What is thinking disorder? What are the causes, classifications and characteristics?

I. Definition and Characteristics of Thinking Disorder On the basis of feeling and perception, people further analyze, compare and understand the characteristics of certain things from the superficial phenomena and external relations of things with the help of words, and make use of existing knowledge and formed concepts to synthesize, judge and reason, thus rising from perceptual knowledge to rational knowledge. This complete psychological activity is called thinking. Normal thinking activities often have the following characteristics:

Thinking is based on feeling and perception, which has the authenticity of objective things, that is, the concreteness of thinking; The process of thinking activities has a certain goal orientation, that is, the purpose of thinking; Thinking activities are often combined with practical problems to think, not fantasy, that is, the practicality of thinking; Thinking can be tested and verified by practice, that is, the practicality of thinking; Thinking activities conform to the objective laws of logical reasoning in form or structure, are understood by people and can communicate with each other, that is, the logic of thinking. Usually, normal thinking should be concrete, purposeful, practical, practical and logical.

Second, the classification of thinking disorder. Obstacles in thinking process include avoidance, slowness, blocking and redundancy.

Thinking control obstacles include thinking being taken away, thinking being inserted and thinking spreading.

The obstacles of thinking form include rambling thinking, incoherent thinking and broken thinking.

Thinking content disorder refers to various types of delusions and delusional concepts.

Including concepts: pathological symbolic thinking, innovative words, compulsive thinking, thinking escape, thinking insertion, thinking delay, thinking extraction, thinking poverty, thinking interruption, delusion and redundancy.

1. Pathological symbolic thinking Pathological symbolic thinking is a conceptual transformation that concretizes abstract concepts, uses unique "symbols" or uses irrelevant specific concepts to represent an abstract concept, and the patients themselves do not explain it, but others cannot understand it. It is characterized by replacing abstract concepts with concrete things, such as patients wearing cotton-padded jackets in order to "completely expose their thoughts".

The concretization of abstract concepts is very strange, and it is difficult for others to understand without my own explanation and explanation. If the patient walks with red bricks on his feet, it is called "walking on a red and special avenue".

Pathological symbolic thinking is relatively fixed, and once the patient approves it, it will not change. Although this symbolic thinking cannot be understood by others, patients still think it is a better concept.

2. Innovative words, also known as "neologisms", refer to the creation of some words, characters, languages, figures and symbols to replace the morbid concepts that only one person knows. This symptom is common in schizophrenia and belongs to the category of association disorder.

Its characteristic is that patients sometimes create some words or languages by themselves. Although others don't understand them, only he understands them, but he thinks others should also understand them. Innovative words or innovative words, or graphics, symbols, etc. To express a special meaning, it may be condensed from several words with different concepts, which is called conceptual condensation, or vice versa.

This symptom is common in western countries, and new words may be related to the use of pinyin.

3. compulsive thinking this is a kind of thinking that is repeatedly presented. Patients know it is unnecessary, but they can't get rid of it, which belongs to thinking control disorder. More common in obsessive-compulsive disorder, occasionally depression, schizophrenia and encephalitis sequela.

It is characterized by patients' repeated thoughts, which are clearly unnecessary or unreasonable, but difficult to overcome and restrain, and patients want to restrain, which is an important feature of compulsive thinking.

Patients repeatedly think about some special questions, such as why 1 year is 365 days? Why do people only have two hands instead of three? These questions can't be answered and have no practical significance, but the patient is exhausted, which is called forced exhaustion.

Patients' attitudes towards forced thinking are different. They will show strong anxiety and tension in the early stage, but they will get better in the later stage.

Compulsive thinking often leads to compulsive behavior, such as always worrying that you will say something unpleasant, so you can't help but cover your mouth when you meet acquaintances.

4. Thinking escape, also known as wandering thought, belongs to the obstacle of thinking process, which means that the speed of association is obviously accelerated and a large number of concepts are constantly emerging. Thinking avoidance is a typical symptom of mania.

It is characterized by the acceleration of association, the proliferation of thinking activities, the increase of words, and the emergence of concepts like barrage. Therefore, the patient is eloquent, gushing, and one topic is not finished, and then he turns to another topic.

Patients often feel that the tongue is racing with thinking because of rapid association, and the tongue always lags behind their own thinking activities. So the patient's words are often omitted, fragmented and out of touch.

There is often phonetic connection or semantic connection between the upper and lower stages of patients' discourse, which is also called phonetic connection and semantic connection. Although there are some irrelevant points in the patient's speech, he can finally return to the original theme.

When the patient thinks seriously, he can't express all his thoughts because he thinks too fast, so that he can't say a sentence. This is considered as broken thinking or rambling thinking.

5. Thinking insertion is also called human thinking. Patients feel different from their own thinking in their own brains, which is more common in schizophrenia. Its characteristic is that the basic feature of the symptom of thinking insertion is the self-attribute obstacle of thinking, that is, the non-"self" thinking is positively perceived.

