Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
In considering whether an individual has thought disorder, patterns of their speech are closely observed. Although it is normal to exhibit some of the following during times of extreme stress (e.g. a cataclysmic event or the middle of a war) it is the degree, frequency, and the resulting functional impairment that leads to the conclusion that the person being observed has a thought disorder.
- "Alogia" (also "poverty of speech") – A poverty of speech, either in amount or content; it can occur as a negative symptom of schizophrenia.
- "Blocking" – An abrupt stop in the middle of a train of thought; the individual may or may not be able to continue the idea. This is a type of formal thought disorder that can be seen in schizophrenia.
- "Circumstantiality" (also "circumstantial thinking", or "circumstantial speech") – An inability to answer a question without giving excessive, unnecessary detail. This differs from tangential thinking, in that the person does eventually return to the original point.
- "Clanging" or "Clang association" – a severe form of flight of ideas whereby ideas are related only by similar or rhyming sounds rather than actual meaning. This may be heard as excessive rhyming and/or alliteration. e.g. "Many moldy mushrooms merge out of the mildewy mud on Mondays." "I heard the bell. Well, hell, then I fell." It is most commonly seen in bipolar affective disorder (manic phase), although it is often observed in patients with primary psychoses, namely schizophrenia and schizoaffective disorder.
- "Derailment" (also "loose association" and "knight's move thinking") – Thought and/or speech move, either spontaneously or in response to an internal stimulus (distinguishing derailment from "distractible speech," "infra"), from the topic's track onto another which is obliquely related or unrelated. e.g. "The next day when I'd be going out you know, I took control, like uh, I put bleach on my hair in California."
- "Distractible speech" – During mid speech, the subject is changed in response to an external stimulus. e.g. "Then I left San Francisco and moved to... where did you get that tie?"
- "Echolalia" – Echoing of another's speech that may only be committed once, or may be continuous in repetition. This may involve repeating only the last few words or last word of the examiner's sentences. This can be a symptom of Tourette's Syndrome. e.g. "What would you like for dinner?", "That's a good question. "That's a good question". "That's a good question". "That's a good question"."
- "Evasive interaction" – Attempts to express ideas and/or feelings about another individual come out as evasive or in a diluted form, e.g.: "I... er ah... you are uh... I think you have... uh-- acceptable erm... uh... hair."
- "Flight of ideas" – a form of formal thought disorder marked by abrupt leaps from one topic to another, albeit with discernable links between successive ideas, perhaps governed by similarities between subjects or, in somewhat higher grades, by rhyming, puns, and word plays (clang associations), or innocuous environmental stimuli – e.g., the sound of birds chirping. It is most characteristic of the manic phase of bipolar illness.
- "Illogicality" – Conclusions are reached that do not follow logically (non-sequiturs or faulty inferences). e.g. "Do you think this will fit in the box?" draws a reply like "Well duh; it's brown, isn't it?"
- "Incoherence (word salad)" – Speech that is unintelligible because, though the individual words are real words, the manner in which they are strung together results in incoherent gibberish, e.g. the question "Why do people comb their hair?" elicits a response like "Because it makes a twirl in life, my box is broken help me blue elephant. Isn't lettuce brave? I like electrons, hello please!"
- "Loss of goal" – Failure to follow a train of thought to a natural conclusion. e.g. "Why does my computer keep crashing?", "Well, you live in a stucco house, so the pair of scissors needs to be in another drawer."
- "Neologisms" – New word formations. These may also involve elisions of two words that are similar in meaning or in sound. e.g. "I got so angry I picked up a dish and threw it at the geshinker."
- "Perseveration" – Persistent repetition of words or ideas even when another person attempts to change the topic. e.g. "It's great to be here in Nevada, Nevada, Nevada, Nevada, Nevada." This may also involve repeatedly giving the same answer to different questions. e.g. "Is your name Mary?" "Yes." "Are you in the hospital?" "Yes." "Are you a table?" "Yes." Perseveration can include palilalia and logoclonia, and can be an indication of organic brain disease such as Parkinson's.
