Thinking disorder
Thought disorders are impairments of the thinking process caused by medical illness . In psychopathology , thinking disorders represent a group of symptoms that occur in various neurological and mental illnesses .
For the diagnosis , everyday and behavior-related thinking is assessed, as shown in conversations and in the organization of everyday life. Intelligence and memory are seen as separate categories and do not play a central role in assessing mental and psychological health and diagnosing thought disorders. On the other hand, cognitive abilities such as attention , working memory and executive functions cannot be regarded as independent of the thought disorders. Because such neuropsychological deficits play an important role in many mental disorders. They can definitely influence everyday thinking or interact with thought disorders and should therefore be taken into account.
A distinction is made between formal and content-related thought disorders. However, it is not possible to clearly differentiate each symptom. Formal thought disorders are impairments of the process of thinking, for example they influence the speed of thinking. Thought disorders related to content concern the topics of thinking. The content is exaggerated or incorrect or is perceived as nonsensical and agonizing. These can be ideas and beliefs about the environment or your own person or intrusive thoughts.
The relationship between form and content of thought is far more complex than this simple dichotomy suggests. However, it is well suited for the rough description and classification of pathological phenomena and has established itself accordingly. Formal and substantive thought disorders can occur independently of one another or together and can also appear mixed up. In a weak form, many characteristics of the thought disorders are part of normal experience and are not necessarily indicative of a mental disorder. They only become clinically relevant when they are frequent and severe or when their lifestyle is impaired and can then be an essential characteristic of a mental disability .
Everyday thinking
Everyday thinking can be observed in conversations and in the organization of everyday life. It can be distinguished from mindsets that are critical to handling cognitive tests or problem-solving skills. Many patients who cannot cope with everyday life due to a psychopathologically formal thought disorder have little or no intellectual disability. Often the difficulties experienced by those concerned are not due to problems with formal logical inference.
Everyday thinking can be described with four central elements. The first step is to choose a thought content, e.g. B. a question or a need. By keeping the thought content in working memory, it becomes a thought goal. The selective attention makes it possible to also include distant aspects (further thought contents) in the thought process. In the working memory, the new thinking contents are related to the thinking goal until the thinking goal is reached.
The selection of a lot of inflowing information, keeping the thinking goal as well as the intermediate results and the control over longer thought processes are of decisive importance for everyday thinking. Slight restrictions in these abilities are not necessarily an indication of a mental disorder. In the case of many psychiatric or neurological diseases, everyday thinking is disturbed to such an extent that even coping with everyday life without professional requirements is difficult.
Formal thinking disorders
Formal thought disorders are disorders of the thought process that show up in verbal utterances. This can involve changes in the speed, coherence and stringency of the thought process. Disturbances in thinking can become particularly noticeable under emotional stress.
There is no uniform systematic order for formal thought disorders. The various symptoms often overlap one another when they are assigned. The demarcation to content-related thought disorders is not always clear, as for example with restricted thinking.
The following classification of formal thought disorders can be understood as a classification in a narrower sense . It would have to be differentiated from a classification in the broader sense , in which various of the disorders recorded in the following more syndromic are summarized under the umbrella term of coherence . This happens due to the ambiguity of these rather syndromic terms in the sense of a logically satisfactory definition. Bleuler's textbook, for example, expressly assigns fleeting thinking to manic states , inhibited thinking to depressive states , distracted thinking to schizophrenia and impoverished thinking to chronic diffuse brain diseases.
Features according to the AMDP system
In the AMDP system , twelve terms are used to describe formal thought disorders, which are presented below. Most of the information on classification is obtained through observation in a conversation. Features that are obtained from the description of the subjective experience of the person concerned are provided with a corresponding note.
Thought inhibition
Thinking is subjectively perceived as irregularly slowed down, slowed down or blocked, as if it had to be carried out against an inner resistance. In contrast to slowed thinking, this is about the sensation of the person concerned, not about an external perception.
Slowed thinking
Thinking is continually delayed and appears slowed down and halting; a thought cannot be thought through to the end, or not immediately. In contrast to the thought inhibition to be distinguished from this, it is about a change perceived by other people (external perception). This is possible, for example, in the case of (inhibited) depression or clouded consciousness .
Cumbersome thinking
The essential cannot be separated from the incidental. The contextual context of thinking is always preserved here, but it is lost in insignificant details. The thinking appears to be rambling, pedantic or petty and is not strictly focused on a goal.
Concentrated thinking or lack of thoughts
Here the scope of content and mental flexibility are limited. The restricted thinking is fixed on a few contents of consciousness and the thoughts revolve around only a few topics. There is no overview and various aspects cannot be included. The vocabulary is reduced and some memory content may have been lost. Despite offers, the person concerned cannot change the subject, or only with difficulty. Patients can perceive this as a failure to get away from certain thoughts.
