Causes of thinking disorders in patients. Impaired thinking in mental illness

Improves our quality of life. Intelligence is the ability to achieve goals or cope with emerging difficulties. It is in the fight against problems, in solving new problems that affect our lives, that all the best people develop. From here we can make a division into a strong mind and a weak mind.

The mind is logical and intuitive. The logical mind builds logical chains flowing from one another. Strong thinking brings these chains to the end, that is, to the specific action that needs to be taken. Consider the following example of a logical chain:

• I need money.
• To have money, you need to work.
• To work, you need to find a job.
• This means you need to set aside time, make inquiries with friends, look at job advertisements, register with the labor exchange, and visit several enterprises. All this will allow me to pass an interview at some point and start working.

A strong mind will create one more, final link in this logical chain. In this case, it will be specific: who to call, who to talk to, where to go. And this will be with a clear indication of the time when these actions should be performed.

Weak thinking will stop the process of creating a logical chain somewhere in the middle. This kind of thinking is typical for most people who do not complete the thinking process. And completely in vain. Try to think differently, and you will have a completely different life result.

In addition to logical thinking, there is also intuitive thinking. If logical thinking consists mainly of verbal and conceptual constructions, then intuitive thinking works with images. Intuition involves a holistic perception of the world, and decision-making based on such perception. No parts, abstract structures or dogmas are isolated from the world. Intuition works directly with reality - with images and their changes over time.

For example, a boxer enters the ring. He was warned that his opponent liked to throw knockout blows with his left hand. The logical conclusion is that it is the left side that you are most afraid of. Intuition may suggest something completely different - watching how the opponent fights, the boxer may decide to be wary of a right-hand strike. In doing so, he will rely on the experience of his previous fights.

Sometimes intuition is right, sometimes logic is right. In any case, a person who is fluent in both types of thinking is able to respond competently to the situation. A strong intuitive mind requires experience. If you have no experience, intuition is unlikely to be able to suggest anything. In addition, strong intuition requires the ability to see key images and compare them with each other and with memories from the past. In order to develop intuition, you need to train your thinking, forcing it to work with images.

The ability to think in images is called intelligence. Intelligence differs from logical thinking in speed. Decisions that require thought and a balanced approach are best left to logic. Quick wit is the ability to find quick solutions, often non-obvious and non-standard ones.

Here are some questions to test your wits:

1. A glider belonging to Hungary fell on the border of Poland and the Czech Republic. Which country will get the motor from the glider?
2. The man turned off the light, went to bed and fell asleep before the room became dark. How did this happen if the person was alone in the room?
3. One driver did not take his driver's license with him. In addition, there was a “No Entry” sign. Why didn't the police stop him?
4. Who walks while sitting?
5. What question cannot be answered with “yes”?
6. What question cannot be answered with “no”?
7. You are in a running race and you have passed the runner in second position. What position did you take?

Write your answers in the comments.

To develop imaginative thinking, use visual images: diagrams, graphs, charts, mind maps, flowcharts. They will help you to grasp the whole matter, to understand what needs to be done, done, and improved.

Thus, it is most effective to use both logical and intuitive thinking to solve your problems. The algorithm is as follows:

• Formulate your desires and goals.
• By building a logical chain, arrive at what needs to be done. and write down specific tasks.
• Based on these tasks, make visual representations that will include all the required steps and the dependencies between them. This way you can embrace the entire problem and start working with it as a whole.

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Classification of thinking according to Zeigarnik. The theory is based on:

1. Violation of the operational side of thinking (synthesis, analysis, abstraction)

a) reduction in the level of generalization

b) distortion of the generalization process

a) in the thinking of patients one can distinguish concreteness, an insufficient level of abstraction, the use of simple unambiguous connections between phenomena, and a concrete situational type of problem solving. Those. the patient draws a conclusion, uses the situation to combine situations with each other, the situations are related to life experience. For example: classification methodology. When considering a specific situation, patients will be allocated an abstract sign. This will manifest itself in organic diseases of the brain, epilepsy, mental retardation, mental retardation.

b) repression of judgments based on non-basic latent features. The patient does not use standard signs, but collateral connections. For example: a sparrow and a nightingale - a person with schizophrenia will say that they can make sounds.

2. Violation of the dynamic side of thinking.

Lability of thinking - excessive mobility of thought processes (often in a manic state). The patient jumps from one thing to another, thinks out loud.

Inconsistency, slipping - the patient is able to maintain the correct line of reasoning for some time, but at some point he switches and performs the task incorrectly.

Often with vascular diseases of the brain

Often caused by fluctuations in attention.

Fleeting fluctuations in performance:

• responsiveness
• the patient is not able to maintain the course of reasoning for a long time and his mental activity is disorganized as a result of the appearance of side stimuli.
• inertia of thinking (rigidity, rigidity) is due to the rigidity of already formed connections, methods of action and past experience. It is difficult to switch from one type of activity to another, and difficulties arise in inclusion in the task.

3. Violation of the motivational aspect of thinking

1). reasoning- ethereal reasoning. The patient discusses some topic in sufficient detail, which is not required by the situation.

In patients with schizophrenia, unproductive reasoning and ineffectiveness of the process. Each mental illness has its own specifics.

