Thought disorder: signs, causes and ways to effectively help patients

Thinking is one of the forms of higher mental activity of a person. With the help of various senses, we receive certain information about the environment, but it is the mental processes that allow us to evaluate and analyze it, make plans for the near future, and set certain life goals. Thinking disorders are one of the first and key symptoms of many mental illnesses; it is because of this that a person gradually loses his ability to work, and sometimes the ability to perform even simple everyday skills. Therefore, the doctors at the Leto mental health center determine the treatment tactics for such disorders taking into account their root cause.

Etiology

Thinking is a single process in which both hemispheres participate. The speech center is located in the left; it provides a logical analysis of objects and phenomena based on signals received from the senses. Thanks to this, a person forms a certain opinion about a particular situation. The right hemisphere is responsible for the emergence of emotional and sensory images. They cannot always be expressed verbally; sometimes they are described as intuition, subconscious, etc.

Therefore, almost any neurological disease affects perception processes in one way or another. The most common causes of thought disorders include:

• epilepsy;
• acute and chronic infections that occur with complications on the central nervous system (encephalitis, meningitis, syphilis, undiagnosed or decompensated form of HIV/AIDS), parasitic infestations;
• neoplasms in the brain: cysts, vascular aneurysms, benign or malignant tumors;
• previous strokes;
• dyscirculatory encephalopathy;
• brain damage due to liver dysfunction;
• consequences of traumatic brain injuries;
• deficiency of B vitamins, folic acid, severe metabolic disorders.

Sometimes the syndrome is associated with genetic defects in the production of basic neurotransmitters and the formation of neuronal connections. In such cases, the symptoms of the disease manifest themselves either at an early age with speech delays, problems with the formation of logical associations, or in adults in combination with severe mental disorders.

Thinking disorders are typical for:

• schizophrenia;
• almost all forms of psychopathy;
• dementia;
• Alzheimer's disease;
• autism;
• oligophrenia;
• acute and chronic psychoses.

The syndrome may also be accompanied by depression and other affective disorders, anxiety and phobic neurosis. In such cases, the pathology is acquired. Such changes occur under the influence of stressful and traumatic factors.

The relationship between delusions and hallucinations in mentally ill patients

Where do delusional ideas come from? The answer to this question can be given if we are based on data from modern psychiatric science and the clinical course of a particular disease. A number of delusional states are inextricably linked with disturbances in the sphere of perception as a whole. For example, hallucinations are often accompanied by delusions: the patient hears voices that threaten him, and he automatically experiences delusions of persecution with an incorrect interpretation of what is happening.

Similar conditions can occur with senestopathies (when the patient feels strange or imaginary pain in any internal organ). As a result of these sensations, a hypochondriacal form of delirium appears.

Clinical features

In foreign psychiatry there is no unified classification of thinking disorders, since they are considered in the structure of other diseases. Domestic specialists prefer to work with a fairly simple classification that accurately reflects all the features of the syndrome. In accordance with it, the following forms of the disease are distinguished:

• dynamic: changing the pace of thinking;
• structural, associated with a violation of the logical sequence of thoughts, the ability to perform consistent, planned actions;
• pathologies of judgment, in which the patient cannot adequately assess what is happening around.

Dynamic thought disorders

This group includes:

• Lethargy. Accompanied by a slowdown in the train of thought, and as a result, speech. The patient prefers simple, monosyllabic sentences, as if constantly searching for words. The reaction speed decreases, the ability to systematize information deteriorates or is completely absent.
• Acceleration of thought processes. The pace of thinking increases many times over, but at the same time the person is unable to concentrate on anything, constantly “jumping” from one thing to another, but does not bring anything to its logical conclusion.
• "Jump" of thoughts. In the patient’s head, thoughts change so quickly that they resemble a kaleidoscope; he does not even have time to voice them, which is why his speeches are often called “verbal hash.”

Such forms of the syndrome are characteristic of mania, schizophrenia, and depression.