- "Phonemic paraphasia" – Mispronunciation; syllables out of sequence. e.g. "I slipped on the lice and broke my arm."
- "Pressure of speech" – Unrelenting, rapid speech without pauses. It may be difficult to interrupt the speaker, and the speaker may continue speaking even when a direct question is asked.
- "Self-reference" – Patient repeatedly and inappropriately refers back to self. e.g. "What's the time?", "It's 7 o'clock. That's my problem."
- "Semantic paraphasia" – Substitution of inappropriate word. e.g. "I slipped on the coat, on the ice I mean, and broke my book."
- "Stilted speech" – Speech characterized by the use of words or phrases that are flowery, excessive, and pompous. e.g. "The attorney comported himself indecorously."
- "Tangentiality" – Wandering from the topic and never returning to it or providing the information requested. e.g. in answer to the question "Where are you from?", a response "My dog is from England. They have good fish and chips there. Fish breathe through gills."
- "Word approximations" – Old words used in a new and unconventional way. e.g. "His boss was a ."
Thought disorder (TD) or formal thought disorder (FTD) refers to disorganized thinking as evidenced by disorganized speech. Specific thought disorders include derailment, poverty of speech, tangentiality, illogicality, perseveration, and thought blocking.
Psychiatrists consider formal thought disorder as being one of two types of disordered thinking, with the other type being delusions. The latter involves "content" while the former involves "form". Although the term "thought disorder" can refer to either type, in common parlance it refers most often to a disorder of thought "form" also known as formal thought disorder.
Eugen Bleuler, who named schizophrenia, held that thought disorder was its defining characteristic. However, formal thought disorder is not unique to schizophrenia or psychosis. It is often a symptom of mania, and less often it can be present in other mental disorders such as depression. Clanging or echolalia may be present in Tourette syndrome. Patients with a clouded consciousness, like that found in delirium, also have a formal thought disorder.
However, there is a clinical difference between these two groups. Those with schizophrenia or psychosis are less likely to demonstrate awareness or concern about the disordered thinking. Clayton and Winokur have suggested that this results from a fundamental inability to use the same type of Aristotelian logic as others. On the other hand, patients with a clouded consciousness, referred to as "organic" patients, usually do demonstrate awareness and concern, and complain about being "confused" or "unable to think straight"; Clayton and Winokur suggest that this is because their thought disorder results, instead, from various cognitive deficits.
The condition is also known as hebephrenia, named after the Greek term for "adolescence" – "ἥβη" (hḗbē), and possibly the Ancient Greek goddess of youth, Hebe, daughter of Hera. The term refers to the ostensibly more prominent appearance of the disorder in persons around puberty.
The prominent characteristics of this form are disorganized behavior and speech (see formal thought disorder), including loosened associations and schizophasia ("word salad"), and flat or inappropriate affect. In addition, psychiatrists must rule out any possible sign of catatonic schizophrenia.
The most prominent features of disorganized schizophrenia are not delusions and hallucinations, as they are in paranoid schizophrenia, although fragmentary delusions, unsystemized and often hypochondriacal, and hallucinations may be present. A person with disorganized schizophrenia may also experience behavioral disorganization, which may impair his or her ability to carry out daily activities such as showering or eating.
The emotional responses of such people often seem strange or inappropriate. Inappropriate facial responses may be common, and behavior is sometimes described as 'silly', such as inappropriate laughter. Sometimes, there is a complete lack of emotion, including anhedonia (the lack of pleasure), and avolition (a lack of motivation). Some of these features are also present in other types of schizophrenia, but they are most prominent in disorganized schizophrenia.
The following specifiers for schizophreniform disorder may be used to indicate the presence or absence of features that may be associated with a better prognosis:
- With Good Prognostic Features, used if at least two of the following features are present:
- Onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning
- Confusion or perplexity at the height of the psychotic episode
- Good premorbid social and occupational functioning
- Absence of blunted or flat affect
- Without Good Prognostic Features, used if two or more of the above features have not been present.