• in schizophrenia - the topic is significant, has an abstract nature, there are many details in its development in the absence of the result of reasoning, the inadequacy of the whole situation. Pretentiousness of definitions, isolation from reality
• with epilepsy - the patient as a moralist, a defender of rules, ethical standards, a person explains himself pathetically, the position of a broadcaster.
• in case of organic brain lesions, reasoning is of a compensatory nature; for the patient it is a way to compensate for his failure, to avoid performing a difficult task.
• putting into the plan loud external speech, the execution of operations and the general program of actions.

Avoiding the topic, avoiding a difficult situation.

2). diversity of thinking When performing the same task, the patient comes from different attitudes, often not related to either the instructions or the content of the task. As a result, the patient may make conflicting judgments. Most common in schizophrenia

Diversity levels:

• slippage - single acts, single deviations from the general progress of the task
• actual diversity
• fragmented thinking in general

It is often impossible to restore the patient's logical connections and judgments. Speech and judgments are fragmentary, may be correctly grammatically formulated, but are devoid of meaning, entire phrases are meaningless, but with the correct grammatical structure.

4. Violation of criticality

Violation of criticality - the personal level is activated. They occur frequently, in principle, in everyone, with the exception of neurotics.

Inability to adequately evaluate one’s actions, their compliance with the requirements of the task, insufficient planning, control over one’s actions, error correction.

Different patients have different aspects of criticality. Criticality is associated with social adaptation, the ability to evaluate one’s behavior in accordance with social requirements and rules.

B Most people think. But the quality of their thinking is very weak, as it does not lead to results. What does it mean? The author of the book “How to Become Smarter,” Konstantin Sheremetyev, believes that a person of strong thinking ultimately comes to a specific action and does not need additional reflection.

How to learn this?

Rule 1. Let's start from the end

When you start a solution, you should have a rough idea of ​​what kind of result you will get.

The trick is that no matter what you think, you ALWAYS get results. Material result. What surrounds you is the result of your thoughts.

Let's say you thought something about money. Your money. For example, we dreamed of having more of them, and the thought stopped there. Then the amount of money you have will not change. The idea has not been completed.

To change, you need to start from the end. That is, first think about how much money is a normal amount for you. We thought and wrote. Now you can think about how to get them.

Otherwise it becomes a trap. You've come up with some financial idea, but it still won't give you as much as you want. Therefore, it was not even worth thinking about.

Rule 2. End with action

Once you start thinking, you need to think to its logical conclusion. How do you know when to stop? To do this, the following rule: strong thinking stops only when it is clear next concrete step. That is, you wrote on paper an action of yours that does not require any additional resources.

Example. You decide to talk to your boss about raising your salary. If you write only this, then it is not clear when and what exactly needs to be done. But if you write: “On Wednesday, at 10-00, I’ll go to the reception and make an appointment,” then this is a completely different matter.

Sometimes the next step is unclear because it depends on other people. In this case, as a first step, write a contact with this person.

Example. You want to gather a fun group for a barbecue. But in your company, only one person has a car in which he can take everyone. In this case, there is no need to plan further. You need to write down for yourself: “Call Petya and find out if he wants to go to the barbecue.”

Thinking that does not result in action is weak thinking.

As a rule, it ends in empty dreams. If the problem is not very important, then there is nothing to worry about. We just wasted time.

But if the problem is vitally important to you, then thinking without action leads to neurosis. After all, simple thinking does not change your life, so the problem returns again and again.

Rule 3. Moving from the known to the unknown

When the problem is too complicated, there is no point in wandering around in the fog. Always start with what is clear and obvious. Write it down on paper. And then, when you see what exactly you don’t understand, you begin to look for it, find out, find out and gradually build the overall picture.

Therefore, when faced with an incomprehensible problem, we wrote down what we knew and went to collect further information.

Rule 4. We move only forward

Strong thinking moves from one thought to another strictly in the direction of the result. It’s written on your piece of paper what you’re thinking about, and that’s what you’re thinking about. Without rushing from side to side.

A common mistake looks like this. You have already decided something, sketched out an action plan, and then got scared: “Oh, what if it doesn’t work out!” - and you start thinking about another option. Everything is a dead end. You will continue to wander in circles. You can find out whether it will work or not, only trying to do this.

In the example with kebabs, you can make the following mistake. Having already decided that you will call Petya, think: “Oh, what if he refuses! I’d rather organize something else.”

In this case, you are at a dead end.

• First, your thinking was immediately invalidated because you did not take action.
• Secondly, you decided for Petya. You don't know whether he wants it or not. Maybe he would be glad that someone invites him to a barbecue.
• Thirdly, you will start organizing something else, and in the end you will be afraid again. And this can go on forever.

Most often this is what happens. People with weak thinking may be afraid to make a decision for years. Thinking goes on in circles all the time, and it does not end with action.

A quick decision and concrete action is better than long thinking and trying to foresee everything. It is impossible to foresee everything.

Rule 5. Only you can make a decision

When you start thinking about a problem, most often in any everyday problem your solution affects other people.

For example, you want to talk about a salary increase or make a date.

The mistake of weak thinking is that you put the decision on someone else. It looks like this: if you are refused, then someone else is to blame. And you don’t even think about how to do it correctly.

Strong thinking is that while thinking, immediately think for another person. Why should he agree with you? What is its benefit?

