Formal Thought Disorders

Loosening Of Association

A breakdown in the logical linkages between concepts and a loss of goal-directedness in speech are referred to as "loosening of association. "People seem confused and their speech is irrational, making it difficult to understand what they are trying to say.

Derailment

Derailment, sometimes referred to as "Knights Move Thinking," is the abrupt change in subject without any sort of association or logical flow.
It can be likened to an unexpected derailment of a train or an unexpected move by a chess knight. People have been known to switch topics suddenly in the middle of sentences or in between, with no obvious reason or connection. Cameron called it "asyndesis" comparing it to a knight's move in chess, in which the flow of thinking suddenly veers off topic.

Derailment can also be defined as the flying of thoughts, especially in situations where people are under pressure to speak. Every derailment takes the conversation farther away from the original subject, and people are frequently oblivious that their answers no longer pertain to the original inquiry.

Nancy Andreason

The quick flow of ideas, frequently with tangential linkages between them, is known as "flight of ideas."  Though ideas can be communicated quickly and in a linear manner, they lack logic and coherence.
The person could abruptly switch topics, which makes it difficult to follow their line of reasoning.

Connection Between Loosening Of Association And Derailment

 Both phenomena cause people to lose their train of thought, which leads them to speak in a way that is not rational or purposeful.
In the association model, people are "on track" mentally, but they might get off course when they abruptly alter their course without following reasoning. 

Tangentiality

Tangentiality: Answering a question in an indirect or tangential way, deviating from the main subject without coming back to it. This is analogous to sketching a tangent to a circle in geometry, in which the line touches the circle once and then withdraws without coming back.

Concept

Tangentiality is currently regarded as a separate notion, primarily related to answers to questions rather than transitions in spontaneous speech. Previously, it was sometimes used interchangeably with loosening of association.

Example of Tangentiality

An example of tangentiality would be if a patient was asked about their home and instead of immediately answering the question, they answered by talking about how beautiful the neighborhood is, naming local attractions, and recalling unrelated memories. 

Accurate diagnosis and appropriate care of formal thought disorders depend on the ability to recognize tangential responses. Tangentiality can impede good communication and understanding during clinical examinations.

Neologisms In Psychiatry

 An entirely new term or expression from which no sense can be derived.  Frequently observed in schizophrenia patients.  There are two categories: common words that are transformed into unique terms. 

Types Of Neologisms

Common Words Used in Unusual Ways: Patients may employ common words that have symbolic connotations. For instance, use "I open banana" rather than "I peeled the banana." . Changing terms to reflect one's own meaning. Totally New Words: Terms that have never before been used in the language. Could be an entirely original word or a misrepresentation of an already-existing one. Occurs when word formation rules are misused.

Types Of New Words

• Stopwords
  • Using incorrect words instead of correct ones.
  • Example: Saying "vessel" instead of "watch."
• Word Monstrosity
  • Result of severe grammatical errors.
  • Example: "Honor spending" instead of "Hockey is a national sport."
• Technical Neologism
  • Creating technical terms for private experiences.
  • Attempts to describe experiences beyond normalcy.
  • Example: "My arm is being coded" for experiencing stretching sensations.

Causes Of Neologisms

In patients, it may take a backseat to stereotypes or behaviors.
Auditory hallucinations, in which people hear and repeat unfamiliar phrases, may be the cause. Word fusion brought about by the combining of ideas or connections. Can happen in addition to prior illnesses or motor impairments.

Differential Diagnosis

Paraphasia

Often seen in aphasic individuals, incorrect word usage stems from impairments in phonetic structure. May resemble neologisms, but they arise from distinct circumstances.

Malapropism

Clearly misusing terms. Not of psychological importance. Using "I'm back in the bank" as an example would be preferable to "I'm back with my mom."

Talking Past Point 

Talking past the point is when you answer a question about a related issue instead of the question itself. Shows comprehension of the question but a purposeful straying into irrelevant subjects.
Although unrelated, responses demonstrate understanding of the question. For instance, when asked what color the grass is, you could say, "It's white." Linked to the Ganser Syndrome: Initially classified by Ganser as criminals; characterized by imprecise responses and cognitive impairment.

Associated Disorders

Ganser Syndrome 

Currently included in the DSM-5 under the category of dissociative disorders; not just a problem for criminals; also observed in other groups. Past connections to acute schizophrenia and pseudodementia.

