Thought blocking is a sudden unintended cessation in the train of thought, experienced by the patient as 'snapping off'. After this breaking off, which may even occur in the middle of a sentence, the previous idea may be taken up again or replaced by another thought. Thought blocking occurs in organic states, in depression, and frequently in schizophrenia where it is described as part of negative thought disorder.
In loosening of associations the flow of thinking is interrupted by deviations towards distant or unrelated thoughts, in contrast with flight of ideas in which there is only a speeding up of access to nearby associations. Since loosening of associations leads to the production of abnormal concepts, it is considered to be positive formal thought disorder. In tangentiality the ideas deviate towards an obliquely related theme. In fusion, different kinds of associations evoked by an original thought are blended to produce a word or sentence. Derailment is characterized by the interpolation of ideas which neither the patient nor the observer can link with the previous stream of thought. Muddling designates an extreme degree of derailment and fusion.
Neuropsychological research suggests that loosening of associations may be caused by a failure of inhibition in the associative network, (49) occurring as positive thought disorder in schizophrenia. In organic states, incoherent thinking, which is clinically similar to derailments, may be attributable to a primary intellectual impairment and not to an increased spread of associations.
This kind of thought disorder is not based on an interruption of the flow of thought but on an inability to preserve conceptual boundaries; ideas only distantly related to the concept under consideration become incorporated in it. (50> Overinclusive thinking occurs in schizophrenia, and also in other psychotic and neurotic disorders.
In organic mental disorders and subnormality of intelligence, inability to think abstractly may be attributed to a diminished capacity to structure a concept. The concrete thinking of schizophrenics may be caused by a dysfunction of working memory;(49) the patient cannot keep in mind the abstract use of a notion relevant in a given context and slips into more concrete meanings. This process may be enhanced by loosening of associations. The fact that schizophrenics sometimes manifest overly abstract thinking may also be explained by a disturbance of working memory such that the concrete meaning of the initial thought is not retained.
Disorder of control of thinking
In obsessions and compulsions the subject recognizes his thoughts as being produced by himself but is unable to control them.
In passivity of thought, the patient experiences his thoughts as manipulated by alien influences. The interpretations resulting from this feeling are described as 'thought withdrawal', 'thought insertion', or 'thought broadcasting' (which denotes the patient's conviction that his thoughts are diffused to other people). These 'delusions of the control of thought' were included by Schneider(42) among his 'first rank symptoms' of schizophrenia.
A particular variation of thought insertion occurring in schizophrenia is crowding of thoughts. In this condition, the patient experiences an excessive increase in the amount of thoughts imposed from the outside and compressed in his mind.
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