In this case, your proposal will already be formulated much more intelligently and has a higher chance of success.

And it’s a completely empty option when you try to talk if you haven’t made any decision yet. This results in empty chatter, because you yourself don’t know what you want, much less your interlocutor.

So remember. When you think, from beginning to end you think only yourself, and the decision will be made by you personally. And then you begin to communicate and see the result of your thoughts.

Example. If you want to invite a girl, then decide YOURSELF where you want to invite her. If at the cinema, then which one, in which cinema and for which session. And the first action is that you collect this information: what interesting things are going on now and where. And only after that you meet the girl and offer a ready-made solution. If she doesn't like one movie, offer another, if she doesn't like this time, offer another, etc. Your chances of going to the movies will increase dramatically than if you said:

Let's go to the cinema.

What's going on now?

Yes, I don’t know, I thought you knew...

Rule 6: Think clearly

A person cannot know everything. This seems like an obvious idea, but when you forget about it, complications arise: you start thinking about the problem, having a vague idea of ​​what you are thinking about.

Example. You came to buy a small computer, and the seller asks you:

Do you want a laptop or netbook?

If you clearly understand the difference, then there is no problem. But if you don't understand, you may fall into a trap. You can pretend you know and start solving a vague problem. It is clear that in the fog you can easily make a mistake and buy something completely different from what you need.

In real life, such situations are everywhere. You cannot be an expert on everything, you cannot understand computers, cars, washing machines, vacuum cleaners and other things in detail, but you need to use it all.

So remember this rule of strong thinking: don't understand - ask.

People fall into the trap of foggy thinking because they are afraid of appearing stupid. But a really smart person remembers that you can’t know everything, so it’s the smart person who constantly asks for advice.

Rule 7: Check the chain

This is the final rule of strong thinking. When you have outlined the solution to the problem and outlined the first action, do not rush to complete it. Remember: “Measure twice, cut once.”

You need to carefully look at the entire chain link by link. In this case, you must answer two questions for each link:

1. Do you understand what needs to be done here?
2. Will the result make it possible to move on to the next link?

And when you have gone through the chain, then answer the question along the chain as a whole:

Will the chain lead to the desired result?

If the answers to all questions are positive, then you can safely proceed to action.

From the book “How to become smarter”,

Source

Thinking disorders are one of the most common symptoms of mental illness. Some of them are considered typical for one or another form of the disease. Thinking disorders can come in many different forms. Based on the structure of thinking, the following types of pathology of thinking are distinguished:

violation of the operational side of thinking;

disturbance of the dynamics of thinking;

violation of the motivational component of thinking.

Violation of the operational side of thinking

It is known that thinking is based on a system of concepts that make it possible to reflect action in generalized and abstract forms. According to S.L. Rubinstein, generalization is a consequence of analysis that reveals significant connections between phenomena and objects. L. S. Vygotsky believed that generalization is given in the system of language, which helps to convey universal human experience and allows one to go beyond individual impressions. In some forms of pathology of mental activity, patients lose the ability to use the system of generalization and abstraction operations. Violations of the operational side of thinking can have the following options:

reduction in the level of generalization;

distortion of the generalization process.

Reducing the level of generalization

The decrease in the level of generalization is expressed in the fact that direct ideas about objects and phenomena dominate in the subjects’ judgments, and purely specific connections between objects are established. This can be especially clearly illustrated by analyzing the results obtained using the method of classifying objects. For example, patients combine heterogeneous concepts into groups: a notebook and a table (because you can only write in a notebook on the table), a book and a sofa (because it is convenient to read a book on the sofa). The analyzed items are combined by patients on the basis of secondary ones, namely latent ones (from Lat. latens - hidden or secret) or private signs. With a pronounced decrease in the level of generalization, classification as a mental operation is inaccessible to patients. The subjects establish specific situational connections. Similar results can be obtained when younger schoolchildren complete tasks using the “Fourth Odd One” method. For example, from the series goat, chicken, cat And cow stands out cat, since “she lives in an apartment, and therefore she is domestic, and everyone else lives in a shed (on the street); They are street animals, not pets.”

Experimental data show that the classification operation, which is based on identifying the leading property of an object and abstracting from many other specific properties and features of objects, causes difficulties. It is this circumstance that is the reason why patients resort to specific situational group formation. For example, when presenting subject cards with images thermometer, clock, scales And points a patient with epilepsy suggested removing scales, since “you can’t put them in your pocket, but everything else can.”

The lack of understanding of the conventionality and generality of the proposed image when patients explain proverbs and metaphors is especially clear. The true meaning of a proverb becomes clear only when a person is distracted from the specific facts that are given in the proverb, and specific individual phenomena acquire the character of a generalization. Only under this condition is the content of the proverb transferred to other situations. This transfer is similar to the transfer of a solution method from one problem to another. Behind the transfer is a generalization, followed by an analysis interconnected with a synthesis.

The most flagrant and most common violation is the literal understanding of a proverb, leading to the loss of its generalized meaning. For example, a patient with epilepsy interprets the proverb “Strike while the iron is hot” as follows: “Iron cannot be forged when it is cold.”

