Thinking disorders can be divided into formal and content thinking disorders. They do not represent independent diseases, but occur in the context of mental disorders, neurological diseases or individual syndromes. The therapy of the thought disorder depends on the underlying disease.
What are thought disorders?
Thinking disorders represent mental abnormalities that can occur in the context of various mental disorders, syndromes, and neurological diseases. The “Association for Methodology and Documentation in Psychiatry” (AMDP) distinguishes between formal and substantive thinking disorders. Formal thought disorders are limitations of the thought process. The AMDP assessment evaluates a patient’s cognitive functioning using the following criteria, such as slow thinking, inhibition of thinking, narrowed thinking, perseveration, rumination, and flight of ideas. The other category of thought disorders, content thought disorders, are composed primarily of various delusional thoughts, but also by compulsions and overvalued ideas. Depending on what the delusion is directed at, the AMDP findings divide content thought disorders into the following categories:
Delusions, delusional dynamics, relationship delusions, impairment delusions, persecution delusions, jealousy delusions, and guilt delusions. However, delusions of impoverishment and hypochondriacal delusions may also occur.
Causes
Thought disorders occur in the context of various mental disorders; symptoms characteristic of them may also manifest as a result of various physical causes, such as poisoning, brain damage, stroke, and others. An example of a formal thinking disorder is inhibited thinking, which is often due to “depression” or another mental disorder. Affected individuals experience their own thinking, or the thinking process, as being slowed down or blocked. Some patients have the feeling of having to “think” against an inner resistance, which prevents them from pursuing a clear thought to its conclusion. This is a typical cognitive effect of depression, which is an affective disorder, that is, a disorder of emotional feeling. The main features of depression are depressed mood on the majority of days – over a period of two weeks or longer – and loss of pleasure and/or interest in (almost) everything. Inhibited thinking, however, can also occur in the context of numerous other disorders and syndromes. An example of a content thinking disorder is persecutory delusion, which is best known as paranoia associated with schizophrenia. Schizophrenia is a psychotic disorder that often fully manifests by the beginning of the third decade of life. Schizophrenia may include delusions as well as hallucinations, which can affect any modality, but primarily occur as visual, auditory, or tactile hallucinations. Psychology and psychiatry refer to these symptoms as positive symptoms; potential negative symptoms, on the other hand, include flattening of affect: affected individuals experience a limited range of emotions.
Diseases with this symptom
- Autism
- Concussion
- Schizophrenia
- Poisoning
- Stroke
- Brain tumor
- Alzheimer’s disease
- Paranoia
- Dementia
- Affective disorders
- Creutzfeldt-Jakob disease
- Obsessive-compulsive disorder
- Psychosis
- Hallucinations
- Depressive mood
Diagnosis and course of the disease
Formal and content thinking disorders usually represent only part of the findings and are not diseases in their own right. Physicians, psychologists, and therapists diagnose thinking disorders based in part on AMDP guidelines. The AMDP issues checklists that the treating physician can go over with the patient during a consultation, or that the patient can fill out after a session. In this process, the practitioner assesses the patient based on various criteria that correspond to each of the formal and substantive thought disorders. Since thought disorders usually affect conversational skills, observation is usually sufficient. In addition, standardized cognitive tests can provide insight into the patient’s current performance.Certain tests, such as the clock test or the CERAD test battery, are potentially useful in finding a difference between dementia-related impairments and performance impairments that are due to other mental and neurological syndromes, disorders, or diseases. The disease course of a thinking disorder depends on what specific cause underlies it. Many thinking disorders are treatable. Early diagnosis is of high importance and can significantly influence the success of treatment.
Complications
The underlying division into formal and content thinking disorders also separates the areas of complications into mental disorders, neurologic diseases, and individual syndromes. In formal thought disorders, complications are noticeable through unusual observations, such as altered speech patterns and content of what is said. A sudden break in the train of thought or slurred speech are signs of possible deterioration. Affected individuals may not be able to speak at all or may suffer from sudden fluency. Persons give incomprehensible, incoherent answers, memory contents can sometimes not be accessed. Thoughts sometimes consist only of single word fragments. Complications of content-related thought disorders are often manifested in recurrent threatening obsessive thoughts and impulsive imaginings. A distorted perception and misinterpretation of real circumstances characterize the conditions usually accompanied by massive discomfort. An intense emotionality in the formation of the will influences the affected persons who are so convinced of a guiding thought. This leads to neglect of the activities of daily life. The person is only partially accessible to objections. The realization of one’s own convictions against social norms becomes the goal of life. Religious fundamentalists or political fanatics are found here and are close to delusion and obsessive-compulsive disorders. A frequent complication of depression is suicide attempts. Triggers can be extreme stress situations, which in the case of persecutory or relationship delusions additionally bring a danger to others.
