Thought disorders22.pptx disorder of thoughts

Disorder of thought

1. THOUGHT DISORDERS PRESENTED BY-DR. TULSI SHARMA GUIDE-DR. HARFUL SINGH BISHNOI SIR

2. THOUGHT- Thought is an idea produced by thinking or occurring suddenly in mind or the action or process of thinking. We gain access to the patient`s thought via their speech.

3. FORMAL THOUGHT DISORDER- Healthy thinking- Suggested by schneider 3 features 1 st constancy 2 nd organization 3 rd continuity(connection)

4. Features of formal thought disorders- (suggested by schneider) Derailment(loosening of association) Substitution Omission Drivelling (dis-organized) Fusion(Desultory)

5. DERAILMENT - Eg ; when asked about a symptom of breathlessness. ‘I felt breathless, like running a marathon. Marathon, the ancient Greek town….. Democracy today has gone wild, hasn’t it?’ Formal thought disorder is a synonym for disorders of conceptual or abstract thinking that are most commonly seen in schizophrenia.

6. TERMS RELATED TO FORMAL THOUGHT DISORDER Neologism- These are new words which are construted by the patient or ordinary words which he uses in a special way. Asyndesis - lack of adequate connections between successive thoughts. Over-inclusion- refers to the widening of the boundaries of concepts such that things are grouped together that are not often closely connected.

7. FORMAL THOUGHT DIORDER-TYPES NEGATIVE FTD- Loss of cocept formation, that was normal earlier. POSITIVE FTD- Makes false concepts blends 2-3 concepts, it lead to incongruent thought.

8. Disorder of stream of thought tempo Flight of ideas Retardation of thinking Circumstantiality continuity Perseveration Thought blocking

9. FLIGHT OF IDEAS- Rapid flow of thoughts Easily diverted Without any direction No connection between successive thoughts But can be easily understood Chance factors of association are present(clang association) Seen in mania

10. Eg:Q-Where do you live? A-Birmingham, Kingstanding ; see the king he’s standing, king, king, sing, sing, bird on the wing, wing, wing on the bird, bird, turd turd ’.

11. PROLIXITY OF SPEECH- It is ordered flight of ideas Despite many irrelevance in speech, patient will return to the task in hand. It is lively embellishment of thinking Seen in hypomania

12. RETARDATION OF THINKING(BRADYPHRENIA) Train of thoughts are slowed down No. of ideas or mental images are decreased Patient has difficulty in decision making Loss of concentration Loss of clarity of thinking Seen in Schizophrenia, depression

13. CIRCUMSTANTIALITY- The thought process is slow It contains many unnecessary and trivial details But finally the point is reached It is different from prolixity of speech.

14. PERSEVERATION- Mental operations tend to persist beyond the point at which they are relevant and thus prevent progress of thinking It is common in generalized and local organic disorders Ideational type-idea repeated in every question Difficulty in switching type Compulsive type It is different from streotypy

15. Special types of perseveration Logoclonia- last word is repeated Palilalia- last syllable is repeated Stereotypy is different from perseveration as it has no point of relevance

16. THOUGHT BLOCK- Sudden arrest of the train of thoughts Leaving patient blank New thoughts begins after that Common in anxious patient

17. DISORDER OF POSSESSION OF THOUGHTS Obsessions and compulsions Here the thoughts are within inner subjective space or they are person’s own thoughts Thought alienation Here the thoughts are in outer objective space or they are not person’s own thoughts

18. OBSESSIONS AND COMPULSIONS Repeated thoughts/images/ideas/impulses Unwanted and intrusive They are own thoughts but are unable to resist Within ego boundary Senseless/anxiety provoking Time consuming Ego dystonic

19. THOUGHT ALIENATION PHENOMENON Patient has the experience that his thoughts are under the control of outside agency or that others are participating in his thinking Ego boundary is broken It includes thought insertion, thought withdrawl and thought broadcast

20. THOUGHT INSERTION- In thought insertion, the patient knows that the thougts are being inserted into his mind and he recognizes those as being foreign and coming from outside. THOUGHT WITHDRAWL- In thought withdrawl , the patient finds that as they are thinking, their thought suddenly disappear and are withdrawn from their mind by a foreign influence. THOUGHT BROADCASTING- In thought broadcasting, the patient knows that as he is thinking, everyone is thinking in ‘unison’ with him. This term is also been used to describe the belief that one’s thoughts are quietly escaping from one’s mind and other people might be able to access them.

21. THOUGHT ECHO- Here patient hears his own thought spoken aloud. -Also known as thought sonorization -It is a type of auditory hallucination -It is one of the first rank symtoms of schizophrenia.

