Psychiatry - O. K. Napreyenko 2001

General Psychiatry
Disorders of Thought

Thinking is a mental process through which a person reflects the most essential and core aspects of surrounding phenomena and comprehends their interconnections. It provides the foundation for judgment, the generalization of facts and inferences, the accumulation of knowledge, The formation of hypotheses and theories, and the resolution of problems faced by the individual and society. Thinking is an active function of the intellect.

Most psychiatric researchers classify Thought Disorders according to their tempo, the connection of associations (form), and their content.

Classification OF THOUGHT DISORDERS

Thought Disorders by Association Tempo

1. Accelerated.

2. Mentism.

3. Retarded.

4. Circumstantial (viscous).

5. Thought blocking (Sperrung).

Thought Disorders by Association Connection (Form)

1. Resonating (logic-splitting).

2. Paralogical.

3. Atactic.

4. Incoherent.

5. Schizophrasic (disconnected).

6. Symbolic.

7. Perseverative.

8. Autistic (dereistic).

9. Katathymic (affective).

10. Concrete (formal, primitive).

Thought Disorders by Association Content

Pathological ideas:

a) delusional;

b) delusion-like;

c) overvalued, dominant;

d) compulsive.

Classification of delusions by content

1. Delusions of persecution:

a) of reference;

b) of physical or psychological influence;

c) of poisoning;

d) of loss, damage, or theft;

2. Delusions of grandeur:

a) of wealth;

b) of noble ancestry;

3. Delusions of self-deprecation:

a) of sinfulness;

b) of self-blame;

d) of accusation;

e) of jealousy;

e) querulous (litigious);

g) erotic.

c) of invention and discovery;

d) of reform.

c) nihilistic;

d) of possession.

Delusions According to the Mechanism of formation

1. Interpretative delusion, delusion of interpretation (paranoid).

2. Unsystematized, senso-perceptual (paranoid).

THOUGHT DISORDERS BY THE TEMPO OF ASSOCIATION FLOW

Accelerated thinking is a state characterized by an increased number of associations, thoughts, and ideas, along with an accelerated flow of thought. Speech becomes inconsistent: before finishing one thought, the patient jumps to another ("flight of ideas"). A typical feature is the loss of the subject of reasoning. The patients' judgments are hasty, superficial, and one-sided. Accelerated thinking is observed in manic states and alcohol intoxication.

Mentism is an involuntary, continuous, and uncontrollable flow of thoughts, ideas, memories, and images of distressing content. The patient is unable to concentrate on any single thought. Mentism is characteristic of Kandinsky-Clérambault syndrome.

Slowed thinking occurs when The process of forming associations is inhibited. There are fewer ideas. Thoughts and mental representations are formed slowly. Speech also becomes slow, hesitant, and punctuated by prolonged pauses. Patients subjectively experience difficulty in thinking, complaining that they have few thoughts, cannot complete a thought, or bring their reasoning to a logical Conclusion. Slowed thinking is observed in depressive and asthenic states.

Detailed thinking (circumstantiality, viscosity of thought) is characterized by psychic inertia, difficulty in transitioning from one thought to another, and the loss of The ability to separate the main point from trivial details. Thinking is slowed, inert, and fixated on specific details and minutiae. The patient's judgments are dominated by random details irrelevant to the core idea. Detailed thinking is characteristic of patients with epileptic dementia and oligophrenia.

Thought blocking (sperrung — German for blockade or stoppage) is a sudden, short-lived, spontaneous cessation of the flow of thoughts, which is easily noticeable during a conversation. The patient suddenly falls silent, later explaining this as a sudden stoppage of thought. It is observed in patients with Schizophrenia.

THOUGHT DISORDERS CLASSIFIED BY THE CONNECTION OF ASSOCIATIONS (FORM)

Resoner's thinking (sterile wordiness, circumlocution) is characterized by arguments that are not based on real facts. These are empty verbal References that do not correspond to the topic of conversation and fail to achieve their purpose—sterile reasoning devoid of concrete content, yet "dressed" in proper stylistic form. It is observed in schizophrenia.

