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Disorders of the thought process and thought content

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Disorders of the thought process and thought content

Two critical components of a mental health assessment are thought process and thought content. Assessment of an individual’s thoughts might be incorporated into the general patient interview.

Thought Process (Bickley et al., 2021)

The thought process describes “how” people think. It is the logic, organization, coherence and meaning of the patient’s thoughts resulting in the goal. Pay attention to any of the next speech patterns that suggest an abnormal thought process.

Sudden interruption of speech in the course of a sentence or before an idea is accomplished; the patient “loses thinking” Marked by schizophrenia.
Mild thought disorder; speech containing too many details, indirect, slow in attending to the purpose It appears in individuals with obsessions.
Words chosen based on sound reasonably than meaning (i.e. rhyming and wordplay) It occurs in schizophrenia and manic episodes.
Answers questions by providing false facts or events to fill within the gaps created by memory loss Observed in Korsakoff’s syndrome on account of alcoholism.
Extraneous statements and changing topics which might be loosely related or unrelated Observed in schizophrenia, manic episodes and other psychotic disorders.
Repeating other people’s words and phrases It occurs in manic episodes and schizophrenia.
Continuous flow of increased speech with rapid topic changes; changes are based on associations, word play, or distracting stimuli, however the ideas should not well related Often seen in manic episodes.
Unintelligible and irrational speech, devoid of meaningful connections, sudden changes in topic; grammatical or word usage disorders Observed in severe psychotic episodes (often in schizophrenia)
Fictitious, invented or distorted words Observed in schizophrenia, psychotic disorders and aphasia.
Constant repetition of words or ideas It occurs in schizophrenia and other psychotic disorders.

Thought Content (Bickley et al., 2021)

Thought content describes “what” the patient is pondering, including insight and judgment. When assessing the content of thoughts, allow the patient to take the initiative reasonably than asking direct questions. Notice any of the next patterns that suggest incorrect thought content.

Fear, worry, anxiety and/or physical symptoms of tension Anxiety disorders
Repetitive behaviors that the patient performs in response to the obsession to cut back anxiety; behaviors are excessive Anxiety disorders
Distorted personal beliefs that don’t change even within the face of contradictory evidence; delusions include:

  • Persecution – torment
  • Magnificent – pompous
  • Jealous – jealous
  • Erotomania – the idea that one other person is in love with a given person
  • Somatic – body functions or sensations
  • Unspecified – delusions with no particular persecutory or grandiose element; belief that external events, objects or people have personal significance (e.g. commands from the radio or television)
  • Psychotic disorders
  • Delirium
  • Severe mood disorders
  • Dementia
The feeling that one’s self or identity is different, modified, unreal, lost, or separated from the mind or body Psychotic disorders
Feeling that the environment are strange, unreal or distant Psychotic disorders
Persistent thoughts, images, or desires that appear invasive and unwanted; the patient tries to disregard or suppress the sensation with other thoughts or behaviors (i.e. compulsive behavior) Anxiety disorders
Constant irrational fears Anxiety disorders

General Guidelines for Effective Mental Health Interviewing (Lippincott Procedures, 2022)

Use these strategies when interviewing a patient to assist assess thought process and content.

  • Start the conversation with broad, empathetic statements.
  • Discuss normal behaviors before discussing abnormal ones.
  • Phrase questions sensitively to reduce patient anxiety.
  • Ask the patient to make clear unclear statements.
  • Help the patient consider the issues.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and interviewing (thirteenth ed.). Wolters Kluwer Health: Philadelphia.

Hinkle, J. (2021). Brunner and Suddarth’s textbook of medical-surgical nursing (fifteenth edition)vol ed.). Wolters Kluwer Health. https://wolterskluwer.vitalsource.com/books/9781975161057

Lippincott procedures. (2022, February 18). Psychiatric nursing assessment. https://procedures.lww.com/lnp/view.do?pId=858982&hits=assessment,assessment,mental,assessment,health

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