Structural thinking disorders

The following syndromes include:

• Dissociation. Characteristic is the absence of a logical connection between individual judgments while maintaining consciousness.
• Incoherence. The person is completely disoriented, unable to focus on anything, speech is meaningless, sometimes it is just a collection of sounds. Usually a symptom of serious organic brain damage.
• Thoroughness. They note a tendency to become fixated on certain details. The patient answers any question in detail and thoroughly, dwelling on completely unnecessary and uninteresting details. The speech is verbose, replete with aphorisms, metaphors, and comparisons.
• Perseveration. The patient is constantly focused on the same thought, and therefore is not able to form new logical associations. This pathological process is also reflected in speech: the patient repeats the same word or phrase for a long time.
• Reasoning. There is no focus on any object. Pay attention to the tendency to fruitless and meaningless reasoning and philosophizing.
• Symbolism. Typically, the desire to give any objects a special meaning (usually negative or frightening), which determines the manner of behavior. For example, the color blue is associated with misfortune, a cut flower with death, etc.
• Autism. Characterized by a lack of connection between thinking and the surrounding reality. The patient forms images and logical chains of conclusions that are understandable only to him alone.

These types of thinking disorders are characteristic of severe mental illness, autism spectrum disorders, and schizoaffective syndrome.

Pathology of judgments

Usually develops against the background of exacerbation of pathologies of the psycho-emotional sphere or with psychosis caused by alcohol or drug use. This variant of the disease can manifest itself:

• Obsessive ideas. These are persistent thoughts that appear against the will of the patient. A person understands their absurdity and inappropriateness, but cannot get rid of them. This syndrome is not accompanied by intellectual impairment, but causes severe anxiety and restlessness, which does not have the best effect on the productivity of thinking and performance.
• Super valuable ideas. They represent judgments formed on the basis of real events, but their meaning for the patient clearly does not correspond to the situation. A striking example of people with super-valuable ideas are religious fanatics who evaluate both their own and others’ actions from the point of view of sinfulness and repentance.
• Delirious. This is a false, distorted, usually ridiculous conclusion that has nothing to do with reality. The plot of delirium is different: from ideas of jealousy and persecution to love experiences.

Motivational aspect

The motivational and personal component of thinking is one of the most important in the study of mental disorders. Thus, in almost any form of schizophrenia, especially at an early stage or before an attack, there are symptoms such as apathy and lack of initiative. Any person should be interested in his destiny. If there is no concern for the future, then there will be no motivation to do anything to achieve it.

Moreover, it is important to note that there are two aspects of apathy. The first is associated with complete insensibility, which is observed in severe patients. The second is typical for milder cases, when apathy is considered as a common lack of motivation. With the first, everything is clear without an examination, but the second type of patient is sent to experts for examination, during which three main criteria are assessed:

• diversity of judgments;
• reasoning;
• criticality violations.

Let's take a closer look at each.

Diversity of judgments

With schizophrenia, a person’s judgments become contradictory. Their thought process can proceed on different planes, while the patient does not perceive such logical contradictions as errors. This is due to the lack of a clear goal for which the conclusion is formed.

In fact, the patient has several plans to solve one problem, each of which may be completely unrelated to the other. Moreover, one of them may contradict the second, but the patient does not understand this. Often one goal is dictated by the desire to complete a task, and the second is related to personal preferences.

The following case can be cited as an example. The patient is asked to distribute the cards into groups. At first he does this correctly, explaining everything clearly and logically, since the process of generalizing judgments, in principle, works well. Then he changes his mind and excludes mushrooms from the group on the basis that he was once poisoned by them and therefore does not eat them anymore.

In this case, there is a lack of goal setting. In everyday life, this will interfere with decision-making. As a result, a person may refuse to perform certain actions altogether.

A particular example of the diversity of thinking is its fragmentation, when the patient’s speech turns into a “word salad.” The beginning of a phrase refers to one situation, the middle to another, and the end to a third. In mild forms of schizophrenia, the patient may temporarily wander away from the topic due to various associations. However, he is still able to return to the topic, especially with support from a specialist.

Based on one conversation with a person, it is impossible to draw a conclusion about the fragmentation or diversity of thinking. It is necessary to carry out various techniques, including “classification” and “exclusion of items”. If contradictions appear when performing most of the tasks, appropriate conclusions are drawn about thinking disorders.

Reasoning

Reasoning is typical idle talk, a tendency to meaningless reasoning, fruitless philosophizing, which does not lead to the formation of a full-fledged intellectual product. This phenomenon is typical not only for sick people, but also for healthy people.