The presence of negative symptoms and poor eye contact both appear to be prognostic of a poor outcome. Many of the anatomic and functional changes seen in the brains of patients with schizophrenia also occur in patients with schizophreniform disorder. However, at present there is no consensus among scientists regarding whether or not ventricular enlargement, which is a poor prognostic factor in schizophrenia, has any prognostic value in patients with schizophreniform disorder. According to the American Psychiatric Association, approximately two-thirds of patients diagnosed with "provisional" schizophreniform disorder are subsequently diagnosed with schizophrenia; the remaining keep a diagnosis of schizophreniform disorder.
These symptoms are not due to situations such as, person is depressed because of difficulty making friends. It is normal to experience dysfunctional emotions and behaviors at times.
Criteria are met for a neurotic or personality disorder, preferably at least two.
Some symptoms may include:
1. Depression.
2. Mania.
3. Anxiety.
4. Anger.
5. Dissociative symptoms such as depersonalization, derealization, deja vu, etc.
6. Emotional instability.
7. Psychopathic behavior.
8. Narcissism.
9. Paranoia.
10. Obsessive-compulsive behavior.
Schizophreniform disorder is a type of mental illness that is characterized by psychosis and closely related to schizophrenia. Both schizophrenia and schizophreniform disorder, as defined by the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-IV-TR), have the same symptoms and essential features except for two differences: the level of functional impairment and the duration of symptoms. Impairment in social, occupational, or academic functioning is usually present in schizophrenia, particularly near the time of first diagnosis, but such impairment may or may not be present in schizophreniform disorder. In schizophreniform disorder, the symptoms (including prodromal, active, and residual phases) must last at least 1 month but not more than 6 months, while in schizophrenia the symptoms must be present for a minimum of 6 months.
If the symptoms have persisted for at least one month, a provisional diagnosis of schizophreniform disorder can be made while waiting to see if recovery occurs. If the symptoms resolve within 6 months of onset, the provisional qualifier is removed from the diagnosis. However, if the symptoms persist for 6 months or more, the diagnosis of schizophreniform disorder must be revised. The diagnosis of brief psychotic disorder may be considered when the duration of symptoms is less than one month.
The main symptoms of both schizophreniform disorder and schizophrenia may include:
- delusions,
- hallucinations,
- disorganized speech resulting from formal thought disorder,
- disorganized or catatonic behavior, and negative symptoms, such as
- an inability to feel a range of emotions (flat affect),
- an inability to experience pleasure (anhedonia),
- impaired or decreased speech (aphasia),
- a lack of desire to form relationships (asociality), and
- a lack of motivation (avolition).
The current diagnostic criteria for MCDD are a matter of debate due to it not being in the DSM-IV or ICD-10. Various websites contain various diagnostic criteria. At least three of the following categories should be present. Co-occurring clusters of symptoms must also not be better explained by being symptoms of another disorder such as experiencing mood swings due to autism, cognitive difficulties due to schizophrenia, and so on. The exact diagnostic criteria for MCDD remain unclear but may be a useful diagnosis for people who do not fall into any specific category. It could also be argued that MCDD is a vague and unhelpful term for these patients.
In the mental health field, schizophasia or word salad is language that is confused and often repetitious, symptomatic of various mental illnesses.
It is usually associated with a manic presentation of bipolar affective disorder and other symptoms of serious mental illnesses, such as psychosis, including schizophrenia. It is characterized by an apparently confused usage of words with no apparent meaning or relationship attached to them. In this context, it is considered to be a symptom of a formal thought disorder. In some cases schizophasia can be a sign of asymptomatic schizophrenia; e.g. the question "Why do people believe in God?" could elicit a response consisting of a series of words commonly associated with religion or prayer but strung together with no regard to language rules.
Schizophasia should be contrasted with another symptom of cognitive disruption and cognitive slippage involving certain idiosyncratic arrangements of words. With this symptom, the language may or may not be grammatically correct depending on the severity of the disease and the particular mechanisms which have been impacted by the disease.
The American diagnostic codes, from the "DSM-IV", do not specifically code for this disorder although they include it as a symptom under the diagnosis of schizophrenia.
