What is thought disorder. Features, types and characteristic signs of impaired thinking Disorders of thinking by pace

Thinking

Thinking is the main and specific cognitive process for a person, during which internal (semantic) connections are established dialectically, characterizing the structure of objects of reality, their relationship to each other and to the subject of cognitive activity. Thinking is closely connected with another basic cognitive process - the process of perception, and must have arisen as a result of its progressive evolutionary development. The struggle for existence, which is the main mechanism of species dynamics, forced at each moment of conflict interaction of competing individuals first to the maximum tension of physical forces (stress mobilization) in order to satisfy their unconditional needs (food, sexual, self-preservation), thereby ensuring the survival of the individual and the preservation of the species. . At a certain stage of development, when purely physical resources were exhausted, a more effective adaptive mechanism became the possibility of first generalizing, based on individual experience, the uniqueness of problem situations and their algorithmic resolution, and then the need to search for new non-standard (creative) solutions.

These circumstances have become a stimulus that provides a qualitative leap - the transition from the concretely perceived moment of being to the analytical-synthetic assessment of past experience and the prediction of one's behavior in the future. Thus, its temporal boundaries were expanded and prerequisites were created for the intensive development of other mental functions (long-term and short-term memory, imagination, perspective thinking, etc. - that is, consciousness and self-consciousness in the broad sense of this concept). In parallel and interdependently with these processes, new purely human properties arose and developed - the symbolism of language and speech, fine arts, the rudiments of religious feeling, the scientific consciousness of the world and one's place in it.

Thus, the transition from the system representations about the surrounding world, which gradually took shape on the basis of his individual and collective perception of the system concepts. The latter reflected the most significant signs of phenomena and objects that allow generalizations and developed into a picture understanding the surrounding world. The symbolism of language as a function of communication from a means of designating realities has increasingly turned into a means of communication, information exchange, forming the collective consciousness of the population. As well as specific concepts describing individual objects, phenomena (cat, table, fire) arose abstract, generalizing specific realities (animals, furniture, natural disasters).

The ability to form and assimilate semantic, generic concepts arises at a certain stage of the historical and ontogenetic development of mental activity and is called abstract thinking. The inability to operate with abstract concepts, subjective thinking based on insignificant features does not reveal the meaning of phenomena or leads to a contradictory (illogical) interpretation of their essence. This, in turn, indicates either an atavistic delay in its development, or the presence of a mental disorder.

The thinking of normal people organizes pictures of the surrounding and inner world on the basis of an analysis of cause-and-effect relationships, subjecting its results to experimental verification, and sooner or later it turns out to be able to reveal the internal connections of objects and phenomena.

Creative, or so-called dialectical, thinking, which is the basis of professional clinical, as the most productive form, is based on analysis and synthesis. Analysis involves finding out how a given object, object, phenomenon, due to its individual characteristics, differs from others that are outwardly similar. In order to establish this, it is necessary to study its structural and dynamic originality. In relation to the patient, this means the need to study the exclusivity of personal phenomenology, including the study of biological, mental and social status.

Synthesis, on the contrary, means the desire to establish internal connections of outwardly dissimilar objects, which is impossible either at the level of perception or at the level of specific formal thinking. Sometimes this connection is represented by only one characteristic, which, nevertheless, is fundamental. According to legend, the law of universal gravitation was revealed to Newton at the moment when an apple fell on his head. Perception of external signs indicates only the similarity of forms. Understanding the internal connections allows us to consider in one row completely different objects that have only one common quality - mass. The human mind, thanks to this property, is also capable of extrapolating a known internal connection beyond the limits of the experimental perception of space and time, which makes its possibilities practically limitless. This is how a person realizes the laws that govern the world, and the constant revision of existing ideas.

So-called formal thinking, which is atavistic or has painful causes, follows the path of analogies, which are established on the basis of external similarities, and therefore cannot be creatively productive. In medicine, it is called paramedical, but it is by no means the prerogative of paramedics. A doctor who thinks in this way, completing his special education, has canonized ideas about the register of existing, in his opinion, forms of diseases in their descriptive characteristics with an appropriate algorithm for subsequent actions. The diagnostic task is most often solved on the basis of a formal calculation of symptoms with the assignment of their array to a known nosological matrix. This happens according to the principle of answering the question: who does the bat look more like - a bird or a butterfly? In fact, a horse (both are mammals). Cognitive activity organized in this way can only cliché standard situations within the framework of solving the simplest problems. It needs guidance, control, and can only be acceptable to those who aspire to the role of an executor.

Thought disorders are detected either using test procedures (pathopsychologically) or on the basis of a clinical method in the analysis of the speech and written production of the subject.

There are formal disorders of thinking (disorders of the associative process) and the so-called pathological ideas.

Disorders of thinking in form (disorders of the associative process)

Thinking tempo disorders

Painfully accelerated thinking. It is characterized by an increase in speech production per unit of time. The basis is the acceleration of the flow of the associative process. The flow of thought is determined by external associations, each of which is an impetus for a new topic of reasoning. The accelerated nature of thinking leads to superficial, hasty judgments and conclusions. Patients speak hastily, without pauses, separate parts of the phrase are interconnected by superficial associations. Speech acquires the character of a "telegraphic style" (patients skip conjunctions, interjections, "swallow" prepositions, prefixes, endings). "Leap of ideas" - the extreme degree of accelerated thinking.

Painfully accelerated thinking is observed in manic syndrome, euphoric states.