When working with the “Associating phrases with proverbs” method, subjects are offered individual proverbs and cards on which their exact or approximate meaning is revealed. For example, the following phrases are suggested for the proverb “You can’t hide an awl in a sack”: “The shoemaker repaired his boots with an awl”; “The truth cannot be hidden”; “The shoemaker carelessly dropped an awl into the bag.” The difficulty of the task here is transferred to another plane: you need not only to understand the abstraction, but also to exclude what does not correspond to the meaning of the proverbs.

A decrease in the level of generalization is also evident when studying patients using the pictogram technique. Thus, the drawings of patients with schizophrenia are highly schematic and empty symbolism. The images created by patients with epileptic disease and mentally retarded persons are of a specific situational nature and indicate their lack of understanding of transference and convention. It is these features that are manifested in their pedantry, thoroughness and viscosity.

The non-generalized nature of associations in patients suffering from epilepsy and in mentally retarded individuals is also revealed when carrying out tasks to establish the sequence of events. When decomposing a series of plot pictures, patients are guided by the particular details of the picture, without linking them into a single plot. The associations that arise are determined only by individual, isolated elements of the presented picture. The semantic relationships between the elements of the situation perceived by the patient do not play any role in the occurrence of the association.

The problem of mediation was first posed by L. S. Vygotsky. Mastering the meanings of words in the process of his development, a person generalizes objective connections and relationships, controls his behavior. The word, as a means of communication and generalization, forms a unity in its development and serves as the basis for mediation.

Pathopsychological studies show that the mental activity of mentally ill patients imperfectly reflects the objective and human worlds and the relationships in them. At the same time, a full-fledged process of reflecting the objective properties and patterns of phenomena presupposes the ability to abstract from specific details.

Generalization bias

This violation of the operational side of thinking is the antipode of the process of decreasing generalization. It is observed most often in patients with schizophrenia. The distortion of a generalization is expressed in a “departure” from specific connections in an extremely exaggerated form. If in patients with epilepsy the level of generalizations is characterized by specific situational connections (and this means a decrease in the level of generalization), then patients with schizophrenia reflect in their generalizations only the random side of phenomena, the substantive content of which they do not take into account and distort.

When solving tasks in patients with schizophrenia, only random associations are updated. The connections with which patients operate do not reflect either the content of the phenomena or the semantic relationships between them. For example, patients may combine fork, table And shovel according to the principle of hardness into one group. They perform classification tasks either on the basis of such general characteristics that it goes beyond the content of the phenomena, or on the basis of purely external, insignificant characteristics. For example: bug And shovel are combined into one group due to the fact that “they dig the ground with a shovel, and the beetle also digs in the ground.”

The meaningless nature of judgments appears especially clearly when performing pictograms. In them, patients establish only formal, meaningless or emasculated connections. The conventionality of the drawings can reach the point of absurdity and complete schematization. For example, to remember the word “doubt”, draw som, and for the word “separation” - onion. Another patient, in order to remember the word “doubt,” draws a lump of clay, since “Glinka has a romance “Doubt,” let’s draw clay.”

The judgments of patients with schizophrenia are dominated by connections that are inadequate to specific life relationships. Arises a symptom of emasculated reasoning. It is especially evident when comparing and defining concepts. For example, the word “clock” is defined as “the impulse or pulse of the vital activity of all mankind.” And the “sleigh and cart” compared by one of the patients are defined by him as a “modification of appearance”,

I. P. Pavlov noted that the use of speech is a human advantage, but at the same time it conceals the possibility of separation from reality, withdrawal into fruitless fantasy, if the “closest” guides of reality are not behind the word. Due to the lack of verification by practice, the mental activity of patients becomes inadequate, and their judgments turn into “mental chewing gum.” Paradoxically, speech does not make the task easier, but makes it more difficult, since spoken words evoke new, often random associations that are not inhibited by patients with schizophrenia. Reasonable judgments of patients are determined not so much by violations of their ideas, but by the desire to bring any insignificant phenomenon under a certain “concept”.

Violation of the dynamics of mental activity

Recognizing the reflexive nature of thinking means recognizing it as a process. S. L. Rubinstein repeatedly emphasized that reducing thinking to the operational side and not taking into account

its processual side means eliminating thinking itself. The true manifestation of thinking as a process is a chain of inferences that turns into reasoning. The occurring thinking disorders in most cases are not reduced to the disintegration of concepts, but are dynamic thinking disorders. To them include lability And inertia of thinking.

Lability of thinking

Disturbances in the dynamics of mental activity can be expressed in lability or instability of the method of performing a task. Lability of thinking - This is an alternation of adequate and inadequate decisions. The level of generalization may generally not suffer, but the adequate nature of judgments may be unstable. Reaching high levels of generalization in some cases, patients occasionally stray along the path of incorrect or random combinations. Lability of thinking can be expressed in:

alternation of generalized and specific situational combinations;

replacing logical connections with random combinations;

the formation of groups of the same name (for example, representatives of blue-collar professions).

Lability of thinking often manifests itself in patients with manic-depressive psychosis in the manic phase of the disease. Manic states characterized by an increased affective state and psychomotor agitation. Patients constantly speak loudly, laugh, joke, accompanying their speech with expressive gestures and facial expressions. Sometimes individual words are shouted out. Characterized by extreme instability and scattered attention. The associations that arise are chaotic in nature and are not inhibited. Understanding the meaning of the proverb, patients cannot concentrate on it. Often a word in a proverb evokes a chain of associations that lead the patient far away from the initial topic.

