tangential speech vs word salad

John Sommers-Flanagan

The mental status examination: key terms and resources.

At first, conducting a mental status examination (MSE) can feel “different” and daunting to non-medical mental health professionals. However, even though the MSE is a modernist medical-psychiatric assessment tool, it’s also possible to conduct MSEs more collaboratively.

To help address a recent listserv request, below, I’ve pasted some Tables from the MSE chapter in Clinical Interviewing . These Tables are not comprehensive, but along with other resources provide relatively good coverage of how and when to administer an MSE and some useful vocabulary words.

In addition to the Tables below, Dr. Thom Field from City University of Seattle has a set of training videos. You can find them here: http://www.thomfield.com/mental-status-exam-training.html

Also, there are several other resources posted on this blog. In fact, the most viewed of all posts on this blog is titled “Two Sample Mental Status Examination Reports” https://johnsommersflanagan.com/2012/08/10/two-sample-mental-status-examination-reports/

In addition, there is a nifty (IMHO) MSE protocol here: https://johnsommersflanagan.com/mental%20status/

And another sample MSE report: https://johnsommersflanagan.com/2012/11/23/another-sample-mental-status-examination-report/

And an interesting post on “Psychic Communications . . . and Cultural Differences in Mental Status” https://johnsommersflanagan.com/2013/01/02/psychic-communications-and-cultural-differences-in-mental-status/

And a short MSE video clip: https://johnsommersflanagan.com/2013/02/28/mental-status-examination-video-clip/

Okay. Enough tangential speech from me. The Tables are below:

Table 8.1. Descriptors of Client Attitude Toward the Examiner

The client attacks the examiner physically or verbally or through grimaces and gestures. The client may “flip off” the examiner or simply say to an examiner something like, “That’s a stupid question” or “Of course I’m feeling angry, can’t you do anything but mimic back to me what I’ve already said?”

The client responds directly to interviewer comments or questions. There is a clear effort to work with the interviewer to gather data or solve problems. Frequent head nods and receptive body posture are common.

The client is reluctant to share information about himself. When clients are mildly suspicious they may appear guarded in terms of personal disclosure or affective expression.

The client is indirectly nasty or biting. Sarcasm, rolling of the eyes in response to an interviewer comment or question, or staring off into space may represent subtle, or not so subtle, hostility. This behavior pattern can be more common among young clients.

The client is on the edge of his seat. The client is not very tolerant of pauses or of times when interviewer speech becomes deliberate. She may make statements about wanting an answer to concerns immediately. There may be associated hostility and competitiveness.

The client’s appearance and movements suggest lack of concern or interest in the interview. The client may yawn, drum fingers, or become distracted by irrelevant details. The client could also be described as apathetic.

The client is overly solicitous of approval and interviewer reinforcement. He may try to present in an overly positive manner, or may agree with everything the interviewer says. There may be excessive head nodding, eye contact, and smiles.

The client’s eye contact is constant, or nearly so; the client’s body leans forward and listens closely to the interviewer’s every word. Client voice volume may be loud and voice tone forceful. The client is the opposite of indifferent.

The client tries to use the examiner for his or her own purpose. Examiner statements may be twisted to represent the client’s best interests. Statements such as “His behavior isn’t fair, is it Doctor?” are efforts to solicit agreement and may represent manipulation.

The client opposes virtually everything the examiner says. The client may disagree with reflections, paraphrases, or summaries that appear accurate. The client may refuse to answer questions or be completely silent. This behavior is also called oppositional.

The client openly discusses problems and concerns. The client may also have a positive response to examiner ideas or interpretations.

The client offers little or no active opposition or participation in the interview. The client may say things like, “Whatever you think.” He may simply sit passively until told what to do or say.

The client may move in seductive or suggestive ways. He or she may expose skin or make efforts to be “too close” to or to touch the examiner. The client may make flirtatious and suggestive verbal comments.

The client may repeatedly look around the room (e.g., checking for hidden microphones). Squinting or looking out of the corner of one’s eyes also may be interpreted as suspiciousness. Questions about the examiner’s notes or about why such information is needed may signal suspiciousness.

Table 8.2. Thought Process Descriptors

Sudden cessation of speech in the midst of a stream of talk. There is no clear reason for the client to stop talking and little explanation. Blocking may indicate that the client was about to associate to an uncomfortable topic. It also can indicate intrusion of delusional thoughts or hallucinations.

Excessive and unnecessary detail provided by the client. Very intellectual people (e.g., college professors) can become circumstantial; they eventually make their point, but don’t do so directly and efficiently. Circumstantiality or overelaboration may be a sign of defensiveness and can be associated with paranoid thinking styles. (It can also simply be a sign the professor was not well-prepared for the lecture.)

Combining unrelated words or phrases because they have similar sounds. Usually, this is manifest through rhyming or alliteration; for example: “I’m slime, dime, do some mime” or “When I think of my dad, rad, mad, pad, lad, sad.” Some clients who clang are also perseverating (see below). Clanging usually occurs among very disturbed clients (e.g., schizophrenics). As with all psychiatric symptoms, cultural norms may prompt the behavior (e.g., clang associations among rappers is normal).

Speech in which the client’s ideas are fragmented. Usually, an idea is stimulated by either a previous idea or an external event, but the relationship among ideas or ideas and events is weak. In contrast to loose associations (see below), there are logical connections in the client’s thinking. However, unlike circumstantiality (see above), the client never gets to the point. Clients who exhibit flight of ideas often appear over-active or overstimulated (e.g., mania or hypomania). Many normal people exhibit flight of ideas after excessive caffeine intake—including one of the authors.

Minimal logical connections between thoughts. The thinking process is nearly, but not completely random; for example: “I love you. Bread is the staff of life. Haven’t I seen you in church? I think incest is horrible.” In this example, the client thinks of attraction and love, then of God’s love as expressed through communion, then of church, and then of an incest presentation he heard in church. It may take effort to track the links. Loose associations may indicate schizotypal personality disorder, schizophrenia, or other psychotic or pre-psychotic disorders. Extremely creative people also regularly exhibit loosening of associations, but are able to find a socially acceptable vehicle through which to express their ideas.

Virtually total unexpressiveness. There may be signs the client is in contact with others, but these are usually limited. Mutism can indicate autism or schizophrenia, catatonic subtype. Mutism may also be selective in that young clients will be able to speak freely at home, but become mute and apparently unable to speak at school or with professionals (see DSM-5, **).

Client-invented words. They’re often spontaneously and unintentionally created and associated with psychotic disorders; they’re products of the moment rather than of a thoughtful creative process. We’ve heard words such as “slibber” and “temperaturific.” It’s important to check with the client with regard to word meaning and origin. Unusual words may be taken from popular songs, television shows, or a product of combining languages.

Involuntary repetition of a single response or idea. The concept of perseveration applies to speech and/or movement. Perseveration is often associated with brain damage and psychotic disorders. After being told no, teenagers often engage in this behavior, although normal teenagers are being persistent rather than perseverative; that is, if properly motivated, they’re able to stop themselves voluntarily.

Tangential speech is similar to loose associations, but connections between ideas are even less clear. Tangential speech is different from flight of ideas because flight of ideas involves pressured speech.

A series of unrelated words. Word salad indicates extremely disorganized thinking. Clients who exhibit word salad are incoherent. (See the second half of the preceding “Dear Bill” letter for an example of word salad.)

Table 8.3. Characteristics of Different Perceptual Disturbances
Hallucinations	Illusions	Flashbacks
False sensory experiences	Perceptual distortions	Sudden and vivid sensory-laden recollections of previous experiences
Auditory hallucinations are most common and usually associated with schizophrenia, bipolar disorder, or a severe depressive episode	Illusions are more common among clients who have vivid imaginations, who believe in the occult, or have other schizotypal personality disorder symptoms	Flashbacks are most common among clients with post-traumatic stress disorder
Do you ever hear or see things that other people can’t see or hear? When and where do you usually see or hear these things (checking for hypnogogic or hypnopompic experiences)? Does the radio or television ever speak directly to you? Has anyone been trying to steal your thoughts or read your mind?	What was happening in your surroundings when you saw (or experienced) what you saw (or experienced)? Did the vision (or image or sounds) come out of nowhere, or was there something happening?	Have you had any similar experiences before in your life? Sometimes when people have had very hard or bad things happen to them, they keep having those memories come back to them. Does that happen to you? Was there anything happening that triggered this memory or flashback to the past?

Table 8.4. Mental Status Examination Checklist
		Hypothesis
Appearance
Behavior/Psychomotor Activity

Attitude Toward Examiner
Affect and Mood
Speech and Thought
Perceptual Disturbances
Orientation and Consciousness
Memory and Intelligence
Judgment, Reliability and Insight

Thinking Process Abnormalities in Schizophrenia

From Tangential Thought to Incoherence

Thomas Barwick / Stone / Getty Images

Thought Content vs. Thought Process

Thinking refers to our ability to make decisions, solve problems, reason, and remember. In a broader sense, thinking is the totality of experiences in one’s mind.

People with schizophrenia have trouble keeping their thoughts straight and expressing them. Disorganized thinking is one of the primary symptoms of schizophrenia .

Disorganized thinking can lead to various thought process disorders that cause tangential thought, disjointed thoughts, a collapse or sudden stop in the thought process, randomly spoken words, and incoherence.

Typically, we process our thoughts logically and coherently. However, this process is disrupted in those with schizophrenia, leading to disorganized thought and disordered speech.

Causes of Disorganized Thinking

The causes of disorganized thinking (or schizophrenia ) are unclear. It may be related to a factors such as genetics and family history, environment, and trauma. Some people with disorganized thinking have structural differences in their brains, as evidenced by unusual activation in regions involved in:

Language and speech processing
Auditory perception
Social interaction
Higher-order cognitive functions like decision-making, evaluating, brainstorming, and learning

Thoughts, emotions, sensations, memories, and fantasies are the essential building blocks of the way the brain functions. Any disruption in the thought process—the way these blocks are linked—will affect certain areas of life.

It makes sense to try to understand disorganized thinking from two perspectives: thought content and thought process. While changes in someone's thought content affect what they perceive or think about, changes in thought process impact the way they form their ideas and express them.

Auditory hallucinations (hearing sounds not based in reality)

Delusions (fixed sets of ideas that are at odds with reality)

Depersonalization or derealization

Grandiosity

Circumstantial thinking

Clang associations

Distractibility

Tangential thinking

Word salad (incoherence)

Types of Disorganized Thinking

Here's a more in-depth look at those thought process abnormalities.

Some people with disordered thinking experience distractibility. They may begin talking about one thing and then completely shift topics before completing their sentence. This is often due to nearby stimuli that interfere with the thought process.

For example : "I moved to New York after college. What are you eating for lunch?"

Circumstantial Thinking

Circumstantial thinking occurs when a person talks in circles, providing excessive and unnecessary detail before getting to the point.

One Classic Example

Here's an example from neuroscientist and neuropsychiatrist researcher Nancy Coover Andreasen:

Question : "What is your name?"
Response : "Well, sometimes when people ask me, I have to think about whether or not I will answer because some people think it's an odd name even though I don’t really because my mom gave it to me and I think my dad helped but it's as good a name as any in my opinion, but yeah it's Tom."

Tangential Thinking

Tangential thinking occurs when someone moves from thought to thought but never seems to get to the main point. Instead, the thoughts are somewhat connected but in a superficial or tangential way.

For example : "I really got mad as I was waiting in line at the grocery store. I cannot stand lines. Waiting and waiting. I waited for a long time to get my driver's license. Driving these days is just crazy."

Derailment or Loose Associations

In cases of severely disordered thinking, thoughts lose almost all connections with one another and become disconnected and disjointed. This illogical thinking is called derailment or "loose" associations.

For example : "I really enjoyed some communities and tried it, and the next day when I’d be going out you know, um I took control like uh, I put, um, bleach on my hair in, in California. My roommate was from Chicago and she was going to the junior college. And we lived in the YMCA so she wanted to put it, um, peroxide on my hair…"

Clang Associations

Clanging is when the individual chooses words based on sound (rhyming or pun associations) rather than meaning. They may also use made-up words or neologisms and may speak in a flat- or unusual-sounding voice.

For example : "I had a little goldfish too, like a clown. …Happy Halloween down."

Incoherence

People with very severe disordered thinking may experience incoherence, where there are no discernible connections between words. This incoherence (also known as "word salad") makes it impossible to understand the individual’s thought process.

For example : "They’re destroying too many cattle and oil just to make soap. If we need soap when you can jump into a pool of water, and then when you go to buy your gasoline, my folks always thought they should, get pop but the best thing to get, is motor oil, and, money..."

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders includes criteria to help your doctor diagnose schizophrenia. Your doctor will look for typical symptoms of the condition, like disordered speech, delusions, hallucinations, disorganized or catatonic behavior, and reduced emotional expression.

They may also look for disorganized thinking by examining how you communicate and direct your attention.

Your doctor will also need to rule out other conditions that can affect thought processes, like:

Bipolar disorder
Major depressive disorder

Treatment for Disorganized Thinking

Treatment for thought process abnormalities in schizophrenia often includes medication, psychotherapy, life skills training, and family support.

The right medication can help to reduce disordered thinking and improve functioning. This may include antidepressants, mood stabilizers, or anti-anxiety medication alongside antipsychotics for long term management of the symptoms of schizophrenia.

Psychotherapy

Talk therapy, including cognitive behavioral therapy (CBT) , can help you better identify thought process abnormalities and find ways to cope with unusual or dysfunctional ways of thinking.