Additionally, requirements for a proposed diagnosis such as the number and duration of symptoms and the impact on functioning are continuing to be investigated. But there is no doubt that both ADHD and SCT are found in children and adults and are linked to significant impairment and a diminished quality of life (QoL). The research by Barkley suggests that this is especially true if ADHD and SCT occur together: In adults, those comorbid cases were more likely to be unmarried and to be out of work on disability compared to cases with ADHD alone. But SCT alone is also present in the population and can be quite impairing in educational and occupational settings, even if it is not as pervasively impairing as ADHD.
ADHD is the only disorder of attention currently defined by the DSM-5 or ICD-10. Formal diagnosis is made by a qualified professional, and includes demonstrating six or more symptoms of inattention, hyperactivity and impulsivity, or both. This results in three types of ADHD:
- a predominantly inattentive presentation (ADHD-I)
- a predominantly hyperactive-impulsive presentation (ADHD-HI)
- a combined presentation (ADHD-C)
The symptoms must also be inappropriate and must interfere with social, school, or work functioning, in addition to meeting multiple other diagnostic requirements. The symptoms used in the diagnosis are shown below.
SCT is proposed to be a similar disorder to the predominantly inattentive presentation (ADHD-I), but, as discussed later, importantly distinct from it. One problem is that some individuals who actually have SCT are now mistakenly diagnosed with the inattentive presentation. The list of symptoms that follows is from leading researchers of SCT, however, no universally accepted set of symptoms has been developed since this symptom cluster has not yet been recognized as an independent disorder.
Disorganized schizophrenia, also known as hebephrenia or hebephrenic schizophrenia, is a subtype of schizophrenia, although it is not recognized in the latest version of the "Diagnostic and Statistical Manual of Mental Disorders". It's recognized only in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).
Disorganized schizophrenia is thought to be an extreme expression of the "disorganization syndrome" that has been hypothesized to be one aspect of a three-factor model of symptoms in schizophrenia, the other factors being "reality distortion" (involving delusions and hallucinations) and "psychomotor poverty" (lack of speech, lack of spontaneous movement and various aspects of blunting of emotion).
It has possibly the earliest onset compared to all other schizophrenias, considered to begin in some within childhood. Symptoms of "schizophrenia" "simplex" include an absence of will, impoverished thinking and flattening of affect. There is a gradual deterioration of functioning with increased amotivation and reduced socialization. It is considered to be rarely diagnosed and is a schizophrenia without psychotic symptoms.
In a study of patients in a Massachusetts hospital, persons suffering with "simple schizophrenia" were found to make attempts at reality fulfillment with respect to the more primitive needs; tending toward the achievement of fulfillment of these needs rather than engaging in fantasy as is typically found as a reaction to environmental stimuli by the psychotic person.
Tangentiality as a medical symptom is a physical symptom observed in speech that tends to occur in situations where a person is experiencing high anxiety, as a manifestation of the psychosis known as "schizophrenia", in dementia or in states of delirium.
Simple-type schizophrenia is a sub-type of schizophrenia as defined in the International Classification of Diseases . It is not included in the current "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). Simple-type schizophrenia is characterized by negative ("deficit") symptoms, such as avolition, apathy, anhedonia, reduced affect display, lack of initiative, lack of motivation, low activity; with absence of hallucinations or delusions of any kind.
In psychiatry, thought broadcasting is the belief that others can hear or are aware of an individual's thoughts. This differs from telepathy in that the thoughts being broadcast are thought to be available to anybody.
Thought broadcasting can be a positive symptom of schizophrenia. Thought broadcasting has been suggested as one of the first rank symptoms (Schneider's first-rank symptoms) believed to distinguish schizophrenia from other psychotic disorders.
In mild manifestations, a person with this thought disorder may doubt their perception of thought broadcasting. When thought broadcasting occurs on a regular basis, the disorder can affect behavior and interfere with the person's ability to function in society. According to an individual's personality this is considered to be a severe manifestation of thought broadcasting that is usually indicative of schizophrenia.