The appearance of symptoms is not controlled by will, and some people call it "forced thinking".

The inserted thinking content is often grotesque and often inconsistent with the patient's own ideas.

This is a kind of self-experience, which has no special performance objectively, or is manifested as a speech communication obstacle caused by interfering with the association process, such as speech interruption or ambiguity. Sometimes patients complain that they can't work or move normally.

The psychological reaction to thinking insertion is different. Because I have experienced such a "pervert", I am often anxious and distressed. Some patients are frightened, but others are indifferent. They only complain about the existence of symptoms when the doctor asks.

Patients often blame this symptom on "external force" and have secondary delusions.

The symptoms of thinking insertion are different from compulsive thinking. The fundamental difference is that compulsive thinking is "thinking" by oneself, and there is no obstacle to thinking independently.

6. Thinking retardation, also known as thinking inhibition, is a kind of association speed obstacle in thinking association obstacle. Mental retardation is mostly pathological and can be seen in various mental diseases.

Its characteristics are that association is suppressed, the speed is slow, and thinking is blocked. Patients often find it very difficult to consider problems, and it takes a long time to respond to some concepts, or their thinking activities are limited to one aspect or they are repeatedly entangled in a certain concept. This is also called thinking stickiness.

With the sticky association process, patients have to think hard for a long time to express their meaning, so it is difficult to speak hesitatingly and the number of words is reduced. Slow speech and low pronunciation.

7. Poor thinking is a common symptom of thinking association disorder. It shows that the number of associations is reduced and the thinking content is poor, which is common in schizophrenia, senile psychosis and brain organic psychosis.

Its characteristic is that the number of thinking associations is obviously less than usual or in the past, and there is a lack of concepts. In the process of thinking and association, people often feel inadequate, and even the thinking content is empty and poor.

Because the thinking content is empty and poor, the vocabulary will be reduced, and the words will be monotonous. Questions are often answered with "yes" or "no". When talking to him, he is at a loss, often silent, and the statement of the problem is too simple.

8. Thinking extraction is also called thinking deprivation. Patients feel that their thinking is suddenly affected by external forces and taken away. More common in schizophrenia.

Its characteristic is that the symptoms of thinking extraction belong to the self-attribute obstacle of thinking, that is, thinking is not controlled by itself, but by external forces.

The complaints of patients are often "the brain suddenly became empty", "the thought suddenly stopped" and "the thought was taken away by something".

The patient thinks that this situation is caused by "external force", that is, the thinking is suddenly interrupted by external force or reason.

The external forces that lead to thinking extraction can be specific, such as machines and lasers. , leading to the delusion of physical influence, also can not be specific, generally called external force.

Patients are often accompanied by thinking block symptoms, that is, they suddenly stop in the conversation and cannot continue the original topic in the future. Some people think that thinking extraction is the subjective experience of thinking disorder, and thinking disorder is the objective expression of thinking extraction. But they can exist independently.

The symptoms of thinking extraction are different from poor thinking and slow thinking, because the latter two symptoms have no self-attribute obstacle of thinking and no experience of being pulled away by external forces.

Patients have different secondary reactions to the symptoms of thinking extraction, most of them are slow to respond, but some patients may show anxiety or even panic when the symptoms first appear.

9. Thinking interruption is a disorder of associative autonomy, which means that under conscious circumstances, without external reasons, thinking is interrupted or words suddenly stop, and in an instant, new content keeps up. More common in schizophrenia.

Its characteristic is that when the patient is conscious, the conversation is suddenly interrupted and silent, not for choosing the right vocabulary, but for a short pause in thinking activities. Although the conversation is resumed, it is often impossible to continue the original topic. Patients may have obvious involuntary feelings.

In the process of thinking, patients suddenly have another kind of thinking insertion, which is called thinking insertion. Sometimes patients complain that their thinking is deprived by external forces, which is called thinking being taken away. The patient's thinking can not be maintained, and the process of continuing thinking is blocked, which is called thinking obstruction. The above three kinds of physical passive experiences will all lead to the interruption of thinking.

10. Paranoia refers to a morbid belief, which is absurd and lacks factual basis, but is firmly believed by patients and cannot be explained by their cultural level and social background. Delusion is the most common and important symptom of thinking disorder, and it is an absurd conclusion drawn by patients on the basis of psychopathology. Although this absurd conclusion is inconsistent with the objective reality, it is firmly believed by patients and cannot be corrected by persuasion, education, facts and reasoning, nor can it be shaken by experience and lessons. This morbid belief is not commensurate with the patient's cultural level, social status and common sense.