In the case of a lack of thoughts or thoughts, the thinking contains too little content and is poor in connection, without ideas and without ideas. This can be observed both by the person concerned and by an examiner. Occurrence is possible with certain forms of schizophrenia (e.g. schizophrenia simplex ) or schizoid personality disorder , but also with dementia , severe depressive thought inhibition and obsessive-compulsive disorder .
Perseveration
The same thought has to be thought over and over again, it repeats itself like in a loop and the thinking sticks to it. During the conversation, previously given words and information are often repeated, even if they no longer fit into the current context. Occurrence possible e.g. B. with schizoaffective depression , with schizophrenia, obsessive-compulsive disorder or with frontal brain syndrome .
Brooding
Constant, intellectual preoccupation with often unpleasant topics that is not expedient. It is captured from the description of the introspective experience of the person concerned. In contrast to narrow thinking, changing to other topics is possible without difficulty in a conversation.
Rushing thoughts (also mind hunting)
The person concerned feels exposed to the pressure of many different ideas or thoughts. Similar to the flight of ideas, only it is about the perception of the person concerned, not about an external perception. Over-thinking is mentioned as a possible symptom in mania and schizophrenia .
Flight of ideas or flight of thoughts
The pace of thinking can be increased. The person concerned has a lot of thoughts going through his head in a short time, sometimes several thoughts at the same time. The associations are loosened and the thoughts leaps and bounds. The topics are constantly changing and the person concerned cannot stick to one train of thought. Often found in mania and also in healthy people, especially under the influence of stimulating psychoactive substances such as alcohol , caffeine , cannabis or amphetamine .
Talking past
Questions asked are not answered even though their content has been understood and recorded, the answer is known or obvious and there was no intention to leave the question unanswered.
Tearing off thoughts and locked thinking
The tearing off of thoughts is a sudden interruption of the otherwise fluid train of thought felt by the person concerned without a recognizable cause or motivation. In the external perception, this is observed as blocked thinking.
Incoherent or dissolute thinking
The individual thoughts and parts of the conversation remain unrelated, they are illogical , fragmentary and fragmented. Sometimes the thoughts only consist of single words or fragments of words ( schizophasia , " word salad" as an extreme formal thought disorder in schizophrenia), also possible in the "confused mania".
Neologisms
These are new word formations ( neolalia ) and private symbolism, sometimes opposing or similar words are combined to form a new word ( contamination ). This is possible, for example, in schizophrenia or in early childhood autism .
Other forms
The AMDP system cannot cover all variations of formal thought disorders. In the following, other forms are shown that are generally recognized in psychopathology and cannot be assigned or subordinated to one of the terms of the AMDP system.
Concretism
Metaphors and idioms are not understood in their figurative meaning, but taken literally.
Thought disorders in terms of content
We speak of content-related thought disorders when the thinking is determined by exaggerated or wrong ideas or by misinterpretations of perceptions that are not understandable for outsiders, or the person concerned perceives the content of thought as nonsensical and distressing. These include the delusion, the overvalued idea and the obsessive thoughts.
Obsessive thoughts
Obsessive-compulsive thoughts are ego-dystonic thoughts, impulses or (also pictorial) ideas that repeatedly impose themselves and are perceived as nonsensical or inappropriate. On the one hand, they can occur as unwanted ideas against internal resistance and mostly trigger discomfort, tension or fear; its content is often threatening, aggressive, blasphemous or obscene. On the other hand, obsessive thoughts can occur arbitrarily and, like compulsive actions, serve to reduce tension or anxiety. Misinterpretations of real conditions and pathological doubts also occur as obsessive thoughts. However, in obsessive-compulsive thoughts, unlike delusional thoughts, there is at least a certain amount of insight into the distorted perception.
Overvalued idea
An over-valued idea (also: fixed idea ) is a permanently life-determining guiding principle that influences motivation , drive and volition (will formation) and is filled with intense emotionality . People with an overriding idea are subjectively convinced of this guiding principle and their actions are carried by it. Thinking can persistently revolve around the associated ideas and suppress other thoughts. The resulting neglect of everyday life management tasks leads to isolation, self-neglect and crankiness. The person is difficult to access for object points and objections. Progressively, the realization of one's own convictions becomes a goal in life against all odds. Often an over-valued idea can be found among religious fundamentalists or political fanatics and is close to delusion and obsessive-compulsive disorder.
In contrast to a delusion or a delusion, a person with an overvalue idea can still grapple with the possibility of possibly having a faulty idea, whereby the course to delusion is fluid. When a third party takes over an overriding idea, there are transitions to induced madness . There is also an ego syntony: the thoughts are not perceived as inappropriate or uncomfortable, as is the case with OCD. The rejection of obsessive-compulsive thoughts ( ego dystonia ) can, among other things, decrease as an obsessive-compulsive disorder becomes more chronic and thus gradually transition to an over-valued idea.