The term refers simplistically to a thought disorder shown from speech with a lack of observance to the main subject of discourse, such that a person whilst speaking on a topic deviates from the topic. Further definition is of speech that deviates from an answer to a question that is relevant in the first instance but deviates from the relevancy to related subjects not involved in a direct answering of the question. In the context of a conversation or discussion the communication is a response that is ineffective in that the form is inappropriate for adequate understanding. The person's speech seems to indicate that their attention to their own speech has perhaps in some way been overcome during the occurrence of cognition whilst speaking, causing the vocalized content to follow thought that is apparently without reference to the original idea or question; or the person's speech is considered evasive in that the person has decided to provide an answer to a question that is an avoidance of a direct answer.
Though the American Psychiatric Association's criteria for attention deficit hyperactivity disorder (ADHD), and the World Health Organization's criteria for hyperkinetic disorder each list a very similar set of 18 symptoms, the differing rules governing diagnosis mean that hyperkinetic disorder features greater impairment and more impulse-control difficulties than typical ADHD, and it most resembles a severe case of ADHD combined type.
Unlike ADHD, a diagnosis of hyperkinetic disorder requires that the clinician directly observes the symptoms (rather than relying only on parent and teacher reports); that onset must be by age 6 not 7; and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings. While ADHD may exist comorbid with (in the presence of) mania or a depressive or anxiety disorder, the presence of one of these rules out a diagnosis of hyperkinetic disorder. Most cases of hyperkinetic disorder appear to meet the broader criteria of ADHD.
Hyperkinetic disorder may exist comorbid with conduct disorder, in which case the diagnosis is hyperkinetic conduct disorder.
Behavioural symptoms are evident through an individual's actions. People with DES often lose their social skills because their judgments and insights into what others may be thinking are impaired. They may have trouble knowing how to behave in group situations and may not know how to follow social norms. The central executive helps control impulses; therefore when impaired, patients have poor impulse control. This can lead to higher levels of aggression and anger. DES can also cause patients to appear self-centered and stubborn
Utilization behaviour is when a patient automatically uses an object in the appropriate manner, but at an inappropriate time. For example, if a pen and paper are placed in front of an individual with DES they will start to write or if there is a deck of cards they will deal them out. Patients showing this symptom will begin the behaviour in the middle of conversations or during auditory tests. Utilization behaviour is thought to occur because an action is initiated when an object is seen, but patients with DES lack the central executive control to inhibit acting it out at inappropriate times.
Perseveration is also often seen in patients with DES. Perseveration is the repetition of thoughts, behaviours, or actions after they have already been completed. For instance, continually blowing out a match, after it is no longer lit is an example of perseveration behaviour. There are three types of perseveration: continuous perseveration, stuck-in-set perseveration, and recurrent perseveration. Stuck-in-set perseveration is most often seen in dysexecutive syndrome. This type of perseveration refers to when a patient cannot get out of a specific frame of mind, such as when asked to name animals they can only name one. If you ask them to then name colours, they may still give you animals. Perseveration may explain why some patients appear to have obsessive-compulsive disorder.
In psychology, alogia (Greek ἀ-, “without”, and λόγος, “speech”), or poverty of speech, is a general lack of additional, unprompted content seen in normal speech. As a symptom, it is commonly seen in patients suffering from schizophrenia, and is considered a negative symptom. It can complicate psychotherapy severely because of the considerable difficulty in holding a fluent conversation.
Alogia is often considered a form of aphasia, which is a general impairment in linguistic ability. It often occurs with intellectual disability and dementia as a result of damage to the left hemisphere of the brain. People can revert to alogia as a way of reverse psychology, or avoiding questions.
The emotional symptoms that individuals with DES experience may be quite extreme and can cause extensive problems. They may have difficulty inhibiting many types of emotions such as anger, excitement, sadness, or frustration. Due to multiple impairments of cognitive functioning, there can be much more frustration when expressing certain feelings and understanding how to interpret every day situations. Individuals with DES may have higher levels of aggression or anger because they lack abilities that are related to behavioural control. They can also have difficulty understanding others' points of view, which can lead to anger and frustration.