22. DISORDERS OF THE CONTENT OF THOUGHT Delusions Overvalued ideas Depressive cognition Preoccupations Phobias Suicidal ideas Death wishes

23. DELUSION- Delusion is defined as a false, unshakeable belief that is out of keeping with the patient’s social and cultural background. A delusion is the product of internal morbid process and this is what makes it unamenable to external influences. DIMENSIONS-Affective response -Deviant behaviour -Bizarreness -Extension -Conviction -Preoccupation -Disorganization -systematization

24. PRIMARY AND SECONDARY DELUSIONS- PRIMARY DELUSIONS- True delusions/apophany Cannot be deduced from any other morbid phenomenon Reported in acute schizophrenia Delusional mood Sudden delusional idea Delusional perception

25. DELUSIONAL MOOD- Patient has the knowledge that there is something going around him that concerns him, but he does not know what it is. DELUSIONAL MEMORY- These can be distorted or false memories coming spontaneously into mind . -This include delusional perception and delusional intuition

26. DELUSIONAL PERCEPTION/TWO MEMBEREDNESS -The delusional perception is the attribution of a new meaning, usually in the sense of self reference, to a normally perceived object. - Eg -patient says that they are of royal descent because they remember that the spoon they used as a child had a crown on it. -It should not be confused with delusional misinterpretation

27. DELUSTIONAL INTUITION/SUDDEN DELUSIONAL IDEA/AUTOCHTHONOUS- In sudden delusional idea, a delusion appears fully formed in the patient’s mind. -It is seen in depressive disorder or schizophrenia. - Eg -Patient says that they are of royal descent because when they were taken to a military parade as a small child the king saluted them.

28. SECONDARY DELUSIONS Derived apparently from preceding morbid experience Systematized-one basic delusion and remainder of the system is logically built over it. Eg ; patient with auditory hallucination may believe that he is being followed. -patient with depression may believe people think she is worthless

29. TYPES OF DELUSIONS DELUSION OF REFERENCE- Misinterpretation of events and incidences in the outside world as having direct personal reference to self.

30. DELUSION OF PERSECUTION- The person believes that people around him are against him and trying to harm him in one way or other.

31. DELUSIONS OF MISIDENTIFICATION- Group of delusional phenomena in which patient misidentify familiar person, objects, or self, and believe that they have been replaced or transformed Capgras syndrome Fregoli syndrome Syndrome of intermetamorphosis Syndrome of subjective doubles

32. CAPGRAS SYNDROME- Believe that a familiar person or object has been replaced by a nearly identical duplicate. FREGOLI SYNDROME- Believe that a familiar person acquires different physical identities while the psychological identity remains the same.

33. DELUSION OF INTER-METAMORPHOSIS- Believe that another person has changed both his physical and psychological indentities , that is has been transformed into another. SYNDROME OF SUBJECTIVE DOUBLES- Believe that another person has been physically trans- formed into the patient’s own self.

34. DELUSION OF INFEDILITY/OTHELLO SYNDROME/MORBID OR PATHOLOGICAL JEALOUSY- The person believes that his/her spouse is unfaithful and is having elicit relationship with someone else.

35. DELUSION OF GRNDIOSITY This patient has sense of inflated worth, power, knowledge, identity or special relationship to a deity or famous person. Delusion of grandiose ability Delusion of grandiose identity Delusion of grandiose mission

36. NIHILISTIC DELUSION/COTARD SYNDROME- Nihilistic delusions or delusions of negation occur when the patient denies the existence of their body, their mind, their loved ones and the world around them. Seen in severe depression.

37. DELUSIONS IN SCHIZOPHRENIA Delusion of persecution Delusion of reference Delusion of infedility Delusion of misiterpretation , Delusion of love Bizzare delusion Delusion of retrospective falsification Delusion of procreation

38. DELUSION IN MOOD DISORDER DELUSION OF GRANDIOSITY DELUSION OF GUILT DELUSION OF POVERTY NIHILISTIC DELUSION DELUDION OF ENORMITY HYPOCHONDRICAL DELUSION DELUSIONS OF PARASITOSIS

39. OVERVALUED IDEA- An overvalued idea is a thought that, because of the associated feeling tone, take precedene over all other ideas and maintain this precedence permanently or for a long period of time.

40. DEPRESSIVE COGNITIONS Ideas of worthlessness- frequent underestimation of one’s knowledge, talent and capabilities. Ideas of helplessness Ideas of hopelessness-bleak and pessimistic view of future.

41. PHOBIA- Phobias are fear restricted to a specific object, situation or idea. Fear is out of proportion to demands of the situation. It cannot be explained or reasoned away. It is not under voluntary control. The fear tends to an avoidance of the feared situation.