Impaired thinking in mental illness

I. Violations of the dynamics of thinking.

1. Acceleration of thinking (“leap of ideas”) Conventionally, more associations are formed per unit of time than in the norm, and their quality suffers. Images, ideas, judgments, and conclusions that quickly replace each other are extremely superficial. The abundance of ease of new associations that spontaneously arise from any stimulus is reflected in speech production, which may resemble the so-called. machine gun speech. From continuous speaking, patients sometimes lose their voice, or it becomes hoarse, whispering. In general, the acceleration of thinking is an obligatory derivative of a manic syndrome of various origins (affective disorders, schizophrenia, drug addiction, etc.) A leap of ideas (fuga idearum). This is an extraordinary acceleration of thinking: the thought process and speech production are constantly flowing and jumping; they are incoherent. However, if this speech is recorded on a tape recorder and played at a slow pace, some sense can be determined in it, which never happens with true incoherence of thinking. At the heart of the jump of ideas is the increased lability of cortical processes.

Characteristic:

• Quick associations, increased distractibility, expressive gestures and facial expressions.
• The analysis, synthesis, comprehension of a situation is not broken.
• Little thought is given to the answer.
• Errors are easily corrected if they are pointed out.
• Associations are chaotic, random, not braked.
• The generalized meaning of the task is available, can perform it at this level if it is not distracted.

2. Inertia of thinking Manifestations: inhibition, poverty of associations. The slowdown of the associative process is most pronounced in an absolutely «empty head, in which thoughts do not appear at all.» Patients answer questions in monosyllables and after a long pause (the latent period of speech reactions increases by 7-10 times compared to the norm). The overall goal of the thought process is preserved, but switching to new goals is extremely difficult. Such a violation is usually characteristic of epilepsy (“primary violation”), epileptoid psychopathy, manic-depressive syndrome, but can be observed in apathetic and asthenic conditions, as well as in mild degrees of clouding of consciousness. Patients can change the way they work, change the course of judgments, switch to another type of activity. Characterized by slowness, stiffness, poor switching. The solution to the problem is available if it is performed in only one specific way. The inertness of the connections of past experience leads to a decrease in the level of generalization.

3. Inconsistency of judgment An unstable way of doing a task. The level of generalization is not reduced. Analysis, synthesis, assimilation of instructions are preserved. Understand the figurative meaning of proverbs, metaphors. The adequate character of judgments is unstable. Alternate right and wrong way of doing the task. 81% vascular disease 68% trauma 66% TIR 14% schizophrenia (in remission) With an unexpressed degree of the disease, such inconsistency of judgments can be corrected. Often it is enough to attract attention for the patient to correct himself. Fluctuations occur at the slightest change in the conditions of the task.

4. «Responsiveness» In patients suffering from severe vascular disease. The instability of the method of performing the task and the fluctuations in mental achievements associated with it acquire a grotesque character. Example: after performing the classification, the patient suddenly begins to treat the pictures as real objects: he tries to place the card with the ship, because if you put it down, it will sink. Such patients may not be oriented in place and time. They are not critical to their condition. They do not remember the names of relatives, significant dates, the name of the doctor. Speech is impaired and may be incoherent. The behavior is often ridiculous. There are no spontaneous statements. These disturbances are dynamic. Over a short period of time, the nature of the judgments and actions of patients fluctuates. Characterized by increased responsiveness to a variety of environmental stimuli that are not addressed to them. Sometimes objects of the environment are interwoven into speech. A forced tendency is created, without selection, to reflect in speech everything that is perceived. Rapid response to external random stimuli is combined with poor switchability. In earlier works, the responsiveness phenomenon was described as field behavior.

It is necessary to distinguish between responsiveness and distractibility (in children). They have different genes:

• responsiveness is a consequence of a decrease in the level of cortical activity; contributes to the destruction of purposeful activity.
• distractibility is a consequence of an enhanced orienting reflex, high activity of the cortex.

The formation of a large number of temporary connections is the basis for further purposeful activity.