Paralogic thinking manifests as a violation of the logic of expression. A specific concept is replaced by a symbol or sign understood only by the patient. The patient draws completely unjustified, sometimes absurd Conclusions that lack objective evidence, do not correspond to their own judgments, and are incomprehensible to others. It is striking for its "twisted" logic. Paralogic thinking is characteristic of patients with schizophrenia with paranoid personality development.

Atactic thinking is characterized by an incorrect, paradoxical combination of concepts and thoughts that lack logical connections and spontaneously string together. It manifests as atactic speech disorder and nonsensical utterances that are incomprehensible to others, even though the sentence Structure is correct and grammatically sound. The utterances may contain neologisms, agglutination (merging) of words, etc. It is characteristic of patients with schizophrenia.

Incoherent thinking is a profound thought disorder in patients with altered consciousness, manifested by the lack of connection between concepts and judgments. The patient's thoughts are fragmented and speech is disorganized. The capacity for synthesis is lost. The patient is disoriented in space and perceives objective reality fragmentarily. Speech appears as a chaotic set of words or sentence fragments, sometimes rhyming. It is observed in exogenous-organic psychoses.

Tangled (disjointed) thinking is manifested by the loss of semantic links between concepts, although the grammatical and syntactic forms of the sentences are preserved. In extreme cases, the patient's speech resembles so-called word salad (schizophasia). A subtype of this is double thinking, where the patient perceives their own thoughts as belonging to someone else (phenomena of psychic automatism). Disjointed thinking is characteristic of schizophrenia.

Symbolic thinking is when one concept becomes a symbol for another, sometimes based on accidental, secondary features. It is characteristic of schizophrenia and manifests, for example, in symbolic notations (numbers, geometric shapes, etc.) found in the patient's writing.

Perseverative thinking consists of prolonged fixation on and dominance of one and the same thought or idea, the repetition of identical words and phrases, and the recurrence of the same images regardless of changing situations. For instance, the patient Answers different questions with the same phrase. For example: "What is your name?" "Ivan Ivanovych." "How old are you?" "Ivan Ivanovych." And so on. It is observed in schizophrenia, organic Brain lesions, senile and atherosclerotic dementia, as well as Pick's and Alzheimer's diseases.

Autistic (dereistic) thinking is detached from reality. The circle of associations with the external world is limited. Associations arise primarily on The basis of ideas, concepts, and sensations connected with morbidly dominant experiences. Patients withdraw into themselves, keep aloof, and do not communicate with anyone. Responses to questions are formal. Fantasy and reality coexist without being separated by the patient, and wishes are perceived as reality. It is characteristic of schizophrenia.

Catathymic (affective) thinking is the loss of logical thinking due to METABOLISM/18.html">The Influence of affectively colored representations, desires, and fears. It is observed in paranoid personality development.

Concrete (formal, primitive) thinking is limited to concrete, primitive concepts and judgments, failing to reach the level of abstraction. It involves the inability to "detach" from the formal features of phenomena and objects or to penetrate their inner essence. For example, when asked to explain the meaning of the proverb "The apple does not fall far from the tree," a patient replies: "An apple that falls from a tree will always lie not far from the apple tree." This type of thinking is characteristic of patients with oligophrenia.

THOUGHT DISORDERS CLASSIFIED BY THE CONTENT OF ASSOCIATIONS

Among thought disorders, morbid ideas are of particular importance: delusional, delusion-like, overvalued (dominant), and obsessive ideas. Their essence lies in the fact that the patient's judgments and conclusions contain assertions that contradict reality.

