Associative loosening characterizes the REM dream phase in healthy individuals. Systematic thought patterns are suspended during associative loosening, and brain areas interact nonsystematically affectively. As a disease symptom, associative loosening characterizes delusional disorders such as schizophrenia.
What is associative loosening?
Psychology and psychoanalysis assume that people link the simplest elements in the form of sensory impressions in learning processes. In this context, associations are connections of two or more actually isolated contents of the psyche that activate each other during subsequent recall and stimulate a chain of associations. Accordingly, association learning is stimulus linkage that involves basic biological forms of learning such as habituation and conditioning in addition to cognitive linkages. When associative loosening occurs, a person’s associative thinking and learning is restricted. This means that cognitively meaningful or controlled linkages of thought content can no longer occur. Past thought rules, thought structures, and thought programs are no longer available to patients with associative loosening in a current situation. Associative loosening shows effects on different areas of the person. Thus, symptoms arise simultaneously in the areas of thinking, acting and feeling. Not only does associative loosening characterize a wide variety of disorders with delusional symptoms. Also, the process of associative loosening is related to art processes. The association of the genius of madness derives from this commonality.
Causes
Eugen Bleuler used associative relaxation to describe central phenomena of schizophrenia. In the causative framework of schizophrenia, he attributed the symptoms of formal thought disorders and characteristic affect disorders to associative loosening. Associative loosening, in addition to schizophrenia, may be causally related to impulse control disorders and manias. In addition, drug use of cannabis and classical hallucinogens such as LSD sometimes leads to associative loosening. Freud also described for the dream state a high exchange of affects and a cognitively no longer comprehensible assignment of individual contents. This phenomenon, too, ultimately corresponds to associative loosening. Thus, the primary cause of associative loosening of the brain can be generalized as an impairment of ordering or cognitively stabilizing control. The effect of this impairment deprives affective patterns of associative recall and leads to increased interchangeability of affect. New patterns may acquire neural fixation in the state of cognitive loosening, thereby altering brain processes in the long run.
Symptoms, complaints, and signs
Associative loosening is accompanied by a variety of phenomena. Affected individuals often exhibit erratic attention. Typical patterns of action are brought to dissolution. Work processes are no longer performed appropriately. Associations are no longer meaning-based, but rather sound-based. Grammatical structures slowly dissolve. Thinking becomes more and more erratic and is frequently interrupted by thought tearing off, flight of ideas or interjections. Patients’ speech seems disjointed. They often misspeak or create more or less incomprehensible word neologisms. Related to the pathological phenomenon of associative looseness are free associations, which are common in the context of psychoanalysis, in the context of surrealism and in the context of brainstorming. In associative loosening, however, the abandonment of systematic thought content no longer takes place consciously or for a limited period of time, but occurs uninfluentially and usually occurs in conjunction with delusional systematics. As a formal thought disorder, associative loosening makes content-related thought disorders such as delusions possible in the first place. Without structure and control of thought processes, reality testing can no longer occur.
Diagnosis and course
The diagnosis of associative loosening is usually made by a psychologist. Usually, the symptom is consulted as evidence of disease in the context of the diagnosis of superordinate diseases. In the diagnosis, the psychologist must distinguish associative looseness from the higher level, the disintegration of entire thought patterns. The distinction from delusion also plays a role in the diagnosis. On the other hand, associative relaxation can also be an incipient delusion.The prognosis for patients with associative loosening depends on the causative disease. Specifically, in schizophrenia, loosening develops into delusional symptomatology in nearly all cases.
Complications
In most cases, associative loosening causes the patient to experience various psychological symptoms. In most cases, it is no longer possible for the affected person to perform certain tasks or to follow the action of another person while doing so. Even the formation of grammatically correct sentences is only possible with difficulty, so that the patient’s everyday life is severely restricted. Thoughts often wander and there are severe speech disorders. As a rule, the patient himself does not notice that he is suffering from associative loosening, however, he is incomprehensible to other people due to the speech disorders. There is a severe loss of reality and ordinary thought processes are no longer possible. The quality of life suffers greatly from the disease. The treatment of associative loosening takes place with a psychologist. If the patient is a danger to himself or to other people, it can also be done in a closed clinic. In most cases, medication is also used to accompany the treatment. If the complaint is due to drug abuse, withdrawal must be carried out. Various clinics are also available to the patient for this purpose. With early treatment, there is always a positive course of the disease.
When should one go to the doctor?
