From the Guidelines
Thought disorders are complex disturbances in the form, content, and organization of thinking that significantly impact communication and cognitive functioning, and can be categorized into various types, including delirium, psychosis, and anxiety disorders, which require prompt diagnosis and treatment to improve morbidity, mortality, and quality of life. Historically, these disorders were first systematically described by Emil Kraepelin in the late 19th century, who noted "loosening of associations" in schizophrenia patients 1. Eugen Bleuler expanded on this concept in 1911, coining the term "schizophrenia" and identifying thought disorder as a fundamental symptom. Kurt Schneider later developed the concept of first-rank symptoms, including thought insertion, withdrawal, and broadcasting. Karl Jaspers contributed phenomenological approaches to understanding thought disorders in the early 20th century. In the context of altered mental status, delirium is a defined and diagnosable medical condition that includes inattention as a cardinal feature, may fluctuate over the course of day with lucid intervals, and may present with subtle disturbances in consciousness compared with other forms of acute altered mental status, making detection more difficult and thus easy to miss 1.
Some of the key types of thought disorders include:
- Delirium: a medical emergency characterized by inattention, disorganized thinking, and altered level of consciousness, which can be precipitated by underlying medical conditions, substance use, or withdrawal 1
- Psychosis: a condition characterized by delusions, hallucinations, disorganized speech or thought, and disorganized or abnormal motor behavior, which can be primary (related to an underlying psychiatric disorder) or secondary (related to an underlying medical condition or substance use) 1
- Anxiety disorders: a category of disorders characterized by excessive fear or anxiety, including separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, and generalized anxiety disorder, which can be diagnosed using standardized assessment tools and criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 1
The diagnosis and treatment of thought disorders require a comprehensive approach, including clinical interviews, standardized assessments, and pharmacological and non-pharmacological interventions, with the goal of improving morbidity, mortality, and quality of life. Treatment typically involves antipsychotic medications, cognitive remediation therapy, and social skills training to address communication deficits, as well as management of underlying medical conditions and substance use disorders 1. In the case of anxiety disorders, treatment may involve guided self-management, focused intervention, and pharmacological management with anxiolytic medications, as well as psychological therapy and psychosocial interventions 1.
In terms of historical context, the understanding and classification of thought disorders have evolved over time, with contributions from various researchers and clinicians, including Emil Kraepelin, Eugen Bleuler, Kurt Schneider, and Karl Jaspers, among others. The development of standardized assessment tools and diagnostic criteria, such as the DSM-5, has improved the accuracy and reliability of diagnosis and treatment of thought disorders. Overall, the prompt diagnosis and treatment of thought disorders are critical to improving morbidity, mortality, and quality of life, and require a comprehensive and multidisciplinary approach.
From the Research
Thought Disorders
Thought disorders refer to a range of psychiatric conditions that affect an individual's thought processes, content, and perception. These disorders can manifest in various ways, including:
- Disorganized thinking: characterized by loose associations, tangential thinking, and neologisms 2
- Delusional thinking: marked by the presence of fixed, false beliefs that are not amenable to reason or evidence 3
- Hallucinations: perceptions in the absence of external stimuli, which can be auditory, visual, or tactile in nature 4
Historical Context
The concept of thought disorders has evolved over time, with early descriptions of psychiatric conditions dating back to ancient civilizations. In the late 19th and early 20th centuries, psychiatrists such as Emil Kraepelin and Eugen Bleuler developed classification systems for psychiatric disorders, including thought disorders 5. The development of antipsychotic medications in the mid-20th century revolutionized the treatment of thought disorders, with drugs such as chlorpromazine and haloperidol becoming widely used 6.
Types of Thought Disorders
Several types of thought disorders have been identified, including:
- Schizophrenia: a chronic and debilitating condition characterized by disorganized thinking, delusions, and hallucinations 4
- Schizoaffective disorder: a condition that combines symptoms of schizophrenia and mood disorders, such as depression or mania 2
- Brief psychotic disorder: a condition marked by a sudden onset of psychotic symptoms, such as hallucinations and delusions, that resolve within a short period of time 3
- Delusional disorder: a condition characterized by the presence of fixed, false beliefs that are not accompanied by other psychotic symptoms 5
Assessment and Diagnosis
The mental status examination (MSE) is a crucial tool in the assessment and diagnosis of thought disorders. The MSE involves a comprehensive evaluation of an individual's thought processes, content, and perception, as well as their mood, affect, and cognitive function 2, 3. The use of standardized assessment tools, such as the Mini-Mental State Examination and the Mini-Cog, can aid in the diagnosis and monitoring of thought disorders 3.