Social Skills Training

An inability to clearly communicate your thoughts and feelings can take a toll on your family, social life, and work relationships. Social skills training can help you improve communication with others to better navigate these relationships.

Family Support

Family members are often crucial providers of care for someone with schizophrenia. Family therapy may help ensure that you and your loved ones understand your condition and feel supported.

Treatment for thought process problems depends on the root cause. In many cases, medication, psychotherapy, skill training, and family support are part of a treatment plan.

The Takeaway

Disorganized thinking can be difficult to deal with, but with the help of a healthcare provider and the people close to you, you can make great strides and find strategies that work for you.

Learning more about the symptoms of schizophrenia can help with this process, as can joining an in-person or online support group. Finding support can provide an outlet to express your emotions and help you develop strategies to communicate your thoughts.

Hart M, Lewine RR. Rethinking thought disorder . Schizophr Bull . 2017;43(3):514-522. doi:10.1093/schbul/sbx003

Wensing T, Cieslik EC, Müller VI, Hoffstaedter F, Eickhoff SB, Nickl‐Jockschat T. Neural correlates of formal thought disorder: An activation likelihood estimation meta‐analysis . Hum Brain Mapp . 2017;38(10):4946-4965. doi:10.1002/hbm.23706

Hinzen W, Rosselló J. The linguistics of schizophrenia: Thought disturbance as language pathology across positive symptoms . Front Psychol . 2015;6:971. doi:10.3389/fpsyg.2015.00971

Sass L, Parnas J. Thought disorder, subjectivity, and the self . Schizophr Bull . 2017;43(3):497-502. doi:10.1093/schbul/sbx032

Andreasen NC. Thought, language, and communication disorders. I. Clinical assessment, definition of terms, and evaluation of their reliability . Arch Gen Psychiatry . 1979;36(12):1315-21. doi:10.1001/archpsyc.1979.01780120045006

Kuperberg GR. Language in schizophrenia Part 1: an Introduction . Lang Linguist Compass . 2010;4(8):576-589. doi:10.1111/j.1749-818X.2010.00216.x

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed . Washington, DC; 2013. doi:10.1176/appi.books.9780890425596

Patel KR, Cherian J, Gohil K, Atkinson D. Schizophrenia: Overview and treatment options . P T . 2014;39(9):638-645.

Chen X, Long F, Cai B, Chen X, Chen G. A novel relationship for schizophrenia, bipolar and major depressive disorder Part 5: a hint from chromosome 5 high density association screen . Am J Transl Res . 2017;9(5):2473-2491.

Stepnicki P, Kondej M, Kaczor AA. Current concepts and treatments of schizophrenia . Molecules . 2018;23(8). doi:10.3390/molecules23082087

Almerie MQ, Okba Al Marhi M, Jawoosh M, et al. Social skills programmes for schizophrenia . Cochrane Database Syst Rev . 2015;(6):CD009006. doi:10.1002/14651858.CD009006.pub2

Caqueo-Urízar A, Rus-Calafell M, Urzúa A, Escudero J, Gutiérrez-Maldonado J. The role of family therapy in the management of schizophrenia: Challenges and solutions . Neuropsychiatr Dis Treat . 2015;11:145-151. doi:10.2147/NDT.S51331

By Adrian Preda, MD Adrian Preda, MD, is a board-certified psychiatrist with specialties in adult and geriatric psychiatry and clinical neuropsychiatric research.

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Thought Disorder

Formal thought disorder refers to an impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language.

Indeed, the most basic assessment of thought content requires at least some degree of language competence.
For research purposes, scales have been developed to study the quality and severity of abnormalities in thought, language, and communication.
In clinical practice, formal thought disorder is assessed by engaging patients in open-ended conversation and observing their verbal responses.
A number of medical and surgical conditions can affect language performance; the term formal thought disorder is used when these conditions are excluded from the diagnosis.
The cause of formal thought disorder is not established. Research has implicated abnormalities in the semantic system in patients with schizophrenia .
Thought disorder is often accompanied by executive function problems and general disorganization.
Abnormalities in language are common in the general population, in everyday conversation. Thus, the categorical presence or absence of the following language problems is not absolutely diagnostic of any condition. However, heightened frequency and severity of these problems should be noted by the physician and accounted for in the patient’s diagnostic formulation.

Formal thought disorder descriptors (adapted from the Thought, Language, and Communication scale) [1] :

Poverty of speech: restricted quantity of speech; brief, unelaborated responses
Poverty of content of speech: adequate speech quantity with prominent vagueness and inappropriate level of abstraction
Pressure of speech: increased rate and quantity of speech; speech may be loud and difficult to interrupt
Distractible speech: topic maintenance difficulties due to distraction by nearby stimulus
Tangentiality: Replies to questions are off-point or totally irrelevant.
Derailment (loosening of associations): spontaneous speech with marked impairments in topic maintenance
Incoherence (word salad, schizaphasia): severe lack of speech cohesion at the basic level of syntax and/or semantics within sentences
Illogicality: marked errors in inferential logic
Clanging: speech in which word choice is governed by word sound rather than meaning; word choice may show rhyming or punning associations
Neologism: the creation of new "words"
Word approximations: unconventional and idiosyncratic word use
Circumstantiality: excessively indirect speech; speech is liable to be overinclusive and include irrelevant detail
Loss of goal: difficulty in topic maintenance in reference to failure to arrive at the implicit goal of a statement
Perseveration: excessive repetition of words, ideas, or subjects
Echolalia: speech repeats words or phrases of interviewer
Blocking: interruption of speech while ostensibly in pursuit of a goal
Stilted speech: odd language use that may be excessively formal, pompous, outdated, or quaint
Self-reference: The patient is liable to refer the subject of conversation back to him/herself.
Paraphasic error (phonemic): word mispronunciation, slip of the tongue
Paraphasic error (semantic): substitution of an inappropriate word to make a specific statement

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Decoding Word Salad: Understanding Disorganized Thinking in Psychology

Do you ever find your thoughts feeling jumbled and chaotic, making it difficult to make sense of things? You may be experiencing disorganized thinking, a common symptom in various mental health conditions.

In this article, we will explore the causes, signs, and symptoms of disorganized thinking, as well as how it is diagnosed and treated. We will discuss coping strategies and whether disorganized thinking is a permanent condition. Join us as we unravel the complexities of this fascinating psychological phenomenon.

Disorganized thinking is a symptom of various mental health disorders, including schizophrenia, bipolar disorder, and substance abuse.
Signs of disorganized thinking include speech disorganization, confused thought processes, and difficulty with problem solving.
Treatment options for disorganized thinking include medication, therapy, and lifestyle changes, and individuals can also learn coping strategies to manage their symptoms.
1 What Is Disorganized Thinking?
2.1 Schizophrenia
2.2 Bipolar Disorder
2.3 Substance Abuse
3.1 Speech Disorganization
3.2 Confused Thought Processes
3.3 Difficulty with Problem Solving
3.4 Inability to Maintain Focus
4 How Is Disorganized Thinking Diagnosed?
5.1 Medications
5.2 Therapy
5.3 Lifestyle Changes
6 How Can One Cope with Disorganized Thinking?
7 Is Disorganized Thinking a Permanent Condition?
8 Frequently Asked Questions

What Is Disorganized Thinking?

Disorganized thinking , also known as formal thought disorder, is a common symptom observed in various neurological and psychiatric conditions such as schizophrenia.

It is characterized by an individual’s inability to think clearly or logically, leading to fragmented and incoherent thoughts. This cognitive dysfunction can manifest in speech patterns, where the person may exhibit tangentiality, derailment, or loosening of associations, making their communication challenging to follow for others. Disorganized thinking is often associated with disturbances in language processing, leading to difficulties in conveying ideas effectively and understanding complex information.

What Are the Causes of Disorganized Thinking?

Disorganized thinking can stem from a variety of sources, with conditions like schizophrenia, bipolar disorder, and substance abuse playing significant roles.

Individuals suffering from schizophrenia often experience disorganized thoughts due to disturbances in their perception and thinking processes. In the case of bipolar disorder , the alternating states of mania and depression can lead to cognitive difficulties and erratic thought patterns. Substance abuse can also disrupt neurocognitive functions, impairing logical reasoning and contributing to disorganized thinking.

Schizophrenia

Schizophrenia is a complex psychiatric disorder characterized by a diverse array of symptoms, including disorganized thinking, auditory hallucinations, and disturbances in verbal communication.

Disorganized thinking is a hallmark feature of schizophrenia, leading individuals to struggle with connecting thoughts cohesively and expressing themselves clearly. This symptom can manifest in various ways, such as fragmented speech patterns, illogical associations, and tangentiality in conversations.

Additionally, auditory hallucinations are prevalent among those with schizophrenia, where individuals perceive voices or sounds that are not actually present. These hallucinations can be distressing, causing significant distress and impacting daily functioning.

The disturbances in verbal communication associated with schizophrenia can range from speech poverty, where individuals use minimal words, to alogia, which refers to the inability to produce coherent speech.

Bipolar Disorder

Bipolar disorder , characterized by manic and depressive episodes, can also manifest disorganized thinking in the form of rapid speech, flight of ideas, and erratic behaviors.

During manic episodes, individuals with bipolar disorder often experience heightened energy levels, decreased need for sleep, and exaggerated self-confidence. This can result in impulsive decision-making, reckless behavior, and difficulty concentrating on tasks. Flight of ideas is a common symptom during manic phases, where thoughts race uncontrollably from one idea to another. This can lead to disjointed speech patterns and excessive talking.

Disorganized thinking further complicates the ability to communicate effectively, as individuals may struggle to stay on topic or maintain coherence in their conversations. Symptoms such as distractibility, poor judgment, and grandiose beliefs can contribute to a sense of chaos and confusion in the individual’s mind.

Substance Abuse

Substance abuse, particularly drug-induced states, can induce temporary disorganized thinking due to the impact on neurological functions and cognitive abilities.

When an individual engages in substance abuse, the chemical alterations caused by drugs interfere with the normal functioning of the brain. This disruption can manifest in various ways, one of which is through disorganized thinking – where a person may struggle to maintain coherent thoughts or logical reasoning. Cognitive impairments due to drug-induced states are often transient, meaning that once the substance clears the system, the cognitive functions can gradually return to normal.

What Are the Signs and Symptoms of Disorganized Thinking?

Recognizing disorganized thinking involves observing signs such as speech disorganization, confused thought processes, difficulty in problem-solving, and an inability to maintain focus.

Speech disorganization can manifest in rapid or incoherent speech patterns, tangential conversations, and even derailment into unrelated topics. Individuals experiencing disorganized thinking may exhibit cognitive deficits, showing challenges in logical reasoning, memory retention, and decision-making processes. These individuals might struggle with maintaining coherent narratives or following sequential train of thoughts, often jumping from one idea to another without a clear connection.

Challenges in concentration can be evident when individuals have trouble attending to tasks, sustaining attention during conversations, or comprehending complex information. They may display scattered attention, being easily distracted or forgetful during discussions or activities, affecting their overall ability to effectively communicate and engage in tasks.

Speech Disorganization

Speech disorganization, often characterized by word salad and semantically confused language, reflects underlying issues in language processing and communication.

In word salad, the individual may string together seemingly random words and phrases, making it difficult for listeners to follow the intended message. Language processing deficits can lead to challenges in understanding and producing coherent speech, affecting various aspects of verbal communication.

Disorganized thinking can result in disjointed narratives, fragmented responses, and tangential speech, where the speaker struggles to convey thoughts in a logical sequence. This disorganization can impede effective communication and create barriers to expressing ideas clearly.

Individuals experiencing speech disorganization may display reduced fluency, impaired word retrieval, and disruptions in grammar and syntax, hindering their ability to convey thoughts effectively. These difficulties can impact social interactions, professional communication, and overall verbal expression.

Confused Thought Processes

Confused thought processes may present as grammatically correct but semantically confused statements, indicative of a thought disorder affecting logical reasoning.

When one experiences such cognitive disarray, the words may align perfectly in structure, yet fail to convey a clear, cohesive message. This paradox of correctness without coherence can perplex both the individual grappling with these thoughts and those attempting to decipher them. Semantic ambiguity disrupts the flow of communication and impedes the exchange of ideas, hindering the essence of logical thinking. The intricate interplay between grammar and semantics in thought processes underscores the complexity of cognitive function and its profound impact on an individual’s ability to reason effectively.

Difficulty with Problem Solving

Disorganized thinking often leads to challenges in problem-solving tasks , reflecting cognitive impairments associated with certain neurological conditions.

The effects of disorganized thinking on problem-solving can vary greatly depending on the specific nature of the neurological condition. For instance, individuals with conditions such as schizophrenia may experience significant difficulties in organizing thoughts and forming coherent strategies to tackle problems, which can severely impede their problem-solving abilities. On the other hand, individuals with conditions like traumatic brain injury might struggle with processing information efficiently, leading to slower problem-solving and a higher likelihood of making errors.

Inability to Maintain Focus

Individuals experiencing disorganized thinking may struggle to maintain focus, often becoming easily distracted and displaying signs of attention deficit.

This challenge can manifest in various ways, such as difficulties in completing tasks, forgetfulness, and trouble concentrating on conversations or work assignments. These individuals may find it hard to follow instructions, make decisions, or stay organized in their daily lives. The constant influx of thoughts and competing stimuli can overwhelm their cognitive abilities, leading to a cycle of frustration and inefficiency.