Symptoms of Ganser Syndrome

1. Approximate Answers: Responses that are close but incorrect.
2. Clouding of Consciousness: Altered state of consciousness.
3. Somatic Conversion Features: Physical symptoms without medical explanation.
4. Pseudo Hallucinations: False sensory perceptions.

Differential Diagnosis

Pseudodementia- Occurs with depression; this is not the same as Ganser Syndrome.

Chronic Catatonia- Estimated responses are recorded, particularly when answering private inquiries.

Acute Schizophrenia- Talking past the point might appear, especially in teenagers. Cutting suggested treating Ganser Syndrome through cognitive impairmentmproposes that it is an indication of particular cognitive deficiencies.

Incoherence In Formal Thought Disorder

Incoherence: Speech that lacks a logical structure and is therefore unintelligible. Distinguished by incoherent or disjointed speech patterns.
As an illustration, consider the patient's answer to the query, "When God is one, what do you do? The dog, is it in the sun? How to grease the mesh. Uncle Sam has taken all of your money if you need it."
Speech is hard to understand because it lacks logic and coherence.

Mechanisms

Incoherence may result from:

1. Grammatical errors.
2. Syntactical errors.
3. Semantic errors.

Types of Incoherence

Word Salad

Reduction of speech to meaningless repetition of words, sounds, or phrases; name derived from the German word "wort salat."  Is an extreme example of incoherence.

Schizophasia

Kraepelin invented it. Speech is typified by erratic, incomprehensible statements. 

Jargon Aphasia

Contains jargon or unintelligible words in speech; Is classified as incoherent under the TNC scheme.

Pragmatism

Grammatical flaws leading to incoherence. The speech is neither coherent or properly structured.

Illogicality

There is a lack of logical consistency in the speech pattern where inferences are drawn. For instance: "Friends are your books because books are yours." Books can be either black or blue in hue, and they can be living or nonliving. He is the book you should read because friends can offer you advise." Someone makes erroneous deductions without following a logical path. The patient draws erroneous or unjustified conclusions from one sentence to another. The conclusions drawn are not supported by logic.

Word Approximation

Has to do with paraphasia and associated mechanisms. Paraphasia: The destructive rewording of words with distorted audio.  Literal/phonemic and verbal/semantic are the two primary categories.

Verbal/Semantic Paraphasia

In class: A newly introduced word that shares a general meaning with the proper word.  "A four-legged setup" for a chair is one example.
The new word and the proper word have similar meanings.  Out-of-class: A new term with a personal meaning that has nothing to do with the right phrase. Putting "moving chairs" in an automobile is one example.  People give unconnected terms personal meanings.

Literal/Phonemic Paraphasia

Abuse of phonemes. Saying "gang" for "orange" or "computer" for "computer" are two examples.  Involves mispronouncing words, which causes speech distortion.

Metonyms

Similar to verbal paraphasia seen in the classroom, this method entails providing answers in the form of riddles or oblique references.
Using a single, blind eye to describe an object (needle). Metonyms can mimic verbal paraphasia in the classroom.  Indirect references or riddles may be used to present responses.

Clanging (Clang Association)

Word associations made more by sound or puns than by logical reasoning.  Involves alliteration, consonant sounds, or vowel sounds repeated.  Two examples are "fine tune" (repeated consonant sounds) and "Kingpin" (repeated vowel sounds).

Characteristics

• Assonance: Repetition of vowel sounds in successive words.
• Consonance: Repetition of consonant sounds in successive words.
• Alliteration: Repetition of the first consonant sound in successive words.
• Combination: Combination of assonance, consonance, or alliteration.

Punning

Connection between words due to similarity in sound or spelling.

Clinical Examples

• Similar Sound, Different Spelling: "Profit" and "Prophet."
• Similar Spelling, Different Sounds: "Bear" and "Beer," "Steel" and "Steal."

Poverty Of Speech

Restrictions in spontaneous speech that result in answers that are succinct, specific, and lack nuance. Questions are typically answered quickly and succinctly.  The patient might need to be reminded to give more specific answers. An illustration would be if a patient were asked about pollution and said, "Yes, I think it is there.”

Poverty Of Content Of Speech

While there is a sufficient quantity of speech, the information is shallow, unclear, and uninformative.  Speech is long but doesn't cover much ground. Language lacks specificity, is repetitious, and is imprecise.
As an illustration, when asked what causes pollution, the patient answers incoherently with phrases like "It's there in the house, on the road, people suffer, trees suffer." I believe we ought to strive for it."

Also Read: Thought Disorder: Causes, Types, Symptoms, Risk Factors, Diagnosis And Treatment

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