Painfully slow thinking. In terms of pace, it is the opposite of the previous disorder. Often combined with hypodynamia, hypothymia, hypomnesia. It is expressed in speech retardation, stuckness. Associations are poor, switching is difficult. Patients in their thinking are not able to cover a wide range of issues. A few inferences are formed with difficulty. Patients rarely show speech activity spontaneously, their answers are usually laconic, monosyllabic. Sometimes contact cannot be established at all. This disorder is observed in depressions of any origin, with traumatic brain damage, organic, infectious diseases, epilepsy.

Violations of harmonious thinking

Broken thinking is characterized by the absence of logical agreements between words in the speech of patients; grammatical connections can be preserved at the same time. Nevertheless, the patient's speech can be completely incomprehensible, devoid of any meaning, for example: "Who can single out the temporal divergence of the relativity of concepts included in the structure of the universe," etc.

At incoherent thinking there are not only logical, but also grammatical connections between words. The speech of patients turns into a set of separate words or even sounds: “I’ll take ... I’ll get myself ... a day-stump ... ah-ha-ha ... laziness”, etc. This thought disorder occurs in schizophrenia, exogenous organic psychoses, accompanied by amental stupefaction.

Violation of purposeful thinking

reasoning(fruitless philosophizing, reasoning). Thinking with a predominance of lengthy, abstract, vague, often of little content reasoning on general topics, about well-known truths, for example, when a doctor asks “how do you feel?” talk for a long time about the benefits of nutrition, rest, vitamins. This kind of thinking is most common in schizophrenia.

autistic thinking(from the word autos - himself) - thinking, divorced from reality, contrary to reality, not corresponding to reality and not corrected by reality. Patients lose touch with reality, plunge into the world of their own bizarre experiences, ideas, fantasies, incomprehensible to others. Autistic thinking is one of the main symptoms of schizophrenia, but can also occur in other diseases and pathological conditions: schizoid psychopathy, schizotypal disorders.

Symbolic thinking. Thinking, in which ordinary, commonly used words are given a special, abstract meaning, understandable only to the sickest person. At the same time, words and concepts are often replaced by symbols or new words (neologisms), patients develop their own language systems. Examples of neologisms: "mirror aster, pince-necho, electric ekskvozochka." This kind of thinking occurs in schizophrenia.

Pathological thoroughness(detailedness, viscosity, inertia, stiffness, torpidity of thinking). It is characterized by a tendency to detail, getting stuck on particulars, “marking time”, inability to separate the main from the secondary, the essential from the unimportant. The transition from one circle of ideas to another (switching) is difficult. It is very difficult to interrupt the speech of patients and direct them in the right direction. This kind of thinking is most often found in patients with epilepsy, with organic diseases of the brain.

Perseveration of thinking. It is characterized by the repetition of the same words, phrases, due to the pronounced difficulty in the switchability of the associative process and the dominance of any one thought, idea. This disorder occurs in epilepsy, organic diseases of the brain, and in depressed patients.

Disorders of thinking by content

Includes delusional, overvalued and obsessive ideas.

crazy ideas.

They are false, erroneous judgments (inferences) that arose on a painful basis and are inaccessible to criticism and correction. A mistaken, but healthy person, sooner or later, can either be dissuaded, or he himself will understand the fallacy of his views. Delusion, being one of the manifestations of a disorder of mental activity in general, can be eliminated only through special treatment. According to psychopathological mechanisms, delusional ideas are divided into primary and secondary.

Primary delusion, or delusion of interpretation, interpretations arises directly from mental disorders and comes down to establishing incorrect connections, an incorrect understanding of the relationship between real objects. Perception here usually does not suffer. In isolation, primary delusional ideas are observed in relatively mild mental illnesses. The morbid basis here is most often a pathological character or personality changes.

Secondary or sensual delusions is a derivative of other primary psychopathological disorders (perception, memory, emotions, consciousness). Allocate hallucinatory, manic, depressive, confabulatory, figurative nonsense. It follows from the foregoing that secondary delirium occurs at a deeper level of mental disorder. This level or "register", as well as the delusions genetically associated with it, are called paranoid (in contrast to the primary - paranoid).

According to the content (on the topic of delusions), all delusions can be divided into three main groups: persecution, greatness and self-abasement.

To the group ideas of persecution delusions of poisoning, relationships, influences, persecution proper, "love charm" are included.

Delusional ideas of greatness also varied in content: delusions of invention, reformism, wealth, high birth, delusions of grandeur.

TO delusional ideas of self-deprecation(depressive delirium) include delusions of self-accusation, self-abasement, sinfulness, guilt.

Depressive plots are usually accompanied by depression and are presented asthenic. Paranoid delusions can be both asthenic and sthenic (“persecuted pursuer”).

Delusional Syndromes

paranoid syndrome characterized by a systematized delusion of attitude, jealousy, invention. The judgments and conclusions of patients outwardly give the impression of being quite logical, but they proceed from incorrect premises and lead to incorrect conclusions. This delirium is closely connected with the life situation, the personality of the patient, either altered by a mental illness, or being pathological from birth. Hallucinations are usually absent. The behavior of patients with paranoid delusions is characterized by litigation, querulant tendencies, and sometimes aggressiveness. Most often, this syndrome is observed in alcoholic, presenile psychoses, as well as in schizophrenia and psychopathy.

paranoid syndrome. Characterized by secondary delirium. The group of paranoid syndromes includes hallucinatory-delusional, depressive-delusional, catatonic-delusional and some other syndromes. Paranoid syndromes occur in both exogenous and endogenous psychoses.