Delusional ideas (delusions)

Delusional ideas constitute a thought disorder involving false, incorrect judgments that distort reality. They completely dominate the patient's consciousness and are impervious to logical correction (persuasion). From the patient's perspective, they are thinking correctly and have no doubts. Delusions cannot be corrected either by persuasion or by tangible evidence. This is precisely what distinguishes them from erroneous judgments or beliefs. Delusional ideas may lose their vividness and urgency over time, but any attempt to prove otherwise only strengthens the patient's belief in being right and fuels the further progression of the disorder. It is fitting to recall the aphorism: "A hundred wise men cannot convince a single madman."

Delusional ideas are quite diverse in their content, structure, and role in the overall clinical picture of a mental illness. The sources of their formation lie in everyday life, the patient's spiritual sphere, external impressions, and circumstances. The content of delusions is influenced by individual personality psychology, the level of intellectual development, education, profession, and the environment in which the patient lives.

The specific content of delusions depends on the historical era. For example, in the Middle Ages, ideas of the devil, witchcraft, and sorcery predominated; later, ideas of magnetism, telepathy, and hypnosis; whereas today, Complaints more often concern the effects of electric currents, cosmic rays, atomic energy, radar, etc. In this regard, we can cite Modells observation: "Madness always reflects the times to a greater or lesser degree."

W. Griesinger, A. V. Snezhnevsky, and other psychiatrists classified delusional ideas into three groups according to their content.

I. Delusions of persecution. The patient believes that they and their relatives are being watched and persecuted, that someone wants to kill them, etc. Delusions of this content manifest in various ways.

Delusions of reference. The patient believes that everything happening around them directly concerns them and carries a special meaning: everyone looks at them meaningfully; various actions, gestures, utterances, radio and television broadcasts, and sometimes even natural phenomena are not just random occurrences, but have a direct bearing on the patient.

Delusions of influence. The patient claims that the changes in their body are caused by someone else, that they are being influenced through apparatuses, rays, electric current (delusions of physical influence), or through hypnosis, telepathy, suggestion (delusions of psychic influence).

Delusions of poisoning. The patient is convinced that someone wants them dead, and therefore poison is being added to their food, toxic medications are being administered, gas is being let into their apartment, etc.

Delusions of loss, injury, and theft. The sufferer is certain that unknown criminals or acquaintances are going to rob them or have already stolen from them, ruined them, or deprived them of their apartment, property, or earnings. They even "discover" traces of a crime in their apartment.

Delusions of accusation. According to the patient, people around them are accusing them of lying, bad conduct, immoral behavior, etc.

Delusions of jealousy. The affected individual believes that their spouse is unfaithful and, together with a lover, wants to kill them. Furthermore, the "facts" cited by the patient to prove the infidelity are unreal, fantastical, and at times absurd.

Kverulans (litigious) delusions. The patient claims that their rights are being restricted and that they are being wronged, which generates an irresistible urge to defend their rights and interests through numerous complaints, lawsuits, and Applications to the courts, the prosecutor's office, and government authorities.

Delusions of an erotomanic nature — a subtype of delusions of reference and influence, sometimes combined with persecutory delusions: a specific person of the opposite sex is in love with the patient, harbors a strong passion for them, and therefore tries in various ways to draw attention to themselves, allure the patient, or win their affection.

Persecutory delusions (delusions of reference, persecution, influence, poisoning, and harm) are accompanied by a sense of fear, distrust, and suspicion toward others.

II. Delusions of grandeur. The patient is convinced of their own exceptionalism ("capable, can do anything, wealthy, holds a high social standing"). This arises against the backdrop of an elevated mood. Megalomanic delusions manifest in various ways.

Delusions of wealth. Patients claim that their salary is calculated in billions, that they possess tons of precious metals and gemstones, a vast inheritance, etc.

Delusions of noble ancestry. The patient believes they originate from a noble Lineage and have Blood ties with prominent figures in politics, art, science, etc.

Delusions of invention and discovery — a thought disorder in which an individual groundlessly, often lacking specialized education and experience, "invents" devices, engines, or medicines, or "discovers" laws whose application, in their view, will foster progress and make humanity happy.