Associative loosening is usually diagnosed by a psychologist. Anyone who suspects the disorder in themselves or others should consult a doctor quickly. The latter can determine whether it is indeed associative loosening and subsequently diagnose the causative disorder. If symptoms of schizophrenia or delusion increase, a physician must be consulted immediately. This is especially true if the individual has already been diagnosed with a mental illness. Anyone who notices a change in consciousness after drug use (especially cannabis and classic hallucinogens such as LSD and DMT) should discuss this with their family doctor or a psychologist. Any changes in consciousness should also be clarified quickly in the case of existing manias or physical illnesses. An associative loosening almost always indicates a severe course of the original illness. Immediate medical clarification is also important in order to stop the increasing loss of reality and the speech disorders that often accompany it. In any case, a physician should be consulted when associative loosening is suspected.
Treatment and therapy
Treatment of patients with associative loosening depends primarily on the cause. Schizophrenia can be alleviated in many cases by administration of antipsychotics. Timely intervention is particularly critical in this case. Incipient delusional symptoms may be mitigated or even delayed. In the case of associative loosening in the context of mania, neuroleptics are often given in acute therapy to dampen the effects of neurotransmitters and thus block the exchangeability of affects. In the long term, manics are given medications such as lithium salts, which can dampen and delay future episodes. If associative loosening occurs in the context of drug abuse, this phenomenon may mark the onset of drug-induced psychosis. Even withdrawal cannot stop the process in many cases. Psychosis can develop even with currently complete abstinence as a late consequence of drug abuse. All associative loosening is hardly treatable, especially when brain processes have already been permanently altered. In such cases, supportive therapy is indicated, which ideally improves the patient’s quality of life and everyday existence.
Outlook and prognosis
The prospects for recovery from associative loosening are not given. Based on current scientific knowledge, the brain damage is considered irreversible and cannot be repaired with existing medical options. In most cases, the disease is a concomitant of another diagnosed underlying disease. The administration of medication or therapy in affected patients is therefore geared to the other diseases.The aim here is to bring about relief from the symptoms and optimize the quality of life. In some cases, cognitive training succeeds with the patient. This leads to an overall improvement in memory performance and has positive effects on the recall of existing information. Nevertheless, the results achieved are manageable and represent only minimal relief from associative loosening. The focus of the treatment is on a holistic enhancement of the patient’s existing potential. The development of the personality, a participation in the social and societal life or a release from an existing alcoholism are specifically treated as well as medically treated. Since associative loosening cannot be cured under the given conditions, doctors and therapists focus on the areas of the patient’s life where they can achieve a significant improvement in health for the patient.
Prevention
Associative loosening due to substance abuse can be prevented in the form of abstinence. However, because the phenomenon can also occur in the context of schizophrenia and mania, few fully comprehensive preventive measures exist. Schizophrenia in particular is a clinical picture whose occurrence is related to toxic factors, hormonal factors, immunological, perinatal and psychosocial factors in addition to biological factors. Not all of these can be prevented.
Follow-up
Brain damage causes associative loosening. These are not considered curable, which is why follow-up care cannot prevent recurrence. Instead, physicians use ongoing treatment to try to normalize their patients’ daily lives and rule out complications. The initial diagnosis is usually made by psychologists and psychiatrists. They also organize scheduled follow-up care. In most cases, medication is used to try to stop the typical symptoms. Some disorders can be traced back to drug abuse. A therapeutic approach is then aimed at first getting away from these addictive substances. In many cases, this means that previous social contact must be discontinued. This is because, not least, those close to the patient sometimes encourage the harmful behavior. In practice, associative detoxification is often associated with ups and downs. This means that phases of recovery are followed by crises. In the process, associative relaxation means that those affected are not even aware of their disorder. If a far-reaching loss of reality occurs, the sufferer can cause serious harm to himself or others. In such situations, the relatives are of great importance. It is their task to encourage the patient to see a doctor. This is not always easy. After all, in his own reality, the affected person does not see himself as sick.
What you can do yourself
What sufferers can do themselves to improve their condition in the case of associative loosening depends on the cause of the disorder. Associative loosening may be due to continued abuse of mind-altering drugs. Regular use of cannabis and hallucinogens such as LSD is particularly risky in this context. Affected individuals should therefore stop using these substances at the first sign of mental impairment and consult a doctor immediately. If there is already a dependence on these drugs or if the patient cannot control consumption for other reasons, therapy must be initiated immediately. If drug use is widespread in the social environment, contact with this group of people should be discontinued or restricted. The social isolation that often accompanies this can be alleviated by exchanges with other affected persons in local self-help groups or virtually on the Internet. Often, the affected persons themselves are not aware of their disorder. It is then the task of the family environment to confront the patient with his or her illness and to convince him or her of the necessity of a visit to the doctor. This is often a challenge that demands a lot of patience from the relatives. If the patient is completely uncomprehending, severe disorders, in particular a far-reaching loss of reality, which endangers the patient himself or makes him dangerous to others, may also require compulsory admission to a closed institution.