Developing effective strategies to cope with these distractions and improve focus is essential for enhancing productivity and overall well-being.

How Is Disorganized Thinking Diagnosed?

Diagnosing disorganized thinking typically involves a comprehensive assessment that includes neuropsychological tests , psychiatric evaluations , and a review of medical history.

In neuropsychological assessments, cognitive functions such as attention, memory, language, and executive functioning are carefully evaluated through standardized tests to identify any deficits or abnormalities that may contribute to disorganized thinking.

Psychiatric evaluations play a crucial role in understanding the emotional and psychological aspects of disorganized thinking. Mental health professionals assess symptoms, behavior patterns, and potential underlying mental health disorders that could be influencing the disorganization in thought processes.

A review of medical history helps in ruling out any potential physical health conditions, medication side effects, or substance abuse issues that might be causing cognitive disruptions leading to disorganized thinking.

What Are the Treatment Options for Disorganized Thinking?

Treatment strategies for disorganized thinking encompass a range of options, including medications, therapy, and lifestyle modifications tailored to individual needs.

Medication interventions, such as antipsychotics or mood stabilizers, are commonly prescribed to manage symptoms of disorganized thinking. These medications help regulate neurotransmitters in the brain, aiding in better cognitive functioning.

Therapy approaches, such as cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT), focus on addressing distorted thought patterns and enhancing coping skills to deal with disorganized thinking effectively.

Lifestyle adjustments, including stress management techniques, regular exercise, adequate sleep, and a balanced diet, play a crucial role in supporting overall mental well-being and reducing the impact of disorganized thinking.

Medications

Medications such as antipsychotics are commonly prescribed to manage disorganized thinking and associated symptoms in psychiatric conditions like schizophrenia.

Antipsychotic medications play a crucial role in alleviating disorganized thinking by targeting neurotransmitters in the brain, particularly dopamine receptors. These medications help regulate the brain’s chemical imbalances, reducing hallucinations, delusions, and cognitive disturbances.

Doctors carefully evaluate each individual’s symptoms and medical history to determine the most suitable antipsychotic medication and dosage. It’s essential for patients to adhere to their prescribed medication regimen to experience the full benefits of treatment. Regular monitoring and adjustments are often necessary to ensure the medication’s effectiveness and manage potential side effects.

Therapeutic interventions like cognitive-behavioral therapy and psychotherapy play a crucial role in addressing cognitive deficits and disorganized thinking patterns.

These types of therapy offer individuals effective strategies and tools to challenge negative thought patterns, develop healthier coping mechanisms, and enhance problem-solving skills.

Cognitive-behavioral therapy, for example, focuses on identifying and modifying maladaptive behaviors and thoughts, helping individuals regain control over their cognitive processes.

On the other hand, psychotherapeutic approaches delve deeper into emotions, beliefs, and past experiences, aiming to provide a holistic understanding of the individual’s psychological functioning.

Lifestyle Changes

Incorporating lifestyle modifications , such as stress management techniques and holistic approaches, can complement medical treatments in addressing disorganized thinking.

Understanding the impact of healthier lifestyle choices on mental well-being is crucial. By adopting regular exercise routines, balanced diets, and sufficient sleep, individuals can promote better cognitive function and emotional stability.

Practicing mindfulness and meditation can help reduce excessive mental clutter and improve focus. Through these positive changes , individuals may experience reduced stress levels and enhanced clarity of thought.

Seeking support from therapists, engaging in support groups, and incorporating relaxation techniques into daily routines are key components of a holistic approach to managing disorganized thinking.

How Can One Cope with Disorganized Thinking?

Coping with disorganized thinking involves developing effective strategies, leveraging support systems, and adopting self-care practices to enhance cognitive functioning and overall well-being.

One useful strategy is mindfulness exercises, such as deep breathing or meditation, to ground oneself and reduce overwhelming thoughts. Engaging in regular physical activity can also improve mental clarity and concentration.

Building a strong support network, whether through friends, family, or therapy groups, can provide a sense of belonging and understanding. Connecting with others who have similar experiences can offer valuable insights and reassurance.

Keeping a structured daily routine and using tools like calendars, planners, or apps for organization can assist in managing cognitive challenges effectively. It’s important to be patient with oneself and practice self-compassion during moments of confusion or frustration.

Is Disorganized Thinking a Permanent Condition?

Disorganized thinking is not necessarily a permanent condition, as early intervention, proper management, and ongoing support can contribute to recovery and reduce the risk of relapse.

Individuals who receive timely treatment and engage in therapy sessions often experience significant improvements in their cognitive processes and decision-making abilities. Structured routines and cognitive behavioral therapy play a crucial role in helping individuals regain focus and coherence in their thoughts. Through consistent practice of mindfulness techniques and cognitive exercises, patients can learn how to manage disorganization and enhance their ability to think logically. It is essential to acknowledge that the journey to recovery may have setbacks, and some individuals might experience relapse episodes. It is crucial for them to remain connected to their support network, continue therapy, and actively participate in follow-up appointments to minimize the chances of relapse.”

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Loose Associations:

Loose associations, a term commonly used in psychology and psychiatry, refers to a thinking or communication pattern characterized by a lack of coherence and logical connections between thoughts and ideas. It is often observed in individuals with certain mental disorders, such as schizophrenia.

Characteristics:

Disjointed Thoughts: Thoughts and ideas expressed by an individual with loose associations may appear fragmented and disconnected from each other. There is often a lack of clear transitions or logical flow between topics.
Tangential Speech: Individuals with loose associations often engage in tangential speech, where they shift from one topic to another without obvious links. Their conversations may seem illogical or nonsensical to others.
Word Salad: In severe cases, loose associations can result in word salad, where the person’s speech becomes incomprehensible due to the jumbling of words, phrases, and unrelated ideas.
Derailment: Derailment, also known as “loose association of ideas,” occurs when an individual quickly jumps from one topic to another, displaying a lack of focused thought or conversation.
Incoherence: The lack of logical connections between thoughts and ideas can lead to incoherent speech or writing, making it difficult for others to follow or understand.

The exact causes of loose associations are not fully understood, but it is believed to be related to disruptions in cognitive processes and brain functioning. Some factors that may contribute to the development of loose associations include:

Schizophrenia or schizoaffective disorder
Bipolar disorder during manic episodes
Psychotic disorders
Substance abuse or withdrawal
Neurological conditions

Treatment for loose associations often focuses on managing the underlying condition causing the symptom. This may involve a combination of medications, psychotherapy, and support services tailored to the individual’s needs. The goal is to improve cognitive functioning, facilitate better communication, and reduce the disruptive effects of loose associations on daily life.

Understanding Schizophrenia Speech Patterns

Schizophrenia can cause a variety of symptoms. You may already be familiar with some, like hallucinations and delusions. However, you might not know that schizophrenia can also affect the ways people speak. They might display “word salad,” poverty of speech, echolalia, derailment, and more. Disorganized speech and other schizophrenia symptoms can often be managed with the proper support and treatment.

Schizophrenia: An overview

Schizophrenia is often a severe mental illness. Usually starting in the young adult years, this disorder can change the ways people experience reality, express emotions, and interact with others. Scientists still haven’t determined the exact cause of schizophrenia. However, certain factors may raise people’s risk, such as genetics, birth weight, and childhood environment .

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide that can help doctors diagnose mental health disorders. The manual generally lays out definitions and criteria for a variety of mental illnesses. In the latest version of the DSM (DSM-5), schizophrenia is listed as a “psychotic disorder." Psychotic disorders can be defined as mental illnesses that involve losing track of reality or having a “psychotic episode.” People with schizophrenia may experience multiple psychotic episodes during their lives.

Schizophrenia can cause a variety of symptoms affecting people’s thoughts and behavior. These symptoms may be more intense during psychotic episodes, but they may also continue when a person is no longer in psychosis. Some examples include the following:

Hallucinations: When you hallucinate, you may see, hear, or feel something that isn’t there. People with schizophrenia may commonly hear voices or other sounds. They may also have visual hallucinations, although this tends to be rarer .
Delusions: A delusion is usually a false belief that a person holds strongly, despite evidence against it. Schizophrenia can involve various types of delusions. For example, a person might believe they can read minds, that the government is spying on them, or that their TV is sending them hidden messages.
Changes in mood and motivation: Schizophrenia can make it hard to experience pleasure. The condition can also affect motivation to do daily tasks. As a result, people with schizophrenia may stop bathing, going to work, seeing their loved ones, or engaging in hobbies.
Changes in emotional expression: Schizophrenia can also make people less expressive. For example, someone might stop showing facial expressions or using gestures to communicate. People with schizophrenia may also talk in a flat tone of voice.
Disorganized speech: “Disorganized speech” generally refers to abnormalities in a person’s way of thinking that come across in the way they speak. Because thoughts and speech tend to be intertwined, this symptom is sometimes also called “formal thought disorder.”

These symptoms and others can create challenges for people with schizophrenia. They may have trouble at work, in relationships, and in daily life. They may also experience other mental illnesses, like anxiety and depression .

A woman in a pink cardigan sits in a grye armchair in her home and looks at the cellphone in her hand.

Exploring schizophrenia speech patterns

Now that we’ve considered general schizophrenia symptoms, let’s focus on one: disorganized speech. Language abnormalities can be common among people with schizophrenia, but what do they look like? The answer to this question may not be the same for everyone. However, there are a few common forms of disorganized speech.

Word salad: “Word salad” can describe a way of speaking that is incomprehensible to other people. For example, a person might string random words together, speak in sentence fragments, or change the order of words to the point where other people can’t follow what they’re saying.

Poverty of speech: “Poverty of speech” usually refers to speaking very little. For example, someone might only respond to questions with one-word answers. They might also refuse to talk without being prompted by others.

Making up new words: People with schizophrenia may come up with new words and phrases. This can make it hard for others to follow what they’re saying. For example, a person might say something like, “I took my ‘spuzzle’ out to the ‘skove’ this morning.”

Echoing other people: When a person with schizophrenia is talking to someone else, they might repeat what the other person says rather than responding to it in their own words. This symptom can also be called “echolalia.”

Going off on tangents: Also known as “derailment,” this can happen when someone loses track of their original point as they speak. They might bounce between ideas or follow a train of thought that’s hard to understand. For example, someone might say, “Today I had ice cream, which was cold. Winter is almost here. That reminds me, I need to get a winter coat. Maybe a green one. I like looking at the green grass. It’s green like spinach. I know I need to eat healthier.”

Scientists are looking into the neurological reasons or “neural correlates” for these language disturbances within the brain. In a study from 2017, 51 schizophrenia patients were interviewed to analyze their speech. They were also given tasks to analyze various brain functions. Researchers found that communication problems were often associated with the following:

Poor working memory
Poor performance on cognitive tasks
Low information processing speed

Given this, there might not be one specific factor that causes schizophrenia-related speech changes. Rather, it may be that schizophrenia causes general issues with cognitive function that may lead to speech disorders. That said, this topic is still being researched.

Getting treatment for schizophrenia

Living with schizophrenia can be challenging. However, various treatments may support your mental health and improve your daily functioning. Some examples can include medication, social skills training, and community support programs.

Other treatments are being explored for schizophrenia-related speech disorders. In 2016, researchers gave 17 patients with schizophrenia a specialized communication program. After 20 sessions, participants typically saw a significant improvement in their communication, language skills, and social appropriateness .

Psychotherapy may be helpful if you have schizophrenia. By working with a therapist, you may be able to improve your thought patterns and develop healthy ways of managing your symptoms. If you’re living with other mental health conditions besides schizophrenia, a therapist may be able to help you reduce those symptoms as well.

A middle aged man in a white button down shirt sits at a table and holds a tablet in his hand while gazing off deep in thought.

Adhering to your treatment plan may ease the challenges of living with schizophrenia —and that may be easier to do if you have a therapist you trust. That said, finding the right mental health professional can sometimes take trial and error. Online therapy platforms like BetterHelp typically let you change therapists at any time, at no additional cost. This may make it easier to find the right therapist for you.

A growing body of research shows that online therapy can effectively treat anxiety and depression, which can often occur alongside schizophrenia . In 2017, researchers analyzed data from 373 studies of internet-based therapy. They found that online therapy was usually effective at treating depression, anxiety, PTSD, bipolar disorder, and more . However, in-person support may be needed if you’re experiencing acute psychosis.

Schizophrenia Case Study: Examining Symptom Management And Long-Term Outcomes Medically reviewed by Andrea Brant , LMHC
Can You Develop Schizophrenia Later In Life? Understanding Late-Onset Schizophrenia Medically reviewed by Nikki Ciletti , M.Ed, LPC
Schizophrenia
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Article Contents

Questions about the dichotomy of disorders of thought vs disorders of mood, selective attention: the brain's filter/prioritizer, defective selective attention is observed as manic distractibility, student case conference, defective manic sensory processing predisposes grandiosity and paranoia, detrimental effects of misdiagnosis.