5. Slipping Correctly solving any task and adequately reasoning about any subject, patients suddenly stray from the correct train of thought due to a false, inadequate association, and then again are able to continue reasoning consistently, without repeating the mistake, but without correcting it either. It is typical for fairly well-preserved patients with schizophrenia. Slips are sudden, episodic. In an associative experiment, random associations and associations by consonance often appear (grief-sea). The process of generalization and abstraction is not disturbed. They can correctly synthesize the material, correctly highlight the essential features. At the same time, for a certain period of time, the correct course of thinking is disturbed in them due to the fact that patients in their judgments begin to be guided by random signs that are insignificant in a given situation.

II. Violations of the operational side of thinking in mental illness.

1. Reducing the level of generalization In the judgments of patients, direct ideas about objects and phenomena dominate; operating with general features is replaced by the establishment of specific relationships between objects. They cannot select the signs that most fully reveal the concept. 95% oligophrenia 86% epilepsy 70% encephalitis

2. Distortion of the generalization process. They reflect only the random side of phenomena, the essential relationships between objects are little taken into account; the subject content of things and phenomena is not taken into account. It is more common in patients with schizophrenia (67%) and psychopaths (33%). Violation of the process of generalization is caused by the fact that patients are not guided by culturally accepted relationships between objects. So in the problem the fourth patient can unite a table, a bed and a closet, calling them volumes limited by wooden planes.

III. Violations of the motivational component of thinking.

1. Diversity of thinking — judgments of patients about any phenomena proceed in different planes. Patients do not complete tasks, although they learn the instructions, they retain mental operations of comparison, distinction, generalization, and distraction. The patient’s actions are devoid of purposefulness. Diversity appears especially clearly in tasks for the classification of objects and the exclusion of objects.

2. Reasoning — «a tendency to fruitless sophistication», «a verbal tumor» (I.P. Pavlov). Speech is replete with complex logical constructions, pretentious abstract concepts, terms that are often used without understanding their true meaning. If the patient with thoroughness strives to answer the doctor’s question as fully as possible, then for patients with reasoning it is not important whether their interlocutor understood them. They are interested in the process of thinking, not the final thought. Thinking becomes amorphous, devoid of clear content. Discussing simple everyday issues, patients find it difficult to accurately formulate the subject of the conversation, they express themselves in a florid way, they consider problems from the point of view of the most abstract sciences (philosophy, ethics, cosmology). Such a tendency to lengthy, fruitless philosophical reasoning is often combined with absurd abstract hobbies (metaphysical intoxication). Psychological research. Thus, from the point of view of psychiatrists, reasoning is a pathology of thinking itself, however, psychological studies (T.I. Tepenitsyna) have shown that these are violations not so much of intellectual operations as of the personality as a whole (increased affectivity, inadequate attitude, desire to let down any , even the most insignificant phenomenon under some kind of «concept»). Studies have shown that the inadequacy, reasoning of patients, their volubility acted in cases where there was an affective capture, an excessive narrowing of the circle of meaning-forming motives, an increased tendency to «value judgments». Affectivity is also manifested in the very form of the statement: significant, with inappropriate pathos. Sometimes only one intonation of the subject allows us to regard the statement as resonant (that is why what is described in textbooks looks so faded — there is no emotional intonation). Types of reasoning in various mental pathologies:

1. Schizophrenic (classical) reasoning.
2. epileptic reasoning
3. organic reasoning

3. Violation of criticality. Loss of purposefulness of thinking, superficiality, incompleteness of thinking; thinking ceases to be the regulator of human actions. S.L.u.e.shtein: only in the process of thinking, in which the subject more or less consciously correlates the results of the thought process with objective data, is an error possible and that “the ability to realize an error is the privilege of thought.” In psychopathology, criticality is a critical attitude towards delirium, hallucinations, and other painful experiences. According to Zeigarnik: criticality is the ability to deliberately act, check and correct one’s actions in accordance with objective conditions.

4. Associativity of thinking. A rare phenomenon that occurs with damage to the frontal lobes of the brain and deep schizophrenia, which led to the complete collapse of the motivational sphere. It is characterized by the fact that thinking is determined by the laws of associations.