Patients experience increased “responsiveness” - a sensitive response to any stimulus not directed at them. At the same time, the appearance of “interweavings” is characteristic, that is, the introduction into the context of tasks of words denoting the objects in front of them. Any phrase can cause patients to act in ways that are inappropriate to the content of their activity.

Inertia of thinking

The difficulty of switching from one way of working to another is called inertia of thinking. This thinking disorder is opposite in meaning to the previous one. Changing conditions make it difficult to generalize the material. The inertia of the connections of previous experience leads to a decrease in the operations of generalization and abstraction (for example, when carrying out subject classification). Patients with epilepsy, with the consequences of severe injuries, as well as the mentally retarded, demonstrate the viscosity of thinking and a kind of reasoning, manifested in thoroughness and excessive detail. They exhibit slowness and stiffness of intellectual processes and difficulty switching.

This form of thinking disorder is characterized by delayed responses, when the trace stimulus retains its meaning. The trace stimulus acquires greater signaling value than the actual one. For example, when performing the task “Name the opposite word”, the patient selects the word “silence” for the word “singing”, and the word “silence” for the word “wheel”. Antonyms for the words “deception” - “faith” and “voices” - “lies” are selected in a similar way.

Thinking is a basic and human-specific cognitive process, during which internal (semantic) connections are dialectically established that characterize the structure of objects of reality, their relationships with each other and with the subject of cognitive activity. Thinking is closely related to another basic cognitive process - the process of perception and necessarily arose as a result of its progressive evolutionary development. The struggle for existence, which is the main mechanism of species dynamics, forced at each moment of conflict interaction of competing individuals first to the maximum tension of physical forces (stress mobilization) in the interests of satisfying their unconditional needs (food, sexual, self-preservation), thereby ensuring the survival of the individual and the preservation of the species . At a certain stage of development, when purely physical resources were exhausted, a more effective adaptive mechanism became the possibility of first generalizing on the basis of individual experience the uniqueness of problem situations and their algorithmic resolution, and then the need to search for new non-standard (creative) solutions.

These circumstances have become an incentive that provides a qualitative leap - a transition from the specifically perceived immediacy of existence to an analytical-synthetic assessment of past experience and prediction of one’s behavior in the future. Thus, its time boundaries were expanded and the prerequisites were created for the intensive development of other mental functions (long-term and short-term memory, imagination, perspective thinking, etc. - that is, consciousness and self-awareness in the broad sense of this concept). In parallel and interdependently with these processes, new purely human properties arose and developed - the symbolism of language and speech, fine art, the beginnings of religious feeling, scientific consciousness of the world and one’s place in it.

Thus, the transition from the system was carried out submissions about the world around him, which gradually took shape on the basis of his individual and collective perception of the system concepts. The latter reflected the most significant signs of phenomena and objects that allowed for generalizations and formed a picture understanding the surrounding world. The symbolism of language as a function of communication from a means of denoting realities increasingly turned into a means of communication, exchange of information, forming the collective consciousness of the population. Along with specific concepts, describing individual objects, phenomena (cat, table, fire) arose abstract, generalizing specific realities (animals, furniture, natural disasters).

The ability to form and assimilate semantic, genus-forming concepts arises at a certain stage of the historical and ontogenetic development of mental activity and is called abstract thinking. The inability to operate with abstract concepts, subjective thinking based on unimportant signs does not reveal the meaning of phenomena or leads to a contradictory (illogical) interpretation of their essence. This, in turn, indicates either an atavistic delay in its development, or the presence of a mental disorder.

The thinking of normal people organizes pictures of the surrounding and internal world based on the analysis of cause-and-effect relationships, subjecting its results to the test of experience, and sooner or later it turns out to be able to identify the internal connections of objects and phenomena.

Creative, or so-called dialectical, thinking, which is the basis of professional and clinical thinking, as the most productive form, is based on analysis and synthesis. Analysis involves finding out how a given object, subject, phenomenon, due to its individual characteristics, differs from others that are outwardly similar. In order to establish this, it is necessary to study its structural and dynamic originality. In relation to the patient, this means the need to study the exclusivity of personal phenomenology, including the study of biological, mental and social statuses.

Synthesis, on the contrary, means the desire to establish internal connections between outwardly dissimilar objects, which is impossible either at the level of perception or at the level of specific formal thinking. Sometimes this connection is represented by only one characteristic, which, nevertheless, is fundamental. According to legend, the law of universal gravitation was revealed to Newton at the moment when an apple fell on his head. The perception of external signs only indicates the similarity of forms. Understanding internal connections allows us to consider completely different objects in one row that have only one common quality - mass. Thanks to this property, the human mind is also capable of extrapolating a certain internal connection beyond the limits of the experimental perception of space and time, which makes its possibilities practically limitless. This is how a person becomes aware of the laws that govern the world and constantly revises existing ideas.

