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Formal thought disorder
In psychiatry, thought disorder or formal thought disorder is a term
used to describe a symptom of psychotic mental illness.
It describes a persistent underlying disturbance to conscious thought
and is classified largely by its effects on speech and writing. Affected
persons may show pressure of speech (speaking incessantly and quickly),
derailment or flight of ideas (switching topic mid-sentence or
inappropriately), thought blocking, rhyming or punning or 'word salad'
when individual words may be intact but speech is incoherent.
Subtypes in detail
Pressure of speech
An increase in the amount of spontaneous speech compared to what is
During mid speech, the subject is changed in response to a stimulus.
e.g. "Then I left San Francisco and moved to... where did you get that
Replying to questions in an oblique, tangential or irrelevant manner.
e.g. "What city are you from ?", "Well, that's a hard question. I'm from
Iowa. I really don't know where my relatives came from, so I don't know
if I'm Irish or French".
Ideas slip off the track on to another which is obliquely related or
unrelated. e.g. "The next day when I'd be going out you know, I took
control, like uh, I put bleach on my hair in California".
Incoherence (word salad)
Speech that is unintelligible due to the fact that, though the
individual words are real words, the manner in which they are strung
together results in incoherent gibberish, e.g. the question "Why do
people believe in God?" elicits a response like "Because make a twirl in
life, my box is broken help me blue elephant. Isn't lettuce brave? I
like electrons, hello."
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Conclusions are reached that do not follow logically (non sequiturs or
faulty inductive inferences).
Sounds rather than meaningful relationships appear to govern words. e.g.
"I'm not trying to make noise. I'm trying to make sense. If you can't
make sense out of nonsense, well, have fun".
New word formations. e.g. "I got so angry I picked up a dish and threw
it at the geshinker".
Old words used in a new and unconventional way. e.g. "His boss was a
Speech that is very delayed at reaching its goal. Excessive long
Loss of goal
Failure to show a chain of thought to a natural conclusion.
Persistent repetition of words or ideas. e.g. "I'll think I'll put on my
hat, my hat, my hat, my hat, my hat, my hat, my hat, my hat..."
Echoing of other people's speech e.g. "Can we talk for a few minutes ?",
"Talk for a few minutes".
Interruption of train of speech before completed.
Speech excessively stilted and formal. e.g. "The attorney comported
Patient repeatedly and inappropriately refers back to self. e.g. "What's
the time?", "It's 7 o'clock. That's my problem".
Mispronounciation; syllables out of sequence. e.g. "I slipped on the
lice broke my arm".
Substitution of inappropriate word. e.g. "I slipped on the coat, on the
ice I mean, and broke my book".
The concept of thought disorder has been criticized as being based on
circular or incoherent definitions. For example, thought disorder is
inferred from disordered speech, however it is assumed that disordered
speech arises because of disordered thought. Similarly the definition of
'Incoherence' (word salad) is that speech is incoherent.
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article "Formal thought disorder".