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Disorders of Thought Are Severe Mood Disorders: the Selective Attention Defect in Mania Challenges the Kraepelinian Dichotomy—A Review

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C. Raymond Lake, Disorders of Thought Are Severe Mood Disorders: the Selective Attention Defect in Mania Challenges the Kraepelinian Dichotomy—A Review, Schizophrenia Bulletin , Volume 34, Issue 1, January 2008, Pages 109–117, https://doi.org/10.1093/schbul/sbm035

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Kraepelin said severe mental illness was due to 2 diseases subsequently characterized as disorders of thought vs disorders of mood, ie, the Kraepelinian dichotomy. Schizophrenia, traditionally considered the disorder of thought, has been defined by the presence of hallucinations, delusions, catatonia, and disorganization. Tangentiality, derailment, loose associations, and thought blocking are typically considered pathognomonic of schizophrenia. By contrast, the mood disorders have been characterized only as disorders of the emotions, though both depression and mania, when severe, are now recognized to include the same psychotic features traditionally considered diagnostic of schizophrenia. This article addresses disordered thinking in mania in order to clarify the relationship between schizophrenia and psychotic mood disorders. Normally, the brain's selective attention mechanism filters and prioritizes incoming stimuli by excluding from consciousness extraneous, low-priority stimuli and grading the importance of more relevant data. Because this “filter/prioritizer” becomes defective in mania, tangential stimuli are processed without appropriate prioritization. Observed as distractibility, this symptom is an index of the breakdown in selective attention and the severity of mania, accounting for the signs and symptoms of psychotic thinking. The zone of rarity between schizophrenia and psychotic mood disorders is blurred because severe disorders of mood are also disorders of thought. This relationship calls into question the tenet that schizophrenia is a disease separate from psychotic mood disorders. Patients whose case histories are discussed herein gave their written informed consent to participate in this institutional human subjects committee–approved protocol.

Descriptions of the major psychiatric diseases were recorded in the 19th and early 20th centuries. Kraepelin described 2 distinct disorders (the Kraepelinian dichotomy), dementia praecox, renamed schizophrenia by Bleuler in 1911, and manic depressive insanity, now called bipolar disorder ( tables 1 and 2 ). 1 , 2 Kraepelin , Bleuler, Schneider, and others defined schizophrenia by the presence of disordered thought manifested in the psychotic symptoms of hallucinations, delusions, catatonia, and/or disorganization. 1–3 Bleuler and Schneider equated psychosis with schizophrenia, regardless of prominent mood symptoms. 2 , 3 The 1933 introduction of schizoaffective disorder by Kasanin recognized the importance of mood symptoms in psychotic patients, drew attention to similarities between bipolar and schizophrenia, and reflected an effort to erode the Kraepelinian dichotomy. 4 Despite this, the concept of schizophrenia, promoted by Bleuler and Schneider, has been influential and resistant to change in the United States where academic psychiatry has differentiated the mood disorders as disorders of the emotions from the schizophrenias as disorders of thought. A growing literature is challenging this concept.

DSM-IV-TR Diagnostic Criteria for Schizophrenia (Modified) a

A. Characteristic symptoms: patient must have 2 symptoms during a 1-month (active) phase (except as noted below) (only 1 symptom is required if delusions are bizarre or hallucinations are a voice commenting on one's behavior/thoughts or if 2 or more voices are conversing with each other )

1. Delusions

2. Hallucinations

3. Disorganized speech (frequent derailment, incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (affective flattening, alogia, and avolition)

B. Social/occupational dysfunction: work, interpersonal relations, or self-care have markedly deteriorated

C. Duration: continuous signs for 6 months with 1-month active-phase symptoms and may include prodromal or residual symptoms

D. Exclude schizoaffective and mood D/O with psychotic features

E. Exclude substance and general medical condition

F. Exclude preexisting pervasive developmental D/O

1. Delusions

2. Hallucinations

3. Disorganized speech (frequent derailment, incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (affective flattening, alogia, and avolition)

B. Social/occupational dysfunction: work, interpersonal relations, or self-care have markedly deteriorated

C. Duration: continuous signs for 6 months with 1-month active-phase symptoms and may include prodromal or residual symptoms

D. Exclude schizoaffective and mood D/O with psychotic features

E. Exclude substance and general medical condition

F. Exclude preexisting pervasive developmental D/O

Abbreviated format without change in meaning or substance. DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision .

These symptoms/criteria are disease nonspecific and occur frequently in mood D/O, severe with psychotic features.

These qualifications that allow a diagnosis of schizophrenia with only 1 of the characteristic symptoms in “A” are from K. Schneider's 3 first-rank symptoms.

D/O, disorders.

This criterion is often underemphasized or ignored; a diagnosis of schizophrenia is made before reaching criterion D.

DSM-IV-TR Diagnostic Criteria and Specifiers for Mania (modified for brevity)

a. Diagnostic criteria for a manic episode (defines bipolar mood D/O)

A. Distinct period for at least 1 week (or inpatient hospitalization necessary) of abnormal and persistently elevated, expansive, or irritable mood

B. In the period, 3 symptoms (4 if mood is only irritable) persist to a significant degree

1. Distractibility

2. Insomnia with increased energy

3. Grandiosity/increased self-esteem

4. Flight of ideas

5. Increased activities: including phoning, spending, travel, investing, gambling, sex; excessive involvement in pleasurable activities with high potential for negative outcome

6. Speech: pressed to incoherent

7. Thoughts: racing, loose, tangential

C. Symptoms cause marked impairment in functioning (job, social, family) or hospitalization warranted because of severity of symptoms

D. Symptoms not due to substance or general medical condition

b. Specifiers for mood D/O diagnoses:

A. Presenting state—for bipolar: manic, depressed, mixed; for unipolar: single episode or recurrent

B. Severity: mild, moderate, severe without, severe with psychotic features ; partial, full remission

C. Course/onset: chronic (symptoms over 2 years) , seasonal affective D/O, rapid cycling (at least 4 episodes/year), postpartum onset (within 4 weeks), with or without full interepisode recovery

D. Features: catatonic , melancholic, atypical

a. Diagnostic criteria for a manic episode (defines bipolar mood D/O)

A. Distinct period for at least 1 week (or inpatient hospitalization necessary) of abnormal and persistently elevated, expansive, or irritable mood

B. In the period, 3 symptoms (4 if mood is only irritable) persist to a significant degree

1. Distractibility

2. Insomnia with increased energy

3. Grandiosity/increased self-esteem

4. Flight of ideas

5. Increased activities: including phoning, spending, travel, investing, gambling, sex; excessive involvement in pleasurable activities with high potential for negative outcome

6. Speech: pressed to incoherent

7. Thoughts: racing, loose, tangential

C. Symptoms cause marked impairment in functioning (job, social, family) or hospitalization warranted because of severity of symptoms

D. Symptoms not due to substance or general medical condition

b. Specifiers for mood D/O diagnoses:

A. Presenting state—for bipolar: manic, depressed, mixed; for unipolar: single episode or recurrent

B. Severity: mild, moderate, severe without, severe with psychotic features ; partial, full remission

C. Course/onset: chronic (symptoms over 2 years) , seasonal affective D/O, rapid cycling (at least 4 episodes/year), postpartum onset (within 4 weeks), with or without full interepisode recovery

D. Features: catatonic , melancholic, atypical

Note : DSM -IV-TR , Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ; D/O, disorders.

Signs and symptoms associated or confused with schizophrenia.

By 1978, Pope and Lipinski observed that patients with severe mood disorders did experience hallucinations, delusions, catatonia, and disorganization, which are, in fact, disorders of thought. 5 They and others have concluded that psychosis and disordered thought are common in severe bipolar and that many patients diagnosed with schizophrenia (because they experience hallucinations and/or delusions) are misdiagnosed and actually suffer from severe but unrecognized bipolar disorder. 5–13 Furthermore, chronicity of course, treatment resistance, or cognitive deficits do not distinguish these 2 disorders. 11 , 12 , 14–23 Persistent cognitive defects in executive function and working memory were initially associated with patients diagnosed with schizophrenia. 17 However, severe bipolar patients can suffer a chronic deteriorating course with similar permanent cognitive impairment that worsens with increasing episodes and impairs executive function and memory, even during remissions. 11 , 12 , 14 , 21 Similar neurodevelopmental defects have been suggested in the etiology of both bipolar disorder and schizophrenia. 22 , 23 Another realm of overlap is sleep disturbances that are common to patients diagnosed with schizophrenia and bipolar disorder. 24 , 25 Such phenotypic overlap supports the conclusion that schizophrenia may be the same disease as a psychotic mood disorder. 5 , 13 Is one of these a more valid disorder?

In contrast to schizophrenia, bipolar disorder is scientifically grounded as a “bona fide” disease because its diagnostic criteria are unique. Classic bipolar patients are so different from normals and patients with other medical conditions and they demonstrate such a large variance in their thoughts and behavior between episodes of mania and depression, that selection confidence is high. Schizophrenia has no unique symptom or group of symptoms not accounted for by severe psychotic bipolar. Despite phenotypic similarities, further clarification of the relationship between schizophrenia and psychotic bipolar can be expected from the elucidation of mechanisms of psychotic thought, but such an understanding remains challenging and speculative. 18–23 , 26–29

The human brain possesses the ability to selectively process incoming information. Attention is part of this processing and is a multidimensional construct. Selective attention refers to those mechanisms which lead our consciousness to be dominated by 1 thing rather than another. 26 Partly under voluntary control, partly subconscious, and partly dependent on stimulus salience, some stimuli are processed more thoroughly than others. Experimental models, including Donald Broadbent filter theory and various cognitive neuroscience techniques in psychiatric patients, have focused on selective attention and its malfunction. 18–21 , 26–29 Selective attention appears to govern an initial filtration process that is linked with a prioritization mechanism before stimuli reach consciousness ( figures 1 –3). Stimuli that reach consciousness are the basis of thoughts, verbalizations, and actions. This filter/prioritizer enables one to screen out and avoid attending to extraneous distractions during a conversation or other focused activity such as an initial diagnostic interview. Although there is wide individual variability in what is likely to attract or distract one's attention, stimuli indicating emergency or life-threatening situations are universally given priority in euthymic individuals. For example, the smell of smoke appropriately overrides most conversations. By contrast, at a ball game, depending on their individual interests, a home run or touchdown might appropriately distract only some from a serious discussion.

Selective Attention in Mood Disorders: Mania. In mania, the subject of “mom” is inappropriately lost when stimulus 2, the “keys”, is passed through the filter and prioritized, possibly due to it being the most recent stimulus. The keys idea is not verbalized because of a flurry of sequential internal stimuli based initially on keys and then on subsequent internal stimuli (see text). This series of internal stimuli includes items 3–9. Stimulus 7 is shown as a dashed line of external input because the room may have been warm. Only 5 and 9 are verbalized. Although there are connections to each thought based on the patient's report, the failure to filter and prioritize causes stimuli to come so fast and demand attention (apparently based on most recent order) that there is not enough time to verbalize all of them. An observer hears only “mom,” “pyramids,” and wanting water, concluding there has been a “blockage of thought.” The present explanation is predicated on the core manic symptoms of distractibility, flight of ideas, and racing thoughts. Manic thought is indeed disordered. The potentially critical external stimulus of “smoke” (item 10) may pass the filter but may not be adequately prioritized in mania to receive action. “Smoke” may be quickly overridden by the next stimulus such as “cigarettes are expensive” or “Smokey the Bear is cute.” The first 9 stimuli are actual thoughts of the patient as discussed in the text; stimulus 10 is hypothesized. This exchange and series of thoughts might occur in as little as 1 minute. Three areas of central nervous system data processing are denoted by each set of 3 boxes, each set representing 1 of 3 states of mood. The examples of the stimuli used in the figure derive from an actual patient interview during a student case conference (see text). Represented by the first box in each of the 3 sets, external stimuli appear to meet a filter that eliminates trivial data in euthymia while most or all stimuli pass through the filter in mania. Excessive stimuli may be stopped at the filter in depression. Internal stimuli are shown but their filtration is not indicated in the figure. Represented by the middle boxes, a second data-processing mechanism is a prioritizing function that can rearrange the importance of stimuli, diminishing or exaggerating attention to incoming data. The third boxes in each set represent action or verbalization. The time elapsed during processing of the interview material differs among mood states. In euthymia, the 8 stimuli take 2–5 minutes; the 10 stimuli in mania, less than a minute and 5 steps in depression, 5–10 minutes.

Selective Attention in Mood Disorders: Euthymia. In euthymia, the psychiatrist's questions about “mom” are prioritized and are not overridden by the “keys” (neither of the 2 keys stimuli 1 or 2) or by miscellaneous stimuli, 1 or 2. The first “keys (1)” stimulus is impactful enough to pass the filter but is shown as downgraded by the prioritizer function (second box), and there is no action or verbalization. A second “keys (2)” stimulus when the professor picked up his keys does not pass filtration. Internal stimulus 4 (mom 2) and external stimulus 6 (“mom 3” as in the form of another question from the interviewer) are appropriately prioritized and verbalized in continuing with the psychiatric interview. The dialogue about the topic of “mom” may last 5 minutes and is only overridden by a hypothetical stimulus, “smoke.” The sight or smell of smoke (stimulus 7) readily passes the filter and is highly prioritized. Note increase in line thickness and elevation to the top of the “action” box, receiving immediate attention above the “mom” topic.

Selective Attention in Mood Disorders: Depression. In depression, all cognitive processes appear to be slowed. A depressed patient may have difficulty maintaining focus on “mom” not because of subsequent interrupting stimuli but because of a defect in concentration associated with depression. Other stimuli may be inappropriately filtered out or receive an unwarranted reduction in prioritization. Stimulus 5, “smoke,” is shown as passing the filter but not receiving a high enough prioritization rank to produce an action. No internal stimuli are generated, in sharp contrast to the manic state where an excessive number of internal stimuli reach consciousness. In depression, only 5 stimuli may require 5–10 minutes with less comprehension than 8 stimuli in euthymia in the same time.