So-called formal thinking, which is atavistic or has morbid reasons, follows the path of analogies, which are established by signs of external similarity, and therefore cannot be creatively productive. In medicine it is called paramedic, but is by no means the prerogative of paramedics. A doctor who thinks in this way, having completed his special education, has canonized ideas about the register of existing, in his opinion, forms of diseases in their descriptive characteristics with the corresponding algorithm for subsequent actions. The diagnostic task is most often solved on the basis of a formal calculation of symptoms with the assignment of their array to a known nosological matrix. This happens on the principle of answering the question: who is more like a bat - a bird or a butterfly? Actually like a horse (both are mammals). Cognitive activity organized in this way can only cliché standard situations within the framework of solving the simplest problems. It needs guidance, control and can only be acceptable to those applying for the role of performer.

Thinking disorders are identified either using test procedures (pathopsychologically) or on the basis of a clinical method when analyzing the speech and written products of the subject.

There are formal thinking disorders (disorders of the associative process) and so-called pathological ideas.

Disorders of thinking by form (disorders of the associative process)

Disturbances in the pace of thinking

Painfully accelerated thinking. Characterized by an increase in speech production per unit of time. It is based on the acceleration of the associative process. The flow of thought is determined by external associations, each of which is an impetus for a new topic of reasoning. The accelerated nature of thinking leads to superficial, hasty judgments and conclusions. Patients speak hastily, without pauses, individual parts of the phrase are connected by superficial associations. Speech takes on the character of a “telegraphic style” (patients skip conjunctions, interjections, “swallow” prepositions, prefixes, endings). “Leap of ideas” is an extreme degree of accelerated thinking.

Painfully accelerated thinking is observed in manic syndrome and euphoric states.

Painfully slow thinking. In terms of tempo it is the opposite of the previous disorder. Often combined with physical inactivity, hypothymia, and hypomnesia. Expressed in speech inhibition, stuckness. Associations are poor, switching is difficult. Patients in their thinking are not able to cover a wide range of issues. A few conclusions are formed with difficulty. Patients rarely show speech activity spontaneously; their answers are usually laconic and monosyllabic. Sometimes contact cannot be established at all. This disorder is observed in depression of any origin, with traumatic brain injury, organic, infectious diseases, and epilepsy.

Impaired thinking

Torn thinking characterized by the absence of logical agreements between words in the speech of patients; grammatical connections can be preserved. Nevertheless, the patient’s speech may be completely incomprehensible, devoid of any meaning, for example: “Who can highlight the temporary discrepancy in the relativity of concepts included in the structure of the world,” etc.

At incoherent thinking There are not only logical, but also grammatical connections between words. The speech of patients turns into a set of individual words or even sounds: “I’ll take it... I’ll get it myself... damn it... ah-ha-ha... laziness,” etc. This thinking disorder occurs in schizophrenia, exogenous-organic psychoses, accompanied by amentive clouding of consciousness.

Violation of purposeful thinking

Reasoning(fruitless philosophizing, reasoning). Thinking with a predominance of lengthy, abstract, vague, often unsubstantial reasoning on general topics, regarding generally known truths, for example, when a doctor asks “how do you feel?” They talk for a long time about the benefits of nutrition, rest, and vitamins. This type of thinking is most common in schizophrenia.

Autistic thinking(from the word autos - himself) - thinking, divorced from reality, contradicting reality, not corresponding to reality and not corrected by reality. Patients lose touch with reality, immerse themselves in the world of their own bizarre experiences, ideas, fantasies that are incomprehensible to others. Autistic thinking is one of the main symptoms of schizophrenia, but can also occur in other diseases and pathological conditions: schizoid psychopathy, schizotypal disorders.

Symbolic thinking. Thinking in which ordinary, commonly used words are given a special, abstract meaning, understandable only to the patient himself. In this case, words and concepts are often replaced by symbols or new words (neologisms), patients develop their own language systems. Examples of neologisms: “mirror, pince-necho, electric excovochka.” This type of thinking occurs in schizophrenia.

Pathological thoroughness(detailedness, viscosity, inertia, stiffness, torpidity of thinking). Characterized by a tendency to detail, getting stuck on details, “treading water,” and an inability to separate the important from the secondary, the essential from the unimportant. The transition from one set of ideas to another (switching) is difficult. It is very difficult to interrupt the speech of patients and direct them in the right direction. This type of thinking is most often found in patients with epilepsy and organic diseases of the brain.

Perseveration of thinking. It is characterized by the repetition of the same words and phrases, due to the pronounced difficulty in switching the associative process and the dominance of any one thought or idea. This disorder occurs in epilepsy, organic brain diseases, and in depressed patients.

Thinking disorders by content

They include delusional, overvalued and obsessive ideas.

Delusional ideas.

They are false, erroneous judgments (inferences) that arose on a painful basis and are inaccessible to criticism and correction. A delusional but healthy person can sooner or later either be dissuaded, or he himself will understand the error of his views. Delirium, being one of the manifestations of a disorder of mental activity as a whole, can only be eliminated through special treatment. According to psychopathological mechanisms, delusional ideas are divided into primary and secondary.

Primary delusion, or delusion of interpretation, interpretations stems directly from thinking disorders and comes down to the establishment of incorrect connections, incorrect understanding of the relationships between real objects. Perception usually doesn't suffer here. In isolation, primary delusions are observed in relatively mild mental illnesses. The painful basis here is most often a pathological character or personality changes.