Delusions of reformism — morbid judgments based on a system of subjective, formally logical arguments that emerged in the process of "developing" and "implementing" various reforms, ranging from minor to global ones. Patients develop classifications of human knowledge, draw up plans for an "academy of human happiness," etc.

III: Delusions of self-deprecation — a morbid state of thought in which the patient considers themselves a failure, a nobody, a deeply inadequate person.

Delusions of sinfulness. Patients attribute immoral motives, impulses, aspirations, and actions to themselves, considering themselves sinners who have no right to live because their relatives, loved ones, and the entire world are suffering on their account.

Delusions of self-blame. Patients blame themselves for life mistakes, immoral thoughts and desires, and for "committing" an immoral act or crime for which they deserve severe punishment.

Hypochondriacal delusions — the persistent conviction of the patient that they have an incurable disease and will perhaps die soon. To prove this, they cite A number of arguments based on their bodily sensations, the opinions of others, and clinical tests, even though the latter show no abnormalities or only minor changes. Physical examinations indicate the absence of any somatic illness. The sufferer refuses to believe those who try to convince them otherwise, including physicians.

Nihilistic delusions (Cotard's syndrome) — a subtype of hypochondriacal delusions. The patient claims that their Internal Organs are atrophied and non-functional, and are in a state of decay ("The Heart has stopped," "the blood has congealed in the vessels," etc.). Consequently, they "await" death. Sometimes they consider themselves a walking, decomposing corpse.

Delusions of possession — unique hypochondriacal delusions whose essence lies in the patient's firm belief that certain animals, mythical creatures, or imaginary beings have inhabited their body.

Distinctions are made between primary (interpretative) delusions and secondary (sensory-perceptual) delusions.

Interpretative (primary) delusions. Mediated (Abstract) cognition of reality is impaired. Clinically, it is characterized by a more or less complex system of ideas involving distorted judgment and misinterpretation of life's realities, while the immediate reflection of reality remains unimpaired. Accurately perceiving their environment, surroundings, and reality, patients express a false, pathologically erroneous judgment about them that is impervious to logical correction. Interpretative delusions include delusions of grandeur (intellectual superiority, invention, discovery, erotomanic delusions). They develop in individuals with paranoid personality traits (overestimation of one's own personality, psychic rigidity, distrust, suspicion, etc.). Primary delusions develop slowly, sequentially, and go through several stages. Initially (K. Jaspers, 1923), the patient notices that the people surrounding them and the events happening around them carry some secret, promise something, or have a specific bearing on the patient, yet all of this remains undefined. Patients await something that is bound to happen, which puts them on edge.

Subsequently, delusional concepts emerge. As a result, past events acquire a special meaning, a new coloring and significance in the form of an "epiphany" ("at last I realized that I am God, and everything happening in the world is the result of my commands," etc.).

The final stage of primary delusions is their crystallization, during which the delusional ideas acquire "coherence and completeness." In the case of primary delusions, the capacity for logical thinking is primarily lost. Such patients "confirm" their viewpoint with selectively chosen evidence. They take into account only what aligns with the idea they are defending, while dismissing all other arguments.

Primary (interpretative) delusions include delusions of persecution, poisoning, reference, invention, discovery, litigious delusions, delusions of grandeur, and erotomanic delusions. Interpretative delusions are characteristic of paranoid and paraphrenic syndromes.

Sensory-perceptual (secondary) delusions are characterized by a disorder of sensory cognition, accompanied by heightened affect and generalized perplexity, alongside impaired abstraction. At the same time, a cohesive worldview is not maintained. Morbid ideas rely not on a system of reasoning, but primarily on images, fantasy, and guesswork. The patient sees hints directed at them everywhere: in people's smiles, newspaper articles, radio and television broadcasts, glowing light bulbs, etc., assuming, for instance, that these are signals from their imagined enemies.

