Disorder of Stream of Thought

disorders of stream of thoughts

include both the amounts and speed of thoughts
at one extreme there is pressure of thoughts , mean unusual abundanceوفرة and pass the mind rapidly
at other extreme , poverty of speed when the patient have only few and seem to move slowly within mind
the experience of pressure and thoughts occur in mania
while poverty occur with depression
sudden interruption of thoughts occur in schizophrenia ( blank mind ) which important Dx .
other reason for sudden interruption
1 – momentary gap ( normal )
2 – anxious
3 – thoughts withdrawal
4 – schizophrenia ( Dx )
Disorders of thoughts form ( FTD )
divided into 3 groups
1 – flight of idea :- quick movement from one topic to other , so the stream of thoughts which is not complete or sedentary changed but can be understand because link between them is normal clangضجيج association , punningحشو , rhyining .
2 – preservation :- persistent and inappropriate repetition of the same thoughts seen in dementia , mental retardation , due to failure to switch off .
3 – loosening of association
lose of normal structure and thoughts .
muddled مشوشةand illogical thoughts
lack of clarity
knight s حصان الشطرنجmovement ( derailment ) الانحراف transition from one topic to other either between sentences or in the middle of sentences .
sometime called ( word salad or vevorgeration ) .


Vabeirdenتماسية:- talking past to other point . patient seen to be near to matter on hand but never quite reach it , Dx of schizophrenia .

neologism :-الرطنة

FTD used to form new word invented by himself . it must be distinguish from
incorrect prouniciation
wrong use by limited education
organic or brain causes

explanation of thoughts disorders

many attempts have been made to explain thoughts disorders but more have been convincing مقنعة.
Gold stein 1944 >>> proposed FTD due to inability to form abstract thinking ( concrete thing )
Game zone 1938 >>> inability to form boundaries between concepts
pyre 1962 >>> concept are too broad ( cover inclusion )
Recently more than one cause

particular kinds of abnormal thoughts

delusion : - ( not exclusively ) false belief that is firmed held on inadequate ground and not affect by argument or evidence to controversy and is not conventional belief that person might be expected to hold his given education and cultural background .
this definition intend to separate delusion which is indicative of mental disorder from other kind of strong held belief .
although delusion is false belief , but in exceptional state it can be true or subsequently true , e,g. morbid jealousy .

partial delusion :- delusion that appear during recovery from his disorder , a patient pass through increase doubts about his belief before rejecting it as false . it is safe to use past delusion only when it have been preceded by full delusion .


double delusion :- patient have double incompatible belief of same subject like saying he is a member of royal family but weak servant

overvalued idea :- it is isolated preoccupying belief neither delusional nor obsessional , it usually dominant patient life for many year and affect him life e.g. religion idea , ideological .

primary delusion :- ( autochthonous ) delusion appear suddenly with full convictionاتهام without any preceded mental events e .g . schizo , patient suddenly think that his sex changed .

delusional mood:- sudden feeling of change of patient surrounding ( paradis day يوم القيامة ) .
delusional perception:- delusion of having another meaning of the external stimuli
secondary delusion :- they are derived from some preceding morbid experience e.g. ( like hallucination when someone hearing voice as being follow )
e.g.2 ( depress patient my belief that people think him as worthless )

systemized delusion :- complicated delusion result from accumulation of different sound of ambiguous different situation or ideation ( اي حركة يسويها يبني عليها اوهام وكذلك تراكم مئات الاوهام )

shared delusion :- Foli au dex

aperson who live with deluded patient come to share him his delusion . delusion will regress with the secondary one if they are separated ( poverty delusion , illness delusion ) .

delusional perception :-

false meaning that has been although to normal perception . the patient has experienced and to record the order in which change has occurred in belief affect and interruption of sense data .

Fergoli delusion

Pt recognized No. of people as having different appearance but believe they are ( single persecutor ) >>>> it is opposite of capagras .


Delusional memory
some delusion concerned past rather than present event , egpt believe that there is plot of poising against him for many year ago making him vomiting for the time being .

descriptions of delusion

1 – according to fixity
complete
partial
2 – according to onset
primary
secondary
3 – other delusional experience
delusional mood
delusional memory
delusional perception
4 – according to themes
persecutory delusion
delusion of reference
Grandious delusion
Nihilistic delusionالعدمية
hypochondrical delusion
Religion delusion
sexual delusion thought insertion
delusion of control of thoughts >>>> thought withdrawal
thought broadcasting


Delusional themes ( according to themes )
persecutory ( paranoid ) delusion :-
patient think that other people try to humiliate him يذل , poison him , conspirate يخدع يتأمر against . mostly seen in schizo , severe affective .

Delusion of reference :-

idea that external object , event have a personal significant to patient .
Capgras syndrome is a delusion, where the patient believes that someone, usually aclose relative or family member, has been replaced by an impostor.
Grandious delusion :- داء العظمة
belief of self exaggerated importance . the patient may think himself wealthy , unusual abilities , seen in mania .
Delusion of guilt
self punishment and worthlessness feeling seen in depression .

Nihilistic delusion

belief of being body organ function failure ( bowel are block ) ( seen in severe type of depression ) .

Hypochondrical delusion

patient may belief wrongly and in the face of all medical evidence that he is ill .

Religion delusion

unusual and firmly held religious belief among of minority of religion .


delusion of jealousy
are more common among men . not all jealous idea are delusion , less intense preoccupation are common .
it is idea of infidelity directed to ward partner or couple . they lead to aggressive behavior to ward unfaithful searching hand .

sexual or amorous delusion عشق

more frequent in women . it concerned with sexual intercourse secondary to somatic hallucination felt in the genetelia .
amorous delusion :- woman belief what she is loved by man who is usually inaccessible by higher class
Erotic delusion are more prominent of De clarambault syndrome .

Delusion of control ( schneiderian )

patient belief that is action , impulse , thought control by an out side agency … symptoms suggest schizo for example his hand more by extensive agency , this delusion with thoughts possession which is either thoughts insertion , thoughts withdrawal , or thoughts broadcast .

Obsessional and Compulsive symptoms

obsession :- are reccurent persistent thoughts or image that enter mind despite person efforts to exclude it
subjective sense of struggle
persistent , resistant however enter the mind
thoughts mentioned by patient as his own
as senseless
lack of conviction of thoughts and delusion
Compulsion ( Ritual )
are repetitive and seemingly purposeful behavior , they are accompanied by subjective sense ,
they must carried out by urge to resist .
it usually associated by obsession , divided into ( checking , cleaning , _____ )


Disorder of mood
in psychiatry 2 terms are used to referred to emotional state ( mood , affective )
Mood :- prevailing the emotional state that colored the person life . it may be altered or fluctuated or it may be inconsistent with patient thoughts or action or current event
1 – change in mood >>> toward anxiety , depression , anger , elation .
2 – abnormal fluctuation of mood :- the extreme form of total loss of emotional liability so called apathy .

Blunted :- reduce emotional rather than lost

labile :- when mood change are very marked
incongruity of mood :- patient may laugh when describe of death .

Phobia :-

persistent irrational fear and wishes to avoid a specific object , place which out of real danger .
obsessional phobia :-
recurrent thoughts about doing harm with knive ( phobia of knive ) . ( most common type of phobia in schizo )

Depersonalization :-

change in self awareness such feel unreal . person feel detected from his own experience unable to feel emotion .

Derealization :-

object and people appear unreal and life less two dimension like card board .


Motor symptoms and signs
abnormal of social behavior and social expression , posture occur frequently in mental disorder .

Tic

irregular repeated movement involving group of muscle , eg side way movement of head , raising of one shoulder .