Perseveration Inability to shift from one idea to the next
Pressure of thought Increased rate and quantity of thoughts
322 • The patient with mental disorder
The main difference between them is that delusions either
lack a cultural basis for the belief or have been derived from
abnormal psychological processes.
These are usually beliefs of great personal significance. They
fall short of being full delusions but are abnormal because of
their effects on a person’s behaviour or wellbeing. For example,
in anorexia nervosa, people may still believe they are fat when
they are seriously underweight – and then respond to their belief
rather than their weight, by further starving themselves.
These beliefs also matter greatly to the person, resulting in
powerful emotions and important behavioural consequences;
they are always of clinical significance. They are classified by
• of thought interference (broadcasting, insertion and
Bizarre delusions are easy to recognise, but not all delusions
are weird ideas: a man convinced that his partner is unfaithful
may or may not be deluded. Even if a partner were unfaithful,
it would still amount to a delusional jealousy if the belief were
held without evidence or for some unaccountable reason, such
as finding a dead bird in the garden.
may be understandable but unusually rapid, as in the flight of
ideas that characterises hypomania, or unduly ‘single track’ and
perseverative, as in some cases of dementia. Sometimes thinking
appears to be very circumstantial, and the patient hard to pin
down, even when asked simple questions.
More severe disruption of the train of thought is termed
loosening of associations or formal thought disorder, in which
the patient moves from subject to subject via abrupt changes of
direction that the interviewer cannot follow. This is a core feature
of schizophrenia. Concrete thinking, in the sense of difficulty
handling abstract concepts, is a common feature of dementia,
and can be assessed by asking the patients to explain the
It may help to illustrate your assessment with verbatim examples
from the interview, chosen to illustrate the patient’s manner of
Thought content refers to the main themes and subjects occupying
the patient’s mind. It will become apparent when taking the history
but may need to be explored further via specific enquiries. It
may broadly be divided into preoccupations, ruminations and
abnormal beliefs. These are defined in Boxes 16.7 and 16.8.
Preoccupations occur in both normal and abnormal mood states.
Sadly dwelling on the loss of a loved one is entirely normal in
bereavement; persisting disproportionate guilty gloom about the
state of the world may be a symptom of depression.
These are preoccupations that are in themselves abnormal –
and therefore symptoms of mental disorder – by reason of
repetition (as in obsessional disorders) or groundlessness (as
Comments
Post a Comment
اكتب تعليق حول الموضوع