Unlike interpretative delirium, secondary delirium is associated with hallucinatory experiences and Affective Disorders. Sensory-figurative delirium is un sistematic. It is rooted in sensory-rich, vivid, figurative representations, which explains the fragmentary and inconsistent nature of its manifestations.

The content of figurative delirium varies, oscillating between realistic and purely fantastical themes. This category includes antagonistic or Manichaean delirium (M. Dide, P. Girand, 1922), which is driven by the struggle between the dual forces of good and evil, where The Nature and consequences of this conflict depend on the patient's behavior, intentions, and actions.

Affective (holothymic according to E. Bleuler, 1906) delirium presents with either depressive or manic coloring. Depressive manifestations vary widely, encompassing delusions of harm, loss, and Various Forms of hypochondriacal delirium—up to Cotard's syndrome, where hypochondriacal concerns take on a megalomanic dimension ("my suffering will never end, the world will perish, humanity will vanish, only I and my suffering will remain"...). Affective delirium with a manic coloring manifests as delusions of grandeur.

Catasthetic delirium (V. A. Gilyarovsky, 1949 refers to delusions associated with interoceptive disturbances. Painful sensations originating from internal organs primarily generate hypochondriacal delusions, as well as delusions of influence and persecution.

Structurally, delusional ideas are divided into systematic and unsystematic.

Systematized delirium. Delusional ideas are integrated into a specific system centered around a unifying core thought. Judgments evolve into a system of views that define the patient's worldview as a whole, monopolizing their entire mental life. This distorts the objective reflection of internal connections between phenomena in the real world. One pathological judgment links to another, crystallizing a delusional system. Paranoiac (paranoid) and paraphrenic delirium are systematized. Mechanistically, systematized delirium is interpretative. K. Jaspers noted that at this stage, "delusional work"—which demands "all the intellectual faculties of the individual"—gives rise to a "delusional system" that remains comprehensible in its internal connections yet incomprehensible regarding its primary experience.

Unsystematized delirium is characterized by a lack of a coherent "system of proof." Such delusional ideas are disjointed, disconnected, fragmentary, absurd, and rapidly changing. By mechanism of origin, unsystematized delirium is sensory-figurative and linked to perceptual disturbances (hallucinations), making it characteristic of paranoid syndrome.

Residual delirium is characterized by the patient's lingering conviction in the truth of experiences that occurred during an acute phase of illness against the backdrop of altered consciousness.

Induced (communicated) delirium occurs in relatives and other individuals (recipients) who maintain close, prolonged contact with a patient (the inductor). The plot of the delirium varies (most commonly involving persecution, litigation, or erotism), but closely mirrors that of the inductor. Such disorders typically arise in individuals with diminished critical faculties and heightened suggestibility due to congenital mental anomalies (such as oligophrenia or psychopathy) or acquired mental deficits (atherosclerotic dementia, prolonged asthenic states, etc.). Induced delirium usually resolves within a few days after the recipient ceases contact with the inductor. Occasionally, induced delirium affects a significant number of people and can even lead to "psychic epidemics," a phenomenon particularly widespread in the Middle Ages.

If the recipient is also mentally ill (e.g., with schizophrenia), reciprocal induction occurs, resulting in conformal delirium. Even after such co-delirants are separated, the delirium may persist and subsequently evolve independently in each individual.

Paranoid delirium involves The Emergence of systematized delusional ideas directed at specific individuals, events, or circumstances. It typically begins with self-overestimation and overvalued ideas, later progressing to the interpretation of delusional thoughts. Paranoid delirium develops following an unpleasant experience or conflict. Initially, delusions of grandeur emerge, accompanied by delusions of persecution (reference, influence, poisoning, etc.). These interconnect to form a specific delusional (paralogical) narrative. Paranoid delirium lacks perceptual disturbances, and intellectual-mnestic Functions remain intact. In the Cytology/cytology/16.html">Early stages of paranoid delusions, patients feel "pursued" by imaginary enemies, but eventually, they themselves become the pursuers ("persecuted pursuers," in the words of Lasègue and Falret).

