15th November 2023

Types of Formal Thought Disorder

Poverty of speech

Also known as alogia. The patient will speak with a reduced quantity of speech, there will be less reciprocal conversation, and the patient may not speak spontaneously; rather, they will wait to be asked a question. It is associated with depression and schizophrenia. In fact, a recent study identified a 3-factor model of formal thought disorder as best representative of first-episode psychosis: disorganised thought, poverty of speech and verbosity (Roche et al., 2015).

Pressure of speech

The patient will talk at a faster rate than what would be normal, making it difficult to follow the conversation. It is most associated with being in a manic state. It may be difficult to find a time to interrupt them, and any interruptions may be met with irritability and/or agitation.

Derailment and word salad

Derailment is also known as the loosening of association and knight’s move thinking. Derailment refers to a lack of association between consecutive thoughts spoken by the patient; the speech is incomprehensible; however, the syntax and grammar of the sentence is intact. This can be compared with a word salad, whereby the speech is incomprehensible, but the syntax and grammatical rules are violated, for example, by not having prepositions, conjunctions or articles present. An example of a word salad could be: ‘Look photo clock mum to folder job centre.’

Derailment and word salad most commonly occur in schizophrenia.

Neologism

A neologism is a completely made-up word. It can also refer to using a legitimate word but to mean something different, e.g. ‘smadar’ for clock (new) or ‘light’ for water (different).

Stock words

A stock word is similar to a neologism in that it is either a completely made-up word or a pre-existing word that is used to mean something different. However, it is used in an idiosyncratic way repetitively, in a variety of situations and will often be overused. For example, ‘I ride my glanar (bike?) to work every morning. Except when it’s glanar (raining?), then I take the bus because I don’t want to get wet. Once I’m at work, I say glanar (hello?) to my colleagues, and I sit down at my glanar (desk?) to get on with some work.

Stilted speech

Stilted speech is pompous, overly formal speech that is inappropriate in the context spoken. It involves vocabulary and grammar that would be more appropriate in formal writing rather than conversational speech. It also consists of unnecessary repetition or corrections.

It is associated with autistic spectrum disorder, schizophrenia, or schizotypal personality disorder. With schizophrenia, it is thought to represent a difficulty in understanding the relationship between language and context (known as pragmatics) (Covington et al., 2005).

Concrete thinking

Concrete thinking is when a patient interprets things literally. Their understanding of abstract concepts is limited. They may misunderstand things like metaphors, which makes the term ‘concrete’ thinking rather ironic.

Developmentally speaking, very young babies think concretely and cannot conceive of objects unless they are physically present. It is essential for the development of the theory of mind, an important social skill. Eventually, they develop the ability to think more abstractly and theoretically.

Concrete thinking is pathologically present in autistic spectrum disorder, formal thought-disorder-type schizophrenia, fronto-temporal dementia and intellectual disability.

Illogicality

This refers to when the patient’s logic is flawed. For example, a patient being asked when they do their gardening at home, and the patient replying that he does it at night because he can see better. It is most associated with schizophrenia.

References

• Fish, F., Casey, P., Kelly, B. Fish’s Clinical Psychopathology. Signs and Symptoms in Psychiatry. Cambridge University Press. 4th Ed 2019.
• Roche, E., Lyne, J. P., O’Donoghue, B. et al. (2015). The factor structure and clinical utility of formal thought disorder in first episode psychosis. Schizophrenia Research. 168, 92-98.
• Oyebode, F. (2015). Sims’ Symptoms in the Mind. Textbook of Descriptive Psychopathology. Elsevier: 5th Ed.
• Prathap, S. (2019). SPMM Smart Revise. SPMM Course.
• Covington, M. A., He, C., Brown, C., Naçi, L., McClain, J. T., Fjordbak, B. S., Semple, J., & Brown, J. (2005). Schizophrenia and the structure of language: the linguist’s view. Schizophrenia research, 77(1), 85–98.