Disorders of the Form of Thought

Form of thought

Form of thought is the way people experience or express thoughts and the way thoughts proceed one after the other irrespective of their quantity. It helps in the diagnosis of psychiatric disorders.

Normal thinking forms include the following.

Dereistic Thinking (daydreams)
Imaginative thinking
Rational thinking

Formal Thought Disorder

The term ‘formal thought disorder’ is a synonym for disorders of conceptual or abstract thinking that are most seen in schizophrenia and organic brain disorders.
In schizophrenia, disorders in the form of thinking may coexist with deficits in cognition, and these forms of thought disturbance may prove difficult to distinguish in certain cases.
Cameron used the term ‘Asyndesis’ to describe the lack of adequate connections between successive thoughts.
Cameron placed particular emphasis on ‘over-inclusion’, which is an inability to narrow down the operations of thinking and bring into action the organized attitudes and specific responses relevant to the task at hand

Perseveration:

the patient retains a constellation of ideas long after they have ceased to be appropriate, for example, “where do you live?”, “London”, “How old are you”, “London”…

Explanatory concepts for formal thought disorder

Loss of association (asyndesis)
Concrete Thinking – inability to think abstractly; unable to differentiate between primary and secondary meanings of words
Loss of redundancy (Cloze technique)
Loss of internal monitoring with consequent inability to ‘repair’ thought processes (Frith)
Impaired semantic memory or impaired access to this.

Schneider named five features of formal thought disorder:

Derailment
Substitution
Omission
Fusion
Driveling

Schneider claimed that individuals with schizophrenia complained of three different disorders of thinking that correspond to these three features of normal or non-disordered thinking.

Transitory thinking

Transitory thinking is characterized by derailments, substitutions, and omissions. An omission is distinguished from desultory thinking because in desultoriness the continuity is loosened but in omission, the intention itself is interrupted and there is a gap. The grammatical and syntactical structures are both disturbed in transitory thinking.

Driveling thinking

With driveling thinking, the patient has a preliminary outline of a complicated thought with all its necessary details but loses the preliminary organization of the thought, so that all the constituent parts get muddled together. A patient with driveling has a critical attitude towards their thoughts, but these are not organized and the inner material relationships between them become obscured and change significance.

Desultory thinking

In desultory thinking, speech is grammatically correct, but sudden ideas force their way in from time to time.

Verschmelzung: fusion, ‘melting’,
Faseln: muddling
Entgleiten: snapping off
Entgleisen: derailment

Disorders of the form of thought include flight of ideas, loosening of associations, circumstantiality, etc.

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