thought disorder thought disorder a thought disorder (td) is a disturbance in cognition which affects language, thought and communication. psychiatric and psychological glossaries in 2015 and 2017 identified thought disorders as encompassing poverty of ideas, neologisms, paralogia, word salad, and delusions - all disturbances of thought content and form. two specific terms have been suggested - content thought disorder (ctd) and formal thought disorder (ftd). ctd has been defined as a thought disturbance characterized by multiple fragmented delusions, and the term thought disorder is often used to refer to an ftd: a disruption of the form (or structure) of thought. also known as disorganized thinking, ftd results in disorganized speech and is recognized as a major feature of schizophrenia and other psychoses (including mood disorders, dementia, mania, and neurological diseases). disorganized speech leads to an inference of disorganized thought. thought disorders include derailment, pressured speech, poverty of speech, tangentiality, verbigeration, and thought blocking. one of the first known cases of thought disorders, or specifically ocd as we know it today, was in 1691. john moore, who was a bishop, had a speech in front of queen mary ii, about "religious melancholy." thought disorderother namesformal thought disorder (ftd), thinking disordercloth embroidered by a person diagnosed with schizophrenia; non-linear text has multiple colors of threadspecialtypsychiatry, clinical psychology formal thought disorder affects the form (rather than of the content) of thought. unlike hallucinations and delusions, it is an observable, objective sign of psychosis. ftd is a common core symptom of a psychotic disorder, and may be seen as a marker of severity and as an indicator of prognosis. it reflects a cluster of cognitive, linguistic, and affective disturbances that have generated research interest in the fields of cognitive neuroscience, neurolinguistics, and psychiatry. eugen bleuler, who named schizophrenia, said that td was its defining characteristic. disturbances of thinking and speech, such as clanging or echolalia, may also be present in tourette syndrome; other symptoms may be found in delirium. a clinical difference exists between these two groups. patients with psychoses are less likely to show awareness or concern about disordered thinking, and those with other disorders are aware and concerned about not being able to think clearly. content thought disorder content thought disorder is a thought disturbance in which a person experiences multiple, fragmented delusions, typically a feature of schizophrenia and some other mental disorders which include obsessive-compulsive disorder and mania. at the core of thought content disorder are abnormal beliefs and convictions (after taking the person's culture and background into consideration) ranging from overvalued ideas to fixed delusions. these beliefs and delusions are typically non-specific diagnostically, even if some delusions are more prevalent in one disorder than another. neurotypical thought—consisting of awareness, concerns, beliefs, preoccupations, wishes, fantasies, imagination, and concepts—can be illogical, and can contain contradictory beliefs and prejudices or biases. individuals vary considerably, and a person's thinking may also shift from time to time. content thought disorder is not limited to delusions. other possible abnormalities include suicidal, violent, and homicidal ideas and: preoccupation: centering thought on a particular idea in association with a strong affection obsession: a persistent thought, idea, or image which is intrusive or inappropriate, and distressing or upsetting compulsive behavior: the need to perform an act persistently and repetitively (without it necessarily leading to a reward or pleasure) to reduce distress magical thinking: belief that one's thoughts alone can bring about effects in the world, or that thinking something corresponds with doing that thing overvalued ideas: false or exaggerated belief held with conviction, but without delusional intensity phobias: irrational fears of objects or circumstances in psychosis, delusions are the most common thought content disorder. a delusion is a firm, fixed belief based on inadequate grounds, not amenable to rational argument or evidence to the contrary, which is out of sync with a person's regional, cultural, or educational background. delusions are common in people with mania, depression, schizoaffective disorder, delirium, dementia, substance use disorders, schizophrenia, and delusional disorders. common examples in a mental status examination include the following: erotomania: belief that someone is in love with oneself grandiose delusions: belief that one is the greatest, strongest, fastest, richest, or the most intelligent person ever persecutory delusion: belief that the person, or someone to whom the person is close, is being malevolently treated in some way ideas and delusions of reference: belief that insignificant remarks, coincidental events, or innocuous objects in one's environment have personal meaning or significance thought broadcasting: belief that others can hear (or are aware of) one's thoughts thought insertion: belief that one's thoughts are not one's own, but belong to someone else and have been inserted into one's mind thought withdrawal: belief that thoughts have been "taken out" of one's mind, and one has no power over this influence: belief that other people (or external agents) are covertly exerting power over oneself outside control: belief that outside forces are controlling one's thoughts, feelings, and actions infidelity: belief that a partner is cheating on oneself somatic: belief that one has a disease or medical condition nihilistic: belief that the mind, the body, the world at large, or parts thereof no longer exist formal thought disorder formal thought disorder (ftd) is also known as disorganized speech. evidence of disorganized thinking, it is a hallmark feature of schizophrenia. ftd, a disorder of the form (rather than content) of thought, encompasses hallucinations and delusions and is an observable sign of psychosis. a common, core symptom of psychosis, it may be seen as a marker of severity and a predictor of prognosis. ftd reflects a cluster of cognitive, linguistic, and affective disturbances which has generated research interest from the fields of cognitive neuroscience, neurolinguistics, and psychiatry. it can be subdivided into clusters of positive and negative symptoms and objective (rather than subjective) symptoms. on the scale of positive and negative symptoms, they have been grouped into positive formal thought disorder (posftd) and negative formal thought disorder (negftd). positive subtypes were pressure of speech, tangentiality, derailment, incoherence, and illogicality; negative subtypes were poverty of speech and poverty of content. the two groups were posited to be at either end of a spectrum of normal speech, but later