Paraphrenic delirium. In mature individuals, systematized delusional ideas develop gradually over a long period (years or decades) and are linked to perceptual disturbances. Paraphrenic delirium begins with ideas of persecution (reference, physical and mental influence, poisoning, etc.). As the delusional ideas crystallize, ideas of grandeur emerge. Mechanistically, paraphrenic delirium is both interpretative and sensory-figurative. Intellectual-mnestic and emotional-volitional decline of the personality is absent for a prolonged period. Depending on which mental disorders predominate within The structure of paraphrenic delirium, several forms are distinguished.

Systematized paraphrenia is characterized by systematized delusions of persecution, while expansive (grandiose) delusions recede into the Background. Fantastic paraphrenia is dominated by numerous expansive delusional ideas (grandeur). If the clinical picture is dominated by delusional confabulations, it is classified as confabulatory paraphrenia, which features retrospective delirium. Expansive paraphrenia is marked by a pronounced elevated affective state.

Paranoid delirium is characterized by the appearance of delusions of reference, influence, poisoning, persecution, grandeur, self-abasement, and the like. These ideas are unsystematized, meaning they do not form a coherent "system of proof." The developmental mechanism of paranoid delirium is tied to perceptual disorders (illusions, hallucinations, metamorphopsias, etc.). It is a sensory-figurative delirium accompanied by affective tension (fear, anxiety, anger, motor agitation). The interpretation of reality is fragmentary, inconsistent, and disjointed. Delusional experiences and statements lack a "core" around which a delusional system could form.

Delusion-like ideas are pathological ideas involving the overestimation or underestimation of one's own personality, arising against the backdrop of an altered mood (elevated or depressed). They are rooted in actual real-world facts. Unlike true delusions, such ideas can be corrected to some extent, though not always or permanently, and they are never absurd.

Most commonly, delusion-like ideas are observed within the structure of manic and depressive states. In a manic state, against the backdrop of an elevated mood, the patient overestimates their own potential and abilities. In a depressive state, delusion-like ideas of self-abasement, self-accusation, sinfulness, and loss emerge.

Overvalued ideas (dominant ideas) are thoughts that overshadow all others. They arise from real circumstances but subsequently acquire excessive emotional charge, assume a dominant position in a person's consciousness, and influence the overall thought process. All other thoughts are inhibited or, conversely, concentrated to reinforce the overvalued idea. Such ideas most frequently center on matters that deeply affect the patient's personality.

Overvalued ideas do not always constitute a fully formed phenomenological entity. As the illness progresses, they may transform into delusional ideas (limited delusions of reference). Intermediate pathological ideas are also distinguished—the so-called overvalued delirium of Birnbaum (K. Birnbaum, 1915)—which can transition into paranoid delirium. Overvalued ideas are extremely difficult to correct, and sometimes entirely resistant to correction. At the same time, patients in this group may maintain sound judgment on other topics.

Most frequently, overvalued ideas are observed in psychopathic individuals, particularly those with paranoid personality disorders.

Obsessive thoughts are ideas that intrude upon a person's mind, feeling alien to their consciousness at that moment. The patient evaluates them critically, considers them absurd, and fights against them in an effort to rid themselves of them. Patients may experience "dirty" thoughts that contradict their morals, or blasphemous notions, including those directed toward respected and loved ones. Such thoughts can trouble religious individuals while they are in church, looking at icons, or praying.

Obsessive phenomena also include sterile rumination and obsessive memories. Such patients become immersed in prolonged, agonizing contemplation regarding completely irrelevant, unrealistic events and concepts. The patient may ponder what will happen to them after death, how their body will decompose, what their ashes will turn into, what plants will grow, and so on. Obsessive memories are compulsive, intensely painful recollections of past misdeeds, accompanied by a sharp, vivid sense of shame and remorse. The patient tries in vain to forget.