In schizophrenia, one of the most typical variants of the hallucinatory-paranoid syndrome is often observed - Kandinsky-Clerambault syndrome, which consists of the following symptoms: pseudohallucinations, mental automatisms, delusional ideas of influence. Automatisms are called the phenomenon of loss of a sense of belonging to oneself thoughts, emotional experiences, actions. For this reason, mental actions of patients are subjectively perceived as automatic. G. Clerambo (1920) described three types of automatisms:

Ideatorny(associative) automatism is manifested in a feeling of extraneous interference in the course of thoughts, their insertion or withdrawal, breaks (sperrungs) or influxes (mentism), the feeling that the patient’s thoughts become known to others (symptom of openness), “echo of thoughts”, violent inner speech, verbal pseudo-hallucinations, perceived as a feeling of transferring thoughts over a distance.

Sensory(senestopathic, sensual) automatism. It is characterized by the perception of various unpleasant sensations in the body (senestopathy), a burning sensation, twisting, pain, sexual arousal as made, specially caused. Gustatory and olfactory pseudohallucinations can be considered as variants of this automatism.

Motor(kinesthetic, motor) automatism is manifested by a feeling of compulsion of certain actions, actions of the patient, which are performed against his will or caused by external influences. At the same time, patients often experience a painful feeling of physical lack of freedom, calling themselves “robots, phantoms, puppets, automata,” etc. (feeling of mastery).

The explanation of such inner experiences with the help of hypnosis, cosmic rays, or various technical means is called delusional impact and sometimes has a rather absurd (autistic) character. Affective disorders in this case are most often represented by a feeling of anxiety, tension, in acute cases - fear of death.

paraphrenic syndrome. It is characterized by a combination of fantastic, absurd ideas of grandeur with expansive affect, phenomena of mental automatism, delusions of influence and pseudo-hallucinations. Sometimes the patients' delusional statements are based on fantastic, fictitious memories (confabulatory delirium). In paranoid schizophrenia, paraphrenic syndrome is the final stage in the course of psychosis.

In addition to the chronic delusional syndromes described above, in clinical practice there are acutely developing delusional states that have a better prognosis (acute paranoia, acute paranoid, acute paraphrenia). They are characterized by the severity of emotional disorders, a low degree of systematization of delusional ideas, the dynamism of the clinical picture and correspond to the concept of acute sensory delirium. At the height of these states, there may be signs of gross disorganization of mental activity in general, including signs of impaired consciousness (oneiroid syndrome).

Acute sensual delusions can also be presented Capgras syndrome(Kapgra J., 1923), which includes, in addition to anxiety and ideas of staging, the symptom of twins. With a symptom negative twin the patient claims that a close person, for example, a mother or father, is not such, but is a dummy figure, disguised as his parents. Symptom positive twin consists in the belief that unfamiliar faces, who have specially changed their appearance, are presented to the patient as close people.

Cotard's syndrome(nihilistic delirium, delirium of denial), (Cotard Zh., 1880) is expressed in erroneous conclusions of a megalomaniac, hypochondriacal nature about one's health. Patients are convinced that they have a serious, fatal disease (syphilis, cancer), “inflammation of all the viscera”, they talk about the defeat of individual organs or parts of the body (“the heart has stopped working, the blood has thickened, the intestines have rotted, food is not processed and comes from the stomach through lungs to the brain”, etc.). Sometimes they claim to have died, turned into a rotting corpse, perished.

Overvalued ideas

Overvalued ideas- judgments that arise on the basis of real facts that are emotionally overestimated, exaggerated and occupy an unreasonably large place in the minds of patients, crowding out competing ideas. Thus, at the height of this process, with overvalued ideas, as well as with delirium, criticism disappears, which makes it possible to classify them as pathological.

Inferences arise both on the basis of the logical processing of concepts, ideas (rationally), and with the participation of emotions that organize and direct not only the process of thinking, but evaluate its result. For personalities of the artistic type, the latter can be decisive according to the principle: “if you can’t, but you really want to, then you can.” The balanced interaction of rational and emotional components is called affective coordination of thinking. Emotional disorders observed in various diseases and anomalies cause its violations. Overvalued ideas are a special case of an inadequately excessive saturation with the affect of any particular group of ideas, depriving all others of the competitiveness. This psychopathological mechanism is called the mechanism catathymia. It is quite clear that pathological ideas that arise in this way can have not only a personal, painful, situational conditionality, but also meaningfully related to life topics that cause the greatest emotional resonance.

These topics are most often love and jealousy, the significance of one's own activity and the attitude of others, one's own well-being, health and the threat of losing both.

Most often, overvalued ideas arise in a situation of conflict in psychopathic personalities, in the debut manifestations of exogenous-organic and endogenous diseases, as well as in cases of their mild course.

In the absence of a persistent disorganization of the emotional background, they can be of a transient nature and, when it is ordered, be accompanied by a critical attitude. Stabilization of affective disorders in the process of developing a mental illness or chronization of a conflict in abnormal personalities leads to a persistent decrease in critical attitude, which some authors (A.B. Smulevich) propose to call "overvalued nonsense."

Obsessions

Obsessions or obsessions, are pathological ideas that arise spontaneously, are of an obsessive nature, to which there is always a critical attitude. Subjectively, they are perceived as painful and in this sense are "foreign bodies" of mental life. Most often, obsessive thoughts are observed in diseases of the neurotic circle, however, they can also occur in practically healthy people with an anxious and suspicious nature, rigidity of mental processes. In these cases, they are usually unstable and do not cause significant concern. In mental illness, on the contrary, concentrating on oneself and on the fight against them all the activity of the patient, they are experienced as extremely painful and painful. Depending on the degree of emotional saturation, firstly, abstract (abstract) obsessions are distinguished. They can be represented by obsessive sophistication (“thinking chewing gum”), obsessive counting ( arithmomania).

