Basic concepts and classification
Normally, thinking operates with concepts that reflect the true essence of phenomena. Primitive thinking (e.g., in oligophrenia) relies only on superficial representations.
Full-fledged speech consists of judgments and logical conclusions (inferences). All thought pathologies are divided into two broad groups that can coexist in the same patient:
- Disorders of the associative process (distortion of the mode of thinking). The course of reasoning loses its purposeful direction and becomes chaotic.
- Pathological judgments and inferences (distortion of content). The appearance of gross errors in conclusions, which can occur even against the background of logical reasoning.
Disorders of the associative process
These disorders affect the pace, mobility, and goal-directedness of thoughts. Main clinical phenomena:
- Acceleration and flight of ideas (fuga idearum): a rapid stream of superficial associations, pressure of speech, instantaneous distractibility. Characteristic of mania.
- Slowing of thinking: poverty of associations, monosyllabic answers. Patients appear intellectually impaired, but after the psychosis resolves, function is restored.
- Pathological circumstantiality (viscosity): "labyrinthine thinking" with an abundance of superfluous details and an inability to single out the main point. Indicates organic brain damage (e.g., in epilepsy).
- Reasoning (rezonerstvo): sterile, quasi-scientific discourse on everyday topics. The patient cares about the process of philosophizing itself rather than conveying meaning to the interlocutor.
- Incoherence of speech (razorvannost): the sentence is grammatically correct, but devoid of any meaning (schizophasia).
- Incoherence (inkogerentnost): total collapse of both grammar and meaning ("word salad"). Occurs in severe impairments of consciousness (amentia) or end-stage states.
Stereotypies and transient disorders
When thinking is impoverished, stereotypies appear in speech — pathological repetitions:
- Perseverations: the patient gets stuck on the previous answer and cannot switch to a new question.
- Verbigeration: rhythmic repetition of meaningless sounds or words, acting as a compulsive motor act (in schizophrenia).
- Stereotyped turns of phrase: speech is completely filled with clichés (e.g., exclusively proverbs).
Paroxysmal disorders are distinguished separately, in which the patient feels a loss of control over their thoughts: mentism (continuous, chaotic flood of thoughts) and sperrung (sensation of sudden blockage, "empty head"). Both phenomena are often part of the structure of psychic automatism syndrome.
Content pathology: Delusions
Delusions are false judgments arising as a result of illness that completely take over consciousness and are not amenable to disuasion. Delusions are an absolute criterion of psychosis.
The plot (fabula) of delusions is closely related to the dominant affect:
- Persecutory: fabulae of physical surveillance, poisoning, remote influence via rays/hypnosis, litigiousness, and material damage. Accompanied by fear and can lead to aggression ("persecuted persecutor" syndrome).
- Depressive: ideas of self-blame, self-abasement, severe illness (hypochondriacal).
- Grandeur: conviction in high origin, wealth, or making great discoveries.
Briefly: answers to topical questions
What types of overvalued ideas exist?
The following types of overvalued ideas are distinguished:
- Of own exclusivity — overestimation of one's own abilities (poetic, musical, scientific) and a tendency toward inventionism or reformism.
- Of physical defect — perception of a minor cosmetic defect as a tragedy of a lifetime and the cause of all failures.
- Of ill-disposed attitude — fixation on a real grievance, in which any actions of others are seen as a desire to infringe upon the patient's interests.
- Of litigiousness (querulance) — a tendency to endless complaints to all sorts of instances, the number of which is constantly growing.
What components make up the Kandinsky-Clérambault syndrome of psychic automatism?
The Kandinsky-Clérambault syndrome of psychic automatism consists of three main components:
- Pseudohallucinations — perceptual disturbances accompanied by a sense of being made or externally controlled.
- Delusional ideas of control — a variant of persecutory delusions (delusions of physical influence).
- Phenomena of psychic automatism — include ideational (associative, e.g., the symptom of openness), motor (kinesthetic, when all the patient's movements are controlled), and cenestopathic (creating sensations of pain, burning, heat) automatisms.
All these symptoms are closely interrelated: pseudohallucinations and automatisms are associated with delusions of influence and the "feeling of possession", in which the patient is sure that they do not belong to themselves.
What types of obsessive ideas (obsessions) exist?
Among obsessive phenomena (obsessions), obsessive fears (phobias) are most common. The following types are distinguished:
- Claustrophobia — fear of enclosed spaces.
- Agoraphobia — fear of crowds and open spaces.
- Mysophobia — fears of contamination and infection.
- Thanatophobia — fear of death.
- Nosophobia — fear of developing a dangerous disease (cardiophobia, cancerophobia, syphilophobia, AIDS phobia).
- Social phobia — fear of people, public speaking.
- Acrophobia — fear of heights.
- Xenophobia — fear of foreigners, strangers.
- Zoophobia — fear of animals.
- Panphobia — fear of everything.
Sources also mention contrast obsessions and obsessive (compulsive) drives.
To avoid confusing structural disorders: Reasoning — form is present, no goal (empty philosophizing). Incoherence (razorvannost) — grammar is present, no meaning (words are agreed, but absurd). Incoherence (inkogerentnost) — neither form nor meaning is present ("word salad").
Class and exam questions
Is it possible to assess a patient's thinking during mutism?
No. Without oral or written speech, it is impossible to draw a conclusion about thinking. Medical guesses will lead to error.
How to distinguish organic circumstantiality from delusional thinking?
A patient with delusions is circumstantial only when talking about their overvalued ideas; on abstract topics, they answer briefly. The "organic" patient gets bogged down in details when discussing any topic.
What are neologisms and when do they occur?
This is the invention by a patient of their own words, the meaning of which is clear only to them. Most often, it is a sign of symbolic thinking in schizophrenia.
What else to study on this topic
- Detailed classification of persecutory delusions (especially delusions of control)
- Specific disorders in schizophrenia (paralogo-autistic and autistic thinking)
- Symptom of dissociation: contrast between speech passivity and written graphomania
- Differential diagnosis of mentism and mental exhaustion in asthenia
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