Distractibility is a recognized core diagnostic symptom of mania ( table 2 ). 30 In mania, the selective attention function deteriorates and the filter/prioritizer becomes more porous allowing inappropriate and irrelevant stimuli to gain attention and focus ( figure 1 ). This defect is observed clinically as manic distractibility, poor judgment, and lack of insight. The level of distractibility provides a clinical index reflecting the severity of the information-processing defect in manic patients. 18 , 28 , 29 Increasing distractibility in mania leads to disorganization of thought and behavior and to psychosis. Although disorganization is still considered diagnostic of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ( DSM-IV-TR ), 30 it is a prominent characteristic of severe mania, likely exacerbated by failure of the selective attention function and increasing distractibility. 18 There are a number of symptoms of disordered thinking that are traditionally considered pathognomonic for schizophrenia such as tangentiality, derailment, loose associations, ideas of reference/influence, blocking, rhyming, punning, echolalia, clanging, word salad, paranoia, disorganization, and incoherence ( table 3 ). How this set of symptoms derives instead from manic distractibility is considered below ( figure 1 ).

Symptoms of Disordered Thought and Speech Traditionally Indicative of Schizophrenia or Mania

Schizophrenia	Mania
A disorder of thought	A disorder of mood
Delusions	Distractibility
Hallucinations	Racing thoughts
Disorganized speech	Flight of ideas
Disorganized behavior	Pressure of speech
Incoherence	Grandiosity
Paranoia
Catatonia
Tangentiality
Circumstantiality
Loose associations
Derailment
Blocking
Echolalia
Echopraxia
Clanging
Rhyming
Punning
Word salad
Ideas of reference
Ideas of influence

Schizophrenia	Mania
A disorder of thought	A disorder of mood
Delusions	Distractibility
Hallucinations	Racing thoughts
Disorganized speech	Flight of ideas
Disorganized behavior	Pressure of speech
Incoherence	Grandiosity
Paranoia
Catatonia
Tangentiality
Circumstantiality
Loose associations
Derailment
Blocking
Echolalia
Echopraxia
Clanging
Rhyming
Punning
Word salad
Ideas of reference
Ideas of influence

Note that no single symptom or combination of symptoms is disease specific for schizophrenia, and all are more likely explained by the core manic symptom of distractibility.

In mild mania, the defect in the filter/prioritizer system is modest, allowing fairly appropriate evaluation of incoming data, but with reduced dampening of ideas and more activity than are usual for that individual. During this state, new ideas are triggered more readily and are expressed with less restriction and more confidence. Hypomanic patients typically become more productive in their areas of endeavor as well as in additional ventures. History demonstrates that some of the most famous and successful writers, composers, musicians, artists, generals, and politicians have suffered from bipolar mood disorder. When the filter/prioritizer mechanism becomes less discriminating, however, rationality and the quality of productivity decrease.

In moderately severe mania, sequential stimuli demand attention even though they are tangential, loose, or seemingly unrelated to the subject of a conversation. For example, during an initial diagnostic interview, a patient with moderate mania may attend to irrelevant stimuli from pictures on the wall, a clock, noises outside, the interviewer's tie, and other inappropriate distractions rather than the interviewer's questions. Redirection of the patient may become difficult due to increasing distractibility and irritability.

In severe mania, the brain's filter/prioritizer is very porous to inappropriate distractions. The ability to distinguish and thus to discard trivial sensory input is lost, and the manic brain seems to attempt to process and vocalize myriad stimuli ( figure 1 ). This defect results in the experience of racing thoughts, flight of ideas, and confusion, typically described by manic patients and observed by the interviewer as a pressure of speech extending to disorganization and incoherence. New ideas and thoughts come so fast that even speaking as rapidly as possible, a patient may be able to express only a small percentage of them. Conversely, critical stimuli may be overlooked. Rational conversation becomes difficult because such patients are confused by sensory and thought overload, as demonstrated below.

The case of a 56-year-old married male, recently readmitted to the acute inpatient unit, was presented in a weekly student conference. He carried the diagnosis of schizophrenia, disorganized type. The student reported his presenting symptoms of derailment, loose associations, blocking, delusions, and gross disorganization of thoughts, speech, and behavior for over 6 months ( table 1 ). He fulfilled DSM criteria for schizophrenia and demonstrated additional signs and symptoms usually associated with this diagnosis ( table 4 ). After the student's presentation, the patient was invited into the conference room for an interview with the attending professor. About 2 minutes into the interview, as the patient answered a question about his mother, with a normal rhythm but a modest pressure, the professor “accidentally” knocked his key chain off the table. The patient stopped talking, remained silent for about 15 seconds, and then said, with appropriate emotion, “The pyramids are magnificent structures.” After another unusual pause, the patient said, “May I have a glass of water?” These appear to be textbook examples of “schizophrenic thought blocking,” understood as the sudden obstruction in or loss of a thought during a flow of speech, and observed as an unusual silence followed by the emergence of a totally unrelated subject. There is no apparent association between “mother,” “pyramids,” and wanting water. This presentation appeared to meet all the DSM criteria for schizophrenia, but the rule out for psychotic mood disorder had been overlooked.

Other Signs and Symptoms Often Thought Indicative of Schizophrenia a

1. Loner; poor premorbid personality

2. Onset of psychotic illness in late adolescence or early adulthood

3. Disorder of thought, formal thought disorder

4. Derailment, tangentiality, loose associations, disorganization, blocking, incoherence, word salad, clanging, echolalia, echopraxia, speaking in tongues

5. Catatonia

6. Coprophagia, coprophilia

7. Downward drift in society and employment

8. Multiple, brief jobs

9. Street person

10. Ideas of control or reference, paranoia

11. Mood incongruent hallucinations and/or delusions

1. Loner; poor premorbid personality

2. Onset of psychotic illness in late adolescence or early adulthood

3. Disorder of thought, formal thought disorder

4. Derailment, tangentiality, loose associations, disorganization, blocking, incoherence, word salad, clanging, echolalia, echopraxia, speaking in tongues

5. Catatonia

6. Coprophagia, coprophilia

7. Downward drift in society and employment

8. Multiple, brief jobs

9. Street person

10. Ideas of control or reference, paranoia

11. Mood incongruent hallucinations and/or delusions

None of these symptoms or combinations are disease specific for schizophrenia, and all occur frequently in severe mood disorders with psychotic features.

These signs and symptoms can overlap with the fringes of normal behavior or be caused by multiple circumstances.

The patient was asked by the attending professor to focus his attention and try to explain how his thoughts had jumped from discussing his mother to pyramids to wanting water. With some redirection, he was able to maintain focus to say that the key chain stimulated the thought of “the key of life” leading to the idea that life began in Egypt's Nile River valley. “Egypt” brought him to pyramids and how “magnificent” they must be. Egypt also stimulated the thought of a desert, of feeling hot and then thirsty, so he asked for a glass of water. This sequence of thoughts occurred in a matter of seconds.

An analysis of what transpired in this interaction demonstrates distractibility, flight of ideas, and racing thoughts and may be explained by a defect in the selective attention function typical to mania ( figure 1 ). The patient's filter/prioritizer failed to prevent his inappropriate distraction to and processing of “keys.” Because he was unable to maintain appropriate focus on the interviewer's questions about his mom, this theme was lost. Including the initial subject of “mom,” the extraneous stimulus of the attending professor's keys led to a cascade of at least 9 internally generated loosely associated ideas: (1) mom, (2) the professor's keys, (3) the key of life, (4) Egypt, (5) the magnificent pyramids, (6) the desert, (7) feeling hot, (8) being thirsty, and (9) wanting water. The patient's mind was racing to such an extent that he only had time to verbalize “pyramids are magnificent” and wanting water, items 5 and 9 ( figure 1 ). Such a breakdown apparently allows so many thoughts to reach consciousness that there is no time to say them all. By the patient's report, there are connections to all his thoughts, but an observer is oblivious to the connections because only about 20% of his thoughts are verbalized, and none have any relationship to the subject of “mom.” During euthymia, distraction to the keys falling to the floor would usually be blocked at the filter or given such low priority that the interview subject of “mom” would continue appropriately and uninterrupted ( figure 2 ). In depression, exclusion of stimuli may be increased ( figure 3 ).

Bleuler and Schneider would interpret this interchange as thought blocking, loose associations, derailment, disorganization, and incoherence of thought and speech, leading to a diagnosis of schizophrenia, 2 , 3 but these signs are also compatible with manic distractibility. Upon additional inquiry, the patient under discussion endorsed the DSM , disease-specific symptoms diagnostic of a manic episode ( table 2 ). 30 The significant other of the patient confirmed his manic symptoms.

In severe psychotic mania with more extensive damage to the filter/prioritizer mechanism, patients may only focus on words or sounds that rhyme or may only be able to say words or make sounds with no apparent relationship to one another. These disorganized and incoherent patterns of speech, called rhyming, punning, clanging, echolalia, and word salad, are traditionally associated with schizophrenia and not mania ( table 3 ). An example of such manic incoherence comes from a recovered patient who said that, when manic, he had been able to focus on the first letter of each word spoken by others and to “make entire sentences beginning with each of those letters.” His speech had been incoherent (word salad) and his behavior, disorganized, delusional, and psychotic, yet he had felt organized. He met disease-specific DSM criteria for mania. 30

Another extremely disorganized patient was brought to the emergency department (ED) by the police. He had been in the middle of a busy intersection gesturing frantically and speaking rapidly, nonstop in a “foreign language” or “in tongues” to any one or no one. In the ED, he continued to speak rapidly without pause but with a rhythm that indicated a potential for meaning. No English words were discernable. His affect was of extreme excitement and agitation. His wife denied that he spoke a foreign language and said that he had been in this mental state for 2 days without sleep or food. In retrospect, his initial diagnosis of disorganized schizophrenia was likely incorrect because he probably suffered from excited mania, severe with psychotic features. Such a presentation can be understood as a severe disintegration in the filter/prioritizer function. This case emphasizes the importance of considering a diagnosis of mania in disorganized individuals observed to be “speaking in tongues” and inappropriately “preaching.”

The disease-specific manic symptom of grandiosity may also relate to this filter/prioritizer defect. In mania with psychotic features, the filter/prioritizer is so defective that judgment, insight, and the ability to discriminate reality from misperceptions and illusions are lost. Without adequate mechanisms to filter and evaluate data, illusions or misperceptions can be exaggerated to delusional fame, knowledge, and wealth. The occurrence of one such thought can stimulate an unfiltered sequence of progressively more grandiose delusions. Once manic patients are convinced they have special abilities, powers, ideas, knowledge, or wealth, the natural consequence is the occurrence of “paranoid delusions” that others want these possessions. Called “ideas of reference,” unrelated conversations or gestures by others in public, on television or radio, are personalized and are similarly misinterpreted and exaggerated as threatening. Such patients are dangerous because they may strike first, convinced they are in mortal danger. Because survival becomes the dominant focus, overriding and obscuring their grandiosity, patients' presenting complaints in the ED are fear and paranoia, not the grandiose delusions. 31 Ideas of reference and influence, held as pathognomonic of schizophrenia by Schneider 3 and the current DSM ( table 1 ), 30 have been discounted as disease-specific symptoms because they occur frequently in psychotic bipolar patients. 32–36 Pursuit of mood symptoms in such patients is critical because interviewer focus on the paranoid, psychotic symptoms can lead to the misdiagnosis of manic patients as schizophrenic, resulting in mismanagement.

Further confusing accurate diagnoses in psychotic patient is the observation that bipolar patients can suffer such severe and chronic psychotic symptoms that disturbances of mood are hidden for weeks at a time. 11 , 12 Some physicians, assuming that psychosis means schizophrenia, may not aggressively pursue mood symptoms. The author concurs with Pope who said, “To misdiagnose schizophrenia as bipolar rarely does harm; to misdiagnose bipolar disorder as schizophrenia may adversely affect a patient's entire future.” 32 , 33 The misdiagnosis of schizophrenia in patients with bipolar causes substantial negative outcomes, including pharmacological mismanagement. Once misdiagnosed as schizophrenic, the concept that schizophrenia is a lifelong disease inhibits reconsideration of both the diagnosis and a reduction in dosage of neurotoxic, antipsychotic medications. 32 , 33 Most critical, bipolar patients misdiagnosed with schizophrenia are unlikely to receive mood-stabilizing medicines; without these, the rate of cycling increases and patients deteriorate related to kindling and excitotoxicity. 11 , 12 , 34 The high rate of suicide in patients diagnosed with schizophrenia (misdiagnosed), because of psychotic symptoms, may reflect a lack of a trial on lithium, an effective antisuicide and antikindling medication. The potential for neurotoxic effects from antipsychotic medications is greater in patients diagnosed with schizophrenia because the antipsychotics are given in higher dosages and for longer periods of time than in patients diagnosed with bipolar. 37 The impact of the stigma of the “schizo” prefix is substantial and lifelong. For psychotic patients who do not experience obvious mood symptoms, a temporary DSM diagnosis of psychotic disorder, Not Otherwise Specified, 30 is recommended while obscure mood and/or organic explanations are explored further. There are many subtle organic causes of psychosis. 37–39

Distractibility is an index of the severity of a core defect in information processing in the manic brain involving selective attention. 18 This breakdown in mania leads to gross disorganization of thought and behavior, hallucinations, delusions, and incoherence and seems to explain most of, if not all, the signs and symptoms of disturbed thought, traditionally attributed to schizophrenia ( tables 1, 3, and 4 ). The cognitive deficits in schizophrenia and bipolar share commonalities and overlap. 18–21 , 28 , 29 Adding further doubt to the dichotomy of schizophrenia and bipolar and suggesting common neuropathology is a rapidly growing body of phenotypic and genotypic data from a wide array of basic science and preclinical fields such as neurochemistry, 40–42 brain metabolism, 43 , 44 imaging, 45 , 46 epidemiology, 47 cognitive function (selective attention/insight), 14–23 , 28 , 29 , 48 and genetics 49–59 that show considerable similarities and overlap. Molecular genetic results reveal 5–9 shared susceptibility loci. 49 , 50 , 54–59 “The beginning of the end of the Kraepelinian dichotomy” has been predicted based on the phenotypic and genotypic overlap. 57 Data that have supported the dichotomy or shown a bimodal distribution of discriminate scores with a natural discontinuity might be explained by differences between psychotic and nonpsychotic mood disorders, not 2 separate disorders. As recently stated, “ … the validity of the diagnostic distinction between schizophrenia and bipolar disorder is increasingly challenged …. The diagnostic split between schizophrenia and bipolar disorder is unable to define distinct etiological and/or pathophysiological entities.” 60 and “Unfortunately, once a diagnostic concept such as schizophrenia … has come into general use, it tends to become reified. That is, people too easily assume that it is an entity of some kind that can be evoked to explain the patient's symptoms and whose validity need not be questioned.” 61 Disordered thought and the functional psychoses can be accounted for by a single disorder, the disorder we currently diagnose as bipolar disorder. A correct differential diagnosis is critical because psychotic bipolar patients misdiagnosed with schizophrenia or schizoaffective disorder do not receive standard of care treatment.