Emotionally intense obsessions include obsessive doubts and contrast obsessions. With them, patients can return home many times, experiencing anxious doubts whether they closed the door, turned off the gas, iron, etc. At the same time, they are well aware of the absurdity of their experiences, but they are unable to overcome the doubts that arise again and again. With contrasting obsessions, patients are seized with fear of doing something unacceptable, immoral, illegal. Despite all the burdensomeness of these experiences, patients never try to realize the impulses that have arisen.

Obsessions are usually the ideational component of obsessive states and rarely occur in their pure form. In their structure, there is also an emotional component (obsessive fears - phobias), obsessive inclinations - compulsions, motor disorders - obsessive actions, rituals. In the most complete form, these violations are presented in the framework of obsessive-phobic syndrome. Obsessive fears (phobias) can have different content. In neurosis, they are most often understandable, closely related to the real life situation of the patient: fears of pollution and infection ( mysophobia), enclosed spaces ( claustrophobia), crowds and open spaces ( agoraphobia), of death ( thanatophobia). The most common obsessive fear of a serious illness ( nosophobia), especially in cases provoked psychogenically: cardiophobia, carcinophobia, syphilophobia, speedophobia.

In schizophrenia, obsessive experiences often have an absurd, incomprehensible, out-of-life content - for example, thoughts that ptomaine, needles, pins may be present in food consumed; domestic insects can crawl into the ear, nose, enter the brain, etc.

Anxious and intense affect in these cases is quite often weakened. rituals- a kind of symbolic protective actions, the absurdity of which the patients can also understand, but their implementation brings relief to the patients. For example, to distract themselves from obsessive thoughts about infection, patients wash their hands a certain number of times using soap of a certain color. To suppress claustrophobic thoughts, before entering the elevator, they turn around their axis three times. Such actions patients are forced to repeat many times with all the understanding of their meaninglessness.

Most often, obsessive-phobic syndrome is observed in obsessive-compulsive disorder. It can also occur within the framework of endogenous psychoses, for example, with neurosis-like debuts of schizophrenia, as well as with constitutional anomalies (psychasthenia).

One of the variants of obsessive-phobic syndrome is dysmorphophobic (dysmorphomanic) syndrome. At the same time, the patient's experiences are focused on the presence of either an imaginary or a real physical defect or deformity. They can be both intrusive fears and overvalued thoughts with a decrease or absence of a critical attitude, intense affect, secondary ideas of attitude, and incorrect behavior. In these cases, patients try to eliminate existing shortcomings on their own, for example, get rid of freckles with acid, fight excessive fullness by resorting to debilitating fasting, or turn to specialists to surgically eliminate what they think is a deformity.

Dysmorphomania syndrome can be observed in abnormal personalities in adolescence and adolescence, more often in girls. They also often have similar syndromes - anorexia nervosa syndrome and hypochondriasis. The delusional variant of the dysmophomania syndrome is most typical for the debut manifestations of paranoid schizophrenia.

Thinking disorder, also referred to as the term "thinking disorder", is a violation of thinking in its structure, content and pace (violation of the dynamics, motivational component and operational side). Impaired thinking can manifest itself in different ways and it is more correct to define a group of a number of disorders under such a generalization, which we will consider below.

Disturbance of thinking can manifest itself in the following forms:

Violations of the dynamics of thinking

Acceleration of thinking, jumps of ideas. Here, the violation of thinking manifests itself in the form of speech expression and an endless stream of various associations. Speech, like the thought process, is characterized by its own abruptness and incoherence. Any conclusions, images and associations appear spontaneously, any irritant can provoke their appearance, they are characterized by general superficiality. In this case, the patient talks non-stop, which can even lead to hoarseness, up to loss of voice. The difference from incoherent thinking is that in this case, the reproducible statements have a certain meaning. Accelerated thinking is characterized by chaotic and accelerated associations, spontaneous responses, expressive facial expressions and gestures, increased distractibility, the ability to analyze the awareness of actions and understand mistakes, and the ability to correct them.
Inertia of thinking. As characteristic signs corresponding to this disorder of thinking, one can designate the slowness of associations, the absence of any type of independent thoughts in the patient, lethargy. In this case, the answers to the questions are difficult, in general, their nature is monosyllabic and brief, the speech reaction differs significantly from the norm in terms of the degree of delay. When trying to switch the thought process to other topics, certain difficulties arise. A violation of this type of thinking is characteristic for states of clouding of consciousness (mild form), for asthenic and apathetic states, and for manic-depressive syndrome.
Inconsistency of judgments. This deviation is accompanied by instability of judgments, instability of associations while maintaining the ability to analyze, assimilate and generalize. This type of impaired consciousness accompanies manic-depressive psychosis, cerebral vascular pathologies, schizophrenia (within the remission stage), and brain injury.
Responsiveness. Under the responsiveness as a violation of thinking is understood an increased reaction to the impact of any type of stimulus, both related to it and not having it. Here, speech is “diluted” with those objects that surround a person, that is, the names of those objects that are in sight are simply reproduced aloud. Also, patients tend to lose orientation in space and time, they do not remember important events, names and dates. Behavior may be absurd, speech incoherent or with certain disorders. This disorder is relevant for those patients who have severe forms of cerebrovascular pathologies.
slippage. The disturbance manifests itself as a sudden deviation noted within the main line of reasoning, while slipping occurs to random associations. Subsequently, there may be a return to the original theme. Such manifestations are characterized by their own episodic and at the same time suddenness. Often they appear during the performance of exercises to identify the associative series. Comparisons in this case are random, in associations the replacement occurs with consonant words (rhyme, for example, “jackdaw - stick”, etc.). This type of disorder occurs in schizophrenia.