Secondary or sensory delusion is a derivative of other primary psychopathological disorders (perception, memory, emotions, consciousness). There are hallucinatory, manic, depressive, confabulatory, and figurative delusions. From the above it follows that secondary delusions arise at a deeper level of mental disorder. This level or “register”, as well as the delusion genetically associated with it, is called paranoid (in contrast to the primary – paranoid).

According to the content (on the topic of delusion), all delusional ideas can be divided into three main groups: persecution, grandeur and self-abasement.

To the group persecution ideas include delusions of poisoning, relationships, influence, actual persecution, and “love charm.”

Delusions of grandeur also varied in content: delirium of invention, reformation, wealth, high birth, delirium of greatness.

TO delusional ideas of self-deprecation(depressive delusions) include delusions of self-blame, self-abasement, sinfulness, and guilt.

Depressive plots are usually accompanied by depression and are presented asthenically. Paranoid delusions can be either asthenic or sthenic (“pursued pursuer”).

Delusional syndromes

Paranoid syndrome characterized by systematized delusions of relation, jealousy, and invention. The judgments and conclusions of patients outwardly appear to be quite logical, but they proceed from incorrect premises and lead to incorrect conclusions. This delusion is closely related to the life situation, the personality of the patient, either altered by mental illness, or pathological from birth. Hallucinations are usually absent. The behavior of patients with paranoid delusions is characterized by litigiousness, querulant tendencies, and sometimes aggressiveness. Most often this syndrome is observed in alcoholic, presenile psychoses, as well as in schizophrenia and psychopathy.

Paranoid syndrome. Characterized by secondary delirium. The group of paranoid syndromes includes hallucinatory-delusional, depressive-delusional, catatonic-delusional and some other syndromes. Paranoid syndromes occur in both exogenous and endogenous psychoses.

In schizophrenia, one of the most typical variants of hallucinatory-paranoid syndrome is often observed - Kandinsky-Clerambault syndrome, which consists of the following symptoms: pseudohallucinations, mental automatisms, delusional ideas of influence. Automatisms are the phenomenon of loss of the sense of belonging to oneself in thoughts, emotional experiences, and actions. For this reason, the mental actions of patients are subjectively perceived as automatic. G. Clerambault (1920) described three types of automatisms:

Ideatorial(associative) automatism manifests itself in a feeling of outside interference in the course of thoughts, their insertion or removal, breaks (sperrungs) or influxes (mentism), the feeling that the patient’s thoughts are becoming known to others (a symptom of openness), “echo of thoughts”, violent inner speech, verbal pseudohallucinations, perceived as a sensation of thoughts being transmitted over a distance.

Sensory(senestopathic, sensory) automatism. It is characterized by the perception of various unpleasant sensations in the body (senesthopathy), a feeling of burning, twisting, pain, sexual arousal as caused, specially caused. Gustatory and olfactory pseudohallucinations can be considered as variants of this automatism.

Motor(kinaesthetic, motor) automatism is manifested by a feeling of compulsion of certain actions, actions of the patient, which are performed against his will or caused by external influences. At the same time, patients often experience a painful feeling of physical lack of freedom, calling themselves “robots, phantoms, puppets, automata,” etc. (feeling of mastery).

The explanation of such internal experiences using hypnosis, cosmic rays or various technical means is called delusional influence and sometimes has a rather ridiculous (autistic) character. Affective disorders are most often represented by feelings of anxiety, tension, and in acute cases, fear of death.

Paraphrenic syndrome. It is characterized by a combination of fantastic, absurd ideas of greatness with expansive affect, phenomena of mental automatism, delusions of influence and pseudo-hallucinations. Sometimes delusional statements of patients are based on fantastic, fictitious memories (confabulatory delusions). In paranoid schizophrenia, paraphrenic syndrome is the final stage of the course of psychosis.

In addition to the chronic delusional syndromes described above, in clinical practice there are acutely developing delusional states that have a better prognosis (acute paranoia, acute paranoid, acute paraphrenia). They are characterized by the severity of emotional disorders, a low degree of systematization of delusional ideas, the dynamism of the clinical picture and correspond to the concept of acute sensory delusion. At the height of these states, signs of gross disorganization of mental activity as a whole may be observed, including signs of impaired consciousness (oneiric syndrome).

Acute sensory delirium may also present Capgras syndrome(Capgras J., 1923), which includes, in addition to anxiety and ideas of staging, the symptom of doubles. When symptom negative double the patient claims that a close person, for example, a mother or father, is not such, but is a dummy figure disguised as his parents. Symptom positive twin consists in the belief that unfamiliar persons who have deliberately changed their appearance appear to the patient as close people.

Cotard's syndrome(nihilistic delirium, delirium of denial), (Cotard J., 1880) is expressed in erroneous conclusions of a megalomaniac, hypochondriacal nature about one’s health. Patients are convinced that they have a serious, fatal disease (syphilis, cancer), “inflammation of all the insides,” they talk about damage to individual organs or parts of the body (“the heart has stopped working, the blood has thickened, the intestines have rotted, food is not processed and comes from the stomach through lungs to brain”, etc.). Sometimes they claim that they have died, turned into a rotting corpse, perished.