Delusion is an individual psychological phenomenon, and the collective belief is sometimes difficult to understand, but if it can't be attributed to pathological belief, it can't be called delusion. In the early stage of the disease, because the integrity of the patient's critical power has not been obviously damaged, he is still skeptical about delusion, but at a certain stage of the disease, he is not only convinced, but also delusional is reflected in the whole behavior of the patient. Some patients have slow-developing and hidden delusions, which are particularly dangerous. They blame and chase everywhere, and hidden delusions often suddenly turn into impulsive behaviors, and self-mutilation, injury and destruction of things happen from time to time. Some patients' delusions develop rapidly, such as exaggerated delusions, reactive delusions and menopausal delusions of manic patients or paralytic dementia patients. Some delusions can be temporarily relieved when the environment improves, but they often linger for life. In the late stage of the disease, they often become more fragmented due to mental decline.

Delusions can be classified in many ways, roughly as follows:

According to the occurrence process is divided into:

Primary illusion. Sudden delusions in the brain, which psychology can't explain, have nothing to do with perception and life experience, and the reasons are unknown, such as delusional state of mind, delusional perception and delusional memory.

Secondary delusion. There are other psychological process obstacles in advance, which can be explained psychologically. Delusions are often secondary to hallucinations, emotional changes, personality abnormalities, mental defects and so on. Such as hallucinations and delusions, emotional delusions.

According to the systematic content is divided into:

Systematic illusion. The content of delusion is systematic, closely structured, small in scope, hidden in development and close to reality.

Nonsystematic illusion. Delusion lacks a system, its structure is slack, its scope is wide and changeable, its content is absurd and full of loopholes, it has no reasoning and is obviously divorced from reality.

According to the content, the most common delusions in clinic are delusion of victimization, delusion of reference, delusion of exaggeration, delusion of sin, delusion of hypochondriasis, delusion of nothingness, delusion of jealousy, delusion of love and delusion of physical influence.

Delusions include the following concepts: delusion of victimization, delusion of reference, delusion of jealousy, delusion of exaggeration, delusion of diffusion, delusion of memory, delusion of nothingness, delusion of hypochondriasis, delusion of shadow, delusion of primary, delusion of love and delusion of sin.

1 1. Overlapping is also called pathological redundancy. Its association process is tortuous and mixed with many unnecessary details. Although we can finally get back to the topic, the focus is not prominent, which delays the time to achieve our intentions and goals. Common in epileptic mental disorders and senile mental disorders.

The manifestations are verbosity, clinical failure to grasp the key points, too many unnecessary details and irrelevant branches, which usually indicate that patients' abstract generalization and understanding ability are low.

Although it contains a lot of unnecessary content, it does not obliterate the theme or the purpose of the speech, which is different from the rambling thinking of adolescent patients with schizophrenia who finally completely digress.

The premise of repetition is that you are willing to talk to others and tell others as much as you know, which is different from nagging without motivation and initiative.

In addition to the above-mentioned thinking disorder, there are several symptoms of thinking disorder that are not easy to classify.

Introverted thinking refers to patients indulging in their own spiritual world alone in a conscious state, or saying stupid things, or bowing their heads, sometimes laughing privately, sometimes angry, sometimes indifferent, and the whole mental activity is completely isolated from the external reality. This symptom is a characteristic of schizophrenia, which is only found in schizophrenic patients, and may be accompanied by hallucinations, delusions, apathy, decreased will and other symptoms.

Talking alone means that the patient talks to himself, and the content is too much to hear clearly. All kinds of mental illness can cause this symptom. This symptom is normal in childhood. Common in schizophrenia, but also in bipolar disorder, neurosis, mental retardation. Dementia, mental disorders caused by psychoactive substances, reactive mental disorders, etc.

Aphasia refers to the partial loss of speech function, which is caused by local brain damage. Including:

(1) Broca's aphasia: speaking less or slowly, and laboriously, with unclear pronunciation, manifested as telegraphic speech, lack of changes in articles, conjunctions, auxiliary verbs and intonation, without grammar, but with good comprehension. Aphasia is common in patients with lower frontal cortex (Broca area) injury caused by hemorrhage, ischemia, infarction and trauma. Clinically, it is easy to be confused with incoherent thinking. Patients with this disease have a clear consciousness, but they can still express themselves even if their grammar is incomplete. The incoherence of thinking is a pile of words produced on the basis of consciousness disorder, which does not express any meaning.

(2) Wemmick aphasia: speaking quickly and effortlessly. Grammar is basically correct, but the speech content is empty and the words are inaccurate, which is often accompanied by serious understanding defects. Common in patients with left hemisphere lesions.

Mutism means that the patient has no words and doesn't say a word when asked. Some patients can express their meaning by writing and acting. The patient has no aphasia and normal vocal organs, but the psychomotor or speech motor cortex function is inhibited. It is found in schizophrenia, such as catatonic, psychogenic stupor, depressive stupor, organic stupor and hysteria.