Impairments within operational thinking

Reduced level of generalization. Such a violation is characterized by difficulty in generalizing signs, that is, the patient is not capable of selecting signs and properties that, in general, could characterize any concept. The construction of generalizations comes down to replacing them with separate features, specific connections with objects, random aspects in certain phenomena. This phenomenon is typical for epilepsy, encephalitis, oligophrenia.
Generalization distortion. This type of thinking disorder consists in the inability to establish a basic defining relationship that applies to specific subjects. A person singles out only random aspects in a particular phenomenon and connections of a secondary scale between objects. Cultural and generally accepted definitions for the patient does not exist in principle. The combination of objects can be made on the basis of shape, material or color, that is, with the exception of their intended purpose and inherent functions. The listed features of impaired thinking are inherent in such diseases as psychopathy and schizophrenia.

Violations of the motivational component

Diversified thinking. In this case, we are talking about such a violation of thinking, in which the purposefulness of actions is absent as such. The patient is not able to carry out any classification for phenomena and objects, he cannot single out signs by which their generalization could be made. There are various mental operations (distinction, generalization, comparison, etc.), some instructions can be perceived, but not subject to execution. A person judges objects in planes different from each other, there is no consistency in this. The choice of objects and their classification can occur on the basis of their own preferences (habits, taste, perceptions). Judgments lack objectivity.
Reasoning. Violation of thinking is characterized by empty and meaningless verbosity, endless and lengthy reasoning is characteristic of a person, and they do not have any specific idea or goal. Discontinuity is characteristic of speech, in reasoning there is a constant loss of the thread connecting them. Quite often, "sophistication", being quite lengthy, is not connected with each other, there is no semantic load in them. Similarly, the object of thought itself may also be absent. The statements are rhetorical in nature; the speaker does not need a response or the attention of the interlocutor. The considered pathology of thinking corresponds to the condition of patients with schizophrenia.
Rave. Delusion is such a violation of thinking in which a person reproduces his own conclusions, ideas or ideas, and this information is in no way connected with the current environment. It does not matter to him whether the reproduced information corresponds to reality or not. Guided by this type of inference, a person, thereby, is in a state detached from reality, thereby being absorbed into a delusional state. It is impossible to dissuade a person that his delusional ideas are such, that is, he is completely sure of the truth of the ideas at the basis of delusion. Delusion in its specificity and content can manifest itself in various forms (religious delusion, delusion of poisoning, delusion of persecution, hypochondriacal delusion, etc.). As one of the most common variants of delusional states, anorexia is also considered today, in which an illusory perception of one's own weight is created, which is complemented by an unchanging desire to get rid of excess weight.
Uncriticality. This pathology of thinking is characterized by incompleteness and general superficiality of thinking. Thinking becomes unfocused, and therefore the actions and actions of the patient are not regulated.
Obsessive states. Pathology of this type is accompanied by phobias, experiences and thoughts that involuntarily appear in the mind. Obsessive states as a violation of thinking are not subject to meaningful control, their “companion” also becomes a gradual personality disorder. Also, obsessive states are accompanied by the implementation of certain actions (the impurity of the world surrounding a person becomes the reason for constant washing of hands after touching any objects, etc.).

Thinking

Thought disorders are detected either using test procedures (pathopsychologically) or on the basis of a clinical method in the analysis of the speech and written production of the subject.

There are formal disorders of thinking (disorders of the associative process) and the so-called pathological ideas.

Disorders of thinking in form (disorders of the associative process)

Thinking tempo disorders

Painfully accelerated thinking is observed in manic syndrome, euphoric states.

Violations of harmonious thinking

Violation of purposeful thinking

Disorders of thinking by content

Includes delusional, overvalued and obsessive ideas.

crazy ideas.

According to the content (on the topic of delusions), all delusions can be divided into three main groups: persecution, greatness and self-abasement.

To the group ideas of persecution delusions of poisoning, relationships, influences, persecution proper, "love charm" are included.

Delusional ideas of greatness also varied in content: delusions of invention, reformism, wealth, high birth, delusions of grandeur.

TO delusional ideas of self-deprecation(depressive delirium) include delusions of self-accusation, self-abasement, sinfulness, guilt.

Depressive plots are usually accompanied by depression and are presented asthenic. Paranoid delusions can be both asthenic and sthenic (“persecuted pursuer”).

Delusional Syndromes

Overvalued ideas

These topics are most often love and jealousy, the significance of one's own activity and the attitude of others, one's own well-being, health and the threat of losing both.

Obsessions

As a result of studying this chapter, the student should:

know

Forms of disorders in the course of mental operations and disorders of thinking, mainly related to the content of thoughts;

be able to

to differentiate, when working with a patient, disorders of speed, purposefulness and harmony of thought processes;
identify obsessive, overvalued and delusional ideas and differentiate them from each other;

own

Diagnosis of various types of disorders of mental operations in patients, using the method of clinical conversation and experimental psychological techniques.

Under thinking is understood as a purposeful mental process of establishing by a person essential for him at a given time and situation of connections, relations and qualities of perceived or represented objects. Disorders of mental operations, as well as disorders of perception, sharply affect the behavior of sick people of any age, making it inadequate to real circumstances.

In young children, manipulation of objects is the leading form of activity. Targeted transformative actions with objects underlie visual-effective thinking. It, of course, exists at other ages, but usually it is not the leading one, since it requires a lot of energy, time and is not always possible due to objective reasons (objects can be excessively large, heavy and inaccessible to work with them or dangerous).