Super valuable ideas

Super valuable ideas– judgments arising on the basis of real facts, which are emotionally overestimated, exaggerated and occupy an unreasonably large place in the minds of patients, crowding out competing ideas. Thus, at the height of this process, with overvalued ideas, as well as with delusions, criticism disappears, which allows them to be classified as pathological.

Inferences arise both on the basis of the logical processing of concepts and ideas (rationally), and with the participation of emotions that organize and guide not only the thinking process itself, but also evaluate its result. For artistic personalities, the latter can be of decisive importance according to the principle: “if you can’t, but really want to, then you can.” The balanced interaction of rational and emotional components is called affective coordination of thinking. Emotional disorders observed in various diseases and anomalies cause its disturbances. Overvalued ideas are a special case of inadequately excessive saturation with affect of any particular group of ideas, depriving all others of competitiveness. This psychopathological mechanism is called the mechanism catathymia. It is quite clear that pathological ideas that arise in this way can not only have a personal, painful, situational conditionality, but are also meaningfully connected with life topics that cause the greatest emotional resonance.

These topics most often are love and jealousy, the significance of one’s own activities and the attitude of others, one’s own well-being, health and the threat of losing both.

Most often, overvalued ideas arise in situations of conflict in psychopathic individuals, in the debut manifestations of exogenous-organic and endogenous diseases, as well as in cases of their mild course.

In the absence of persistent disorganization of the emotional background, they can be transient in nature and, when it is regulated, accompanied by a critical attitude. Stabilization of affective disorders during the development of mental illness or chronic conflict in abnormal individuals leads to a persistent decrease in critical attitude, which some authors (A.B. Smulevich) propose to call “overvalued delirium.”

Obsessions

Obsessions or obsessions, are spontaneously arising pathological ideas that are obsessive in nature, to which there is always a critical attitude. Subjectively, they are perceived as painful and in this sense are “foreign bodies” of mental life. Most often, obsessive thoughts are observed in diseases of the neurotic range, but they can also occur in practically healthy people with an anxious and suspicious character and rigidity of mental processes. In these cases, they are usually not persistent and do not cause significant concern. With mental illness, on the contrary, concentrating all the patient’s activity on himself and the fight against them, they are experienced as extremely painful and painful. Depending on the degree of emotional saturation, firstly, abstract obsessions are distinguished. They can be represented by obsessive philosophizing (“mental chewing gum”), obsessive counting ( arithmomania).

Emotionally intense obsessions include obsessive doubts and contrasting obsessions. With them, patients can return home many times, experiencing anxious doubts whether they closed the door, turned off the gas, iron, etc. At the same time, they perfectly understand the absurdity of their experiences, but are unable to overcome the doubts that arise again and again. With contrasting obsessions, patients are gripped by the fear of doing something unacceptable, immoral, or illegal. Despite all the painfulness of these experiences, patients never try to realize the impulses that arise.

Obsessions, as a rule, represent the ideational component of obsessive states and are rarely found in their pure form. Their structure also includes an emotional component (obsessive fears - phobias), obsessive desires - compulsions, motor disorders – obsessive actions, rituals. These violations are presented in the most complete form within obsessive-phobic syndrome. Obsessive fears (phobias) can have different contents. With neuroses, they most often have an understandable nature, closely related to the patient’s real life situation: fears of contamination and infection ( misophobia), closed premises ( claustrophobia), crowds and open spaces ( agoraphobia), of death ( thanatophobia). The most common are obsessive fears of a serious illness ( nosophobia), especially in cases provoked psychogenically: cardiophobia, cancerophobia, syphilophobia, speedophobia.

In schizophrenia, obsessive experiences often have absurd, incomprehensible, divorced from life content - for example, thoughts that the food consumed may contain cadaveric poison, needles, pins; domestic insects can crawl into the ear, nose, enter the brain, etc.

Anxious-tense affect in these cases quite often weakens rituals– unique symbolic protective actions, the absurdity of which patients can also understand, but their implementation brings relief to the patient. For example, in order to distract themselves from obsessive thoughts about infection, patients wash their hands a certain number of times, using soap of a certain color. To suppress claustrophobic thoughts, before entering the elevator, they turn around their axis three times. Patients are forced to repeat such actions many times, despite the full understanding of their meaninglessness.

Most often, obsessive-phobic syndrome is observed with obsessive-compulsive disorder. It can also occur within the framework of endogenous psychoses, for example, with neurosis-like debuts of schizophrenia, as well as with constitutional abnormalities (psychasthenia).

One of the variants of obsessive-phobic syndrome is dysmorphophobic (dysmorphomanic) syndrome. In this case, the patient’s experiences are focused on the presence of either an imaginary or a real physical defect or deformity. They can be both in the nature of obsessive fears and overvalued thoughts with a decrease or absence of a critical attitude, intense affect, secondary ideas of attitude, and incorrect behavior. In these cases, patients try to eliminate existing deficiencies on their own, for example, get rid of freckles with the help of acid, fight excessive obesity by resorting to grueling fasting, or turn to specialists for the purpose of surgically eliminating what they believe is an existing deformity.

Body dysmorphomania syndrome can be observed in abnormal personalities in adolescence and adolescence, more often in girls. They also often have syndromes close to this - anorexia nervosa syndrome and hypochondriacal syndrome. The delusional variant of dysmofomania syndrome is most typical for the debut manifestations of paranoid schizophrenia.