studies showed them to be poorly correlated. a comprehensive measure of ftd is the thought and language disorder (tald) scale. the kiddie formal thought disorder rating scale (k-ftds) can be used to assess the presence of formal thought disorder in children and their childhood. although it is very extensive and time consuming, its results are in great detail and reliable. nancy andreasen preferred to identify tds as thought-language-communication disorders (tlc disorders). up to seven domains of ftd have been described on the thought, language, communication (tlc) scale, with most of the variance accounted for by two or three domains. some tlc disorders are more suggestive of severe disorder, and are listed with the first 11 items. diagnoses the dsm v categorizes ftd as "a psychotic symptom, manifested as bizarre speech and communication." ftd may include incoherence, peculiar words, disconnected ideas, or a lack of unprompted content expected from normal speech. clinical psychologists typically assess ftd by initiating an exploratory conversation with patients and observing the patient's verbal responses. ftd is often used to establish a diagnosis of schizophrenia; in cross-sectional studies, 27 to 80 percent of patients with schizophrenia present with ftd. a hallmark feature of schizophrenia, it is also widespread amongst other psychiatric disorders; up to 60 percent of those with schizoaffective disorder and 53 percent of those with clinical depression demonstrate ftd, suggesting that it is not exclusive to schizophrenia. about six percent of healthy subjects exhibit a mild form of ftd. the characteristics of ftd vary amongst disorders. a number of studies indicate that ftd in mania is marked by irrelevant intrusions and pronounced combinatory thinking, usually with a playfulness and flippancy absent from patients with schizophrenia. the ftd present in patients with schizophrenia was characterized by disorganization, neologism, and fluid thinking, and confusion with word-finding difficulty. there is limited data on the longitudinal course of ftd. the most comprehensive longitudinal study of ftd by 2023 found a distinction in the longitudinal course of thought-disorder symptoms between schizophrenia and other psychotic disorders. the study also found an association between pre-index assessments of social, work and educational functioning and the longitudinal course of ftd. possible causes several theories have been developed to explain the causes of formal thought disorder. it has been proposed that ftd relates to neurocognition via semantic memory. semantic network impairment in people with schizophrenia—measured by the difference between fluency (e.g. the number of animals' names produced in 60 seconds) and phonological fluency (e.g. the number of words beginning with "f" produced in 60 seconds)—predicts the severity of formal thought disorder, suggesting that verbal information (through semantic priming) is unavailable. other hypotheses include working memory deficit (being confused about what has already been said in a conversation) and attentional focus. ftd in schizophrenia has been found to be associated with structural and functional abnormalities in the language network, where structural studies have found bilateral grey matter deficits; deficits in the bilateral inferior frontal gyrus, bilateral inferior parietal lobule and bilateral superior temporal gyrus are ftd correlates. other studies did not find an association between ftd and structural aberrations of the language network, however, and regions not included in the language network have been associated with ftd. future research is needed to clarify whether there is an association with ftd in schizophrenia and neural abnormalities in the language network. transmitter systems which might cause ftd have also been investigated. studies have found that glutamate dysfunction, due to a rarefaction of glutamatergic synapses in the superior temporal gyrus in patients with schizophrenia, is a major cause of positive ftd. the heritability of ftd has been demonstrated in a number of family and twin studies. imaging genetics studies, using a semantic verbal-fluency task performed by the participants during functional mri scanning, revealed that alleles linked to glutamatergic transmission contribute to functional aberrations in typical language-related brain areas. ftd is not solely genetically determined, however; environmental influences, such as allusive thinking in parents during childhood, and environmental risk factors for schizophrenia (including childhood abuse, migration, social isolation, and cannabis use) also contribute to the pathophysiology of ftd. the origins of ftd have been theorised from a social-learning perspective. singer and wynne said that familial communication patterns play a key role in shaping the development of ftd; dysfunctional social interactions undermine a child's development of cohesive, stable mental representations of the world, increasing their risk of developing ftd. treatments antipsychotic medication is often used to treat ftd. although the vast majority of studies of the efficacy of antipsychotic treatment do not report effects on syndromes or symptoms, six older studies report the effects of antipsychotic treatment on ftd. these studies and clinical experience indicate that antipsychotics are often an effective treatment for patients with positive or negative ftd, but not all patients respond to them. cognitive behavioural therapy (cbt) is another treatment for ftd, but its effectiveness has not been well-studied. large randomised controlled trials evaluating the effectiveness of cbt for treating psychosis often exclude individuals with severe ftd because it reduces the therapeutic alliance required by the therapy. however, provisional evidence suggests that ftd may not preclude the effectiveness of cbt. kircher and colleagues have suggested that the following methods should be used in cbt for patients with ftd: practise structuring, summarising, and feedback methods repeat and clarify the core issues and main emotions that the patient is trying to communicate gently encourage patients to clarify what they are trying to communicate ask patients to clearly state their communication goal ask patients to slow down and explain how one point leads to another help patients identify the links between ideas identify the main affect linked to the thought disorder normalise problems with thinking signs and symptoms language abnormalities exist in the general population, and do not necessarily indicate a condition. they can occur in schizophrenia and other disorders (such as mania or depression), or in anyone who may be tired or stressed. to distinguish thought disorder, patterns of speech, severity of symptoms, their frequency, and any resulting functional impairment can be considered. symptoms of td include derailment, pressured speech, poverty of speech, tangentiality, and thought blocking. ftd is a hallmark feature of schizophrenia,