"author":83,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[87],"tags":[150],"class_list":["post-1482","post","type-post","status-publish","format-standard","hentry","category-characteristics-of-the-mental-status-examination","tag-the-psychiatric-interview"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Thought - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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