Formal thought disorder

Formal thought disorder is common in schizophrenia, although it is also encountered in mania and depression. Forms of formal thought d/o characterized by a disturbance of ideation includes thought blocking, poverty of speech, flight of ideas. Disturbances of thought continuity include circumstantiality, tangentiality, clang association, loose associations, derailment, and echolalia.

• • Circumstantiality: Overinclusion of trivial or irrelevant details (hair splitting), belaboring, impedes the sense of getting to the point, before arriving to the point. Beating around the bush.

  • Derailment (loose associations): A breakdown in both the logical connection between ideas and the overall sense of goal-directedness. The words make sentences, but the sentence don’t make sense. Person jumps from one topic to another which is unrelated or only remotely related without realizing that the subjects are not meaningfully connected. - like channel surfing.

  • Flight of ideas: A succession of multiple associations so that thoughts seem to move abruptly from idea to idea; often (but not invariably) expressed through rapid, pressured speech. There is loss of progression of thought and is fragmentary at best. Worse form of derailment.

  • Neologism. The invention of new words or phrases or the use of conventional words in idiosyncratic ways.

  • Incoherence. Speech that is incomprehensible because of illogic, lack of meaningful connections.

  • Clang associations: Thoughts are associated by the sound of words rather than by their meaning, e.g., through rhyming or assonance. “lighting fires, and eating wires.”

  • Thought blocking. A sudden disruption of thought or a break in the flow of ideas in mid-sentence.

  • Confabulation. Fabrication of facts or events in response to questions, to fill in the gaps in impaired memory.

  • Perseveration. Repetition out of context of words, phrases, or ideas. Persistent repetition of words or ideas.

  • Echolalia. Repetition of the words and phrases of other. Parroting.

  • Tangentiality. In response to a question, the pt. gives a reply that is appropriate to the general topic without actually answering the question. E.g: Doctor: “Have you had any trouble sleeping lately?” Patient: “I usually sleep in my bed, but now I’m sleeping on the sofa.” Like a politician.