Violations of this type of thinking can be registered already from the second half of the first year of a child's life. For example, in children with congenital mental retardation, manipulation of objects at an early and even preschool age can be completely unproductive - children shift objects from place to place, twist, toss them, do not build from cubes and sand, often destroying and scattering buildings of other children.

In patients with visual agnosia, with apraxia, visual-effective thinking at any age is unproductive. Even in the simplest everyday situations, if it is necessary to rearrange any objects in a certain way, the patients are helpless. Patients may show failure in solving constructive tasks.

With concrete-figurative thinking, the transformation of the original problem situation into a new one occurs not due to actions with objects, but due to the transformation of images of representations of these objects (secondary images). This type of thinking develops and is clearly presented starting from preschool age, therefore disorders of mental operations of this type can be recorded from this age period. Often, such disorders occur in people with organic brain damage (especially its parieto-occipital regions), with congenital and acquired dementia. At the same time, variants are possible in which the patient pays much more attention to manipulating images of representations than to reality, and thus can live mainly in his inner world, even ignoring reality (for example, in autistic syndrome).

However, in psychiatric illnesses, it is especially common violations of abstract-logical thinking When the purposeful manipulation of conventional signs and symbols that replace the objects of reality and their qualities is distorted, the laws of formal and dialectical logic are not observed. With a certain degree of conventionality, these disorders can be divided into two groups: "general" disorders; "local", associated mainly with a certain content.

1. "General" (formal, structural) thinking disorders.

This group can be divided into three subgroups:

- disorders of the rate of the flow of mental operations;
- disorders of purposeful thinking;
- Violations of its harmony, orderliness.

Violations of the tempo of the flow of thought with mental illness can be recorded from 2-3 years of age. For example, there is often an acceleration of thinking, which manifests itself in tahilalia(quick speaking) - patients literally choke on their own speech, “swallow” the endings of words and phrases. At the same time, their general activity, vigor in actions usually increases, and the movements of patients become swift and impetuous. Within certain limits, patients can be quite productive in their actions, but with a significant increase in the speed of mental operations, patients do not have time to bring each thought to its end, switching to the next one, which is also not completed, then the next, etc. Patients become inconsistent in their actions. Especially clearly the productivity of thinking suffers from a phenomenon called the "whirlwind of ideas." This phenomenon usually occurs in short-term attacks. At the same time, patients are in a stupor, experience fear or horror, and report that thoughts rush at such a great speed that it is impossible to express them in words. In childhood, this phenomenon is extremely rare.

The opposite is also possible, but speed disorder - slowing down the pace of mental operations. Speech in patients is slow, laconic, with long pauses. At the same time, they correctly assess everything that happens, but they do it extremely slowly. Patients also tend to move slowly. Their assessment of the speed of the flow of time is sometimes also distorted: patients have the impression of a sharp slowdown in the flow of time, up to its “stop” (usually in the presence of deep depression).

Purposeful Thinking Disorders are manifested in such symptoms as reasoning, thoroughness of thinking and pathological symbolism.

At reasoning the style of speech behavior is often pathos-rhetorical. The ultimate goal of the patient's reasoning is unclear, vague and, as a rule, irrelevant. Reasoning can be observed in patients from 3-4 years of age.

A four-year-old girl says: “We are all friendly here, we are good friends and love each other, because we are friends, we are friendly guys, which means that we have love. It's an important feeling that we need to play together. Friendship is like great love, and our love is great, great ... "

A 40-year-old patient, sitting with a doctor in the lobby of a hospital department, says: “We shouldn’t have settled here with you, it’s sad here. You look at the piano. What misery! He stands on three legs. It's the disabled person. All life on earth has four limbs. It's beautiful, durable and reliable. Look - the table has four legs, and the chair has four legs. There goes the cat. She also has four legs. Four is the square, the perfect form, and the form determines the content of what four is. Four heads are better than two. And the space must be four-dimensional. And the engine is four-stroke. And there should be four children in the family ... "

Thinking disorder can manifest itself in excessive detail, excessive detail, viscosity. The longer the patient argues, the more he deviates from the main topic of the statement, attracting a lot of unnecessary, unimportant details. The pace of speech can be normal.

A five-year-old boy answers a question about his name: “They wanted to call me Alyosha, and when I was born, my parents lived in the South in a small house. Cherries grew near the house. My mom brought me some delicious jam. There are cherries. If you want to eat, take it, it's very tasty and pitted. Mom says that you need to eat fruit ... "

Speech thinking, as operating with signs that replace objects and their qualities, not only ensures its own activity, but also allows you to receive from other people and transmit to them the necessary information. When perceiving and transmitting information, words have not only a certain range of meanings, but also an individual meaning, often embedded in the context of statements. However, this meaning is usually quite clear to people receiving this information. In mental illness, the individual meaning of statements may be difficult or inaccessible to understanding by other people, which sharply violates the adequacy of the patient's communication.

A 55-year-old patient, entering the doctor's office, says: “Doctor, please open the book that you are holding in the middle. Yesterday I told one side of my unlucky life. But there is another, second half, and I would like to talk about it ... ”If the patient did not comment on the first phrase, but limited herself only to it, then it would be impossible to understand the meaning of her statement.

Pathological symbolism often manifested in the work of the mentally ill.