Obsessive thoughts (ideas) are frequently combined with obsessive doubts, apprehensions, fears (phobias), impulses, and actions. In such cases, it is more accurate to view them collectively as obsessive-compulsive states (obsessive-compulsive syndrome).

Obsessive doubts manifest as a persistent uncertainty regarding the completion of actions (e.g., whether the apartment door is locked, whether a tap is dripping, whether the gas was turned off). Repeated checks fail to reassure the patient, even though they recognize the groundlessness and pathological nature of their doubts. Patients experience a sense of insecurity regarding the accuracy and correctness of their work, frequently returning to tasks and rechecking themselves, yet remaining unsatisfied and anticipating disastrous outcomes. Obsessive apprehensions manifest when patients, while performing various actions (even automated ones), doubt their own capabilities, fearing they might falter, make a mistake, or appear clumsy.

Obsessive fears (phobias) are quite numerous, representing intense fears concerning various phenomena. Patients recognize the absurdity of their phobias and try to overcome them, but to no avail.

The most commonly observed obsessive fears include agoraphobia (fear of open spaces, squares, wide streets), hypsophobia (fear of heights), claustrophobia (fear of enclosed spaces), mysophobia (fear of contamination), thanatophobia (fear of sudden death), tokophobia (fear of dying during childbirth), oxyphobia (fear of sharp objects), nosophobia—such as cancerophobia, syphilophobia, AIDS phobia, etc. (fear of illness), monophobia (fear of solitude), hydrophobia (fear of Water), sitophobia (fear of eating), gynophobia (fear of being with a woman), mixophobia (fear of failing in an intimate situation), urodophobia (fear of involuntary urination), erythrophobia (fear of blushing), phobophobia (fear of fear itself), and pantophobia (all-encompassing fear), among others.

Obsessions (compulsive urges) refer to a sudden compulsion to perform a specific action, which the patient critically evaluates (recognizing its absurdity), tries to avoid, but ultimately fails to do so. Obsessive urges and actions (unaccompanied by phobias) include habitual movements that are difficult to suppress despite considerable effort—for example, gritting one's Teeth, constantly touching the face, pulling at facial Skin, or repeatedly adjusting one's Hair. An obsession is also considered to be the habitual inclusion of meaningless filler words in speech, such as "you know," "so to speak," "frequently," "in a word," and so on.

In psychiatric practice, one encounters contrasting obsessive urges—compulsions. Examples include the compulsive urge to use foul language in public, to strike a random passerby or a loved one, or to burst out laughing in tragic situations. Unlike delusions, contrasting obsessions are never acted upon. This is precisely what distinguishes them from impulsive actions.

Compulsive actions may be combined with phobias, in which case they take on a ritualistic character. Performing an obsessive ritual alleviates the patient's psychological distress, serving as a form of psychological defense. These actions are carried out contrary to common sense, ostensibly to avert an imaginary misfortune. For instance, patients may clap their hands in a specific sequence, wash their hands with soap until a certain number of soap bubbles appear, or count bald people on the street up to a pre-determined number, and so forth.

If, due to certain circumstances, a patient is unable to perform a compulsive action, they experience psychological discomfort (unease, anxiety, panic) that persists until the action is completed.

Obsessive states are observed in obsessive-compulsive neurosis, psychasthenic personality disorder, cerebrovascular pathology, post-traumatic brain disorders, and schizophrenia.

Review Questions

1. Definition of the concepts "thinking" and "mental operations".

2. Classification of thought disorders.

3. Disorders of thinking in terms of tempo.

4. Disorders of thinking in terms of form.

5. What are delusional, obsessive, and overvalued ideas, and What is the difference between them?

6. Types of delusional ideas according to their content.

7. Forms of delusion formation (systematized and unsystematized).

8. Types of obsessive ideas.