Delusion
In psychopathology, the delusion is characterized by a life-determining false conviction of a person, which cannot be reconciled with his social and cultural reality and which for him is unequivocally certain. All related thoughts, ideas and conceptions are experienced as ego-synton and immediately evident for the person concerned ; they do not require any proof or verification. The delusion can occur in psychoses , in various forms of schizophrenia, in mania, in psychotic depression or in isolation as a delusional disorder.
Although psychopathology has dealt extensively with delusion as a mental disorder, there is no generally accepted definition. The following describes the difficulties of the individual aspects of the definition mentioned.
The flawedness of the conviction is not always considered necessary and it is sometimes difficult or impossible to test or refute the assumptions (e.g. in the case of delusions with religious content). Furthermore, irrational ideas are not always to be regarded as pathological. Humans have a general ability to imagine, as it is e.g. B. shows in a very light form in superstition and unfounded fears.
A private conviction of reality only becomes clinically meaningful as a madness when the contrast to social and cultural reality and the subjective certainty are so great that social isolation occurs and everyday life is determined by it. In this regard, the symbiotic delusion is an exception. The irrational beliefs of a third party (often a close reference person ) are accepted beyond doubt and the delusion is thus carried by part of the social environment.
The topics and contents of a madness can be very diverse. Common forms are:
The delusional idea is a single thought of which the person concerned is firmly convinced and which he does not recognize as nonsensical. The delusional ideas relate to a delusional content (persecution, etc.) and can come together to form a delusional system.
In the case of delusional ideas, a distinction is made between primary (non-derivable) and secondary (derivable) delusional ideas. Primary delusional ideas suddenly arise out of context through external stimuli (experiences). Secondary delusional ideas arise from the pathological processing of external stimuli. A connection to reality is recognizable, but the delusional ideas are wrong in terms of content.
See also
literature
- Walter F. Haupt, Kurt-Alphons Jochheim , Helmut Remschmidt : Neurology and psychiatry for nursing professions. 10th edition. Thieme, Stuttgart 2009, ISBN 978-3-13-453610-2 .
- Theo R. Payk: Psychopathology. From symptom to diagnosis . 4th edition. Springer, 2015, ISBN 978-3-662-45531-9 .
Individual evidence
- ↑ Theo R. Payk: psychopathology. From symptom to diagnosis. 2nd Edition. 2007, pp. 245-285.
- ↑ a b Friedel M. Reischies (2007): Psychopathologie . Jumper. ISBN 978-3-540-37253-0 . “The disruption of elementary executive functions has far-reaching effects. There is an overlap between the fields of executive disorders and formal thought disorders. A disturbance of the working memory is also reflected in thought disorders. "P. 103 (quote) and 306 (delusion)
- ↑ Friedel Reischies et al. (2001): Neuropsychological deficits in acute schizophrenic psychosis without neuroleptic medication. In: Neuropsychology. No. 12. pp. 42-48.
- ↑ The AMDP system. Manual for the documentation of psychiatric findings. 9. revised and exp. Edition. Hogrefe 2016, ISBN 978-3-8017-2707-9 .
- ↑ Eugen Bleuler : Textbook of Psychiatry. 15th edition. Springer Verlag, Berlin 1983, p. 44. ( GoogleBooks )
- ↑ Uwe Henrik Peters : Dictionary of Psychiatry and Medical Psychology. 3. Edition. Urban & Schwarzenberg, Munich 1984, p. 273.
- ↑ a b c d e Christian Scharfetter (2017): General Psychopathology: An Introduction . 7th edition, Thieme. ISBN 9783132025172 . Cape. 9.5.1 (Formal thought disorders); Cape. 14.1 (definition of delusion).
- ↑ Christian Müller (ed.): Lexicon of Psychiatry: Collected treatises of the most common psychopathological terms . Springer-Verlag, 1973. ISBN 978-3-642-96154-0 . P. 373f.
- ↑ Ingo Simon (2013). Diagnostic training psychotherapy: case studies for the exam . Books on Demand. ISBN 978-3-8482-8689-8 . P. 18f.
- ↑ Stefan Grüne (2007): Anamnesis - Examination - Diagnostics . Springer publishing house. ISBN 978-3-540-32866-7 . P. 237f.
- ↑ Therapy encyclopedia of psychiatry, psychosomatics, psychotherapy . Springer-Verlag 2006. ISBN 978-3-540-30986-4 . P. 288.
- ^ Sentence after Hadumod Bußmann (Ed.): Lexikon der Sprachwissenschaft. 3rd, updated and expanded edition. Kröner, Stuttgart 2002, ISBN 3-520-45203-0 , p. 584, Lemma Schizophasie.
- ↑ Frank W. Paulus: Obsessive-compulsive disorder. ( Memento of the original from February 26, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Lecture at Saarland University.
- ↑ Hans-Jürgen Möller et al. (2005): Psychiatry and Psychotherapy. Thieme, p. 46. ISBN 978-3-13-128543-0 .