The author would like to acknowledge Heather Nachbar, Martha Mundis, and Anita Swisher for technical support.

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consciousness related finding
depressive disorders
hallucinations
mental disorders
mood disorder
psychotic disorders
schizophrenia
tangential thinking
distractibility
thought blocking
selective inattention

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Celebrities who struggle with mental health disorders, what are the different types of thought disorders.

“The cat fell silly cows struggle down.” “Through the tunnel, purple mountain a desk eat ruby jade.”

While these sentences don’t seem to make any sense, they’re a common occurrence in many individuals with thought disorders. Though disorders can impact the organization, content, and flow of an individual’s thoughts and speech, encompassing a spectrum of conditions that can impair cognitive functioning and interpersonal interactions. Today, the experts at our residential mental health facilities are delving into the diverse types of thought disorders out there, detailing their unique symptoms. Keep reading to learn common examples of thought disorders and how our mental health experts effectively treat them.

What Is a Thought Disorder?

A thought disorder refers to a disruption in a person’s usual pattern of thinking that’s observed in individuals with mental health disorders. Thought disorders entail abnormalities in the coherence, organization, and logical progression of a person’s thoughts. These irregularities are exhibited as disruptions in the formation and expression of ideas or thoughts, often impairing communication, and interpersonal interactions.

Thought disorders can occur in numerous ways, including derailment (loose associations), tangentiality (off-topic responses), incoherence (lack of logical flow), and poverty of thought (restricted content). These abnormalities reflect an underlying problem associated with cognition and can negatively impact a person’s ability to effectively share their ideas and engage in meaningful conversations.

Common Examples of Thought Disorders

As providers of dual diagnosis treatment , we come across people with various mental health problems as well as addiction issues. Thought disorder first appeared in scientific literature around the 1980s, when it was initially described as a symptom of schizophrenia. Each type of thought disorder has unique symptoms. While it is common for individuals to display some of the symptoms of thought disorder occasionally, thought disorder is not classified until it negatively affects the person's ability to communicate.

Here are some common examples and types of thought disorders:

Alogia: Also known as poverty of thought, this thought disorder is characterized by brief and unelaborated responses to questions. People with this type of thought disorder rarely speak unless prompted, and it is often seen in individuals with dementia or schizophrenia.
Blocking: When a person seems unable to complete their thought because of constant pauses, they are likely experiencing blocking.
Circumstantiality and tangentiality: The circumstantial type of speech is superfluous and roundabout. The speaker will go off on irrelevant tangents before coming back to the main point of the story. Tangential thinking involves abrupt changes in subject matter that are unrelated to the initial topic.
Clanging or clang association: A person with a clanging thought process makes word choices based on the sound of the word rather than the meaning of the word. They may rely on using rhymes, alliterations, or puns and create sentences that do not make sense. A clanging thought process is a common symptom of mania in bipolar disorder.
Concrete thinking: Individuals with this thought disorder struggle with abstract reasoning and instead rely heavily on literal and concrete interpretations of information. This is often seen in conditions like autism spectrum disorder.
Delusional thinking: Individuals who experience delusional thought disorders hold false beliefs that are resistant to reasoning or evidence disproving them. These beliefs can range from paranoid delusions (belief in being chased or persecuted) to grandiose delusions (exaggerated sense of self-importance).
Disorganized thinking (formal thought disorder, or FTD): Also referred to as disordered thinking and disorganized thought process, disorganized thinking occurs in individuals with schizophrenia and schizoaffective disorder , where individuals display disjointed, illogical, and incoherent thinking. Typical disorganized thinking examples and symptoms include tangentiality (deviating off-topic), derailment (loose associations), and thought blocking (sudden interruption of thought process).
Echolalia and echopraxia: People experiencing echolalia repeat other people’s words or phrases, while individuals with echopraxia mimic the movements and gestures of others.
Flight of ideas: Common in bipolar disorder, flight of ideas refers to a rapid and continuous flow of thoughts that are loosely connected, making it difficult for the individual to maintain a coherent conversation.
Incoherence: Also referred to as “word salad” and incoherent thought process, this disorganized thinking example affects the order of words and semantics, making it difficult for the individual to create consistent speech.
Neologism: Also referred to as neologism thought process, a person who struggles with neologism will often create new words or expressions when they talk.
Perseveration thought process: Also referred to as preservative thought process, this type of thought disorder refers to the repetition of words or topics excessively and obsessively.
Pressure of speech: A person with pressure of speech problems will speak at a faster rate and often in a higher volume. It can be difficult to get a word in with this person.
Thought broadcasting: Also associated with schizophrenia, this thought disorder example involves the conviction that one’s thoughts are being broadcasted aloud so people around can hear the thoughts.
Thought insertion and withdrawal: Common in individuals with schizophrenia, these involve the belief that thoughts are being embedded into one's mind (insertion) or forcibly removed from one's mind (withdrawal) by external forces or entities.
Word approximations: This thought disorder refers to the abnormal and incorrect use of words in the middle of sentences.

Understanding these various types of thought disorders is essential for mental health professionals working in treatment facilities, as it enables individualized assessment, diagnosis, and interventions to address the specific cognitive disturbances exhibited by clients. If your loved one is exhibiting signs of a mental health disorder, our PHP facilities for mental health can help.

Call Banyan Mental Health today at 888-280-4763 to learn more about our adult mental health services for schizophrenia, bipolar disorder, and more.

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Schizophrenia can cause a decline in overall daily functioning. Disorganized symptoms tend to manifest in early onset Schizophrenia and can cause a person to have difficulties living independently. Patients experiencing disorganized symptoms may seem zoned out or distracted and they may have difficulties relating to others and completing tasks.

Disorganized symptoms fall into three main categories:

Thought Disorders

Disorganized Speech

Bizarre Behaviors

Schizophrenia causes patients to have disorganized and confused thought processes. Patients can experience difficulties organizing their thoughts which can cause them to have troubles concentrating, following along, maintaining a steady train of thought, communicating, completing tasks, and making decisions.

Examples of Disorganized Thoughts:

Distractibility – Losing track of what one is doing in response to a nearby stimulus
Circumstantial Thinkin g – Inability to differentiate the essential from the unessential
Tangential Thinking – Completely losing one’s train of thought

Disorganized thoughts lead to disorganized speech. Schizophrenia patients often struggle to communicate. A patient’s words can come out jumbled, or they may ramble or respond to questions with unrelated answers. A patient’s disorganized speech may be mild or completely incoherent and incomprehensible.

Examples of Disorganized Speech:

Loose Associations – Shifting topics frequently with no connection between topics.
Derailment – Speech proceeds along a given path and then suddenly slips into a new direction.
Neologisms – Using made up words only understood by the speaker.
Perseveration – Repeating words, phrases, or sentences over and over again.
Clanging – Talking in rhyme with no reason or meaning.
Logorrhea – Incoherent, compulsive talking.
Word Salad – Speaking with an unintelligible mix of random words and phrases.
Graphorrhea – Writing with an unintelligible mixture of words and phrases.
Thought Blocking – Abruptly stopping speech mid train of thought and then forgetting what one was talking about.
Pressured Speech – Speaking at a fast, incomprehensible pace.
Circumstantial Speech – An inability to answer a question without giving excessive, unnecessary detail.
Tangential Speech – Talking past or around the point without returning to the original topic.
Echolalia – Repeating noises and words heard rather than one’s own thoughts.

Bizarre or inappropriate behaviors are often found in Schizophrenia. Patients may exhibit behaviors completely lacking purpose and demonstrate inappropriate emotional responses and conduct.

Examples of Bizarre Behaviors:

Inappropriate Affec t – Emotional responses that aren’t appropriate for the situation such as smiling or laughing at something sad.
Kleptomania
Intermittent Explosive Disorder
Pathological Gambling
Hand Waving
Body Rocking
Head Banging
Not bathing or brushing teeth
Wearing a heavy coat in July
Childlike Silliness
Unpredictable Agitation
Talking to Oneself
Catatonia – A rigid posture and complete lack of response.

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Disorders & Issues
Schizophrenia

Positive Symptoms Of Schizophrenia: The Disorganized Dimension And Negative Symptoms

Symptoms of schizophrenia disorganization.

Schizophrenia is a complex mental health condition characterized by a variety of symptoms that can significantly impact an individual's ability to think, feel, and behave clearly. Among these, disorganized symptoms are particularly challenging as they directly affect the coherence and structure of thought and action. Disorganized symptoms can be broadly categorized into disorganized speech and behavior, each with its own set of manifestations.

Derailment— Individuals may abruptly shift from one topic to another without any logical connection. This makes it difficult for the listener to follow the conversation.
Word Salad—Speech may become so fragmented and disconnected that it resembles a "word salad," where words are put together without any apparent meaning or logic, rendering the conversation nearly impossible to comprehend.
Contrary Actions—Actions that defy social norms are a hallmark of disorganized behavior. For instance, a person might wear heavy winter clothing on a hot summer day without any logical reason.
Inappropriate Emotions—Emotional responses may be completely out of sync with the situation, such as laughing during a serious or sad moment.

These symptoms of disorganization in schizophrenia stand out because they significantly disrupt an individual's ability to function normally in daily life. Disorganized speech makes effective communication a challenge, while disorganized behavior can lead to difficulties in performing routine tasks and social interactions. Understanding these symptoms is crucial for recognizing the challenges faced by individuals with schizophrenia and providing them with the appropriate support and treatment.

Exploring Disorganized Thinking

Disorganized thinking in schizophrenia is characterized by a severe disruption in the logical flow of thoughts, manifesting in speech that makes little sense, if any. This condition can significantly impair communication, rendering normal conversation difficult. Patients may frequently lose their train of thought, respond to questions with unrelated answers, or be unable to focus on a single topic. Illustrative case vignettes include a patient who, in the middle of a sentence about their day, suddenly begins discussing unrelated past events without realizing the abrupt topic change, highlighting the challenges faced in daily functioning due to these thought disturbances.

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Impact of Disorganized Behavior

The direct impact of disorganized behavior on sufferers includes significant challenges in managing self-care routines, maintaining employment, and engaging in social interactions. For instance, an individual may struggle to follow basic hygiene practices or appear in socially inappropriate attire, affecting their relationships and professional life. Personal anecdotes or short case studies reveal how these behaviors can lead to isolation or misunderstanding from others, emphasizing the profound effects on the individual’s quality of life.

Root Causes of Disorganized Behavior

Current understanding links the root causes of disorganized behavior in schizophrenia primarily to neurobiological factors, including dysfunctions in brain regions responsible for thought organization and processing. Ongoing research continues to explore these connections, seeking to elucidate the exact mechanisms and thus opening pathways for new treatment modalities. The emphasis on neurobiological underpinnings hints at a complex interplay of genetics and brain chemistry.

Diagnosing Disorganized Schizophrenia

Diagnosis of disorganized schizophrenia heavily relies on identifying key symptoms of disorganized speech and behavior during clinical assessment. Healthcare professionals play a critical role in noticing these symptoms, differentiating them from other types of schizophrenia, and determining the extent to which they affect the patient's life. Comprehensive evaluation, often involving interviews and observations, is crucial for an accurate diagnosis.

Managing Disorganized Symptoms

Effective management of disorganized symptoms in schizophrenia includes a combination of antipsychotic medication and psychosocial interventions tailored to the individual’s needs. Treatment plans often prioritize restoring functionality and aiding patients in achieving a better quality of life through improved thought coherence and behavior regulation. The significance of personalized care plans cannot be overstated, as they are key to addressing the unique challenges faced by each individual suffering from disorganized schizophrenia.

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Schizophrenia and Modes of Thought

Convergent and divergent thinking are examined in terms of schizophrenia..

