Thinking Problems-Reality Testing Checklist and Early Screening
Thinking Problems
A. Thinking problems in mental health are underestimated as sources of distress and impairment especially when mild or overshadowed by more dramatic symptoms such as anger, depression, anxiety and behavioral disruptions.
B. Severe thinking problems are missed because they are not looked for, asked about or their manifestations are not recognized, until they are so severe that they are difficult to miss by anyone, as is their presentation as full blown psychotic behavior or as in Schizophrenia.
C. Schizophrenia in many ways can be the most impairing of mental health disorders, and it can be used to study thinking problems their diagnosis and treatment.
D. Symptoms of Schizophrenia fall into two broad categories positive symptoms reflecting and excess and distortion of normal functions, and negative symptoms reflect a diminution or loss of normal function.
E. Positive symptoms include hallucinations, delusions and disorganized thinking and behavior.
F. Negative symptoms include decreased or lack of the following a) emotional expression, b) in thought and speech, c)in goal directed behavior, and d)of normal pleasure in things.
G. Diagnosis of Schizophrenia is made when two or more of the following symptoms have been present for at least one month, with impairment of functioning at home, work, school, or relationships for a duration of six months. The symptoms are 1) delusions- false beliefs not based on reality, 2) hallucinations- hearing, seeing things that aren’t really there or other similar sensory experiences, 3) disorganized speech- caused by loose connections, derailment, illogicalness, thought blocking, 4) disorganized illogical behavior or catatonia-peculiar or excessive motor behavior, or stupor, or negativism and mutism 5) negative symptoms
H. Good prognostic features include, 1)onset of psychotic symptoms within four week, 2) confusion at the height of psychotic episode, 3) good premorbid functioning, 4) absence of blunted or flat affect or emotional responses
I. Early mild and subtle manifestations of both positive and negative symptoms can be seen in other mental health disorders besides Schizophrenia, including as personality traits that need to be recognized so appropriate and early medication management may occur.
Thinking-Reality Testing Symptom Clusters
1) [ ]Hallucinations- hearing, seeing, tasting, feeling, smelling or sensing things that aren’t real
2) [ ]Delusions – believing things that aren’t based on reality, like one is god, the famous, very bad
3) [ ]Paranoia - reading hidden meanings into things, people out to get, hurt, deceive, harm you
4) [ ]Oddness – being peculiar, different, strange, bizarre, eccentric, unusual in behavior
5) [] Illogicalness – thinking and behavior doesn’t make sense, is disorganized
6) [ ]Disconnectedness- a disconnect, or loose connection between thoughts-feelings-behavior
7) [ ]Blocking – thinking gets stuck or blocked, so there is inability to finish or start a thought
8) [ ]Insertion/Withdrawal- thoughts are seemingly put in or taken out one mind with no control
9) [ ]Psychomotor Abnormalities – mind-body is too slow, too fast, mind fast body slow, vice versa
10) [ ] Repeating – repeating what is done [echopraxia] or said [echolalia] like an echo
11) [ ] Negativism- motiveless resistance to directives, being physically rigid, Mutism
12) [ ] Posturing- peculiar postures, movements , mannerism, grimacing, but not tics
13) [ ] Emotionless- diminished, blunted, inappropriate emotional responses and reactivity
14) [ ] Anhedonia - diminished , little or lack of interest or pleasure in most things
15) [ ] Avolition- lack or diminished drive , very difficult if not impossible to start and finish things
16) [ ] Alogia – diminished or lack of speaking, or thinking, or representations of such like writing
Features, symptoms, and traits found in Schizotypal, Schizoid, and Paranoid Personality Disorders can be used as a screening tool for the positive and negative symptoms that may be responsive to medication treatment.
Symptom Screen for Early Manifestation of Problems with Thinking and Reality Testing
1) Ideas of reference are the feeling that events have special unusual meaning to that person
2) Odd beliefs, strange fantasies not consistent with the cultural norm the influence behavior
3) Odd peculiar speech ,too vague, overly specific, too elaborate, talks in circles, or tangent
4) Suspiciousness, paranoid, thinks people are looking and talking about them,
5) Emotions, thinking, and behavior are not appropriate to the situation
6) Lack of close friends or confidants other than first degree relatives
7) Excessive social anxiety around people and places that doesn’t get better with familiarity
8) Social anxiety not associated with negative self judgment , but with paranoid fears
9) Reads hidden demeaning or threatening meanings into benign remarks and events
10) Persistently bears grudges, unforgiving of insults, injuries or slights
11) See comments on work, reputation, character as attacks that are not apparent to others
12) Suspects without sufficient basis that others are out to use, abuse, harm or deceive
13) Neither desires nor enjoys close relationships including being part of a family
14) A loaner, almost always chooses solitary activities
15) Takes pleasure in few if any activities
16) Appears indifferent to the praise or criticism of others
17) Shows coldness, detachment or a restricted, blunted, flattened emotional responsiveness