As an example, we can mention a student’s uncertain answer in an exam, when he does not know how to fill in his lack of knowledge of a particular subject. In such cases, he simply talks about what comes to mind, just so as not to remain silent. In general, this is an adequate human reaction to a complex and unpredictable situation. In a sense, he's just buying time.

In schizophrenia, idle talk occurs without any purpose, out of nowhere. In this case, the patient usually speaks pretentiously, pretentiously or mannered, trying to impress. He can speak with a smart look and complete platitudes that do not require any philosophizing. He does not listen to the opinions of other people at such moments. It is simply important for him to speak, especially on topics that are directly related to him. As a result, the speech turns into a long and lengthy monologue that has no clear content.

Criticality Violations

Uncriticality is characterized by a loss of purposefulness of thinking, its incompleteness. The thought process ceases to be a regulator that limits and controls a person’s actions.

To assess criticality, a simple test, or Ebbinghaus test, is performed. The patient is offered a text with gaps that he must fill in with words. He selects concepts himself, based on subjective opinion. However, in the end he must prepare a logically coherent and understandable text.

Then the expert reads it. If contradictions are detected, he asks the patient to find and correct them himself. Then the error correction rate begins to be assessed. If the subject does not see the errors, the experimenter points them out, but the patient must still make corrections on his own.

Experts distinguish three types of criticality:

• to the presence of a disease or specific symptoms;
• personal;
• to the effectiveness of their activities during experiments.

The last type of criticality is directly related to thinking. The doctor points out mistakes, and the patient corrects them. A healthy person should be interested in this, since he has a goal and his fate is important to him. A schizophrenic is usually indifferent to comments. If he was told that he did something wrong, he will accept it and do nothing. In other words, he doesn’t care - “whether it’s will or not.”

The described complex of symptoms of thinking damage is not observed in all patients. It all depends on the specific form of pathology and its stage.

Schizophrenia affects not only thinking, but also other cognitive abilities of a person - perception, attention and memory. Let's touch on them, since they are largely related to the subject discussed in the article - the thought process.

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Thinking

Thinking is a basic and human-specific cognitive process, during which internal (semantic) connections are dialectically established that characterize the structure of objects of reality, their relationships with each other and with the subject of cognitive activity. Thinking is closely related to another basic cognitive process - the process of perception and necessarily arose as a result of its progressive evolutionary development. The struggle for existence, which is the main mechanism of species dynamics, forced at each moment of conflict interaction of competing individuals first to the maximum tension of physical forces (stress mobilization) in the interests of satisfying their unconditional needs (food, sexual, self-preservation), thereby ensuring the survival of the individual and the preservation of the species . At a certain stage of development, when purely physical resources were exhausted, a more effective adaptive mechanism became the possibility of first generalizing on the basis of individual experience the uniqueness of problem situations and their algorithmic resolution, and then the need to search for new non-standard (creative) solutions.

These circumstances have become an incentive that provides a qualitative leap - a transition from the specifically perceived immediacy of existence to an analytical-synthetic assessment of past experience and prediction of one’s behavior in the future. Thus, its time boundaries were expanded and the prerequisites were created for the intensive development of other mental functions (long-term and short-term memory, imagination, perspective thinking, etc. - that is, consciousness and self-awareness in the broad sense of this concept). In parallel and interdependently with these processes, new purely human properties arose and developed - the symbolism of language and speech, fine art, the beginnings of religious feeling, scientific consciousness of the world and one’s place in it.

Thus, a transition was made from the system of ideas

about the surrounding world, which gradually developed on the basis of his individual and collective perception of a system of
concepts
.
The latter reflected the most significant features of phenomena and objects that allowed us to make generalizations and formed a picture of understanding
the surrounding world.
The symbolism of language as a function of communication from a means of denoting realities increasingly turned into a means of communication, exchange of information, forming the collective consciousness of the population. Along with concrete concepts
that describe individual objects and phenomena (cat, table, fire),
abstract concepts arose that
generalize specific realities (animals, furniture, natural disasters).

The ability to form and assimilate semantic, genus-forming concepts arises at a certain stage of the historical and ontogenetic development of mental activity and is called abstract thinking.