A 42-year-old patient, being treated in a psychiatric hospital, hung a lot of drawings in his ward, each of which featured a lot of animals and a naked woman in the plot. When asked by the doctor why there is only such a storyline in different drawings, the patient replied: “You see that everywhere there are women without clothes, and they like to dress, which means that they need to be provided first of all with fabrics. It is necessary to develop weaving production in Russia.” After these words, the patient took out a lot of drawings from his folder (completely ridiculous in fact) and declared that in them all the details of the machines are encrypted in separate elements of the animals depicted in the drawings: for example, the neck of a goose means a detail of the G-1 machine, and the head of a giraffe - detail "Zh-2", etc.

Disorders of harmony, orderliness of speech signs in the process of thinking can be expressed in influxes and breaks in thought, in perseverations, fragmentation and incoherence of speech-thinking operations. In the influx of thoughts, patients register several thoughts with different content at the same time, because of which the productivity of their thinking decreases. Patients usually sit in a stupor and experience horror at such moments, noting that thoughts seem to creep on each other, twist into a ball, interfere with each other.

At broken thoughts there is, as it were, a sudden cessation and forgetting of what the patient has just been thinking about, and during illness this happens so often that the productivity of activity is disturbed.

Perseverations consist in the involuntary repeated repetition of the same thought, phrase, word or syllable by the patient. For example, a three-year-old patient says: “Mishenka will go for a walk now, go for a walk, walk, now he will go for a walk, walk, walk ...” A patient at the age of 65, in response to any question, stereotypically and monotonously repeats: “This is not a hospital, but a prison , and prison, and prison, prison, prison ... "

Fragmentation of thinking characterized by a break in the logical connection between individual thoughts, phrases, words, but at the same time the general structure of the laws of the language is preserved, i.e. there is a correct agreement of words with each other, the use of punctuation marks in written speech. For example, a 12-year-old patient reports: “I decided to leave the hospital this morning because the weather for breakfast is the same. Like yesterday and tomorrow, but in the movies I didn’t lie in slippers. They are green and fluffy for me, like a steamer in the ocean of streets and lanes, as well as nooks and crannies on marmalade, which I love ... "

With the incoherence of thinking and speech in the statements of patients, both the logical and grammatical connection between words and phrases is broken. This is especially often observed in patients with disorders of consciousness.

A 42-year-old patient says: “This is, well ... oh, how ... where will he go, a beautiful glass ... ah. .boo".

2. In the second group of disorders of abstract-logical thinking, pathology is mainly limited to a certain content of the patient's statements: these are dominant, overvalued, obsessive, violent and delusional ideas.

Dominant Ideas inherent in any healthy and sick person. These are thoughts that are relevant to a person at a given moment in time, they prevail over all other plots. As soon as the need underlying the generation of this thought is satisfied, it will cease to dominate and another will appear. When communicating with a patient, it makes sense for a specialist to have a productive contact with what is now relevant for the patient, and continue the clinical conversation, having exhausted the patient's interest and attention to this content.

Under overvalued ideas understands such thoughts that a person seems to be extremely important for a long time. This does not mean that he is constantly focused on them, but on the whole the patient subordinates his life activity to the realization of this idea. He is, as it were, emotionally brightly “charged” with them, involved in them so much that he subordinates everything in his life to the realization of an overvalued idea. However, it is impossible to exhaust it, to saturate it to the limit, to the end. For example, a passionate collector of paintings, stamps and other things is never able to collect everything completely, but spends all his free time, energy, money on collecting. Thus, super-chain ideas turn out to be closely “soldered” both with a person’s personality and with a certain life situation, which is brought to a kind of grotesque, although, in principle, it is not completely absurd. Such ideas rarely occur in people before adolescence. They appear both in mental illness and quite often in people with predominantly psychopathic personality traits.

obsessive thoughts are characterized by the absurdity of the content and do not correspond to the circumstances at all, making it difficult for a person to adequately perform actual actions. People always critically evaluate their obsessive thoughts, try to force them out by force of will, distraction, get rid of them and not implement them in actions. However, while suppressing obsessive thoughts, they experience growing anxiety, emotional tension, discomfort, suffer and, in order to relieve this growing painful tension, nevertheless fulfill their “obsession”, experiencing for some time a sense of relief and release from them. But after a pause, obsessive thoughts reappear, and the patient's struggle with them continues painfully. Obsessive thoughts can be in the form of memories, reasoning, fruitless sophistication, recalculation of something, urges to some ridiculous actions, etc. .e. actions that replace obsessive plots, but in fact are also obsessive.

For example, a patient at the age of 31, in order not to be tormented by obsessive thoughts about an electrical appliance turned off or not turned off at home, went down and up the stairs to his fourth floor three times a day, after which he calmed down and went to work. Obsessive thoughts can appear in patients from preschool age.

At violent (compulsive) thoughts, also absurd, inadequate to reality, patients treat them critically, but there is no struggle with them, therefore, after the appearance of a violent thought, patients immediately implement it in actions. Such thoughts are usually simple, elementary in content: throw something, break something, hit someone, jump up, shout, etc. Violent thoughts and actions can appear in patients from early childhood.

crazy ideas are false judgments and conclusions of a sick person, the truth of which he does not doubt, and under the influence of real facts of reality and counterarguments of the surrounding people, these ideas in the patient cannot be corrected, dissuaded and critical of them. The patient is unable to consider his statements from a point of view other than his own. He does not catch contradictions, logical inconsistencies in his reasoning, turning any counterarguments of the interlocutor into "evidence" of the validity of his own false conclusions. At the same time, the patient can become angry with the person who objects to him, become aggressive towards him, and even involve him in the plot of his crazy ideas.

A person becomes capable of sufficient formal-logical operations by the age of 10-12, and a deep understanding and use of dialectical logic - by adolescence. Therefore, clearly formulated delusions rarely occur in patients younger than 10-11 years. In children of preschool and primary school age, delusional fantasies may appear in the structure of mental illness. Unlike delirium, such statements are very changeable in details, they easily modify the plot under the influence of objections, but the main core of false statements remains constant.

