Thought Process

Aka: Thought Process, Thought Content, Thought Form, Delusion, Obsession, Concreteness, Abstract Thought, Abstract Thinking Ability

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II. Exam: Thought Form

  1. See Disorganized Speech
  2. Logical flow of ideas or circumstantial with lengthy story of loosely related or unrelated details?
  3. Flight of ideas (rapidly moving from one idea to another related idea)?
  4. Evasive?
  5. Tangential (Loose Associations between unrelated thoughts, although connected in the patient's view)?
  6. Perseveration (frequently repeated thought or phrase)?
  7. Blocking (interrupted speech or train of thought, only to be resumed minutes later)?

III. Exam: Thought Content

  1. Preoccupation or Obsession
    1. Obsessions are Delusions with insight that the intrusive thoughts are not normal
    2. Do you think about some things often?
  2. Excessively suspicious, phobic, ritualistic?
  3. Hypochondriacal symptoms?
  4. Deja Vu Sensations?
  5. Depersonalization?
  6. Harm to self or others?
    1. Suicidal Thoughts?
    2. Homicidal Thoughts?
  7. Delusions
    1. Fixed, false beliefs (e.g. persecutory, grandiose, influential) not consistent with external reality
    2. Persistent bizarre Delusions suggest Schizophrenia or schizoaffective disorder
    3. Acute Delusions suggest Alcohol or drug Intoxication
    4. Do you have strong ideas that other people rarely see the same way?
  8. Lack of Insight (unaware that thoughts are abnormal)?

IV. Exam: Concreteness

  1. Concreteness is a loss of abstract thinking
  2. Ask about relatedness between objects (what is similar?)
    1. Baseball and orange
    2. Car and train
    3. Desk and bookcase
    4. Happy and sad
  3. Test proverbs (what do these mean?)
    1. When the cats away, the mice will play
    2. You can lead a horse to water but you cannot make him drink
    3. Haste makes waste
    4. Ignorance is bliss

V. Interpretation

  1. Abnormal Thought Process suggests Psychosis (especially Schizophrenia)
  2. Obsessions are seen in Psychosis and Obsessive Compulsive Disorder
  3. Concreteness with normal intelligence suggests Psychosis (especially with bizarre or personalized answers)

VI. References

  1. Zum, Swaminathan and Egan in Herbert (2014) EM:Rap 14(7): 11-13
  2. Tomb (1992) Psychiatry, 4th Ed, Williams and Wilkins, Baltimore, p. 6-11

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