The inability to operate with abstract concepts, subjective thinking based on unimportant signs does not reveal the meaning of phenomena or leads to a contradictory (illogical) interpretation of their essence. This, in turn, indicates either an atavistic delay in its development, or the presence of a mental disorder.

The thinking of normal people organizes pictures of the surrounding and internal world based on the analysis of cause-and-effect relationships, subjecting its results to the test of experience, and sooner or later it turns out to be able to identify the internal connections of objects and phenomena.

Creative, or so-called dialectical, thinking, which is the basis of professional and clinical thinking, as the most productive form, is based on analysis and synthesis. Analysis involves finding out how a given object, subject, phenomenon, due to its individual characteristics, differs from others that are outwardly similar. In order to establish this, it is necessary to study its structural and dynamic originality. In relation to the patient, this means the need to study the exclusivity of personal phenomenology, including the study of biological, mental and social statuses.

Synthesis, on the contrary, means the desire to establish internal connections between outwardly dissimilar objects, which is impossible either at the level of perception or at the level of specific formal thinking. Sometimes this connection is represented by only one characteristic, which, nevertheless, is fundamental. According to legend, the law of universal gravitation was revealed to Newton at the moment when an apple fell on his head. The perception of external signs only indicates the similarity of forms. Understanding internal connections allows us to consider completely different objects in one row that have only one common quality - mass. Thanks to this property, the human mind is also capable of extrapolating a certain internal connection beyond the limits of the experimental perception of space and time, which makes its possibilities practically limitless. This is how a person becomes aware of the laws that govern the world and constantly revises existing ideas.

So-called formal thinking, which is atavistic or has morbid reasons, follows the path of analogies, which are established by signs of external similarity, and therefore cannot be creatively productive. In medicine it is called paramedic, but is by no means the prerogative of paramedics. A doctor who thinks in this way, having completed his special education, has canonized ideas about the register of existing, in his opinion, forms of diseases in their descriptive characteristics with the corresponding algorithm for subsequent actions. The diagnostic task is most often solved on the basis of a formal calculation of symptoms with the assignment of their array to a known nosological matrix. This happens on the principle of answering the question: who is more like a bat - a bird or a butterfly? Actually like a horse (both are mammals). Cognitive activity organized in this way can only cliché standard situations within the framework of solving the simplest problems. It needs guidance, control and can only be acceptable to those applying for the role of performer.

Thinking disorders are identified either using test procedures (pathopsychologically) or on the basis of a clinical method when analyzing the speech and written products of the subject.

There are formal thinking disorders (disorders of the associative process) and so-called pathological ideas.

Treatment and diagnosis of thought disorders

Before prescribing treatment, the medical doctor excludes possible functional pathologies of the central nervous system using X-ray or tomographic scanning, examination of cerebral vessels, clinical and laboratory blood tests.

If the syndrome is caused by neurological causes, a highly specialized specialist is invited for consultation. In the absence of organic brain damage, psychosocial testing is performed to determine the specific type of mental illness and its severity.

Treatment directly depends on the diagnosis. Thus, for schizophrenia and psychopathy, neuroleptics and tranquilizers are prescribed, and psychotherapy is only auxiliary and is indicated outside the period of exacerbation. Psychoses require hospitalization and intensive drug treatment. Neuroses and depression respond well to cognitive behavioral therapy.

Thinking disorders are a strict indication for seeing a doctor, and the earlier treatment is started, the higher the likelihood of a favorable prognosis and long-term remission. To consult with a doctor, you must either make an appointment or arrange a specialist home call from our operators by calling 8(969)060-93-93 .

Overvalued ideas, manias and their features

Supervaluable ideas are understood as the patient’s thoughts that are extremely important to him. Usually they have a pronounced emotional component and are devoid of objective meaning. For example, a patient may believe that his dismissal from work is unfair and constantly thinks only about this. An overvalued idea differs from an obsessive state in that the patient does not feel the desire to get rid of it, but, on the contrary, continues to cultivate it in his mind. Such patients are deeply convinced of the importance of their ideas and their significance in the world around them. One of the mental illnesses in which they almost always appear is paranoid syndrome.