Posted July 15, 2014

Note that this author, Dr. Ann Olson, has published a book entitled Illuminating Schizophrenia: Insights into the Uncommon Mind. This book is available for purchase on the amazon.com website.

Concrete thinking can be distinguished from abstract thinking, and both of these have implications regarding tested intelligence . Essentially, concrete thinkers can be said to achieve lower scores on intelligence tests, as compared to abstract thinkers, who achieve higher scores. The best indicator of overall intelligence of the various subtests of the Wechsler Adult Intelligence Scale-III is the Vocabulary subtest. This subtest is a measure of the test subject’s ability regarding concept formation. As concepts are symbols, the ability to acquire knowledge of vocabulary words to some extent demonstrates symbolic, conceptual or abstract thought. In terms of this:

(1) Concrete thinking is defined by the American Heritage Medical Dictionary (2007) as “thinking characterized by a predominance of actual objects and events and the absence of concepts and generalizations.”

(2) Abstract thinking is defined by the above dictionary as “thinking characterized by the ability to use concepts and to make and understand generalizations, such as properties or pattern shared by a variety of specific items or events.”

Creativity is also an aspect of intelligence. In terms of creativity:

(3) Divergent thinking is defined on the website, AudioEnglish.org and Princeton Wordnet as, “thinking that moves away in diverging directions so as to involve a variety of aspects and which sometimes leads to novel ideas and solutions, associated with creativity.”

(4) Creativity is defined in the Random House Dictionary (2014) as “the ability to transcend traditional ideas, rules, patterns, relationships, or the like, and to create meaningful new ideas, forms, methods, interpretations, etc.; originality, progressiveness, or imagination .”

It is interesting to note that concrete thinking has negative connotations, while divergent thought is somewhat a neutral descriptor. In contrast, abstract thinking has positive connotations and creativity has quite positive connotations. Concrete thinking has been contended to be associated with schizophrenia, and divergent thinking is apparent in those who are schizophrenic.

Robert Unger (2009) can be paraphrased as stating that “divergent thinking,” which can be said to include “loosening of associations,” is commonly experienced by poets and artists. Unger states: “Divergent thinking leads to having more unusual experiences such as are seen in both artistic types and those diagnosed as psychotic.” It is clear that schizophrenics have idiosyncratic experiences of reality, and they deal with perceptual differences that are outside of the norm. It is also apparent that schizophrenics can be characterized as possessing the quality of divergent thinking.

As stated in a previous article by this author: It has been theorized by the researcher Elizabeth Stannard Gromisch that, when intelligence and creative thinking are distinguished, creativity is viewed as divergent thinking, which is not necessarily negative, but is divergent from the norm. However, intelligence is a different construct, and it is not synonymous with creativity. Gromisch asserts that creative people who are divergent thinkers filter out less information than that which is accrued from the environment than less creative people (Gromish. 2010). This will lead to divergent or unusual experience.

As previously stated in an article by this author: It may be valid to view creativity as based upon organizing a greater amount of miscellaneous details, aspects of the world and the self that may be raw material for formulating new ideas. Note that miscellaneous ideas can overwhelm the processes of thought, as reflected in loose associations, word salad, and other characteristics of thought seen in the schizophrenic and signified by impaired verbal ability.

Other abilities contribute to productive creativity and divergent thought. These include convergent thinking, analytical reasoning and deductive reasoning. Note the following:

(5) Convergent thinking is thought to be, in the field of psychology, a cognitive process in which ideas are examined for their logical validity or in which a set of rules are followed.

(6) As paraphrased from the Collins English Dictionary, (2003), analytical reasoning allows one to examine things closely and thoroughly, by deriving conclusions from parts or relationships. This type of reasoning is systematic, rational and perceptive, as opposed to constructive and inventive qualities, which characterize creative thinking.

Cross-section through a cluster of maize leaves

As stated by Michael Kallet, in his book Think Smarter, Critical Thinking to Improve Problem Solving and Decision Making Skills , (2014), analytical reasoning involves a cognitive process (a mode of critical thinking) in which a person attempts to find a single, correct answer to a problem. This is opposite from divergent thinking in which a person generates many unique, creative responses to a single question or problem.

It is quite obvious that schizophrenics may have abilities related to concrete thinking exclusively. They may lack abilities related to convergent thinking and analytical reasoning. This is not because they are tremendously deficient intellectually, but because they have unusual experience that is essentially difficult to approach rationally.

Schizophrenics think about circumstances or experiences that are different from the norm. They may utilize more details from their experiences that, as stated by Gromish (2010), are a basis for divergent thinking. In terms of these realities, schizophrenics may appear to be deficient intellectually, even in terms of tested intelligence, simply because the task of thinking about their experience is much more difficult than it is for the average person, who may have a normative and perhaps shallow approach to understanding the world.

Non-schizophrenics may rely on assumptions about the mental and material worlds. They may also derive abstract information about their experience, but thinking that is uniquely innovative relies, at least in part, on non-normative experience. This does not mean that non-schizophrenics are limited in their thinking, but a combination of divergent and convergent thinking may be required for creativity that addresses problems of thought productively.

If you take a person who has unusual and uncommon experience, such as the experience of a schizophrenic who is a divergent thinker, couple with the abilities of an abstract thinker, who sees the world on the level of symbols and concepts, and, add to this combination, the capacity for analytical reasoning, or the ability to sift though concepts and ideas so as to find ideas pertinent to the goals of his thought, this person might emerge as having qualities that do not generally correspond with norm. Moreover, it simply might be novel to find someone who has this combination of abilities.

Cultivating creativity might be an aspect of intellectual development that would be useful to people generally. This means that divergent thinking may be explored as an avenue to effective problem solving. It might be useful to make people aware of the copious details that underlie what might be dogmatic views of the world and the nature of problems that are associated with it. The stimuli and the goals of divergent thought may be recognized and utilized in a variety of contexts, such as academic and therapeutic contexts. This may not be limited to finger-painting and art therapy . It might apply to the goals of critical, analytical, and convergent thought.

The American Heritage Medical Dictionary, Boston : Houghton Mifflin Co., 2007.

Princeton Wordnet George A. Miller, A Lexical Database for English Communications of the ACM Vol. 38, No. 11: 39-41, 1995.

Collins English dictionary: complete and unabridged, 6th ed. Glasgow: HarperCollins, 2003.

Kallet, Michael, “Smarter, Critical Thinking to Improve Problem Solving and Decision Making Skills”, Wiley; 1 edition, 2014.

Random House Dictionary, Random House LLC. 2014.

Stannard-Gromish, Elizabeth (2010) The Dopamine Connection Between Schizophrenia and Creativity. Website: Psych Central, 2013.

Robert Unger, The relationship between two types of creativity, and psychosis ; Website: The Relationship Between “Schizophrenia” and other “Psychotic Disorders, 2009.

Ann Olson, Psy.D., is a doctor of psychology, a writer of fiction, creative nonfiction, and poetry.

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Schizophr Bull
v.34(1); 2008 Jan

Disorders of Thought Are Severe Mood Disorders: the Selective Attention Defect in Mania Challenges the Kraepelinian Dichotomy—A Review

C. raymond lake.

2 Department of Psychiatry, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7341

Questions About the Dichotomy of Disorders of Thought vs Disorders of Mood

Descriptions of the major psychiatric diseases were recorded in the 19th and early 20th centuries. Kraepelin described 2 distinct disorders (the Kraepelinian dichotomy), dementia praecox, renamed schizophrenia by Bleuler in 1911, and manic depressive insanity, now called bipolar disorder ( tables 1 and and2 2 ). 1 , 2 Kraepelin , Bleuler, Schneider, and others defined schizophrenia by the presence of disordered thought manifested in the psychotic symptoms of hallucinations, delusions, catatonia, and/or disorganization. 1 – 3 Bleuler and Schneider equated psychosis with schizophrenia, regardless of prominent mood symptoms. 2 , 3 The 1933 introduction of schizoaffective disorder by Kasanin recognized the importance of mood symptoms in psychotic patients, drew attention to similarities between bipolar and schizophrenia, and reflected an effort to erode the Kraepelinian dichotomy. 4 Despite this, the concept of schizophrenia, promoted by Bleuler and Schneider, has been influential and resistant to change in the United States where academic psychiatry has differentiated the mood disorders as disorders of the emotions from the schizophrenias as disorders of thought. A growing literature is challenging this concept.

DSM-IV-TR Diagnostic Criteria for Schizophrenia (Modified) a

1. Delusions

2. Hallucinations

3. Disorganized speech (frequent derailment, incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (affective flattening, alogia, and avolition)

B. Social/occupational dysfunction: work, interpersonal relations, or self-care have markedly deteriorated

C. Duration: continuous signs for 6 months with 1-month active-phase symptoms and may include prodromal or residual symptoms

D. Exclude schizoaffective and mood D/O with psychotic features

E. Exclude substance and general medical condition

F. Exclude preexisting pervasive developmental D/O

DSM-IV-TR Diagnostic Criteria and Specifiers for Mania (modified for brevity)

a. Diagnostic criteria for a manic episode (defines bipolar mood D/O)

A. Distinct period for at least 1 week (or inpatient hospitalization necessary) of abnormal and persistently elevated, expansive, or irritable mood

B. In the period, 3 symptoms (4 if mood is only irritable) persist to a significant degree

1. Distractibility

2. Insomnia with increased energy

3. Grandiosity/increased self-esteem

4. Flight of ideas

5. Increased activities: including phoning, spending, travel, investing, gambling, sex; excessive involvement in pleasurable activities with high potential for negative outcome

6. Speech: pressed to incoherent

7. Thoughts: racing, loose, tangential

C. Symptoms cause marked impairment in functioning (job, social, family) or hospitalization warranted because of severity of symptoms

D. Symptoms not due to substance or general medical condition

b. Specifiers for mood D/O diagnoses:

A. Presenting state—for bipolar: manic, depressed, mixed; for unipolar: single episode or recurrent

B. Severity: mild, moderate, severe without, severe with psychotic features ; partial, full remission

C. Course/onset: chronic (symptoms over 2 years) , seasonal affective D/O, rapid cycling (at least 4 episodes/year), postpartum onset (within 4 weeks), with or without full interepisode recovery

D. Features: catatonic , melancholic, atypical

Note : DSM -IV-TR , Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision ; D/O, disorders.

By 1978, Pope and Lipinski observed that patients with severe mood disorders did experience hallucinations, delusions, catatonia, and disorganization, which are, in fact, disorders of thought. 5 They and others have concluded that psychosis and disordered thought are common in severe bipolar and that many patients diagnosed with schizophrenia (because they experience hallucinations and/or delusions) are misdiagnosed and actually suffer from severe but unrecognized bipolar disorder. 5 – 13 Furthermore, chronicity of course, treatment resistance, or cognitive deficits do not distinguish these 2 disorders. 11 , 12 , 14 – 23 Persistent cognitive defects in executive function and working memory were initially associated with patients diagnosed with schizophrenia. 17 However, severe bipolar patients can suffer a chronic deteriorating course with similar permanent cognitive impairment that worsens with increasing episodes and impairs executive function and memory, even during remissions. 11 , 12 , 14 , 21 Similar neurodevelopmental defects have been suggested in the etiology of both bipolar disorder and schizophrenia. 22 , 23 Another realm of overlap is sleep disturbances that are common to patients diagnosed with schizophrenia and bipolar disorder. 24 , 25 Such phenotypic overlap supports the conclusion that schizophrenia may be the same disease as a psychotic mood disorder. 5 , 13 Is one of these a more valid disorder?

Selective Attention: the Brain's Filter/Prioritizer

The human brain possesses the ability to selectively process incoming information. Attention is part of this processing and is a multidimensional construct. Selective attention refers to those mechanisms which lead our consciousness to be dominated by 1 thing rather than another. 26 Partly under voluntary control, partly subconscious, and partly dependent on stimulus salience, some stimuli are processed more thoroughly than others. Experimental models, including Donald Broadbent filter theory and various cognitive neuroscience techniques in psychiatric patients, have focused on selective attention and its malfunction. 18 – 21 , 26 – 29 Selective attention appears to govern an initial filtration process that is linked with a prioritization mechanism before stimuli reach consciousness ( figures 1 –3). Stimuli that reach consciousness are the basis of thoughts, verbalizations, and actions. This filter/prioritizer enables one to screen out and avoid attending to extraneous distractions during a conversation or other focused activity such as an initial diagnostic interview. Although there is wide individual variability in what is likely to attract or distract one's attention, stimuli indicating emergency or life-threatening situations are universally given priority in euthymic individuals. For example, the smell of smoke appropriately overrides most conversations. By contrast, at a ball game, depending on their individual interests, a home run or touchdown might appropriately distract only some from a serious discussion.

