Wednesday, March 5, 2014

Lexicon of Madness -- Loose associations

Loose associations: One of the most commonly observed forms of thought disturbance among patients with schizophrenia. The flow of thought is marked by rapid and unexpected shifts from topic to topic: "Christmas is my favorite holiday. Bills have to be paid; there's no money tree in the backyard. Gotta keep the dogs in house -- they might kill the cat." With careful listening and thorough familiarity with the patient, an astute clinician may be able to discern the subtle connections among what appear to be unrelated statements. Derailment is a term used to describe thought processes that deviate unexpectedly and without any apparent association between the two ideas: "A mother is a good thing to have. Noses and eyes get red." Clang associations involve the linking of words or phrases by rhyme or punning, but not logic or meaning:  (said to a clinician with a white beard) "Santa Claus! Wipe your paws, you dirty dog. Where's your raincoat, London Fog?" In thought blocking, the patient abruptly stops in the middle of his train of thought, does not complete the thought, and seems unable to recall what he had been starting to say: "When I was in school, we had this science teacher -- " (Dr.: "Yes, go on, you had this science teacher...") "Science teacher?" Circumstantiality describes speech that takes a long and indirect route from origin to endpoint. It is often marked by overinclusive details and parenthetical remarks: (Dr.: "How have you gotten along with people at work?") "I used to work at a flower shop, we'd have a lot of people come in, there was this one guy, Mr. Rose, that was his name, and he never did buy a rose, I didn't get paid much there but I had a nice apartment, pretty nice, for just $200 a month I think it was, so it paid the bills, so to speak, though the water was somethings real, real cold in the mornings and you had to run the tap for a while, but I didn't pay the water bill, so 'utilities included,' if you know what I mean, I used to work in the back, by myself, they sort of left me alone, kinda ignored me I guess, teased me a bit, I don't blame them, I couldn't do the deliveries because driving makes me nervous." Tangentiality describes thought processes that never get from origin to endpoint; there is an absence of goal-directed speech: (Dr.: "How far did you go in school?") "School was okay, I liked baseball, watched it on t.v., more day games back then, I think, I'd skip school sometimes, I had a friend, he was weird, too, they called us 'the weirdos,' his father was an electrician, working with electricity all day, I wonder if his hair always stood up on end." Incoherence describes thought that is disorganized and not understandable. Word salad is incoherent speech composed of seemingly disconnected words and phrases: "Baubles isn't babble but trouble and oil don't mix." Neologisms are new words created by the patient, which may be reflective of their psychological state: "I ain't no war-Mongo" (said by a combat veteran who resembled the character Mongo, from Blazing Saddles); "Dr. Vishnewski said I have issues with trust and intimacy -- all I need is some medicine for my honorrhea."

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