Crazy ideas are primary and secondary.

Secondary delusion arises in connection with and on the basis of the pathology of other mental processes. Suppose a patient has hallucinations of a frightening nature, he hears the voices of people who are going to kill him, therefore, being convinced of the reality of the hallucinatory plot, he barricades himself in his house, arm himself and is confident in the correctness of his actions. Secondary delirium can also occur against the background of vivid emotional disturbances. For example, with deep depression, patients develop delusions of self-accusation, and against the background of delight from the perception of great works of art, architecture, or places of ancient human history, some individuals may develop delusions of reincarnation into biblical characters (Jerusalem syndrome). At a later age, patients often have delusions of damage, etc., against the background of anxiety.

Primary delusion is formed in patients without a noticeable connection with disorders of other mental processes. Often at the beginning of a painful process, a delusional mood appears with an anxious search for some special hidden meaning in the environment. Then there is a delusional perception, in which the patient registers in the surrounding objects of reality, in the actions of people, some special, hidden, but incomprehensible meaning. And, finally, the patient may form an interpretive primary delusion of attitude and special meaning, which is gradually systematized and the patient becomes "everything is clear and understandable." This clarity, "crystallization of delirium" in some patients occurs quite quickly in the form of the phenomenon of "insight", "eureka". The specific content of delusions may be related to the age, gender, cultural and intellectual level of the patient, his lifestyle, ethnicity and, of course, the nature of the mental illness. According to its plot orientation, there may be delusions of persecution, damage, influence, poisoning, greatness, reincarnation into another person or animal, etc. In any case, delirium grossly violates the adequacy of the behavior of a sick person and his actions can be dangerous both for himself and for those around him. Despite a certain connection of delusional ideas with some personal characteristics of patients, they cannot be derived from these characteristics according to psychological patterns. Delusion is a psychopathological phenomenon, and a sick person thinks and acts differently when it is present than in a healthy state.

Control questions and tasks

1. What is thinking?
2. Name the types of thinking.
3. What are the signs of disturbances in the rate of mental operations?
4. Name the similarities and differences between detailed thinking and reasoning.
5. Name the similarities and differences between broken thinking and incoherent thinking.
6. List the signs of pathological symbolism in the thinking of sick people.
7. What is the difference between dominant and overvalued ideas?
8. Name the similarities and differences between overvalued and crazy ideas.
9. Describe obsessive thoughts.
10. Name the similarities and differences between obsessions and delusions.
11. Specify the types of delusions.
12. What are the age-related features of thinking disorders?

Thinking is, first of all, a kind of activity that is based on a system of concepts, has a focus on solving any problems, obeys goals, taking into account the conditions in which a particular task is carried out.

Thinking disorders differ from any other disorders in complexity and great variety. The study of thinking in most cases comes down to the analysis of written and oral speech, since the thought process is very closely connected with speech. The adequacy of the performance of special tests and the behavior of a person in a given situation are also assessed.

All thinking disorders can be divided into three large groups:

1. Violations associated with the operational side of thinking (disorders of the generalization process);

2. Violations associated with the dynamics of thinking (disorders of the logical course of thought);

3. Violations on the part of the motivational component (disorders of purposeful thinking).

Thinking Disorders: Operating System Disorders

The level of the generalization process is distorted or reduced. In judgments of the patient direct ideas about the phenomena and processes can prevail. Operating with generalizing features can be replaced by the establishment of a purely personal, specific relationship to objects. Such a patient, when performing a test task, will not be able to choose from the proposed signs those that are the most generalizing and essential. The level of generalization is so reduced that, for example, he does not understand what the difference is between a crow and a dog, between a plate and a table.

If the generalization process is distorted, judgments will reflect only the random side of the phenomenon. When performing a test task, the patient can identify particular properties and signs that do not reflect either the semantic relationships between phenomena or the content between them. In most cases, such thinking disorders are observed in patients with schizophrenia, but sometimes they can also occur with other diseases.

Thinking disorders: disturbances in the dynamics of thinking

In people subsequently severe craniocerebral trauma, as well as in patients with epilepsy, mental disorders are often detected that are directly related to the dynamics of mental processes. In psychiatry, these disorders are referred to as "viscosity". The patient cannot change the course of his judgments and switch to some other one. In addition, such a patient is characterized by slowness of all intellectual processes.

In manic-depressive psychosis, people have another violation of the dynamics of thinking - lability. This type of violation is characterized by the instability of all intellectual processes. The patient cannot consistently reason for a long time, despite the fact that his level of generalization is not reduced. With all this, any association that has arisen, an idea is reflected in his speech. There is a violation of the logic of reasoning, which manifests itself in the form of some jumps of ideas - a person constantly jumps to another thought.

In schizophrenics, slowing down or speeding up thinking is often combined with a feeling of imposition of thoughts from the outside, or vice versa, with the forcible taking away of thoughts.

Thinking disorders: violations of the motivational component

These are regulatory and criticality violations, which include:

1. Fragmentation of thinking - a violation of the links between different judgments, concepts, as a result of which, with a preserved grammatical structure, speech loses its meaning.

2. Reasoning - empty reasoning, not supported by real facts.

3. Pathological thoroughness - a slow transition from one thought to another, getting stuck on unimportant details and a complete loss of the ultimate goal of the whole conversation.

With such violations, a person loses objectivity, due to which his own idea of the world appears in the form of overvalued ideas, and various types of nonsense.