When should you see a doctor?
Temporary thought disorders are usually not problematic. A doctor should be consulted if the symptoms appear suddenly and without apparent cause, worsen as they progress, or make normal functioning in everyday life difficult or even impossible due to their intensity and occurrence. In addition, a doctor should be consulted if there are other accompanying complaints such as headaches, anxiety attacks or depressive episodes. In most cases, thought disorders occur during stressful phases of life and thus lead to an increase in stress. Those affected who find themselves in difficult life circumstances should therefore quickly consult a specialist and have the symptoms clarified. Through rapid treatment, the thinking disorders can usually be quickly resolved. If the symptoms occur as a result of drug use or in the context of treatment with medication, this also requires professional clarification by the doctor. Concentration deficiencies and impaired thinking usually increase with age – a visit to the doctor is advisable if this occurs beyond the normal level or if other accompanying symptoms can be observed. Underpulse and fatigue may indicate kidney weakness or hypotension, and chest tightness may indicate arteriosclerosis. With children and infants who suffer from impaired thinking or give the impression of reduced mental capacity, a doctor should always be consulted.
Treatment and therapy
The therapy of a thinking disorder depends on its cause. In principle, both psychological/psychotherapeutic and psychiatric/pharmacological treatments can be considered. Thinking disorders that are due to a neurological or other physical cause require appropriate medical treatment of the underlying condition. In particular, psychological and pharmacological therapies are by no means mutually exclusive, but may be applied simultaneously and sequentially. Severe depression and psychotic disorders, for example, often also require drug treatment. If patients are (temporarily) no longer able to care for themselves due to the present thought disorder and possible other signs of illness, inpatient treatment may be indicated.Especially self-endangerment makes inpatient therapy necessary, for example in case of suicide attempts, very urgent and intrusive thoughts of death, severe self-injury and others. In addition, thought disorders, especially content-related thought disorders, can result in danger to others, for example in persecutory or relationship delusions. The selection of the appropriate therapeutic method depends not only on the underlying cause but also on individual factors, so it is not possible to generalize.
Outlook and prognosis
With thought disorder, there is usually no prospect of cure without the use of medication or comprehensive medical and psychological treatment. A thought disorder is often present from childhood and does not appear suddenly. Exceptions to this are accidents, after which a person may have thought disorders. The prognosis for treatment varies greatly and can hardly be predicted universally. Often the patient’s own will is of great importance here. This can also be supported by friends and family, so that the process of thinking returns to normal and the thinking disorders disappear. In most cases, in case of thinking disorders, a psychiatrist or a psychologist is consulted, who deals with the patient through various games on tasks and thus helps him with the problem. However, the disorder can also lead to aggression and misbehavior if the thinking disorders are severe and are not treated. The patient must not be isolated under any circumstances and must learn to deal with the problem properly. In the case of content thinking disorders, it is not uncommon to have to take medication for mental disorders to eliminate the symptom.
Prevention
Specific prevention of thought disorders is not possible because they do not occur in isolation, but in the context of other diseases, disorders, or syndromes. When the underlying disease is known, patients can prevent relapses to some extent by taking their prescribed medications and not stopping them willy-nilly. Especially (but not exclusively) in psychotic disorders, this circumstance represents a frequent reason for relapse. In addition, general coping strategies can help avoid extreme stressful situations that could trigger a relapse. However, these measures are only general prevention; patients may take additional measures depending on the underlying disorder.
Here’s what you can do yourself
Thinking disorders can have a major impact on the lives of people with the disorder and reduce their quality of life. There are usually not very many options for self-help, since thinking disorders occur mainly in old age and are related to the usual aging process. A person suffering from thinking disorders often depends on help from other people. This includes, first of all, the person’s own family as well as friends and relatives. If it is difficult to care for the person, the assistance of a nursing facility may also be accepted. There, the person is in the care of trained professionals and, above all, in safety. This is because it often happens that people with thinking disorders put themselves in danger or injure other people. The thought disorders can also be transformed into psychopathic thoughts in a few cases, if these disorders are brought about due to the influence of violence. In such cases, a psychologist must be urgently consulted, who will treat the person in a therapy. Thus, further possible conflicts can be avoided. Treatment with medication is also possible in this case. If the disturbances concern the memory, then exercises for memory training can be used here. In addition, a motivation for the person himself is important, so that it comes to no more thinking disorders.