Hyperkinetic disorder is a psychiatric neurodevelopmental condition emerging in early childhood that features an enduring pattern of severe, developmentally inappropriate symptoms, namely inattention, hyperactivity, and impulsivity across different settings (e.g., home and school) that significantly impair academic, social and work performance. The disorder, which appears in the World Health Organization's ICD-10, is roughly similiar to the "combined presentation" of attention deficit hyperactivity disorder in the American Psychiatric Association's DSM-V.
Hyperkinetic people display disorganized, poorly controlled and excessive activity; they lack perseverance in tasks involving thought and attention, and tend to move from one activity to the next without completing any. They are frequently accident-prone, reckless and impulsive, and may thoughtlessly (rather than defiantly) break rules. Cognitive impairment and delayed language and motor development are more common in this group than in the general population; and they may experience low self-esteem and engage in dissocial behavior as a consequence of the disorder.
While hyperkinetic children are commonly incautious and unreserved with adults, they might be isolated and unpopular with other children.
Posttraumatic embitterment disorder (PTED) is a proposed disorder modeled after posttraumatic stress disorder. Some psychiatrists are proposing this as a mental disorder because they believe that there are people who have become so bitter, they can barely function. PTED patients do not fit the formal criteria for PTSD and can be clinically distinguished from it, prompting the description of a new and separate disorder.
German psychiatrist Michael Linden, who has conducted research on the proposed disorder, describes its effect on people: "They feel the world has treated them unfairly. It's one step more complex than anger. They're angry plus helpless." He says that people with the disorder are almost treatment resistant and that; "These people usually don't come to treatment because 'the world has to change, not me. He believes that 1 to 2 percent of people are affected at any given time, and explains that, although sufferers of the disorder tend to have a desire for vengeance, "...Revenge is not a treatment."
PTED so far has no official status and is not listed in the DSM-IV-TR or ICD-10-CM.
In psychiatry, derailment (also loosening of association, asyndesis, asyndetic thinking, knight's move thinking, or entgleisen) is a thought disorder characterized by discourse consisting of a sequence of unrelated or only remotely related ideas. The frame of reference often changes from one sentence to the next.
In a mild manifestation, this thought disorder is characterized by slippage of ideas further and further from the point of a discussion. Derailment can often be manifestly caused by intense emotions such as euphoria or hysteria. Some of the synonyms given above ("loosening of association", "asyndetic thinking") are used by some authors to refer just to a "loss of goal": discourse that sets off on a particular idea, wanders off and never returns to it. A related term is tangentiality—it refers to off-the-point, oblique or irrelevant answers given to questions. In some studies on creativity, "knight's move thinking", while it describes a similarly loose association of ideas, is not considered a mental disorder or the hallmark of one; it is sometimes used as a synonym for lateral thinking.
Alogia is characterized by a lack of speech, often caused by a disruption in the thought process. Usually, an injury to the left hemisphere of the brain will cause alogia to appear in an individual. In conversation, alogic patients will reply very sparsely and their answers to questions will lack spontaneous content; sometimes, they will even fail to answer at all. Their responses will be brief, generally only appearing as a response to a question or prompt.
Apart from the lack of content in a reply, the manner in which the person delivers the reply is affected as well. Patients affected by alogia will often slur their responses, and not pronounce the consonants as clearly as usual. The few words spoken usually trail off into a whisper, or are just ended by the second syllable. Studies have shown a correlation between alogic ratings in individuals and the amount and duration of pauses in their speech when responding to a series of questions posed by the researcher.
The inability to speak stems from a deeper mental inability that causes alogic patients to have difficulty grasping the right words mentally, as well as formulating their thoughts. A study investigating alogiacs and their results on the category fluency task showed that people with schizophrenia who exhibit alogia display a more disorganized semantic memory than controls. While both groups produced the same number of words, the words produced by people with schizophrenia were much more disorderly and the results of cluster analysis revealed bizarre coherence in the alogiac group.
People with psychosis normally have one or more of the following:
- hallucinations
- delusions
- catatonia
- thought disorder.
Impairments in social cognition also occur.