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Object name is schbulsbm035f01_lw.jpg

Defective Selective Attention Is Observed as Manic Distractibility

Symptoms of Disordered Thought and Speech Traditionally Indicative of Schizophrenia or Mania

Schizophrenia	Mania
A disorder of thought	A disorder of mood
Delusions	Distractibility
Hallucinations	Racing thoughts
Disorganized speech	Flight of ideas
Disorganized behavior	Pressure of speech
Incoherence	Grandiosity
Paranoia
Catatonia
Tangentiality
Circumstantiality
Loose associations
Derailment
Blocking
Echolalia
Echopraxia
Clanging
Rhyming
Punning
Word salad
Ideas of reference
Ideas of influence

Student Case Conference

Other Signs and Symptoms Often Thought Indicative of Schizophrenia a

1. Loner; poor premorbid personality

2. Onset of psychotic illness in late adolescence or early adulthood

3. Disorder of thought, formal thought disorder

4. Derailment, tangentiality, loose associations, disorganization, blocking, incoherence, word salad, clanging, echolalia, echopraxia, speaking in tongues

5. Catatonia

6. Coprophagia, coprophilia

7. Downward drift in society and employment

8. Multiple, brief jobs

9. Street person

10. Ideas of control or reference, paranoia

11. Mood incongruent hallucinations and/or delusions

An external file that holds a picture, illustration, etc.
Object name is schbulsbm035f02_lw.jpg

An external file that holds a picture, illustration, etc.
Object name is schbulsbm035f03_lw.jpg

Defective Manic Sensory Processing Predisposes Grandiosity and Paranoia

The disease-specific manic symptom of grandiosity may also relate to this filter/prioritizer defect. In mania with psychotic features, the filter/prioritizer is so defective that judgment, insight, and the ability to discriminate reality from misperceptions and illusions are lost. Without adequate mechanisms to filter and evaluate data, illusions or misperceptions can be exaggerated to delusional fame, knowledge, and wealth. The occurrence of one such thought can stimulate an unfiltered sequence of progressively more grandiose delusions. Once manic patients are convinced they have special abilities, powers, ideas, knowledge, or wealth, the natural consequence is the occurrence of “paranoid delusions” that others want these possessions. Called “ideas of reference,” unrelated conversations or gestures by others in public, on television or radio, are personalized and are similarly misinterpreted and exaggerated as threatening. Such patients are dangerous because they may strike first, convinced they are in mortal danger. Because survival becomes the dominant focus, overriding and obscuring their grandiosity, patients' presenting complaints in the ED are fear and paranoia, not the grandiose delusions. 31 Ideas of reference and influence, held as pathognomonic of schizophrenia by Schneider 3 and the current DSM ( table 1 ), 30 have been discounted as disease-specific symptoms because they occur frequently in psychotic bipolar patients. 32 – 36 Pursuit of mood symptoms in such patients is critical because interviewer focus on the paranoid, psychotic symptoms can lead to the misdiagnosis of manic patients as schizophrenic, resulting in mismanagement.

Detrimental Effects of Misdiagnosis

Distractibility is an index of the severity of a core defect in information processing in the manic brain involving selective attention. 18 This breakdown in mania leads to gross disorganization of thought and behavior, hallucinations, delusions, and incoherence and seems to explain most of, if not all, the signs and symptoms of disturbed thought, traditionally attributed to schizophrenia ( tables 1, 3, and 4 ). The cognitive deficits in schizophrenia and bipolar share commonalities and overlap. 18 – 21 , 28 , 29 Adding further doubt to the dichotomy of schizophrenia and bipolar and suggesting common neuropathology is a rapidly growing body of phenotypic and genotypic data from a wide array of basic science and preclinical fields such as neurochemistry, 40 – 42 brain metabolism, 43 , 44 imaging, 45 , 46 epidemiology, 47 cognitive function (selective attention/insight), 14 – 23 , 28 , 29 , 48 and genetics 49 – 59 that show considerable similarities and overlap. Molecular genetic results reveal 5–9 shared susceptibility loci. 49 , 50 , 54 – 59 “The beginning of the end of the Kraepelinian dichotomy” has been predicted based on the phenotypic and genotypic overlap. 57 Data that have supported the dichotomy or shown a bimodal distribution of discriminate scores with a natural discontinuity might be explained by differences between psychotic and nonpsychotic mood disorders, not 2 separate disorders. As recently stated, “ … the validity of the diagnostic distinction between schizophrenia and bipolar disorder is increasingly challenged …. The diagnostic split between schizophrenia and bipolar disorder is unable to define distinct etiological and/or pathophysiological entities.” 60 and “Unfortunately, once a diagnostic concept such as schizophrenia … has come into general use, it tends to become reified. That is, people too easily assume that it is an entity of some kind that can be evoked to explain the patient's symptoms and whose validity need not be questioned.” 61 Disordered thought and the functional psychoses can be accounted for by a single disorder, the disorder we currently diagnose as bipolar disorder. A correct differential diagnosis is critical because psychotic bipolar patients misdiagnosed with schizophrenia or schizoaffective disorder do not receive standard of care treatment.

Acknowledgments

The author would like to acknowledge Heather Nachbar, Martha Mundis, and Anita Swisher for technical support.

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Trump keeps losing his train of thought. Cognitive experts have theories about why

By Olivia Goldhill Aug. 7, 2024

A screen shows former president Donald Trump's mouth as he speaks — politics coverage from STAT

I n a speech earlier this year, former President Trump was mocking President Biden’s ability to walk through sand when he suddenly switched to talking about the old Hollywood icon Cary Grant.

“Somebody said he [Biden] looks great in a bathing suit, right? When he was in the sand and he was having a hard time lifting his feet through the sand, because you know, sand is heavy. They figure three solid ounces per foot. But sand is a little heavy. And he’s sitting in a bathing suit. Look, at 81, do you remember Cary Grant? How good was Cary Grant, right? I don’t think Cary Grant — he was good. I don’t know what happened to movie stars today,” he said at a March rally in Georgia. Trump went on to talk about contemporary actors, Michael Jackson, and border policies before returning to the theme of how Biden looks on the beach.

This shifting from topic to topic, with few connections — a pattern of speech called tangentiality — is one of several disjointed and occasionally incoherent verbal habits that seem to have increased in Trump’s speech in recent years, according to interviews with experts in memory, psychology, and linguistics.

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COMMENTS

The Signs and Causes of Disorganized Speech
Contamination: fusing ideas into one another. Accelerated thinking: rapid flow and increased volume of speech. Flight of ideas: losing track of where a thought is going. Inhibited thinking: slow ...
The Mental Status Examination: Key Terms and Resources
Tangential speech is different from flight of ideas because flight of ideas involves pressured speech. Word Salad: A series of unrelated words. Word salad indicates extremely disorganized thinking. Clients who exhibit word salad are incoherent. (See the second half of the preceding "Dear Bill" letter for an example of word salad.)
Thinking Process Abnormalities in Schizophrenia
Disorganized thinking is one of the primary symptoms of schizophrenia. Disorganized thinking can lead to various thought process disorders that cause tangential thought, disjointed thoughts, a collapse or sudden stop in the thought process, randomly spoken words, and incoherence. Typically, we process our thoughts logically and coherently.
Thought Disorder
Incoherence (word salad, schizaphasia): severe lack of speech cohesion at the basic level of syntax and/or semantics within sentences; Illogicality: marked errors in inferential logic; Clanging: speech in which word choice is governed by word sound rather than meaning; word choice may show rhyming or punning associations
Flight of Ideas: Causes, Examples, Treatments, and More
Tangential speech: Also known as tangentiality, this describes the phenomenon in which a person constantly digresses to random, irrelevant ideas and topics. A person might start telling a story ...
How Schizophrenia Speech Patterns Can Manifest
processing speed. memory recall. attention. association. If you're unable to retrieve the memory of a word, for example, it might manifest as long pauses in your speech pattern. Or, you might ...
Decoding Word Salad: Understanding Disorganized Thinking in Psychology
Speech disorganization can manifest in rapid or incoherent speech patterns, tangential conversations, and even derailment into unrelated topics. Individuals experiencing disorganized thinking may exhibit cognitive deficits, showing challenges in logical reasoning, memory retention, and decision-making processes. ... A word salad is a type of ...
Disorganized Speech Example: Understanding Incoherent Communication
Tangential Speech: Tangential speech is one example of disorganized speech, in which the speaker frequently goes off-topic and struggles to maintain a coherent flow of information. ... Word Salad: Another example is word salad, where the speaker produces a jumble of words that lack meaningful connections or coherence. The resulting speech may ...
What Is Word Salad Schizophrenia?
They might change "piece" to "peace.". Or "bury" to "berry.". Here are a few examples of word salad: Bags stain purple vacuum. Running lately people purpose purple. Too often ...
Loose Associations
Tangential Speech: Individuals with loose associations often engage in tangential speech, where they shift from one topic to another without obvious links. ... Word Salad: In severe cases, loose associations can result in word salad, where the person's speech becomes incomprehensible due to the jumbling of words, phrases, and unrelated ideas.
Understanding Schizophrenia Speech Patterns
However, there are a few common forms of disorganized speech. Word salad: "Word salad" can describe a way of speaking that is incomprehensible to other people. For example, a person might string random words together, speak in sentence fragments, or change the order of words to the point where other people can't follow what they're ...
Episode 046: Do I have Schizophrenia?
Circumstantial speech - The person will eventually answer a question, but in a markedly roundabout manner. Derailment - The person suddenly switches topic without any logic or segue. Neologisms - The creation of new, idiosyncratic words. Word salad - Words are thrown together without any sensible meaning.
Language in schizophrenia Part 1: an Introduction
Schizophrenia is a devastating mental disorder that affects 1% of the world's adult population. Thought, language and communication dysfunction characterize all its symptoms, but manifest at their most extreme as positive thought disorder, with disorganized and sometimes unintelligible speech. This is the first of two articles that discuss ...
Tangential speech
Tangential speech or tangentiality is a communication disorder in which the train of thought of the speaker wanders and shows a lack of focus, never returning to the initial topic of the conversation. [1] It tends to occur in situations where a person is experiencing high anxiety, as a manifestation of the psychosis known as schizophrenia, in dementia or in states of delirium. [2]
Disorders of Thought Are Severe Mood Disorders: the Selective Attention
These disorganized and incoherent patterns of speech, called rhyming, punning, clanging, echolalia, and word salad, are traditionally associated with schizophrenia and not mania . An example of such manic incoherence comes from a recovered patient who said that, when manic, he had been able to focus on the first letter of each word spoken by ...
Different Types of Thought Disorders
Tangential thinking involves abrupt changes in subject matter that are unrelated to the initial topic. Clanging or clang association: A person with a clanging thought process makes word choices based on the sound of the word rather than the meaning of the word. They may rely on using rhymes, alliterations, or puns and create sentences that do ...
Disorganized Symptoms of Schizophrenia
Word Salad - Speaking with an unintelligible mix of random words and phrases. Graphorrhea - Writing with an unintelligible mixture of words and phrases. Thought Blocking - Abruptly stopping speech mid train of thought and then forgetting what one was talking about. Pressured Speech - Speaking at a fast, incomprehensible pace.
Positive Symptoms Of Schizophrenia: The Disorganized Dimension And
Word Salad—Speech may become so fragmented and disconnected that it resembles a "word salad," where words are put together without any apparent meaning or logic, rendering the conversation nearly impossible to comprehend. Disorganized Behavior: Contrary Actions—Actions that defy social norms are a hallmark of disorganized behavior.
Schizophrenia and the Family: Learning to Communicate
Schizophasia or "word salad" refers to the use of unrelated words or words with no meaning. Speech is incomprehensible. Perseveration is when the individual keeps repeating words or sentences.
Schizophrenia and Modes of Thought
In contrast, abstract thinking has positive connotations and creativity has quite positive connotations. Concrete thinking has been contended to be associated with schizophrenia, and divergent ...
Disorders of Thought Are Severe Mood Disorders: the Selective Attention
These disorganized and incoherent patterns of speech, called rhyming, punning, clanging, echolalia, and word salad, are traditionally associated with schizophrenia and not mania (table 3). An example of such manic incoherence comes from a recovered patient who said that, when manic, he had been able to focus on the first letter of each word ...
Disorganized Speech
Loose Associations (Tangential Speech) Speech moves quickly through multiple topics (seemingly unrelated, although connected in the patient's view) Schizophasia (Word Salad) Confused and repetitive speech; Use of unrelated words or words without meaning; Circumstantial Speech. Lengthy story of loosely related or unrelated details; Flight of ideas
Formal Thought Disorders
Formal Thought Disorders. Circumstantiality: overly detailed speech with eventual return to the topic of focus after many digressions. Schizophrenia, dementia. Tangentiality: continuous diversion from the topic of focus with no return to it. Looseness of associations: continuing change of topic with only loose associations between topics.
Experts: Trump speech patterns hint of potential cognitive decline
Increased tangentiality, all-or-nothing-thinking, and unusually simple sentence structure are called 'suggestive' of cognitive decline.

John Sommers-Flanagan

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Thinking Process Abnormalities in Schizophrenia

Thought Content vs. Thought Process

Causes of Disorganized Thinking

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Types of Disorganized Thinking

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Clang Associations

Incoherence

Treatment for Disorganized Thinking

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Decoding Word Salad: Understanding Disorganized Thinking in Psychology

What Is Disorganized Thinking?

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What Are the Signs and Symptoms of Disorganized Thinking?

Speech Disorganization

Confused Thought Processes

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Is Disorganized Thinking a Permanent Condition?

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Understanding the Salary of Clinical Psychologists

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Insight into Clinical Child Psychology

Understanding Schizophrenia Speech Patterns

Schizophrenia: An overview

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Disorders of Thought Are Severe Mood Disorders: the Selective Attention Defect in Mania Challenges the Kraepelinian Dichotomy—A Review

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Student Case Conference

Defective Manic Sensory Processing Predisposes Grandiosity and Paranoia

Detrimental Effects of Misdiagnosis

Acknowledgments

Formal Thought Disorders

Snapshot: Initialising...

Trump keeps losing his train of thought. Cognitive experts have theories about why

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