II. Exam: Thought Form
- See Disorganized Speech
- Logical flow of ideas or circumstantial with lengthy story of loosely related or unrelated details?
- Flight of ideas (rapidly moving from one idea to another related idea)?
- Evasive?
- Tangential (Loose Associations between unrelated thoughts, although connected in the patient's view)?
- Perseveration (frequently repeated thought or phrase)?
- Blocking (interrupted speech or train of thought, only to be resumed minutes later)?
III. Exam: Thought Content
- Preoccupation or Obsession
- Obsessions are Delusions with insight that the intrusive thoughts are not normal
- Do you think about some things often?
- Excessively suspicious, phobic, ritualistic?
- Hypochondriacal symptoms?
- Deja Vu Sensations?
- Depersonalization?
- Harm to self or others?
- Suicidal Thoughts?
- Homicidal Thoughts?
- Delusions
- Fixed, false beliefs (e.g. persecutory, grandiose, influential) not consistent with external reality
- Persistent bizarre Delusions suggest Schizophrenia or schizoaffective disorder
- Acute Delusions suggest Alcohol or drug Intoxication
- Do you have strong ideas that other people rarely see the same way?
- Lack of Insight (unaware that thoughts are abnormal)?
IV. Exam: Concreteness
- Concreteness is a loss of abstract thinking
- Ask about relatedness between objects (what is similar?)
- Baseball and orange
- Car and train
- Desk and bookcase
- Happy and sad
- Test proverbs (what do these mean?)
- When the cats away, the mice will play
- You can lead a horse to water but you cannot make him drink
- Haste makes waste
- Ignorance is bliss
V. Interpretation
- Abnormal Thought Process suggests Psychosis (especially Schizophrenia)
- Obsessions are seen in Psychosis and Obsessive Compulsive Disorder
- Concreteness with normal intelligence suggests Psychosis (especially with bizarre or personalized answers)
VI. References
- Zum, Swaminathan and Egan in Herbert (2014) EM:Rap 14(7): 11-13
- Tomb (1992) Psychiatry, 4th Ed, Williams and Wilkins, Baltimore, p. 6-11